Coronary artery disease is common in patients with abdominal aortic aneurysm and arteriosclerosis obliterans, and one-stage or two-stage coronary artery bypass grafting have been performed. However, few operative cases of concomitant heart valve disease and arteriosclerotic disease have been reported. This case presented with severe aortic valve regurgitation (LVEF 24.3%) and arteriosclerosis obliterans (ASO) of both iliac arteries. To maintain the IABP catheter route and to prevent lower limb ischemia, aortic valve replacement with a bileaflet mechanical valve and abdominal aortic replacement with a bifurcated graft were carried out simultaneously. In spite of the high degree of operative invasiveness with median sternotomy and abdominal incision, the postoperative course was uneventful due to the shortened operation time and maintenance of good peripheral circulation.

Patients with mechanical valve prosthesis must receive long-term oral anticoagulant therapy, thus it is important to set the optimal international normalized ratio of prothrombin time (PT-INR) that effectively prevented thromboembolic complications without excessive bleeding. In this study, anticoagulant therapy was evaluated in terms of the activity of coagulation and fibrinolysis in 137 patients after isolated mechanical valve replacement. With a lower target range of 1.5-2.0 for the PT-INR, thrombin antithrombin III complex (TAT) increased to more than 3.0ng/ml in 30 cases, and the activity of coagulation appeared to increase due to insufficient anticoagulant therapy. After the target range was raised to 2.0-2.5 in all cases, the PT-INR increased significantly from 1.63 to 2.25 (p<0.01) and TAT decreased significantly from 7.58 to 2.81ng/ml (p<0.01). This showed that activity of coagulation and fibrinolysis was suppressed by high intensity anticoagulation. It is necessary to review the individual activity of coagulation and fibrinolysis to determine the intensity of anticoagulation. We recommend 2.0-2.5 as the target range for the PT-INR.

A 68-year-old female had been diagnosed with granuloma annulare a year earlier. She was prescribed tranilast and was recovering, but had to discontinue the tranilast because she suffered liver damage as a side effect.
She was also suffering from a worsening rash and so decided to try Kampo medicine. We prescribed orengedokuto because of thermal symptoms suggestive of hot flushes, the appearance of her tongue, and the character of her rash. Initially, the rash improved, but from the 3rd day following admission did not change greatly. We suspected the existence of interior cold and started combining maobushisaishinto. Five days later, the granulomas had rapidly shrunk. We believe she had overlapping diseases of a yin and yang pattern from the fact that she improved clinically.

We report two cases of chest and abdominal symptoms, the causes of which can not be established in a medical sense, successfully treated with daisaikoto. The first case was an 81-year-old male. He complained of tightness in his chest. Since the frequency of his symptom was increasing, he underwent further evaluation in hospital, but no abnormalities were found. We administered daisaikoto with reference to his constipation and kyo-kyo-kuman (subchondrial resistance and discomfort), the tightness in his chest disappeared and three months later his qi stagnation score and SDS score had improved.
The second case was an 83-year-old male. He had been suffering epigastric pain, tightness of chest and abdomen and a feeling of fullness in the abdomen since two years previously, when he suffered multiple traumatic injuries. We administered daisaikoto in light of his epigastric pain, constipation and kyo-kyo-kuman.The epigastric pain and tightness of the chest and abdomen gradually disappeared, and the number of his unscheduled visits to the clinic decreased.
Thus, daisaikoto may be used to treat patients with chest or abdominal symptoms and depression, the cause of which can not be established in any medical sense.

We report five cases of painful swelling caused by hymenoptera stings and centipede bites treated with ourengedokuto and inchingoreisan soon after the time of injury. The first case was a 70-year-old male. He was stung by a hornet on the left hand 30 minutes prior. The second case was a 45-year-old male. He was stung by a hornet on the left face 20 minutes prior. The third case was a 55-year-old male. He was stung by a hornet on the left lower thigh 10 minutes prior. The fourth case was a 39-year-old male. He was stung by a hornet on the right thigh 60 minutes prior. The fifth case was a 35-year-old male. He was bitten by a centipede on the right first toe 20 minutes prior. All cases received Kampo therapies immediately and continued them every few hours. In all cases, their pain, redness and swelling at the site of injury were relieved by the next day. We consider Kampo therapies can contribute to the healing of hymenoptera stings and centipede bites at an early stage.

