Objective/Design: The purpose of this study was to confirm the effect of herbal tea therapy (HTT) on Ménière’s disease, especially, about the quality of life (QOL). We studied 26 patients with Ménière’s disease who came to the International University of Health and Welfare MITA hospital between 2007 and 2008.
Methods: We divided subjects into two groups, one with 16 patients treated with herbal tea (HTT group) and one with 10 patients treated without herbal tea (non-HTT group). All patients were diagnosed as having Ménière’s disease and underwent otoneurologic examination, audiometric measurements, questionnaires of functional level and tinnitus every month. Moreover, we instructed these patients to keep a record of the number of times vertigo was experienced. In the HTT group, after 6 months of general treatment, we treated patients with herbal tea for one year. This herbal tea was effective as a diuretic, in promoting antivertigo, antistress, and relaxation. We compared results before and after HTT. Moreover, based on SF-36 questionnaires, we compared clinical symptoms between groups.
Result: HTT reduced the percentage of relapse and improved their Ménière’s symptoms, especially vertigo. QOL scores, especially for mental function, were higher in the HTT group than in the non-HTT group.
Conclusion: We thought that HTT might improve their mental health or stress and prevent worsening of Ménière’s disease.

Acute symptomatic deep vein thrombosis (DVT) is usually managed by intravenous heparin and oral warfarin. Recently, direct oral anticoagulants (DOAC) have been introduced for the treatment of acute DVT. DOAC may be useful for very elderly patients who live in rural areas, where medical resources are limited. An 83-year-old woman presented to our clinic with left leg edema. Contrast enhanced computed tomography showed massive deep vein thrombosis in her left internal iliac vein. We diagnosed her with acute deep vein thrombosis. Since she refused to be hospitalized, we treated her with rivaroxaban as an outpatient. She had a good clinical course without hospitalization or an adverse event. DOAC may be useful for very elderly patients in rural areas.

Objective/Design: The purpose of this study was to confirm the effect of herbal tea therapy on Ménière’s disease. We studied 15 patients with Ménière’s disease who came to the International University of Health and Welfare MITA hospital between 2007 and 2008.
Methods: According to criteria of the Japan Society for Equilibrium Research, all patients were diagnosed as having Ménière’s disease and underwent otoneurologic examination, audiometric measurements, questionnaires of functional level and tinnitus every month. Moreover, we instructed these patients to keep a record of the number of times vertigo was experienced. After 6 months of general treatment, we treated patients with herbal tea for one year. This herbal tea was effective as a diuretic, in promoting antivertigo, and relaxing. We compared results before and after herbal tea therapy.
Result: Herbal tea therapy was effective in about 10 patients, but 5 patients relapsed. However, symptom of the relapsed patients improved after using less medicine, although the quantity of medication was less than before starting the herbal tea therapy. Herbal tea therapy improved their Ménière’s symptoms, especially vertigo after 6 months from starting herbal tea therapy.
Conclusion: Our study provides evidence that herbal tea therapy is useful for preventing worsening of Ménière’s disease.

Ischemic colitis following cardiac surgery is a rare but critical complication. We report two cases of ischemic colitis following cardiac surgery successfully treated with stenting of the stenotic celiac trunk. Case 1 was a 65-year-old man who developed perioperative myocardial infarction during off-pump coronary artery bypass grafting. He experienced abdominal pain and bloody stool on postoperative day 19. Severe ischemic changes in the sigmoid colon and descending colon were seen on colonoscopy, and CT scan revealed significant stenosis of the celiac trunk and occlusion of the inferior mesenteric artery and bilateral internal iliac arteries. Revascularization of the celiac trunk via stenting resulted in dramatic improvement in colonic ischemic changes. Case 2 was a 60-year-old woman who underwent a restoration procedure for a left ventricular aneurysm. She experienced gradual onset of postprandial pain beginning 9 days after surgery and massive bloody stool on postoperative day 33. Imaging revealed severe ischemic changes in the descending colon on colonoscopy and stenoses of the celiac trunk, superior mesenteric artery, inferior mesenteric artery, and bilateral common iliac arteries on CT angiogram. Stenting was performed to the celiac trunk on postoperative day 52. Her abdominal pain and bloody stool were completely resolved after treatment. Prior to the introduction of endovascular treatment of mesenteric ischemia in 1980, the standard treatment had been open surgical repair. Since then, endovascular repair has become widely accepted. In our experience, endovascular treatment of the mesenteric vessels may be an effective and less invasive approach to treating mesenteric ischemia in unstable patients after cardiac surgery.

Introduction : The purpose of this study was to clarify the antimicrobial susceptibility of Haemophilus influenzae in central Tokyo over a ten-year period.
Methods : We investigated the susceptibility of Haemophilus influenzae isolated in Tokyo Saiseikai Central Hospital for 10 years from 2004 through 2013.
Results : Significant increases in the proportion of strains resistant to ampicillin, ampicillin / sulbactam and cefditoren pivoxil were noted for some years in comparison to the first year studied. There were no significant changes in the susceptibility to levofloxacin and clarithromycin. The proportion of strains resistant to ampicillin and cefditoren pivoxil showed statistically significant increases during the study period. The proportion of the strains resistant to ampicillin / sulbactam isolated from children was greater than from adults for every year studied. Levofloxacin resistant strains were isolated only from adults. The proportion of strains resistant to clarithromycin were about 1% in Japanese national surveillance data, but the proportions in this study were over 9%.
Conclusion : Over a ten-year period in central Tokyo, Haemophilus influenzae strains resistant to ampicillin and cefditoren pivoxil increased. Strains resistant to clarithromycin occurred at a higher rate than nationally.

