ABSTRACT
BACKGROUND@#Although fat accumulation in human organs is associated with a variety of diseases, there is little evidence about the effect of a fatty pancreas on the development of subclinical chronic pancreatitis over the clinical course.@*METHODS@#We conducted a prospective cohort study from 2008 to 2014 of patients who underwent a medical checkup consultation for fat accumulated in the pancreas. Patients included in the analysis were divided into a non-fatty pancreas group (n = 9710) and fatty pancreas group (n = 223). The primary end point was the odds ratio (OR) for chronic pancreatitis associated with fatty pancreas, which was diagnosed using ultrasonography. We used a multiple logistic regression model to estimate the OR and the corresponding 95% confidence interval (CI).@*RESULTS@#Ninety-two people were diagnosed with chronic pancreatitis, including both presumptive and definitive diagnoses. Twelve people were diagnosed with chronic pancreatitis by ultrasonography among the 223 patients with fatty pancreas, and 80 patients among 9710 were diagnosed with non-fatty pancreas. The crude OR was 6.85 (95% CI 3.68, 12.75), and the multiple adjusted OR was 3.96 (95% CI 2.04, 7.66).@*CONCLUSIONS@#Fat accumulation in the pancreas could be a risk factor for developing subclinical chronic pancreatitis.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Adipose Tissue , Diagnostic Imaging , Pathology , Alcohol Drinking , Epidemiology , Japan , Epidemiology , Life Style , Logistic Models , Pancreas , Diagnostic Imaging , Pathology , Pancreatitis, Chronic , Diagnosis , Epidemiology , Physical Examination , Prospective Studies , Risk Factors , Smoking , EpidemiologyABSTRACT
Between 1987 and 2002, 22 internal iliac artery aneurysms in 14 patients were repaired. In 13 we performed aneurysm excision or reconstruction. There were 3 cases in which simple proximal ligation of the internal iliac artery was performed; in 2 of these CT scans confirmed that the reduction of the internal iliac artery aneurysms was not recognized, but blood flow was not shown in the aneurysm. However, 6 years postoperatively 1 patient was confirmed with an expansion of the aneurysm, and blood flow was seen on a CT scan. In the 2 latest patients, the blood pressure of the internal iliac artery was measured before and after proximal clamping of the internal iliac artery, but the blood pressure of aneurysms could not be fully lowered by proximal ligation of the internal iliac artery. Therefore, endoaneurysmorrhaphy seemed to be the operative method of choice for treatment of the internal iliac artery aneurysms.
ABSTRACT
A 72-year-old man suffering from congestive heart failure, swelling of the lower limbs and hematuria was transferred from another hospital with a diagnosis of large aneurysms of the abdominal aorta and the left common iliac artery. Iliac arteriovenous fistula (AVF) was definitively diagnosed preoperatively by contrast-enhanced CT and angiogaphy. At operation, an infrarenal abdominal aortic aneurysm of 8cm and left iliac arterial aneurysm of 12cm were identified. After proximal and distal aortic clamping, the aneurysm was entered and an AVF orifice of 1cm communicating with the left common iliac vein was disclosed at the right posterior wall of the left common iliac artery. Venous blood reflux was controlled by inserting an occlusive balloon catheter to the fistula and intraoperative shed blood was aspirated and returned by an autotransfusion system. The AVF was closed from inside the iliac aneurysm by three interrupted 3-0 monofilament mattress sutures with pledgets. The aneurysms were resected and replaced with a bifurcated Dacron prosthetic graft. The patient had an uncomplicated postoperative recovery; the lower limb edema subsided and heart failure improved rapidly. Preoperative identification of the location of the AVF is mandatory to make surgery safe. Moreover, easy availability or routine use of the devices for controlling undue blood loss such as an autotransfusion system and an occlusive balloon catheter are other important supplementary means to obtain good results of surgical treatment.
ABSTRACT
A 63-year-old woman underwent coronary artery bypass grafting and mitral annuloplasty 4 years previously. She was readmitted owing to heart failure. Cardiac catheterization revealed worsened mitral regurgitation, although the internal thoracic artery (ITA) graft had good patency. Reoperation was performed by median resternotomy and continuous retrograde cardioplegia without clamping the ITA graft. The mitral valve had a perforation in the anterior leaflet, and was replaced by a 29mm Carbo-Medicus valve. The patient was discharged with transient myocardial ischemia. Although median resternotomy and continuous retrograde cardioplegia at reoperation provided on excellent view and myocardial protection, myocardial ischemia in the region perfused by the ITA graft may occur when the ITA graft cannot be clamped during continuous retrograde cardioplegia.
