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Objective: The relationship between specific distributions of isolated soleal vein thrombosis (SVT) and risk factors was investigated. Subjects and Methods: The subjects included 93 patients with SVT diagnosed with ultrasonography. Results: In the acute thrombus distribution, the thrombi of central veins were significantly more frequent than the thrombi of medial veins in the unilateral SVT. The thrombi of central veins were not more significantly frequent than the thrombi of medial veins in the bilateral SVT. Conclusion: The risk factors of bilateral SVT are considered to be different from that of the unilateral SVT. (*English translation of J Jpn Coll Angiol 2013; 53: 159-166)

This study examines the pathogenesis of abdominal aortic aneurysms (AAAs) with respect to pathological characteristics and expressions of matrix metalloproteinases (MMP)-2, MMP-9 and tissue inhibitor of metalloproteinases (TIMP)-1, in Tottori University Hospital, Japan. Thirty-four consecutive patients were operated on for (AAAs). During surgery, the anterior wall of the aneurysmal aorta was resected from the site of maximal diameter throughout the wall. AAA specimens consisted of the aneurysmal aortas, while control specimens consisted of the undulated aortas of autopsy cases. The expression of MMP-2, MMP-9 and TIMP-1 was evaluated by immunohistochemistry, Western blotting and competitive polymerase chain reaction (C-PCR). Immunohistochemistry showed MMP-2-positive cells and TIMP-1 positive cells mainly in the intima, and MMP-9-positive cells in the intima and adventitia. Western blotting revealed the expression of MMPs and TIMP-l variably in all the cases examined. C-PCR showed significantly higher elevation of MMP-2 mRNA in the small-diameter AAAs (30–45 mm), plus higher MMP-9 mRNA expression in both the small-diameter and the medium-large-diameter AAAs (45 < mm), than in controls. The ratio of MMP-2 to TIMP-1 mRNA levels in the small-diameter AAAs, and the ratio of MMP-9 to TIMP-1 mRNA levels in both the small-diameter and medium-large-diameter AAAs were significantly higher than in controls. The mRNA levels were significantly correlated between MMP-2 and MMP-9, between MMP-2 and TIMP-1, and between MMP-9 and TIMP-1 in the AAAs. This study demonstrates that increases in mRNA imbalanced expression of MMPs/TIMP, as well as increases of MMP-2 and MMP-9 expression, may play crucial roles in the development and growth of AAAs, and TIMP-1 may play an important rule of preventing the aortic expansion.

The aim of this study is to compare the effect of a high-frequency repetitive (HF) stretch or an intermittent (I) stretch on the cell proliferation and survival of human dermal fibroblasts and to determine the activation of any relevant signal pathways. Cultured human dermal fibroblasts were exposed to either HF or I stretch. Cell number was measured by counting, while DNA synthesis was assessed by 5-bromo-2'-deoxyuridine (BrdU) staining and apoptosis by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling staining. To investigate the potential mechanisms of repetitive strain on the proliferation and survival of fibroblasts, the activation of relevant transduction pathways, such as p38 mitogen-activated protein kinase (MAPK), extracellular signal-regulated kinase (ERK)1/2, AKT, and BAD, was assessed by Western blot. In addition, the effect of inhibition of these pathways on the fibroblast response was also studied. After either HF or I stretch for 7 days, fibroblast number was significantly decreased and there were less BrdU-positive cells. The numbers of apoptotic and/or necrotic fibroblasts were not affected. p38 MAPK and ERK1/2 were significantly activated after HF stretch, but AKT and BAD were significantly activated after I stretch. The inhibitors of p38 MAPK and MAPK/ERK kinase as well as dominant-negative AKT reduced cell number after both HF and I stretch but these pathways were not critical for the stretch-induced decrease in cell number.

Most patients with severe motor and intellectual disabilities (SMID) have restricted mobility capability and have been bedridden for long periods because of paralysis of the extremities caused by abnormal muscular tonicity due to cerebral palsy and developmental disabilities. Such patients are associated with a high risk of complications like deep vein thrombosis (DVT). Here, we report twelve patients (42.9%) with DVT among 28 patients with SMID during prolonged bed rest. However, we did not detect thrombosis in the soleal veins, finding it mostly in the femoral and common femoral veins. We applied anticoagulant therapy (warfarin), and carefully followed up the cases with DVT, regulating the warfarin dosage at prothrombin time-international normalized ratio (PT-INR) values around two to prevent recurrence of chronic thrombosis. Regarding laboratory data for the coagulation system, there were no cases above 5 µg/ml for the D-dimer and there were significant differences between the DVT and non-DVT groups in the D-dimer levels. The plasma levels of D-dimer in patients with DVT diminished to less than 1.0 µg/ml after warfarin treatment. Concerning sudden death (4.2%) in patients with SMID, we have to be very careful of the possibility of pulmonary thromboembolism due to DVT. Therefore, we should consider the particularity of the underdeveloped vascular system from underlying diseases for the evaluation of DVT. A detailed study of DVT as a vascular complication is very important for the smooth medical care of SMID, and serial assessment of compression Doppler ultrasonography of the lower extremities, as a noninvasive examination and measurement of D-dimer, is very helpful. (This article is a translation of Jpn J Phlebol 2014; 25: 34-42.).

