Background: Treating chronic wounds is challenging. Despite standard wound care, some chronic wounds fail to heal. Therefore, hyperbaric oxygen therapy (HBOT) was developed as an adjunct to standard wound care.
Objective: To evaluate the efficacy of HBOT for treating chronic wounds due to a variety of causes at our institution.
Methods: We reviewed the medical records of patients with chronic wounds treated with HBOT in addition to standard wound care at the Department of Dermatology, Nippon Medical School Hospital, from 2009 through 2012. Twenty-nine patients were reviewed (14 men and 15 women; mean age, 64.1±14.4 years). The cause of chronic wounds was diabetes mellitus (DM) in 13 patients, venous stasis in 10, polyarteritis nodosa cutanea in 2, and livedoid vasculopathy, pyoderma gangrenosum, chronic renal failure, and systemic sclerosis in 1 patient each. The patients underwent HBOT for 60 minutes with 100% oxygen delivered via a mask in a hyperbaric chamber pressurized to 2.8 atmospheres of absolute pressure. The response of the chronic wounds to HBOT was evaluated according to the following criteria: "excellent": more than 90% wound healing; "good": a greater than 30% reduction in wound size, and wound healing was confirmed on follow-up visits within 6 weeks; "fair": wound healing was achieved with a combination of further invasive interventions; and "poor": the wound showed a less than 30% reducion or worsened during HBOT, or wound healing had not been completed by follow-up visits within 6 weeks.
Results: The response to HBOT was "excellent" in 6 patients, "good" in 8, "fair" in 11, and "poor" in 4. All 4 patients with a "poor" response had DM and had undergone hemodialysis.
Conclusions: HBOT is an effective treatment for patients with chronic wounds, due to a variety of causes, when used in combination with conventional standard therapy or further interventions. However, HBOT is less effective in patients with DM than in patients with venous stasis because hemodialysis, which is more common in patients with DM, has negative effects on wound healing.

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Objective: Although recent progress has expanded the indications for thoracic aortic surgery to include elderly patients, the procedure remains extremely invasive. We performed a chart review to determine the early and late outcomes of thoracic aortic surgery using hypothermic circulatory arrest (HCA) and antegrade selective cerebral perfusion (ASCP) in octogenarians.
Materials and Methods: Of 79 patients who underwent surgery for thoracic aortic aneurysms from April 2007 through December 2012, 8 patients 80 years or older were selected for analysis. Mean age at the time of surgery was 84.3±1.39 years. The diagnoses were aortic dissection in 5 patients and degenerative thoracic aneurysm in 3 patients. All patients underwent surgery with HCA. The lowest body temperature was 25℃ ASCP was used as an additional brain-protection technique. Emergency operations were performed in 5 patients (62.5%).
Results: The mean duration of HCA was 60.4±19.7 minutes, that of aortic cross-clamping time was 143.0±30.4 minutes, and mean pump time was 207.8±44.4 minutes. The hospital mortality rate was 0%. Major postoperative complications occurred in 3 (37.5%) patients: stroke, temporary neurologic dysfunction, and paraparesis in 1 patient each. No patients required temporary dialysis for new-onset renal dysfunction. There were no deaths during the 65-month follow-up period.
Conclusion: The early and late outcomes after thoracic aortic surgery at our hospital using HCA with ASCP in octogenarians are acceptable. The operations are performed with an acceptable operative risk, even under emergency situations, including acute aortic dissection.

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Background: Because direct application of low-energy shock waves induces angiogenesis, we investigated the safety and efficacy of this new therapy to develop a noninvasive method of repeatable therapeutic angiogenesis for treating peripheral arterial disease (PAD).
Subjects and Methods: The subjects were 10 patients who had symptomatic PAD and limited ischemia in a below-the-knee artery. Low-energy shock waves were directly applied to the calf muscles 6 times every other day. Intracorporeal changes were evaluated with ultrasonography to determine adverse effects of therapy. To assess blood flow of the microcirculation, transcutaneous oxygen tension (TcPO₂), skin perfusion pressure (SPP), and ^99mtechnetium-tetrofosmin (^99mTc-TF) scintigraphy were performed before and after therapy. The TcPO₂ was measured while subjects inhaled pure oxygen (maximum TcPO₂). The ^99mTc-TF perfusion index was determined as a ratio of uptake in muscle to that in the brain (control) for quantitative analysis.
Results: No adverse effects were noted in any patient. Maximum TcPO₂ values increased significantly on the calf (57.3±28.4 to 71.0±14.5 mm Hg, p=0.044) and the dorsum of the foot (52.2±21.8 to 76.1±17.9 mm Hg, p=0.012). The SPP tended to increase after therapy on the dorsum and plantar surfaces of the foot, but the differences were not significant. The ^99mTc-TF perfusion index in the foot significantly increased (0.48±0.09 to 0.61±0.12, p=0.0013), but that in the leg did not change.
Conclusion: We have demonstrated that low-energy shock wave therapy is safe and can restore blood flow in the microcirculation in patients with symptomatic PAD.

