An 87-year-old man who had a history of aortic valve replacement (Carbomedics n 23) due to severe aortic valve regurgitation 3 years previously was admitted to our hospital suffering from syncope. The ascending aorta was 40mm in diameter at the time. At the time of admission, the patient's ECG showed elevation of the ST segments in leads V₁-V₃ and depression in leads V₅, V₆, II, III and _aV_F. Emergency coronary angiography performed for suspected acute myocardial infarction showed a type A acute aortic dissection extending to the ostium of the left coronary artery. However, because of his age and stable condition without cardiac tamponade, we treated this patient with conservative therapy including antihypertensive medication. He experienced no major complication and was discharged 31 days after admission. It is concluded that the occurrence of acute aortic dissection after aortic valve replacement is not common, but for a patient with a dilated aortic root at the time of aortic valve replacement, strict postoperative care is necessary. An operation is the first choice of treatment for acute type A aortic dissection, but in this case the patient's overall condition had to be considered.

A 72-year-old woman was admitted to our hospital because of a mass in the right ventricle. She has a history of renal cell carcinoma of the left kidney, which was completely removed by nephrectomy in 1996. Echocardiography, CT and MRI showed a large tumor in the right ventricle without any inferior vena cava involvement. A biopsy performed on that tumor confirmed that the tumor was a metastasic tumor in the right ventricle from the renal cell carcinoma. The tumor grew quickly, and almost completely obstructed the right ventricular outflow tract. On February 24, 2004; an operation was performed to remove the tumor, which protruded from the ventricular septum and occupied the right ventricular cavity from the attachment of the tricuspid valve to the right ventricular outflow tract close to the pulmonary valve. A transannular patch was placed in order to dilate the right ventricular outflow tract. Histopathology diagnosed that the tumor was a metastasis from the renal cell carcinoma. The postoperative course was uneventful. Interleukin-2 was administered postoperatively. Echocardiography performed eight months after the surgery showed that although the tumor in the right ventricle had grown, it had not produced stenosis of the right ventricular outflow tract. The patient died as a result of the recurrent tumor blocking the right ventricular outflow tract 11.5 months after the surgery.

A 60-year-old woman was admitted because of dyspnea and a cough. Computed tomography and transthoracic echocardiography showed a tumor in the left atrium. However, transesophageal echocardiography alone could show the tumor and its extension in the interior wall of the left atrium. Peripheral blood chemistry showed a high CA125 level. The first operation was carried out in order to perform a complete resection of the tumor which was 3.5×4.0×2.0cm, but the interior wall of the left atrium seemed normal. The CA125 level returned to within a normal range 80 days after the first operation. Histopathology showed the tumor had myxomatous changes and ring structure formations, but malignancy was also suspected. Transthoracic echocardiography performed 14 months after the first surgery showed a recurrence of the tumor, and subsequent transesophageal echocardiography showed the tumor and its invasion in the interior wall of the left atrium. A second operation was performed to resect the tumor, which had invaded a part of the left atrial interior wall. The histopathology showed the tumor was myxoid but had mitoses and foci of necroses. This tumor was consistent with a myxosarcoma. The patient died as a result of a recurrent tumor blocking the left atrium 20 months after the first surgery.

Malignant disease in the mediastinum often involves cardiac structures such as the cardiac chamber and great vessels, and causes circulatory impairments that limit therapeutic options and longevity. In the present study, we evaluated curative or palliative surgical management for 6 cases of such malignancy in the mediastinum with circulatory impairment who were operated on between January 2001 and February 2004 (4 men and 2 women aged 17 to 72 years). Procedures included tumor resection with cardiopulmonary bypass (CPB) for mitral strangulation due to left atrial myxosarcoma; pericardiectomy without CPB for constrictive pericarditis due to invasive thymoma; radical nephrectomy for renal cell carcinoma with right atrial tumor thrombus using CPB; two pericardial fenestrations with or without partial tumor resection for cardiac tamponade due to pericarditis carcinomatosis caused by malignant lymphoma or lung cancer; and right ventricular metastatic lesion resection with outflow tract reconstruction for the recurrence of renal cell carcinoma using CPB. The follow-up ranged from 4 days to 30 months. Procedure-related death occurred in the patient with invasive thymoma due to heart failure on postoperative day 4. Five operative survivors had improved quality of life and received other therapeutic options. Although the patient with malignant lymphoma died of sepsis during chemotherapy at three weeks, the remaining 4 patients were discharged from the hospital postoperatively but 3 died during follow-up due to the progression of malignant disease. The cause of death were local recurrence at 20 months after operation in the patient with myxosarcoma, liver metastasis at 13 months in the renal cell carcinoma patient, and carcinomatous cachexia at 8 months in the patient with metastatic lung cancer. The patient with recurrence of renal cell carcinoma is doing well without any symptoms of tumor progression at 30 months after metastatic lesion rsection. Despite poor prognosis of the patients of mediastinal malignancy, surgical management for circulatory impairments can be indicated with acceptable risk to lengthen survival and improve the quality of life.

