We report two cases of numbness and pain of neuropathy due to ANCA (antineutrophil cytoplasmic antibody)-associated vasculitis successfully treated with Ogikeishigomotsuto. The first case was a 57-year-old female who complained of high fever, painful skin eruptions of the lower limbs, and proteinuria. Although the severe pain was reduced with steroid therapy, neuropathy-related numbness and pain remained widespread in her lower limbs. After we prescribed Ogikeishigomotsuto, most of her pain disappeared while her degree of numbness diminished by almost half in two weeks. In addition, her steroid therapy could be tapered off without adverse effect. The second case was an 82-year-old female with fever and myalgia. Although myalgia of the upper arm disappeared with steroid treatment, walking became difficult due to numbness from the lower legs, to the soles of her feet. With Ogikeishigomotsuto administration, she became better able to walk because her legs had warmed up, and the range of her numbness had decreased. These cases suggest that Ogikeishigomotsuto may be effective against numbness and neuropathic pain due to ANCA-associated vasculitis.
Numbness ; Pain ; Peripheral neuropathy ; Antineutrophil cytoplasmic antibody measurement ; Vasculitis

A 84-year-old man was admitted with an abdominal tumor. Prosthetic graft replacement between the aorta and the left external iliac artery was performed 17 years previously. CT scan and angiography showed a large anastomotic pseudoaneurysms at the sites of proximal and distal anastomosis. A Y graft prosthesis replacement was performed. The size of the proximal anastomotic pseudoaneurysm was 7×6×5cm, and that of the distal anastomotic pseudoaneurysm was 15×10×10cm. They resulted from cutting at anastomosis. Large anastomotic pseudoaneurysms at both sites is rare.

Pure autonomic failure (PAF) is a degenerative disorder with diverse autonomic nervous symptoms, but without somatic nervous symptoms. We encountered a patient with PAF who was successfully treated with keishikashakuyakuto. A 61-year-old man complained of diarrhea, abdominal pain, dysuria and orthostatic hypotension. PAF was strongly suspected, based on a low level of plasma noradrenalin at rest and a finding of severe diffuse sympathetic nerve injury on ¹²³I MIBG myocardial scintigraphy. Various Kampo formulas were not effective, or could not be administered continually. Urinary retention was treated with self-catheterization. After the extract of keishikashakuyakuto was administered, his complaints of diarrhea and abdominal pain gradually decreased, and he was able to eat various kinds of food. His daily living activities improved.Moreover, he could urinate by himself, so the self-catheterization was stopped. Five years later, the diagnosis of PAF was clinically confirmed, but his daily living activities did not deteriorate. This suggests that keishikashakuyakuto can be effective for diseases with diverse autonomic nervous symptoms, such as the present case.

A 73-year-old woman was admitted to undergo three simultaneous operations: aortic valve replacement (AVR), coronary artery bypass grafting (CABG) and abdominal aortic aneurysm repair. She had previously undergone percutaneous catheter intervention in the left coronary anterior descending artery. Computed tomography revealed an abdominal aortic aneurysm 5cm in diameter. Aortic valve stenosis (AS) was shown with a pressure gradient of 60mmHg, and 90% stenosis of the distal right coronary artery was also shown. CT scan and aortography revealed porcelain ascending aorta. The patient underwent simultaneous operations because of severe AS, coronary artery disease and abdominal aortic aneurysm. An aortic cannula was placed in a position higher in the ascending aorta with no calcification. Cardiopulmonary bypass was started using a two-staged venous cannula through the right atrium. At first, AVR was performed with cardioplegic solution and ice slush. Because it was difficult to inject the cardioplegic solution into the coronary artery selectively due to the calcified orifice of coronary artery, we closed it immediately by removing the calcified intima of the porcelain aorta after completion of AVR. The second cardioplegic solution was injected through the ascending aorta. Next, CABG to RCA was performed using the right gastroepiploic artery without anastomosis to the ascending aorta. Cardiac surgery was first performed, followed by abdominal aortic aneurysm repair after discontinuation of cardiopulmonary bypass. The patient was extubated the next day and stayed for two days in the intensive care unit. She is very well now one year after the operation.