Cystic adventitial disease of the popliteal artery is a rare cause of lower extremity occlusive disease. We report 2 cases of this disease. Two male patients aged 27 and 59 year old complaining of intermittent claudication visited our vascular service. Angiography showed a smooth sharp defect of the popliteal artery. Postcontrast computed tomography (CT) scanning and magnetic resonance image (MRI) showed a cystic lesion around the popliteal artery. One patient underwent resection of the cyst, which in the other patient endscopic surgery was performed with the aid of intravascular ultrasonograpy and intravascular endscope. Fifty three cases of this disease have been reported in Japan so far. These patients included 45 men and 8 women with a mean age of 47.7, ranging from 19 to 76 years old. Chief complaints were commonly intermittent claudication and sensory disturbance. In all cases, angiography revealed a smooth sharp defect. Recently 3D-CT scan, ultrasonography and magnetic resonance angiography (MRA) also are accurate for cystic lesions around the popliteal artery and these new technologies easily distinguish such cases from arteriosclerosis obliterans, Buerger disease and popliteal entrapment syndrome. Treatment consist resection of the cyst, in 27 cases reconstruction of the popliteal artery using a saphenous vein graft or artificial graft in 19 cases, percutaneus aspiration under the guide of CT and endscopy in 2 cases and 1 with spontaneous resolution, was seen in 1 case. In conclusion, we encountered 2 cases of cystic adventitial disease of the popliteal artery. 3D-CT scan, ultrasonography and MRA were useful for preoperative diagnosis and evaluation of postoperative condition.

We report five cases of painful swelling caused by hymenoptera stings and centipede bites treated with ourengedokuto and inchingoreisan soon after the time of injury. The first case was a 70-year-old male. He was stung by a hornet on the left hand 30 minutes prior. The second case was a 45-year-old male. He was stung by a hornet on the left face 20 minutes prior. The third case was a 55-year-old male. He was stung by a hornet on the left lower thigh 10 minutes prior. The fourth case was a 39-year-old male. He was stung by a hornet on the right thigh 60 minutes prior. The fifth case was a 35-year-old male. He was bitten by a centipede on the right first toe 20 minutes prior. All cases received Kampo therapies immediately and continued them every few hours. In all cases, their pain, redness and swelling at the site of injury were relieved by the next day. We consider Kampo therapies can contribute to the healing of hymenoptera stings and centipede bites at an early stage.

We encountered a recurrent suprarenal abdominal aortic aneurysm (AAA) patient with coronary artery disease and hyperlipidemia after repair of infrareanal AAA. A 72-year-old woman complaining of an abdominal throbbing mass was admitted. Computed tomography (CT) and aortography revealed infrarenal AAA which was totally removed and Dacron graft was replaced. The patient was followed as an outpatient. At the time of initial graft replacement there was no remarkable aneurysmal change in suprarenal abdominal aorta. Five years after the initial operation, a suprarenal AAA 5cm in diameter was detected by ultra sonographic examination. CT scan and aortography confirmed suprarenal AAA involving the celiac trunk of the supramesenteric artery and renal artery. Redo AAA operation with reconstruction of these branches was performed under V-A bypass support in a thoracoabdominal approach. Slight renal and liver dysfunction occurred postoperatively. However, serum creatine GOT and GPT values normalized by the ninth postoperative day. Postoperative aortography revealed patency of all branches.

Reperfusion injury occasionally occurred after revasculization of acute arterial occlusion (AAO). The most common reason of death is myonephropatic metabolic syndrome due to reperfusion injury. This paper focusses on the criterion of systemic inflammatory response syndrome (SIRS). From January 1987 to April 1996, we treated 89 patients (male 59/female 30) with lower limb AAO. The mean age was 68.5 (ranging from 16 to 94) years old. There were 59 cases of thrombosis, 25 of embolism, 2 trauma and 3 dissecting aneurysm of the aorta. These patients were divided into two groups according to whether or not they fulfilled the criterion of SIRS. Of these patients, 46 cases met the criterion of SIRS (SIRS group) but the other 43 did not (non-SIRS group). We compared the two groups. The mortality of the SIRS group (23.9%) was higher than the non-SIRS group (2.3%). The ischemic time of the SIRS group (83.1±113.3 hours) was longer than the non-SIRS group (37.5±38.2 hours). Complications of MNMS were more common in the SIRS group (15.3%) than in the non-SIRS group (2.3%). The ischemic area in the SIRS group was remarkably less than in the non-SIRS group. Conclusion: The criterion of SIRS as indicated by the measurement of interleukin 8 (IL-8) was a useful prognostic parameter for limb salvage rate and mortality of AAO patients.

In general the incidence of peripheral arterial aneurysm is said to be low. We focussed on popliteal aneurysm and enrolled 18 legs in 14 patients with popliteal aneurysm who visited us during the period from 1974 to January 1998 in our study. Acute arterial occlusion was observed as a complication in 6 of the 14 patients (42.9%) and rupture developed in 4 patients (28.6%), and on those occasions this disease was frequently detected and treated for the first time. Although this disease is said to scarcely affect prognosis, we encountered patients for whom amputation of the leg was unfortunately required. This disease was thus considered to require sufficient care. Popliteal arterial aneurysm is frequently palpable from the body surface and increased recognition of this disease should enable more appropriate treatment.

Otsujito is a well-known herbal preparation used for treating hemorrhoidal disease. However, we considered the anatomical similarities between the lips and the anus, and here report a case of inflammation of the lips with blood stasis successfully treated with otsujito as well.
The case was a 59-year-old woman suffering from eczema on her face and neck. The eczema showed a tendency to improve with herbal treatment, but inflammation and pruritus of the lips continued. Taking into account the presence of blood stasis, we included otsujito in the treatment and her symptoms improved.
Otsujito contains bupleurum, cimicifuga, scutellaria, and rhubarb, which dissipates heat, and angelica,which resolves blood stasis. Therefore, we consider that inflammation of the lips with blood stasis can be treated with otsujito.

Introduction
Essential hypertension is one of the leading causes of hypertension; responsible for more than 90% of such cases. Diet cure or drug treatment are usually prescribed for this disease. We drew notice to the antihypertensive effects of acupuncture.
Method
Subjects were healthy persons as well as patients complainig of simple essential hypertension. According to the WHO method, they were divided into three groups, e. g. normal, limitaneus, hypertensive. In situ needles were inserted in the antihypertensive points of both auricular sides for one week.
Effect
This treatment gave immediate results in 70% of the limitaneus and hypertensive groups. There was no observable effect for the balance. A number of these subjects were obese; a factor to be considered.
Evaluation
This method is very uncomplex and takes but minimal amount of time to treat patients.