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Background True primary enterolithiasis is an uncommon condition, and nontraumatic perforation of the small intestine (NTPSI) is also an unusual entity. Therefore, NTPSI due to true primary enteroliths is an exceptionally rare complication. Moreover, enterolithiasis and radiation enteritis are also unique combinations. Herein, we present an exceedingly rare case of NTPSI induced by multiple true primary enteroliths associated with radiation enteritis. Case presentation A 92-year-old woman with acute abdominal pain was transferred to our hospital because a computed tomography (CT) scan performed by her family doctor revealed free air and fluid collection within her abdomen. Our initial diagnosis was upper gastrointestinal perforation, and we selected nonoperative management (NOM) with adnominal drainage. Although her general condition was stable, jejunal juice was drained continuously. Given that the CT performed 10 days after onset demonstrated perforation of the small intestine and adjacent concretion, we performed an emergency partial resection of the small intestine and jejunostomy. The resected bowel was 1 m in length and had many strictures that contained multiple enteroliths in their proximal lumens. The patient’s postoperative course was uneventful. The enteroliths were composed of deoxycholic acid (DCA). She was diagnosed with peritonitis due to NTPSI derived from multiple true primary enteroliths associated with radiation enteritis, as she had previously undergone hysterectomy and subsequent internal radiation therapy. Conclusions Clinicians should consider the rare entity of true primary enteroliths associated with radiation enteritis in NTPSI cases with unknown etiologies.

This study was performed to evaluate surgical outcomes in octogenarian patients undergoing valve surgery. Sixty patients (mean age 82.3 ± 1.9 years) who underwent valve surgery were reviewed. Aortic valve disease was found in 65% of the patients. Preoperatively, 20% of the patients were in NYHA class IV. An urgent operation and concomitant coronary artery bypass grafting were performed in ten patients each. A bioprosthetic valve was exclusively used for valve replacement except in two patients. Mitral valve repair was done in seven patients. Operative mortality was 13.3% for the period. No risk factors for operative mortality were detected by multivariate analysis; however, urgent operation, preoperative NYHA class IV, preoperative renal dysfunction, perioperative use of an intra-aortic balloon pumping, and prolonged cardiopulmonary bypass time had significant effects on operative mortality. The actuarial survival rate at 1 and 3 years after surgery was 82.6 and 71.5%, respectively, and 97.6% of late survivors reported that their activity level was equal to or better than the preoperative level. Valve surgery can be performed in octogenarian patients with acceptable mortality, good long-term results, and good quality of life. Early referral to surgery should be important to obtain a better postoperative outcome.

Our aim was to evaluate the long-term results of implantation of the Carpentier–Edwards pericardial (CEP) valve in the aortic position. Between January 1996 and December 2007, 244 patients who underwent aortic valve replacement using the CEP valve were enrolled in this study. A 19-mm valve was used in 39 patients, a 21-mm valve in 94 patients, a 23-mm valve in 81 patients, and a 25-mm valve in 30 patients. The early and the late results were evaluated. Furthermore, echocardiographic examination was performed at follow-up. There were 5 early deaths, with an early mortality rate of 2.0%. Follow-up was performed in 95.4% of the survivors of the operation for a mean period of 4.1 years. Actuarial survival rates at 5, 10, and 12 years were 85.3 ± 2.8, 80.0 ± 3.7 and 70.0 ± 9.8%, respectively. Thromboembolism was observed in 6 patients, endocarditis in 2 patients, reoperation in 4 patients, and structural valve deterioration in 2 patients. Actuarial freedoms from thromboembolism, endocarditis, and reoperation at 10 years were 96.9 ± 0.14, 97.7 ± 0.16, and 97.0 ± 0.16%, respectively. Echocardiographic examination revealed that the pressure gradients across the valve prosthesis for valves of each size were acceptable. Left ventricular mass index decreased significantly in all valve sizes. The long-term results of implantation of the CEP bioprosthesis in the aortic position were satisfactory. The CEP bioprosthesis maintained its hemodynamic performance even as late as 10 years after implantation.

This report describes 3 aged patients undergoing emergent surgery who refused elective operation for a thoracic aortic aneurysm because of freedom from symptoms attributable to the aneurysm at the time of presentation. A 77-year-old women with a thoracoabdominal aneurysm 57 mm in diameter at presentation had recurrent hemoptysis 12 months later. A 78-yar-old man with a saccular type distal arch aneurysm 64 mm in diameter at presentation was transported with shock and hemothorax 27 months later. Another 82-year-old man with a saccular type distal arch aneurysm 60 mm in diameter at presentation was admitted with severe chest and back pain 36 months later. All of them underwent tube graft replacements of the aneurysm urgently and were discharged on foot. Aged patients with life-threatening events should not be denied surgical intervention because of excessive operative mortality and morbidity, even if they had previously refused elective surgery.

In order to investigate the difference in microbubble generation between roller and centrifugal pumps, this quantitative bench study was conducted. Using a mock circuit and fresh bovine blood, a roller pump or a centrifugal pump was run with 51/min of flow and 350 mm Hg of total pressure head. Microbubbles were produced by inflow tube occlusion (3 or 5s). Blood temperature was maintained at 25° and 36°C. Using a Doppler microbubble detector, the maximum diameter of the bubbles was monitored every 0.1s for 60s (total, 600 samples) at the prearterial filter (pump outflow side) and the postarterial filter sites. The number of microbubbles larger than 32μm were counted. The roller pump generated significantly more large microbubbles than the centrifugal pump. Substantial numbers of large microbubbles were encountered at the postfilter site, particularly when the roller pump was used. The centrifugal pump does not create excessive negative pressure by inflow occlusion; microbubble generation was less than that of the roller pump. Furthermore, since the centrifugal pump has a pressure discrepancy in the pump, small bubbles tend to stay around the center of the pump. This study confirmed that the centrifugal pump generated fewer microbubbles than the roller pump during inflow obstruction. Therefore, the centrifugal pump is safer in terms of microbubble generation. Additional care should be taken to prevent air emboli while using the roller pump because substantial numbers of microbubbles may go through the arterial filter.[PUBLICATION ABSTRACT]

Heavy traffic congestion daily occurs at merging sections on highway. For releasing this congestion, possibility of alternative configuration of vehicles on multiple-lane road is discussed in this paper. This is the configuration where no vehicles move aside on the other lane. It has a merit in making smooth merging at an intersection or a junction due to so-called the \"zipper effect\". We show, by developing a cellular automaton model for multiple lanes, that this configuration is achieved by simple local interactions between vehicles neighboring each other. The degree of the alternative configuration in terms of the spatial increase of parallel driving length is studied by using both numerical simulations and mean field theory. We successfully construct a theoretical method for calculating this degree of the alternative configuration by using cluster approximation. It is shown that the theoretical results coincide with those of the simulations very well.