A 39-year-old woman, who had undergone aortic valve replacement with a Carpentier-Edwards pericardial bioprosthesis 16 years previously, was admitted to our hospital with a diagnosis of acute heart failure due to acute aortic regurgitation. An emergency operation was undertaken with the patient in a state of shock due to sudden cardiac arrest. The ascending aorta was cross clamped, and cardiac arrest was induced, and aortotomy was done. One of the leaflets of the CEP was entirely collapsed and dislocated to the LV side, which caused acute aortic regurgitation. Although there was no evidence of endocarditis, slight calcification and small perforation of the leaflet of the valve was observed. Aortic valve replacement was performed with a mechanical heart valve but it was impossible to wean from ECC, and therefore we additionally performed mitral valve annuloplasty with a prosthetic ring for moderate mitral regurgitation. After 4 h cardiopulmonary assistance, ECC was successfully withdrawn. She was discharged in a good condition an post operative day 29th.

Papillary muscle rupture is one of the common complications of acute myocardial infarction. We report a case of 77-years-old man with an acute posterior papillary muscle rupture without obvious coronary artery disease. The patient presented with cardiogenic shock and pulmonary edema. Emergency coronary angiogram showed no obstruction in coronary arteries. An echocardiogram and right heart catheterization data suggested acute mitral regurgitation caused by ruptured posterior papillary muscle. Percutaneous cardiopulmonary support was induced because of his unstable hemodynamics, and then emergency mitral valve replacement was performed. Intraoperative findings suggested some ischemic changes in the posterior papillary muscle. Pathologically, both old and new ischemic lesion presented in the same papillary muscle. Moreover, severe thickening of a small vessel wall was noted. This case presented one of the possible mechanisms of so-called idiopathic papillary muscle rupture.

A clinical study was carried out on 336 patients diagnosed with nasal allergic symptoms in Otolaryngological Clinic of Obihiro Kousei Hospital from April 1993 to July 1995. The diagnosis was made based on their history, numbers of eosinophils in the peripheral blood and nasal secretion and the results of the radioallergosorbent test (RAST).
House dust and mites were the most frequent allergens, as reported by almost all clinics in Hokkaido. On the other hand, in this Tokachi district, pollinosis allergens include birch pollinosis in 98 patients (40.8%), orchard grass pollinosis in 66 patients (27.5%), regweed pollinosis in 75 patients (31.6%) and timothy pollinosis in 77 patients (32.1%).
It seems that Pecatnres are due to the local characteristics such as cllimate, geographical features and plant distribution in the Tokachi area.

The Fontan type operation is currently considered to be a safe procedure. However, in some patients excluded from the indication for the Fontan type operation is contraindicated. A 12-year-old girl given a diagnosis of pulmonary atresia with intact ventricular septum was considered a high risk and was excluded form the indications of the Fontan procedure. She underwent balloon angioplasty for aortic stenosis (valvular) at the age of 2, and bidirectional Glenn anastomosis and aortic valve plasty at the age of 5. At the age of 7, she underwent cardiac catheterization. Although the Fontan procedure was contraindicated, her symptoms gradually progressed year by year, and desaturation caused a decrease in her exercise tolerance. At age 12, she underwent coil embolization of aortopulmonary collaterals and a fenestrated Fontan procedure. In order to keep the procedure as minimally invasive as possible, we performed intraoperative stenting of the peripheral pulmonary stenosis, and all manipulation of fenestrated extracardiac conduit Fontan procedures were performed in the beating heart with cardiopulmonary bypass. The postoperative course was uneventful. The oxygen saturation increased to 95%, and her exercise tolerance dramatically improved. Here we report some special techniques that hybrid operation and satisfactory results.

The purpose of this study was to clarify the characteristics of the gait function for the elderly with a special reference to the angle of the ankle joint and that of the metatarsophalangeal (MP) joint at heel contact and toe off. Five healthy young men (aged 22 to 23 yrs) and five healthy elderly men (aged 65 to 71 yrs) participated as the subjects in this study. The angle variation of the right ankle joint and that of the MP joint detected in goniometers were analyzed synchronously with the data of the force plate and the image data of bare foot movements during free, slow, and fast gait. The following results were obtained:
1. The walking speed, step length, and cadence for the elderly during free gait were significantly small. Furthermore, the step length of the elderly was shorter than that of the younger subject even with the same height. Moreover, it was found that the fluctuation in both the step length and cadence resulted in an fluctuation in walking speed.
2. One reason for the decrease in step length and cadence, and the increase in duration of the double supporting time for the elderly is the lowering of walking speed.
3. The angle of the ankle at heel contact, the angle of the ankle at toe off, and the angular displacement of the MP joint were significantly smaller for the elderly during free gait and during walking within a range of speeds. Also, the angle of the ankle at heel contact, and the angle of the ankle at toe off for young and elderly subjects were separated into two groups during walking within a range of speeds. It may be showed that the reason for the smallness of the angle of the ankle at heel contact and the angle of the ankle at toe off for the elderly irrespective of walking speed is due to an elderly behavior that unconsciously makes the angle smaller to prevent the danger of falling.
In conclusion, the difference in variables between young and elderly subjects during free gait and walking within a range of speeds exemplifies the characteristics of gait function for the elderly.

