The plasma carnitine fraction, which involves in skeletal muscle metabolism, was measured in 130 patients with peripheral arterial disease (PAD). The ratios of acyl carnitine and free carnitine (carnitine ratio) are 0.42±0.22 in patients with critical limb ischemia (CLI) and 0.26±0.13 in patients with intermittent claudication (IC), respectively, being significantly high in the patients with CLI (p<0.01). Even in omitted hemodialysis patients, the carnitine ratio is higher in the patients with CLI than in the patients with IC (0.31±0.14 vs. 0.24±0.10, p<0.05). When the multivariate analysis was performed using gender, diabetes, dyslipidemia, chronic hemodialysis as the explanatory variables, dialysis (p<0.001) and CLI (p<0.01) are shown to be the significant determinant factors of carnitine ratio. These results indicate that carnitine metabolism is deeply related to the severity of ischemia in the muscle. The carnitine ratio may become a marker of severity of limb ischemia of PAD and a possible indicator of preclinical CLI.

Objectives: We examined the preventive effect of edaravone injection before aortic clamping for spinal cord ischemia in a rabbit model. Methods: The 13 rabbits were divided into three groups. In Sham group (S group) rabbits, the aorta was not clamped (n=3). In normal saline group (N group) rabbits, normal saline was injected just before aortic clamping, and the clamping time was 25 minutes (n=5). In Edaravone group (E group) rabbits, edaravone (3 mg/kg) was injected just before aortic clamping, and the clamping time was 25 minutes (n=5). The modified Tarlov score was evaluated after 24 hours, 48 hours and 7 days. Histopathological evaluation was performed on the specimen of the spinal cord. Results: The modified Tarlov’s score was tended to be higher in S group than in N group, and was similar in S group and in E group at each measuring point. Histopathological evaluation revealed more serious neuropathy in N group than in E group, but no significant difference was noted between S group and E group. Conclusions: Preventive injection of edaravone before aortic clamping might be effective for spinal cord ischemia in a rabbit model.

Horseshoe kidney (HSK) is an uncommon renal complication. The coexistence of abdominal aortic aneurysm (AAA) with HSK is rare. Presence of HSK may be complicated to the anterior approach for the reconstructive surgery of the aorta and iliac vessels, because the isthmus of the HSK lies across the aorta and it has anomalous renal vessels. Technical problems are related to exposure, vascular access, and the preservation of renal tissue. The HSK has a variant arterial supply in the majority of patients with accessory renal arteries arising from the aorta or iliac arteries. The purpose of this report is to describe our experience in the successful treatment of patients who had the coexistence of AAA with HSK. We report two cases of successful reconstruction of the aorta in patients with endovascular repair (EVAR), and open repair without reconstructing accessory renal arteries. Routine spiral CT angiography (CTA) showed the isthmus of HSK and a number of accessory renal arteries and their locations. Since the renal function was normal and the diameter of the accessory renal arteries was smaller than 3 mm, and that of the main renal artery was larger than 5 mm, we planned to repair surgically without reconstructing accessory renal arteries. Postoperatively, renal function remained normal for the long term, and the patients made an uneventful recovery. Their preoperatively careful analysis of the isthmus of HSK and accessory renal arteries can be essential for rational treatment without reconstructing accessory renal arteries of 3 mm or less under normal renal functions.