Successful Surgical Repair of Type A Acute Aortic Dissection in a Patient with Vascular Ehlers-Danlos Syndrome.

Surgery for vascular complications of a patient with vascular Ehlers-Danlos syndrome (vEDS) is challenging due to the fragility of the associated tissues. In this study, we present a type A acute aortic dissection case in a patient with vEDS successfully treated via total arch replacement. A 42-year-old woman was transferred to our hospital 10 days after the onset of symptoms and underwent emergency surgery. Intraoperative findings revealed severe inflammatory changes without tissue fragility that is distinctive of vEDS. The postoperative course was uneventful except for left recurrent laryngeal nerve palsy, and 24 months after the operation, the patient has remained free from any arterial event.

An anomalous hyperplastic anterior choroidal artery associated with an unruptured internal carotid-posterior communicating artery aneurysm.

The anterior choroidal artery (AChA) injuries can result in severe neurologic deficits, so requiring careful observation to avoid inadvertent damage during neuroendovascular procedures. In this case report, we present the unusual case of an anomalous hyperplastic AChA associated with a fetal-type posterior communicating artery (PCoA), and an unruptured internal carotid artery (ICA) -PCoA aneurysm. A 54-year-old woman presented with persistent headache. Brain magnetic resonance imaging (MRI) showed an unruptured cerebral aneurysm in the right ICA, and cerebral angiography revealed a proximal fetal-type PComA and a distal anomalous hyperplastic AChA. Coil embolization was performed with no neurologic deficits and the target lesion was embolized with a total of 6 coils. An anomalous hyperplastic AchA has a lengthy course with numerous choroidal and perforating branches, and therefore, an abundant perfusion region. Thorough knowledge of the development and anatomy of anomalous arteries is important for safely performing endovascular procedures without causing any ischemic complications.

Influence of preoperative right ventricular function on left ventricular remodeling and survival after subvalvular repair for functional mitral regurgitation.

OBJECTIVES: The objective of this study was to analyze our surgical experiences with mitral valve plasty (MVP) combined with subvalvular procedures (SVPs) for functional mitral regurgitation (FMR) and to determine which preoperative factors affected clinical outcomes. METHODS: This study retrospectively analyzed 33 patients who underwent MVP combined with SVPs for FMR with a left ventricular ejection fraction lower than 40% and advanced remodeled left ventricles. The mean follow-up period was 49 ± 33 months. RESULTS: The preoperative mean right ventricular fractional area change (RVFAC) used to quantify right ventricular (RV) systolic function was 26 ± 11%. Sixteen patients (48%) had an RVFAC < 26%. One patient died during hospital stay, and nine more patients died of cardiac causes during follow-up. The 3- and 5-year rates of freedom from cardiac-related mortality were 78% and 68%, respectively. RVFAC was the significant predictor of cardiac-related mortality in a univariate analysis (risk ratio [RR] = 0.92, 95% confidence interval [CI] 0.85-0.99, p = 0.03) and demonstrated a non-significant tendency to predict cardiac-related mortality in the Cox multivariate analysis (RR = 0.94, 95% CI 0.86-1.003, p = 0.08). Continued reverse left ventricular remodeling was associated with an RVFAC ≥ 26%. At 3 years, there was also a significant difference in survival rates of cardiac-related mortality between patients with an RVFAC ≥ 26% and < 26% (94% vs. 61%; p = 0.03). CONCLUSIONS: Preoperative RV function affected left ventricular remodeling and cardiac-related mortality after MV surgery. MVP combined with SVPs for FMR provided promising results for patients without severe RV dysfunction.

Clinical Outcomes of a Customized Mitral Valve Plasty for Functional Mitral Regurgitation with a Low Ejection Fraction and Implications for Preoperative Right Ventricular Function.