The effects of psychosocial education on undergraduate medical students were evaluated in an open trial. Undergraduate medical students were exposed to psychosomatic medicine and, in particular, holistic medicine as part of their undergraduate medical education. Almost all students (94.9%) reported addressing “extramedical” clinical problems with a holistic approach (n=98). Psychological, social, and economic problems were mentioned in 64.3%, 50.0%, and 5.1% of reports, respectively. Problems in relationships between members of the medical staff and patients were included in 37.8% of reports. Self-evaluation with the Egogram Check Lists by students who had undergone clinical practice revealed scores of “Critical Parent, ” “Nurturing Parent, ” “Adult, ” “Free Child, ” and “Adapted Child” of 2.59 1.57, 4.59±1.89, 4.79±1.54, 4.85±1.64, and 4.65±1.64, respectively (n=82). “Adult” scores were higher after clinical practice than before (n = 32, p<0.02, Student's paired t-test). Clinical practice seemed to help students mature and become better able to cope with problems objectively. Education in psychosomatic medicine is an important component of undergraduate medical education.

Cystic adventitial disease of the popliteal artery is a rare cause of lower extremity occlusive disease. We report 2 cases of this disease. Two male patients aged 27 and 59 year old complaining of intermittent claudication visited our vascular service. Angiography showed a smooth sharp defect of the popliteal artery. Postcontrast computed tomography (CT) scanning and magnetic resonance image (MRI) showed a cystic lesion around the popliteal artery. One patient underwent resection of the cyst, which in the other patient endscopic surgery was performed with the aid of intravascular ultrasonograpy and intravascular endscope. Fifty three cases of this disease have been reported in Japan so far. These patients included 45 men and 8 women with a mean age of 47.7, ranging from 19 to 76 years old. Chief complaints were commonly intermittent claudication and sensory disturbance. In all cases, angiography revealed a smooth sharp defect. Recently 3D-CT scan, ultrasonography and magnetic resonance angiography (MRA) also are accurate for cystic lesions around the popliteal artery and these new technologies easily distinguish such cases from arteriosclerosis obliterans, Buerger disease and popliteal entrapment syndrome. Treatment consist resection of the cyst, in 27 cases reconstruction of the popliteal artery using a saphenous vein graft or artificial graft in 19 cases, percutaneus aspiration under the guide of CT and endscopy in 2 cases and 1 with spontaneous resolution, was seen in 1 case. In conclusion, we encountered 2 cases of cystic adventitial disease of the popliteal artery. 3D-CT scan, ultrasonography and MRA were useful for preoperative diagnosis and evaluation of postoperative condition.

Objectives: The present study was examined the effects of dietary supplement containing Kurozu concentrate on Blood Pressure, QOL and Traditional Chinese Medicine (TCM) Constitution. Methods: Forty subjects with slightly high blood pressure were assigned randomly to 2 groups (active group and placebo group). Kurozu-containing foods or the placebo was administered to the subjects daily for 12 weeks. At week 0, 6 and 12, blood samples were collected, physical measurements were taken, and the quality of life (SF-36v2) and TCM constitution were examined. Results: Significant differences on blood pressure and TCM constitution between the groups were observed at week 12. The change of QOL between the groups was observed significantly at week 6. Conclusion: These findings suggest that foods containing Kurozu have hypotensive action and improve effects on constitutional problems. In addition, it was confirmed that foods containing Kurozu are safe to ingest.

　　Serious aggravation of de novo hepatitis B caused by revitalization of the hepatitis B virus in HBs antigen negative, HBs antibody or HBc antibody positive patients has recently been reported. The incidence of de novo hepatitis B infection which occurs in patients undergoing immunosuppression or chemotherapy develops at times into a medical lawsuit. To cope with the situation, the Ministry of Health, Labour and Welfare (MHLW) issued the guideline for the management of hepatitis B infective occurring in patients treated with immunosuppressive therapy or chemotherapy (the revised edition). In our institution, the Chemotherapy Committee discussed our measures against de novo hepatitis B, and determined to carry out the in-hospital examination of the HBc antibody to provide reliable safe and speed medicine.　　During the investigation period, HBc antibody was examined for confirmation of anamnesis of Hepatitis B in patients receiving chemotherapy, immunosuppressive medicine, examination of infectious disease before blood transfusion and examination of viral hepatitis. In our institution, the number of cases which are adapted for the MHLW guideline (the revised edition) was 15 of 218 examples, and as a result HBs antigen negative, HBs antibody or HBc antibody positive patients, who could not be found in the routine screening for HB infection turned out to be not a few.　　Since it was expected that the number of patients undergoing immunosuppression and chemotherapy would continue to increase in the future, the necessity for observance of guideline was suggested to provide relief, safety in medical treatment.