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MicroRNAs (miRNAs) are sequence-specific inhibitors of post-transcriptional gene expression. However, the physiological functions of these non-coding RNAs in renal interstitial mesenchymal cells remain unclear. To conclusively evaluate the role of miRNAs, we generated conditional knockout (cKO) mice with platelet-derived growth factor receptor-β (PDGFR-β)-specific inactivation of the key miRNA pathway gene Dicer. The cKO mice were subjected to unilateral ureteral ligation, and renal interstitial fibrosis was quantitatively evaluated using real-time polymerase chain reaction and immunofluorescence staining. Compared with control mice, cKO mice had exacerbated interstitial fibrosis exhibited by immunofluorescence staining and mRNA expression of PDGFR-β. A microarray analysis showed decreased expressions of miR-9-5p, miR-344g-3p, and miR-7074-3p in cKO mice compared with those in control mice, suggesting an association with the increased expression of PDGFR-β. An analysis of the signaling pathways showed that the major transcriptional changes in cKO mice were related to smooth muscle cell differentiation, regulation of DNA metabolic processes and the actin cytoskeleton, positive regulation of fibroblast proliferation and Ras protein signal transduction, and focal adhesion-PI3K/Akt/mTOR signaling pathways. Depletion of Dicer in mesenchymal cells may downregulate the signaling pathway related to miR-9-5p, miR-344g-3p, and miR-7074-3p, which can lead to the progression of chronic kidney disease. These findings highlight the possibility for future diagnostic or therapeutic developments for renal fibrosis using miR-9-5p, miR-344g-3p, and miR-7074-3p. [ABSTRACT FROM AUTHOR]

Background: The best thromboprophylaxis for pregnant women with congenital antithrombin deficiency (CAD) is controversial. Objective: To clarify the effectiveness of a protocol for venous thromboembolism (VTE) prevention in pregnant women with CAD. Methods: Women at high risk of VTE were administered antithrombin concentrate and heparin after conception, whereas those at low risk of VTE were administered heparin alone until delivery. All women received antithrombin concentrate at delivery except for one who was diagnosed with CAD. Results: Ten women had CAD, including one in the high-risk group and nine in the low-risk group. No women had VTE at delivery as per the protocol for VTE prevention. Almost all women had increased antithrombin activity before delivery followed by maintenance at ≥ 70% due to antithrombin concentrate administration. VTE prophylaxis during and after delivery was successful in all women with CAD. However, one woman in the low-risk group did not receive heparin and developed VTE induced by severe hyperemesis at 9 gestational weeks, before the diagnosis of CAD. Women in the high-risk group received antithrombin concentrate after delivery but had increased D-dimer levels at postpartum. Conclusions: Our protocol to prevent VTE in pregnant women with CAD is safe and effective. [ABSTRACT FROM AUTHOR]

Although gestational hypertension (GH) is a well-known disorder, gestational proteinuria (GP) has been far less emphasized. According to international criteria, hypertensive disorders of pregnancy include GH but not GP. Previous studies have not revealed the predictors of progression from GP to preeclampsia or those of progression from GH to preeclampsia. We aimed to determine both sets of predictors. A retrospective cohort study was conducted with singleton pregnant women who delivered at 22 gestational weeks or later. Preeclampsia was divided into three types: new onset of hypertension/proteinuria at 20 gestational weeks or later and additional new onset of other symptoms at < 7 days or at ≥ 7 days later. Of 94 women with preeclampsia, 20 exhibited proteinuria before preeclampsia, 14 experienced hypertension before preeclampsia, and 60 exhibited simultaneous new onset of both hypertension and proteinuria before preeclampsia; the outcomes of all types were similar. Of 34 women with presumptive GP, 58.8% developed preeclampsia; this proportion was significantly higher than that of 89 women with presumptive GH who developed preeclampsia (15.7%). According to multivariate logistic regression models, earlier onset of hypertension/proteinuria (before or at 34.7/33.9 gestational weeks) was a predicator for progression from presumptive GH/GP to preeclampsia (odds ratios: 1.21/1.21, P value: 0.0044/0.0477, respectively). [ABSTRACT FROM AUTHOR]

