The combined method of antegrade and retrograde administration of cardioplegic solution has been established for coronary bypass surgery. We applied this technique in patients undergoing aortic and mitral valve surgery. Between January 1989 and December 1990, 28 patients underwent both aortic and mitral valve replacements. To compare the myocardial protective effect according to the method of cardioplegic administration, they were divided into two groups; Ante group (antegrade, n=15) and Retro group (combined method of antegrade and retrograde, n=13). Aortic occlusion time and cardiopulmonary bypass time were shorter in Retro group. The mean interval of each cardioplegic administration was significantly shorter in Retro group (Ante group, 29.2±4.8min vs Retro group, 24.0±3.8min; p<0.01). These results suggest that retrograde cardioplegia method never disturbs ongoing operation during each delivery while antegrade method often does. Serum CPK-MB at 6hr of reperfusion tended to be less in Retro group (Ante group, 120±80IU/l vs Retro group, 78±50IU/l; p=0.09). The results of postoperative cardiac functions were the same in both groups. We therefore believe that this method is an optimal strategy even in patients with valvular heart disease.

Since late 2013 through March 2014, Japan experienced a rapid rise in measles cases. Here, we briefly report on the ongoing situation and share preliminarily findings, concerns and challenges and the public health actions needed over the coming months and years.

Measles is a notifiable disease in Japan based on nationwide case-based surveillance legally requiring physicians to report all clinically diagnosed and laboratory-confirmed cases within seven days, but preferably within 24 hours. After a large outbreak in 2007–2008 (more than 11 000 cases reported in 2008 alone) and a goal of elimination by April 2015, a catch-up programme using the bivalent measles-rubella (MR) vaccine was offered for grades seven and 12 (ages 12–13 and 17–18 years) from April 2008 through March 2013. During this period, there was an estimated 97% decline in measles notifications, and the cumulative number of reported cases has been steadily declining over the last five years (732 cases in 2009, 447 cases in 2010, 439 cases in 2011, 293 cases in 2012 and 232 cases in 2013). However, since late 2013 through March 2014, the country experienced a resurgence only a year after a large rubella outbreak.