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Background: Purpose of the present systematic review is to investigate preclinical evidence in favor of the working hypothesis of efficacy of cannabinoids in ocular pain treatment. Methods: Literature search includes the most relevant repositories for medical scientific literature from inception until November, 24 2021. Data collection and selection of retrieved records adhere to PRISMA criteria. Results: In agreement with a priori established protocol the search retrieved 2471 records leaving 479 results after duplicates removal. Eleven records result from title and abstract screening to meet the inclusion criteria; only 4 results are eligible for inclusion in the qualitative synthesis impeding meta-analysis. The qualitative analysis highlights the antinociceptive and anti-inflammatory efficacy of Δ8-tetrahydrocannabinol, cannabidiol and its derivative HU-308 and of new racemic CB1 allosteric ligand GAT211 and its enantiomers GAT228 and GAT229. Moreover, CB2R agonists RO6871304 and RO6871085 and CB2R ligand HU910 provide evidence of anti-inflammatory efficacy. CB2 agonist HU308 reduces of 241% uveitis-induced leukocyte adhesion and changes lipidome profile. Methodological and design issues raise concern of risk of bias and the amount of studies is too small for generalization. Furthermore, the ocular pain model used can resemble only inflammatory but not neuropathic pain. Conclusions: The role of the endocannabinoid system in ocular pain is underinvestigated, since only two studies assessing the effects of cannabinoid receptors modulators on pain behavior and other two on pain-related inflammatory processes are found. Preclinical studies investigating the efficacy of cannabinoids in ocular inflammatory and neuropathic pain models are needed to pave the way for clinical translation.

Ageing of the world population makes of dementia a challenge for health systems worldwide. The cognitive disturbance is a serious but not the only issue in dementia; behavioural and psychological syndromes known as neuropsychiatric or behavioural and psychological symptoms of dementia remarkably reduce the quality of life of patients. Rising evidence is unraveling the pathophysiology of these symptoms in which all the neurotransmitter systems in the Central Nervous System (CNS) are implicated, with a pivotal role of alterations of the glutamatergic neurotransmission. Pharmacological agents for the treatment of these disorders endowed with efficacy and safety are not available yet; aromatherapy provides the best evidence in the control of agitation, the most resistant symptom. Basic research effort demonstrates that the essential oil of bergamot induces anxyolitic-like effects, devoid of sedation, typical of benzodiazepines, with noteworthy advantage for demented patients. People suffering from dementia often cannot verbalize pain, thus resulting unrelieved and contributing to agitation. Bergamot essential oil provides extensive evidence of analgesic properties independent from the route of administration. Among other mechanisms, modulation of autophagy, a process involved in neuropathic pain, seems to be implicated in the analgesic activity of bergamot essential oil. These data, together with the reported safety profile form the rational basis for bergamot as a neurotherapeutic to be trialed for the control of behavioural and psychological symptoms of dementia.

Off-pump coronary artery bypass grafting has become an attractive surgical alternative for myocardial revascularization because of the advantage of myocardial protection and other benefits of patients. However, it is still regarded as a controversial treatment for the coronary artery disease accompanied by atrial fibrillation (AF). A significant number of patients in need of coronary revascularization have chronic AF. Although the Cox-Maze III procedure is the gold standard for the surgical treatment of AF, few of these patients undergo AF operations at the time of their coronary bypass grafting. We report herein a case of the pulmonary vein isolation to eliminate the AF by means of epicardial radiofrequency ablation combined with 2 vessels coronary artery bypass grafting on the beating heart with the aid of cardiopulmonary bypass.

症例は29歳の女性. 繰り返す肺炎の精査加療目的で当科入院となった. 胸部XP, CTでは左下肺野に嚢胞状陰影が認められた. 気管支鏡検査では可視範囲内に異常は認めず, その分枝も正常であった. 臨床的に病変肺と正常肺の気管支系に交通があると考えられたが, 血管造影にて腹腔動脈に由来する異常血管が認められたことから肺分画症の診断にて手術を行った. 前側方切開にて開胸したところ, 横隔膜から左下葉に流入する異常血管が確認され肺葉内肺分画症と診断した. 術式は, 健常部との境界が不明瞭で病変の取り残しの恐れがあると判断し下葉切除術を選択した. 切除標本を用いた造影では, 異常動脈は下肺静脈に還流していた. 本例は, 気管支・肺動脈の分枝が正常であり, 異常血管が弾性動脈であったことから副肺芽に由来するPryce III型の肺葉内肺分画症であり, 炎症性に正常肺の気管支との間に交通が生じたと考えられた.