In this study, we focused on the effect of hypertension on the transcription factors nuclear factor kappaB (NFkappaB) and ets in the mechanisms of abdominal aortic aneurysm (AAA), and we investigated how hypertension affects the progression of AAA. AAA was produced by elastase perfusion in hypertensive rats and normotensive rats. The size of AAA rapidly increased in hypertensive rats as compared with normotensive rats. Western blot analysis demonstrated that the expression of matrix metalloproteinase (MMP)-2, -3 , -9, and -12, as well as intercellular adhesion molecule, was increased in hypertensive AAA rats, accompanied by upregulation of NFkappaB and ets. Moreover, in situ zymography showed that the activity of MMPs was increased in the aorta of a hypertensive AAA model as compared with that in a normotensive AAA model. Interestingly, transfection of chimeric decoy oligodeoxynucleotide (ODN) resulted in significant inhibition of aortic dilatation both in normotensive and hypertensive rats at 4 weeks after transfection. Destruction of elastic fibers was also significantly inhibited by transfection of chimeric decoy ODN in both hypertensive rats and normotensive rats. The expression of MMP-2, -3, -9, and -12, as well as intercellular adhesion molecule, was significantly attenuated by the chimeric decoy ODN, accompanied by inhibition of the migration of macrophages. Also, the effect of chimeric decoy ODN was confirmed in an organ culture. The present study demonstrated that hypertension accelerated the progression of experimental AAA through upregulation of NFkappaB and ets. Inhibition of NFkappaB and ets could be a novel therapeutic strategy to treat AAA in hypertensive patients.

This report describes the successful treatment of a case of cardiac adenocarcinoma with the clinical presentation as Budd-Chiari syndrome. Complete surgical excision of the atriocaval mass was successfully achieved under deep hypothermic circulatory arrest. Histopathological diagnosis of this tumor was tubular adenocarcinoma with positive immunostaining by carcinoembrionic antigen. Subsequent systemic search could not detect any evidence of extra-cardiac primary site and distant metastatic lesion. A 2-year follow-up without any adjuvant therapy revealed no sign of recurrence.

Despite the discovery of multiple TAAs, only a limited number is available for clinical application, particularly against epithelial malignancies. In this study we searched for novel TAAs using expression profiles of gastric cancer examined with cDNA microarray, and identified the SCRN1 gene as a candidate. SCRN1 was confirmed to be expressed in five out of seven gastric cancers with semiquantitative RT-PCR. With Northern blot analysis, it was detected abundantly in the testis and ovary, but it was barely detectable in 14 other normal human adult organs. Colony formation assay revealed that its augmented expression is associated with promoted cell growth. As these expression profiles and functional features of SCRN1 appeared to be compatible with the characteristics of the hypothesized ideal TAAs, we examined whether SCRN1 protein contains antigenic epitope peptides restricted to HLA-A*0201. We synthesized the candidate peptides derived from SCRN1, and tried to induce CTLs with each peptide. The CTL clones were successfully induced with a peptide SCRN1-196 (KMDAEHPEL), and they lyzed not only the peptide-pulsed targets but also the tumor cells expressing both SCRN1 and HLA-A*0201 endogenously. These results strongly suggest that SCRN1-196 is an epitope peptide restricted to HLA-A*0201. Furthermore, we synthesized an anchor-modified peptide SCRN1-9 V (KMDAEHPEV), in which leucine at position 9 was substituted for valine to increase the binding affinity to the HLA-A*0201 molecules. The CTL clones induced by SCRN1-9 V also recognized tumor cells expressing its natural SCRN1 protein endogenously. These results strongly suggest that SCRN1 is a novel TAA and these peptides, both native and modified, may be applicable for cancer vaccines to treat gastric cancer.

Endothelial cells (ECs) are exposed to repetitive cyclic strain (CS) in vivo by the beating heart. The aim of this study was to assess the influence of CS amplitude and/or frequency on EC proliferation and survival and to determine the role of AKT in CS-induced EC proliferation and survival. Cultured bovine aortic ECs were exposed to 10% strain at a frequency of 60 (60 cpm-10%) or 100 (100 cpm-10%) cycles/min or 15.6% strain at a frequency of 60 cycles/min (60 cpm-15.6%). AKT, glycogen synthase kinase (GSK)-3β, BAD, and cleaved caspase-3 were activated by CS in ECs. Increasing the magnitude or frequency of strain resulted in an earlier phosphorylation of GSK-3β, although the magnitude of phosphorylation was similar. After CS at 60 cpm-10% for 24 h, the number of nontransfected ECs was significantly increased by 8.5% ( P < 0.05). We found that the number of apoptotic ECs was slightly decreased with exposure to CS. ECs transfected with kinase-dead AKT (KA179) as well as plasmids containing a point mutation in the pleckstrin homology domain of AKT (RC25) not only prevented AKT, GSK-3β, and BAD phosphorylation but also inhibited the CS-induced increase in cell number as well as the CS-induced protection against apoptosis (both P < 0.05). The ratio of 5′-bromo-2′-deoxyuridine-positive cells was increased when ECs transfected with RC25 and KA179 as well as nontransfected ECs and ECs transfected with Lipofectamine 2000 were exposed to CS. We conclude that AKT is important in enhancing the survival of ECs exposed to CS but is not involved in EC proliferation.

