We recently experienced a case of Y graft replacement for recurrent blue toe syndrome (BTS) following cardiac catheterization. A 64-year-old male, who had undergone cardiac catheterization, complained of bilateral multiple toe cyanosis and pain. Angiograms revealed that infrarenal aortic stenosis was the recurrent embolic source. He refused surgical treatment because he thought the BTS was an iatrogenic complication. No conservative therapy was effective. He finally suffered from right foot and all left toe necrosis after nine months. Then he recieved Y graft replacement. Thereafter no embolic episode was seen. Cardiac catheterization recently has become a routine examination. However, informed consent is very important because it is difficult to anticipate BTS following the examination. Surgical treatment is recommended for recurrent BTS because conservative therapy fails in most cases.

To study the effects of prolonged kendo practice in a hot environment on cardiovascular function, certain hemodynamic parameters were measured in 5 male college kendo fencers before and after 1 hour of kendo practice performed at a dry bulb temperature of 30.4t and wet bulb temperature of 26.2°C After kendo practice, body weight was significantly decreased and both hematocrit and blood viscosity were significantly increased. The left ventricular end-diastolic dimension and the left atrial dimension, measured by echocardiography, were significantly reduced after kendo practice, and stroke volume, ejection fraction, and fractional shortening were also significantly decreased after practice. The same fencers were subjected to lower body negative pressure testing designed to reduce the left ventricular end-diastolic dimension to the same degree as kendo practice, and comparable decreases in stroke volume, ejection fraction, and fractional shortening were observed. The ratio of end-systolic wall stress to end-systolic volume index was significantly increased during both kendo practice and lower body negative pressure testing. We conclude that prolonged kendo practice in a hot environment impairs cardiac pump function by reducing preload in parallel with the decrease in venous return, that myocardial contractility may not deteriorate despite marked hemoconcentration, and that fluid intake during practice may prevent deterioration of cardiovascular function.

Detection of the coronary artery is usually an easy procedure in the coronary artery surgery. However in cases with an intra-muscular and/or intra-fat coronary artery, it requires special skill and experience. Dissection of epicardial adipose tissue and/or muscle along the epicardial groove is a common procedure to reach such coronary artery in conventional CABG (C-CABG). Recently, off-pump CABG (OPCAB) has become a standard operation, and detection of such a coronary artery is difficult under the beating heart. Then conversion to the C-CABG becomes necessary to avoid ventricular rupture. We report a new procedure to easily detect such a coronary artery in OPCAB, using an ultrasonic Fowmeter used in neurosurgery. Because the tip of the probe is small (2mm in diameter) and flexible, its handling is quite similar to that of the micro-blade knife. Furthermore, audiable Doppler flow sound allows detection and dissection of the coronary artery without looking away from the operative field to check the coronary flow. In our case, use of the instrument enabled us to detect the anterior descending branch of the left coronary artery which was very deep in adipose tissue. Therefore, application of this ultrasound instrument is beneficial in OPCAB with an intra-muscular and/or intra-fat coronary artery.

Background: A 30-60 min rest after exercising is generally recommended before taking a bath. Although this was considered an appropriate bathing method, effects of pre-bath rest on recovery from exercise fatigue remain unclear. Here, we aimed to examine the effects on fatigue recovery of pre-bath rest after a workload, with the focus on changes in lactic acid levels. Methods and Results: Ten healthy adult men increased their blood lactic acid levels through a treadmill workload performed in accordance with the Bruce method, then took either a 60-min post-workload rest followed by a 10-min full-immersion 38°C bath (Experiment A) or a 10-min full-immersion 38°C bath followed by a 60-min rest (Experiment B). Body temperature, blood pressure, pulse rate, and blood lactic acid level were measured at three time points: before workload (Test 1), after workload (Test 2), and after bathing/resting (Test 3). Decreases and percent decreases in blood lactic acid levels were calculated by comparing Test 3 results with Test 2 results. These calculated values and the measured values in three tests were compared between Experiment A and Experiment B using paired-t test. There were no significant differences in maximum systolic blood pressure, maximum diastolic blood pressure, maximum workload attained, and maximum pulse rate measurements between Experiment A and Experiment B. Differences in systolic blood pressure and diastolic blood pressure measurements in Tests 1, 2, and 3 were not significant. The pulse rates measured at the final measurement (Test 3) were significantly higher in Experiment A than in Experiment B (90.4 ± 18.2 bpm vs 79.6 ± 11.6 bpm, p = 0.04). No significant differences were observed in other measurement timings. The body temperature measurements at the final measurement were slightly higher in Experiment A than in Experiment B (36.4 ± 0.4 vs 36.1 ± 0.3°C, p = 0.05). No significant differences were observed in other measurements. Blood lactic acid levels before workload (Test 1) were significantly higher in Experiment A (6.6 ± 4.7mmol/L) than in Experiment B (2.0 ± 1.4 mmol/L, p = 0.02), but those at other measurement points (Test 2 and Test 3) were similar. Neither decreases nor percentage decreases in blood lactic acid levels differed between Experiment A and Experiment B. Conclusions: Resting before a post-exercise bath did not change the decreases or percent decreases in blood lactic acid levels after bathing at 38°C, suggesting negligible effects of pre-bath resting on recovery from exercise fatigue.

Based on the social context of an aging society and surveys conducted since 2020, the need for comprehensive perspectives and approaches that consider patients'psychosocial background and a cross-organ perspective has been identified. As a result, a new quality and ability, namely comprehensive attitudes toward patients, has been established as part of the core curriculum for medical education in FY2022. Specific learning objectives include "holistic perspectives and approaches," "community perspectives and approaches," "life perspectives and approaches," and "social perspectives and approaches". An educational design that draws on multiple learning theories to enable reflection on one's own way of being has been proposed to integrate abstract and concrete, conceptual and experiential, and self and others perspectives. It is expected that this medical education will lead to improvement in the well-being of individuals, families, and communities.