The Imai technique can be an option for coronary management in the presence of high-risk coronary anatomy, particularly distal intramural coronary artery stenosis and inseparable coronary arteries with an almost single orifice. Adequate neopulmonary artery augmentation must be performed to prevent right ventricular outflow stenosis.

Peripheral neuropathy in the hand has often been reported in workers using hand-held vibrating tools. But the affected location in the hand is not clearly demonstrated. To elucidate the impaired segment of the median nerve within the hand, fractionated median sensory nerve conduction velocity (SCV) was measured in the digital, finger-to-palm, palm-to-wrist and wrist-to-elbow segments. Subjects were 56 patients with hand-arm vibration syndrome and 43 healthy controls of similar age. SCV in the digital and the wrist-to-palm segments was significantly slower in the patients than the controls. Slowed SCV in the digital segment was encountered in 36% of the patients, while the slowing in SCV in the wrist-to-palm segment (across the carpal tunnel) was found in 20% of them. The slowing in the digital segment was more frequently encountered in the advanced stage of the Stockholm sensorineural (SN) stage for hand-arm vibration syndrome: 10% in OSN (no neurological symptoms) while 56% in 3SN (severe stage). The present study has demonstrated that vibrationinduced nerve impairments dominantly exist both in the digits and across the carpal tunnel. Careful neurophysiological assessment is important to confirm the impaired location within the hand.

To evaluate peripheral neuropathy in patients with vibration syndrome, an examination was conducted of sensory nerve conduction velocity (SCV) in the digital segment of the median nerve in the middle finger and vibration perception threshold (VPT) at 125 Hz on the same middle fingertip. In addition, possible correlations were investigated between the two measurements. SCVs in the digital segment were measured by stimulating at the wrist electrically and recording from two pairs of electrodes in the finger. Fractionated SCVs were also measured in the palm‐to‐finger, wrist‐to‐palm, and elbow‐to‐wrist segments. The subjects were 52 patients with vibration syndrome and 40 healthy controls of similar age. SCVs in the digital segment and the wrist‐to‐palm segment were significantly slower in the patients than in the controls, and VPTs were higher in the patients. The strongest correlation of VPTs with SCVs among nerve segments measured was shown in the digital segment. With all increase in VPTs. SCVs in the digital segment tended to be slower, and slowed digital SCVs were encountered more frequently: 13% in VPTs below 5.0 dB and 56% in VPTs above 17.5 dB. Slowed digital SCVs were found in 43% of the patients and increased VPTs were encountered in 92%. © 1996 Wiley‐Liss, Inc.

Although the causes of stroke are diverse, thromboembolism due to a mobile aortic thrombus is rare. We describe a surgical case of acute massive pulmonary embolism after critical cerebral infarction associated with a mobile ascending aortic thrombus in a 52-year-old woman. Concomitant surgical removal of the aortic thrombus and pulmonary embolectomy was performed successfully, and the patient has been stable without recurrent thromboembolic complications after 18 months of follow-up.

Additional internal fixation using an HA/PLLA sternal pin significantly improved the stability of sternotomy closure in the anterior-posterior and cranial-caudal directions within a small deviation.