The patient was placed on anticoagulant therapy with warfarin after aortic valve replacement. Although it was initially possible to stabilize the international normalized ratio (INR=2.90), the prothrombin time was significantly prolonged (INR=31.39) after intravenous infusion of miconazole for 9 days at a dose of 200mg/day to treat lichen planus. Warfarin therapy was discontinued until the INR decreased to within the acceptable range, which required 14 days, and then warfarin was resumed. A stable INR value was achieved approximately 50 days later. Treatment with miconazole results in significant promotion of the anticoagulant effect of warfarin and a long period was required before normalization of the INR could be achieved in this patient. Accordingly, miconazole therapy should only be indicated in patients receiving treatment with warfarin when administration is essential. Caution should be employed when using this drug in combination with warfarin, and careful monitoring of the bleeding time is necessary.

It has been demonstrated that exercise induces heat shock proteins (HSPs) . However, no study has investigated changes in HSPs following endurance training at different speeds. Therefore, this study was designed to investigate the effect of treadmill training at different running speeds on induction HSPs. One group of male Wistar rats was assigned as a sedentary control, three groups were assigned for exercise training (10 m/min, 20 m/min and 30 m/min) and another three groups for one acute bout of exercise (10 m/min, 20 m/min and 30 m/min) . Each training group ran at each speed for 30 min/day, 5 days a week for 8 weeks. The acute exercise group performed the exercise only once. Forty-eight hours after the last exercise session was completed, the rats were sacrificed and the plantaris (PLA) and soleus (SOL) muscles were dissected. In the acute exercise group, the content of HSP72 in both the PLA and SQL increased (p<0.05) at all speeds, and the content of HSP60 increased significantly (p<0.05) at all speeds for the PLA, but not for the SOL. On the other hand, in the endurance group, the content of HSP72 and HSP60 in both muscles increased in 30 m/min groups. These results indicate that an increase in HSP72 and HSP60 by endurance training is induced by high intensity training in both muscles. This was not found to be the case with the acute exercise groups.

A 54-year-old man was admitted to our hospital because of hypertrophic obstructive cardiomyopathy (HOCM). Medical treatment was not effective. Cardiac catheterization showed a peak systolic pressure gradient of 143mmHg between the left ventricle and the ascending aorta. Echocardiogram showed a systolic anterior motion and moderate mitral regurgitation without asymmetric septal hypertrophy. He underwent mitral valve replacement (MVR) with a 27-mm SJM instead of myectomy due to his relatively thin ventricular septum of 16mm. Postoperative cardiac catheterization revealed no significant pressure gradient between the left ventricle and the ascending aorta. MVR is the most effective surgical treatment of HOCM without asymmetric septal hypertrophy.

A 22-year-old man was hospitalized due to severe back pain having being diagnosed as Stanford type A aortic dissection, AAE, mitral regurgitation and pectus excavatum associated with Marfan's syndrome. A single staged operation including ascending aortic replacement, mitral valve replacement and sternal turnover with a rectus muscle pedicle was carried out in order to keep the blood supply to the plastron to reduce the risk of infection during such a long operation. By this approach, it was found that the operative field was excellent and postoperative hemodynamics were stable. However, frail plastron occurred because of difficulties in keeping the patient stabilized because of severe pain thus re-fixation was required. The necessity of strong pain control after such an operation was also recognized.

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.