Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：日本静脈学会  

2004年の新潟県中越地震(中越地震)では10万人以上が車中泊避難を行ったことから被災地では深部静脈血栓症(deep vein thrombosis;DVT)が遷延し慢性化していることが判明している。中越地震6年後のDVT検診を小千谷市と十日町市で行い867人(平均年齢65.9±11.2歳)が受診した(292人が初めて検診を受診)。その結果、下腿DVTを85人に認め、17人(5.8%)が初めて検診を受けた人であり中越地震6年後のDVT頻度は5.8%と推定された。また高血圧、高脂血症、糖尿病のうち高血圧のみDVTが有意に関連していた(p<0.001)。また震災後発症の脳梗塞または一過性脳虚血発作(TIA)は下腿静脈のDVT有りでは7人(8.2%)、DVT無しでは28人(3.6%)であり、年齢と性別を層別化したMantel-Haenszel検定においてDVT保有者でオッズ比2.73(95% CI;1.11-6.68)で有意に脳梗塞が多かった(p<0.01)。以上より震災後のDVTは遷延しやすく高血圧と関連することが示唆された。また震災後のDVTは慢性期の脳梗塞・TIAと関連することも示唆された。(著者抄録)

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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Language：Japanese   Publisher：(一社)日本脳神経超音波学会  

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Language：Japanese   Publisher：(一社)日本検査血液学会  

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Language：Japanese   Publisher：(一社)日本脳神経超音波学会  

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Language：Japanese   Publisher：(一社)日本脳神経超音波学会  

脳・神経疾患による臥床入院患者における下肢深部静脈血栓症(DVT)の発生頻度と予測因子について検討した。対象は平成18年6月〜19年3月までに入院し、48時間以上の臥床となった脳・神経疾患患者108例であった。疾患内訳は脳梗塞48例、脳梗塞以外の神経筋疾患(パーキンソン症候群や筋ジストロフィー等)60例で、下肢静脈超音波検査と凝血学的検査が行なわれた。その結果、1)108例中21例(19.4%)にDVT(うち2例に肺塞栓症)が認められ、発生部位は大腿静脈6例、ヒラメ筋静脈14例(他下腿2分枝併存例を含む)等であった。2)DVT有群と無群の平均D-dimerは7.5 vs 2.8g/μml、平均年齢は72.3 vs 63.8歳といずれも有意差が確認された。3)D-dimerは脳梗塞例のDVT有群と無群では5.8 vs 3.2、神経筋疾患では9.6 vs 2.5と有意差がみられなかったが、神経筋疾患ではD-dimerがDVTの確定診断に結び付く可能性が示唆された。

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Language：Japanese   Publisher：ライフサイエンス出版(株)  

72歳男。患者は呼吸困難を主訴とした。38歳時に統合失調症を発症し、内服加療で症状は安定していた。その後、69歳時に交通事故で外傷性くも膜下出血を発症し、精神症状の悪化で入退院を繰返し、身体拘束を3回実施された。3回目の身体拘束は肺炎の加療のために行われ、抗生剤治療により炎症所見は改善した。だが、SpO2の低値が続き、D-dimer値は著明に上昇、もしくは低下、再上昇を繰り返した。一方、造影CTでは左下肺静脈に造影欠損がみられ、肺血流シンチグラフィーでは左肺に欠損像が確認された。更に下肢静脈エコーが実施されたが、血栓は指摘されなかった。治療としてIVCフィルターを挿入し、抗凝固療法を開始した結果、肺血流シンチグラフィーを再検すると、右肺に明らかな欠損像を認められるも、再発時もD-dimerの上昇は認めなかった。尚、身体拘束期間中はヘパリンカルシウム静注を行っていた。

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Language：Japanese   Publisher：(一社)日本医療検査科学会  

バイダスDダイマー2を用いて、日本人においても高感度D-ダイマーによる深部静脈血栓症(DVT)除外診断が可能か検討した。入院後48時間以上の床上安静を必要とした75例を対象とした。比較のため健常者28例についても高感度D-ダイマーを測定した。下肢DVTの診断は下肢静脈エコー検査を基準検査として行った。最低検出限界は、45ng/mlまでの測定が可能であった。健常者群のD-ダイマー値は248.8±125.1ng/mlで、1例を除いて500ng/ml未満であった。下肢静脈エコー検査で、患者75例中22例がDVTと診断された。血栓の存在部位はいずれもヒラメ静脈で、D-ダイマーの平均値はDVT陰性群1133.3±997.7ng/ml、DVT陽性群2013.3±1232.5ng/mlであった。500ng/mlをカットオフ値とした場合の感度は100%、特異度は30.1%、陰性的中率は100%であった。

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Language：Japanese   Publisher：(一社)日本臨床検査医学会  

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Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

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Language：Japanese   Publisher：The Japan Society of Ultrasonics in Medicine  

DOI： 10.3179/jjmu.35.S525

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Language：Japanese   Publisher：(一社)日本神経学会  

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Language：Japanese   Publisher：(一社)日本臨床化学会  

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Language：Japanese   Publisher：(一社)日本医療検査科学会  

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Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

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Language：Japanese   Publisher：The Japanese Society of Extra-Corporeal Technology in Medicine  

経頭蓋超音波検査(TCD)では脳動脈内の気泡,血栓などの微小栓子がHigh Intensity Transient Signals(HITS)として検出することが可能である。CPB中に脱血回路から空気が混入した症例で,脳動脈内でHITSが多数検出され,術後の覚醒遅延や痙攣などの合併症を経験した。今回,TCDを用いて3種類の静脈貯血槽(VR)の気泡捕捉能力を検討したので報告する。3種類のVRを用いて模擬回路を作製し,静脈回路に設けた空気の注入口から1mLの空気を注入し,VR出口,人工肺出口,動脈Filter出口にてHITSの検出を行った。灌流液には豚血を用い,灌流温36℃,灌流量は4L/minとした。3種類のVRから出る気泡数に有意差は認められなかったが,気泡径はVRのFilterサイズが150μmのA-VRから流出する気泡径が大きい傾向にあった。人工肺前後では気泡数に有意差が認められたが,動脈Filter前後では有意差が認められず,10μm以下のマイクロバブルみら捕捉はできないことが示唆された。マイクロバブルの捕捉には人工肺のほかにVRの除泡能が大きく関与することが示唆された。

DOI： 10.7130/hokkaidoshakai.31.71

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Other Link： http://search.jamas.or.jp/link/ui/2004162391

Language：English   Publisher：The Japan Academy of Neurosonology  

Background and Purpose: With recent transcranial Doppler ultrasonography (TCD) techniques, high intensity transient signals (HITS) can be detected automatically. However, the significance of automatically detected HITS without associated sound is unclear. We attempted to determine whether HITS detected automatically during veno-arterial extracorporeal membrane oxygenation (V-A ECMO) reflect the state of blood coagulability. Methods : In an animal study, V-A ECMO was performed in 11 adult pigs by aortic and pulmonary cangulation using a roller pump and membrane oxygenator. HITS were counted automatically during bypass before and after administration of anticoagulants. In a clinical study of 6 patients with V-A ECMO after cardiac surgery, HITS were detected during and after removal of ECMO. Results: In the animal study, the majority of HITS recorded during V-A ECMO had no associated sound. The HITS count before and after ECMO was 0 and 49±35/10-min (n=11), respectively. The HITS count after administration of heparin was 4±4/10-min (n=5), and that after administration of argatroban was 7±7/10-min (n=6) . HITS counts were significantly reduced after administration of either anticoagulant (p<0.001) . In the clinical study, HITS were detected frequently during ECMO (158±99/15-min (n=6) ), but no HITS were detected after its removal. The HITS count rate was negatively correlated with activated clotting time. Conclusions: Automatically detected HITS without associated sound may reflect the degree of coagulation during V-A ECMO. Therefore, inaudible HITS may be a useful indicator of the level of anticoagulation during V-A ECMO.

DOI： 10.2301/neurosonology.12.120

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Language：Japanese   Publisher：The Japan Academy of Neurosonology  

Purpose: High-intensity transient signals (HITS) are commonly detected during cardiopulmonary bypass (CPB) . However, the clinical significance of HITS during CPB is still controversial. Micro-bubbles are reported to produce HITS of more than 400-500 Hz. We attempted to elucidate the incidence of HITS exceeding 400 Hz during CPB. Methods: The subjects were 6 patients who underwent open heart surgery using CPB. HITS were detected by TC2020, PIONEER (Nicolet /EME) with a 2.0-MHz pulsed Doppler probe at the middle cerebral artery. Transesophageal echocardiography (TEE) was undertaken during the operation. Results: The total number of HITS during CPB was 1707±1392 (n=6) . Of the total HITS, 88.1±6.8% had a frequency of more than 400 Hz. On the other hand, HITS of less than 400 Hz were frequently detected at aortic cannulation, aortic decannulation and aortic cross-clamping. HITS of more than 400 Hz were detected in cases showing cardiac or aortic micro-bubbles in TEE. Conclusion: The present findings suggest that the majority of HITS during CPB reflect micro-bubbles, and that aortic manipulation may be related to the formation of solid micro-emboli. HITS frequency analysis may be useful for differentiating between micro-bubbles and solid micro-emboli formed during CPB.

DOI： 10.2301/neurosonology.12.64

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Other Link： http://search.jamas.or.jp/link/ui/2000087438

Language：Japanese   Publisher：The Japan Academy of Neurosonology  

Recently, high-intensity transient signals (HITS) obtained by transcranial Doppler ultrasonography (TCD) were reported to reflect micro-emboli in cerebral arteries. Frequent detection of HITS in patients with mechanical valve replacement has been reported for many years. However, the mechanism and significance of these signals has remained unclear. We attempted to elucidate whether HITS indicate a risk of cerebral infarction in patients with mechanical valve (St. Jude Medical valve: SJM) replacement, and also carried out an animal experimental study to clarity the mechanism of HITS formation.<BR>HITS was frequently detected in patients with SJM valves. The HITS count after surgery in patients with cerebral infarction (83 ± 66/15 min) was significantly higher than that in patients without a history of stroke (7 ± 7/15 min) (p<0.001) . The HITS count in patients with mechanical valve replacement appeared to increase with time after surgery. Thus, the HITS count appeared to indicate the risk of cerebral infarction after mechanical valve replacement. In the experimental study, injection of clotted blood into the aorta produced low-frequency and small-intensity HITS. Introduction of micro-bubbles into the aorta produced high-frequency and large-signal-intensity HITS. These two kinds of HITS were detected in patients with SJM valves. Thus, HITS in patients with SJM valves may be produced by both gaseous and solid micro-emboli.

