A 57-year-old male had single bypass graft to the right coronary artery with a saphenous vein graft 20 years previously. He noticed recurrent anginal pain since 1991 and thoracic aortic aneurysm was also pointed out in 1993. Coronary angiography showed that the saphenous vein graft was occlusion, accompanied with the distal portion of the occluded anterior descending coronary artery perfused by collateral flow from the circumflexus branch. The left ventricular function was moderately impaired (EF=38%). Re-do of coronary artery bypass grafting was done to the AV branch of the right coronary artery with the right gastroepiploic artery and the primary sequential grafting to anterior descending coronary artery and diagonal branch with left internal thoracic artery. One month after CABG, graft replacement of descending thoracic aorta was done because of thoracic aortic aneurysm. The postoperative course was uneventful except for the complication of chylothorax after the second operation. Postoperative angiography showed good patency of the left internal thoracic artery and right gastroepiploic artery and no abnormality of the graft anastomosis.

A 61-year-old male had received aortic valve replacement due to AR in 1987 and the operative findings showed the enlargement of the ascending aorta and maximum diameters of 4cm in the ascending aorta. He had been doing well until 1992 when he sufferred cerebral infarction and aortic root dilatation reached a maximum diameter of 7.5cm demonstrated by CT. Cabrol's operation using the previously replaced aortic valve was carried out because the prosthetic valvular function was normal and the type of coronary arteries was balanced. Postoperative angiography showed good patency at anastomosis of bilateral coronary arterial orifices and he had a satisfactory postoperative course. The dilatation of the ascending aorta over 4cm accompanied with AR may need not only AVR but also aortic root replacement.

A 64-year-old woman with a diagnosis of calcified aortic valvular stenosis and unstable angina, had calcification of the aortic valve reaching the aortic annulus, and the ascending aorta had some calcifications in its lateral and posterior walls. There was a 70mmHg pressure gradient in the aortic valve and coronary angiogram showed 90% stenosis of right coronary artery #1 and total occlusion of left circumflex artery #13 perfused with collateral flow from right coronary artery. The translocation of the aortic valve was carried out. The postoperative course was uneventful and postoperative angiograms showed good patency of the double saphenous vein grafts and no abnormality of the composite graft anastomosis. Translocation of the aortic valve is effective in patients with stenotic aortic annulus caused by calcified aortic valve, although it is mainly indicated in infective endocarditis.

We have tried surgical pathologic diagnosis using a still image transmission system. The equipment we used was a medical information network system (Telepathology) developed jointly by Inohara Shokai and NTT. During the 9-month period from April to December in 1995, we performed pathological diagnosis on a total of 63 cases received via this system. The cases included 21 stomach cancers, 13 colorectal cancers, 5 breast tumors, 4 lung tumors, 5 thyroid tumors and 3 ovary tumors. Materials presented for pathologic examination were 44 lymph nodes, 20 stumped sections of the lesions and 13 tumor tissues. The correct diagnosis ratio was as high as 93.7%. Improvement in the specimen-making procedure reduced the time required to arrive at a firm diagnosis. However, the quality of images of low magnification is unsatisfactory. It should also be pointed out that there is much room for improvement in the technical skill and knowledge of the persons concerned. Nevertheless, great expectations could be placed on this system. With progress in data transmissions technology, it will find its use more widely.

A 60-year-old male was diagnosed as having sarcoidosis four months previously because of bilateral hilar lymphadenopathy seen on a chest X-ray, uveitis, and elevation of serum angiotensin converting enzyme. In summer, the patient suffered from hypercalcemia, hypercalciuria, and renal dysfunction. Renal biopsy showed interstitial nephritis with gallium scintigraphy demonstrating high uptake in the bilateral hilum, eyes, and kidneys. Corticosteroid treatment was effective in remarkably improving the renal disorder and radiographic abnormalities.
The calcium metabolic abnormalities and the granulomatous interstitial nephritis showed a marked response to corticosteroid therapy, so that immediate administration of corticosteroid may be justified even in cases without histological evidences. Gallium scintigraphy is suggested to be useful in noninvasive examination in acute stage of sarcoidosis.

