A 59-year-old man was admitted to our hospital for a feeling of weakness and abdominal pain. He had a history of appendectomy and laparotomy for ileus 38 years ago. He was found to be anemic. ...Colonoscopy revealed multiple ulcerations with two fistulas, which ran in the longitudinal direction, in the transverse colon. Barium enema revealed dilation of the lumen of the transverse colon and fistulous openings from a dilated ileum and a contracted ileum. The patient was diagnosed with blind loop syndrome due to ileocolic side-to-side anastomosis, and laparotomy was performed. The ileocolic anastomosis was resected and the short circuit was released. Annular strictures of the proximal and the distal ileum were seen at the anastomotic site, and histological examination revealed erosion in the mucosa and acute peritonitis at the anastomotic site of the ileum. Endoscopic diagnosis, such as diagnosis of ileal strictures, was important because blind loop syndrome by short circuit of the small intestine and colon is an indication for surgical removal of the short circuit.
An aggressive approach to vascular reconstruction should be adopted in patients with Buerger's disease and peripheral ischemia who are often young and otherwise active. A patient with severe ...Buerger's disease is reported who was treated successfully by complete vascular reconstruction with staged bypass surgery while also performing repeated angiography to preserve the foot function. A 48-year-old man with Buerger's disease presented with necrosis of the foot. Angiography showed occlusion of the right distal external iliac artery and no runoff below the knee. Repeated angiography after performing a lumbar sympathectomy demonstrated patency of the distal portion of the deep femoral artery. Angiography was again performed after a reconstruction of the deep femoral artery and patency of the anterior tibial artery was observed. A staged bypass operation on the tibial artery was therefore able to achieve a prompt healing of both the toe ulcers and plantar wound.
Although a recent survey on pediatric cardiomyopathy in Japan showed that 48% of patients died despite the medical treatment, pediatric cardiac transplantation is not legal in Japan. We determined ...the feasibility of partial left ventriculectomy as an alternative to end-stage dilated cardiomyopathy.
We retrospective analyzed partial left ventriculectomy in 4 pediatric patients with end-stage dilated cardiomyopathy.
In case 1, an 8-month-old girl underwent semiemergency partial left ventriculectomy. Her ejection fraction increased from 10% to 25%, and her condition improved initially, but she developed heart failure and underwent cardiac transplantation 6 months later in the US. In case 2, a 3-year-old boy developed severe heart failure 2 months after ventricular septal defect repair. Intensive medical therapy failed, so partial left ventriculectomy was done, which increased his ejection fraction from 15% to 35%. His condition is stable 35 months after surgery. In case 3, a 2-year-old girl with a chromosomal anomaly undergoing ventricular septal defect repair developed progressive heart failure 1 year later. Despite emergency partial left ventriculectomy, she died of hemoptysis 2 weeks postoperatively. In case 4, a 2-year-old girl developing progressive heart failure unresponsive to medical therapy after 10 months underwent elective partial left ventriculectomy and remains in stable condition 18 months postoperatively.
Partial left ventriculectomy is appropriate for selected patients with end-stage dilated cardiomyopathy if medical therapy is not effective and heart transplantation is not possible.
The purpose of this study was to elucidate the mechanism by which bradykinin (BK) enhances prostacyclin (PGI2) production in human umbilical vein endothelial cells (HUVEC). BK-induced enhancement of ...PGI2 synthesis was observed in a dose- and time-dependent manner, and it also increased Ca2+i followed by enhancement of cytosolic phospholipase A2 (cPLA2) activity. The PKC inhibitors GF109203X and H7 attenuated the BK-induced increase in Ca2+i and inhibited the BK-induced PGI2 synthesis. Phorbol 12-myristate 13-acetate increased cPLA2 activity and PGI2 synthesis but failed to alter Ca2+i. BK increased cPLA2 mRNA eightfold by 15 min, and this increase was inhibited by pretreatment with the PKC inhibitors. In response to cycloheximide pretreatment, cPLA2 mRNA was superinduced. These results suggest that BK stimulates PGI2 synthesis in HUVEC by activation of cPLA2 by dual mechanisms: an elevation of Ca2+i and a PKC-dependent pathway. Moreover, changes in calcium kinetics and expression of cPLA2 mRNA may underlie the BK-induced PGI2 enhancement in these cells.
Despite the many procedures introduced to prevent surgical site infection during cardiothoracic surgery, serious infections still occur. We attempted to reduce surgical site infection by spraying ...antibiotic solution in the operative field--a procedure since introduced at 4 other Japanese institutions.
In the latter half of 1990, we began spraying an antibiotic solution of cefazolin (1g) and gentamicin (40 mg)/40 ml of saline placed in a 50 ml syringe and dispensed through an 18 G needle bent at 60 to 80 degrees to clean the wound during surgery.
