Patients with an aortic root pseudoaneurysm communicating to the right atrium are rare. A 67-year-old woman underwent ascending aorta and total aortic arch replacement for acute type A aortic dissection at our institute 9 years prior to the current presentation. She was transported to our emergency department with complaints of chest pain, palpitations, and cold sensation. A continuous murmur was heard at the right sternal margin. Contrast-enhanced computed tomography (CT) and ultrasonic cardiography showed a huge pseudoaneurysm at the proximal anastomotic site and an aorto-right atrial fistula. Ascending aortic replacement with concomitant direct closure of the fistula was successfully performed. The patient was discharged in good condition on the 14th postoperative day. Careful follow-up with CT is important after acute type A aortic dissection repair.

Homozygous familial hypercholesterolemia is a rare metabolic disorder with characteristic clinical presentations, such as tendon xanthomas, hypercholesterolemia, and significant cardiovascular disease including premature coronary artery disease. We describe a case of a 56-year-old woman with homozygous familial hypercholesterolemia. She had been treated with low-density lipoprotein apheresis for 23 years. Preoperative echocardiography and coronary angiography showed severe aortic valve stenosis and right coronary artery stenosis. Aortic valve replacement with patch enlargement of the aortic valve annulus, and coronary artery bypass grafting were successfully performed. She was discharged uneventfully.

We describe a case of cardiac surgery for a patient with CD36 deficiency. A 56-year old man had progressive dyspnea on effort for 1 year. On admission, echocardiography revealed severe aortic valve regurgitation. He required medical treatment for heart failure, and subsequently elective aortic valve replacement was planned. Pre-operative cardiac scintigraphy (¹²³I-BMIPP) showed total defect of myocardial uptake. CD 36 deficiency was diagnosed based on the characteristic findings. CD 36 deficiency could cause transfusion related complication by donor blood transfusion. We prepared 1,200 ml autologous blood preoperatively in a two week period. The operation was performed successfully without donor blood transfusion. He was discharged uneventfully.

AIMTo investigate more efficient synthetic method of the nitrogen analogue 4 of salacinol (1) for searching new antidiabetic agents.

METHODSThe synthesis of the key intermediate 2, 4-O-isopropylidene-L-erythritol 1,3-cyclic sulfate (2a) was accomplished by modification of reports from D-glucose via seven steps in much more less expensive. Using this method, an efficient synthesis of 4 was carried out. The glycosidase inhibitory activity of 4 was tested for the intestinal alpha-glucosidase in vitro and compared with that of salacinol.

RESULTSA nitrogen analogue 4 of salacinol (1) was synthesized by the coupling reaction between the cyclic sulfate 2a and an azasugar 3b.

CONCLUSIONSubstitution of the sulfur atom in 1 with a nitrogen reduced the activity considerably.

Animals ; Enzyme Inhibitors ; chemical synthesis ; chemistry ; pharmacology ; Glycoside Hydrolase Inhibitors ; Intestinal Mucosa ; drug effects ; enzymology ; Molecular Structure ; Nitrogen Compounds ; chemical synthesis ; pharmacology ; Rats ; Structure-Activity Relationship ; Sugar Alcohols ; chemical synthesis ; chemistry ; pharmacology ; Sulfates ; chemical synthesis ; chemistry ; pharmacology ; alpha-Glucosidases ; metabolism

Aim To investigate more efficient synthetic method of the nitrogen analogue 4 of salacinol (1) for searching new antidiabetic agents. Methods The synthesis of the key intermediate 2,4-O-isopropylidene-L-erythritol 1,3-cyclic sulfate (2a) was accomplished by modification of reports from Dglucose via seven steps in much more less expensive. Using this method, an efficient synthesis of 4 was carried out. The glycosidase inhibitory activity of 4 was tested for the intestinal α-glucosidase in vitro and compared with that of salacinol. Results A nitrogen analogue 4 of salacinol (1) was synthesized by the coupling reaction between the cyclic sulfate 2a and an azasugar 3b. Conclusion Substitution of the sulfur atom in 1 with a nitrogen reduced the activity considerably.

