Perioperative changes of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in surgically treated cases of abdominal aortic aneurysm (AAA) were investigated. A retrospective review of 34 patients of AAA who underwent operation was carried out. All patients received cardiac catheterization before the AAA operation. ANP and BNP were measured on the preoperative day, postoperative day (POD) 1 and POD 2, respectively. Twenty-two cases were complicated by ischemic heart disease (IHD). In all cases of AAA, ANP and BNP increased significantly at POD 1 and POD 2. The levels of ANP and BNP in the AAA with IHD group were significantly higher than those in the AAA without IHD group at all points. These results suggest that postoperative care for cardiac overload during the AAA operation is especially needed for patients with IHD.

We investigated 58 general medicine outpatients with a questionnaire on sex, BMI, lifestyle habits and the pathological condition of ki. We classified sex, BMI and sleep, diet and exercise as lifestyle habit factors, and classified ki deficiency, ki obstructive depression, ki counter flow as the pathological signs of ki. After we established a disease group and a control group, we calculated ratios for the factors in each group. As a result, there were associations between hours of sleep, and recovery from fatigue with sleep, to ki deficiency. There were also associations between recovery from fatigue with sleep, and sex, to ki obstructive depression and ki counter flow.

This report presents five serial cases of female alcohol dependence treated at neuropsychiatric division of the Saku Central Hospital for the past two years, with special references on descriptive and clinical features.
1) In rural communities, alcohol dependence in women appears to be detected and treated in their earlier stage than men. This may be ascribable to a fewer number of female drinker and closer interpersonal relationship as compared with large cities.
2) All five cases in this clinical study were secondary alcoholism which had an affective disorder antedating the onset of alcoholism. Of them, three (64, 63 and 49 years of age) were with depression and two (35 and 33 years of age) were with psychoneurosis.
3) Suicide attempt was made by a 35-year-old woman, who had experienced loss of a close interpersonal relationship and had been conflicting with her husband. This may suggest that female alcoholics are more likely to commit suicide.
4) No significant relationship was found between drinking pattern and menstrual cycles in two cases with menstruation.
5) Although we have never experienced fetal alcohol syndrome up to present at our hospital, there are several foreign literatures on that subject. It must be required to let female alcoholics aware of this syndrome.

A 43-year-old woman underwent aortic valve replacement for aortic regurgitation causing aortitis syndrome. The postoperative course had been uneventful and inflammation was controlled by steroid therapy. She developed a moderate degree of dyspnea with cardiomegaly. Two years after the first aorta valve replacement (AVR), severe aortic regurgitation was observed on both echocardiography and aortography. Dehiscence of the prosthetic valve was suspected and an emergency operation was performed. To secure the reimplanted prosthetic valve, we applied the technique of passing felt-pledgeted sutures through the aortic wall in the vicinity to the right coronary cusp and the noncoronary cusp and others through the left coronary cusp with everting mattress sutures. The postoperative course of the second AVR has been uneventful for two months. Since prosthetic valve detachment can occur even if inflammation of aortitis is well controlled, strict management of inflammation is recommended for a prolonged period to prevent reccurence of aortitis and subsequent valve dehiscence.

A 16-year-old girl with aortitis syndrome under treatment with a low dose of prednisolone was admitted because of severe headache and intermittent claudication. Angiography revealed diffuse stenosis of the thoracoabdominal aorta and the bilateral renal arteries. Extra-anatomical bypass grafting from the ascending to the abdominal aorta was first made with a 14mm woven Dacron graft through a midline sternolaparotomy. Bilateral renal arteries were difficult to dissect due to periarterial adhesion. Bypass grafting for the left renal artery could be performed with a 5mm external velour wrap-knit Dacron graft (Sauvage, Bionit); however, the right renal artery was so thin that bypass was made with a 4mm EPTFE graft which was demonstrated to be occluded by follow-up angiography 3 years after surgery. The postoperative course has been uneventful and she has been free from symptoms up to now. The good long-term function of the bypass graft from the ascending aorta holds promise for diffuse coarctation of the thoracoabdominal aorta due to aortitis syndrome.

Objective: To investigate the effect on early mobilization in patients undergoing extra-corporeal membrane oxygenation (ECMO) and acute blood purification therapy in the intensive care unit (ICU). Methods: We conducted this multicenter retrospective cohort study by collecting data from six ICUs in Japan. Consecutive patients who were admitted to the ICU, aged ≥18 years, and received mechanical ventilation for >48 hours were eligible. The analyzed were divided into two groups: ECMO/blood purification or control group. Clinical outcomes; time to first mobilization, number of total ICU rehabilitations, mean and highest ICU mobility scale (IMS); and daily barrier changes were also investigated. Results: A total of 204 patients were included in the analysis, 43 in the ECMO/blood purification group and 161 in the control group. In comparison of clinical outcome, the ECMO/blood purification group had a significantly longer time to first mobilization: ECMO/blood purification group 6 vs. control group 4 (p=0.003), higher number of total ICU rehabilitations: 6 vs. 5 (p=0.042), lower mean: 0 vs. 1 (p=0.043) and highest IMS: 2 vs. 3 (p=0.039) during ICU stay. Circulatory factor were most frequently described as barriers to early mobilization on days 1 (51%), 2 (47%), and 3 (26%). On days 4 to 7, the most frequently described barrier was consciousness factors (21%, 16%, 19%, and 21%, respectively) Conclusion The results of this study comparing the ECMO/blood purification group and the untreated group in the ICU showed that the ECMO/blood purification group had significantly longer days to mobilization and significantly lower mean and highest IMS.