[Surgical Repair of Stanford Type A Acute Aortic Dissection Associated with Anomalous Retroaortic Left Brachiocephalic Vein;Report of a Case].

Anomalous retroaortic left brachiocephalic vein( ARLBV) is a rare vascular abnormaly, usually asossiated with congenital heart diseases. We present a very rare case of Stanford type A acute aortic dissection associated with ARLBV. A 70-year-old man was referred to our hospital complaining of worsening back pain and chest pain. Computed tomographic angiogram showed Stanford type A acute aortic dissection from the ascending aorta to the distal abdominal aorta. Furthermore, systemic venous anomalies were revealed. The left brachiocephalic vein coursed the left side of the aortic arch, anterior to the central pulmonary artery, and posterior to the ascending aorta, and joined the right brachiocephalic vein. Replacement of the ascending aorta was performed in an emergency, and the postoperative course was uneventful.

[Video-assisted Thoracoscopic Pericardial Fenestration for Pericardial Effusion in a Patient with Crow-Fukase Syndrome].

A 65-year-old woman was referred to our department with recurrent pericardial effusion. Her serum vascular endothelial growth factor was high, serum M-protein was positive, and nerve conduction velocity of extremities was decreased. Therefore, she was diagnosed with Crow-Fukase (polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes:POEMS) syndrome, which is characterized by the presence of plasma cell dyscrasia with them. We performed video-thoracoscopic pericardial fenestration with 4×4 cm window. The postoperative course was uneventful, and the pericardial effusion completely disappeared. Video-assisted thoracoscopic pericardial fenestration was a safe and effective treatment for recurrent pericardial effusion.

[Triple-stage Endovascular Treatment for Chronic Type B Aortic Dissection Including Hybrid Procedure;Report of a Case].

A 66-year-old man developed an extended chronic type B dissection involving the thoraco-abdominal aorta with a large entry at the aortic arch and a patent false lumen. We performed triple-stage endovascular repair which included the vascular plug, endovascular aortic repair and hybrid thoracic endovascular aortic repair. His postoperative course was uneventful and the false lumen was finally thrombosed.

[Delayed Hemolytic Anemia Associated with Anti-Jk3 Antibody Following Cardiovascular Surgery;Report of a Case].

We report a 73-year-old man who underwent total aortic arch replacement with an open stent graft for aortic arch aneurysm. The patient received blood transfusion intraoperatively without any signs of hemolysis. However, on post-operative day 16, he developed hemoglobinuria, and was found to have anemia, elevated serum lactate dehydrogenase, elevated total bilirubin, and decreased serum haptoglobin. Initially, the cause for these findings was unknown. Upon further testing, however, antibodies against the high frequency antigen, anti-Jk3 was identified. The patient was conservatively treated and was discharged in stable condition on post-operative day 24. Jka and/or Jkb are red blood cell antigens observed in over 99.9% of the population worldwide. Jk (a-b-) represents the null phenotype and is very rare. This specific phenotype can be extremely dangerous, as homologous transfusion might cause severe delayed hemolysis. The actual patient carried Jk (a-b-) phenotype and, due to intraoperative transfusion of red blood cells, anti-Jk3 antibody was produced. Although very rare, patients who carry the red blood cell phenotype Jk( a-b-) may experience dangerous, or even fatal outcome due to such a common medical treatment as blood transfusion, if this condition is not recognized beforehand.

[Thoracic Endovascular Aortic Repair Following Axillo-femoral Bypass in a Patient with Stanford B Acute Aortic Dissection Accompanied by Abdominal Visceral Ischemia;Report of a Case].

A 60-year-old woman was transfer-red to the emergency department of our medical center with worsening chest and back pain. Computed tomography revealed Stanford type B aortic dissection. There was a false lumen from the distal arch to the abdominal aorta just above the celiac artery. Although she was at 1st treated conservatively, she abruptly developed acute renal failure and lower limb ischemia because of an enlarged false lumen, and emergency axillo-femoral bypass surgery was performed with an 8 mm tube graft. However, renal failure gradually worsened, which necessitated continuous hemodiafiltration was performed. Thoracic endovascular aortic repair was then performed, and her renal function recovered.

Improved adhesion of human cultured periosteal sheets to a porous poly(L-lactic acid) membrane scaffold without the aid of exogenous adhesion biomolecules.

Human cultured periosteal sheets, which are developed from small excised periosteum tissue segments (PTSs) in culture dishes by simple expansion culture, have been applied as a promising autologous osteogenic grafting material for periodontal regenerative therapy. However, the weak initial adhesion of PTSs to dish surfaces often hampers cellular outgrowth and limits the number of preparations. To correct this weakness and still avoid the use of animal-derived adhesion biomolecules, we have developed a novel, biodegradable, porous poly(L-lactic acid) (pPLLA) membrane. Freshly excised PTSs bound well to the highly porous pPLLA membrane, possibly due to the presence of semihemispheric 20-30 µm diameter openings on the upper surface. Global gene expression analysis demonstrated that periosteal sheets cultured on pPLLA membranes upregulated expression of many adhesion molecules. Osteogenic induction stimulated the production of proteoglycans by these cells and concomitantly enhanced their expansion and penetration into the deep pore regions of the membrane in parallel with the progression of in vitro mineralization. These findings suggest that our pPLLA membranes not only facilitate initial adhesion, primarily mediated by adsorbed proteins, but also enhance biological adhesion by inducing endogenous adhesion molecules in periosteal sheet cultures. Therefore, the efficacy of periosteal sheets in therapy should be greatly enhanced by using this new pPLLA membrane.