In this study, we consider the Kondo temperature and differential conductance for an Aharonov-Bohm ring with an embedded quantum dot connected with noncollinear ferromagnetic leads. Starting from the tight-binding model, we propose an equivalent Anderson model, in which the density of states depends on the Aharonov-Bohm phase. By applying the poor man's scaling approach to the Hamiltonian, we derive the dependences of the Kondo temperature and differential conductance on the Aharonov-Bohm phase, spin polarization, angle of magnetic moment, and asymmetry parameters. We show conditions for the nonmonotonic behavior of the differential conductance in terms of the spin splitting and Aharonov-Bohm phase. In addition, by extending the model to the case of a finite ring size, we show that the Kondo temperature crucially depends on ring size, but the properties of the scaled temperature are similar to ones for the small ring-size limit. [ABSTRACT FROM AUTHOR]

Background: We followed up four patients receiving reconstructive hip arthrodesis with a free-vascularized fibular graft (FVFG) for malignant bone tumor in order to restore lower limb function after wide resection of the periacetabular bone tumor. Questions/purposes: As malignant pelvic bone tumors have a poorer prognosis than those affecting the distal extremities, there have been relatively few reports on clinical functional results after long-term follow-up. Methods: The postoperative follow-up period averaged 11.3 years (range, 8 to 14 years). Radiographs of the AP view of the pelvis were evaluated on the basis of bone union of the FVFG. Clinical results were evaluated with use of the Musculoskeletal Tumor Society (MSTS) scoring system and the Short Form 36 (SF-36). Results: Successful reconstructive arthrodesis of the hip joint was accompanied by radiological findings of bone union and hypertrophy of the FVFG in three patients. The other patient experienced pseudarthrosis of the graft due to deep infection. The patient who underwent successful reconstruction of a type IIA resection had an MSTS score of 93 %, whereas those undergoing a type IA/IIA/III resection scored 57 % and 83 %, respectively. Our patients scored more than 70 % in the physical component summary of the SF-36 for Japanese people, and good lower limb function was maintained for a long period postoperatively. Unsuccessful reconstruction lowered the MSTS score to 43 % and the physical component summary score of the SF-36 to 29. Conclusions: Reconstructive hip arthrodesis with FVFG might afford an effective pelvic reconstructive procedure to achieve lower limb sparing and long-term maintenance of lower limb function in patients with periacetabular malignant bone tumor. Level of evidence Level IV, series of case reports. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is not only a cause of hypertension; it also possibly affects the pathogenesis and progression of aortic disease because an inspiratory effort-induced increase in negative intrathoracic pressure generates mechanical stress on the aortic wall. The objective of the present study was to examine the incidence by location of OSA as a complication in patients with aortic aneurysm and patients with aortic dissection (AD). An overnight sleep study was conducted in the following study groups: the aortic disease group ( n = 95) consisting of patients with thoracic aortic aneurysm (TAA, n = 32), patients with abdominal aortic aneurysm (AAA, n = 36), and patients with AD ( n = 27); and a control group ( n = 32), consisting of patients with coronary risk factors who were matched with the aortic disease group for age, gender, and body mass index (BMI). The 3% oxygen desaturation index (ODI) was significantly higher in all the TAA, AAA, and AD groups ( P = 0.045, P = 0.003, and P = 0.005, respectively) than in the control group. The incidence of moderate to severe OSA [apnea hypopnea index (AHI) ≥15 events/h] was significantly higher in the first three groups ( P = 0.026, P = 0.001, P = 0.003, respectively) than in the control group, while no significant difference was found between the TAA group and the AAA group with respect to these variables. Furthermore, no significant differences were found between the thoracic AD subgroup and the abdominal AD subgroup with respect to AHI and 3% ODI, as well as with respect to the incidences of moderate to severe OSA. Patients with TAA, patients with AAA, and patients with AD showed high incidences of moderate to severe OSA. Although this result suggests that OSA may be one of risks for aortic disease, unelucidated mechanism(s) other than negative intrathoracic pressure may be involved in the pathogenesis of aortic disease. [ABSTRACT FROM AUTHOR]

