The concept of damage control and improved understanding of the pathophysiology of abdominal compartment syndrome (ACS) have been proven to be great advances in the management of both traumatic and nontraumatic surgical conditions. The practice of damage control surgery includes 3 components: 1) abbreviated resuscitative surgery for rapid control of hemorrhage and abdominal contamination by gastrointestinal contents, followed by temporary abdominal wall closure for planned reoperation and prevention of ACS; 2) restoration of physiologic function, including rewarming and correction of coagulopathy and hemodynamic stabilization in the intensive care unit; and 3) re-exploration for the definitive management of injuries and abdominal wall closure. Although this new approach can decrease the mortality rate of patients with severe physiological derangement, the establishment of clearly defined indications is necessary. For patients who require damage control surgery, interventional radiology should be integrated into the strategy for achieving hemostasis. Angiographic evaluation and embolization should be considered immediately after initial operation, especially for patients with combined intraperitoneal and retroperitoneal hemorrhage, severe hepatic injury, or ongoing hemorrhage after damage control surgery.
In many patients who require conventional open abdominal management following damage control surgery or decompressive laparotomy for ACS, the granulating abdominal contents are covered with only a skin graft, which is associated with a risk of enterocutaneous fistula. These patients will ultimately require complex abdominal wall reconstruction at a later stage. We have performed early fascial closure using an anterior rectus abdominis sheath turnover flap method. This technique may reduce the need for skin grafting and subsequent reconstruction and can be considered as an alternative method for the early management of patients with open abdomen.

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Background: It is important to follow up patients surviving acute myocardial infarction (MI), to detect the presence of any life-threatening arrhythmias. Various non-invasive examinations, such as signal-averaged ECG (SAECG), have been reported to predict the fatal ventricular tachycardia (VT); however, these conventional methods have limitations in detecting VT occurring in patients with complete right bundle branch block (CRBBB) QRS. Wavelet transform has been increasingly reported as a superior time-frequency analysis on the surface ECG in detecting abnormal high-frequency components (HFCs), thus suggesting abnormal myocardial conductions; however, it remains unclear whether wavelet-transformed ECG (WTECG) is useful in patients with CRBBB.
Objective: The purpose of this study is to assess the predictive value of WTECG for detecting arrhythmogenic substrates in MI patients with CRBBB.
Methods: Both the WTECG and SAECG were evaluated in 22 subjects with CRBBB, including 10 subjects without cardiovascular diseases (control group), 7 prior MI patients without VT (Non-VT group), and 5 prior MI patients with sustained VT (VT group). A 12-lead ECG (10 kHz sampling) was recorded and the representative QRS complex (300 ms) was transformed at a frequency range of 40-280 Hz using the Gabor function as the analyzing wavelet. In the power curve along a time course, the percentages of the peak power values at each frequency (60, 80, 120, 150, and 200 Hz) in the corresponding power values at 40 Hz (P60/40, P80/40, P120/40, P150/40, and P200/40, respectively) were calculated. 'The power percentages (P120/40, P150/40, or P200/40) ≥50%' was defined as an abnormal HFC (AHFC), and the number of the leads in which an AHFC was detected (NL-AHFC) of 8 leads (I, aV_F, V1-V6) was counted for comparison of the two MI groups.
Results: There was no significant difference among the three groups in the SAECG recording. The power percentages of HFCs (P120/40, P150/40, and P200/40) in Non-VT group were significantly higher than those in control group (48.2 ± 36.5 vs. 30.6 ± 7.7, P<0.001; 47.8 ± 35.5 vs. 26.9 ± 7.1, P<0.001; 47.3 ± 39.4 vs. 24.9 ± 7.6, P<0.001; respectively). NL-AHFC (P150/40) in VT group significantly increased more than in Non-VT group (3.2 ± 0.4 vs. 1.4 ± 0.8, P=0.001). When 'NL-AHFC (P150/40) ≥3' was defined as abnormal, the sensitivity, specificity, positive and negative predictive values for detection of VT in MI patients with CRBBB was 100, 85.7, 83.3, and 100%, respectively.
Conclusion: WTECG might be a novel non-invasive method to detect arrhythmogenic substrates in MI patients with CRBBB.

