A 73-year-old man who underwent redo aortic valve replacement due to dysfunction of tissue heart valve developed hypoxemia with bilateral infiltrates on frontal chest radiograph and hypotension shortly after his operation. Due to the presence of progressive hypotension and hypoxemia, we inserted an intra-aortic balloon pump and, furthermore, provided percutaneous cardiopulmonary support. We ruled out cardiogenic pulmonary edema based on information from various examinations, including echocardiography, and subsequently diagnosed possible transfusion-related acute lung injury (possible TRALI). The patient was treated by mechanical ventilation and circulatory support under close supervision, showing a trend of improvement from postoperative day 2 and discontinuing mechanical ventilation on postoperative day 11. The patient made an uneventful recovery and was discharged on postoperative day 50. Cardiac surgery patients are at particular risk for TRALI, so physicians should consider TRALI whenever a patient develops hypoxemia during or shortly after transfusion. Rapid diagnosis and appropriate treatment of TRALI are especially important in cardiac surgery patients.

We surgically treated a case of anomalous origin of the left coronary artery from the pulmonary artery with the specific route of the left coronary artery in a 17-month-old boy. He had suffered persistent cough and poor weight gain since the age of 4 months. An ultrasound cardiography, at the age of 16 months, revealed retrograde blood flow of the left coronary artery into the main pulmonary artery. Moreover, a chest computed tomography showed an anomalous left coronary artery arising from the bifurcation of the right pulmonary artery and winding in contact on the posterior aortic wall. Though the anomalous left coronary artery shared adventitia with the aortic wall we were able to separate the coronary artery from the aorta, and the patient underwent direct transplantation of the left coronary artery. The postoperative course was uneventful and recovery was rapid.

For A 38-year-old male diagnosed a congenital complete atrioventricular block in the neonatal period, epicardial lead and pacemaker was implanted through left thoracotomy. Although we tried to implant a pacemaker through the subclavian vein as an adult, it was unsuccessful because of obstruction of the bilateral subclavian vein. For this reason, we performed a pacemaker implantation with transatrial-endocardial lead through the right thoracotomy due to save the generator electric power. This is one of the useful techniques for cases with obstruction of the upper extremity vein.

In general hospitals or clinics, medical treatment and instruction in medical therapies and nursing are carried out by the medical staff (doctors, pharmacists and nurses) on hand. It is necessary to understand overall trends in patient illness, in addition to personal information, in order to practice medical care comprehensively. For these reasons we analyzed popular medicines, patient make up, and major disease distributions at our own Kampo clinic institute, for patients admitted since 2001.
34% of our patients were male and 66% were female. The majority of these patients were between 20 to 30 years old or, 50 to 70 years old. There were few patients, either male or female, in their 40s. As for major disease distribution, atopic dermatitis was most common among both males and females. Next in line were cold sensations and endometriosis, for females, while respiratory organ diseases such as bronchial asthma or nasal inflammation, and Alzheimer's disease were most common, for males.
Among major disease types, atopic dermatitis was treated with Oren-gedoku-to (JTDN: Japanese Traditional Drug Name) and Ogi-kenchu-to (JTDN), while diabetes was treated with Hachi-mi-gan (JTDN) and Seishin-renshi-in (JTDN). Cold sensations were treated with Toki-shigyaku-ka-goshuyu-shokyo-to (JTDN) and Toki-shakuyaku-san (JTDN), while hypertension was treated with Cho-to-san and Saiko-ka-ryukotsu-borei-to (JTDN).
The present report contains information useful for diagnosis with Kampo medicines, as well as instruction in the nursing and use of these medications by doctors, pharmacists and nursing staff. This report may be utilized in order to administer appropriate medical care for patients.

To develop an osseointegration analyzing system for dental implants, a new analyzing system which can assess the level of osseointegration between an implant and trabecular bone was constructed using digital radiography with morphological filter and node-strut analysis. For assessment of this system, a grayscale test chart that simulates six levels of an osseointegration was created. In addition, digital implant images were made in which the trabecular pattern around the implant was varied over a total of five levels. Implant osseointegration was evaluated on the basis of seven parameters related to the number of nodes (Nd) and terminuses (Tm) of the skeleton bound to the implant (Im) and the skeletal length. The seven parameters were as follows: the number of struts connecting the Im with the Nd and Tm (N.ImNd, N.ImTm), the total number of N.ImNd and N.ImTm (N.Im), the strut length connecting the Im with the Nd and Tm (ImNd, ImTm), and the ratios of the struts connecting the Im with the Nd and Tm (ImNd/TSL, ImTm/TSL), where TSL is the total strut length.Strong correlations (R² = 0.971-1.0) between the theoretical values from the test charts and the measured values were demonstrated. N.ImNd showed the strongest correlation, R² = 0.948, from the digital implant images, followed by N.Im and ImNd, with correlations of R² = 0.86 and R² = 0.84, respectively. This new system for evaluating implant osseointegration by applying morphological processing and node-strut analysis could be useful for computer-assisted diagnosis of digital dental implant images.

