A 67-year-old woman was admitted to our hospital for examination of a chest X-ray abnormality. Chest computed tomography and coronary angiography revealed a giant aneurysm and coronary-pulmonary artery fistula originating from both the proximal left anterior descending and the right coronary artery. The fistula was ligated and the aneurysm was resected by means of extracorporeal circulation. The postoperative course was uneventful. Computed tomography and coronary angiography showed that the aneurysm and coronary-pulmonary artery fistula had completely disappeared.

A 70-year-old man with severe chest pain was transferred to our hospital by ambulance. Computed tomography revealed a ruptured thoracic aortic aneurysm and massive bleeding into the posterior mediastinum. Emergency total aortic arch replacement was performed through median sternotomy. However sternal closure induced severe hypotension because the heart was elevated anteriorly by the posterior mediastinal hematoma. The hematoma could not be eliminated fully so the sternum was kept open at the first operation followed by delayed sternal closure 3 days after the operation. After that, the postoperative course was uneventful and the patient was discharged on postoperative day 43.

Ogikeishigomotsuto is a Kampo formula used for numbness or body pains. We experienced 29 cases in which attending physicians believed the drug would be effective. In 18 cases the drug was effective and in 11 cases it was not. We analyzed the difference in subjective symptoms between the responder group and the non-responder group. We concluded that some symptoms could be indicators for choosing the formula. Hypersensitivity to cold and heaviness of the whole body has previously been reported in many articles. In our cases, we observed a high incidence and specificity of the symptoms reported above, as well as arthralgia, dry skin and irritability in the responder group compared to the non-responder group. We believe these newly detected subjective symptoms can also be indicators for choosing Ogikeishigomotsuto.

We present a case of megacolon successfully treated with Kampo medicine. A 65-year-old male diagnosed with megacolon in 1999, came to our department in July 2003 complaining of severe abdominal distention. We successively used different Kampo formulae, in accordance with the diagnostic standard known as “SHO” which were: Daikenchu-to, Koboku-sanmotsu-to, Chukenchu-to, and Koboku-sanmotsu-to again. Daikenchu-to was only partly effective. Koboku-sanmotsu-to made the abdominal distention worse, forcing a change of drug. Chukenchu-to relieved the symptoms for some time, but the patient had to be hospitalized because of pseudoaldosteronism caused by the drug. Koboku-sanmotsu-to, however, worked smoothly on the second occasion and the symptoms disappeared. The efficacy of Koboku-sanmotsu-to was completely different on the two occasions it was used. This suggests that the pathological conditions were in a state of change, and these changes were identical to changes of SHO. This case reinforces the importance of detecting changes of the SHO accurately.

We report three cases of pneumonia successfully treated with Kampo therapy. Case 1 was a 69-year-old female who was hospitalized with a fever and cough. Administration of Keishinieppiitto led to an improvement in her cough and a rapid reduction of fever, and we continued her treatment using Kampo medicine only. By the 7th day of admission, the infiltration shadow had disappeared, and on the 11th day, laboratory data on WBC and CRP had decreased to a normal range. Case 2 was a 66-year-old female who was hospitalized with cough, sputum and fever. She received modern western medical treatment, including antibiotics for one month, but her symptoms showed little improvement. After we administered Saiko-keishi-kankyo-to-go-Hange-koboku-to, her symptoms gradually improved. By the 15 th day of admission, her CRP levels had decreased to 0.7mg/dL, and the infiltrative shadow had disappeared. Case 3 was a 78-year-old male who was hospitalized with cough, sputum, anorexia and general malaise. A multiple nodular lesion in the lung was also detected by chest CT. Consequent diagnostic examinations were conducted, while providing him with Saikokeishito. Although the final diagnosis was pneumonia, of unknown etiology, his fever decreased and on further examination his laboratory data had improved. If a Kampo formula is selected in accordance with the diagnosis of Kampo medicine, we consider that pneumonia can be treated with Kampo medicine without the use of antibiotics.

In the past 13 years, 17 patients underwent reoperation after intracardiac repair, including reconstruction of the right ventricular outflow tract. Primary diagnoses of the cardic anomalies were tetralogy of Fallot (TOF) (8 patients), extreme type (TOF) (4 patients), TOF with absent pulmonary valve (1 patient), double outlet right ventricle (DORV) (2 patients), truncus arteriosus (1 patient) and transposition of the great arteries (TGA) (1 patient). Patients were divided into 4 groups based on the surgical procedures for reconstruction of the right ventricular outflow tract as follows: Group A, porcine valved conduit; Group B, autologous pericardial valve bearing tube graft; Group C, transannular patch; Group D, outflow patch with pulmomary valvotomy. The main reason for reoperation in groups A and B was pulmonary stenosis due to calcification of the porcine valve or shrinkage of the pericardial tube graft. Average periods between corrective surgery and reoperation were 7 and 13 years in groups A and B, respectively. Reoperation was performed for massive tricuspid regurgitation and residual shunt, 15 and 24 years after previous operations in groups C and D, respectively. Low cardiac output syndrome, proconged right heart and respiratory failure were major postoperative complications in groups A, B and C. Furthermore, one patient in group A and one other in group C died in the long-term period after reoperation. Both patients had had markedly dilated hearts associated with frequent PVCs. In conclusion, earlier reoperation for progressive and/or residual lesions should be performed to obtain better surgical outcome and quality of life of the patients.

A 66-year-old woman complained of dyspnea due to congestive heart failure, and was given a diagnosis of severe aortic insufficiency. Antiphospholipid syndrome and idiopathic thrombocytopenic purpura (ITP) had been diagnosed with 9 years previously. We planned preoperative plasma exchange and steroid pulse infusion to reduce the level of auto-antibodies for phospholipids. The aortic valve replacement was performed safely. Anticoagulant therapy with low molecular weight heparin and oral steroid therapy was administered after the operation to avoid thrombosis or bleeding. The patient's postoperative course was stable. She was discharged without any complication. In conclusion, preoperative plasma exchange and steroid pulse infusion, postoperative anticoagulant therapy and oral steroids resulted in a favorable outcome in a case of heart surgery for a patient with antiphospholipid syndrome.

We report a case of prolonged lumbago with severe cold intolerance successfully treated with keppuchikuoto and uzushakusekishigan. The patient was a 71-year-old female with lumbar spinal canal stenosis which was refractory to several nerve and intervertebral disc block therapies and oral medications. She had been also suffering from constipation, leg cramps, intermittent chest pains, and severe cold intolerance. We prescribed keppuchikuoto for chronic blood stagnation and deficiency and uzushakusekishigan for intermittent chest pains in order to improve those symptoms all together. The severity of her lumbago and severe cold intolerance were remarkably reduced after the administration of the two formulas. This case suggests that the two formulas exerted their effectiveness by ameliorating chronic severe cold intolerance, blood stagnation, and blood deficiency and resulted in remarkable improvement in lumbago.