「福島県合同輸血療法委員会」（以下，「合同輸血療法委員会」）は，県内輸血医療関係者によって血液製剤の適正使用を目的に活動していた「福島県血液製剤使用に係わる懇談会」と，安全な輸血療法の普及と学術的な部分で草の根的に活動している「福島県輸血懇話会」との連携をより強くした新たな組織として2007年に設立された．以降，自己血輸血講習会，血液製剤使用適正化に向けた意見交換会，輸血に関するアンケート調査等の事業は「合同輸血療法委員会」が引き継いだ．さらに実践的な輸血情報が共有できるよう，看護師を対象とした輸血教育研修会，輸血医療研修会も主催してきた．「福島県輸血懇話会」と共に輸血治療に関する認識，安全性確保に対する意識向上のため，意図して種々の医療従事者が各種会合に集うことを可能とする体制を構築してきた．今後「合同輸血療法委員会」の活動を通して，医師，検査技師，看護師，薬剤師，事務部門，行政，血液センターが共に手を携えて福島県輸血医療の質向上を図っていく必要がある．

Percutaneous transluminal laser-assisted angioplasty of a renal artery stenosis was performed in a 16-year-old woman with renovascular hypertension. The stenotic portion of the renal artery was predilated by delivering Nd-YAG laser energy to the terminal tip of a laser catheter. Although the luminal diameter did not increase sufficiently with laser angioplasty alone, it allowed passage of the balloon catheter and subsequent successful balloon angioplasty. Immediately after dilatation, the patient's blood pressure fell to normal, and plasma renin activity decreased. There were no serious complications. Thermal laser angioplasty seems to be an effective adjunct technique for the treatment of severe renal artery stenosis which does not allow initial passage of a balloon catheter.

To estimate the length of the aorta from the subclavian artery to the renal artery in Japanese adults, its length was measured on computed tomographic (CT) images. Data from a total of 110 patients without aortic or aortic valvular diseases (54 men, 56 women) who had undergone 7-mm-slice-interval CT examination of the entire aorta was analyzed in this study. The length of the aorta was found to be 214.1 ± 20.7 mm and showed a positive correlation with height (r = 0.664). Especially, the length of the aorta in male patients was correlated with body mass, i.e., height, weight, and body surface area. From these results, it appears that the majority of commercially available intra-aortic balloon catheters are too long for use in the Japanese population. It is concluded that a shorter, more suitable catheter should be made available for safe use in Japanese patients.

症例は64歳，男性．小脳梗塞の診断で入院中，心雑音を指摘され，大動脈弁閉鎖不全症と診断された．当院で大動脈弁置換術を施行したが，術中左腕頭静脈の存在は確認できなかった．術後遠隔期の左肘静脈からの造影では，左上大静脈遣残や副半奇静脈，肋間静脈などの胸腔内静脈との交通が造影されず，左上肢の静脈還流は，左総頸静脈から頭蓋内の静脈交通を介し右総頸静脈から上大静脈を経て右心房に還流する稀な形態を示していた．既往に左上肢の浮腫はなく，静脈性高血圧症は否定されたが，左上肢静脈血の頭蓋内還流と小脳梗塞発症との明らかな因果関係は不明であり，今後注意深い経過観察が必要である．

新鮮凍結血漿 (Fresh Frozen Plasma: FFP) は採血後, -20℃以下で凍結保存される. 使用時には30～37℃の恒温槽で解凍されているが, その作業操作は病院施設により異なる. そこで今回, 新たに開発されたFFP解凍装置 (FP-40, 北陽電機/川澄化学) を評価した.FFPは1単位 (FFP-1), 2単位 (FFP-2) 及び5単位 (FFP-5) 製剤を用いFP-40の解凍時間, 解凍時の水温の変動を評価した. また, 解凍後の凝固因子 (PT: プロトロンビン時間, APTT: 活性化部分トロンボプラスチン時間, フィブリノーゲン, 第V因子及び第VIII因子) を測定した.標準的な恒温槽で解凍した場合, FFP-1を解凍するのに約17分かかったが, FP-40では約5分で解凍が可能であった. FP-40の解凍能力は, FFP-2で約9分, FFP-5で約15分であり, 4バッグまで同時に解凍しても解凍時間に影響を及ぼさなかった. また, 解凍時の水温は常に安定していた. PTはFP-40で88.2%, 恒温槽で81.7%であり, 有意な差が認められた (p<0.05). その他の項目 (APTT, フィブリノーゲン, 第V因子, 第VIII因子) では両解凍方法間に有意な差を認めなかった.新たに開発された解凍装置はFFPを安定条件下で解凍でき, より短時間での解凍を可能にした. 病院内での操作性の統一や品質管理, 作業効率の向上の観点から, FFPを適正温度で安全・短時間で解凍できる専用装置の使用は有用であると考えられる.

