[On-pump Beating Minimally Invasive Cardiac Surgery Valve Plasty for Infective Endocarditis Located in the Tricuspid Valve:Report of a Case].

The patient is a 50-year-old man. He was healthy by nature, had fever in the 38 ℃ range for about a week, blood culture identified methicillin-sensitive Staphylococcus aureus( MSSA), and ultrasoundcardiography(UCG) showed a 10 mm vegetation adherent to the tricuspid valve, which led to the diagnosis of infective endocarditis. The patient was transferred to our hospital for surgery because UCG showed severe tricuspid regurgitation and the vegetation enlarged to 20 mm in size. We resected the posterior apex with vegetation attachment and performed tricuspid valve plasty using the Kay stitches, and the regurgitation disappeared. The patient continued additional antimicrobial therapy and was discharged without any complications at 30 days after operation. Tricuspid valve surgery was considered to be a safe procedure that could be performed at minimally invasive cardiac surgery.

Effect of nadir hematocrit during cardiopulmonary bypass on the early outcomes after surgical repair of acute type A aortic dissection.

OBJECTIVE: Although hemodilution during hypothermic cardiopulmonary bypass (CPB) had been thought to improve microcirculation and reduce blood viscosity, there has been no report investigating the effect of low nadir hematocrit (Hct) values caused by severe hemodilution on the surgical outcomes of patients with acute type A aortic dissection (ATAAD). METHODS: We retrospectively reviewed 112 consecutive patients who emergently underwent emergency surgical repair of ATAAD at our institution. The patients were classified into the high Hct (nadir Hct ≥ 21% during CPB; n = 51) and low Hct (nadir Hct < 21% during CPB; n = 61) groups. After propensity score matching of preoperative characteristics, surgical outcomes were compared between the groups. RESULTS: Although there was no difference in the surgical procedure, longer CPB time and more blood transfusion during surgery were needed in the low Hct group than in the high Hct group. After surgery, estimated glomerular filtration rate was significantly lower (p = .015), lactaic acid was higher (p = .045), and intubation time was longer (p = .018) in the low Hct group than in the high Hct group, although there was no difference in hospital mortality between the groups. The AUC of the nadir Hct during CPB as a prognostic indicator of prolonged postoperative ventilator support was 0.8, with the highest accuracy at 16.7% (sensitivity 88%, specificity 76.9%). In all cohorts, female sex was an independent risk factor for a lower nadir Hct value of <21% during CPB. CONCLUSION: A lower nadir Hct value of <21% during CPB may be associated with postoperative renal dysfunction and prolonged ventilator support in patients with ATAAD.

Aortic Agatston score correlates with the progression of acute type A aortic dissection.

Aortic calcification in the tunica media is correlated with aortic stiffness, elastin degradation, and wall shear stress. The study aim was to determine if aortic calcifications influence disease progression in patients with acute type A aortic dissection (ATAAD). We retrospectively reviewed a total of 103 consecutive patients who had undergone surgery for ATAAD at our institution between January 2009 and December 2019. Of these, 85 patients who had preoperatively undergone plain computed tomography angiography (CTA) for evaluation of their aortic calcification were included. Moreover, we assessed the progression of aortic dissection after surgery via postoperative CTA. Using a classification and regression tree to identify aortic Agatston score thresholds predictive of disease progression, the patients were classified into high-score (Agatston score ≥ 3344; n  =   36) and low-score (<3344; n  =   49) groups. Correlations between aortic Agatston scores and CTA variables were assessed. Higher aortic Agatston scores were significantly correlated with the smaller distal extent of aortic dissection (p < 0.001), larger true lumen areas of the ascending (p  =  0.009) and descending aorta (p =   0.002), and smaller false lumen areas of the descending aorta (p =  0.028). Patients in the high-score group were more likely to have DeBakey type II dissection (p =  0.001) and false lumen thrombosis (p  =  0.027) than those in the low-score group, thereby confirming the correlations. Aortic dissection in the high-score group was significantly less distally extended (p < 0.001). A higher aortic Agatston score correlates with the larger true lumen area of the ascending and descending aorta and the less distal progression of aortic dissection in patients with ATAAD. Interestingly, the findings before and after surgery were consistent. Hence, aortic Agatston scores are associated with aortic dissection progression and may help predict postoperative residual dissected aorta remodeling.

