A 71-year old woman, who underwent direct closure of an atrial septal defect with mild tricuspid regurgitation (TR) 18 years previously, suffered terminal cardiac failure with extreme cardiomegaly, mitral regurgitation and severe TR. Medical treatment gradually became ineffectual and we decided to perform surgical therapy. Mitral annuloplasty with a prosthetic ring, tricuspid valve repair, plications of extended bilateral atrium walls and epicardial ventricular pacemaker implantation were performed. In tricuspid valve repair, anterior tricuspid leaflet was augmented by use of glutaraldehyde-preserved autologus pericardial patch and tricuspid annuloplasty with addition of a slightly larger prosthetic ring. Atrio-ventricular regurgitations disappeared and she was discharged 63 days after the operation. Valve extension is a very effective technique to treat severe secondary TR, and long term follow-up is necessary.

Pulmonary artery aneurysm (PAA) may be associated with congenital shunt disease such as patent ductus arteriosus, and its frequency and management are often controversial. We report successful surgical treatment of PAA following an operation for atrial septal defect (ASD). The patient was a 47-year-old woman who underwent closure of ASD at the age of 9. When she was investigated because of thyroid tumor, enlargement of her main pulmonary artery was pointed out and she was admitted to our hospital. Several examinations revealed a diagnosis of pulmonary valve insufficiency and 70mm PAA with dilatation extending to both proximal arteries. We performed replacements of pulmonary valve and pulmonary artery with a bioprosthetic valve and T-shaped graft. The patient is doing well 2 years after operation.

The numbers of cases of high level of serum lactate dehydrogenase (LDH) found in the mass screening program by Naganoken Koseiren Kenkokanri Center was 1, 358 (1.5% of total 89, 837 examinees) in 1995. In 235 of these cases, 141 cases (60.0%) were diagnosed as normal; 56 cases (23.8%), hyper lactate dehydrogenasenemia; 27 (11.5%), diseases of the liver or gallbladder. Close medical examinations including abdominal ultrasonography and check on viral hepatitis may be necessary for cases of increased LDH levels detected by mass screening.

Diffuse peritonitis due to perforation of pyometra is relatively rare. We experienced three cases of this type of peritonitis between 1993 and 1999. Three women aged 77, 83 and 91 years had mild abdominal pain, slight fever and defecation for nearly one week. Following these, severe abdominal symptoms developd. These patients underwent emergency laparotomy as they were diagnosed with diffuse peritonitis. At first, intestinal perforation was suspected, but perforation of pyometra was confirmed when lapasortomy was done. On preoperative examinations, physical findings were scanty in comparison with hemological ones, and free air on abdominal X-ray films was not detected. Thus, we failed to establish the preoperative diagnosis. The prognosis was very poor in two of the three patients. One was with advanced cervical cancer and the other was in multiple organ failure on admission. Differential diagnosis of this disease is important for the management of acute abdominal diseases in elderly women.

Objective: The Japanese risk management plan (RMP) contains the risk minimization action plans for important potential risks of drugs.  One of the basic risk minimization action plans is reminding on package insert; however, we found that some potential risks were not described in package inserts.  In this study, we investigated the description of potential risks on package inserts.
Design: Document analysis.
Methods: We collected all posted RMP documents and the package inserts of corresponding products from the Pharmaceutical and Medical Devices Agency website on January 31, 2015 and investigated the risk minimization action plans of important potential risk items and whether the items had been described in each package insert.
Results: Of 268 important potential risk items in 81 products, 56 items were not described on package insert.  The major reason for not including the risk items on the package insert was “causality was not indicated sufficiently” and some items had no written reason.
Conclusion: About 20% of important potential risks are not described in package inserts.  Because most post-marketing pharmacovigilance plans depend on spontaneous reporting by healthcare personnel, description on package insert, the most frequently referred drug information resource, should be considered.

We evaluated long-term results of 126 consecutive bypass surgeries for chronic limb ischemia including 54 aorto-femoral (AF), 26 femoro-femoral crossover (FF), 7 axillo-femoral (AxF), and 39 femoro-above the knee popliteal (FP) bypasses. Patients who had undergone FF bypasses were significantly older than those who received AF bypasses (p<0.01). Preoperative ankle brachial pressure indices (ABI) of the AxF and FF patients were significantly lower than those of AF patients (p<0.05). Compared with AF patients, the AxF and FF groups included significantly higher percentages of Fontaine III and IV limbs treated by limb salvage surgery (p<0.05). The cumulative graft patency rates 5 years after AF, FF, and FP bypasses were 94.7%, 91.3%, and 64.3%, respectively. In the FP group, patients with intermittent claudication before surgery showed a 5-year graft patency rate of 82.5%, while that in patients who underwent surgery for limb salvage was 43.3%. The secondary graft patency rates 5 years after AF, FF, and FP bypasses were 94.6%, 91.3%, and 83.3%, respectively. All patients whose bypass grafts were occluded were male and were smokers. Poor run-off and insufficient anticoagulation therapies were also associated with graft occlusion. Two of the 12 patients who developed graft occlusion underwent limb amputation.

