We examined three cases where Kampo medicine had effects on palindromic rheumatism. All the patients are men with arthralgia accompanied by redness, fever, and swelling. All cases are RF negative. Cases 2 and 3 are brothers. Case 1: A 58-year-old patient with recurrent arthralgia on shoulders, hands, and legs for 30 years. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) was noted, the administration of Sho-Saiko-to reduced the symptom.
Case 2: A 40-year-old patient with recurrent arthralgia on shoulders, hands and legs for nine years. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) and contraction of the abdominal muscles (Fukuhikokyu) was noted, the administration of Eppi-ka-jutsu-to-go-Shigyaku-san-ryo was replaced, which reduced the symptoms.
Case 3: A 46-year-old patient with recurrent arthralgia on knees and fingers, and pain in hip joints. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) and contraction of the abdominal muscles (Fukuhikokyu) were noted, the administration of Shigyaku-san reduced the symptoms.
All cases were typical palindromic rheumatism, and Eppi-ka-jutsu-to was effective to a certain degree. Kampo diagnosis of Saiko (Saiko-sho) was made and additional Saiko-drugs (Saiko-zai) reduced the frequency, the degree, and the length of the period of symptoms.

To introduce problem-based learning (PBL) in small groups to medical education in Japan, a questionnaire was sent to 10 foreign medical schools where PBL has been used. Five schools in the United States and one each in the United Kingdom, Canada, and Australia responded to all 15 questions concerning their educational system, faculty training, faculty evaluation, and student evaluation. The faculty is trained in 7 medical schools, retrained in 4, and self-trained in 5. The faculty is objectively evaluated by students and a faculty committee in seven schools and the results are returned to the faculty. The students are evaluated by self-evaluation, written tests, and oral examination in al schools, and also by peer-evaluation in one school. The evaluation of students directly affects their promotion in all schools but one. Such effective evaluation and feedback systems, including evaluations of the students' learning skills and their attitude toward learning, play important roles in effective PBL.

Two hemodialysis patients underwent coronary artery bypass grafting. Emergency coronary artery bypass grafting was performed in one patient with unstable angina and acute left ventricular failure. The other patient underwent a combined operation of coronary artery bypass grafting and replacement of abdominal aortic aneurysm. In both patients, hemofiltration was used during cardiopulmonary bypass. In the early postoperative periods, peritoneal dialysis and extracorporeal ultrafiltration method (ECUM) were used in Case 1, while Case 2 was treated by hemofiltration and ECUM. Postoperative coronary angiography showed that all grafts of both patients were patent, and both patients weve discharged from hospital without angina.

A 49-year-old man presented in emergency center with complaints of severe lumbago and severe pain of the right lower limb. Symptoms were suggestive of hernia nuclei pulposi and he was referred to orthopedic department of our hospital. His pain was not relieved by analgesics and the right lower leg was cyanotic with a swollen, hard, and tender calf. On palpation a pulsating mass was revealed in the mid-abdomen. He was transferred to the cardiovascular floor. CT and IA-DSA revealed an abdominal aortic aneurysm and no occlusion of the major arteries of the right lower leg. The serum glutamic oxaloacetic, lactic dehydrogenase levels all increased especially the creatinine phosphokinase increased to 46, 460IU/l, and the urine myoglobin level was 4, 200ng/ml. Myonephropathic metabolic syndrome (MNMS) was suspected. Urine volume was maintained with fluid infusion and diuretics. The blood urea nitrogen and potassium levels remained within normal limits throughout the course. The immediate recognition of MNMS and treatment of the condition were successful in preventing serious complications. But all the toes of the right foot became necrotic and they were amputated. Two months after admission, replacement of the abdominal aortic aneurysm was performed successfully. The patient was discharged in good condition one month after the operation.

Four patients with multiple dissecting aortic aneurysms treated surgically from 1960 to 1996 were evaluated clinically. The incidence of multiple dissecting aortic aneurysms was 3.2% of all surgically treated cases of aortic dissection. Only one case suffered from Marfan's syndrome. Morphologically, all cases showed chronic DeBakey II+III type dissection. Case 1 was treated by Bentall's operation for DeBakey II type dissection and the residual aortic aneurysm was not treated surgically. Case 2 underwent a two-staged operation: Bentall's operation first, followed by entry closure with plication of the DeBakey III type aneurysm. Case 3 underwent a two-staged operation: graft replacement of the ascending aorta combined with coronary artery bypass grafting in the first operation and graft replacement of descending and abdominal aorta in the second. Case 4 was treated by graft replacement of the hemiarch, resuspension of the aortic valve and entry closure of the DeBakey III type dissection. Among them, two cases (Cases 1 and 2) whose aneurysms were treated incompletely showed a rapid growth and rupture of residual DeBakey III type aneurysm. In conclusion, one-staged aggressive and complete operation should be done for the patients with multiple dissecting aortic aneurysms. When a two-staged operation is selected, more intensive follow-up of the residual aortic aneurysm is needed.

