We gave Borei-takusya-san to six patients with intractable edema under the waist. This treatment cured three of the six. Two of the cured patients had Ki-deficiency or Yang-Ki-deficiency in the kidneys. In these cases, we first intensified Ki in the kidneys and improved their conditions to Yin-disease, first stage. We noticed improvement of their subjective symptoms and objective signs after we gave them Borei-takusya-san in combination with their prescriptions. All of the ineffective cases presented some conditions of hypo-tonus or hypo-reactivity.
With reference to many ancient medical books and our own experience we studied the use of Borei-takusyasan. It applies to patients (1) with oliguria, (2) with edema under the waist, (3) without Ki deficiency and Yang-Ki-deficiency in the kidneys and with (4) more reactive stage than Yang-disease, second stage and Ki between excess and deficiency. (5) If they had Ki-deficiency or Yang-Ki-deficiency in the kidneys, we should first replenish with Ki sufficiently, and make out prescriptions for the patients.
We consider that Borei-takusya-san is capable of wide application to the patients with edema under the waist, following our indications.

This report describes the results of endovascular stent graft repair for abdominal aortic aneurysms in comparison with conventional open surgery. Endovascular repair of abdominal aortic aneurysm was performed in 21 patients (SG group) and 69 patients were treated with conventional open surgery (OS group). The SG group had a higher preoperative risk than the OS group. The complete exclusion of the aneurysm at 2 weeks after the stent graft treatment was obtained in 16 out of 21 SG cases (76%). On the other hand, in the OS group, 68 of 69 cases underwent successful surgery (99%). The average amount of bleeding during the endovascular stent graft repair was 427ml and the average operation time was 242 minutes. Both blood loss and operation time were significantly lower compared to the OS group. The endovascular stent graft repair was less invasive in comparison with conventional open surgery. However, judging from the initial success rate, open surgery is more reliable than the endovascular stent graft repair. Our data suggested that the endovascular stent graft repair should be performed only in selected cases.

We studied the appearance of pleural effusion and inflammatory reactions after endovascular grafting in cases of aortic dissection. From December 1995 to January 2000, 16 patients with chronic double-barrel type aortic dissection (DeBakey type III b) were treated by endovascular grafting. In all cases, enhanced computed tomography (CT) of the chest was examined before operation and at about the 7th postoperative day (POD). Patients were divided into 3 groups. Group P: patients who had pleural effusion before the operation. Group E: patients who had new pleural effusion after the operation. Group N: patients who did not have any pleural effusion. In each group, onset of dissection, patient's age, maximum diameter of dissecting aorta, period of postoperative fever (above 37.0°C), and WBC counts and CRP value at POD 1, 3, 7 and 14 were compared. Four patients were in group P, 4 patients were in group F, and 8 patients were in group N. Period between onset and operation was 41.6±34.6 months in group P, 18.2±27.3 months in group E and 7.3±11.6 months in group N. There was no relation between the effusion and the period after onset. Postoperative fever continued for 5.0±2.0 days in group P, 13.5±2.6 days in group E and 2.5±0.3 days in group N. The period of fever of group E was significantly longer than in group N and P (p<0.01). WBC showed a peak on the first POD in each group. CRP showed a peak value on POD 3 in group P and N. There was no significance among the 3 groups about WBC and CRP, but group E showed slightly high CRP values on POD 7 and 14. No patient had complications regarding respiratory function. After endovascular grafting for aortic dissection, postoperative pleural effusion appeared in 25% of patients. They had prolonged postoperative fever, but there was no respiratory function complication. Endovascular grafting is a minimally invasive procedure with regard to respiratory function.

In Japan, doctors inexperienced stent-graft new devices are required to secure agreement on criteria and choice of the device size in endovascular aneurysm repair (EVAR) from experienced doctors. It was hoped that strict patient selection might reduce the learning curve for initial successes in given procedures. In a leading center in Japan, a number of cases which were scheduled for operation at other institutes were evaluated anatomically. We surveyed the initial success of Zenith AAA system implantation in the remaining cases by inexperienced doctors and evaluated the results. This study aimed to verify the validity of strict patient selection in improving the success rate of inexperienced doctors. We enrolled 112 consecutive patients from 19 institutes, who were scheduled for repair between January and October in 2007. All patients were evaluated on the basis of a less-than-3mm reconstructed CT image. Mean patient age was 76±5.7 years. All cases satisfied the Zenith's anatomic prerequisites. Fifteen cases were excluded for various reasons, the major reason being insufficiency of the proximal landing zone (LZ) length, angle and contour. The second reason was difficulty to approach via the iliac artery. Ninety seven cases were included, of which 17 cases were low-risk candidates for EVAR. Medium-risk seventy two cases requiring some advice to avoid problems with device size, technique of implantation and choice of main-body side. Eight cases were high-risk, requiring the presence of an experienced surgeon. Excluded cases had significantly shorter proximal LZ, larger aortic diameters 15mm below the renal artery and tortuous access routes on preliminary measurement by inexperienced doctor. Perioperative mortality was 0%, while the major complications were injury to the iliac artery in one high-risk case and thromboembolism of the superficial femoral artery in another. Perioperative proximal type I endoleak occurred in 5 cases. In 3 of these cases, the endoleak was eliminated by implantation of a Palmatz stent. In the other 2 cases, it disappeared within a month without additional procedures. These cases had a significantly greater angle between the proximal LZ and the suprarenal aorta and significant amount of mural thromboses in the proximal LZ. Perioperative type III endoleak occurred in 3 cases. In all cases the endoleak was eliminated by additional procedure. Perioperative type II endoleak occurred 8 cases. In 3 of these cases, the endoleak disappeared within a month. In the 5 other cases, the endoleak did not disappear. Mid-term results showed iliac leg thromboembolism in one case and new type II endoleaks in 3 cases. Type II endoleak occurred in cases which had significantly greater angles between the proximal LZ and the aneurysm. The results which were evaluated in our center had excellent perioperative and mid-term outcomes. We think this evaluation system is effective for risk assessment and reduces the learning curve in EVAR. In anatomically marginal cases, it is possible for proximal type I endoleak and injury of the iliac artery to occur. It is impossible to exclude these marginal cases if treatment need for EVAR is a priority. In these cases, lessexperienced operators should be trained in troubleshooting techniques in advance.

