The combination effects of chloroquine with Cepharanthin^® or minocycline hydrochloride were evaluated against a blood-induced infection with chloroquine-resistant P. berghei NK 65 in ICR mice. The infected mice in an untreated control group showed a progressively increasing parasitemia leading to mouse death. A two-day dosage of 20 mg base/kg of chloroquine alone produced little effect against P. berghei NK 65 infection, and all mice died from day 13 to 15 with an increasing parasitemia. A four-day dosage of 4 mg/kg of Cepharanthin^® alone produced no antimalarial activity, and all mice died by day 10. A four-day dosage of 50 mg/kg of minocycline hydrochloride alone produced a slight effect, but all mice died by day 18. Furthermore, mice given chloroquine in combination with Cepharanthin^® died from day 14 to 15. Mice given Cepharanthin^® plus minocycline hydrochloride also died from day 15 to 17. On the other hand, infected mice treated with chloroquine plus minocycline hydrochloride survived during the experiment. All mice treated with chloroquine alone, minocycline hydrochloride alone, chloroquine plus Cepharanthin^® or Cepharanthin^® plus minocycline hydrochloride showed low parasitemia levels during drug administration and a few subsequent days, but then malaria parasites re-increased in the bloodstream of the treated mice until death. On the other hand, malaria parasites in the mice given chloroquine plus minocycline hydrochloride decreased on day 6 and then could not be detected by microscopic examination during the observation period. This finding strongly suggests that the combination effects of chloroquine and minocycline hydrochloride are worthy of evaluation in human malaria. The results also clearly demonstrate the necessity and importance of in vivo experiments in estimating the activities of drugs.

Congenital quadricuspid aortic valve is a very rare malformation. Most cases have been discovered as an incidental finding at aortic valve surgery or at autopsy. It frequently evolves to aortic regurgitation, which can manifest in adulthood and may require surgical treatment. A 66-year-old man was admitted because of dysprea. Echocardiogram revealed aortic regurgitation, mitral regurgitation, and tricuspid regurgitation. We performed aortic valve replacement, mitral annuloplasty, and tricuspid annuloplasty successfully. The aortic valve showed one large, two intermediate and one smaller cusp, which were classified as typed by Hurwitz's classification. An accessory cusp was situated between the right and left coronary cusps. No coronary abnormality was involved. The postoperative course was uneventful and he is doing well 6 months after operation.

We analyzed the clinical features of 21 cases with drug-induced liver injury due to Kampo medicines between the years 2000 and 2009 in our institute. The mean age in these cases was 55.2 ± 13.4 years. Five of the cases were men, and 16 were women. In 17 of the 21 cases, drug-induced liver injury had occurred within 3 months after beginning Kampo medicines. There were no subjective symptoms in 11 cases. Nine cases of both hepatocellular injury, and of mixed-type injury were seen. Causative Kampo medicines included an Ogon (Scutellariae Radix) component in 19 cases. A drug-induced lymphocyte stimulation test (DLST) was performed in 5 cases. The test was positive for Kampo medicines in only one of the 5 cases. Liver injury improved or normalized in 18 cases (85.7%) after discontinuing causative Kampo medicines. In another 2 cases, liver injury normalized after changing a Kampo medicine to the same prescription without Ogon. These results suggest that even if patients complain of no symptoms we must perform blood tests to check liver function within 3 months of prescribing Kampo medicines, especially those including Ogon, to facilitate early diagnosis of drug-induced liver injury.

A 62-year-old woman with idiopathic thrombocytopenic purpura (ITP) was admitted to undergo cardiac surgery for aortic stenosis, angina pectoris, and paroxysmal atrial fibrillation. A bleeding tendency was expected due to the dramatic decrease in platelets during cardiopulmonary bypass. We performed high-dose transvenous gammaglobulin infusion (400mg/kg/day) for 5 consecutive days immediately before surgery. The gammaglobulin therapy caused steady increase of thrombocytes from 4 days after surgery, even though the platelet count showed no significant change preoperatively. The postoperative course was satisfactory with neither a bleeding tendency nor wound infection. High-dose transvenous gammaglobulin therapy is thus useful for perioperative patients with accompanying ITP, who are often under medication with steroids. This therapy is also effective for prevention of infection.

