ABSTRACT
Circulation is required for the delivery of oxygen and nutrition to tissues and organs, as well as waste collection. Therefore, the heart and vessels develop first during embryogenesis.The circulatory system consists of the heart, blood vessels, and blood cells, which originate from the mesoderm. The gene expression pattern required for blood vessel development is predetermined by the hierarchical and sequential regulation of genes for the differentiation of mesodermal cells. Herein, we review how blood vessels form distinctly in different tissues or organs of zebrafish and how vessel formation is universally or tissue-specifically regulated by signal transduction pathways and blood flow. In addition, the unsolved issues of mutual contacts and interplay of circulatory organs during embryogenesis are discussed.
ABSTRACT
Circulation is required for the delivery of oxygen and nutrition to tissues and organs, as well as waste collection. Therefore, the heart and vessels develop first during embryogenesis.The circulatory system consists of the heart, blood vessels, and blood cells, which originate from the mesoderm. The gene expression pattern required for blood vessel development is predetermined by the hierarchical and sequential regulation of genes for the differentiation of mesodermal cells. Herein, we review how blood vessels form distinctly in different tissues or organs of zebrafish and how vessel formation is universally or tissue-specifically regulated by signal transduction pathways and blood flow. In addition, the unsolved issues of mutual contacts and interplay of circulatory organs during embryogenesis are discussed.
ABSTRACT
Paroxysmal atrial fibrillation (pAf) is an arrhythmia that often occurs in the elderly. The quality of life often declines due to severe palpitations caused by pAf. We present a case of recurrent pAf that occurred on postoperative day 2 of coronary artery bypass grafting and pulmonary vein isolation for unstable angina pectoris and pAf. The patient was a 62-year-old man who complained of palpitations, which was consistent with pAf on the monitor ECG. During hospitalization, the patient was constantly wearing an ECG monitor. During pAf, the heart rate was around 120 bpm, and pAf could continue for up to and beyond 24 hours. Paroxysmal atrial fibrillation with strong palpitations was observed every day, even after starting beta-blockers and anticoagulants. After discharge, a Japanese Kampo medicine called shakanzoto was taken for a month, but there was no improvement. After that, it was changed to another Japanese Kampo medicine called saikokaryukotsuboreito, because abdominal examination revealed kyokyokuman (hypochondriac discomfort and distension (resistance)) and saiboki (brisk pulsation in the para-umbilical region). Palpitations quickly improved dramatically. It was speculated that not only palpitations but also pAf had been improved.
ABSTRACT
Background : Fungal mycotic aneurysm is rare ; however, special care and treatment are required for the deep fungal infection itself. Case : The patient was a 69-year-old man with a history of sepsis due to Candida albicans. He suffered from back pain and moderate fever. CT revealed saccular-form aneurysm at the infrarenal abdominal aorta. After emergent in situ bifurcated graft replacement of the infected aneurysm, antifungal treatment was attempted in reference to the antifungal drug sensitivity of C. albicans from intraoperative cultures and findings of fungal endophthalmitis in an ophthalmic examination. After an uneventful acute course, follow up CT images after 12 months postoperatively revealed pseudoaneurysm formation proximal to the site of graft anastomosis. Reoperation was planned with a trans-thoracic and transabdominal approach because of concerns about thoracoabdominal aortic infection. However, the reoperation displayed only inflammatory tissue around the graft and aortic tissue. Removal of the previous graft and reconstruction of the bilateral renal artery, and the pararenal abdominal aorta to the bilateral common iliac artery was performed. Intraoperative tissue cultures revealed no evidence of microorganisms. He returned home with oral antifungal treatment and is doing well at 8 months after the reoperation. Conclusions : Management of fungal mycotic aneurysms requires both surgical treatment and antifungal treatment. Antifungal agents should be selected based on the results of a susceptibility test and after examinations for metastatic comorbidities.
ABSTRACT
A 62-year-old man was referred to our hospital because of dyspnea. Electrocardiogram showed chronic atrial fibrillation and echocardiogram revealed severe tricuspid regurgitation. His history included a motorbike accident at age 17, and a heart murmur was pointed out in the following year. He developed paroxysmal atrial fibrillation when he was 45 years old. Heart failure was not controlled by medication and tricuspid valve repair was indicated. At surgery, the anterior leaflet of tricuspid valve was widely prolapsed due to chordal rupture. We performed chordal reconstruction with 4 expanded polytetrafluoroethylene (CV-5®) sutures, and ring annuloplasty. Furthermore, a small fenestration at the tricuspid annulus was noticed and was closed with a direct suture. The biatrial modified Maze procedure was performed subsequently. The patient is doing well without TR recurrence, and restored sinus rhythm is maintained. We report successful repair of traumatic tricuspid regurgitation.
