Objective/Design: The purpose of this study was to confirm the effect of herbal tea therapy on Ménière’s disease. We studied 15 patients with Ménière’s disease who came to the International University of Health and Welfare MITA hospital between 2007 and 2008.
Methods: According to criteria of the Japan Society for Equilibrium Research, all patients were diagnosed as having Ménière’s disease and underwent otoneurologic examination, audiometric measurements, questionnaires of functional level and tinnitus every month. Moreover, we instructed these patients to keep a record of the number of times vertigo was experienced. After 6 months of general treatment, we treated patients with herbal tea for one year. This herbal tea was effective as a diuretic, in promoting antivertigo, and relaxing. We compared results before and after herbal tea therapy.
Result: Herbal tea therapy was effective in about 10 patients, but 5 patients relapsed. However, symptom of the relapsed patients improved after using less medicine, although the quantity of medication was less than before starting the herbal tea therapy. Herbal tea therapy improved their Ménière’s symptoms, especially vertigo after 6 months from starting herbal tea therapy.
Conclusion: Our study provides evidence that herbal tea therapy is useful for preventing worsening of Ménière’s disease.

The purpose of this study was to estimate the postoperative growth of untreated segments of the dissected aorta with non-thrombotic communicating false lumen, and also to evaluate the clinical outcome in relation to the aortic enlargement after surgery. Nineteen patients who underwent surgical treatment of aortic dissection were studied with enhanced CT scans and angiograms during the postoperative follow-up period. In Stanford type A patients, mean aortic dilatation rate calculated at the segment showing maximal dilatation was 5.1mm/year during 13-82 months (average, 41 months) after surgery, as a sequela of enlargement of the false lumen. Differences in the aortic dilatation rates between the different segments of the aorta were observed and these were per annum 4.8mm in the ascending aorta, 5.4mm in the transverse aortic arch, 4.3mm in the proximal descending aorta, 2.7mm in the distal descending aorta and 2.4mm in the abdominal aorta. In all patients, major communications were detected at the perianastomotic sites on angiography. In Stanford type B patients, false lumens with small communications were observed to show gradual thrombotic occlusion, but no significant aortic dilatation was detected during the follow-up period (13-70 months, average: 44 months), except three cases of sudden death who had major communications. Nine late events related to dissection, consisting of 4 sudden deaths suspected to be due to aortic rupture, 2 intestinal necroses and 3 cerebral infarctions, occured in 6 patients (32%), among which three patients had undergone arterial fenestration, one of whom had double barrel anastomosis. In the remaining two, major leakages were recognized at distal aortic anastomotic sites on postoperative angiography. The results of this study, we stress the importance of periodic check-ups using enhanced CT scan and if necessary, angiography after surgery of the patients having communicating false lumen. Early detection of progressive aneurysm formation and timely surgical reintervention can yield a good prognosis.

Older adults tend to lose the opportunities and abilities to pursue hobbies and perform various activities. Club activities provided in the community for old people seem to be beneficial in that the activities prevent them from becoming housebound, and improve overall QOL. In the present study, we conducted a survey by sending out self-answered questionnaire to 424 elder residents in rural areas. We collected information about their life circumstances, the presence or absence of physical pain, activities of Daily Living (ADLs), the degree of enjoyment from activities on the list, the frequency of going out, PGC morale scale and so on. The activities enjoyed frequently by the elderly were bathing, eating and watching TV. The degrees of enjoying eating and bathing showed positive correlations with the PGC morale scale, but the degree of enjoying gambling correlated negatively with the scale. A regression analysis was performed with the PGC morale scale as dependent variables. As a result, a significant model was structured to predict the life sati of the aged by making interpersonal distress, enjoyment derived from gambling, basic ADLs, physical pain and dwelling alone as indepeudent variables. These results will assist us in providing adequate health care to pelple of advanced age.
Morale ; pleasurable emotion ; Academic degree ; Bathing self care ; Activities

Intracardiac repair for cardiac anomalies associated with a transposed aorta from the right ventricle is a technically demanding operation. We present two cases of left ventricular outflow tract (LVOT) obstruction after the use of an ePTFE flat patch to reconstruct the LVOT. Case 1 : A 10-year-old boy had undergone the Rastelli operation, VSD enlargement, and intraventricular re-routing using an ePTFE flat patch for repair of the DORV with noncommitted VSD and pulmonary stenosis at the age of 5. Five years later, catheter examination revealed severe LVOT obstruction. Intraventricular re-routing using a part of the ePTFE graft concomitant with re-replacement of an extracardiac conduit was successfully performed. Case 2 : A 13-year-old girl had undergone a double-switch operation (Senning operation, the Rastelli operation, and intraventricular re-routing by the use of an ePTFE flat patch) for the repair of corrected TGA, PA and VSD at the age of 7. Six years later, catheter examination revealed severe LVOT obstruction. Intraventricular re-routing using part of the ePTFE graft concomitant with re-replacement of an extracardiac conduit was successfully performed. We consider that the use of a flat patch for reconstruction of a left ventricular out flow tract in cases with transposition of the aorta from the right ventricle involves a risk of future development of LVOT obstruction.

