We report a case of idiopathic thrombocytopenic purpura (ITP) accompanied by steroid-induced avascular necrosis of the femoral head in a 68-year-old woman. Extremely low platelet counts of ITP patients prohibit any surgical interventions. Her platelet count was 25,000/μL. We performed a total hip arthroplasty with high-dose immunoglobulin therapy and transfusion of platelet concentrates. Her platelet count increased to 94,000/μL just before the operation. No hemostatic complications were encountered perioperatively, and the postoperative course was uneventful. She left the hospital 20 days after the operation with a T-cane. Her platelet count decreased to 34,000/μL on the day she left the hospital. Three years after the operation, she had no groin pain and could walk without ambulatory assistive devices. We did not observe implant loosening.

A 64-year-old man who underwent aortic valve replacement with a 25mm Bjork-Shiley valve in 1993 began to have severe anemia and required repeated transfusions by November 2003. Doppler echocardiography showed only mild aortic regurgitation, but revealed turbulent flow around the mechanical valve. Autoimmune hemolytic anemia (AIHA) was diagnosed and he was treated with prednisolone (PSL) starting May 2004. Because of unremitting hemolysis requiring multiple transfusions and the occurrence of renal dysfunction, he underwent rereplacement of the aortic valve with a 25-mm Freestyle valve. His hemolysis and general condition immediately improved. This case suggests the possibility that mild regurgitant jet and turbulent jet stress can cause severe hemolysis when AIHA develops.

The main objective of this study was to describe the long-term results of left internal thoracic artery grafting of the left anterior descending artery with a sternotomy or anterior minithoracotomy without using extracorporeal circulation. From March 1997 to February 2000, a median sternotomy was performed in 8 patients and a minithoracotomy in 22 patients. We compared and analyzed the findings of these groups. An emergency operation was performed in 75% of the patients in the median sternotomy group and in 27.3% of those in the minithoracotomy group (p=0.03). The operation time was 2.1h in the median sternotomy group and 3.9h in the minithoracotomy group (p<0.01). The early graft patency rate was 100% in the median sternotomy group and 90.4% in the minithoracotomy group (NS). The five-year actuarial survival rate was 100% in the median sternotomy group and 86.4% in the minithoracotomy group. The five-year cardiac event free rate was 100% in the median sternotomy group and 86.4% in the minithoracotomy group. In conclusion, the results for the median sternotomy group were comparatively better than for minithoracotomy group. Minithoracotomy and median sternotomy have differences in operation time, early graft patency and early outcome. The median sternotomy technique therefore remains an invaluable operative modality for the treatment of one-vessel disease.

Purpose: Many types of antihistamines used for the treatment of allergic rhinitis induce drowsiness as a side effect. Whether or not patients taking the internal drugs know of this untoward effect is a matter of importance. Recently we conducted a questionnaire survey to know how many patients are aware of this.Method: The subjects were 257 patients who visited our hospital for treatment of alergic rhinitis and took the prescription from February through March this year. The patients filled in a questionnaire given at the window of the dispensary. All the participants in this survey gave their informed consent.Results: Effective replies (90.3%) were obtained from 232 patients (mean age: 53.5±17.5; sex: 85 males and 147 females). Of those respondents, 45 individuals (19.9%) said they did not know that the antihistamines produce drowsiness. Furthermore, the survey found that 24 out of the 45 individuals were actually taking the type of antihistamine that caused drowsiness and 21 individuals were not given any explanation of the side effect by their doctors. The patients said that if they knew of the side effect they would not have taken the medicine. Moreover, it was found that 10 out of the 21 patients drove their cars while they felt drowsy.Conclusions: The survey revealed the hard fact that the drowsiness as side reaction the patients might have after taking antihistamines was made light of. The findings brought home to us the importance of giving clear directions to the patients about the medicine and the precaution against the side effects.
Drowsiness ; Surveys ; Antihistamines ; adverse effects ; Effective

We investigated the history and indications of Toenho, Kinseiho, and Cho-Sanshaku-Shinteiho, which are different formulae with the same name of seishoekkito. According to the description in “Futsugoyakushitsuhokankuketsu” written by Sohaku Asada, Kinseiho exhibits an immediate effect, while Toenho has preventive effects. However, according to the original text, Kinseiho was formulated such that it could be administered regularly in the summer for prophylaxis. Furthermore, Kinseiho is regarded as a simplified formula with the central structure of Toenho. This implies that Kinseiho is composed of selected crude drugs used in Toenho that are responsible for the main effects of Toenho, such as invigorating spleen energy, clearing fever and generating body fluids. Moreover, there is an instruction to arrange Kinseiho to fit each patient’s condition. In this study, it was found that Cho-Sanshaku-Shinteiho described in “Futsugoyakushitsuhokankuketsu” is a modification of Kinseiho prescribed by Katsuki Gyuzan for patients with fever, consistent with the concept of personalized medicine. The medical extract preparation seishoekkito, which is currently widely used, is Kinseiho. We may use it with heat-clearing formula, fluid-regulating formula or some modifications to make the appropriate formulation based on the patient's symptoms.

A 57-year-old man, who had suffered chest, back and right leg pain about 10 years before, underwent CT and was found a chronic type B aortic dissection with an enlarged false lumen and a narrowed true lumen that was occluded at the infrarenal abdominal aorta. A conventional surgical repair seemed to be too high risk considering his comorbidities, thus we chose a staged hybrid repair. First, surgical repair of the abdominal aorta with an abdominal aortic fenestration was performed. Then, one month after the first operation, zone 2 thoracic endovascular aortic repair with left carotid-axillary artery bypass was performed. At the second operation, the stent graft was purposely deployed from zone 2 into Th12 level of a false lumen through the fenestration followed by coil embolization of a true lumen just distal to the entry tear. The postoperative course was uneventful and he had no complications at 6 months follow-up. Deploying stent graft into a false lumen could be a feasible option in case deploying into a true lumen is not suitable if the anatomical condition permits.

BACKGROUND: Osteoporosis is considered a public health problem with high worldwide prevalence. One approach to prevention is through the promotion of physical activity, especially exercise, during adolescence. METHODS: This study compared bone variables in different body segments in adolescents according to participation in track and field. The study included 34 adolescents (22 boys), of whom 17 were track and field athletes and 17 were control subjects. Bone mineral density (BMD, g/cm2) and bone mineral content (BMC, g) were analyzed using dual energy X-ray absorptiometry (total body stratified by body segments). Peak height velocity was used to estimate somatic maturation. RESULTS: Athletes had higher BMD (P=0.003) and BMC (P=0.011) values in the lower limbs and higher whole body BMD (P=0.025) than the control group. However, when adjusted for confounding factors, the difference was not maintained. The groups had similar lean soft tissue values (P=0.094). Training overload was positively correlated with BMD in the upper limbs (r=0.504; 95% confidence interval, 0.031-0.793). Although track and field athletes had higher BMD and BMC values in the lower limbs, these differences were not significant when adjusted for confounding factors. CONCLUSIONS: Track and field participation in adolescence appears to influence BMD and BMC in lower limbs, and fat-free mass seems to mediate this effect. Also, higher training loads were found to be positive for bone health in upper limbs.
Absorptiometry, Photon ; Adolescent ; Athletes ; Bone and Bones ; Bone Density ; Child ; Humans ; Lower Extremity ; Motor Activity ; Osteoporosis ; Pilot Projects ; Prevalence ; Public Health ; Sports ; Track and Field ; Upper Extremity