Intermittent cold blood cardioplegia with retrograde coronary perfusion was demonstrated in 11 CABG cases and the effects of myocardial protections were compared with 11 cases of antegrade perfusion. We evaluated the effects from the assistant perfusion time after aortic declamping, the incidence of occurrence of spontaneous beating, the dose of catecholamin required after CPB, and the changes in myocardial enzyme values. The two groups were similar in age, ejection fractions, and the extent of coronary artery disease. There were no cases of death and no PMI in all 22 cases, and the mean number of grafts and aortic clamping time were similar in the two groups. Concerning the effects of myocardial protections, there were no significant differences in any items in the two groups. We conclude that intermittent cold blood cardioplegia with retrograde coronary perfusion provides the same myocardial protective effects as the antegrade perfusion in CABG cases.

Purpose : This study aimed to explore the factors which interfere with advance decision-making with regards to artificial hydration and nutrition (AHN) in the senescent population.
Methods : Subjects were local residents aged 60 years or older who were leading an independent life and who could go out by themselves. A cross-sectional study using a self-administered questionnaire was conducted from August to November 2011. Valid responses were obtained from 116 subjects, for a valid response rate of 90.6%. Advance AHN decisions, knowledge about AHN, intentions regarding advance directives and end-of-life care, experience providing long-term care, in addition to other questions, were analyzed using a multiple logistic regression model.
Results : With respect to advance decisions regarding AHN, 25 respondents (21.6%) indicated that they could not make a decision, while 91 respondents (78.4%) could. Sixteen respondents (13.8%) desired some component of AHN, while 75 respondents (64.7%) did not desire any AHN. Factors related to difficulty with advance decisions regarding AHN were : 1) lack of adverse experiences associated with decreased cognitive function (“experience of failure”) (OR=12.0, 95%CI=1.42-100.41, p<.022), 2) lack of experience providing long-term care for a family member (“experience of caring”) (OR=3.0, 95%CI=1.04-8.53, p<.042), and 3) desire to defer such decisions to others in the event of unconsciousness or other incompetency rather than an advance decision (“reliance on others”) (OR=5.6, 95%CI=1.95-16.24, p<.001).
Conclusion : Factors related to difficulty with advance decisions regarding AHN in the senescent population were lack of adverse experiences associated with decreased cognitive function, lack of experience providing long-term care for a family member, and desire to defer such decisions to others in the event of unconsciousness or other incompetency rather than an advance decision.

The purpose of this study was to determine sway characteristics of a supported leg during a lateral stepping over obstacle task with different obstacle height and movement patterns, using a small triaxial accelerometer. We examined 20 healthy young adults to assess their trochanter malleolar distance traveled during a lateral stepping over obstacle task with obstacle heights of 30%, 50%, and 70%. The lateral stepping over tasks revealed flexion and extension patterns. We directed the subjects to grasp a forward handrail, perform the lateral step, and subsequently step over to the side. We calculated synthetic acceleration (SA) from acceleration data measured using two small triaxial accelerometers and two web cameras. We calculated supporting leg sway; RMS phases of X-, Y-, and Z-axes; and SA data. The subjects showed increased RMS of Y-axis and SA according to the obstacle height for the flexion pattern; however, they did not show change in RMS of Y-axis and SA according to the obstacle height for the extension pattern. During lateral stepping over, the RMS of Y-axis and SA for the flexion pattern were higher than for the extension pattern. The findings for the flexion pattern suggest that the center of gravity shifts higher according to increased obstacle height; consequently, the supporting leg becomes unstable. The findings for the extension pattern suggest that the “screw-home” rotation effect of the supporting leg during movement can support lateral stepping over better than the flexion pattern.

A 56-year-old man with uncontrolled diabetis mellitus was admitted with general fatigue and high fever. Abdominal CT and aortography showed a saccular aneurysm in the left common illiac artery. Salmonella choleraesuis infection was diagnosed on the basis of blood culture. We performed a two-staged operation because of the tight inflammatory adhesions and the abcess formation around the aneurysm. First we performed surgical treatment of the aneurysm and extra-anatomical bypass grafting (F-F crossover bypass). Then the in situ graft replacement was performed, 4 weeks later. After the second surgery, antibiotics were administered for 6 more weeks. The patient remains asymptomatic for 6 months after the record operation.

We assessed the change in intraoperative cerebral oxygen metabolism during coronary artery bypass grafting (CABG) in patients with cerebrovascular desease (CVD) identified by preoperative computed tomography or magnetic resonance imaging. The study population consisted of 36 patients who underwent consecutive CABG and were divided into two groups on the basis of preoperative CVD. With near-infrared spectroscopy, the change in oxygenated hemoglobin/total hemoglobin ratio (%Oxy-Hb), which was regarded as regional tissue oxygenation, was obtained. In addition, jugular venous bulb oxygen saturation (SjO₂) was measured simultaneously. Moreover, the influence of intraoperative parameters on cerebral oxygenation was assessed by regression analysis. Thirteen patients (36%) were given a diagnosis of CVD preoperatively (group A) and were compared with the remaining 23 patients as controls (group B). All of group A were asymptomatic cerebral infarction. The average %Oxy-Hb was 51.2±4.1% in group A and 62.0±12.1% in group B (p=0.04), and SjO₂ was 63.5±8.6%in group A and 68.1±7.7% in group B (p=0.12). In serial changes, %Oxy-Hb during the late phase of cardiopulmonary bypass (CPB) and SjO₂ during the early phase of CPB were significantly lower in group A. The positive correlation between perfusion pressure and SjO₂ was demonstrated in groupA (r=0.699, p<0.0001) while no correlation was observed in group B. It is concluded that patiens with silent cerebral infarctions had poorer intraoperative cerebral oxygen metabolism during CABG. It is necessary to keep a higher perfusion pressure in these patients during CPB because cerebral autoregulation may be impaired.