Extra-anatomic bypass graft for management of axillary artery occlusion in pitchers.

OBJECTIVE: Our goal was to evaluate the long-term results of vein bypass grafts for axillary artery occlusion, specifically those placed extra-anatomically to prevent arterial injury in pitchers. METHODS: With the greater saphenous veins used as the selected conduit, arterial bypass grafts were routed anterior to the pectoralis minor muscle in four baseball pitchers who had occlusion of the axillary artery. We performed a follow-up in excess of 10 years with evaluations of the bypass grafts by ultrasonic duplex scan and magnetic resonance angiography. RESULTS: All four pitchers treated in this manner returned to the game and played for several seasons without a recurrence of the arterial injury. Long-term evaluation of the bypass grafts did not reveal any structural or functional disorder. CONCLUSIONS: Axillary artery occlusion in an athlete can be effectively treated with a vein bypass graft placed extra-anatomically, anterior to the pectoralis minor muscle. The greater saphenous vein should be considered the conduit of choice.

A challenging treatment for an ischaemic ulcer in a patient with Buerger's disease: vascular reconstruction and local flap coverage.

An ischaemic heel ulcer in a patient with Buerger's disease was reconstructed using an in situ saphenous vein graft combined with a local flap. The bypass was sufficient to restore blood supply to the ischaemic limb but a flap was necessary to cover the persistent heel ulcer, which remained after revascularisation. One month after bypass surgery the ulcer was debrided and the resulting defect was covered with a lateral supramalleolar flap. The postoperative course was uneventful and the flap donor site healed well. When treating ischaemic ulcers in a patient with Buerger's disease, vascular reconstruction should be considered first in order to salvage the limb. After revascularisation, a local flap can be used to cover a persistent defect but very few local flaps have been reported. This report is the first published case of successful local flap transfer after bypass surgery in a patient with Buerger's disease. We think that a local flap is one possible treatment for a non-healing ulcer after revascularisation.

A novel interstitial deletion of KAL1 in a Japanese family with Kallmann syndrome.

We identified a novel interstitial deletion that spanned from exons 5 to 10 of KAL1 in two Japanese brothers with X-linked Kallmann syndrome (KS; MIM no. 308700). Both brothers had hypogonadism, unilateral renal agenesis, and disturbance of the sense of smell, but they had no other neurological manifestations, including mental disturbance. Their mother was confirmed to be an asymptomatic carrier, by use of a comparative multiplex polymerase chain reaction (PCR) analysis. The present patients are further examples of patients with KS without mental disturbance caused by a mutation confined to KAL1.

Increased theophylline metabolism in the menstrual phase of healthy women.

BACKGROUND: We previously reported on a Japanese woman with premenstrual asthma whose serum theophylline concentration was lower before the onset of her menstrual period. We evaluated the clearance of theophylline in each phase of her menstrual cycle and found an increase in clearance in the premenstrual and menstrual phases. OBJECTIVE: This study was designed to investigate whether changes in theophylline clearance may occur with the menstrual cycle in nonasthmatic women. METHODS: Aminophylline, 250 mg, was infused intravenously for 45 minutes, and the clearance of theophylline was calculated in seven healthy, ovulatory women on days 1 or 2, 10, and 20 or 25 of the menstrual cycle. The serum concentration of theophylline was determined with an enzyme immunoassay (homogeneous). RESULTS: Theophylline clearance was significantly higher and its half-life was significantly shorter in the menstrual phase than in the follicular phase. CONCLUSION: The metabolism of theophylline, and consequently, its clearance were increased in healthy women around the onset of menses. Clinicians must therefore consider the menstrual variation in theophylline metabolism when prescribing this drug to female patients.

[Respiratory function in students who had asthma in childhood].

Students who had asthma in childhood can be divided into three groups: "asthma-remission" group "asthma-relapsing" group and "non-asthma-remission" group. When we made inquiries about three different groups, the incidence of each group was 58%, 27% and 15%, respectively. In order to determine if childhood asthma affects respiratory function in adulthood, we measured respiratory functions by spirometry in 26 students who had asthma in childhood, and in seven control students. There was no significant difference between students with childhood asthma and control students in terms of FEV1.0% of predicted value. However, students who had asthma in childhood had lower levels of V25/HT% of predicted value in comparison with control students. The effects of deep inhalation in the three groups were evaluated by determining the values of maximal expiratory flow at 40% (MEF40) of vital capacity from partial (P) and maximal (M) flow-volume curves. There was no difference between the remission group and the control group in the MEF40 M/P ratio. This suggests that childhood asthma may deteriorate respiratory functions in adulthood by remodeling of peripheral airways.

[Two cases of solid and cystic tumor of the pancreas (including one case of MRI)].

Solid and cystic tumor of pancreas is an uncommon neoplasm which is histologically low grade malignant but amenable to cure by surgical excision. It tends to occur in young women. US and CT depict a well circumscribed mass that can be solid, mixed solid and cystic and largely cystic. Their ratio depends on the degree of hemorrhage and necrosis. Angiography shows a mildly to moderately vascular mass which corresponds to solid parts. MRI is useful to detect the hemorrhage which is common in this tumor.

[In vitro antibacterial activity and pharmacokinetics of ofloxacin in chronic respiratory tract infections].

Serum and sputum levels of ofloxacin (OFLX) were measured in 5 patients with chronic respiratory tract infections and were compared with antibacterial activity in vitro. Sputum OFLX levels higher than the MIC's against H. influenzae and K. pneumoniae were maintained during the period when daily oral administrations were continued. The MIC70 of OFLX against S. aureus was under 0.78 microgram/ml and the MIC70 of OFLX against P. aeruginosa was 1.56 micrograms/ml. The maximum OFLX levels in sputum were higher than these MIC's during the period when 200-300 mg X 2 times/day oral administrations were maintained. From these results, OFLX was considered to be effective and useful for the treatment of patients with chronic respiratory tract infections.

Bleeding esophageal varices caused by Graves' hypervascular cervical goiter.

A 65-year-old woman presented with an episode of hematemesis and a recurrent cervical goiter due to Graves' disease. The angiogram revealed bleeding esophageal varices which had developed through a drainage vein of the vascular goiter. Total thyroidectomy resulted in eradication of the esophageal varices.

Suppressive effect of elcatonin, an eel calcitonin analogue, on excessive urinary hydroxyproline excretion in polyostotic fibrous dysplasia (McCune-Albright's syndrome).

A 12-year-old Japanese girl with polyostotic fibrous dysplasia and endocrine concomitants, was treated with elcatonin, a synthetic eel calcitonin analogue, 10 MRC unit/twice a week given by intramuscular injection. Significant decreases in 24 hr urinary content of hydroxyproline and other amino acids from bone collagen were observed during the course of treatment over 5 months. This biochemical result suggests that the synthetic eel calcitonin analogue exhibits the therapeutic effect in patients with polyostotic fibrous dysplasia by inhibiting bone resorption.