Chronic disseminated intravascular coagulation (DIC) complicates 5.7% of thoracic aortic aneurysm. DIC with thoracic aortic aneurysm is characterized by hyperfibrinolysis, but usually shows a stable condition in a state of compensated non-overt DIC with limited hemorrhagic symptoms. However, in some cases, hemorrhage caused by external factors may induce uncompensated overt DIC and lead to serious hemorrhagic tendencies. In the present study, we report a patient with a thoracic aortic aneurysm complicated by DIC who exhibited marked hemorrhagic tendencies. DIC remarkably improved following administration of recombinant human soluble thrombomodulin.

There are few reports on the long term efficacy of surgery for endocardial cushion defect (ECD) in elderly patients. We report a case with a successful course after ECD operation. A 70-year-old man was admitted with incomplete ECD, grade III mitral and tricuspid regurgitation, pulmonary hypertension and atrial fibrillation. The operative procedures included direct closure of the mitral cleft, pericardial patch closure for the ostium primum defect, direct closure of the tricuspid cleft and tricuspid annuloplasty. Pulmonary hypertension was improved after the operation, and he was discharged on the 41st day after the operation. Now, 3 years and 6 months after the operation, he has maintained an improved quality of life (QOL) with an uneventful postoperative course. The present report may suggest one solution for the long term effective treatment by operation for elderly patients who suffer from ECD, especially to achieve better QOL.

[Objective]Although warm-tube moxibustion is easy-to-use in acupuncture therapy, the timing of moxa removal varies among practitioners. In the present study, we used near infrared spectroscopy (NIRS) to compare effects of different durations of moxibustion stimulation on improvement in local circulation as measured by changes in blood oxygenation dynamics in muscle tissue.
[Methods]Twelve healthy adults underwent warm-tube moxibustion with a single cone applied to the upper right shoulder region;measurements of tissue blood oxygenation dynamics (ΔOxy-Hb, ΔTotal-Hb) were obtained at intervals of 0.5 s. Control measurements were first taken for 15 min without intervention (Control);then, subjects received moxibustion 2 min after the start of measurement and had the moxa removed at the following time points: 30 s after patients experienced heat pain (Removal 30, moxibustion group); 45 s after heat pain (Removal 45, moxibustion group);or did not have the moxa removed (Continuous moxibustion group). These 4 different conditions were compared. Additionally, we determined the burning temperature of moxa and the skin temperature and intensity of heat pain sensation at the site of moxibustion.
[Results]Compared with the Control, the Removal 30, Removal 45, and Continuous moxibustion groups had significant increases in ΔOxy-Hb, ΔTotal-Hb, and skin temperature, with no significant differences among the moxibustion groups. No significant difference in the intensity of heat pain sensation was observed among the moxibustion groups. All moxibustion groups began to show rapid increases in both ΔTotal-Hb and ΔOxy-Hb around the time when subjects began to feel heat pain, suggesting that the axon reflex evoked by noxious stimuli of heat pain increased blood volume and arterial blood flow.
[Conclusion]Hemodynamic improvement in muscle tissue through the use of continuous warm-tube moxibustion for 30 s or longer after the occurrence of heat pain was confirmed.

Objective : To examine the relation between psychoactive drugs and the outcome of dysphagia in patients with psychiatric disorders. Methods : We examined 53 inpatients who were prescribed speech therapy in the psychiatry ward of our hospital from January 2011 to April 2012. We categorized the patients into a poor outcome group and a good outcome group by the necessity for alternative nutrition at discharge and analyzed the number and kind of typical antipsychotic, atypical antipsychotic, hypnotic, antidepressant and mood stabilizer, total amount of typical antipsychotic, atypical antipsychotic used at admission and at discharge, sex, psychiatric disorder, central nervous system disease, aspiration pneumonia, duration of hospitalization, psychiatric disorder disease period, speech therapy intervention period and GAF scale at admission. Results : The outcome of dysphagia had a significant relation with the number and kind of antipsychotic used, especially typical antipsychotic used at admission. The good outcome group had a higher total amount of antipsychotic use, especially atypical antipsychotics. Conclusion : Long-term practical oral intake should not comprise antipsychotic polypharmacy, especially typical antipsychotics before onset of dysphagia, but should instead consist of a monopharmacy approach with atypical antipsychotics.