ABSTRACT
Studies have shown that postoperative disseminated intravascular coagulopathy (DIC) occurs in some patients with cardiac disease, acute aortic dissection, and ruptured abdominal aortic aneurysm. The specific pathophysiology of DIC in these settings are related to low cardiac function, shock, infection and sepsis as well as activation of coagulation cascade in the aneurysm sac or dissected aorta. A soluble form of recombinant human thrombomodulin (rhsTM) was approved in 2008 for the treatment of DIC. This report describes the safety and efficacy of rhsTM for the treatment of DIC in patients with cardiovascular disease operated in our department. Between October 2010 and March 2012, 35 patients with postoperative DIC were treated with rhsTM. Diagnosis of DIC was based on the diagnostic criteria for DIC of the Japanese Association for Acute Medicine (JAAM). During the first 6 months of the study period, after a diagnosis of DIC was made, the patients were treated with gabexate mesilate and antithrombin III, and if patients showed no improvement with conventional treatment, they received rhsTM for 6 days. During the last 10 months of the study period, patients received rhsTM soon after a diagnosis of DIC was made. Twenty seven patients survived for 28 days after rhsTM treatment, and the mortality rate was 22.9% (8/35). Patients who survived showed improvement in acute phase DIC scores, FDP levels, D-Dimer, fibrinogen and platelet counts during rhsTM treatment, but no improvement was observed in patients who died. No serious adverse events were found up to 28 days after the start of rhsTM administration. In conclusion, this study showed no adverse events of rhsTM, and further studies are needed to confirm that rhsTM administration is an effective therapeutic modality in the management of DIC after cardiovascular surgery.
ABSTRACT
This study examined age-related changes in dynamic balance (DB) ability, and the relationship between DB ability and isometric knee extension strength (IKES). Subjects were 100 females who regularly performed some light gymnastic exercises at a gymnastics club once or twice a week. Subject ages ranged from 20 to 85 years old. The measured items were height, body weight (BW), IKES, and DB ability. Results were as follows: 1. The average DB ability tended to gradually decrease as the subjects got older. There were some significant differences in the average DB ability between the 20 to 29 and 60 to 69 age groups, and between the 20 to 29 and over 70 age groups. 2. It was shown that there was a significant negative correlation between age and DB ability (r=0.471, p<0.001). 3. There was a significant negative correlation between age and IKES/BW (r=0.579, p<0.001). 4. It was shown that there was a significant positive correlation between IKES/BW and DB ability (r=0.368, p<0.001). 5. There was a significant negative correlation between BMI and DB ability (r=0.370, p<0.001). This study showed that DB ability rapidly decreased over 60 years old, and also the value tended to be higher in persons with a higher knee extension strength and lower BMI. Therefore, it was suggested that it is important to increase the knee extension strength and maintain an appropriate BMI in order to maintain DB ability.
ABSTRACT
A 73-year-old man was referred to our hospital for treatment of a sacral aneurysm of the distal aortic arch with a maximum dimension of 66 mm. He underwent total arch replacement (TAR) with cardiopulmonary bypass (CPB), moderate hypothermia, circulatory arrest (CA) of the lower body and antegrade selective cerebral perfusion (SCP) via a median sternotomy. Through the aneurysm, the descending aorta was divided and distal anastomosis was performed using the stepwise technique. After the inserted tube graft was extracted, a four-branched arch graft was anastomosed. The arch vessels and the proximal aorta were then anastomosed to the four-branched graft. The operation time was 515 min, CPB time was 305 min, aorta cross clamp (ACC) time was 213 min, SCP time was 143 min, and CA of the lower body was 97 min. On postoperative day (POD) 5, right-upper abdominal pain suddenly developed, with low grade fever. Acute cholecystitis was suspected and antibiotic therapy was started. On POD 6, his abdominal pain shifted to the lower-right region. His blood examination results were unchanged. Acute peritonitis was suggested by abdominal-enhanced computed tomography (CT), and emergency open cholecystectomy was then performed. There was no evidence of gall stones, and a bacterial culture of the ascites was negative. The pathological diagnosis was thromboendarteritis of the gallbladder artery, accompanied with thrombophlebitis and thrombosis, causing massive infarction at the neck of the gallbladder wall. His postoperative course was uneventful and he discharged in an ambulatory state on POD 16. In TAR, the risk of gastrointestinal ischemia is considerable because of prolonged circulatory arrest of the lower body and debris embolism. It is necessary to recognize possible gallbladder infarction, although it is rare, as a differential diagnosis of acute abdomen after TAR.
