A 44-year-old woman with Marfan's syndrome presented complaining of severe back pain. Angiography revealed annulo aortic ectasia, aortic regurgitation, acute aoric dissection (DeBakey IIIb) and distal aortic arch aneurysm. One month after admission, she underwent cardiopulmonary bypass was established through the femoral artery, the superior and inferior vena cava. The heart was arrested by aortic cross clamping and retrograde cold (20°C) cardioplegia. At first, a modified Bentall's procedure was done in addition to a Carrel patch procedure. After this procedure, the heart was perfused continuously (300ml/min) with warm (37°C) blood until the end of the cardiopulmonary bypass. The heart recovered a sinus rhythm spontaneously. Subsequently, aortic arch replacement and the elephant trunk method was done with the aid of deep hypothermia and circulatory arrest. The patients is well 1 year after the operation. This technique is useful for patients who require prolonged aortic cross clamping time.

Anterior cruciate ligament (ACL) is the first restraint against anterior tibial translation (ATT) in the knee joint. Previous studies suggested that knee joint laxity might be increased by the repeated stress imposed on the knee joint. The purpose of this study was to demonstrate the effect of the repeated soccer ball kicking actions on the ATT in healthy knees. Forty female collegiate students volunteered for this study. KT-2000 knee arthrometer was used to measure ATT before and after the task. The findings demonstrated that the repeated kicking actions had no significant effect on the ATT in healthy knees. The maximum knee extension angle on the striking side was greater than the supporting side (p<0.05). Significant correlations between mean anterior translation and maximum knee extension angle were observed on both sides (p<0.05). The kicking force on a soccer ball resulted in no increase in the knee laxity.

Objective: To quickly collect and provide information on package insert revisions, packaging changes, discontinuation of drug manufacturing and distribution, and other information without fail.
Methods: Information was collected with the use of a drug information service site (SAFE DI) managed by an organization formed by 15 pharmaceutical wholesalers (SAFE Co., Ltd.).  The information obtained was processed into a house journal and provided to the department of pharmacy and other hospital personnel via an employees-only website (hospital LAN).
Results: Before the introduction of the SAFE DI, incomplete or delayed information collection sometimes forced personnel to urgently cope with packaging changes or discontinuation of drug manufacturing and distribution and assume a heavy workload.  Introduction of the system allowed quick collection and dissemination of such information without fail.
Conclusion: The recently introduced SAFE DI contributes to qualitative improvement in collection and dissemination of information.  Introduction of such a system may also be useful in other hospitals.

For the purpose of establishing a method for evaluation of crude drugs, we demon strated the effect of aqueous extracts from the roots of seven different (types of) Angelicae (“Toki”) and rhizomes of seven different (types of) Atractylodes (lancea) (“Jutsu”) on the binding of immune complexes to macrophages. Among the extracts from “Toki”, extract of Angelica acutiloba Kitagawa (harvested in Nara Prefecture and the Hokuriku district in Japan) had the most potent enhancing activity on the binding. Among the extracts from “Juste”, extract of Atractylodes lancea DC, (An Hui Sheng in China) had the most potent enhancing activity. However, when the extracts were made from the codecoction of Angelica and Atractylodes lancea, the enhancing activities were varied. These results suggest that the combination of crude drugs tays an important role in the appearance of the pharmacological activities.

A comparative study was made on bathing-induced changes in body temperature, blood pressure, pulse rate and tissue blood flow of 12 healthy adults using tap water and artificial CO₂ water at 37°C to clarify the physiological effects of CO₂ at various concentrations of 0, 100, 300, 600, 800 and 1000ppm. There was no change in body temperature during bathing in either water, whereas blood pressure and pulse rate were similarly decreased during bathing, but either of these decreases was not significantly different between tap water and CO₂-water. Therefore, it seemed that the decrease in blood pressure due to vasodilation during bathing would be controlled through some regulatory system like autonomic nerve system not so as to result in too much decrease. But, tissue blood flow was more increased during bathing in CO₂-water than tap water, suggesting that blood circulation in the tissue near skin surface would have been more enhanced by bathing in hot CO₂-water, resulting in a decrease of blood pressure.
Since the increase in tissue blood flow during bathing was dependent on the concentration of CO₂, it seemed that an improvement of tissue circulation and metabolism would have resulted from venous return increase associated to venous dilatation, one of dose-dependent CO₂ effects.

