[Transthoracic Endovascular Aortic Repair for Malperfusion after Ascending Aortic Replacement for Stanford Type A Acute Aortic Dissection;Report of a Case].

A 53-year-old man was presented with Stanford type A acute aortic dissection. We first performed emergency ascending aortic replacement under selective cerebral perfusion with moderate hypothermia. He developed abdominal pain after the surgery. Six days after the 1st surgery, computed tomography revealed that the new entries were located in the distal anastomosis site and the distal aortic arch, and the true lumen of the aorta was obstructed by the false lumen and stenosis. Visceral malperfusion was diagnosed and emergent total debranching thoracic endovascular aortic repair (TEVAR) was planned. One proximal covered stentgraft and 2 distal bare stents were deployed.

A 103 Year Old Man With a Ruptured Abdominal Aortic Aneurysm.

INTRODUCTION: With wider use of stent grafts, treating nonagenarians with abdominal aortic aneurysm has become more common in Japan. This is the report of a 103 year old patient with a ruptured abdominal aortic aneurysm who successfully underwent emergency endovascular aortic repair. To the present authors' knowledge, this report describes the oldest patient treated for a ruptured abdominal aortic aneurysm with a successful outcome. REPORT: A 103 year old man with ruptured abdominal aortic aneurysm was successfully treated by endovascular aortic repair. The post-operative course was uneventful, and he was discharged from the hospital on post-operative day 11. Two months later, in the outpatient clinic, the patient was doing well. CONCLUSION: It is important that decisions concerning the operative indications for a ruptured abdominal aortic aneurysm in elderly patients are based not only on age, but also on a comprehensive pre-operative assessment, including consideration of the patient's activity of daily life and personal wishes, as well as the desires of family members.

Effects of Storage Temperature and pH on the Antifungal Effects of Commercial Oral Moisturizers against Candida Albicans and Candida Glabrata.

Background and objectives: Oral moisturizers have been used to treat dry mouth. This study aimed to investigate the effects of storage temperature and pH on the antifungal effects of oral moisturizers against Candida albicans and Candida glabrata. Materials and Methods: Thirty-one oral moisturizers and amphotericin B (AMPH-B) were stored at 25 and 37 °C for 1 week. Subsequently, they were added to cylindrical holes in 50% trypticase soy agar plates inoculated with C. albicans and C. glabrata (107 cells/ml). The antifungal effects were evaluated based on the sizes of the growth-inhibitory zones formed. Two-way analysis of variance was used to determine the effects of storage temperature and pH on the growth-inhibitory zones. Results: Significant differences in the effects of storage temperature and pH of the moisturizers were observed against C. albicans and C. glabrata. The growth-inhibitory zones of samples stored at 37 °C and with neutral pH were significantly larger than those stored at 25 °C and with acidic pH, respectively. The sizes of the zones formed by most of the oral moisturizers were larger than those formed by AMPH-B (concentration, 0.63 µg/ml). Conclusion: The antifungal effects of oral moisturizers against C. albicans and C. glabrata were affected by their storage temperature and pH.

Clip-and-loop technique for left atrial appendage occlusion.

The left atrial appendage is thought to be responsible for the majority of embolic strokes, and has become an important target in the surgical management of atrial fibrillation. We present an original clip-and-loop technique using an AtriClip via a left minithoracotomy for post-stroke patients with atrial fibrillation. This procedure was performed in 43 cases between March 2018 and January 2020. No patient had a thrombus at the edge of the clip or communication into the left atrial appendage 3 months after surgery. Anticoagulant could be discontinued in all patients. Follow-up at 23 ± 10 months showed no recurrence of stroke.

Recurrence of Aortoenteric Fistula after Endovascular Aortic Repair.

Aortoenteric fistula (AEF) after endovascular aortic repair (EVAR) is a rare complication, with only 32 cases reported previously. A 71-year-old man who presented with severe duodenal bleeding due to primary AEF (PAEF) underwent successful EVAR. Four years later, the AEF recurred because of dilatation of the aneurysm sac. He underwent emergent surgery, removal of the stent graft, and replacement of an artificial bifurcated graft with placement of a greater omental flap. EVAR for PAEF was an effective option for acute treatment, but it caused refistulization in the long term. EVAR should be considered as a bridge therapy to definitive surgery.

Zone 0 Thoracic Endovascular Aortic Repair Using Reverse Extra-Anatomical Aortic Arch Debranching Technique for an Anastomotic Pseudoaneurysm and Acute Aortic Dissection that Developed after Bentall's Surgery Combined with Sjögren's Syndrome.

A 66 year-old man with a previous history of Sjögren's syndrome was admitted with anastomotic pseudoaneurysm and aortic dissection in the ascending aorta, which developed after Bentall's surgery, a procedure that has severe complications and high mortality. Using the reverse extra-anatomical aortic arch debranching technique, zone 0 thoracic endovascular aortic repair was performed emergently. The postoperative course was uneventful. Twenty months later, computed tomography showed remodeling of the dissection, resolution of the pseudoaneurysm, and patency of the reverse extra-anatomical aortic arch debranching graft.

A retainer-free obturator prosthesis in a fully dentulous patient with palatal defects.

Retainers are the most important component in the success of an obturator prosthesis. However, the optimal retainer design for a fully dentulous patient with palatal defect needs four widely separated retainers-resulting in unsatisfactory esthetics-and regulates engagement of deep undercuts of the defect cavity, which leads to an inadequate palatal seal. A new retainer-free obturator prosthesis that closes only the defect cavity and is retained by undercuts within the defect was designed and proved useful for problems caused by a clasp-retained obturator prosthesis for a fully dentulous patient with palatal defects.

