Coronary artery bypass surgery was performed in 7 chronic hemodialysis patients. Hemodialysis and extracorporeal ultrafiltration methods were used during cardiopulmonary bypass, and continuous hemofiltration was performed in the early postoperative days in the intensive care unit. Water and electrolyte balances were successfully controlled in all patients, and hemodialysis was restarted after the second postoperative day. There were no perioperative complications and all patients are surviving. These methods of perioperative management for chronic hemodialysis patients undergoing coronary artery bypass surgery, especially consinuous hemofiltration in the early postoperative days, are considered safe and useful.

A 65-year-old man suffered abdominal pain and anterior chest pain due to a ruptured abdominal aortic aneurysm (AAA) and acute myocardial infarction. Abdominal CT scanning demonstrated infrarenal AAA measuring 6.0cm in diameter with retroperitoneal hematoma. Coronary angiography was performed revealing total occlusion of the left anterior descending and 90% stenosis in the circumflex coronary artery. The operation was performed immediately after CAG. After median sternotomy, cardioplumonary bypass was initiated using moderate hypothermia (32.0°C). After completion of CABG, AAA replacement using a Y-shaped prosthesis was performed during extracorporeal circulation. Extracorporeal circulation protects the heart from the hemodynamic changes after aortic clamping or declamping during abdominal aortic surgery. Our experience shows that one-stage operation is a feasible option for patients with AAA and coronary artery disease accompanied by impaired left ventricular function.

Subclavian arterial aneurysms are relatively rare compared to aortic aneurysms. The common causes of subclavian arterial aneurysms are arteriosclerosis, non-specific inflammation, thoracic outlet syndrome, and trauma. A case of a subclavian arterial aneurysm is reported. The patient was a 57-year-old woman. She had no previous history of hypertension, infection and trauma. She underwent complete resection of the aneurysm and reconstruction of right subclavian artery. Exploration of the aneurysmal wall revealed circumferential ridge which caused stenosis of the right subclavian artery at the orifice of the aneurysm. It has been suggested that a subclavian arterial aneurysm developed as a result of abnormal development of the embryologic right fourth and distal sixth aortic arches.

It is commonly believed that prosthetic valve implantation in actively infected patients is to be avoided. After normalization of C-reactive protein and white blood cell counts, and sterilization of blood cultures by treatment with antibiotics, we performed valvular surgery. We performed mitral valve repair in cases where the mitral valve lesion did not involve the annulus. From July 1992 to November 1996, 13 patients (mean age, 50 years) were treated surgically for infective endocarditis (IE) at Kansai Medical University. Twelve of the patients had native valve endocarditis (NVE), and 1 had prosthetic valve endocarditis (PVE). In 6 patients, the causative organisms were determined. These included: α-Streptococcus in 4 patients, Enterococcus in 1, and methicillin-resistant Staphylococcus aureus (MRSA) in 1. The affected valves were as follows: aortic valve alone in 4 patients, mitral valve alone in 6, aortic and mitral valves in 2, and a prosthetic aortic valve in 1. The PVE was due to a MRSA infection which occurred 9 months after aortic valve replacement. All patients were treated preoperatively for heart failure and the infection. The surgical procedures performed were: aortic valve replacement in 4 patients, mitral valve replacement in 3, mitral repair in 3, double valve replacement in 2, and re-aortic valve replacement in 1. There were no deaths or recurrences of IE in hospital or during follow-up to date. In all of the mitral valve repair cases, the mitral regurgitation on follow-up echocardiograms was grade I. Our results show that surgical treatment of IE after management of preoperative conditions can be successful. Furthermore, despite the absence of laboratory findings indicative of ongoing inflammation or infection, pathologic examination revealed active inflammatory reactions and organisms in 4 cases. In 1 patient, MRSA was culthued from an annular abscess that was resected intraoperatively. We suggest that cessation of antibiotic therapy be regarded with caution and suggest that the infected site must be resected surgically.

A 50-year-old man was admitted with a fusiform descending thoracic aortic aneurysm measuring 60mm. Chest CT scan revealed porcelain aorta from the aortic arch to the abdominal aorta. Severe calcification found on the descending aortic wall was considered to entail greater risk for conventional aortic repair and reconstruction of intercostal arteries. Therefore endovascular stent grafting was planned. The stent graft was deployed from near the origin of the left subclavian artery to the 10th thoracic vertebral level. Neither paraplegia nor other complication occurred. Endovascular stent grafting may be a safe and effective method for descending thoracic aneurysms with severely calcified aorta.

A 16-year-old boy with multiple injuries suffered in a motorcycle accident was admitted to our hospital. On admission, X-ray films showed left hemothorax and bone fractures of the left humerus, thigh bone, and pelvis. Computed tomography of the chest revealed a pseudoaortic aneurysm approximately 6.0cm in diameter at the proximal portion of the descending aorta. Because of multiple severe associated injuries, we considered that conventional aortic repair in the acute phase would be difficult. We therefore performed an endovascular stent-graft treatment 140 days after injury. The postoperative course was uneventful and the pseudoaneurismal sac has confirmed to decrease. Transluminal placement of endovascular stent-graft is a technically feasible method for treatment of traumatic aortic aneurysm. However, because the long-term results are still unknown, we should follow-up carefully, particularly in young patients.

[Objective]To analyze the situation of clinics that want to employ acupuncturists and masseurs and to obtain basic data to find employment in the clinic in the future.
[Methods]The subjects were 52 clinics that responded to the questionnaire survey saying they wanted to employ acupuncture and massage therapists. They were divided into three groups according to the license (acupuncture group (n = 5), acupuncture &massage group (n = 25), massage group (n = 22)). The situation and the business realities of the clinic were analyzed.
[Results]Clinics with obstetrics and gynecology want to employ only acupuncturists. There were as many employment needs for both acupuncturists and masseurs in clinics with orthopedics and rehabilitation. The employment satisfaction rating is higher for the patient's need standpoint than cost-effectiveness.
[Conclusion]We analyzed the status of clinics that want to employ acupuncturists and masseurs. This study is expected to help promote the employment of medical acupuncturists and masseurs.

Purpose: In this study, we performed a longitudinal examination of the occurrence of homeboundness among community-dwelling elderly individuals and changes in associated factors, including the sense of coherence (SOC).Methods: A questionnaire survey was conducted targeting community-dwelling elderly individuals to evaluate homebound status, a basic checklist (CL), and SOC. Among these individuals, frail elderly people who maintained a non-homebound state were extracted and a follow-up survey was carried out one year later. Those who maintained the non-homebound state one year later were classified into the maintenance group and those who became socially withdrawn were classified into the transition group. Factors predicting the homebound state one year later were examined using multiple logistic regression analysis. Furthermore, the changes in CL and SOC between the transition and maintenance groups were compared.Results: In the transition group, motor function, cognitive function, and sense of manageability on the initial survey were significantly lower than those in the maintenance group. Significant correlations were noted in the homebound transition group with lack of money management (OR: 3.04, 95% CI: 1.19-7.82) and a declined sense of manageability (OR: 0.82, 95% CI: 0.69-0.99). Depression and the sense of manageability had also significantly deteriorated one year later compared with those in the maintenance group.Conclusion: This study suggests that individuals who transition to a state of homeboundness have a slightly lower SOC than those who maintain their non-homebound status.