Ischemic mitral regurgitation (IMR) is a serious and increasingly common clinical disorder, but at present, the relationship between left ventricular shape and IMR is not completely understood. Thirty patients with moderate or severe IMR who underwent mitral valve surgery combined with coronary artery bypass grafting were studied retrospectively. Left ventricular shape, left ventricular regional wall motion, hemodynamic index, condition of the coronary artery, severity of IMR and long term results were assessed using ventriculography and angiography. Left ventricular shape at end diastole and end systole were quantified based upon the ratio of the major-to-minor axis and the sphericity index. Hospital mortality rate was 13.3%, 5 years survival rates were 10.5%, and 5-year rate of freedom from congestive heart failure (CHF) were 7.8%. Significant difference between cardiac deaths (n=11) and survivors (n=19) included requiring intensive care admission, requiring intra-aortic balloon pumping, recurrent myocardial infarction, the ratio of the major-minor axis at end diastole, the sphericity index at diastole, and the sphericity index at end systole. Multivariable regression analyses were performed with the Cox proportional hazards model. Significant determinants of survival were the sphericity index at end systole and LV regional wall motion at the site of the anterobasal segment or apex. These findings indicate that the shape of the LV and LV regional wall motion in IMR may be important determinants of prognosis and suggest that surgical attention to shape may be helpful for mitral valve surgery.

We report two cases the first was a 74-year-old woman who had received coronary artery bypass grafting [SVG-to-LAD, SVG-to-Cx, SVG-to-RCA, the left internal thoracic artery (LITA) was mobilized but was unsuitable for the graft] two years previously. Postoperative angiography revealed graft occlusion. Since repeated catheter intervention was not successful, reoperation was performed. A MIDCAB procedure with radial artery graft and proximal anastomosis was performed on the left axillary artery. The operation was successful and there were no complications. Two weeks after the operation, the graft patency was confirmed and she was discharged. The second case was a 64-year-old man who received coronary artery grafting (LITA-to-LAD, SVG-to-Cx and SVG-to-RCA). Two months after the operation, recurrent chest pain was caused by severe stenosis of the LITA anastomotic site. Percutaneous transluminal coronary angioplasty was performed but was unsuccessful. He received redo CABG in the same manner using the saphenous vein. The postoperative course was uneventful and he was discharged 6 days after the operation. This procedure is useful for the patients whose left internal thoracic artery has been used on a previous operation. Good early results were obtained in both patients.

A 62-year-old man was transferred to our institution with ventricular fibrillation. Percutaneous cardiopulmonary support (PCPS) was established and he underwent successful percutaneous transluminal coronary angioplasty. Since his left ventricular function did not recover, he was placed on a left ventricular assist system (LVAS). Under general anesthesia, a 10-cm longitudinal incision was made on the right parasternum. The third and fourth cartilages were completely resected. The pericardium was incised longitudinally. At first, an inflow cannula was insected to the right side of the left atrium. The ascending aorta was then partially excluded and an outflow cannula with a 10mm Gore-Tex prosthesis was anastomosed end-to-side to the aorta with a continuous Gore-Tex suture. After the pump was established, PCPS was gradually discontinued. During 9 days of support, his left ventricular function recovered and subsequently he was weaned from LVAS. Unfortunately, he died two days after LVAS removal. We think this procedure is useful because it is easy to perform, reduces the bleeding, shortens the operating time.