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Five patients with non-severed traumatic arterial obstruction of the extremity were treated during the last four years. Three were males and two were females. The mean age was 33 years with a range of 5-55 years. The cause of injury was a traffic accident in two patients and in the other three, it was industrial, domestic or iatrogenic. In three patients the obstruction was accompanied by a fracture. The anatomical location of the lesion in the five patients was the external iliac, common femoral, popliteal, axillar or brachial artery respectively. The nature of the obstruction was thrombosis in two patients and extrinsic compression or kinking in three.Only in two patients was the blood supply restored within six hours after injury. In the other three patients, it was restored in about 53, 93 or 172 hours. In all patients, the postoperative course was uneventful.In general, the permissible time lag between the injury and arterial repair is thought to be 6 to 8 hours, but this time lag is not absolute.

A case of jejunal diverticulosis with massive melena, of which bleeding point was locally diagnosed by preoperative angiography, is reported. A 52-year-old male with the complaint of massive melena was admitted in pre-shock state. As anemia was not improved by conservative therapy and selective superior mesenteric angiogram revealed a bleeding lesion in the jejunum, emergency operation was performed. Two diverticula were recognized at the mesenteric border of the jejunum about 50cm and 130cm below the ligament of Treitz. Both of them were bilocular, and linear ulcers were found at their septums. A stump of artery was exposed in the ulcer of oral side diverticulum and the source of the bleeding was found macroscopically. Histopathologically a linear ulcer and ruptured artery at the bottom of the ulcer were shown and the additional discussion was made from a point of clinical surgery.

During the past five years, arterial reconstruction was performed in five cases of chronic maintenance hemodialysis for complications of arteriovenous fistula. The subjects were three males and two females. The cases of arteriovenous fistula with complications involved three cases of arteriovenous fistula between the cutaneous veins proximal to the brachial artery, one case of gore-tex graft arteriovenous fistula between the brachial artery and vein and one case of bovine graft arteriovenous fistula between the femoral artery and vein. The complicatons for which arterial reconstruction was necessary involved four cases of intrafistular infection and one case of acute arterial embolism. In the four cases of infection, autoplasty of the venous bypass was performed, bypassing the involvement and passing under the medial skin at the elbow joint area. This course was considered to be appropriate because the graft was not bent by movement of the joint. In the one case of arterial embolism, embolectomy was performed with a Fogarty catheter. The most troublesome complication was that of infection, and much care must be taken to prevent infection in arteriovenous fistulation or intrafistular puncture.

A 28-year-old man was evaluated for complaining of dyspnea. Chest X-ray film revealed a right sided pneumothorax with complete collapse. A thoracic tube was inserted and slowly drainaged, because there was a possible occurrence of Reexpansion pulmonary edema (REPE) with a lapse of 42 days after the onset. About 3 hours after drainage, he complained of cough, dyspnea and chest pain. Chest X-ray film revealed glass-like shadows. Immediately, thoracic tube was connected to the continuous suction at the pressure of -12 cmH2O. At the same time, 0.2 supply and injection of steroid were started. On the next day, these symptoms were improved. His chest X-ray film returned to normal within a week. There were 12 cases of spontaneus pneumothorax during the past 3 years in our hospital, of which 3 were complicated by REPE. In all the 3 cases, complete collapse of the lung due to pneumothorax had existed for 3 days or more. In the treatment of these cases, it is necessary to consider REPE.