In order to determine the pharmacological effects of Crocus (traditionally classified as an herb helpful in eliminating Blood Stagnation), the 11-dehydro TXB₂, platelet aggregation, blood viscosity and laboratory data of 12 healthy sexually mature females were examined during the menstrual, follicle and corpus luteum phases before the test substance was administered. Compared with the follicle or corpus luteum phases, higher levels of 11-dehydro TXB₂ and increased mean cell volume (MCV) were found during the menstrual phases. This suggested that the increase in blood viscosity may be due to a lowering of erythrocyte deformation resulting from increased mean cell volume. From the fact that the highest endometrial PGE₂ value was exhibited during the menstrual Phase, PGE₂ was thought to be involved in the MCV increase. Next, plain hot water was administered to the six cases in the control group (for four weeks), and Crocus infusion administered to the other six cases (for four weeks), after which a comparative study was made of their indicators. The significant lowering of the MCV and blood viscosity during the menstrual phase upon Crocus administration suggested that an improvement in erythrocyte deformation brought about by decreased MCV played a role in the reduction of blood viscosity. Moreover, a decrease in 11-dehydro TXB₂ was observed during the low blood estrogen follicle phase. It has been reported that there is an overall increase in blood viscosity and acceleration of platelet and thrombin synthesis associated with the disease state known as “Blood Stagnation”. From the clear effects of Crocus upon these indicators, its effectiveness as an herb useful in eliminating Blood Stagnation in healthy sexually mature females was indicated.

In this study, the difference between the effects of “power-up type” and “bulk-up type” strength training exercise was investigated by analyzing parameters such as structural and functional adaptations in the neuromuscular system. Eleven subjects were divided into power-up and bulk-up groups. The power-up group comprised five male subjects who performed 5 sets at 90% of one repetition maximum (1 RM) with a 3-min rest between sets (repetition method) . The bulk-up group comprised six male subjects who performed 9sets at 80-60-50%, 70-50-40%, and 60-50-40% of 1 RM with rest intervals between sets of either 30 s or 3 min (interval method) . Both groups performed isotonic knee extension exercise twice a week for 8 weeks. The power-up group showed a lower rate of improvement than the bulk-up group in terms of cross-sectional area (CSA) of the quadriceps femoris at levels 30%, 50% and 70% from the top of the femur, and also in average isokinetic strength (Isok. ave. ; 180 deg/s, 50 consecutive repetitions) . However, the power-up group showed a greater rate of improvement in 1 RM, maximal isometric strength (Isom. max), and maximal isokinetic strength (Isok. max ; 60, 180, 300 deg/s) . Furthermore, the rate of reduction in strength over 50 consecutive isokinetic repetitions decreased in the bulk-up group. On the other hand, the power-up group showed no significant changes in the above throughout the entire training program. These results indicate that the characteristics of the two types of training exercise are as follows : (1) power-up exercise is effective mainly for improving muscular strength and anaerobic power, and (2) bulk-up exercise is effective mainly for improving hypertrophy and anaerobic endurance. These findings support the idea that “power-up type” and “bulk-up type” strength training exercises should be applied appropriately according to the training aim.

The purpose of the present study was to determine the change in total excess volume of CO₂output (CO₂excess) due to bicarbonate buffering of lactic acid produced during exercise and change in swimming performance following resistance training for 8 weeks in competitive swimmers. Ten healthy university competitive swimmers were assigned to either a resistance training and swimming training group (COMBINE: N=5) or a swimming training only group (SWIM: N=5) . Muscle mass was measured using magnetic resonance imaging (MRI) . CO₂excess and blood lactate concentration were measured during incremental exercise on a cycle ergometer and swimming performance was measured during competition. COMBINE showed a significantly higher percentage change in muscle mass (11.1±4.5%) than SWIM (3.5±2.5%) . The percentage change in CO₂excess, CO₂excess per body weight (CO₂excess/BW) and CO₂excess/BW per blood lactate accumulation (CO₂excess/BW/ΔLa) during exercise was significantly higher in COMBINE (107.3±60.1, 102.6±56.8, 59.1±37.7%, respectively) than in SWIM (42.5±10.0, 42.9±10.4, 13.4±22.4%, respectively) . The percentage change in swimming performance was significantly higher in COMBINE (2.2±1.8%) than in SWIM (-2.0±3.6%) . A negative correlation between percentage change of muscle mass and percentage change of CO₂excess/BW/ ΔLa (SWIM: r=-0.993, P<0.01, COMBINE: r=-0.744, P>0.05) was found. It was suggested that combined swim and resistance training resulted in greater increases in the bicarbonate buffering system (CO₂excess/BW/ΔLa) . However, increases in muscle mass may have subsequently caused a relative decrease in the contribution of the bicarbonate buffering system.