Cirrhosis is a chronic condition that can lead to liver failure. Currently, the viable option for decreasing mortality is liver transplantation. However, transplant surgery is highly invasive. Therefore, cell-based therapy has been developed as an alternative. Based on promising findings from preclinical research, some new trials have been registered. One of them was autologous bone marrow cell infusion therapy and found that ameliorating liver fibrosis activated liver regeneration. Now, majority of trials focus on low-immunogenicity mesenchymal stem cells (MSCs) appropriate for allogeneic administration. However, despite about 20 years of research, only a limited number of cell-based therapies have entered routine practice. Furthermore, potential shortcomings of cell-based therapy include a limit on the number of cells, which may be administered, as well as their failure to infiltrate target organs. On the other hand, these research show that MSCs act as “conducting cells” and regulate host cells including macrophages via extracellular vesicles (EVs) or exosome signals, leading to ameliorate liver fibrosis and promote regeneration. Therefore, the concept of cell-free therapy, which makes use of cell-derived EVs or exosomes, is attracting attention. Cell-free therapies may be safely administered in large doses and are able to infiltrate target organs. However, development of cell-free therapy exhibits its own set of challenges and such therapy may not be completely curative in the context of liver disease. This review describes the history of cell-based therapy research and recent advances in cell-free therapy, as well as discussing the need for more effective therapies.

Purpose: Preoperative sarcopenia worsens postoperative outcomes in various cancer types including colorectal cancer. However, we often experienced postoperative anastomotic leakage in muscular male patients such as Judo players, especially in rectal cancer surgery with lower anastomosis. It is controversial whether the whole skeletal muscle mass impacts the potential for anastomotic failure in male rectal cancer patients. Thus, the purpose of this study was to clarify whether skeletal muscle mass impacts anastomotic leakage in rectal cancer in men. Methods: We reviewed the medical charts of male patients suffering from rectal cancer who underwent colo-procto anastomosis below the peritoneal reflection without a protective diverting stoma. We measured the psoas muscle area and calculated the psoas muscle index. Results: One hundred ninety-seven male rectal cancer patients were enrolled in this study. The psoas muscle index was significantly higher in patients with anastomotic leakage (P<0.001). Receiver operating characteristic curve determined the optimal cut-off value of the psoas muscle index for predicting anastomotic leakage as 812.67 cm2/m2 (sensitivity of 60% and specificity of 74.3%). Multivariate analysis revealed that high psoas muscle index (risk ratio [RR], 3.933; P<0.001; 95% confidence interval [CI], 1.917–8.070) and super low anastomosis (RR, 2.792; P=0.015; 95% CI, 1.221–6.384) were independent predictive factors of anastomotic leakage. Conclusion This study showed that male rectal cancer patients with a large psoas muscle mass who underwent lower anastomosis had a higher rate of postoperative anastomotic leakage.

Pulmonary arteriovenous malformations (PAVMs) are often treated by pushable fibered or non-fibered microcoils, using an anchor or scaffold technique or with an Amplatzer plug through a guiding sheath. When performing percutaneous transcatheter microcoil embolization, there is a risk of coil migration, particularly with high-flow type PAVMs. The authors report on a unique treatment in a patient with a giant high-flow PAVM whose nidus had a maximum diameter of 6 cm. A detachable coil, not detached from a delivery wire (an anchored detachable coil), was first placed in the feeding artery under flow control by balloon occlusion, and then multiple microcoils were packed proximally to the anchored detachable coil. After confirming the stability of the microcoils during a gradual deflation of the balloon, we finally released the first detachable coil. The nidus was reduced in size to 15 mm at one year postoperatively.
Arteriovenous Malformations/*therapy ; Balloon Occlusion/*methods ; Catheterization ; Contrast Media/diagnostic use ; Embolization, Therapeutic/instrumentation/*methods ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pulmonary Artery/*abnormalities ; Pulmonary Veins/*abnormalities ; Tomography, X-Ray Computed

Objectives: Infective endocarditis (IE) has an extremely poor prognosis unless appropriate treatment is received. Hemodialysis patients with IE show higher rates of morbidity and mortality in comparison with non-dialysis patients with IE. We focused on hemodialysis patients, as well as patients in other stages of chronic kidney disease. We sought to assess the relationship between renal function and mortality in patients with IE.
Methods: We carried out a retrospective cohort study on 45 consecutive patients with IE in an urban teaching hospital between November 2003 and August 2008. We collected demographic and clinical data as well as pre- and post-discharge outcomes. Patients were subdivided into four groups according to their eGFR level at admission: A: eGFR≧60 ml/min/1.73 m² (n=23); B: eGFR 30-59 ml/min/1.73 m² (n=15); C: eGFR<30 ml/min/1.73 m² (n=3); and, D: dialysis patients (n=3). It was not possible to determine the outcome status of one patient. The Trend Test was used to evaluate the association between renal function and mortality.
Results: There were 29 male and 16 female patients with IE and the mean age was 67.9+-17.6 (SD). There were 10 diabetic patients (22%). Thirty-nine patients (84%) were either discharged or transferred to another hospital. Seven patients (16%) died: two (9%) Group A patients; three (20%) Group B patients; no Group C patients; and, two (67%) Group D patients. Patients with lower eGFR had higher mortality rates (Trend Test, P=0.046).
Conclusion: We presume a trend towards a higher mortality rate in conjunction with advancing CKD stage.