Patients with an aortic aneurysm have a high incidence of coronary artery disease. Percutaneous transluminal coronary angioplasty (PTCA) has not established as a safe, effective procedure in patients with an aortic aneurysm. From November 1987 to November 1993, 5 patients underwent PTCA prior to aortic aneurysm repair. Three patients had abdominal aortic aneurysm and 2 had thoracic aortic aneurysm. There were 4 men and 1 woman whose mean age was 68 years (range 63 to 76). In 4 patients primary success of PTCA was achieved. The remaining 1 patient failed PTCA and underwent emergency coronary bypass surgery. Early mortality was 0%. All five were followed up after aneurysm repair for a mean of 28 months (range 12-66 months). There was no myocardial infarction or death. These results indicate that PTCA prior to aneurysm repair is a relatively safe and effective procedure, particularly in elderly patients with an aortic aneurysm.

Risk factors for stroke after coronary artery bypass grafting (CABG) were assessed. We retrospectively investigated 681 consecutive patients who underwent isolated, first-time CABG at our institute between 1987 and 1998. Ninety-eight patients (14%) had a history of preoperative stroke. They tended to be older and with a higher incidence of peripheral vascular disease (PVD) than those without preoperative stroke. In spite of several techniques for prevention of postoperative stroke, such as the aortic non-touch technique, 14 patients (2.0%) suffered postoperative stroke. Postoperative stroke was diagnosed soon after surgery in 7 patients (50%), and the causes of stroke in these patients seemed to be intraoperative manipulation of the ascending aorta in 5, and hypoperfusion during cardiopulmonary bypass in two. Stroke in the remaining 7 patients occurred after normal awakening from anesthesia, and the cause was unknown. We then compared the patients with postoperative stroke (n=14) to those without postoperative stroke (n=667). Statistical analysis demonstrated no significant difference between the two groups in variables such as history of preoperative stroke, duration of cardiopulmonary bypass, and prevalence of PVD. Four (29%) of the patients with postoperative stroke died, due mainly to aspiration pneumonia. The morbidity and mortality of the patients who suffered postoperative stroke were very high.

The effect of spa-drink (Misasa hot spring) on exocrine pancreatic function was studied in controls and drink therapy group. To examine exocrine pancreatic function, two different methods were used for determination of pancreatic chymotrypsin activity. One was a colorimetric method for the determination of fecal chymotrypsin activity and the other was PFD fest. Following conclusions were obtained.
1) With spa-drink therapy, fecal chymotrypsin activity was raised in 2 weeks in 40% of patients, while it remained unchanged in the next 2 weeks.
2) With spa-drink therapy, PFD value was raised in 2 weeks in 50% of patients, while it returned to the pre-treatment value in the next 2 weeks.
3) Spa-drink therapy for 2 weeks was effective for improving exocrine pancreatic function.

We investigated muscle activities of the scapular muscles during low row procedure (LR) usually used 12 weeks after a rotator cuff repair, and evaluated its effective application period comparing with scapular retraction procedure (SR) used for early postoperative period. Twelve healthy adults (mean age, 26.8 years) were enrolled in the current study. %MVICs (maximal voluntary isometric muscle contractions) of middle trapezius, lower trapezius, serratus anterior, posterior deltoid, and infraspinatus were calculated from the surface electromyography during both LR and SR. The %MVIC of either the middle trapezius or lower trapezius was not significantly different between during the LR and the SR. The %MVIC of the serratus anterior, posterior deltoid and infraspinatus during the LR was significantly higher than those during the SR (p=0.018, p<0.001, p<0.001, respectively). Additionally, the %MVIC of the posterior deltoid and infraspinatus in the SR was less than 20%. In training phase after rotator cuff repair, LR was considered to be effective procedure for most of the scapular muscles 12 weeks after a surgical repair of the rotator cuff. However, LR earlier than 12 weeks after the surgery is considered to yield a risk of re-tear of the rotator cuff, and SR may be a preferred training procedure in this early phase.

An 80-year-old man felt a loss of strength and sharp pain in both lower limbs while playing gate-ball, consulted a nearby doctor, and was followed up. Because the sharp pains in both lower limbs became aggravated the next day, he was given a previously prescribed medication. Both femoral pulses were absent and acute arterial obstruction of the lower limbs was suspected. A contrast-enhanced CT scan showed a thrombosed infrarenal abdominal aortic aneurysm with a maximum transverse diameter of 37 mm, and both external iliac arteries were contrast imaged by collateral circulation pathways. We diagnosed acute thrombosis of an abdominal aortic aneurysm, and was urgently transported to our hospital. We classified his lower limbs as Balas grade III and TASC classification grade IIb and Rutherford classification grade IIb. He exhibited no abdominal symptoms and since we confirmed the blood flow of his lower limbs, we decided to perform revascularization. An extra-anatomical bypass (axillo-bifemoral bypass) was conducted because he had dementia, and was old. After the operation, myonephropathic metabolic syndrome (MNMS) did not develop, and the patient was discharged on foot on the 16th postoperative day. Acute thrombosis of an abdominal aortic aneurysm is a rare disease. Because the ischemic area widens, often causing serious MNMS after the revascularization, it has a poor prognosis. Here, we report a case in which one such patient was rescued.

Results: In the early phase after surgery, 71% and 43% of the participants were nonindependent ambulators at 1W and 2W, respectively. Histopathology indicated that patients with solid tumors (ependymoma, astrocytoma, or lipoma) showed significantly lower indices at 1W and 2W than those with vascular tumors (hemangioblastoma or cavernous hemangioma). Regarding tumor location, thoracic cases exhibited poorer lower-limb function at 1W and 2W and poorer walking ability at 2W than cervical cases. According to the receiver operating characteristic (ROC) analysis, 2 WISCI II points at 2W had the highest sensitivity (100%) and specificity (92.2%) in predicting the level of walking independence at 1 year postoperatively (the area under the ROC curve was 0.99 (95% confidence interval, 0.93–1.00). Conclusions The higher the lower-limb function scores in the early phase, the better the improvement in walking ability is predicted 1 year after ISCT resection.