There is no medical education system of diabetic foot in Japan, where there is absent from podiatrists. The highest priority for diabetic foot ulcers in the treatment by the pathophysiology of the ulcer is noted in “Kobe Classification”. However, the number of elderly people, diabetes, peripheral artery disease (PAD) are now rapidly increasing in Japan. And then, the number of hospital beds in the country decreased, in a situation where it is difficult for diabetic patients with the foot ulcers to have long-term hospitalization treatment. The next stage of “Kobe Classification” aimed at the initial wound treatment is how to preserve their own gait and to seek to return to society.
Spontaneous isolated dissection of the superior mesenteric artery (SMAD) is not still well known. We retrospectively analyzed our 30 patients with SMAD to elucidate the treatment strategy and long-term follow-up outcomes. Due to severe abdominal symptom we performed a stents deployment and surgical reconstructive surgery for each one case. Anerysmectomy and bypass surgery was performed for a patient with aneurysmal change. Other 27 patients were managed conservatively. SMAD patients had only two vascular events (renal infarction and graft occlusion), and showed good prognosis for 6–146 (mean 69) months follow-up. We found that there is a few SMAD patients necessary of invasive management at acute phase and that most patients are safely conservatively treated with good prognosis.
Dissection of the superior mesenteric artery is usually managed conservatively. In some cases, however, arterial reconstruction is necessary for acute mesenteric ischemia. We used retrograde open mesenteric stenting for 2 cases with dissection of the superior mesenteric artery. During laparotomy, stents were inserted from the distal superior mesenteric artery to the dissected portion in the retrograde fashion. In one case, surgical fixation of the intima was also performed. Pulsation of the marginal artery was recovered. The both patients discharged from hospital uneventfully. This procedure can increase success rate as compared with bypass surgery or percutaneous stent insertion.
Trousseau syndrome is known as conditions that cause stroke due to hypercoagulability associated with malignant tumor. Ovarian cancer is a major cause of this syndrome, but there is few report caused by ovarian mucinous adenocarcinoma. We report a rare case of this associated with mucinous adenocarcinoma. A 70-year-old woman admitted due to disorientation. Examinations revealed multiple cerebral infarctions and ovarian mucinous adenocarcinoma. The progression of mucinous adenocarcinoma is slow, but the progressed case is poor prognosis. Although our case had unfortunate outcome, in future both anticoagulant therapy and immediate treatment of cancer by careful monitoring with CA125 should be essential.
Large anastomosis causes often high flow in arteriovenous fistula (AVF). A 50-year-old man on hemodialysis sustained high-output heart failure. He had an AVF created in his left forearm. An echogram indicated blood flow that was 2600 mL/min in the proximal brachial artery. B-type natriuretic peptide level was 1720 pg/mL. After fistula reconstruction surgery with small anastomosis (2 mm) in his same forearm, his heart failure resolved and blood flow was 810 mL/min on three months. This method is a simple and effective intervention for high flow in AVF.