Patulous Eustachian tube (patulous ET) is not a rare disease, for which the prevalence rate is considered to be higher than 5%. Autophonia and ear fullness are common symptoms of patulous ET. Various treatments in cluding drug therapies and surgical procedures are attempted, although they do not give satisfactory results.
In oriental medicine, patulous ET is considered a Qui deficiency and/or blood deficiency. And Kamikihito is known as a popular Kampo prescription for patulous ET. Here we report the effect of hochuekkito on Patulous ET. Hochuekkito was administered to 10 patients, and complete improvement was had in 4 cases, partial im provement in 1 case and 5 cases had no change. Elevated ET tonus, gains in fatty tissue surrounding the ET, and influence on psychogenic factors were speculated as mechanisms by which hochuekkito brought about its effect.
Through this report, we expect that hochuekkito can be an alternative treatment for patulous ET.

Introduction
In elderly patients, chronic subdural hematoma is often associated with such complications as cardiac disease, asthma and bronchiectasis. Acupuncture anesthesia was given to a group of such patients instead of endotracheal anesthesia.
Method
Anesthesia was applied to acupoints of chinese acupuncture anesthesia from ante to just post operation. Patients were four men and one woman ranging from 64 to 73 years old who had not only fundamental disorders such as right bundle-branch block, atrial fibrillation, myocardiopathy, asthma and bronchiectasis, but also had comparatively disturbed levels of consciousness. One of them was incompatible with endotracheal anesthesia. Another patient received acupuncture anesthesia together with an injection of diazepan (10mg) and pentazocine (30mg).
Conclusion
The postoperative course in these five cases was uneventful and all of them left the hospital unassisted.

We investigated muscle activities of the scapular muscles during low row procedure (LR) usually used 12 weeks after a rotator cuff repair, and evaluated its effective application period comparing with scapular retraction procedure (SR) used for early postoperative period. Twelve healthy adults (mean age, 26.8 years) were enrolled in the current study. %MVICs (maximal voluntary isometric muscle contractions) of middle trapezius, lower trapezius, serratus anterior, posterior deltoid, and infraspinatus were calculated from the surface electromyography during both LR and SR. The %MVIC of either the middle trapezius or lower trapezius was not significantly different between during the LR and the SR. The %MVIC of the serratus anterior, posterior deltoid and infraspinatus during the LR was significantly higher than those during the SR (p=0.018, p<0.001, p<0.001, respectively). Additionally, the %MVIC of the posterior deltoid and infraspinatus in the SR was less than 20%. In training phase after rotator cuff repair, LR was considered to be effective procedure for most of the scapular muscles 12 weeks after a surgical repair of the rotator cuff. However, LR earlier than 12 weeks after the surgery is considered to yield a risk of re-tear of the rotator cuff, and SR may be a preferred training procedure in this early phase.

We performed endovascular stent grafting of a perforated descending aorta, caused by empyema after surgery for lung cancer, in a 75-year-old man. After diagnosing hemorrhage from a perforation of the proximal descending aorta, caused by left empyema, the perforation was repaired with a saphenous vein patch and a pectoralis major muscle flap. However, re-hemorrhage from the same lesion occurred 2 months postoperatively. Temporary hemostasis was achieved with gauze packing and he was transferred to our hospital for endovascular stent grafting. The infection did not resolve after fenestration, so the descending aorta was cropped out to the fenestration lesion. Therefore, endovascular stent grafting was performed on the same day. Postoperatively the bleeding stopped completely without any signs of graft infection, and he was transferred to another hospital on postoperative day 9. No re-hemorrhage or graft infection of the aortic perforative lesion occurred in the early postoperative period. However, the patient died of massive bleeding from the aorta wall of the proximal stump of the stent graft, caused by recurrence of the infection 2 months after the 2nd operation. In this situation, endovascular scent grafting provides the only chance of saving the patient's life. If endovascular stent grafting is performed as a lifesaving procedure, meticulous operative technique is imperative.

