A 75-year-old man received a diagnosis of an abdominal aneurysm and underwent abdominal aortic replacement. His left internal iliac artery was sacrificed because of the difficulty of reconstruction. Rhabdomyolysis of the left gluteus muscle resulted in acute renal failure (ARF) postoperatively. Continuous hemodiafiltration (CHDF) was performed from postoperative day (POD) 1 through POD 10 for the management of his ARF. During CHDF, the maximum value of serum creatinine was 5.10 mg/dl and it returned to the normal range of 1.10 mg/dl on POD 20. We conclude that the early deployment of CHDF was effective in rhabdomyolysis-induced ARF.

Cerebral protection during surgical procedure of aortic arch aneurysm is one of the most important factor which limits the time of surgical repair of the aortic arch and arch branches. We introduced the selective cerebral perfusion system by gravity with cold blood for repair of aortic arch aneurysm from 1988. This study was undertaken to determine whether this new selective cold blood cerebral perfusion system is usefull for repair of aortic arch aneurysm. From July 1988 to May 1991, twenty-three patients with aortic arch aneurysms were repaired using the selective cerebral perfusion system with cold blood. Both carotid arteries were selectively perfused with oxygenated cold blood (16°C) via the reservoir combined with heat-exchanger fixed 1.5 meter high from the head of the patient. Surgical repair was performed under moderate core hypothermia (20-25°C) avoiding prolonged cardiopulmonary bypass to rewarm the patient. Cerebral perfusion pressure was 45 mmHg (mean) and perfusion flow via the carotid arteries was 400ml/min. Mean selective cerebral perfusion time was 60min and mean cardiopulmonary bypass time was 193min. Emergency operations were performed in seven of 23 patients because of ruptured aortic arch aneurysms. There was no intraoperative death. Three of 23 patients (13%) died due to postoperative complication. Nineteen of 20 survivors discharged from the hospital and are good clinical condition. One patient needs the care for rehabilitation in the hospital due to cerebral infarction. Although our experience is limited, successful cerebral protection and avoidance of prolonged cardiopulmonary bypass were achieved. Selective low pressure cerebral perfusion with cold blood may be a useful method for repair of aortic arch aneurysm.

We reviewed our experience with 19mm size aortic valve prostheses for cases with small aortic annulus. Forty-six patients operated on between 1990 and Septembr 2002 were enrolled in this study. Clinical late assessment was performed to evaluate the incidence of valverelated complications, residual transprosthetic gradient, left ventricular mass index (LVMI), and NYHA functional class. Postoperative echocardiography was performed to evaluate hemodynamic performance of the prostheses. Follow up was 1 to 12.7 years (mean 5.3±3.6). There was no hospital mortality (0%). Actuarial survival rates at 10 years were 81.4±1.5%. The late postoperative peak gradient was 25±11mmHg. LVMI was significantly reduced in late phase. NYHA functional class significantly improved in the late period. Although 19mm size aortic valve prosthesis remains small transprosthetic pressure gradient, LVMI significantly reduced and patient activity was satisfactory maintained in the late period.

The aim of this study was to clarify the comorbidities of patients with Leriche syndrome and ischemic heart disease. We enrolled 26 patients with Leriche syndrome and who had undergone preoperative coronary angiography were enrolled. The comorbidities of diabetes, hypertension, and coronary artery disease developed in more than half of Leriche patients with Leriche syndrome. Marked coronary artery disease was diagnosed in 14 patients, 7 of whom underwent coronary artery bypass surgery. The Revascularization procedures performed in patients with Leriche syndrome were anatomical aortofemoral bypass in 15 and an extra-anatomical axillofemoral bypass in 9. In 2 cases of extra-anatomical bypass, occlusion developed in the long-term.

It has been demonstrated that atrial fibrillation (AF) frequently occurs after coronary artery bypass grafting (CABG) and may cause cerebral infarction. The purpose of this research is to clarify the risk factors of AF in patients who underwent off-pump CABG (OPCABG). In this study, 142 patients (111 men and 31 women) were enrolled with an average age of 67 years old (range, 33-83). According to multivariate analysis, age and the preoperative peak early (E)/late (A) diastolic velocities ratio (E/A) were the independent predictors of postoperative AF. Patients who suffered from postoperative AF required a significantly longer hospital stay.