We report a case of successful medical treatment for graft infection after abdominal aortic aneurysm repair. A 63-year-old man with a ruptured abdominal aortic aneurysm underwent a prosthetic graft replacement via a retroperitoneal approach. He became febrile on the 26th postoperative day (POD). A CT scan demonstrated fluid collection around the grafts. Re-operation was performed and gross pus was found around the prosthetic graft. After all pus and nonviable tissue were removed, two irrigation tubes and a drainage tube were placed adjacent to the graft for continuous irrigation with 0.5% povidone-iodine and super-acidic solution. Inflammatory reactions were gradually improved, and the patient discharged on the 88th POD.

The purpose of this study was to evaluate the association between subjective usefulness of pedometer and step count, exercise adherence, and the possibility of a pedometer helping exercise adherence.
The subjects were 106 community-dwelling citizens (mean age±SD, 66±5) who were put on an individual exercise program in addition to walking. The targeted step count was 8000 steps/day. Every subject wore a pedometer that registers 7 days of physical activity.
The rate of adherence was 98.1%, and about 73% of subjects answered that using a pedometer is useful for physical activity. There was no difference in exercise habit at baseline between subjects answering useful or not useful.
Only in the case of females, was step count and prevalence of targeted 8000 steps significantly higher in the group who felt a pedometer was useful than in the group who didn't feel it useful. However, in the group of males who felt the usefulness of a pedometer, step count significantly increased during the 3 months. In addition, the females who reached their targeted step count performed better in the 10 m hurdle walk and 6 min walk than those who could not reach the targeted step count.
The awareness of self-health wellness, without the anxiety of physical fitness and adherence to exercise was higher in the subjects who felt a pedometer was useful than in the subjects who didn't.
The subjects who felt a pedometer was useful achieved their targeted number of steps and increased walking ability and tended to adhere better to physical activity.
It is suggested that a pedometer motivates adherence to physical activity and is useful for helping exercise adherence in the future. However, we need a randomized control trial for determining the relationship between exercise adherence and using a pedometer.

Among 62 patients who underwent hybrid arch TEVAR, which is a combination of supra-aortic bypass and TEVAR to treat arch aneurysm, 5 patients encountered postoperative cerebral infarction. In 2 patients, whose thoracic aorta were extremely shaggy, cerebral infarction were multiple and fatal. Other 3 patients, whose aorta were not shaggy, developed visual disturbance after TEVAR and minor cerebral infarction were detected in the area of vertebral artery. To prevent cerebral infarction after hybrid arch TEVAR, the blood flow from the left subclavian to vertebral artery is considered to be significant.

Cordyceps militaris has been known to produce an anticancer agent, cordycepin. Investigation on optimum culture condition for C. militaris had been performed. In the research program for discovering a novel function in the culture of C. militaris, the culture media was applied to a proliferation assays using various cell lines. The media showed significant anti-proliferative activities against al cell lines, especially to human leukemia cell line HL-60. The activity-guided purification of active ingredient was performed to obtain uracil. To the best of our knowledge, uracil has not been reported to possess anti-proliferative activity. However, the uracil obtained from the culture media was subjected to ICP-MS analysis to reveal that sodium, potassium and magnesium were found to co-exist with uracil, which might show anti-proliferative activity. Further study on the mechanism of the expression of the activity is now underway.

An 84-year-old man with a thoracic aortic aneurysm underwent total arch replacement with selective antegrade cerebral perfusion. Immediately after the operation, respiratory distress and hypotension developed and Chest X-ray films and computed tomography showed bilateral lung edema. Echocardiography showed a small, underfilled left ventricle, but with preserved systolic function. We suspected transfusion-related acute lung injury (TRALI), and started sivelestat and steroid pulse therapy. His respiratory condition gradually improved, and he was discharged on postoperative day 78. The diagnosis of TRALI was confirmed by positive test results of an HLA class I antibody in the transfused fresh frozen plasma and T- and B-cells of the patient. TRALI should be considered as a cause of acute lung injury after surgery with blood transfusion.