Tuberculous valvular endocarditis is rare and diagnosis before death is seldom achieved. A case of severe aortic regurgitation due to tuberculous endocarditis in a 56-year-old man is presented. Replacement of the aortic valve in emergency and administration of anti-tuberculuos medication permitted an uneventful recovery. This is a rare case report of successful surgical treatment of tuberculous valvular disorder.

In our department, we perform CABG operations using arterial grafts as much as possible, and in the present study, we investigated 96 patients who underwent CABG operations using arterial grafts alone during the 4-year period from October 1988 to August 1992. The sex ratio (M/F) was 64/32, and the mean age was 63.2 years. Of those 56 patients underwent bypass surgery for one artery each, using a total of 56 grafts. In 18 cases of bypass surgery for 2 arteries 34 grafts were used for 36 arteries, and in 16 patients who underwent surgery for 3 arteries, 42 grafts were used for 48 arteries. In 6 patients who underwent bypass surgery for 4 arteries, 16 grafts were used for 24 arteries. All 148 arteries harvested from 96 patients were available. Forty-one RITAs were used for 43 arteries, 68 LITAs for 72 arteries and 39 RGEAs for 49 arteries. There were 2 (2.0%) operative deaths. Among 135 grafts for 146 arteries on which arteriography was performed after operation, 133 grafts (98.6%) among 142 arteries (97.3%) were patent. In detail, the patency rate of ITA was 98 of 100 grafts (98.0%) and 102 of 105 arteries (97.1%), that of RGEA was 35 of 35 grafts (100%) and 40 of 41 arteries (97.6%), and therefore, good patency was observed in both ITA and RGEA.

In this study, we showed the bioavailability of ubiquinol (QH) in the form of water-dispersive powder.Two groups of 5 healthy young subjects received single oral administration of 100 mg of QH in the form of a soft capsule containing QH dissolved in safflower oil or 40% water-dispersive powder in the fasting period, and changes in the plasma QH concentration were monitored over time.The water-dispersive powder form of QH exhibited superior bioavailability even when administered in the fasting period.

Cystadenoma is an uncommon benign epithelial neoplasm. Cystadenoma usually occurs on the palatal and buccal mucosa, but is less commonly found in the retromolar regions.A 43-year-old male patient noticed a swelling on his gingiva distal to the right mandibular second molar. Physical examination showed a diffuse poorly circumscribed swelling extending from the lingual gingiva distal to the right mandibular second molar to the floor of the mouth and pharynx. The tumor size was 20 x 27 mm. The surface mucosa was purply-blue in parts. About 4 ml of pale yellow serous fluid was aspirated. The tumor was surrounded by a capsule and was excised successfully above the periosteum, incorporating a 2 mm safety margin including the surface mucosa. The tumor consisted of a fibrous capsule with multiple cystic cavities of various sizes. The cysts were lined by a layer of columnar epithelium, with intracystic papillary proliferation in some areas. No cytologic atypia or invasion of the surrounding tissues were observed.There is no evidence of recurrence ten years after excision, suggesting that complete excision is sufficient treatment in such cases.

[Purpose] We report a case treated by acupuncture in a health care facility for the elderly to evaluate the effect of acupuncture on severe pulmonary emphysema.
[Case and methods] A 88 year-old man visited Meiji University of Oriental Medicine Hospital with dyspnea in March 2000 and was diagnosed with pulmonary emphysema. He was hospitalized in October 2002 because his chronic respiratory failure was worsening : oxygen therapy was started. After discharge from hospital, he entered a health care facility for the elderly and acupuncture treatment for lumbago was initiated. Thereafter, acupuncture treatment for dyspnea and stiff shoulder started. He was determined to be grade V according to Fletcher-Hugh-Jones classification of dyspnea. Spirometry of the patient before acupuncture for dyspnea showed 88.0 % in %VC, 38.2 % in FEV 1 %, and 30 % in %FEV 1, and the patient was diagnosed with chronic obstructive pulmonary disease of serious grade. Acupuncture treatment was performed once or twice a week, and acupuncture treatment for dyspnea was performed 21 times (total of 33 treatments).
[Results] Subjective symptoms of lumbago, stagger of the legs, and shoulder stiffness were evaluated with Numerical Scale or Pain Scale. The state of dyspnea was evaluated with Numerical Scale and Borg Scale, and exercise tolerance was evaluated with 6 min of walking. After 33 acupuncture treatments, dyspnea on exertion, exercise tolerance, and the findings of spirometry were not improved. But dyspnea on rest had disappeared with improvement in lumbago, stagger of the legs, and shoulder stiffness. These results indicate that acupuncture as a general treatment is effective for the improvement of dyspnea, especially in elderly patients whose general state of health is not good because of restriction in their ability to exercise in the course of daily life due to dyspnea of exercise such as lumbago, stagger of the legs, and shoulder stiffness.