Laparoscopic total adrenalectomy has become a standard technique for small adrenal tumors; however, bilateral adrenalectomy results in postoperative adrenal insufficiency, necessitating lifelong steroid replacement. To preserve adrenocortical function in a 41-year-old woman with bilateral adrenocortical adenoma (BAA) causing Cushing's syndrome, we performed laparoscopic bilateral partial adrenalectomy. We based our preoperative diagnosis of bilateral adrenocortical tumors causing Cushing's syndrome on the results of endocrinological investigations and imaging findings. Thus, we performed lateral transperitoneal laparoscopic bilateral partial adrenalectomy, preserving the adrenal glands, which were normal. Pathological examination of both tumors confirmed the diagnosis of adrenocortical adenoma. The patient had no postoperative complications, and her adrenocortical function was normal without steroid replacement at her 10-month follow-up. This report shows that Cushing's syndrome resulting from bilateral adenomas can be effectively treated by laparoscopic bilateral partial adrenalectomy as a minimally invasive, adrenocortical-preserving operation.

We examined the electrophysiological effects of trapidil on the ionic currents influencing the repolarization and on the transient inward current (IT;) that can cause triggered arrhythmia using the whole-cell patch-clamp technique in guinea pig ventricular myocytes. Trapidil shortened the action potential duration (APD) and increased the delayed rectifier potassium current (I K ) in a concentration-dependent manner. The effect of trapidil on the rapidly and slowly activating components of I K (I K r and I K s , respectively) was studied by the envelope of tails test. Trapidil failed to affect I K r and selectively enhanced I K s . Trapidil increased the amplitude of the L-type Ca 2 + current (I C a , L ), with an acceleration of its inactivation, whereas isoproterenol, a β-adrenoceptor agonist, increased the amplitude of the I C a , L in a different manner. Isoproterenol activated I T i ; however, trapidil not only failed to facilitate I T i but also suppressed isoproterenol-induced IT;. The inhibitory effect of trapidil on isoproterenol-induced I T i is at least partly via a reduction of Ca 2 + overload through an acceleration of I C a , L inactivation and/or a sarcoplasmic reticulum (SR) Ca 2 + channel modulation. These results suggest that trapidil does not prolong the QT interval and has an antiarrhythmic effect on arrhythmias elicited by triggered activity secondary to Ca 2 + overload at much higher concentrations than clinical concentration.

Runt-related transcription factor 3 belongs to the runt domain family of transcription factors that play a pivotal role during normal tissue development and tumorigenesis in several organs. We directed our attention to the expression of RUNX3 protein in human lung AC and non-neoplastic lung tissues, comparing the results with clinicopathological profiles. We evaluated the expression of RUNX3 protein in 17 pairs of lung AC and non-neoplastic lung tissue. Furthermore, 98 lung AC were studied to examine the frequency of RUNX3-positive cells. Western blot analysis showed a single band at 45 kDa in all 17 AC and non-neoplastic tissues. Immunohistochemistry revealed immunoreactivity in alveolar type II pneumocytes or Clara cells. RUNX3 was expressed more frequently in the carcinomas with a BAC component than in those without (P

The pathophysiology of abdominal aortic aneurysms (AAA) is considered to be complicated. As matrix degradation contributes to the progression of AAA, the destruction and degradation of elastin fibers caused by an increase in matrix metalloproteinases (MMPs) plays a pivotal role in the development of AAA. Although ets, an essential transcription factor for angiogenesis, regulates MMPs, the role of ets in the development of AAA has not yet been clarified. Thus, we evaluated the role of ets in a rat AAA model using a decoy strategy. Transfection of ODN into AAA was performed by transient aortic perfusion of elastase and by wrapping the AAA in a delivery sheet containing decoy ODN. The inhibitory effect of ets decoy ODN on ets binding activity was confirmed by gel mobility shift assay. MMPs expression was decreased in the aorta transfected with ets decoy ODN as compared to scrambled decoy ODN. Also, ultrasound study demonstrated that elastase-induced aneurismal dilation was significantly suppressed by transfection of ets decoy ODN at 4 weeks after treatment as compared to scrambled decoy ODN. Moreover, the destruction of elastin fibers was inhibited in the aorta transfected with ets decoy ODN, accompanied by a reduction of MMPs expression. An inhibitory effect of decoy ODN on MMP expression was confirmed by ex vivo experiments showing that transfection of decoy ODN into an organ culture of human aorta resulted in significant inhibition of the secretion of both MMP-1 and MMP-9. Here, we demonstrated that ets may play a pivotal role in the progression of AAA through the activation of MMPs in a rat model. Ets might be a potential target to develop pharmacotherapy/gene therapy to treat AAA through the inhibition of MMPs.

