An abdominal aortic rupture due to seatbelt blunt injury: report of a case.

A 66-year-old man, who was a passenger in a car involved in a low-speed head-on motor vehicle accident, was rushed to our hospital. His abdomen was tender and distended. An enhanced computed tomography scan showed a massive retroperitoneal hematoma, and its three-dimensional imaging revealed an active leak of the contrast medium from the aortic bifurcation.

Omental torsion.

A 65-year-old man presented to the emergency department complaining of right lower abdominal pain. Abdominal computed tomography showed a whirling pattern of fatty streaks and vessels in the greater omentum. From this typical finding, a diagnosis of omental torsion was made immediately, which was confirmed by subsequent surgery.

Preexisting antibodies to platelet factor 4-heparin complexes in patients with acute coronary syndrome who have no history of heparin exposure.

Preexisting heparin-induced thrombocytopenia (HIT) antibodies are detected in some patients who have not previously been exposed to any kind of heparin. However, the role of preexisting HIT antibodies in acute coronary syndrome (ACS) is still unknown. This study was carried out to clarify the role of preexisting HIT antibodies in patients with ACS.

[Heparin-induced thrombocytopenia (HIT): pathogenesis, laboratory test, and treatment].

Heparin-induced thrombocytopenia(HIT) due to immunological mechanisms is known as an important adverse reaction to heparin treatment, and heparin treatment should be applied while keeping in mind the risk of onset of HIT 5-14 days after the initiation of heparin. The presence of HIT had not been fully recognized in clinical practice in Japan despite the management of HIT being well confirmed in Western countries. Recognition of HIT has increased since argatroban, a direct thrombin inhibitor, obtained the approval of the FDA for prevention and treatment of HIT.

Surgical treatment for abdominal aortic aneurysm in a patient with urinary diversion.

In two cases of abdominal aortic aneurysm (AAA) with urinary diversion after radical cystectomy, surgical aneurysm repair was successfully performed. Based on comprehensive preoperative examinations, the surgical strategy for aneurysm should be carefully planned so as not to injure diverted ureters.

Incidence of heparin-PF4 complex antibody formation and heparin-induced thrombocytopenia in acute coronary syndrome.

A multicenter prospective study on the rate of seroconversion of antibodies to heparin-PF4 complexes (heparin-induced thrombocytopenia [HIT] antibodies) during and after heparin treatment for 4 weeks was carried out in Japanese patients with acute coronary syndrome (ACS). A total of 254 ACS patients treated with heparin were enrolled consecutively from 12 facilities of cardiology. Two patients with preexisting HIT antibodies were excluded from the analysis.

Treatment of cerebral vasospasm with intra-arterial fasudil hydrochloride.

Objective: Symptomatic cerebral vasospasm is a major cause of disability and death in patients with aneurysmal subarachnoid hemorrhage. The purpose of this study was to determine the efficacy of intra-arterial infusion (IAF) of fasudil hydrochloride for symptomatic vasospasm in terms of neurological improvement and the angiographic features of cerebral vessels.

Methods: A consecutive series of 23 patients underwent IAF therapy for the treatment of symptomatic vasospasm after subarachnoid hemorrhage.

[Anesthetic management for a patient of myotonic dystrophy with pheochromocytoma].

We experienced an anesthetic management for a patient of myotonic dystrophy with pheochromocytoma. Much attention is required to manage myotonic dystrophy on surgical manipulation. This disease interacts with anesthetic drugs.

Pseudoaneurysms of peroneal artery: treatment with transcatheter platinum coil embolization.

This report describes two cases of pseudoaneurysms of the peroneal artery which were successfully treated by transluminal platinum coil embolization. A pseudoaneurysm developed following a penetrating wound of the calf, and another did following thromboembolectomy of the occluded femoropopliteal bypass with a Fogarty balloon catheter. The coils were guided and released into the proximal peroneal arteries via the placed catheters on the ipsilateral and contralateral femoral arteries, respectively.

Large perigraft seroma after aortoiliac bypass with an expanded polytetrafluoroethylene graft: report of a case.

A 63-year-old man who had undergone aortoiliac bypass with an expanded polytetrafluoroethylene (PTFE) graft was referred to our hospital for investigation and treatment of a possible pseudoaneurysm of the abdominal aorta. A tender, pulsatile, and bulging mass, about the size of an adult fist, was palpated around the navel. Enhanced computed tomography (CT) showed a large low-density area around the abdominal aorta and PTFE graft, and aortography showed a patent graft with no anastomotic leakage.

Infrainguinal bypass surgery for chronic arterial occlusive disease associated with essential thrombocythemia: report of a case.

A 63-year-old man was referred to our hospital with a 3-year history of intermittent claudication, and his angiogram showed a total occlusion of the bilateral infrainguinal arteries. In addition, based on a platelet count of 172 x 10(4)/mm(3) as well as the characteristic bone marrow findings, he was diagnosed to have essential thrombocythemia. After the platelet count and aggregation response improved on administration of ranimustine and antiplatelet agents, infrainguinal bypass surgery was performed using the saphenous vein and prosthetic grafts.

