We used acupuncture therapy to treat a Diffuse Axonal Injury (DAI) patient who had developed delirium that persisted for many months after the traffic accident. The patient was diagnosed with mania-depressive syndrome from an oriental medical perspective, and was treated for blood stagnation and depression of qi and qiblood energy deficiency. The selected meridian points were Baihui, Dazhui, Geshu, Dazhu, Qimen, Taichong, and Zusanli, to Promote improvement of cyclical flow of qi to the brain through the Bladder Meridian and Gorvenor Vessel Meridian. As the early results of acupuncture therapy headache disappeared and the Sleep-Wake Schedule Disorder improved to normal. After 40 sessions of acupuncture therapy, that consciousness level improved and the Japan Coma Scale (JCS) score indicated “alert”. From these results, it was suggested that the cyclical flow of qi to the brain was improved and blood stagnation had disappeared, therefore the symptoms improved. Based on the result of this treatment for a DAI patient, we understood the importance of considering the brain as a meridian, individual from the body.

A 77-year-old woman was referred to our hospital for treatment of a ruptured thoracoabdominal aortic aneurysm (TAAA) with a maximum diameter of 7cm. Considering her age and level of daily activity, the placement of an endovascular stent graft was performed as an emergency rescue procedure. For termination of the endoleak from the distal portion of the stent graft detected by CT the next day, another stent graft placement was added after establishment of blood supply to the superior mesenteric and celiac arteries by placing a Y-shaped graft from the abdominal aorta to each artery with success. The patient was discharged from our hospital 25days after surgery with disappearance of endoleak and good graft patency. A hybrid technique with grafting to abdominal branches, followed by placement of stent graft, can be an alternative treatment for such high-risk patients with ruptured TAAA.

Twister orthoses are used to correct in-toeing and out-toeing, and consist of a pelvic band, a twister cable, and an ankle-foot orthosis (AFO). The twister cable is made of spiral coiled springs and connects the pelvic band with the AFO. Twister orthoses are used for children with lower limb paralysis who in many cases present with a rotation deformity of the hip joint ; however, their use in adults has not yet been reported. We report our experience treating two cases of adult poststroke hemiplegic patients whose gate ability was improved by using twister orthoses.

Objective : With clinical application in mind, we developed a method to measure the movement of a selected joint three-dimensionally as a conic domain (joint sinus cone). The method was applied to shoulder joint motion during daily living activities exercises in a group of hemiparetic poststroke patients. The results were compared to the exercise range of physically unimpaired persons. Methods : The subjects dressed in jackets and performed certain other tasks in a sitting position and the range of motion of the shoulder joint in three dimensions was measured using a 6-dimensional electromagnetic tracking system. Measurement results were analyzed with a plane display using a Lambert Azimuthal equal area. Results : This method was able to determine findings difficult to see with the naked eye, such as the narrow range of motion in a paralyzed shoulder joint and poor functionality also in the contralateral shoulder. Conclusion : The dressing measurement was achieved using magnetic measurement equipment. By displaying the results through a map projection it was possible to appreciate the whole range of the motion. Because this method facilitates the expression of complex joint exercise ranges, it will be useful in the analysis of daily behavior restrictions due to impairment.

A 69-year-old woman, who had undergone a right nephrectomy for renal tuberculosis in her teens, was admitted with a low grade fever, anorexia and progressive dyspnea. Transthoracic echocardiography showed cardiac tamponade and chest CT revealed an enlarged ascending aorta. She was treated with pericardiocentesis. Specimens of pericardial effusion failed to demonstrate any acid-fast bacilli, but they did reveal a high level of adnosine deaminase (72 IU/l). A diagnosis of tuberculous pericarditis was considered, and antituberculous chemotherapy was started. However, he presented with severe back pain 32 days later and CT revealed type A acute aortic dissection. We therefore replaced the ascending aorta and aortic root. A histopathological examination of the ascending aorta revealed evidence of a granulomatous inflammatory reaction with Langhans giant cells. She thereafter received antituberculous chemotherapy with 4 drugs for 2 months, with continued rifampicin and isoniazid treatment. There was no evidence of any graft infection after 70 days.

Background : Constraint-induced movement therapy (CI therapy) is a rehabilitation treatment that effectively improves upper extremity function in patients with chronic hemiparesis after stroke. In Japan, no previous studies have shown the effects of CI therapy in a large size sample, and the Simple Test for Evaluating Hand Function (STEF), a standard assessment tool for upper extremity function, is rarely used to evaluate the effects of CI therapy. Little is known regarding the factors capable of predicting the outcome of CI therapy. The present study aimed to examine potential predictors of outcomes after CI therapy and the effects of CI therapy using STEF. Methods : This study included patients with hemiparesis in the chronic stage of stroke (≥180 days from onset). We compared upper extremity function before and after CI therapy intervention, which involved 5 hours per day for 10 consecutive weekdays of training. We assessed upper extremity function using the STEF, Wolf Motor Function Test-functional ability scale (WMFT-FAS) before and after intervention, and investigated potential predictors (age, gender, time since stroke, type of stroke, side of stroke, hand dominance, spasticity). Results : There were 107 subjects. Our comparison revealed that both STEF and WMFT-FAS scores improved significantly following intervention, from means of 31.3 to 42.7 points and 51.8 to 57.0 points, respectively. No significant predictors that influenced the functional outcome were identified. Conclusion : CI therapy is effective for improving upper extremity function. It is important not to exclude people from CI therapy based on any supposed predictors.