Purpose: To minimize surgical invasiveness for extensive aortic aneurysms and expand the indications for thoracic endovascular aortic repair (TEVAR), we evaluated outcomes of hybrid procedures combining conventional surgical aortic repair and TEVAR for thoracic aortic aneurysms. Methods: The following hybrid procedures were performed: second-stage TEVAR after total aortic arch replacement using the elephant trunk as the landing zone in 17 patients; and for multiple aortic aneurysms, vascular graft replacement and TEVAR in 13 patients, vascular graft replacement and TEVAR with bypass in 2 patients, and TEVAR with bypass in 23 patients. Results: There were three (5.3%) hospital deaths, from serious complications including stroke, paraplegia, paraparesis, and aspiration pneumonia; and eight late deaths. There was only one aneurysm-related death, of a patient who underwent emergency surgery for an esophageal fistula resulting from enlargement of a residual false lumen of a thoracoabdominal aorta after second-stage TEVAR. Conclusion: Hybrid procedures minimize surgical invasiveness in thoracic aortic aneurysm repair, but further evaluation of a larger number of patients is necessary. [ABSTRACT FROM AUTHOR]

Pyogenic spondylitis can be life-threatening for elderly patients. To discuss the characteristics of the disease in the elderly, medical records of 103 consecutive cases of pyogenic spondylitis were reviewed. Of these, 45 cases were 65 years of age or older, and these 45 cases were enrolled into further study. In this study, the proportion of elderly patients among the total number with pyogenic spondylitis was 43.7%, and this figure has increased with the passing of time as follows: 37.5% (1988-1993), 44.4% (1994-1999), and 55.5% (2000-2005). The microorganisms were isolated in 16 cases: Staphylococcus aureus in 13 cases (including methicillin-resistant Staphylococcus aureus in nine) and others in three. Twenty-five patients had associated diseases: diabetes in 18 patients and malignant tumors in seven. Thirty patients were treated conservatively, and 15 patients underwent surgery. Twenty-six patients had paralysis. All 15 patients treated surgically, and eight of the 11 patients treated conservatively showed improvement in paralysis. Bone union was achieved in all cases except one. Our results indicate that a good outcome can be expected from conservative treatment in elderly patients as well as the young. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic efficacy of comparative supine and sitting lateral radiographs in the diagnosis of incident osteoporotic vertebral fracture (OVF), 41 incident OVF in 38 patients, which had been diagnosed by magnetic resonance imaging, were evaluated. Methods: There were 27 female and 11 male patients with the average age of 78 years (range, 54-94 years). Using lateral decubitus-position radiographs, fractures were classified into normal, wedge, biconcave, and crush types, and graded from 0 to 3. Vertebrae showing any measurable changes in the vertebral body height between supine and sitting radiographs were referred to as mobile fractures. Mobile fractures and fixed (nonmobile) fractures were compared with regard to gender and age of patients, location, fracture grade, and the presence of prevalent OVF. The Mann-Whitney U test and the Fisher's exact probability test were used for statistical analysis. Results: Of 41 incident OVF, 33 vertebrae (80.5%) showed dynamic mobility in supine and sitting lateral radiographs. Of nine OVF with small deformities (grade 0 or 0.5) and 19 OVF with prevalent OVF, dynamic mobility was seen in six (66.7%) and 15 (78.9%), respectively. Age was significantly higher in patients with mobile fractures than those with fixed fractures. Mobile fractures included a significantly lower percentage of thoracic vertebrae (6%) than of fixed fractures (37.5%). Seven out of eight fixed fractures (87.5%) were grade 1 or less. Conclusions: These findings indicate that comparative supine and sitting lateral radiographs are a simple diagnostic procedure for incident OVF available in daily clinics. [ABSTRACT FROM AUTHOR]