Objective: The physiological changes of the respiro-circulatory functions between skilled subject and unskilled subjects during the practice of Up-right Standing Posture of Shaolin Internal Qigong were compared. Method: The heart rate (HR), maximum oxygen uptake (VO2), respiratory efficiency (RE), and respiratory rate (RR), blood pressure, and lactic acid in the blood were measured.Results: The high correlations between the HR and the VO2 values obtained from the exhaustion test were observed in all subjects. The higher values than at the rest were observed in the average HR and the average VO2 during practicing the Up-right Standing Posture both in the skilled subject and unskilled subjects. However, both HR and VO2 levels were almost constant during the practice in both the skilled subjectand unskilled subjects. The RE values changed in the time course of the practice, whereas the RR values were almost constant during the practice. The average RE showed different patterns between the skilled subject and unskilled subjects, the former increased and the latter decreased their RE levels.In addition, the average values of systolic and diastolic blood pressure of the skilled subject increased each 10 mmHg approximately at pre- and post- Up-right Standing Posture, and the increasing tendency was also recognized in the unskilled subjects. The values of the lactic acid in the blood of the skilled subject increased slightly, whereas the average values of the unskilled subjects increased by 3.4 mmol/1. Conclusion: Shaolin Internal Qigong could improve respiratory efficiency by the maximum isometric muscle contraction while the skilled subject maintained natural breathing. In addition, Shaolin Internal Qigong was considered to influence the reflex system because it inhibited both blood pressure increase and respiratory rate change. Shaolin Internal Qigong fit very well with Tuina doctor training course for promoting the physical ability and manipulation abilities of them.

Twelve cases of ruptured abdominal aortic aneurysm (RAAA) were treated during 5 years. Nine showed severe hypotension (systolic pressure below 70mmHg) and three required cardiac massage prior to operation. At the beginning of this study, direct laparotomy was conducted on 4 cases but mortality was high mortality (75%). Left thoracotomy with antero-lateral incision through the 7th intercostal space was carried out to access the thoracic aorta for clamping before laparotomy, since the major mortality of this disease is due to abrupt bleeding following anesthesia and operation. Left thoracotomy before laparotomy was conducted on 8 cases, half of whom required aortic clamping during operation (clamping time 21min). Operative mortality following thoracotomy decreased (12.5%). The aneurysm size and the time of operation for the groups with or without thoracotomy were the same, though the degree of bleeding significantly differed (3, 925ml in the group with thoracotomy, 7, 193ml in the group without thoracotomy). Left thoracotomy befor laparotomy obtained good results in case of RAAA.

Two cases of blue toe syndrome were effectively treated by PGE1. Case 1 was an 80-year-old man who had an ulcer lesion of the 5th toe. Angiography indicated the symptoms were caused by microemboli from an extended lesion of the aorta and iliac artery. The wound was healed by lipo PGE1 (10μg×30 days). Case 2 was a 54-year-old man who had dull pain and skin color change of the 3rd and 4th fingers. A thrombus could not be detected by transthoracic echocardiography, but was found by transesophageal echocardiography. The symptoms improved by PGE1 (60μg×20days). Blue toe syndrome is induced by a microembolism in the peripheral arteries, and thus the conventional treatment has been the administration of fibrinolysins and anticoagulants. PGE1 was used in this study for the first time in consideration of its vasodilating effect on the collateral circulation and to prevent a secondary thrombus by inhibiting platelet aggregation.

Patients who underwent the bypass operation during 5 years from 1987 to 1992 in the 1st Department of Surgery, Hiroshima University School of Medicine, were divided into 2 groups; AIOD group (51 cases) had lesions in the aorta and iliac artery, and FPOD group (46 cases) had lesions in the femoral artery and popliteal artery. A comparative study of these two groups was made. There was no significant difference in age, sex, symptom severity, smoking history, serum cholesterol level, serum triglyceride level. The complication rate of peripheral lesions of the AIOD group was 24% and of the FPOD group was 57%. The cumulative patency rate for 5 years of the AIDO group was 100% and of the FPOD group was 61%. The AIOD group exhibited better patency. In addition to the lower complication rate of peripheral lesions, all the AIOD group had underwent reconstruction operation for peripheral lesions simultaneously. The run-off state of the peripheral region may thus possibly be related to patency.

Fifty-one cases which underwent surgery for arteriosclerosis obliterans in the aorta and iliac artery at the First Department of Surgery, Hiroshima University School of Medicine were divided into two groups. The EAB group (18 cases) underwent extra-anatomic bypass operation, and the AB group (33 cases) underwent anatomic bypass operation. A comparative study showed the mean age of the EAB group to be 10 years higher than that of the AB group, and the former group exhibited severer symptoms. Renal and pulmonary function declined in the EAB group, and the occurrence rate of complications such as cerebral infarction was also higher At operation, the following approaches were employed; long-term administration of PGE-1 before and after operation, operation with a better visual field under light general anesthesia, simultaneous reconstructive operation in peripheral lesions, artificial vessels of externally supported velour knitted Dacron. There was no case of obstruction in the past 5 years. Extra-anatomic bypass operation therefore provides as good postoperative patency as anatomic operation.