Fisher syndrome is characterized by ophthalmoplegia, ataxia and areflexia after preceding infection. The ophthalmoplegic symptom is described in a volume of Yomeibyo of the Shokan Ron, the classic Chinese encyclopedia of medical treatment. The Shokan Ron recommends Dai-joki-to as a treatment for this symptom. Accordingly, we administered Dai-joki-to to one patient diagnosed with atypical Fisher syndrome. The result was a prompt reduction of the ophthalmoplegic symptom in the patient. As Fisher syndrome is not a critical disease, Dai-joki-to administration should be considered as an alternative treatment to plasmapheresis.

Objective : Blunt aortic injury often accompanies other organ injuries, and therefore requires an appropriate lifesaving surgical strategy. Patients : During the past 8 years, blunt aortic injury was reviewed, based on 5 lifesaving cases experienced in our hospital. There were 3 men and 2 women (aged 57-70, average 64.2). The Injury Severity Scores were 13-25 (an average of 17.2). Intervention : Regarding our strategy, stabilization of vital signs should be at first aimed by intensive primary care, concomitantly with diagnostic procedures. When stabilization of vital signs is obtained, a delayed operation would be considered after damage control resuscitation. As for 3 of these 5 cases, an emergency surgery was performed because of distinct aortic hemorrhage with instability of vital signs, and stent graft repair was applied based on anatomical indication in two cases. In the other 2 cases, primary diagnosis suggested aortic injury by the bone fracture pieces. Damage control was conducted following stabilization of vital signs, and delayed surgery was done with removal of the bone fracture pieces and repair of aortic injury, which improved activities of daily living. Results : All cases recovered with no particular complication, and were discharged on 9-32 days average postoperatively. Conclusion : Blunt aortic injury is often fatal, but the appropriate diagnosis and treatment can play an important role in obtaining the good results.

To evaluate peripheral occlusive diseases quantitatively, we performed color duplex sonography. Between July 1996 and July 1998, we examined 68 limbs of 40 patients using color duplex sonography in addition to intraarterial digital subtraction angiography for evaluation of peripheral arterial occlusive disease. We classified the wave form of blood flow into four types (Type I-IV). Furthermore we measured the systolic velocities of the dorsal pedial and the posterior tibial arteries as well as the brachial artery. We also calculated the flow volume, and the ratio of systolic velocities and flow volume of lower to upper extremity (AVI, AFI). The waveform was significantly higher in Fontaine class III and IV, and showed remarkable improvement after arterial reconstruction. The value of AVI as well as AFI showed lower in Fontaine class I, II, III, and IV in order. In four limbs classified as Fontaine class II or more with normal ankle pressure index, the values of AVI were rather lower. On the other hand, three limbs with normal values of peak AVI (>0.9) and lower API (<0.75) were in Fontaine class I. The types of waveform correlated with clinical symptoms, and showed a remarkable regression after arterial reconstruction. The new AVI and AFI values had better correlation with clinical symptoms than API.