Purpose: We investigated the surgical results of secondary thoracic endovascular aneurysm repair (TEVAR) using the elephant trunk graft after total aortic arch replacement (TAR) for extensive thoracic aortic lesions. Methods: The subjects comprised 16 patients who underwent TEVAR as a staged procedure following TAR at our institution between 1997 and 2007. Long-term results were retrospectively surveyed (mean observation period 68.4 months). We performed TEVAR with the elephant trunk graft as a proximal landing zone for the descending thoracic repair, the mean duration between TAR and TEVAR was 4.7 weeks for the staged operations and 18.3 months for the nonstaged operations. Results: Early results were good in all cases, with no deaths and no noteworthy complications. For the seven patients without dissection, long-term results were also good. Among the nine patients with dissection, the false lumen in the thoracoabdominal area enlarged in three during follow-up. We performed thoracoabdominal repair in two, but one died of an aneurysm-esophageal fistula. There was only one long-term aneurysm-related death. Conclusion: Second-stage TEVAR using the elephant trunk graft after TAR allows less invasive surgery for extensive aortic lesions and achieves good long-term results. However, enlargement of the false lumen was a long-term concern in patients with aortic dissection, and careful follow-up is essential. [ABSTRACT FROM AUTHOR]

To determine the role of percutaneous vertebroplasty (PVP) in bone formation and the union of vertebral pseudarthrosis, we analyzed 14 patients with an average follow-up duration of 21 months. Evaluation methods included back pain (visual analog scale: VAS), wedge angle, dynamic mobility, radiographic remodeling including callus and spur formation, and union status. The Student's t test was used for statistical analysis and a probability of less than 0.05 was determined as a significant difference. Back pain improved in all 14 patients with a VAS score of 57.8 ± 23.5 mm (average ± standard deviation) preoperatively and 14.7 ± 16.4 mm at the final follow-up ( P < 0.001). The wedge angle decreased from 21.6° ± 8.3° (average ± standard deviation) preoperatively to 13.2° ± 6.9° at the final follow-up ( P < 0.001). Callus formation was seen in four patients. Bony spurs were seen in the affected vertebra in preoperative radiographs in all patients, and were further developed to a solidified form during follow up after PVP. Dynamic mobility of the affected vertebrae was 6.9 ± 2.9 mm preoperatively, which decreased to 1.1° ± 0.7° at the final follow-up ( P < 0.001). Notably, all patients showed the dynamic vertebral mobility of 2 mm or less. Nevertheless, only two patients exhibited the dynamic vertebral mobility of 0 mm at the final follow-up, which is referred to as bone union. These findings indicate that PVP serves as a mechanical stabilizer for vertebral pseudarthrosis, which leads to immediate pain relief and segmental bony responses. [ABSTRACT FROM AUTHOR]

A Neurometer device is an electrical nerve stimulator used to determine the current perception threshold (CPT) evoked by stimulating A-beta fibers at 2,000 Hz, A-delta fibers at 250 Hz and C fibers at 5 Hz. CPT evaluation is used for analyzing peripheral nerve dysfunction. In this study, the sensory disturbance of the lower-extremity was quantitatively analyzed using CPT testing before and after lumbar discectomy. In 33 patients (L4/5: 16 and L5/S: 17), as subjective evaluations, tactile sensation and leg pain were assessed before and 2 weeks after surgery. In the subjectively improved group ( n = 22), significant decreases in CPT at 2,000 and 250 Hz were noted postoperatively, whereas in the unchanged group ( n = 11), no significant changes in CPT at any frequencies was noted. The leg pain improved in all patients. Likewise, CPT at 5 Hz, which stimulated C fiber, decreased significantly for both improved and unchanged groups. CPT measured by a Neurometer is very useful in assessing lower-extremity sensory functions before and after surgery for lumbar disc herniation. [ABSTRACT FROM AUTHOR]

