The objective of this report is to discuss the efficacy of in situ replacement for treating mycotic aneurysm, particularly using rifampicin-bonded grafts and omental pedicle grafts, on the basis of ...our 7 years of experience.
Between December 2003 and December 2010, we performed surgical treatments in 23 patients (for the thoracic aorta in 6 patients, for the thoracoabdominal aorta in 8 patients, and for the abdominal aorta in 9 patients; 7 emergency, 10 urgent, and 6 elective operations) with mycotic aneurysm by using rifampicin-bonded grafting and omental pedicle grafting.
One patient died in hospital because of local recurrent infection. One patient required an additional operation on another aortic site, and 3 patients had spinal cord injuries (2 transient and 1 permanent). Overall survival at 5 years was 95%, and the rate of freedom from aortic events at 5 years was 86%.
In situ replacement using rifampicin-bonded grafting and omental pedicle grafting is effective for treating mycotic aneurysms of the thoracic and abdominal aorta.
The effects of dietary sucrose on the metabolic rate of plasma glucose and ruminal propionate as well as the change in nitrogen kinetics were examined in four mature wethers fitted with rumen ...fistulas in Tsukuba, Japan in 1990. Wethers were fed at 12 equal intervals daily on crushed lucerne hay cubes (1233 g DM/day), with or without 204 g/day of sucrose. Plasma urea and glucose kinetics were determined following a single intravenous injection of I5Nurea and U-13Cglucose respectively; and the kinetics of ruminal ammonia and propionate were determined following a single intraruminal injection of 15Nammonium chloride and 2–13csodium propionate respectively. Following supplementation of sucrose to the diet, nitrogen retention was increased (P < 0·05) with a decrease in plasma urea concentration (P < 0·05) and urinary urea excretion (P < 0·05). Sucrose supplementation decreased (P < 005) the concentration and irreversible loss rate of ruminal ammonia. Urinary allantoin excretion did not change with sucrose treatment, but the flow rate of non-ammonia-nitrogen from the rumen was increased P < 0·05). The transfer rate of ruminal ammonia to plasma urea was also decreased (P < 0·01), whilst the transfer rate of plasma urea to ruminal ammonia was increased (P < 0·05) by dietary sucrose. Sucrose supplementation resulted in a higher concentration of propionate and butyrate (P < 0·05) in the rumen with no significant change in acetate or pH. The concentration of plasma glucose did not change with sucrose treatment, but the concentration of insulin, pool size (P < 0·05) and the irreversible loss rate of glucose (P < 0·01) were increased, reflecting the increase in the production rate of ruminal propionate (P < 0·05). It was concluded that the supplementation of sucrose affected the metabolism of urea and glucose in plasma via a change in ruminal production rate of ammonia and propionate, respectively.
This study was designed to evaluate proximal native coronary stenosis (PNCS) after coronary artery bypass grafting (CABG). In 36 patients undergoing postoperative coronary arteriography, the PNCS ...bypassed with internal thoracic artery (ITA), saphenous vein graft (SVG) and right gastroepiploic artery (RGEA) progressed in 9 of 23 vessels (39%), in 15 of 28 vessels (53%), in 4 of 11 vessels (36%), respectively. Stenosis of no grafted coronary vessels progressed in 3 of 26 vessels (11%). Twelve native coronary vessels (9: 99% and 3: 90% stenosis vessels) bypassed with grafts were obstructed. This study confirms that the PNCS progresses significantly by CABG just after the operation and that it tends to progress highly with SVG in comparison with arterial grafts such as ITA or RGEA. Because operative mortality for repeated CABG is approximately twice as high as that for primary CABG, it is important to decide whether early postoperative percutaneous transluminal angioplasty is needed or not, in considering of future graft failure and stenosis progression of the native coronary vessels by CABG.