In order to reduce the blood transfusion volume in open heart surgery, the new blood autotransfusion technique using cardiotomy reservoir unit BCR 3538, which was configured to serve also as a receptacle for postoperative mediastrinal drainage, was introduced. To investigate the utility and the problem in this system, every clotting factor, platelets' function and the extent of the hemolysis were measured serially both in patients' arterial blood and the shed mediastinal blood. The bank blood transfusion was significantly reduced to 250ml±330ml by this system compared to the 1080ml±820ml in the cases of usual system (p<0.01). Every clotting factor recovered well in patients' arterial blood after cardiopulmonary bypass (CPB). In the reservoir blood, the clotting factor IX, XI, XII were extremely suppressed at 1h CPB, and 3h after the CPB, every clotting factor except fibrinogen (42±28mg/dl) showed the quite higher activity, such as factor VIII 400%, IX 365%, XI 72%, XII 267%. Namely, the anticoagulability of the reservoir blood was maintained due to the effect of the residual heparin at 1h after the CPB, and due to the contact defibrinogation of the shed mediastinal blood at 3h after CPB. The free hemoglobin level was extremely high on the reservoir blood at 3h after CPB. In 6 cases, the autologous blood retransfusion was abandoned by clott formation in the unit because of the contamination of the intraoperatively used fibrin glue. From this study, the autologous blood transfusion using cardiotomy reservoir BCR 3538 was useful not only for saving the transfusion of the bank blood but also the hemostasis after CPB. But to reduce the hemolysis in this system, and to establish the safety against the other clotting material such as fibrin glue were the problems which should be resolved in future. I appreciate the kind support of Alexander von Humboldt Foundation for this study.

A 47 year-old man with frequent attacks of ventricular tachycardia (VT) due to arrhythmogenic right ventricular dysplasia (ARVD) developed severe right heart failure following cryoablation of the multiple VT focuses. Inotropic support and intraaortic balloon pumping failed to maintain the systemic circulation, so that we performed the right heart bypass (RHB) using a heparin-coated tube and roller pump. With the use of RHB, systemic circulation improved. We attempted to wean the patient off after 14 days RHB support. However this was unsuccessful because of poor RV function, and RHB was recommenced. The patient finally died of multiple organ failure on the 21st postoperative day, but the major organ function was well maintained for at least two weeks. The heparin-coated tube and roller pump system is easy to handle, and is suitable as a short term lifesaving adjunct for severe right ventricular failure.

We applied a new circulatory support system to three patients with descending aortic operation between 1989 and 1990. The new system consisted of a polyvinylchloride tube coated with hydrophilic heparinized polymer and a roller pump. Low doses of heparin (0.5mg/kg) were administered in two patients and none in one patient before aortic bypass. The aortic crossclamping time ranged between 52 and 64 minutes. In two patients, whose inflow cannulae were 18Fr. or 20Fr., successful bypass flow exceeded 2l/min and optimal distal aortic pressure were maintained during aortic cross-clamping. The postoperative courses of these patients were uneventful, free from thromboembolic episodes and subsequently discharged from hospital. Furthermore, postoperative careful examination revealed no thrombus formation occurred in the three devices. In conclusion, our new simple, antithrombogenic circulatory system is extremely useful for descending aortic operations.

Five patients with isolated stenosis of the left main coronary artery or stenotic ostial lesions underwent direct coronary artery surgery. These surgical approaches included vein patch angioplasty in 2 cases, punch out endarterectomy in 1 case, and resection of the thickened aortic wall and transaortic endarterectomy in 2 cases. Early results were satisfactory, except for one case who died due to severe LOS and MOF. In the late postoperative period, one case of vein patch angioplasty died due to cerebral bleeding, and in the other case, stenosis existed in position of distal patch anastomosis. Since direct coronary artery surgery was successful in both early and late postoperative fidings, it is believed to be useful and safe technique if the candidates are selected properly.

A minimally invasive approach to coronary artery revascularization without cardiopulmonary bypass has been performed recently and its feasibility and effectiveness have been proved. However, occlusion of the coronary artery during anastomosis in the beating heart is liable to cause myocardial ischemia or infarction. To prevent these and to perform minimally invasive coronary artery bypass on the beating heart safely, intra-coronary shunt was developed and applied in animal experiments. Materials and methods: The left internal mammary artery was harvested endoscopically and anastomosed to the left anterior descending coronary artery in the beating heart without cardiopulmonary bypass in seven pigs. Three of them utilized intracoronary shunt tubes (group S) and the other did not (group C). Results: Use of an intracoronary shunt tube facilitated non-blood exposure of the coronary artery during anastomosis. In group C, three pigs out of four had ventricular fibrillation during occlusion for the anastomosis. In group S the anastomosis was accomplished without change of ECG except one case and without any elevation of CPK-MB and Troponin T during and after the anastomosis. Conclusion: These results showed that an intra-coronary shunt can prevent myocardial ischemia and may be very useful especially to those who do not develop collateral branches from other coronary arteries.

Investigation was made into the health care conditions in a rural district in Akita Prefecture. Topographically, the district is divided into two parts-one characterized by mountain and the other by flat terrain.
1. In remote, depopulated villages, per capita cost of public health is on the increase.
2. The number of health personell, particularly public health nurses, is not enough to carry on various health programs.
3. With the prospect of greater numbers of the aged in society, there is an urgent need for increased medical services along with the consolidation of primary health care. In order to meet the need, it is necessary to establish a regional community health system comprised of a hospital as a nucleus and neighborhood medical instituions such as clinics and health centers.