[Calcified Amorphous Tumor Diagnosed After Stroke:Report of a Case].

Calcified amorphous tumor (CAT), a non-neoplastic tumor, is rare. Histopathologic features are the presence of calcified nodules in an amorphous background of fibrin. CAT is reported to be associated with renal dysfunction or hemodialysis, and possibly causes cerebral embolism. We report a case of CAT diagnosed after stroke. A 58-year-old male with a 2-year history of hemodialysis was diagnosed with an acute stroke, and was treated medically. Paralysis promptly improved, but transthoracic echocardiography revealed a tumor attached to the posterior mitral leaflet and dense mitral annular calcification. To prevent embolism due to the large tumor, we performed resection of the tumor. Pathological findings showed calcifications surrounded by amorphous fibrous tissue, indicating CAT. Postoperative course was uneventful.

[Pulmonary Adenocarcinoma in Situ with Positive Findings in Pleural Lavage Cytology].

We report a rare case of positive findings in pleural lavage cytology(PLC) in the patient with pulmonary adenocarcinoma in situ (AIS). A 78-year-old woman was presented with a 30 mm pure groundglass nodule (GGN) in the left upper lobe on chest computed tomography (CT). After 2 years follow- up, thoracoscopic surgery was performed to resect the nodule. PLC was performed before pulmonary resection. Histopathological diagnosis was 25 mm AIS. However, PLC showed positive findings of malignant cells. CT examination at 1 year and 6 months postoperatively showed pleural dissemination findings and the patient died of lung cancer at 3 years and 2 months postoperatively. PLC's contribution to TNM staging has not yet been clarified. The positive findings in PLC and large size of pure GGN were considered likely to be poor prognostic indicators.

[Acute Coronary Syndrome in a Patient with Giant Coronary Artery Aneurysm:Report of a Case].

Coronary artery aneurysm is a rare entity defined as expansion more than 1.5 times of normal coronary artery in diameter. A 77-year-old male was admitted to our hospital with a diagnosis of acute coronary syndrome and a giant right coronary artery aneurysm. Coronary angiography showed occlusion of the right coronary artery and significant stenosis of left anterior descending artery and left circumflex artery. Enhanced computed tomography( CT) showed a right coronary artery aneurysm with a diameter of 38 mm. Urgent coronary artery bypass grafting and coronary artery ligation proximal and distal to the aneurysm were performed. His postoperative course was uneventful.

A Case of Severe Aortic Stenosis after Aortic Valve Neocuspidization Using Autologous Pericardium (Ozaki Procedure).

A 56-year-old man with a history of left nephrectomy for Wilms' tumor on chronic hemodialysis underwent aortic valve neocuspidization using autologous pericardium (Ozaki procedure) for aortic stenosis (AS) due to a bicuspid aortic valve 6 years ago. The AS gradually progressed and a decrease in the left ventricular ejection fraction was observed. Because of this, we decided to perform reoperative aortic valve replacement using a mechanical valve. Intraoperative findings showed severe calcification at the site where the autologous pericardium was sutured to the annulus. However, the degeneration of the valve leaflets themselves was mild. While excellent mid-term results have been reported for the Ozaki procedure, the long-term results are still unclear. In this case, the annulus was severely calcified, which reduced the mobility of the leaflet. We report the first case of AS progression requiring reoperation in the long-term period after the Ozaki procedure.

[Coronary Aneurysm with Fistula].

We successfully treated two rare cases of coronary aneurysm with fistula. Case 1;A 65-year-old female referred to our hospital with the coronary aneurysm and fistula. Right coronary aneurysm with fistula leading to coronary sinus was observed. Coronary bypass surgery using a saphenous vein to #4PD was performed, and two right ventricle branches were reconstructed. Coronary aneurysm was resected. Case 2;A 46-year-old male was admitted with chest discomfort. Coronary aneurysm with fistula from the left main trunk to left ventricle was demonstrated. Ligation of the coronary artery aneurysm and suture closure of the entry site to the left ventricle was performed. Both patients had uneventful recovery.

[Third Tricuspid Valve Replacement:Report of a Case].