Emission properties and Cu(i)-Cu(i) interaction in 2-coordinate dicopper(i)-bis(N-heterocyclic)carbene complexes.

The synthesis, characterization, and emission properties of 2-coordinate dicopper(i) complexes bearing two trimethylene-bridged bis-NHC ligands, [Cu2(L3Me)2](PF6)2 (1), [Cu2(L3Et)2](PF6)2 (2), [Cu2(L3Bu)2](PF6)2 (3), [Cu2(L3MeOPh)2](PF6)2 (4) and [Cu2(L3Mes)2](PF6)2 (5), where L3R denotes trimethylene-bridged bis(N-heterocyclic)carbene (NHC) ligand substituted by two R groups at the nitrogen atoms of NHC, have been investigated. The quantum yield, Φ, and the lifetime, τ, of the emission of 2, are 0.21 and 25 µs, respectively in methanol, which is a well-known solvent for quenching the luminescence of many copper(i) complexes. The 8-shaped geometry of the dicopper(i) complexes brings a considerable copper(i)-copper(i) interaction which affects the luminescent properties. Additionally, we find that methoxyphenyl and mesityl groups substituted at the nitrogen atom of the NHC moiety drastically stabilize the bis(NHC) copper(i) complexes even in air-saturated acetone-d6.

[PREPUBERTAL MATURE TERATOMA OF THE TESTIS MASQUERADING OF A SIMPLE CYST OF THE TESTIS].

A 6-month-old boy was referred to our hospital with left scrotal swelling. Scrotal ultrasound examination revealed a 2 cm cystic mass without solid component in left testicular parenchyma. Serum AFP, hCG and LDH levels were within normal limits. Although we suspected a simple cyst of the testis or a benign testicular tumor, the left testicle was explored via an inguinal incision in case of malignancy. Since intraoperative frozen section revealed benign, we preserved the remaining testis. The wall of cystic mass had a small solid lesion. The definitive pathological examination of the cyst wall showed mature teratoma including squamous epithelium, glandular epithelium of enteric type and cartilage. At 4 years of follow up, he was free of recurrence without testicular atrophy.

Synthesis of Oligo(spiroketal)s from Naturally Occurring myo-Inositol.

Dehydrating polycondensation of tetraol-type monomers derived from naturally occurring myo-inositol with 1,4-cyclohexanedione formed a series of oligo(spiroketal)s. One of the spiroketals had reactive allyl pendants, which were useful for side-chain modifications via thiol-ene chemistry.

Evaluations for hydronephrosis after the establishment of tubeless cutaneous ureterostomy.

PURPOSE: To investigate hydronephrosis after the establishment of tubeless cutaneous ureterostomy by using our definition of the tubeless condition and our indications for catheter insertion. MATERIALS AND METHODS: Twenty-eight (54 renal units) patients with both establishment of tubeless cutaneous ureterostomy 3 months after surgery and at least 12 months of follow-up were investigated in this study. The 4-grade system was used to evaluate the hydronephrosis. The definition of the tubeless condition in cutaneous ureterostomy was as follows: 1) the catheter stent is not placed in the renal pelvis through the stoma, 2) the grade of hydronephrosis is less than 3, and 3) the kidney is functioning. Indications for catheter insertion after the establishment of tubeless cutaneous ureterostomy were as follows: 1) difficulty in curing acute pyelonephritis by drug treatments, 2) flank pain due to hydronephrosis, or 3) increase in the grade of hydronephrosis. RESULTS: The follow-up period was 12 to 78 months (average, 40.5±22.1 months). After the establishment of tubeless cutaneous ureterostomy, 6 of 54 renal units (11.1%) were eligible for catheter insertion. The catheter insertion was performed in 4 renal units. Another 2 renal units were followed up without intervention, and they gradually became atrophic. The renal functions were preserved in the other 52 renal units. CONCLUSIONS: Our results suggest that our definition of the tubeless condition and our indications for catheter insertion would be useful for the evaluation and management of hydronephrosis after establishment of tubeless cutaneous ureterostomy.