We report here that the Id2 (inhibitor of DNA binding 2) gene is a novel target of transcriptional activation by EWS–FLI1 and EWS–ERG, two fusion proteins that characterize Ewing family tumors (EFTs). To identify downstream targets of these EWS–ETS fusion proteins, we introduced EWS–ETS fusion constructs into a human fibrosarcoma cell line by retroviral transduction. cDNA microarray analysis revealed that Id2 expression was up-regulated by introducing the EWS–ETS fusion gene but not by the normal full-length ETS gene. An Id2 promoter-luciferase reporter assay showed that transactivation by EWS–ETS involves the minimal Id2 promoter and may function in cooperation with c-Myc within the full-length regulatory region. A chromatin immunoprecipitation assay revealed direct interaction between the Id2 promoter and EWS-FLI1 fusion protein in vivo. Significantly higher expression of Id2 and c-Myc was observed in all of the six EFT cell lines examined compared to six other sarcoma cell lines. Moreover, high levels of Id2 expression were also observed in five of the six primary tumors examined. Id2 is generally thought to affect the balance between cell differentiation and proliferation in development and is highly expressed in several cancer types. Considering these previous studies, our data suggest that the oncogenic effect of EWS–ETS may be mediated in part by up-regulating Id2 expression.Oncogene (2002) 21, 8302–8309. doi:10.1038/sj.onc.1206025 [ABSTRACT FROM AUTHOR]

We have previously reported that an osteosarcoma vaccine generated by ex vivo transfection of B7-1 cDNA induces protective as well as curative immunity against B7-1–negative parental osteosarcoma. Because establishment of human osteosarcoma cell lines, which is a prerequisite for ex vivo gene transfer, is rarely successful, we, in the present study, investigated the therapeutic efficacy of adenovirus-mediated in vivo B7-1 gene transfer to pre-established primary tumor as well as pulmonary metastasis of osteosarcoma. Adenovirus-mediated rat B7-1 gene transfer induced (a) expression of B7-1 molecules in osteosarcoma cells by both in vitro and in vivo infection procedures, (b) curative immunity against pre-established primary osteosarcoma and, subsequently, hosts gained protection against additional challenge of parental B7-1–negative osteosarcoma cells, (c) systemic immunity against pre-established pulmonary metastasis, and (d) activation of regional lymph node CD4+ T cells, expansion of dendritic cells and natural killer cells and the secretion of interferon-γ. These findings collectively support the therapeutic value of adenovirus-mediated in vivo gene transfer on osteosarcoma, which is of greater simplicity than cell-based B7-1 vaccine, and represent an attractive strategy for therapy of patients with metastatic osteosarcama who acquired resistance to current therapeutic protocols. Cancer Gene Therapy (2002) 9, 747–755 doi:10.1038/sj.cgt.7700491 [ABSTRACT FROM AUTHOR]

To investigate the clinical characteristics of insufficiency fracture of the spine, patients aged 65 years or older, who had been hospitalized for acute low back pain without either an acute traumatic event or a previous history of malignant disease, were examined by plain radiographs and technetium-99m methylene disphosphonate bone scanning. Fifteen patients were diagnosed as having a vertebral insufficiency fracture on the basis of: (a) radiographic oseteopenia of the vertebra; (b) positive bone scan images; and (c) no episode of newly identified malignant disease in a subsequent 1 year follow up. These patients were analysed with respect to age, gender, bone mineral density, the number and distribution of the affected vertebrae, the extent of vertebral deformity, and consistency between radiographic and bone scan findings. Vertebral insufficiency fractures exhibited: (a) strict female predominance; (b) concave deformity of the affected vertebra; (c) a wide range of the vertebral height ratios and fracture distribution; and (d) low consistency between the vertebral deformity assessed by the lateral radiograph and positive activity on bone scanning. These findings represent a unique clinical feature of vertebral insufficiency fracture, and also emphasize the difficulty of radiographic diagnosis, as well as the importance of a comprehensive diagnostic approach. [ABSTRACT FROM AUTHOR]

To investigate the demographic details and patterns of injuries related to horse handling, we reviewed 637 horse-related injuries in 581 stable- or stud-workers in a representative area of thoroughbred stabling in Japan. We found that (1) injuries occurred most frequently in a group of a relatively young workers, with a seasonal variation; (2) the principal mechanism of injury was kicks, which accounted for 39.2% of all injuries, including 11 serious and one lethal visceral injuries; (3) the upper half of the body was more frequently involved than the lower half; and (4) the peripheral bones (hand and foot) and the ribs accounted for more than half of 148 fractures. These findings are distinct from those in horse-riding injuries reported in the literature and emphasize the importance in developing preventive strategies specifically for workers in horse stables. [ABSTRACT FROM AUTHOR]