A 79-year-old man underwent tricuspid valve replacement (TVR) with a bovine pericardial bioprosthesis, Carpentier-Edwards Perimount (CEP), for tricuspid regurgitation 27 years earlier. Twenty-one years after the first operation, he underwent re-TVR with a bovine pericardial bioprosthesis, Magna Mitral Ease, due to prosthetic valve dysfunction. Since the prosthetic valve dysfunction progressed again, the third TVR was performed six years after the second operation. The findings of the resected bioprosthesis showed sclerosis of the septal cusp, and pannus formation between the septal and posterior cusps. For the third TVR, the porcine bioprosthesis Epic was used. Neither transvalvular nor perivalvular leakage was observed postoperatively, and the patient was discharged without any complications.

[Papillary Fibroelastoma Arising from the Left Atrial Wall:Report of a Case].

Papillary fibroelastoma (PFE) is a rare benign cardiac tumor generally arising from the valvular endocardium. We report an extremely rare case of PFE arising from the left atrial wall. A 70-year-old male patient was admitted to our hospital with a diagnosis of left atrial tumor. Echocardiography and enhanced computed tomography showed an approximately 14 mm mass on the left atrial wall. Moreover, the magnetic resonance imaging showed hyperintenseness on a T2-weighted image. We diagnosed the tumor as a myxoma. Intraoperatively, we found a mobile tumor on the left atrial wall. It had a sea anemone-like appearance and was suspected to be PFE. We performed the tumor resection including the left atrial wall. Histological examination confirmed PFE. His postoperative course was uneventful.

[Anterior Mediastinal Myxoid Liposarcoma Detected by Chest Computed Tomogram in the Patient with Pneumothorax].

A 57-year-old woman visited our hospital with left chest pain. Chest computed tomography (CT) scanning showed left pneumothorax with apical bullae and a nodular shadow in the left anterior mediastinum accidentally. However, a week later, we could not detect a mediastinal shadow on chest CT image after healing of left pneumothorax. Video assisted thoracoscopic surgery was scheduled in order to remove bullae and evaluate an anterior mediastinal lesion. The mediastinal lesion was tumorous and resected with around pericardial fat tissue. Pathological diagnosis was a myxoid liposarcoma of 15×10mm in size without infiltration into the surrounding tissue. The postoperative course was uneventful without recurrence 6 months later.

[Stanford Type A Aortic Dissection after Off-pump Coronary Artery Bypass Grafting Using Automated Proximal Anastomotic Device;Report of a Case].

Operative mortality of Stanford type A aortic dissection( AAD) repair with previous cardiac surgery is high, especially with previous coronary artery bypass grafting. We report an extremely rare case of AAD related to the PAS-Port system. A 68-year-old male patient on dialysis was admitted to our hospital with a diagnosis of AAD. Half a year before he had undergone off-pump coronary artery bypass grafting using PAS-Port system for a proximal anastomosis of a vein graft. Urgent graft replacement of the ascending aorta was performed, and the proximal anastomotic site of the vein graft was attached to the prosthetic graft. Intraoperative investigation revealed that an intimal tear was located on the anastomotic site made by the PAS-Port system. The postoperative course was uneventful and he has been visiting our hospital regularly for dialysis.

[Surgical Treatment for Mycotic Aortic Aneurysms].

Mycotic aortic aneurysms are relatively rare. Diagnosis and treatment may sometimes be difficult. We have treated 5 cases of mycotic aortic aneurysms in our institution. The patients were 4 males and 1 female with a mean age of 65.6±16.7 years old. All patients had vascular diseases and complained of fever. Preoperative blood cultures were positive in 4 cases. The strategy for treatment of mycotic aortic aneurysms consisted of removal of infective focuses as much as possible and revascularization using an artificial graft combined with omentopexy. Administration of antibiotics was continued for 6 months. All patients have been alive without recurrence of infections for a mean period of 22.6 months, which was considered to be an acceptable result. Artificial graft replacement combined with omentopexy and long-term administration of antibiotics is suggested to be useful for the treatment of mycotic aortic aneurysms.

[Therapeutic use of amiodarone against postoperative fibrillation after cardiac surgery].

