We present two cases of thoracic aortic aneurysm combined with aberrant right subclavian artery. Case 1 was a 71-year-old man, and case 2 was a 74-year-old man with an aortic arch aneurysm associated with a diverticulum of Kommerell. In both cases, we performed total aortic arch replacement through median sternotomy using cardiopulmonary bypass, systemic hypothermia and selective cerebral perfusion. We reconstructed all 4 arch branches. The aberrant right subclavian artery arose from the distal portion of the aortic arch, distal to the origin of the left subclavian artery. It crossed the midline between the esophagus and spine. To prevent compression of the trachea and esophagus by the right subclavian artery, we reconstructed it by the anterior side of the trachea. The postoperative course was uneventful.

A-23-year-old man, with intellectual disability and history of self-inflicted injuries, presented with chest pain. A 3mm “picked” wound in the left chest was observed on physical examination. Chest computed tomography revealed a needle in the pericardium. Emergency surgery was performed by median sternotomy. At first we could not find the needle because it was completely buried in the heart, but when the posterior wall of the heart was exposed, the head of the needle appeared protruding from the posterior wall. It was removed and the wound of the posterior wall was closed with direct mattress sutures without cardio-pulmonary bypass. On inspection, the needle was 34mm long.

OBJECTIVEMany elderly patients with hip fracture (HF) present with gait deficits. As such, an HF both indirectly and directly increases the number of elderly people requiring care, making it a major medical and economic problem in an aging society. To facilitate the treatment of HF and attempt to resolve the consequences, we have attempted to derive an equation that would predict gait ability. The prediction equation was developed by multivariate analysis using standard evaluation methods, with inclusion of guaranteed objectivity where possible. We attached greater importance to the prediction of gait ability early in the period of hospitalization, since this allows for early determination of an efficient therapeutic strategy.

METHODSThe subjects were 54 HF patients (six men, 48 women; mean age: 78.0 +/- 8.4 years) admitted to general hospitals in Hirosaki, Aomori prefecture, between 1998 and 2007. All were aged 60 years or older and were able to walk immediately before injury; physical therapy was initiated for all individuals during hospitalization. Evaluation items related to physical function, psychological function, and complications that may affect gait were evaluated; these included the manual muscle test, motor age test, Katz's index, dementia (HDS-R), consciousness disturbance, among others.

RESULTSBased on data for 35 patients who could gait at discharge and 19 patients who could not, a model including MAT, HDS-R, and the New York Heart Association classification of cardiac function scores (P < 0.001) was obtained using multiple logistic regression analysis (discriminant hitting ratio: 94.4%).

CONCLUSIONSThe effectiveness of the derived model suggests that both physical and psychological functions should be considered for gait prediction.

A 57-year-old man underwent subtotal graft replacement of the thoracic aorta for aneurysms of both the ascending and descending aorta. On the 20th post-operative day, pus was found to be draining from the sternotomy wound. The wound was opened and irrigated with 2% Povidoneiodine solution for a total of 3 months. Culture of the pus from the irrigation revealed Staphylococcus epidermidis. When there were no clinical indications of infection and wound cultures were negative, the necrotic sternum and surrounding tissue were debrided and an omental graft was placed in the cavity. Upon follow-up examination, the patient is doing well 10 months after the initial surgery.

We performed a video-assisted thoracoscopic surgery (VATS) to clip the patent ductus arteriosus (PDA), which was 5mm in internal diameter, in an 11-year-old girl, who first underwent a coil embolization ending in failure. Under general anesthesia with one-lung ventilation in a right lateral decubitus position, four thoracostomies were made in the left hemithorax. The PDA was clipped by two titanium clips, the length of which is 11mm at closing. Transesophageal echocardiography confirmed the location of the PDA and the absence of a residual shunt. The patient showed neither left recurrent laryngeal nerve dysfunction nor hemorrhage after operation, and was discharged on the 9th postoperative day. The clipping of the PDA by VATS can be applied for PDA without calcification if the external diameter is up to 7mm. This technique was minimally invasive and reliable. It was excellent in terms of the high quality of life achieved by the patient.

The internal mammary artery (IMA) has been widely used in CABG due to the excellent long-term results. However, the extensive use of bilateral IMA grafting has been believed to increase operative morbidity and mortality. This study was designed to determine if bilateral IMA grafting in diabetic patients increased the likelihood of mediastinitis. We analyzed the data of 386 consecutive patients who underwent isolated CABG in 1992 to 1996. The definitions of sternal wound complications are as follows, (1) mediastinal dehiscence and (2) mediastinal wound infection. Subtypes include superficial wound infection and deep wound infection (mediastinitis). Among these patients 97 received unilateral IMA grafts and 289 did bilateral IMA grafts. mediastinitis did not occur in any subjects. The occurrence rate of mediastinal dehiscence and superficial wound infection was 7.2% (7/97) for bilateral IMA grafting, 7.3% (21/289) for unilateral IMA grafting. No patients died of wound complications. The occurrence rate of mediastinal dehiscence and superficial wound infections were 12.0% (4/33) for bilateral IMA grafting in diabetic patients, 12.0% (14/117) for unilateral IMA grafting in diabetic patients. That of this complications was 4.7% (3/64) for bilateral IMA grafting in non-diabetic patients, 4.1% (7/172) for unilateral IMA grafting in diabetic patients, without significant differences in wound complication. Bilateral IMA grafting in diabetic patients carried no great risk of mediastinitis, but diabetes mellitus itself was a great risk for mediastinitis.