The mortality of emergency surgical intervention for type A acute aortic dissection (AAD) has been variously reported as 15-30%. These findings are often derived from series spanning 10-20 years. Recent advances in surgical techniques, anesthesia, and perioperative medical management are likely to have lowered the mortality of emergency operations over the last few years. In fact, many factors, such as surgical techniques, use of sealed prosthesis, access of cardiopulmonary bypass, cerebral protection techniques, and postoperative surveillance have markedly changed during this long time interval, influencing the recently-improved surgical outcomes. For example, open distal anastomosis to avoid aortic cross clamping and antegrade systemic recirculation after distal anastomosis have dramatically improved the early and late outcomes of surgery for AAD. On the other hand, in recent aging society, the number of octogenarians undergoing emergency surgery for AAD has been steadily increasing and this may negate the impact of the beneficial advances. We reviewed clinical trend of the optimal treatment strategy for type A acute aortic dissection and presented our newly modified technique, namely, less invasive quick replacement (LIQR) with rapid re-warming for octogenarians undergoing emergency surgery for type A acute aortic dissection.
Background: The prognosis of patients with Kawasaki disease has been improved by the use of gamma-globulin. However, cases that are resistant to gamma-globulin have been difficult to manage. In this pilot study, we hypothesized that the combined use of dalteparin and gamma-globulin would reduce the prevalence of coronary artery lesions and prevent resistance to gamma-globulin therapy in Kawasaki disease. Methods: This was a retrospective study of 126 patients with Kawasaki disease who were admitted to our hospital. The data of the incidence of nationwide surveys of Kawasaki disease in 2005 and 2006 were used as the control group. The patients were treated with dalteparin + (gamma-globulin +aspirin) or dalteparin + aspirin alone. The survey of coronary artery lesion by echocardiography was followed-up three months after discharge. Results: The prevalence of gamma-globulin-resistant cases for our hospital vs. the nationwide survey was 8.2% vs. 16.2%, respectively (p < 0.001). The prevalence of cardiovascular damage (acute period) was 4.8% vs. 12.9%, respectively (p < 0.02). The prevalence of cardiovascular sequelae was 0.0% vs. 3.8% (p < 0.03). Conclusions: Compared with the nationwide survey, it is possible that dalteparin significantly reduces the prevalence of resistant cases and cardiovascular damage and sequelae. However, randomized controlled trials are needed to determine whether this approach should be widely adopted.
Aim: Kampo, Sino Japanese traditional medicine has been employed for the treatment of upper respiratory infections, including influenza-like symptoms, for more than 2000 years. Interestingly, recent clinical studies have revealed the possible effectiveness of Kampo medicines to improve influenza-like symptoms. However, the mechanisms by which Kampo-medicine affects acquired immune systems against influenza infection have not been well understood. In the present study, we examined the ex vivo immune response of peripheral blood mononuclear cells (PBMCs) from healthy subjects against influenza antigens using ELISPOT assay, as well as viral replications. Materials and methods: Peripheral blood samples were obtained from 6 healthy voluneers after obtaining informed consents. PBMCs were stimulated with influenza-HA antigen for 48 hours in the presence or absence of Kakkon-to, Mao-to, Syoseiryu-to, and Keishi-toin. IFN-γ production was evaluated by ELISPOT assay. Viability of PBMCs was determined by measuring formazan formation. Viral replication was estimated with hemmaglutination assay with influenza-sensitive MDCK cells. Results: Influenza-HA antigen-specific IFN-γ production was down-regulated by treatment with Kakkon-to, Mao-to, Syoseiryu-to, and Keishi-to. Treatment with Syoseiryu-to alone inhibited cell viability. PBMCs viability was reduced by influenza-HA antigen stimulation in the presence of Kampo-medicine. The four Kampo formulae employed in the present study showed no remarkable effects on influenza virus replication in MDCK cells. Conclusion: Four Kampo-medicines that are frequently employed to treat upper respiratory infections have minimal or adverse effects on influenza-specific immune responses and viral replications. The therapeutic effects of Kampo-medicines might be with a consequence of their anti-inflammatory effects.
A male infant was transferred to our neonatal intensive care unit (NICU) on the first day of life because of thrombocytopenia of the cord-blood sample. His mother had developed thrombocytopenia at a gestational age of 28 weeks and 5 days, and her platelet counts were around 10 × 104/μl thereafter. However, her platelet count spontaneously recovered after the delivery. The blood examination of the infant on admission showed thrombocytopenia of 4.4 × 104/μl. The serum from the mother contained an antibody that reacted with the infant and his father's platelets. An anti-HPA-4b antibody was found in the mother's serum. Infants who are borne from a mother who has exhibited thrombocytopenia during her pregnancy, might also develop thrombocytopenia, which could be a possible cause of neonatal aloimmue thrombocy-topenia.
We report a case of malignant peritoneal mesothelioma that formed a huge tumor in the abdomen. A 78-year-old woman was admitted to our hospital because of an abdominal tumor and pyrexia. The tumor was palpable in the right lower abdomen. The tumor was contrasted at the margin and the tumor was measured as 12.5 cm × 6.6 cm using contrasted computed tomography (CT). Contrast enema showed that the tumor did not invade the intestine. Angiography showed that the tumor did not exhibit hypervascularity. The prospective diagnosis was that this was a tumor of the mesentery based on the findings of CT, contrast enema, and angiography. After laparotomy, the extracted abdominal tumor was diagnosed as a malignant peritoneal mesothelioma by pathologic analysis. The diagnosis of this disease is difficult without laparotomy or laparoscopy. This disease generally has a poor prognosis and requires strict follow-up.