Forty-six patients with liver cirrhosis were classified into three groups ac cording to glucose tolerance test and the presence or absence of diabetic state. The results of xylitol tolerance test, galactose tolerance test, BSP retention, ICG disappearance rate and other routine liver function tests were compared between these three groups. The results show that liver cirrhosis in patients with overt diabetes was less severe than that in non-diabetics. It is conceivable, therefore, that the glucose intolerance in most of the cirrhotic patients with overt diabetes is not due to the so called hepatogenous diabetes, but to essential diabetes with concomitant cir· rhosis. Intravenous xylitol tolerance test may be available for the differential diagnosis of hepatogenous diabetes from essential diabetes with concomitant cirrhosis, since the change in serum glucose level after the administration of xylitol was characteristic in each group. Further studies must be done to substantiate this possibility.
We studied whether the diameter of the saphenous vein graft affects the result of femoro-popliteal bypass surgery.Thirty-eight patients with bypasses from the femoral artery to the above knee popliteal artery were studied. Bypasses without a patent anterior or posterior tibial artery were excluded. The great saphenous vein was used as a bypass graft in 20 extremities and Dacron grafts (6 mm or 8 mm diameter) were used in 18 arteries. The smallest diameter of the saphenous vein was measured preoperatively with ultrasonography. Vein grafts were divided into two groups: small vein graft (< or =3 mm) and large vein graft (> or =3.5 mm). The ankle brachial pressure index (ABI) was measured at 1 week and 3 months after operation.The diameter of the vein graft (2.5 to 4 mm, 3.4+/-0.5 mm) was positively correlated with postoperative ABI (R2 0.607, P<0.0001). The postoperative ABI at 1 week was significantly lower in the small vein graft group (0.72+/-0.09) than in the large vein graft group (0.95+/-0.11) and in the Dacron graft group (1.05+/-0.16). The ABI at 3 months was still significantly lower in small vein graft group (0.78+/-0.07).The diameter of the vein graft was positively correlated with postoperative ABI after femoro-popliteal above knee bypass. Postoperative ABI was lower using a vein graft with a diameter of < or =3 mm than that using a bigger vein graft or a Dacron graft.
Macroscopic whole cell currents were measured from single rabbit cardiac myocytes, using the suction electrode voltage-clamp technique, under euthyroid, hyperthyroid, and hypothyroid conditions. In ventricular myocytes, the temperature dependence of the transient outward current (I(t)) was greatly reduced in hyperthyroid conditions, with Q10 values (between 22 and 32 degrees C) reduced from normal values of 6.14 +/- 0.93 (SE, n = 8) to 2.14 +/- 0.14 (n = 6). In contrast, two of the other major currents in these cells were relatively unaffected. Under hyperthyroid conditions, there was very little change in the amplitudes or temperature dependence of L-type calcium currents and of steady-state currents, which reflect mainly the inwardly rectifying potassium current. In atrial cells no changes in the temperature dependence of I(t) were observed, with virtually identical Q10 values (close to 4) in eu- and hyperthyroid conditions. Under hypothyroid conditions, there was no change in the temperature dependence of I(t) in either ventricular or atrial cells. We conclude that the regulation of I(t) in ventricular cells is unique, rendering it extremely sensitive to temperature changes and to elevations in thyroxine levels. These results are discussed in the context of long-term regulation of ionic channels.
A 58-year-old woman reporting an abdominal mass was found to have a mass 4 cm in diameter in the middle of the abdomen. We diagnosed the tumor as originating in the mesentery. Laparotomy revealed an ovoid tumor 4.5×4.5×4.5cm solid in the cut surfece in the mesentery of the jejunum. Histologically, it was diagnosed as mesenteric fibromatosis. The woman is alive without recurrence 13 months after resection. Mesenteric fibromatosis is very rare in patients without familial polyposis of the colon (FPC) or those not undergoing previous abdominal surgery. To our knowledge, only 25 cases, including ours, have been reported in the Japanese literature. We discuss isolated mesenteric fibromatosis originating in the mesentery of the jejunum and review the literature.