[Psoas abscess after ureteral stent exchange for cutaneous ureterostomy: report of a case].

A 69-year-old man underwent a radical cystectomy and cutaneous ureterostomy for carcinoma in situ of the urinary bladder. The ureteral stents were exchanged for cutaneous ureterostomy 35 days after the operation. The patient suffered from high fever with chills a few hours after the stent exchange, and was readmitted to our hospital. High fever was not improved by treatment with Ceftriaxone for 5 days. Five days after the stent exchange, computed tomography (CT) revealed a right psoas abscess. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in the blood culture. Urine culture showed MRSA, Pseudomonas aeruginosa and Enterococcus faecium. Computed tomography-guided percutaneous catheter drainage and treatment consisting of vancomycin, minocycline and ciprofloxacin were performed for the psoas abscess. This treatment significantly reduced the size of the abscess and high fever was improved. The catheter was removed 22 days after the drainage. However, magnetic resonance imaging revealed a spondylitis at L4 and L5. Therefore, antibiotics treatment was continued for about 3 months. There has been no sign of recurrence of bladder cancer and psoas abscess at 23 months after the operation.

[Incidence and risk factors of early postoperative paralytic ileus after radical cystectomy and cutaneous ureterostomy with a unilateral and parallel stoma].

To identify the incidence and risk factors for developing early postoperative paralytic ileus (POPI) after radical cystectomy and cutaneous ureterostomy with a unilateral and parallel stoma, we retrospectively reviewed 21 patients (mean age 73.0, 19 males and 2 females) with a minimum of 3 months of follow-up. POPI occurred in 4 patients (19.0%), who did not need surgical treatment and the insertion of a nasogastric tube. Age and past history of abdominal surgery influenced the occurrence of POPI. The patients with and without POPI had a mean age of 82.3±7.4 and 70.8±6.3 years old, respectively (p＝0.0025), and 75.0% (3/4) and 11.8% (2/17) of the patients, respectively, had a past history of abdominal surgery (p＝ 0.0276). There were no significant differences between patients with and without POPI in any of the following factors examined : sex, body mass index, American Society of Anesthesiologists score, pT-category, neoadjuvant chemotherapy, preoperative serum levels of hemoglobin, creatinine, total protein, and albumin, operative time, blood loss, transfusion volume, stomal side, postoperative day of ambulation, and removal of epidural anesthesia tube. In conclusion, our results showed that increasing age and a past history of abdominal surgery were significantly associated with the occurrence of POPI after radical cystectomy and cutaneous ureterostomy.

Miliary tuberculosis following transrectal ultrasonography (TRUS)-guided prostate biopsy.

Miliary tuberculosis (TB) after transrectal ultrasonography (TRUS)-guided prostate biopsy is an extremely rare complication. A 75-year-old patient who presented with high fever and cough following TRUS-guided prostate biopsy for his high serum prostate-specific antigen (PSA) level (13.104 ng/ml) was diagnosed with miliary TB after clinical, laboratory, and radiological assessments. Histopathological examination of the prostate revealed TB with acid-fast bacilli. He was treated with chemotherapy for 9 months. The patient is now symptom-free, and his post-treatment PSA level was 5.023 ng/ml. This case is reported to acknowledge the possibility that miliary TB can occur as a complication of prostate biopsy if the patient suffers from prostate TB.

[A case of retroperitoneal schwannoma treated by laparoscopic resection].

We report a case of retroperitoneal schwannoma treated by laparoscopic surgery. A 32-year-old woman presented with a mass in the retroperitoneal space that was incidentally revealed by abdominal echography. Computed tomography and magnetic resonance imaging showed a mass 95 mm in diameter in the retroperitoneal cavity which had a cystic component. With a diagnosis of retroperitoneal tumor, laparoscopic resection was performed. Pathological diagnosis was retroperitoneal benign schwannoma consisting of Antoni A and B types. Our case is the largest retroperitoneal schwannoma tumor which was removed by laparoscopic surgery.