The patient was a 74-year-old woman who had undergone mitral valve replacement with a mechanical valve for rheumatic mitral valve stenosis at age 60. She was scheduled for aortic valve replacement for severe aortic stenosis. However, she had significantly worsening anemia before the operation. Capsule endoscopy showed angiodysplasia with bleeding in her small intestine, which was considered the cause of the anemia. Because of progressive anemia, we tried embolization under angiography. However, there was no evidence of extravasation. Neither melena nor exacerbation of anemia was observed, and she underwent aortic valve replacement. She was discharged on postoperative day 22 without gastrointestinal bleeding. Heyde syndrome is aortic valve stenosis associated with gastrointestinal bleeding induced by von Willebrand disease and angiodysplasia in small intestine. Molecular multimeric analysis of von Willebrand factor and the existence of angiodysplasia with hemorrhage of the digestive tract are important for definitive diagnosis. Capsule endoscopy, which is a general examination, is more useful for diagnosis than molecular multimeric analysis of von Willebrand factor. Aortic valve replacement is the only therapeutic option for Heyde syndrome. It is important to decide the appropriate timing of AVR with cardiopulmonary bypass.

An 8 year-old boy had a cardiac murmur pointed out on day three after birth and was given a diagnosis of ventricular septal defect (VSD). He underwent VSD patch closure at two months after birth. He was also found the having Loeys-Dietz syndrome on the basis of mutation of TGFBR2 and physical examination at the age of 2 years. He had been followed up at pediatrics clinic of our hospital since then, and was hospitalized for a 46.5-mm extension of valsalva sinus diameter and moderate aortic insufficiency. The aortic valve was three-cusped and had no abnormality. We performed valve-sparing aortic root replacement. He was discharged on day 18 after the operation without any problems in the postoperative course. Use of an artificial heart valve for the surgery of the aortic root lesion in childhood will probably cause reoperation in the future and difficulty in Warfarin anticoagulation control. A careful decision is needed in the choice of an operation method. Valve-sparing aortic root replacement is a useful operation for patients without aortic valve abnormality.

Background : The Japanese Society for Dialysis Therapy in 2011 reports that the number of hemodialysis patients has been increasing and that there is an increase in long-term hemodialysis patients and the aging of hemodialysis induction. Therefore, it can be expected that the number of valve surgeries in chronic hemodialysis patients will increase. However, there are many problems between chronic hemodialysis and valve surgery. Objectives : To describe the results of valve surgery in chronic hemodialysis patients at our institution and evaluate the selection of prosthetic valve and associated problems. Methods : Between January 2001 and June 2011, a total of 29 patients on chronic hemodialysis including 3 patients for re-operation, underwent valve replacements. The average age was 67.3±9.3 years and 17 (65%) were men. The average dialysis duration was 7.9±6.4 years. The etiologies of renal failure were 8 for chronic glomerulonephritis (31%), 8 for nephrosclerosis (31%) and 3 for diabetic nephropathy (12%). Results : There were 2 (7.7%) in-hospital deaths, which resulted from ischemia of intestine and multiple organ failure due to heart failure. Twelve (46%) patients died during the follow-up period and the 5-year survival rate after surgery was as poor as another authors have reported previously (30.6%). However, the 5-year survival rate after hemodialysis introduction was 87.1%, which was better than the report of the Japanese Society for Dialysis Therapy in 2011 (60%). Average age was significantly higher in bioprosthetic valves than in mechanical valves (p=0.02). There was no significant difference in survival rate among mechanical and bioprosthetic valves (p=0.75). There was no significant difference in valve-related complication free rate among mechanical (27.5%) and bioprosthetic valves (23.4%) (p=0.9). Three patients with mechanical valves had cerebral hemorrhage, and 1 patient with bioprosthetic valve had structural valve deterioration. Conclusions : Surgical result of valvular disease in hemodialysis patients was as poor as another authors reported previously (5-year survival rate : 30.6%), but survival rate after hemodialysis introduction was not very poor (87.1%). There was no significant difference in survival rate among mechanical and bioprosthetic valves. Bioprosthetic valve has the risk of reoperation due to early structural valve deterioration, but there was no significant difference in valve-related complication free rates. Therefore, we should select prosthetic valve in consideration of individual cases.

