The patient was an 89-year-old male who underwent transcatheter edge-to-edge repair to the mitral valve using MitraClip for severe degenerative mitral regurgitation (MR) one year earlier. Although two clips were implanted, grade III/IV MR still remained. As his heart failure progressed, he was referred to us for surgery. The patient also had aortic stenosis. He underwent mitral valve repair and aortic valve replacement. The postoperative course was uneventful. He was transferred to the referring hospital on postoperative day 14. When performing MitraClip for degenerative MR, it is important to consider carefully not only the operative risk for open surgery but also the anatomical adequacy of MitraClip. When MitraClip fails to control MR, early surgical intervention should be considered.

A 76-year-old female was admitted with complaints of dyspnea on exertion and lower leg edema. She had undergone an aortic valve replacement thirty-nine years before and a redo aortic valve replacement and mitral valve replacement twenty-eight years before. She also had hemolytic anemia with jaundice. Echocardiography showed severe paravalvular leakage in the aortic and mitral valves, and a blood flow in the aortic annulus that flows from the aortic side into the left atrium. We diagnosed heart failure and hemolytic anemia due to paravalvular leakage and decided to perform a double-valve replacement for the third time. On operation, after removing the aortic valve through aortotomy, aorto- mitral fibrous continuity was extensively calcified and perforated, and its strength was not enough to sew the prosthetic valve to it. Therefore, we decided to perform the Commando procedure. Aortotomy was extended between the noncoronary aortic sinus and the left coronary aortic sinus until it reached the dome of the left atrium. After the prosthetic mitral valve was excised, annuloplasty of the posterior mitral annulus was performed using a bovine pericardial patch, and the new prosthesis mitral valve was implanted. The anterior part of the annulus corresponding to the aorto-mitral fibrous continuity was reconstructed by sewing the base of a two-tongued triangular bovine pericardial patch to the sewing cuff of the mitral prosthesis. After closing the left atrial ceiling with the posterior patch, the aortic prosthesis was secured to the aortic annulus and the pericardial patch. The anterior patch was used to close the right side of the aortotomy. The postoperative course was uneventful, and postoperative echocardiography revealed no paravalvular leakage.

The patient is a 39-year-old-man who had rheumatic heart disease and had undergone mitral and aortic valve replacements with mechanical St. Jude prostheses as well as tricuspid valve repair and a MAZE procedure 17 years previously. He was admitted with ventricular tachycardia (VT) and an implantable cardioverter-defibrillator (ICD) was implanted. Four months later, he was admitted again with VT, and attempts to manage the VT with drugs were not successful. We performed electro-anatomical mapping and ablation for VT by re-median sternotomy. His postoperative course was uneventful. At 15 months after surgery, no recurrence of VT was recognized.

A 71-year-old female, who had diabetes mellitus and chronic renal failure on dialysis, had undergone mitral valve repair and tricuspid valve annuloplasty. Five months after the operation, she suffered from infectious endocarditis and underwent mitral valve replacement. Postoperatively, a total fluid volume of 300 to 600 ml/day was drained from the pericardial tube, and its appearance became milky after the start of oral intake of food. She was diagnosed with chylomediastinum. Despite fasting and total parenteral nutrition for 2 weeks and subcutaneous octreotide administration, the volume of fluid drainage was not reduced. Therefore, we planned lymphangiography treatment with Lipiodol on postoperative day 37. On operation, under local anesthesia, the left inguinal lymph node was punctured under ultrasound guidance, and Lipiodol was injected at a rate of 12 ml/h for 1h. On the next day, the volume of fluid drainage was reduced, and the pericardial tube could be removed 9 days after lymphangiography.

Computed diffusion-weighted MRI is a recently proposed post-processing technique that produces b-value images from diffusion-weighted imaging (DWI), acquired using at least two different b-values. This article presents an argument for computed DWI for prostate cancer by viewing four aspects of DWI: fundamentals, image quality and diagnostic performance, computing procedures, and future uses.
Magnetic Resonance Imaging ; Prostate* ; Prostatic Neoplasms*

Fifty-two-year-old man who suffered from headache and left neck pain was brought to a nearby hospital by ambulance. Anisocoria and disorder in the field of view of the left eye were observed. Emergency brain MRA showed obstruction of the left internal carotid artery. The patient was transported to our hospital for emergency surgery for suspected acute type A aortic dissection on CT scan. Operative findings revealed a thrombus attached to the ascending aorta continued to left common carotid artery. Thrombectomy for left carotid artery and partial arch replacement were performed. The patient was discharged in good condition on the 16th postoperative day. We encountered a very rare mural thrombus in the ascending aorta.

