To determine the hemostatic effets of aprotinin in coronary artery bypass surgery, a prospective study was performed. Thirty four patients (group A) who received aprotinin (2×10⁶ unit) in the cardiopulmonary circuit were compared with 31 control patients (group C) who did not. Activated clotting time was measured in group A for 60 minutes during cardiopulmonary bypass, but no significant difference was observed in the platelet counts of the two groups. Intraoperative blood loss was 366ml in group A compared with 514ml in group C, and postoperative blood loss was 354ml versus 570ml, respectively (p<0.05). Total blood loss was significantly reduced in group A by 34% compared with group C (720ml versus 1, 084ml, p<0.05). There was no difference in incidence of perioperative myocardial damage. It seems necessary to investigate the complications of the hemostatic effects of aprotinin and it effects on graft patency.

No case of graft replacement for abdominal aortic aneurysm in a case of congenital deficiency of coagulation factor X III has yet been reported. Recently we performed graft replacement of 66-year-old man with congenital deficiency of coagulation factor X III. Concentrated factor X III separated from human placenta (Fibrogamin^®) was used during, before and after the operation. We measured factor X III activity, and when the activity was so low that replacement therapy was necessary, we administered Fibrogamin immediately. We maintained coagulation factor X III activity at over 70%. No adverse reaction of factor X III replacement therapy was observed. The postoperative course was uneventful and the patient did not have delayed wound healing.

A 68-year-old woman complained of hemoptic shock and recovered with conservative treatment. Ruptured descending aorta into the left lung was diagnosed. Graft replacement of the descending aorta was successfully performed. We speculated that spontaneous rupture of the descending aorta into the left lung might have occurred due to high blood pressure affecting the weak aortic wall with sclerotic change, causing hemoptysis. The ruptured descending aorta was successfully replaced without dissection between the ruptured aorta and the left lung. The postoperative course was uneventful with neither pulmonary nor infectious complications.

A 45-year-old woman who was a Jehovah's Witness was admitted to our hospital with a complaint of palpitation and sort on-effort. A ruptured aneurysm of the sinus of Valsalva (RASV) associated with stenosis of the right ventricular outflow was diagnosed. Operative findings revealed a RASV with a double chambered right ventricle (DCRV) and a ventricular septal defect (VSD). RASV, DCRV and VSD were successfully repaired with extracorporeal circulation without use of homologous blood. We reported this case because congenital combination of RASV, DCRV and VSD is very rare.

A 69-year-old man complained of abdominal pain with inflammatory reaction. Abdominal aortic aneurysm (AAA) with a left main trunk lesion was diagnosed and he successfully underwent Y-graft replacement of the abdominal aorta and coronary artery bypass grafting. Finally AAA was classified as “inflammatory” by histopathological findings. We present this case of “inflammatory AAA” associated with coronary artery disease, and discuss it with a review of literatures.

A 51-year-old man with osteogenesis imperfecta and who had aortic regurgitation was admitted to our hospital for aortic valve replacement. His height was 146cm and his weight was 49kg. The patient had suffered from bone fractures several times since childhood. Bone deformity, blue sclera and his status were clinically indicative of osteogenesis imperfecta. Aortic valve replacement with a 25mm SJM^® prosthetic valve was successfully performed for aortic valve insufficiency and slight annulo-aortic ectasia. Soft tissues and the sternum were fragile. Pathological examination (Elastica-Masson stain) of the aortic valve and left ventricular wall revealed a loss of fibrous tissues and remarkable thickening due to elastic fibers. The patient was discharged 31 days after surgery. Osteogenesis imperfecta is one of the collagen diseases caused by gene abnormality, in which fragile bones are easily fractured. Cardiovascular disease is rarely associated with it and the surgery-related mortality rate is reported to be approximately 30%, due to bleeding.

We report a case of ulcerative colitis (UC) after mitral valve replacement (MVR) surgery due to infective endocarditis (IE). A 59-year-old woman underwent MVR for mitral regurgitation due to IE. Six days after the surgery, melena was observed suddenly, and she received a blood transfusion. Ulcer and erosion were observed in the rectum 5 to 10 cm from the anal ring by endoscopy. We changed her antibiotic treatment and stopped warfarin potassium. Heparin sodium was started 2 days after melena. We diagnosed ulcerative colitis from the finding of the rectal lesion and biopsy. We gave mesalazine and betamethasone as treatment for UC. The patient's condition improved and her general condition stabilized. She was discharged 36 days after surgery.

