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By using 24 hour urinary creatinine levels, skeletal muscle mass (kg), its rate (%) of body weight and creatinine height index (%) were determined in old Japanese women suffering from walking difficulty in nursing home and compare with those of young university students. Those of old subjects showed approximately 30-50%, 36-44% and 44-46% of young subjects, respectively. It is suggested that these values are important and useful biomarkers for the planning and the achievement of rehabilitation program for the maintaining and restoring skeletal muscle mass and for the careful support by registered care workers to aged persons. J. Med. Invest. 65:122-125, February, 2018.

Treatment of pelvic arteriovenous malformations (AVMs) is frequently challenging because of the complex structures and anatomical diversity among cases. We present a case series of six patients with pelvic AVMs. All patients had a similar anatomical structure consisting of multiple feeders from the unilateral internal iliac artery, collecting into a dilated venous sac in the unilateral paravesical space and draining into a single outflow, eventually joining the pre-prostatic vein or internal iliac vein. Five among these patients were successfully treated by catheter-directed embolo-sclerotherapy. In addition to our six cases, we identified six previous case reports of pelvic AVM with similar anatomical characteristics. Herein, we summarize the clinical and anatomical features of these 12 paravesical AVM cases. In all cases, the patients were men; the AVM was predominantly located at the right paravesical space and demonstrated good therapeutic effect of catheter-directed embolosclerotherapy. These paravesical AVMs may constitute a new subgroup of pelvic vascular anomalies with the same etiology that are treatable by adequate catheter intervention.

Three of four (75%) vein biopsy samples from four patients (all male, mean onset: age 33.0, mean biopsy: age 59.7) of chronic phase phlebitis migrans showed positive periodontal bacteria DNA under the PCR (polymerase chain reaction) method. Of the 24 cases of Buerger disease (22 males, 2 females, mean onset: age 31.9, mean examination: age 62.6) that were investigated in our vascular laboratory, 65% of the patients suffered from moderate to severe varicose veins. Eight cases had a history of phlebitis migrans and three had an active ulcer or uncontrollable erosion in the foot. The rate of incidence was significantly higher than that of the well-matched control group. Other findings included one instance of deep vein thrombosis, and one instance of deep vein reflux. We could suggest that some intractable ulcer or erosion cases of Buerger disease may be complicated by superficial vein incompetence or other deep vein insufficiency. We also we need to check Buerger disease patients with duplex for vein reflux and other insufficiencies. Treatment of the varicose veins (including elastic stockings) was effective for all of the patients. (English Translation of Jpn J Phlebology 2011; 22: 25–31.)

大伏在静脈本幹硬化療法の高位結紮を併用する方法，高位結紮をしない方法の両者において，術後1年の経過を報告する．【方法】HL+法48例：高位結紮およびGSV根部を部分切除し，GSV断端から末梢側へ硬化剤を注入した．HL－法43例：下腿のGSV分枝から硬化剤を注入し，エコーでフォームをGSV本幹内，SFJまで誘導した．硬化剤は3%または1%POL：CO2=1 : 3，Tessari法で作製した．術後1，3，6，12カ月後に超音波検査にて経過を追った．【結果】大腿部の閉塞率はHL+法：6カ月後80.4%，12カ月後75.5%，HL－法：6カ月後63.4%，12カ月後52.8%であった．深部静脈血栓症などの有害事象は認めなかった．【結語】フォーム硬化療法は大伏在静脈不全に対する治療として，安全に施行できる．HL－法はHL+法に比べ，閉塞率は劣るが，治療としての有用性が示唆された．

Objectives Postoperative deep venous thrombosis (DVT) is usually asymptomatic but can result in a fatal pulmonary embolism (PE). To assess the ability of transcranial Doppler (TCD) ultrasound apparatus to detect venous emboli in patients who had undergone total knee arthroplasty (TKA). Methods Forty-eight patients undergoing TKA were examined postoperatively by using compression ultrasonography, computed tomographic angiography, and TCD ultrasonography that detected high-intensity transient signals (HITS) in femoral veins. An original scoring system based on both the number of HITS and the locations of DVT was tested for its accuracy in predicting PE development. Results Twenty-three of the 48 patients had DVT postoperatively, and 8 had an asymptomatic PE. The sensitivity and specificity of the HITS assessment alone in identifying PE development were 75% and 92.5%, respectively. The scoring system, however, had a sensitivity of 100% and a specificity of 85% and the area under the receiver operating characteristic (ROC) curve (AUC) was 0.96. Conclusions Application of a scoring system based on the detection of both DVT and HITS may be an effective and efficient method of screening for PE after knee arthroplasty.

