A very rare case of open heart surgery associated with hereditary spherocytosis (HS) is reported. A 10-year-old girl was admitted for repair of an atrial septal defect (ASD). She was found to have HS by the microscopic findings of a blood smear and characteristic osmotic fragility, but splenectomy had not been undertaken preoperatively. She underwent successful radical operation by means of a centrifugal pump, and poloxamer 188 and haptoglobin were used during cardiopulmonary bypass for prevention of hemolysis. No significant hemolysis occurred intra- or postoperatively. Cardioplumonary bypass using a centrifugal pump appeared to be effective in this patient with HS.

We report a case of rheumatoid arthritis (RA) that was successfully treated with Kei-kyo-so-so-o-shinbu-to. A 56-year-old woman had been receiving treatment in our department for RA since 1992, and polyarthralgia and multi-joint swelling had become exacerbated from the beginning of April 2003. C-reactive protein and erythrocyte sedimentation rate were elevated. She was hospitalized on_??_, but even with some Kampo formulas, these levels did not improve. The epigastric region was extended and appeared to be in a state of “Hotori-senpai” from _??_, and the administration of Kei-kyo-so-so-o-shinbu-to was begun on _??_. From the next day, pain, swelling of joints, and the “Hotori-senpai” status began to improve, as did the inflammatory reactions. Thus, it was considered, when Kei-kyo-so-so-o-shinbu-to was prescribed, focusing on the “Hotori-senpai”, “Ki-bun” and “Sui-in” status of this patient, that this prescription exerted immediate favorable effects.

Case1was a 91-year old man diagnosed with multiple cerebral infarctions. He had undergone percutaneous endoscopic gastrostomy in the same year. One year later, we initiated acupuncture treatment because of recurrent respiratory tract infections. The acupuncture points selected were LU 5, Chize and KI 13, Taixi. Before acupuncture, the frequencies of antibiotics-use and feverish days were 6.3 days and 2.7 days per month on average. During acupuncture therapy, these frequencies were reduced to 1.2 days and 0.6 days per month, respectively.Case 2 was an 81-year old man diagnosed with right thalamic hemorrhage. He underwent percutaneous endoscopic gastrostomy in the same year. After 6 months, we began acupuncture treatment, also because of recurrent respiratory tract infections. The acupuncture points were the same as in Case 1.Prior to acupuncture, antibiotics-use and feverish days were 8 days and 4.5 days per month, which were then reduced to1and 0.6 days per month, respectively.Case 3 was a 93-year old man diagnosed with dementia. He was being fed via nasoenteric tubes. After 3 months, again because of recurrent respiratory tract infections, acupuncture treatment was begun. The acupuncture points were the same as in Cases 1 and 2.His use of antibiotics and feverish condition were 9 days and 10 days per month on average before acupuncture, but with acupuncture therapy these were improved to 2 days and 1.3 days per month.Based on this experience, it is suggested that acupuncture be considered for the treatment of recurrent respiratory tract infections in elderly, tube-fed patients.
Acupuncture ; days/month ; Respiratory ; therapeutic aspects ; Cases

This study sought to determine whether aerobic exercise training affects cognitive functioning among semi-independent (> 75 years) and independent elderly people. Seventy-six semi-independent and independent elderly subjects were divided into the following groups: semi-independent control (n = 16); semi-independent training (n = 13); independent control (n = 22); independent training (n = 25). During the 12-week intervention, subjects in both training groups performed a bench-stepping exercise at the intensity of the lactate threshold. Subjects were assessed at baseline and post-intervention using the Frontal Assessment Battery test (FAB), the Modified Mini-Mental State Exam (3MS), and a bench-stepping test of aerobic capacity. During the intervention, FAB scores improved only in the semi-independent training group (p = .002), while 3MS and MMSE scores improved in both the semi-independent training (p = .032 and p = .004) and independent training groups (p = .001 and p = .013). FAB and 3MS scores were higher in the semi-independent training (p = .001 and p = .002) compared with the semi-independent control group after the intervention. Finally, post-intervention scores for FAB, and 3MS in the semi-independent training group almost reached the baseline levels of the independent control and independent training groups. These results indicate that moderate intensity bench-stepping exercise training can improve cognitive and frontal lobe functioning in semi-independent elderly people, almost to the level exhibited by independent elderly people.

Myocardial revascularization combined with valvular surgery were performed on 8 patients between 1986 and 1990. There were 4 males and 4 females (mean age=60.6 years). Mitral valve replacement was performed in 3 patients, aortic valve replacement in 2, and double valve replacement in 3. There were no operation death, but one late death was seen. No angina attack was evident and NYHA functional class was improved in all patients in survivers. Coronary angiography should be performed in all adult patients who have valvular disease and those with significant artery disease should undergo bypass grafting concomitant with valvular surgery.

Retrograde cardioplegia is now an alternative or adjunctive method used worldwide as a cardiac protection during open heart surgery. However, its use involves some limitation. We operated on a patient suffering from aortic stenosis associated with PLSVC. During the operation on this patient for aortic valve replacement, retrograde infusion of cardioplegic solution could not be performed because the coronary sinus was excessively dilated and prevented the balloon from occluding it. Other anomalous lesion of the coronary sinus make the retrograde infusion of the cardioplegic solution difficult and these must always be kept in mind when cardioplegia is infused from the coronary sinus.

From January of 1987 to December 1992, twelve patients (7 males and 5 females, mean age, 52.8 years) underwent emergency surgery for DeBakey type I acute aortic dissection. The surgical procedure was resection of the initial intimal tear and replacement of the ascending aorta (four patients underwent hemiarch replacement). Operative mortality was 41.7% (5/12). Three died in the operating room due to heart failure (2) and uncontrollable bleeding (1). Another two early deaths resulted from extension of the residual false lumen. All surviving patients each had a patent double-channeled aorta and aneurysmal dilatation of the false lumen was noted in 3 patients. There were two late deaths, one due to rupture of the residual false lumen and the other, to stroke during re-operation for enlargement of the residual false lumen. It is apparent from these results that in type I acute aortic dissection extensive operation such as total arch replacement is necessary.

In the past 11 years, we treated 41 patients with Stanford type B aortic dissection. Principally, medical therapy was carried out and surgery was performed only when complications related to the dissection occurred. Twenty two patients (53.7%) had complications, including 5 (12%) with peripheral limb ischemia, 3 (7%) with rupture, 13 (32%) with dilatation of the aorta, 4 (10%) with extension of dissection (type A dissection). Seventeen patients received surgery including palliative operation. Among 41 patients, 3 died due to aortic rupture and 2 died at surgery for type A dissection, while 4 of them had developed proximal extension of the dissection. The 5-year survival rate for all patients was 86.7±6.6%. Long term survival will improve in patients with Stanford type B aortic dissection when the operative mortality for type A dissection is reduced and sound management policies are developed.

Between January 1980 and September 1993, 7(8.4%) of 83 patients with aortic dissection had coincident atherosclerotic true aneurysms of thoracic and/or abdominal aorta or had undergone operation of true aortic aneurysms. There was no difference in the segments of aortic dissection; 4 of 50 patinets classified as DeBakey III and 3 of 33 patients classified as DeBakey I or II, whereas the site of atherosclerotic true aneurysms was more often in the abdominal aorta than in the thoracic aorta. Five patients had undergone surgery for or had the abdominal aortic aneurysms and 2 patients had thoracic aortic aneurysms. In 2 patients who had previously undergone abdominal aortic aneurysmectomy, the dissected aorta ruptured soon after the onset of dissection. In the patients in whom the true aneurysm and the aortic dissection involve the same segments surgical treatment would be extended and complex.