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Introduction Paraplegia is a serious complication after thoracic and thoracoabdominal aortic aneurysm surgery. The aortic cross-clamp blocks blood flow to the intercostal artery as a feeding blood vessel, so the spinal cord is at risk of being exposed to ischemia. Hypothermia with systemic cooling is a useful means of avoiding spinal ischemia caused by aortic blockade but has various side effects. Theoretically, local cooling by epidural cooling catheter is an effective method to reduce the side effects. However, the use of needle sensors to measure the temperature of the human spinal cord is not ethically applicable in the real clinical field. The purpose of the study is to build computer modeling of human-sized spinal cords and a basic platform for simulating spinal cord cooling. This is being done to prove that local cooling can cool the human spinal cord in the same way, even in human spinal cords larger than laboratory animals. Methods We tried to model a horizontal cross-section of tissue near the spinal cord at a size equivalent to that of an adult human. The tissue around the spinal cord was decomposed into many small matrices for analysis using the finite element method. Next, the analysis was performed using a high-speed computer on the assumption that the matrix exchanges heat with the adjacent matrix over time according to Pennes' bio-heat equation. Repeated calculations were performed on a high-speed computer to calculate temperature changes in the central part of the spinal cord. Result By setting the temperature of the cooling catheter to 20°C, temperatures at the center of the spinal cord after 5, 10, 15, 20 and 25 minutes were 34.08°C, 33.64°C, 33.48°C, 33.40°C, and 33.36°C, respectively. After stopping the cooling, the temperature at the center of the spinal cord recovered to baseline temperature within 10 minutes. Conclusion Results were similar to those of previous animal studies using our local cooling system, suggesting that evaluation of cooling catheter's performance by computational simulation (CS) is effective.

Spontaneous rupture of the thoracic aorta is rare. We present a 76-year-old man who developed spontaneous rupture of the aortic arch associated with massive periaortic hematoma and hypovolemic shock. Because the site of rupture could not be identified, emergency hybrid endovascular aortic repair to shield a long segment of the aorta was performed according to the extent and density of periaortic hematoma on axial CT scans. His blood pressure improved just after deployment of the endograft. Rapid diagnosis by CT and prompt control of aortic hemorrhage by endografting salvaged this patient. Three-dimensional (3D) volume-rendered CT images are useful for identifying the site of aortic rupture, but may not be available in an emergency.

An asymptomatic 75-year-old woman was identified with a 40-mm-sized, round-shaped lesion beside the pulmonary artery on computed tomography (CT). Coronary angiography showed a coronary artery fistula (CAF) with an aneurysm branching from the left anterior descending artery toward the pulmonary artery. The CAF aneurysm (CAFA) was resected and coronary artery bypass graft surgery using the left internal thoracic artery was performed successfully. Pathological analysis revealed that medial depletion similar to segmental arterial mediolysis (SAM) may contribute to aneurysm formation.

An asymptomatic 65-year-old woman was identified with an oversized round-shaped hypoechoic lesion (62 mm in diameter) between right and left atria by echocardiogram. A contrast-enhanced 320-slice multidetector computed tomography demonstrated a giant aneurysmatic fistula branched from the left main coronary trunk towards right atrium. The patient underwent an elective surgical repair. The aneurysm was resected, followed by coronary artery bypass graft surgery using bilateral internal thoracic arteries. The surgery was successful, and the patient enjoys normal life without any symptoms for 15 months.

Mediastinal schwannomas are sometimes diagnosed as pericardial or bronchogenic cysts, if cystic degeneration is extensive. When mediastinal schwannomas are not diagnosed as primary cardiac tumors, the use of cardiopulmonary bypass in their resection appears to be infrequent. We report the case of a 48-year-old woman who presented with symptoms from a suspected intrapericardial cyst. Multiple diagnostic images revealed a large mass, potentially a proteinaceous or hemorrhagic cyst, in the transverse sinus behind the ascending aorta and against the left main trunk. After complete resection with the use of cardiopulmonary bypass, the mass was identified as a benign extracardiac schwannoma. More than 3 years postoperatively, the patient had no relevant symptoms. We discuss the preoperative diagnosis, the method of resection, and our broad strategy for dealing with such a case.

