A study was conducted to determine non-invasively the effects of endurance training on the size of the inferior vena cava in humans. Twelve healthy male subjects were assigned to either an exercise-trained group (ET, n=7) or a sedentary control group (S, n=5) . The ET group underwent cycle-endurance training for 8 weeks (80%Vo₂max, 40 min/day, 4 days/week) . The S group led normal lives during the 8-week period. Before and after the training period, cross-sectional areas (CSA) of the inferior vena cava and the ascending and abdominal aorta were measured by echography. The CSA of the inferior vena cava after training was significantly larger than that before training in the ET group. There was no significant difference in the S group. These results indicate that the inferior versa cava can be morphologically altered as an adaptive response to endurance training. We consider that this adaptation partly contributes to the improvement in the efficiency of venous return from exercising muscles to the heart. Although the present training also increased the CSA of the aorta, the degree of change was smaller than that seen in the inferior vena cava, implying that the factors of adaptation and adaptability to endurance training in the inferior vena cava differ from those in the aorta.

A 44-year-old male, with past history of mitral valve re-replacement, tricuspid annuloplasty and re-replacement of aorto-biiliac prosthetic graft 4 years previously, was admitted to Asahi General Hospital because of massive melena, sepsis and shock. Angiography revealed a false aneurysm at the site of the anastomosis between the graft and the right external iliac artery. He was diagnosed as having graft-enteric fistula, and the emergency operation, including partial resection of the graft, excision of the false aneurysm and extraanatomic bypass, was performed successfully. Pathogenesis, diagnosis and treatment of graft-enteric fistula are discussed.

A case of xenograft valve dysfunction presenting with musical cooing murmur is reported. The patient was a 47-year-old woman and had received mitral valve replacement with porcine xenograft (Carpentier-Edwards 31-M) 10 years before Preoperative echocardiogram showed vibration of a leaflet outside the stent of the bioprosthetic valve. Cardiac catheterization revealed stenosis as well as regurgitation of the bioprosthetic valve. The resected xenograft valve showed a tear which produced regurgitation and musical cooing murmur in one of three pliable leaflets and it also showed pannus formation which caused stenosis.

We administered daikenchuto to the patients having recurrent aspiration pneumonia with tube feeding, who had good responses. Case 1 : A 94-year-old-man with congestive heart failure suffering from recurrent aspiration pneumonia even after percutaneous endoscopic gastrostomy (PEG) placement : following daikenchuto administration, he did not suffer from pneumonia, and his general condition became stable. Case 2 : An 80-year-old-man suffering from severe pneumonia after PEG placement, and experiencing recurrent pneumonias after treatment with antibiotics:following daikenchuto administration, we did not find gastric contents in his oral cavity as before, and his general condition became stable. Case 3 : An 85-year-old-man with congestive heart failure and cerebral infarction also suffering from aspiration pneumonia : a nasogastric tube was placed, but he suffered from recurring pneumonias with tube feeding. After administering daikenchuto, he did not suffer from pneumonia and was discharged from the hospital. Case 4 : An 81-year-old-man with recurrent pneumonia and congestive heart failure : after treatment with antibiotics, we placed a PEG tube because of his severe anorexia caused by oral feeding difficulties. In order to prevent aspiration pneumonia, we administered daikenchuto prophylactically. He subsequently developed very little fever until his discharge to a nursing home.

Chronic expanding hematoma (CEH) is a rare, slow-developing disease that occurs months to years after trauma or surgery. Most CEH in soft tissue occurs in the thigh or upper extremities and can occur with or without an inducible cause. Ninety-one cases of CEH in soft tissue have been reported previously in the Japanese and English literature but its occurrence on the sole has not been reported. Here, we report four cases of successfully treated CEH, including a case occurring on the sole, and provide a review of the literature.
Asian Continental Ancestry Group ; Hematoma* ; Humans ; Thigh ; Upper Extremity

A 70-year-old woman with an 8-year history of systemic sarcoidosis developed round, red-brown eruptions, with central atrophic lesions on her lower legs. The features of the biopsy specimen resembled those of necrobiosis lipoidica (NL), but although necrobiosis was present there were well-formed non-necrotizing granulomas in the dermis. The histological diagnosis was cutaneous sarcoidosis. Systemic sarcoidosis presenting with NL has rarely been reported. The histological features of cutaneous sarcoidosis sometimes mimic those of other granulomatous diseases, including NL and granuloma annulare, which are difficult to distinguish. We discuss the novel association between sarcoidosis and other granulomatous diseases.
Aged ; Biopsy ; Dermis ; Female ; Granuloma ; Granuloma Annulare ; Humans ; Hydrazines ; Leg ; Necrobiosis Lipoidica ; Necrobiotic Disorders ; Sarcoidosis