Objective and Methods : Data on isolated coronary artery bypass grafting (CABG) performed in 2013 and 2014, and registered in the Japan Cardiovascular Surgery Database were reviewed for preoperative characteristics, postoperative outcomes, and choice of graft material for the left anterior descending artery (LAD). Results : Isolated CABG was performed off-pump in 54.7% of cases, and graft material for the LAD was left internal thoracic artery in 74.3% and right internal thoracic artery in 15.6%. Operative mortality was 2.0% in elective cases, 8.2% in emergency cases, and 3.0% overall. In elective cases, operative mortality was 1.1% for off-pump CABG compared with 3.0% for on-pump CABG. Conclusions : Clinical results of our isolated CABG was reasonable and acceptable.

The purpose of this study was to examine the effects of long-term habitual exercise on daily total energy expenditure (TEE) and its components, body composition and maximal oxygen uptake (VO₂max) in middle-aged Japanese women. Twenty-eight subjects aged 39 to 58 years were assigned either to a nonhabitual exercise group (Control ; n=12) or a habitual exercise group (Exercise ; n=16). TEE, physical activity level (PAL) and the daily physical activity energy expenditure (PAEE) were assessed by doubly labeled water (DLW) method. The exercise-induced energy expenditure (ExEE) and nonexercise-induced energy expenditure (NExEE) were evaluated based on the activity record investigation conducted simultaneously during the DLW measurement period. The result follows that TEE was significantly (p<0.01) higher in the Exercise group (2520 kcal · day^-1) than in the Control group (1921 kcal · day^-1). There was no significant difference in basal metabolic rate between the groups. PAEE and ExEE were significantly higher in the Exercise group than in the Control group (p<0.01). Habitual exercise induced an increase in TEE without resulting in a compensatory reduction of NExEE. The percentage body fat (fat%) was significantly lower in the Exercise group (25.5%) than in the Control group (30.9%). VO₂max was higher in the Exercise group (1788 ml · min^-1) than in the Control group (1417 ml. min^-1). After correction for body weight, fat% was negatively associated with TEE (p<0.01), PAEE (p<0.01) and ExEE (p=0.05), while VO₂max was positively associated with TEE (p<0.05), PAL (p<0.05), PAEE (p<0.05) and ExEE (p<0.01). These results suggest that habitual exercise is associated with the increase of TEE, the improvement of body composition and VO₂max. The improvement of VO₂max was mainly caused by the increase in ExEE, indicating that the exercise intensity is important to the improvement of cardiorespiratory endurance fitness.

A 24-year-old woman with patent ductus arteriosus underwent division of the ductus. On the fifth postoperative day (POD 5), MRSA was detected in pus from the wound. On POD 8, an emergency operation was performed for left tension hemothorax due to a ruptured aorta with MRSA infection. The bleeding site in the descending aorta was covered with a viable omental flap under deep hypothermic circulatory arrest. Although MRSA was detected in the pleural effusion and the aortic wall, the patient recovered from pyothorax, and pneumonia caused by Pseudomonas aeruginosas and acute renal failure. On POD 37, a pseudoaneurysm of the descending aorta was found and graft replacement was performed on POD 56 due to enlargement of the aneurysm. However, MRSA was not detected in the left pleural effusion. The postoperative course was uneventful. Omental transfer should be considered for the treatment of severe aortic wall infection, even in the presense of MRSA infection.

Side to side difference in tennis players' mid-radius and cross-sectional study on mid-tibia of jumpers and sedentary controls suggest that the improvement of mechanical properties of cortical bone in response to long-term exercise is related to geometric adaptation and not to volumetric bone mineral density. In the present study, geometric and mechanical properties of right tibia were estimated along 64 directions centering center of gravity of the bone on cross-sectional peripheral quantitative computed tomography (pQCT) images. The tibias of 17 jumpers (7 females, 10 males) and 15 controls (8 females, 7males), aged 18-23, were scanned at mid site using pQCT. Periosteal and endocortical radius were larger, cortical thickness was thicker, and mechanical properties (moment of inertia of area and strength strain index) were greater in jumpers compared to those of controls. The differences in cortical thickness between the two groups were dependent on direction of measurement. Defined a direction from tibia's center of gravity to fibula's as 0°, difference in the cortical thickness between jumpers and controls was the greatest at around 240°. Along this direction, differences in mechanical properties were also the most significant, suggesting that the site-specific adaptation of bone to long-term exercise is due to geographical relation of bone to muscle.