Recent evidence has shown that certain tumors have characteristic cell populations related to tumor progression. Therefore, we investigated tumor cell populations in 7,12-dimethylbenz[a]anthracene (DMBA)-induced rat mammary tumor, an established estrogen-sensitive angiogenic tumor model. The tumors pathologically identified as invasive ductal carcinoma were immunostained using antibodies against the following various molecules: vascular endothelial growth factor (VEGF), integrins, estrogen receptor alpha (ERα), human epidermal growth factor receptor-2 (HER2), p27, and laminin, all of which are known to be related to tumor progression, proliferation and/or prognosis. The basal layer, the outermost layer of tumor lobules facing the basement membrane, was mainly VEGF and integrin (α3, α6, β1) positive. In contrast, the inner layer, the internal cell layers of the tumor lobules, was mainly ERα and HER2 positive. The p27-positive rate in the inner layer was similarly low to that in the basal layer, suggesting a similar high proliferative potency between these layers. Laminin was positive in the basement membrane surrounding the tumor lobules. These results suggest that the tumor lobules consist of at least two cell populations, the basal and inner layers, with respect to the expression of VEGF, integrins, ERα and HER2; and that these cell populations may have distinct functions in the pathophysiology of this mammary tumor.

完全左脚ブロックを伴う重症虚血性心筋症に対して,冠動脈バイパス術に自己骨髄単核球細胞移植術(BMCI)による血管新生療法と両心室ペーシング(BVP)を用いた心臓再同期治療を同時施行し,良好な結果を得たので報告する.症例は67歳,男性.心不全増悪による呼吸困難を主訴とし,左冠動脈の広範囲びまん性閉塞病変に起因する虚血性心筋症に対する外科的治療目的で当科紹介となった.心臓超音波検査ではLVDd 71mmと左室腔の拡大を認め,心電図検査はQRS幅180msの完全左脚ブロックを呈していた.冠動脈造影検査で#5:50%,#6,7,8:90%(ステント内多発病変),#12:100%(枯れ枝状末梢性びまん性閉塞),#14:75%の有意狭窄病変を認めた.当大学倫理委員会の承認を得て,冠動脈バイパス術(1枝:#14)と同時に,末梢性びまん性閉塞病変を有する左室高側壁領域へのBMCIとBVPを施行した.術後15ヵ月が経過,自覚症状および心機能の著明な改善を認めた.

Background— Two phenomena, inflammation and matrix degradation, contribute to the progression of abdominal aortic aneurysm (AAA). Importantly, the inflammation is regulated by the transcription factor nuclear factor (NF)–κB, whereas the destruction and degradation of elastin fibers by matrix metalloproteinases (MMP) are regulated by ets. Thus, we developed a novel strategy to treat AAA by simultaneous inhibition of both NF-κB and ets by using chimeric decoy oligodeoxynucleotides (ODN). Methods and Results— AAA was induced in rats by transient aortic perfusion with elastase, whereas transfection of decoy ODN was performed by wrapping a delivery sheet containing decoy ODN around the aorta. Gel-mobility shift assay at 7 days after treatment demonstrated that both NF-κB and ets binding activity were simultaneously inhibited by chimeric decoy ODN. Transfection of chimeric decoy ODN resulted in significant inhibition of the progression of AAA such as aneurysmal dilation at 4 weeks after treatment as compared with control, accompanied by a reduction of MMP expression. Moreover, the destruction of elastin fibers was inhibited in the aorta transfected with chimeric decoy ODN. Importantly, transfection of chimeric decoy ODN demonstrated potent inhibition of aneurysmal dilatation compared with NF-κB decoy ODN alone, whereas scrambled decoy ODN had no effects. Interestingly, the migration of macrophages was significantly inhibited by chimeric decoy ODN. Conclusions— We demonstrated that inhibition of the progression of AAA was achieved by a novel strategy with chimeric decoy ODN used against NF-κB and ets in rat model. NF-κB and ets are considered to play an important role in the pathogenesis of AAA.

症例は76歳の女性である.左乳頭の硬結を主訴に来院し,乳頭部に1.0cm大の辺縁整な硬い腫瘤を認めた.生検にて浸潤性乳管癌との診断を受け,乳房温存術を施行した.切除標本では乳頭および乳頭直下に限局した癌巣を認めた.病理組織学的には浸潤性乳管癌(硬癌)であり,リンパ管浸潤や脈管浸潤を認めなかった.

症例は55歳男性.慢性肺気腫で在宅酸素療法を施行中であった.平成9年の検診で右肺門部異常陰影を指摘され,胸部CTで前縦隔の嚢胞状腫瘤として描出されたので,成熟型奇形腫と診断されたが,呼吸不全のため経過観察とされていた.平成11年1月5日,突然の血痰と胸痛,呼吸困難のため入院した.胸部CTで上記腫瘍の右肺穿破と診断された.抗生剤を投与しながら肺炎の消退を待った後,胸腺および腫瘤摘出と右肺上葉部分切除術を行った.病理組織は嚢胞性成熟型奇形腫であった.術後経過は良好であった.結語:成熟型奇形腫の肺内穿破は早期の手術が原則であるが,高度の呼吸不全患者においては炎症所見の消退を待ち,切除範囲の縮小をはかることも有用と考えられた.