Purpose: In terminally ill patients with advanced cancer,it is recognized that delirium is reversible in 20-50% of the patients with it. Identification of its cause is vital to ensure the quality of life of the patients with delirium at the end of life. We would like to report a case of the advanced cervical cancer patient with delirium, successfully treated by intravenous administration of vitamin B1. Case: An 83-year-old woman, who was diagnosed the advanced cervical cancer with carcinomatous peritonitis, was admitted to Shizuoka Cancer Center Palliative Care Unit. Four days after the admission, she presented sleep-wake cycle disturbance, poor attention, poor concentration,and short-term memory loss, and these conditions were diagnosed with delirium. Vitamin B1 deficiency was suspected by normal examinations including laboratory results and head computed tomography except for the low level (19ng/ml) of vitamin B1. One week after starting intravenous administration of vitamin B1, the symptoms of delirium were improved. Conclusion: In this case, delirium by vitamin B1 deficiency developed even though having adequate oral intake (about 1,000kcal/day), indicating malabsorption of vitamin B1 due to hypoperistalsis and edema of the bowel. Advanced cancer patients can easily develop vitamin B1 deficiency due to inadequate oral intake, increased consumption of vitamin B1 and malabsorption of vitamin B1. Therefore,the examination of vitamin B1 deficiency is necessary for patients with delirium that cannot be specified. Palliat Care Res 2009; 4(2): 330-333

An emergency percutaneous cardiopulmonary support system (PCPS) was employed 11 arrest victims (5 males, 6 females; mean age 59.3 years) refractory to conventional resuscitation measures. Cardiac operation was subsequently performed in two patients and coronary angioplasty in two. The 7 other patients continued on cardiopulmonary support by PCPS after successful resuscitation. Duration of support was 10.5±9.1 (mean±S. D.) hours, the flow rate was 2.5±0.7l/min, and PCPS was applied 5-70min (mean, 24.9min) following the onset of cardiac arrest. The entire intraluminal surface of PCPS device had been heparin coated, activated coagulation time was maintained about 150 seconds, with or without minimal systemically administered heparin. Seven of 11 patients (63.6%) were successfully weaned from the PCPS. The early survival (<30 days) was 6 patients (54.5%), and late survival was 4 patients (36.4%). We conclude that PCPS can improve survival in patient unresponsive to conventional resuscitation when instituted soon after cardiac arrest.

Between December of 1989 and May of 1993, 7 of 338 patients (2.1%) who underwent median sternotomy for cardiac operations developed mediastinitis. All of these infections caused by Staphylococcus species. Six of seven patients with mediastinitis were successfully treated with debridement, irrigation and omental transposition into the mediastinum. Between December of 1989 and May of 1992, sterile bone wax was used as a hemostatic agent in 233 of these patients. Between June of 1992 and May of 1993 an argon beam coagulator was used in place of bone wax in 105 patients. The incidence of mediastinitis significantly differed in relation to whether patients received bone wax or not (7 of 233 patients who did (3.0%) versus none in 105 patients who did not (0%) p<0.01). We conclude from this study that bone wax may be a promoting agent in postoperative mediastinitis, so the routine use of bone wax should be reconsidered.

Bypass grafting from the ascending thoracic aorta to the common iliac artery was performed to manage proximal hypertension in a patient with atypical coarctation of the thoracic aorta. The patient's history was significant for an acute aortic thrombosis at the level of the diaphragm for which she underwent an axillo-bifemoral bypass grafting as an emergency operation. Although she was doing well following the initial bypass grafting, the second bypass grafting was required to treat proximal hypertension refractory to medical management. The axillo-femoral bypass graft had a smaller diameter and a longer subcutaneous distance, and the blood supply to the abdominal viscera may have been insufficient. The proximal hypertension was well controlled following ascending thoracic aorta to common iliac bypass, because the diameter (16mm) of the graft is larger than that of the axillo-bifemoral bypass graft (8mm).

Dacron prostheses are the most widely used grafts in replacement procedures for abdominal aortic aneurysms, but they are not perfect grafts. We encountered a rare case of late graft complication. A 66-year-old man was admitted to our hospital with a pulsatile mass in an abdominal operation scar. He had received placement of a Y-shaped Cooley double velour knitted Dacron graft 18 years previously. Computed tomography and angiography demonstrated graft dilatation and an aneurysm. After resection of the graft aneurysms, the operative findings showed a non-anastomotic aneurysm formation due to longitudinal division near the graft guideline. In this case, this graft failure may have been due to the deterioration of the filter of the Dacron prosthesis itself. Therefore it is important to perform careful long-term follow-up in patients with implanted Dacron arterial prostheses.