We herein describe the findings of a 32-year-old female was known to have had an electrocardiogram abnormalities and had avoided excessive exercise since her high school student days. She suddenly lost consciousness due to ventricular fibrillation (Vf) in July 2007. As a result she was taken to our hospital by ambulance. Emergency coronary angiography demonstrated an anomalous origin of the left coronary artery from the pulmonary artery (Bland-White-Garland Syndrome). She therefore underwent surgery. During the operation, the main pulmonary artery (PA) was transected while on the cardiopulmonary bypass and the left main coronary trunk (LMT) ostium was detected. Antegrade cold blood cardioplegia was induced, and retrograde continuous cold blood cardioplegia was subsequently applied to the coronary sinus, thus obtaining a complete cardiac standstill. The LMT ostium was excised with a cuff of the main PA wall as a button. During further dissection of the LMT distally to the bifurcation, the LMT wall was injured, thus resulting in the need to repair it under deep hypothermic circulatory arrest (DHCA) in order to obtain a bloodless surgical field. During core cooling, the LMT was anastomosed to the left posterolateral wall of the ascending aorta, then the LMT was repaired with a patch consisting of a non-treated autologous saphenous vein (SV) under DHCA. Several surgical techniques for BWG syndrome have been reported. Among these techniques, the direct implantation of the left coronary artery to the ascending aorta is the most physiological and therefore is considered to be the best technique. In this case, direct implantation was accomplished, however, the LMT also had to be repaired.

We have developed a new gait assisting device for patients with hemiplegia, by which a single therapist alone can work with : 1) swing of the paretic limb, 2) stance of the paretic limb, and 3) alternate lateral weight-shift during gait. This device (ASSWS : Assistance of Swing, Stance and Weight Shift) imitates the kinesiological complex (patellar ligament, quadriceps, iliotibial ligament and gluteus maximus) to maintain a standing posture for the lower extremities. We compared the results of a gait analysis using a motion analyzer for gait with ASSWS and gait without ASSWS. With ASSWS, the walking speed was faster, stride length was longer, and stride duration was shorter. No differences in floor reaction force were identified. With ASSWS, the flexion peak of the hip joint became larger and the knee joint was in a more flexed position throughout the walking cycle. Also, the joint moment of hip extension, hip flexion and knee extension all increased with use of the ASSWS.

In the presence of Leriche syndrome, the lower extremities are perfused by collateral flow from internal mammary arteries. If an internal mammary artery graft is used in coronary artery surgery, an acute ischemic limb will develop postoperatively. A 52-year-old man was admitted to our department with bilateral claudication. Multidetector row computed tomography with contrast showed total occlusion of the infrarenal abdominal aorta and rich collateral flow to the lower extremities from internal mammary arteries. Cardiac angiography revealed three-vessel disease. Simultaneous coronary artery bypass grafting and an ascending aorto-bifemoral bypass were performed without cardiopulmonary bypass. Postoperative computed tomography angiography showed that grafts to the coronary and bifemoral arteries were patent. This combined procedure is useful for patients with coronary artery disease and aortoiliac occlusive disease. This procedure without cardiopulmonary bypass has not previously been reported.

PURPOSE: This study evaluated the availability of multi-directionally forged (MDF) titanium (Ti) as a component of removable partial dentures (RPDs). MDF-Ti remarkably improved the mechanical properties of RPDs due to its ultrafine-grained structure. MATERIALS AND METHODS: The wear resistance, plaque adhesion, and machinability of MDF-Ti were tested. As controls, commercially pure (CP) titanium was used for wear, plaque adhesion, and machinability tests. For wear resistance, the volume losses of the titanium teeth before and after wear tests were evaluated. Plaque adhesion was evaluated by the assay of Streptococcus mutans. In the machinability test, samples were cut and ground by a steel fissure bur and carborundum (SiC) point. An unpaired t-test was employed for the analysis of the significant differences between MDF-Ti and the control in the results for each test. RESULTS: Wear resistance and plaque adherence of MDF-Ti similar to those of CP-Ti (P>.05) were indicated. MDF-Ti exhibited significantly larger volume loss than CP-Ti in all conditions except 100/30,000 g/ rpm in machinability tests (P<.05). CONCLUSION Although the wear resistance and plaque adherence of MDFTi were comparable to those of controls, MDF-Ti showed better machinability than did CP-Ti. MDF-Ti could be used as a framework material for RPDs.

PURPOSE: This study evaluated the availability of multi-directionally forged (MDF) titanium (Ti) as a component of removable partial dentures (RPDs). MDF-Ti remarkably improved the mechanical properties of RPDs due to its ultrafine-grained structure. MATERIALS AND METHODS: The wear resistance, plaque adhesion, and machinability of MDF-Ti were tested. As controls, commercially pure (CP) titanium was used for wear, plaque adhesion, and machinability tests. For wear resistance, the volume losses of the titanium teeth before and after wear tests were evaluated. Plaque adhesion was evaluated by the assay of Streptococcus mutans. In the machinability test, samples were cut and ground by a steel fissure bur and carborundum (SiC) point. An unpaired t-test was employed for the analysis of the significant differences between MDF-Ti and the control in the results for each test. RESULTS: Wear resistance and plaque adherence of MDF-Ti similar to those of CP-Ti (P>.05) were indicated. MDF-Ti exhibited significantly larger volume loss than CP-Ti in all conditions except 100/30,000 g/ rpm in machinability tests (P<.05). CONCLUSION Although the wear resistance and plaque adherence of MDFTi were comparable to those of controls, MDF-Ti showed better machinability than did CP-Ti. MDF-Ti could be used as a framework material for RPDs.