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Twenty to thirty percent of patients with atopic dermatitis (AD) are positive for antinuclear antibodies (ANAs). In this study we investigated the prevalence of ANA in 100 patients with AD and examined the difference between ANA-positive (ANA (+)) and ANA-negative (ANA (-)) patients with AD. ANAs were identified with indirect immunofluorescence on Hep-2 cells. Nineteen patients (19%) with AD were found to be positive for ANAs at titers ranging from 1 : 40 to 1 : 640. The rate of ANA positivity in male patients (20.4%) was higher than that in female patients (17.6%). The rate of ANA positivity differed significantly between patients with AD and healthy control subjects (p=0.0001, odds ratio: 2.8). There was also a relationship between ANA (+) AD and photosensitivity in male subjects (p=0.0346). The ANA (+) patients with AD showed higher levels of cedar pollen-specific IgE than did ANA (-) patients (p=0.0232). In ANA (+) patients disease severity was correlated with basophil counts (r=0.513, p=0.0344) and serum LDH levels (r=0.741, p=0.0056). The results indicate that patients with AD who are positive for ANA are a subpopulation of patients with AD.

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We describe a symptomatic splenic artery aneurysm (SAA) with occasional left-sided abdominal pain which was successfully treated with transcatheter embolization. A 65-year-old man was referred to a nearby clinic because of left shoulder and abdominal pain developing the day after blunt trauma to the shoulder and abdomen. Radiography revealed no fracture, and the patient went home. He stopped working for 7 months. Left-sided abdominal pain then developed several times after strenuous physical labor, and the patient was referred to a nearby hospital. The patient had a history of asthma and untreated hypertension; the use of iodinated contrast material was therefore avoided. Unenhanced computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen revealed a hematoma in the splenic hilum. The patient was referred to Nippon Medical School Hospital. His neurologic status was stable. Unenhanced CT of the abdomen at a nearby hospital revealed a low-density area in the splenic hilum. Fat-suppressed, T1-weighted images showed a hyperintense lesion adjacent to the splenic hilum. Fat-suppressed, T2-weighted images showed a dark hemosiderin rim, a bright ring, and an intermediate central core, which indicated a recurrent chronic hematoma in the abdomen. Dynamic contrast-enhanced MRI revealed a small hyperenhanced lesion adjacent to the hematoma, which appeared to be an SAA. After an injection of corticosteroids, selective splenic arteriography was performed. The splenic artery was catheterized via a right femoral approach. Arteriography showed an SAA, 1 cm in diameter with extravasation of contrast material. The neck of the SAA was catheterized with a microcatheter, and coils were placed successfully into the SAA to prevent recurrent bleeding. Postembolization angiography showed total occlusion of the SAA. The patient was discharged 7 days after embolization and has since resumed normal activities, with no residual symptoms.

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A 3-year-old girl was diagnosed with restrictive cardiomyopathy (RCM) after showing symptoms of heart failure, and a 6-year-old boy was found to have RCM after abnormal electrocardiographic findings were seen during school-based heart disease screening. Both had typical clinical features of the disease. Plasma levels of brain natriuretic peptide increased significantly in both patients, allowing us to distinguish this disease from constrictive pericarditis which has similar clinical and hemodynamic features. The early diastolic mitral annular velocity recorded by tissue Doppler echocardiography was also useful to discriminate RCM from constrictive pericarditis. The former case successfully received heart transplantation, but the latter case died suddenly prior to receiving a heart transplant. The plasma level of brain natriuretic peptide and tissue Doppler echocardiography helped us to diagnose this disease earlier and follow it more carefully, which has important implications in optimal treatment and improved prognosis of RCM in children.

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The treatment of splenic cysts remains controversial. A 25-year-old Japanese woman with a 10-cm-long abdominal mass in the left upper quadrant of the abdomen complained of mild, dull pain. A huge splenic cyst was confirmed on computed tomography and magnetic resonance imaging. The cyst wall was adherent to the splenic parenchyma to approximately 30% of its maximum diameter, calculated with magnetic resonance imaging. Laparoscopic unroofing of the cyst was performed. After the great omentum adhering to the cystic wall of the spleen was dissected, branches from the splenic hilar vessels were clipped. Histological examination of the cyst revealed pseudocyst of the spleen. The postoperative course was uneventful. Laparoscopic unroofing is a safe surgical procedure for patients with symptomatic pseudocyst of the spleen.

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