An experiment was conducted to investigate the effects of changes in ruminal conditions arising from feeding and sucrose supplementation to the diet on the natural abundance of 15N (delta 15N value) ...of some biological components and of feces and urine in sheep. Four wethers fitted with ruminal fistulas were fed on alfalfa hay cubes with or without sucrose either 2 or 12 times daily. With twice-daily feeding, the delta 15N values of ruminal ammonia and plasma urea decreased after feeding, whereas only small changes were observed throughout the sampling period with 12 times daily feeding. With 12 times daily feeding with and without sucrose, the delta 15N values of ruminal ammonia were higher (P 0.05) than those of the diet and plasma urea. The delta 15N values of ruminal bacteria were lower (P 0.05) than those of ruminal ammonia but higher (P 0.05) than those of the diet. The delta 15N values for feces were higher (P 0.05) than those of the diet, and no differences (P 0.25) were observed between the delta 15N values of urine and those of the diet. Dietary sucrose supplementation lowered (P 0.05) the delta 15N values of ruminal ammonia but had no effect (P 0.10) on values for ruminal bacteria and plasma urea. Nitrogen excretion in urine was decreased (P 0.05) by sucrose supplementation to the diet, but the delta 15N value of urine showed no effect (P 0.25) of sucrose addition. The delta 15N value of plasma protein and the calculated value for retained N were increased (P 0.05) by dietary sucrose supplementation. These results suggest that the natural abundance of 15N in the animal body is a reflection of N metabolic rate
We reported successful distal repair using the frozen elephant trunk technique to treat a mycotic aneurysm extending from the ascending aorta to the descending aorta. A blood culture sample was ...positive for Escherichia coli, and total arch replacement with a rifampicin-bonded graft covered the omental pedicle flap.
Future planetary rovers are expected to probe over steep sandy slopes, such as crater rims, where wheel slippage can be a critical issue. One solution to this issue is to mount redundant actuators on ...the locomotion mechanisms of the rovers such that they can actively reconfigurate themselves to adapt to the driven terrain. In this study, we propose a mechanical model of a rover based on a wheel-soil contact model combined with the classical terramechanic theory. The effects of the rover reconfiguration on its slippage tendencies are analyzed based on slope traversing experiments and numerical simulations. The validation of the proposed contact model is also discussed based on experimental and numerical simulation results. According to the experimental results, both longitudinal and lateral slippages are greatly reduced by tilting the rover in an uphill direction. The results of the numerical simulation match the experimental results quantitatively, and indicate the possible need to include a slope failure model.
The relationship between the duration of postoperative mechanical ventilation and pre-, intra- and just post-operative factors was studied in 48 patients undergoing coronary artery bypass grafting ...with cardiopulmonary bypass. The patients were divided into 2 groups on the basis of the duration of mechanical ventilation: group A with less than 24 hours (n=35) and group B with more than 24 hours (n=13). Investigation of the perioperative parameters which significantly correlated with the duration of mechanical ventilation revealed that emergency case, cardiac dysfunction, high dose administration of cathecolamine, high left atrial pressure (LAP), low serum albmin, and renal dysfunction after transfer to intensive care unit (ICU) were found to be increased risks of postoperative respiratory failure.
This report compares long-term results with total arch replacement with frozen elephant trunk (FET) to ascending aortic or hemiarch replacement (AHR) for acute type A aortic dissection.
The subjects ...were 120 consecutive patients, including 65 who received FET and 55 who had AHR for acute type A aortic dissection from 1997 to 2008. The late results after surgery were retrospectively compared between the FET and ARH groups.
Three patients in the FET group died, and 2 patients in the AHR group died. In long-term follow-up (mean, 67 months), the survival rate after 5 years was 95.3% for the FET group and 69.0% for the AHR group (p = 0.03). The event rate for the thoracic aorta after 5 years showed a significant difference between the FET and AHR groups (95.7% versus 73.0%, p = 0.01). A false lumen at the proximal descending aorta was patent in 16 patients (29%) in the AHR group, but it was thrombosed in all in the FET group.
In patients with acute type A aortic dissection, it is possible to perform extensive primary repair using the FET technique with relative safety. FET may reduce the necessity for further operations to manage a residual false lumen.
This prospective study was designed to elucidate the meaning of systemic inflammatory response syndrome (SIRS), the mechanisms that lead to the protraction of SIRS, and whether SIRS is potentially a ...simple and effective postoperative indicator or not in patients who are operated on with cardiopulmonary bypass (CPB). We studied the duration of SIRS in 90 patients. Our data showed that 83 (92%) of the 90 patients met 2 or more criteria for SIRS and that significant relationship between the protraction of SIRS and the duration of aortic clamping time, CPB time, operation time, and the risk of postoperative organ damage and complication. Those results suggest that SIRS after cardiac surgery with CPB can be regarded as right criteria and highly valuable indexes of preparatory state of organ dysfunction.
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