The crude drug Aconite Root (bushi in Japanese) contains toxic compounds called bushi diester alkaloids(BDA), and the raw material with high BDA content has been considered suitable for processing into prepared bushi. Moreover, processing methods and an upper BDA content limit are prescribed in the 16th edition of Japanese Pharmacopoeia. In this study, we closely examined descriptions of high quality bushi in ancient herbal literature, and elucidated the relationship between bushi forms and BDA contents. The results showed that large-sized bushi with enlarged rootlets called “horns” (tsuno in Japanese) were considered higher quality, and the horns and the root tops (hozo in Japanese) were cut off when used as bushi. Meanwhile, chemical studies have shown that larger bushi contains less BDA, and the root tops and the horns contain more BDA than the root body. These results suggest that selecting larger roots and cutting off the more potent parts were processes for reducing BDA. Therefore we conclude that consistently less toxic bushi was considered a higher quality product in ancient times.

A 60 year old man presented with a history of right leg claudication which occurred after walking a distance of 200 m. He had no history of cardiovascular risk factors or trauma in the lower extremities. Palpation disclosed no right popliteal or pedal pulse. Ankle-brachial pressure index (ABI) was 0.60 on the affected side. Computed tomography (CT) demonstrated the presence of a highly stenotic lesion in the right popliteal artery due to compression from periarterial polycystic masses. Magnetic resonance imaging (MRI) revealed no communication to the knee joint bursa. Further, angiography showed a beak-like severe stenosis on the knee of the right popliteal artery. Based on the results of these three imaging techniques we confirmed the diagnosis of cystic adventitial disease (CAD). The patient underwent a surgical exploration of his popliteal artery through a posterior approach. Evacuation of all cysts by longitudinal incision of his adventitia yielded yellow mucoid gelatinous material. The popliteal artery was replaced using the great saphenous vein because the previous imaging showed thrombus formation at the cyst site. He had an uneventful postoperative recovery with ABI of 1.10.

We report a case of a caseous calcification lesion originating from a calcified anterior mitral annulus. A 59-year-old woman on chronic hemodialysis was referred to our hospital due to an elevated brain natriuretic peptide value. Transthoracic echocardiography demonstrated moderate aortic valve stenosis with regurgitation and a pendulous mass in the left ventricular outflow tract, and therefore we perfomed. The patient underwent resection of the mass with aortic valve replacement. Pathological examination of the mass revealed interstitial calcium deposits but without tumors or inflammatory cells. We speculated that the cardiac mass was caseous calcification which originated from a severely calcified mitral annulus based on its echocardiographic and pathological features.

We report a case of successful anatomical reconstruction with omentopexy of an infected abdominal aortic aneurysm (AAA) in a patient with a previous history of coronary artery bypass grafting with the right gastroepiploic artery. A 60-year-old man was referred to our institute because of fever and abdominal pain during hemodialysis for chronic renal failure. Antibiotic therapy was started after computed tomography revealed an infected abdominal aortic aneurysm. After infection control, surgical treatment was scheduled. At surgery, left axillo-bifemoral bypass was performed first, because it was unclear whether the omentum was large enough for omentopexy. At laparotomy, adequate omentum and infective AAA were confirmed. AAA repair using a rifampicin-soaked graft, and omentopexy were performed. Enterobacter aerogenes was detected from the resected aortic wall. After the operation, intravenous antibiotic was used for 25 days until CRP was normalized. One year follow-up showed no sign of re-infection.

We herein report on a case in which we conducted bypass surgery for occlusion of a left axillary artery aneurysm with ischemic symptoms 21 years after the contraction of Kawasaki disease and achieved symptomatic improvement. The case involved a 22-year-old man who had been suffering from Kawasaki disease since the age of one. He had been undergoing antiplatelet therapy for bilateral axillary artery aneurysms by orally taking aspirin for 20 years. He suffered from symptoms of upper limb ischemia 21 years after receiving a diagnosis of peripheral aneurysms and occlusion of a left axillary artery aneurysm upon 3DCTA. We conducted aneurysmotomy, plication, and bypass surgery between the axillary and brachial arteries via the autologous vein. Pathological examination revealed due to the formation of atheroma in the tunica intima and disarrangement of the layer structure in the tunica media : thickening of the tunica media was partially observed. His fatigue upon exertion of his left upper extremity remarkably improved following surgery. Although peripheral aneurysms associated with Kawasaki disease are rare, as seen in this case, peripheral arterial disease remains and progresses even after long periods of time. It is believed necessary to carry out long term follow-up and examine the approaches to therapy including surgery in accordance with the site and degree of the disease.

An 83-year-old woman underwent stent graft endovascular repair using a Medtronic TALENT device for a saccular aortic aneurysm in the distal arch. The landing zone which targeted the proximal side was directly distal to the orifice of the left common carotid artery (Z2), and the stent graft was placed at the targeted position. However, a decline in the right radial arterial pressure was observed immediately following this, and a retrograde dissected ascending aorta was observed on a transesophageal echocardiogram. The endovascular surgery was immediately converted to open surgery, and an intimal tear to the lesser curvature of the arch, caused by a bare spring (bare stent) of the proximal stent graft, was observed. Total arch replacement was performed by means of the concomitant use of the placed stent graft. Sometimes a TALENT stent graft exhibits specific movements (e.g. a misaligned opening) on its initial deployment. It is therefore believed that special attention is necessary when placing it in the aortic arch.

