The aim of this paper is to investigate the effect on the physiological response of fluid ingestion before walking in a swimming pool. Nine healthy students were candidates for this study. First of all, they were divided into two groups water ingestion (W(+))(300Ml) before pool walking group and no water drinking (W(-)) beforehand. Body temperature was measured in the tympanic space and venodilation was measured in the fingers. Walking conditions were 3 km/h for 1,750 m in an indoor pool with a water temperature of 29.7±0.5°C, at a room temperature of 25.4±1.4°C and relative humidity of 79.4±4.3%. The pool was 25 m in length and 1.0 m deep. The following results were obtained: The values for tympanic temperature in the W(-) group were significantly higher than that of pre-walking (p<0.05). Vasodilation of the veins in the fingers significantly expanded in the group of W(+)(p<0.05). The values of systolic blood pressure(SBP) in the W(-) group decreased significantly in comparison partially (p<0.05).We could conclude that fluid ingestion before walking in a swimming pool has a good effect on tympanic temperature, venous dilation and systolic blood pressure.

Recently, laser has been widely applied in the field of medicine and surgery. However, laser application is very rare in the cardiovascular surgery through world. Among the patients with ischemic heart disease there are some cases for whom aortocoronary bypass could not be carried out, because of small branches and diffuse stenoses of the coronary arteries. Besides, there are some problems in keeping long-term patency after vascular anastomosis especially for small-caliber vessels. For resolving these problems we have performed and continued to achieve laser works concerning, 1) myocardial revascularization by laser, 2) laser vascular anastomosis, 3) laser angioplasty. Subsequently, myocardial revascularization by high energy CO₂ laser could be successfully carried out experimentally. It was microscopically clarified that transventricular laser channels newly created in the ischemic myocardium were patent even 3 years after surgery. On the basis of excellent results of experimental studies laser was successfully employed in a 55 year-old male patient who had severe anginal attack and 90% stenosis of the left anterior descending coronary artery. On the other hand, vascular anastomosis by low energy CO₂ laser (out put 20-40mW, irradiation time 6-12s/mm) was satisfactorily utilized in 83 patients with intermittent claudication, chronic renal insufficiency and angina pectoris after a feasibility of the procedure was clearly confirmed by hemodynamic and histological examinations. Finally, laser angioplasty using Argon laser was fundamentally studied in the mongrel dogs and human cadaver. Based on the successful results of these studies, laser angioplasty was clinically applied in the 17 patients with multiple coronary stenoses or severe stenoses of the peripheral arteries. From these excellent results, laser application was inevitable for treatment in the field of cardiovascular surgery. Clinical experience of 101 patients treated by laser was reported in detail.

We encountered a case of femoro-popliteal bypass using the in situ saphenous vein bypass procedure employing a new valvulotome and technique of angioscopically assisted valvulotomy. The new combined angioscope and valvulotome system for the in situ saphenous vein bypass grafting is safe and effective for resection of valve leaflets and to avoid valvulotome-induced injury in comparison with blind retrograde valvulotomy, and allows minimal skin incision through identification of venous tributaries by angioscopic guidance. Further detailed clinical observation may be needed for the evaluation of the long-term benefits of this maneuver.

A 62-year-old man with a complete type of Behçet's disease suffering from lower abdominal pain was admitted to our hospital. Abdominal CT and angiograms demonstrated a right isolated iliac aneurysm. When his general conditions had become stable, we evaluated the activity of Behçet's disease, especially inflammation and the existence of intestinal lesions, and found no abnormalities. He underwent graft replacement for the iliac aneurysm. The postoperative course was uneventful. Angiograms revealed good opacification of the graft and no abnormality of the anastomotic site. Some reports have emphasized anastomotic complications of vascular surgery associated with Behcet's disease. We should periodically check for inflammatory signs, anastomotic aneurysm and other recurrent aneurysms.

To evaluate peripheral occlusive diseases quantitatively, we performed color duplex sonography. Between July 1996 and July 1998, we examined 68 limbs of 40 patients using color duplex sonography in addition to intraarterial digital subtraction angiography for evaluation of peripheral arterial occlusive disease. We classified the wave form of blood flow into four types (Type I-IV). Furthermore we measured the systolic velocities of the dorsal pedial and the posterior tibial arteries as well as the brachial artery. We also calculated the flow volume, and the ratio of systolic velocities and flow volume of lower to upper extremity (AVI, AFI). The waveform was significantly higher in Fontaine class III and IV, and showed remarkable improvement after arterial reconstruction. The value of AVI as well as AFI showed lower in Fontaine class I, II, III, and IV in order. In four limbs classified as Fontaine class II or more with normal ankle pressure index, the values of AVI were rather lower. On the other hand, three limbs with normal values of peak AVI (>0.9) and lower API (<0.75) were in Fontaine class I. The types of waveform correlated with clinical symptoms, and showed a remarkable regression after arterial reconstruction. The new AVI and AFI values had better correlation with clinical symptoms than API.

