A 67-year-old man presented complaining of unstable angina. Coronary angiography revealed 50% stenosis of the left main trunk of the left coronary artery and a coronary artery aneurysm in the left anterior descending artery (LAD) #6. Furthermore, significant stenosis was noted in the peripheral LAD #7 and #9. The patient had hepatitis C, probably due to an earlier transfusion, and was suffering from liver cirrhosis (Child-Pugh classification grade A) and advanced thrombocytopenia. We anastomosed the saphenous vein graft (SVG) to the LAD and diagonal branch by off-pump coronary artery bypass grafting; we did not treat the aneurysm. There were no postoperative complications and the patient's progress was good. On postoperative coronary angiography, the aneurysm was occluded and the patency of the SVG was satisfactory.

We experienced the coronary artery bypass grafting (CABG) with essential thrombocythemia (ET). A case is a man of 73 years old. As for him, 3 vessel disease including left main trunk was recognized on coronary angiography, and it was planned CABG. However, we recognized blood cell aberration in blood examination, and it was diagnosed as ET. ET is classed as a chronic myeloproliferative disorder. It has two opposite tendencies, a bleeding tendency and thrombus tendency. Ischemic heart disease to merge ET is acute myocardial infarction by thrombus in case of most, and there are a few cases to need blood circulation reconstruction of coronary artery for angina pectoris. Perioperative hemorrhage and postoperative graft closure become a problem in CABG with ET. With the hydroxycarbamide which is DNA synthesis inhibitor of a platelet count, a function controlled it, and enforced CABG. He doesn't have any cardiac events and complications due to ET for 7 years post CABG. We report this case with a review of the literature.

We tried to evaluate the right ventricular function using a modified Swan-Ganz catheter with a rapid responsive thermistor. Twenty-four dogs comprised this series. Twelve were the model of left heart failure (Group A), and the other twelve were the model of right heart failure (Group B) produced by multiple ligation of coronary arteries. Dogs were studied for some of the circulatory indices before and after ligation with left atrial pressure at 10, 15 and 20mmHg in group A, and right atrial pressure at 10, 15 and 20mmHg in group B by volume loading. In group A, when the left atrial pressure was kept constant, right ventricular ejection fraction (RVEF) and right ventricular stroke work index (RVSWI) were decreased significantly after the ligation of coronary arteries. But there was no significant change in the peak right ventricular pressure-right ventricular endsystolic volume index ratio (peak RVP/RVESVI) associated with ligation. In group B, significant changes were observed in RVEF, RVSWI and peak RVP/RVESVI. Thus, it was found that right ventricular contractility in selective left heart failure was not reduced. E_max was considered to be a valuable index of ventricular contractility not affected by preload and afterload of ventricle, but this index is not easily measured clinically. The index peak RVP/RVESVI which is nearly equivalent to E_max, has an advantage in that it can be determined by the thermodilution method widely used in general. We conclude that this index is very useful to us for post-operative care in cardiac surgery.

The earlier the diagnosis of acute type A aortic dissection is made, the more frequent the complications of aortic root destruction and/or a compromised coronary artery are encountered. Only aortography is diagnostic in these lesions, however, recently this modality tends to be avoided in order to try to improve the survival rate of the patients by obtaining diagnosis by noninvasive modalities. Therefore, contrast-enhanced CT scans in 49 patients with aortic dissection were analyzed in order to detect the slightest signs suggesting aortic root lesions. In 4 of the 6 cases in which intimal flap was detected in the aortic root by CT and in 2 of the 14 cases with an aortic root more than 35mm in diameter, aortic root reconstruction and/or concomitant CABG were neccessary for the repair of the destroyed aortic root. The aortic root diameter was more than 40mm in 8 of 9 patients with aortic root destruction, with a mean value of 45.6±3.6mm (p<0.01). In summary, detection of a septum in the aortic root and/or an aortic root dilated more than 40mm on CT were important signs suggesting the dissection extending to the aortic sinus combined with aortic root destruction. In such cases aortic root reconstruction and/or concomitant CABG may be necessary.

Background: Alopecia areata (AA) is considered complex genetic and tissue-specific autoimmune disease. We recently discovered a nonsynonymous variant in the coiled-coil alphahelical rod protein 1 (CCHCR1) gene within the AA risk haplotype. And a water avoidance stress test on CCHCR1 knockout mice induced AA-like lesions. Objective: To investigate the difference clinical findings of AA in patients with the CCHCR1 variant and without. Methods: We conducted a retrospective analysis of the data from 142 AA patients. Among these patients, 20 (14.1%) had a variant of CCHCR1. We evaluated the sex distribution of the patients, age at onset, distribution of the clinical types, prevalence of a positive family history of AA, prevalence of association of AA with atopic dermatitis, response to steroid therapy, and recurrence rate. We used multivariate logistic regression analysis and Fisher’s exact test for statistical analysis. We also investigate electron microscopic observations of hair samples with the CCHCR1 variant and without. Results: The results showed a significant correlation between the CCHCR1 variant and the recurrence rate compared with the variant-negative group (p=0.0072). Electron microscopy revealed abnormalities in the hair shaft structure and hair cuticle in patients with the CCHCR1 variant (p=0.00174). Conclusion Our results suggest that AA with CCHCR1 variant is clinically characterized by a high recurrence rate and hair morphological abnormality.

Recently, arterial keton body ratio (AKBR) has attracted attention as a new indicator of liver function which is in equibilium with the ratio between oxidized and reduced forms of free nicotinamide-adenine dinucleotides (free NAD⁺/NADH ration) in the mitochondria. There are few reports on whether AKBR contributes to the hepatic energy charge in the open heart surgery with extra corporeal circulation (ECC) or not. This study was undertaken to clarify the contribution of AKBR to the hepatic energy charge during ECC and the relationship between AKBR and hepatic blood flow. AKBR was determined before, during and after ECC in the open heart surgery for 14 patients. Furthermore, the blood flow in hepatic artery, portal vein and liver microcirculation was measured before, during and after ECC in canine models. Finally, the pulsatile perfusion was performed in canine models and compared with the conventional non-pulsatile perfusion for the blood flow and AKBR. In clinical cases, AKBR was decreased in all cases during the ECC. AKBR which was measured at 2 or 3hr after weaning from the ECC was negatively correlated to the total perfusion time with -0.57 as the correlation coefficient. Six patients who were on the ECC over 180min did not show a good recovery of the AKBR after weaning from the ECC. Especially, three patients presented a clinical picture of acute hepatic failure with jaundice, elevation of the serum levels of transaminase and direct hyperbililubinemia, but only one showed hypoglycemia. These patients showed no improvement in clinical data and AKBR. The patient with improved AKBR recovered clinically. In our experiment, the blood flow in the hepatic artery, portal vein was measured by electromagnetic blood flow meter and the liver microcirculation was measured by laserdoppler flowmeter. The blood flow was decreased remakably in the non-pulsatile group at all sites of measurement: it recovered after ECC in hepatic artery and portal vein, but liver microcirculation did not improve well. AKBR was decreased during ECC and did not recover after ECC in the non-pulsatile perfusion. When the pulsatile perfusion was performed, liver circulation was maintained well, and AKBR recovered well after ECC. The above results suggest that AKBR reflects the liver microcirculation and pulsatile perfusion is beneficial to the liver microcirculation. Pulsatile circulation, however, involves several problems, hemolysis, the decrease of platelets, and so on, but these problems have been improved gradually. We think that the pulsatile perfusion will be used in clinical operations to maintain the good hepatic circulation.