A 74-year-old woman presented to our hospital with complaints of dysphagia. On examination, we diagnosed extensive thoracic aortic aneurysm and esophageal compression due to a descending thoracic aortic aneurysm. We planned a two-stage approach for repairing the extensive thoracic aortic aneurysm ; the first stage involving the repair of the ascending and arch segments, and the second stage involving the repair of the descending aorta. In the first stage, we performed the Bentall procedure and total arch replacement with a long elephant trunk. Following this, her dysphagia resolved, although the size of the descending aortic aneurysm was the same as that before the procedure (49 mm in diameter). We decided to treat her conservatively in the outpatient clinic without the second stage, because the descending aorta was asymptomatic and not sufficiently large. One year later, she presented with a sudden recurrence of dysphagia and swelling of buttocks. She was diagnosed with an expansion of the descending aortic aneurysm (62 mm in diameter) and a hematoma in the gluteal muscle due to aneurysm-induced disseminated intravascular coagulation (DIC). After emergency admission, she underwent a successful thoracic endovascular aortic repair and was discharged following a smooth recovery from dysphagia and aneurysm-induced DIC. We report this case along with a review of the literature.

An 81-year-old patient, who had a postinfarction left ventricular aneurysm with thrombus underwent left ventricular aneurysmectomy with right coronary artery bypass grafting (CABG). Preoperative examination showed 99% stenosis of the left coronary artery (#7) and 90% stenosis of the right coronary artery (#3). The operation was performed because angina was not improved and formation of thrombus was suspected on the wall of the aneurysm. The operation was performed under cardiopulmonary bypass and by antegrade and continuous retrograde cardioplegia. The aneurysm was resected and a relatively fresh thrombus which was detected on the endocardium of the aneurysm was extracted. The left ventricle was closed by direct linear suture with felt reinforcement. Because the area of resection included part of the left anterior descending artery, only right CABG (#3) with a saphenous vein was done. Weaning from bypass was very easy and the postoperative course was uneventful.

Objectives: We developed versions 2 and 3 of the Biological Prognostic Score (BPS) for advanced cancer patients and confirmed the prediction accuracy. Methods: We conducted a parametric survival analysis using blood test data, performance status (PS), clinical symptoms, age, sex, and cancer type as variables for advanced cancer patients who completed or suspended cancer treatment, in the development of BPS2 and BPS3. We then prospectively compared the accuracy between BPS2/BPS3 and the Palliative Prognostic Index (PPI). Results: We developed the BPS2 and BPS3 based on the data from 589 patients in a development cohort. While the former version was calculated based on the cholinesterase, blood urea nitrogen, and white blood cell counts, the latter was calculated based on the BPS2, ECOG PS and edema. For 206 patients in a validation cohort, the overall accuracy in prediction of survival for 3 and 6 weeks using the BPS2 and BPS3 were significantly higher than those for the PPI. Conclusion: The usefulness of BPS2 and BPS3 was suggested.

Coronary artery bypass surgery and abdominal aortic aneurysm repair were performed simultaneously during cardiopulmonary bypass in two patients with severe left ventricular dysfunction. Both patients underwent coronary artery bypass surgery first, followed by abdominal aortic aneurysm repair during cardiopulmonary bypass. Combined surgery is reasonable for patients with combined coronary artery disease and abdominal aortic aneurysm. Aortic aneurysm repair during cardiopulmonary bypass for patients with severe left ventricular dysfunction also appears safe and effective.

Acute encephalopathy is classified into multiple syndromes, such as acute encephalopathy with biphasic seizures and late reduced diffusion (AESD), clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) and acute necrotizing encephalopathy (ANE), characterized radiologically by lesions in the cerebral subcortical white matter, splenium of the corpus callosum and bilateral thalami, respectively. We described a previously healthy 8-year-old boy who had febrile and biphasic seizures, and encephalopathy. MRI showed abnormal signal intensity in the corpus callosum on day 2 and cerebral subcortical white matter and bilateral thalamic lesions on day 8. This is the first case of acute encephalopathy in which callosal, subcortical and thalamic lesions co-existed. The clinical course of this case was typical for AESD, atypical for MERS, and different from that of ANE.
Brain Diseases