Introduction De nombreuses etudes ont etudie les caracteristiques doppler des emboles traversant le systeme arteriel, estimant ainsi leur composition et leur taille, dans le cadre de la prevention de l’infarctus cerebral. Les caracteristiques des emboles cheminant dans le systeme veineux restent a determiner, en vue de la prevention de l’embolie pulmonaire (EP). L’objectif de cette etude etait de demontrer que les emboles veineux peuvent etre discrimines par echo-doppler dans une etude animale, et de determiner si les EP pourraient etre predites par cette technique en pratique clinique. Methodes Etude animale—De l’huile de saindoux, du thrombus, ou de la moelle osseuse etaient injectes dans les veines femorales de porcs. Les signaux transitoires de haute intensite (high intensity transient signals, HITS) etaient identifies par echo-doppler transhepatique au niveau de la veine cave inferieure. Le volume d’intensite (dB) et les variations de frequences (Hz) de chaque signal etaient obtenus. Les valeurs seuils auxquelles les thrombi, les emboles graisseux, et les emboles de moelle pouvaient etre discrimines etaient calculees par analyses des courbes des caracteristiques du fonctionnement du receveur (courbes ROC, receiver-operating characteristic). Etude humaine—Il s’agissait de 47 patients operes pour prothese totale de genou. A J0 et J1, les HITS etaient recherches au niveau de la veine femorale commune affectee par echo-doppler. Une tomodensitometrie injectee etait realisee, puis les patients etaient divises en deux groupes selon la presence ou non d’une EP. Les deux groupes etaient distingues suivant le volume d’intensite (dB) et les variations de frequences (Hz) de chaque signal et les sensibilites et specificites calculees. Resultats Etude animale—Le thrombus et la moelle osseuse pouvaient etre differencies de l’huile de saindoux a des variations de frequences de 208 Hz et 196 Hz (avec une sensibilite de 86,9% et 85,7%, et une specificite de 82,3% et 91,8%, respectivement). Etude humaine—Les sensibilites et specificites etaient de 76,7% et 75,0% dans la discrimination des patients avec et sans EP a une variation de frequence de 208 Hz. Conclusions Les resultats de notre etude animale indiquent qu’un embole peut etre identifie et discrimine dans le systeme veineux. Notre etude clinique montre que les variations de frequences (208 Hz) du signal doppler constituent le meilleur parametre dans la discrimination des patients presentant ou non une EP apres prothese totale de genou.

78歳男性．4年前より右鼠径部膨隆・陰嚢腫大を自覚するも放置していた．陰嚢腫大が進行し，歩行障害を主訴に当院を受診した．来院時，陰嚢底部が右大腿中点まで達していた．CTにて回盲部腸管を内容物とする右鼠径ヘルニアと診断した．また，虫垂は先端に糞石を有し，炎症性に腫大していた．右総腸骨動脈瘤（最大径45mm）の合併も認めた．二期手術を行うこととし，まず鼠径部アプローチにて虫垂切除とヘルニア根治術（メッシュプラグ法）を施行した．ヘルニア内容物は約150cmの回腸と盲腸であり，腸管に虚血性変化や癒着は認めなかった．術後経過に問題はなく，動脈瘤の変化も認めなかった．3カ月後に右総腸骨動脈瘤に対してYグラフト置換術を施行した．ヘルニア手術時より1年経った現在も，ヘルニア再発はなく，メッシュプラグや人工血管の感染といった合併症も認めていない．

A mechanism by which acetylcholine (ACh) may elicit vasoconstrictor response in coronary vessels was studied in rat hearts perfused at a constant flow rate. In spontaneously beating hearts, bolus injections of ACh and carbachol (CCh) produced biphasic changes in coronary perfusion pressure (CPP): a transient increase at the initial period followed by a sustained decrease. In KCl-arrested hearts, ACh and CCh produced a monophasic increase in CPP, which was attenuated by either removal of endothelial cells by saponin or cyclooxygenase inhibition by diclofenac sodium. In the spontaneously beating heart, ACh-induced vasoconstriction was almost abolished by atropine (0.1 microM) and was markedly attenuated by an M2 antagonist, methoctramine (0.1 microM), but not by an M1 antagonist, pirenzepine (1 microM). Arecaidine propargyl ester (APE), an M2 agonist, produced coronary artery constriction which was attenuated by methoctramine (0.1 microM) but not by pirenzepine (0.1 microM) in both spontaneously beating and KCl-arrested hearts. McN-A-343, an M1 agonist, increased CPP in both beating and KCl-arrested hearts, but to a lesser degree than APE. These results suggest that the release of vasoconstrictor prostaglandins from endothelial cells contributes to the vasoconstrictor response to ACh in perfused rat coronary vessels, and the response to ACh appears to be mediated, in part, via the M2 subtype of muscarinic receptors.

Background Many studies have identified features of the emboli traveling in the arterial system by Doppler ultrasound, and estimated their composition and size for anticipation of cerebral infarct. Another concern is features of the emboli in the venous system for anticipation of pulmonary embolism (PE). The objective is to prove that the emboli in the venous system can be discriminated by Doppler ultrasound in animal study and to assess whether PE can be predicted by using this technique in clinical case. Methods Animal study — lard oil, thrombus, or bone marrow was injected to the femoral veins in pigs. High intensity transient signals were transhepatically identified at the inferior vena cava using Doppler ultrasound. Intensity volume (dB) and frequency shift (Hz) of each signal were obtained. The cutoff values at which thrombi, fat emboli, and marrow emboli could be discriminated were calculated by receiver-operating characteristic curves analysis. Human study—Subjects were 47 patients who underwent total knee arthroplasty. On postoperative day 0 and 1, High intensity transient signals were identified at the affected common femoral vein using Doppler ultrasound. Contrast computed tomography was done, and the patients were divided into two groups according to the presence of PE. The two groups were distinguished by intensity volume (dB) and frequency shift (Hz) of each signal and calculated the sensitivity and specificity. The statistics analysis was done as in animal study. Results Animal study—Thrombus and bone marrow could be discriminated from lard oil well at frequency shift of 208 Hz and 196 Hz (with sensitivity of 86.9, 85.7%, and specificity of 82.3%, 91.8%, respectively). Human study—The sensitivity and specificity were 76.7 and 75.0% to discriminate patients with and without PE at frequency shift of 208 Hz. Conclusions Our animal study results indicated that emboli could be identified and discriminated in the venous system. Clinical study informed that the frequency shift (208 Hz) of the Doppler signal was the best parameter to discriminate PE with and without PE in patients with total knee arthroplasty.