DOI： 10.2301/neurosonology.12.7

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Other Link： http://search.jamas.or.jp/link/ui/1999195240

Language：Japanese   Publisher：The Japan Academy of Neurosonology  

High intensity transient signals (HITS) were detected in patients with a high risk of stroke. The signals were detected in the middle cerebral artery for 15-30 min by a TC2020 or Multi-Dop DX4. HITS were never detected in young healthy volunteers (n=20) . The HITS count in patients with cerebral infarction (16-20/30 min, n-42) was significantly higher than that in patients without cerebrovascular disease (0.5±0.7/30 min, n17) (p<0.01) . In the cerebral infarction group, the HITS count in patients without antiplatelet (20±29/30 min, n=20) was significantly higher than that in patients with antiplatelet (9±6/30 min, n=22) (p<0.01) . HITS were frequently detected in patients fitted with mechanical valves (St. Jude Medical valve) (14.3±34.5/15 min, n=51), and the count was significantly higher than that in open heart surgery patients without mechanical valves (0.05+0.08/15 min, n=11) (p<0.01) . In the mechanical valve replacement group, the HITS count in patients with cerebral infarction after surgery (88±66/30 min, n=43) was significantly higher than that in patients without a historyof stroke (7±7, n-8) (p<0.01) . The HITS intensity in the mechanical valve replacement group (15.1+4.3 dB, n=31) was significantly greater than that in the cerebral infarction group (10.8+1.1dB, n-32) (p<0.05) . In the mechanical valve replacement group, the HITS intensity in patients with post-surgical cerebral infarction (18±3.5 dB, n8) was significantly greater than that in patients without a history of stroke (14.5±5.6 dB, n=23) (p<0.0001) . During veno-arterial extracorporeal membrane oxygenation (V-A ECMO), HITS were frequently detected (124±60/15 min, n=6), and the HITS count was negatively correlated with activated coagulation time (ACT) . HITS may therefore reflect the presence of microemboli and indicate the risk of stroke or the state of blood coagulation.

DOI： 10.2301/neurosonology.10.16

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Other Link： http://search.jamas.or.jp/link/ui/1997205194

Language：Japanese   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.30.3_552_2

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Language：English   Publisher：OXFORD UNIV PRESS  

Background: While there is a concern about the increase in the occurrence of acute aortic dissection (AAD) caused by the worsening of hypertension, mental stress, etc., there is a lack of data regarding the influence of disasters on this event. The aim of this study was to address this issue in the acute-subacute phase after the Kumamoto Earthquake occurred on 14 April 2016. Methods: We retrospectively investigated the impacts of the Kumamoto Earthquake on various cardiovascular diseases, including AAD, utilizing the medical records of patients in 16 hospitals in Kumamoto Prefecture during the period from 14 April to 30 June (78 days) in 2014, 2015, 2016, and 2017. Results: The occurrence of heart failure and venous thromboembolism increased significantly in the acute-subacute phase after the earthquake. When comparing the earthquake year (2016) to the non-earthquake years (2014, 2015, and 2017), the difference in the occurrences and mortalities of AADs were not significant. When other characteristics of the patients were compared between the earthquake year and the non-earthquake years, there were no differences. Conclusions: It might be possible that the Kumamoto Earthquake did not affect the incidence of AAD or deaths from AAD, possibly because the climate was mild and the preventive efforts based on previous experience were successful.

DOI： 10.1093/ajh/hpz183

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Language：Japanese   Publisher：ぎょうせい  

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Language：Japanese   Publisher：農山漁村文化協会  

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Language：Japanese   Publisher：農山漁村文化協会  

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Language：Japanese   Publisher：消防防災科学センター  

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Language：Japanese   Publisher：イマジン出版  

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Language：English   Publisher：IEEE  

Repair of dissected aorta requires remodeling the structure of the media. Modeling approaches specific to endovascular stenting for aortic dissection have been reported. We created a goat model of descending thoracic aortic dissection and reproduced its morphological characteristics in a mock circulatory system. The purpose of this study was to examine a newly developed aortic stent which was capable of installing to the aortic dissected lesion for biomedical hemodynamics point of view. In this study, we examined the changes in hemodynamics of dissected lesions and the amelioration by endovascular stent intervention. Firstly, we performed animal experiments with the dissected aorta and examined the effects of stenting on volumetric changes in the false lumen. Secondly, we made several types of 3-D stereolithographic dissected aortic models with silicone rubber membrane between the false and the true lumens. Then, the hemodynamic characteristics in each model were evaluated in the pulsatile flow conditions in a mock circulatory system. These modelling approaches enabled the quantitative examination of post-therapeutic effects of stenting followed by elucidating of hemodynamic changes in the vicinity of stents, which may follow the management of clinical amelioration of interventional treatment with aortic stenting.

DOI： 10.1109/EMBC44109.2020.9176423

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Other Link： https://dblp.uni-trier.de/conf/embc/2020

Language：English   Publisher：VIA MEDICA  

Introduction: Tsunami victims of the Great East Japan Earthquake were screened for deep-vein thrombosis (DVT) in order to compare the DVT incidence rates between temporary and non-temporary housing resident groups.Material and methods: Lower extremity venous ultrasonography was performed on 290 subjects (64 men and 226 women; mean age = 71.9 +/- 7.9 years) at 44 months after the disaster. All subjects completed questionnaires to gather information about their background factors which included the Kessler Psychological Distress Scale: K6.Results: The DVT detection rate was 10.7% in the temporary group. In the non-temporary group, it was 11.3% among the subjects who previously lived in temporary housing. For the subjects who were living in their own homes, it was 9.2%. Psychological distress levels measured by K6 were significantly higher in the temporary housing group than in the non-temporary housing group. The multivariate analysis showed that the background factor associated with DVT risk was SV (soleal vein) dilatation in all subjects as well as in the non-temporary housing group, while hypertension and use of sleeping pills were found to be the factors in the temporary housing group.Conclusions: DVT detection rates were similar between the temporary and non-temporary housing groups, and were higher than that in the Japanese general population. The psychological distress level of the tsunami victims measured by K6 was also higher in the temporary housing group than in the non-temporary housing group. It is necessary to establish a long-term and awareness-raising disaster victim support system.

DOI： 10.5603/AA.2020.0025

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：English   Publisher：SPRINGER JAPAN KK  

To ensure that experiences and lessons learned from the unprecedented 2011 Great East Japan Earthquake are used to improve future disaster planning, the Japan Diabetes Society (JDS) launched the Research and Survey Committee for Establishing Disaster Diabetes Care Systems Based on Relevant Findings from the Great East Japan Earthquake under the supervision of the Chairman of the JDS. The Committee conducted a questionnaire survey among patients with diabetes, physicians, disaster medical assistance teams (DMATs), nurses, pharmacists, and nutritionists in disaster areas about the events they saw happening, the situations they found difficult to handle, and the needs that they felt required to be met during the 2011 Great East Japan Earthquake. A total of 3,481 completed questionnaires were received. Based on these and other experiences and lessons reported following the 2011 Great East Japan Earthquake and the 2004 Niigata-Chuetsu Earthquakes, the current Manual for Disaster Diabetes Care has been developed by the members of the Committee and other invited authors from relevant specialties. To our knowledge, the current Manual is the world's first to focus on emergency diabetes care, with this digest English version translated from the Japanese original. It is sincerely hoped that patients with diabetes and healthcare providers around the world will find this manual helpful in promoting disaster preparedness and implementing disaster relief.

DOI： 10.1007/s13340-019-00397-7

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Language：Japanese   Publisher：建築ジャーナル  

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Language：Japanese   Publisher：建設政策研究所  

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Language：Japanese   Publisher：環境新聞社  

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Other Link： http://search.jamas.or.jp/link/ui/2019166224

Language：Japanese   Publisher：一般社団法人 日本血栓止血学会  

DOI： 10.2491/jjsth.30.81

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Language：Japanese   Publisher：The Japan Academy of Neurosonology  

A 21-year-old Indonesian woman came to hospital with severe headache and vomiting. Brain MRI showed multiple subcortical lesions. High-intensity transient signals (HITS) was detected in the carotid artery and transesophageal echocardiography (TEE) was performed to search for embolic sources. Mobile string-like structures were found in the aortic arch. We started anticoagulation therapy. One month later, TEE reexamination revealed that the aortic arch cord had shrunk, but numerous cords were found in the pulmonary artery. She was suspected with <i>Angiostrongylus cantonensis</i> infection and treated with antiparasitic agent and steroids. One month later, the TEE was performed again, and the cord-like structure in the aortic arch almost disappeared, and the abnormal structure in the pulmonary artery also disappeared. It is known that <i>A. cantonensis</i> can cause eosinophilic meningoencephalitis, but its prognosis is good, and it is thought that it may be mild. In this case, although the definitive diagnosis has not been made, the possibility was considered to be high because antiparasitic agent was effective. HITS detection for investigating the cause of multiple subcortical lesions was considered to be useful in determining the embolic mechanism.

