We reported the case of a 9-year-old girl who complained of irritability with sounds, headache, nausea and ease of fatigability, who was successfully treated with the Kampo formulation, ryokito. Her irritability with sound occurred following bilateral ear pain. Her headache, nausea and antipathy towards smells appeared in conjunction with aggravation of this pain symptom. We recognized this patient as having a Ki-distribution imbalance, and so prescribed ryokito as a decoction. Following her use of this formulation, her complaints improved remarkably within about 8 weeks.

The number of senile eye cataract cases increases year by year. Recent developments in new operation techniques have brought more safety and ease i.e. ultrasonic phacoemulsication and lens replacement. However, some complications of these techniques result in troublesome outcomes. In this paper the authors report a female patient aged 74 years old who suffered from severe photophobia after cataract surgery, which was successfully treated with the Kampo formulation, ryokeikansoto. Such troublesome cases tend to be neglected to in medical journal publications when the background of the complaint is unknown.

A 67 year-old women who suffered from painful palms and soles with burning sensation for 2 years was treated. At first, she visited the department of dermatology and then consulted our department. The authors considered these symptoms as already being described in the great classic Kinkiyoryaku (Chin Keiu Yao Lueh). We then prescribed shokenchuto, which resulted immediate clinical improvement. The authors have again realized that the classical textbook is based on proper clinical observations that are useful today.

Reitakutsukito, a Kampo formulation which is described in the textbook Ranhitsu-Hizou, has been well known as a suitable formulation for sinusitis related signs and symptoms.
We reported previously three cases, i.e. chronic headache, bronchial asthma and bronchial amyloidosis with sinusitis, successfully treated with this formulation. Here we report on a clinical trial of reitakutsukito for 5 cases in which the chief complaints were pre-menstrual disorder, chronic headache, anorexia, finger dysesthe sia and chronic cough accompanied with sinusitis. We attempted to make clear the sho for this Kampo formulation by means of administering this formulation alone, or with concomitant use of supportive formulations.

IABP has been widely used as a circulatory assist device since introduction of the percutaneous insertion method. However, vascular complications associated with IABP have remained a high incidence. We developed a new sheath for IABP insertion to maintain the lower limb perfusion in the patients with tortuous or stenotic iliofemoral arteries. The new sheath has an internal diameter of 12Fr, an outer diameter of 14Fr and has 10 side holes which serve as an internal shunt. The new sheath used for IABP presented good lower limb perfusion in three patients with tortuous or stenotic iliac arteries who presented limb ischemia with an ordinary IABP sheath. The internal shunt sheath may also be useful for diagnosis of lower limb perfusion by injection of contrast medium into a side port of the sheath in cases of leg ischemia suspected after insertion of IABP.

Myocardial revascularization combined with valvular surgery were performed on 8 patients between 1986 and 1990. There were 4 males and 4 females (mean age=60.6 years). Mitral valve replacement was performed in 3 patients, aortic valve replacement in 2, and double valve replacement in 3. There were no operation death, but one late death was seen. No angina attack was evident and NYHA functional class was improved in all patients in survivers. Coronary angiography should be performed in all adult patients who have valvular disease and those with significant artery disease should undergo bypass grafting concomitant with valvular surgery.

Six patients with malignant retroperitoneal tumor extending into the inferior vena cava (VCI) were surgically treated with use of a normothermic extracorporeal circulation (ECC). Origin of malignant tumor was renal cancer in four, adrenal cancer in one and seminoma in one. Four patients excluding two of renal cancer had metastasis to the lung or bone preoperatively. One of renal cancer with lung metastasis and invasion to the colon died six months after surgery. The remaining five patients have been alive and well with follow up of 1 year to 7 years (mean 3 years 3 months). Cytological examination of an arterial filter of ECC and intra-circuit blood was made and negative in two patients. Long term results and cytology revealed a rare chance of intraoperative dissemination of malignant cells. These results suggested feasibility of surgery using normothermic ECC for the treatment of malignant retroperitoneal tumor with extension into VCI.

We developed a percutaneous left ventricular assist system (PLVAS) using a centrifugal pump. PLVAS is the transseptal left atrial-femoral artery bypass to unload the left ventricle using a centrifugal pump. This PLVAS can be implanted through the inguinal vessels under fluoroscopy and also in 2 cases additional transesophageal echocardiogram guiding was performed. This PLVAS was applied to 6 patients with profound heart failure and refractory cardiogenic shock. The implantation of PLVAS required 30-60 minutes. The PLVAS assist flow was maintained at 3.0-4.0l/min. One patient with acute myocardial infarction survived and has been doing well for more than 1 year. The complications directly related to this procedure were minimal. PLVAS appears to be useful for patients with severe heart failure and may be useful as a short-time support or bridge to other more aggressive forms of life support.

In order to promote regional cooperation in palliative care, we developed a regional cooperation clinical pathway for home palliative care that offers simple support and is easy to use. We then administered a questionnaire survey to 14 healthcare professionals with various specialties who were involved in the introduction of the pathway, and we revised the pathway on the basis of the survey results. The revised pathway was then tested in 13 patients who were discharged from 3 designated cancer care hospitals in Toyama City to home care, and another questionnaire survey was conducted afterwards in the same manner. The mean overall score on the questionnaire was 2 in seven, 3 in seven (on a scale of 0 to 3) at the time of introduction, whereas the score after trial use was 1 in one, 2 in four, 3 in five. We believe that more innovative approaches to the implementation of such pathways are required.

A 49-year-old man who had had severe tripple vessel coronary disease and low left ventricular function (EF=29%) underwent coronary artery bypass grafting. Following the procedure he could not be weaned from cardiopulmonary bypass (CPB) even with an intra-aortic balloon pumping (IABP). Left ventricular assist using a centrifugal pump (CFP) together with IABP was then utilized with a dramatic recovery from profound postcardiotomy cardiogenic shock, and the CPB was successfully terminated. The left ventricular function recovered gradually from intraoperative myocardial damage. The CFP was successfully removed at 86 LHB hour and the IABP at 9th postoperative day. At present 12 months after LHB, he reveals no angina. Settting up the left ventricular support using a CFP is simple and not-time-consuming, so this system with IABP is of practical use in the case of unpredicted postcardiotomy cardiogenic shock.