Although paraplegia following descending thoracic and thoracoabdominal aortic repair is well known, paraplegia after repairing ascending aorta has been rarely reported. We describe a very rare case of postoperative paraparesis after repairing type A acute aortic dissection. A 64-year-old man with type A acute aortic dissection whose aortic false lumen was all thrombosed, was treated with rest and his blood pressure was strictly controlled. The follow-up computed tomography revealed that blood flow in the false lumen was recognized in the ascending aorta 8 days after admission. At the same time the diameter of the ascending aorta was enlarged. We performed emergency ascending aortic replacement under deep-hypothermic circulatory arrest and selective cerebral perfusion. We recognized that he showed paraparesis 4 days after operation and magnetic resonance imaging showed high signals in the spinal cord, which indicated spinal cord infarction. He received rehabilitation for 5 months, and fully recovered neurologically. The causes of paraplegia after repairing type A acute aortic dissection have not been clarified. In our case, we presumed the causes included over 60 min circulatory arrest which invoked low spinal perfusion, the anterior spinal artery was thrombosed by selective cerebral perfusion, some intercostals arteries were occluded by postoperative change of the descending aortic false lumen pressure. This case is very rare, and we had to take all possible precautions.

In step with the widespread use of antimicrobial agents in medical treatment, microbial substitution and emergence of new drug-resistant bacteria have become life-threatening problem today. Both have resulted from the postopreative practice of administering prophylactic medication and long-term, desultory drug administration. Drug-resistant microbes can occur easily with the inadequate use of drug. Therefore, our hospital has held in check the incidence of drug-resistant microbial infection by letting ICT members make the rounds of the wards and go over the notifications of the prescription of specific antimicrobial agents and the reports on drug-resistant bacteria. At the begiing, the notification and the report were filed separately. Recently, the information obtained from thses two channels has become easier of access because all the necessary data appear on the same screen at once by using patients' IDs. We believe that the streamlining of work and putting two kinds of data together have proved very usefull for infection control, as it has become possible to keep careful watch over the use of specific antimicrobial agents and the detection of drug-resistant microorganism simulataneously. By sharing the information obtained by us with all the rest on the hospital staff, we will continue to make efforts along this line and contribute toward the prevention of the outbreak of nosocomial infections as well as community-acquired ones.
Microorganism ; Pharmaceutical Preparations ; Medical Surveillance ; microbial ; Bacterial

From April 1987 to March 1990, we performed open heart surgery using extracorporeal circulation in 90 patients (average age, 51.8 years old) and vascular surgery (graft replacement of abdominal aortic aneurysm and surgery for ASO) in 29 patients (average age, 58.1 years old). Among there, 8 patients with open heart surgery (EEC group) and 9 patients with vascular surgery (vascular group) had suffered from renal insufficiency preoperatively. In the two groups, we compared operative mortality, complications and postoperative severity of renal failure. Preoperative renal insufficiency was defined as a serum creatinine level of more than 1.4mg/dl and postoperative renal failure was defined as 2.0mg/dl. There was no significant difference in operative mortality, in postoperative creatinine, Ccr, BUN and serum potassium and in effectiveness of hemodialysis in the two groups. In conclusion, it seems that we should not hesitate to perform cardiovascular surgery with extracorporeal circulation for patients with renal insufficiency or in hemodialized patients.

From January 1987 to October 1992, 60 consecutive patients operated on for infrarenal abdominal aortic aneurysm (AAA) were reviewed to evaluate the effect of previous laparotomies giving on the results of aneurysmal surgery. Eleven of 60 patients had previous laparotomies. Two of them required emergency operation for ruptured aneurysms. One of them died during surgery as a result of excessive hemorrhage prior to cross-clamping the aorta. Severe peritoneal adhesion had made if difficult to properly expose the aorta for cross-clamping to control hemorrhage. There were no statistical significance in mortality between the previous laparotomy and non-laparotomy groups. Excluding ruptured cases, we compared the previous laparotomy group (9 patients) and non-laparotomy group (37 patients) with reference to perioperative factors, including operation time, blood loss, non-oral feeding days, bed-ridden days, and hospital stay but there were no statistically significant differences. These results suggested that previous laparotomy is not a serious risk factor in operations for AAA.

This is a case report of a 40-year-old man with leiomyosarcoma of the inferior vena cava. He had suffered from shortness of breath and edema on lower limbs over several months. Clinical examinations including UCG, CT and MRI revealed the mass in the right atrium. The stalk of mass was located near junction of the right atrium and inferior vena cava by cavography. He was operated upon using extracorporeal circulation. The tumor originated from inferior vena cava, measuring 8.5×5.5×4.8cm in size, 130g in weight, was successfully removed. Partial defect of anterior wall on the inferior vena cava was reconstructed using Gore-Tex patch. Histologically, the tumor was composed of the spindled cells with arranged bundles. Immunohistochemically, they were positive for Dessmin and Vimentin. Seven months after the surgery, he has been followed at OPD. In review of the Japanese literature to our knowledge, only 14 cases were reported including this case.