Histological evaluation of alveolar ridge augmentation using injectable calcium phosphate bone cement in dogs.

Alveolar ridge augmentation is an important procedure to restore tooth loss. Several types of graft materials have been used for augmenting the alveolar ridge. An injectable calcium phosphate cement (CPC) has been applied to periodontal bone defects and has shown favourable results. Thus, this CPC may work as an effective graft material for alveolar ridge augmentation. The aim of this study was to evaluate the effectiveness of the CPC for large-scaled (about 7 x 8 x 6 mm) ridge augmentation in dogs. Alveolar ridge defects were created bilaterally in the maxilla of six beagle dogs. The CPC was applied to one of the bilateral maxillary defects. The untreated defect on the contralateral side served as control. The animals were sacrificed at 6 months after surgery and decalcified histological specimens of the alveolar ridge were prepared histometrically and evaluated under a light microscope. Newly formed and reconstructed alveolar ridges covering the CPC were observed in all experimental sites. In the control sites, only slight newly bone formation was observed. Histomorphometrical analysis indicated that the CPC grafted group exhibited significantly (P = 0.0001) increased area and height in new bone formation compared with those of the control group. The results indicate that the CPC appears to be an effective material for alveolar ridge augmentation and may act as a space maintainer to conduct new bone formation.

Effect of rhBMP-2 with PLGA/gelatin sponge type (PGS) carrier on alveolar ridge augmentation in dogs.

Recombinant human bone morphogenetic protein-2 has been shown to promote bone formation because of its osteoinductive property. The purpose of this study was to evaluate the efficacy of rhBMP-2 delivered on a poly (D, L-lactic-co-glycolic acid) copolymer/gelatin sponge (PGS) in vertical alveolar ridge augmentation on height-reduced edentulous mandible to verify the retention of rhBMP-2 withstanding the pressure of soft tissues. Coronal defects of the alveolar bone were created in six adult beagle dogs. After a healing period of 9 weeks, PGSs with or without rhBMP-2 (0 or 0.4 mg mL(-1)) were implanted on the defects(6 mm in height, 30 mm in length, 8 mm in width). Sixteen weeks after implantation, the bone mineral content (BMC) and the total bone area were measured by peripheral quantitative computed tomography. The BMC and the total bone area of the defect sites with rhBMP-2 group were significantly greater (133+/-33 mg mm(-1), 277+/-54 mm2, respectively) than those of the control group (80+/-19 mg mm(-1), 155+/-49 mm2, respectively) (P<0.01, P<0.0001, respectively; paired t-test). From the histological analyses, the height of newly formed bone in the experimental group was greater than that of the control group (4.3+/-0.9 mm, 0.22+/-0.28 mm, P<0.0001, n=6, paired t-test). These results indicate that PGS has characteristics of effective bone graft substitutes for implantation of rhBMP-2 on vertical alveolar ridge augmentation in huge defect of mandibles in dogs.

[Successful second stage operations for bilateral giant bullae with cardiovascular disease by thoracotomy and thoracoscopic surgery: a case report].

A 65-year-old male was admitted to our hospital because of bilateral giant bullae and right side pneumothorax. He had had a myocardial infarction and had been receiving medications. Considering his age, ischemic heart disease and hypertension, we excised the bullae in two operations. The first operation was open chest bullectomy of a giant bulla and small bulla on the right side. After this procedure, his clinical course was uneventful. In the second operation, thoracoscopic excision of the left side giant bulla was performed using only one endoscopic stapler by rotating each side of the bulla and making a clear excision line between the bulla and normal lung. His post operative course was excellent and he was discharged from our hospital on the 15th day after the second operation.

[Immediate surgical treatment for the traumatic pulmonary pseudocyst: a case report].