Sokeikakketsuto was administered to 33 patients with recurrent cramps of the calf appearing once a week or more and persisting for 2 weeks or more. Treatment response was evaluated 1 month after the start of drug therapy. Patients whose cramps disappeared immediately after starting were regarded as showing a complete response, those with disappearance after 1 month as showing a partial response, those with a reduction to <50% after 1 month as showing a slight response, and those in whom 50% or more of cramps persisted after 1 month as showing no response. A complete response was achieved in 12 patients, a partial response in 11, a slight response in 9, and no response in 1. In 23 (69.6%) of the 33 patients, cramps disappeared within 1 month after the start of drug therapy. In 32 (96.9%), there was a reduction to <50%. In 29 (87.8%) of the 33 patients, cramps disappeared within 3 months, suggesting the efficacy of this drug. Two-package administration in the evening/at bedtime was more effective than 1-package administration for controlling cramps of the calf at night until early in the morning. The intensive pre-attack administration of 2 packages before sleep was the most effective. Sokeikakketsuto may be useful for treating recurrent cramps of the calf.

Purpose & Methods: With the aim of investigating how early palliative care intervention should be provided, we conducted questionnaire-based screening and QOL evaluations of patients undergoing first-line chemotherapy before and at 3 to 4 weeks after the initiation of treatment, using "a questionnaire on the ease of daily living" and the EuroQol (EQ5D), respectively. Results: Of the 66 patients who participated in this investigation, 56 completed the second survey. With respect to "Concerns and Worries", more than half of the respondents complained concernes/worries about "Conditions and/or Treatments" both before and after chemotherapy, but there were changes in content between the first and second surveys. "Physical Symptoms" were experienced by more than 80 percent of patients before treatment. After treatment, 13 patients saw improvement or disappearance of their symptoms and 22 patients experienced new symptoms. "Emotional Distress" decreased after treatment. This decrease was more pronounced among patients who expressed concerns about their conditions and/or treatments in the first survey. EQ5D health utility scores tended to decrease in patients who had presented with adverse reactions, but improved in those free of adverse reactions. Conclution: Changes were observed in patients' palliative care needs before and after the initiation of first-line chemotherapy, which indicates a need for sequential screening over the course of treatment.

In our medical district, home care physician-led liaison system has not yet been established for pain relief using a patient-controlled analgesia（PCA）pump. Therefore, it has been difficult to perform continuous opioid infusion at home. We investigated the liaison system based on our experience with breast cancer patients in whom oral drug administration became difficult during palliative care at home and thus continuous opioid subcutaneous infusion was started in cooperation with a palliative care hospital team and based on the discussion among home care study group physicians of the medical association. Based on the results of our study, we established the system called“Home PCA Raku-raku（Easy）Pack”that are characterized by the following：（1）opioids are prescribed by a home care physician；（2）a certified cancer pain management nurse accompanies a nurse to visit the patients’ home, assesses their conditions, and changes the drug solution；（3）the pump rental fee is paid by the home care physician, and the cost of consumables is paid by the hospital；and（4）the home care physician calculates the fee for home management of malignant tumors, and the hospital calculates the collaborative medical management fee and the visiting nursing management fee. This system was applied to 6 patients during a period of approximately 2 years. The result of a questionnaire survey for home care physicians and visiting nurse stations using this system showed that the system was generally beneficial.

Objectives: A cancer salon was established at Jichi Medical University Hospital in April 2014 operated based on the plan-do-check-act (PDCA) cycle. This study aims to understand the actual situation of the cancer salon and outcomes of participants, and utilize the information for optimal administration. Methods: The cancer salon was open to the public and conducted in our hospital. The program consisted of mini-lectures, relaxation, and interaction with the participants. We conducted a questionnaire survey for the participants. Results: We held 11 sessions from April 2014 to March 2015. The total number of participants was 369, and the average number of participants per session was 34 (22-50). Participants mainly consisted of patients and families who received care in our hospital. A high percentage of participants were women in their 60’s, patients who were newly diagnosed cancer within 3 years, or patients with breast cancer. Participants’ satisfaction tended to be high in lectures and relaxation, and there was a tendency for anxiety to be alleviated in their psychological state. Discussion: We must challenge that we refine quantitative evaluation methods and develop the system of assessment of detailed needs and provide appropriate support. Furthermore, we would like to propagate this system to the area around our hospital, support the development of cancer salons at other medical institutions, collaborate with them, and contribute to the creation of an inclusive society.

Thirteen cases of ruptured abdominal aortic aneurysm were treated during a period of 7 years and 5 months. In 6 cases, left thoracotomy was used before laparotomy to clamp the descending thoracic aorta. The merits and demerits of this method were evaluated in this study. It is useful for early improvement of cerebral and coronary circulation and prevention of sudden spurting hemorrhage, especially in cases with the previous laparotomies. On the other hand, this method has a shorter clamp time limit and requires much time in cases with pleural adhesions. It may increase the amount of operative bleeding and the incidence of postoperative respiratory insufficiency. It may also cause an intraoperative thoracic aortic dissection and rupture of thoracic aortic aneurysms if present. It is considered that this method is advantageous, but should be used only in selected cases.