Objective : We performed a systematic review to investigate improvements in body function and structure, activity, and health-related quality of life from exercise programs of >150 days' duration in patients with knee osteoarthritis (OA). Methods : We collected data on randomized controlled trials (RCTs) comparing the effects of exercise intervention with those of either nonintervention or psychoeducational intervention in patients with knee OA. Data were collected on pain, stiffness, muscle strength, range of motion, flexibility, maximal oxygen uptake, proprioception, time to climb a flight of stairs, disability as assessed by the Western Ontario and McMaster Universities Arthritis Index (WOMAC), walking distance (e.g., 6-min walking-distance test), walking time (e.g., time to walk arbitrary distances), walking velocity, and health-related quality of life assessed using the SF-36^® Health Survey (SF-36). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to determine the quality of the evidence. Results: Forty-one RCTs were identified. Outcomes that were significantly affected by exercise programs of >150 days were knee flexion muscle strength at a functional level, time to climb a flight of stairs and walking distance at activity level, and SF-36 General Health, Physical Functioning, Role-Physical, and Bodily Pain scales. The quality of evidence for these outcomes was moderate to high. Conclusion : In patients with knee OA, improvements in body function, activity, and health-related quality of life can be maintained with exercise programs of >150 days' duration, and these findings are supported by a moderate to high level of evidence.

We experienced a case of chronic pain responding to electrical acupuncture therapy while on spinal cord stimulation. A 35 year-old male presented with chronic neck pain. At 16 years of age, he had neck pain due to traffic accident with stellate ganglion block and epidural block. At 29 years of age, he sensed radiating pain in the 3rd to 5th digits of the left hand during epidural block. At 33 years of age, nerve root injury occurred after insertion of an epidural catheter, resulting in epidural abscess. Although the abscess resolved after antibiotic treatment, he had stiff fingers in the left hand together with neck pain and restricted range of motion of the neck. At 34 years of age, a spinal cord stimulation device was inserted which improved the stiff fingers in the left hand, but not the neck pain and restricted neck motion. He therefore visited our institute. At presentation, neck pain together with dysphagia and mastication pain were observed, and the patient was on a liquid diet. He was given electrical acupuncture treatment in additional to trigger point block and stellate ganglion laser. After two treatments, he was able to resume a normal diet. With reduced neck pain, he also undergo rehabilitation mainly through voluntary neck movements. This case demonstrates that electrical acupuncture treatment may be safe and effective for patients fitted with spinal cord stimulation device.

A 60 year old man presented with a history of right leg claudication which occurred after walking a distance of 200 m. He had no history of cardiovascular risk factors or trauma in the lower extremities. Palpation disclosed no right popliteal or pedal pulse. Ankle-brachial pressure index (ABI) was 0.60 on the affected side. Computed tomography (CT) demonstrated the presence of a highly stenotic lesion in the right popliteal artery due to compression from periarterial polycystic masses. Magnetic resonance imaging (MRI) revealed no communication to the knee joint bursa. Further, angiography showed a beak-like severe stenosis on the knee of the right popliteal artery. Based on the results of these three imaging techniques we confirmed the diagnosis of cystic adventitial disease (CAD). The patient underwent a surgical exploration of his popliteal artery through a posterior approach. Evacuation of all cysts by longitudinal incision of his adventitia yielded yellow mucoid gelatinous material. The popliteal artery was replaced using the great saphenous vein because the previous imaging showed thrombus formation at the cyst site. He had an uneventful postoperative recovery with ABI of 1.10.

