Cu behaviors and effects of mine drainage in Kosaka River,Hokuroku mining district,Northeast Japan

Focusing on the origin of the heavy metal,this study aims to build an imputed method to estimate the heavy metal content in river water by making a distinction between the heavy metal of natural origins and that caused by human activities.Supported by GIS,Kosaka watershed within the Hokuroku basin was divided into several sub-watershed polygons and the outflows of water and Cu were calculated for each polygon.Compared with the natural origin,the dominant Cu emissions affected the river water more significantly in local.Based on the mass balance closure,the heavy metal content of Cu in the Kosaka River was estimated by the conflux accumulation of tributaries and mine drainages.The estimated Cu concentrations were checked by comparing with the actually measured values at monitoring points along the Kosaka River and the results are coincidence with each other in general.It is revealed that the mainstream water quality could be estimated by seizing the water quality of upstream tributaries and human drainages.

Coronary stenting with cardiogenic shock due to acute ascending aortic dissection

A 65-year-old man developed chest pain under cardiogenic shock. Coronary angiography revealed severe stenosis from the ostium of the left main coronary artery(LMCA) to the left anterior descending artery(LAD). Intravascular ultrasound(IVUS) identified a large hematoma that originated from the aorta and extended into the LAD, thereby compressing the true lumen. Type A aortic dissection(TAAD) that involved the LMCA was diagnosed by IVUS. Coronary stenting was performed via the LMCA to the proximal LAD, which resulted in coronary blood flow restoration and no further propagation of dissection. Elective surgical aortic repair was performed 2 wk after the stenting. LMCA stenting under IVUS guidance is effective for prompt diagnosis and precise stent deployment in patients with cardiogenic shock due to TAAD with LMCA dissection.

Outcomes of Single-Incision Laparoscopic Appendectomy at a Single Center

Background and Objectives: Recently, single-incision laparoscopic surgery has been popular for minimally invasive surgery and cosmetic improvement. We studied outcomes of single-incision laparoscopic appendectomy (SILA) in accordance with our strategy for acute appendicitis. Methods: Clinical outcomes were revealed in each of nine emergency SILA (e-SILA) cases and eight interval SILA (i-SILA) cases performed for the treatment of acute appendicitis between September 2010 and August 2012 at our hospital. Results: The male to female ratio was 6:3 for e-SILA and 5:3 for i-SILA cases. Mean ages were 33.1 ± 17.8 years and 41 ± 21.6 years for e-SILA and i-SILA, respectively. The pretreatment white blood cell (WBC) count and C-reactive protein (CRP) levels were 14960 ± 4080/μL and 1.4 ± 2.3 mg/d, respectively, for e-SILA and 12657 ± 4290/μL and 6.7 ± 8.3 mg/d, respectively, for i-SILA. The maximum transverse diameter of appendix was 12.6 ± 3.5 mm for e-SILA and 11.6 ± 3.5 mm for i-SILA. Appendiceal abscesses were encountered in one (11%) e-SILA and three (38%) i-SILA cases. Perforation of the appendix at operation occurred in two (22%) e-SILA cases and no i-SILA cases. Generalized peritonitis occurred in 4 (44%) e-SILA cases but in none of the i-SILA cases. The postoperative hospital stay was 5.3 days for e-SILA, 2.7 days for i-SILA. Conversion to laparotomy was not required in either group. One additional trocar was needed for an e-SILA case, and paralytic ileus occurred as a postoperative complication in one e-SILA case. Conclusion: The outcomes of SILA performed under our strategy were acceptable and useful without major postoperative complications.