We report a case of mycotic abdominal aortic pseudoaneurysm caused by a penetrating atherosclerotic ulcer (PAU). An 81-year-old woman was admitted to a local hospital with fever and abdominal pain, and when her symptoms were not improved by antibiotics, she was referred to our department. Computed tomography (CT) and angiography showed a saccular aneurysm below the renal arteries, and an emergency laparotomy was performed because we suspected a mycotic abdominal aortic pseudoaneurysm. An abscess was found on the proximal side of the jejunum, caused by an aneurysm penetrating the serosa. We diagnosed a mycotic pseudoaneurysm after finding the anterior wall of the aorta penetrated by intense calcification. The pseudoaneurysm was resected with the abscess and the area was covered with a pedicled omental flap to prevent infection. An axillofemoral bypass was also done. The patient recovered well.

1980年から1997年に手術した腹部大動脈瘤(AAA)191例(非破裂161例,破裂30例)の遠隔期予後を検討した.30日死亡は非破裂群1.2%,破裂群36.6%,在院死亡はおのおの3.1%,53.3%であった.耐術例の累積生存率は5年76.3%,10年42.3%で,一般人口より低かった.非破裂群と破裂群に有意差はなかった.遠隔期の死因は心臓関連死が28.8%,脳血管障害19.2%,悪性腫瘍17.3%,大動脈腸管瘻や再発した真性動脈瘤(真性瘤),吻合部動脈瘤(吻合部瘤)など中枢側吻合部周囲大動脈病変の破裂が9.6%であった.遠隔期に中枢側吻合部周囲の大動脈病変を10%,胸部大動脈瘤を3.7%,大動脈解離を4.2%に認めた.グラフト累積開存率は10年97.4%,15年90.9%であった.AAA患者では術後遠隔期において,冠動脈疾患や大動脈瘤の再発などを早期に発見するために,長期的な経過観察が必要である.

症例は84歳,女性.左乳癌に対する胸筋合併乳房切除術,胃潰瘍に対する開腹下による胃切除術,左胸膜孤立性線維性腫瘍に対する後側方開胸下による腫瘍摘出術の既往があった. 1997年3月に左前胸部のボーエン病に対して腫瘍切除術および遊離皮膚移植術を施行された. 1998年7月より同部位に皮膚潰瘍を形成し,難治のため2000年3月に左第3肋骨を含めた胸壁全層切除術を施行した.既往歴および切除部位より,右大胸筋を上腕骨停止近傍で切離した右大胸筋皮弁を作製して胸壁を再建した.呼吸機能は良好に維持された.術後2年経過した現在,日常生活には支障はない.

Background Structural changes in the number, size, and shape of mitochondria (mt) have been observed in the atrial muscles of patients with atrial fibrillation (AF) and of animals with rapid atrial pacing, however, it is not known whether the mitochondrial function is impaired in human atrium with AF. Materials and Methods We determined adenine nucleotides concentrations and mtDNA deletions in 26 human right atria obtained at the time of cardiac surgery, using HPLC and PCR amplification, and studied the relationship between mtDNA deletions and clinical manifestations, the haemodynamic parameters of the patients and adenine nucleotide concentrations in their atrium. Results The age and the prevalence of AF were significantly higher in the patients with a mtDNA deletion of 7·4 kb than in those without a deletion; there were no significant differences regarding haemodynamic parameters between the two groups. The concentrations of ATP, ADP, AMP and total adenine nucleotides in the right atrium were significantly lower in the patients with mtDNA deletions than the patients without a deletion. In a gender- and diseased-matched population, the mtDNA deletion was still significantly associated with age and a decreased concentration of adenine nucleotides in the atrium. Using quantitative PCR analysis, the proportion of mtDNA deletion to normal mtDNA of the atrium, was estimated to be 0·3–2% in four cases. Conclusion These results suggest that the deletion of mtDNA associated with ageing or AF can lead to a bioenergetic deficiency due to an impaired ATP synthesis in the human atrium; however, no conclusion can be made whether mtDNA deletion were the result or the cause of an impaired ATP synthesis, ageing, hemodynamic deterioration, or AF.

成人開心術24例を送血温の復温速度0.1℃/minで緩徐復温群 (S群) と急速復温群 (R群) に分類し, 体外循環復温期における脳血流と脳酸素代謝の変動を検討した. 経頭蓋ドプラ血流計を用いて中大脳動脈平均血流速 (mean MCAv) を測定し, 体外循環前値を基準とした変化率で脳血流変化を評価した. この mean MCAvと脳動静脈血酸素含量較差の積を脳酸素消費指数 (D-CMRO2) と定義し, 脳酸素代謝の指標とした. また, 同時に近赤外線分光法で脳内酸素量変化を表す酸化ヘモグロビン (Oxy Hb) を測定した. S群では全経過で mean MCAvがD-CMRO2を上回り平衡して変動したが, R群では復温開始後のD-CMRO2は mean MCAvに比べて大きく増加し, 復温終期に mean MCAvを上回った. また, R群の復温期に内頸静脈血酸素飽和度やOxy Hbの急激な変化を認めた. 体外循環の急速復温により, 脳血流と脳酸素代謝の均衡が破綻する可能性が示された.

