Between April 1990 and December 1995, a total of 32 patients underwent emergency coronary artery bypass grafting for acute refractory coronary ischemia. The IABP group (Group A) included 27 patients who could be stabilized hemodynamically only by preoperative intraaortic balloon pump support, and the PCPS group (Group B) included 5 patients who required percutaneous cardiopulmonary support as well as IABP because of profound cardiogenic shock. In addition to surgical patients, the PTCA group (Group C) included 6 patients who were managed with catheter intervention under PCPS and IABP support for acute myocardial infarction associated with severe cardiogenic shock. Patients undergoing CABG (groups/A & B) had more prevalent three-vessel disease and left main coronary artery disease than patients receiving PTCA alone. The hospital mortality was significantly lower (7.4%, 2/27) in patients of Group A. While only one of five patients in group B could be weaned from PCPS and is alive, five of six patients in group C could be weaned from PCPS, but eventually only one of them survived. Emergency CABG is beneficial for patients who have multi-vessel disease or left main coronary artery lesion with relatively small myocardial infarction. In contrast, for patients with massive irreversible myocardial damage due to acute infarction, culprit lesions should be managed with catheter interventional therapy including balloon dilatation or stent placement and elective surgery should be planned for selected patients.

A 66-year-old man had presented with nausea and vomiting at a neighboring hospital. Abdominal CT scan revealed a giant aortic abdominal aneurysm accompanied by duodenal obstruction. Y-graft replacement operation was performed in our hospital. Although aortic abdominal aneurysm is often unexpectedly diagnosed by abdominal CT scan, very few cases of aortic abdominal aneurysm have been diagnosed in association with ileac abdominal symptoms; for example vomiting and abdominal pain. We report a case of giant aortic abdominal aneurysm with symptoms of duodenal obstruction, describing pathophysiologic aspects.

Objective: Our previous study reported many technical alarms in the dispensing inspection support system due to setting or operation errors, but not due to dispensing errors, and that countermeasures reduce technical alarms. In this study, we investigated the long-term effects of the countermeasures.Methods: The log data of the inspection results were extracted from the dispensing inspection support system and divided into image inspection and weight inspection data. The details and frequency of technical alarms before (April-June 2019), after (April-June 2020), and one year after (April-June 2021) the countermeasures were compared by chi-square test.Results: The frequency of technical alarms in image inspection was 13.7, 11.3, and 9.1% in 2019, 2020, and 2021, respectively (p< 0.01). However, the frequency of technical alarms in weight inspection was 3.0, 3.0, and 1.6% in 2019, 2020, and 2021,respectively (p< 0.01). The ratio of technical alarms to all alarms was 98.2% for image inspections and 91.2% for weight inspections in 2021.Conclusion: The frequency of technical alarms was reduced by the countermeasures. However, the ratio of technical alarms to all alarms is still high, and further improvements are needed to prevent the loss of reliability due to technical alarms.