A 40-year-old man was admitted because of coronary heart disease with a totally calcified ascending aorta and Leriche's syndrome. Establishing a cardiopulmonary bypass seemed to be difficult because neither the ascending aorta nor femoral artery was suitable as a cannulation site. It was not until a prosthetic conduit for revascularization of the lower extremities was anastomosed to the right axillary artery in preparation for the conversion from off-pump to on-pump that off-pump CABG was performed. Subsequently revascularization of the lower extremities was completed. The patient had a satisfactory postoperative course. Off-pump CABG is useful for patients with a severely calcified ascending aorta and occlusive lesions below the descending aorta.

Object: To clarify the emotional and instrumental support influencing male caregivers for people with dementia living at home.

Patients/Materials and Methods: The subjects were 298 male caregivers. Nursing care burden was assessed using the Zarit Caregiver Burden Scale. Ability to cope with care problems was assessed using the Nursing Care Problems Coping Scale for Male Caregivers for People with Dementia Living at Home (NCSM). Emotional support was assessed using the Emotional Support Network Scale. Instrumental support was assessed using the question “Do you have someone to help when you have a problem with nursing care?”.

Results: There was a significant correlation (P < 0.04) between the point (index) of NCSM and Zarit Caregiver Burden Scale. A positive significant correlation was found in three coping styles. A negative significant correlation was found in one coping style, and no significant correlation in one coping style. The ‘Solve the problem’ coping style was linked to support from both within and beyond the family. Both ‘Emotional avoidance’ and ‘Cognitive transformation’ coping styles were linked to support from within the family, and “Request assistance” style only to external support. There were no correlations between the source of support and the “Careful supervision and waiting” coping style.

Conclusion: Emotional and instrumental support for male caregivers was more than three times more likely to be obtained from within the family than outside it. With families becoming smaller, it is becoming more important for communities and society in general to provide emotional and instrumental support for male caregivers. Male caregivers need support from someone with whom they feel comfortable. It is particularly necessary to consider how to support male caregivers who use the “Emotional avoidance” coping style.

In general hospitals or clinics, medical treatment and instruction in medical therapies and nursing are carried out by the medical staff (doctors, pharmacists and nurses) on hand. It is necessary to understand overall trends in patient illness, in addition to personal information, in order to practice medical care comprehensively. For these reasons we analyzed popular medicines, patient make up, and major disease distributions at our own Kampo clinic institute, for patients admitted since 2001.
34% of our patients were male and 66% were female. The majority of these patients were between 20 to 30 years old or, 50 to 70 years old. There were few patients, either male or female, in their 40s. As for major disease distribution, atopic dermatitis was most common among both males and females. Next in line were cold sensations and endometriosis, for females, while respiratory organ diseases such as bronchial asthma or nasal inflammation, and Alzheimer's disease were most common, for males.
Among major disease types, atopic dermatitis was treated with Oren-gedoku-to (JTDN: Japanese Traditional Drug Name) and Ogi-kenchu-to (JTDN), while diabetes was treated with Hachi-mi-gan (JTDN) and Seishin-renshi-in (JTDN). Cold sensations were treated with Toki-shigyaku-ka-goshuyu-shokyo-to (JTDN) and Toki-shakuyaku-san (JTDN), while hypertension was treated with Cho-to-san and Saiko-ka-ryukotsu-borei-to (JTDN).
The present report contains information useful for diagnosis with Kampo medicines, as well as instruction in the nursing and use of these medications by doctors, pharmacists and nursing staff. This report may be utilized in order to administer appropriate medical care for patients.

