A 51-year-old man, with an abnormal shadow on chest X-ray film, was found to have a right-sided aortic arch with mirror-image branching and Kommerell's diverticulum. Neither congenital heart anomalies nor vascular ring was observed. We performed descending aorta replacement with a Hemashield^TM 24-mm graft, because the trachea and esophagus were compressed by the diverticulum, and to eliminate the risks of aneurysmal change or rupture. The operation was performed through right thoracotomy, and with total CPB under deep hypothermic circulatory arrest. The patient was discharged on the 18th postoperative day. This is rare adulthood case of right aortic arch with Kommerell's diverticulum and no anomalies in the heart.

We evaluated the efficacy of sternal coaptation pins used to improve the fixation of the transected sternum after coronary artery bypass grafting (CABG) with the internal thoracic artery (ITA). The subjects were 37 patients who underwent scheduled single CABG with ITA in our department and they were classified into two groups, i. e., Group A, without sternal pins (18 patients), and Group B, with sternal pins (19 patients). The efficacy was assessed by the following measurements : drain bleeding volume up to 12 and 24 h after ICU admission, the time until the removal of drain, surgical site infection (SSI) and the maximum split level between the sternal body and manubrium after surgery. Drain bleeding volume up to 12 and 24 h after ICU tended to be less in Group B. The time until the removal of drain was significantly shorter in Group B. SSI was 17% in Group A but 0% in Group B. The use of sternal coaptation pins reduced misalignment of the coapted sternum, and we belive that the use of sternal coaptation pins contributed to the early removal of drain, and SSI reduction.

The kind of respiratory disease, age, and areas where patients came from, were analyzed in 763 patients with COPD admitted at our hospital for last 7 years from 1992 to 1998. 1. For the last 7 years 886 patients with respiratory diseases were admitted at our hospital. Of these patients, 763 (86.1%) were those with COPD. Of the 763, 613 (80.3%) were patients with asthma, 27 with chronic bronchitis, 41 with obstructive bronchiolitis, and 87 with pulmonary emphysema. 2. The number of patients with pulmonary emphysema showed a tendency to increase. 3. The number of patients from distant areas was considerably larger (43.8% in 1997, 53.4% in 1998) compared to the number of patients from Tottori prefecture. The number of patients from Okayama, Hyogo, Osaka, Hiroshima, Yamaguchi, and Ehime prefectures was predominantly larger than the number of patients from other distant areas. 4. Regarding the age distribution of these patients, the number of patients over the age of 60 was predominantly larger than the number of patients under the age of 59: patients between the ages of 60 and 69 were more frequently observed in those coming from distant areas (outside Tottori prefecture), and those over the age of 70 in those coming from Tottori prefecture.

Background : Endovascular treatment of the thoracic aorta (TEVAR) for type B aortic dissection is reported to be effective if the interval between the onset and the procedure is relatively short. However, the optimal timing for TEVAR is still controversial. Method : From December 2008 to April 2015, we experienced 46 TEVARs for type B aortic dissection. The interval between onset and TEVAR was within 3 months in 15 cases (Group A), from 3 months to 1 year in 10 cases (Group B), and more than 1 year in 21 cases (Group C). Result : Primary success was obtained in all cases, and no new intimal tear was formed during the procedure. There was no hospital death. At the time of discharge, disappearance of ULP or thrombosed thoracic false lumen occurred significantly more frequently in Group A (93%) than in Group B (50%) and Group C (43%) (p<0.05). At 6 months, the rate of the patients with reduced aneurysm diameter more than 5 mm was significantly higher in Group A (87%) and Group B (70%) than in Group C (19%) (p<0.05). Three cases of Group C had enlargement of the aneurysm despite of TEVAR, and graft replacement of thoracoabdominal aorta was performed in one of the cases. Conclusion : For type B aortic dissection, TEVAR is more effective if performed within 3 months from the onset.

We observed peripheral circulation in patients suffering from peripheral neuropathy in order to quantify the effect of spa therapy on peripheral neuropathy.
The peripheral circulation was observed using thermography and Laser-Doppler blood flowmetry. Thirteen patients with a mean age of 71.9 years (range of 59-82) suffering from diabetic neuropathy with coldness, numbness, neuralgia in their feet or walk disturbance, and 11 patients with a mean age of 72.3 years (range of 60-84) suffering from lumbago, were examined by the methods. The blood flow, mass and velocity were measured by a Laser-Doppler blood flowmetry, after pre-loading with hot water at 36°C for 5min (hot loading), and after cold loading with cold water at 20°C for 5min. Thermographic results were analyzed quantitatively by calculating a recovery ratio as: Recovery ratio=[Total counts of thermography (Pixels) over 27°C after cold loading] ÷ [Initial counts over 27°C after hot loading]×100 (%).
The recovery ratio in diabetes mellitus was between 0-93.5% (mean=46.8%), whereas the recovery ratio in lumbago was between 0-91.3% (mean=41.3%). The blood flow in patients with diabetes mellitus was 1.11-5.36 (ml/min/100g tissue), (mean=2.44), the blood mass was 85-255 (mean=155), and the velocity was 0.447-0.784 (mean=0.591). The blood flow in patients with lumbago was 1.18-3.82, (mean=2.19), the blood mass was 89-195 (mean=144), and the velocity was 0.464-0.8 (mean=0.615). The recovery ratio and blood flow in patients with diabetes mellitus were correlated, r=0.62 and p<0.0002, as the recovery ratio and blood mass were correlated, r=0.59 and p<0.0001. However the blood flow and the velocity in these patients were not correlated, r=0.11. The recovery ratio and blood flow in patients with lumbago were not correlated, r=0.02, but the recovery ratio and blood mass showed some correlation, r=0.38. The recovery ratio and the velocity in these patients were correlated, r=0.64 and p<0.005. The blood flow in patients with diabetes mellitus was greater after hot loading (mean=2.89) than after cold loading (mean=2.44). The blood mass in patients with diabetes mellitus was greater after hot loading (mean=180) than after cold loading (mean=155). However, there was no significant change in the velocity after hot loading (mean=0.572) compared with the velocity after cold loading (mean=0.591).
It was revealed that patients with diabetes mellitus with low recovery ratios in thermography had low blood flow and blood mass in their peripheral circulation. Patients suffering from lumbago had different peripheral circulation compared with diabetes mellitus. Spa therapy was effective on diabetic peripheral neuropathy as the peripheral circulation improved with hot water at 36°C