Structural valvular deterioration of Hancock standard valve in the mitral position 33 years after initial implantation.

A 77-year-old woman who had undergone mitral valve replacement (MVR) with a 29 mm Hancock standard (H-S) bioprosthesis (Model 242) and tricuspid annuloplasty (Kay's method) at the age of 44 years was admitted urgently with acute heart failure. Echocardiography showed severe transvalvular leakage of the prosthesis and moderate tricuspid regurgitation. The patient underwent reMVR with a 29 mm Carpentier-Edwards Perimount Magna Mitral bioprosthesis and tricuspid annuloplasty with a 30 mm MC3 ring.

Silent myocardial ischemia in asymptomatic patients with type 2 diabetes mellitus without previous histories of cardiovascular disease.

Background: The number of patients with type 2 diabetes mellitus (T2DM) continues to increase all over the world. Cardiovascular disease (CVD), especially coronary artery disease (CAD), is a major cause of the morbidity and mortality in patients with T2DM. The prognosis of patients with silent myocardial ischemia (SMI) is worse than that in those without.

Aortic Stenosis in a Patient With Sjogren's Syndrome.

Sjogren's syndrome (SS) is an autoimmune disease characterized by dryness of the mouth and the eyes. Systemic involvement in SS is well known, however, obvious cardiac manifestations, particularly significant valve disorders, are extremely rare and only three cases of significant valve disease associated with SS that required surgical intervention have been previously described. We report a case of aortic stenosis (AS) associated with SS in an elderly patient.

The impact of three-dimensional optical coherence tomography and kissing-balloon inflation for stent implantation to bifurcation lesions.

The rates of restenosis and stent thrombosis after the therapeutic stent deployment for bifurcation lesions are still comparably high after the introduction of the new-generation drug-eluting stents (DESs), because of the various factors including their morphology. We experienced a case of a successful percutaneous coronary intervention using three-dimensional optical coherence tomography (3D OCT) with a single stent deployment to a bifurcation lesion of the left anterior descending artery (LAD) and left circumflex artery (LCx) with a following kissing-balloon inflation (KBI). The 3D OCT, after the inflation of the jailed ostium of the LCx following the stent deployment to the LAD crossing the LCx, could clearly demonstrate a stent deformation and incomplete apposition at an opposite site of the LCx, which may cause high rates of restenosis and stent thrombosis.

Japanese nationwide surveillance in 2011 of antibacterial susceptibility patterns of clinical isolates from complicated urinary tract infection cases.

To investigate antimicrobial susceptibility patterns of various bacterial pathogens isolated from complicated urinary tract infection (UTI) cases, the Japanese Society of Chemotherapy, the Japanese Association of Infectious Disease, and the Japanese Society of Clinical Microbiology conducted the second nationwide surveillance from January to September 2011. With the cooperation of 42 medical institutions throughout Japan, 1036 strains belonging to 8 clinically relevant bacterial species were collected. Among methicillin-resistant Staphylococcus aureus (MRSA) strain, the vancomycin (VCM) MIC for 5.

Blockade of brain angiotensin II type 1 receptor inhibits the development of atrial fibrillation in hypertensive rats.

Background: Hypertension is a powerful risk factor of atrial fibrillation (AF). The pathophysiology of AF with hypertension is associated with sympathoexcitation or the renin-angiotensin system; however, current therapies cannot sufficiently prevent its development. We previously revealed that brain angiotensin II type 1 receptor (AT1R) blockade causes a depressor response via sympathoinhibition.

Ebstein's anomaly in adult patients over 50 years of age.

Ebstein's anomaly (EA) is a rare congenital heart disease of the tricuspid valve, and less than 5% of patients with EA survive beyond the age of 50. We report two unoperated cases of EA in adult patients aged over 50 years. Two patients, a 70-year-old Japanese woman and a 59-year-old Chinese woman, were referred to us for tachyarrhythmias.

Sutureless repair for left ventricular free wall rupture after acute myocardial infarction.

We report three cases of left ventricular free wall rupture (LVFWR) after acute myocardial infarction, which were repaired using a sutureless technique without cardiopulmonary bypass. At operation, a sheet of fibrin tissue-adhesive collagen fleece (TachoComb) was secured to the hematoma surrounding the tear and the infarcted area under compression by the surgeon's fingers. After complete hemostasis, several sheets of an absorbable gelatin sponge (Gelfoam) were glued onto the collagen fleece in layers.

Structural valve deterioration in a starr-edwards mitral caged-disk valve prosthesis.

Background: The durability of the Starr-Edwards (SE) mitral caged-disk valve, model 6520, is not clearly known, and structural valve deterioration in the SE disk valve is very rare.

Methods And Results: Replacement of the SE mitral disk valve was performed in 7 patients 23-40 years after implantation. Macroscopic examination of the removed disk valves showed no structural abnormalities in 3 patients, in whom the disk valves were removed at <26 years after implantation.

[Issues and indications for off-pump coronary artery bypass grafting].

We have evaluated the usefulness of off-pump coronary artery bypass grafting (CABG)[OPCAB]. The subjects were 153 patients who underwent isolated CABG between May 2005 and May 2009. They were divided into 2 groups( on-pump/arrest;ON group:76 subjects vs OPCAB;OFF group:77 subjects).

Postoperative elongation of the xiphoid process --report of a case--.

