A 22-year-old woman without any serious distincted symptoms was found to have hypertension on a health examination. On further examinations, involving echocardiography and chest enhanced CT, showed dilatation of the ascending aorta, aortic coarctation, well-developed intercostal arteries and other collateral arteries. She was only 137 cm tall and weighed 52 kg. Besides, she had not had menstruation for the past two years. Chromosomal studies revealed Turner syndrome. Left lateral thoracotomy was thought to have the risk of heavy bleeding from collateral arteries, therefore we chose ascending-to-descending aorta bypass grafting through median sternotomy. She had an uncomplicated postoperative course. Here we report about operation in a adult case of coarctation of the aorta and discuss the usefulness of extraanatomical bypass grafting.

A 72-year-old man was referred to our hospital because of lumbago and an abdominal aortic aneurysm (AAA). Computed tomography revealed the AAA to be 5cm in diameter with a retroperitoneal hematoma. A diagnosis of chronic contained rupture of an AAA was made, and an operation was performed. At laparotomy, a punched-out defect (10×20mm) that was thought to connect the thrombosed aneurysm to an organized retroperitoneal hematoma was discovered on the right side of the aorta. The aneurysm was replaced with a Y-shaped prosthetic graft. The patient's postoperative course was uneventful. This case of chronic contained rupture of an AAA was distinctly different from cases of acute rupture. Although patients with chronic contained rupture of an AAA are hemodynamically stable, such cases should be assessed and treated as quickly as possible because of the risk of re-rupture.

We report a successfully treated case of infectious endocarditis with ventricular septal defect (VSD) and double-chambered right ventricle. A 41-year-old man complained of dyspnea. Echocardiography showed his tricuspid valve, aortic valve, and pulmonary valve had vegetation and severe regurgitation. He received treatment with antibiotics but it was not effective. He underwent TVR, AVR, pulmonary valve resection, VSD patch closure and RV abnormal muscle resection. Pathological findings of resected valves showed infectious endocarditis. He recovered uneventfully and resumed his original social activities.

A 61-year-old woman developed shock during transportation to our hospital in an ambulance under a diagnosis of acute myocardial infarction, Emergency coronary angiography showed left anterior interventricular descending branch #6 to be completely occluded. At the same time, ultrasonic cardiography showed pericardial effusion. Therefore we diagnosed left ventricular free wall rupture, and performed emergency surgery to repair the rupture site. After pericardiotomy massive hemorrhage occurred and we diagnosed blow-out type left ventricular free wall rupture. We immediately established extracorporeal circulation via the femoral artery and vein, and cross clamped the ascending aorta, then achieved cardiac arrest. Because the area of myocardial infarction was extensive, we applied the David-Komeda method to avoid bleeding due to left ventricular systolic pressure, left ventricular aneurysm or ventricular septal rupture. The postoperative course was good; the patient was weaned from PCPS on the 3rd day postoperatively, IABP on the 5th day postoperatively and from the respirator on the 8th day postoperatively. She was discharged on postoperative day 40. Currently she has no cardiac complains, no left ventricular aneurysm and no neurological problems. Left ventricular free wall rupture can remain a fatal complication after acute myocardial infarction. We consider the David-Komeda method useful for repairing left ventricular free wall rupture (blow-out type) after acute myocardial infarction as well as ventricular septal rupture without a risk of left ventricular aneurysm, bleeding or ventricular septal wall rupture.

Unkei-to was used successfully to treat three patients with primary Sjögren's syndrome (pSjS). The first case was a 67-year-old woman. In April 1993, she visited Tonami General Hospital with the symptom of dry eyes. Her condition was diagnosed as pSjS from being antinuclear antibody (ANA) positive, dry eye, and decrease of saliva secretion. She used eye drops, but her dry eye did not improve, she visited our department in June 1995. Administration of Unkei-to improved her symptoms after 6 months of treatment.
The second case was a 73-year-old woman. In 1987, she was treated in our hospital for lumbago based on spondylosis. In 1991, she began to suffer from pain and swelling of the right sterno-clavicular joint (RSCJ) and was admitted. She was anti-SS-A/Ro ANA positive, schirmer's test was positive, lymphocyte infiltration was observed by lip biopsy, and thus pSjS was diagnosed. Treatment with Unkei-to resulted in the improvement of pain and swelling of RSCJ, as well as a decrease in serum C-reactive protein. But a favorable effect on dry mouth was not attained in this case.
The third case involved a 39-year-old woman who began to experience polyarthralgia and dry mouth in June 1991. She visited a neighborhood hospital and was diagnosed as pSjS from hyper γ-globulinemia, anti SS-A ANA positivity, and decrease of saliva secretion. She first visited our hospital in March 1994. We administered Keishikaryojutubu-to and improvement of polyarthralgia was observed. Subsequently, she suffered from symptoms of dry eye and dry mouth. We treated her with Unkei-to, which improved the symptoms of dryness, but not polyarthralgia in this case.
These observations suggest that Unkei-to might be a useful agent for the treatment of pSjS.

