The purpose of this study was to reveal physiological conditions of commuter cyclist from the standpoint of multiple approaches. Ten male employees (37 ± 9 yr) who usually commute by bicycle participated in this study. Global Positioning System (GPS) was used to analyze their commuting route three-dimensionally. And heart rate was recorded simultaneously to determine their exercise intensity. Blood test, oral glucose tolerance test (OGTT), and maximal aerobic test was conducted in our laboratory. Semantic differential method (SD) questionnaire was conducted to clarify their feelings during and after their commute. The results of blood test and OGTT showed that all of determined values were good and no one exceeded the standard value. GPS log showed that subjects covered 13.3 ± 7.2 km and 40 ± 20 minute with integrating 201 ± 114 meter altitude gain per commute. Heart rate data showed 129 ± 12 bpm per commute. However, subjects demonstrated higher peak heart rate during their commute ranged between 157 and 181 bpm, we determined details by frequency distribution method. The data revealed that commuter cycling was consisted by aerobic exercise with intermittent vigorous intensity exercise. Despite of such a hard exercise cycling to work, the result of SD questionnaire indicated that subjects felt briskness with less tiredness when they commute. Commuter cycling with a higher than moderate exercise intensity, could have good physical and mental effects for employees.

Three patients with hyperosmolar hyperglycemic non-ketotic diabetic coma (HHNKDC) following open-heart surgery are presented. Because the symptoms of HHNKDC are not specific, it is difficult to recognize this unique complication in the early postoperative stage. The mortality rate of this complication is high. Thus, HHNKDC should be recognized as early as possible after open-heart surgery, since it is curable if diagnosed at an early stage.

We report a case of successful graft replacement of the total aortic arch using selective cerebral perfusion for recurrent distal aortic arch aneurysm (DAAA). A 72-year-old man who had a history of patch aortoplasty for saccular DAAA was admitted to our hospital. Computed tomography and digital subtraction angiography showed recurrent saccular DAAA and coronary angiography revealed 90% stenosis of the first diagonal branch, resulting in a diagnosis of recurrent DAAA with coronary artery stenosis. A graft replacement of the total aortic arch with the aid of selective cerebral perfusion and coronary artery bypass grafting to the first diagonal branch was carried out. Postoperatively, he had no cerebral complications. One year after the operation, he had an operation for an abdominal aortic aneurysm. The patient is now leading a normal life.

The retroperitoneal approach for abdominal aortic aneurysm (AAA) has been used to reduce the risk of postoperative ileus and respiratory failure. This technique is usually used in patients with non-ruptured infrarenal AAA because it has been considered to be more time consuming to approach the aorta than the normal transabdominal approach. However, we may not have sufficient information if the aneurysm is confined to the infrarenal abdominal aorta in a ruptured case. In such a situation, the retroperitoneal approach might be better than the transabdominal approach because an aortic clamp can easily be applied to the suprarenal aorta. We report three cases of ruptured AAA treated successfully by the retroperitoneal approach.

From January 1979 through May 1982, 36 premature infants less than 2.5kg and less than 35 weeks of gestation, including 24 patients with respiratory distress syndrome, underwent ligation of patent ductus arteriosus (PDA) due to being unresponsive to medical treatment. Ten patients died postoperatively mainly from intracranial hemorrhage and necrotizing enterocolitis. Surviving 26 patients were examined for developmental sequelae based on questionnaire survey. One infant died of respiratory failure secondary to severe bronchopulmonary dysplasia 28th month after operation. We found no evidence of recurrent ductal patency following ligation during the follow-up period. Twenty four patients exhibited normal motor and mental development to attend the ordinary elementary school everyday, but one patient shows mental retardation. Most of patients suffered from the frequent upper respiratory infection in childhood to require rehospitalization. There are no patients with hoarseness, but 2 patients developed funnel chest and one required the operation. One third of the patients had ophthalmological handicap (myopia or strabismus). Surgical ligation of PDA in premature infants seems to reduce the duration of postoperative mechanical ventilation and the incidence of bronchopulmonary dysplasia. Analyzing long-term follow-up indicates that infants who undergo PDA ligation grow almost normally and do not appear to be at increased risk for sensorineural handicaps. Therefore we emphasize that surgical ligation of PDA is an effective and appropriate treatment of choice for significant PDA in premature infants.

Clinical course and outcome of 34 patients with peripheral and visceral artery aneuryms, operated during 1975-1990, were analysed. There were 24 males and 10 females. Ages ranged from 14 to 87, with an average of 55 years. Peripheral aneurysms located most frequently in the lower extremity, and the incidence of various origin of the aneurysms were as follows: 14 in femoral, 5 in popliteal, 4 in internal iliac, 3 in subclavian, 2 in common iliac arteries, and 1 in each of vertebral, radial, splenic, renal and anterior tibial artery. Most common cause of aneurysm was arteriosclerosis. Multiple aneurysms were found in 59% of sclerotic type and in most of these with bilateral aneurysms in the iliac, femoral and popliteal. Ruptured aneurysms were seen in 26% of this series. Most of the aneurysms in the extremities were totally excised without difficulty, while the aneurysms in common iliac and internal iliac were opened with partial excision or obliterated with endoaneurysmorrhaphy. Arterial reconstruction was performed using saphenous vein graft or synthetic vascular graft, excepting that the internal iliac artery itself was not reconstructed. The early operative results were satisfactory, but late results showed two death and three complications of cardiovascular system. Therefore, careful follow up of the postoperative patients was recommended.