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The surgical management of prosthetic valvular endocarditis (PVE) can be challenging. We report a case of a 46-year-old female patient who had a history of four cardiac operations. We chose a mitral valve replacement via right thoracotomy to enable optimal exposure of the mitral valve (MV). Because of multi-reoperations, we employed systemic hyperkalemia for cardiac arrest to protect the heart during cardiopulmonary bypass (CPB) without aortic cross-clamping. Here, we present a complex operation that performed management of CPB under hyperkalemia and the patient had a good postoperative recovery.

Blunt abdominal aortic injury (BAAI) is very rare. In general, BAAI occurs in high-energy accidents. Here, we present a case of BAAI in a low-energy accident. A 70-year-old female was injured after falling 3 m. Her vital signs were stable. She had lumbar fractures (L1, L2) and BAAI associated with a fragment of the fractured L2 vertebral body. On the fifth posttrauma day, we performed an operation because computed tomography showed a bone fragment of the lumbar fractures (L1, L2) threatening the abdominal aorta. The aortic injury site was transected, and the fragment of the L2 vertebral body was removed. Even in low-energy accidents, BAAI should be considered. BAAI with stable vital signs can be electively treated.

Labeling stem cells with FDA-approved superparamagnetic iron oxide particles makes it possible to track cells in vivo with magnetic resonance imaging (MRI), but high intracellular levels of iron can cause free radical formation and cytotoxicity. We hypothesized that the use of cationic liposomes would increase labeling efficiency without toxic effects. Rabbit skeletal myoblasts were labeled with iron oxide by: 1) uptake of iron oxide incorporated into cationic transfection liposomes (group I) or 2) customary endocytosis (group II). In both groups, cell proliferation and differentiation were measured and toxicity was assayed using trypan blue and ratio fluorescence microscopy with BODIPY® 581/591 C11. The effects of the intracellular iron oxide on magnetic resonance image intensities were assessed in vitro and in vivo. Both methods resulted in uptake of iron intracellularly, yielding contrast-inducing properties on MRI images. In group II, however, incubation with iron oxide at high concentrations required for endocytosis caused generation of free radicals, a decrease in proliferation, and cell death. Cytotoxic effects in the remaining cells were still visible 24 h after incubation. Conversely, in group I, sufficient intracellular uptake for detection in vivo by MRI could be achieved at 100-fold lower concentrations of iron oxide, which resulted in a high percentage of labeled cells, high retention of the label, and no cytotoxic effects even after stressing the cells with a hypoxia–reoxygenation insult. The use of cationic liposomes for iron oxide stem cell labeling increases labeling efficiency approximately 100-fold without toxic effects. This technique results in high-contrast-inducing properties on MRI images both in vitro and in vivo and could thus be a valuable tool for tracking stem cells noninvasively.

Abstract.: Purpose: We evaluated the efficacy of platelet scintigraphy using autologous platelets labeled with 111In-oxine, to assess the degree of arteriosclerotic activity in arteriosclerosis obliterans (ASO). Methods: Thirty-three patients with clinical signs of ASO, seen between January 1996 and August 1999, were enrolled in this study. Scintigraphic imaging results were compared with the findings of contrast angiography in 26 patients, 17 of whom were taking antiplatelet and/or anticoagulant drugs during the platelet imaging study. Results: Angiography demonstrated atherosclerotic lesions at 38 sites from the abdominal aorta to the popliteal arteries in 23 patients. There was an accumulation of platelets at 17 of these sites (45%) and at 6 other sites without definite angiographic abnormalities. Lesions that resulted in less than 50% stenosis were detected slightly, but not significantly, less often than lesions with higher degrees of stenosis and occlusion (50% vs 30%, P = 0.73). The frequency of true-positive scintigraphic results was statistically higher in patients not taking antithrombotic agents than in those taking antithrombotic agents (70% vs 32%, P = 0.02). Conclusions: Our results suggest that imaging with 111In-oxine-labeled platelets may be useful for evaluating the pathophysiologic characteristics of atherosclerotic lesions in patients with ASO.

A 62-year-old man was crushed in a car accident and diagnosed with a fractured left ninth rib, pulmonary and heart contusion, hemopneumothorax, and descending aortic injury based on a computed tomography scan. He underwent chest tube drainage and was intubated for mechanical ventilation because a bone fragment of the ninth rib threatened to penetrate the descending aorta. On the second posttrauma day, computed tomography showed the bone fragment of the ninth rib approaching the descending aorta. He underwent graft replacement of the injured portion of the descending thoracic aorta, and we removed the fractured left ninth rib.

Purpose: To report successful endovascular treatment of massive hemorrhage from an aortoureteric fistula.Case Report: An 82-year-old man who had undergone total cystectomy and bilateral ureterostomy for bladder cancer was transferred with massive hemorrhage from the ureterostomy. Angiography demonstrated an aortoureteric fistula between the terminal aorta and the left ureter. The patient had pancytopenia from unknown causes on admission, so a stent-graft made from a Gianturco Z-stent covered with Dacron graft was implanted; complete hemostasis was obtained immediately. He died of coexistent plasma cell leukemia 42 days after the operation; however, complete hemostasis had been maintained, and infection around the stent-graft was not recognized at autopsy.Conclusions: Stent-graft implantation can be a useful therapy for control of massive bleeding from an aortoureteric fistula.

True aneurysms of tibial artery are uncommon. We report a case of a 47-year-old woman who suffered from a distal embolism in the left toes. The surgical intervention involved an aneurysmectomy and the interposition of the posterior tibial artery using the saphenous vein graft. She has been doing well 22 months after the operation.