Between April 1990 and December 1995, a total of 32 patients underwent emergency coronary artery bypass grafting for acute refractory coronary ischemia. The IABP group (Group A) included 27 patients who could be stabilized hemodynamically only by preoperative intraaortic balloon pump support, and the PCPS group (Group B) included 5 patients who required percutaneous cardiopulmonary support as well as IABP because of profound cardiogenic shock. In addition to surgical patients, the PTCA group (Group C) included 6 patients who were managed with catheter intervention under PCPS and IABP support for acute myocardial infarction associated with severe cardiogenic shock. Patients undergoing CABG (groups/A & B) had more prevalent three-vessel disease and left main coronary artery disease than patients receiving PTCA alone. The hospital mortality was significantly lower (7.4%, 2/27) in patients of Group A. While only one of five patients in group B could be weaned from PCPS and is alive, five of six patients in group C could be weaned from PCPS, but eventually only one of them survived. Emergency CABG is beneficial for patients who have multi-vessel disease or left main coronary artery lesion with relatively small myocardial infarction. In contrast, for patients with massive irreversible myocardial damage due to acute infarction, culprit lesions should be managed with catheter interventional therapy including balloon dilatation or stent placement and elective surgery should be planned for selected patients.

Orengedokuto, a Kampo formulation, has traditionally been used to treat various diseases, including hypertension with neuropsychiatric symptoms, gastritis, dermatitis, hematemesis and hemorrhagic stools. We report 8 cases of intractable hemorrhage that could not be controlled by Western medicine, but were successfully treated with orengedokuto. We elaborate on 3 cases, including 1 case treated by enema administration of orengedokuto, which was found to be a useful method. In a representative case, an 80-year-old man with aplastic anemia who was taking anticoagulants due to a history of mitral valve replacement presented with a chief complaint of black stool. Hemorrhagic gastritis was diagnosed. We repeatedly attempted endoscopic hemostatic therapy, but failed to achieve hemostasis. Oral administration of orengedokuto demonstrated hemostatic effects within a few days of starting treatment. In all 8 these cases, moreover, we observed quick clinical responses with no side effects. Although the hemostatic mechanism of orengedokuto remains unclear, we speculate that orengedokuto contains a short-acting component that affects primary hemostasis. As such, conventional orengedokuto may also have potential as a novel hemostatic agent.