We investigated the effect of amiodarone (AMD) administered intravenously for the treatment of post-operative atrial fibrillation( POAF) after cardiac surgery. After rapid administration of 150 mg for 10 minutes, AMD was administered in 1.0 mg per minute for 6 hours followed by 0.5 mg per minute for 18 hours. AMD was then administered orally 200 mg per day for 1 or 2 weeks. Twenty-five cases were enrolled from January 2010 to June 2013. In 18 cases(72%), the patients were successfully defibrillated by this protocol. In the other 7 cases, the patients required electrical defibrillation, but in 1 patient developed chronic atrial fibrillation. It was thought that AMD could be a choice for POAF.

[Treatment strategy for patients with simultaneous cardiac and malignant diseases].

The choice of treatment strategy for patients with simultaneous cardiac and malignant diseases is often debatable. We report 11 patients with simultaneous cardiac and malignant diseases who were hospitalized in our institution over the past 6 years. The patients were 9 males and 2 females with a mean age of 71.9±9.0 years old. There were 7 cases of ischemic heart disease( IHD), and 4 cases of valvular disease. Malignant diseases consisted of 4 cases of colon cancer, 2 cases of pulmonary cancer, 2 cases of hepatic cancer, and 1 case each of sigmoid colon cancer with liver metastasis, gallbladder cancer, and pancreatic cancer. Eight of the 11 cases(73%)were hospitalized because of a symptom associated with cardiac disease, and malignant disease was diagnosed incidentally during examination or treatment. Four of the IHD cases preceded coronary revascularization by off-pump coronary artery bypass grafting (OPCAB) or percutaneous coronary intervention (PCI). Two of the valvular cases and 2 of the IHD cases underwent cardiac surgery after treatment of malignant diseases. In 3 cases, only 1 of the diseases was treated. Seven cases died of malignant diseases at the present. The choice of treatment strategy should be established for patients with simultaneous cardiac and malignant diseases in consideration of the severity of the cardiac disease and the expected prognosis of the malignant disease because there is no standardized method of treatment.

Associations between dietary n-6 and n-3 fatty acids and arachidonic acid compositions in plasma and erythrocytes in young and elderly Japanese volunteers.

BACKGROUND: We reported that the compositions of arachidonic acid (ARA) in erythrocytes and plasma phospholipids (PL) in the elderly were lower than those in the young, though the ARA intake was nearly identical. OBJECTIVE: We further analyzed data in four study groups with different ages and sexes, and determined that the blood ARA levels were affected by the kinds of dietary fatty acids ingested. METHODS: One hundred and four healthy young and elderly volunteers were recruited. Dietary records together with photographic records from 28 consecutive days were reviewed and the fatty acid composition in plasma lipid fractions and erythrocyte PL was analyzed. RESULTS: No correlations for ARA between dietary fatty acids and blood lipid fractions were observed. A significant negative correlation between eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA) intake and ARA composition in erythrocyte PL was observed. ARA composition in erythrocyte PL was significantly lower in elderly subjects than in young subjects, because EPA and DHA intake in elderly subjects was higher than in young subjects. However, after removing the effect of dietary EPA+DHA intake, the ARA composition in erythrocyte PL in elderly subjects was significantly lower than that in young subjects. CONCLUSIONS: Changes in physical conditions with aging influenced the low ARA composition of erythrocyte in elderly subjects in addition to the effects of dietary EPA and DHA.

[Prophylactic use of amiodarone against postoperative atrial fibrillation after cardiac surgery].

We investigated the effect of amiodarone on prevention of post-operative atrial fibrillation (POAF) after cardiac surgery. Thirty cases of amiodarone (AMD) group including elective coronary artery bypass grafting and valve operation were enrolled from January 2007 to January 2010. The control (C) group consisted of 45 cases treated before 2007. Amiodarone was administered orally for the total of 14 days; 400 mg 7 days before the surgery, and a half dose after the surgery. POAF occurred significantly less in AMD group (4/30 : 13.3%) than in C group (13/45 : 28.9%) [p = 0.029]. With regard to duration of POAF, that of AMD group was significantly shorter than that of C group (16.0 hours vs 40.23 hours : p = 0.018). This research suggested that amiodarone might be effective in preventing POAF.

