Studies on pulsatile and nonpulsatile perfusion have long been performed. However, investigators have not reached a conclusion on which is more effective. In the present study, pulsatile cardiopulmonary bypass (CPB) was investigated in terms of the effects on cytokines, endothelin, catecholamine, and pulmonary and renal functions. Twenty-four patients who underwent coronary artery bypass grafting were divided into a pulsatile CPB group and a nonpulsatile CPB group. Parameters examined were hemodynamics, interleukin-8 (IL-8), endothelin-1 (ET-1), epinephrine, norepinephrine, lactate, arterial ketone body ratio, urine volume, blood urea nitrogen, creatinine, renin activity, angiotensin-II, lactate dehydrogenase, plasma-free hemoglobin, tracheal intubation time, and respiratory index. The IL-8 at 0.5, 3, and 6 h after CPB, and ET-1 at 3, 6, 9, and 18 h after CPB were significantly lower in the pulsatile group. Both epinephrine and norepinephrine were significantly lower in the pulsatile group. The respiratory index was significantly higher in the pulsatile group. In the present study, inhibitory effects on cytokine activity, edema in pulmonary alveoli, and endothelial damage were shown in addition to the favorable effects on catecholamine level, renal function, and peripheral circulation that have already been documented.

In situ replacement with excision of infected tissue, lavage using 10 l saline solution, and omentum plasty for PIAAA successfully resolved the condition. High local concentrations of rifampin-soaked grafts or superficial femoral vein may also be an alternative for an in situ replacement conduit.

Purpose: Cystic adventitial artery disease is an uncommon non-atherosclerotic peripheral vessel disease. Furthermore cystic adventitial disease of the common femoral artery is an extremely rare entity. We report the case of a 54 year-old man complaining of intermittent claudication who was referred to our vascular service. Methods and Results: Doppler ultrasound and multidetector-row computed tomography (CT) with 3-dimensional volume rendering revealed severe stenosis with cystic an adventitial cyst in the common femoral artery. Intra-operative Doppler ultrasound showed the cyst to be multilocular type. Reversed great saphenous vein interposition was successfully placed. Conclusion: Removal of cyst together with artery and interposition using reversed great saphenous vein is the optimal treatment procedure to prevent recurrence.

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Relapsing polychondritis (RP) is a rare, inflammatory, multiorgan disorder affecting cartilaginous structure and other connective tissue. Cardiovascular complications occur in 10%-52% of patients. We report a case of emergency surgery for an acute aortic dissection in a patient with RP. A 45-year-old female who had been taking corticosteroids (10 mg/day) for 2 years for RP presented at another hospital with dyspnea and severe chest and back pain. Acute aortic dissection was diagnosed, and we performed emergency replacement of the ascending aorta. We could not control the bleeding from suture holes of the native aorta because the vessel was so fragile. Thus, we performed a delayed sternal closure. The day after surgery, bleeding had decreased, and we could close the chest wall. Infection was well controlled, and the patient suffered minimal additional complications. She was discharged to home by herself 29 days after surgery and returned to normal life.Keywords: acute aortic dissection, relapsing polychondritis, emergency operation, delayed sternal closure Case ReportA 45-year-old female presented at the emergency department of another hospital with dyspnea and severe chest and back pain at work. She was diagnosed with acute aortic dissection (Stanford type A) and was transferred to our hospital for emergency surgery. She had a history of RP treated with corticosteroids (10 mg/day) for the previous 2 years. Computed tomography (CT) on admission showed acute aortic dissection (Stanford type A). The dissection started at the right coronary artery and continued to the infrarenal abdominal aorta (Fig. 1). No other medical history was available at the time of admission. We performed emergency surgery. Through a median sternotomy, the dissected, ascending aorta was reconstructed by end-to-end anastomosis with a vascular graft (Triplex Ⓡ 28 mm, Terumo Corporation, Tokyo, Japan) using the less invasive quick replacement (LIQR) technique. 5) Stump plasty was performed with a felt strip sandwiched in the distal and proximal ends. Withdrawal from extracorporeal circulation was uneventful, but bleeding from the needle holes in the native aorta was uncontrollable. As a result of bleeding problem, we could