Unilateral Leg Swelling Caused by Common Femoral Vein Compression by a Hip Ganglion Cyst in the Groin.

BACKGROUND: As a rare cause of unilateral leg swelling, extrinsic vein compression caused by intraperitoneal, retroperitoneal, or inguinal lesions has been noted. A rare case of leg swelling as a cause of extrinsic compression of common femoral vein from a ganglion cyst in the groin is presented. CASE PRESENTATION: A 38 year old man was referred with a 3 week history of left leg swelling. Following a radiological diagnosis of common femoral vein compression from a cystic groin mass, he firstly underwent needle aspiration. Although the lesion became somewhat smaller, his left leg was still swollen, and he underwent surgical excision of the lesion 2 days after needle aspiration. Histopathological features of the cystic wall were consistent with those of a ganglion cyst. He was discharged from the hospital with complete improvement of the leg swelling, and has remained free from recurrence 1 year after surgery. CONCLUSION: Femoral vein compression by a ganglion cyst in the groin is a very rare pathology; however, it should be kept in mind in the differential diagnosis of unilateral leg swelling.

Importance of the six angiosomes concept through arterial-arterial connections in CLI.

AIM: We reviewed the importance of six angiosomes concept in the foot area through arterial-arterial connections. METHODS: We retrospectively analyzed 145 limbs from 111 critical limb ischemia (CLI) patients to investigate whether the wound location corresponded with the occlusion of the feeding artery. We also analyzed 57 limbs that underwent endovascular therapy (EVT). Regardless of which target vessel underwent EVT in the calf area, it was considered "direct" if the feeding artery flow in the foot area was achieved and "indirect" if not achieved. The wound healing rate was compared between the direct group and the indirect group relative to the six angiosomes of the foot. Further, we analyzed the absolute difference of the skin perfusion pressure (SPP) values measured before and after EVT. RESULTS: A concordance rate of 82.1% (119/145 limbs) was observed between the wound location and the site of vessel occlusion. The wound healing rate of the six angiosomes-direct group was significantly higher than that of the six angiosomes-indirect group (96.6% vs. 72.7%; P=0.03). The SPP values were significantly higher in the six angiosomes-direct group than those in the six angiosomes-indirect group (20.3±18.1 mmHg vs. 5±14.5 mmHg; P=0.039). CONCLUSION: In the case of the patency of the arterial-arterial connections, even if one undergoes EVT for any of the three vessels in the lower leg, wound healing is likely to be achieved, if we can achieve six angiosome-direct flow.

[Functional diagnosis with color ultrasound in occlusion of peripheral arteries]. / Funktionelle Diagnostik durch farbige Ultraschall-Methode für Verschluss der Peripheralarterien.

In recent years the number of the patients with occlusive disease of the peripheral arteries is increasing also in Japan. For such patients there are many methods to make final diagnosis. Among a lot of methods we have chosen color duplex sonography for functional diagnosis in the patients with occlusive disease of the peripheral artery. During 2 years we have investigated color duplex sonography in addition to digital subtraction arteriography for 40 patients (68 limbs) with occlusive disease of the peripheral artery. First of all waveform of blood flow and the systolic velocities of the dorsal- and the posterior tibial arteries as well as the brachial artery were observed and measured. The blood flow volume and the ratio of systolic velocities and flow volume of lower to upper extremity (AVI, AFI) were measured and their values were also analysed in each patient. These data were compared with Fontaine's classification as a clinical symptom. For the patients with Fontaine class I, or II conservative treatments were carried out, and operative interventions such as bypass graft, or endovascular operation were carefully performed for the patients with Fontaine's class III or IV. Consequently, clinical symptoms and waveforms of systolic flow, and its velocity were remarkably improved by surgical interventions. Thus, color duplex sonography was a useful procedure to make diagnosis and to decide operative indication in the patients with occlusive disease of the peripheral artery.

Ca(2+)-dependent inhibition of inwardly rectifying K(+) channel in opossum kidney cells.