OBJECTIVES: Spinal cord deficits are devastating complications after surgery for thoracic and thoracoabdominal aortic aneurysms. We developed a regional spinal cord cooling system using an epidural catheter containing cold saline within an isolated counter-current lumen to prevent such complications and reviewed the clinical results. METHODS: We enrolled 37 patients with thoracic (n= 13) and thoracoabdominal (n= 24) aortic aneurysms that were repaired using the regional spinal cord cooling system under mild hypothermia with a partial femoro-femoral bypass. RESULTS: Although 2 patients died before hospital discharge (hospital mortality, 5.4%), none developed neurological deficits such as paraplegia or paraparesis. CONCLUSIONS: The outcomes of surgery for thoracic and thoracoabdominal aortic aneurysms under regional spinal cord hypothermia using a custom-designed epidural catheter were excellent. Although our patient cohort was small, the results indicate that our technique might help to improve the outcomes of thoracic and thoracoabdominal aortic repair.

In this report we describe a special method of using a pedicled latissimus dorsi muscle flap for a mycotic aneurysm. The method involves wrapping the flap around a prosthetic graft. Using this method, an in situ graft, which replaces an aneurysm, can help to avoid recurrence of local infection.

Reports describing solitary fibrous tumors of the pericardium are rare. Surgical treatment was performed on a 49-year-old woman with a large pericardial mass. The mass was attached to the left ventricular wall with a broad stalk and was free of the parietal pericardium. It was apparent macroscopically that the tumor had invaded the left ventricular muscle. On histopathology, the tumor was diagnosed as a solitary fibrous tumor with low-grade malignancy.

Surgery was performed on a 53-year-old male patient with a painful mass in front of the elbow. The mass originally occurred after needle insertion during a routine health checkup and grew in size during a 1-year period. Intravenous tumor with arterio-venous fistula was diagnosed, and it was resected. Histopathological diagnosis of intravenous lobular capillary hemangioma was made. Occurrence of this tumor after a routine health checkup is rare. The etiology of this tumor occurring simultaneously with arteriovenous fistula is discussed.

We developed an epidural cooling catheter containing cold saline solution circulating in an isolated lumen. After placement by a minimally invasive approach, we evaluated protection effect against ischemic spinal cord injury in pigs.Fourteen pigs underwent thoracic aortic double clamping for 45 minutes under systemic mild hypothermia (36 degrees C). Group A (n = 7) underwent local hypothermia with the cooling catheter. Group B (n = 7) underwent catheter placement only, without cooling. Spinal cord somatosensory evoked potentials were recorded to assess electrophysiologic status. Neurologic function was evaluated with a modified Tarlov score.At aortic crossclamping, spinal temperature in group A (26.5 degrees C +/- 2.4 degrees C) was significantly lower than that in group B (35.3 degrees C +/- 0.6 degrees C, P = .0001). Mean time from aortic crossclamping to onset of potential loss was significantly longer in group A (28.4 +/- 6.6 minutes) than in group B (18.3 +/- 5.0 minutes, P = .007). Mean duration of total loss of potentials was significantly shorter in group A (19.0 +/- 6.7 minutes) than that in group B (31.3 +/- 5.9 minutes, P = .003). Group A showed significantly better neurologic function (mean Tarlov score 4.4 +/- 0.8) than that of group B (0.1 +/- 0.4, P = .0001). Mean total number of intact motor neurons was significantly greater in group A (24.5 +/- 6.8) than that of group B (9.9 +/- 6.8, P = .0001).By cooling the spinal cord selectively and continuously, the newly designed epidural cooling catheter prevented ischemic injury in a pig model of aortic crossclamping.

