We studied the effects of the electrolyte composition (K, Ca, Na) and prostaglandin E₁ of the extra-cellular fluid on the tension development of isolated canine coronary arterial strips. In 20mEq/l potassium solution, 4.7mEq/l calcium produced coronary artery contraction. This Ca-induced contraction was partially inhibited dose-dependently (between 10^-15M and 10^-12M) by prostaglandin E₁. Above 10^-11M, intensity of the inhibition did not change. In the presence of 20mEq/l potassium, the reduction of sodium concentration to 12mEq/l increased the tension of coronary artery. Prostaglandin E₁ did not affect this tension development. After 5min perfusion of prostaglandin E₁, Ca-induced contraction was not inhibited. It is concluded that low calcium, high sodium cardioplegic solution may relax the canine coronary artery. Addition of prostaglandin E₁ to cardioplegic solution may reduce the coronary artery contraction partially.

We describe two patients who underwent repeat off-pump coronary revascularization by axillocoronary artery bypass grafting. A 63-year-old man (case 1), who had undergone coronary artery bypass grafting (CABG) 13 years previously, was admitted to our hospital with exertional angina. The saphenous vein grafts (SVG) to the left anterior descending artery (LAD), circumflex artery (Cx), and right coronary artery (RCA) all were occluded. The left internal thoracic artery (LITA) also was occluded because it had been injured. Because the patient declined to undergo a redo CABG, percutaneous transluminal coronary angioplasty (PTCA) to the LAD was attempted. However, coronary dissection occurred, and an emergency operation was performed. A 66-year-old man (case 2), who had undergone CABG 12 years previously, was admitted with unstable angina. The LITA to the LAD and the SVG to the RCA were occluded. The SVG to the Cx had 99% stenosis in its mid-portion and was the cause of the angina. PTCA and stenting of this SVG were performed. Two weeks later, an operation was done. In both patients, the left axillary artery was selected as the site of the proximal anastomosis. Both patients underwent off-pump bypass grafting to the LAD from the left axillary artery using a SVG. Both grafts were patent postoperatively. This approach resulted in early symptomatic improvement.

Diffuse peritonitis due to perforation of pyometra is relatively rare. We experienced three cases of this type of peritonitis between 1993 and 1999. Three women aged 77, 83 and 91 years had mild abdominal pain, slight fever and defecation for nearly one week. Following these, severe abdominal symptoms developd. These patients underwent emergency laparotomy as they were diagnosed with diffuse peritonitis. At first, intestinal perforation was suspected, but perforation of pyometra was confirmed when lapasortomy was done. On preoperative examinations, physical findings were scanty in comparison with hemological ones, and free air on abdominal X-ray films was not detected. Thus, we failed to establish the preoperative diagnosis. The prognosis was very poor in two of the three patients. One was with advanced cervical cancer and the other was in multiple organ failure on admission. Differential diagnosis of this disease is important for the management of acute abdominal diseases in elderly women.

The School of Medicine, University of Tsukuba, was founded in 1974 and had graduated 1, 561 students by 1994. From 1980 through 1987, 44% to 73% of graduates became hospital staff, 16% to 40% became university staff, and 0% to 8% became general practitioners. More than 80% of graduates did a 2-year residency (sotsugo-kenshu) at our university hospital and 40% completed a 6-year residency. Almost 10 years of postgraduate training was required to become an established medical practitioner. This length of time indicates that postgraduate training is the most important part of the medical career. About 80% of graduates earned doctor of philosophy (Ph. D.) degrees, whereas 93% became registered specialists, indicating that graduates tended to become specialists rather than to pursue Ph. D. degrees. This difference is more evident among female graduates: 85% became specialists whereas only 53% received a Ph. D. Most graduates considered the School of Medicine to have a good curriculum, but some younger graduates had complaints. The graduates chose their career specialties on the basis of their own interests and aptitudes. We should take these data into account to prepare a system of life-long education and learning.

In this study, we investigated the effect of exercise training on serum and liver chblesterol levels and on biosynthesis of liver cholesterol in rats. The training was carried out at low [Low-Ex, 60% max O₂ consumption (VO₂) ] and high (High-Ex, 75% max VO₂) intensities for 16 weeks. The energy expenditure was adjusted to be equivalent. The succinate dehydrogenase activities of gastrocnemius muscle in the Low-Ex group and High-Ex group were higher than that of control, 36% and 109% (p<0.05) respectively. The levels of total and high density lipoprotein cholesterol in serum were 14-26% lower than those of control, but no difference was detected between the trained groups. The activity of HMG-CoA reductase in liver microsome was significantly higher than that of control for both trained groups. However, the stimulation of this enzyme activity was not changed by training intensity.

The effects of voluntary exercise on resting systolic blood pressure and vascular lesions of stroke-prone spontaneously hypertensive rats (stroke-prone SHR) were investigated with and without 1 % saline loading. Forty male stroke-prone SHR aged 7 weeks were assigned to one of 4 experimental groups. Each consisted 10 animals ; sedentary control (S), sedentary with 1 % saline loading (SS), exercised control (E), and exercised with 1 % saline loading (ES) . Animals were sacrificed at the 5 th week. In the prehypertensive phase, resting caudal arterial systolic blood pressure was significantly lower in the E group than in the S group. However, after being loaded with 1 % saline, the ES group showed higher resting systolic blood pressure than those of the SS group. In addition, the ES group revealed severer renal, myocardial, and cerebrovascular lesions than those of the rest of the groups.

We experienced a case that right massive pleural effusion was successfully controlled with Denver shunt from the right chest cavity to right femoral vein. A 80-years-old woman had received hemodialysis due to chronic renal failure twice in a week. She was diagnosed as right breast cancer and underwent right breast conserving surgery at December, 2008. In postoperative follow-up duration, she had difficulty in breathing and visited to the emergency room in our hospital. She was diagnosed as respiratory failure due to right massive pleural effusion from the X-ray result and the blood gas analysis. There was no pleural effusion within the left chest space. No malignant cell was detected in the effusion. We thought that diuretics and shunt tube from the right chest cavity to the abdominal cavity would be ineffective because of her chronic renal failure, and for that reason, we placed the shunt tuve from the chest cavity to the right femoral vein. Respiratory failure and the quality of life were successfully improved for about 7 months by using it. Palliat Care Res 2011; 6(1): 301-307

Plasma concentrations of tumor necrosis factor α (TNFα), interleukin-1β (IL-1β) and interleukin-6 (IL-6) were measured successively during and after open heart surgery (13 cases). Plasma concentrations of TNFα did not increase during surgery but increased gradually after the 1st operative day reached the maximum level at the 7th operative day (128±15pg/ml, which was a 3-fold increase compared with the previous value). Plasma concentrations of IL-1β remained at the previous level during surgery and increased only once at 6 hours after operation. Conversely, plasma concentrations of IL-6 increased dramatically during cardiopulmonary bypass (CPB) reaching a peak at the end of CPB (260±200pg/ml, which was a 15-fold increase over the previous value) and recovered to previous values rapidly thereafter. Plasma IL-6 concentrations changed rapidly during surgery, while plasma concentrations of TNFα and IL-1β did not increase sharply. This may indicate that IL-6 may play a role as a mediator of acute inflammatory reaction.