We report a case of severe aortic regurgitation due to deformation of the right coronary cusp which remained in a double-folded shape. A 76-year-old woman was admitted in August 2015 for the evaluation and treatment of dyspnea. She had no history of rheumatic fever, syphilis, endocarditis, or chest trauma. During physical examination, a grade IV/VI diastolic murmur was noted along the left sternal border. Her chest x-ray film showed marked cardiomegaly with interlobular pleural effusion (Vanishing tumor). An aortography revealed abnormally dilated proximal part of right coronary artery as well as severe aortic regurgitation. At operation, the ascending aorta was exposed through median sternotomy with the patient on total cardiopulmonary bypass. The left and non-coronary cusps were easily identified and noted to be normal. The right coronary cusp was recognized to be turned inside out and stayed in a double-folded shape, which made mal-coaptation of cusps and caused aortic regurgitation. The size of the right coronary cusp was larger than other two cusps. A very large right coronary ostium which occupied almost all of the sinus of Valsalva was confirmed. The aortic valve was excised and reconstructed with glutaraldehyde-treated autologous pericardium. She had an uneventful recovery and was discharged on POD 32. The mechanism of how right coronary cusp became disfigured was discussed. We think that the lesions of the sinus of Valsalva and proximal part of the RCA may have caused the double-folded right coronary cusp abnormality.

We consecutively enrolled all patients who visited our Kampo clinic from October 2004 to September 2008, and examined whether or not milk drinking causes abdominal fullness, pain or diarrhea in the patients. Among 3,175 patients enrolled, 35 patients (1.1%) complained of symptoms of milk intolerance. Granulated Kampo extracts containing lactose were administered to 20 patients among the 35 patients, but these Kampo extracts did not cause symptoms of lactose intolerance in 13 patients among the 20 patients. The true incidence of lactose intolerance caused by granulated Kampo extracts may be smaller than 1% at most.

OBJECTIVES: The purpose of this study is to evaluate the effects of teriparatide (TPTD) on bone mineral density (BMD), bone strength, and bone quality in Akita mouse models of diabetes mellitus. METHODS: Twelve-week-old female Akita mice and control mice (C57/BL/6NCrSlc) were divided into 4 groups: control mice treated with vehicle (n = 7) or TPTD (n = 6); and Akita mice treated with vehicle (n = 6) or TPTD (n = 7). TPTD or vehicle was administered subcutaneously 3 times a week for 8 weeks. Blood glucose, serum sclerostin, total tibial BMD, femoral shaft bone strength, and bone quality using Fourier-transform infrared spectroscopy imaging were evaluated. RESULTS: No significant differences in serum sclerostin levels were evident among these groups after 8 weeks of treatment. TPTD significantly increased BMD in control mice (+12.7%, P = 0.02) and Akita mice (+29.2%, P = 0.001) compared with vehicle. Maximum load and stiffness were significantly higher in Akita mice treated with TPTD than in Akita mice treated with vehicle (+56.6%, P = 0.03 and + 90.5%, P = 0.02, respectively). On Fourier-transform infrared spectroscopy imaging, the mineral/matrix ratio was significantly lower in Akita mice treated with vehicle than in control mice (−12.2%, P = 0.02), and TPTD treatment significantly increased the mineral/matrix ratio (P = 0.003). CONCLUSIONS TPTD thus improved BMD and bone strength in both control mice and Akita mice, with improvements in the mineral/matrix ratio among Akita mice.

A 52-year-old woman who had two episodes of cerebral hemorrhage due to cerebral arteriovenous malformation (AVM) had been treated with gamma knife radiosurgery twice. Complete obliteration of the AVM was confirmed after treatment and she was making steady progress. Twenty years after gamma knife radiosurgery, computed tomography showed cyst formation. The cyst grew larger with ensuing neurological signs and symptoms, so we performed surgery. Thereafter, it was possible to make a pathological assessment. Delayed cyst formation after gamma knife radiosurgery for AVM is known to be one of the late adverse effects of radiation but little is known beyond 10 years postoperatively. We report here on a case of cyst formation 20 years after gamma knife radiosurgery for AVM.

A 68-year-old woman had unstable angina pectoris with asymptomatic right internal carotid artery and right middle cerebral artery occlusion with impaired cerebral perfusion reserve. The cardiology, cardiovascular surgery, anesthesiology, and neurosurgery departments discussed the treatment plan. We simultaneously performed superficial temporal artery-middle cerebral artery anastomosis and coronary artery bypass grafting to reduce the likelihood of perioperative ischemic stroke. Fortunately, neither cerebral ischemia nor myocardial ischemia occurred. Simultaneous superficial temporal artery-middle cerebral artery anastomosis and coronary artery bypass grafting can be a therapeutic option for patients with unstable angina and impaired cerebral perfusion reserve. However, the risk of bleeding associated with anticoagulation during coronary artery bypass grafting cannot be ignored.