A 59-year-old man was hit by a car in the back of the knees. He had a cold sensation and pulselessness in the right leg. He did not have bone fractures, but had dirty skin injuries in the back of bilateral knees. DSA revealed complete obstruction of the right popliteal artery and good collateral flow to the peripheral arteries in the right lower leg. We did not perform emergency operation because of the good collateral flow and dirty skin injuries. After the healing of the skin injuries, we performed popliteal artery reconstruction with autologous saphenous vein graft. The postoperative course was uneventful with successful patency of the graft.

The effects of artificial sodium sulfate bathing on cardiopulmonary and neurohumoral systems as compared to plain water bathing were studied on five healthy subjects. The results of bathing tests made for 10 minutes at 42°C were as follows:
1) The body surface temperature was higher in three of the five subjects in artificial sodium sulfate bathing than in plain water bathing. The forehead temperature of all subjects in artificial sodium sulfate bathing was higher than in plain water bathing (p<0.05: at 17, 18min. after bathing). The change in oral temperature also showed the same tendency (p<0.05: at 27min. after bathing).
2) The frequency of respiration was less in artificial sodium sulfate bathing than in plain water bathing. Although the heart rate decreased during artificial sodium sulfate bathing as compared to the case of plain water bathing, a clear difference was not observed after bathing. The systolic blood pressure in four of the five subjects decreased in artificial sodium sulfate bathing compared to plain water bathing. One subject, who exhibited low blood pressure before bathing, was restored to his normal blood pressure after artificial sodium sulfate bathing. The sysytolic blood pressure was lower in artificial sodium sulfate bathing than in plain water bathing. (p<0.03: at 20min. after bathing).
3) The serum levels of noradrenalin, adrenalin, serotonin, ADH, renin, aldoster-one, cortisol, β-endorphine, Na⁺, K⁺, and Cl^- showed no significant differences between the two types of bathing.
4) All subjects felt increased warmth and smoothness of the skin after the artificial sodium sulfate bathing compared to plain water bathing.
The above results suggest that the artificial sodium sulfate bathing is superior to plain water bathing in maintaining body temperature, decreasing blood pressure, and feeling (i. e., body warmth and skin texture) after bathing. These effects result from not only the direct action on the skin but also the indirect action due to absorption of the substance through the skin by the mechanism of artificial sodium sulfate bathing.

Fourteen patients with 22 solitary aneurysms of the iliac artery were operated in a 16-year period (1983 to 1999). Patients were divided into two groups. The non-ruptured group consisted of 6 patients who underwent surgical intervention before aneurysm rupture, and their mean age was 78.5 years. The ruptured group consisted of 8 patients who underwent surgical intervention for aneurysm rupture, with a mean age of 68.5 years. Although seven patients underwent emergency surgery for aneurysm rupture, less than half of them were operated upon within 24hr after the onset of aneurysm rupture. The average size of aneurysms was similar in the two groups (common iliac artery aneurysms: non-ruptured 47mm vs. ruptured 44mm in diameter, internal iliac artery aneurysms: non-ruptured 55mm vs. ruptured 55mm). Two patients died in the ruptured group, in which the operative mortality rate was 25%. Six patients (75%) of the ruptured group had hypovolemic shock, and two of them died during surgical repair. Of the patients with shock, two patients had intestinal ischemia after operation. Intestinal ischemia was one of the serious complications of ruptured iliac aneurysms. These results suggest that in patients with shock from ruptured iliac artery aneurysms, strategy for treatment is an important determinant of the outcome.

A 61-year-old woman was admitted with abdominal and low back pain. The patient underwent graft replacement for inflammatory abdominal aortic aneurysm. One month postoperatively, the patient fell into hypovolemic shock with massive melena and hematemesis. Laparotomy and duodenotomy revealed a fistula between the third portion of the duodenum and the distal anastomosis of the vascular prosthesis. The fistula of the aorta was repaired with omentopexy, gastrojejunostomy and Braun's anastomosis. One month later, aortoduodenal fistula recurred. The vascular prosthesis was partially removed and the aorta was closed at the infrarenal level. After the closure of the posterior duodenal defect, a left axillo-femoral bypass was constructed. She fully recovered and discharged.