Aspergillus infective endocarditis (ASIE) is a very rare disease that carries an extremely poor prognosis. We report a case of ASIE successfully treated by a tricuspid valve replacement and administration of an antifungal drugs. The patient was a 69-year-old man who was taking steroids for an autoimmune disease and was admitted to our hospital because of a persistent fever of 39°C. As chest CT showed infiltrative shadows in both lung fields and the aspergillus antigen was detected in the blood, we diagnosed invasive pulmonary aspergillosis (IPA), and initiated administration of micafungin sodium (MCFG). Later, the patient's heart failure worsened, and echocardiography revealed vegetation measuring 8 mm in diameter in the anterior cusp of the tricuspid valve. As this indicated a definitive diagnosis of ASIE, administration of voriconazole (VRCZ) was initiated. However, the vegetation grew into a movable wart measuring 20 mm in diameter within a week, based on which a diagnosis of drug-resistant ASIE was made, and surgery was considered indicated. Very large vegetations were found in the anterior cusp of the tricuspid valve, anterior papillary muscle, the tendinous chord of the medial papillary muscle and the trabeculae carneae of the right ventricle. Based on the findings, it was judged that tricuspid annuloplasty was impossible and tricuspid valve replacement was performed using a biological valve. As to the antifungal medication, long-term administration of VRCZ and MCFG was continued. The patient followed a favorable course and was discharged from the hospital on the 220th day. The patient aking lifelong VRCZ and has shown no evidence of recurrence of the ASIE. To improve the prognosis of ASIE, rapid and radical surgical resection of the vegetations and appropriate administration of antifungal drugs are important.

We evaluated the surgical strategy for thoracic aortic aneurysm associated with abdominal aortic aneurysm. From January 1982 to March 1999, 24 consecutive patients underwent surgical treatment for thoracic aortic aneurysm with abdominal aortic aneurysm. Staged operation was performed if one was only slightly dilated, but extensive operation was needed if the size of both aneurysms was greater than 6cm. In cases of thoracic aortic aneurysm with abdominal aortic aneurysm up to 4cm in size, surgical treatment was performed only for the thoracic aortic aneurysm. Circulatory support during operation was established from the ascending aorta, and circulatory arrest with deep hypothermia and retrograde cerebral perfusion were used for brain protection during surgery for thoracic aortic arch aneurysm. Hospital mortality was 12.5% (3/24 cases). The causes of death were cerebral infarction and respiratory failure. Antegrade systemic perfusion and aortic no-touch technique were an effective method of surgery for thoracic aortic aneurysm with abdominal aortic aneurysm to avoid perioperative embolism and major complications. We successfully performed staged operation, but regular radiographic follow-up was needed.

A 30-year-old woman who had no specific symptom was diagnosed with Turner syndrome at the age of 6 years. Subsequently, she was followed up at a hospital. However, she stopped going to the hospital when she was 18 years old. At 30 years of age, she underwent examinations involving echocardiography and enhanced chest CT at a hospital, which revealed severe aortic valve regurgitation and extreme dilatation of the aortic root. We performed the Bentall procedure through a median sternotomy following which she had an uncomplicated postoperative course. Aortic root enlargement increases the risk of aortic dissection in patients with Turner syndrome. However, no aortic events occurred before the surgery in this case. We considered the reason was related to the mosaic karyotype of this case.

Diffuse axonal injury (DAI) is identified as one of the most important causes of cognitive disorders in patients with traumatic brain injury. Radiologic recognition of DAI can help in understanding the clinical syndrome and in making treatment decisions. However, CT and conventional MRI are often normal or demonstrate lesions that are poorly related to the cognitive disorders present. Recently, diffusion tensor imaging (DTI) and fiber tractography (FT) have been shown to be useful in detecting various types of white matter damage. The aim of this study was to evaluate the feasibility of using DTI and FT to detect lesions in DAI patients, and to correlate these DAI lesions with the patients' cognitive disorders. We investigated 9 normal volunteers and 9 patients with DAI. The DAI patients had impaired intelligence, as well as attention, memory and executive function disorders that restricted their activities of daily living. In the DAI patients, DTI showed abnormal brain areas in the corpus callosum, fornix, frontal and parietal lobe white matter, and FT revealed interruptions of the white matter fibers in the corpus callosum and the fornix when compared with the normal volunteers, while no lesions were found on conventional MRI. DTI and FT can directly visualize DAI lesions, which cannot be reliably detected by conventional methods. Accordingly, both DTI and FT may be useful techniques for the evaluation of DAI, and may have the potential to be applied to planning rehabilitation therapy, and predicting the neurologic prognosis in DAI patients with cognitive disorders.