Background and Purpose : Many cases of amnesia caused by thalamic hemorrhage involve anterior nucleus hemorrhage, dorsomedial nucleus hemorrhage, and intraventricular rupture. In the present study, intraventricular rupture was studied with a focus on cases with hematoma compression at the fornix. Methods : Of 116 patients with thalamic hemorrhage admitted to our hospital, 50 patients aged <70 years who had hemorrhage during their first stroke confined to the thalamus, internal capsule, and corona radiata, and who neither developed hydrocephalus nor showed dementia prior to onset were investigated. Thalamic hemorrhages were classified by CT findings and the extent of intraventricular rupture. Memory was studied by the FIM memory scores on admission and discharge. Results and Conclusion : Patients with dorsomedial nucleus hemorrhage showed no tendency toward amnesia and were equivalent to patients with posterolateral nucleus hemorrhage, which does not usually result in amnesia on its own. Of the 30 patients with posterolateral nucleus hemorrhage, a high degree of amnesia was observed in the 18 with intraventricular rupture. A high proportion of patients with dorsomedial nucleus hemorrhage experienced intraventricular rupture (5 of 6 patients). Equivalent degrees of amnesia were observed in patients with intraventricular rupture with dorsomedial nucleus hemorrhage and those with posterolateral nucleus hemorrhage. The present findings in conjunction with the fact that amnesia in thalamic hemorrhage involves episodic memory impairment suggest that amnesia in patients with dorsomedial or posterolateral nucleus hemorrhage or with intraventricular rupture does not stem from damage to the dorsomedial nucleus, which is part of the Yakovlev circuit involved in emotional memory. Instead, the primary cause appears to be the effects of intraventricular rupture on the Papez circuit surrounding the lateral ventricle and foramen of Monro.

Early surgical resection for cardiac myxoma is necessary because it may frequently cause cerebral infarction. However the optimal surgical timing for the disease is controversial because the acute phase of infarction may induce intracranial hemorrhage. An 82-year-old woman referred to our hospital because of unconsciousness and right hemiparesis. MRI showed infarction in the left middle cerebral artery area and UCG revealed a left atrial mass. The fourth day after the onset, brain CT showed hemorrhagic infarction and MRI showed new infarction. There was no enlargement of the hemorrhagic focus on brain CT and the patient underwent surgery on the fifth day after the onset. The postoperative course was uneventful. Despite the existence of hemorrhagic infarction, open heart surgery may save patients with cerebrovascular event.

We report a case of coronary artery bypass grafting (CABG) in a patient with systemic lupus erythematosus (SLE). A 24-year-old woman with SLE had been treated with steroids and immunosuppressive agents for 7 years. The patient was admitted to Kumamoto University Hospital for the management of unstable angina. CABG was successfully performed using bilateral internal thoracic arteries and postoperative 3D-CT demonstrated good patency of both arterial grafts. The patient experienced no significant postoperative complications, and has remained well to date (8 months postdischarge).

We report a case of chronic mesenteric ischemia associated with severe aortic valve regurgitation and stenosis (ASR). The patient was a 76-year-old man who had been given a diagnosis of ASR in his 40s. He gradually developed heart failure and chronic kidney disorder due to deterioration of ASR. He had started hemodialysis 1 year before admission and had complained of abdominal pain after meals and weight loss during that period. He was admitted to the Department of Cardiology in our hospital for evaluation of ASR. Severe ASR with low output syndrome (C. I. 2.00 L/min/m²) were confirmed by cardiac catheter examination. In addition, abdominal angiography revealed total occlusion of the superior mesenteric artery (SMA) and severe stenosis of the celiac artery (CA). We considered that low cardiac output due to severe ASR had exacerbated the mesenteric ischemia. We performed AVR and abdominal aorta-SMA bypass at the same time to prevent acute mesenteric ischemia in the perioperative period. The combination of valvular disease and CMI is very rare. This is the first report in Japan of simultaneous valve replacement and mesenteric artery revascularization.

We herein report on a case in which we conducted bypass surgery for occlusion of a left axillary artery aneurysm with ischemic symptoms 21 years after the contraction of Kawasaki disease and achieved symptomatic improvement. The case involved a 22-year-old man who had been suffering from Kawasaki disease since the age of one. He had been undergoing antiplatelet therapy for bilateral axillary artery aneurysms by orally taking aspirin for 20 years. He suffered from symptoms of upper limb ischemia 21 years after receiving a diagnosis of peripheral aneurysms and occlusion of a left axillary artery aneurysm upon 3DCTA. We conducted aneurysmotomy, plication, and bypass surgery between the axillary and brachial arteries via the autologous vein. Pathological examination revealed due to the formation of atheroma in the tunica intima and disarrangement of the layer structure in the tunica media : thickening of the tunica media was partially observed. His fatigue upon exertion of his left upper extremity remarkably improved following surgery. Although peripheral aneurysms associated with Kawasaki disease are rare, as seen in this case, peripheral arterial disease remains and progresses even after long periods of time. It is believed necessary to carry out long term follow-up and examine the approaches to therapy including surgery in accordance with the site and degree of the disease.