DOI： 10.2301/neurosonology.32.129

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Language：Japanese   Publisher：公益社団法人 日本生体医工学会  

<p>【背景】解離性大動脈瘤では解離偽腔内に流入する血流がもたらす乱流による複雑な圧流量特性が観察される。治療効果と安全性を評価する上では血管内治療用の解離性大動脈瘤内の血圧血流速の医工学的モデリングが重要となっている。【目的】これまで解離性大動脈瘤の動物実験モデルを作成し血行動態の再現を行ってきた。本研究では動物実験から得られた超音波画像を基に解離性大動脈瘤血行動態のモデリングを目的としてそれらの解析手法に関して評価を進めた。【方法】〔動物解離モデル〕健常成山羊を麻酔下にて開胸し、下行大動脈の中枢側外膜を切開後、中膜を外科的に剥離し、血管開口部を切開し大動脈解離を作成した。〔モデル化手法・解析〕下行大動脈の超音波短軸像を血管長軸に沿って1mm毎の断層像とし、データの数値的再構成により形状モデルを構築した。作成したモデルを用いて模擬循環回路による流れ可視化と数値流体解析を行った。【まとめ】動物モデルでは臨床に近い形態と血流を再現できる一方、血管内治療の血行力学的評価については血流形態の差や計測誤差の課題がある。解離性大動脈瘤治療ではさまざまな医工学モデリング方法論で安全性評価が可能である。</p>

DOI： 10.11239/jsmbe.Annual57.S220_2

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Language：English   Publisher：WILEY  

To ensure that experiences and lessons learned from the unprecedented 2011 Great East Japan Earthquake are used to improve future disaster planning, the Japan Diabetes Society (JDS) launched the “Research and Survey Committee for Establishing Disaster Diabetes Care Systems Based on Relevant Findings from the Great East Japan Earthquake” under the supervision of the Chairman of the JDS. The Committee conducted a questionnaire survey among patients with diabetes, physicians, disaster medical assistance teams (DMATs), nurses, pharmacists, and nutritionists in disaster areas about the events they saw happening, the situations they found difficult to handle, and the needs that they felt required to be met during the 2011 Great East Japan Earthquake. A total of 3,481 completed questionnaires were received. Based on these and other experiences and lessons reported following the 2011 Great East Japan Earthquake and the 2004 Niigata-Chuetsu Earthquakes, the current “Manual for Disaster Diabetes Care” has been developed by the members of the Committee and other invited authors from relevant specialties. To our knowledge, the current Manual is the world’s first to focus on emergency diabetes care, with this digest English version translated from the Japanese original. It is sincerely hoped that patients with diabetes and healthcare providers around the world will find this manual helpful in promoting disaster preparedness and implementing disaster relief.

DOI： 10.1007/s13340-019-00397-7

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Language：English   Publisher：JAPANESE CIRCULATION SOC  

Background: After previous earthquakes, a high prevalence of deep vein thrombosis (DVT) has been reported. We examined DVT prevalence and risk factors in evacuees of the Kumamoto earthquakes by performing mobile DVT screening at various evacuation centers around the epicenter. Methods and Results: For 1 month after the Kumamoto earthquake on 14 April 2016, mobile DVT screening using portable ultra-sonography (US) was performed at 80 evacuation centers. Questionnaires, physical examination, and US of the lower limb were carried out, and simple D-dimer measurements were undertaken for DVT-positive examinees. The total number of examinees was 1,673, of whom 178 (10.6%) had DVT. The prevalence of DVT seemed to be gradually decreasing in the screening period, but age, use of sleep medication, prevalence of hypertension, dyslipidemia, leg edema, and lower leg varix were significantly higher in the DVT positive group than in the negative group. On multivariable logistic regression analysis, high age (≥70 years old), use of sleep medication, lower leg edema, and lower leg varix were significant predictors of DVT. In examinees with these 4 predictors, the DVT positive rate was 71.4%. Conclusions: In the first month after the Kumamoto earthquakes, DVT prevalence and severity, evaluated on D-dimer level, decreased with the passage of time. Mobile DVT screening indicated significant factors stratifying DVT risk in the evacuees.

DOI： 10.1253/circj.CJ-18-1369

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Language：English   Publisher：ANNALS VASCULAR DISEASES EDITORIAL OFFICE  

A right-sided aortic arch, associated with an aberrant left subclavian artery and a Kommerell's diverticulum, is a rare congenital anomaly. Case 1: A 53-year-old man, complaining of dysphasia, underwent a two-stage hybrid operation. Total arch replacement with the reconstruction of supra-aortic vessels was performed via a median sternotomy. Thoracic endovascular aortic repair was subsequently completed with the femoral approach. Case 2: A 81-year-old man, complaining of syncope and dizziness, underwent thoracic endovascular aortic repair after endovascular aneurysm repair for a common iliac artery aneurysm. Treatment strategies for Kommerell's diverticulum should be individually determined depending on the clinical situation and anatomical features.

DOI： 10.3400/avd.cr.18-00170

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Language：Japanese   Publisher：消防防災科学センター  

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Language：Japanese   Publisher：The Japan Academy of Neurosonology  

<b>Purpose:</b> We attempted to detect high intensity transient signals (HITS) at common carotid artery (carotid HITS) by paste type Doppler probe in residents at Kashiwazaki City where big earthquake occurred in 2008. Calf deep venous thrombosis (DVT) has been detected frequently in the residents due to earthquake. It was examined whether it relates to DVT, cerebro-cardiovascular diseases (CCVDs), etc. <br><b>Subjects and Methods:</b> We conducted screening for 522 residents in Kashiwazaki City in 2016–2017. HITS were detected by using 2.0MHz paste type probe at carotid artery for 5min.<br> <b>Results:</b> Carotid HITS was detected in 39 (7.5%). Statistically significant risk factors in the carotid HITS positive group were arterial velocity pulse index (AVI), CCVDs and atrial fibrillation. Univariate analysis of cerebro-cardiovascular disease indicated an odds ratio of 3.8 (95% CI: 1.8–7.9, <i>p</i> = 0.001) in the carotid HITS positive, and furthermore odds ratio 3.6 (95% CI: 1.6–7.9, <i>p</i> = 0.001) was found in the same group in multivariate analysis.<br><b>Conclusion:</b> Carotid HITS was a significant risk factor for CCVDs and atrial fibrillation in the general population. Therefore, it was suggested that detection of HITS at carotid artery by paste type probe may be useful for prevention of embolic disease.

DOI： 10.2301/neurosonology.32.46

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Background: An increase in cardiovascular diseases has been reported following major disasters. Previous work has shown that ultrasonographic findings from ultrasound cardiography examination (UCG) increased until the 44th month after the tsunami caused by the Great East Japan Earthquake. The present study conducted UCG among victims in the tsunami disaster area and investigated the frequency of disaster-related cardiovascular diseases and changes over time until the 55th month after the disaster. Methods: The subjects were residents of temporary housing complexes and neighboring housing in Watari-gun, Miyagi Prefecture, Japan. There were 207 subjects in the 18th month, 125 in the 30th month, 121 in the 44th month, and 106 in the 55th month after the disaster. Data were collected through UCG and self-report questionnaire. Results: Significant changes were observed among subjects with clinical findings from the UCG, which increased over the study period-from 42.0 to 60.8, 72.7, and 73.6% beginning in the 18th month after the disaster (p<0.0001). Conclusions: It is possible that the UCG can become a useful examination to visualize the potential impact of a major disaster on the cardiac function of victims. Victims with clinical findings continued increasing not only during the acute phase after a disaster but also in the long term. We therefore need to keep this in mind, and note that it is important to establish a support system to control cardiovascular diseases from the early stage of disaster.

DOI： 10.1186/s12199-018-0721-4

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

DOI： 10.1016/j.cjca.2018.01.014

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Language：Japanese   Publisher：東京法規出版  

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Other Link： http://search.jamas.or.jp/link/ui/2019264151

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Introduction: A prospective study was designed to elucidate incidence and predictors of deep venous thrombosis (DVT) in patients undergoing craniotomies. Materials and Methods: Ninety-two patients who underwent craniotomies received pre- and postoperative venous ultrasonography and/or contrast-enhanced spiral computed tomography for diagnosis of DVT. The primary endpoint was DVT occurrence. Serial levels of serum D-dimer, soluble fibrin, and thrombin–antithrombin complex (TAT) were analyzed. Results: Twenty-four of 92 patients (26.1%) had DVT, of whom 10 (41.7%) were diagnosed preoperatively. In patients with preoperative DVT, age, incidence of decreased performance status and leg paresis, levels of D-dimer, soluble fibrin, and TAT were significantly greater. In patients with postoperative DVT, length of surgery, incidence of decreased postoperative performance status, levels of D-dimer on postoperative days (POD) 3, 7, and 14, and TAT on POD7 were significantly greater. Patients with postoperative DVT had elevated D-dimer levels on POD 7 compared with POD 3. The D-dimer cutoff of 2.65 μg/mL at POD 7 could be used to identify DVT with 85.7% sensitivity and 72.3% specificity. A cutoff of 5.25 μg/mL at POD 7 yielded a specificity of 96.9%. Decreased performance status and elevated D-dimer were independent predictors for preoperative DVT, prolonged operation time, and elevated D-dimer on POD 7 for postoperative DVT. Conclusions: DVT frequently was observed in patients before and after undergoing craniotomies. Patients with decreased performance status should be preoperatively screened for DVT by checking D-dimer levels. Elevated D-dimer levels on POD 7 compared with POD 3 and D-dimer levels greater than 2.65 μg/mL at POD7 suggest the presence of DVT.

DOI： 10.1016/j.wneu.2017.12.139

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Language：Japanese   Publisher：The Japan Research Association for Textile End-Uses  

DOI： 10.11419/senshoshi.59.7_510

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Language：Japanese   Publisher：The Japanese Society on Thrombosis and Hemostasis  

DOI： 10.2491/jjsth.29.370

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Other Link： http://search.jamas.or.jp/link/ui/2018060328

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Other Link： http://search.jamas.or.jp/link/ui/2018235908

Language：Japanese   Publisher：メディカルレビュー社  

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Language：Japanese   Publisher：国立病院総合医学会  

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Background. To evaluate the diagnostic performance of ultrasonography for screening of a population at risk for deep vein thrombosis (DVT) in a post-disaster setting. Methods. Ultrasonography was applied as a screening technique to the residents of a temporary housing facility who were displaced following the Great East Japan Earthquake. Thirty DVT screening sessions were held from April 2013 to June 2015. Individuals were invited to participate if they were identified as “high risk” for DVT, defined as those with low activity levels, a history of lower limb trauma, baseline lower limb pain or swelling, a cancer-bearing status, or a history of venous thromboembolic event. Ultrasonographic examinations were performed from the calf to the popliteal veins using portable devices. Results. Of the 3,316 subjects screened (682 men and 2,634 women) with a mean age of 71 ± 9.7 years, DVT was diagnosed in 382 (11.5%). DVT was more likely in older, symptomatic, or female patients with a history of venous thromboembolism and attempting to perform daily exercise. The rate of DVT diagnosis increased from 9.9% in 2013 to 13.5% in 2015. Conclusions. Ultrasonography is efficient for screening at-risk populations in challenging settings.