Using swine, we investigated whether epidural placement of a cooling catheter rather than infusing iced saline solution could protect the spinal cord from ischemia during aortic surgery.We divided 14 domestic pigs into two groups of 7 each. Each underwent epidural catheter placement preceding 30 minutes of aortic cross-clamping distal to the origin of the left subclavian artery. In group 1, cold water was circulated continuously through the lumen of the catheter connected to an external unit. In group 2, animals received catheter placement without cooling. Spinal cord somatosensory evoked potentials were recorded. Neurologic status involving hind limbs was graded sequentially after surgery.At aortic cross-clamping, spinal temperature in group 1 (31.7 degrees +/- 0.6 degrees C) was significantly lower than in group 2 (37.8 degrees +/- 0.4 degrees C; p0.0001). No significant elevation of intrathecal pressure accompanied cooling with the catheter (group 1, 8.1 +/- 1.7 mm Hg; group 2, 8.0 +/- 1.5 mm Hg). Mean duration of total loss of potentials was significantly shorter in group 1 (7.4 +/- 3.8 minutes) than group 2 (19.7 +/- 7.3 minutes; p = 0.0002). Pigs in group 1 exhibited better hind limb function recovery (mean Tarlov score, 4.7 +/- 0.5) than group 2 (0.6 +/- 0.8; p = 0.0017). Group 1 showed normal histologic characteristics, whereas group 2 showed loss of motor neurons in the ventral horns.Epidural cooling catheter without iced saline infusion can cool the spinal cord without elevating intrathecal pressure, protecting the cord against ischemia.

ObjectiveParaplegia remains a serious complication of thoracic and thoracoabdominal aortic operations. To avoid this dreadful complication, N-methyl-d-aspartate (NMDA) receptor antagonists have been examined in the ischemic or excitotoxic neuronal injury model. In the present study, we evaluated the protective efficacy of NMDA receptor antagonists that were infused segmentally after aortic clamping, as a spinoplegia, to reduce aspartate neurotoxicity in the spinal cord.MethodsInfrarenal aortic isolation was performed in New Zealand white rabbits. Group A animals (n = 7) were pretreated with the segmental infusion of MK-801, a noncompetitive NMDA receptor antagonist, followed by segmental aspartate (50 mmol) infusion for 10 minutes. Group B animals (n = 6) received pretreatment with CGS19755, a competitive NMDA receptor antagonist, followed by the same aspartate infusion as group A. Group C animals (n = 7) received vehicle only, followed by aspartate infusion as a control group. In addition, group D animals (n = 6) were pretreated with MK-801 that was administrated intravenously 1 hour before aspartate infusion. Neurologic status was assessed at 12, 24, and 48 hours after operation by using the Tarlov score. The spinal cords were procured at 48 hours for histopathologic analysis to determine the extent of excitotoxic neuronal injury.ResultsMost of the animals in groups A and D revealed full recovery or mild motor disturbance. Group B and C animals exhibited paraplegia or paraparesis with marked neuronal necrosis. In the Tarlov score at 48 hours, group A animals represented better neurologic function than group C (P < .01) and similar motor function to group D animals. Severe histopathologic change was not observed in groups A and D. Animals in groups A and D showed a greater number of motor neurons than animals in groups B and C (P < .01). The difference could be due to chance between group A and D animals (P = .08).ConclusionsThese results showed that the segmental infusion of noncompetitive NMDA receptor antagonist as an intraoperative spinoplegia could have a protective effect on the spinal cord neurons against excitotoxic neuronal injury in vivo. On the other hand, efficacy of the use of competitive antagonist was suggested to be limited in this model, probably because of the insurmountable obstacle of the blood-brain barrier.Clinical RelevanceParaplegia is a devastating complication during surgical repair of the thoracic and thoracoabdominal aortas. Excitatory amino acids neurotoxicity through the N-methyl-d-aspartate (NMDA) receptor is no doubt the pathologic hallmark of ischemic and postischemic spinal cord injury. Systemic administration of either a competitive or noncompetitive NMDA antagonist has been reported to have neuroprotective effect, in terms of preoperative treatment, with dose-related central sympathomimetic and sedative effects. Local administration, particularly of a noncompetitive NMDA antagonist, infused segmentally after aortic clamping could therefore be a potent intraoperative pharmacologic strategy to minimize the effective dose that retains NMDA antagonism without undesirable adverse effects. Our ability to reproduce this model could facilitate pharmacologic prevention or provide a new surgical technique as a spinoplegia for NMDA receptor-mediated neuronal injury.