Two hemodialysis patients underwent coronary artery bypass grafting. Emergency coronary artery bypass grafting was performed in one patient with unstable angina and acute left ventricular failure. The other patient underwent a combined operation of coronary artery bypass grafting and replacement of abdominal aortic aneurysm. In both patients, hemofiltration was used during cardiopulmonary bypass. In the early postoperative periods, peritoneal dialysis and extracorporeal ultrafiltration method (ECUM) were used in Case 1, while Case 2 was treated by hemofiltration and ECUM. Postoperative coronary angiography showed that all grafts of both patients were patent, and both patients weve discharged from hospital without angina.

A 49-year-old man presented in emergency center with complaints of severe lumbago and severe pain of the right lower limb. Symptoms were suggestive of hernia nuclei pulposi and he was referred to orthopedic department of our hospital. His pain was not relieved by analgesics and the right lower leg was cyanotic with a swollen, hard, and tender calf. On palpation a pulsating mass was revealed in the mid-abdomen. He was transferred to the cardiovascular floor. CT and IA-DSA revealed an abdominal aortic aneurysm and no occlusion of the major arteries of the right lower leg. The serum glutamic oxaloacetic, lactic dehydrogenase levels all increased especially the creatinine phosphokinase increased to 46, 460IU/l, and the urine myoglobin level was 4, 200ng/ml. Myonephropathic metabolic syndrome (MNMS) was suspected. Urine volume was maintained with fluid infusion and diuretics. The blood urea nitrogen and potassium levels remained within normal limits throughout the course. The immediate recognition of MNMS and treatment of the condition were successful in preventing serious complications. But all the toes of the right foot became necrotic and they were amputated. Two months after admission, replacement of the abdominal aortic aneurysm was performed successfully. The patient was discharged in good condition one month after the operation.

A 73-year-old woman complaining of increased dyspnea, but no shock, was admitted under an echographic diagnosis of right atrial tumor. Echo-cardiogram at the time of admission did not reveal the right atrial tumor, and a massive pulmonary embolus was detected a pulmonary arteriography. After the infusion of tissue plasminogen activator and heparin, pulmonary arterial systolic pressure was decreased from 66 to 43mmHg, and dyspnea was improved. However, repeated pulmonary arteriograms showed no change of the pulmonary embolus, thus emergency pulmonary embolectomy was indicated. Massive thrombi, which were suspected to have moved from the lower extremities, were successfully removed. During operation, the following critical events were encountered; shock during IVC taping and severe hypoxia immediately after the pulmonary revascularization. These problems were successfully controlled by partial extracorporeal circulation. Pulmonary pressure decreased to 25mmHg postoperatively and she is doing well with anticoagulant therapy.

From January 1982 to August 1993, 23 cues of advanced renal cell carcinoma with tumor thrombus in the inferior vena cava (IVC) were treated surgically. In terms of clinical stage, 12 cases were in stage III and 11 cases were in stage IV. The 23 cases were divided into three groups according to the location of the tumor thrombus in the IVC. In two cases, the tumor thrombus extended to near the right atrium or the hepatic vein, and in six cases, the thrombus extended to the hepatic IVC. All these tumor thrombus with invasion to the IVC wall were removed under partial cardiopulmonary bypass. In 15 cases, tumor thrombus were limited to near the junction of the renal vein, which were removed by balloon catheter or finger after clamping of proximal and distal side of IVC and renal vein. Direct suture of the IVC wall in 12, patch repair with EPTFE in 10 and graft replacement with EPTFE graft in 1 were performed. Eight patients who had distant metastasis, regional lymph node metastasis and extracapsular invasion died within one year, but 4 patients were alive more than four years. Survival rate at three years and five years according to the Kaplan-Meier method was 37.5% and 18.8%, respectively. In conclusion 1) partial cardiopulmonary bypass was useful and could control bleeding when tumor thrombus in the IVC extended to the junction of the hepatic vein or right atrium. 2) long term survival cases were recognized in cases with no distant metastasis, no regional lymph node metastasis and no extracapsular tumor invasion. 3) nephrectomy associated with tumor thrombectomy in the IVC was valuable on the basis of long-term prognosis.