A 37-year-old man had been hospitalized at another hospital where he was being treated for encephalitis. Early one morning, the patient had sudden precordial chest pain and dyspnea, so he was examined further. Contrast-enhanced CT revealed filling defects in both pulmonary arteries and in the right and left atria, indicating acute pulmonary embolism. Cardiac ultrasound revealed thrombi floating in the right and left atria, and the patient displayed pulmonary hypertension (estimated pressure : 50 mmHg). Since scattering of thrombi in the left atrium carried the risk of arterial embolism, emergency surgery was performed at this hospital. An incision was made in the right atrium with the heart stopped, revealing a tubular thrombus trapped in the foramen ovale. The trapped thrombus was completely removed, and the patient's life was saved since arterial embolism, e.g. paradoxical cerebral embolism, did not occur. This case involved a rare pathology and is thus reported here together with a discussion of the literature.

The objective of this study was to investigate the edema suppresive effect of single-dose crystalloid cardioplegia against immature myocardium. 50 puppies (3-21-day-old) were separated into 4 groups by the method of myocardial preservation, group A: preservation at 30°C, group B: topical cooling used only, group C: topical cooling with cardioplegia (St. Thomas Hospital solution: 4°C, pH 7.8, 350 mOsm/l), group D: topical cooling with oxygenated cardioplegia, and gravimetric water content of myocardium (%) was measured at control, 5, 30, 60, 90, 120, 150, and 180 min after aortic clamp. All hearts had elevated myocardial water content with linear change pattern, although which in groups A and B was consecutively increased while which in groups C and D was increased immediately after aortic clamp followed by slow increase thereafter. Increase of myocardial water content from 5 min after aortic clamp in group B at 90 min was significantly higher (p<0.01) than those in groups C and D, at 180 min that in group A was higher than that in group C and that in group B was higher than those in groups C and D (p<0.05, p<0.01, p<0.01, respectively). This study has shown that evolution of myocardial edema was suppressed by the administration of cardioplegia, while myocardial water content was seemingly higher because coronary vascular dilatation resulted in increase of intravascular water. We could not find the effect of the topical cooling only or oxygenated cardioplegia.

Recent epidemiological studies have revealed that osteoporosis is closely associated with common chronic diseases including diabetes, hypertension, chronic kidney disorders, and chronic obstructive pulmonary disease (COPD). COPD is a chronic inflammatory airway disease but now well known to be associated with various systemic comorbidities including osteoporosis. Osteoporosis and osteoporotic fractures are extremely common in COPD patients, which have significant impacts on their quality of life (QOL), activities of daily life (ADL), respiratory function, and possibly their prognosis. COPD-associated osteoporosis is however extremely under-recognized, hence undertreated. Recent studies have suggested that both decreased bone mineral density (BMD) and impaired bone quality compromise bone strength causing fractures in COPD. In COPD patients, various general clinical risk factors for osteoporosis are present including smoking, older age, low body weight, and physical inactivity. In addition, disease-related risk factors such as decreased pulmonary function, inflammation, glucocorticoid use and vitamin D deficiency/insufficiency have been linked to the development of osteoporosis in COPD. Increased awareness of osteoporosis in COPD, especially that of high prevalence of vertebral fractures is called upon among general physicians as well as pulmonologists. Routine screening for osteoporosis and risk assessment of fractures will enable physicians to diagnose COPD patients with comorbid osteoporosis at an early stage. Timely prevention of developing osteoporosis together with appropriate treatment of established osteoporosis may improve QOL and ADL of the COPD patients, preserve their lung function and eventually result in better prognosis in these patients.
Activities of Daily Living ; Body Weight ; Bone Density ; Chronic Disease ; Comorbidity ; Epidemiologic Studies ; Humans ; Hypertension ; Inflammation ; Kidney ; Lung ; Mass Screening ; Osteoporosis* ; Osteoporotic Fractures ; Prevalence ; Prognosis ; Pulmonary Disease, Chronic Obstructive* ; Quality of Life ; Risk Assessment ; Risk Factors ; Smoke ; Smoking ; Vitamin D

We report two cases of chest and abdominal symptoms, the causes of which can not be established in a medical sense, successfully treated with daisaikoto. The first case was an 81-year-old male. He complained of tightness in his chest. Since the frequency of his symptom was increasing, he underwent further evaluation in hospital, but no abnormalities were found. We administered daisaikoto with reference to his constipation and kyo-kyo-kuman (subchondrial resistance and discomfort), the tightness in his chest disappeared and three months later his qi stagnation score and SDS score had improved.
The second case was an 83-year-old male. He had been suffering epigastric pain, tightness of chest and abdomen and a feeling of fullness in the abdomen since two years previously, when he suffered multiple traumatic injuries. We administered daisaikoto in light of his epigastric pain, constipation and kyo-kyo-kuman.The epigastric pain and tightness of the chest and abdomen gradually disappeared, and the number of his unscheduled visits to the clinic decreased.
Thus, daisaikoto may be used to treat patients with chest or abdominal symptoms and depression, the cause of which can not be established in any medical sense.