The effect of intracellular Ca(2+) on the activity of the inwardly rectifying ATP-regulated K(+) channel with an inward conductance of about 90 pS was examined by using the patch-clamp technique in opossum kidney proximal tubule (OKP) cells. The activity of the inwardly rectifying K(+) channel rapidly declined with an application of ionomycin (1 microM) in the presence of 10(-6) M Ca(2+) in cell-attached patches. The application of 10 microM phorbor-12-myristate-acetate (PMA) with 10(-6) M Ca(2+) reduced the K(+) channel activity. Although the channel activity was not influenced by an increase of bath Ca(2+) from 10(-7.5) to 10(-6) M, the activity was inhibited by protein kinase C (PKC, 1 U/ml) with 10(-6) M Ca(2+) in inside-out patches. The inhibitory effect of Ca(2+) with ionomycin on the channel activity was diminished by the pretreatment with a specific PKC inhibitor, GF 109203X (5 microM), in cell-attached patches. By contrast, the application of Ca(2+)/calmodulin kinase II (CaMK II, 300 pM) dramatically increased this channel activity in inside-out patches. In cell-attached patches, the addition of both GF 109203X and cyclospolin A (5 microM), a potent inhibitor of protein phosphatase 2B (calcineurin), instead stimulated the K(+) channel activity with ionomycin and 10(-6) M Ca(2+). The addition of protein phosphatase 2B (calcineurin) (2 U/ml) to the bath with calmodulin (1 microM) and Ni(2+) (10 microM) to stimulate calcineurin inhibited the channel activity in inside-out patches. Furthermore, the inhibitory effect of PKC or calcineurin on this channel activity was abolished by a removal of Ca(2+) from bath solution. These results suggest that Ca(2+)-dependent inhibitory effect on the inwardly rectifying K(+) channel in OKP cells was mainly mediated by Ca(2+)-PKC-mediated phosphorylation, and that the Ca(2+)-calmodulin-dependent phosphorylation process may be counterbalanced by the Ca(2+)-calmodulin-dependent dephosphorylation process.

Transvenous embolization for vertebral arteriovenous fistula: report of two cases and technical notes.

BACKGROUND: Vertebral arteriovenous fistulas are relatively rare. Although the common treatment is transarterial embolization, it may be impossible to pass through the fistula (e.g. a microfistula created by a needle puncture). We report two patients with vertebral arteriovenous fistulas due to penetrating trauma who were successfully treated by transvenous embolization. METHOD: We present 2 patients with vertebral arteriovenous fistulas. One patient is presented to demonstrate complications following attempted internal jugular cannulation and the other is presented to demonstrate complications after surgery for a jugular foramen neurinoma. Both patients manifested the sign of a severe bruit. FINDINGS: To identify the fistula point, simultaneous transarterial and transvenous angiography was performed. Using the transvenous approach, microcoils were applied to the fistula and the bruit completely disappeared. Interpretation. Transvenous embolization is a useful technique and a first-choice strategy to treat patients with the vertebral arteriovenous fistula due to penetrating trauma.

Impending rupture in an aortic arch aneurysm by Candida infection.

A 68-year-old man was hospitalized with the complaints of left back pain and fever. He had a history of using steroids to treat uveitis for about thirty years. Computed tomography on the chest demonstrated an impending rupture in an aortic arch aneurysm, which was consequently surgically excised. Candida albicans was identified in the wall of the aneurysm, so fluconazole and itraconazole were administered. The patient was discharged at 120 days after surgery without recrudescence of the candida. To our knowledge, this is the fifteenth case of a successfully treated aneurysm caused by candida infection.

Cleft palate in spondyloepiphyseal dysplasia congenita: case reports.

Cleft palate is one of the common features of spondyloepiphyseal dysplasia congenita (SEDC). However, there are few clinical data about cleft palate in SEDC. We report four patients with cleft palate and SEDC including two with overt cleft palate and two with submucous cleft palate. Our results suggested that SEDC associated with cleft palate should be treated in the same way as solitary cleft palate, and submucous cleft palate may be more common in patients with SEDC than previously appreciated.

Primary osteosarcoma of heart with severe congestive heart failure.

We present a case report on a 54-year-old woman with extraskeletal osteosarcoma of the left atrium featuring severe congestive heart failure. We resected the tumor, which occupied the left atrium and had widely infiltrated the atrial wall, but the patients died of the tumor 9 months after surgery. This is to our knowledge the 32nd case of cardiac osteosarcoma ever reported.