PURPOSE: To evaluate clinical outcomes of customized mitral valve plasty (MVP) for the treatment of functional mitral regurgitation (FMR) with a low ejection fraction (EF) and to determine which preoperative factors affected the clinical outcome. METHODS AND RESULTS: MVP was adjusted according to the degree of left ventricle (LV) remodeling. We performed mitral annuloplasty (MAP) alone in 14 patients and added subvalvular procedures (SVPs) in 22 patients at a high risk of recurrent MR. During follow-up, reverse LV remodeling was obtained and the 3-year and 5-year non-recurrence rates of MR grade ≥2 were 94% and 89%, respectively. Two patients died during their hospital stay, and four more patients died of cardiac causes during follow-up. The 3-year and 5-year rates of freedom from cardiac-related mortality were 86% and 81%, respectively; no significant difference was observed between the two treatment groups. Right ventricular fractional area change (RVFAC) was a significant predictor of cardiac mortality. Patients with an RVFAC of <26% had significantly poorer cardiac-related mortality (71% at 3 years) than those with an RVFAC of ≥26% (95% at 3 years). CONCLUSION: Customized MVP provided durable mitral competence and reverse LV remodeling. Preoperative RV function was associated with cardiac-related mortality.

Successful treatment of left ventricular patch infection by latissimus dorsi muscle flap covering without patch removal.

Removal of the infected prosthesis is considered an essential procedure in the treatment of prosthetic graft infection following cardiovascular surgery. Here, we present a case of left ventricular patch infection following repair of left ventricular rupture that was successfully treated by coverage with a latissimus dorsi muscle flap without patch removal. A 61-year-old man underwent double-patch repair for left ventricular-free wall rupture following posterior myocardial infarction. He underwent drainage and omental transposition with re-sternotomy for postoperative mediastinitis by Candida albicans, followed by pericardial fenestration via left thoracotomy for infectious pericarditis; however, left ventricular patch infection was detected. Considering the high invasiveness of a reoperation for patch removal, we preserved and covered the patch using a left pedicled latissimus dorsi muscle flap via left thoracotomy. The postoperative course was uneventful, and the patient was asymptomatic with no signs of recurrence at 30 months.

Investigation of aluminum and iron deposition on metaplastic bones in three patients with diffuse pulmonary ossification.

Diffuse pulmonary ossification (DPO) is a rare pulmonary lesion. DPO is typically detected at autopsy rather than premortem. Recently, however, several cases were diagnosed antemortem using computed tomography, high-resolution computed tomography, or video-assisted thoracic surgery. In the present study, we evaluated DPO at autopsy from two patients with post-myocardial infarction (cases 1 and 3) and one patient with duodenal cancer (case 2). Multiple metaplastic bones (nodular in case 1 and 3 or dendriform in case 2) were detected in these three cases. In an attempt to detect aluminum and iron deposition in these metaplastic bones, histochemical investigations were performed. The two nodular types of one and three cases were positive for aluminum and iron, but the dendriform type of case 2 was positive only for aluminum. The depositions occurred in a linear pattern along the calcifying front. It is of great interest that these deposition patterns were similar to those of bones from three previously reported DPO cases and from the bones of hemodialysis patients. It is suggested that these abnormal metal depositions in the calcifying front might disturb the normal mineralization processes of the metaplastic bones, although no morphological abnormality was detected, except for dense black color of calcifying front lines. Further investigations are needed in more patients with DPO to obtain more information on this topic.

[Bilateral sensorineural hearing impairment due to Streptococcus suis meningitis 20 days after swine bite].

Streptococcus suis (S. suis) is a zoonotic pathogen in pigs, which can be transmitted to humans by close contact. Meningitis is the most common clinical manifestations of S. suis infection and hearing impairment is a frequent complication. The risk of S. suis meningitis is higher in people who work in the swine industry. The patient was a 53-year-old woman working in the swine industry, who developed headache and fever 20 days after a swine bite. She was diagnosed as meningitis and S. suis was detected in the cerebrospinal fluid. We treated her with ceftriaxone, vancomycin, and dexamethasone, and signs of meningeal irritation diminished three days after admission. However, bilateral sensorineural hearing impairment occurred on the ninth day after admission. We added methylprednisolone (500 mg, 2 days) but moderate hearing impairment remained on the left. Antibiotic therapy should be considered for wounds of people involved in the swine industry for preventing S. suis infection.When S. suis meningitis occurs, symptoms of hearing impairment must be monitored carefully.

Growth temperatures of archaeal communities can be estimated from the guanine-plus-cytosine contents of 16S rRNA gene fragments.

