We performed a retrospective study of the effects of steroids and the factors that deteriorate renal function in 30 patients with primary focal segmental glomerular sclerosis. The mean observation periods from the onset of proteinuria and from the histological diagnosis by renal biopsy were 6.1 ± 5.0 years and 3.9 ± 3.01 respectively. 87% of the patients had been recerving steroid therapy with or without other drugs. In this study, the patients were divided into 3 groups by the initial dose of steroids. A multivariate analysis was performed on the laboratory findings of the 3 groups. In a short-term observation, there were no significant defferences among the groups. However, in a long-term observation (more than one year) it was clarified that the patients who had been given high doses of steroids tend to maintain their renal functoin. We also found that the patients responding to steroids showed a significantly better prognosis than steroid-resistant patients upon examination their nephrotic status and renal functoin.
This statistical analysis confirmed that the factors deteriorating the renal function are hypertension and hyperlipidemia.
In addition, it was revealed that hyperuricemia, is responsible for the renal dissease, failure?

A 27-year-old man who presented with worsening dyspnea was transferred to our hospital due to congestive heart failure with multiple organ dysfunction. Echocardiogram showed severe left ventricular systolic dysfunction and a huge thrombus in the left ventricle. An urgent operation was performed to remove the thrombus simultaneously with the placement of bilateral extracorporeal ventricular assist devices. After the operation, despite a rapid improvement in the liver function, renal dysfunction persisted and he remained anuric for nearly a month. We continued maximal circulatory support with biventricular assist device to optimize his end-organ function. His renal function gradually improved, allowing him to be registered as a heart transplant candidate on the 140th postoperative day. On the 146th postoperative day, the patient underwent successful removal of the right ventricular assist device, and the left extracorporeal device was replaced by an implantable device (HeartMate II). He was discharged 78 days after the implantation. We present here a case where adequate support with biventricular assist device enabled a successful bridge to transplantation even in a patient with end-stage heart failure having end-organ dysfunction.

The patient was 62-year-old woman was brought to the emergency room with chest pain and dyspnea. Computed tomography revealed a hematoma around the ascending aorta, a notch in the aortic wall, pericardial effusion and a hematoma around the pulmonary artery. We diagnosed early thrombotic type of acute aortic dissection. An ascending aorta replacement was performed via median sternotomy under hypothermic circulatory arrest. Upon operation, there was a 1.0 cm intimal tear just above the left main trunk and there was no specific evidence of aortic dissection. So we diagnosed spontaneous aortic rapture. Her postoperative course was uneventful and she was discharged 18 days after surgery.

We report two cases of chest and abdominal symptoms, the causes of which can not be established in a medical sense, successfully treated with daisaikoto. The first case was an 81-year-old male. He complained of tightness in his chest. Since the frequency of his symptom was increasing, he underwent further evaluation in hospital, but no abnormalities were found. We administered daisaikoto with reference to his constipation and kyo-kyo-kuman (subchondrial resistance and discomfort), the tightness in his chest disappeared and three months later his qi stagnation score and SDS score had improved.
The second case was an 83-year-old male. He had been suffering epigastric pain, tightness of chest and abdomen and a feeling of fullness in the abdomen since two years previously, when he suffered multiple traumatic injuries. We administered daisaikoto in light of his epigastric pain, constipation and kyo-kyo-kuman.The epigastric pain and tightness of the chest and abdomen gradually disappeared, and the number of his unscheduled visits to the clinic decreased.
Thus, daisaikoto may be used to treat patients with chest or abdominal symptoms and depression, the cause of which can not be established in any medical sense.

Background : Acute massive pulmonary embolism is a life-threatening disease. It is often treated with thrombolytic therapy, however, the mortality rates are unsatisfactorily high in patients who developed shock and subsequent cardiac arrest. Surgical pulmonary embolectomy is a last resort for patients with hemodynamic instability. We studied the outcomes of our patients who underwent pulmonary embolectomy for acute pulmonary embolism. Methods : Eight patients who underwent pulmonary embolectomy between January 2011 and December 2014 were studied. Our surgical indications were as follows. Patients who experienced cardiac arrest and treated with PCPS, and those in persistent vital shock, with contraindications of thrombolytic therapy, or with right heart floating thrombus. However, patients with ischemic encephalopathy or acute exacerbation of chronic thromboembolic pulmonary hypertension, and those who had already been treated with thrombolytic therapy were excluded. Preoperative ECMO was indicated for those in sustained shock. Pulmonary embolectomy was performed through median sternotomy and with cardiopulmonary bypass. After antegrade cardiac arrest, all clots were removed with forceps under direct vision through incisions in the bilateral main pulmonary arteries. IVC filter (Günther Tulip) was placed through the right atrial appendage. In our early cases, IVC filter (Neuhaus Protect) was placed after chest closure. Anticoagulation was not administered until hemostasis was achieved. Results : Seven patients underwent pulmonary embolectomy for massive pulmonary embolism, and in one patient pulmonary embolectomy was indicated for right heart floating thrombi although the pulmonary embolism was submassive. Three patients underwent cardiopulmonary resuscitation and were treated with ECMO. Other 3 patients in sustained shock vital were electively treated with ECMO. The other patient developed cardiopulmonary arrest shortly after anesthetic induction and intubation, and suffered disturbance of consciousness postoperatively. All patients were successfully weaned from cardiopulmonary bypass and underwent IVC filter placement (5 Neuhaus Protect, and 3 GProtec Tulip). One patient died due to a vascular complication associated with catheter insertion (retroperitoneal hematoma). No patients developed residual pulmonary hypertension. There were postoperative complications including pneumonia in 5 patients, tracheostomy in 2 patients, atrial fibrillation in 3 patients, and pericardial effusion in 1 patient. One patient who suffered disturbance of consciousness died 2.4 months after the surgery. Other patients had not developed any thrombotic and hemorrhagic complications during a median follow-up of 13.1 months. Conclusions : Pulmonary embolectomy is an effective treatment of acute massive pulmonary embolism. We believe that our strategy is useful, consisting of preoperative hemodynamic stability by an institution of ECMO, complete removal of clots by bilateral main pulmonary incisions, and prevention of recurrence by IVC filter placement.

