In 5 cases of profound left ventricular failure, simultaneous application of a percutaneous cardiopulmonary support system (PCPS) in which the entire circuit was coated with heparin, and intra-aortic balloon pumping (IABP) were performed. No case responded to therapy consisting of large amounts of inotropic agents, followed by IABP. With the assistance of the PCPS (mean flow rate 2.3l/min) combined with moderate doses of inotropic agents and IABP, the hemodynamics of all 5 patients were stabilized. Using low amounts of heparin, the activated coagulation time during PCPS was maintained between 150 and 200 seconds. No complications directly related to this procedure such as thromboembolism and bleeding were observed. Four cases have been successfully weaned from the PCPS. Of the four, two cases are long-term survivors and are currently functioning normally in society. At present, the indications, optimum parameters for PCPS flow rate, and when to start weaning from the PCPS have not been established. However, we conclude that simultaneous use of PCPS and IABP is useful to maintain adequate systemic circulation in cases not responding to medication and IABP.

In this seminar, the effects of acupuncture and moxibustion on muscle diseases and muscular functions/metabolism were reported, and the status of these techniques were summarized.
In the clinical study section, it was reported that the effects of treatment on muscle diseases and muscular functions were evaluated using objective criteria, such as electromyograms. In the review of the methods for the evaluation of muscular functions using surface electromyograms, the static electromyograms, dynamic electromyograms, and power-spectrum analysis were presented, and the effects of acupuncture and manual treatment on diseases mainly in locomotor organs and their problems were discussed. For example, 72.9% of the 48 patients with cervical dystonia were found to show improvement by 10 courses of acupuncture treatment, and effects were observed in all patients by electromyography. Similar effects were obtained with patients with drug-induced dystonia. In many of the patients with writer's cramp who underwent 10 courses of acupuncture treatment, improvement in writing tests, subjective evaluation, and the strength of pen stokes were observed.
In the review of the basic studies, the effects of acupuncture, electroacupuncture, and transcutaneous electrical nerve stimulation (TENS) on muscular tension, muscular metabolism (energy metabolism, intracellular pH, lactate metabolism), muscular circulation, and noxious and non-noxious motor reflex were surveyed, and their mechanisms and problems were discussed.

We report a case of coronary artery bypass grafting (CABG) in a patient with systemic lupus erythematosus (SLE). A 24-year-old woman with SLE had been treated with steroids and immunosuppressive agents for 7 years. The patient was admitted to Kumamoto University Hospital for the management of unstable angina. CABG was successfully performed using bilateral internal thoracic arteries and postoperative 3D-CT demonstrated good patency of both arterial grafts. The patient experienced no significant postoperative complications, and has remained well to date (8 months postdischarge).

We report a case of a caseous calcification lesion originating from a calcified anterior mitral annulus. A 59-year-old woman on chronic hemodialysis was referred to our hospital due to an elevated brain natriuretic peptide value. Transthoracic echocardiography demonstrated moderate aortic valve stenosis with regurgitation and a pendulous mass in the left ventricular outflow tract, and therefore we perfomed. The patient underwent resection of the mass with aortic valve replacement. Pathological examination of the mass revealed interstitial calcium deposits but without tumors or inflammatory cells. We speculated that the cardiac mass was caseous calcification which originated from a severely calcified mitral annulus based on its echocardiographic and pathological features.

The purpose of this study is to evaluate MRI findings for the shoulder pain in hemiplegic stroke patients in relation to clinical characteristics. We studied 18 hemiplegic patients with first-ever stroke presenting with shoulder pain in the affected side (mean age±SD=67.6±10.1years ; 8 men and 10 women ; 12 right and 6 left hemiplegia). All patients had shoulder pain during passive movements and 4 also had pain at rest. The mean duration from stroke onset to MRI was 67±42 days. MRI revealed abnormal findings in all patients. Tendinosis of the long head of the biceps and supraspinatus tendon injuries were most frequently found. The tendinosis of the long head of the biceps was related to hemihypesthesia and a reduced range of motion for external rotation of the shoulder. The supraspinatus tendon injuries were related to older age and lower Fugl-Meyer (FM) and Functional Independence Measure (FIM) scores. The mean number of abnormal findings per patient was 3.2±1.4. The patients with more than 3 abnormal findings were significantly older, had shorter duration from stroke onset and lower FM and FIM scores than those with less findings. It was suggested that those patients with more severe paresis might have more abnormal findings on their MRIs for shoulder pain.

