Background and objective : Diet has been recognized as an important part of Kampo medicine, and various plants with which we often cook are included as components of many Kampo formulations. Accordingly, nutritional science is closely related to Kampo medicine. So there is a need for national registered dietitian and nutritional science students to learn Kampo medicine. Despite this, no survey has reported on the awareness of nutritional science students toward Kampo medicine in Japan. We conducted for the first time a survey on this awareness amongst nutritional science students about Kampo medicine.Methods : A 13-item anonymous questionnaire was distributed to the third-year students in a national registered dietitian training program in Japan.Results : We obtained answers from 509 students in 9 institutions. Of the respondents, 59.3% answered that they were interested in Kampo medicine, and 86.4% of the students who were not interested in Kampo medicine answered that the reason was they had no chance to learn it. However, 81.3% of the students answered that they would attend lectures on Kampo medicine if it was adopted as part of their curriculum.Conclusions : These results suggest that Kampo medicine should be included in educational programs for nutritional science students.

We conducted a survey to measure the change of awareness about Kampo medicine following through four lectures of educational interventions delivered to the third-year students in a national registered dietitian training program. Awareness with regard to Kampo medicine was surveyed before and immediately after the interventions. We also collected the same questionnaire again five months after the interventions. The students' scores changed significantly between before and immediately after the interventions in the favorable direction regarding their interest in Kampo medicine, the necessity of including Kampo medicine in future educational programs, and the potential usefulness of Kampo medicine at their future workplaces, and the changes were maintained for five months.
About 70% of students answered that they became more familiar with Kampo medicine as a result of the classes, but their knowledge of Kampo medicine was poor before the lectures and even immediately after the interventions. These results suggest that education about Kampo medicine for students in a national registered dietitian training program is important, because it could be a positive incentive for them to learn about Kampo medicines and herbs and to accept the use of Kampo medicine at their future workplaces.

Seven years ago, we began the “Toride Project” which aimed at organized care, mainly on based a low-protein diet (LPD), for chronic renal failure patients. This project cumulatively involved 486 patients, and 219 of them have been followed up at our hospital.
In this paper, we report the 12 patients who had before shown progressive deterioration of renal function and turned out stable (less than 5% change) in creatinine clearance (Ccr) for 12-54 months after involved in the project. Their diseases were chronic glomerulonephritis (CGN; 10 cases) and nephrosclerosis (NSC; 2 cases), and the mean Ccr was 20.9±1.3 (SE) ml/min (16-32 ml/min). All of them carried out the well maintained LPD (0.62±0.02 g/kg/day), and showed relatively low urinary protein excretion (UPE; 0.4±0.2g/day). In contrast, 10 other cases (CGN; 9, NSC; 1) showed persistent deterioratiom of renal function even if they continued the LPD (0.60±0.02 g/kg/day). They significantly showed higher UPE (1.6±0.3 g/day, p<0.05) than the 12 cases mentioned above. Moreover, frequent examination revealed that the day-to-day change in their protein intake was more widely distributed (coefficient of variation; 19.5±1.3% vs 10.8±0.6%, p<0.05).

A 27-year-old woman was given a diagnosis of infectious endocarditis with severe tricuspid regurgitation. Despite adequate antibiotics therapy, her general condition did not improve, and moreover multiple pulmonary abscesses were detected by computed tomography. Therefore surgery was indicated. Surgery consisted of removal of vegetation and tricuspid valve plasty with autologous pericardial patch augmentation of the anterior leaflet. Tricuspid valve plasty was carried out without prosthetic materials. Her postoperative course was uneventful with only mild tricuspid regurgitation. One year after surgery, neither recurrence of infection nor worsening of tricuspid regurgitation was noted. This method could be a useful technique for young patients with severe infection.

We described a patient with free wall rupture followed by papillary muscle rupture due to acute myocardial infarction. A 69-year-old man was transferred complaining of transient unconsciousness. His clinical history, electrocardiogram, and chest CT showed myocardial infarction with free wall rupture indicated that several days had passed since the onset. Coronary angiography showed occlusion of the right coronary artery and severe stenosis of the left anterior descending artery. Since cardiac rupture was at inferior wall and hemorrhage wasn't active, repair of the rupture using fibrin glue and fibrin sheet and coronary artery bypass grafting to the left anterior descending artery was performed without cardiopulmonary bypass. On the 10th postoperative day, his arterial oxygen saturation suddenly deteriorated. Transesophageal echocardiography revealed papillary muscle rupture and severe mitral regurgitation. Emergency mitral valve replacement was performed. After two emergency operations, he gradually recovered and were discharged to home. In three months after discharge, he was admitted again due to congestive heart failure with left ventricular aneurysm at inferior wall and recovered in response of conservative treatment. Surgical experience of double rupture is rare. Based on this case, it may be necessary to perform reperfusion therapy toward even this case of recent myocardial infarction, to prevent papillary muscle rupture. It also may be better to use a patch on free wall rupture to prevent cardiac aneurysm.

