Three-dimensional echo-guided suture of atrial septal defect with Maniceps in an experimental model.

Toward the establishment of suture closure procedures for atrial septal defect or patent foramen ovale under guidance of three-dimensional (3D) echocardiography but without use of cardiopulmonary bypass (off-pump surgery), an experimental study was conducted using a laparoscopic suture instrument, Maniceps. First, the panel setting of the 3D echo system which was optimal for precisely visualizing the surgical instruments on the image display with the least time delay was determined. The optimal setting was: 1) harmonic imaging, 2) no smoothing, 3) low scanning line density, and 4) a scanning range around 55 degrees.

Autologous bone-marrow mononuclear cell implantation reduces long-term major amputation risk in patients with critical limb ischemia: a comparison of atherosclerotic peripheral arterial disease and Buerger disease.

Background: Bone-marrow mononuclear cell (BM-MNC) implantation improves ischemic symptoms in patients with critical limb ischemia (CLI). The purpose of this study was to evaluate long-term clinical outcomes after autologous BM-MNC implantation in patients with CLI.

Methods And Results: We assessed long-term clinical outcomes after BM-MNC implantation in 51 patients with CLI, including 25 patients with peripheral arterial disease (PAD) and 26 patients with Buerger disease.

Treatment strategy for acute type a aortic dissection complicated with organ ischemia.

Objective: We report our current treatment strategy for acute type A aortic dissection with organ ischemia as well as notable findings in our experience.

Materials And Methods: Among 101 cases of acute type A aortic dissection, 25 had organ ischemia. Malperfusion was assessed at the aorta, proximal portion of the branch, organ parenchyma, and organ function by means of multiple modalities, including transesophageal echocardiography (TEE), near-infrared spectroscopy, and physical examinations.

Three-dimensional CT Venography: A Diagnostic Modality for the Preoperative Assessment of Patients with Varicose Veins.

Objective: We preoperatively assessed varicose veins by means of computed tomography (CT) with contrast injection in the veins of the lower extremity (CT venography). This paper reports the procedures, results and implications of CT venography from the surgical aspect.

Methods: A total of 48 legs in 39 patients were examined.

Cerebral hemorrhage after mitral valve replacement in a patient with active infective endocarditis during the acute phase of a cerebellar infarction: a case report.

A 60-year-old woman presented with a high fever (39°C or higher). Transthoracic echocardiography revealed a large and mobile vegetation on the anterior mitral leaflet with moderate mitral regurgitation. Computed tomography revealed a cerebellar infarction.

Telomerase activation without shortening of telomeric 3'-overhang is a poor prognostic factor in human colorectal cancer.

Our previous report demonstrated a good correlation between high telomerase activity of cancer tissues and a poor prognosis of patients with colorectal cancers, except for several cases. To elucidate the additional factors that contribute to patient prognosis, the correlation among the expression levels of telomere binding proteins (TBP), the lengths of telomeres, the lengths of telomere 3'-overhang (3'-OH) and telomerase activity in 106 paired colorectal cancer and corresponding noncancerous mucosa (NCM) specimens were examined. The expression levels of eight TBP genes (TRF1, TRF2, TIN2, TANK1, TANK2, POT1, RAP1 and TPP1) were analyzed.

Late occurrence of atrial arrhythmias after the simple left atrial procedure for chronic atrial fibrillation in mitral valve surgery.

Background: We postulated that chronic atrial fibrillation (AF) associated with mitral valve disease originated from the distended left atrium and is maintained by itself. We had performed a simple left atrial procedure for the elimination of chronic AF associated with mitral valve disease in patients from 1993 to 1998. This paper evaluated the long-term results of the simple left atrial procedure after more than 10 years, and discussed the late occurrence of atrial arrhythmias in relation to the left atrial procedure.

Cold blood spinoplegia under motor-evoked potential monitoring during thoracic aortic surgery.

Objective: Motor-evoked potential monitoring is used to prevent paraplegia during thoracic aortic surgery. Multidetector computed tomography has been used preoperatively to detect the Adamkiewicz artery, but the hemodynamic significance of the Adamkiewicz artery is controversial. This study aims to evaluate whether the multidetector computed tomography-defined Adamkiewicz artery is hemodynamically essential and needs to be reconstructed with cold blood spinoplegia under motor-evoked potential monitoring.

