Thermogenesis induced by amino acid administration prevents intraoperative hypothermia and reduces postoperative infectious complications after thoracoscopic esophagectomy.

Minimally invasive thoracoscopic esophagectomy has potential advantages in minimizing the impairment of respiratory function and reducing surgical stress. However, thoracoscopic esophagectomy occasionally results in anesthesia-induced hypothermia, particularly in cases involving artificial pneumothorax with CO2. Thermogenesis induced by amino acid administration has been reported during anesthesia. Here, we tested the efficacy of amino acid treatment for the prevention of hypothermia, and we investigated the potential of this treatment to reduce postoperative infectious complications after thoracoscopic esophagectomy. We conducted a randomized trial in patients with esophageal cancer who underwent thoracoscopic esophagectomy in the prone position in two groups and analyzed the incidences of hypothermia and surgical complications. One-hundred and thirty patients were randomized. Administration of amino acids resulted in a significant increase in core body temperature. In the saline (n = 60) and amino acid (n = 70) administration groups, 30% and 14.2% of patients, respectively, experienced infectious surgical complications (P = 0.029), and 21.6% and 22.8% of patients, respectively, experienced noninfectious surgical complications (P = 0.86). Univariate analysis revealed that blood loss and amino acid administration were significant factors for infectious surgical complications. Multivariate analysis revealed that amino acid administration was an independent factor reducing infectious surgical complications (P = 0.025, 95% confidence interval: 0.105-0.864). Administration of amino acids prevents hypothermia and reduces postoperative infectious complications after thoracoscopic esophagectomy.

Manufacturing carbon storage sintered body using microwave-selective and high-speed heating techniques.

Microwave sintering of fly ash samples with large amounts of unburned carbon and CaCO3 was examined in this study. To this end, CaCO3 was mixed with fly ash sintered body to fix CO2. The decomposition of CaCO3 was observed when the raw material was heated to 1000 °C using microwave irradiation; however, a sintered body containing aragonite was obtained when the raw material was heated to 1000 °C with added water. Further, carbides in the fly ash could be selectively heated by controlling the microwave irradiation. The microwave magnetic field created a temperature gradient of 100 °C in a narrow region of 2.7 µm or less in the sintered body, and it helped suppress the CaCO3 decomposition in the mixture during sintering. By storing water in the gas phase before spreading, CaCO3, which is difficult to sinter using conventional heating, can be sintered without decomposing.

Optimal sampling interval to estimate heart rate at rest and during exercise in atrial fibrillation.

To investigate the ideal sampling interval for the estimation of heart rate (HR) at rest and during exercise in atrial fibrillation (AF), maximal exercise testing with continuous electrocardiographic acquisition was performed in 10 patients with chronic AF (mean age 66 +/- 4 years) and 10 subjects in normal sinus rhythm (mean age 31 +/- 6 years). Measurements of HR were obtained at 9 different sampling intervals (1, 2, 3, 6, 10, 15, 20, 30 and 60 seconds) at rest and 7 different sampling intervals (1, 2, 3, 6, 10, 15 and 20 seconds) during the last 30 seconds of each minute during exercise. The HR obtained from each interval was compared with true HR (determined by a 4-minute sample at rest and by the last 30 seconds of each minute during exercise). Among patients with AF, large differences were observed between the HR obtained and true HR, both at rest and during exercise, using small sampling intervals. The mean of these differences ranged between 16 +/- 11 beats/min (range 14 to 22) using 1-second sampling intervals and 2.2 +/- 2.0 beats/min (range 1.6 to 4.4) using 20-second sampling intervals during progressive exercise. Variability of the HR obtained from a given random sample was also high when short sampling intervals were used among patients with AF. These observations were contrasted by subjects in normal sinus rhythm, among whom neither variability nor measurement error were influenced remarkably by changing the sampling interval or increasing HR.

Complex vascular reconstruction using donor's vessel grafts in orthotopic liver transplantation.

