An attack of Raynaud's Phenomenon (RP) is characterized by blanching of the fingers in response to cold or emotional stimuli.
We analyzed the effect of ninjinyouei-to on RP in patients with MCTD. Subjects in this study comprised 19 patients, two males and 17 females, with a mean age of 38 years, and a mean duration of disease of 57.6 months. The study was performed at a time when RP occurred frequently in our country, that is in the period from November 1992 to March 1993.
We administered 9.0g of ninjinyouei-to to each case for four weeks and measured the surface skin temperature of the hands before and after medication with a thermograph using a Thermoviewer-JTG 3300.
There was a significantly higher temperature on the left first finger-tip after medication. Our thermographic findings in this study demonstrate a quantitative efficacy of ninjinyouei-to on RP in MCTD.

The government of Indonesia and the Japan International Cooperation Agency launched a three-year project (2008–2011) to strengthen the surveillance of human avian influenza cases through a comprehensive surveillance system of local-priority communicable diseases in South Sulawesi Province. Based on findings from preliminary and baseline surveys, the project developed a technical protocol for surveillance and response activities in local settings, consistent with national guidelines. District surveillance officers (DSOs) and rapid-response-team members underwent training to improve surveillance and response skills. A network-based early warning and response system for weekly reports and a short message service (SMS) gateway for outbreak reports, both encompassing more than 20 probable outbreak diseases, were introduced to support existing paper-based systems. Two further strategies were implemented to optimize project outputs: a simulation exercise and a DSO-centered model. As a result, the timeliness of weekly reports improved from 33% in 2009 to 82% in 2011. In 2011, 65 outbreaks were reported using the SMS, with 64 subsequent paper-based reports. All suspected human avian influenza outbreaks up to September 2011 were reported in the stipulated format. A crosscutting approach using human avian influenza as the core disease for coordinating surveillance activities improved the overall surveillance system for communicable diseases.

The effect of spa-drink (Misasa hot spring) on exocrine pancreatic function was studied in controls and drink therapy group. To examine exocrine pancreatic function, two different methods were used for determination of pancreatic chymotrypsin activity. One was a colorimetric method for the determination of fecal chymotrypsin activity and the other was PFD fest. Following conclusions were obtained.
1) With spa-drink therapy, fecal chymotrypsin activity was raised in 2 weeks in 40% of patients, while it remained unchanged in the next 2 weeks.
2) With spa-drink therapy, PFD value was raised in 2 weeks in 50% of patients, while it returned to the pre-treatment value in the next 2 weeks.
3) Spa-drink therapy for 2 weeks was effective for improving exocrine pancreatic function.

Short-term effects of spa-drink therapy on gastric mucosal blood flow were evaluated using endoscopic organ reflex spectrophotometry together with an Olympus XQ-10 forward-viewing gastrofiberscope.
Thirty-eight subjects were divided into three groups by random sampling: 12 subjects to a group for injecting hot spring water (38 to 40°C, 150ml), 12 subjects to a group for injecting warm tap water (38 to 40°C, 150ml), and 14 subjects to a groups for injecting warm air (150ml). Hot spring water, tap water, or air was injected into the stomach through the fiberscopic injection channel. Gastric mucosal blood flow was measured immediately before and 10 minutes after the injection on the three points of gastric mucosa: lesser curvature of the angle, and that of the antrum, and the pylorus.
The following results were obtained:
1) Hot spring water was more effective in increasing gastric mucosal blood flow than air. The difference was statistically significant on all of the three points.
2) Hot spring water was more effective in increasing gastric mucosal blood flow than tap water. The difference, however, was significant only on the mucosa of the gastric antrum.
In conclusion, spa-drink therapy was useful for treating chronic gastritis and gastric ulcer in which impairment of gastric mucosal blood flow plays an important pathogenetic role. Studies on the long-term effects of spa-drink therapy on the gastric mucosal blood flow are now under way.

Distal anastomosis during total arch replacement (TAR) for thoracic aortic aneurysm (TAA) is often difficult to perform because of the limited surgical view. The most common methods available are direct anastomosis of a 4-branched graft to the distal aorta, or stepwise anastomosis with the elephant trunk procedure. However, the stepwise technique requires graft-to-graft anastomosis, which is often associated with bleeding. In the present study, we developed a new approach, which we have termed the “Branched Graft Inversion technique”, which does not require anastomosis between grafts, and facilitates anastomosis with a view equal to that in the stepwise technique. A 65-year-old man with a diagnosis of saccular-type thoracic aortic aneurysm was admitted. Cardiopulmonary bypass was established by cannulating the ascending aorta and femoral artery via a median sternotomy. We performed distal anastomosis under selective cerebral perfusion during hypothermic circulatory arrest (25°C). An inverted branched graft was inserted into the descending aorta and anastomosed using mattress and running sutures together with outer reinforcement with a Teflon felt strip. The distal end of the inverted branched graft was then extracted, and reconstruction of the neck vessels and proximal anastomosis were performed. Our newly developed Branched Graft Inversion technique was useful during TAR for TAA.

We experienced 26 cases of free internal mammary artery (IMA) grafting for coronary artery bypass (CABG) during past 44 months. There were 3, 6 distal anastomoses per patient and 1.6 distal anastomoses per patient were performed with free IMA. The early mortality rate (within 1 month after surgery) was 3.8%. The surgical complications were 0 in mediastintis requiring operation, 0 in reoperation for bleeding and 1; phrenic nerve paralysis with respiratory dysfunction, the patency rate at 1 month after surgery were 97.2% in free IMA and were 96.1% in in-situ IMA. Conclusion was as followed that the use of free IMA for CABG provided excellent result in early period and we would anticipate to expand the use of IMA.