Therapeutic effects of two methods (1) an acupuncture technique using superficial needling applied during exhalation in the sitting position and (2) a low output laser irradiation technique applied during exhalation in the sitting position, were studied using an indicator represented by the distance between the finger tip and floor obtained when a subject bends forward from the standing position.
1. The acupuncture technique using superficial needling applied during exhalation in the sitting position significantly improved the distance between the finger tip and floor as compared with that before application (p<0.05).
2. The low output laser irradiation technique applied during exhalation in the sitting position improved the distance between the finger tip and floor as compared with that before application (p<0.01). No significant difference in the distance between the finger tip and floor were observed in the non-irradiated group.
3. Considering the therapeutic effects from application at various regions of the body, the acupuncture technique improved the distance between the finer tip and floor when it was applied to Waiguan (TE5) (p<0.05) and Zusanli (S36) (p<0.02)

A 61-year-old man underwent an emergency operation for a ruptured infrarenal abdominal aortic aneurysm. Operations included bifurcated graft replacement of the abdominal aorta, oversewing of five lumbar arteries between L3 and L5, and ligation of the occluded inferior mesenteric artery. Because of the severe adhesions and arteriosclerotic changes over the bifurcation of the abdominal aorta and both common iliac arteries, prolonged aortic cross-clamp time was needed. In spite of stable his postoperative general condition, he suffered paresthesia and complete sensory loss on the left lower leg and the right sole. Moreover he was found to have paresis on the left leg and the right thigh. Knee and ankle deep-tendon reflexes were absent on the left. Lasègue's sign was positive bilaterally, which was more brisk on the left. There was no incontinence of urine and feces. EMG showed neurogenic polyphasic potentials on the lower extremities. MRI of the thoracolumbar spine and sacrum showed no evidence responsible for this neurological deficit, but IV-DSA revealed complete occlusion of the left common and internal iliac arteries. Following the active rehabilitation, he was able to walk unaided, but remained to have residual paresthesia on the left lower leg at his discharge. It was concluded that ischemic injuries to the cauda equina resulted in this rare complication, which seemed to be secondary to oversewing of critical lumbar arteries, prolonged aortic cross-clamp time, and the acute occlusion of the left common and internal iliac arteries.

A 67-year-old man was considered a candidtate for CABG because coronary angiogram showed obstruction segment 6 and stenoses of segments 9 and 12. He underwent emergency CABG due to acute myocardial infarction (AMI) with cardiogenic shock caused by hemorrhage from a gastric ulcer. Because of hypoxia due to pulmonary edema and acute renal failure an intraaortic baloon was inserted. He had a history of cerebrovascular stroke. Although coronary angiogram revealed multiple vessel disease, we performed off-pump coronary artery bypass (saphenous vein graft-left anterior descending artery) for salvage, because cardiopulmonary bypass was considered very risky and further systemic heparinization might be fatal. He has returned to his job, and is now free from angina. As AMI with cardiogenic shock is often caused by a lesion in the LAD, CABG without cardiopulmonary bypass may be an effective technique in certain selected patients.

We describe our surgical experience of localized thoracoabdominal aneurysm in a 60-year-old woman with hypertension and hyperlipidemia. She was admitted for severe nausea associated with uremia. The initial CT scan revealed bilateral hydronephrosis, retroperitoneal fibrosis, inflammatory abdominal aneurysm, and localized thoracoabdominal aneurysm. To resolve the bilateral urinary tract obstruction, bilateral ureteral stents were inserted. After the renal function improved, the thoracoabdominal aneurysm was removed and replaced with an 18-mm woven-Dacron graft under partial cardiopulmonary bypass. The inflammation and fibrosis along the abdominal aorta did not extend to the thoracoabdominal aneurysm. Following the case presentation, we discussed the pathophysiologic aspects of this patient.

　　With the introduction of the diagnosis procedure combination (DPC) system, the reduction of the health expenditure is expected. The use of generic drugs is promoted. It is imperative for introduction of generic drugs to assure the appropriate use of drugs to decrease medical costs without reducing medical services. Additionally, we should make a concerted effort to prevent the injudicious use of antimicrobial agents resulting in the emergence of drug resistance. In this study, we assessed the effects of switching to generic antimicrobial drugs on drug purchases cost, AUD (antimicrobial use density), hospital days, and antimicrobial susceptibility of Pseudomonas aeruginosa. This study was carried out at Yashima General Hospital for the period from April 2008 to September 2011. The Health, Labor and Welfare Ministry designated Yashima General Hospital as a DPC hospital from July 2009. Since the DPC introduction, the drug purchase cost has been decreased about 40% without reduction of AUD, hospital days, and antimicrobial susceptibility of Pseudomonas aeruginosa. Hospitals are making efforts to assess and improve management efficiency while maintaining the quality of medical care. Our results suggested that the introduction of generic drugs with assessment of efficacy may be one of the useful methods for pharmacy management.

