The effect of moxibustion on duodenal motility was examined. Duodenal motility was measured by the balloon method in anesthetized, artificially ventilated rats. The stimulation temperature and duration of moxibustion varied. Treatments were applied to the hind paw and abdomen.
The duodenal motility exhibited an excited response by pinch stimulation of hind paw, and inhibitory response by abdominal pinch stimulation. Duodenal motility did not show any response to indirect moxibustion stimulation of the hind paw and abdomen. Duodenal motility exhibited an excited response by direct application of moxibustion to the hind paw and an inhibitory response by direct application of moxibustion to the abdomen.

In a 3 year-old girl with acyanotic tetralogy of Fallot, preoperative echocardiography revealed a thick fibrous tissue hanging on the right side of large ventricular septal defect. According to the definition of Kirklin, we diagnosed it as “flap valve ventricular septal defect.” And this diagnosis was supported by the findings of electrocardiogram and cardiac catheterization. At the operation, it was confirmed that the flap was only attached to the posterior margin of ventricular septal defect, and that it hardly played any part in tricuspid valve function. To our knowledge, this is the first case of “tetralogy of Fallot with flap valve ventricular septal defect” reported in Japan.

We present the case of a 68-year-old woman with abdominal aortic aneurysm (AAA) complicated by right ectopic kidney, in another term, congenital pelvic kidney. The patient underwent AAA repair and right renal artery reconstruction using renal perfusion with cold Ringer's acetate, and no deterioration of renal function was observed. 3D-CT was essential diagnostic procedure in order to identify the blood supply to the ectopic kidney for planning a careful surgical technique.

The effect of spa-drink (Misasa hot spring) on exocrine pancreatic function was studied in controls and drink therapy group. To examine exocrine pancreatic function, two different methods were used for determination of pancreatic chymotrypsin activity. One was a colorimetric method for the determination of fecal chymotrypsin activity and the other was PFD fest. Following conclusions were obtained.
1) With spa-drink therapy, fecal chymotrypsin activity was raised in 2 weeks in 40% of patients, while it remained unchanged in the next 2 weeks.
2) With spa-drink therapy, PFD value was raised in 2 weeks in 50% of patients, while it returned to the pre-treatment value in the next 2 weeks.
3) Spa-drink therapy for 2 weeks was effective for improving exocrine pancreatic function.

Short-term effects of spa-drink therapy on gastric mucosal blood flow were evaluated using endoscopic organ reflex spectrophotometry together with an Olympus XQ-10 forward-viewing gastrofiberscope.
Thirty-eight subjects were divided into three groups by random sampling: 12 subjects to a group for injecting hot spring water (38 to 40°C, 150ml), 12 subjects to a group for injecting warm tap water (38 to 40°C, 150ml), and 14 subjects to a groups for injecting warm air (150ml). Hot spring water, tap water, or air was injected into the stomach through the fiberscopic injection channel. Gastric mucosal blood flow was measured immediately before and 10 minutes after the injection on the three points of gastric mucosa: lesser curvature of the angle, and that of the antrum, and the pylorus.
The following results were obtained:
1) Hot spring water was more effective in increasing gastric mucosal blood flow than air. The difference was statistically significant on all of the three points.
2) Hot spring water was more effective in increasing gastric mucosal blood flow than tap water. The difference, however, was significant only on the mucosa of the gastric antrum.
In conclusion, spa-drink therapy was useful for treating chronic gastritis and gastric ulcer in which impairment of gastric mucosal blood flow plays an important pathogenetic role. Studies on the long-term effects of spa-drink therapy on the gastric mucosal blood flow are now under way.

