The internal thoracic artery is a useful conduit for coronary artery bypass grafting (CABG). Recently we have developed a method for increasing blood flow by directly injecting a phosphodiesterase III (PDE III) inhibitor into the left internal thoracic artery (LITA) to inflate the artery and prevent its contraction. In the present study we compared the reactivity of the LITA to three drugs: PDE III inhibitor, papaverine hydrochloride and isosorbide dinitrate (ISDN). Forty-two patients with a mean age of 66.8±11.5 years old who were undergoing primary CABG were enrolled in this study and were randomly separated into one of three groups based on the vasodilating drug administered. Each drug was used in 14 cases. Graft free flow (GFF) and systemic blood pressure were measured before and one minute after drug administration to calculate blood vessel resistance (R). All the drugs significantly increased GFF, and reduced both R and blood pressure. A comparison of the change rate of blood pressure did not differ significantly among the three drug groups. The PDE III inhibitor significantly increased change rates of both GFF and R, compared with the other drugs. These results indicate that PDE III inhibitor is most effective for increasing the blood flow of LITA grafts for CABG.

OBJECTIVESCertain symptoms and signs are culturally specific. 'Hie' (chill sensation) is a major symptom experienced by Japanese people; however, it is not easily understood by Westerners. Although Hie is not life-threatening, it greatly hampers the quality of life in sufferers. To develop a remedy for Hie, valid and reliable measures are required. This is the first study aimed at developing a standardized questionnaire to quantitatively measure Hie symptom.

METHODSThis was a cross-sectional study. To identify question items, we conducted a literature search using published books that mention Hie and related symptoms. The first draft of the questionnaire was prepared by selecting 31 items, including three empirically used items, using the Delphi method. A total of 744 Japanese volunteers completed the draft questionnaire. Simple correlation and factor analyses were performed to select items for the final version of Hie questionnaire and for evaluating its test-retest reliability.

RESULTSThe following ten question items were ultimately selected: feeling a breeze, shivery feeling, tolerance, sensitivity to cold, Hie-like sensation in an airplane, dislike of air conditioning, use of gloves, use of an electric blanket, use of heavy clothing and need for heating devices. Of the ten Hie-related question items, five pertained to physical symptoms and the other five to daily behaviours. The internal consistency of the ten-item questionnaire was high, with a Cronbach's alpha of 0.85. The test-retest reliability of the questionnaire was preserved by the paired two-tailed t test.

CONCLUSIONSA new questionnaire was developed to evaluate the subjective symptom of Hie. This questionnaire demonstrated sufficient reliability and could be used as a tool to assess this symptom.