The hospital records of 59 patients treated for ruptured abdominal aortic aneurysms during the past eleven years were reviewed. The patients were classified into two groups: an elderly group aged 80 years old or wore (18 cases) and a control group aged under 80 years old (41 cases). Previous diagnoses of abdominal aortic aneurysm had been made more frequently in the aged group (44.4%) than in the control group (22%). Of the patients who fell into shock preoperatively, only 6 patients (60%) received graft replacements in the aged group, but all patients received graft replacements in the control group. Graft replacements were performed as safely in non-shock patients in the elderly group as in cases of non-ruptured abdominal aortic aneurysm. The overall survival rate including non-operative cases in the elderly group (38.9%) was lower than that in the control group (61%). The survival rates in patients receiving graft replacemes showed no significant difference between the elderly group (63.3%) and the control group (67.6%). Many of the aged patients who fell into shock due to aortic rupture died without receiving surgery. Hypovolemic shock which results in ischemia in vital organs is the most likely major cause of death in patients of advanced age. In conclusion, graft replacements should be performed electively and safely before aneurysmal rupture, particularly in elderly patients.

The hospital records of 50 patients treated for ruptured abdominal aortic aneurysms during the past ten years were reviewed. Nine patients in cardio-pulmonary arrest on arrival at our emergency room and 3 resuscitated patients were included in this study. The patients were classified into four groups: the non-shock group (17 cases), shock group (21 cases), post-cardiac resuscitation group (3 cases) and the cardio-pulmonary arrest on arrival (CAPOA) group (9 cases). The mortality rates including preoperative death in each group were 5.9% (non-shock), 57.1% (shock), 66.7% (post resuscitation) and 88.9% (CPAOA). The overall mortality rate was 46%, although the mortality rate in patients receiving graft replacement was 35.6%. The mortality in the non-shock group was significantly lower than in the other three groups. Longer duration of shock, lower preoperative systolic blood pressure level, longer operative time, greater blood loss and greater amount of blood transfused were risk factors in cases of graft replacement. The risk factors associated with preoperative death were advanced age and acidosis due to severe shock. The correct initial diagnoses were made in prior hospital in 28 cases. Incorrect diagnoses, which were made more often in non-shock patients than in patients in shock, were abdominal pain of unknown origin in 6, ureterolithiasis in 4, lumbago, appendicitis and gastritis in 2 cases each. The delayed diagnosis might have resulted in more severe shock or cardiac arrest. In conclusion, to reduce the mortality of ruptured AAA, correct initial diagnosis and expeditious preoperative management are most important.

Stanford type B acute aortic dissection without complications has been considered to be an indication for medical rather than surgical treatment. To investigate the availability of medical treatment and early rehabilitation, we evaluated 90 cases treated between 1986 and 1999 with type B acute aortic dissection. These consisted of 79 nonruptured cases and 11 ruptured cases at the beginning of treatment in our medical center. No surgery was performed in any of the nonruptured cases but surgery was performed in 8 of 11 ruptured cases. Surgical mortality in the rupture type was 12.5% (1/8). During medical treatment of the nonrupture type, 3 patients died of sudden rupture (1 case) and bowel ischemia (2 cases). An early rehabilitation program in which the goal was for the patient to walk around the ward within 2 weeks was performed for 31 consecutive cases of nonrupture type without vascular complications. Mortality was not significantly different between the early and conventional rehabilitation groups. The incidence of pneumonia and ICU syndrome during medical treatment was 13.0% (6/46) and 37% (17/46), respectively in the conventional group and 0% and 12.9% (4/31), respectively in the early group. The incidence of ICU syndrome was significantly lower in the early group than in the conventional group. Despite the limitations of this study, medical treatment and early rehabilitation showed good results in cases of uncomplicated type B acute aortic dissection.

Background: Gingyo-gedoku-san (GGGS) is an herbal medicine approved for upper respiratory infections in Japan. We conducted an open-label, multi-center, prospective trial, comparing GGGS with oseltamivir in patients with influenza and influenza-like illness (ILI) as a pilot study.
Methods: Subjects were healthy persons aged between 16 and 40, and were enrolled from January 12, 2010 to March 24, 2011. Fifteen patients were enrolled in this trial (8 and 7 for GGGS and oseltamivir, respectively). RT-PCR was positive for pandemic influenza A (H1N1) in 10 patients. The patients were provided with either GGGS or oseltamivir for 5 days. The primary outcome was mortality and/or hospitalization 7 days after the initial diagnosis. Body temperature and other clinical characteristics were also evaluated.
Results: All patients recovered from illness without complication or hospitalization. The mean time to resolve symptoms for the GGGS and oseltamivir groups was 3.9 days and 3.3 days, respectively (p=0.43). The GGGS group appeared to have a smaller symptom score AUC than the oseltamivir group, (p=0.26). Time to recover activity level appeared to be shorter in the GGGS group (p=0.10), with shorter time to recover health status (p=0.02). Sub-group analysis on patients with positive PCR showed similar results between the two groups.
Conclusion: GGGS was associated with symptom improvements resembling oseltamivir for both influenza and ILI. Randomized controlled trials involving larger sample sizes are needed to confirm these results.