Objective: Paraplegia remains a serious complication of aortic operations. The production of free radicals during reperfusion after transient ischemia is believed to induce secondary spinal neuronal injury, resulting in paraplegia. The aim of the present study was to clarify the protective effect and method of administration of antioxidants on the neurological and histological outcome in the animal model for reperfusion injury after transient spinal cord ischemia. Methods: New Zealand white rabbits underwent surgical exposure of the abdominal aorta that was clamped for 15 minutes to achieve spinal cord ischemia. Group A animals received two 10 mg/kg doses of 3-methyl-l-phenyl-2-pyrazolin-5-one (MCI-186) at the time of release of the aortic clamp and 30 minutes later. In group B, MCI-186, 5 mg/kg, was given three times, at the time of aorta clamp release, 30 minutes and 12 hours later. In group C (control group), one dose of vehicle was administered. Neurological status was assessed using modified Tarlov’s score until 168 hours after operation. Spinal cord sections were examined microscopically to determine the extent of ischemic neuronal damage. Results: Groups A and B animals had better neurological function than group C (p(0.001). In contrast, group C animals exhibited paraplegia or paraparesis with marked neuronal necrosis. The number of surviving neurons within examined sections of the spinal cord was significantly greater in group B than in group C (p(0.001). Conclusion: In a 15-minute ischemia-reperfusion model using rabbits, systemic repetitious administration of MCI-186, a free radical scavenger, was found to have a protective effect on the spinal cord neurons both neurologically and histologically. We postulate that the drug minimizes the delayed neuronal cell death for reperfusion injury after transient ischemia by reducing the free radical molecules. Moreover, it was thought that we could protect delayed neuronal cell death more effectively by administering MCI-18612 hours later.

A 35-year-old female presented with nonsustained ventricular tachycardia (NSVT) and a large intrapericardial mass. The mass was attached to the left ventricular wall with a broad stalk. On histopathology, the tumor was diagnosed as a lipoma. Postoperatively, the NSVT disappeared. doi: 10.1111/jocs.12095 (J Card Surg 2013;28:268–270)

Objective: Much evidence has been gathered to show that neurotoxicity of excitatory amino acids is mainly activated through an N-methyl-d-aspartate (NMDA) receptor cascade. We evaluated the protective effects of NMDA receptor antagonists, MK-801 and CGS19755 on spinal cord neurons using the NMDA receptor mediated neurotoxicity model in vivo. Methods: New Zealand white rabbits underwent an infrarenal aortic isolation. Group A animals (n=7) received segmental aspartate (50 mM) infusion for 10 minutes. Group B animals (n=6) were pretreated with MK-801 (6mg/kg), a noncompetitive NMDA receptor antagonist, that was administrated intravenously for 3 hours beginning 1 hour before the segmental infusion of aspartate (50 mM) of 10 minutes. Group C animals (n=6) received pretreatment with CGS19755 (30mg/kg), a competitive NMDA receptor antagonist, that was administrated in the same fashion as group B, followed by the segmental infusion of aspartate (50 mM). Neurologic status was scored at 12, 24, and 48 hours after operation using the Tarlov score. All the animals were sacrificed for histologic assessment at 48 hours. Results: Group A animals exhibited paraplegia or paraparesis with marked neuronal necrosis. Group B and C animals showed significantly better neurologic function compared with group A (p=0.0013, A vs. B) (p=0.0011, A vs. C). Pathohistological change was not observed in group B and C animals. Conclusions: NMDA receptor antagonists can have protective effects on spinal cord neurons against aspartate induced neurotoxicity. This model may be useful in assaying protective agents in the spinal cord against neuronal injury mediated by NMDA receptors in vivo.

