The authors encountered 2 rare cases of adventitial cystic disease of the popliteal artery. Case 1 was a 51-year-old woman with dull pain in the lower limbs during walking. Case 2 was a 34-year-old man with numbness in the lower limbs on bending his knees. In both cases, angiography showed crescent stenosis, and computed tomography (CT) showed cyst-like lesions about the artery. Magnetic resonance imaging (MRI) indicated the lesions to have high density at T 2 imaging. With a diagnosis of adventitial cystic disease, cystectomy was conducted with satisfactory results. Adventitial cystic disease is rare and only 43 cases have so far been reported in this country. All of these were reviewed to clarify the characteristics of this disease. Its clinical symptoms often resemble those of arteriosclerosis obliterans (ASO) as intermittent claudication, but it differs from ASO in that it is usually achieved cure by cystectomy alone and seldomly required bypass operation. In the case of intermittent claudication in young patients, adventitial cystic disease should be diferrentiated from ASO.

A 78-year-old man consulted our hospital with complaint of abdominal mass. Blood examination indicated a inflammatory reaction. An abdominal aortic aneurysm, 5.5cm in size, was found by CT scanning examination. Its wall quite thick (mantle sign), and enhanced by contrast medium. Y graft replacement was carried out. Microscopic hiatological examination of the aneurysmal wall indicated severe inflammation being assisted of chronic inflammatory cells, like lymphocytes and plasma cells at the adventitia. Ten cases of inflammatory abdominal aortic aneurysm reported in Japan so far are reviewed and features of this disease are discussed.

We describe a case of cardiac surgery for a patient with CD36 deficiency. A 56-year old man had progressive dyspnea on effort for 1 year. On admission, echocardiography revealed severe aortic valve regurgitation. He required medical treatment for heart failure, and subsequently elective aortic valve replacement was planned. Pre-operative cardiac scintigraphy (¹²³I-BMIPP) showed total defect of myocardial uptake. CD 36 deficiency was diagnosed based on the characteristic findings. CD 36 deficiency could cause transfusion related complication by donor blood transfusion. We prepared 1,200 ml autologous blood preoperatively in a two week period. The operation was performed successfully without donor blood transfusion. He was discharged uneventfully.

Patients with an aortic root pseudoaneurysm communicating to the right atrium are rare. A 67-year-old woman underwent ascending aorta and total aortic arch replacement for acute type A aortic dissection at our institute 9 years prior to the current presentation. She was transported to our emergency department with complaints of chest pain, palpitations, and cold sensation. A continuous murmur was heard at the right sternal margin. Contrast-enhanced computed tomography (CT) and ultrasonic cardiography showed a huge pseudoaneurysm at the proximal anastomotic site and an aorto-right atrial fistula. Ascending aortic replacement with concomitant direct closure of the fistula was successfully performed. The patient was discharged in good condition on the 14th postoperative day. Careful follow-up with CT is important after acute type A aortic dissection repair.

Two cases of blue toe syndrome were effectively treated by PGE1. Case 1 was an 80-year-old man who had an ulcer lesion of the 5th toe. Angiography indicated the symptoms were caused by microemboli from an extended lesion of the aorta and iliac artery. The wound was healed by lipo PGE1 (10μg×30 days). Case 2 was a 54-year-old man who had dull pain and skin color change of the 3rd and 4th fingers. A thrombus could not be detected by transthoracic echocardiography, but was found by transesophageal echocardiography. The symptoms improved by PGE1 (60μg×20days). Blue toe syndrome is induced by a microembolism in the peripheral arteries, and thus the conventional treatment has been the administration of fibrinolysins and anticoagulants. PGE1 was used in this study for the first time in consideration of its vasodilating effect on the collateral circulation and to prevent a secondary thrombus by inhibiting platelet aggregation.

This is a rare case of abdominal apoplexy encountered in a 50-year-old man who had aortic and mitral valve replacement due to dominant regurgitation resulting from infective eneocarditis. On the 4th day after the operation, retroperitoneal bleeding, probably due to rupture of the splenic artery aneurysm, occurred and he developed shock. On the 28th day, there was bleeding in the digestive tract and blood pressure was low, probably due to rupture of the microaneurysm of the small artery distributing to the ileum. Rupture of an abdominal vessel without a recognizable external cause is called abdominal apoplexy, and our case was caused by mycotic aneurysm caused by infective endocarditis. Angiography facilitated the accurate diagnosis.

