Horseshoe kidney is an unusual abnormality occurring in 0.25% of the population. In surgery for AAA with horseshoe kidney, reconstruction of aberrant renal and preservation of renal isthmus is important. We report 3 cases of AAA with horseshoe kidney treated successfully without division of the isthmus.

An 83-year-old man had acute type B aortic dissection combined with a large athelosclerotic abdominal aortic aneurysm (AAA) over 8cm in diameter. The dissection advanced into the wall of the AAA. The patient was treated with strict medical therapy for two months and successfully underwent an early elective abdominal aortic repair concomitant with off-pump aortocoronary bypass grafting. This strategy of meticulous medical management may improve clinical outcome for the acute phase in such rare cases.

We studied the effect of bath products consisting of sodium bicarbonate and sodium sulfate on living subjects when these products are used with herbal ginseng extract as a trial for a new bath product; changes in dynamic circulation were used as indicators.
Experiments were conducted from December 1990 to February 1991 on 20 subjects consisting of healthy male adults (35.6±8.9 years).
Two types of bath products were used. One consists of sodium bicarbonate and sodium sulfate and the other was the combination of the former with ginseng extracted by alcohol. Twenty five grams of each product was dissolved in 200 liters of water.
As indicators of dynamic circulation, skin surface temperature on thorax, abdomen, dorsal side of hand and dorsum of foot, volume of blood flow in leg skin (on tibia), deep body temperature in frontal region and right calf, electrocardiograph, blood pressure, and the volume of the pulsewave in the right index finger and big toe were measured. After the experiment, each subject's opinion was gathered through a questionnaire.
The experiment was performed in an air conditioned room (26°C and 50% humidity) with bathing at 41°C for 10 minutes. The value of each indicator was measured before bathing and 15, 30, 45, and 60min after bathing.
Although no significant differences in measured values were found between the two kinds of bathing, we observed faster decrease in skin temperature and faster lowering of blood flow rate in the ginseng bath group as compared with the control group. We also noted a decreased difference in pulsewave height between upper and lower extremities after bathing in the ginseng bath group, but not in the control group. This response was observed solely in the ginseng bath group because a significant increase in pulsewave height occurred in the big toe while no increase is observed in the fingers in contrast to the control group.
Faster decrease in blood flow rate in the skin and increase in pulsewave height caused by the exposure to the same temperature imply increased heat conducting distance and interruption of heat transfer from deep areas to the skin. We therefore conclude that ginseng bathing is effective in keeping the body warm. The results of inquiries after bathing indicated that many subjects felt that ginseng bathing tended to warm their bodies.
As a result of using ginseng extracted by alcohol with bath products consisting of sodium bicarbonate and sodium sulfate, differences in peripheral vessel resistance between extremities tended to decrease after bathing. We consider that this is due to the improved general circulation throughout the whole body.

We reevaluated our heparin and protamine administration protocol during and after cardiopulmonary bypass (CPB). In 12 patients who underwent cardiac surgery using a heparin-coated circuit under mild hypothermia, heparin concentration was measured with the Hepcon^®/HMS. Before initiating CPB, 1.5mg/kg of heparin was given to maintain the activated clotting time (ACT) at more than 400sec. Patients were divided into two groups. In group I (n=6), heparin was neutralized with an empirical dose of protamine (1.5mg protamine/mg initial heparin). In group II (n=6), the protamine dose was determined by the residual heparin concentration, measured with the Hepcon^®. Patients in group II received a lower dosage of protamine than group I (1.7±0.0 vs. 3.6±0.4mg/kg, p<0.001). There were no significant differences in the intraoperative bleeding, postoperative bleeding and activated clotting time between the groups. By determining the appropriate protamine dosage, this heparin analysis system may be useful in managing CPB.

During the 18-month period from January 1, 1981 to June 30, 1082, we encountered a total of 11 cases of child peptic ulcer-three gastric ulcer and eight duodenal ulcer casen.
There is every indication that the incidence of child peptic ulcer will increase in a rural area like Yuri, which is situated in Japan's northeastern prefecture of Akita.
To be noted is the fact that 10 cases out of 11 of peptic ulcer were found in three-year lower secondary schoolchildren and the remaining one was found in a sixth grader of six-year elementary school. The incidence as well as the number of visits to our clinics went up as the age advances and reached a peak in third graders of lower secondary school.
The reason why third graders of lower secondary school were attacked most by peptic ulcer is probably that they, at puberty, are under psychic or psychogenic stress with anxiety over high school entrance examinations, mental strain from forced attendance at a cramming school, trouble in getting along with friends, and dissatisfaction with parents.
Therefore, child peptic ulcer should not be treated as a disease of the digestive organ alone but as a disorder in the autonomic nervous system with an aid of psychosomatic medicine and psychiatry. For the prevention of the disease, it would also be necessary to take account of socio-cultural factors.