We report the case of a 55-year-old woman with aortitis syndrome. She was admitted to our hospital because of repeated chest pain and syncope. An electrocardiogram and the laboratory data suggested acute myocardial infarction, and coronary angiography showed severe bilateral coronary ostial stenosis. No valvular disease was observed. Aortitis syndrome was suspected because of the stenosis of the brachiocephalic artery in addition to the bilateral coronary ostial stenosis, while the patient did not have elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Coronary artery bypass grafting was performed, and the patient's postoperative course was uneventful. However, she again experienced chest pain 9 months after surgery due to aortic regurgitation (AR) and diffuse narrowing change of the left internal thoracic artery graft. Aortic valve replacement and Re-CABG was performed, and the patient was treated with steroid therapy postoperatively. The postoperative course was uneventful, but the patient thereafter died due to bleeding of a malignant adrenal tumor at 21 months after the second surgery.

Aim:The usefulness of high-density barium, which was made to 150w/v% (MIX150), was examined to obtain better radiographs of the intestines. Methods: “MIX150” was compared with existing pharmaceutical “BAM100” to evaluate x-ray images (barium adhesion, dryness evaluation). MIX150 was used in 232 patients (mean age 56 years), while BAM 100 in 210 patients (mean age 55 years). Results: In terms of adhesion, MIX150 was excellent in the the cecum significantly and in dryness evaluation, in the entire region of the colon. Conclusion: High-density barium (150w/v%) was useful for enhancing the quality of radiographic images.
physical density ; Euphoric mood ; Roentgen Rays ; Barium ; Lower case vee

A sinus of Valsalva aneurysm is a rare cardiac disorder, and reports of it with an anomalous origin of the coronary artery are scarce. A 35-year-old male was admitted to our department with fatigue and cough. Multi-detector-row computer tomography (MDCT) revealed an isolated extracardiac right sinus of Valsalva aneurysm with an anomalous origin of the left circumflex artery (LCX) and total occlusion of the right coronary artery (RCA). Its diameter was about 70 mm. We performed a partial aortic root remodeling procedure with a trimmed J-graft because he had neither aortic regurgitation (AR) nor annuloaortic ectasia (AAE). Concomitantly, coronary artery bypass grafting to the RCA (Seg. 3) using a saphenous vein, and reconstruction of the LCX by Piehler's technique using a saphenous vein were added. The patient's postoperative course was uneventful, and he was discharged on the 28th postoperative day. Postoperative MDCT revealed that the aneurysm of the right sinus of Valsalva was not enhanced, and the RCA and LCX were patent. This procedure preserved the patient's own normal aortic valve and sinus of Valsalva and enables him to have more physiologically normal hemodynamics than aortic root reconstruction using a composite graft, e.g. Bentall procedure, Cabrol procedure, although the potential progression of the AR requires careful follow-up.

  The Association of Radiologists under the umbrella of the Hokkaido Prefectural Federation of Agricultural Cooperatives for Health and Welfare (Hokkaido Koseiren) set up in 2003 a committee with the aim of improving the accuracy of mass health examinations. Recently, the committee reviewed the results of abdominal examinations by sonography performed at the eight hospitals affiliated with the Koseiren during fiscal 2006 that ended March 31, 2007. Of those individuals who underwent thorough health checkups, 91.3% had their abdomen examined by ultrasound. Something anomalous was detected in 68.1% of the examinees and 4.5% needed to undergo closer checkups, the rate of response to which was 74.5%. The detection ratio of cancer by ultrasonography was worked out at 0.048%. The ratio of patients requiring a closer exam to the total and the cancer detection ratio varied widely from hospital to hospital. The wide dispersion was ascribable to the difference in the standard of judgment for indicating closer examinations and the difference in the number of examinees so far as the cancer detection ratio was concerned, from hospital to hospital. A look at the primary findings of anomalies revealed that fatty liver topped the list accounting for 27.4% followed by cholelithiasis with 3.6%. From this, we realized that the abdominal examinations by sonography served to detect cancer and lifestyle-induced health problems as well. Organ-wise, the cancer cases found during the period from 1998 to 2009 broke down as follows: kidney (79 cases), liver (40 cases), pancreas (30 cases), gall bladder (24 cases), others (8 cases) and spleen (none). The cancer detection ratio per year ranged from 0.03 to 0.05% during the period.