ABSTRACT
In recent treatment of mitral regurgitation due to active infective endocarditis, significant attempts have been made to repair as much of the mitral valve as possible. In cases where the leaflet is damaged extensively because of infection, valve repair generally becomes difficult unless the defect is reinforced by glutaric aldehyde-preserved autologous pericardium. We report a case in which mitral valve plasty for mitral regurgitation was performed under these circumstances. A 27-year-old man was admitted to our hospital because of headache and persistent fever. Transthoracic echocardiography revealed a 13-mm friable vegetation attached to the anterior leaflet of the mitral valve with severe mitral regurgitation. Urgent surgery was performed based on a diagnosis of active infective endocartitis. After cardiopulmonary bypass was performed and the aorta was cross-clamped, a left atriotomy was carried out on the interatrial groove. Much vegetation was attached to the damaged mitral leaflet from A3 to P3, and prolapse of the commissural leaflet was observed. The vegetation and damaged leaflet were then removed. Removal of the superficial vegetations enabled preservation of more than half of the A3. The valve was repaired by the resection-suture technique without using the autologous pericardium, as glutaric aldehyde solution was not available. Mitral annuloplasty using a 28-mm physio ring was performed thereafter. The postoperative course was uneventful and without any residual regurgitation. Nine months after surgery, no recurrence of infection or mitral regurgitation was not observed.
ABSTRACT
The purpose of this study was to clarify physical characteristics related to low back pain (LBP) in collegiate track and field athletes. We particularly focused on the nature of the track and field. The subjects were 21 male collegiate track and field athletes including only sprinters, hurdlers, long jumpers and triple jumpers. The examined parameters were physical characteristics, isokinetic flexor and extensor strength in the knee and trunk regions. The evaluation of LBP was estimated by a questionnaire test and orthopedic surgeons' diagnosis. According to these evaluations, we divided all track and field athletes into two groups ; LBP group (n＝11, 52.4%) and no LBP group (n＝10, 47.6%). As a result, a take-off leg of knee flexor/extensor strength ratio in the LBP group was significantly lower than that in the no LBP group (<i>P</i>＜0.05). The LBP group showed a significant difference between a take-off leg and a lead leg in knee flexor strength compared with the no LBP group (<i>P</i>＜0.05). The LBP group has been short engaged in the track and field than the no LBP group (<i>P</i>＜0.05). In the trunk flexor and extensor strength, there was no significant difference between the LBP and the no LBP group in this study. These results suggest that the imbalanced knee muscle strength may be one of some factors related to chronic low back pain in collegiate track and field athletes.
ABSTRACT
Case 1 was a 48-year-old mother who was under observation for Marfan syndrome and thoracic aortic dilation. She was brought to the hospital with chest pain, and a CT scan revealed acute aortic dissection (Stanford A). Aortic incompetence was also observed, and an emergency Bentall procedure was performed. Case 2, her daughter, was a 26 years old and 39 weeks pregnant. She did not meet the diagnostic criteria for Marfan syndrome. She experienced severe back pain on the same day that her mother was admitted for aortic dissection. Because the patient did not agree to the use of a contrast agent due to concern about its effect on the fetus, emergency cesarean section was performed. Subsequently, a CT scan performed on the patient showed acute aortic dissection (Stanford B). Accordingly, antihypertensive therapy was commenced. In both cases, the patients were discharged after they recovered. Although case 2 did not meet criteria for Marfan syndrome, because of the hereditary disposition, we strongly suspect this was a Marfan syndrome pregnancy. This type of case is included in the case literature on cesarean and vigilant perinatal care is thought to be necessary.