DOI： 10.1002/jcu.22505

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Language：Japanese   Publisher：日本医事新報社  

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Other Link： http://search.jamas.or.jp/link/ui/2017325507

Language：Japanese   Publisher：日本医事新報社  

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Other Link： http://search.jamas.or.jp/link/ui/2017325506

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Other Link： http://search.jamas.or.jp/link/ui/2018063725

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Other Link： http://search.jamas.or.jp/link/ui/2018020183

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Background: Severe aortic tortuosity of the access route often prevents successful complete exclusion of an aneurysm in thoracic endovascular aortic repair (TEVAR).Case presentation: We performed antegrade TEVAR on a 79-year-old man with right hemiparesis. We deployed the stent graft from the ascending aorta with a tube graft conduit to treat a descending thoracic aortic aneurysm associated with rickets and multiple comorbidities. Although the application of a ministernotomy diminished the potential advantages of endovascular treatment in view of less invasive surgery, antegrade TEVAR using an ascending aortofemoral through-and-through wire technique was a good option in this patient because a conventional retrograde approach was not feasible due to his severely tortuous aorta.Conclusions: To avoid device-related complications, it is crucial to make a prudent preoperative decision on a patient-by-patient basis, taking into account the appropriate access site, adjuvant guidewire technique, and adjunctive surgical interventions.

DOI： 10.1186/s40792-017-0324-0

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Language：Japanese   Publisher：東京法規出版  

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Language：Japanese   Publisher：The Japan Academy of Neurosonology  

For a period of 4 years, we conducted deep vein thrombosis (DVT) examinations among people living in temporary homes and those living in their own homes in areas affected by the Great East Japan Earthquake. We divided those with positive results for DVT after receiving numerous examinations into a DVT disappeared group and a DVT remained group. The thrombus formation sites were the soleus muscle veins for both groups. In terms of characteristics, multiple organized thrombi were recognized, and there was no spread to the central side. In addition, the DVT remained group exhibited an increased maximum diameter of the soleal vein. We believe that stasis of blood flow due to the extension of the soleal veins contributed to the continued formation of thrombi.

DOI： 10.2301/neurosonology.30.43

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Language：Japanese   Publisher：Japanese Society of Phlebology  

<p>The emergency shelters for Joso flood disaster in 2015 and the 2016 Kumamoto earthquake were set up immediately after both disasters occurred. After Niigata Chuetsu earthquake in 2004, significant rates of the evacuees with deep vein thrombosis (DVT) were reported. Since then, many vascular ultrasound examinations for DVT have been performed in the shelters for each disaster and therefore, the examinations for evacuees of both disasters were also performed. After medical interviews, blood pressure and oxygen saturation measurements, vascular ultrasound examinations for calf were conducted in a sitting position. Elastic compression stockings were handed out to the evacuees at the end of examination. To reduce disaster related death, it is important to prevent the occurrence of critical pulmonary thromboembolism and so, examinations for early detection of DVT in the shelters are quite meaningful.</p>

DOI： 10.7134/phlebol.16-38

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Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00990&link_issn=&doc_id=20171214040017&doc_link_id=%2Fdg3nigta%2F2017%2Fs13108%2F008%2F0514-0514%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2017%2Fs13108%2F008%2F0514-0514%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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Language：English   Publisher：EDIZIONI MINERVA MEDICA  

A quadricuspid aortic valve (QAV) is a rare congenital aortic valve anomaly. Here we describe a case of a patient with a QAV associated with severe aortic, mitral, and tricuspid regurgitations that were treated surgically. Transesophageal echocardiography clearly demonstrated a QAV. The aortic vlave was excised and replaced with an 18-mm ATS AP360 valve (ATS Medical Inc., Minneapolis, MN), and the mitral valve was replaced with a 29-mm St. Jude valve (St. Jude Medical Inc., St. Paul, MN). Subsequently, tricuspid annuloplasty was performed with a 30-mm MC3 ring (Edwards LifeSciences, Irvine, CA) for annular enlargement. The patient's postioperative course was uneventful. Despite the widespread use of cardiac echocardiography, some cases of a QAV are incidentally detected during surgery. As a QAV can be associated with other congenital malformations, it is crucial to diagnose a QAV accurately using a combination of available imaging modalities, prior to surgery.

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Other Link： http://search.jamas.or.jp/link/ui/2017051824

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OBJECTIVE: Endovascular repair for retrograde type A aortic dissection with an entry in the descending aorta (RAAD) is challenging. We present early and mid- term results of endovascular repair for acute phase of RAAD by using commercially-available device.

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Language：Japanese   Publisher：The Japan Academy of Neurosonology  

<b>Introduction:</b> The aim of this study is to clarify the important role of deep venous thrombosis (DVT) in disaster refugees.<br> <b>Methods:</b> We visited the Minami-sanriku Tome shelter in Miyagi Prefecture, one of the areas affected by the Great East Japan Earthquake, to examine the incidence of DVT by using an ultrasound device from March 14 to May 4, 2011. One hundred eighty-seven people, who were aged over 60 years and had lower limb trauma, lower limb symptoms, a history of lengthy periods of resting inside a car, and/or a motionless lifestyle in the shelter, participated in the examination. The ultrasound examination was mainly intended to check for DVT findings below the knee.<br> <b>Results:</b> The incidence of DVT in the participants was 5.3% (10/187). When comparing those with DVT with those without, age, percentage of women, and percentage with lower limb trauma were significantly higher in DVT patients than in non-DVT people. After logistic regression analysis, lower limb trauma was an independent strong risk factor for DVT (<i>p</i> < 0.0001, odds ratio=26.5).<br><b>Conclusion:</b> In conclusion, lower limb trauma is the most important cause of DVT formation in disaster refugees.

DOI： 10.2301/neurosonology.29.104

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DOI： 10.1253/circj.CJ-66-0121

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The surgical strategy for coexisting lung cancer and aneurysm is controversial owing to the risk of aneurysm rupture during the perioperative period of pulmonary resection. We performed simultaneous pulmonary resection and endovascular repair in 2 patients with coexisting lung cancer and aneurysm. Case 1:A 74-year-old man presented at our hospital with cT2aN0M0 lung cancer and a 5.0 cm abdominal aortic aneurysm. Because computed tomography indicated the possibility of advanced lung cancer, we decided to perform simultaneous surgery for lung cancer and the aneurysm. Under general anesthesia, endovascular aneurysm repair was performed before right lower lobectomy with lymphadenectomy. The postoperative course was uneventful, and the patient was discharged on postoperative day 12. Case 2:A 72-year-old man presented at our hospital with cT2aN1M0 lung cancer, a 5.0 cm left internal iliac artery aneurysm, and right renal cell carcinoma( RCC). Because the lung cancer was advanced and the patients needed following surgical treatment for RCC, we decided to perform simultaneous surgery for lung cancer and the aneurysm. Under general anesthesia, endovascular aneurysm repair was performed before right upper lobectomy with lymphadenectomy. The postoperative course was uneventful, and the patient was discharged on postoperative day 11.

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Language：Japanese   Publisher：公益財団法人 日本心臓財団  

DOI： 10.11281/shinzo.47.880

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DOI： 10.11281/shinzo.47.894

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DOI： 10.11281/shinzo.47.930

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DOI： 10.11281/shinzo.47.881

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DOI： 10.11281/shinzo.47.940

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DOI： 10.11281/shinzo.47.939

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We describe a patient with successfully treated giant bilateral internal iliac artery aneurysms that were associated with acute renal failure secondary to bilateral hydronephrosis, lumbosacral plexopathy, and ileus. After hemodialysis for 1 month, the patient underwent graft replacement of the abdominal aorta and iliac arteries, including complete obliteration of the internal iliac artery branches, reconstruction of the inferior mesenteric artery, and ureterolysis. Weaning from hemodialysis was achieved and postoperative renal function improved. Although the patient had serious preoperative co-morbidities, emergency traditional open surgery should be the gold standard for securely releasing compression of the neighboring organs instead of endovascular treatment.

DOI： 10.3400/avd.cr.15-00065

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OBJECTIVE: To estimate the frequency of deep vein thrombosis (DVT) among non-surgical inpatients, and to evaluate the D-dimer assay as a screening tool for DVT. METHODS: Subjects were non-surgical inpatients aged 20 years or older who had been bedridden for at least 24 hours and had moderate-to-high risk factors for DVT. We assessed the presence of DVT by venous ultrasonography. Patients who received a diagnosis of venous thromboembolism (VTE) before admission, who had symptoms or findings of VTE at admission, or who had surgery or trauma within the past 3 months before admission were excluded. RESULTS: DVT was confirmed in 96 of 525 patients (18.3%). In a logistic regression analysis, longer duration of hospitalization, higher D-dimer value, and history of cancer surgery were significantly associated with the occurrence of DVT. The D-dimer assay showed high sensitivity (96.1%) and high negative predictive value (97.6%). CONCLUSION: Non-surgical inpatients with a long-term hospitalization or history of cancer surgery have a risk for DVT, and need to be considered for added DVT preventive measures as recommended in the prevention guidelines. In addition, the D-dimer assay is beneficial for the screening of DVT in medical practice.