A 65-year-old man who underwent closure of a traumatic arteriovenous fistula presented with pulsating masses in the right femoral region. A diagnosis of multiple aneurysms from the right external iliac artery to the superficial femoral artery complicated by ipsilateral varicosis of the short saphenous vein was made. Stripping of the short saphenous vein and iliopopliteal bypass with reimplantation of the profunda femoris artery were performed in two stages. Hemodynamic factors are considered to be involved in the mechanism of aneurysm formation following treatments for traumatic arteriovenous fistula, and long-term follow-up is needed after their closure.

Marfan syndrome (MFS; MIM #154700) is a connective tissue disorder characterized by cardiovascular, skeletal, and ocular abnormalities. The fibrillin-1 gene (FBN1; MIM no. 134797) on chromosome 15 was revealed to be the cause of Marfan syndrome. To date over 137 types of FBN1 mutations have been reported. In this study, two novel mutations and a recurrent de-novo mutation were identified in patients with MFS by means of single-strand conformational polymorphism (SSCP) analysis. The two novel mutations are a 4-bp deletion at nucleotide 2820-2823 and a G-to-T transversion at nucleotide 1421 (C474F), located on exon 23 and exon 11, respectively. A previously reported mutation at the splicing donor site of intron 2 (IVS2 G + 1A), which is predicted to cause exon skipping, was identified in a sporadic patient with classical MFS.

近年増加傾向にある女性肺癌の臨床像を解析するため, 鳥取県の検診成績をもとにその特徴を検討した. 過去11年間における検診発見肺癌341例の内訳は女性が115例, 男性が226例で, 約1:2の比率であった. 背景因子では女性は男性よりも有意に喫煙歴が少なく, 腺癌症例が多かった.予後は女性が男性より有意に良好であり, 特に病期ではII, III, IV期の進行症例において, 組織型では腺癌症例において男性より有意に予後良好であった. Coxの比例ハザードモデルによる多変量解析では病期, 手術の有無とともに性差は有意な予後因子であり, ハザード比1.61で女性が男性よりも予後良好であった.

異なる進展形式を有するdumbbell型腫瘍3例の胸腔鏡下手術を報告した.症例1は62歳女性でEden III型, 症例2は40歳男性でEden IV型, 症例3は12歳女性でEden II型であった.症例1, 3は整形外科による後方経路からの脊柱管内腫瘍の切除を先行した後, 胸腔鏡下に残存腫瘍を摘出した.症例2は胸腔鏡下手術のみで摘出した.症例3は術後に髄液漏を合併した.病理はすべて良性の神経鞘腫であった.Dumbbell型腫瘍においてEdenI型は胸腔鏡手術が困難で, IV型は胸腔鏡のみでも施行可能である.II, III型はまず整形外科や脳神経外科による脊柱管内操作を優先し, 神経損傷の危険を回避した後, 胸腔鏡下に椎間孔を開放するように残存腫瘍を完全切除することが望ましい.しかしながら, 特にII型は硬膜を切開するため, 術後の髄液漏に注意を要する.

Background . The recent introduction of operations on a warm heart has prompted clinical reports on the usefulness of continuous blood cardioplegia, but no in-depth basic evaluation of continuous cardioplegia has been done. The cardioprotective effects of magnesium (Mg) and calcium (Ca) in continuous warm hyperkalemic crystalloid cardioplegic solutions were investigated in an isolated rat heart model. Methods . Isolated rat hearts were arrested for 180 minutes at 37°C with a continuous warm hyperkalemic (20 mmol/L) modified Krebs-Henseleit bicarbonate buffer solution containing 1.2, 8.0, or 16.0 mmol/L of Mg and 0.1 to 2.5 mmol/L of Ca in different concentrations. Recovery of cardiac function and tissue damage were estimated. Results . For each Mg concentration, the percentage recovery of aortic flow generated dose-response curves depending on Ca concentration. However, as Mg concentration increased, the recovery of aortic flow decreased in the groups with 0.5 mmol/L of Ca or less. Conclusions . In continuous warm cardioplegia the combination of low Ca and high Mg concentration caused severe cardiac injury, and normal Ca concentration avoids cardiac injury regardless of Mg concentrations.

症例は1歳9ヵ月, 男児.灯油誤飲にて当院小児科に入院中, 右胸水貯留をきたし, 入院後10日目に当科紹介となった.直ちに胸腔ドレーンを挿入したが, ドレナージ不良のため全身麻酔下に胸腔鏡下掻爬ドレナージ術を施行した.胸腔内はフィブリン塊や膿性被膜で満たされており, 約6cmのミニ開胸とした.内視鏡補助下にフィブリン塊や膿性被膜を吸引除去した.やや硬い肥厚胸膜は超音波手術装置 (USU, オリンパス社) を用いて剥離した.胸腔内を単一とした後, 16Frの胸腔ドレーンを2本留置して手術を終了した.術後は胸腔洗浄をおこない, 肺の再膨脹も良好で術後9日目でドレーンを抜去し, 術後16日目に退院した.急性膿胸に対する胸腔鏡下掻爬ドレナージ術は成人と同様に幼児にも安全で有用な術式である.