Nonpenetrating blunt trauma causing pulmonary pseudocyst is very rare. A 25-year-old young male suffered from motor vehicle accident. He was transferred to our hospital with severe hemoptysis. Immediately he was intubated and kept under mechanical ventilation. A chest X-ray film and CT-scan revealed a marked cavity lesion surrounded by an extensive infiltrate and alveolar air consolidation. Ordinary, it has benign clinical courses by conservative management. However, he was suffered massive and continuous bleeding from endobronchial tube. Therefore, one lung ventilation using a uni-vent tube blocker was performed. After twelve hours blockade, the cavity lesion was enlarged and trans-bronchial bleeding was continued severely. Emergency right lower lobectomy was carried out successfully.

Recurrence of cystic adventitial disease in an interposed vein graft.

A case of cystic adventitial disease (CAD) of the popliteal artery with intermittent claudication in the left calf is reported. This patient was first treated by total excision of the cyst and the involved artery followed by graft interposition with an autogenous saphenous vein. Recurrence of CAD in the interposed vein graft was noted after 6 months, and excision of the cyst with the involved graft and graft interposition with an autogenous saphenous vein was again required. We consider that the definitive evidence from early recurrence in the interposed vein graft shown in this case will close the discussion of the cause of CAD. The cystic lesion is thought by some to originate from the adventitia; traumatic, embryologic, or systemic abnormality theories were proposed. We assume that the mucin-secreting synovial cells originating from the neighboring joint capsule, tendon sheath, or, in some cases, from the ganglion itself, directly invade the adventitia through any rough or injured crack caused by trauma to the adventitia or simply attach to and encircle the adventitia. Total resection of the lesion with grafting is the recommended treatment for CAD because of the excellent results. However, as shown in our case, complete removal of the synovial cells even by resection technique may be difficult; therefore intensive follow-up is fundamentally necessary in this disease.

[Atresia of the right coronary ostium associated with annulo-aortic ectasia--a case of successful surgical repair].

A case of a 51-year-old male with atresia of the right coronary artery and annulo-aortic ectasia is described. He presented with heart failure and underwent open-heart surgery. Preoperative aortography did not show the ostium of the right coronary artery. At surgery the right coronary ostium was not found on the intimal surface of the aneurismal aortic wall. A fine cord was attached to the adventitial surface of the anterior aortic root. A modified Bentall's procedure was performed to reconstruct the left coronary artery alone. The post-operative course was uneventful. It is speculated that the hypoplastic ostium of the right coronary artery was pulled up and formed a flap-like closure with increased expansion of the aorta.

Evaluation of intravascular hemolysis by haptoglobin administration after prosthetic valve replacement.

Although the measurement of serum haptoglobin (S-Hp) is of great use for evaluation of intravascular hemolysis, it is not applicable in patients with mechanical prosthetic valves because S-Hp is virtually absent. We administered haptoglobin preparation to 10 patients with Björk-Shiley mitral prosthetic valves and 10 patients with the same aortic prosthetic valves. Serum haptoglobin levels were measured periodically afterwards. The maximum haptoglobin levels (Hp (max)), serum, haptoglobin reducing rate ((Hp-delta Hp)/delta t) and expected haptoglobin disappearing time (hours) were obtained from the subsequent samples. The screening studies which were performed at the same time were not predictors of difference in the 2 groups. On the other hand, serum haptoglobin reducing rate and expected haptoglobin disappearing time indicated that hemolysis is higher in patients with an aortic prosthetic valve than with a mitral prosthetic valve. This haptoglobin administration test seems to be useful for the comparative examination of the intravascular hemolysis caused by the difference in the position of the prosthetic valve.

[Acute aortic dissection in a patient with Marfan's syndrome and severe pectus excavatum--emergency surgical repairs of ascending aortic dissection and aortic regurgitation complicated by pectus excavatum in Marfan's syndrome].

A case of acute aortic dissection Stanford Type A occurring in a patient with Marfan's syndrome, complicated with aortic regurgitation and severe pectus excavatum, is reported with successful surgical correction. The patient was a 33-year-old woman, who suffered from severe back pain riding to work. An emergency operation consisting of Cabrol's procedure for aortic dissection Stanford Type A and sternal turnover for pectus excavatum was performed simultaneously. Because of the postoperative mediastinal bleeding the implanted sterno-costal complex was removed on the second POD and the prosthetic sternum was reimplanted on the tenth POD. The two-stage operation seems preferable in such an emergency case to avoid postoperative bleeding and infection.