DOI： 10.3400/avd.oa.14-00132

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Language：Japanese   Publisher：(一社)日本人工臓器学会  

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2012年に発生したイタリア北部地震(エミリア地震)は群発性地震でマグニチュード5〜6の直下型地震が2ヵ月間に7回、場所を変えて起きた。人々は家が崩壊する恐怖から車中泊や玄関にマットを敷いて寝るなどを数週間から数ヵ月行った。そのため車中泊では肺塞栓症(PE)で死亡者も出た。またPEとDVTは前年よりも増加していた。この状況は新潟県中越地震後と似ていたため調査を行った。被災地の8市と震源地から150km離れたトレント市で下肢静脈エコー検査を地元の医師、NPO、献血団体、スローフード協会などの協力で行った。その結果被災地の447名(男114名、女292名、平均年齢55.0歳)にエコー検査を行い39名に下腿DVTを認めた。トレントでは平均年齢55.8名の40名中2名に下腿DVTを認めた。被災地の被験者全体では年齢とDVT陽性率に相関を認めたが、各市別に被験者の年齢とDVT陽性率は相関せず、逆に若年でDVT陽性率が高い結果であった。また各市別では車中泊率とDVT陽性率に相関を認め、震災後のベッド使用率とDVT陽性率は強い負の相関を認めた。以上の結果から、エミリア地震では車中泊によるDVTが多かったことで若年でもDVTが多く、また震災後のベッド使用でDVTが予防されたものと考えられた。今回の結果はエミリア地震被災地ではDVT陽性率が高いことが示唆され、新潟県中越地震の経験からすると今後脳梗塞、心筋梗塞、肺塞栓症などの二次的健康被害がDVT陽性者で増加する危険性がある。したがって今後も被災者に対する医療的支援、特にDVTの定期的な検査が必要であり、そのためには世界的な支援が必要である。(著者抄録)

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We report herein a rare case of endocardial blood cyst (EBC) in an adult patient. A 63-year-old asymptomatic woman underwent echocardiography, which incidentally detected a cardiac tumor in the right atrium. On echocardiography, the tumor was revealed to be a 30-mm round mass with thin, hyperechogenic walls and heterogeneously hypoechogenic contents. The lesion was attached to the septum. On computed tomography, the tumor appeared partly calcified and showed poor contrast-enhancement. On magnetic resonance imaging, the lesion appeared isointense or slightly hyperintense in T1 and T2-weighted sequences. Myxoma was strongly suspected based on these preoperative imaging findings. The tumor was successfully excised under cardiopulmonary bypass. Gross examination confirmed that the cyst was filled with blood. The cystic walls comprised thin-layered fibrous tissue lined with endocardial cells. No tumor cells were found. The diagnosis of EBC was confirmed based on histopathological examination, and the postoperative course was uneventful.

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Other Link： http://search.jamas.or.jp/link/ui/2015038160

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Other Link： http://search.jamas.or.jp/link/ui/2015038120

Objectives: A retrospective analysis of data collected during subject screening following Japan's March 2011 earthquake and tsunami was performed. We aimed to determine the incidence of deep venous thrombosis (DVT) among screened subjects and to identify risk factors associated with the development of DVT as independent variables. Methods: Calf ultrasonography was undertaken in 269 subjects living in 21 shelters in Miyagi prefecture during the one-month period immediately following the March 2011 disaster. Information regarding the health and risk factors of subjects was collected by questionnaire and assessment of physical signs. Results: Of the 269 evacuees screened, 65 (24%) met the criteria for calf DVT.We found lower limb trauma, reduced frequency of urination and sleeping in a vehicle to be independent positive predictors of DVT. Conclusions: Evacuees had an increased risk of developing DVT, associated with tsunamirelated lower limb injury, immobility and dehydration.

DOI： 10.1177/0268355512474252

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Other Link： http://search.jamas.or.jp/link/ui/2014333894

Language：Japanese   Publisher：一般社団法人日本外科学会  

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Language：Japanese   Publisher：The Japan Academy of Neurosonology  

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by acute thunderclap headaches with or without other neurological symptoms, and reversible multi-segmental vasoconstriction of the cerebral arteries. We describe the case of a 49-year-old woman presenting with severe, sudden-onset headaches and multi-segmental vasoconstriction of the cerebral arteries demonstrated on magnetic resonance angiography (MRA). Headaches disappeared within several days, and vasoconstriction of cerebral arteries was markedly improved 6 weeks after the onset. We therefore diagnosed RCVS. In addition to MRA, we repeatedly performed transcranial-color flow imaging (TC-CFI) and transcranial Doppler ultrasonography (TCD) to evaluate cerebral arterial blood flow and risk of cerebral infarction. The first TCD study was performed 6 weeks after the onset; 11 high-intensity transient signals (HITS) were detected in 30 min at the region of vasoconstriction in the right MCA. To the best of our knowledge, this is the first report of HITS-positive RCVS. Ten weeks after the onset, MRA demonstrated disappearance of cerebral arterial vasoconstriction, and TCD detected only 1 HITS in 30 min. Interestingly, TC-CFI still indicated elevated flow velocity in the bilateral MCAs. These findings suggest that TC-CFI may be more sensitive and useful than MRA for diagnosis of RCVS.

DOI： 10.2301/neurosonology.27.76

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Language：Japanese   Publisher：The Japan Academy of Neurosonology  

<b>Background and Purpose</b>: Deep venous thrombosis (DVT) in the upper part of the body is rare, accounting for approximately 1 &ndash; 4% of all DVTs. The incidence and clinical significance of jugular vein thrombosis (JVT) were investigated in consecutive patients with acute ischemic stroke.<br><b>Subjects and Methods</b>: From December 2006 to March 2007, 71 patients (46 men, aged 70.8 &plusmn; 13.2 years) hospitalized within 48 hours after ischemic stroke or TIA onset were retrospectively examined. The presence of JVT was evaluated by ultrasonography. Patients with jugular vein catheterization were not included. Age, sex, hypertension, diabetes mellitus, hyperlipidemia, smoking status, presence of a malignant tumor, and D-dimer were assessed.<br><b>Results</b>: JVT was demonstrated in four patients (5.6%). The rate of a malignant tumor was significantly higher in patients with JVT than in those without (100% vs. 14.9%, p<0.001). The tumors were as follows: esophageal cancer (1); lung cancer (1); and uterine cervical cancer (2). The stroke subtype in three patients was Trousseau syndrome with a high D-dimer value, and that in the other patient was a lacunar stroke with a normal D-dimer value.<br><b>Conclusions</b>: Ultrasonographic evidence of JVT in patients with acute ischemic stroke could be a marker of a coincidental malignant tumor with or without Trousseau syndrome.

DOI： 10.2301/neurosonology.26.139

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Language：Japanese   Publisher：公益財団法人 日本心臓財団  

DOI： 10.11281/shinzo.46.569

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We describe a case of patent ductus arteriosus (PDA) in a 76-year-old woman with a history of stroke, atrial fibrillation, and chronic obstructive pulmonary disease. Cranial diffusion-weighted imaging (DWI) performed for preoperative assessment showed a hyperintense lesion in the left cerebellum. Preoperative transesophageal echocardiography (TEE) demonstrated two highly mobile masses approximately 5 mm in diameter adherent to the left and non-coronary cusps of the aortic valve. We performed transpulmonary patch closure of PDA under hypothermic circulatory arrest. Subsequently, two frond-like masses were completely shaved off the cusps, preserving the native aortic leaflets. Pathological examination confirmed the diagnosis of papillary fibroelastoma (PFE). To our knowledge, this is the first report of PDA associated with PFE. Perioperative use of TEE is an effective tool for management of cardiovascular patients with suspected cardiogenic embolism.

DOI： 10.5761/atcs.cr.12.02114

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After the Great East-Japan Earthquake, the prevalence of deep vein thrombosis (DVT) in disaster shelters in Ishinomaki (Pacific coast, Miyagi, Japan) was found much higher than that ever reported in Japan. In Ishinomaki, twelve patients were found to have pulmonary thromboembolism for one month since the earthquake and DVT was found in 10 of those patients. The calf DVT was examined using ultrasonography in the shelters (from March to July 2011) and in temporary emergency housings (from August to December 2011). Calf DVT was found in 190 of 701 evacuees. DVT prevalence was higher in the tsunami-flooded shelters (34.2%) than in that in the non-flooded shelters (19.1%). This indicated that deteriorated and crowded condition in the tsunami-flooded shelters might induce thrombogenesis in calf veins. Therefore, evacuees were recommended to leave tsunami-flooded areas. DVT prevalence in the shelters was gradually reduced, however, that was still higher in the temporary emergency housings (8.9%) than in the non-disaster area in Japan (2.2% in Yokohama city). The risk of calf DVT in the temporary emergency housings was increased because of reduced blood flow in the calf veins caused by immobility. The residents of the housings were required to be physically active to avoid calf DVT. (English translation of Jpn J Phlebol 2013; 24: 380-384).

DOI： 10.3400/avd.oa.14-00106

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We describe a successfully treated case of acute type B aortic dissection complicated with lower extremity, visceral, and spinal cord malperfusion. To restore perfusion to both lower extremities, we performed an emergency right axillo-bifemoral bypass. Furthermore, we performed total arch replacement, including primary entry closure, because of delayed visceral organ ischemia. Unexpectedly, delayed paraplegia occurred after hospital discharge; however, the patient recovered without any neurologic sequelae after early introduction of hyperbaric oxygen therapy. Because another episode of organ malperfusion in the long term cannot be anticipated, and even though the previous organ malperfusion episode was treated successfully, close observation is mandatory for detecting clinical manifestations in combination with the availability of imaging modalities.

DOI： 10.3400/avd.cr.14-00059

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Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

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Other Link： http://search.jamas.or.jp/link/ui/2015060356

Language：English   Publisher：ELSEVIER SCIENCE BV  

Background: This study aimed to investigate whether left atrial appendage (LAA) dysfunction evaluated by transesophageal echocardiography (TEE) during sinus rhythm is predictable of paroxysmal atrial fibrillation (PAF) as an embolic source in the acute stage of stroke. Methods and Results: We measured and analyzed LAA flow velocity (LAA-FV) and LAA ejection fraction (LAA-EF) in 300 acute ischemic stroke patients by TEE. We divided the acute ischemic stroke patients into 3 groups. The atrial fibrillation (AF) group (n = 58) comprised patients whose TEE was performed during AF rhythm. The PAF group (n = 42) comprised patients with a history of AF but with normal sinus rhythm when TEE was performed. The normal sinus (sinus) group (n = 200) did not have any history of AF. We found that mean LAA-FV and LAA-EF values in the PAF group were significantly lower than those in the sinus group (P <.001). The diagnostic accuracy of LAA-FV for the diagnosis of PAF calculated as the area under receiver operating characteristic curves was low (.582, 95% confidence interval [CI] =.498-.665) but that of LAA-EF was modest (.721, 95% CI =.653-.789), with an optimal cutoff point of 49.1%. Conclusions: LAA dysfunction as determined by TEE (LAA-EF < 49.1%) in the acute stage of stroke is predictive of PAF with moderate accuracy. Long-term electrocardiographic monitoring is recommended for cryptogenic stroke patients with LAA dysfunction. © 2013 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jstrokecerebrovasdis.2013.03.020

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：OXFORD UNIV PRESS INC  

DOI： 10.1093/ejcts/ezs610

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Language：Japanese   Publisher：一般社団法人日本外科学会  

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Other Link： http://search.jamas.or.jp/link/ui/2013333120

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Other Link： http://search.jamas.or.jp/link/ui/2013320278

Language：Japanese   Publisher：Japanese Society of Phlebology  

After the Great East Japan Earthquake, the prevalence of deep vein thrombosis (DVT) in disaster shelters in Ishinomaki (Pacific coast, Japan) was found much higher than that ever reported in Japan. In Ishinomaki, twelve patients were found to have pulmonary thromboembolism for one month after the earthquake and DVT was found in 10 of those patients. The calf DVT was examined using sonography in the shelters (from March 2011 to July 2011) and in temporal emergency housings (from August 2011 to December 2011), and the results indicated that 190 of 701 evacuees had DVT. DVT prevalence was higher in evacuees in the tsunami-flooded shelters (127 of 371 evacuees, 34.2%) than in those in the non-flooded shelters (63 of 330 evacuees, 19.1%). This indicated that deteriorated and crowded condition in the tsunami-flooded shelters might induce thrombogenesis in calf veins. Therefore, evacuees were immediately recommended to leave tsunami-flooded areas. DVT prevalence in the shelters reduced gradually; however, this prevalence was found to be higher in the temporal emergency housings (32 of 360 evacuees, 8.9%) than in the non-disaster area in Japan (2.2% in Yokohama city). The risk of calf DVT in the temporal emergency housings increased because of reduced blood flow in the calf veins caused by immobility. The residents of the housings require to be physically active in order to avoid calf DVT.

