Diffusion Tensor Imaging of the Spinal Canal in Quantitative Assessment of Patients with Lumbar Spinal Canal Stenosis

Methods@#Study participants comprised five healthy volunteers (mean age, 27.2 years) and 27 patients with LSS (mean age, 58.4 years) who were individually assessed using 3.0 Tesla magnetic resonance imaging. Intraspinal ADC and FA values of 10 intervertebral discs from healthy volunteers and 52 intervertebral discs from LSS patients were measured. Also, intraspinal canal area, Schizas classification (A: normal, B: mild stenosis, C: severe stenosis) and correlations with symptoms were investigated. Clinical symptoms were checked for the presence of low back pain (LBP), intermittent claudication (IMC), and bladder and bowel dysfunction (BBD). @*Results@#Compared to healthy individuals, LSS patients had significantly lower ADC (pppr=0.63, pp=−0.61, ppp<0.05) in patients with IMC or BBD. @*Conclusions@#Intraspinal DTI parameters such as ADC and FA values were associated with the Schizas classification, intraspinal canal area, and clinical symptoms, suggesting that ADC and FA may be useful for quantitative assessment of LSS.

Diffusion Tensor Imaging of the Spinal Canal in Quantitative Assessment of Patients with Lumbar Spinal Canal Stenosis

Methods@#Study participants comprised five healthy volunteers (mean age, 27.2 years) and 27 patients with LSS (mean age, 58.4 years) who were individually assessed using 3.0 Tesla magnetic resonance imaging. Intraspinal ADC and FA values of 10 intervertebral discs from healthy volunteers and 52 intervertebral discs from LSS patients were measured. Also, intraspinal canal area, Schizas classification (A: normal, B: mild stenosis, C: severe stenosis) and correlations with symptoms were investigated. Clinical symptoms were checked for the presence of low back pain (LBP), intermittent claudication (IMC), and bladder and bowel dysfunction (BBD). @*Results@#Compared to healthy individuals, LSS patients had significantly lower ADC (pppr=0.63, pp=−0.61, ppp<0.05) in patients with IMC or BBD. @*Conclusions@#Intraspinal DTI parameters such as ADC and FA values were associated with the Schizas classification, intraspinal canal area, and clinical symptoms, suggesting that ADC and FA may be useful for quantitative assessment of LSS.

Posttreatment human papillomavirus testing for residual or recurrent high-grade cervical intraepithelial neoplasia: a pooled analysis / 부인종양

OBJECTIVE: We conducted a pooled analysis of published studies to compare the performance of human papillomavirus (HPV) testing and cytology in detecting residual or recurrent diseases after treatment for cervical intraepithelial neoplasia grade 2 or 3 (CIN 2/3). METHODS: Source articles presenting data on posttreatment HPV testing were identified from the National Library of Medicine (PubMed) database. We included 5,319 cases from 33 articles published between 1996 and 2013. RESULTS: The pooled sensitivity of high-risk HPV testing (0.92; 95% confidence interval [CI], 0.90 to 0.94) for detecting posttreatment CIN 2 or worse (CIN 2+) was much higher than that of cytology (0.76; 95% CI, 0.71 to 0.80). Co-testing of HPV testing and cytology maximized the sensitivity (0.93; 95% CI, 0.87 to 0.96), while HPV genotyping (detection of the same genotype between pre- and posttreatments) did not improve the sensitivity (0.89; 95% CI, 0.82 to 0.94) compared with high-risk HPV testing alone. The specificity of high-risk HPV testing (0.83; 95% CI, 0.82 to 0.84) was similar to that of cytology (0.85; 95% CI, 0.84 to 0.87) and HPV genotyping (0.83; 95% CI, 0.81 to 0.85), while co-testing had reduced specificity (0.76; 95% CI, 0.75 to 0.78). For women with positive surgical margins, high-risk HPV testing provided remarkable risk discrimination between test-positives and test-negatives (absolute risk of residual CIN 2+ 74.4% [95% CI, 64.0 to 82.6] vs. 0.8% [95% CI, 0.15 to 4.6]; p<0.001). CONCLUSION: Our findings recommend the addition of high-risk HPV testing, either alone or in conjunction with cytology, to posttreatment surveillance strategies. HPV testing can identify populations at greatest risk of posttreatment CIN 2+ lesions, especially among women with positive section margins.