[A case of acute dissecting aneurysm associated with AAE (annuloaortic ectasia) necessitating coronary bypass surgery].

We report a successful surgical treatment of acute dissecting aneurysm of the ascending aorta associated with annuloaortic ectasia. The patient was a 29-year-old male, who was admitted to the hospital 5 hours after the onset of anterior chest pain. Aortography revealed acute dissection of the ascending aorta (DeBakery type I) with AAE. The intimal tear surrounding the right coronary ostium was found. The procedure between the right coronary artery and aorta (replaced artificial graft) using saphenous vein graft was also required in addition to Bentall's operation. Postoperative studies revealed disappearance of the dissection, patency of the bypass graft. The postoperative course was uneventful and the patient is in active life two years after operation.

[A case of quadricuspid aortic valve associated with coronary arterial legion].

A case of quadricuspid aortic valve is reported in a patient with coronary artery disease and abdominal aortic aneurysms. A 54-year-old male who had undergone aortic replacement because of abdominal aortic aneurysms three years before presentation was readmitted due to complaints of angina pectoris and palpitations. Aortography and coronary arteriography revealed severe aortic regurgitation and proximal occlusion of LAD and RCA. Surgical correction consisted of aortic valve replacement with a Björk-Shilely valve and coronary revascularization of LAD. During the operation, a quadricuspid aortic valve with one smaller and three larger cusps that showed mild myxomatous degeneration without dystrophic calcification and normal coronary arterial orifices were noted. Accordingly, severe aortic regurgitation may have resulted from the dysfunction of congenital malformed cusps and acquired sclerotic coronary disease was the main cause of the chest pain.

[Surgical repair of partial anomalous pulmonary venous connection to the coronary sinus--a case report of PAPVC with mitral and tricuspid valve regurgitation in adult].

We have recently performed a successful repair of a total right anomalous pulmonary venous connection to the coronary sinus associated with mitral and tricuspid regurgitation. A 54-year-old female was inaccurately diagnosed as atrial septal defect associated with mitral and tricuspid regurgitation preoperatively. Operation revealed that all the right pulmonary veins connected to the coronary sinus. Mitral regurgitation which might be caused by distortion of the anterior leaflet was repaired by McGoon's technique. A Carpentire-Edwards ring was employed for the tricuspid annuloplasty. Repair of the atrial septal defect was undertaken with a pericardial septation patch which was sutured in place. The roof of the coronary sinus was widened by cutback, so that blood from the pulmonary veins could drain into the left atrium. The postoperative course was uneventful, except for a supraventricular arrhythmia.

Campylobacter fetus infection of abdominal aortic aneurysm.

A 61-year-old man with Campylobacter fetus infection of an abdominal aortic aneurysm treated surgically is presented herein, the fifth survival case reported in the literature. Fever and back pain preceded the enlargement of atherosclerotic abdominal aortic aneurysm. The patient tolerated satisfactorily total excision of the aneurysm followed by axillo-femoral prosthetic bypass. Antibiotic therapy consisted of intravenous infusion of fosfomycin and gentamicin and oral administration of minocycline. The organism cultured from the aneurysmal wall and intraluminal thrombi was identified as Campylobacter fetus from its typical characteristics. It is concluded that this organism should be considered in all cases of infected aneurysm in elderly or debilitated patients.

Disruption of externally supported knitted dacron graft three years after implantation--a case report.

A knitted Dacron velour externally supported prosthesis was broken in two pieces at the supported portion 3 years after femoroposterior tibial bypass grafting. This type of graft problem has never been reported. Details of the clinical course, angiogram, CT scan, and scanning electron micrograph of a portion of the graft are shown. The externally supported Dacron prosthesis broke into two pieces along the broken coil of the middle portion. A possible cause of this failure may have been due to damage of the Dacron fibers in the process of heat fusing the coil. This presentation emphasizes the possibility of this rare externally supported graft complication, and the necessity for careful follow-up not only of the graft patency but also for the mechanical defects of the implanted externally supported Dacron graft itself.