ABSTRACT
Topical cardiac hypothermia has unequivocal preservation effects during ischemia, but it has some disadvantages. Topical cooling, especially with ice slush, can injure the phrenic nerve, disturb the equal distribution of the cardioplegic solution due to coronary artery spasm and damage the epicardium. It is easy to prevent cooling injury without topical hypothermia, but the myocardial oxygen demands are increased. In order to supply the myocardium with oxygen for the increased oxygen demands during ischemia, isolated rat hearts were immersed in perfluorochemicals (PFC) which have excellent transportation of oxygen. The effects of immersion in PFC during mild hypothermic ischemia (at 20°C without cardioplegia and at 30°C cardioplegic arrest) on the cardiac function on reperfusion were evaluated. Under 20°C hypothermic ischemia without cardioplegia, cardiac beating was maintained for 20±4 minutes in the hearts were immersed in PFC, and for 10±2 minutes in the hearts that were not immersed in any solution. In the recovery of cardiac function (LVDP and LV<sub>max</sub> d<i>p</i>/d<i>t</i>) after mild hypothermic (30°C) cardioplegic arrest, the hearts immersed in PFC showed better results than hearts that were not immersed.
ABSTRACT
A gelatin-sealed knitted Dacron graft which has zero-porosity at implantation and does not require preclotting preparation has been developed. Gelatin-sealed aortic grafts were implanted into 39 patients and vascular surgery reconstruction was performed for thoracic aortic aneurysm (TAA) in 10, abdominal aortic aneurysm (AAA) in 19, and arteriosclerosis obliterans (ASO) and other conditions in 10. A total of 39 bifurcated or straight grafts were inserted. The Gelseal Dacron graft had superior handling characteristics and biocompatibility in comparison to conventional graft. There was no measurable blood loss from the body of the sealed graft at the time of implantation. The gelatin-sealed Dacron graft (<i>n</i>=10) was compared with an Intervascular Micron<sup>®</sup> graft (<i>n</i>=10) implanted into the abdominal aorta. No problems were evident with regard to intraoperative bleeding, allogenic and autologous transfusion volume and blood parameters between the two groups. These results suggested that the Gelseal Dacron graft sealed with gelatin was a safe, zero-porosity implantable prosthesis for clinical use.
ABSTRACT
Twenty six adult patients who underwent prosthetic heart valve replacement and treated anti-thrombogenic therapy, were divided into 2 groups. One was administered Warfarin alone, another was administered Warfarin plus Aspirin (162mg/day) as antiplatelet therapy. Trapidil (300mg/day) was administered to all of the patients. Platelet aggregation, plasma level of TXB<sub>2</sub> (stable metabolite of thromboxane A<sub>2</sub>), and 6-keto-PGF<sub>1</sub> (stable metabolite of PGI<sub>2</sub>) were measured before and 1, 3, 6 months after Trapidil therapy. Platelet aggregability suppressed in both 2 groups. Plasma TXB<sub>2</sub> level, and TXB<sub>2</sub>/6-keto-PGF<sub>1</sub> ratio showed a tendensy to decrease (<i>p</i><0.05) 6 months after administration. In the Aspirin plus Trapidil group, platelet aggregability, serum TXB<sub>2</sub> level, and TXB<sub>2</sub>/6-keto-PGF<sub>1</sub> ratio are significantly lower than that in the Trapidil only. These results suggest that Trapidil is clinically useful for antiplatelet agent, but the combined Aspirin plus Trapidil therapy is more efficacious than the Aspirin or Trapidil single therapy.
ABSTRACT
We have recently experienced a case of impending ruptured aneurysm of the common iliac artery associated with a gelatinous substance in the retroperitoneal space. A 69 year-old male had been diagnosed as a left common iliac aneurysm at another hospital by CTscan during the examination of lower abdominal pain. At the midnight of the day he admitted, the severity of pain gradually intensified. But there was no sign of anemia nor hypotension. Next morning CTscan showed low density left retroperitoneal mass. The patient underwent emergency laparotomy. The further inspection revealed about 600cm<sup>3</sup> of gelatinous substance in left retroperitoneal space without the sign of aneurysmal rupture. A bifurcated graft replacement was performed. The low density mass was not recognized by CTscan done 42 days postoperatively. Electrolyte study of the gelatinous substance indicated its serous leakage through the impending ruptured aneurysm. Our present report constitutes a completely distinct variety of common iliac aneurysm, associated with a gelatinous substance in retroperitoneal space without a major rent of the aneurysmal wall.
ABSTRACT
We have examined the role of readmission of oxygen in the initiation of reperfusion-induced arrhythmias by separating readmission flow from readmission of oxygen on a temporal basis. Isolated rat hearts (<i>n</i>=12/group) were subjected to 10 minutes of global ischemia and reperfusion. In controls reperfused with aerobic perfusion medium, 100% of hearts developed ventricular tachycardia 1.48±0.78 seconds after reperfusion, and ventricular fibrillation occurred 13.47±2.91 seconds after reperfusion. Also in hearts reperfused with anoxic perfusion medium, 100% of hearts developed ventricular tachycardia 1.98±0.96 seconds after reperfusion, and ventricular fibrillation occurred 27.01±18.52 seconds after reperfusion. But the duration of the time from reperfusion to the onset of ventricular fibrillation were statistically differrent in these two groups (<i>p</i><0.05). In conclusion anoxic reperfusion delayed ventricular fibrillation but prevent neither ventricular fibrillation nor ventricular tachycardia. This implies that oxygen-derived free radicals may play an important role in the initiation of reperfusion-induced arrhythmias, but are unneccessary for arrhythmogenesis.