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Aim: The objective of this multicenter phase II study was to evaluate the effects of biweekly paclitaxel and carboplatin combination chemotherapy on response rate and toxicities in patients with epithelial ovarian cancer.
Patients and Methods: Patients with International Federation of Gynecology and Obstetrics stage II to IV ovarian cancer received paclitaxel at a dose of 120 mg/m² and carboplatin at an area under the curve of 3 mg/mL per minute every 2 weeks for 8 or more cycles. Inclusion criteria included an Eastern Cooperative Oncology Group performance status of 0 to 2 and no previous chemotherapy. Informed consent was obtained from each patient before the start of treatment.
Results: From March 2003 through July 2009, 42 patients from 5 institutions were eligible to be evaluated for response and toxicity. The median age was 60.5 years (age range, 34-81 years). The International Federation of Gynecology and Obstetrics stage was stage II in 3 patients, stage III in 31 patients, and stage IV in 8 patients. The response rate was 66.7% (95% confidence interval: 50.5%-80.4%). Sixty-nine percent (29 of 42) of patients received 8 or more cycles of chemotherapy. The median progression-free survival was 18.5 months, and overall survival was 59.1 months. The most common grade 3 or 4 hematological toxicity was neutropenia (61.0%). No patients had grade 3 or 4 thrombocytopenia. The most common grade 3 nonhematological toxicities were neuropathy (4.9%) and nausea (2.4%).
Conclusion: Paclitaxel combined with carboplatin using a biweekly schedule is a safe and effective chemotherapy regimen for patients with epithelial ovarian cancer. Our results suggest that a biweekly schedule is well tolerated and is less toxic than a triweekly schedule.

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Intracranial chondroma is a rare benign neoplasm that occurs most often at the skull base. In extremely rare instances, it arises from the dura mater of the convexity or from the falx cerebri. The tumor cells are thought to originate from meningeal fibroblasts, perivascular mesenchymal tissue, or ectopic chondrocytes. Because the clinical presentation of such cases is nonspecific and because neuroimaging findings are not pathognomonic, intracranial chondromas mimic other intracranial tumors. Herein, we report a chondroma originating from the dura mater in the frontal region. The patient had been followed-up radiologically for 3 years after a preliminary diagnosis of meningioma until the correct diagnosis of chondroma was established with postoperative histological examination.

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Gaucher disease is an autosomal recessively inherited lysosomal storage disease in which a deficiency of glucocerebrosidase is associated with the accumulation of glucocerebroside in reticuloendothelial cells. Clinically, 3 types of Gaucher disease have been defined on the basis of the presence or absence of neurological symptoms. The frequency of gallbladder involvement is reportedly greater in patients with type 1 Gaucher disease than in healthy persons. We report a case of recurrent cholelithiasis and liver failure in a patient with type 2 Gaucher disease who showed severe progressive neurological involvement.

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A 79-year-old man experienced sudden-onset left hemiparesis and disturbance of consciousness. Diffusion-weighted magnetic resonance imaging showed an acute ischemic stroke in the territory of the right middle cerebral artery. He underwent systemic thrombolysis via the intravenous administration of tissue plasminogen activator (t-PA). Chest radiography and computed tomography performed the following day showed severe hemothorax with atelectasis of the left lung and multiple rib fractures; the initial chest radiogram had revealed rib fractures but we did not recognize them at the time. Conservative treatment with the placement of chest tubes was successful, and the patient recovered without further deterioration. Although systemic thrombolysis with t-PA is an accepted treatment for acute cerebral ischemic stroke, posttreatment intracranial hemorrhage has a negative effect on prognosis. Extracranial bleeding is a rare complication, and our search of the literature found no reports of hemothorax after treatment with t-PA in patients with cerebral ischemic stroke. We have reported a rare case of severe hemothorax after systemic thrombolysis with t-PA. This important complication indicates the need to rule out thoracic trauma with radiography and computed tomography of the chest.

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A 61-year-old man was admitted to our department with purpura and hemorrhagic bullae on his lower limbs, dull pain affecting the entire abdomen, and hematochezia. Histopathological examination and immunostaining revealed leukocytoclastic vasculitis of the small blood vessels of the dermis and IgA deposition; multiple ulcers were observed in the ileum during lower gastrointestinal (GI) endoscopy, so we made a diagnosis of IgA vasculitis (Henoch-Schönlein). Treatment with oral prednisolone (PSL) at a dose of 80 mg/day (1 mg/kg/day) for one week resolved the symptoms almost completely. However, when the PSL dose was later reduced, dull epigastric pain and discomfort flared up again. Multiple punched-out ulcers were observed in the duodenum during upper GI endoscopy, and immunostaining revealed cytomegalovirus (CMV) in vascular endothelial cells and infiltrating cells. The patient's serum was positive for CMV antigenemia. On the basis of these findings, we concluded that the CMV enteritis had developed as a complication arising from the patient's immunosuppressed state, which was itself a result of the steroid therapy. We treated the patient with ganciclovir, which relieved the abdominal symptoms.

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This study was designed to determine whether genetic differences influence the rewarding effects of nicotine in 4 inbred strains of mice (DBA/2, BALB/c, C3H, and C57BL/6). Nicotine (subcutaneous) induced a place preference in DBA/2 and BALB/c mice but a place aversion in C57BL/6 mice. A low dose of nicotine produced a significant place preference, whereas a high dose of nicotine produced place aversion in C3H mice. These effects were completely reversed by the nicotinic receptor antagonist mecamylamine. These results strongly suggest that a conditioned state, such as rewarding effects or aversive effects, can be influenced by genetic background.

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