Recently, the number of physicians using Kampo (Japanese traditional herbal) medicines has been increasing in Japan, and it is becoming more common for pharmacists to dispense Kampo medicines. As Kampo medicines become more popular, in addition to extract formulae, the use of decocting formulae that are more suited to each patient's predisposition and symptoms has increased. Therefore, more pharmacists are dispensing such decocting formulae. However, dispensing decocting formulae can be a complicated task. The risk of dispensing errors is not small. In present paper, we examined preventive measures based on investigations of errors involving decocting formulae in our Kampo clinic. From 1990 to 1999, there were 54 cases in which errors were found after patients received their medicines, and 44 of these cases were dispensing errors. To prevent such errors, in addition to having the knowledge of Kampo medicine and medicinal herbs that is needed for dispensing decocting formulae, it is also necessary to understand the contents of the prescription. The most important preventive measures are to re-inspect the weight and contents of the prescription after preparing it, and to do a final inspection of the medicine contents with the patient. It is expected that this report will play a role in preventing dispensing errors of Kampo medicines by pharmacists.

A 52-year-old man presented with a pulsatile mass in the right groin. He had undergone lumbar sympathectomy and aorto-right femoral artery bypass using an 8mm Microvel double velour graft, 14 years previously, for aortoiliac occlusive disease caused by thromboangiitis obliterans. Based on a clinical diagnosis of an anastomotic aneurysm, an operation was performed. When the aneurysm was incised, it was found that the anastomosis of the graft to the femoral artery was intact and that the graft itself had a defect, 3cm in size on the anterior wall, 1.5cm proximal to the distal anastomosis. The final diagnosis was a nonanastomotic false aneurysm due to prosthetic graft failure. The failed portion of the graft was resected, and a 10mm Hemashield Gold woven double velour graft was interposed between the old graft and the right femoral artery. Generally, arterial grafts below the groin are subject to high levels of mechanical stress, and graft failure is not uncommon. Vascular surgeons should keep in mind that graft failure is not rare in patients with long-standing prosthetic grafts.

Patient: A 74-year-old man. Previous history: Total arch replacement for thoracic aortic aneurysm at 72 years old. History of current condition: The patient presented at a local otolaryngology clinic complaining of hoarseness of the voice. Left vocal cord paralysis was present, and as he had previously undergone thoracic vascular graft replacement, he was referred to our department. Further investigation with computed tomography (CT) revealed air in the mediastinum, and he was admitted for treatment of mediastinitis. Post-admission course: Upper gastrointestinal endoscopy revealed esophageal ulceration. After antibiotic treatment, thoracic subtotal esophagectomy via right thoracotomy, esophagostomy, and gastrostomy were performed on admission day 39. Vascular graft infection was also suspected, and antibiotic treatment was therefore continued. As some improvement in inflammatory response was evident, antibiotic treatment was discontinued and the patient's condition was monitored, but fever developed on day 107, and CT again revealed air in the mediastinum. Bronchoscopy revealed a broncho-mediastinal fistula in the left main bronchus. On day 110, repeated total arch replacement using a vascular graft, omentoplasty, and left main bronchus repair were performed via left thoracotomy. Esophageal reconstruction was left for later surgery, but follow-up CT on day 160 again revealed air in the mediastinum. Bronchoscopy was performed the same day and revealed a broncho-mediastinal fistula in the left main bronchus, located on distally from the previous fistula. This fistula was surgically closed on day 173. The subsequent course was favorable, and antethoracic esophageal reconstruction by jejunal elevation was performed on day 233. The patient was able to start eating on day 244, and was discharged in an improved condition on day 250.

Valsalva sinus aneurysm (VSA) is a rare disease, especially that of Konno classification Type IV. When VSA ruptures, the patient has uncontrollable congestive heart failure because of massive left-right shunt. We encountered two cases with ruptured VSA of the right atrium. Case 1 : A 71-years-old man with a ruptured noncoronary VAS complained of dyspnea on effort. He underwent surgical treatment consisting of aneurysm resection and patch closure with Hemashield after medical treatment for congestive heart failure. He progressed well after operation and was discharged on the 14th postoperative day in stable condition. Case 2 : A 41-year-old man had heard systolic murmur. We diagnosed VSA rupture with echocardiography. He was symptomless but his left ventricle diastolic diameter was dilatated and Qp/Qs was 2.0 by blood gas sampling. He underwent elective surgical treatment consisting of aneurysm resection and patch closure with Hemashield. He was discharged on the 14th postoperative day in stable condition.