A 29-year-old woman with severe chest and back pain was referred to our hospital. She exhibited the following physical symptoms of Marfan syndrome : arachnodactyly, wrist sign, thumb sign, pectus excavatum, pes planus, scoliosis, and myopia. Computed tomography revealed a Stanford type A aortic dissection with dilatation of the aortic root, therefore, emergency surgery was performed. Total arch replacement, including an elephant trunk procedure, was performed, followed by valve-sparing aortic root replacement using the reimplantation technique. Following an initially uneventful postoperative course, she was reintubated on the third postoperative day due to laryngeal edema and aspiration. On the sixth postoperative day, it was difficult to ventilate her due to severe tracheal stenosis. Although we managed to return her to spontaneous breathing under proper sedation, it was difficult to maintain stable ventilation. She developed a recurrent respiratory distress following physical irritation such as intratracheal aspiration or a postural change. We believe that during the perioperative management of patients with Marfan syndrome with thoracic deformities, such as pectus excavatum and scoliosis, the possibility of postoperative tracheal stenosis due to tracheal fragility, tracheal edema, and compression of the surrounding tissues must be considered.

A 69-year-old housewife with chronic eczema was treated by Kampo-medicine. For about 20 years, she had suffered from episodes of general eruptions every summer. At our outpatient clinic, skin lesions, chiefly consisted of papules with erosions, were noticed on bilateral external surface of the nose, the back of right hand and the back of the neck.
At first, decoctions of Keishibukuryo-gan-ka-Daio was prescribed for one month, and afterwards, Keishibukuryo-gan-ka-Daio Yokuinin for the rest. The lesions was completely improved after two or five months of the treatment, and the other skin lesions appeared on bilateral forearms, disappearing also after two or three months of the same design of the treatment. After the therapy by Kampo-medicine, no skin lesions were noticed at least for more than two years.
The therapeutic mechanism of the skin lesions was briefly discussed from both the stand point of “Cell pathology” and that of “Whole body pathology”.

A 19-year-old girl with atopic dermatitis was treated by Kampo-medicine. At our outpatient clinic, her skin lesions were especially prominent on her face and cervical region, although noticed also on chest, abdomen, cubital and popliteal regions.
At first, decoctions of Byakko-ka-Ninzin-To was prescribed in ordinary quantities of composite materials (crude drugs), and afterwards, the crude drug (Coptis japonica, Makino) was added. To improve facial flush and thirst, quantities of Coptis japonica and Gypsum were gradually increased. After 25 weeks of this therapy, the skin lesions almost disappeared, and afterwards, no remedy was needed at least for more than three years.
The therapeutic mechanism of the skin lesions was briefly discussed from both the stand point of “Cell pathology” and that of “Whole boby pathology”.

Bacterial endopthalmitis is associated with risk for poor visual prognosis, however, it is rarely combined with infective endocarditis. A 66-year-old man underwent pacemaker implantation and received antibiotic therapy due to persistent fever. A month after the pacemaker implantation, he was admitted to our hospital because of disturbance of vision and consciousness. Disseminated intravascular coagulation (DIC) with decrease of platelet count was also present. His eyes were reddish and swelled, and the conjunctiva were turbid and edematous in both sides. Transesophageal echocardiography demonstrated 18×13mm pendulous verruca originating from the tricuspid annulus. The patient underwent concomitant resection and repair of the tricuspid valve and removal of both infected eyes after DIC treatment. The postoperative course was uneventful and he was discharged from the hospital 43 days after the operation. We conclude that careful observation of the eyes may be needed for patients with infective endocarditis when they have some visual symptoms.

A 31-year old woman with pustulosis palmaris et plantaris was treated by Kampo-medicine. At our outpatient clinic, her skin lesions were especially prominent on her calcaneal and plantal regions of both feet, although noticed also on her palmar regions of both hands.
Decoctions of Keishi-ka-Ôgi-Tô was prescribed according to her Shô (signs and symptoms on whole body). Pustules apparently increased in 2 weeks after this therapy, but afterwards decreased. After 4 months, the skin regions almost disappeared. Although a slight, transient recurrence was noticed at the 10 months of this therapy, the disease was almost completely healed after 12 months.
The therapeutic mechanism of the skin lesions was briefly discussed from both the stand point of “Cell pathology” and that of “Whole body pathology”.

