This paper reports on a case in which a heavily-calcified so-called “porcelain aorta” (including the ductus arteriosus) was observed, together with a patent ductus arteriosus and aortic stenosis associated with a bicuspid aortic valve. A 76-year-old man had been referred to our hospital on a diagnosis of aortic stenosis. Since angiography revealed slight contrast in an area on the right side of the heart, echocardiography was performed and revealed patent ductus arteriosus. Severe circumferential calcification of the ascending aorta and aortic arch was observed on CT scans. Almost no calcification was observed in other areas. Aortic valve replacement and closure of the ductus arteriosus (transpulmonary approach) were performed by means of a balloon to temporarily occlude the aorta, as surgical clamping was impossible due to calcification. Hypothermic systemic perfusion and antegrade selective cerebral perfusion were used. The postoperative progress of the patient was good. Bicuspid aortic valve and patent ductus arteriosus are highly likely to be present in combination in cases of congenital cardiac anomaly, and it is therefore necessary to be particularly attentive when diagnosing such cases. It was considered that our patient, an adult suffering patent ductus arteriosus, was a rare case in which the calcified ductus arteriosus was observed and the calcification had spread to the ascending aorta.

We report a rare case of primary cardiac lymphoma in the right atrium. An 85-year-old woman with severe heart failure was referred to our hospital. The echocardiography revealed a huge tumor occupying the right atrial cavity. We conducted an emergency operation to resect the tumor. However, as the tumor strongly adhered to the wall of the right atrium and tricuspid valve, we performed partial resection of the tumor to improve hemodynamics. The pathological examination of the tumor was consistent with malignant lymphoma of B-cell origin. Although the postoperative chemotherapy was effective to reduce a volume of the tumor, the patient died because of the adverse reaction to medication.

We performed endovascular stent-graft placement on 39 patients with abdominal aortic aneurysms between 1996 and March 2002-a period of approximately 5 years (first half: until the end of June 1998, second half: July 1998 onward). Three patients in the first half of the period and 8 patients in the second half were 80 years or older. Two cases of mycotic aneurysm were observed. During the second half, we encountered high-risk cases in which the patients had complications such as coronary artery disease (5 patients), COPD (1 patient) and thoracic aortic aneurysm (4 patients). Although we had to switch to surgery in 3 patients during the first half of the period, we successfully placed stent-grafts in the other 36 cases (92%). Endoleaks were observed in 6 patients, and dissection of the iliac artery was observed in 5 patients (stents had been placed in all patients). In 50% of all cases in the first half of the period and 89% of all cases in the second half, stent-graft placement was successful and no endoleak was observed. During the follow-up period, 3 cases required additional treatment, and another 4 cases required surgery. Four patients died in hospital during the first half of the period, and 3 patients died during the following 3 years. The 3-year survival rate was 82%. It was considered that stent-graft placement for abdominal aortic aneurysms is particularly effective for high-risk patients, and that the results of this type of therapy will improve in the future.

We studied 73 patients, 70 years of age or older, who underwent aortic valve replacement for aortic stenosis between October, 1990 and October, 2004. There were 31 men and 42 women with a mean age of 75.7±3.6 years. Mechanical valves were implanted in 37 patients, and bioprostheses in 36 patients. Operative mortality was 1 of 73 (1.4%) and the New York Heart Association functional class improved to class I or class II in all of the hospital survivors. Follow-up (100%) extended from 0.3 to 11.6 years (mean 3.7 years). There were 16 late deaths (5.9% per patient-year), including valve-related deaths in 6 patients. The overall survival rates at 5 and 10 years was 74.2% and 44.3%, respectively. The freedom from valve-related events at 5 and 10 years was 78.8% and 78.8%, respectively. The 10-year survival rates and freedom from valve-related events were not different between the patients with mechanical valves and those with bioprostheses. The size of the implanted valve did not influence the late survival or freedom from valve-related events. The outcome after aortic valve replacement in the elderly (70 years and older) was excellent with low operative mortality, and acceptable late mortality and morbidity. Thus, aortic valve replacement for elderly patients should have the same indications as for younger patients. Bioprostheses showed good long-term results with no structural valve deterioration, thromboembolism, or bleeding events. Mechanical valves, which required the maintenance of an anticoagulant therapy, were also useful with acceptable late morbidity. The long-term results with small valves (≤19mm) were comparable to the results with large valves (>19mm) in the elderly. Thus, the use of these small valves in this particular age group seems to be acceptable.

Dizziness and vertigo are frequent complaints in the clinic, but standardized treatments have not yet been established. Here we report three cases of dizziness and vertigo successfully treated with takushato. Case 1 involved a 38-year-old woman who experienced dizziness, which had made her feel as if she was sea sick for 2 years, and which was worsening. After taking takushato for a month, her dizziness improved.Because she complained of an abnormal pharyngeal sensation, her prescription was changed to hangekobokuto in combination with takushato, and her dizziness almost disappeared 2 months after her first visit. Case 2 involved a 61-year-old woman who had had dizziness and vertigo for 4 months. Although no abnormality was observed on MRI, she developed labile vertigo a few days later. After taking takushato for a month, she felt no dizziness or vertigo at all. Case 3 involved a 67-year-old woman in whom labile vertigo had developed even while supine for 2 months, and although receiving medication for a diagnosis of benign paroxysmal positional vertigo, did not improve. Triple dose takushato was remarkably effective, and improved her otological findings. Takushato is one hopeful option for the medical treatment of refractory dizziness and vertigo.