UNLABELLED Myocardial SPECT may be useful for assessment of the therapeutic effects and the mechanisms of cardiac regeneration medicine. We aimed to assess first the feasibility and the short-term safety of autologous bone marrow-derived mononuclear cell transplantation (BMCT) into the ischemic myocardium in patients who undergo off-pump coronary artery bypass surgery (OPCAB). In addition, we aimed to assess our hypothesis that the BMCT may help ameliorate myocardial perfusion in patients with ischemic heart disease (IHD) using myocardial perfusion scintigraphy. METHODS We performed BMCT in 10 patients with IHD during OPCAB. Cells for BMCT were collected by intraoperative bone marrow aspiration or by preoperative cellular apheresis after pretreatment with granulocyte colony-stimulating factor. After OPCAB was performed in all graftable ischemic areas, a total of 3.4 +/- 1.2 x 10(9) mononuclear cells, including 5.2 +/- 1.6 x 10(6) CD34-positive (CD34(+)) cells, were injected into ungraftable ischemic myocardial areas. Dipyridamole-stress and resting (99m)Tc myocardial SPECT was performed before and 1 mo after the procedures. RESULTS BMCT was performed safely in all patients. Compared with before treatment, myocardial (99m)Tc tracer uptake on the dipyridamole-stress image increased similarly in BMCT- and OPCAB-treated areas, whereas tracer accumulation at rest did not change in all myocardial areas. The improvement of myocardial perfusion was not correlated with the total number of mononuclear cells transplanted. However, it was positively correlated with the number of transplanted CD34(+) cells: (99m)Tc tracer uptake after/before BMCT (ratio) = 1.091 x (CD34(+) cell number [x10(6)])(0.074) (r(2) = 0.48, P < 0.05), although new development of coronary vessels was not documented cineangiographically. Myocardial histopathology in 2 of 3 autopsy cases revealed coronary angiogenesis in the areas corresponding to the sites of BMCT. CONCLUSION The present study demonstrates the feasibility of BMCT combined with OPCAB. This therapy improves myocardial perfusion possibly via CD34-related development of coronary microvessels.

J Nucl Med. Tsuguo Igari, Hitoshi Ohto and Hitoshi Yokoyama Hiroyuki Yaoita, Shinya Takase, Yukio Maruyama, Yoshiyuki Sato, Hirono Satokawa, Nobuo Hoshi, Nobutaka Ono, Patients with Ischemic Heart Disease Transplantation Combined with Off-Pump Coronary Artery Bypass Surgery in Derived Mononuclear Cell − Scintigraphic Assessment of the Effects of Bone Marrow http://jnm.snmjournals.org/content/46/10/1610 This article and updated information are available at: http://jnm.snmjournals.org/site/subscriptions/online.xhtml Information about subscriptions to JNM can be found at: http://jnm.snmjournals.org/site/misc/permission.xhtml Information about reproducing figures, tables, or other portions of this article can be found online at:

腹部大動脈瘤に合併した，比較的稀とされる左側下大静脈の1例を経験した．症例は79歳，男性で，腹部大動脈瘤の精査中に左側下大静脈の合併が明らかになり，手術時確認した．下大静脈は腎動脈分岐部直下で腹部大動脈を乗り越え，左側後方の走行となっていた．動脈瘤手術時に癒着剥離の際，軽度の損傷を来したが，術後，とくに下大静脈の狭窄や血栓形成もなく軽快退院した．

At present, there are various biomaterials that have high biocompatibility. In particular, there are many types of coated circuits in cardiopulmonary bypass (CPB) systems. However, only a few clinical studies have investigated platelet aggregation caused by these coated circuits. In this study, a CPB system coated with poly-2-methoxyethylacrylate (X coating) was used to ascertain whether platelet aggregation could be suppressed during CPB, and a comparison was made between X coating and ordinary (covalently bonded) heparin coating. The subjects were 19 adult patients who were scheduled to undergo valve replacement or valvuloplasty. They were divided into two groups: group X (X coating) and group H (heparin coating). The platelet aggregation threshold index (PATI, grading curve) and β-thromboglobulin and plalelet factor IV levels were assessed preoperatively (control), 5 min after heparin administration, 10 and 60 min after the start of CPB, and 0 and 2 h after the end of CPB. The results indicated that platelet aggregation was reduced during CPB and that platelets were activated. The changes in platelet aggregation associated with the X coating were shown to be similar to those associated with heparin coating.