[On-pump beating coronary artery bypass grafting for the post-thoracoplasty patient with porcelain aorta; report of a case].

A 79-year-old post-thoracoplasty patient who had undergone coronary artery bypass grafting (CABG) 20 years before was admitted to our hospital because of chest pain. Coronary angiogram showed occlusion of the both saphenous vein grafts. And the computed tomography revealed severe calcification of the ascending aorta. We performed on-pump beating CABG cannulating his femoral vessels and anastomosed bilateral internal thoracic artery grafts without manipulation of the ascending aorta. On-pump beating CABG is useful for the patients with past medical history of CABG.

Age-related changes of dietary intake and blood eicosapentaenoic acid, docosahexaenoic acid, and arachidonic acid levels in Japanese men and women.

We studied the relationship between dietary intake and the blood compositions of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and arachidonic acid (ARA) in four study groups with different ages and sexes. One hundred and four subjects were recruited. Dietary records together with photographic records from 28 consecutive days were amassed and the fatty acid composition in erythrocyte membranes and plasma lipid fractions was analyzed. Fish intake in the elderly group was significantly higher than that in the young group in both men and women. The compositions of ARA in erythrocytes and plasma phospholipids in the elderly were lower than those in the young, but the ARA intake was nearly identical. In the elderly group, the percentage of dietary ARA consumed at the same time as EPA and DHA derived from fish was high. We considered that these fatty acids markedly inhibited the incorporation of dietary ARA into blood phospholipids.

Improvements in seasonal allergic disease with Lactobacillus plantarum No. 14.

We conducted two randomized, placebo-controlled, double-blind studies of Lactobacillus plantarum No. 14 (LP14) in female students with seasonal allergic diseases. We also examined the mitogenic activity and cytokine inducibility of LP14 using Peyer's patch cells and mesenteric lymph node cells of swine. For subjects who took 8.7×10(8) of LP14, a significant improvement in ocular symptom-medication score was observed. In the placebo group, the T helper type 1 (Th1)/T helper type 2 (Th2) ratio tended to decrease after a 6-week intake period, while in the LP14 group, the percentage of Th1 cells significantly increased. Post-intake eosinophil counts significantly increased in comparison to those at intake cessation in the placebo group, but it appeared to be suppressed in the LP14 group. There were no changes in fecal microflora. LP14 strongly induced the gene expression of Th1-type cytokines. This study indicates the clinical effects of LP14 on seasonal allergic diseases.

[Mitral regurgitation associated with essential thrombocythemia and gallbladder cancer].

A 64-year-old man with essential thrombocythemia was admitted to our hospital because of cardiac failure. Echocardiography revealed severe mitral regurgitation and a gallbladder tumor was detected incidentally by ultrasonography. Although the gallbladder tumor was strongly suspected to be malignant, we considered that the radical operation would be possible because of its early stage. After treatment of cardiac failure, cholecystectomy was performed. Pathological examination proved that the gallbladder tumor was malignant in T1N0M0 stage I. Afterwards, mitral valve plasty and maze operation were performed concomitantly. During the operation, activated coagulation time was kept over 400 sec with heparin. The operation was completed without major problems and the postoperative course was uneventful. The patient has not suffered from the recurrence of a gallbladder carcinoma or mitral regurgitation for 2 years.

Successful surgical repair of a bilateral coronary-to-pulmonary artery fistula.

A 58-year-old woman was admitted to our department for evaluating an abnormal blood flow in the main pulmonary artery by transthoracic echocardiography. Coronary angiography revealed the presence of fistulas originating from the left anterior descending artery and also the right coronary artery to the main pulmonary artery. Under cardiopulmonary bypass, both fistulas were ligated near the origin, and direct closure of drainage site in the main pulmonary artery was performed. The postoperative course was uneventful, and coronary angiography after surgery showed that the coronary-to-pulmonary artery fistulas (CPAFs) disappeared. We report a surgical repair of a bilateral CPAF because the cardiac anomaly is extremely rare.