A 70-year-old man who had been followed up in our outpatient clinic for mild aortic regurgitation underwent curative surgery for progression of the regurgitation due to a prolapsed right coronary cusp, associated with annular dilatation and aortic root aneurysm formation. The Operation consisted of subvalvular circular annuloplasty to reduce the size of the aortic annulus, adjustable leaflet suspension for the prolapsed right coronary cusp, and modified aortic root remodeling, which replaced the Valsalva sinus of both non and right coronary cusps while sparing the Valsalva sinus of the left coronary cusp. Coronary artery bypass grafting was additionally performed for the 90% stenosis of the proximal right coronary artery segment. The postoperative course was uneventful with no need of blood transfusion. He was discharged from the hospital 10 days postoperatively. This combination of valvuloplasty with valve-sparing aortic root reconstruction procedure can be useful.

Balloon aortic valvuloplasty (BAV) is a treatment for high risk patients with severe aortic valve stenosis (AS). Rapid pacing is needed to reduce cardiac output when dilating the balloon, but it may cause cardiac ischemia or lethal arrhythmia. In this case report, percutaneous cardiopulmonary support (PCPS) was used to prevent these complications with BAV. We achieved adequate blood pressure and cardiac output during BAV without using rapid pacing by drawing a certain amount of blood into the reservoir equipped with the PCPS circuit. When performing BAV, PCPS may be a useful option for the patients who have high risks of circulatory failure.

Since students who would like to study Kampo medicine more have no opportunity to communicate each other in Northern Japanese Universities, we newly started joint study conferences held by medical students in 2013. The objectives of this paper are to report on these annually held student-based Kampo study conferences in the Hokkaido and Tohoku areas, and the ways each university studies Kampo medicine. In the conference, the students reported on their club activities. Then they studied the history of Kampo medicine and simulation of abdominal diagnosis, and performed group work on case reports together. The number of student participants in these conferences has tripled over 3 years from 18 to 58 (for a total of 111 participants). All members were satisfied with the content. And this reflects medical students' need for a wider perception of Kampo medicine, rather than a limited one gained in their university club activities. We hope this conference will play a major role in other nationwide student-based Kampo study conferences in the years to come.

Background: Gingyo-gedoku-san (GGGS) is an herbal medicine approved for upper respiratory infections in Japan. We conducted an open-label, multi-center, prospective trial, comparing GGGS with oseltamivir in patients with influenza and influenza-like illness (ILI) as a pilot study.
Methods: Subjects were healthy persons aged between 16 and 40, and were enrolled from January 12, 2010 to March 24, 2011. Fifteen patients were enrolled in this trial (8 and 7 for GGGS and oseltamivir, respectively). RT-PCR was positive for pandemic influenza A (H1N1) in 10 patients. The patients were provided with either GGGS or oseltamivir for 5 days. The primary outcome was mortality and/or hospitalization 7 days after the initial diagnosis. Body temperature and other clinical characteristics were also evaluated.
Results: All patients recovered from illness without complication or hospitalization. The mean time to resolve symptoms for the GGGS and oseltamivir groups was 3.9 days and 3.3 days, respectively (p=0.43). The GGGS group appeared to have a smaller symptom score AUC than the oseltamivir group, (p=0.26). Time to recover activity level appeared to be shorter in the GGGS group (p=0.10), with shorter time to recover health status (p=0.02). Sub-group analysis on patients with positive PCR showed similar results between the two groups.
Conclusion: GGGS was associated with symptom improvements resembling oseltamivir for both influenza and ILI. Randomized controlled trials involving larger sample sizes are needed to confirm these results.

Background : Endoscopic vessel harvesting (EVH) is one of the less-invasive graft harvesting techniques for CABG. On the other hand, it needs certain amount of a learning curve to acquire sufficient technique. Inappropriate manipulation will cause damage of the vein, decrease the patency and affect the patient's long-term survival. Off-the-job training has the potential to shorten the length of the learning curve. In this study we evaluated the effectiveness of a newly developed saphenous vein harvesting model provided by EBM corporation. Purpose : To evaluate the effectiveness of concentrated training with the EVH simulator. Objective and Methods : One novice trainee doctor was recruited for this study. After 20 procedures using the simulator training clinical device, EVH was performed under supervision. This procedure was compared with the last case before the training in terms of setup for the EVH, visualization by endoscope, dissection, division of branches, duration of the procedure, and number required for repair. Results : The duration required to train with the simulator showed a stable average of 10 cases. All the elements in terms of EVH procedure were improved after the simulator training. Discussion : It is important to prepare an appropriate simulator, trainer, and clear purpose for effective training. It was beneficial to enhance the clinical level with the concentrated simulator training. Conclusions : The newly developed EVH model is an effective simulator before performing the initial clinical case.

An 83-year-old woman (BSA 1.36 m2) who had undergone aortic valve replacement (Magna ease 19 mm), mitral valve replacement (Epic mitral 25 mm), tricuspid annuloplasty (De Vega technique), and pulmonary vein isolation eight years earlier was referred to our hospital due to her heart failure symptoms. Ultrasound cardiography revealed severe mitral regurgitation due to perforation of bioprosthetic valve, severe mitral valve stenosis (mean pressure gradient 7.8 mmHg) due to bioprosthetic deterioration, and subsequent pulmonary hypertension (mean pulmonary artery pressure 49 mmHg, tricuspid regurgitation pressure gradient 85.5 mmHg). We performed a redo aortic valve (Inspiris 23 mm) and mitral valve (Epic mitral 29 mm) replacement using the Manouguian technique. The postoperative course was uneventful and pulmonary hypertension improved (tricuspid regurgitation pressure gradient 39.6 mmHg).