[One stage operation for annulo-aortic ectasia and pectus excavatum caused by Marfan's syndrome].

One stage operation was successfully performed on a 32-year-old man with annulo-aortic ectasia (AAE) and pectus excavatum caused by Marfan's syndrome. In the Bentall's operation for AAE, median sternotomy is usually carried out. In this case it was difficult to obtain a favorable viewing field due to an extremely deformed sternum and significant displacement of the heart into the left thoracic cavity. By removing the sternum en bloc, as a cost-sterno complex, the surgery was performed safely with an excellent operative field. In this surgery combined with the sternal turnover, the amount of intra and post operative bleeding was the same as occurs in other open heart surgeries.

[Replacement of superior vena cava with resection of Hodgkin's disease of the thymus: a case report].

A 31-year-old male was diagnosed to have malignant thymoma with superior vena cava occlusion. At operation, we performed extended resection of tumor and superior vena cava, and replacement with ringed PTFE graft. Histological diagnosis was nodular sclerotic type of Hodgkin's disease of thymus. He received radiation with Liniac and chemotherapy post operatively, and post operative venography revealed graft patent. He is doing well 3 years after surgery.

[A case of supravalvular aortic stenosis treated by Doty's operation].

A 11-year-old boy with supravalvular aortic stenosis was treated by extended aortoplasty (Doty's operation) with excellent results. The extended aortoplasty provided satisfactory relief of aortic stenosis and improved function of the aortic valve.

[A case of systemic origin of an aberrant artery to the basal segments of the left lung].

A thirteen-year-old asymptomatic boy was referred to our hospital because of a cardiac murmur detected on a routine physical examination at school. A plane chest radiography showed increased vascular markings in the left lower field. An Aortogram revealed a large artery arising from the descending aorta and suppling the left posterior basal segment which had no pulmonary arteries. A bronchogram showed no abnormal findings in the bronchial tree. A clinical diagnosis of systemic origin of an aberrant artery to the basal segments of the left lung was made, and left lower lobectomy was performed successfully. We discussed the difference of this anomaly from pulmonary sequestration as well as the surgical procedure.

[Clinical experience of omental pedicle flap for bronchopleural fistula].

We present two patients who underwent the omental pedicle flap method for bronchopleural fistula. The first case was a 61-year-old man who developed empyema with bronchial fistula due to recurrent tuberculosis resisted to chemotherapy. He underwent complete muscle and omental flap closure of empyema space. The second case was a 63-year-old man who underwent pneumonectomy for adenocarcinoma of the lung. About two weeks after the operation, a bronchopleural fistula developed at the bronchial stump. He underwent complete omental flap closure of fistula. They are doing well 18 and 9 months following operation, respectively. The omental pedicle flap method is clinically useful as a closure method for bronchopleural fistula because of excellent blood supply of the omentum.

Spontaneous coronary artery dissection with left ventricular aneurysm--a case report of successful surgical repair.

An aorto-coronary artery bypass operation combined with left ventricular aneurysmectomy was performed successfully in a 56-year-old man who had suffered spontaneous coronary artery dissection with left ventricular aneurysm. It is important to perform myocardial revascularization surgery even if the region for anastomosis is dissected.

[Spontaneous coronary artery dissection with left ventricular aneurysm--a case report of successful surgical repair].

Spontaneous coronary artery dissection is a rare entity. To our knowledge, 86 cases have been reported, and there are 7 operative treatment. The patient was 56 year-old male with a history of the previous myocardial infarction. A selective coronary angiography demonstrated marked dilatation of both coronary arteries. The thin radiolucent lines were shown within the LAD and first diagonal branch as a result of partial separation of the intima. A very large left ventricular myocardial aneurysm was also demonstrated within anteroapical walls, he underwent open heart surgery with left ventricular myocardial aneurysmectomy and aorto-first diagonal branch saphenous vein graft. This present case is the second report which describe a successful surgical treatment for the spontaneous coronary artery dissection with left ventricular aneurysm.