The vascular abnormalities of recipients are associated with reconstructive difficulties with an increased risk of postoperative complications. We performed an orthotopic liver transplantation that required a complex vascular reconstruction using donor vascular grafts. A patient with hepatitis B virus cirrhosis received a liver from a brain-dead donor. Dynamic computed tomography revealed complete obstruction of the portal vein due to thrombosis as well as narrowing of the hepatic arteries. We employed orthotopic liver transplantation using the piggy-back technique with complex reconstruction of the portal vein and the hepatic arteries. For portal vein reconstruction, we used the donor's iliac vein as an interpositional conduit from the recipient's gastric coronary vein to graft the portal vein. The hepatic arteries of the graft were reconstructed at the back-table before anastomosis to the side of superior mesenteric artery using an interpositional conduit of the donor's external iliac artery. All postoperative studies revealed good graft function with an excellent blood flow through all vascular anastomoses during the first year postoperatively.

Successful living donor left liver transplantation by using liver graft with multiple large cysts: a case report.

There are few reports regarding the use of liver grafts with multiple large cysts in living donor liver transplantation. A 40-year-old woman who was diagnosed with Wilson's disease underwent living donor left liver transplantation; the donor was her 67-year-old mother. The liver graft had multiple large cysts, with a maximum diameter of 9 cm. At donor hepatectomy, the largest cyst and one small cyst were fenestrated, because they were located in the left paramedian sector; the other cysts were left intact. After transplantation, the liver graft exhibited good function with no cyst-related complications, such as hemorrhage, infection, or rupture, despite slight enlargement of the cysts. Thus, a liver graft with multiple large cysts is transplantable. However, the necessity of treating large cysts remains debatable.

CT assessment of the adult extrathoracic trachea.

A total of 40 neck computed tomographic (CT) scans in adult patients were retrospectively reviewed and absolute measurements made of the anteroposterior (TRAP) and transverse (TRTR) air spaces at the first tracheal cartilage. For each patient, ratio measurements were calculated of the anteroposterior (TRAP/TC) and transverse (TRTR/TC) tracheal air space relative to the glottic air space at the true cord level. Mean TRAP (2.01 cm) and TRTR (1.84 cm) measurements for normal patients agreed closely with figures reported in prior cadaver preparation studies. The lower normal limit found for absolute tracheal diameter was 1.5 cm (TRAP) and 1.4 cm (TRTR), whereas lower normal limits for relative tracheal to glottic air space diameters were 0.7 (TRAP/TC) and 0.6 (TRTR/TC).

cGMP stimulation of stem cell proliferation.

The process by which resting hemopoietic stem cells become activated is poorly understood, but it has been suggested that cyclic nucleotide levels in the cell may play an important role. In the present study, the effect of various, nucleotides and stimulators of nucleotide synthesis upon the formation of in vitro granulocyte colonies has been examined. It was found that physiologic concentrations of 3', 5'-cyclic guanosine monophosphate enhanced the formation of granulocyte-macrophage colonies in the presence of colony-stimulating activity. The cells sensitive to cGMP activation were resistant to thymidine suicide and could not be activated by colony-stimulating activity alone. Therefore it was suggested that the cGMP sensitive stem cell was an ordinarily resting stem cell which was triggered into a proliferative state by cGMP.

Configuration Interaction in the Calculation of Oscillatory and Rotatory Intensities of Nonplanar pi-Electronic Systems.

The interaction of configurations, including all possible singly excited configurations, is incorporated into the calculation of oscillatory and rotatory intensities of simple nonplanar pi-electronic systems such as skewed butadiene and acrolein. The results are discussed in terms of the reliability of the (self-consistent field)-(linear combination of atomic orbitals)-(molecular orbital) wave functions employed.

A case report of midgut nonrotation treated by laparoscopic Ladd procedure.

We performed laparoscopic survey and treatment on a 17-year-old girl who was diagnosed as having complete midgut nonrotation. The Ladd procedure was successfully performed laparoscopically. The patient was discharged 6 days after the operation. Laparoscopic operation is a useful tool for the correct diagnosis and treatment of intestinal malrotation disease in the adult patient.