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Vibrio vulnificus, a recently described strain of the halophilic Vibrio species, was isolated from the blood of a 73-year-old man, who developed rapidly progressive wound infection and fatal septicemia. Twenty-one patients with Vibrio vulnificus infection have been reported in the Japanese literature. Vibrio vulnificus most frequently causes primary septicemia and necrotising cellulitis after the eating of raw fish or shellfish or after exposure to seawater. The infection is characterized by its occurring during the warm months of the year, in patients with underlying diseases, especially liver diseases, and the mortality rate is surprisingly high. Clinicians should therefore consider the possibility of Vibrio vulnificus infection in the differential diagnosis of severe wound infections. Early surgical intervention and intensive antibiotic therapy are recommended for preventing the progress of the septicemia.

From July, 1979 to August, 1987, 10 patients at our institution underwent a repair of annuloaortic ectasia (AAE), either with a separate aortic graft and valve or with Bentall's operation. There were no hospital deaths, although there were two late deaths from unrelated accidental causes. In nine of the patients, echocardiograms were recorded to evaluate the postoperative cardiac function and possible complications. M-mode echocardiography facilitated the evaluation of cardiac function, and two-dimensional echocardiography was better suited to studying the postoperative structures. On the other hand, the real time two-dimensional Doppler flow mapping ensured the diagnosis of dissecting aneurysms through the blood flow pattern. Although the postoperative hemodynamics improved significantly, pseudoaneurysms between the native aortic wall and the graft were detected in three patients, with compression to the composite conduit in one, and residual distal aortic dissection was noted in another three patients. It was thus concluded that the composite graft replacement of the ascending aorta and aortic valve in patients with AAE can be accomplished with a low risk, but pseudoaneurysm formation at the coronary ostial or aortic suture line may be observed late after surgery. Regular postoperative follow-up study is therefore of great importance, and echocardiography would be the most pertinent, non-invasive method of meeting this purpose.

The purpose of this study is to obtain the informations about the fate of the limbs and lives of claudicants due to arteriosclerosis obliterans. Two hundred and seven lower limbs of 165 patients suffering from intermittent claudication were observed for an average period of about six years. Eighty-seven limbs of 69 patients were managed nonsurgically (Group A). Ninety-eight percent of limbs in Group A remained unchanged or improved, and no limb was amputated. One hundred and twenty limbs of 96 patients had arterial reconstructions (Group B). Although 75 percent of limbs in Group B had benefits by successful operations, 26 percent of them experienced graft failures, and 2.7 percent of them were amputated. Five year graft patency rates in the limbs with supra- and infra-inguinal reconstructions were 82.1 percent and 65.7 percent, respectively. Operative mortality rate was 2.1 percent, and mortality rate due to late complications was 3.3 percent. The prognosis of intermittent claudication with regular follow-up was relatively good, therefore, it is important to recognize that arterial reconstruction is not the only way to treat limbs with mild intermittent claudication. About 30 percent of claudicants died within 5 years, and 60 percent of them died from cardiac or cerebrovascular disease. The results suggested that much attention should be paid to the lives as well as the limbs of claudicants.