Tachycardia caused by increased sympathetic nerve activity after cardiovascular surgery can induce an increase in myocardial oxygen consumption and myocardial ischemia. β-Blockers are expected to reduce myocardial oxygen consumption, but traditional β-blockers are long acting so it is difficult to use after cardiovascular surgery. From January 2007 to September 2007, 24 out of 60 patients who underwent cardiovascular surgery were administered landiolol. The average heart rate before landiolol infusion was 99.5±16.5 bpm and decreased to 89.5±10.7 bpm after landiolol infusion (p=0.0008). Average systolic blood pressure before and after landiolol infusion was 109±16 mmHg and 103±13 mmHg, respectively (p=0.15). Average cardiac index (14 patients) before and after landiolol infusion was 3.29±0.83 l/min/m²and 3.26±0.9 l/min/m², respectively (p=0.75). Four patients (17%) had atrial fibrillation during these hospital stay, whereas 20 patients out of 50 patients (40%) who underwent cardiovascular surgery before landiolol was used (from June 2006 to January 2007) had atrial fibrillation (p=0.045). Landiolol can be effective and used safely after cardiovascular surgery.

Tachycardia caused by increased sympathetic nerve activity after cardiovascular surgery can induce an increase in myocardial oxygen consumption and myocardial ischemia. β-Blockers are expected to reduce myocardial oxygen consumption, but traditional β-blockers are long acting so it is difficult to use after cardiovascular surgery. From January 2007 to September 2007, 24 out of 60 patients who underwent cardiovascular surgery were administered landiolol. The average heart rate before landiolol infusion was 99.5±16.5 bpm and decreased to 89.5±10.7 bpm after landiolol infusion (p=0.0008). Average systolic blood pressure before and after landiolol infusion was 109±16 mmHg and 103±13 mmHg, respectively (p=0.15). Average cardiac index (14 patients) before and after landiolol infusion was 3.29±0.83 l/min/m²and 3.26±0.9 l/min/m², respectively (p=0.75). Four patients (17%) had atrial fibrillation during these hospital stay, whereas 20 patients out of 50 patients (40%) who underwent cardiovascular surgery before landiolol was used (from June 2006 to January 2007) had atrial fibrillation (p=0.045). Landiolol can be effective and used safely after cardiovascular surgery.

A 50-year-old man with Marfan syndrome, was given a diagnosis of pseudoaneurysm in an anastomotic site of the left coronary artery after Bentall operation, with severe calcification. He was successfully treated with reanastomosis of a new graft to the left main trunk by the removal of a calcified intima. Coronary artery bypass grafting was not possible because his coronary arteries were covered with thickened fatty tissue due to a previous omental flap procedure for mediastinitis, and therefore we chose left main trunk coronary angioplasty. The whole calcified intima was excluded with a dissector and resected at both ostias of the left descending artery and left circumflex artery. An 8-mm woven Dacron graft was anastomosed at the left main trunk by large stitches of adhesive tissue around the adventitia, to the inside of the lumen of the left main trunk. The patency of the left main trunk was confirmed by CT and he was discharged in a good condition. Close observation is needed for long-term morbidity.

Introduction: The effectiveness of first-aid measures (binding, incision and aspiration) for patients with habu bites and the indications of dry habu equine antitoxin for patients with habu bites are unclear. We investigated the relationships between first-aid measures and prognosis, and between symptoms (pain, swelling and bleeding) and antitoxin administration. Methods: We evaluated responses to a questionnaire submitted by 65 patients with habu bites. Patients who fully recovered were defined as "good", and those who had functional disorders, with or without rehabilitation, were defined as "bad." Fisher's exact test was used for analysis. Results: Pain was significantly related to antitoxin administration; however, swelling and bleeding were not related to antitoxin administration. First-aid measures and local symptoms were not related to prognosis. Conclusion: Our results revealed that many doctors determine the need for antitoxin administration according to pain. Moreover, our results suggested that the need for first-aid measures for patients is minimal. However, to clarify the indications for antitoxin administration and the effectiveness of first-aid measures for patients, further studies are warranted.

Although aortic annular abscess and rupture of the sinus of Valsalva are known as complications of infective endocarditis, few cases in children have been reported. We report a surgical case of a 6-year-old girl with active infective endocarditis complicated with an annular abscess and pseudoaneurysm of the sinus of Valsalva. The patient presented progressive symptoms of heart failure and a subsequent echocardiogram demonstrated severe aortic regurgitation. A computed tomography indicated pseudoaneurysm of sinus of Valsalva and an emergency operation was performed. At operation, a bicuspid aortic valve with vegetation was noted. The annular abscess caused a large tissue defect of the left coronary sinus of Valsalva and formed a pseudoaneurysm. The infected lesion was resected completely. The defective aortic annulus and sinus of Valsalva were repaired with a bovine pericardial patch and aortic valve was replaced with a mechanical valve. The postoperative course was uneventful and the patient was discharged after adequate antibiotic treatment.