Cardiac rupture remains a severe complication after acute myocardial infarction (AMI) and its prognosis is poor. Between February 1985 and February 1995, six male patients (age range, 59 to 76 years, average 65.2) underwent repair of heart rupture after AMI at our clinic. The time interval between heart rupture and emergency surgery ranged from one hour to 24 hours (average 11 hours). Two patients did not recover from the initial shock, and were treated by emergency operation under IABP or PCPS. These two patients both had the blow-out type of heart rupture, and were treated by the felt-sandwich method. Neither patient was cured, due to uncontrollable bleeding. The other 4 patients recovered from circulatory catastrophe after pericardial drainage, and surgery was then carried out. One blow-out type patient died of bleeding. Two cases of hemorrhagic dissecting type were successfully treated by the felt-sandwich method. One oozing type case was treated with fibrin-glue and good results were obtained. The hemorrhagic dissecting type or oozing type showed good results but the blow-out type showed poor results. Initial pericardial drainage after establishing the diagnosis and gentle handling of the heart is essential to obtain good results. For the blow-out type of repture, other strategy is needed to control bleeding and facilitate recovery from shock.

The purpose of this study was to determine the effect of intraoperative autologous blood salvage during elective abdominal aortic aneurysm repair with Cell Saver 4 (Heamonetics Inc.). Fifty patients prospectively received intraoperative autologous transfusion (Group CS; n=50, 1991-94) and 25 received no intraoperative autologous transfusion (Group NCS; n=25, 1983-91). Only 7 patients in Group NCS received no homologous blood (28%), while 43 in Group CS received autologous blood transfusion (86%). There was no difference between the groups with respect to postoperative platelets counts or serum concentrations of total protein, albumin, BUN and LDH. We conclude that the use of the Cell Saver 4 reduces perioperative homologous blood during elective aortic aneurysm repair.

　　The process of creating health promotion activities in the community was analyzed by means of document examination. The results showed that the process has four periods, namely, the preparation period, consensus period, planning-implementation period, and continuation period. Based on our results, we propose a general-purpose design for community resident-centered health promotion activities in areas with different characteristics.

The increase in dementia is becoming a serious health-related issue in Japan. The Ministry of Health, Labour and Welfare has indicated that the most effective method for preventing dementia is to detect and manage mild cognitive impairment (MCI). Accordingly, this study focused on “low physical activity”, which is a risk factor for dementia, and aimed to clarify the correlation between physical activity and MCI by analyzing the amount of physical activity among community-dwelling elderly adults sampled randomly from a cohort. A door-to-door survey was conducted of 26 physically housebound elderly adults and 26 physically nonhousebound elderly adults matched for sex, age, and living quarters who were randomly sampled from a 2013 cohort. Housebound status was assessed using a basic checklist. The survey was conducted at the participants’ homes. Components of the survey included basic attributes, basic checklists, the International Physical Activity Questionnaire, Japanese version of the Montreal Cognitive Assessment (MoCA-J), Kohs Block Design Test (Kohs), Revised Hasegawa’s Dementia Scale, Geriatric Depression Scale─Short Version-Japanese, Instrumental Activities of Daily Living Scale, and grip strength. The chi-squared or Mann─Whitney U test was used for comparisons between the elderly adults with low physical activity and those with high physical activity. The chi-squared test was used to compare the relationships between physical activity and MCI assessments (MoCA-J, Kohs). Statistical analysis was performed using SPSS for Windows, with significance established at p < 0.05. Physically inactive elderly adults were engaged in significantly physical activities and had significantly more inactive periods compared with physically active elderly adults. The inactive elderly adults did not fulfill the level of physical activity needed to maintain fitness. In addition, a significantly higher percentage of inactive elderly adults had MCI compared with active elderly adults according to MoCA-J score. When MCI was assessed using the Kohs, on the other hand, there was no significant difference between the active and inactive elderly adults. Inactive elderly adults were not able to fulfill the level of physical activity necessary to maintain fitness and prevent MCI. There is a need to urgently consider ways to identify inactive community-dwelling elderly adults and to detect and manage MCI at an early stage.