Background . Considerable evidence exists that neurotoxicity of excitatory amino acids is related to the neuronal injury, including paraplegia. However, little is known about aspartate neurotoxicity in the spinal cord in vivo. We evaluated the detrimental effects of exogenous aspartate on spinal cord neurons under metabolic stress. Methods . New Zealand white rabbits underwent an infrarenal aortic isolation. Group A animals (n = 7) received segmental aspartate 50 mmol/L) infusion for 10 minutes. Group B animals (n = 7) received saline as a negative control. Group C animals (n = 5) received segmental aspartate 100 mmol/L) infusion for 5 minutes. Group D animals (n = 7) were pretreated with segmental infusion of (+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]cycloheptan-5,10-imine (MK-801) (6 mg/kg), a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist for 1 minute, followed by segmental infusion of aspartate (50 mmol/L) for 9 minutes. Group E animals (n = 7) received vehicle only, followed by aspartate (50 mmol/L) infusion as a control of group D. Neurologic status was assessed at 12, 24, and 48 hours after operation using the Tarlov score. Results . Group A animals exhibited paraplegia or paraparesis with marked neuronal necrosis. Group B and C animals recovered fully. Group D animals showed significantly better neurologic function ( p = 0.0007) compared with group E animals that exhibited paraplegia or paraparesis. Conclusions . Exogenous aspartate can have detrimental effects on spinal cord neurons under metabolic stress. This model may be useful in assaying neuronal injury mediated by NMDA receptor in vivo.

Background . Paraplegia remains a serious complication of thoracoabdominal aortic operations. However, despite growing in vitro evidence, it has been difficult to demonstrate glutamate neurotoxicity in vivo because of the reuptake activity that occurs. We hypothesized that glutamate can be toxic to the spinal cord under metabolic stress. Methods . Infrarenal aortic isolation was performed in New Zealand white rabbits. Group A animals (n = 7) then received a segmental infusion of glutamate (50 mmol/L) for 5 minutes. Group B animals (n = 7) received saline as a negative control. Group C animals (n = 6) were pretreated with a segmental infusion of 2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo(f)-quinoxaline (4 mg/kg), a competitive α-amino-3-hydroxy-5-methylisoazole-4-propionic acid/kainate antagonist, followed by the segmental infusion of glutamate (30 mmol/L) for 4 minutes. Group D animals (n = 6) received the vehicle agents only, followed by the same glutamate infusion (30 mmol/L) as in group C as a control for group C. Neurologic status was assessed at 12, 24, and 48 hours after operation and scored using the Tarlov system. Results . Group A animals exhibited paraplegia or paraparesis with marked neuronal necrosis. Group B animals recovered fully. Group C animals had better neurologic function than group D animals ( p = 0.0039). Conclusions . Exogenous glutamate can have detrimental effects on spinal cord neurons during a brief period of ischemia. This model may be useful for the purpose of assaying a glutamate receptor antagonist in vivo. (Ann Thorac Surg 1997;63:1057–62)

1991年5月から1996年4月までの5年間に当院に搬送された発症後2週間以内のStanford A型急性大動脈解離25例(男性11,女性14名,平均年齢60.1±11.4歳)について,急性期治療を中心に検討した。当院ではA型大動脈解離の急性期は適応のある症例に対し手術をし,他の症例には内科的治療を施行しできるだけ慢性期に手術をしてきた。従来の急性期での手術適応は破裂,左心不全を伴う重症AR (aortic regurgitation),主要分枝の虚血を伴う重症合併症であったが,1994年以降は適応を拡大しAR合併例,経胸壁心エコーで大動脈基部にflapを認める症例も急性期での手術適応とした。急性期に手術をした症例は適応拡大以前の前期群14例では3例(21.4%),適応拡大以降の後期群11例では7例(63.6%)と急性期手術症例が増加した(p

A 35-year-old female presented with nonsustained ventricular tachycardia (NSVT) and a large intrapericardial mass. The mass was attached to the left ventricular wall with a broad stalk. On histopathology, the tumor was diagnosed as a lipoma. Postoperatively, the NSVT disappeared.