[Combined CABG and valve operation].

We presented 20 patients, who were underwent combined valve and coronary artery bypass surgery in our institute from September 1995 to December 1999. They were 13 male and 7 female, ages ranged from 54 to 79 (mean 67.5 years). Previous cardiac operation was done in 2 cases. The patients carried out a combination of CABG with aortic valve replacement (n = 9), mitral valve replacement (n = 4), mitral valve plasty (n = 6), double valve replacement (n = 1). Emergency operation was performed in 2 cases. The hospital mortality was 5%. One patient who was underwent mitral valve repair and CABG died due to severe heart failure 2 week post operatively. The perioperative complications were found in 2 patients, one was acute renal failure with HD, the other was cerebral infarction. There are no patient with perioperative myocardial infarction. The combined operation of valvular surgery and CABG for the patients with coexisting disease might be safety and reliable methods, even in older one.

A retrospective study of speech development in patients with submucous cleft palate treated by four operations.

Fifty patients with submucous cleft palate (SMCP) who had had four different operations were reviewed. The operations were pushback palatoplasty (n = 18), pharyngeal flap (n = 21), pushback palatoplasty combined with a pharyngeal flap (n = 8), and Furlow palatoplasty (n = 3). Postoperatively the speech of 8, 19, 7, and 2 patients, respectively, improved so that it was within normal limits. A secondary pharyngeal flap was done for six patients, each of whom had previously had a pushback palatoplasty. They all improved, five achieving relatively normal speech, and one good speech. No patient developed hyponasality or airway compromise associated with the pharyngeal flap. The results show that pharyngeal flap and pushback palatoplasty combined with a pharyngeal flap seem to be more reliable procedures than pushback palatoplasty for patients with SMCP.

The outcome of long-term follow-up after palatoplasty.

The speech outcome was studied retrospectively in 140 cleft-palate patients who underwent push-back palatoplasty. Velopharyngeal function and articulation disorders were evaluated serially at 4, 7, 10, and more than 10 years of age. On comparison of velopharyngeal function between 4 years of age and the most recent review (>10 years), it was unchanged in 90 patients (64.3 percent), whereas it showed deterioration in 14 patients and showed improvement in 8 patients. The other 28 patients underwent pharyngeal flap surgery; this group also included patients with functional deterioration. Changes of velopharyngeal function often occurred between 4 and 7 years of age but sometimes occurred after 10 years of age. Articulation disorders were observed in 49 subjects (35.0 percent) at 4 years of age. Many of the patients with glottal stop showed improvement from 4 to 7 years of age. Palatalized articulation showed less improvement than glottal stop (p < 0.01). The number of patients with articulation disorders decreased significantly between 4 years of age and the most recent review (p < 0.001). These findings suggest that speech does not become stable before 10 years of age and that patients with cleft palate should be carefully followed until they are beyond this age.

Carotid rete mirabile presenting subarachnoid haemorrhage. Report Of two cases.

Carotid rete mirabile (CRM) consists of arterial channels between the internal and external carotid arteries in some lower mammals. It is a very rare pathological condition in humans. We report two patients who presented with clinical signs of subarachnoid haemorrhage (SAH). Their sudden-onset SAH was thought to have been due to rupture of cerebral aneurysms, however, angiograms revealed an abnormal vascular network around the cavernous sinus. To our knowledge, 2 of 7 reported patients with CRM presented with SAH, however, only one of these patients had a probable cerebral aneurysm. We suggest that in patients with CRM, the rupture of anastomosing vessels be a probable cause of SAH.

Quantitative assessment of peripheral occlusive arterial diseases by color duplex sonography and blood endothelin level.

