The technical aspect of the gastroepiploic artery graft skeletonization with the harmonic scalpel: the samurai technique

A novel skeletonization technique using the scissors-type harmonic scalpel (Ethicon Endo-Surgery, Cincinnati, OH, USA) is presented. This "samurai technique," which uses the harmonic scalpel by frequently turning over the scissors, facilitates the handling of the gastroepiploic artery, enlarges the caliber size, and allows easy skeletonization without any vessel injury.     

Multichannel NIRS analysis of brain activity during semantic differential rating of drawing stimuli containing different affective polarities

We used 24-channel near-infrared spectroscopy (NIRS) to measure activity in the temporal, parietal, and frontal regions of the brain in eight Japanese women while the participants rated line drawings using semantic differential scales. Participants rated the seven line drawings on 15 bipolar semantic scales, each of which belonged to one of three semantic classes: Evaluation, Activity, or Potency. Suzuki et al. [M. Suzuki, J. Gyoba, Y. Sakuta, Multichannel near-infrared spectroscopy analysis of brain activities during semantic differential rating of drawings, Tohoku Psychologica Folia 62 (2003) 86-98.] had reported previously that the right superior temporal gyrus and the right inferior parietal lobule are associated with Activity rating, while the brain regions around the central fissure were related to Potency rating. Based on these suggestions, we investigated the brain activity in these regions during rating of stimuli containing different affective polarities. When drawings were reported as 'static' or 'calm', oxyhemoglobin concentration was higher around the right superior temporal gyrus as compared to when they were considered 'noisy' or 'excitable'. Oxyhemoglobin concentrations around the central fissure were also higher when drawings were rated as 'soft', 'smooth', or 'blunt' compared to 'hard', 'rough', or 'sharp'. Any characteristic oxyhemoglobin changes were not found during the ratings on the evaluation scales. Our results suggest that activation patterns of the temporal and parietal regions are significantly modified by semantic polarities of Activity and Potency.     

Skeletonization of gastroepiploic artery graft in off-pump coronary artery bypass grafting: early clinical and angiographic assessment

BACKGROUND: Recently skeletonization has been recognized as an alternative to pedicle harvesting of the internal thoracic artery as a technique that increases the length and caliber size of the graft compared with pedicled internal thoracic artery grafts; however, this is not yet popular for harvesting the gastroepiploic artery (GEA). We report here our experience of skeletonized GEA grafting in off-pump coronary artery bypass grafting with early clinical and angiographic results. The purpose of this study was to evaluate skeletonization of GEA grafting in off-pump coronary artery bypass grafting with a large patient volume. METHODS: One hundred sixty-eight patients including 131 men and 37 women (mean age, 65 years; range, 45 to 87 years) underwent the skeletonized GEA grafting in off-pump coronary artery bypass grafting. These patients represent 41% (168 of 407 patients) of those who underwent off-pump coronary artery bypass grafting operations during the same period. We used the GEA graft of choice in patients with right coronary artery lesion. Skeletonization was performed in a unique manner we developed. RESULTS: There were no in-hospital deaths among the study patients. One patient had a perioperative myocardial infarction, which was considered a result of vasospasm of the GEA graft. None of the other patients had severe morbidity. The patency rate of the skeletonized GEA graft was 98.1% (151 of 154 distal anastomoses). CONCLUSIONS: This study suggests that skeletonization of the GEA graft can enlarge its caliber size and improve its flow capacity. In addition, the acceptable early clinical and angiographic outcome suggests that use of the skeletonized GEA graft in off-pump coronary artery bypass grafting surgery is safe and effective.     

Acute myeloid leukemia presenting with obstructive jaundice and granulocytic sarcoma of the common bile duct

A 55-year-old man presented with jaundice and edema of the right leg. Tests of the peripheral blood and bone marrow showed leukocytopenia with 6% blasts and 38.3% of myeloperoxidase-positive blasts, respectively. Computed tomography (CT) scanning disclosed thickening of the common bile duct wall. Granulocytic sarcomas were also found at the left chest wall and the pelvic floor. Endoscopic retrograde cholangiopancreatography confirmed the narrowing of the common bile duct. Biopsy specimens of the common bile duct and pelvic masses revealed myeloblastic infiltration. After placement of a naso-biliary drainage tube, chemotherapy consisting of cytarabine (100 mg/m2/ day for 7 days) and idarubicin (12 mg/m2/ day for 3 days) was commenced. The dose of idarubicin was not modified. No serious complications, including delayed hematopoietic recovery, were observed after chemotherapy, and a complete remission was obtained 35 days later. Jaundice and liver dysfunction also gradually improved. The patient continues to receive consolidation therapy and remains in remission 8 months after the onset of his illness.     

Propagation of tonic posturing in supplementary motor area (SMA) seizures

We analyzed ictal motor symptoms in 10 patients diagnosed to have supplementary motor area (SMA) seizures based on ictal encephalographic (EEG) findings and ictal clinical semiology. Inclusion criteria were (1) EEG seizure pattern in the vertex for the scalp recording or in the area over and/or adjacent to SMA for epicortical recording and (2) ictal motor semiology characterized, as previously reported, by sudden and a brief tonic posturing of extremities and trunk mainly occurring during sleep without loss of consciousness. In 50% (5/10) of the patients, tonic posturing began in one part of the body and moved to other part(s) in 5-10s. Unlike Jacksonian march seen in seizures involving the primary sensorimotor area (S1-M1), it spread in no accordance with the somatotopy in S1-M1. The sequential propagation of tonic posturing may represent the somatotopic organization within the SMA proper.