A patient with mutiple aneurysms of the thoracic aorta in Behçet's disease was treated with transluminally placed endovascular stent grafts. Stent graft devices composed of several units of self-expandable Z stents covered with ultra-thin woven Dacron were inserted through 18 Fr sheaths via the femoral arteries. The stent grafts were deployed successfully and blood flow into the aneurysms was reduced immediately and no blood endoleak was found on aortography. However minor endoleak due to migrations of the stent grafts was recognized in two distal descending aortic aneurysms twenty days after the operation. Extra stent grafts were inserted to interrupt the endoleak and finally all aneurysms were thrombosed without any endoleak. Former surgical replacement of the aorta due to aneurysms associated with vasculo-Behçet's disease often causes anastomotic leakage and pseudoaneurysms. The endoluminal stent graft treatment is a minimally invasive operation in comparison with former surgical operations, and is useful for aortic aeurysms especially for inflammatory aneurysms in Behçet's disease because it requires no anastomotis. However, improvement of the stent graft devices, including components of the delivery system such as the dilator, sheath and pushing rod, and the development of better devices, is required to reduce delivery failure and to make stent graft treatment more reliable.

Ten cases of pseudoaneurysms that developed after thoracic aortic surgery were treated with an endovascular technique using stent grafts for redo operations. All patients were treated under general anesthesia and the stent grafts were implanted through 18 Fr or 20 Fr sheath introducers via femoral arteries under fluoroscopic guidance. The stent graft was composed of several units of self-expanding stainless-steel Z stents covered with an ultra-thin polyester fabric. Stent graft deployment was technically successful in all patients and in 7 of 10 cases exclusion of the aneurysms with no endoleak was achieved within two weeks after the operation (initial success rate: 70%). Minor endoleak was found in 3 patients and one of those finally underwent conventional surgery because of stent graft migration 6 months after the stent graft repair. Two of ten patients died, 10 days and 18 weeks after the operation, due to hemoptysis, which had already been observed before the operation. Endovascular stent graft repair of pseudoaneurysms after thoracic aortic surgery is a minimally invasive operation in comparison with conventional redo surgery with extracorporeal circulation. These results and experiences suggest that stent graft repair can be a safe and useful redo treatment for pseudoaneurysms. However, careful long-term investigations are necessary to prove the value and effect of this endovascular treatment and a new strategy for cases with hemoptysis is required.

A 60-year-old woman with acute Stanford type A dissecting aneurysm underwent Dacron graft replacement of the total aortic arch combined with the modified elephant trunk technique. Follow-up CT and angiogram demonstrated blood flow into the false lumen from the distal anastomosis. In order to interrupt the blood flow, endovascular stent grafting was undertaken. She recovered uneventfully, and was discharged on the 14th postoperative day. Follow-up CT taken in the third postoperative month demonstrated exclusion of the blood flow into the false lumen of descending thoracic aorta. Aortic arch replacement followed by endovascular stent grafting of the descending thoracic component is a potential therapeutic option in patients with dissecting aneurysm.

A high-risk abdominal aortic aneurysm patient with multiple complications was treated by a transluminally placed endovascular stent-graft. A tapered stent-graft composed of 3 units of self-expandable Z stents covered with ultra-thin woven Dacron was inserted through an 18 Fr sheath via the femoral artery. The stent-graft was deployed successfully, and endovascular exclusion of the abdominal aortic aneurysm was achieved. The endoluminal stent-graft treatment is an option for minimally invasive operation in comparison with conventional open surgery, and appears to be effective for aortic aneurysms in certain selected cases.

From April 1983 through March 1993, 10, 767 women underwent health examinations at the Health Care Center in Obihiro Kosei Hospital. Cervical smears were taken from theuterine cervix for cervical cancer screening. One hundred and six women had abnormal results, greater than class III. Those patients who were diagnosed as having carcinoma numbered 10 (0.09%). Of the cervical carcinomas found, 1 was frankly invasive (adenocarcinoma Ib); 3, microinvasive (2; squamous cell carcinoma and 1; co-existence of adenocarcinoma and squamous cell carcinoma); and 6, carcinomas in situ (squamous cell carcinoma).

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.