A 72-year-old man presented with abdominal aortic aneurysm (AAA) and was referred to our hospital by his physician. A computed tomography revealed a 95-mm AAA with three right renal arteries. The main right renal artery branched from the AAA, and two remaining arteries branched from the same level as the left renal artery. The patient underwent AAA repair and main right renal artery reconstruction without any renal protection. After the operation, renal function did not deteriorate. 3D-CT was useful for diagnosing renal artery branching, evaluation of renal blood perfusion, and determining the operation method.

We studied 90 consecutive cases undergoing open heart surgery with preoperative collection of autologous blood and ultrafiltration during extracorporeal circulation. Among the 58 out of 90 patients (64.4%), open heart surgeries were achieved without homologous blood. We evaluated 13 factors (age, height, weight, body surface area, cardiopulmonary bypass time, aortic cross clamping time, dilutional rate, Hct before predonation, lowest Hct during cardiopulmonary bypass, amount of predonated autologous blood, term of autologous blood predonation, amount of bleeding during surgery, amount of bleeding after surgery) in connection with open heart surgery without homologous blood. Among these factors, age, body surface area, cardiopulmonary bypass time, aortic cross clamping time, lowest Hct during cardiopulmonary bypass, amount of predonated autologous blood, amount of bleeding during surgery and amount of bleeding after surgery demonstrated differed significantly between the only autologous blood transfusion group and the homologous blood transfusion group. According to the evaluation by multivariate regression analysis of these factors, the amount of bleeding after surgery was the most contributor to open heart surgery without homologous blood, followed by amount of bleeding during surgery and body surface area. We concluded that open heart surgery without homologous blood may be achieved in more patients by understanding these factors. Autologous blood predonation by the “leapfrog” method, control of the dilution rate by ultrafiltration during extracorporeal circulation and fresh autologous blood transfusion after extracorporeal circulation were effective to achieve open heart surgery without homologous blood.

A cervical aortic arch is a very rare congenital malformation of aortic arch. A case is reported of a 42-year-old woman with an extensive circular aneurysm of a left-sided cervical aortic arch. The arch aneurysm was successfully removed surgically and replaced with woven Dacron graft. Histologic examination of the aneurysm revealed atherosclerosis and intimal defect.

In a consecutive series of 160 surgically treated abdominal aortic aneurysm, four patients with acute aortic thrombotic occlusion of an abdominal aortic or iliac aneurysm were encountered. Three of four aneurysms were 7cm in diameter or smaller. Also, 3 of 4 patients had chronic occlusive disease of legs. Our mortality rate was 75%. The recommendation is made that all abdominal aortic aneurysms be resected if there is substantial associated distal occlusive disease.

A 44-year-old woman with over 20 years history of rheumatic heart disease developed progressive heart failure from aortic stenosis and mitral restenosis after open mitral commissurotomy. In December, 1986, she underwent aortic and mitral valve replacements with Medtronic Hall prosthesis (aortic: 21mm, mitral: 27mm). Following an eventful recovery, she was discharged from the hospital and continued on a regimen of Coumadin. In February, 1991, the patient developed chest and back pain, which necessitated her emergency admission to our clinic. During the coronary examination, the aortic prosthetic occluder was not moving, fixed in the opening position, lasting from one to several minutes. She underwent emergency operation for replacement of the defective valve. At operation, we noted the pannus formation into the valve orifice on the inflow side of aortic prosthesis. She made a satisfactory recovery and has enjoyed good health since that time.

To investigate the effect of nafamostat mesilate (FUT) for disseminated intravascular coagulation (DIC) after surgery using cardiopulmonary bypass, we studied DIC scores and parameters of coagulation and fibrinolysis in the DIC cases. Although 12 patients developed DIC, the platelet counts improved by administration of FUT apart from one complicated by sepsis. The DIC scores decreased as a result of the increase of platelets and fibrinogen and improvement of FDP. Thrombin-antithrombin III complex, D-dimer and plasmin-α₂ plasmin inhibitor complex showed an even higher value at the endpoint of FUT administration. These results indicate that patients with DIC after cardiopulmonary bypass may have severe fibrinolytic acceleration and that administration of FUT can be useful in those cases.

This is a case report of a rare combination of a single coronary artery and a coronary artery fistula. An 8-year-old girl was asymptomatic with a grade II continuous murmur in the third left intercostal space. Selective coronary angio-graphy revealed that a single coronary artery arising from the left aortic sinus was dilated and ended as a fistula to the outflow tract of the right ventricle. At operation, the fistula could not be exposed on the surface of the heart. On cardiopulmonary bypass, the aorta was clamped, and the fistula was closed by direct suture in the right ventricle. The postoperative course was uneventful with no complications.

Elderly people with chronic lung diseases are always suffered from dyspnea, so they also have much troubles in gastrointestinal functions on the basis of anxiety and insomnia. As a result, they become malnourished with a weakened immune system and are often hospitalized due to respiratory infections for a long time. Their quality of life deteriorates. This time, we experienced an elderly female patient with old pulmonary tuberculosis who was generalized weakness, showed improved appetite loss, physical activity, and dementia symptoms by taking ninjin'yoeito and kososan. She could avoid re-hospitalization due to respiratory infections. Ninjin'yoeito enhanced her energy and physical strength. As a result, she seems to have become markedly healthy. This prescription is expected to be useful for the rapidly increasing number of elderly patients with chronic lung diseases.

Number of chronic obstructive pulmonary disease (COPD) patients tend to increase in middle and older aged people. They have shown a certain degree of improvement with various Western medicine treatments including smoking cessation guidance, rehabilitation, home oxygen therapy, inhalation therapy and so on. However, it is a clinical problem that some elderly people have acute exacerbations frequently due to infectious diseases and have poor prognoses. This time, we experienced an elderly COPD patient with type II respiratory failure. He was repeatedly hospitalized and needed treatment with a ventilator temporarily. We conducted Kampo medical examination on him, and diagnosed that he had cold state in the lungs. So, we administered ryokankyomishingeninto to him. As a result, he recovered dramatically, and he was never hospitalized again due to respiratory failure for a long time. It is suggested that ryokankyomishingeninto may be effective for some COPD patients who have cold state in the lungs.