ABSTRACT
A 67-year-old man had been followed up in our cardiology clinic for ischemic foot, and routine echocardiography revealed an 8×9mm highly echogenic mass on the mitral posterior leaflet. Because of the high thromboembolic risk, open-heart surgery was scheduled for surgical treatment of the tumor. His preoperative coronary angiogram showed 3 vessel disease. Coronary artery bypass grafting and tumor removal were performed consequently. His postoperative course was uneventful and the lesion was pathologically diagnosed a papillary fibroelastoma. No recurrence has occurred one year after the operation. Surgical treatment of cardiac tumors is mandatory for preventing embolism regardless of the size and location. Most of the tumors on cardiac valves are papillary fibroelastomas and recurrence of this tumor has not been reported so far. When the tumor is attached to a mitral leafet, simple tumor resection, with or without mitral valve repair, is justified instead of performing mitral replacement with en bloc resection of tumors and the entire leaflets.
ABSTRACT
This study examined peculiarities in both muscle strength and cross-sectional area (CSA) among soccer players in comparison with those of archers as contrasting athletes. Subjects were 15 male soccer players and 9 male archers at N University. Measurement items were height, body weight (BW), isokinetic muscle strength (knee extension, knee flexion, hip extension, hip flexion) and CSA (psoas muscles). Isokinetic muscle strength (30, 120, 240°/sec.) was measured by Cybex6000 (Lumex Co.), and the psoas muscle CSA was determined using magnetic resonance imaging (Hitachi, Japan). Results were as follows : 1. There was no significant difference in isokinetic knee extension and flexion strength/BW at all angular velocities between soccer players and archers. 2. On isokinetic hip flexion strength/BW, the average values of soccer players were significantly higher at all angular velocities than those of archers. However, there was no significant difference in the average values of isokinetic hip extension strength at all angular velocities between the two groups. 3. The average value for the psoas muscle CSA in soccer players was significantly higher than that of archers. In this study, the biggest difference in muscle strength between soccer players and archers was hip flexion strength, and the CSA of the psoas muscle in soccer players, which is the main component of hip flexion, was significantly larger than that of archers. These findings showed the peculiarity of soccer players due to the constant demands of movements involved in ball kicking and running during practice and competition.
ABSTRACT
The purpose of this study was to examine the effect of two kinds of neck muscle training on the isometric cervical extension strength (ICES) and cross-sectional area (CSA) of the neck extensor muscles.The subjects which were examined consisted of 22 male college judo athletes. Each was assigned to one of three groups: shrug and upright rowing training (SU); shrug, upright rowing and dynamic neck muscle training (COM); and control (CONT). The SU and COM groups trained 3 days per week for 9 weeks. The ICES and CSA of the neck muscles were measured before and after muscle training.The ICES of the COM group showed a significant increase after training. For the CSA, although a significant increase was only found in a superficial area of the neck extensor muscles in the SU group, the COM group showed significant increases in all areas.This study determined that combined neck muscle training is effective for developing the neck extensor muscles.
ABSTRACT
To investigate the relationship between adolescent sport activity and abnormalities of the lumbar spine on radiography and magnetic resonance imaging (MRI), 237 collegiate athletes (mean age 19.4), representing judo, wrestling, and track, were analyzed from the point of contact or noncontact sports. Radiologic and/or MRI abnormalities of the lumbar spine were found in 68.7% of contact sports athletes (judo and wrestling, n=147), 53.3% of noncontact sports athletes (track, n=90), 69.9% of athletes who have played contact sports over 9 years (C9 athletes, n=83), and 47.1% of atheletes who have done noncontact sports over 9 years (N9 athletes, n=17). Discopathy related abnormalities on radiologic examination were found in 25.3% and 11.8% of C9 and N9 athletes. Disc degeneration on MRI was found in 45.8% and 29.4% of C9 and N9 athletes. Spondylolysis was found in 31.3% of C9, 5.9% of N9, 31.3% of elementary-C (athletes who played contact sports during elementary school, n=96), 32.8% of elementary-L/I (limited contact/impact sports, n=58), and 8.6% of elementary-N athletes (noncontact sports, n=35), respectively. From these results, we concluded that contact sports activity during adolescence induces lumbar spine abnormalities at a higher rate compared to noncontact sports and that spondylolysis is related to contact or limited contact/impact sport activity during elementary school.
ABSTRACT
The purpose of this study was to examine the effects of dynamic neck muscle training using a cervical extension machine (CEM) on isometric cervical extension strength (ICES) and a cross-sectional area of neck extensor muscles.Subjects were 18 male college judo athletes divided into a control group (n=10) and training group (n=8), respectively. In the training group, dynamic neck muscle training was performed for a 6 week training period, followed by a 10 week training period. There was a detraining period of 12 weeks between the first training period and the second. The ICES was measured at eight angles using a CEM, and the neck muscle cross-sectional area was determined using magnetic resonance imaging.The ICES and cross-sectional area of neck extensor muscles in the training group showed significant increases after the second training period. In particular, the increase in the cross-sectional area was greater in the deepest layer of the neck extensor muscles (rotator, multifidus and semispinaris cervicis muscles) than in the superficial layer (trapezius muscle). In the control group, no significant changes in ICES or cross-sectional area were observed.In conclusion, it was shown that dynamic neck muscle training using a CEM was effective in developing both ICES and the cross-sectional area of neck extensor muscles, especially in the deepest layer.