UNLABELLED: To evaluate peripheral occlusive diseases quantitatively, we performed color duplex sonography and measured the blood endothelin (ET-1) level. MATERIALS AND METHOD: We measured the systolic velocities of the dorsal pedial and the posterior tibial arteries as well as the brachial artery. We also calculated the flow volume, and the ratio of systolic velocities and flow volume of the lower to upper extremity (AVI, AFI). Furthermore we measured the blood ET-1 level and investigated the relationship between this value and clinical symptoms. RESULTS: The value of AVI as well as AFI decreased in the order of Fontaine class I, II, III and IV. In four limbs with a Fontaine class greater than II with a normal ankle pressure index, the values of AVI were low. On the other hand, three limbs with normal values of peak-AVI (> 0.9) and lower API (< 0.75) were in Fontaine class I. The value of the ET-1 level was higher in Fontaine class III and IV than in class II, and decreased after revascularization along with improvement of clinical symptoms. CONCLUSIONS: The new AVI and AFI values showed a better correlation with clinical symptoms than API. The ET-1 level was significantly higher in Fontaine class III and IV, and showed marked regression after arterial reconstruction. Thus, the new AVI and AFI values may provide a novel means of identifying patients with the peripheral occlusive diseases, and the measurement of ET-1 level may be potentially useful in identifying the severity of arteriosclerosis.

The effect of forskolin on the sound-evoked potentials in the guinea pig cochlea.

The effect of forskolin (FSK) on cochlear sound-evoked potentials was examined in the guinea pig. The perfusion of the scala vestibuli (SV) with FSK (2 x 10(-4) M) produced a significant increase in the amplitude of negative summating potential (- SP) with no change in cochlear microphonics (CM) amplitude, and a significant decrease in the amplitude of compound action potential (CAP) with a significant prolongation of N1 latency and a 20 dB CAP threshold elevation. The results lead us to speculate that FSK-induced changes may be involved in the transient formation of endolymphatic hydrops.

Failure of forskolin to elevate the endocochlear potential in experimental endolymphatic hydrops of the guinea pig.

The effect of forskolin (FSK) on the endocochlear potential (EP) in scala media (SM) was examined in experimental endolymphatic hydrops of the guinea pig. Two weeks after obliteration of the endolymphatic sac the EP of hydroptic ears and that of the contralateral control ears were measured by means of microelectrodes. The perfusion of scala vestibuli (SV) with FSK (200 microM) produced EP elevation in the contralateral control ears but failed to do so in the experimental hydroptic ears. Histological examination of experimental endolymphatic hydrops showed mild hydrops with intact appearance of outer and inner hair cells, and the stria vascularis. The mechanism underlying the failure of FSK to elevate the EP in experimental endolymphatic hydrops is discussed.

Effect of endoplasmic Ca2+-ATPase inhibitors on cochlear potentials in the guinea-pig.

The effect of endoplasmic Ca2+-ATPase inhibitors on cochlear potentials was examined in the guinea-pig. Perilymphatic perfusion with thapsigargin (10[-6] M) produced a significant decrease in the amplitudes of cochlear microphonics, negative summating potential and compound action potential, and a significant prolongation of N1 latency with no change in the endocochlear potential. These changes were all dose dependent. Another endoplasmic Ca2+-ATPase inhibitor, cyclopiazonic acid (10[-5] M), produced the same effects as thapsigargin on cochlear potentials. These results suggest that endoplasmic Ca2+-ATPase inhibitors may have inhibitory functions on cochlear potentials.

Extra-anatomical bypass with EPTFE graft for residual pulmonary artery stenosis in Tetralogy of Fallot.

We describe the case of 35-year old woman who had undergone radical surgery to correct Tetralogy of Fallot malformation at the age of nine admitted to our hospital because of palpitation and exertional dyspnea. Angiography revealed 90% re-stenosis of the right pulmonary artery and grade IV tricuspid regurgitation. Right lung was perfused only 16.7% as shown by pulmonary perfusion scintigraphy. Interposition between the pulmonary trunk and right pulmonary artery using an EPTFE graft and tricuspid annuloplasty using a Duran ring was performed. Blood flow to the right lung improved markedly from 16.7% to 37.0% and her symptom disappeared completely.

Craniofacial morphology of conotruncal anomaly face syndrome.

