In particular, pseudoaneurysms formed at suture lines often are injured during resternotomy. Between 1993 and 1997, 5 patients with large ascending aortic aneurysms eroding the sternum underwent graft replacement using profound hypothermic circulatory arrest. A VA bypass was established through the femoral artery and vein and the patients were cooled to achieve profound hypothermia. After total disappearance of EEG activity was confirmed, circulatory arrest was established and resternotomy was conducted. In 4 patients who had pseudoaneurysms at proximal suture lines, the aneurysms were injured during resternotomy, however the grafts above the aneurysms were clamped 5 to 10min after resternotomy and cardiopulmonary bypass resumed. Infected grafts were removed and replaced with new grafts in 4 cases and hemiarch repair was conducted in 1 case. There was 1 hospital death due to multiple organ failure. Four patients survived operations and were discharged without any deficit. The hypothermic circulatory arrest technique makes it easier to obtain a good operative field and to manage any rupture immediately than by the selective cerebral perfusion technique.

To clarify a mechanism of psychologic relaxation by artificial hot spring, the effect of hot spring bathing on psychologic sweating was studied in 11 healthy subjects (1 female and 10 males, age 26±5.7 years). After lying in the supine position for 5 minutes, the subjects were asked to take a bath with plain water or artificial hot spring for 5 minutes in the sitting position. The temperature of the bath was 40°C. To prepare the artificial hot spring, sodium sulfate tablet (Tsumura & Co.) was solved in 200L of plain water. For the measurement of psychologic sweating, Perspiro (Suzuken, Co. Ltd) was used. Sensor was attached to the first finger by biphasic adhesive tape. The psychologic sweating was induced by deep respiration, mental arithmetic, hand grip, blood pressure measurement and blood sampling. There were no statistical significant differences of CV value, heart rate, blood pressures, catecholamine values and serum β endorphin levels before and after the bathing. The psychologic sweating markedly decreased after the bathing (11.5±19.6 to 1.1±2.7 for plain water bathing, 14.9±21.9 to 1.6±5.1 for artificial hot spring, N. S.).
The decrease in psychologic sweating after bathing suggests the action of psychologic relaxation by bathing.

Between 1974 and 1991, we treated 10 aortic arch branch aneurysms in eight men and two women, who ranged in age from 17 to 81 years old (mean age, 55 years). Five patients had subclavian artery aneurysms, four had carotid artery aneurysms, and one had an inominate artery aneurysm. The chief complaint was a mass on the neck and supraclavicular fossa in five patients, rupture and an abnormal shadow on chest X-rays in two patients each, and acute artery occlusion in the upper limb in one patient. The operative method was usually excision of the aneurysm and reconstruction. The causes were arteriosclerosis in five patients, the thoracic outlet syndrome in two patients, and inflammatory, traumatic and iatrogenic in one patient each. Intraoperative hemorrhage occurred in one patient and graft occlusion in another one. The other patients have had a good course. This disease is rare, but because of complicated rupture and acute artery occlusion, it is desirable to perform surgery as soon as possible after the first diagnosis.

Effects of intracellular Na+, K+ and Cl- on Ca(2+)-regulated exocytosis activated by 10 microM acetylcholine (ACh) were studied in guinea-pig antral mucous cells which are permeabilized by nystatin treatment. Ca(2+)-regulated exocytotic events were modulated by [Na+]i, [K+]i and [Cl-]i via mediation of PTX-sensitive G proteins. Increases in [Na+]i and PTX inhibit G protein (G(Na)), which suppressed the exocytosis. Increases in [K+]i caused the exchange of G proteins (from G(Na) to G(K)) to increase, and GK evoked activation of the exocytosis and was inhibited by PTX. Increases in [Cl-]i and PTX inhibit G protein (G(Cl)), which stimulates exocytotic events. Based on these observations, the exocytosis in antral mucous cells were modulated by intracellular ions, concentration of which were increased or decreased by cell volume changes caused by Ach.
Acetylcholine/pharmacology ; Animal ; Cell Membrane Permeability/drug effects ; Exocytosis/physiology* ; Exocytosis/drug effects ; Gastric Mucosa/metabolism ; Gastric Mucosa/cytology ; Guinea Pigs ; Hypertonic Solutions/pharmacology ; Ionophores/pharmacology ; Nystatin/pharmacology ; Pertussis Toxins/pharmacology ; Potassium/pharmacokinetics* ; Pyloric Antrum/metabolism* ; Pyloric Antrum/cytology ; Sodium Chloride/pharmacokinetics* ; Vasodilator Agents/pharmacology

A 66-year-old woman who had percutaneous mitral valve commissurotomy 12 years before was admitted complaining of dyspnea on effort. Echocardiography showed severe mitral stenosis and regurgitation, and moderate tricuspid regurgitation associated with atrial fibrillation. Based on her past history we suspected allergy to metal, and skin patch tests showed a positive reaction to zinc, manganese, nickel, cobalt, dichromate, stainless steel, titanium alloys, and nickel-chromium-cobalt alloys. We selected an artificial organ which would not cause an allergic reaction. The St. Jude Medical standard cuff mechanical valve was the only compatible prosthetic valve. Anterolateral right thoracotomy, instead of median sternotomy, was selected. Mitral valve replacement with a 27-mm St. Jude Medical standard cuff mechanical valve and tricuspid valve annuloplasty with a 27-mm Duran flexible band were performed. Her postoperative course was uneventful. She is doing well without any allergic symptom 18 months after the surgery.

A rare case of juxtarenal aortic occlusion due to Takayasu's arteritis is reported. A 46-year-old man who had been suffering from intermittent claudication from the age of 44 when Buerger's disease was suspected at another hospital because of exacerbation of the symptom. Occlusion of the abdominal aorta and severe aortic wall thickness were identified by the abdominal CT scan. After the improvement of inflammation, under the diagnosis of juxtarenal aortic occlusion due to inflammatory disease, we performed an aortobifemoral bypass grafting using a Y-shaped prosthesis (proximal anastomosis was end-to-end) found a tight inflammatory adhesion around the abdominal aorta. Histopathological examination of the resected specimen revealed an infiltration of lymphocytes, plasma cells in aortic media and adventitia, severe fibrosis in the aortic adventitia, and a diagnosis of Takayasu's arteritis was made. The postoperative course was uneventful but we should periodically check for inflammatory signs, and anastomotic aneurysms.

No abstract available.
Betamethasone* ; Butyrates* ; Diethylpropion* ; Humans* ; Keratinocytes*

We treated 261 arteriosclerosis obliterans cases with critical leg ischemia since 1976. Those patients aged 75 years and older were designated as the elderly group and were compared with those under 75 years of age. Among the elderly patients with critical leg ischemia, the percentages of women and Fontaine scale IV cases were higher. The condition of those who had to undergo an initial major amputation was often complicated by cerebrovascular diseases, resulting in a higher early death rate after operation. Therefore, the necessity of early diagnosis and immediate treatment must be emphasized. There were no differences in patency and limb salvage rates between the two groups. In cases of arterial reconstruction however, graft occlusion in the elderly group immediately after operation was frequently observed. It is important to include drug therapy in follow-up to prevent occlusion of the graft following surgery in elderly patients.