We report a case of subacutely developed constrictive pericarditis with hemopericardium. A 67-year-old man was admitted to the hospital because of chest discomfort at the inspiration and edema of the lower ex-tremities one month after catheter ablation therapy for WPW syndrome (type A). According to UCG and chest CT findings, cardiac tamponade with hemopericardium was suspected and a removal of hematoma was planned. Operative inspection, however, reveald that the heart was strangulated by thick epicardium, causing disturbance of cardiac dilatation. Then a epicardiectomy was performed. The cardiac function was improved and the postoperative course was uneventful. This case was diagnosed as effusive constrictive pericarditis. The possibility of constrictive pericarditis must be considered in cases of subchronic cardiac tamponade.

Rupture of an abdominal aortic aneurysm (AAA) is usually predicted on the basis of measuring the maximum diameter. However, since the size of a normal aorta varies depending on each individual, this indicator does not seem to be ideal. The authors propose a new indicator for the enlargement of aorta and have started clinical application of this technique. The abdominal aortic diameter was measured by using two-dimensional ultrasonography in 261 adults (aged 20 and over). The control group consisted of subjects with no evident aortic dilatation. Patients with AAA were divided into the nonruptured group and the ruptured group. Analysis of the data from the control group revealed that the abdominal aortic diameter could be defined by the following equation: Diameter (mm) = 0.147 x age (years) + 0.169 x height (cm) - 15.9. The baseline diameters of the abdominal aorta were calculated by applying the age and height of individual subjects in this equation. The measured diameter was divided by the baseline diameter to obtain the aortic expansion index (AEI). If a cut-off value of the aneurysm diameter and the AEI (calculated by using age 20) for the prediction of significant risk of rupture is set at 44.2 mm (= mean - 2SD of the aneurysm diameter in the ruptured group) and at 2.7 (= mean - 2SD of the AEI in the ruptured group), the risk of rupture based on the diameter in the nonruptured group is underestimated in 11% of cases. However, when the risk of rupture is based on the AEI, the risk is not underestimated in any case in the nonruptured group. The authors conclude that the AEI is a useful indicator for quantitatively evaluating the risk of rupture of an AAA.

A 69-year-old woman was admitted because of an abnormal solitary round shadow in the right lower lung on chest X-ray. However we could not make an accurate preoperative diagnosis using either transbronchial lung biopsy or CT guided needle biopsy. Since intraoperative thoracoscopic needle biopsy revealed malignant findings, right middle lobectomy with R 2a lymph node dissection was performed. Histological examination determined pulmonary mucoepidermoid carcinoma originating from the peripheral bronchus of B 5b. Pulmonary mucoepidermoid carcinoma commonly occurres in the bronchial glands of the central bronchus, and gradually invades the pulmonary parenchyma. Since mucoepidermoid carcinoma of the peripheral bronchus is very rare, the clinical features of this casewere reported.

A 60-year-old woman, who had undergone a radical mastectomy for mucinous breast cancer 15 years before, was admitted to the hospital because of an abnormal shadow on a chest roentgenogram. Preoperative chest CT showed a small well-circumscribed tumor in S9 of the right lung. Tumor markers for both breast and lung cancers were with in normal limits. We were not able to determine whether the tumor was pulmonary matastasis of the previous breast cancer or primary lung cance, and so a thoracoscopic surgery was selected. The thoracoscopic findings included two well-circumscribed colloidal tumors in S9 and S2 so that a partial resection of the right lung for the both tumors was performed. The intraoperative frozen section diagnosis was pulmonary metastasis from the mucinous breast cancer. Since metastatic lung tumor from mucinous breast cancer sometimes becomes apparent after a long disease-free interval, we must carefully follow up such diseases for long time.

Coronary artery bypass grafting (CABG) in patients with severely diseased ascending aorta has been associated with high risk for cerebral vascular accidents due to atheromatous embolism. In this situation, aortic no-touch techniques are widely employed as most important surgical strategy to prevent these complications. A case of 75-year-old man with effort angina associated with porcelain ascending aorta was reported here. He successfully underwent off-pump axillo-coronary bypass grafting with saphenous vein graft and has remained uneventful during his follow-up period. The off-pump axillo-coronary artery bypass grafting seemed to be an appropriate procedure for coronary revascularization with severely diseased ascending aorta.

症例は77歳,男性である.腹部大動脈瘤術後9年目に中枢側吻合部瘤のため入院した.吻合部瘤は腎動脈より3cm末梢側に存在し,最大径55mmであった.再手術症例で脳梗塞の既往があり,また解剖学的にも適応があったためステントグラフト内挿術を施行した.術後endoleakやmigrationは認めず,現在外来通院中である.ステントグラフト内挿術は腹部大動脈瘤の再手術症例に対し有効な手段であり,解剖学的に可能であれば積極的に試みるべき治療手技であると考えられた.

Objective: To evaluate accurately the calf muscle pump in patients with venous insufficiency using foot vein pressure measurements during three different exercises. Design: Prospective study in three groups, comparing patients with venous disease with controls. Setting: Second Department of Surgery, Tottori University Faculty of Medicine. Patients: Twenty normal legs, 29 legs previously affected by deep vein thrombosis and 36 legs with primary varicose veins. Main outcome measures: The foot vein pressure was measured during ankle dorsiflexions, knee-bending and walking on the spot at 40 paces per minute during which minimum ambulatory venous pressure (AVP) and venous refilling time (VRT) were assessed. Results: The three groups differed significantly from each other in AVP and VRT after dorsiflexion and in AVP during walking on the spot, but not after knee-bending. Conclusion: Dorsiflexion is the most useful exercise distinguishing various severities of venous insufficiency, but walking on the spot is more useful for accurately evaluating the calf muscle pump.

