Moderate hypothermic circulatory arrest (moderate HCA) with selective cerebral perfusion has been developed for cerebral protection during thoracic aortic surgery. However, visceral organs, particularly the kidneys, suffer great tissue damage under moderate HCA, and acute renal failure after HCA is an independent risk factor for early and late mortality. The present study investigates whether atrial natriuretic peptide (ANP) can prevent a reduction in renal perfusion and protect renal function after moderate HCA. Twelve pigs (weight 36.7 ± 1.7kg), cooled to 30°C by a cardiopulmonary bypass, were randomly assigned into an ANP group (n = 6) treated with recombinant ANP (0.05μg/kg/min) and a control group (n = 6); moderate HCA was subsequently induced for 60 minutes. Systemic arterial mean pressure and renal artery flow did not significantly differ between the two groups during the study. The renal medullary blood flow was significantly increased in the ANP group after HCA (109.3 ± 35.7% vs. 207.5 ± 113.2%; p = 0.03). Myeloperoxidase activity was significantly reduced in the medulla of the ANP group (0.057 ± 0.035 vs. 0.026 ± 0.019U/mg; p = 0.03). Renal medullary ischemia after HCA was ameliorated by ANP by increasing medullary blood flow and by reducing sodium reabsorption in the medulla. Additionally, ANP reduced the inflammatory properties produced after ischemia in the renal tissues.

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In orthopedics, particularly in osteotomy, the total amount of bleeding is largely due to hemorrhaging from the bone with difficulties in hemostasis, and blood transfusions are required in many of surgeries for the large joints. We surveyed the status of blood transfusions in 236 cases of rotational acetabular osteotomy (hereafter called RAO) to statistically investigate the actual conditions of autotransfusion as well as factors involving allogeneic transfusion. Results showed that the factors involving allogeneic transfusion include the amount of autologous blood conservation, the amount of bleeding, and the duration of surgery. Furthermore, the blood transfusion requirements are reduced with the change of anesthetic regimens or management of infusion, or improvement of surgical procedures. Awareness of blood transfusions is also altered because of autotransfusion, and the risk of allogeneic transfusions may be decreased. However, allogeneic transfusions may be avoided excessive so that postoperative hypohemoglobinemia may occur. Therefore, clear criteria and skilled knowledge regarding transfusions and blood conservation are required.

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ICG fluorescence image-guided surgery has been used as a less invasive approach for sentinel lymph node navigation surgery operations. Recently, we found that fluorescence image can obtain immediately after a mixture of ICG and bile juice, which has not been reported yet. Furthermore, we happened to observe the ICG fluorescence image of cholangiogram when we performed hepatectomy on the patient with liver cancer, because he had received ICG test for the evaluation of liver function test prior to the operation. Based on these facts, we applied (ICG) fluorescence imaging by emitting diode showed the usefulness for the imaging of intraoperative cholangiography. In our preliminary animal study, we could find shining the ICG fluorescence image of cholangiogram following the injection of ICG into cystic duct. The gallbladder, cystic duct and common bile duct were clearly demonstrated. We could observe these images using PDE camera at laparotomy as well as by the newly devised ICG fluorescence-image endoscope (FIE) for laparoscopic cholecystectomy. The intensity of ICG fluorescence detected by the PDE camera is superior to that by FIE. Clinically, we applied FIE for patients who underwent laparoscopic cholecystectomy as follows. Prior to dissection of cystic duct, 1-2ml of ICG solution was directly injected into gallbladder, using Kurmar forceps. We found fluorescence image along with the biliary tract clearly. Rather similar results were obtained when we injected systemically 10ml ICG solution several hours prior to the operation, we could not obtained the fine image of cholangiography when the cystic duct and common bile duct were covered with thick fat tissue, In our preliminary animal and clinical study, we confirmed that ICG fluorescence image-guided intraoperative cholangiography is promising approach for laparoscopic cholecystectomy or biliary reconstruction in hepato-pancreatico-biliary surgery without using conventional X-ray image system.