Purpose Surgical revascularization is the standard treatment for chronic limb-threatening ischemia (CLTI). However, some patients may require reintervention. The Global Anatomic Staging System (GLASS), which evaluates the complexity of infrainguinal lesions, was proposed. This study aimed to identify predictors for graft revision and evaluate whether GLASS impacts vein graft revision. Methods Between 2011 and 2018, CLTI patients who underwent de novo infrapopliteal bypass using autogenous veins were retrospectively analyzed. To assess anatomic complexity with GLASS, femoropopliteal, infrapopliteal, and inframalleolar/pedal (IM) disease grades were determined. The outcomes of patients with or without graft revision were compared. Cox regression analysis was performed. Results Thirty-six of the 80 patients underwent reintervention for graft revision. Compared to the non–graft revision group, the graft revision group exhibited significantly higher rates of GLASS stage III (66% vs 81%, p = 0.046) and grade P2 IM disease (25% vs 58%, p = 0.009). Multivariate analysis revealed that IM grade P2 (hazard ratio [HR], 3.35; 95% confidence interval [CI], 1.66–6.75; p = 0.001) and spliced vein grafts (HR, 3.18; 95% CI, 1.43–7.06; p = 0.005) were significantly associated with graft revision. Conclusions This study demonstrated that IM grade P2 and spliced vein grafts were predictors of graft revision. The GLASS stratification of IM disease grade may be useful in optimizing treatment for CLTI.
Background:To validate the criteria for endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm (AAA) at Nagoya University Hospital, the results of both treatments were retrospectively compared.Methods and Results:Patient selection for EVAR was primarily based on suitable anatomy, minimum age 75 years, and significant comorbidity. From June 2007 to April 2014, 426 patients were treated via EVAR (EVAR group) and 346 patients were treated with open surgery (OS group). The mortality rates of the EVAR and OS groups were not significantly different (0.2% vs. 1.1%; P=0.33). Patient age, operation time, amount of bleeding, and duration of hospital stay were significantly lower in the EVAR group compared with the OS group. The incidence of comorbidity was higher in the EVAR group compared with the OS group. The incidence of early postoperative complications was significantly higher in the OS group, whereas the incidence of late complications for both groups was similar. The cumulative aneurysm-related survival rates were similar (98.9% vs. 98.5%; P=0.767). The cumulative survival rates and reintervention-free rates at 5 years were lower for the EVAR group (76% vs. 89%, P=0.019; 81% vs. 89%, P=0.046).Conclusions:Patient selection practices and criteria for EVAR and open repair at Nagoya University Hospital are generally acceptable. (Circ J 2015; 79: 1699–1705)
Purpose: An accurate distal deployment is essential for successful thoracic endovascular aortic repair (TEVAR) of a paradiaphragmatic aortic aneurysm. This study aimed to investigate the anatomical and intraoperative factors that affect the accuracy of distal deployment during TEVAR. Methods: We conducted a retrospective review of preoperative and postoperative computed tomography scans of 426 patients undergoing TEVAR at our institution between October 2008 and May 2021, of which the stent-graft was attempted to be deployed just above the celiac axis or the superior mesenteric artery in 56 patients. Based on the anatomical factors related to the malposition (deployed >10 mm away from the target vessel) and the greater curve to the straight-line ratio (G/S ratio), the patients were categorized as severe tortuosity (n=21) and mild tortuosity (n=35) groups to compare the operative and clinical outcomes. Result: Stent-graft malpositioning occurred in 21 cases. Among all anatomical variables, only the G/S ratio was significantly larger in the malpositioned cases (p=0.049). A cutoff G/S ratio value of 1.15 was determined using the receiver operating curve analysis. In the severe tortuosity group, the distal end of the stent-graft was significantly farther (median: 10.0 [interquartile range (IQR): 2.5–19.5] mm vs 3.0 [0–8.0] mm; p=0.015) from the target vessel, and the tilt angle of the stent-graft’s distal edge was larger (median: 21.4 [IQR: 15.8–24.5] vs 9.5 [5.5–12.5] degree; p<0.01) than that in the mild tortuosity group. Both groups were comparable for the incidence of a primary type Ib endoleak (p=0.454), a secondary type Ib endoleak (p=1.0), and the rate of distal reintervention (p=0.276). Conclusion: Severe tortuosity in the distal descending thoracic aorta is associated with a malpositioned and tilted distal end of the stent-graft. Clinical Impact Thoracic endovascular aortic repair (TEVAR) for paradiaphragmatic thoracic aortic aneurysms requires accurate distal landing. In this paper, a retrospective CT analysis revealed that the greater curve to the straight-line ratio (G/S ratio) was associated to affects the malposition of the stent graft, defined as being deployed more than 10 mm away from the target vessel. Further, a comparative analysis based on the G/S ratio demonstrated that severe aortic tortuosity was associated with a more distal and tilted deployment of the stent graft.