The inter of this study was to observe the effects of training on histochemical and biochemical properties in the skeletal muscle fibers.
Wistar strain albino rats were assigned to endurance (E), sprint (S) and control (C) group at 4 weeks old. Animals of trained groups were trained by treadmill for 12 weeks. After training, all animals were sacrificed and M. Soleus (SOL) and M. Extensor Digitorum Longus (EDL) were taken out.
Using histochemical staining methods for Hematoxylin and Eosin, Actomyosin ATPase and Succinate Dehydrogenase (SDH), area and composition of the three muscle fiber types were examined. Furthermore, the chemical properties of glycolytic and oxidative enzyme activities were examined.
The results obtained were as follows:
1. The E and S trained groups, respectivelly, showed lower increase of body weight than the control group.
2. Hypertrophy of all fiber types in EDL were observed in the both trained groups. Area of SO fibers in SOL were also increased in the E group as compared to the C group.
3. The differences observed for fiber composition among the three groups. The rate of FOG fiber in SOL decreased significantly in the both trained groups as compared to the C group. The rate of SO fiber in both muscles were slightly higer for the E group relative to the C Group, but these differences were no significant. However, in the E group significant increase was observed for oxidative enzyme activity. The Phosphofructo-kinase activity in EDL of the S group was significantly higher in comparison to the other groups.
These results suggested that there is the discrepancy between histochemical proper-ties and biochemical properties in the effects of training on skeletal muscle fibers and that the necessity of histochemical and biochemical analysis.

We report a case of aneurysm localized to the noncoronary sinus of Valsalva with moderate aortic regurgitation (AR). The patient was a 49-year-old woman who had been suspected to have some kind of connective tissue disorders. She underwent an aortic root remodeling procedure to replace the isolated, unruptured and extracardiac aneurysm and the ascending aorta. Postoperative angiogram showed no aneurysm and improved AR. This procedure was able to preserve her own aortic valve and normal sinuses of Valsalva and enable her to obtain better quality of life, although progression of the enlargement of the aorta or AR requires careful follow-up.

We report a successful staged repair of anomalous origin of right pulmonary artery from the ascending aorta in a neonate. A two-day-old girl, who suffered from severe circulatory failure, was admitted. In spite of all medical treatment, acidosis and systemic hypotension developed. Right pulmonary artery banding was performed in an emergency procedure, resulting in immediate elevation of systemic blood pressure. Definitive operation was subsequently performed on the 48th day after birth. The right pulmonary artery, which was de-banded and divided from aorta, was anastomosed directly to the pulmonary trunk in a side-to-end manner. The postoperative course was uneventful and the pulmonary artery pressure was within the normal range.

It has been experienced that Kampo, with its philosophy that every disease is psychosomatic in origin and that herbs affect both the psyche and the soma, sometimes has a dramatic effect on somatoform disorders, though there has been no study examining the effects of Kampo on somatoform disorders. In this preliminary study, the morbidity of somatoform disorders among patients who visited the Keio Kampo Clinic and the patients' psychological well-being were examined.
One hundred patients (17 males and 83 females; mean age [±SD], 39±16) who sought Kampo treatment for the first time at Keio University Hospital participated in this study. A Japanese checklist derived from the somatoform disorders schedule (version 1.1) was used to check the somatoform symptoms. To assess psychological well-being, the subjective well-being inventory (SUBI) was performed. The subjects' clinical records were examined afterwards to rule out symptoms which could be medically explained.
Somatoform patients and medically ill (non-somatoform) patients were 65% and 26% of the total respectively. The somatoform patients showed significantly lower SUBI positive scores than the non-somatoform patients (p=0.042), while SUBI negative scores were significantly higher (p=0.001). Among the somatoform patients, there was a negative correlation between numbers of somatoform symptoms and SUBI positive scores (r=0.267; p=0.032), and a positive correlation between numbers of somatoform symptoms and SUBI negative scores (r=0.337; p=0.006).
Following the SUBI scores through treatment courses may lead to a better understanding of the pathology of somatoform disorders and to more effective use of Kampo.