DOI： 10.7134/phlebol.409

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J00990&link_issn=&doc_id=20130812030023&doc_link_id=%2Fdg3nigta%2F2013%2Fs12703%2F018%2F0162-0162%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2013%2Fs12703%2F018%2F0162-0162%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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Language：Japanese   Publishing type：Book review, literature introduction, etc.   Publisher：The Japanese Society of Hematology  

DOI： 10.11406/rinketsu.53.1730

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Other Link： http://search.jamas.or.jp/link/ui/2012353346

Left atrial free-floating thrombi increase the risk of catastrophic complications such as systemic embolization. We describe the case of a left atrial free-floating thrombus in an octogenarian with a history of stroke and atrial fibrillation; the thrombus was detected unexpectedly by scheduled transesophageal echocardiography. Surgical removal of the thrombus was performed successfully in spite of the patients great age. Routine transesophageal echocardiography therefore is an effective and indispensable tool for individualized management of patients with a history of stroke and atrial fibrillation.

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Other Link： http://search.jamas.or.jp/link/ui/2012288490

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Other Link： http://search.jamas.or.jp/link/ui/2012270058

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Other Link： http://search.jamas.or.jp/link/ui/2012259954

Language：Japanese   Publisher：一般社団法人日本外科学会  

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Language：Japanese   Publisher：(株)南江堂  

86歳男。79歳時にS状結腸癌でS状結腸切除術、81歳時に白内障で手術を受けた。腹痛、背部痛が出現した。その後、食欲低下、体重減少があり、入院した。血小板数減少、フィブリン分解産物(FDP)の上昇を認め、播種性血管内凝固症候群(DIC)が疑われた。CTで解離性胸部大動脈瘤および解離性腹部大動脈瘤を認めた。DICの確定診断にはいたらなかったが、出血傾向を懸念し凝固障害の改善のため、メシル酸ガベキサートの投与を開始した。経時的CTで腹部大動脈瘤の拡大傾向を認めた。腹部大動脈瘤の切迫破裂を疑い、破裂死の予防のため、開腹で腹部大動脈瘤の切除分岐型人工血管置換、胸部下行大動脈ステントグラフト内挿術を一期的に施行した。術後一時的に血小板数は上昇したが徐々に減少し、Dダイマーなど凝固系の検査値は術前と同様であった。全身状態は順調に回復し、24病日に独歩により退院した。

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Language：Japanese   Publisher：公益財団法人 日本心臓財団  

DOI： 10.11281/shinzo.44.957

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DOI： 10.11281/shinzo.44.955

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：KARGER  

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High prevalence of deep vein thrombosis (DVT) in disaster shelters has been reported in the aftermath of earthquakes in Japan. Calf DVT was examined using sonography in the shelters after the Great East Japan earthquake on March 11, 2011. By the end of July 2011, 701 out of 8,630 evacuees suspected with calf DVT, judged by inspections or medical interviews, were examined in 32 shelters, and 190 evacuees were confirmed to have calf DVT. The prevalence of DVT was 2.20%, which was 200 times higher than the usual incidence in Japan. The DVT prevalence seemed to decrease with time. By the end of May, a significantly higher prevalence of DVT was found in tsunami-flooded shelters (109 of 3,871 evacuees; 2.82%) than in non-flooded shelters (53 of 3,155 evacuees; 1.68%). After June, its prevalence was still higher (18/541; 3.33%) in tsunami-flooded shelters than in non-flooded shelters (10/1063; 0.94%). The cause of the high prevalence of DVT was supposed to be dehydration due to the delay in supplying drinking water, vomiting, and diarrhea experienced by the evacuees because of a shortage of clean water to wash their hands. Dehydration was especially noticed in women because they restricted themselves of water intake to avoid using unsanitary toilet facilities. Moreover, crowded shelters restricted the mobility of elderly people, which would exacerbate the prevalence of DVT. Those deteriorated and crowded shelters were observed in tsunami-flooded areas. Therefore, long-term shelters should not be set up in flooded areas after tsunami. © 2012 Tohoku University Medical Press.

DOI： 10.1620/tjem.227.199

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An 86-year-old man was admitted for abdominal pain. Dissected descending thoracic aortic aneurysm and infrarenal abdominal aortic aneurysm were observed under computed tomographic (CT) scan. Hematologic studies revealed low platelet count and an increase in fibrin degradation products (FDP), and disseminated intravascular coagulation( DIC) associated with dissecting aortic aneurysm was highly suspected. Platelet transfusion was performed and gabexate mesilate was administered, however, no improvement of DIC could be obtained. An increase in aortic diameter was observed under CT scan and surgery was performed. The infrarenal aneurysm was replaced with a bifurcated prosthetic graft under open repair. Simultaneously, an endovascular stent-graft was delivered from the left limb of the abdominal graft and implanted into the descending thoracic aorta. The postoperative recovery was uneventful but platelet count did not improve in this case.

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Other Link： http://search.jamas.or.jp/link/ui/2011335646

Language：Japanese   Publisher：The Japanese Society on Thrombosis and Hemostasis  

DOI： 10.2491/jjsth.22.229

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We present a case of floating thrombus originating from an almost normal thoracic aorta in a 54-year-old man who presented with acute arterial occlusion of his left leg. Transesophageal echocardiography (TEE), computed tomography, and magnetic resonance imaging showed two masses in an almost normal aorta after embolectomy for the acute arterial occlusion. Although the embolus was thrombus histologically, malignant tumors could not be ruled out. The masses did not decrease in size after 7 days of anticoagulant therapy, so they were extirpated under cardiopulmonary bypass (CPB) and TEE guidance. Frozen section examination during CPB indicated that there was no evidence of malignancy in the removed mass. TEE played an important role in the diagnosis and surgery of this condition, and it was useful when deciding on a surgical strategy. Because the treatment strategy for this disease remains controversial, further studies are needed. © 2011 The Japanese Association for Thoracic Surgery.

DOI： 10.1007/s11748-010-0752-2

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Language：English   Publisher：JAPANESE CIRCULATION SOC  

Background: Unfractionated heparin (UFH) is the standard drug for the initial treatment of pulmonary embolism (PE) and deep vein thrombosis (DVT) in Japan, whereas fondaparinux is the standard drug in Europe and the United States. Here, we examine the efficacy and safety of fondaparinux in Japanese patients. Methods and Results: In 2 randomized, open-label, multicenter studies, 80 Japanese patients with acute PE or DVT received either subcutaneous fondaparinux or intravenous UFH as a non-comparative reference, in a 3:1 ratio, for 5-10 days. Concomitant warfarin therapy was continued until Day 90. Multidetector-row computed tomography-based assessment showed that 57.9% and 45.9% of the patients with acute PE and acute proximal DVT had proximal DVT and PE as a complication, respectively. There was no recurrence of symptomatic venous thromboembolism. In the fondaparinux group, the respective improvement rates at the end of the initial treatment and follow-up periods were 71.4% and 86.8% for 42 patients with PE, and 57.8% and 83.3% for 46 patients with DVT; similar results were noted in the UFH group. One patient in the fondaparinux group experienced major bleeding during the initial treatment, but no such episode in the UFH group. Conclusions: Once-daily, subcutaneous fondaparinux is as effective and safe without monitoring as adjusteddose intravenous UFH for the initial treatment of acute PE and DVT in Japanese patients.

DOI： 10.1253/circj.CJ-10-1036

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Language：Japanese   Publisher：一般社団法人日本外科学会  

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Language：Japanese   Publisher：時事通信社  

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Other Link： http://search.jamas.or.jp/link/ui/2011220118

Language：Japanese   Publisher：The Japanese Society for Quality and Safety in Healthcare  

DOI： 10.11397/jsqsh.6.248

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Other Link： http://search.jamas.or.jp/link/ui/2011249620

Language：Japanese   Publisher：The Japan Stroke Society  

Background and Purpose: Venous thromboembolism is one of the leading causes of mortality during the acute recovery phase of cerebrovascular disease. Ultrasonographic examination is a powerful tool for detecting and predicting deep vein thrombosis (DVT). However, little is known about the clinical significance of deep vein dilatation in a recumbent position in acute cerebrovascular disease patients. We investigated the relationship between DVT and deep vein diameters in the lower limbs in acute cerebrovascular disease patients. <br>Subjects and Methods: From January to June 2010, a total of 86 patients hospitalized within 48 hours after cerebrovascular disease onset had their lower limbs examined using duplex ultrasonography within 7 days after admission. The predictive value of deep vein diameters for the presence of DVT was examined using logistic regression analyses. <br>Results: DVT was detected in 16 patients with acute stroke. The diameters of the popliteal veins (POVs) in the DVT group were significantly greater than those in the non-DVT group, 9.1&plusmn;3.4 mm and 7.1&plusmn;1.9 mm, respectively (p=0.001). However, there was no significant difference in the soleal vein diameters. Univariate logistic regression analysis showed a significantly higher odds ratio [OR] of the 4th quartile of the POV diameter (8.4–19.3 mm) compared to the 1st quartile (OR: 5.54, 95% confidence interval [CI], 1.01–30.50; p=0.049). <br>Conclusions: POV dilatation (>8.4 mm) in a recumbent position is associated with DVT in acute cerebrovascular disease patients.