Prokaryote growth temperatures in environmental samples are difficult to measure because it is hard to culture viable prokaryotes in natural environments. We comprehensively surveyed growth temperatures and 16S rRNA sequences of prokaryotes to estimate their growth temperatures based on guanine-plus-cytosine contents (P(GC)) of their 16S rRNA sequences. We focused on archaea because of the wide range of growth temperatures within this group. Their minimum (Tmin), optimum (Topt) and maximum (Tmax) growth temperatures correlated strongly with PGC of their 16S rRNA genes. Linear regression equations were established to approximate Tmin, Topt and Tmax from P(GC). We also established a linear regression equation for calculating P(GC) of 16S rRNA genes based on the melting temperatures (Tm) of PCR fragments, without using a clone library or sequencing. Environmental samples were obtained from a wide variety of microbial natural habitats. Tm of archaeal 16S rRNA genes amplified by real-time PCR were determined by melting curve analysis. Based on those values, P(GC) of 16S rRNA genes and mean Tmin, Topt and Tmax were calculated using the linear regression equations. These temperatures correlated strongly with the in situ temperatures. Tmax agreed particularly well with these temperatures, suggesting many archaea live at their maximum growth temperatures.

In situ biomass production of a hot spring sulfur-turf microbial mat.

Sulfur-turf microbial mats develop in sulfide-containing hot spring water dominated by chemolithoautotrophic sulfur-oxidizing bacteria. The sulfur-turf mat that developed at a source of hot water (72°C, pH 6.8) exhibited a growth rate of 0.48±0.04 h(-1) and biomass production of 4.6±1.0 mg of C h(-1). On a per-cell basis, this biomass production was at least an order of magnitude higher than the CO(2) uptake rate calculated for a photosynthetic mat dominated by thermophilic Synechococcus spp. at 70°C. The sulfur-turf-associated microbial community likely contributes to carbon fixation and primary production in this geothermal habitat.

Biomass production and energy source of thermophiles in a Japanese alkaline geothermal pool.

Microbial biomass production has been measured to investigate the contribution of planktonic bacteria to fluxations in dissolved organic matter in marine and freshwater environments, but little is known about biomass production of thermophiles inhabiting geothermal and hydrothermal regions. The biomass production of thermophiles inhabiting an 85 degrees C geothermal pool was measured by in situ cultivation using diffusion chambers. The thermophiles' growth rates ranged from 0.43 to 0.82 day(-1), similar to those of planktonic bacteria in marine and freshwater habitats. Biomass production was estimated based on cellular carbon content measured directly from the thermophiles inhabiting the geothermal pool, which ranged from 5.0 to 6.1 microg C l(-1) h(-1). This production was 2-75 times higher than that of planktonic bacteria in other habitats, because the cellular carbon content of the thermophiles was much higher. Quantitative PCR and phylogenetic analysis targeting 16S rRNA genes revealed that thermophilic H2-oxidizing bacteria closely related to Calderobacterium and Geothermobacterium were dominant in the geothermal pool. Chemical analysis showed the presence of H2 in gases bubbling from the bottom of the geothermal pool. These results strongly suggested that H2 plays an important role as a primary energy source of thermophiles in the geothermal pool.

[A case of pulmonary carcinomatous lymphangiosis exhibiting multiple patchy opacities, caused by CA 19-9 producing metastatic stomach cancer].

A 64-year-old man was admitted to our hospital complaining of Hugh-Jones II dyspnea. Chest CT showed multiple diffuse patchy shadows in both lung fields. A diagnosis of pulmonary carcinomatous lymphangiosis was made on the basis of the presence of adenocarcinoma cells within the lymphatic vessels in transbronchial lung biopsy (TBLB) specimens. The primary site was a tumor in the stomach. It is very rare for pulmonary carcinomatous lymphangiosis to show multiple patchy shadows in CT. Tumor cells were positive for CA 19-9. There were high titers of carbohydrate antigens, SPAN-1, CA 19-9, SLX, CA 125 and CA 724 both in the bronchial alveolar fluid (BALF) and in the serum. SPAN-1, CA 19-9 and SLX titers were higher in the BALF than in the serum. In this case, liver metastasis had also occurred with carcinomatous lymphangiosis. This case is very interesting in that type I and II carbohydrate antigens were correlated with blood-borne metastasis.