成人開心術17症例を術前正常群 (10例) と脳血管障害群 (7例) に分類し, 経頭蓋ドプラ血流計を用いて体外循環中の CO2 reactivity の維持に関して比較した. 全例一定体灌流量の定常流, 中等度低体温体外循環下で, α-stat strategy で導入維持された後, high PaCO2 state と low PaCO2 state を設定し, 両群において脳血流変化および脳酸素消費量の変動を検討した. その結果PaCO2の上昇に従い両群とも脳血流変化は, 有意な増加を認め, CO2負荷に対しての脳血管反応性は維持されていた. しかし脳酸素消費は, 正常群では両 PaCO2 state 間で有意な変動はないが, 脳血管障害群ではCO2負荷時には脳血流の増加に対し逆に脳酸素消費の抑制が認められた. この原因として動脈硬化の強い領域と正常領域の血管反応性の相違が, 脳組織血流の不均等性を増幅するためではないかと推測された.

Objective: In patients with isolated soleal vein thrombosis (SVT), the relation between acute thrombi and positive anti-nuclear antibody (ANA) was investigated. Subjects and Methods: The subjects were 116 lower extremities in 86 patients with SVT. They were diagnosed and examined by ultrasonography and blood serum analysis (D-dimer, ANA), and had been followed up every three months. Results: They had acute SVT in 35 limbs (30%) and chronic SVT in 86 limbs (70%), and they had positive ANA in 63%. They had recurrent SVT in 26%, and all were positive for ANA. Conclusion: ANA-positivity might be a risk factor for acute thrombi in patients with SVT. (*English Translation of J Jpn Coll Angiol 2010; 50: 417-422.)

As yet no clear criteria are available for differentiation of normal from abnormal abdominal aortic diameter in relation to the development of aortic aneurysm. The purpose of this study was to elucidate the age-related changes in the abdominal aortic diameter. A total of 194 individuals (97 men and 97 women) aged twenty years or more with no abnormalities in the abdominal aorta on physical examination were measured by B-mode two-dimensional ultrasonography for the maximum anteroposterior diameter of the abdominal aorta. Results were as follows: 1. A multiple regression analysis demonstrated that the age, height, and body weight were factors influencing the aortic diameter. The most significant factor among them was the age (the partial correlation coefficient was +0.811, P 2. The relationship between the diameter and the height was evaluated by stratification of the subjects at ten-year intervals. The correlation coefficients showed significant positive correlations observed in all age groups (P< 0.001) . 3. The relationship between the diameter and the age was studied according to the height by dividing the subjects into five height groups. The correlation coefficients showed significant positive correlations observed in all height groups (P < 0.001 ) .

症例は63歳,男性である.吐下血を主訴に来院した.7年前に腹部大動脈瘤にて人工血管置換術を受けていた.臨床症状より吻合部瘤に発生した大動脈腸管瘻を疑い,造影CTにて診断した.人工血管の感染は否定できなかったので,腋窩-大腿動脈バイパス術を先行させたのち,Y-グラフトを除去し断端閉鎖を行い,良好な結果を得た.

A 38-year-old man was involved in a traffic accident and experienced a heavy blow to the abdomen. He had traumatic abdominal aortic dissection with right lower extremity ischemia. He underwent percutaneous balloon fenestration, which is safe and minimally invasive, for relief of right lower extremity ischemia. He has been working for 2 years without any signs of vascular compromise. Percutaneous balloon fenestration is one of the few treatments for traumatic abdominal aortic dissection. (J Vasc Surg 2000;32: 616-8)

Objective This study was performed to examine the role of the endothelial constitutive NO synthase (ecNOS) gene in patients with abdominal aortic aneurysm (AAA). Methods We determined the distributions of polymorphism in intron 4 of the ecNOS (ecNOS4) gene, amplified by polymerase chain reaction, and compared the allele frequencies between subjects with abdominal aortic aneurysms (AAAs) and healthy individuals. Patients Fifty-eight patients with AAAs and 410 race-matched healthy controls were studied. Results Two alleles of the ecNOS4 gene, containing 4 (a-allele) and 5 (b-allele) repeats, were identified. We found that the a-allele frequency of this gene was significantly higher in the surgical than in the non-surgical group. Conclusion The results of this study suggest that the a-allele of the ecNOS4 gene is indicative of the need for surgery for AAA. Analysis of the alleles of the ecNOS4 gene polymorphism could provide useful information concerning the clinical course of AAA progression.(Internal Medicine 39: 537-539, 2000)

症例は71歳の男性で, 左腰痛を主訴に来院した. CTにより, 最大径5cmの炎症性腹部大動脈瘤と左水腎症と診断され, 内科に入院した. 1カ月後のCTにより, 動脈瘤は7cmに拡大し, 後腹膜腔への破裂が判明したため, 緊急手術になった. 瘤の後壁に50×10mmの破裂孔と血腫が存在し, sealed rupture と考えられ, 直型人工血管で動脈瘤を置換した.