We herein describe the findings of a 32-year-old female was known to have had an electrocardiogram abnormalities and had avoided excessive exercise since her high school student days. She suddenly lost consciousness due to ventricular fibrillation (Vf) in July 2007. As a result she was taken to our hospital by ambulance. Emergency coronary angiography demonstrated an anomalous origin of the left coronary artery from the pulmonary artery (Bland-White-Garland Syndrome). She therefore underwent surgery. During the operation, the main pulmonary artery (PA) was transected while on the cardiopulmonary bypass and the left main coronary trunk (LMT) ostium was detected. Antegrade cold blood cardioplegia was induced, and retrograde continuous cold blood cardioplegia was subsequently applied to the coronary sinus, thus obtaining a complete cardiac standstill. The LMT ostium was excised with a cuff of the main PA wall as a button. During further dissection of the LMT distally to the bifurcation, the LMT wall was injured, thus resulting in the need to repair it under deep hypothermic circulatory arrest (DHCA) in order to obtain a bloodless surgical field. During core cooling, the LMT was anastomosed to the left posterolateral wall of the ascending aorta, then the LMT was repaired with a patch consisting of a non-treated autologous saphenous vein (SV) under DHCA. Several surgical techniques for BWG syndrome have been reported. Among these techniques, the direct implantation of the left coronary artery to the ascending aorta is the most physiological and therefore is considered to be the best technique. In this case, direct implantation was accomplished, however, the LMT also had to be repaired.

Constipation is one of the most common symptoms seen in elderly people, and is sometimes difficult to treat. Daikenchuto is a well-known Kampo formulation for treating ileus. Here, we report a case in which daikenchuto was not effective and constipation was effectively treated with kobokushokyohangeninjinkanzoto. The patient was an 81-year-old woman who had been hospitalized for treatment of a thighbone fracture. She was originally constipated, and her constipation had worsened over the course of hospitalization. Colonoscopy examination and abdominal computerized tomography showed no structural lesions. Her constipation improved after the administration of daikenchuto, but the improvement was transient. Since the constipation and abdominal distension worsened after she began eating again, we administered kobokushokyohangeninjinkanzoto. Subsequently, her condition improved remarkably. Eight days later, we changed the initial kobokushokyohangeninjinkanzoto to ninjinto and hangekobokuto. Her complaint did not recur, and she was discharged 17 days later. In case of deficiency pattern ileus, kobokushokyohangeninjinkanzoto may be considered as an alternative to daikenchuto. Furthermore, we believe that the combination of ninjinto and hangekobokuto is an effective alternative to kobokushokyohangeninjinkanzoto.

We describe two cases of cardiac failure in elderly patients successfully treated with shimbuto. Case 1 was that of an 84-year-old man with severe aortic stenosis and liver cancer. His cardiac failure led to repeated hospitalization. After taking shimbuto, his pleural effusion decreased and cardio thoracic ratio improved. Case 2 was that of an 84-year-old man who was hospitalized because of cardiac failure and aspiration pneumonia after undergoing an operation for lung cancer. After taking shimbuto, his urine volume increased and cardiac failure improved. No notable adverse events were observed in any of the abovementioned cases. It is important that kanzo is not included in shimbuto to demonstrate risui action, hence the use of other “ho” formulations should be avoided. These cases suggest that shimbuto is indicated for elderly patients with cardiac failure under terminal care.

BACKGROUND/AIMS: There are few prospective studies on cold forceps polypectomy (CFP) using jumbo cup forceps. Therefore, we examined patients with diminutive polyps (5 mm or smaller) treated with CFP using jumbo cup forceps to achieve an adenoma-free colon and also assessed the safety of the procedure and the recurrence rate of missed or residual polyp after CFP by performing follow-up colonoscopy 1 year later. METHODS: We included patients with up to 5 adenomas removed at initial colonoscopy and analyzed data from a total of 361 patients with 573 adenomas. One-year follow-up colonoscopy was performed in 165 patients, at which 251 lesions were confirmed. RESULTS: The one-bite resection rate with CFP was highest for lesions 3 mm or smaller and decreased significantly with increasing lesion size. Post-procedural hemorrhage was observed in 1 of 573 lesions (0.17%). No perforation was noted. The definite recurrence rate was 0.8% (2/251 lesions). The probable recurrence rate, which was defined as recurrence in the same colorectal segment, was 17%. Adenoma-free colon was achieved in 55% of patients at initial resection. Multivariate analysis revealed that achievement of an adenoma-free colon was significantly associated with number of adenomas and years of endoscopic experience. CONCLUSIONS: CFP using jumbo biopsy forceps was safe and showed a high one-bite resection rate for diminutive lesions of 3 mm or smaller. The low definite recurrence rate confirms the reliability of CFP using jumbo biopsy forceps. Number of adenomas and years of endoscopic experience were key factors in achieving an adenoma-free colon.
Adenoma ; Biopsy ; Colon ; Colonoscopy ; Follow-Up Studies ; Hemorrhage ; Humans ; Multivariate Analysis ; Polyps ; Prospective Studies ; Recurrence ; Surgical Instruments

We report three cases of depression, which were effectively treated with oriental medicine. All three patients were employees at the same workplace, which had a total of 17 employees. Case 1 was a 46-year-old, who had worked at the company for 20 years and complained of depression and insomnia. Case 2 was a 28-year-old woman, who had worked at the company for 9 years and complained of nausea and mood disturbance. Case 3 was a 41-year-old man, who had worked at the company for 15 years and complained of restlessness, insomnia, and depression. The three patients were treated with yokukansan and yokukansankachimpihange, which are Kampo formulations, and subsequently showed improvements in symptoms. In choosing prescriptions for these patients, we considered the fact that all three patients worked in the same workplace. Yokukansan is traditionally co-administered to mother and her child. Furthermore, Hoffman (1984) proposed the system of sharing emotional contagion in the field of neuropsychiatry. When considered holistically, medication shared by mother and child is an empirical treatment taking into account emotional contagion. This treatment is also considered applicable within a single community, such as the one in the same workplace. Shared medication that takes into account emotional contagion within the same workplace, could be useful as it was for our patients.

We treated dry eyes and eyestrains successfully with electrothermo-acupuncture and Kampo medicine. The case was a 41-year-old woman who was treated with a few eye drops. She came to our hospital to receive Kampo medicine because her photophobia and eye pain got worse. After taking shimbuto, her complaint got better with improving physical fatigue. Electrothermo-acupuncture was effective for photophobia and eye pain promptly and remarkably. After we added kihito to her, she did not need to use eye drops with improving bloody urine and sleeplessness. Photophobia and eye-ache are thought to be related to the trigeminal nerve system. In this case, we consider that the point of application of electrothermo-acupuncture is the trigeminal nerve system. At the same time, “rikan” and “hikyo” might be involved in this case with the general malaise of eye.