Effect of long-term intake of spa water on gastric mucosal blood flow was evaluated using an endoscopic organ reflex spectrophotometry together with an Olympus XQ-10 forward-viewing gastrofiberscope. Three healthy volunteers and nine patients with gastric diseases in remission (six with healed gastric ulcer and three with chronic gastritis) underwent two-week treatment consisting of daily intake of Misasa spa water (weakly radon containing bicarbonate salt spring, 38 to 42°C, 200ml, two times a day between meals), and gastric mucosal blood flow was measured at three spots of the stomach (lesser curvature of the pylorus, antrm, and angle) before and after the treatment period. Life style and medication were kept unchanged during the period. The following results were obtained:
1) Gastric mucosal blood flows (IHb) measured before and after the treatment were respectively 95.0±18.0 and 98.2±15.4 at the pylorus, 104.8±16.9 and 110.8±12.8 at the antrum, 116.1±20.4 and 118.7±18.5 at the angle.
2) Values measured after the treatment were higher than those measured before the treatment at pylorus in 75% of the patients and at the antrum and angle in 67% of the pa-tients.
3) However, assessment of the mean values before and after the treatment using the student's paired t-test revealed a significant increase in blood flow (P<0.05) only at the antrum.
Further studies are in progress to determine (1) the clinical significance of the improvement in gastric mucosal blood flow, such as the maintenance of remission, and (2) the characteristics of gastric diseases which are likely to respond favorably to the treament of taking spa water.

The patient was a 56-year-old male. He had a history of alcoholism since 1975 and diabetes mellitus since 1978. He was treated with insulin therapy. But the control of diabetes mellitus was very poor and he had six hypoglycemic comas attacks. He had diabetic triopathy but no symptoms of gait disturbance, dementia and incontinence. Brain computerized tomography and magneting resonance imaging revealed severe communicating hydrocephalus with mild brain atrophy.¹¹¹In-DPTA cisternography revealed retension of isotope in the ventricle after 48 hours. The pressure of cerebrospinal fluid was normal.
This case report is interesting as it suggests the relationship between normal pressure hydrocephalus and hypoglycemia.

A 64-year-old female was admitted due to iliopsoas abscess caused by misplacement of a central venous catheter (CVC) into the ascending lumbar vein (ALV). Despite removing the CVC and administering an antimicrobial agent, her general condition did not improve. Therefore, we performed a contrast-enhanced head computed tomography (CT) scan. The CT scan revealed a cerebellum abscess. Surgical cerebellum abscess drainage was thus performed urgently. We recommend using anteroposterior radiographs, J-guide wire catheter and ultrasound guidance to prevent misplacement. If misplacement of the CVC is suspected, it should be removed and a CT scan performed without hesitation as soon as possible.

An 78-year-old woman visited our hospital with the chief complaints of abdominal pain, nausea, vomiting and diarrhea. She was operated on for gastric ulcer when she was 56 years old and complained of abdominal discomfort after operation. One day she wished to take Confrey (Symphytum officinale), but she took digitalis leaves (Digitalis purpurea) by mistake. On admission she was drowsy and the systolic blood pressure was 60 mmHg on palpation. Electrocardiograms showed bradycardia, irregular AV-nodal rhythm and ST depressions and T wave inversions with the shortening of the QT interval. Serum levels were potassium, 6.4 mEq/1 ; BUN, 34.4 mg/di ; creatinine, 1.5 mg/di ; digoxin, 2.0 ng/ml (therapeutic level, up to 2.0 ng/ml); and digitoxin, 111ng/ml (therapeutic level, up to 25 ng/ml). Hemodynamic data showed HR, 49 beats/min ; CO, 2.81/min; CI, 2.31/min/m²; SV, 57 ml/beat and SI, 47 ml/beat/m² on administration of dopamine 7μg/kg/min. So VVI pacing was started at 70 bpm and CO increased to 3.6 1/min after pacing. But unfortunately she died of ventricular fibrillation. The digitalis leaves resemble the Confrey leaves and it is easy to mix up these two plants. Although this is a rare case, digitalis intoxication can be life-threatening. So we should prepared ourselves for the treatment of patients poisoned with digitalis and other poisonous herbs.

This report concerns a 62-year-old woman with Wegener's granulomatosis. She complained cough, macroscopic hematuria and oligulia. She had a consolidation without a cavity in the left upper lung field, massive proteinuria (2.5 g/day) and massive hematuria. The serum creatinine level was 2.5 mg/dl. The C-ANCA was positive. Renal biopsy revealed crescentic glomerulonephritis. She wa treated with prednisone and trimethoprim-sulfamethoxazole. The lung shadow, proteinuria and hematuria disappeared in one month. The C-ANCA titer also decreased. The use of trimethoprimsulfamethoxazole which may eliminate an infection as a cause to promote Wegener's granulomatosis should be actively included in the conventional treatment.