A 57-year-old man, who was a chronic axillary crutch user as a result of childhood poliomyelitis, was referred to our hospital because of a sudden onset of right forearm ischemia. The right forearm had no pulse, and three-dimensional computed tomography (3DCT) showed an aneurysm of the right brachial artery associated with arterial occlusion. The thrombosed aneurysm of the brachial artery was resected and the brachial artery was successfully revascularized by interposing a saphenous vein graft. Postoperative 3DCT revealed an asymptomatic left brachial artery aneurysm. His postoperative course was uneventful under warfarin anticoagulation therapy.

ABSTRACT-13-Adrenoceptors in the guinea pig taenia caecum were investigated by measuring relaxation responses to agonists and by a radioligand binding assay using [3H]CGP 12177. The rightward shift of the isoprenaline concentration-response curve was observed by butoxamine, a p2-selective antagonist, and the pA2 value for butoxamine was 6.46. In control preparations, catecholamines caused relaxation with the following rank order of potency: isoprenaline > adrenaline > noradrenaline. However, in the presence of 10-6 M phentolamine, 3 x 10-4 M atenolol and 10-4 M butoxamine, the rank order of potency of the agonists was: isoprenaline > noradrenaline > adrenaline. CGP 12177 caused graded relaxation of the guinea pig taenia caecum, and this response was not influenced by 10-6 M phentolamine, 3 X 10-4 M atenolol, 10-4 M butoxamine or 10-6 M propranolol. The Scatchard plot of the specific [3H]CGP 12177 binding to microsomal fractions from the guinea pig taenia caecum showed two affinity sites of the receptor: high affin ity (KD=0.64 nM) and low affinity (KD=142.21 nM) sites. The pKD value of the high affinity site of [3H] CGP 12177 was in agreement with its pA2 value, and that of the low affinity site was in agreement with its pD2 value. These results suggest that isoprenaline-, noradrenaline and adrenaline-induced relaxations of the guinea pig taenia caecum predominantly involve /2 and (33-adrenoceptors, whereas CGP 12177-induced relaxation is mediated solely through 33-adrenoceptors.

We present a patient with a nine-year history of Behçet's disease (BD), who developed a rapidly expanding aneurysm of the aortic arch. Three-dimensional computed tomography demonstrated a saccular aortic arch aneurysm with a maximal diameter of 5 cm. No bacteria were detected by serial blood cultures. The aneurysm, however, showed a multi-lobular cavity, mimicking an infectious aneurysm. Therefore, we prescribed antibacterial agents for one week. The patient still had a high-fever and an elevated C-reactive protein level thereafter. Aortic arch replacement was performed emergently. Because we were unable to determine whether the aneurysm was caused by infection or BD, the implanted prosthetic graft and the anastomotic sites were covered with a pedicle graft of the greater omentum, and we continued to administer antibacterial agents for four weeks postoperatively. The pathological examination showed neither bacteria nor cystic medial necrosis in the resected aortic wall. Inflammatory changes with eosinophilic infiltration were recognized mainly around the adventitia near the aneurysm. The patient had a favorable postoperative course without any complications.

BackgroundThe purpose of this study was to evaluate retrospectively the clinical performance of the Bicarbon valve (Sorin Biomedica Cardio, Saluggia, Italy) implanted at our center in Japan.MethodsBetween January 1997 and December 2011, 415 patients in our institution were implanted with the Bicarbon valve. Nine of these recipients were excluded from the study because they had already undergone valve implantation and received a Bicarbon valve in a different position. The remaining patients were analyzed for evaluation of the postoperative clinical outcomes. Of the 406 patients (mean age 60.2 ± 11.7 years), 179 underwent aortic valve replacement (AVR), 149 mitral valve replacement (MVR), and 78 both aortic and mitral valve replacement (DVR).ResultsThere were 10 early deaths (2.5 %: 4 in the AVR group and 6 in the MVR group). Three hundred eighty-nine patients were followed up (95.8 % completeness of follow-up) with a mean follow-up of 6.6 ± 4.2 years overall (AVR 6.8 ± 4.2, MVR, 6.7 ± 4.4, and DVR 5.7 ± 3.4 years) and a cumulative follow-up of 2661 patient-years (1214, 1001, and 446 patient-years for AVR, MVR, and DVR, respectively). Ninety-nine patients died (3.7 % per patient-year: 22 valve-related and 77 valve-unrelated deaths). Survival at 10 years was 74.1 ± 4.0 % in the AVR group, 73.7 ± 4.2 % in the MVR group, and 61.0 ± 7.9 % in the DVR group. The linearized incidence of thromboembolic complications, bleeding complications, prosthetic valve endocarditis, paravalvular leaks, and sudden death in all patients was 0.5 %, 0.5 %, 0.2 %, 0.2 %, and 0.4 % per patient-year, respectively. The incidence of valve-related complications and reoperation was 1.6 % and 0.4 %, respectively. No other valve-related complications were observed.ConclusionsThe Bicarbon prosthetic heart valve has shown excellent clinical results and is associated with a low incidence of valve-related complications.

A 46-year-old man with a medical history notable only for schizophrenia was admitted to hospital with complaints of general fatigue and high fever. Transthoracic echocardiography on day 6 after admission demonstrated a large vegetation (17 mm) on the anterior leaflet of the mitral valve with mild regurgitation and mild aortic regurgitation. The patient also complained of abdominal pain. Abdominal computed tomography showed a remarkable enlargement of the superior mesenteric artery aneurysm (SMAA). An excision of the SMAA and double valve replacement was performed, and the patient was administered a six-week course of intravenous antibiotic therapy.