Periannular abscess and mycotic aneurysm due to infective endocarditis are very difficult conditions to treat surgically. Beginning in 1983, we introduced a translocation technique on 9 such cases. In particular, 7 patients who underwent a new sutureless translocation technique all showed an uneventful course and were discharged. There was no hospital death, but four patients died in the late period (2 heart failure, 1 ventricular tachycardia and 1 thrombotic valve). The sutureless translocation method consists of insertion of a composite valve into the ascending aorta (a ring was detached from an intraluminal ringed graft and a prosthetic valve was sutured to it at that point) and coronary artery bypass grafting to the right and left coronary arteries. Our new technique was simple, required only a short aortic clamping time (mean 173.9min) and there was no significant bleeding. This new translocation technique provides a solution for the treatment of periannular abscess and mycotic aneurysm due to infective endocarditis.

Diagnosis of cardiac rupture caused by blunt trauma is sometimes difficult when multi-organ injuries are associated with profound shock. Only prompt diagnosis and urgent treatment can save the patients. We have encountered 16 cases of blunt cardiac rupture, including 4 that survived in the past 10 years. All cases of cardiopulmonary arrest on arrival were unable to be resuscitated. Also, all cases of profound hemorrhagic shock caused by multi-organ injury succumbed. Among the cases in which the region of cardiac rupture was identified, only cases of injury to the right heart chambers were saved. No case of rupture in the left heart chambers survived. It is definitely important to suspect cardiac injury and make a prompt diagnosis to save patients with blunt chest trauma. Ultrasonic cardiography is highly effective for urgent diagnosis of cardiac rupture because it can be performed readily, noninvasively and, therefore, repeatedly.

We encountered two patients complaining of hiccups following the resection of subaural tumor or subarachnoid hemorrhage. In one patient, we measured the autunomic nerves of Ryodoraku, and placed grains of silver on Ryodoraku points which showed abnormal values. We also used the in situ needle technique on acupoints which were considered to be closely related to the phrenic nerve. Furthermore, we inserted round-head subcutaneous needles in auricular acupoints such as “Kaku”, “Shinmon”, “Hishitsuka”, and “Jichu”. After repeating the above treatment twice, the hiccups disappeared completely. In the other patient who had difficulty even taking off clothes, a subcutaneous needle was inserted into “Kaku”, which was repeated twice a week. After five months, the hiccups disappeared completely.
Based on our experience with the two patients above, we had the impression that auricular acupuncture is particularly effective. “Kaku” was the main acupoint used, which is believed to influence the diaphragm. We believe that this technique can therefore be used clinically in the future.

Xenon beam wide wave-length including ultraviolet, visible and ultrared rays.
What effects are produced for the human body by using xenon beam effective on the removal of the living body pain?
After patients suffering from low back pain were radiated by xenon beam, their finger-floor distances were measured.
It was examined and compared with the results after using micro wave therapy.
As a result, in xenon beam therapy group, the more the number of times of stimulation was, the shorter the finger-floor distances became gradually, and after more than five times of stimulation, shortening of them was apparent (p<0.01).
Moreover it was known that shortening could be kept in xenon beam therapy group.

Xenon photorays are incoherent waves like the sun rays, but it shows a bright line spectrum. Each bright line exhibits a form similar to the laser spectrum waves. The microwaves have been conventionally used to deliver stimulation to the deep tissues. The effects of the xenon photorays and microwaves on the range of motion in scapulohumeral periarthritis were compared.
Our findings indicated that xenon photorays were superior to the conventional microwaves in bringing about improvement of the range of motion in scapulohumeral arthropathy.