An attack of Raynaud's Phenomenon (RP) is characterized by blanching of the fingers in response to cold or emotional stimuli.
We analyzed the effect of ninjinyouei-to on RP in patients with MCTD. Subjects in this study comprised 19 patients, two males and 17 females, with a mean age of 38 years, and a mean duration of disease of 57.6 months. The study was performed at a time when RP occurred frequently in our country, that is in the period from November 1992 to March 1993.
We administered 9.0g of ninjinyouei-to to each case for four weeks and measured the surface skin temperature of the hands before and after medication with a thermograph using a Thermoviewer-JTG 3300.
There was a significantly higher temperature on the left first finger-tip after medication. Our thermographic findings in this study demonstrate a quantitative efficacy of ninjinyouei-to on RP in MCTD.

Distal anastomosis during total arch replacement (TAR) for thoracic aortic aneurysm (TAA) is often difficult to perform because of the limited surgical view. The most common methods available are direct anastomosis of a 4-branched graft to the distal aorta, or stepwise anastomosis with the elephant trunk procedure. However, the stepwise technique requires graft-to-graft anastomosis, which is often associated with bleeding. In the present study, we developed a new approach, which we have termed the “Branched Graft Inversion technique”, which does not require anastomosis between grafts, and facilitates anastomosis with a view equal to that in the stepwise technique. A 65-year-old man with a diagnosis of saccular-type thoracic aortic aneurysm was admitted. Cardiopulmonary bypass was established by cannulating the ascending aorta and femoral artery via a median sternotomy. We performed distal anastomosis under selective cerebral perfusion during hypothermic circulatory arrest (25°C). An inverted branched graft was inserted into the descending aorta and anastomosed using mattress and running sutures together with outer reinforcement with a Teflon felt strip. The distal end of the inverted branched graft was then extracted, and reconstruction of the neck vessels and proximal anastomosis were performed. Our newly developed Branched Graft Inversion technique was useful during TAR for TAA.

This study investigated whether significant coronary artery stenosis in 231 consecutive unstable angina patients can be diagnosed by thoroughgoing history-taking initial electorocardiography and symptom- or sign-limited treadmill exercise ECG after medication. The unstable angina patients were divided into those with accelerated angina, those with new-onset effort angina and those with angina at rest based on the findings of detailed inquiry. Initial ECG showed that the sensitivity and specificity of detecting significant coronary artery stenosis in all patients were 55.2% and 63.2%, respectively. In accelerated angina, sensitivity and specificity were 52.2% and 50.0%, respectively. In new-onset effort angina, sensitivity and specificity were 46.7% and 57.1%, respectively. In angina at rest, sensitivity and specificity were 69.0% and 68.3%, respectively. Initial ECG provided valuable diagnostic information about angina at rest. Treadmill exercise ECG offered 66.0% sensitivity and 89.2% specificity in all patients, respectively. In accelerated angina, sensitivity and specificity were 80.0% and 66.7%, respectively. In new-onset effort angina, sensitivity and specificity were 70.8% and 87.8%, respectively. In angina at rest, sensitivity and specificity were 48.3% and 91.4%, respectively. Thus, treadmill exercise electrocardiograms provided valuable diagnostic information in the case of unstable angina, especially accelerated angina and new-onset effort angina. For patients with angina at rest, this testing was very useful for excluding significant coronary artery stenosis.
In conclusion, detailed inquiry, initial ECG and symptom- or sign-limited treadmill exercise ECG after medical stabilization proved to be of great value for diagnosing unstable angina patients with significant coronary artery stenosis.

There are many acquired and hereditary coronary risk factors, and the gender is known as a factor influencing the development of acute myocardial infarction (AMI). To evaluate the role of the gender in the occurrence of AMI, we compared patient backgrounds, their clinical manifestations, outcomes, and coronary angiographic findings between 390 male and 110 female AMI patients, who had been admitted to the coronary care unit (CCU) of the Tsuchiura Kyodo General Hospital and undergone coronary angiography on an emergency basis. The incidence of AMI was the highest in the age group of 60s for males, while for females in the age group of 70s. As coronary risk factors, smoking habit was more common in males, while hypertension, hyperlipidemia and diabetes meritus were more common in females. Coronary angiograms revealed no differences in the number of diseased vessels and location of infarction. Frequencies of urgent PTCA were also identical between the two groups. In clinical outcomes, elder females had poorer prognosis mainly due to a higher incidence of death caused by cardiac rupture. It has been reported that definite increase of AMI after menopause is attributable to disturbed lipid metabolism due to a reduced estrogen level. Our study showed that aged female AMI patients had poorer prognosis possibly due to associated multiple risk factors, mutiple organ disorders and delayed admission to hospital and higher risk of cardiac rupture. Therefore, in the treatment of aged female AMI patients, these tendencies must be taken into account.

We experienced 26 cases of free internal mammary artery (IMA) grafting for coronary artery bypass (CABG) during past 44 months. There were 3, 6 distal anastomoses per patient and 1.6 distal anastomoses per patient were performed with free IMA. The early mortality rate (within 1 month after surgery) was 3.8%. The surgical complications were 0 in mediastintis requiring operation, 0 in reoperation for bleeding and 1; phrenic nerve paralysis with respiratory dysfunction, the patency rate at 1 month after surgery were 97.2% in free IMA and were 96.1% in in-situ IMA. Conclusion was as followed that the use of free IMA for CABG provided excellent result in early period and we would anticipate to expand the use of IMA.