A 71-year-old Japanese woman with severe chest pain was diagnosed with Stanford type A acute aortic dissection. After 3 months of medical treatment, she was operated on under a diagnosis of dissecting aneurysm of the ascending aorta and severe aortic regurgitation. Operative findings showed prolapse of the redundant aortic leaflets and a dilated ascending aorta without intimal tears. Operative and computed tomography findings differed from those of a classical dissection, which was the primary diagnosis of this patient, and were compatible with a diagnosis of aortic intramural hematoma (IMH). Few reports of IMH include concomitant aortic regurgitation. Surgery involved aortic root remodeling and prosthetic graft replacement of the ascending aorta.

Background Epidural placement of a cooling catheter can protect against ischemic spinal cord injury. With the use of rabbits, we investigated whether this epidural cooling technique, when combined with systemic moderate hypothermia, can protect the spinal cord against ischemic metabolic stress. Methods New Zealand white rabbits (n = 28) were assigned to 1 of 4 different groups. Animals underwent abdominal aortic occlusion for 30 minutes using a 3F balloon catheter. Group 1 (n = 7) underwent epidural cooling by the catheter and systemic moderate hypothermia (35°C) induced with a cooling blanket. Group 2 (n = 7) underwent epidural cooling under systemic normothermia (38.5°C). Group 3 (n = 7) underwent systemic moderate hypothermia (35°C) without epidural cooling. Group 4 (n = 7) underwent neither epidural nor blanket cooling as a negative control. Neurologic status of their hind limbs was graded according to the modified Tarlov scale at 1, 2, and 7 days after surgery. Results During infrarenal aortic ischemia, epidural temperature was significantly lower in group 1 (18.5°C ± 0.8°C) than in group 2 (28.6°C ± 1.0°C; P = .0001), group 3 (34.2°C ± 0.06°C; P = .0001), or group 4 (38.5°C ± 0.2°C; P = .0001). Hind limb function recovery was greater in group 1 (mean Tarlov score, 4.9 ± 0.057) than in group 2 (2.6 ± 0.3; P = .0028), group 3 (2.1 ± 0.34; P = .0088), or group 4 (0.0 ± 0.0; P = .0003). Conclusions Epidural cooling catheter combined with systemic moderate hypothermia produced additive cooling ability and protected the spinal cord against ischemia in rabbits more effectively than either intervention alone.

The newly developed Nikkiso HMS–15 is a miniaturized centrifugal pump. It has an impeller diameter of only 50 mm and a priming volume of only 25 ml. A totally new approach was applied to develop this very small pump. The new pump showed comparable hemolysis with pumps twice as big (e. g., the most widely used coneshaped centrifugal pump [index of hemolysis, 0. 005]). This finding refutes the belief that the pump diameter must be sufficiently large in size. Clinical application for cardiac assist was performed for 48 h without any thrombus formation despite low heparin dosage. Also, the pump showed quite favorable blood trauma when applied as a pump for cardiopulmonary bypass during open heart surgery. The compactness, the high controllability, and the system versatility proved to be very effective for clinical application. This pump is considered very reliable for its highly optimized design.

RSV感染症回復後,食物抗原(OVA, α-カゼイン(α-Ca))やダニ抗原(Df)に対する特異的IL 2反応性の充進を認めるようになり,気管支喘息に移行した2ヵ月男児の1症例を経験した.鼻汁中のRSV抗原が陽性であり,無気肺を伴う気管支炎と診断され,入院時初回の喘鳴を認めた.免疫学的検査では,血清IgE値が低値であり,またIgE RASTスコアもハウスダスト,ダニ,卵白,牛乳,大豆のいずれにも0であった.リンパ球のIL 2反応性はDfとα-Caが陽性を示し,その後数ヵ月の経過観察において,その値は増加を示した.さらにまた, OVA抗原ついでスギ抗原が陽性を示した.これらの検査成績に一致して患児は可逆性の呼気性呼吸困難を繰り返すようになり気管支喘息と診断されるに至った. IL 2反応性陽性抗原のうち, Dfは気管支喘息の発症を誘導している可能性が示唆された.また陽性を示したα-Ca, OVA抗原,スギ抗原もアトピー性疾患症状発現の病因抗原になりうることが推測された. RSV感染症がアトピー性疾患の発症とかかわり合いをもつことを示唆する所見を示す1症例と考えられた.

