The aim of this study was to evaluate the Enclose II anastomosis device (Novare Surgical System, Inc., Cupertino, CA). A retrospective record review was conducted of all cases which underwent off-pump coronary artery bypass surgery (OPCAB) at our general hospital between January 2002 and December 2006. We identified 91 patients (a mean age of 71.0 years, the average number of distal anastomoses 2.5/patient) underwent OPCAB. The proximal anastomoses were constructed with the Enclose II (group E, 40 patients), aorta side-clamp technique (group S, 17 patients), and aorta no touch (group N, 34 patients). Group E had more grafts than group N (E:N=2.7:1.7/patient, p<0.0001), while Group E (3.1/patient) had more distal anastomoses than group S (2.6/patient, p=0.0486) and N (1.8/patient, p<0.0001). There was no difference of graft patency in each group (early; E:S:N=99.1%:97.8%:98.0%, 1-year; E:S:N=95.8%:91.3%:95.2%). There was no patient with sustained permanent neurologic deficits after OPCAB. The Novare Enclose II proximal anastomotic device appears to be a safe and effective tool during OPCAB.

Acute respiratory failure after cardiopulmonary bypass is a severe postoperative complication. We evaluated the effects of a specific neutrophil elastase inhibitor, sivelestat sodium hydrate (Ono Pharma Co. Ltd., Osaka, Japan), on postoperative respiratory failure due to acute aortic dissection (type A, AAD). A retrospective review of clinical records was conducted for all cases of emergency surgery for AAD at Ome Municipal General Hospital between June 2001 and August 2006. We identified 16 patients (median age, 64.9 years old; male: female ratio, 4:12) who had an initial postoperative PaO₂/FIO₂ of less than 300mmHg. Among these patients, 11 treated with sivelestat were compared with 5 (the control group) who did not receive sivelestat. There were no significant differences in age, body weight, sex, operating time, cardiopulmonary time, blood transfusion, initial WBC and CRP between the two groups. At arrival in the ICU, the patients in the sivelestat group had a worse respiratory condition based on parameters such as PaO₂/FiO₂ (sivelestat vs. control, 74.1 vs. 181.1mmHg, p=0.0007), A-aDO₂ (sivelestat vs. control, 620.3 vs. 556.7mmHg, p=0.0003), and respiratory index (sivelestat vs. control, 9.29 vs. 4.92, p=0.0002). However, the patients in the sivelestat group showed a greater improvement in these parameters and CRP over a 3-day observation period, compared to those in the control group. We conclude that sivelestat may attenuate postoperative respiratory complications in patients with AAD.

Vertebral osteomyelitis (VO) is a relatively rare, but lethal, complication of infective endocarditis (IE). We report two cases who had been given a diagnosis of IE during conservative therapy for VO. A 60-year-old and a 52-year-old men each suffered onset of severe back pain. Magnetic resonance imaging demonstrated osteomyelitis in the lumbar spine. IE was revealed from congestive heart failure and persistent fever, as an unusual complication of VO. A series of echocardiograms demonstrated the progression of valvular lesions and vegetation, despite treatment with antibiotics. We therefore performed surgery. One underwent aortic and mitral valve replacement, and the other underwent aortic valve replacement. VO was treated with long-term antibiotics and good responses were achieved in both patients. The possibility of VO in the lumbar spine should be considered in patients with IE complaining of severe back pain. Appropriate antibiotic therapy over a prolonged period is recommended.

I. Purpose:
Individual differences in effects of acupunctual anesthesia during uterine endometrial biopsy were tested by means of the modified methods of Cornell Medical Index (CMI-test).
II. Methods:
Two hundred forty eight patients were examined for this tests for three years since Dec. 1982. Needles for acupuncture were applied into Ashisanri (Zusanli) and Saninko (Sanyinjiao.) After careful recognition of sufficient Tokkuki (The chih) following acupuncture, stick-points of needles were lead to Neurometer NAJ.
After approximately 30 minutes of electrical induction, biopsical operation were started. Anesthetical effectiveness of acupuncture were confirmed as follows:
(1) During biopsy, facial features what to speak, body movements, sweating, and condition of anesthesia of patients were observed and checked on the specialized score table in order from zero to 28 points. Acquired points less than 11 were indicated as effective anesthesia.
(2) Following operation the inquires about grade of pain feeling during biopsical procedures were carried out and then they were classified into four ranks: no pain, slight pain. moderate pain and strong one. The last two were considered as no effective.
(3) In addition to the above mentioned two, CMI-test was performed.
III. Results:
From score points; The effectiveness was as follows, normal type group, 79%; subnormal, 77%; breaking down of autonomic nerve system, 44%; neurosis, 86%; psychosomatic type, 68%.
On the other hand, from inquires the following were obtained: normal 65%; subnormal 50%; autonomic nervous disorder, 19%; neurosis, 41% and psychosomatic type, 37%.
There is no critical differences between both results from score points and inquiry system.
It is concluded from results that acupunctual anethesia were not much effective in patients who have disorders of autonomic nervous system and psychosomatic system, while much effective in patients with neurosis.

(1) Some improvements were made in the score table used for evaluation of effectiveness in the previous studies.
(2) The number of the cases evaluated was incresed.
(3) The difference in effectiveness of acupuncture anaesthesia and the doctors' skill of operation, the factor which influences painfulness, were also examined.
(4) The measurement of palm-forearm skin potential was employed as an objective evaluation of pain.
METHODS
Acupuncture anaesthesia was undertaken using Neurometer NAJ. Induction was done through Chinese needles (2 inch no. 28) inserted on Zusanli and Sanyinjiao for 20 minutes.
The evaluation was done on 413 cases which underwent intrauterine curettage under acupuncture anaesthesia in 1982-1985.
The evaluation of the effectiveness was carried out in two ways: (1) using scores based on the observation of patient's expression of the face and other signs, and (2) subjective evaluation (questionnaire) during the operation.
The skin potential was measured between the electrodes applied to the palm and the forearm using ECG (Fukuda-DU3S).
The relationship was examined between the potential and pain during the operation was examined. (10mm-25mm/sec, 0-8mmV)
RESULT
(1) As a result of the improvement in the score table, the effectiveness rate obtained from the questionnaire and that from the score table were close enough to conough to confirm its utility.
(2) Less effectiveness of acupuncture anaesthesia was obtained in the patients classified into the “type of unbalanced autonomic nervous system” according to the classification of the CMI test modified by Majima. This result was coincide with the previous report.
(3) Among five doctors, one obtained the best effective rate of 63%, and others got those of 14-26%.
(4) In the measurement of the potential between the palm and the forearm, values of 0.1-8.0mV appeared. Although there was a tendency that the severer the pain was, the higher the potential was, the actual value of this measurement as a rating method is to be examined.