A 68-year-old man with unstable angina after old myocardial infarction, and Leriche's syndrome was admitted. Coronary angiography found 90% stenosis of the left anterior descending artery (LAD), 99% stenosis of the diagonal branch, 99% stenosis of the right coronary artery (RCA), and 90% stenosis of the 4-posterior descending branch (4 PD). Left circumflex artery (LCX) was diffusely stenotic and small. Aortography revealed complete occlusion of the infrarenal aorta. Due to the risk of limb-threatening ischemia, we planned simultaneous revascularization of myocardium and the lower extremities. Off-pump coronary artery bypass (OPCAB) was performed first. Subsequently Y graft replacement of abdominal aorta was completed. The postoperative course was uneventful and he was discharged on the 14th day after operation.

An 86-year-old woman was transferred to our hospital because of chest pain and left incomplete paralysis. CT-scan revealed a dissecting aortic aneurysm (DeBakey type 2) 6cm in diameter. Coronary angiography and aortography were perfomed to assess the coronary artery disease and ASO, they showed occluded LAD, 90% stenosis of CX and occluded left external iliac artery. We planned a 1-stage operation. Coronary artery bypass grafting with the beating heart was carried out prior to replacement of the ascending aorta. Then we performed femoro-femoro bypass. The postoperative course was uneventful and the patient was discharged 23 days after the operation.

A 71-year-old man was transferred to our hospital because of impending rupture of an abdominal aortic aneurysm (AAA). Preoperative CT scan demonstrated a huge aneurysm of the aortic arch (TAA) associated with an AAA. Emergency coronary angiography revealed 3-vessel disease. One-stage surgery including TAA repair, coronary bypass surgery, and AAA repair was performed to avoid the possibility of rupture of the remaining aneurysms and the risk of ischemic heart diseases. One-stage surgery is a possible approach for patients with severe multivascular diseases.

The purpose of this study was to clarify the effect of warm water bathing (40°C) of the hand on the psychologic sweating measured in the opposite palm. The subjects were 2 males and 4 females, aged 38±10 years (26-58 years). The psychologic sweating was estimated by the apparatus developed by Sakaguchi et al (Sakaguchi, M. et al BME 26: 213, 1988). The room temperature was 27 to 28°C and the relative humidity was 60 to 70%. The sensor was attached using adhesive tape on the right palm. Then the psychologic sweating was measured after deep respiration, mental arithmetic, hand grip, bathing in warm water of 40°C at the level of left wrist. The results showed that the mean values of palmar sweating were 15.6 for deep respiration, 16.8 for mental arithmetic, 15.5 for hand grip and 0 for warm water bathing.
Above results suggest that local water bathing of moderate temperature induces a decrease of psychologic sweating, probably due to relaxing effect of the cerebrum.

Between 1988 and 1991, 231 patients underwent surgical repair for abdominal aortic aneurysm. Among them 132 patients underwent isolated Y graft replacement electively. They were divided into two groups, according to the operative procedure; transperitoneal approach (n=51) and retroperitoneal approach (n=81), and the surgical results were compared retrospectively. There was no significant difference in operative time, amount of operative bleeding, operative transfusion, total transfusion, autotransfusion, duration of intubation, total use of analgesia or length of postoperative stay in the two groups. The amount of fluid drained from the nasogastric tube was significantly greater in the transperitoneal group. The initiation of drinking and eating were both significantly prolonged in the transperitoneal group. The transperitoneal approach is indicated for cases with thoracic or thoracoabdominal aneurysm which may be operated on in the future, cases of bilateral common iliac aneurysms and cases with heart disease. Otherwise it is preferable to select the retroperitoneal approach as the first choice for elective surgical treatment of abdominal aortic aneurysm, because the retroperitoneal approach is superior in terms of the recovery of gastro-intestinal movement.

We here report three cases of choroidal metastases with ocular pain and visual symptoms treated with palliative irradiation. Case 1: A 71-year-old woman was treated with chemotherapy for multiple metastases after surgery for right breast cancer. Sixteen years after surgery, a right choroidal metastasis with ocular pain and visual disturbance was detected. Palliative irradiation to this lesion achieved reduction in ocular pain and shrank the tumor. Case 2: A 54-year-old man presented with right ocular pain and abnormal vision and was diagnosed as having right lung cancer with multiple systemic metastases. Palliative irradiation to a right choroidal metastasis achieved reduction in ocular pain and shrank the tumor. Case 3: A 71-year-old woman developed left eye pain 17 months after surgery for lung cancer in the right upper lobe. She was diagnosed as having a left choroidal metastasis. After palliative irradiation, the tumor shrank and the left eye pain temporarily resolved. Palliative radiation therapy for choroidal metastasis with ocular pain and visual symptoms seems to be effective in improving symptoms.