Background By using a U-shaped lumen catheter, the authors examined the effects of epidural cooling on spinal cord injury after aortic cross-clamping (ACC), with a focus on changes of spinal cord blood flow and expression of inducible nitric oxide synthase. Methods Sixteen pigs were randomized into two groups: Control group (n = 8) or Cooling group (n = 8). In the latter, epidural cooling started at 30 min (baseline) before 45 min of ACC and persisted for the next 30 min of reperfusion period. Spinal cord blood flow and somatosensory-evoked potentials were assessed during peri-ACC period. At 48 h, we evaluated hind limb function by using Tarlov score and expression of inducible nitric oxide synthase on spinal cord using immunohistochemistry. Results After ACC, spinal cord blood flow dropped to a similar extent in both groups. During the reperfusion period, spinal cord blood flow increased up to 113% (103-124%), median (interquartile range), level transiently and decreased to 32% (22-47%) level versus baseline in the Control group, whereas it increased and remained at 92% (86-97%) level in the Cooling group. Simultaneously, somatosensory-evoked potentials showed that onset of loss time was delayed and recovery time was shortened in the Cooling group. Tarlov scores in the Cooling group were significantly higher and accompanied by normal-appearing motor neurons and significantly greater expression of inducible nitric oxide synthase on spinal cord versus the Control group. Conclusions This study shows that epidural cooling during ACC minimized the risk of spinal cord injury, possibly by preventing delayed hypoperfusion and upregulating inducible nitric oxide synthase expression.

We developed a method of regional spinal cord cooling by using an epidural catheter containing cold saline in its isolated counter-current lumen. We describe the clinical application of this innovative procedure to the prevention of paraplegia during surgery for thoracic and thoracoabdominal aortic aneurysms.

Prebeta1-HDL, a putative discoid-shaped high-density lipoprotein (HDL) is known to participate in the retrieval of cholesterol from peripheral tissues. In this study, to clarify potential sources of this lipoprotein, we conducted heparin injection on four Japanese volunteer men and found that serum triglyceride (TG) level decreased in parallel with the increase in serum nonesterified fatty acids and plasma lipoprotein lipase (LPL) protein mass after heparin injection. Plasma prebeta1-HDL showed considerable increases at 15 min after the heparin injection in all of the subjects. In contrast, serum HDL-C levels did not change. Gel filtration with fast protein liquid chromatography system (FPLC) study on lipoprotein profile revealed that in post-heparin plasma, low-density lipoprotein and alphaHDL fractions did not change, whereas there was a considerable decrease in very low-density lipoprotein (VLDL) fraction and an increase in prebeta1-HDL fraction when compared with those in pre-heparin plasma. We also conducted in vitro analysis on whether prebeta1-HDL was produced during VLDL lipolysis by LPL. One hundred microliters of VLDL extracted from pooled serum by ultracentrifugation was incubated with purified bovine milk LPL at 37 degrees C for 0-120 min. Prebeta1-HDL concentration increased in a dose dependent manner with increased concentration of added LPL in the reaction mixture and with increased incubation time, indicating that prebeta1-HDL was produced during lipolysis of VLDL by LPL. Taken these in vivo and in vitro analysis together, we suggest that lipolysis of VLDL particle by LPL is an important source for formation of prebeta1-HDL.

