During past 15 years 78 patients were operated for thoracic aortic aneurysm. Patients operated in emergency or dead within 24 hours after operation or with preoperative renal failure were excluded and remaining 65 patients were studied for factors affecting postoperative renal dysfunction. Postoperative renal dysfunction was based on the serum creatinine value which was within normal limit before operation and exceeded 1.5mg/dl after operation, or which increased by 1mg/dl and more from preoperative value. 23 patiens developed postoperative renal dysfunction and the incidence was 35.4%. As preoperative factors, old age, male and high value of preoperative serum creatinine were significantly (p<0.01) related with postoperative renal dysfunction. As intraoperative factor, decreased urine output per operative hour was significantly (0.01<p<0.05) related. Other preoperative factors; hypertension, diabetes, location of aneurysm, dissecting and nondissecting, intraoperative factors; operation time, volume of operative bleeding, minimum systolic blood pressure during operation, clamping time of aorta, minimum temperature of rectum, difference of adjuncts (temporary shunt or extracorporeal circulation), postoperative factors; systolic blood pressure at arriving ICU, urine output of first postoperative day were not significantly related. Between the operative procedures of graft replacement and extraanatomic bypass, no significant difference was recognized in occurrence of postoperative renal dysfunction, but patients with patch angioplasty etc. developed no renal dysfunction. In the complications within one week after operation, central nervous system dysfunction, infection and hemorrhage had a tendency to occur together with renal dysfunction. For prevention of postoperative renal dysfunction it is important to minimize the renal ischemia, to protect the kidney and to maintain urine output during operation, particularly in patients of preoperative decreased function of kidney and of old male with advanced arteriosclerosis. Also it is necessary to choose the less invasive procedure of operation for patients of severely decreased function of kidney and to consider about organ system relations in patients of postoperative renal dysfunction.

We recently experienced a case of Y graft replacement for recurrent blue toe syndrome (BTS) following cardiac catheterization. A 64-year-old male, who had undergone cardiac catheterization, complained of bilateral multiple toe cyanosis and pain. Angiograms revealed that infrarenal aortic stenosis was the recurrent embolic source. He refused surgical treatment because he thought the BTS was an iatrogenic complication. No conservative therapy was effective. He finally suffered from right foot and all left toe necrosis after nine months. Then he recieved Y graft replacement. Thereafter no embolic episode was seen. Cardiac catheterization recently has become a routine examination. However, informed consent is very important because it is difficult to anticipate BTS following the examination. Surgical treatment is recommended for recurrent BTS because conservative therapy fails in most cases.

We studied the effect of acupuncture on a case of neurogenic impotence caused by surgery for ano-rectal cancer. Acupuncture needles (length: 60mm, diameter: 0.3mm) were inserted into bilateral Zhongliao (BL33) and were stimulated erectrically or rotated manually for 10 minutes. The effectiveness of acupuncture was evaluated by IMP DIARY, which was consisted of the rate of increase on Erectometer, and the changes of the subjective symptoms. We also investigated the effects of acupuncture stimulation on microcirculation of the glans penis. After the treatmeent, IMP DIARY showed improvement of nocturnal penile tumescence, morning erection and erection by masturbation. The microcirculation at the glans penis was increased significantly immediately after acupuncture therapy. From these results, acupuncture treatment to the BL-33 points for neurogenic impotence after surgery for ano-rectal cancer was considered to be useful.