Infrared thermography was performed on 38 forestry workers. The thermograms were analyzed separately for the left and right hands of each subject. Of 75 hands evaluated, vibration-induced white finger was noted in 18 (VWF group), and no symptoms were noted in 57 (non-VWF group). In addition to the above two groups, 42 subjects (84 hands) who had no symptoms of vibration exposure were used as a control group. Based of the thermograms taken after a local warming of the hands for 5min, the temperature distributions of the dorsal aspect of subject's hands were evaluated, and the thermal images of the hand with VWF were categorized into three main patterns. To establish a quantitative evaluation index that incorporates the characteristic thermal image observed in the VWF group, we constructed the representative parameters for each of the three thermogram patterns, and a linear discriminant analysis was performed using the presence or absence of VWF symptoms as the dependent variable and the constructed parameters as the independent variables. A discriminant score derived from this model expression was used as the evaluation index. The accuracy of the index was estimated according to a receiver operating characteristic (ROC) curve, and the area under the curve of 0.942 was obtained (p<0.001). When the cutoff point was set at the maximum point in the Youden index, the sensitivity of the VWF group was 94.4%, and the specificity of the non-VWF group and control group was 84.2% and 89.3%, respectively. These findings suggest that this newly proposed quantitative analysis method, which uses the thermal distributions of the dorsal side of the hand as indicators, may be useful for evaluating peripheral circulatory impairment of HAVS.

The infected arterial aneurysm has a fulminent infectious process frequently resulting in death if not properly treated. We reviewed 10 patients to identify the aneurysm location, etiology, bacteriology, and the mortality of surgical treatment. The abdominal and thoracic aorta was the most common site (6 cases). The primary causes were infected endocarditis, acute cholecystitis, abscess in the psoas muscle and depressed immunocompetence, but there was no case of iatrogenic trauma. Eight patients had positive blood or aneurysmal wall culture, Staphylococcus aureus, Staphylococcus epidermidis and salmonella being the most frequent bacteria identified. The proper treatment of infected arterial aneurysm remains controversial. Three methods of surgical treatment were performed; one, en bloc aneurysmal excision with in situ prosthetic graft replacement, two, open aneurysmal resection and irrigation with large amount of diluted popdon iodine solution followed by in situ prosthetic graft replacement with wrapping by an omental pedicle. Three, extraanatomical bypass grafting. Six of 7 patients in whom the infection subsided with antibiotic therapy showed good long term results. However, 3 patients with uncontrollable infection died 1 to 3 months after operation.

Ten patients, aged 3 to 43 years, with the tetralogy of Fallot underwent in situ pulmonary valve replacement (PVR) 13 times. The implanted valves were a St. Jude Medical prosthesis (3 times) and a bioprosthetic valve (10 times). In 5 patients PVR was performed at the time of radical repair and in the remaining 5 patients PVR was performed after radical repair. Three patients underwent re-PVR at 6 to 13 years after the first PVR. There was one operative death in re-PVR 14 years after the first PVR and one patient died from congestive heart failure 4 years after PVR. In the patients with the tetralogy of Fallot, the rate of PVR in those who had undergone open Brock's operation were significantly higher than that of the patients without open Brock's operation (p<0.05). Actuarial survival rates at 5 years and 10 years were 88.9% and 88.9%, respectively. Rates of freedom from reoperation at 5 years and 10 years were 88.9% and 59.3%, respectively. Although the early operative results are satisfactory, re-PVR is mandatory in the future. Thus the indications of PVR should be considered carefully.