Thrombotic complications in three hemodialysis patients with heparin-induced thrombocytopenia type I.

Although unfractionated heparin is the most commonly used anticoagulant for hemodialysis and has been associated with bleeding episodes, a more devastating complication that can occur is heparin-induced thrombocytopenia (HIT). It is believed that HIT type II is much more dangerous than type I, because HIT type II is associated with thromboembolic complications whereas there are no such complications in HIT type I. However, increased clot formation in the extracorporeal circuit during hemodialysis with unfractionated heparin is sometimes experienced by not only patients with HIT type II but also those with HIT type I.

Acute myocardial infarction caused by delayed heparin-induced thrombocytopenia and acute immunoreaction due to re-exposure to heparin in a systemic lupus erythematosus patient with HIT antibodies.

A patient with systemic lupus erythematosus and anticardiolipin antibodies and antibodies to platelet factor 4/heparin complexes suffered an acute myocardial infarction caused by delayed heparin-induced thrombocytopenia after heparin administration given to treat pulmonary hypertension. Furthermore, additional heparin administration for emergency coronary angiography appeared to have led to an acute immunoreaction, which might have resulted in acute coronary occlusion during coronary angiography and to a decreased platelet count. The present findings suggest that one must suspect delayed-type HIT in rare cases of induction of thrombosis after the cessation of heparin treatment, and avoid re-exposure to heparin in such cases.

Clinical study of Japanese spotted fever and its aggravating factors.

Twenty-eight patients with Japanese spotted fever were clinically investigated. The diagnosis was determined by confirming an increase of specific antibody. All patients were treated with minocycline, and all recovered, excluding one patient with a fulminant course.

Surgical treatment of celiac artery aneurysm: in situ aortoceliac artery reanastomosis: a case report.

The authors present a rare case of celiac artery aneurysm treated by aneurysmectomy and vascular reconstruction, and they review the past literature. A 57-year-old man was referred to their hospital with a complaint of epigastric discomfort. Abdominal echography, 3-dimensional computed tomography, and selective angiography showed a sole celiac artery aneurysm.

The significance of prostate-specific antigen alpha-1-antichymotrypsin complex and its indices for the detection of prostate cancer.

We examined the usefulness of prostate specific antigen alph-1-antichymotrypsin complex (PSA-ACT) and its indices for the detection of prostate cancer in patients with a prostate specific antigen (PSA) level between 2.1 and 10.0 ng/ml.

Surgical treatment for acute ischemia caused by bilateral popliteal artery entrapment syndrome in an elderly patient: report of a case.

We report the unusual case of a 73-year-old man who underwent surgery for bilateral popliteal artery entrapment syndrome (PAES). A medial approach was used to operate on the left leg, and the vein bypass was made from the superficial femoral artery to the crural artery through a subfascial route. A posterior approach was used to operate on the right leg and it was found that the mid-popliteal artery passed medial to and beneath the medial head of the gastrocnemius muscle and was severely compressed by an accessory slip of muscle.

[A patient with polymyalgia rheumatica who exhibited fever as the main symptom for a long period].

We encountered a patient with polymyalgia rheumatica (PMR) who exhibited fever as the main symptom for a long period without muscular pain. As an etiological factor, the condition may have been associated with nonsteroidal anti-inflammatory drugs (NSAIDs). A 71-year-old man consulted our Department of Orthopedics for fever and lumbar pain, which initially developed in early September 2000.

Fulminant Japanese spotted fever definitively diagnosed by the polymerase chain reaction method.

A 72-year-old man was admitted to the emergency ward in our hospital on July 20, 2001, because of consciousness disturbance, fever, generalized skin eruption, and severe general weakness beginning 7 days previously. Physical examination on admission revealed marked systemic cyanosis, erythema, and purpura. Laboratory findings indicated disseminated intravascular coagulation (DIC) and multiorgan failure (platelet count, 0.

Nephrostomy tract tumor seeding following percutaneous manipulation of a renal pelvic carcinoma.

We report a case of nephrostomy tract tumor seeding following percutaneous pyeloscopic manipulation of a renal pelvic carcinoma. To our knowledge, this is the second reported case of such a lesion surrounding the nephrostomy tract. Percutaneous pyeloscopic treatment carries a potential risk of local tumor spillage and implantation in the nephrostomy tract.

[Role of newly developed technology in blood coagulation disorders].

Clarification of blood coagulation disorders has been made progress based on newly developed technologies. ANTITHROMBIN III: In 1979, studies were carried out on antithrombin III(AT III) as a blood coagulation inhibitor from the first Japanese case of congenital AT III deficiency found in the laboratory sample. An alternative anticoagulant to maintain fluidity in extracorporeal circuit in an AT III deficient patient requiring hemodialysis was needed.