A 50-year-old man was admitted with a fusiform descending thoracic aortic aneurysm measuring 60mm. Chest CT scan revealed porcelain aorta from the aortic arch to the abdominal aorta. Severe calcification found on the descending aortic wall was considered to entail greater risk for conventional aortic repair and reconstruction of intercostal arteries. Therefore endovascular stent grafting was planned. The stent graft was deployed from near the origin of the left subclavian artery to the 10th thoracic vertebral level. Neither paraplegia nor other complication occurred. Endovascular stent grafting may be a safe and effective method for descending thoracic aneurysms with severely calcified aorta.

We report 4 cases of valvular injury following nonpenetrating cardiac trauma in 3 men and 1 woman ranging in age from 24 to 72 years. In all cases the cause of trauma was blunt chest trauma. One patient was operated in 4h, but the other 3 patients were operated on more than 6 months after the accidents. Lacerated aortic cusp was observed in 2 patients, ruptured anterior papillary muscle of mitral valve, and ruptured chordae tendinae of the tricuspid vale were observed in 1 patient each respectively. Three patients underwent valve replacement (2 aortic and 1 mitral valves), and another patient underwent chordoplasty in the tricuspid valve. Their post-operative courses were uneventful. Careful observation, such as echocardiography, were required following the blunt chest trauma.

A 16-year-old boy with multiple injuries suffered in a motorcycle accident was admitted to our hospital. On admission, X-ray films showed left hemothorax and bone fractures of the left humerus, thigh bone, and pelvis. Computed tomography of the chest revealed a pseudoaortic aneurysm approximately 6.0cm in diameter at the proximal portion of the descending aorta. Because of multiple severe associated injuries, we considered that conventional aortic repair in the acute phase would be difficult. We therefore performed an endovascular stent-graft treatment 140 days after injury. The postoperative course was uneventful and the pseudoaneurismal sac has confirmed to decrease. Transluminal placement of endovascular stent-graft is a technically feasible method for treatment of traumatic aortic aneurysm. However, because the long-term results are still unknown, we should follow-up carefully, particularly in young patients.

A 47-year-old man had suffered from high grade fever and dyspnea for 10 days. He was transferred to our hospital in a condition of shock. Echocardiography showed severe diffuse hypokinesis of left ventricle (EF 21%), and multiple mobile thrombi in the left ventricle. Under a diagnosis of LV thrombi due to acute myocarditis, transatrial removal of LV thrombi was performed using video-assisted cardioscopy. He was weaned from cardiopulmonary bypass under IABP support. Postoperatively, he suffered from thromboembolism of the cerebral and right brachial artery. Thrombectomy of the right brachial artery and anticoagulation therapy was performed. IABP was removed on POD 3, and he no longer needed respiratory control on POD 4. Echocardiography on POD 6 showed marked improvement of the LV contraction (EF 52%). After rehabilitation, he was discharged on POD 23 on foot. Video-assisted cardioscopy allowed transatrial removal of LV thrombi, and preserved left ventricular function by avoiding ventriculotomy. Perioperative thromboembolism must be taken care of for a patient with multiple LV thrombi.

Marfan's syndrome associated with multiple arterial aneurysms of the abodominal aortic branches in a pair of identical twins is described. The first case, a 21-year-old male, visited our affiliated hospital because of severe upper abdominal pain. Computed tomography (CT) and aortography (AOG) demonstrated multiple abdominal aneurysms, i.e., celiac artery, bilateral renal arteries and superior mesenteric artery, but there were no findings of dissecting aneurysm of the aorta. The aneurysm of the superior mesenteric artery, which had ruptured, was replaced with a greater saphenous vein graft. The postoperative course was uneventful until sudden cardiac arrest occurred on the 5th POD. An autopsy revealed a dissecting aortic aneurysm (DeBakey type I), massive intrathoracic hemorrhage, and subarachnoidal hemorrhage. Two years later, the second case, the 23-year-old twin brother of the prior case, visited our hospital because of upper abdominal pain similar to that of his brother. The clinical course bore a close resemblance to his brother's. CT and AOG revealed the intact aorta and aneurysms of the celiac artery and right renal artery. The ruptured aneurysm of the celiac artery was ligated. Immediately after his returning to the ICU, he developed sudden massive intrathoracic bleeding and cardiac arrest. This is the fourth report of identical twins with Marfan's syndrome in Japan. It is also noteworthy that in both cases rupture of the extra-aortic aneurysm occurred prior to the aortic dissection or aneurysmal formation.