The purpose of the present investigation was to examine the usefulness of the stepping rate for assessing the time spent in moderate to vigorous intensity physical activity (MVPA). In the present investigation, 11 young men wore two pedometers (LIFECORDER EX ; KZ, Walking Style ; WS) during controlled walking and jogging, as well as during free-living conditions for 3 days. In addition to the number of steps, the KZ determined the time spent in physical activity based on the intensity of the physical activity (light intensity physical activity (LPA); below 3 METs, and MVPA ; above 3 METs), and the stepping rate (≧60, ≧80, or ≧100 steps·min^-1). In contrast, the WS was defined as the physical activity for a stepping rate of 60 steps·min^-1 or more, continuously for longer than 10 min as the time spent in physical activity. Regarding the results, under continuous walking/jogging, the KZ-assessed LPA and MVPA well reflected the intensity of the physical activity. On the other hand, the WS accumulated the time spent in physical activity for longer than 90% of the actual exercise duration, regardless of the walking speed. Furthermore, the stepping rate corresponding to 3 METs was 102 steps·min^-1. Under free-living conditions, however, the KZ-detected MVPA differed significantly in comparison to the time of the physical activity as determined by the other algorithms, except for the time spent in a stepping rate of 80 or higher steps·min^-1. In conclusion, these results indicate that 100 steps·min^-1 is a useful stepping rate for the assessment of MVPA. However, under free living conditions, the stepping rate should be determined at a higher frequency than a one minute interval length in order to improve the accuracy of the MVPA assessment.

Recent reports have described several cases of double muscle transfers to restore natural, symmetrical smiles in patients with long-standing facial paralysis. However, these complex procedures sometimes result in cheek bulkiness owing to the double muscle transfer. We present the case of a 67-year-old woman with long-standing facial paralysis, who underwent two-stage facial reanimation using two superficial subslips of the serratus anterior muscle innervated by the masseteric and contralateral facial nerves via a sural nerve graft. Each muscle subslip was transferred to the upper lip and oral commissures, which were oriented in different directions. Furthermore, a horizontal fascia lata graft was added at the lower lip to prevent deformities such as lower lip elongation and deviation. Voluntary contraction was noted at roughly 4 months, and a spontaneous smile without biting was noted 8 months postoperatively. At 18 months after surgery, the patient demonstrated a spontaneous symmetrical smile with adequate excursion of the lower lip, upper lip, and oral commissure, without cheek bulkiness. Dual-innervated muscle transfer using two multivector superficial subslips of the serratus anterior muscle may be a good option for long-standing facial paralysis, as it can achieve a symmetrical smile that can be performed voluntarily and spontaneously.

Recent reports have described several cases of double muscle transfers to restore natural, symmetrical smiles in patients with long-standing facial paralysis. However, these complex procedures sometimes result in cheek bulkiness owing to the double muscle transfer. We present the case of a 67-year-old woman with long-standing facial paralysis, who underwent two-stage facial reanimation using two superficial subslips of the serratus anterior muscle innervated by the masseteric and contralateral facial nerves via a sural nerve graft. Each muscle subslip was transferred to the upper lip and oral commissures, which were oriented in different directions. Furthermore, a horizontal fascia lata graft was added at the lower lip to prevent deformities such as lower lip elongation and deviation. Voluntary contraction was noted at roughly 4 months, and a spontaneous smile without biting was noted 8 months postoperatively. At 18 months after surgery, the patient demonstrated a spontaneous symmetrical smile with adequate excursion of the lower lip, upper lip, and oral commissure, without cheek bulkiness. Dual-innervated muscle transfer using two multivector superficial subslips of the serratus anterior muscle may be a good option for long-standing facial paralysis, as it can achieve a symmetrical smile that can be performed voluntarily and spontaneously.

A 61-year-old man underwent percutaneous coronary intervention (PCI) for the right coronary artery. However, he had an acute onset of right neck pain and swelling after PCI. Contrast enhanced computed tomography (CT) revealed extravasation into the mediastinum and aberrant right subclavian artery. After transfer to our hospital, we performed emergency endovascular repair for iatrogenic arterial injury. His postoperative course was uneventful.