Herb supplies can become unstable because of climate change and the economic development of herb exporters. In this paper, in order to increase the self-sufficiency of herbal resources we examined the possibil ity of changing to herb crop production from tobacco, for which demand is declining. Firstly, we considered demand, quality and the price of raw herb materials to make recommendations for corrections, and selected Angelica (A. ) acutiloba and Bupleurum (B. ) falcatum Linne. Next, we compared the profitability of tobacco and the herbs. Profit margins for A. acutiloba were less than for tobacco. It was thought that the profitability of A. acutiloba could become equivalent to tobacco if an adjustment subsidy were provided. The self-sufficiency rate for A. acutiloba would be one hundred percent with 35 million yen in every year. Although the profitabil ity of B. falcatum has exceeded tobacco, its selling price was about 3 times that of imports, while the price of medical B. falcatum was lower than its selling price. It was thought that the price competitiveness problem of B. falcatum can be covered if a production subsidy is provided, and to reach a 50 percent B. falcatum self sufficiency rate with 660 million yen per year.

Endovascular grafting via the aortic arch, a novel alternative method for aortic aneurysm repair, was performed in 18 patients with aortic arch or distal arch aneurysms. For cerebral protection, selective or retrograde cerebral perfusion was used during delivery and deployment of the stented graft through the aortotomy. Selective cerebral perfusion was performed through both cerebral arteries and the left subclavian artery. Throughout this procedure, the aorta was filled with carbon dioxide to prevent the spinal arteries from air embolism. Two patients were lost, one due to myocardial infarction and one due to pneumonia. Endoluminal leakage was found in 2 patients, for which reoperation was required. However, no cerebral or spinal complications were observed in this series. Thus we conclude that endovascular stent grafting via the aortic arch is an acceptable alternative for the aortic arch or distal arch aneurysm repair with little risk of cerebral or spinal complications.

The internal mammary artery (IMA) has been widely used in CABG due to the excellent long-term results. However, the extensive use of bilateral IMA grafting has been believed to increase operative morbidity and mortality. This study was designed to determine if bilateral IMA grafting in diabetic patients increased the likelihood of mediastinitis. We analyzed the data of 386 consecutive patients who underwent isolated CABG in 1992 to 1996. The definitions of sternal wound complications are as follows, (1) mediastinal dehiscence and (2) mediastinal wound infection. Subtypes include superficial wound infection and deep wound infection (mediastinitis). Among these patients 97 received unilateral IMA grafts and 289 did bilateral IMA grafts. mediastinitis did not occur in any subjects. The occurrence rate of mediastinal dehiscence and superficial wound infection was 7.2% (7/97) for bilateral IMA grafting, 7.3% (21/289) for unilateral IMA grafting. No patients died of wound complications. The occurrence rate of mediastinal dehiscence and superficial wound infections were 12.0% (4/33) for bilateral IMA grafting in diabetic patients, 12.0% (14/117) for unilateral IMA grafting in diabetic patients. That of this complications was 4.7% (3/64) for bilateral IMA grafting in non-diabetic patients, 4.1% (7/172) for unilateral IMA grafting in diabetic patients, without significant differences in wound complication. Bilateral IMA grafting in diabetic patients carried no great risk of mediastinitis, but diabetes mellitus itself was a great risk for mediastinitis.