A 75-year-old man who presented with fever and cough was given a diagnosis with active pulmonary valve endocarditis and transferred to our institution. Blood cultures were positive for Enterococcus faecalis, and transthoracic echocardiography showed a mobile vegetation attached to the pulmonary valve. Despite an 8-week treatment with antibiotics, a relapse of the infection required surgery. During the surgical procedure, we found that the vegetation had destroyed all of the pulmonary valve leaflets. After excising the pulmonary valve leaflets, we implanted a bioprosthetic valve and closed the pulmonary artery with autologous pericardium. The patient completed a 6-week course of intravenous antibiotics and was discharged on postoperative day 68. Postoperative transthoracic echocardiography demonstrated an adequate effective orifice area index. Our case report of isolated pulmonary valve endocarditis without predisposing factors is rare. The implantation of a bioprosthetic valve and enlargement with an autologous pericardial patch is an effective option for achieving a satisfactory hemodynamic profile.

Soshikokito is a Kampo formulation used in the treatment of bronchial asthma, especially in those patients with hot flushes and cold sensation in their feet. But there is also a description in classical textbooks for its usage for the treatment of tinnitus. We report two typical cases of prolonged tinnitus treated successfully with soshikokito. Case1was a 70-year-old woman who visited our clinic complaining of tinnitus, dizziness and insomnia. She had a history of bilateral otitis media in her childhood, and had been suffering from tinnitus after being operated for it. The tinnitus had worsened during the three months prior to her first visit to us. After 3 months' treatment with soshikokito with additional shisoyo, her symptoms improved, so much so that after 8 months, she could live her life normally. Case 2 was a 58-year-old man who presented with tinnitus, hearing disturbance and a sense of irritation. He also complained of insomnia and cold sensation in his limbs. After1month's treatment with soshikokito with additional shisoyo and bushi, most all of his symptoms resolved. In addition, we also evaluated the clinical efficacy of soshikokito for prolonged tinnitus, retrospectively, and found that it was effective in five out of the ten cases we treated with this formulation. Most of the successfully treated patients presented with hot flushes or cold sensation in their feet. These case reports suggest that soshikokito may be a useful formulation for the treatment of not only bronchial asthma, but also of prolonged tinnitus.
Tinnitus ; therapeutic aspects ; seconds ; month ; Esthesia

We report two cases of unexplained thoracodorsal pain, which were successfully treated with the Kampo formulations karogaihakuhakushuto and karogaihakuhangeto. In case 1, the patient was a 67-year-old man. Left thoracodorsal pain appeared in this patient two months after the administration of chemotherapy for transverse colon cancer with hepatic metastasis. Bone metastasis was ruled out by bone scintigraphy, but the cause of the pain was still unknown. The Kampo formulation karogaihakuhakushuto was prescribed and the pain was reduced after two weeks, and disappeared within three months. In case 2, the patient was a 40-year-old man. Right thoracodorsal pain appeared in the right hypochondriac region without an apparent cause. Examinations, such as computed tomography and upper gastrointestinal endoscopy, were conducted, but the cause of the pain remained undiagnosed. The pain was not improved with pain killers, karogaihakuhakushuto was prescribed, and the pain was then reduced in about a month. The authors considered thoracodorsalpain as already described in the great classic Kinkiyoryaku (Chin Keiu Yao Lueh). We then prescribed karogaihakuhakushuto and karogaihakuhangeto, which resulted in immediate clinical improvement. These clinical courses indicate that the formulae can be effective for the treatment of thoracodorsal pain of unknown origin. Furthermore, the effect of herbal medicines and herbal decoctions boiled with rice wine may make it possible to have a more imminent effect on thoracodorsal pain.

A sinus of Valsalva aneurysm is a comparatively rare disease, and it has almost no symptoms unless this is rupture, whereas aortic insufficiency, myocardial ischemia and heart failure might be associated with un-ruptured aneurysm of the sinus of Valsalva. We encountered 2 elderly patients (71 years old and 83 years old) with huge un-ruptured aneurysm of the sinus of Valsalva which causes right ventricular outflow tract obstruction. The orifice of the aneurysm of the sinus of Valsalva was closed using ePTFE patches in the both cases. Plication of aneurysm was attempted in both cases, but it failed in case 1 due to undetermined border of the aneurysm on the right side of the heart. Case 2 was required concomitant aortic valve replacement with a bioprosthesis due to associated aortic regurgitation. The repair of un-ruptured aneurysm of the sinus of Valsalva associated with right ventricular outflow tract obstruction can be performed safely and effectively even in elderly patients.

A brachiocepharic artery aneurysm is relatively rare in comparison with other peripheral artery aneurysms. A 62-year-old woman who had had a sudden chest pain 1 year previously was referred to our hospital because of a right upper mediastinal mass on a chest roentgenogram. Computed tomography demonstrated the dissection and dilatation of the innominate artery. The dissection extended to the right carotid artery and right subclavian artery. Furthermore, the ascending aorta was dilated. We performed reconstruction of the innominate artery with a Y-shaped composite graft and replacement of the ascending aorta and total aortic arch. Her postoperative course was uneventful with no neurological event. We describe our surgical strategy in this report with a review of the literature because operative methods and plans are various according to the shape and extent of the aneurysm of the brachiocepharic artery.

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 56-year-old man, who underwent aortic valve replacement with a stentless artificial valve for aortic valve endocarditis at age 52, found to have left ventricular outflow pseudoaneurysm by transthorasic echocardiography, transesophageal echocardiography and enhanced computed tomography. We repaired the pseudoaneurysm, combined with valve re-replacement. Left ventricular outflow pseudoaneurysm is a rare disease, and is often associated with active endocarditis. Transesophageal echocardiography and CT scan are useful to diagnose this disease, especially to rule out annular abscess. Operative indication is recommended soon after the diagnosis was made to prevent rupture of pseudoaneurysm, or development of either mitral regurgitation or coronary ischemia due to compression from the pseudoaneurysm. Combined aortic valve replacement, with or without mitral valve replacement is necessary to repair the pseudoaneurysm.

Intracardiac repair for cardiac anomalies associated with a transposed aorta from the right ventricle is a technically demanding operation. We present two cases of left ventricular outflow tract (LVOT) obstruction after the use of an ePTFE flat patch to reconstruct the LVOT. Case 1 : A 10-year-old boy had undergone the Rastelli operation, VSD enlargement, and intraventricular re-routing using an ePTFE flat patch for repair of the DORV with noncommitted VSD and pulmonary stenosis at the age of 5. Five years later, catheter examination revealed severe LVOT obstruction. Intraventricular re-routing using a part of the ePTFE graft concomitant with re-replacement of an extracardiac conduit was successfully performed. Case 2 : A 13-year-old girl had undergone a double-switch operation (Senning operation, the Rastelli operation, and intraventricular re-routing by the use of an ePTFE flat patch) for the repair of corrected TGA, PA and VSD at the age of 7. Six years later, catheter examination revealed severe LVOT obstruction. Intraventricular re-routing using part of the ePTFE graft concomitant with re-replacement of an extracardiac conduit was successfully performed. We consider that the use of a flat patch for reconstruction of a left ventricular out flow tract in cases with transposition of the aorta from the right ventricle involves a risk of future development of LVOT obstruction.