Recent progress in human genome analysis has been providing tools for a new approach to disease treatment based on individual differences identified by use of genetic information. The feasibility of genotyping for DNA polymorphisms before treatment depends on the availability of rapid, accurate, and efficient genotyping methods. We previously reported that genetic polymorphisms of the UDP-glucuronosyltransferase 1A1 ( UGT1A1 ) gene were significantly related to severe toxicity of irinotecan (1). We now report that we have succeeded in detecting a 2-bp insertion of repeated sequence in the UGT1A1 gene by use of Invader assay technology. Sixty patients who had received irinotecan-containing chemotherapy from July 1994 to June 1999 were enrolled in this study. All gave informed consent in writing for their peripheral blood to be used for the research. We used the QIAamp Blood Kit (QIAGEN GmbH) to prepare genomic DNA from whole blood (100–200 μL) and genotyped three sites of DNA polymorphisms in UGT1A1 ( UGT1A1*28 , UGT1A1*6 , and UGT1A1*27 ) by the previously described method (1). UGT1A1*28 was distinguished from the most common allele ( UGT1A1*1 ) by …

An asymptomatic 50-year-old Japanese man was diagnosed with an aortic subannular left ventricular aneurysm during a routine physical checkup. Operative findings showed the subaortic aneurysm had developed beneath the noncoronary cusp of the aortic valve and expanded into the epicardium between the aortic root and left atrium. The operation involved patch closure of the orifice of the annular subaortic aneurysm, aortic valvuloplasty, and plication of the dilated ascending aorta.

Background . Reattachment of segmental arteries is one method used to prevent paraplegia associated with thoracoabdominal aortic repair. Nevertheless, even when important segmental arteries are reattached, ischemia causing spinal injury may occur during anastomosis. Methods . In 27 patients undergoing thoracoabdominal aortic repair, we attempted to perfuse the segmental arteries to be reattached with catheters connected to the distal bypass circuit. To identify perioperative risk factors for spinal ischemia, we examined changes in spinal somatosensory evoked potentials. Results . A median value of four segmental arteries were perfused in 20 (74%) of the 27 patients. Changes in somatosensory evoked potential indicative of spinal ischemia were observed in 13 patients (48%). The only risk factor associated with changes in evoked potentials revealed by a multivariate analysis was prolonged aortic cross-clamp time (> 120 minutes). Of the 2 patients who suffered paraplegia, one had the longest clamp time and the other showed spinal cord necrosis due to embolic shower. Conclusions . Despite selective perfusion of segmental arteries, spinal ischemia associated with aortic cross-clamping may occur when clamping is prolonged over 120 minutes. Most of the changes appear to be reversible, however.

OBJECTIVE The purpose of this study was to develop an improved method of direct DNA sequencing, which makes it possible to identify heterozygous mutations of the lipoprotein lipase (LPL) gene in order to understand the underlying genetic disorder of type IV hyperlipoproteinemia. METHODS AND RESULTS The direct sequencing method was improved by devising primers for amplifying the LPL gene and for sequencing DNA amplified by the polymerase chain reaction (PCR)T since the reported base sequences of the introns flanking exons of the LPL gene were limited to 40 bases. Improvement was achieved by attaching nine additional bases to both the PCR amplification primer and sequencing primer, and by optimizing the Tm value of the sequencing primers by adjusting the sequence of the nine extra bases. Use of the sequencing primers having suitable Tm values (48 degrees C-58 degrees C) made it possible to reduce nonspecific bands on the sequence ladder pattern and to identify heterozygous mutation sites in LPL gene exons 5 and 6 as model cases. CONCLUSION Our improved direct sequencing method is useful for identifying heterozygous mutation sites in human LPL gene exons and splicing consensus regions.

Background: For coronary to pulmonary artery fistulas, operations are often indicated by the existence of myocardial ischemia or aneurysmal formations. Because lesions do not form in identical ways, a variety

We report a case of tricuspid regurgitation (TR) that increased markedly after pericardiectomy for constrictive pericarditis. Preoperative mild-to-moderate TR increased to severe following surgery. The patient was asymptomatic