ABSTRACT
The purpose of this study was to investigate characteristics of past injuries of female university soccer players in comparison with injuries in male university soccer players.<BR>We investigated past injuries of female players (n=32) and male players (n=24) . A past injury was defined as any injury sustained during soccer that required admission to a team doctor, medical attention or absence from practices or games for more than seven days.<BR>The most frequent injury was Joint Injuries in both female and male players. High occurrence of overuse injuries of lower leg was most apparent in the female players. The 32 female players had experienced 144 injuries, or 4.5 injuries per player, and the 24 male players had suffered 85 injuries, or 3.5 injuries per player. The numbers of injuries per player of female players were 1.3 times higher than the male players. Also, the incidence of injury was 0.64 (injury/player/year) in female players, and 0.27 (injury/player/year) in male players. The incidence of injury of female players was significantly larger than that of male players.<BR>We conclude that the prevention and care of overuse injuries in lower leg is very important for female succor players.
ABSTRACT
The purpose of this study was to investigate the relationships of ankle ligamentous injuries with physical and positional characteristics in college football players. Specific hypothesis was addressed whether medial ankle ligamentous complex (MALC) injury was often caused by oversized players, offensive or defensive linemen.<BR>53 subjects participated in this study. We examined their previous history of ankle ligamentous injuries and classified them into three groups: (1) the lateral ankle ligamentous complex (LALC) in-jury group; (2) the MALC injury group; and (3) the no ankle ligamentous (NAL) injury group. Regarding MALC injury, we obtained the following results. First, MALC injury occupied 35% of total ankle ligamentous injuries. Second, both body weight and BMI of the MALC injury group were signi-ficantly the heaviest and largest of the groups. Lastly, OL, LB, and DL occupied highest occurring percentage (75%) of MALC injury.<BR>We concluded that MALC injury tended to be incurred by the players with heavier body weight and/or larger BMI. Players OL, LB, or DL also suffered MALC injury. Thus, these results suggest that body weight, BMI and position are considered as the risk factor for MALC injury.
ABSTRACT
The purpose of this study was to investigate relationships between low back pain (LBP) and psychological conditions in university wrestlers.<BR>We examined psychological conditions of seventy male university wrestlers using the Psycholo gical Condition Inventory (PCI) test and evaluated whether psychological conditions have some relationships with LBP. Evaluations of LBP were based on a questionnaire test and the diagnosis of orthopedic surgeons. Based on the LBP evaluation, we assigned all wrestlers into two groups as the LBP group and the non-LBP group.<BR>We obtained the following results. There were twenty-eight university wrestlers (40%) in the LBP group and forty-two wrestlers (60%) in the non-LBP group. Wrestlers in the LBP group showed significantly high values in all factors relating to fatigue in comparison to the non-LBP group.<BR>We conclud that the university wrestlers with LBP feel fatigue in their minds and bodies.
ABSTRACT
The purpose of this study was to investigate the relationship between low back pain (LBP) any physical characteristics in university wrestlers. We especially focused on radiological abnormalitie (RA) in their lumbar regions.<BR>Physical characteristics and isokinetic trunk muscle strength of the 55 male university wrestlers were measured. MRI was used to evaluate the cross-sectional areas of trunk muscles between lumbar spine 3 and 4 (L3/4) . Evaluations of LBP were based on the diagnose of orthopedic surgeons and the questionnaire test. According to this evaluation, we assigned all wrestlers into two groups as the LOP group and the no LOP group. Furthermore, four groups were defined by having RA based on X-ray and MRI diagnose.<BR>We obtained the following results. In comparison between the LOP group and the no LOP group, the trunk muscle extension flexion strength ratio of the LOP was significantly lower than that of the no LOP group. In addition, the LOP without RA group showed significant low strength of their trunk extensors in comparison with the no LOP without RA group.<BR>We considered that the relative low strength of trunk extensors should have some effect on LBP in university wrestlers.