重症虚血肢に対して浅大腿動脈に対するremote endarterectomyおよび大伏在静脈を用いた後脛骨動脈バイパスを行った一例

重症虚血肢の外科的血行再建に際し，大伏在静脈が不良である場合にバイパスグラフト選択に苦慮することが多いが，我々は浅大腿動脈に遠隔血栓内膜摘除術（remote endarterectomy；RE）を行うことによりグラフト長補填が可能であった症例を経験したので報告する．症例は72 歳男性．右第一趾の爪下膿瘍を伴った下肢虚血で当科紹介となった．大腿部大伏在静脈は分岐が多く性状は不良であったため，右浅大腿動脈にremote RE を行い，その末梢側をin-flow としたin-situ バイパスを後脛骨動脈に行った．術後足趾の感染は治癒し，跛行症状も改善した．Bypass graft selection for surgical revascularization of critical limb ischemia is often difficult in cases where the great saphenous vein is inadequate. Herein, we report a case where we performed remote superficial femoral artery（SFA）endarterectomy, by which we adjusted thegraft length. A 72-year-old man with lower limb ischemia accompanied by subungual abscess on the right first toe was referred to our department. As the femoral great saphenous vein had many branches and its condition was poor, we performed remote right SFA endarterectomy followedby an in situ bypass to the posterior tibial artery, in which the distal side was used as an in-flow site. After the surgery, infection of the toe healed and the claudication improved

Treatment Response and Long Term Follow-up Results of Nonspecific Interstitial Pneumonia

The purpose of this study was to investigate the long-term clinical course of non-specific interstitial pneumonia (NSIP) and to determine which factors are associated with a response to steroid therapy and relapse. Thirty-five patients with pathologically proven NSIP were included. Clinical, radiological, and laboratory data were reviewed retrospectively. The male-to-female ratio was 7:28 (median age, 52 yr). Thirty (86%) patients responded to steroid therapy, and the median follow-up was 55.2 months (range, 15.9-102.0 months). Five patients (14%) showed sustained disease progression and three died despite treatment. In the five with sustained disease progression, NSIP was associated with various systemic conditions, and the seropositivity of fluorescent antinuclear antibody was significantly associated with a poor response to steroids (P = 0.028). The rate of relapse was 25%, but all relapsed patients improved after re-treatment. The initial dose of steroids was significantly low in the relapse group (P = 0.020). In conclusion, progression is associated with various systemic conditions in patients who show progression. A low dose of initial steroids is significantly associated with relapse

Modified Bentall operation with bioprosthetic valve and Valsalva graft conduit:the "slit skirt" technique

We elucidated the efficacy of the slit skirt technique to prevent bleeding from the proximal anastomosis between the graft and aortic annulus. Between September 2008 and September 2014, 15 patients underwent a modified Bentall operation with the slit skirt technique at our institution. No patients had bleeding from the proximal anastomosis. No re-thoracotomy for bleeding was required. During midterm follow-up (median period, 21 months), no patient had pseudoaneurysms at the proximal suture line. We conclude that the slit skirt technique is useful to prevent bleeding from the proximal anastomosis after the Bentall operation