Impact of Oral Intake of Glucosylceramide Extracted from Pineapple on Xerostomia: A Double-Blind Randomized Cross-Over Trial.

Background: The aim of this double-blind randomized cross-over trial was to evaluate the effect of oral intake of glucosylceramide extracted from pineapple on oral moisture and xerostomia symptoms. Methods: Sixteen participants who had xerostomia symptoms were randomly allocated into two groups. One group received, as test samples, tablets containing glucosylceramide extracted from pineapple (GCP) followed by placebo tablets. The other group received the test samples in the reverse order. Participants were instructed to take tablets of the first test sample once a day (after breakfast) for two consecutive weeks. Then, after a washout period of four weeks, participants were instructed to take the other test sample for two consecutive weeks. The oral moisture level of the lingual mucosa, xerostomia symptoms, and the number of fungiform papillae was evaluated. Results: The oral moisture significantly increased, and the visual analog scale (VAS) of "How is the dryness of your mouth?" significantly improved after GCP tablets intake and not after placebo tablets intake. The number of fungiform papillae was not significantly different following the intake of GCP tablets or placebo tablets. Conclusion: Results suggested that oral intake of GCP may improve the moisture level and xerostomia symptoms.

A Retrospective Cohort Study of the Cumulative Survival Rate of Obturator Prostheses for Marsupialization.

PURPOSE: After marsupialization of benign tumors and jawbone cysts, insertion of an obturator prosthesis maintains the surgical opening and improves hygiene. To date, there have been no reports clarifying the relationship between the obturator design and treatment outcomes. The purpose of this study was to examine the survival rate of three types of obturator, and to investigate the factors that expedite the removal of the obturator. MATERIALS AND METHODS: The subject group comprised 100 patients who had an obturator inserted after marsupialization at Kagoshima University Hospital between May 31, 2012 and March 31, 2015; 73 patients with lesions in the mandible were eligible. Three types of mandibular obturator were designed and inserted, considering the teeth missing, the anteroposterior position of the lesion, and the buccolingual direction of marsupialization. The endpoint of this study was defined as the removal of the obturator. The analyzed predictor values for the endpoint were age, gender, remaining teeth, nature of primary disease, anteroposterior location of primary disease, buccolingual direction of marsupialization, type of obturator, and dates of insertion and removal. RESULTS: No significant differences were found in the cumulative survival rate among the three types of obturator. Early obturator removal was more frequent in patients with cysts, anterior lesions, and/or marsupialization from the occlusal direction CONCLUSIONS: Because obturator design had minimal effect on the ability of the appliance to maintain the surgical opening, it is preferable to use the least invasive design. Our findings also suggest that the follow-up examination should account for the type of primary disease, the anteroposterior location of the lesion, and the buccolingual direction of marsupialization.

Analysis of the perioperative change in cognitive function of patients with risk factors for cognitive impairment in cardiovascular surgery.

OBJECTIVE: The purpose of the present study is to assess the perioperative changes in the cognitive function of patients after cardiovascular surgery (CVS) and to find out risk factors for early postoperative cognitive decline. MATERIALS AND METHODS: From December 2013 to March 2017, 291 patients underwent elective or urgent CVS with cardiopulmonary bypass in our institution. One hundred and fifteen patients, who agreed to an evaluation of their cognitive function, were included in this study. The cognitive function was evaluated by the HDS-R and MMSE at three time points: before surgery, in the early postoperative period and at discharge. The patients' characteristics, perioperative data, HDS-R and MMSE scores were obtained by reviewing their medical records retrospectively. RESULTS: The patients were stratified into three age groups. In all of the age groups, the early postoperative cognitive functional scores were severely decreased in comparison to the preoperative values. However, by the time of discharge, the function had improved to the same level as before surgery in each of the groups. In addition, the similar tendency was observed in patients with preoperative cognitive dysfunction. Moreover, multiple regression analysis demonstrated that preoperative cognitive function and age were significant risk factors for early cognitive impairment. CONCLUSION: Although preoperative cognitive decline and patients' age were the risk factors for early postoperative cognitive impairment after CVS, a significant recovery can be expected even in elderly patients or patients with low preoperative cognitive function by the time of discharge.

Viscosity and adhesion strength of cream-type denture adhesives and mouth moisturizers.

We evaluated adhesion strength to acrylic resins under various experimental conditions and viscosity of 4 cream-type denture adhesives and 2 mouth moisturizers. The viscosity was determined by a sine-wave vibro viscometer. The adhesion strength tests were performed with 2 resin plates at a universal tester. In Method A, various constant thicknesses of material layer were tested and tensile strength was measured, while in Method B a constant load was applied before measurement. Five tests were carried out for each measurement. With Method A, adhesion strength increased exponentially as the layer got thin. Effect of the material thicknesses (contribution ratio ρ=79.0%) was much larger than that of material type (ρ=15.3%). Materials with higher viscosity had greater levels of adhesion strength in Method A, whereas those with the higher viscosity had lower levels of adhesion strength in Method B. Adhesion strength was significantly affected by the experimental condition prior to applying tension.

Cementogenesis examined from the viewpoint of microcirculation.

The purpose of this study was to perform a three-dimensional observation, via microvascular corrosion casts, of the microcirculation system during deposition of cementum after flap surgery and to investigate the permeable structure of the vascular endothelium. Two stages of wound healing after flap surgery were confirmed based on successive vascular changes. The transition between these stages occurred 3 weeks after surgery, at which time new blood vessels disappeared and an early stage of accumulation of new cementum was apparent. Hence, fibrous repair occurred during the first stage, and repair of hard tissue (ie, formation of cementum) occurred during the second stage. These findings suggest that metabolic activity in cementogenesis is low, based on the condition of the blood vessels, and therefore new cementum is not easily formed.