Septic pulmonary embolization (SPE) is an uncommon pulmonary disorder. The diagnosis of SPE is frequently delayed because of its nonspecific chest roentgenological features. A 76-year-old woman who underwent pacemaker implantation one year previously received antibiotic therapy under a diagnosis of infectious colitis. She suffered septic shock and disseminated intravascular coagulation (DIC) and was admitted to our hospital. Methicillin-resistant Staphylococcus aureus (MRSA) was cultured from her blood and echocardiography demonstrated 13×16 mm vegetation originating from the tricuspid valve. Multiple peripheral nodules with cavitation were found on chest computed tomography and she was given a diagnosis of SPE. She rapidly presented acute respiratory failure and mechanical ventilation was inevitable for 23 days before surgery. She underwent removal of the entire pacing system, resection and repair of the tricuspid valve and epicardial pacemaker lead implantation. Tracheostomy and long-term mechanical ventilation (16 days) was required after surgery, however, she was discharged from our hospital without any complication.

We report a case of a caseous calcification lesion originating from a calcified anterior mitral annulus. A 59-year-old woman on chronic hemodialysis was referred to our hospital due to an elevated brain natriuretic peptide value. Transthoracic echocardiography demonstrated moderate aortic valve stenosis with regurgitation and a pendulous mass in the left ventricular outflow tract, and therefore we perfomed. The patient underwent resection of the mass with aortic valve replacement. Pathological examination of the mass revealed interstitial calcium deposits but without tumors or inflammatory cells. We speculated that the cardiac mass was caseous calcification which originated from a severely calcified mitral annulus based on its echocardiographic and pathological features.

Loeys-Dietz syndrome (LDS) is characterized by vascular findings (aortic aneurysms and dissections) and skeletal manifestations. Since aortic dissection occurs at smaller aortic diameters than observed in Marfan syndrome, early and aggressive surgery is recommended for patients with LDS. A 45-year-old man who underwent aortic valve replacement for aortic regurgitation at the age of 33 was transferred to our hospital with the diagnosis of acute aortic dissection. We performed emergeny ascending aortic replacement, and suspected LDS because of his specific physical characteristics after surgery. His postoperative course was uneventful, however, computed tomography (CT) performed at 2 weeks after operation showed the new entry at the distal anastomotic site, patent false lumen of the descending aorta and rapid enlargement of the distal aortic arch. Therefore, we performed total arch replacement with the elephant trunk method at 3 weeks after the emergency operation. Mutation of the TGFBR2 gene was found and we finally diagnosed LDS. One year after, complete thrombosis of the false lumen of the descending aorta and decrease in size of the distal aortic arch was observed by CT.

We report a case of aortic valve replacement using a bioprosthesis after coronary artery stenting in the left coronary main trunk of a 76-year-old man with symptoms of heart failure. Pre-operation studies revealed severe aortic valve regurgitation and that the left main coronary stent protruded into the aorta. Cardiac arrest was obtained with retrograde cardioplegia. Careful observation was made to avoid injury to the aortic bioprosthesis. The postoperative course was uneventful and cardiac echo graphy showed good function of the aortic valve.

Primary malignant tumors of the heart are rare and are associated with very poor survival. We retrospectively analyzed early and late results for five primary malignant tumors of the heart. There were two operative deaths and two late deaths, and the mean survival of patients who survived operation was 18.3 months. No operative survivors had symptoms of congestive heart failure during follow up period. One patient who underwent histologic biopsy received postoperative chemotherapy and is alive without recurrence 36 months after operation. The operative mortality of primary malignant tumors of the heart was high and unsatisfactory, however, surgical treatment prevented congestive heart failure during follow up and contributed to the selection of postopeative therapeutic options, with or without complete resection of the tumors.