OBJECTIVE AND DESIGN: The conotruncal anomaly face syndrome (CTAF) comprises congenital heart disease and dysmorphic face, and is frequently associated with cleft palate or hypernasality. There have been many discussions about the overlap with velocardiofacial syndrome (VCF). The aim of this study was to clarify the craniofacial characteristics of CTAF patients by clinical examination, and photogrammetric and cephalometric analyses, and to clarify the differences compared to published data on VCF. RESULTS: The facial features of CTAF included hypertelorism, small palpebral fissures, upward slanting of palpebral fissures, bloated eye lids, low nasal bridge, small mouth, open mouth at rest, and malformed auricles. Cephalometric features included bialveolar protrusion, small gonial angle, backward rotation of the mandibular ramus, and labial inclination of the maxillary incisors. An acute cranial base angle was also noted. These results differed from those of VCF. There were, however, no obvious pathognomonic findings for the differential diagnosis between CTAF and VCF. CONCLUSIONS: Considering these findings, use of CATCH 22, the inclusive classification of cardiac anomalies, cleft palate, and dysmorphic face may be of value for the clinical understanding in these patients.

Leriche syndrome. Surgical procedures and early and late results.

During the past thirteen years, 29 patients underwent surgical intervention for Leriche syndrome. Fifteen patients (aged forty-two to seventy-two years, average 60.7 years) underwent anatomical bypass, and 9 of them whose thrombus was confined to the infrarenal aorta received a routine graft insertion. In the other 6 whose thrombus extended to the level of the renal arteries, an open thrombectomy of the juxtarenal aorta was first performed through a transection of the infrarenal aorta under renal ischemia (4-14 minutes, average 7). Twelve elderly or high-risk patients (aged sixty-eight to eighty-four years, average 75.3 years) underwent an axillobifemoral bypass, and another 2 (fifty-eight and sixty years old, respectively) who had been operated on at an earlier time received an ascending aortobifemoral bypass. In cases of anatomical bypass, no graft has occluded and all patients but 1, who died of cerebral infarction, have an active life now. In cases of extraanatomical bypass, 5 of the 28 grafts occluded and only 6 patients have survived. The other 8 patients died of malignancy, atherosclerotic complications, or unknown causes. The 10-year survival rate was 92.9% and 29.5% in the anatomical bypass and extraanatomical bypass group, respectively. In Leriche syndrome, anatomical bypass is preferred to extraanatomical bypass if conditions permit. In the juxtarenal type, an open thrombectomy under renal ischemia is mandatory for anatomical bypass, and a transection of the infrarenal aorta facilitates this procedure. Because the patients with Leriche syndrome are elderly and harbor arteriosclerotic lesions, a careful follow-up is mandatory.

[Surgical results of coronary artery bypass grafting in patients older than 75 years].

We studied 19 patients, all older than 75 years of age, who had isolated coronary artery bypass grafting (CABG) from January 1990 to December 1996. Clinical characteristics, hospital mortality and long-term survival were compared between this elderly group (> or = 75 years) and a younger group (60-74 years) in which 130 consecutive patients underwent the same procedure during the same period. There were no differences of coronary risk factors, renal function, respiratory function and ejection fraction between the two groups. The incidences of left main trunk stenosis (> or = 50%) and three-vessel-disease were more common in the elderly group, but the difference between the groups was not statistically significant. Preoperative use of an intra-aortic balloon pump was more frequent in the elderly group (p < 0.01). The hospital mortality rate of 31.6% for the elderly group was significantly higher than that of 5.4% for the younger group (p < 0.01). However, of particular note is that the 30-day hospital mortality was half (15.8%) and that three of six (50%) hospital deaths occurred between 35 and 148 days. These patients died from acute respiratory failure subsequent to aspiration pneumonia, ruptured dissecting aortic aneurysm, and ischemic enterocolitis. This difference between the 30-day hospital mortality rate (15.8%) and hospital mortality rate (31.6%) emphasizes the influence that postoperative complications can have on subsequent outcome. Of 136 hospital survivors (123 in the younger group and 13 in the elderly), 98% have been followed for a mean of 32 months. The 4-year survival was 60 +/- 22% for hospital survivors of the elderly group. It compares favorably with that for the younger group (85 +/- 5%), and with previously reported data. We conclude that despite a significantly increased hospital mortality, good long-term survival can be realized after CABG, even in patients older than 75 years.