We report a case of a 66-year-old man who presented with an abnormal sensation, tenderness, and pain in the middle of his chest in May 2006, two years after a mitral valve replacement for severe mitral regurgitation and a MAZE operation for chronic atrial fibrillation elective cardiac. He was immediately admitted, and the x-ray examination revealed an abnormal elongation of the xiphoid process. At the time of discharge after the initial operation in 2004, x-rays indicated that the length of the xiphoid process was 3 cm; however, in 2006 it had elongated to 6 cm and was prominent in the anterior view.

Intracardiac metastasis of esophageal squamous cell carcinoma -report of a case-.

We report a case of a 48-year-old man with a history of violent coughing fits and general fatigue underwent urgent surgery for cardiac tamponade, and who was later diagnosed with metastatic intracardiac squamous cell carcinoma of the esophagus. After admittance to Munakata Suikokai General Hospital, Fukuoka, Japan, echocardiography showed extensive pleural and pericardial effusion and a mass, 4 by 2 cm, with a solid echo pattern in the right ventricular cavity. The working diagnosis was primary malignant cardiac tumor of unknown origin with multiple metastases.

[Case report of traumatic hemorrhage from the anterior choroidal artery].

Traumatic hemorrhage from the anterior choroidal artery is very rare. A 74-year-old male was admitted to our hospital immediately after a traffic accident. CT on admission showed right intracerebral hematomas in the posterior limb of the internal capsule and the upper part of the right cerebral peduncle.

[Isolated trigeminal sensory neuropathy due to pontine infarction of the root entry zone--report of two cases].

Secondary trigeminal neuralgia and isolated trigeminal neuropathy due to ischemic lesion of the pons are very rare. We report 2 patients with pontine infarct transecting the central trigeminal pathways resulting in trigeminal neuropathy and/or neuralgia. Case 1: A 48-year-old female presented with lancinating pain and paresthesia and hypesthesia in the right V2 and V3 distributions.

[Rapid disappearance of acute epidural hematoma by percutaneous aspiration of subperiosteal hematoma--case report].

We present the case of an 8-year-old boy who was injured in a bicycle accident and was admitted with a right frontal skull fracture, an acute epidural hematoma, a right frontal laceration, and a subperiosteal hematoma on admission. After the frontal cutaneous suture, the subperiosteal hematoma was aspirated by the percutaneous needle. Two hours later, a CT scan revealed that the epidural hematoma was disappeared.

[Conjugate deviation in ischemia of medial medullary oblongata--report of three cases].

Medial medullary infarct (MMI) is a rare type of brain stem infarction. Its clinical picture was characterized by contralateral hemiparesis, deep sensory disturbance, and ipsilateral hypoglossal paresis, but conjugate deviation or nystagmus is uncommon as initial symptom. Case 1: A 73-year-old man developed vomiting and vertigo.

[Evaluation of the vocal tract during Japanese vowel production in myasthenia gravis using magnetic resonance imaging].

We report a 65-year-old Japanese female whose primary symptom of myasthenia gravis was related to rhinolalia aperta. The vocal tract during vowel production was evaluated using two-dimensional fast advanced spin echo (2D-FASE) MR images on supine and prone position. Before treatment, MRI on prone position demonstrated anterior shift of the palatine uvula and the tongue during Japanese "a", "u" and "o" production following the gravity, the former suggested the paresis of the sphenosalpingostaphylinus and elevator veli palatini muscle and the latter the paresis of the styloglossal and hypoglossal muscles.

[Delayed epidural bleeding caused by traumatic pseudoaneurysm of the middle meningeal artery: case report].

A 16-year-old man who presented with delayed bleeding of epidural hematoma is reported. Computed tomography (CT) on admission demonstrated a small amount of right epidural hematoma and a small fracture of the right lateral orbital wall. He was treated conservatively.

[Case report of Rosai-Dorfman disease mimicking pachymeningitis].

Rosai-Dorfman disease (RDD) is a rare idiopathic histioproliferative disease affecting the lymph nodes. Extranodal sites may be involved and occasionally represent the initial or sole manifestation of the disease. Central nervous system manifestations especially are exceedingly rare.

[Rapid improvement of callosal edema by thiamine administration in Marchiafava-Bignami disease: a case report].

Marchiafava-Bignami disease (MBD) associated with chronic alcoholism is a fatal disorder characterized by demyelination of the corpus callosum. A 62-year-old Japanese man, a heavy drinker for his last over 10 years, was admitted to our hospital because of acute onset of speech disturbance. The first MR images showed abnormal signal intensity of the corpus callosum, which was a typical finding of MBD, but no signal abnormality on diffusion-weighted images.

[A case of hematoma in cisterna magna after mild head injury].

An 18-year-old man suffered severe neck pain, signs of meningeal irritation, and dysesthesia of his left breast and left arm after mild head injury incurred in a traffic accident. On the next day, magnetic resonance imaging(MRI) revealed a hematoma in the cisterna magna, and it extended into the posterior spinal subdural space. Eight days after admission, MRI demonstrated the hematoma on the right posterior aspect of the spinal cord at the level of craniovertebral junction.

[Breast cancer at the site of an implanted pacemaker].

We report here an 81-old-female patient who had a permanent pacemaker implanted in the right chest and who developed breast cancer near the site of the implanted generator. The cancer was diagnosed as stage I adenocarcinoma and radical mastectomy preserving pectoral muscles was indicated. During temporary pacing via the femoral approach, the pacemaker lead was transferred to the left subclavicular area crossing before the sternum and the generator was reimplanted in the left chest without use of lead extension kit.