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The aim of the present study was to evaluate the postoperative quality of life (QOL) in patients with initial dialysis and analyze the predictors of QOL seven months after operation in this population. Subjects were 28 patients who underwent access operation for chronic renal failure. The patients were asked to participate in the prospective longitudinal study in which detailed information was collected through standardized measures of the Short-Form Health Survey (SF-36), and clinical evaluation. Multiple regression analysis was used to determine the predictors of QOL at seven months after initial dialysis. A significant improvement in patients' scores for general health was noted two and three months after initial dialysis compared to those measured preoperatively. Scores of mental health significantly improved four months after initial dialysis. Preoperative performance status (PS) ≥ 1 was significantly associated with poor scores of six subscales in SF-36, which were measured seven months after initial dialysis. A significant postoperative improvement in mental health and general health were found in chronic renal failure patients. Those with poor preoperative PS reported poor QOL at seven months and there was a need for physical, psychologic and social support after initial dialysis.

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Preoperative respiratory function tests are important for evaluating the preoperative condition. To obtain an accurate measurement of respiratory function using spirometry, maximum expiratory effort by patients is necessary. However, under normal breathing and within a few minutes, the impulse oscillation system (IOS) can evaluate total airway resistance (R5), large airway resistance (R20), small airway resistance (R5-R20), and reactance (X5). Preoperative respiratory function assessments (IOS and spirometry) were done on 120 patients scheduled for elective surgery. The subjects were divided into three groups: normal respiratory function (%VC ≥ 80%, %FEV_1.0 ≥ 70%), obstructive impairment (%VC ≥ 80%, %FEV_1.0 ≥ 70%), and restrictive impairment (%VC ≥ 80%, %FEV_1.0 ≥ 70%). Subjects were also divided into two age groups, 30-64 and 65-85 years. Spectrum pattern IOS results show that there was one abnormal pattern in the normal respiratory function group; and a significantly larger number of normal spectrum patterns, as well as a significantly larger number of peripheral airway obstructive spectrum patterns, in the obstructive and restrictive groups than in the normal respiratory function group. Because a conventional respiratory function test requires maximum expiratory efforts by the subject, reproducible and reliable evaluations are often difficult to obtain particularly with the aged. IOS, however, is a useful preoperative respiratory function tool that can be used for accurate measurements under normal breathing.

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In the field of neurosurgery today, various revascularization procedures are combined to perform surgery for such diseases as intracranial ischemic lesions, cerebral aneurysms, and brain tumors. In ischemic brain diseases, the main objective of revascularization is to save the ischemic penumbra and improve symptomatic motor paralysis and aphasia. Furthermore, blocking a parent vessel is required when hemostasis, due to a neck injury, during surgery is difficult or when the long-term prognosis for a brain aneurysm is more favorable by blocking a parent vessel; in this case, revascularization is performed to avoid brain ischemia. While revascularization procedures have mostly been established, it is generally necessary to pass a donor artery through the bone, and in a patient with an ischemic lesion, if intracranial arteriosclerosis is severe, the circulation of the entire skin may be poor, thus resulting in postoperative wound necrosis. Considering these issues, a new bypass procedure called "MMA-MCA bypass", which uses the middle meningeal artery (MMA), was investigated. Using both sides of five cadaver brains, the MMA was anastomosed with 10-0 MONOSOF as proximal as possible to the M2 of the MCA. Anastomosis was possible in all cases, and the brain was excised with the dura attached to identify the site of anastomosis to the MCA. The site of anastomosis was the M2 in seven cases, the M3 in one case, and the M4 in two cases. While it is best to perform a revascularization using an intracranial vessel, the present technique has not been previously investigated. It was procedurally possible to perform a bypass using the MMA. In the future, it will be possible to reduce the occurrence of complications by assessing blood flow volume and performing this bypass in clinical settings.

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In orthopedic surgery,osteotomies require blood transfusions for bleeding from the bone with hemostatic difficulties. In1988 we started collecting blood for autotransfusion in order to avoid allogeneic transfusion. Autologous cryoprecipitate purified from the collected blood has been used during surgery since 1999. We investigated the benefit of autologous cryoprecipitate by statistically comparing our patients who underwent rotational acetabular osteotomy. Thirty patients were randomly assigned to 2groups, with or without autologous cryoprecipitate. Statistical comparison showed no significant differences in the amount of intraoperative and postoperative bleeding and the increase or decrease of cellular components. The autologous cryoprecipitate is expected to be useful for various applications such as fixation of bone fragments and rapid healing of wounds in addition to hemostasis. We should examine and evaluate other factors of autologous cryoprecipitate to determine its usefulness in osteotomy.

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