A Patient with Cat-scratch Disease Diagnosed by Detailed Medical History and Physical Examination / 日本プライマリ・ケア連合学会誌

<p>Cat-scratch disease occurs after a scratch from a cat infected with <i>Bartonella henselae</i>. We report a 64-year-old man with cat-scratch disease who had swollen lymph nodes. Consequently, metastasis of a malignant tumor was suspected as the most likely cause in the differential diagnosis. Therefore, the diagnosis was delayed and several diagnostic examinations were performed. Although diagnosis was difficult in this case, an accurate diagnosis was achieved by taking a detailed medical history, including questioning about pet ownership, and by carefully examining the lower limbs including the femoral region. These steps are important to diagnose cat-scratch disease.</p>

Low-grade myofibroblastic sarcoma of the palate / 国际口腔科学杂志·英文版

Low-grade myofibroblastic sarcoma (LGMS) is a rare, malignant tumor with myofibroblastic differentiation. Despite it being classified as a distinct entity by the World Health Organization, a few cases were reported in the oral and maxillofacial region. Here, a LGMS developed on the palate of a 73-year-old man who presented with a 1-cm tumor on the posterior border of the palate. Based on the histological and immunohistochemical features, a diagnosis of LGMS was established. The tumor was resected, and no recurrence was observed over 2 years. Although the tongue is the most preferred site for LGMS, it may occur in any region of the oral cavity.

Avoiding direct contact between fingers and needle shaft in removing acupuncture needles with alcohol cotton-Assessment of risk reduction using a fluorescent agent- / 全日本鍼灸学会雑誌

[Objective]Using cotton to cover needle shafts when removing acupuncture needles is recommended in order to prevent blood contamination. However, the effect of risk reduction has not been confirmed by experimental studies. We, therefore, observed spreads of fluorescent agent, assumed as blood, with or without alcohol cotton to avoid direct contact between fingers and needle shaft. <BR>[Methods]Subjects were two blind acupuncturists and two acupuncture students. We asked them to insert acupuncture needles to people who played a role of a patient. Of the five acupoints needled, we put the fluorescent agent to one point, and asked the subjects to remove the needles. After all the needles were removed, we took photographs of all points needled and the subjects'hands in order to assess the spread of the fluorescent agent. 'We performed two sessions. In Session A, the subjects used alcohol cotton to cover a needle shaft so that their fingers did not contact the needles directly. In Session B, they did not use alcohol cotton. The subjects were not told that we used the fluorescent agent.<BR>[Results](1) In the forearm of those who were needled, adhesion of the fluorescent agent was not seen in three out of four subjects, in Session A. (2) In two of the four subjects who inserted the needles, the adhesion area of the fluorescent agent in the needle-supporting hands was smaller in Session A compared with Session B. (3) In three of the four subjects who inserted the needles, the adhesion area of the fluorescent agent in the needle-stimulating hands was smaller in Session A compared with Session B.<BR>[Conclusion]It is suggested that covering needle shaft with alcohol cotton during needle withdrawal suppresses the spread of blood contamination.

Combined Coronary Artery Bypass Surgery and Abdominal Aortic Aneurysm Repair during Cardiopulmonary Bypass for Patients with Severe Left Ventricular Dysfunction / 日本心臓血管外科学会雑誌

Coronary artery bypass surgery and abdominal aortic aneurysm repair were performed simultaneously during cardiopulmonary bypass in two patients with severe left ventricular dysfunction. Both patients underwent coronary artery bypass surgery first, followed by abdominal aortic aneurysm repair during cardiopulmonary bypass. Combined surgery is reasonable for patients with combined coronary artery disease and abdominal aortic aneurysm. Aortic aneurysm repair during cardiopulmonary bypass for patients with severe left ventricular dysfunction also appears safe and effective.

Accuracy of Measurement of Cardiac Output and Circulating Blood Volume Levels by Pulse Dye Densitometry, and Postoperative Management of the Open Heart Surgery / 日本心臓血管外科学会雑誌

Using the DDG-2001 pulse dye densitometer, cardiac output (CO) and circulating blood volume (BV) were determined before and after the operation, and its accuracy and the significance of postoperative management were studied. Referring to 14 cases undergoing open heart surgery, CO and BV were determined using the DDG-2001 before application of the cardiopulmonary bypass and immediately, 4h and 12h after the operation. The level of CO was compared with that determined by the thermodilution method, and the level of BV with that calculated from hemoglobin levels determined before and after the cardiopulmonary bypass application and the priming volume in the circuit. Further, body fluid balance after the operation was calculated, and its relation to BV was studied. As to the correlation coefficient and inclination of the regression line, they were 0.77 and 0.849 with CO, and 0.821 and 0.844 with BV, respectively. Upon completion of the operation BV decreased, but increased again 4h and 12h later, although the body fluid balance was negative. CO and BV determined by the pulse dye densitometry favorably correlated with those determined by other methods. Immediately after the operation BV decreased, but then increased in the course of time, although the body fluid balance was negative.

An 81-year-old Case of Left Ventricular Aneurysmectomy with Right Coronary Artery Bypass Grafting / 日本心臓血管外科学会雑誌

An 81-year-old patient, who had a postinfarction left ventricular aneurysm with thrombus underwent left ventricular aneurysmectomy with right coronary artery bypass grafting (CABG). Preoperative examination showed 99% stenosis of the left coronary artery (#7) and 90% stenosis of the right coronary artery (#3). The operation was performed because angina was not improved and formation of thrombus was suspected on the wall of the aneurysm. The operation was performed under cardiopulmonary bypass and by antegrade and continuous retrograde cardioplegia. The aneurysm was resected and a relatively fresh thrombus which was detected on the endocardium of the aneurysm was extracted. The left ventricle was closed by direct linear suture with felt reinforcement. Because the area of resection included part of the left anterior descending artery, only right CABG (#3) with a saphenous vein was done. Weaning from bypass was very easy and the postoperative course was uneventful.

Effects of Single Administration of Milrinone during Cardiopulmonary Bypass / 日本心臓血管外科学会雑誌

We investigated the effects of milrinone administered during cardiopulmonary bypass (CPB) for open heart surgery. Ten patients (group M) received milrinone after aortic declamping during CPB. Ten other patients served as controls with no administration (group C). Soon after the bolus infusion of milrinone, the perfusion pressure dropped significantly in the M group, however, after CPB and at the end of operation, aortic pressure showed no difference between the two groups. There were no differences in heart rate, pulmonary artery pressure and pulmonary capillary wedge pressure. After CPB, cardiac index was high and systemic vascular resistance index was low in the M group. The need for cathecholamine and time for rewarming showed also no significant differences. No adverse reaction was recognized. During CPB, a single administration of milrinone was useful for peri- and post-operative management of patients undergoing open heart surgery.