To investigate of human pancreatic cancer metastasis to the liver, a pancreatic carcinoma line, HPC-3, was injected into the spleens of nude mice. The cells from a few liver metastatic foci of the mice injected with HPC-3 were expanded in vitro and subsequently injected into the spleens of nude mice. By repeating these procedures, we were able to obtain a cell line, designated HPC-3H4. The mice were observed to have liver metastasis in 6 of 6 (100%) cases injected with HPC-3H4, whereas the rate was 0% at 3 weeks after the intrasplenic injection of HPC-3. The tumorigenicity of HPC-3H4 was more rapid than that of HPC-3. The motile activity of HPC-3H4 was also stronger than that of HPC-3, and the adhesion to the extracellular matrix of HPC-3H4 was stronger than that of HPC-3. We also analyzed the cell surface expression of the metastasis-related adhesion molecules. As a result, no substantial changes were observed in the expression level of adhesion molecules. These results suggest that HPC-3H4 is useful for studies aimed at the prevention of liver metastasis. [ABSTRACT FROM AUTHOR]

In this study, we examined the effect of extracellular matrix (ECM) components including type I collagen (Col I), type IV collagen (Col IV), laminin, and fibronectin on differentiation of the human osteoblastic cell line SV-HFO when the cells were treated with dexamethasone (Dex), which induces the cells' mineralization. All ECM proteins clearly increased the alkaline phosphatase (ALP) activity of SV-HFO cells in a dose-dependent fashion. Similarly, treatment with 1α, 25-dihydroxyvitamin D (1,25(OH)D) induced the ECM components to enhance the osteocalcin (OC) synthesis of SV-HFO cells. Each ECM component had distinct effects depending on the soluble factor used; with Dex treatment, fibronectin more efficiently increased the ALP activity of Dex-treated SV-HFO cells than Col I, Col IV, or laminin, while with 1,25(OH)D treatment, Col IV more efficiently increased on OC synthesis than the other ECMs. We also examined the expression of integrins, an ECM receptor family, using monoclonal antibodies. Flow cytometric analysis demonstrated that SV-HFO cells expressed all very late antigen (VLA) integrins including VLA-1 to VLA-6 as well as αβ integrin, and that the expression of VLA integrins is regulated by the Dex-induced cell differentiation. These findings suggest that ECM components have soluble factor-dependent stimulatory effects on the regulation of osteoblastic differentiation of SV-HFO cells, possibly through the cell surface ECM receptors in the integrin family. [ABSTRACT FROM AUTHOR]

Between February 1995 and December 1997, 50 cases (55 lesions) of thoracic aortic aneurysms including 20 cases of aortic dissections were treated with an endovascular technique using the stent grafts. All patients were treated in the operating room under general anesthesia and the stent grafts were implanted through 18 Fr. or 20 Fr. sheathes via femoral arteries under fluoroscopic guidance. The stent graft was composed of several units of self-expanding stainlesssteel Z stents covered with an ultra-thin polyester fabric. Stent graft deployment was technically successful in 53 of 55 lesions (delivery success rate: 96.4%). Exclusion of the aneurysms and entry closing without endoleak were achieved within two weeks after the operation in 43 of 53 lesions (initial success rate: 81.1%). Endoleak was found in 10 lesions (minor endoleak: 8 and major endoleak: 2 lesions). Two patients died in the periopertive period of delivery failures as injury to external iliac artery and damage to the delivery sheath caused by tortuous and narrow access routes. Endovascular stent graft repair of thoracic aortic aneurysms is minimally invasive operation in comparison with conventional surgical graft replacement with extracorporeal circulation. These early results suggest that the stent graft repair is possibly safe and useful treatment for the patients of thoracic aortic aneurysms especially in high risk patients. However, careful long-term follow-up is necessary to prove the value and the effects of this endovascular treatment and improvement of the stent graft system and technical training of endovascular surgery for operators are required to reduce the delivery failure and to determin the stent graft repair is reliable treatment. [ABSTRACT FROM AUTHOR]