Prognostic factors after surgical resection for intrahepatic, hilar, and distal cholangiocarcinoma.

Background: The prognosis of patients with cholangiocarcinoma is unsatisfactory. Therefore, evaluation of prognostic factors and establishment of new therapeutic strategies are needed to improve their long-term survival. The aim of this study was to identify useful prognostic factors for patients with intrahepatic, hilar, and distal cholangiocarcinoma.

Edaravone, a free radical scavenger, promotes engraftment of intraportally transplanted islet cells.

Objectives: Pancreatic islet transplantation requires multiple transplants to achieve insulin independence. Only one third of the islet mass is stably engrafted; one of the causes of which is ascribed to oxidative stress. We confirmed the hypothesis that administration of edaravone, a free radical scavenger, in the early posttransplantation period promotes islet cell engraftment.

Redo an aortic valve replacement for bioprosthetic valve destruction in a patient developing Streptococcus bacteremia three years after the initial operation.

A 66-year-old man with a bioprosthetic aortic valve developed Streptococcus bacteremia and was treated with antibiotics. He responded well to this therapy, and no evidence of bioprosthetic valve endocarditis (BVE) was detected at this time. One-and-a-half years after the antibiotic therapy for bacteremia, the patient was referred to our department with a diagnosis of acute cardiac failure.

[Bacteria isolated from surgical infections and their susceptibilities to antimicrobial agents --special references to bacteria isolated between April 2008 and March 2009].

Bacteria isolated from infections in abdominal surgery during the period from April 2008 to March 2009 were investigated in a multicenter study in Japan, and the following results were obtained. In this series, 712 strains including 18 strains of Candida spp. were isolated from 173 (80.

Sodium 4-phenylbutyrate protects against spinal cord ischemia by inhibition of endoplasmic reticulum stress.

Objective: Delayed paraplegia after operation on the thoracoabdominal aorta is considered to be related to vulnerability of motor neurons to ischemia. Previous studies have demonstrated the relationship between neuronal vulnerability and endoplasmic reticulum (ER) stress after transient ischemia in the spinal cord. The aim of this study was to investigate whether sodium 4-phenylbutyrate (PBA), a chemical chaperone that reduces the load of mutant or unfolded proteins retained in the ER during cellular stress, can protect against ischemic spinal cord damage.

Effect of gefitinib on the survival of patients with recurrence of lung adenocarcinoma after surgery: a retrospective case-matching cohort study.

Background: Patients with lung adenocarcinoma who carry epidermal growth factor receptor (EGFR) gene mutations respond remarkably well to EGFR tyrosine kinase inhibitor (EGFR-TKI), gefitinib, or erlotinib. However, the effect of EGFR-TKI treatment on the prolongation of overall survival (OS) of these patients remains uncertain, although several recent studies have shown prolongation of progression free survival compared with cytotoxic chemotherapy.

Methods: A total of 304 patients with lung adenocarcinoma who had postoperative recurrent disease were studied.

Number of metastatic lymph nodes, but not lymph node ratio, is an independent prognostic factor after resection of pancreatic carcinoma.

Background: This study evaluated the prognostic significance of the number of metastatic lymph nodes and the ratio of metastatic nodes to total number of examined lymph nodes (lymph node ratio, LNR) after resection of pancreatic carcinoma.

Study Design: Records of 119 consecutive patients with pancreatic ductal carcinoma, who underwent R0 or R1 pancreatectomy with regional node dissection, were reviewed retrospectively. Clinical factors, pathologic factors including number of metastatic nodes and LNR, and survival were analyzed by univariate and multivariate analyses.

Surgical intervention for patent ductus venosus.

Patent ductus venosus (PDV) is a rare condition, which usually presents secondary to hepatic atrophy and hepatic failure. We have treated eight cases of PDV, all with hypergalactosemia and hyperbilirubinemia. Ultrasonography and three-dimensional computed tomography demonstrated communication between the portal vein and the inferior vena cava.

Is structural remodeling of fibrillated atria the consequence of tissue hypoxia?