The goal of the present study was to determine the efficacy of reducing the number of leukocytes in autologous blood before storage. The study sample consisted of 121 patients undergoing orthopedic surgery and scheduled to receive up to 1, 200mL autologous blood. They were divided into prestorage leukocyte reduction and no-reduction groups. Body temperature, white blood cell counts, red blood cell counts, and C reactive protein (CRP) levels were compared after operation. Thirteen of 121 patients were excluded from comparison due to rheumatic etiology. Results showed no significant difference in efficiency between the leukocyte-reduced (n=46) and non-reduced (n=62) groups. The leukocyte reduction group showed slightly lower CRP levels for 48h after surgery than the noreduction group. The benefits of prestorage leukocyte reduction of autologous blood remains to be elucidated.

A 31-year-old adult with an aortico-left ventricular tunnel (ALVT) arising from the right aortic sinus is reported. Preoperative transesophageal echocardiography demonstrated a ruptured sinus of Valsalva with severe aortic valve regurgitation which originated from the right coronary sinus entering the outlet portion of the left ventricular outflow tract. Operation revealed the aortic entrance of the tunnel was above the right coronary sinus. Direct closure of the orifice of the tunnel using three stitches of 4-0 polypropylene with felt and aortic valve replacement (AVR) was performed. At 10-month follow-up the patient is asymptomatic and receiving no oral medications except anticoagulants. We believe this to be the oldest case of ALVT managed with AVR.

間欠的空気圧迫装置（IPC）と弾力ストッキング（ES）の組み合わせによる下肢静脈血流への影響を明らかにするために，duplex scanを用いて下肢血流速度を測定した．健常成人例で，duplex scan上異常を認めない6例12肢を対象とした．IPCは加圧カフが足部と下腿部からなるVen Assist model VA-1000（ACI Medical, USA），ESはストッキングタイプのComprinet Pro（TERUMO・BNS, Hamburg）を使用した．IPCにより，大腿および大伏在静脈の最大流速は有意に増加したが（p<0.01），ES単独では血流の変化は明らかではなかった．IPCとES併用では大伏在静脈，総大腿静脈の加圧波の最大流速は低下傾向を示し，加速度は低値となった（p<0.05）．以上の結果，IPCとESの併用により，下肢の血流速度に対する有意の相乗効果は認められなかったが，深部静脈血栓症予防効果の判定にはさらに多面的な検討が必要と考えられた．

過去14年間に経験した急性上肢動脈閉塞7例を報告. 80歳以上が7例中5例を占め,右側が5例,左側が2例.上腕動脈が6例,尺骨動脈が1例.心房細動のない例は医原性の1例のみ.心房細動6例中,抗凝血剤使用は1例で,眼科手術のため休薬した3日目の発症で,発症時は全例服用していなかった.発症から手術までの時間は数時間以内であるが1例13日目.閉塞部位は,上腕動脈のみ閉塞が3例,撓骨動脈も閉塞が2例,按状に撓骨動脈,尺骨動脈の閉塞は1例,尺骨動脈のみ1例.心房細動を有する6例中5例で白色血栓を認めた.初期の3例には術後ワーファリンを用いなかったが2例に塞栓症起こり,その後はワーファリンを使用している.上肢の急性動脈閉塞は下肢に比し,側副血行路の存在から重症化することは少ないとされるが保存的に処置すべきでなく可及的に手術すべきで,殊に,症状があれば直ちに着手すべきである.

両側下肢の腫脹，体重増加を主訴に紹介された47歳女性にCT検査にて右側下大静脈が閉塞した重複下大静脈奇形を認めた．動脈血酸素分圧の低下，肺シンチにて肺梗塞も認めた．血栓溶解療法とヘパリン投与にて軽快したので，フィルター留置せずに内科的治療を継続している．

Four cases among the 149 patients who required repair of an infrarenal abdominal aortic aneurysm (AAA) during the last five years, were chronic contained rupture. The first symptom at onset was back pain and physical examination revealed the patients to be in no acute distress. The sites of rupture were posterior in all cases. They were operated through an extraperitoneal approach. There was no operative mortality and all survived. The CT features, (1) discontinuity of the rim of calcification in the true aneurysm wall, (2) well defined soft tissue density adjacent to the aorta, (3) the concealed psoas muscle and the displaced viscera depending on the size of the lesion, and (4) no appearance of contrast material in the hematoma in some cases, led to the correct diagnosis of contained rupture.

53歳，女性の左下肢深部静脈血栓症，発症後18日に動静脈瘻併設なしで，10mmのリング付きePTFEグラフトにて大腿－大腿静脈交叉バイパスを行い左下肢の腫脹改善し，13年後，静脈造影で開存を確認した．急性期を抗凝血療法で経過し，発症後18日にバイパスしたことが長期開存に繋がったものと考えている1例を報告した．