Implantation Technique of a Left Ventricular Assist System through a Small Right Parasternal Incision / 日本心臓血管外科学会雑誌

A 62-year-old man was transferred to our institution with ventricular fibrillation. Percutaneous cardiopulmonary support (PCPS) was established and he underwent successful percutaneous transluminal coronary angioplasty. Since his left ventricular function did not recover, he was placed on a left ventricular assist system (LVAS). Under general anesthesia, a 10-cm longitudinal incision was made on the right parasternum. The third and fourth cartilages were completely resected. The pericardium was incised longitudinally. At first, an inflow cannula was insected to the right side of the left atrium. The ascending aorta was then partially excluded and an outflow cannula with a 10mm Gore-Tex prosthesis was anastomosed end-to-side to the aorta with a continuous Gore-Tex suture. After the pump was established, PCPS was gradually discontinued. During 9 days of support, his left ventricular function recovered and subsequently he was weaned from LVAS. Unfortunately, he died two days after LVAS removal. We think this procedure is useful because it is easy to perform, reduces the bleeding, shortens the operating time.

Redo Coronary Artery Bypass Grafting via a Small Thoracotomy without Cardiopulmonary Bypass / 日本心臓血管外科学会雑誌

We report two cases the first was a 74-year-old woman who had received coronary artery bypass grafting [SVG-to-LAD, SVG-to-Cx, SVG-to-RCA, the left internal thoracic artery (LITA) was mobilized but was unsuitable for the graft] two years previously. Postoperative angiography revealed graft occlusion. Since repeated catheter intervention was not successful, reoperation was performed. A MIDCAB procedure with radial artery graft and proximal anastomosis was performed on the left axillary artery. The operation was successful and there were no complications. Two weeks after the operation, the graft patency was confirmed and she was discharged. The second case was a 64-year-old man who received coronary artery grafting (LITA-to-LAD, SVG-to-Cx and SVG-to-RCA). Two months after the operation, recurrent chest pain was caused by severe stenosis of the LITA anastomotic site. Percutaneous transluminal coronary angioplasty was performed but was unsuccessful. He received redo CABG in the same manner using the saphenous vein. The postoperative course was uneventful and he was discharged 6 days after the operation. This procedure is useful for the patients whose left internal thoracic artery has been used on a previous operation. Good early results were obtained in both patients.

A Combination of a Modification of Bentall's Procedure, the Elephant Trunk Method and Aortic Arch Replacement for Marfan's Syndrume Using Cardioplegia / 日本心臓血管外科学会雑誌

A 44-year-old woman with Marfan's syndrome presented complaining of severe back pain. Angiography revealed annulo aortic ectasia, aortic regurgitation, acute aoric dissection (DeBakey IIIb) and distal aortic arch aneurysm. One month after admission, she underwent cardiopulmonary bypass was established through the femoral artery, the superior and inferior vena cava. The heart was arrested by aortic cross clamping and retrograde cold (20°C) cardioplegia. At first, a modified Bentall's procedure was done in addition to a Carrel patch procedure. After this procedure, the heart was perfused continuously (300ml/min) with warm (37°C) blood until the end of the cardiopulmonary bypass. The heart recovered a sinus rhythm spontaneously. Subsequently, aortic arch replacement and the elephant trunk method was done with the aid of deep hypothermia and circulatory arrest. The patients is well 1 year after the operation. This technique is useful for patients who require prolonged aortic cross clamping time.

Left Ventricular Shape and Regional Wall Motion in Relation to the Prognosis of Ischemic Mitral Regurgitation / 日本心臓血管外科学会雑誌

Ischemic mitral regurgitation (IMR) is a serious and increasingly common clinical disorder, but at present, the relationship between left ventricular shape and IMR is not completely understood. Thirty patients with moderate or severe IMR who underwent mitral valve surgery combined with coronary artery bypass grafting were studied retrospectively. Left ventricular shape, left ventricular regional wall motion, hemodynamic index, condition of the coronary artery, severity of IMR and long term results were assessed using ventriculography and angiography. Left ventricular shape at end diastole and end systole were quantified based upon the ratio of the major-to-minor axis and the sphericity index. Hospital mortality rate was 13.3%, 5 years survival rates were 10.5%, and 5-year rate of freedom from congestive heart failure (CHF) were 7.8%. Significant difference between cardiac deaths (<i>n</i>=11) and survivors (<i>n</i>=19) included requiring intensive care admission, requiring intra-aortic balloon pumping, recurrent myocardial infarction, the ratio of the major-minor axis at end diastole, the sphericity index at diastole, and the sphericity index at end systole. Multivariable regression analyses were performed with the Cox proportional hazards model. Significant determinants of survival were the sphericity index at end systole and LV regional wall motion at the site of the anterobasal segment or apex. These findings indicate that the shape of the LV and LV regional wall motion in IMR may be important determinants of prognosis and suggest that surgical attention to shape may be helpful for mitral valve surgery.