Subclavian artery aneurysm (SCAA), a peripheral arterial aneurysm, is a rare entity. The surgical procedure and approach depend on the location of the aneurysm. We present a case of the endovascular therapy combined with cross axillary bypass. The patient was a 75-year-old man with a small abdominal aortic aneurysm. Multi-detector computed tomography (MDCT) revealed an intrathoracic right SCAA 38 mm in diameter. The operation was performed successfully under general anesthesia. After cross bypass of bilateral axillary artery, the orifice of the right subclavian artery was covered with a stent-graft inserted into the right common carotid artery-brachiocephalic artery and the right subclavian artery was occluded with coils distal to the aneurysm. Post operation angiogram showed complete exclusion of the SCAA and patency of the right common carotid and right vertebral artery. We thought this hybrid treatment for the intrathoracic SCAA could be a useful surgical strategy.

STUDY DESIGN: Level 4 retrospective review. PURPOSE: Brace treatment is the standard nonoperative treatment for adolescent idiopathic scoliosis (AIS). Rotation correction is also important, because AIS involves a rotation deformity. The purpose of this study was to evaluate the impact of rotation correction after Osaka Medical College (OMC) brace treatment on clinical outcomes in AIS. OVERVIEW OF LITERATURE: Brace treatment has a significant effect on the progression of AIS. However, few reports have examined rotation correction after brace treatment. METHODS: A total of 46 patients who wore the OMC brace were retrospectively reviewed. The curve magnitude was determined according to the Cobb method, and the rotation angle of the apical vertebrae was measured by the modified Nash-Moe method. Based on the difference in the rotation angle before and after the initial brace treatment, patients were divided into two groups. Group A (n=33) was defined as no change or improvement of the rotation angle; group B (n=13) was defined as deterioration of the rotation angle. If the patients had curve or rotation progression of 5° or more at skeletal maturity, or had undergone surgery, the treatment was considered a failure. RESULTS: Differences of rotation angle between before and after the initial brace treatment were 2°±2° in group A and –3°±2° in group B (p<0.001). The rates of treatment failure were 42% in group A and 77% in group B (p<0.05). This study included 25 patients with Lenke type 1 (54%). Group A (24%) with Lenke type 1 also had a significantly better success rate of brace treatment than group B (75%) (p<0.05). CONCLUSIONS: Insufficient rotation correction increased brace treatment failure. Better rotation correction resulted in a higher success rate of brace treatment in patients with Lenke type 1.
Adolescent* ; Braces* ; Congenital Abnormalities ; Humans ; Methods ; Prognosis* ; Retrospective Studies ; Scoliosis* ; Spine ; Treatment Failure

Background: Laparoscopy-assisted gastrectomy requires a lot of disposable products. So we compared the cost between laparoscopy-assisted gastrectomy and open surgery.Patients and methods: For comparison we used five cases each of open distal gastrectomy (ODG), laparoscopy-assisted distal gastrectomy (LADG), open total gastrectomy (OTG) and laparoscopy assisted total gastrectomy (LATG). In this study, we defined the profit of gastrectomy as below and we used the list price for all products. Profit of gastrectomy=Fee for gastrectomy-(Costs of all single use products-Demandable fee for single-use products)Results: Mean profits of ODG and LADG were 278,756.2 yen and 190,292.8 yen. The difference was 88,463.4 yen. Mean profits of OTG and LATG were 395,922.6 yen and 330,653.6 yen. The difference was 65,269 yen. Mean hospital charges, mean length of hospital stay, mean hospital charges per day of ODG, LADG, OTG and LATG were 1,390,464 yen, 21.4 days, 65,140.0 yen and 1,484,254.0 yen, 18.8 days, 80,805.4 yen and 1,956,664.0 yen, 24.4 days, 82,397.1 yen and 1,686,936.0 yen, 18.4 days, 91,894.8 yen, respectively.Conclusion: The turnover of laparoscopic gastrectomy was higher than open gastrectomy, but, the profit was lower because of high costs of disposable products. Hospital charges were not higher but the charge per day was higher because of a shorter hospital stay.
Gastrectomy ; Laparoscopy ; Hospitals ; Mean ; Financial cost

Primary penile melanomas are rare tumors that represent less than 0.1% of all melanomas. We report a case of a 60-year-old Japanese male with a mucosal penile melanoma and describe an increased CD8⁺ T cell infiltration in brain after dacarbazine (DTIC) administration. After partial penectomy and left inguinal lymphadenectomy, he developed multiple lung, bone, spleen, brain and skin metastases. He was treated with interferon-β, DTIC and nivolumab. However, the metastases were not reduced in size. Immunohistochemistry showed an increase of CD8⁺ T cell infiltration and programmed death-ligand 1 (PD-L1) expression after the administration of DTIC, but the expression of programmed cell death protein 1 (PD-1) was negative. We speculate that DTIC exerted immunostimulatory effects, but nivolumab was ineffective due to the negative expression of PD-1 and/or an insufficient infiltration of CD8⁺ T cells. Although this is only one case, this case report could be the first step to discuss the development of effective therapies against melanoma to take advantage of the increased CD8⁺ T cell infiltration elicited by chemotherapeutic agents. It would be beneficial to pay more attention to the relationship between DTIC and immune checkpoint modulators.
Asian Continental Ancestry Group ; Brain ; Cell Death ; Dacarbazine* ; Humans ; Immunohistochemistry ; Lung ; Lymph Node Excision ; Male ; Melanoma* ; Middle Aged ; Neoplasm Metastasis ; Skin ; Spleen ; T-Lymphocytes*