A new technique of left atrial plication (LAP) for giant left atrium (GLA) resulting from mitral regurgitation (MR) is reported. A 66-year-old man was found to have NYHA class III resulting from severe MR, mild TR and GLA with a left atrial diameter (LAD) of 107mm on echocardiogram. Chest X-ray showed the cardiothoracic ratio (CTR) to be 92%, and the right side CTR was 88.4%. Surgery was performed under general anesthesia with endotracheal intubation. Under cardiac arrest established by antegrade and retrograde cardioplegia, mitral repair was performed first through a superior transseptal approach. Left atrial resection was continued paralell to the mitral posterior annulus and to the right side wall of the left atrium, following the right side resection. Simultaneously the left atrial wall was incised 3 to 4cm in width all the way along the resection line and it was closed by a running suture of 3-0 prolene. The continuous line of the left atrial plication formed a spiral shape. A prominent portion of the atrial septum resulted from the LAP and the right atrial wall was also resected and plicated. The postoperative course was uneventful, and the postoperative CTR reduced to 71% with a right side CTR of 54.4% with reduction of LAD to 67mm on ultrasound cardiogram (UCG). This spiral LAP was considered more effective to reduce all dimensions of the giant left atrium dilated in all directions in comparison with other LAP methods previously reported.

BACKGROUND: Leber's hereditary optic neuropathy (LHON) is a mitochondrial disorder with optic nerve atrophy. Although there are no other associated neurological abnormalities in most cases of LHON, cases of "LHON plus" have been reported. CASE REPORT: The proband was a 37-year-old man who had visual and gait disturbances that had first appeared at 10 years of age. He showed horizontal gaze palsy, gaze-evoked nystagmus, dysarthria, and cerebellar ataxia. Brain and orbit MRI disclosed atrophy of the optic nerve and cerebellum, and degenerative changes in the bilateral inferior olivary nucleus. Mutational analyses of mitochondrial DNA identified the coexistence of heteroplasmic G11778A and homoplasmic T3394C mutations. CONCLUSIONS: These results suggest that the combination of G11778A and T3394C mutations leads to an atypical LHON phenotype.
Adult ; Atrophy ; Brain ; Cerebellar Ataxia ; Cerebellum ; DNA, Mitochondrial ; Dysarthria ; Gait ; Humans ; Mitochondria ; Mitochondrial Diseases ; Olivary Nucleus ; Optic Atrophy, Hereditary, Leber ; Optic Nerve ; Orbit ; Paralysis ; Phenotype

Objectives: “Adverse Drug Reaction Relief System” (hereinafter called the Relief System) has been established to provide prompt relief to patients experiencing health damage caused by adverse drug reactions. Since 2018, the Relief System has required community pharmacies that acquire additional points as local support system to actively report adverse drug reactions. Here, we investigated the recognition and utilization of the relief system among community pharmacists.Method: A questionnaire survey was conducted among community pharmacists between August 1 and September 30, 2019.Results: The survey achieved a response rate of 58.1%. The recognition rates of the relief system and Pharmaceuticals and Medical Devices Agency (PMDA) as its application destination were 98.9 and 74.5%, respectively. Of the community pharmacists, 2.6% had experience in utilizing the relief system; and 8.8% did not want to recommend the utilization of the relief system for patients mainly because of the “low recognition of the system” and “the complicated and troublesome preparation of the necessary documents such as medical certificates.” The community pharmacists who acquire additional points as local support system, compared with those who do not, achieved significantly higher rates in two items, including that for preparation of the documented procedures pertaining to adverse drug reactions.Conclusion: Despite the high recognition of the relief system among community pharmacists, the percentage of pharmacists with experience in actually utilizing the relief system and applying to the PMDA was low. One reason that the use of the relief system was not widespread was the low recognition particularly of the destination and procedures of reports on adverse drug reactions. In the future, educational campaigns to improve pharmacists’ comprehension of the relief system will be needed. Moreover, pharmacists must play a central role in enhancing the recognition of the public relief system and promoting medical safety.