Enterovesical fistula is a relatively uncommon complication of colorectal and pelvic malignancies, diverticulitis, inflammatory bowel disease, radiotherapy, and trauma in Asian countries. A case of vesico-ileosigmoidal fistula and a literature review of this disease in Japan are presented. A 70-yr-old male was referred with complaints of urinary pain and pneumaturia. On admission, urinary tract infection and pneumaturia were presented. A barium enema demonstrated multiple diverticulum in his sigmoid colon and the passage of contrast medium into the bladder and ileum. Under the diagnosis of vesico-ileosigmoidal fistula due to suspected diverticulitis of the sigmoid colon, sigmoidectomy and partial resection of the ileum with partial cystectomy were performed. The histopathology revealed diverticulosis of the sigmoid colon with diverticulitis and development of a vesico-ileosigmoidal fistula. No malignant findings were observed. Until the year 2000, a total of 173 cases of vesico-sigmoidal fistula caused by diverticulitis had been reported in Japan. Pneumaturia and fecaluria are the most common types, presenting symptoms in 63% of the cases. Computed tomography, with a sensitivity of 40% to 100%, is the most commonly used diagnostic study. For patients with vesico-sigmoidal fistula, resection of the diseased sigmoid colon and partial cystectomy with primary anastomosis are the safest and most acceptable procedures, leading to the best results.
Aged ; Anastomosis, Surgical ; Bladder Fistula/*etiology/*pathology/surgery ; Colon, Sigmoid/pathology ; Cystectomy ; Diverticulitis/*complications/*pathology/surgery ; Human ; Ileum/pathology ; Male

Investigation on the working time, energy expenditure and fatigue were carried out for members of three families engaged principally in raising silk worms.
Group examinations of physical conditions and blood constituents and survey of nutritional intake were performed on the residents, including the above families, in a community in Fukueisland, Nagasaki-prefecture.
The results were as follows;
1) The average values of energy expenditure on a most busy day in a raising period of silk worm calculated to be 3150 kcal (max. 3500 kcal) for males, 2340 kcal (max. 2890 kcal) for females of the above three families. Their working times on this day were about 14 hours.
2) The physical fatigue of the subjects was estimated by means of Fliker frequency, near point and threshold of patellar reflex. Remarkable changes of these values were found, suggesting the heavy physical load of the raising works, and the changes were more remarkable in olders and females than in youngers and males.
3) Donaggio's reaction and Na/K in the first urine of morning were investigated at an interval of five days during one period of silk worm raising.
The Donaggio's reaction values were increased about two times higher in the latter term, on the other hand Na/K dropped in the former term of the period.
4) The group examinations of the inhabitants in the community showed that the body fat of silk raising farmers were fewer than that of the farmers engaged in other kinds of farming reported by the present authors.
Blood values (Ht, Hb and TP) of them in 1975 were lower than in 1974, because one more raising period was added and so the physical load of them might be greater in '75 than in '74.
5) The nutritional intakes of silk raising farmers were almost as same as these of the farmers in other districts.

Introduction: Chloride hot springs have been suggested to have a high thermal retention effect, with various beneficial effects on health. However, the efficacies of such hot springs for preventing arteriosclerosis and improving blood flow have not been scientifically verified. We investigated flow-mediated vasodilation (FMD) as an index of early arteriosclerosis before and after hot spring bathing to study the effects of chloride hot spring baths on the blood vessels. Subjects and methods: The subjects were 17 healthy adult men and women with an average age of 63 years. The Qua I THERME natrium chloride hot spring in Maebashi City, Gunma prefecture, Japan, was used. Measurements were conducted before and 1 h after bathing. Results and discussion: The mean FMD values in all subjects increased significantly 1 h after in comparison to the values before bathing. The FMD values increased in women, but not in men. Body Mass Index (BMI) was 25 or higher in five cases, among which one cases showed a decrease in FMD% after bathing. Hot spring therapy was shown to increase nitric oxide (NO) levels and expand the vascular smooth muscles temporarily. The results also indicated inhibition of platelet agglutination, smooth muscle propagation, leukocyte adhesion and active oxygen production accompanying bathing, which may lead to improvement of vascular endothelial function.