We report a case of quadricuspid aortic valve concomitant with infective endocarditis. A 73-year-old woman was admitted to our hospital because of general fatigue, loss of body weight and high fever. Transthoracic echocardiography showed moderate aortic regurgitation and left ventricle-right atrium fistulae with vegetation. Infectious endocarditis was diagnosed. Since her fever and hemolytic anemia were not controlled by antibiotics, we operated and the aortic valve had four cusps and there were vegetations on the aortic valve and left ventricle outflow tract. Perforation of the membranous septum was observed. Complete debridement and aortic valve replacement with patch repair of a left ventricle-right atrium (LV-RA) fistula was performed. Although she needed a permanent pacemaker due to complete AV block, her postoperative course was uneventful.

A 48-year-old man was admitted with shortness of breath. He had been given a diagnosis of ankylosing spondylitis by an orthopedic surgeon 20 years previously. A grade III/VI to-and-fro murmur was audible at the left sternal border. Echocardiography revealed moderate to severe aortic regurgitation with annular dilatation. He had also suffered complained rigidity of the neck muscles and back pain for 20 years. He underwent aortic root replacement and his postoperative course was uneventful. Aortic valve regurgitation with ankylosing spondylitis in Japan has been seldom reported, compared with European or American. We discuss surgical problems and the management of these lesions are discussed.

A 62-year-old man presented with a chief complaint of swelling of the left lower extremity. Idiopathic retroperitoneal fibrosis had been diagnosed 6 years previously. Enhanced computed tomography demonstrated occlusion of the left common iliac vein, but without deep vein thrombosis, and a thick dense fibrous layer around the abdominal aorta and in front of the sacrum. After we administered steroid and anticoagulant therapy, remission of the swelling of the left lower extremity was obtained. Presently steroids are being gradually tapered, and he has remained free of recurrence of the swelling of his left lower extremity.

We report a rare case of cystic adventitial disease of the popliteal artery causing intermittent claudication. About 2 months previously, a 21-year-old man had sudden intermittent claudication in the left leg. The left-sided ankle brachial pressure index (ABI) at rest was 0.66. Computed tomography revealed that the arterial occlusion was segmentally caused by cystic lesions. A cystic adventitial lesion of the popliteal artery, measuring 9 cm in diameter, was surgically removed and reconstruction was performed with a saphenous vein graft. Postoperatively the left ABI improved to 1.01, and his symptoms disappeared. The histopathological diagnosis was cystic adventitial disease and the cysts were in the adventitia. The postoperative course was uneventful and he has been without recurrence for 14 months.

Objective: Acanthopanax senticosus Harms extract (ASE) is an ingredient of functional foods, such as health supplements, in Japan. We investigated the effects of ASE on CYP2C9 activity.
Methods and Results: CYP2C9-catalyzed diclofenac 4′-hydroxylase activities in human intestinal and liver microsomes (abbreviated as HIM and HLM, respectively) were significantly decreased by the addition of ASE in a concentration-dependent manner. Kinetic studies of diclofenac 4′-hydroxylase in HLM revealed that ASE addition significantly decreased V_max but had no effect on K_m. These results suggest that diclofenac 4′-hydroxylase activity is suppressed by ASE addition in a non-competitive manner. Then, we investigated the time courses of diclofenac 4′-hydroxylase activity in rat liver microsomes after ASE oral administration (50 to 400 mg/kg). Diclofenac 4′-hydroxylase activities were significantly lowered by the administration of 200 and 400 mg/kg ASE at 0.5 to 4 hr compared with control (0 hr). Furthermore, we investigated the effects of ASE oral administration on the pharmacokinetics of tolbutamide (substrate for CYP2C9) in rats. The area under the concentration-time curve of tolbutamide after ASE oral administration (400 mg/kg) was enhanced by approximately 1.6 times compared with that without ASE oral administration.
Conclusion: These findings indicated that ASE inhibits human intestinal and hepatic CYP2C9 activities.

In Kampo therapy for rheumatoid arthritis (RA), Keishi-ka-ryojutsubu-to, Keishini-eppi-itto and Keishi-shakuyaku-chimo-to are considered to be the primary formulas. However, it is often difficult to control arthritis with the primary formula alone. In this study, we administered 7.5g/day of Ji-daboku-ippo to 12 patients with RA, who had not responded sufficiently to the primary formula alone. Administration of the primary formula and other anti-rheumatoid drugs was also continued.
After three months of this supplemental administration of Ji-daboku-ippo, the mean±SE of the Lansbury's index significantly decreased from 45.3±5.8% to 33.3±3.8% (p<0. 01). After treatment for one year, a decrement in the Lensbury's index (of more than 20%) was seen in the four patients. These results suggest that supplemental administration of Ji-daboku-ippo is effective for patients who fail to respond sufficiently to the primary Kampo formulas used for RA.

Eleven healthy subjects repetitively performed maximal cycling movement for 10 s with 20 s rest intervals. The load of the cycling was respectively set to 30% (high frequency task, lIF' task) and 80% (high power task, TIP task) of the optimal load for exerting maximum anaerobic power. Each task was finished when the exerted maximal power was decreased to 80% of the initial value. While performing each task, transcranial magnetic stimulation (TMS) was delivered to the motor cortex which was effectively able to evoke motor evoked potential (MEP) from the thigh muscles. Elec-tromyographic (EMG) activity of the left rectos femoris (RF), vastus lateralis (VL) and the MEP was analyzed.
The maximal power exerted was decreased to 80.6±1.58 % in the HF task, and 77.3±0.77 % in the HP task. The number of repeated sets in each task was 10.1 ± 1.45 (HF task) and 4.1±0.25 sets (HP task) . The MEP area of the RF and VL was not changed significantly in the HF task, though it was significantly increased in the latter half of the HP task. A two-way ANOVA showed that the time course of the changes in the MEP area was significant in the VL (p<0.01), but not in the RF. In both tasks, the duration of the MEP was progressively prolonged in each 10 sec pedaling, and the prolongation was evident in the latter half of the tasks. However, the magnitude of the prolongation was significantly larger during the HP task. The ratio of the integrated amplitude of the EMG and the exerted power at the initial 5 bouts of cycling (EMG/Power ratio) was significantly increased in both the RF and VL, suggesting that peripheral muscular fatigue was induced during at the latter half of each task. Furthermore, the EMG/Power ratio in the VL was significantly higher during the HP task than the HF task.
These results suggest that central fatigue plays a significant role in decreasing the maximum power output, and that it takes place in a muscle-dependent fashion. It was also suggested that during low load, but relatively higher cadence frequency, central fatigue other than that involving the motor cortex accounts for the decreased power output.