[Objective] The effect of indirect moxibustion on cold symptoms was examined in elderly subjects living in a nursing home.
[Design] A single-case experimental design that enables clinical trials in small a number of subjects was used in this study.
[Methods] Two elderly subjects living in a nursing house participated for 16 weeks. The experimental periods were allocated at random as treatment periods and control periods of eight weeks each. During the treatment periods, subjects were treated with indirect moxibustion GV 14 and BL 12 (both sides) 3 units each, 3 times a week. Rating scores with 4 and/or 5 grades were used to evaluate common cold symptoms.
[Results] Concerning the presence of common cold, there were no significant differences between the treatment and control periods. Moreover, concerning common cold symptoms, there were no significant differences between treatment and control periods.
[Conclusion] Effects of an indirect moxibustion on the common cold symptoms were not detected in this study. We speculated that the living environment of these subjects and the intensity of stimulation were factors. Furthermore, we suspected that a single-case experimental design was unsuitable for common cold research.

Cardiac angiosarcoma is a rare disease which occurs most often in young males and has a remarkably unfavorable prognosis. We experienced one male case aged 46 who had an initial symptom of cardiac tamponade due to rupture of the right ventricle. Hemostasis was made under extracorporeal circulation, and the patient was discharged temporarily. However, a large volume of hemoptysis occurred from right B₆ about 1 month after discharge, because of which resection of the right lower lobe was performed. Tumorous cells identical to those in the perforated cardiac region were detected in the resected tissue, and it was diagnosed histopathologically that the cardiac rupture was caused by angiosarcoma, resulting in pulmonary metastasis. Multiple pulmonary metastases were observed in bilateral lung following fields by CT, but administration of CDDP in iv×2 and in 150mg/day cyclophosphamide, the pulmonary metastases disappeared completely on CT on the 45th day. However, the metastases recurred soon thereafter without responding to chemotherapy, and the patient died 5 months after diagnosis of this disease because of exacerbated dyspnea.

Two cases of secondary oral squamous cell carcinoma (SCC), which developed in recipients of hematopoietic stem cell transplantation (HSCT) for leukemia, are reported. The first patient underwent allogeneic HSCT for chronic myelogenous leukemia at 32 years of age. He suffered from chronic graft-versus-host-disease (GVHD) of the oral mucosa after HSCT, and has subsequently received immunosuppressive therapy. He experienced metachronous multiple SCCs in the maxillary gingiva and the dorsum of the tongue at 36 years and 40 years of age, respectively. The second patient received autologous HSCT for acute myelogenous leukemia at 22 years of age, and she did not experience GVHD after transplantation. SCC developed in the lateral border of the tongue at 27 years of age. PCR analysis detected both HPV16 and HPV18 in the tongue tumor of the first patient, and only HPV18 in that of the second patient, suggesting that the infection of high-risk HPVs was possibly involved in the development of post-HSCT oral cancers in these patients. Since risk factors for post-HSCT oral SCC are not yet well recognized, long-term close follow-up is necessary for the early detection of secondary oral cancers in all transplant recipients.

A 41-year-old woman with neurofibromatosis (NF) was admitted to our hospital for severe pain and right leg swelling of 5 days duration. Paralysis of the right leg due to compartment syndrome was also recognized. She had been diagnosed as von Recklinghausen's neurofibromatosis, previously. 3 D-computed tomography showed a ruptured anterior tibial artery aneurysm. There was a normal patent posterior tibial artery. Since her complaint of pain was severe, we performed an emergency operation. Under the pneumatic tourniquet technique, the aneurysm was resected, and both the proximal and distal sides of the anterior tibial artery were ligated. A massive hematoma was completely removed. Postoperatively, the dorsalis pedis and posterior tibial pulses remained palpable. The paralysis improved considerably and she was given an ambulatory discharge from our hospital 21 days after the operation. Histological examination revealed proliferating wavy spindle cells infiltrating between the adventitia and mesothelium of the aneurysmal wall and staining positively for S 100 immunoperoxidase.