Objective: To develop a label comprehension study (LCS) of package inserts for over-the-counter medications in Japan, we evaluated whether it would be possible to detect differences in the level of understanding due to layout, and font size of different types of package insert using the interview method for LCS we developed previously.
Design: A face-to-face questionnaire investigation.
Methods: Two different types of package insert (including layout, and font size) for H₂-antagonists (package insert groups A and B) were used.  Study participants (≥18 years old) comprised consumers who visited a drugstore with a dispensing service in Saitama Prefecture.  They were randomly assigned to group A or B and divided by age range (young, 18-39 years; middle-aged, 40-59 years; eldely, ≥60 years).  First, the volunteers read the package insert with no time limitation and then answered 14 scenario-type questions during an interview to determine the level of understanding of the insert.  When both the correct answer and correct reason were given, the response was judged as correct.  The level of understanding of the package insert was calculated as the number of persons giving correct responses divided by all respondents.
Results: Questionnaire responses from 86 consumers (43 in each group) were obtained.  The mean age in groups A and B was 46.5 years and 47.0 years, respectively.  The mean level of understanding of the package insert (14 questions) in groups A and B was 50.2 and 38.1%, respectively.  By age range, the mean level of understanding of the package insert in groups A and B in the young group was 60.6 and 56.9%, respectively, and there was no statistically significant difference between the two groups.  However, the mean level of understanding in groups A and B was 56.9 and 35.0% in the middle-aged group and 26.3 and 14.5% in the elderly group, respectively.  The mean understanding in group A was therefore higher than that in group B in both age ranges.  The association between understanding and age within groups indicated that with increasing age, understanding was lower in both groups (group A, p=0.001; group B, p<0.001).  There was no difference in the level of understanding between the young and middle-aged in group A, but the difference in group B was greater than 20%.
Conclusion: By comparing two package inserts of products in a similar pharmacological category using our LCS method, it suggested that font size and layout influenced consumers’ understanding of package inserts.  It might be able to evaluate the difference in the understanding of the package insert by using our LCS method.

Y-graft replacement was successfully performed in a patient aged 93 years with ruptured infrarenal abdominal aortic aneurysm. The patient was in shock on arrival and underwent an emergency operation with the administration of cathecholamines. The ruptured infrarenal abdominal aortic aneurysm with a large hematoma, which was located in the area of the left common iliac artery, was 10cm in the maximum diameter. The bilateral common iliac arteries were strongly calcified and occluded. The distal end of the graft was anastomosed to the external iliac artery. The patient's postoperative course was uneventful.

Introduction: The link between the hydration state and the functional effects of formulations and natural systems is been demonstrated by several studies. Measurement of skin hydration has been used to assess barrier function integrity in vivo and stratum corneum (SC), hydration may increase after the topical application of natural or formulate systems. Thermal muds have great hydration properties thanking at its high water contain due to presence of clays minerals1). Our work was focused on the evaluation of skin’s hydration potentialities of Japanese Biofango®. Objectives: Mudtherapy increase the hydration state of skin and modify its selective permeability favouring the permeation of therapeutic substances product by maturation process. Our goal was the development of a tensiometric model for assessment and optimisation of Japanese Biofango mudtherapy protocol by the evaluation of skin hydration measuring water contact angles on skin surface2). Our work was performed at Sanraku-en spas centre (Tonami-Japan). Materials and Methods: Biofango was constituted by Kunigel, Kaolinite, and WakuraDiatomite contains montmorillonite. BFM mixture was prepared and collected from Sanraku-en maturation plant. Samples were stored at -25°C. Skin’s hydration state analysis were performed before and after treatment by contact angle method (CA) using DSA 2-Kruss Dynamic Tenskinmeter3) water as liquid test and accordingly to traditional Sanraku-en/Biofango protocol. Four subjects with differents age, sex and weights (KS, YS, MO, and KM) were considered as test. Sanraku-en mudtherapy protocol’s steps were (a) first blood pressure measurement, (b) water’s CA measurements on left and right arm before treatment, (c) thermal bath (8’), (d) water’s CA measurements, (e) BFM mudtherapy (20’), (f) water’s CA measurements on polish skin, (g) shower (3’), (h) water’s CA measurements, and (i) final blood pressure measurement. Results: CA of water on subject KS skin showed elevated levels before (CAt0>89.5 deg) and after (CAtf>89.5 deg) treatment. YS subject showed increases of skin hydration after treatment (CAt0>89.5 deg, CAtf=40.27 deg), MO showed more increase of skin hydration than YS (CAt0>89.5 deg, CAtf=20.12 deg), and KM (CAt0>89.5 deg, CAtf=41.30 deg) showed an hydration state similar to YS. Regarding YS subject, we optimized its mudtherapy by the inversion of bath (CAt0>89.5 deg, CAtf>89.5 deg) with mudtherapy phases. As results a major increase of hydration state respect normal protocol (CAt0>89.5 deg, CAtf =30.4 deg) reflecting on skin moisturize after bath phase also (CAt0>89.5 deg, CAtf=87.43 deg). Conclusions: Analyses of hydration state of skin by measurement of water’s contact angles consented to evaluate the capability of Biofango BFM to modify the selective permeability of stratum corneum. Thanking to the method developed was possible to optimise and personalize Sanraku-en protocol.