Objectives: To determine the effects of massage therapy on the immune and psychological state, and serum lipids levels.
Design: A non controlled trial with 32 subjects.
Setting: Kyoto Prefectural School for the Blind and Kyoto Prefectural University of Medicine.
Subjects: 32 adults aged from 18 to 56 years (10 males; 22 females).
Interventions: One 25-min whole body massage.
Outcome Measures: Changes in peripheral blood levels of red blood cells (RBC), hematocrit (Ht), white blood cells (WBC), lymphocytes, neutrophils, CD4+ lymphocytes, CD8+ lymphocytes, CD4+/CD8+ ratio, CD16+ lymphocytes, serum interferon-γ (IFN-γ), serum interleukin 6 (IL6), serum total cholesterol (T-CHO), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c); saliva secretory IgA (s-IgA); State-Trait Anxiety Inventory (STAI).
Results: Psychological measures; Both state and trait anxiety scores decreased significantly (p<0.001). Serum lipids; Significant hemodilution and significantly decreased levels of serum T-CHO, LDLc and HDLc (p<0.001) were observed. Immune measures; Significant decreases of neutrophils (p<0.05) and CD16-positive cell counts (p<0.01) were recognized.
Conclusions: It was suggested from our result in the present study that massage therapy is an effective relaxation/stress management technique which could reduce anxiety and modulate immune function.

Objective: The purpose of this study is to identify the problems in the adverse drug report (ADR) system in early post-marketing vigilance phase (EPM phase) in Japan.
Methods: The incidence of all ADRs and the ratio of serious ADRs were compared between the new drug application phase (ND phase) and the EPM phase.  The target medicines were Moxifloxacin (Avelox®tablets, 400mg), Gatifloxacin (Gatiflo®tablets, 100mg) and Prulifloxacin (Sword®tablets, 100mg).
Results: The average incidence of all ADRs in the ND phase was 100-fold greater than that in the EPM phase.  There were also 2-fold differences in the ratio of serious ADRs of individual medicines.
Conclusion: There are several problems with the ADR system in the EPM phase in Japan.  It is currently possible that the implementation of EPM will vary between in individual medicines and companies.  This suggests that the present data cannot be applied universally.  Thus, there is an urgent need to standardize the implementation of EPM.

A 48-year-old man was readmitted to the hospital because of severe intraventricular conduction defects (QRS duration was 0.30 sec). The patient had been given pilsicainide hydrochloride (150 mg/day) prior to the hospitalization. The blood tests revealed that the concentration of pilsicainide was 3.30 μg/ml, which was several times higher than the average value in patients given in a dosage of 150 mg per day. Five months before the second admission, impaired left ventricular (LV) myocardial function and paroxymal atrial fibrillation were observed in the patient. His illness was diagnosed as myotonic dystrophy as the patient presented with skeletal muscle atrophy, premature frontal baldness, hatchet face, cataract, and testicular atrophy. The trial of remedication with pilsicainide in the same dosage for seven days did not produce the toxic effects as seen previously. Both load-dependent LV dysfunction in myotonic muscular dystrophy and moderately impaired renal function in the patient probably underlay the state of intoxication.

We examined the clinical features, 12-leads ECG, Holter ECG, monitor ECG, and electrophysiologic study (EPS) in nine consecutive paroxysmal atrioventricular block (PAVB) patients treated in our hospital between 1995 and 2000. In some of them, parasympathetic nerve stimulating maneuvers, drug administration and head-up tilt test (HUT) were performed as provocative tests. EPS documented that the sites of AV block were within the His-Purkinje system (H-PSB) in five patients, proximal to the His bundle potential (AHB) in three patients. In the remaining one patient, the His bundle potential was not recorded. The main features of the patients with H-PSB were as follows: 1) often wide QRS complex with or without axis deviation; 2) variable degrees of AV conduction disturbance in a short period; 3) sinus tachycardia, and normal length and constant PQ intervals in a daytime being apt to precede PAVB; 4) rather long ventricular asystoles leading to abrupt syncope; 5) easy induction of the block by intravenousadministration of atropine. In the other hand, the features of the patients with AHB included: 1) narrow QRS; 2) progressively increasing or decreasing in PQ intervals preceding PAVB; 3) ventricular asystole lasting about 3 to 10 seconds; 4) the failure to induce PAVB by any probale provocative tests.
Although we treated all the patients with permanent pacemakers, there might have been other management method for AHB patients who had about 3-second ventricular asystole.

We describe the case of a 60-year-old woman with severe aortic stenosis and severe calcification of the thoracic aorta, who underwent an apico-aortic conduit bypass using an aortic valved graft. Because of stenosis of the annulus of the aortic valve and severe calcification of the thoracic aorta (porcelain aorta), we did not perform ordinary aortic valve replacement. Instead, apico-aortic conduit bypass surgery was performed using a St. Jude Medical Aortic Valved Graft (19-20 mm : St. Jude Medical, St. Paul, MN, USA) and cardiopulmonary bypass (CPB) surgery was performed using descending aortic perfusion and left pulmonary artery drainage, while the subject was in the right decubitus position. The descending aorta was clamped and a 20-mm graft (Hemashield Platinum ; Boston Scientific/Medi-tech, Natick, MA, USA) was sutured to it. Under ventricular fibrillation, the left ventricular apex was circularly resected using a puncher with a diameter identical to that of the 20-mm graft, in order to create a new outflow for the conduit bypass. The graft was sutured to the outflow, and a torus-shaped equine pericardial sheet was used to reinforce the suture line. After recovery of the heartbeat, the aortic valved graft was first sutured to the graft at the outflow and then to the graft at the descending aorta. The CPB time was 285 min and ventricular fibrillation time was 36 min. Therefore, the benefits of using an aortic valved conduit for apico-aortic conduit bypass are reduced operation time, since there is no need to prepare a handmade valve conduit, and easy management of the grafts which are made of the same material.