This study reviewed the operative results in patients who underwent elective isolated coronary artery bypass grafting (CABG) from 1991 to 1997 and the long-term outcome in patients who received an internal thoracic artery (ITA) to left anterior descending artery graft from 1984 to 1995. The morbidity rates were as follows: low output syndrome (LOS), 19 (2.6%); perioperative myocardial infarction (PMI), 14 (1.9%); IABP required, 9 (1.2%); respiratory insufficiency, 32 (4.4%); acute renal failure, 28 (3.8%); mediastinitis, 9 (1.2%); stroke, 13 (1.8%); and reoperation for bleeding, 9 (1.2%). Operative mortality was 0.7%. Patients with moderate or severe impairment of left ventricular function (ejection fraction≤40) or chronic renal failure had high incidences of arrthythmia and respiratory insufficiency; those who were 75 or older at operation had a higher incidence of arrhythmia than those who were 50 or under (p=0.033). Patients who received four or five grafts needed a longer duration of hospitalization than those who received a single graft (p=0.0147). The 10-year actuarial survival rate, cardiac death-free rate and cardiac event-free rate in the entire series were 89.4%, 96.7%, and 80.9%, respectively. Among patients who underwent complete revascularization, the 10-year cardiac event-free rate and catheter intervention-free rate were 82.7% and 91.7%, respectively, compared with 77.5% and 84.2% in patients who underwent incomplete revascularization (p=0.0428, 0.0343). Since this study demonstrated that CABG with cardiopulmonary bypass contributed to favorable operative and long-term results, the indications for minimally invasive direct coronary artery bypass (MIDCAB) and off-pump CABG should be considered carefully and perhaps limited to elderly patients and/or those with major co-morbidities, until the long-term benefits have been clarified.

Chylorrhea is a rare complication after cardiothoracic surgery, occurring in 0.5-2% of patients. It is extremely rare after coronary artery bypass grafting. The initial management of chylorrhea is conservative, but if it is unsuccessful, surgical intervention is indicated. Recently, some cases treated with octreotide have been reported. We report two cases of chylorrhea after internal thoracic artery harvest treated with octreotide.

Aspergillus pseudoaneurysm of the ascending aorta is rare in patients who have undergone coronary artery bypass graft surgery (CABG), and there are few cases reports of patients with AIDS, or after transplantation. A 76-year-old man underwent CABG due to unstable angina in 2002 ; in 2005 and 2006, he suffered 3 episodes of pseudoaneurysm formation in the ascending aorta. The aneurysm was resected and the defect was repaired with a Dacron patch twice. Finally, aortic root replacement with the modified Bentall technique was performed, but pathological examination of the wall of the pseudoaneurysm showed Aspergillus. On day 13, the Aspergillus infection developed into septicemia, and he died.

Aspergillus pseudoaneurysm of the ascending aorta is rare in patients who have undergone coronary artery bypass graft surgery (CABG), and there are few cases reports of patients with AIDS, or after transplantation. A 76-year-old man underwent CABG due to unstable angina in 2002 ; in 2005 and 2006, he suffered 3 episodes of pseudoaneurysm formation in the ascending aorta. The aneurysm was resected and the defect was repaired with a Dacron patch twice. Finally, aortic root replacement with the modified Bentall technique was performed, but pathological examination of the wall of the pseudoaneurysm showed Aspergillus. On day 13, the Aspergillus infection developed into septicemia, and he died.

Surgical treatment of two abdominal and two thoracic aneurysms in hemodialysis patients were performed from 1991 to 1993. Two elective cases survived, but two emergency cases died. The causes of death were PMI and respiratory failure. Ruptured aneurysms are critical and probably result in higher mortality and morbidity than elective replacement of aneurysms. In view of the documented risk of rupture and current operative risk, we believe that elective surgical treatment of aneurysm is a much better treatment than following the aneurysms until they produce symptoms or significantly enlarge.

[Objective]Using cotton to cover needle shafts when removing acupuncture needles is recommended in order to prevent blood contamination. However, the effect of risk reduction has not been confirmed by experimental studies. We, therefore, observed spreads of fluorescent agent, assumed as blood, with or without alcohol cotton to avoid direct contact between fingers and needle shaft.
[Methods]Subjects were two blind acupuncturists and two acupuncture students. We asked them to insert acupuncture needles to people who played a role of a patient. Of the five acupoints needled, we put the fluorescent agent to one point, and asked the subjects to remove the needles. After all the needles were removed, we took photographs of all points needled and the subjects'hands in order to assess the spread of the fluorescent agent. 'We performed two sessions. In Session A, the subjects used alcohol cotton to cover a needle shaft so that their fingers did not contact the needles directly. In Session B, they did not use alcohol cotton. The subjects were not told that we used the fluorescent agent.
[Results](1) In the forearm of those who were needled, adhesion of the fluorescent agent was not seen in three out of four subjects, in Session A. (2) In two of the four subjects who inserted the needles, the adhesion area of the fluorescent agent in the needle-supporting hands was smaller in Session A compared with Session B. (3) In three of the four subjects who inserted the needles, the adhesion area of the fluorescent agent in the needle-stimulating hands was smaller in Session A compared with Session B.
[Conclusion]It is suggested that covering needle shaft with alcohol cotton during needle withdrawal suppresses the spread of blood contamination.

A 71-year-old man had sudden onset of left lower limb swelling and consulted an orthopedic surgeon 14 days later. Venous echography demonstrated compression of the left iliac vein and the thrombus of the common iliac vein. After emergency admission, conservative therapy was given for 7 days, but the symptoms did not sufficiently diminish and a thrombus was also present. We therefore performed femoro-iliac cross-over vein bypass using a 10mm ringed ePTFE graft. Symptoms were completely improved and the graft was shown to be patent by echography after 3 months.

A 66-year-old woman complained of dyspnea due to congestive heart failure, and was given a diagnosis of severe aortic insufficiency. Antiphospholipid syndrome and idiopathic thrombocytopenic purpura (ITP) had been diagnosed with 9 years previously. We planned preoperative plasma exchange and steroid pulse infusion to reduce the level of auto-antibodies for phospholipids. The aortic valve replacement was performed safely. Anticoagulant therapy with low molecular weight heparin and oral steroid therapy was administered after the operation to avoid thrombosis or bleeding. The patient's postoperative course was stable. She was discharged without any complication. In conclusion, preoperative plasma exchange and steroid pulse infusion, postoperative anticoagulant therapy and oral steroids resulted in a favorable outcome in a case of heart surgery for a patient with antiphospholipid syndrome.

The effectiveness of recombinant human erythropoietin (rHuEPO) was evaluated in elderly patients who underwent coronary artery bypass grafting. A total of 133 patients were divided into three groups: those who were 70 years of age or older and received rHuEPO (group I; n=32), those who were also 70 years of age or older but did not receive rHuEPO (group II; n=35), and those who were 60 years or younger and received rHuEPO (group III; n=66). In 87.5% of group I, 42.9% of group II, and 98.5% of group III, homologous blood transfusion could be avoided. The percentage of patients without homologous blood transfusion was significantly higher in group I than in group II (p<0.001). The rate of homologous blood transfusion was significantly higher in group I than in group III (p<0.05), but rHuEPO had equal effects in terms of increase in hemoglobin level in the two groups. Furthermore, in patients without anemia, the rate of homologous blood transfusion was almost the same in the two groups. In conclusion, the administration of rHuEPO enables even elderly patients to undergo coronary artery bypass grafting without homologous blood transfusion.