Seventy patients with rheumatic valvular disease were evaluated with preoperative CT scanning. The correlation of the obtained CT images to the operative findings were examined. Left atrial thrombi were found in 24 cases at the operation. CT scan had detected thrombi in 19 cases (79.2%) and echocardiography in 15 (62.5%). CT failed to find them in 5 cases in which the left atrial thrombi were less than 3g. Echocardiogram, however, failed to detect thrombi in 9 cases, the largest being 14g. There were 15 cases with left atrial calcification, in which 10 cases had left atrial thrombi. Nine cases out of these 10 cases had rough left atrial surface after thrombectomy. Early postoperative CT of 10 with left atrial calcification showed recurrent left atrial thrombi in 4 (40%) cases. Mitral valve calcification was found in 42 cases during operation. CT scan was able to detect it in 40 (95.2%), while echocardiogram detected in 34 cases (81.0%) (p<0.05). All mitral valves with calcification required replacement. Out of 30 cases with non calcified mitral valves, 9 underwent OMC, and the other 21 underwent mitral valve replacement. Aortic valve calcification was found in 9 out of 11 cases with aortic stenosis. All has been diagnosed by CT scan. In conclusion, 1. In detecting the left atrial thrombi, CT scan was superior to echo-cardiography, and provided useful information for planning the operative procedure including atrial approach and valvular manipulation. 2. CT scan could detect calcification of left atrial wall which had high incidence of thrombus formation and rough left atrial surface. 3. CT scan could detect calcification of both mitral and aortic valve, and showed the severity of valvular structural changes.

Primary malignant cardiac tumors are extremely rare. Among these, leiomyosarcoma are particularly exceptional and only about 20 surgically treated cases have been extensively described. We describe a case of right atrial leiomyosarcoma which was accidentally found by computed tomography. The tumor was surgically resected under extracorporeal circulation. Two months later the patient had cerebral hemorrhage due to a brain metastasis, which almost completely disappeared after irradiation. There was no other evidence of recurrence for 12 months after operation.

Background: The posterior transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) were developed for postoperative pain control after lower abdominal surgery. However, there is little data regarding their effects. Their analgesic effects and the distribution of the cutaneous sensory blockade were observed in patients undergoing laparoscopic gynecologic surgery. Methods: After an induction of general anesthesia, patients alternately received bilateral ultrasound-guided QLB type 2 (QLB2) or posterior TAPB using 20 ml of 0.375% levobupivacaine on each side. The measurements included visual analogue pain scores (VAS), cutaneous sensory blockade in each dermatome, demands for postoperative analgesics, and complications for up to 48 h after the block. Our primary endpoint was VAS at 24 h after the block. Results: Forty patients completed the study. The VAS at rest was significantly lower after QLB2 than that after TAPB at 48 h, but not at 24 h. Neither group differed in VAS when coughing at any point in time. Postoperative demands for fentanyl and other analgesics also did not differ for either block. The majority of injections produced a cutaneous sensory blockade in the T11 and T12 dermatomes in both groups. The median number of dermatomes blocked was limited to three dermatomes after either block. No severe complication related to either block was observed. Conclusions The analgesic effects of QLB2 and posterior TAPB did not differ in patients undergoing laparoscopic gynecologic surgery. The cutaneous sensory blockade produced was limited to three dermatomal levels in the majority of patients. However, these findings need to be confirmed through a larger comparative study.