We report a case of syphilitic aortitis (SA) associated with severe right coronary ostial stenosis, aortic regurgitation (AR), and annuloaortic ectasia (AAE). A 48-year-old man presented to a regional hospital with easy fatigability and nocturnal dyspnea. Echocardiography revealed Seller's grade 3 AR. A computed tomography scan showed AAE, dilatation of the ascending aorta, and calcification of both coronary ostia. Coronary angiography demonstrated that the left coronary artery was intact ; however, the right coronary artery was obscure. Active syphilis was detected on routine blood tests on admission. Therefore, the patient was started on a course of ampicillin/sulbactam (ABPC/SBT). Subsequently, he underwent the Bentall procedure and coronary artery bypass grafting with the right internal thoracic artery. The intraoperative findings showed degeneration of the aorta and severe right coronary ostial stenosis. The pathological findings of the aortic wall and aortic valve were consistent with SA. The postoperative course was uneventful. The patient continued receiving ABPC/SBT for 3 weeks postoperatively, and was then switched to oral amoxicillin.

We report a patient, who had neuropathic pain after radiation, called “chronic post-radiation pain syndrome,” who was successfully treated by Shimbuto. The patient was a 83-year-old man, diagnosed with Stage IB non-small cell lung cancer of the left upper lobe. Although the lesion had a surgical indication, he selected radiotherapy, and stereotactic body radiotherapy was performed. A few months later, he experienced neuropathic pain in his anterolateral chest wall. Loxoprofen and acetaminophen had little effect; moreover, tramadol hydrochloride/acetaminophen combination tablets and pregabalin induced drowsiness and dizziness. He then wanted to take Kampo medicine (Japanese traditional medicine) and was observed to have susceptibility to gastrointestinal disorders and cold intolerance by Kampo diagnosis. We prescribed Shimbuto 5 g per day, along with pregabalin. After 2 months, the pain had almost disappeared and he could stop taking pregabalin. Shimbuto is usually prescribed to patients at a risk of gastrointestinal disorders, pain, numbness, and other symptoms induced by cold intolerance. Shimbuto includes the extract of processed aconite root, which is effective for pain and numbness; therefore, it might be a good option for treating neuropathic pain when we have difficulties with Western medicine.