症例は77歳, 女性.6年前に当院にて右後縦隔の脂肪腫切除術を施行.以来, 近医通院中であったが難治性の乾性咳嗽を主訴に当院へ来院.胸部X線写真およびCTで両側後縦隔に広がる脂肪性腫瘤を認め, 脂肪腫再発の診断のもと, 二期的に腫瘍切除術を施行した.病理組織学検査では高分化型脂肪肉腫と診断された.術後, 放射線および化学療法は追加しなかった.術後3ヵ月経過したが再発の兆候はない.可及的な外科的切除が再発防止に重要であると考えられた.また今後の厳重な経過観察も要すると考えられた.

ゼラチン被覆 (Gelseal®) 4分枝付き人工血管を用いた弓部大動脈瘤手術を1996年4月より12月までに9例に施行し, その操作性, 手術成績および問題点について検討を行った. ゼロポロシテイーであるこの人工血管は preclotting の必要がないうえ, 分枝作成の煩わしさもなく, 特に緊急手術時など人員および時間の制約のある場合に有用であると思われた. 手術成績は, 死亡例なく, 急性I型大動脈解離の1例に術後に対麻痺を認めたが, 全例軽快退院し, 良好な結果を得た. しかし, 術後1か月で20%程度のグラフト径の拡大を認めており, 今後の厳重な経過観察を要すると思われた. また, 術後2週目にCRPおよび白血球値の再燃を認めた. 同時期に穿刺を要した心嚢液および胸水の貯留を1例ずつにみたが, グラフトとの関連は不明であった.

症例は74歳, 女性. 難治性の高血圧, 上下肢圧較差, うっ血性心不全と腎不全を認め当院へ紹介され入院した. 大動脈造影検査にて下行胸部大動脈のほぼ中央部に90%狭窄を認め, 下行胸部大動脈縮窄の診断でF-F部分体外循環下に下行胸部大動脈バイパス術を施行した. 術後経過は良好で, 術後28日目に退院した. 病変部大動脈壁の病理組織学的検査では中膜から内膜にかけての著明な肥厚を認め線維筋性異形成による下行胸部大動脈縮窄と診断された.

Nine consecutive patients with coronary artery disease who had a left ventricular ejection fraction (LVEF) of less than 0.4 and underwent coronary artery bypass grafting (CABG) at our institution were studied. All patients had angina pectoris and six of the nine patients (67%) had a history of congestive heart failure. The mean EF was 0.37 +/- 0.03 and the mean LV end-diastolic pressure was 10.1 +/- 4.9 mmHg. An average of 1.56 +/- 0.50 grafts per patient were placed and there was no operative death. The graft patency rate was 92.9% and the mean EF rose significantly from 0.37 to 0.53 after surgery (P less than 0.05). There was one late death, the 4-year actuarial survival rate being 88.9%. Of the eight long-term survivors, six (75%) were totally asymptomatic and only two had mild angina on exertion. This study confirmed that CABG for patients with depressed LV dysfunction can be performed safely with an acceptably low operative mortality, a significant improvement of LV function, and excellent long-term results.

We report a rare case of Stanford type A acute aortic dissection associated with a distal aortic arch atherosclerotic aneurysm. A 71-year-old female was referred to us with the diagnosis of thrombosed Stanford type A acute aortic dissection, however on the next day transesophageal echocardiography revealed the false lumen has been recanalized. In the operation, there was a distal aortic arch atherosclerotic aneurysm which was unidentified at the preoperation. It is very rare that the dissection originated from atherosclerotic aneurysm and proceeded to proximal and distal portion of the aorta.