DOI： 10.3995/jstroke.33.319

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Language：Japanese   Publisher：国立病院総合医学会  

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DOI： 10.11281/shinzo.43.932

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DOI： 10.11281/shinzo.43.958

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Other Link： http://search.jamas.or.jp/link/ui/2010340053

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Other Link： http://search.jamas.or.jp/link/ui/2010340055

Language：Japanese   Publisher：一般社団法人日本外科学会  

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Other Link： http://search.jamas.or.jp/link/ui/2010110082

Language：English   Publisher：SAGE PUBLICATIONS LTD  

Intraoperative autologous blood predonation is reported to be useful for the prevention of homologous blood transfusion in cardiac operations, especially in on-pump coronary artery bypass grafting (CABG). However, CABG is now performed more often off-pump than on-pump. We analyzed the major factors of homologous blood transfusion in 25 consecutive cases of valvular heart operation with intraoperative autologous blood predonation except those with preoperative autologous blood donation. Homologous blood was not transfused in 18 cases, but was in 7 cases only after cardiopulmonary bypass (CPB). The homologous transfusion was not correlated with body weight, CPB dilution or duration, or preoperative hematocrit level, but was found to correlate with age (R =0.289, p=0.0413), bleeding output (R =0.197, p=0.0485), and predonation blood volume (R =0.436, p=0.0152). In conclusion, suitable intraoperative predonation may reduce the necessity for homologous blood transfusion in valvular heart operations. © 2010 Wichtig Editore. 2 2 2

DOI： 10.1177/039139881003300202

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Language：Japanese   Publisher：公益財団法人 日本心臓財団  

DOI： 10.11281/shinzo.42.924

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Language：Japanese   Publisher：The Japan Society of Ultrasonics in Medicine  

The leading causes of cerebral injury during cardiovascular (CV) surgery are cerebral blood flow (CBF) insufficiency and embolism. TCD can detect both CBF velocity and micro-emboli in cerebral arteries. However, the middle cerebral artery (MCA) cannot always be detected by the temporal bone approach in elderly Japanese, in whom monitoring of the extra-cranial internal carotid artery (ICA) by the infra-mandible approach is recommended. CBF velocity measured by TCD is useful for cardiopulmonary bypass or selective cerebral perfusion. Most HITS/MES detected by TCD during CV surgery indicate micro-bubbles. However, many micro-bubbles cause cerebral injury. Cerebral protection therapy is needed in case numerous HITS/MES are detected during CV surgery.

DOI： 10.3179/jjmu.37.305

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Language：Japanese   Publisher：公益財団法人 日本心臓財団  

DOI： 10.11281/shinzo.42.966

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Language：Japanese   Publisher：Japan Heart Foundation  

DOI： 10.11281/shinzo.42.473

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Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

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Other Link： http://search.jamas.or.jp/link/ui/2009143492

Language：English   Publisher：SPRINGER TOKYO  

Left ventricular assist devices (LVADs) have become more important than ever for patients with terminal heart disease. The chronic shortage of donors for heart transplantation may enhance the importance of LVADs as destination therapy. To prevent cerebral complications, the evaluation of high-intensity transient signals (HITS) of transcranial Doppler (TCD) ultrasound is important. In the present study, HITS were measured on seven occasions in patients supported with LVADs. The high-frequency counts in HITS were greater than the low-frequency counts (47 ± 42 vs. 9 ± 9 in 3 min, P = 0.025), and declined further with oxygen delivery to the patient. The high frequency of signals may imply air microemboli, and the counts may increase with time. © 2008 The Japanese Society for Artificial Organs.

DOI： 10.1007/s10047-008-0430-7

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Language：Japanese   Publisher：学習研究社  

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Other Link： http://search.jamas.or.jp/link/ui/2008376835

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Other Link： http://search.jamas.or.jp/link/ui/2008376836

Language：Japanese   Publisher：The Institute of Electronics, Information and Communication Engineers  

By the Niigata Chuetsu earthquake generated in 2004, 10 Pulmonary embolism (PE) was reported, and 3 people of those died. In addition, Deep vein thrombosis (DVT) was accepted to 30.4% of the person of object in investigation performed within two weeks when earthquake outbreak. PE is caused primarily by DVT. Because of these factors, necessity of the early detection of the DVT rises. When DVT occurred, venous blood obstructed a flow concentrates on epibiosis vein. Therefore burdens to the vein increase, and the expansion of the blood vessel is predicted. Near-Infrared ray (wavelength: 780nm) which it is easy to penetrate skin, and absorbed by deoxyhemoglobin. Therefore We built the epibiosis vein imaging device which We used Near-Infrared ray (wavelength: 780nm) and examined the use to Deep vein thrombosis risk evaluation.

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Other Link： http://search.jamas.or.jp/link/ui/2008376595

Language：Japanese   Publisher：The Japan Academy of Neurosonology  

DOI： 10.2301/neurosonology.21.4

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DOI： 10.2491/jjsth.19.39

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Language：Japanese   Publisher：The Japanese Association of Rehabilitation Medicine  

We screened patients with chronic respiratory disorders for deep vein thrombosis (DVT) of the lower extremities using ultrasonography. These patients require pulmonary rehabilitation because of their physical disabilities and the reduction in their activities of daily living (ADL). The average soleus vein diameter, which is the reported source of most DVTs, was 6.1&plusmn;1.5 mm in the control group, 6.8&plusmn;2.1 mm in the home oxygen therapy (HOT) patients, and 7.0&plusmn;1.6 mm in the non-HOT patients. The soleus vein diameters in the HOT and non-HOT patients were significantly greater than in the control group (<i>p</i>=0.003). The prevalence of calf DVTs in the HOT patients was significantly higher than in the non-HOT patients (14.3 % vs. 2.0 %, <i>p</i>=0.027). Therefore, patients with chronic respiratory disorders are at greater risks of developing DVT. Furthermore, it appears that not only the deterioration in ADL but also the presence of respiratory disorders and a hypoxic state may influence the onset of DVT in HOT patients. Chronic respiratory disorder is thought to be one of the risk factors for DVT. Therefore, preventive measures, such as ultrasonographic screening examinations, daily living guidance, and physical therapy, are important for patients with chronic respiratory disorders.

DOI： 10.2490/jjrmc.45.40

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Other Link： http://search.jamas.or.jp/link/ui/2008039919

Language：Japanese   Publisher：社団法人日本リハビリテーション医学会  

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We encountered 2 cases of pulmonary thromboembolism developed during refuge for Niigata Chuetsu earthquake in 2004. Case 1 was a 76-year-old woman who moved to the back seat of a car for refuge since the earthquake struck on October 23rd, 2004. When she emerged from the car on the morning of October 25th, she felt sudden dyspnea and lost consciousness. On arrival at the hospital, she had low blood pressure and hypoxemia, hypocapnia, and metabolic acidosis. Based on her clinical history and her symptoms, pulmonary thromboembolism was suspected and heparinization was begun immediately. In our hospital, the chest CT angiography proved the diagnosis. She was transferred to a university hospital for further treatment. Case 2 was a 79-year-old woman. She spent only one night in a car. Fifteen days after the earthquake, chest tightness and dyspnea occurred. Although her symptoms were improved and disappeared, she came to our hospital. Chest CT images confirmed pulmonary thromboembolism, and treatment with heparin was begun. We think this pulmonary thromboembolism was related to the knee-bending position she had assumed in the car and decreased activity during refuge. This is a clinical condition which could happen during disasters in the future. We should recognize the likelihood of pulmonary thromboembolisms in the disasters in the future.

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Language：Japanese   Publisher：Japan Heart Foundation  

DOI： 10.11281/shinzo1969.39.2_104

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Language：Japanese   Publisher：日本看護協会出版会  

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Language：English   Publishing type：Book review, literature introduction, etc.   Publisher：THIEME MEDICAL PUBL INC  

There have been no reports on acute pulmonary embolism (APE) after earthquakes. Our aim was to clarify the actual the occurrence of APE following the 2004 Mid Niigata Prefecture earthquake in Japan, and to assess the risk factors for APE after the event. We sent questionnaires to 122 hospitals in the Niigata Prefecture after the earthquake. Cities, towns, and villages in the prefecture were classified into two areas (high evacuee rate area, and low evacuee rate area) due to the mean ratio of evacuees to the overall population during 1 week immediately after the earthquake. A rate of 5% and higher was encountered for the high evacuee rate area and a rate of <5% was encountered for the low evacuee rate area. Ten out-of-hospital cases of APE (seven in the high evacuee rate area and three in the low evacuee rate area) were diagnosed within the first month after the earthquake. The relative risk of APE was high in the high evacuee rate area (13.09; p = 0.0002) and also higher in women (8.55; p = 0.04). All patients in the high evacuee rate area had stayed in their automobiles for long periods of time, but none had done so in the low evacuee rate area (p = 0.008). Copyright © 2006 by Thieme Medical Publishers, Inc.