[Objective]Mie University Hospital Department of Anesthesiology established an integrated acupuncture care clinic in April 2010. A total of 8 incidents and accidents occurred during a period of eight months from commencement in April through November of 2010.
Re-examination of the issues from the incident and accident reports, led to the creation of a clinical manual for the acupuncture clinic as a means to improve the safety of the acupuncture clinic.
[Methods]Based on the contents of the reported incidents, which were collected from electronic medical records up to November 1st 2010, a safety manual was created for the prevention of recurring incidents and accidents. Following a request for approval to the Safety Division of Mie University Hospital, the safety manual underwent screening and inspection and was eventually approved.
After the introduction of the manual, the occurrence of incidents and accidents, was tracked using electronic medical records for a period of four months from December 2010 to March 2011.
[Results]The incidents and accidents that occurred before the creation of the manual were all related to acupuncture (dropped acupuncture needles: 5, needles taken home: 1, and leaving needles inserted: 2). Incidents and accidents have not been reported since the introduction of the manual, that is, for a period of four months from December 2010 to March 2011.
[Conclusion]Clinical practice based on the manual suggests the possibility of preventing incidents and accidents, as none have been reported since the introduction of the manual. The safety manual is still incomplete, as it emphasizes mainly the management of acupuncture and not its entire context. If any further negative incidents or accidents occur, a review and improvement of the present manual will be required. In order to deal with any new negative incidents or accidents, organizing a team will be indispensable.
Since Mie University Hospital has an established Safety Division, soliciting the cooperation of the infectious disease control and medical safety experts to ensure safe clinical practices in the acupuncture core clinic should also be arranged.
The results suggest that the creation of a safety manual can be a means of preventing the occurrence of incidents and accidents.

　　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.

Water Jet flow was projected at normal human aortic walls and human chronic obstructive iliac arteries in the air or in the ordinary saline solution. Ordinary saline solution was used for the jet, which was projected at a pressure of 10kg·f/cm² through a nozzle 0.10mm in diameter. When the Water Jet was projected at the normal aortic intima, damage to the wall was more severe with duration of fluid projection, and projection for ten sec ruprured the elastic fiber of the media. But when the fluid jet projected ordinary saline, damage to the aortic wall was slight and projection for 30sec only dissected the surface of the intima. Water Jet projection in air showed slight effect on thrombi of the chronic obstructive iliac arteries, and projection for 60sec only made small irregular holes in the thrombi. When the Water Jet was projected in ordinary saline solution, however, destructive effects on thrombi were stronger and the projection for 40sec could remove almost all the thrombi for a distance of 2cm, while damage to the initima was very slight. This study demonstrated that fluid jet projection using ordinary saline solution could remove thrombi in chronically obstructive artery safely and effectively and suggested the possibility of the Water Jet angioplasty.

A 64-year-old man was admitted with intermittent high fever of 4 months duration and with three episodes of arterial embolism in the previous 2 months. Several investigations revealed evidence that those episodes involving bilateral popliteal arteries and the left external iliac artery originated from mycotic emboli. Severe mitral insufficiency due to infective endocarditis was also recognized. The ischemic symptoms improved after medical treatment. Despite antibiotic therapy for 4 weeks, inflammatory signs did not subside. Since aneurysm formation of the left external iliac artery at the embolized portion was detected on CT, mitral valve replacement and aneurysmectomy with femoro-femoral grafting were done concomitantly. Inflammatory signs disappeared immediately after the operation. Pathological findings indicated organization of the mitral vegetation and evidence of active infection in the aneurysm wall. Though aneurysmal change of a symptomatic embolized site is not common, the preoperative evaluation of possible associated mycotic aneurysm is important to decide on surgical strategy for infective endocarditis complicated by embolism.

　　A 56-year-old woman was referred to our hospital because of an abnormal finding in the right pulmonary hilum on chest X-ray. Enhanced chest computed tomography showed hyperplastic bronchial arteries dilating and winding around the trachea and bronchi. A racemose hemangioma of the bronchial artery with multiple bronchial artery aneurysms (diameter <20mm) was seen displacing the trachea and both main bronchi. Bronchoscopy showed submucosal tumor-like lesions at the distal trachea and in both main bronchi, and a dusky-red elevated pulsatile lesion at the orifice of the left B3b＋c. We performed coil embolization of the bronchial artery aneurysm to prevent abrupt rupture of the bronchial aneurysm.

BACKGROUND/AIMS: The aim of this study was to determine the pharmacodynamics of cisplatin following three different treatment procedures for intrahepatic arterial infusion therapy for hepatocellular carcinoma (HCC). METHODS: We divided 13 HCC patients into the following three groups: group A, lone injection of cisplatin (n=3); group B, combined injection of cisplatin and lipiodol, with embolization using small gelatin cubes (GCs) (n=5); and group C, injection of suspended lipiodol with cisplatin powder, with embolization using small GCs (n=5). In each group, the free cisplatin concentration in the hepatic vein was measured at 0, 5, 10, and 30 minutes. RESULTS: The mean free cisplatin concentrations were as follows. For group A, the mean was 48.58 microg/mL at 0 minute, 7.31 microg/mL at 5 minutes, 5.70 microg/mL at 10 minutes, and 7.15 microg/mL at 30 minutes. For the same time points, for group B, the concentrations were 8.66, 4.23, 3.22, and 1.65 microg/mL, respectively, and for group C, the concentrations were 4.81, 2.61, 2.52, and 1.75 microg/mL, respectively. The mean area under the curve (AUC)0-infinity for the free cisplatin concentration was 7.80 in group A, 2.48 in group B, and 2.27 in group C. The AUC0-infinity for the free cisplatin concentration gradually decreased, from group A to group C. CONCLUSIONS: These results indicate that the combination of lipiodol and small GCs may be useful for delaying cisplatin drainage from the liver.
Carcinoma, Hepatocellular ; Cisplatin ; Drainage ; Drug Delivery Systems ; Ethiodized Oil ; Gelatin ; Hepatic Veins ; Humans ; Liver ; Pilot Projects