Background: Matrix metalloproteinases (MMPs) play an important role in degradation of the extracellular matrix of injured tissue. MMP-9 expression increases in fibrillating atrial tissue; however, the mechanism for this increase has not been clarified.

Methods And Results: Changes in the expression of vascular endothelial growth factor (VEGF), VEGF receptors, and hypoxia-induced transcription factor-1alpha (HIF-1alpha) in fibrillating atrial tissue were investigated.

Reduced pancreatic parenchymal thickness indicates exocrine pancreatic insufficiency after pancreatoduodenectomy.

Background: The aim of this study was to investigate whether perioperative morphologic characteristics are predictive of exocrine pancreatic function after pylorus-preserving pancreatoduodenectomy (PPPD) with pancreaticogastrostomy.

Materials And Methods: A 13C-labeled mixed triglyceride breath test was performed in 52 patients after PPPD to assess postoperative exocrine pancreatic function. A value of percent 13CO2 cumulative dose at 7 h (%CD-7 h) of less than 5% was considered diagnostic of exocrine pancreatic insufficiency.

Hepatic angiomyolipoma: a case report.

We experienced a rare case of hepatic angiomyolipoma (AML). A 66-year old Japanese female presented inhomogeneous echogenic lesion in the lateral segment of the liver on ultrasonography. Contrast computed tomography (CT) revealed early arterial enhancement within the lesion that stayed hyperdense in the equilibrium phase.

HPLC method for measuring meropenem and biapenem concentrations in human peritoneal fluid and bile: application to comparative pharmacokinetic investigations.

A high-performance liquid chromatography (HPLC) method using ultrafiltration to pretreat peritoneal fluid and bile samples is developed to measure meropenem and biapenem concentrations in human peritoneal fluid and bile. Meropenem or biapenem in peritoneal fluid or bile samples is stabilized by mixing with 1 mol/L 3-morpholinopropanesulfonic acid buffer (pH 7.0) (1:1).

Peritoneal pharmacokinetics and pharmacodynamic target attainment of meropenem in patients undergoing abdominal surgery.

Although meropenem is commonly used for intra-abdominal infections, its penetration into the abdominal cavity is not well understood. Meropenem (500 mg) was administered intravenously to 8 patients with inflammatory bowel diseases undergoing laparotomy. The drug concentrations were analyzed and used for a Monte Carlo simulation with minimum inhibitory concentration (MIC) data.

[Selection of surgical treatments for atrial fibrillation].

Radical procedure for elimination of atrial fibrillation (Af) was devised by Cox and named as maze procedure. The concept of maze procedure was interruption of all reentry circuits on both atria. Several modifications of maze procedure were performed.

Prognostic impact of para-aortic lymph node metastasis in pancreatic ductal adenocarcinoma.

Background: The aim of the present study was to clarify the prognostic impact of para-aortic lymph node metastasis in pancreatic ductal adenocarcinoma.

Methods: Medical records of 103 consecutive patients with pancreatic ductal adenocarcinoma, who underwent pancreatic resection with regional and para-aortic lymph node dissection were reviewed retrospectively. Clinicopathological factors and survival were compared between patients with and without para-aortic lymph node metastasis.

Prognostic impact of perioperative serum CA 19-9 levels in patients with resectable pancreatic cancer.

Background: Pancreatic cancer is one of the most deadly cancers, and serum carbohydrate antigen 19-9 (CA19-9) level has been reported to be a useful prognostic marker in pancreatic cancer. The purpose of this study was to determine which prognostic factor (preoperative or postoperative serum CA19-9 level) is more useful.

Methods: Pre- and postoperative serum CA19-9 levels were measured in 109 patients who underwent surgical resection for pancreatic cancer between 1998 and 2009, and their relationships to clinicopathological factors and overall survival were analyzed with univariate and multivariate methods.

Everted leaflet of a bovine pericardial aortic valve.

We report on an everted leaflet of a Carpentier-Edwards Perimount (CEP) valve in an aortic position. A 71-year-old female patient with aortic regurgitation underwent valve replacement with a 21-mm CEP valve. After aortic declamping, transesophageal echocardiography (TEE) revealed significant transvalvular regurgitation due to an immobilized non-coronary leaflet.