We have limited evidence as to the clinical indications for Kampo medicines, especially as they relate to gastrointestinal function. Thus, we investigated the efficacy of the Kampo medicine hangekobokuto (HKT) on patients with functional dyspepsia (FD), with special reference to its clinical indications for gastrointestinal function, including gastric emptying and bowel gas volume.Gastric emptying rate (GER) in FD patients was significantly facilitated by HKT. HKT also improved the gastrointestinal symptoms of the patients. Among these, patients who had inchuusharen, or a symptom of globus sensation, and a representative indication for HKT, showed significant improvement of both their GER and gastrointestinal symptoms compared with patients who did not have inchuusharen. As for bowel gas, the bowel gas volume calculated from a plain abdominal radiogram (gas volume score, GVS) in FD patients decreased significantly, after administration of HKT. Patients who had fukuman, or a feeling that one's stomach is full or bloated, and another representative indication for HKT, showed significant decrease of their GVS to normal levels, compared with patients who did not present with fukuman.These results suggest that the presence of clinical indications, such as inchuusharen or fukuman, are strongly related to HKT efficacy in patients with FD, and that these are useful, scientifically validated markers for the efficient use of HKT.
Clinical ; Final diagnosis (discharge) ; Gases ; seconds ; Volume

Introduction: We perform our trials in Tsurumi ward, Yokohama city aiming at reducing the number of “cancer refugees” to zero. State: There are many patients who receive cancer therapy outside their hometown. Once their treatment is finished due to progressive disease or deteriorating condition, they are told to leave the hospital and to get palliative care in their district. And they become so-called “cancer refugees”. The beds of palliative care units are limited so the ability to accept patients in case of emergencies is poor. In Tsurumi ward, here are a lot of home care clinics providing palliative care but the place patients want to be or receive palliative care when their condition deteriorates isn't fixed. We organized the “Tsurumi Homecare Network” as the core of medical cooperation, and have worked on improving palliative care and increasing patients who die at home. Specifically, our hospital has played a central role as a special place for palliative care, we send out our original questionnaire to home care clinics to find out how they perform palliative care and introduce patients to the appropriate clinic. Patients who are in need of hospitalization are assured acceptance. On the other hand, we propose the cancer treatment hospitals to follow their patients together with us from their early stage of cancer treatment. Problem: To maintain a good relationship for regional palliative care, improving the management for outpatients, strict and timely backup system, advanced quality of homecare-supporting staff for palliative care and cooperation between home care clinic doctors are necessary.

For many years, the pathophysiology of idiopathic intracranial hypertension (IIH) was interpreted as “secondary intracranial hypertension,” and IIH was considered to be caused by brain edema due to obstructive sleep apnea. Another theory proposed cerebrospinal fluid (CSF) absorption impairment due to excessive medication with vitamin A derivatives. Other reports pointed out the importance of obesity, which may cause an impairment of intracranial venous drainage due to elevated right atrial pressure. Patients with medically refractory IIH have traditionally undergone a CSF diversion. Venous outlet impairment on IIH has recently been reported as a causative or contributory cause, and thus focused venoplasty of the stenotic sinus with a stent has emerged as a new treatment strategy. We report the cases of two patients who presented with headache and papilledema with IIH. They successfully underwent stent placement at the stenosis of the transverse sinus and experienced complete resolution of symptoms.
Absorption ; Atrial Pressure ; Brain Edema ; Cerebrospinal Fluid ; Constriction, Pathologic* ; Drainage ; Headache ; Humans ; Obesity ; Papilledema ; Pseudotumor Cerebri* ; Sleep Apnea, Obstructive ; Stents* ; Vitamin A

This study describes the successful use of modified dorsolumbar epidural anesthesia with a fixed volume of anesthetic in a bovine referral center. Among the 130 Holstein cattle scheduled for flank surgery, 90 cattle received a mixed anesthetic consisting of 1 ml of xylazine hydrochloride and 3 ml of lidocaine hydrochloride by modified dorsolumbar epidural anesthesia. Eighteen cattle with dehydration and/or lameness received a mixed anesthetic containing 0.5 ml of xylazine and 3 ml of lidocaine. Infiltration anesthesia was performed in 22 cattle whose epidural space could not be reached in order to perform the flank surgery. The surgeries began about 12 min after the administration of the anesthetic and lasted for about 36 min. The modified method using a fixed volume of anesthetic was successfully introduced and effectively used in a bovine referral center. This modified method will allow veterinarians to save time and effort, thus lowering the cost of each surgery.
Anesthesia, Epidural/methods/*veterinary ; Anesthetics, Local/*administration & dosage ; Animals ; Cattle/*surgery ; Epidural Space ; Female ; Lidocaine/*administration & dosage ; Lumbar Vertebrae ; Xylazine/*administration & dosage

The importance of off the job training in surgical education are widely recognized. The Japanese Board of Cardiovascular Surgery has required a board candidate to do at least 30 hours of off the job training from 2017. U-40 Basic Lecture Course are held annually for young cardiovascular surgeon to learn about basic surgical skills. U-40 Advanced Lecture Course was started to provide opportunity to have more advanced hands-on lecture for young cardiovascular surgeon. However, after the COVID-19 pandemic, the opportunity to hold hands-on seminars are highly limited. In such circumstances, we held a hybrid hands-on seminar. We report details about the hybrid hands-on seminar.