We investigated the effects of milrinone administered during cardiopulmonary bypass (CPB) for open heart surgery. Ten patients (group M) received milrinone after aortic declamping during CPB. Ten other patients served as controls with no administration (group C). Soon after the bolus infusion of milrinone, the perfusion pressure dropped significantly in the M group, however, after CPB and at the end of operation, aortic pressure showed no difference between the two groups. There were no differences in heart rate, pulmonary artery pressure and pulmonary capillary wedge pressure. After CPB, cardiac index was high and systemic vascular resistance index was low in the M group. The need for cathecholamine and time for rewarming showed also no significant differences. No adverse reaction was recognized. During CPB, a single administration of milrinone was useful for peri- and post-operative management of patients undergoing open heart surgery.

Purpose： In this study, we aimed to investigate the discrepancy between interview by medical personnel using 3‒point verbal rating scale (VRS) and patient complaints using numerical rating scale (NRS) in nausea diary for chemotherapy‒induced nausea. Patients and Method： In this study, we targeted patients who received chemotherapy at the gynecology department in our hospital and who recorded information in nausea diary. The discrepancy was estimated from NRS in nausea diary and the degree of nausea obtained by medical interview at approximately the same time period. We classified it into overvaluation, undervaluation or non‒discrepancy. Result： A total of 663 cases was analyzed, and 54 patientswere enrolled. The discrepancy was 25.2％ (undervaluation 5.4%; overvaluation 19.8％), and mostly overvaluation was observed. NRS in nausea diary had a significant correlation with the degree of nausea obtained by medical interview（P<0.001, r=0.66） , and the kappa statistic was 0.36. Conclusion： Ratio of non‒undervaluation is approximately 95%; hence, we conclude that interview by medical personnel using VRS accurately reflects the degree of nausea.

The effectiveness of recombinant human erythropoietin (rHuEPO) was evaluated in elderly patients who underwent coronary artery bypass grafting. A total of 133 patients were divided into three groups: those who were 70 years of age or older and received rHuEPO (group I; n=32), those who were also 70 years of age or older but did not receive rHuEPO (group II; n=35), and those who were 60 years or younger and received rHuEPO (group III; n=66). In 87.5% of group I, 42.9% of group II, and 98.5% of group III, homologous blood transfusion could be avoided. The percentage of patients without homologous blood transfusion was significantly higher in group I than in group II (p<0.001). The rate of homologous blood transfusion was significantly higher in group I than in group III (p<0.05), but rHuEPO had equal effects in terms of increase in hemoglobin level in the two groups. Furthermore, in patients without anemia, the rate of homologous blood transfusion was almost the same in the two groups. In conclusion, the administration of rHuEPO enables even elderly patients to undergo coronary artery bypass grafting without homologous blood transfusion.

An 81-year-old patient, who had a postinfarction left ventricular aneurysm with thrombus underwent left ventricular aneurysmectomy with right coronary artery bypass grafting (CABG). Preoperative examination showed 99% stenosis of the left coronary artery (#7) and 90% stenosis of the right coronary artery (#3). The operation was performed because angina was not improved and formation of thrombus was suspected on the wall of the aneurysm. The operation was performed under cardiopulmonary bypass and by antegrade and continuous retrograde cardioplegia. The aneurysm was resected and a relatively fresh thrombus which was detected on the endocardium of the aneurysm was extracted. The left ventricle was closed by direct linear suture with felt reinforcement. Because the area of resection included part of the left anterior descending artery, only right CABG (#3) with a saphenous vein was done. Weaning from bypass was very easy and the postoperative course was uneventful.

Using the DDG-2001 pulse dye densitometer, cardiac output (CO) and circulating blood volume (BV) were determined before and after the operation, and its accuracy and the significance of postoperative management were studied. Referring to 14 cases undergoing open heart surgery, CO and BV were determined using the DDG-2001 before application of the cardiopulmonary bypass and immediately, 4h and 12h after the operation. The level of CO was compared with that determined by the thermodilution method, and the level of BV with that calculated from hemoglobin levels determined before and after the cardiopulmonary bypass application and the priming volume in the circuit. Further, body fluid balance after the operation was calculated, and its relation to BV was studied. As to the correlation coefficient and inclination of the regression line, they were 0.77 and 0.849 with CO, and 0.821 and 0.844 with BV, respectively. Upon completion of the operation BV decreased, but increased again 4h and 12h later, although the body fluid balance was negative. CO and BV determined by the pulse dye densitometry favorably correlated with those determined by other methods. Immediately after the operation BV decreased, but then increased in the course of time, although the body fluid balance was negative.

Introduction: This study evaluated the effectiveness of co-management of the neurosurgery department by general physicians.Methods: A retrospective observational study was conducted in a tertiary hospital. Length of stay, in-hospital mortality, number of transfers to the intensive care unit (ICU) due to emergency medical problems, prescription sharing ratio with neurosurgeon, and impression reported by nurses were evaluated by comparing one year before and after the co-management of the neurosurgery department was initiated.Results: Length of stay (Median 14 days, 14 days), mortality rate (7.58%, 5.75%) and transfer rate for ICU (3.23%, 1.94%) were not significantly different between one year before and one year after, respectively. Subgroup analysis of patients over 70 years of age hospitalized for cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage showed that the number of patients transferred to the ICU due to medical problems associated with internal medicine significantly decreased (P = 0.04). A general physician was responsible for half of the prescriptions. The nurse's report was highly positive.Conclusion: Co-management of the neurosurgery department by general physicians did not have a significant effect on reducing length of stay or mortality rate; however, we found a decrease in the number of patients transferred to the ICU due to medical problems among elderly stroke patients.