Objective: Both acyclovir (ACV) and valacyclovir (VACV) can cause drug-induced encephalopathy, which occurs primarily in patients with renal impairment because of delayed drug metabolism. Here, we report a case of ACV-associated encephalopathy precipitated by the addition of nonsteroidal anti-inflammatory drugs (NSAIDs).Patient: A 97-year-old woman with a 1-d history of altered consciousness was admitted to our hospital. After treatment with ACV and VACV for herpes zoster, NSAIDs were introduced for pain 5 d prior to admission. VACV and NSAIDs were subsequently administered by her primary care physician 3 d before admission.Results: The patient presented with altered consciousness and acute kidney injury, leading to a suspicion of ACV-associated encephalopathy. Her consciousness improved rapidly with hemodialysis. We diagnosed ACV-associated encephalopathy based on a significantly elevated ACV blood level of 32.7 µg/dL.Conclusion: The addition of NSAIDs during ACV or VACV administration may precipitate ACV-associated encephalopathy. When combining ACV or VACV with NSAIDs for the treatment of herpes zoster, careful monitoring of consciousness level and renal function is recommended.

Objective: To compare effects of the fluoropyrimidines S-1 and capecitabine on prothrombin time international normalized ratios (PT-INR) of warfarin following coadministration and after discontinuation of each fluoropyrimidine treatment.
Methods: Medical records of patients receiving warfarin with either S-1 (6 patients) or capecitabine (7 patients) were obtained from four hospitals.
Results: Increased PT-INR was observed until peak levels of warfarin were achieved in all patients in S-1 and capecitabine treatment groups.　Moreover, PT-INR significantly changed after coadministration within each group (p＜0.05).　Specifically, ratios of peak PT-INR after coadministration of each fluoropyrimidine and those following administration of warfarin alone (PT-INR elevation ratio) were 3.31 and 3.29 in S-1 and capecitabine coadministration groups, respectively.　Moreover, numbers of days to peak PT-INR were 38.3 and 31.3 days, respectively, and did not significantly differ between the treatment groups.　Furthermore, PT-INR returned to pretreatment levels by 17.5 and 15.1 days after discontinuation of S-1 and capecitabine, respectively, and did not significantly differ between the treatment groups.
Conclusion: Coadministration of S-1 and capecitabine similarly prolongs PT-INR by approximately 3-fold compared with administration of warfarin alone; therefore, these drug-drug interactions were clinically suggested to be of high risk for episodes of bleeding and remarkable alterations in coagulation parameters.　Therefore, blood coagulation ability should be more carefully monitored with regard to PT-INRs in patients receiving warfarin with S-1 or capecitabine not only during coadministration but also after discontinuation of fluoropyrimidine treatments.

We report a case of systemic sclerosis complicated with primary biliary cirrhosis successfully treated with orengedokuto (wanbinghuichun) and sekiganryo. The patient was a 68-year-old female. She had been diagnosed with systemic sclerosis 20 years previously, and primary biliary cirrhosis 17 years previously. She received modern Western medical treatment for skin itching and scleroderma, but her symptoms showed little improvement. Therefore, she consulted our clinic in order to receive Kampo therapy. We prescribed orengedokuto (wanbinghuichun), and the skin itching improved in 5 days. As a result of administering sekiganryo in addition to orengedokuto (wanbinghuichun) for severe coldness, the scleroderma was also ameliorated. We consider this to be a case of diseases overlapping between yin and yang syndrome.

A 54-year-old female had left femoral incarcerated hernia. One month later, she received a radical operation for it, but was admitted to our hospital twice because of ileus. Various tests showed no mechanical intestinal obstruction, but small-intestinal edema. She was transferred to our department to receive Kampo medicine. She could not eat any food and her weight decreased from 47 to 37.5 kg. We therefore administered intravenous hyperalimentation. She had a cold sweat on her face and was prone to bed rest because of severe abdominal pain as if in labor, and general fatigue. Her skin was dry, her radial pulse was weak and her abdominal tonus was weak. In addition, lower abdominal tension was more intense than upper and we could observe bowel movements from her skin. At first, we administered bushikobeito, but it had no effect. Referring to her abdominal findings, we considered that daikenchuto and tokikenchuto were compatible in her case, and after changing to chukenchutokatoki her abdominal pain disappeared in 5 days. Thus, Kampo medicine was effective for post-operative pseudo-obstruction.