DOI： 10.1055/s-2006-955468

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Other Link： http://hdl.handle.net/10191/3443

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Other Link： http://search.jamas.or.jp/link/ui/2006091891

Language：Japanese   Publisher：日本臨床生理学会  

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Other Link： http://search.jamas.or.jp/link/ui/2005215005

Language：Japanese   Publisher：(一社)日本脳卒中学会  

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Language：Japanese   Publisher：一般社団法人 日本農村医学会  

<B>はじめに</B><BR>平成16年10月23日午後5時56分新潟県中越地震が起こった。ライフラインが断たれ多くの方が避難所生活を余儀なくされた。一向に収まらない余震に、１万人以上といわれる車中生活者が見られたのが特徴であった。車から出た途端に血栓症で倒れて亡くなる、所謂エコノミークラス症候群の疑いの死亡者が報道されるようになった。そこで、新潟大学呼吸循環外科・榛沢医師が各避難所を回り調査した結果30％の高率で血栓が見つかった。それをふまえ定置での検査も必要と考え、被災地のほぼ中心に位置する当院でエコー検査を実施した。より多くの被災者に知ってもらうため避難所にポスターを貼り、メディアの協力を得て呼びかけを行なった。<BR><B>期間</B><BR>前期 平成16年11月15・17・22・24・29日 12月6・13・20・27日の9日間<BR>後期 平成17年2月28日 3月4・7・14・17・22・28日の7日間<BR><B>対象</B><BR>１）前期：車中泊の経験者・足の痛み・腫れ・浮腫のある方<BR>男性16名（40歳から81歳）女性67名（28歳から83歳）の計83名 <BR>平均年齢59.5歳<BR>２）後期：前期被検者で再検を希望した人32名<BR><B>結果</B><BR>前期：症状あり73名（下肢腫脹・疼痛・足がつる・熱感・違和感・関節痛）症状なし10名<BR>慢性血栓（壁在血栓）8名 充満血栓や浮遊血栓2名 <B>12％に血栓を確認</B><BR>車中泊連続20日以上8名（全員症状はあるが血栓なし）車中泊経験者は血栓が消失しても浮腫・疼痛が残る。<BR>後期：症状あり21名（下肢腫脹・下肢疼痛など）<BR>症状なし11名<BR>浮遊血栓を再度確認1名 新たな浮遊血栓2名 壁在血栓3名 静脈瘤血栓1名 <B>21.9％に血栓を確認</B><BR><B>考察</B><BR>11月12月の検査では12％が陽性と診断された。これは、車中生活で長時間同じ姿勢の維持、トイレの回数を減らす為に水分を摂らずにいた為と考えられる。また、2月・3月のフォローアップでは、21.9％に血栓が見られた。前回異常のなかった2名に血栓が見つかり、参考に行ったＤダイマー検査でも陽性を示した。これらのことから、早期発見の重要性とフォローアップの必要性がある。死亡者を出さないためにも車中泊での問題点や注意点を啓蒙していかなければならない。今回、県内各病院の検査技師からボランティア（延べ40名）からエコー検査に協力して貰った。全国各地で地震が起こっている。今回の経験を生かし、検査技師会を通じて下肢静脈エコー検査の有用性を知って貰い、災害時に検査技師として、率先して現地に赴き、エコノミークラス症候群の早期発見に努めるよう提起していきたいと考えている。

DOI： 10.14879/nnigss.54.0.146.0

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DOI： 10.14879/nnigss.54.0.336.0

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Left ventricular unloading and energy charge as effects of transaortic catheter venting (TACV) during venoarterial bypass (VAB) in normal and failing hearts has been reported previously. The aim of this study was to assess the effectiveness and safety of a special multipurpose catheter for TACV during percutaneous cardiopulmonary support (PCPS) in a preclinical setting. Six adult pigs underwent PCPS with or without the TACV. With standard hemodynamic monitoring, LV volume and function were assessed by direct ultrasonic cardiography (UCG) in each condition. PCPS was smoothly established and the TACV catheter was safely introduced in all cases. As compared with isolated PCPS, the TACV combined with PCPS maintained significant blood flow with LV venting and systemic perfusion: the heart rate of the native heart, systemic arterial pressure, and central venous pressure were stable. Also the additional TACV led to a significant reduction of LV preload during PCPS, and the reduction was 25-30% of LVDd and 20-35% of LVAd. The results of this investigation suggest that clinical application of the TACV technique with a clinical PCPS circuit would be feasible and additional TACV might be useful for LV recovery during PCPS in patients with severe heart failure.

DOI： 10.1111/j.1525-1594.2004.47036.x

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Language：Japanese   Publisher：一般社団法人 日本超音波検査学会  

DOI： 10.11272/jssabst.29.0.240.1

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Language：Japanese   Publisher：一般社団法人 日本人工臓器学会  

DOI： 10.11392/jsao1972.33.2Supplement_s203

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DOI： 10.11392/jsao1972.33.2Supplement_s212

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Other Link： http://hdl.handle.net/10191/3594

Heparin-induced thrombocytopenia and thrombosis syndrome (HITTS) is a potentially life-threatening side effect of heparin therapy, triggered by an immune response, and has been reported to be related not only to the therapeutic use of heparin but also to heparin-coated catheters. A 45-year-old woman with intrapelvic malignancy developed an acute pulmonary thromboembolism (PE) after hysterectomy despite prophylactic heparin use. Subsequent large doses of heparin for treatment of the PE exacerbated the thrombocytopenia and, moreover, a large thrombus formed around the heparin-coated central venous catheter. Anti-heparin-platelet factor 4 complex antibody and heparin-induced platelet aggregation assay were positive, so the diagnosis was HITTS, and heparin was replaced by argatroban after carrying out thrombectomy. This therapy was successful, and the patient made favorable progress.

DOI： 10.1253/circj.67.96

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Language：Japanese   Publisher：Japan Heart Foundation  

DOI： 10.11281/shinzo1969.35.3_175

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Language：Japanese   Publisher：The Japan Academy of Neurosonology  

A proposal has been made to introduce a new Japanese guideline for detection of micro-embolic signals using trans-cranial Doppler (TCD). This guideline is in accordance with the Consensus on Micro-Embolus Detection by TCD proposed by the International Consensus Group on Micro-Embolus Detection in 1998. Micro-embolic signals are called HITS or MES. HITS include artifacts in place of MES. Recommended settings are: (1) use of a 2-MHz probe; (2) sample volume within 10 mm; (3) power set as low as reasonably possible; and (4) use of a headband to affix the TCD probe. The characteristics of HITS/MES are: (5) an intensity at least 3 dB higher than the background that reflects the blood stream; (6) a recording time of more than 30 minutes but not more than one hour to maintain the normal brain temperature; and (7) signals without associated sounds or a low emboli-blood ratio (EBR) excluding HITS. Other recommendations include: (8) recording HITS as digital data, using digital audio tape or CD-R; (9) having data double-checked by an expert who is not familiar with the clinical profile of the examinee; and (10) checking all data manually. The results are better than those obtained from an automatically detected HITS/MES system that is not yet at the completion stage.

DOI： 10.2301/neurosonology.16.168

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Language：Japanese   Publisher：一般社団法人 日本人工臓器学会  

DOI： 10.11392/jsao1972.32.2Supplement_s30

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DOI： 10.11392/jsao1972.32.2Supplement_s110

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Other Link： http://search.jamas.or.jp/link/ui/2003102912

Language：Japanese   Publisher：新潟大学  

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Other Link： http://search.jamas.or.jp/link/ui/2003083783

Language：Japanese   Publisher：Niigata University  

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Other Link： http://search.jamas.or.jp/link/ui/2003083784

Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：一般社団法人日本外科学会  

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Language：Japanese   Publisher：医学図書出版  

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Other Link： http://search.jamas.or.jp/link/ui/2002247147

Language：English   Publishing type：Book review, literature introduction, etc.  

To clarify special imaging assessment that is useful for minimally invasive cardiac surgery (MICS), we examined 141 cases of MICS operations with ministernotomy or minithoracotomy. In the 141 patients, 62 valve, 42 coronary, 37 congenital heart, and 2 other procedures were successfully completed without conversion to full sternotomy. Preoperative chest x-ray, computed tomography, and/or magnetic resonance imaging were necessary for determining the level of ministernotomy, especially in aortic valve operations. Transthoracic echocardiography was useful for selecting procedures of mitral valve or intracardiac repair through the MICS approach. Intraoperative transesophageal echocardiography was essential for continuous monitoring of cardiac function, intracardiac flow, air bubbles, and so forth. The above results suggest that intensive imaging assessment might be very important for successful MICS operations with ministernotomy or minithoracotomy and that extensive indications for this technique exist for various cardiovascular diseases.

DOI： 10.1046/j.1525-1594.2002.06965.x

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In development of an artificial heart, thrombus formation is still serious problem. However, there is no effective means to detect a thrombus. An optical measurement method is one of the best approaches which realize noninvasive thrombus detection. The purpose of this research is to develop the noninvasive thrombus detection method using NIR (Near Infra-Red) laser, and to apply the method to clinical use. By considering the optical characteristic of a thrombus and blood, we have developed the new thrombus detection system. By using this measurement system, the mockup experiment and the animal experiment were performed to detect a fake thrombus such as plastic beads (r=0.2mm) and celite powder (0.1×0.02mm) in the artificial heart circulatory system. The thrombus detection performance and safety of this method have been confirmed as the result of these experiments. After obtaining informed consent, the measurement examination was performed to the artificial heart (LVAS: Left Ventricular Assist System) use patient as the clinical application, and similar signals (LMES: Laser-detected Micro-Embolus Signals) corresponding to the animal experiment were detected. The proposed noninvasive thrombus detection method using NIR laser would be regarded as effective in the surveillance of the thrombus formation at the time of clinical artificial heart use.

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Language：Japanese   Publisher：一般社団法人 日本人工臓器学会  

DOI： 10.11392/jsao1972.31.2Supplement_s97

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Language：Japanese   Publisher：一般社団法人 日本人工臓器学会  

DOI： 10.11392/jsao1972.31.2Supplement_s37

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Language：Japanese  

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Other Link： http://search.jamas.or.jp/link/ui/2002181403

A-37-year-old woman in shock condition was transferred to our hospital after cardiopulmonary resuscitation for ventricular fibrillation. She was unconscious and suspected of suffering ischemic brain damage, with pathologic reflexes and weak brain stem reflexes. Brain CT scan showed cerebral edema without hemorrhage or infarction and an electroencephalograph revealed slow alpha-theta waves. Chest CT scan and echocardiogram showed ascending aortic aneurysm with sever aortic regurgitation. An emergent operation was performed for progression of heart failure. There were no distortion or dilatation of the sinus of Valsalva and annuloaortic ectasia and aortic valve leaflets were almost normal. We considered that the aortic valve dysfunction was cause by dilatation of the sinotubular junction. Ascending aortic and aortic valve replacement were carried out to shorten cardiopulmonary bypass time and to prevent the progression of brain damage. Mild hypothermia was employed as a neuroprotective procedure for three days after surgery. The patient's neurological symptoms, which were right hemiparesis, facial apraxia and motor aphasia, improved and she was discharged from the hospital on foot without any neurological complications on the 47th postoperative day and returned to work after two months.

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Language：Japanese   Publisher：(一社)日本人工臓器学会  

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Language：Japanese  

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Other Link： http://search.jamas.or.jp/link/ui/2002153416

Language：Japanese  

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Other Link： http://search.jamas.or.jp/link/ui/2002161232

Language：Japanese  

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Other Link： http://search.jamas.or.jp/link/ui/2002011629

Language：Japanese