We report five cases of painful swelling caused by hymenoptera stings and centipede bites treated with ourengedokuto and inchingoreisan soon after the time of injury. The first case was a 70-year-old male. He was stung by a hornet on the left hand 30 minutes prior. The second case was a 45-year-old male. He was stung by a hornet on the left face 20 minutes prior. The third case was a 55-year-old male. He was stung by a hornet on the left lower thigh 10 minutes prior. The fourth case was a 39-year-old male. He was stung by a hornet on the right thigh 60 minutes prior. The fifth case was a 35-year-old male. He was bitten by a centipede on the right first toe 20 minutes prior. All cases received Kampo therapies immediately and continued them every few hours. In all cases, their pain, redness and swelling at the site of injury were relieved by the next day. We consider Kampo therapies can contribute to the healing of hymenoptera stings and centipede bites at an early stage.

Sokeikakketsuto was administered to 33 patients with recurrent cramps of the calf appearing once a week or more and persisting for 2 weeks or more. Treatment response was evaluated 1 month after the start of drug therapy. Patients whose cramps disappeared immediately after starting were regarded as showing a complete response, those with disappearance after 1 month as showing a partial response, those with a reduction to <50% after 1 month as showing a slight response, and those in whom 50% or more of cramps persisted after 1 month as showing no response. A complete response was achieved in 12 patients, a partial response in 11, a slight response in 9, and no response in 1. In 23 (69.6%) of the 33 patients, cramps disappeared within 1 month after the start of drug therapy. In 32 (96.9%), there was a reduction to <50%. In 29 (87.8%) of the 33 patients, cramps disappeared within 3 months, suggesting the efficacy of this drug. Two-package administration in the evening/at bedtime was more effective than 1-package administration for controlling cramps of the calf at night until early in the morning. The intensive pre-attack administration of 2 packages before sleep was the most effective. Sokeikakketsuto may be useful for treating recurrent cramps of the calf.

Sixteen patients with congenitally corrected transposition of the great arteries (CTGA) underwent operative closure of ventricular septal defects (VSD). Ages of the patients ranged from 10 months to 25 years. Three different approaches were employed to access to the defect: through right ventriculotomy 3, through left ventriculotomy 5, and de Leval's maneuver 8. Here, right or left ventricle refers to its anatomic morphology. Early postoperative death occurred in a patient who concomitantly underwent extracardiac couduit repair between left ventricle and pulmonary trunk. Late death occourred in 5 (left ventriculotomy in 1 and righ ventriculotomy in 4), among whom 2 expired suddenly of unknown cause (one in each of the right and left ventriculotomy), and 1 expired of pneumonia. Two other deaths were related to their reoperations for replacement of the incompetent left atrioventricular (AV) valve. Another patient who had been repaired by de Leval's maneuver also underwent replacement of the left AV valve and survived. Two patients who had undergone left ventriculotomy developed com-plete heart block leading to implantation of permanent pacemaker. Postoperative complete heart block was temporarily noted in a patient who had been repaired by de Leval's maneuver but returned to sinus rhythm on the 10th postoperative day. Late postoperative function of the systemic ventricle was assessed in 8 by gated radionuclide ventriculography. Calculated ejection fractions in each of the methods were the followings. Left ventriculotomy: 0.38, 0.47. Right ventriculotomy: 0.13. de Leval's maneuver: 0.29, 0.54, 0.66, 0.47, 0.36. These results draw us to the following conclusions that either ventriculotomy holds its drawbacks, that is, left ventriculotomy is apt to develop complete heart block and right ventriculotomy can predispose incompetent left AV valve ultimately leading to the fatal congestive heart failure. de Leval's maneuver, however, is rare to be complicated by the above morbidity and is considered to be the best operative method currently available.

We report a case of systemic sclerosis complicated with primary biliary cirrhosis successfully treated with orengedokuto (wanbinghuichun) and sekiganryo. The patient was a 68-year-old female. She had been diagnosed with systemic sclerosis 20 years previously, and primary biliary cirrhosis 17 years previously. She received modern Western medical treatment for skin itching and scleroderma, but her symptoms showed little improvement. Therefore, she consulted our clinic in order to receive Kampo therapy. We prescribed orengedokuto (wanbinghuichun), and the skin itching improved in 5 days. As a result of administering sekiganryo in addition to orengedokuto (wanbinghuichun) for severe coldness, the scleroderma was also ameliorated. We consider this to be a case of diseases overlapping between yin and yang syndrome.

A 54-year-old female had left femoral incarcerated hernia. One month later, she received a radical operation for it, but was admitted to our hospital twice because of ileus. Various tests showed no mechanical intestinal obstruction, but small-intestinal edema. She was transferred to our department to receive Kampo medicine. She could not eat any food and her weight decreased from 47 to 37.5 kg. We therefore administered intravenous hyperalimentation. She had a cold sweat on her face and was prone to bed rest because of severe abdominal pain as if in labor, and general fatigue. Her skin was dry, her radial pulse was weak and her abdominal tonus was weak. In addition, lower abdominal tension was more intense than upper and we could observe bowel movements from her skin. At first, we administered bushikobeito, but it had no effect. Referring to her abdominal findings, we considered that daikenchuto and tokikenchuto were compatible in her case, and after changing to chukenchutokatoki her abdominal pain disappeared in 5 days. Thus, Kampo medicine was effective for post-operative pseudo-obstruction.