Multiple aortic aneurysms in Behçet's disease were repaired with transluminaly placed endovascular stent grafts. Before deploying the stent graft device for permanent implantation for the saccular aneurysm located in the descending thoracic arota, from which feeding arteries for the spinal cord possibly branched, a retrievable stent graft was inserted and evoked spinal cord potential (ESP) were monitored in order to predict spinal cord ischemia. The original retrievable stent graft, constructed of a self-expandable Z-shaped stainless steel stent covered with e-PTFE, can be easily withdrawn into a 18 Fr. sheath after deployment. Blood flow into intercostal arteries branching from that part of the descending aorta where the permanent stent graft is planned to be implanted, is intercepted by the retrievable stent graft. A change of ESP during the temporary implantation of the device indicates that spinal cord ischemia would be caused by permanent implantation of the stent graft. In this case, no change of ESP was observed and the patient showed no postoperative paraplegia.The retrievable stent graft was useful for prediction of spinal cord ischemia before endoluminal stent graft repair of the descending aortic aneurysm. However, the device is not flexible enough to fit a severely tortuous aorta, therefore we are obliged to select patients to some extent. Further improvement of the device is required to make prediction of spinal cord ischemia with the retrievable stent graft possible in all cases. [ABSTRACT FROM AUTHOR]

We studied changes in blood coagulation and fibrinolytic system in 18 cases of thoracic aortic aneurysm and 5 cases of aortic dissection treated with stent grafts. The mean operation time was 259 ± 67 minutes and the amount of blood loss during operation was 472 ± 456 ml. Although blood transfusion of 220 ± 360 ml was performed in 7 cases, 16 of 23 cases (70%) received no homologous blood transfusion. Consequently, the endoluminal stent graft treatment was minimally invasive compared with the conventional surgical procedure. On the 1st postoperative day, platelet counts and AT-III decreased and TAT increased. The promotion of blood coagulability was found in these patients on the 1st day after the operation. Changes in the fibrinolytic system were less marked than that in coagulation. These results suggest that the thrombosed aneurysm was excluded from systemic blood flow by the stent graft. There was no consumption coagulopathy in any case with aneurysm excluded by stent graft deployment. Stent-graft treatment for thoracic aortic aneurysm can be successfully performed without consumption coagulopathy when the aneurysm is completely excluded. [ABSTRACT FROM AUTHOR]

The therapeutic outocmes of 43 patients with acute closing aortic dissection treated during the past 10 years were evaluated. The patients consisted of 30 men and 13 women with a mean age of 65 ± 9 years. Ten were classified as Stanford type A, and the remaining 33 as type B. During follow-up (6 to 120 months; average 55 months), recanalization and an enlarged ulcer-like projection (ULP) were observed in 5 and 2 type a patients. Although recanalization was not observed in type B patients, enlarged ULP was observed in 10 of them, in 6 of whom developed aneurysm. During the follow-up period, ULP was observed at 30 sites in 26 patients. Monitoring the change in ULP over time showed that the ascending and the proximal descending aorta frequently tended to be enlarged and progressed to aorta frequently tended to be enlarged and progressed to aneurysm. Surgery was performed in 3 patients with recanalization, 5 with enlarged ULP, and 3 with atheroscloerotic aortic aneurysm. Although one patient died of cerebral complications, the other 10 patients showed favorable postsurgical courses. Among 8 patients who died, the actuarial survival rate was favorable, being 96, 91 and 83% at 1, 3 and 5 years. However, the survival rate free from complications related to aortic dissection, defined as rupture, ercanalization, enlarged ULP and aneurysmal change, was 78, 58 and 54% at 1, 3 and 5 years, indicating that aortic dissection-related complications are likely to develop within 3 years. This being the case, conservative therapy may be selected for closing aortic dissection when there are no serious complications in the acute phase. However, closely following patients with diagnostic imaging techniques is essential as there may be complications such as recanalization or enlarged ULP. Such complications should be surgically treated because they may affect long-term prognosis. [ABSTRACT FROM AUTHOR]