Surgical Strategy for the Treatment of Concomitant Abdominal Aortic Aneurysm and Gastrointestinal Malignancy / 日本心臓血管外科学会雑誌

There are various problems associated with the surgical management of concomitant abdominal aortic aneurysm (AAA) and gastrointestinal malignancy. Our surgical strategy for the treatment of concomitant AAA and gastrointestinal malignant diseases, with the exception of colorectal diseases is basically a one-stage operation. This report reviews 6 cases involving concomitant AAA and gastrointestinal malignancy (colon cancer in 3 cases, gastric cancer in 2 and hepatoma in one). In 2 cases involving gastric cancer, we selected a one-stage operation for the coexistent AAA and gastrointestinal malignancy. The postoperative courses were uneventful. In a 69-yearold man with concomitant AAA, hepatoma and ischemic heart disease, a hepatectomy and coronary revascularization preceded AAA repair because the AAA diameter was too small. AAA repair was performed after 4 months when its diameter had been enlarged. In one of the 3 cases involving concomitant AAA and colon cancer, the malignancy was resected first and the patient died of recurrence 7 months after the operation and prior to the operation for AAA. In the second case of colon cancer, AAA repair preceded the resection of the malignancy. A right hemicolectomy was performed 53 days after the AAA operation. The third case had a one-stage operation for coexistent AAA and colon cancer. His postoperative course was uneventful. In this case, we took particular care to avoid graft infection. The 5 cases that underwent both operations have survived without major complications or evidence of recurrence during a follow-up period ranging from 2 months to 4 years.

Lipoprotein(a) in the Abdominal Aortic Aneurysmal Wall / 日本心臓血管外科学会雑誌

Lipoprotein(a) [Lp(a)] has been considered as an independent risk factor for arteriosclerotic diseases. With an anticipation that Lp(a) would also serve as a risk factor for abdominal aortic aneurysms (AAA), we analyzed serum and tissue Lp(a) levels of patients with AAA in relation to those in healthy individuals. Serum Lp(a) levels were significantly higher in the AAA group (53.2±60.8mg/dl) than in the healthy controls (14.6±13.6mg/d) (<i>p</i><0.001). The Lp(a) level in the aneurysmal wall of patients with AAA was 49.8±38.2ng/mg. There was a significant correlation between serum and aneurysmal wall Lp(a) levels in AAA patients (<i>r</i>²=0.79, <i>p</i><0.01). Immunohistochemical examination revealed Lp(a) in the extracellular matrix of the middle layer of the tunica intima, but not in the tunica media or externa.

Surgical Repair of Dissecting Aortic Aneurysms(DeBakey IIIb) Presenting with Visceral Perfusion from the False Lumen / 日本心臓血管外科学会雑誌

We reviewed our experience with 4 cases of chronic dissecting aortic aneurysm (DeBakey IIIb) with the false lumen extending into the abdominal aorta and major branches being perfused from the false lumen. In such cases, resection of the intrathoracic portion of the aneurysm and closing of the distral false lumen may exclude visceral perfusion from the false lumen. In order to ensure continued perfusion of true and false lumens after repair, we performed “double barrel” anastomosis for distal anastomosis in graft replacement of the descending aorta. Follow-up periods ranged from 8 to 21 months, 17 months on average. Postoperatively, neither apparent expansion of the false lumen nor compression of the true lumen was found in these cases. The advantage of this procedure is the effective restoration of visceral perfusion. We emphasize that this procedure is one of the choices of procedures, as a two-staged approach for chronic aortic dissection presenting with visceral perfusion from the false lumen and without an enlarged abdominal aorta, though more patients and longer follow-up are required to fully evaluate this procedure.