Between 1988 and 1992, we experienced 4 cases of removal of renal or hepatic cell carcinoma tumor thrombi extending into the inferior vena cava and the right atrium, under cardiopulmonary bypass. We operated on 3 cases using profound hypothermia and circulatory arrest, and 1 case using moderate hypothermia and the Pringle maneuver. One case developed acute massive pulmonary embolism followed by cardiac arrest during the procedure of freeing the inferior vena cava and died on the second postoperative day due to low output syndrome. The postoperative courses of the other 3 cases were uneventful, and there was no major complication due to surgery. They were discharged and enjoyed normal daily lives. Two cases died due to recurrence of the tumor, 6 and 7 months after the operation, respectively. The merits and demerits of these two surgical methods were discussed. Appropriate selection of these methods and subjects allows safe and complete excision of tumor thrombi with satisfactory operative results.

Twelve cases of ruptured abdominal aortic aneurysm (RAAA) were treated during 5 years. Nine showed severe hypotension (systolic pressure below 70mmHg) and three required cardiac massage prior to operation. At the beginning of this study, direct laparotomy was conducted on 4 cases but mortality was high mortality (75%). Left thoracotomy with antero-lateral incision through the 7th intercostal space was carried out to access the thoracic aorta for clamping before laparotomy, since the major mortality of this disease is due to abrupt bleeding following anesthesia and operation. Left thoracotomy before laparotomy was conducted on 8 cases, half of whom required aortic clamping during operation (clamping time 21min). Operative mortality following thoracotomy decreased (12.5%). The aneurysm size and the time of operation for the groups with or without thoracotomy were the same, though the degree of bleeding significantly differed (3, 925ml in the group with thoracotomy, 7, 193ml in the group without thoracotomy). Left thoracotomy befor laparotomy obtained good results in case of RAAA.

Homozygous familial hypercholesterolemia is a rare metabolic disorder with characteristic clinical presentations, such as tendon xanthomas, hypercholesterolemia, and significant cardiovascular disease including premature coronary artery disease. We describe a case of a 56-year-old woman with homozygous familial hypercholesterolemia. She had been treated with low-density lipoprotein apheresis for 23 years. Preoperative echocardiography and coronary angiography showed severe aortic valve stenosis and right coronary artery stenosis. Aortic valve replacement with patch enlargement of the aortic valve annulus, and coronary artery bypass grafting were successfully performed. She was discharged uneventfully.

Objective: The physiological changes of the respiro-circulatory functions between skilled subject and unskilled subjects during the practice of Up-right Standing Posture of Shaolin Internal Qigong were compared. Method: The heart rate (HR), maximum oxygen uptake (VO2), respiratory efficiency (RE), and respiratory rate (RR), blood pressure, and lactic acid in the blood were measured.Results: The high correlations between the HR and the VO2 values obtained from the exhaustion test were observed in all subjects. The higher values than at the rest were observed in the average HR and the average VO2 during practicing the Up-right Standing Posture both in the skilled subject and unskilled subjects. However, both HR and VO2 levels were almost constant during the practice in both the skilled subjectand unskilled subjects. The RE values changed in the time course of the practice, whereas the RR values were almost constant during the practice. The average RE showed different patterns between the skilled subject and unskilled subjects, the former increased and the latter decreased their RE levels.In addition, the average values of systolic and diastolic blood pressure of the skilled subject increased each 10 mmHg approximately at pre- and post- Up-right Standing Posture, and the increasing tendency was also recognized in the unskilled subjects. The values of the lactic acid in the blood of the skilled subject increased slightly, whereas the average values of the unskilled subjects increased by 3.4 mmol/1. Conclusion: Shaolin Internal Qigong could improve respiratory efficiency by the maximum isometric muscle contraction while the skilled subject maintained natural breathing. In addition, Shaolin Internal Qigong was considered to influence the reflex system because it inhibited both blood pressure increase and respiratory rate change. Shaolin Internal Qigong fit very well with Tuina doctor training course for promoting the physical ability and manipulation abilities of them.