Aggressive anticoagulation therapy is necessary when Toyobo-LVAS is used for long-term treatment of severe heart failure. However, it is necessary to regulate it carefully if there is a hemorrhagic complication due to thromboembolism, but repeated blood testing is painful. We compared simple measurement with the CoaguChek XS^® with the conventional blood testing method. The correlation coefficient was 0.916, and the regression line was Y=0.8027X+0.3399. In addition, drawing blood using the CoaguChek XS^® was very effective in the reported pain reduction in patients.

To identify the factors affecting the high mortality rates associated with ruptured abdominal aortic aneurysm (rAAA), a review was made of the records of 35 consecutive patients (33 males, 2 females, mean age 69.9yr.) treated surgically between 1988 and 1997. Preoperatively profound shock (systolic pressure less than 70mmHg) was seen in 19 patients and loss of consciousness in 9. Maximum diameter of the AAA was 79±20mm and the preoperative hemoglobin level was 9.1±2.4g/dl. Proximal aortic clamp was performed at the intrathoracic aorta in 3 cases, the suprarenal aorta in 6, balloon occlusion in 4, and the infrarenal aorta in 22. Since 1994, diltiazem and nitroglycerin have been routinely given for latent myocardial ischemia and early induction of continuous hemodialysis for renal failure was attempted postoperatively. The overall hospital mortality rate was 20%. Multisystem failure was the most frequent cause of hospital death (57.1%), followed by pneumonia with sepsis in 28.6%, and intraoperative cardiac arrest (14.3%). By univariate analysis of various factors associated with the mortality rate, loss of consciousness, abnormality on electrocarciogram (ECG) and duration of shock for more than five hours were statistically significant. Multivariate analysis with stepwise logistic regression demonstrated that an ECG abnormality and duration of shock more than five hours were associated with high mortality, but not at statistically significant levels. These findings suggest that factors that are predictive of death (loss of consciousness and ECG abnormality) may be a reflection of shock in this patient population.

A 77-year-old man had undergone CABG (coronary artery bypass grafting) (SVGs (saphenous vein grafts) to LAD (left anterior descending coronary artery), OM (obtuse marginal) and RCA (right coronary artery)) 15 years previously. Three years previously, he underwent CABG again (LITA (left internal thoracic artery)-OM, RGEA (right gastroepiploic artery)-RCA) due to recurrence of angina pectoris, but there was no evidence of graft disease in the SVG to the LAD. Six months before the present procedure, graft disease developed in the SVG to the LAD and caused unstable angina pectoris. Therefore, the left axillary artery was bypass grafted to the coronary artery (LAD) using SVG without cardiopulmonary bypass by means of the MIDCAB (minimally invasive direct coronary artery bypass) technique. The patient has had no angina pectoris subsequently. Postoperative angiography revealed that the graft was patent. The axillo-coronary (LAD) bypass appears to be a useful procedure for re-revascularization to the LAD in patients with no available arterial graft, such as ITA (internal thoracic artery) or RGEA.

NIPPV provides positive pressure ventilation through a face mask without intubation. We performed NIPPV for 2 patients with acute respiratory failure following cardiovascular surgery. (Case 1) A 63-year-old man, who had had COPD (Hugh-Jones class III), underwent replacement of the aortic arch. He was extubated after 5 days. However, he was re-intubated under controlled ventilation because of deterioration of his respiratory condition. The patient had NIPPV after extubation on postoperative day 14 because he was alert and had no cardiovascular compromise. On the 18th postoperative day he was weaned from NIPPV. (Case 2) A 67-year-old man underwent coronary artery bypass surgery. On the next day he was extubated, but he suffered from hypoxemia due to impaired respiratory condition on postoperative day 3. The patient underwent NIPPV instead of conventional mechanical ventilation because his condition was stable except for respiration. Respiratory condition improved quickly and he was weaned from NIPPV on the 7th postoperative day. NIPPV is an effective method for managing patients with acute respiratory failure after cardiovascular surgery.