No deep surgical site infections or deaths due to infection have occurred among the 502 patients undergoing cardiothoracic surgery under cardiopulmonary bypass at our hospital. This method was used in over 2,100 cases of similar procedures at 4 other institutions. There were 3 deaths due to severe surgical site infection (0.11%). At one institution treating over 1,000 cases a year, the incidence of death due to surgical site infection decreased significantly after this method was introduced.
These preliminary experiences show that spraying antibiotic solution in the operative field reduces the risk of surgical site infection in cardiothoracic surgery.
A 13-year-old girl presented with dyspnea and chest pain. Chest radiography showed a massive left pleural effusion. Computed tomography revealed a tumor of the fourth rib. A large bloody effusion was ...drained. Her anemia worsened (hemoglobin: 4.8 g/dl), and hemorrhagic shock ensued. An emergency thoracotomy was performed. Bleeding from the ruptured tumor was identified. The fourth rib, the tumor, and the adjacent tissues were resected. Histopathologic examination revealed a ruptured primary osteosarcoma of the rib with pleural dissemination.
BACKGROUND: Assessment of tumor proliferative activity is considered to be the most powerful prognostic factor aside from axillary lymph node status. The purpose of this study is to assess the ...clinical value of measurement of proliferative activity using the MIB-1 labeling index in patients with breast cancer. METHODS: Surgical specimens from 36 patients with benign breast disorders and146 patients with breast cancer were investigated. The MIB-1 labeling index wasdetermined on the specimens stained by immunohistochemical methods as much as possible. Clinical factors associated with the MIB-1 labeling index were reviewed. RESULTS: The MIB-1 labeling index for non-proliferative disorders, proliferative disorders, and breast cancer was 3.4 +/-1.9%, 8.9 +/-6.2% and 20+/-12%, respectively. The MIB-1 labeling index and tumor size, lymph node metastasis status, and clinical stage according to the TNM classification correlated significantly. Survival rate was inversely correlated with the MIB-1 labeling index. No patientwith an MIB-1 labeling index of less than 10% had lymph node metastases, and all are alive without recurrence. Patients with an MIB-1 labeling index of over 30% had an extremely poor prognosis. CONCLUSION: The MIB-1 labeling index is very useful for predicting both either extremely good or extremely poor prognosis, and axillary lymph node metastasis
In this research, a hexapod robot and a 3-axis ground reaction force sensor have been designed and developed. The developed hexapod robot consists of six leg units, each unit is with 3 degrees of ...freedom. The developed ground reaction force sensor has a hemisphere sensing range and the contact between the foot and the ground can be detected as a thrust load and contact between the foot and the wall can be detected as a radial load. Since the developed sensor can be applied regardless of the direction of movement, the sensor can be used to achieve omnidirectional movement of a hexapod robot on rough terrain at a low cost. In this paper, a posture control method of walking on rough terrain is proposed for the hexapod robot with a gyro-sensor and the originally developed ground reaction force sensor. The usefulness of the developed force sensor and the effectiveness of the proposed posture control method have been verified by experiments.
We report herein on our 12-year experience of performing autogenous vein grafting in the lower extremity using a nondissection method. This method involves limiting preparation for the distal ...anastomosis to exposure of the anterior surface of the vascular sheath, and substituting an Esmarch's rubber bandage or a pneumatic tourniquet for vascular clamps. A series of 86 consecutive patients who received 101 autogenous vein grafts employing this method were retrospectively analyzed. The causes of arterial occlusion were atherosclerosis in 55 patients, Buerger's disease in 23, and other causes in 9. There was one operative death, and 12 late deaths were recorded within a follow-up period extending to 12 years. Of four early occlusions and two stenoses, three were successfully revised within 30 days of surgery. A total of 11 revision operations were required for 10 grafts during the follow-up period, and late graft closure occurred in 9 bypasses. The primary, primary revised, and secondary patency rates at 5 years for the entire series (n = 101) were 65%, 85%, and 86%, respectively, with 42 bypasses to the tibial or peroneal artery having 84% primary revised and 86% secondary patency rates. These findings led us to conclude that minimization of the surgical injury at the distal anastomosis contributed to the long-term patency of the distal bypass.
A 3-year-old boy suffered severe heart failure 2 months after ventricular septal defect repair. The cardiothoracic ratio was 67% and the ejection fraction 13%. Echocardiography showed a dilated left ...ventricle and thin myocardium. After thorough study, we made a diagnosis of dilated cardiomyopathy. Because conventional therapy was unsuccessful, we conducted partial left ventriculectomy with Alfieri repair of the mitral valve. The postoperative cardiothoracic ratio was 57% at 1 year of follow-up and the ejection fraction 40%. The New York Heart Association functional class improved from IV to I. In conclusion, the role of partial left ventriculectomy is both as a bridge to transplantation and as a definitive repair in dilated cardiomyopathy during childhood.