A 52-year old man was referred to our hospital for atrial fibrillation ablation therapy. A multislice computed tomography study demonstrated a giant coronary artery aneurysm situated just proximal to the left anterior descending (LAD), LAD stenosis and coronary-pulmonary artery fistula. The fistula was ligated and the aneurysm was resected under cardiopulmonary bypass. The left internal thoracic artery was used as a bypass graft to the LAD as well as a patch for closure of the LAD orifice to avoid left circumflex artery stenosis. We report a rare case of giant LAD aneurysm with coronary-pulmonary artery fistula.

[Aim] Diffuse pan-bronchiolitis (DPB) causes severe respiratory dysfunction and severely limits a patient's daily activities. Case: This paper reports a case of a DPB patient whose respiratory symptoms were successfully improved by acupuncture. In a case report in January 2002, a 62-year-old male visited the Department of Respiratory Internal Medicine at Gifu University Hospital, complaining of cough, pumlent sputum and dyspnea on exercise. His general condition had worsened despite ordinary medical treatment. Thus acupuncture was added to the treatment in August, 2001. Intervention: The patient received acupuncture treatments once a week for 50 weeks. The acupuncture treatment was based on the Chinese medicine theory. Measurements: Outcome measures were respiratory symptoms using the Fletcher-Hugh-Jones (F-H-J) classification, 6-minute walking distance (6 MWD), blood test, arterial blood gas and pulmonary function tests. Computed tomography (CT) was assessed. Each evaluation was done after 15 weeks and 50 weeks later.
[Results] After 15 weeks of acupuncture treatment, cough, pumlent sputum, walking distance, the Borg scale and respiratory function were significantly improved compared with the baseline. Moreover, the effect of the acupuncture treatment continued for 50 weeks.
[Conclusion] This suggests that acupuncture treatment was effective in treating the advanced case of DPB.

Emphysema with bronchial asthma (BA) in chronic obstructive pulmonary disease (COPD) causes severe respiratory dysfunction and severely limits a patient's daily activities. This paper reports the case of a COPD patient whose respiratory symptoms were successfully improved with acupuncture. In July 1998, a 69-year-old male visited the Department of Respiratory Internal Medicine at Gifu University Hospital, complaining of dyspnea on exercise, and asthma attacks. His general condition had worsened despite strictly controlled medication and home oxygen therapy (HOT). Acupuncture was thus added to these treatments from ******. Before initiating the acupuncture treatment, the severity of dyspnea in the patient was diagnosed as level III (Severe), according to the GOLD classification. Spirometry showed severely disturbed respiratory function (%VC: 90.7%, FEV₁%: 35.1%, %FEV₁: 38.2%, V 25: 0.20 L/S). The basic combination of meridian points used in this case included LU 1 (Zhongfu), LU 5 (Chize), LU 9 (Taiyan), CV 4 (Guanyuan), CV 12 (Zhongwan), CV 22 (Tiantu), ST 40 (Fenglong), BL 13 (Feishu), BL 23 (Shenshu) and KI 3 (Fuliu). The patient received acupuncture treatments once a week for 10 weeks. Respiratory function and symptoms were measured. After 10 weeks of acupuncture treatment, asthma attacks, walking distance, the Borg scale and respiratory functions were significantly improved compared with the baseline. This suggests that acupuncture treatment was effective in treating advanced cases of both asthma and COPD.

The purposes of this study were to 1) develop“cramp screening tests”to investigate susceptibility to exercise induced muscle cramp (EIMC) and 2) examine the effect of muscle fatigue and dehydra. tion-rehydration on EIMC using the tests. Twenty healthy male subjects were placed into three groups based on their experience of EIMC ; high (n=4, frequent cramps in daily life), low-medium (n=12, cramps with special conditions such as strenuous exercise), and no cramps (n=4), and performed two cramp screening tests for the toe flexors and hamstrings. The results indicated that the higher the frequency of muscle cramps in daily life, the higher the cramp induction rates in the tests. To investigate the effect of muscle fatigue on EIMC, 15 out of the 20 subjects performed 100 rhythmic isometric (knee joint angle of 90°) or isokinetic contractions (range of motion : 60-120°, flexion : 60°/s, extension ; 300°/s) of the knee flexors in separate days. Susceptibility to EIMC decreased in the exercised muscle after the fatiguing exercises, but significantly increased in the toe of the exercised limb. To verify the effect of dehydration on EIMC, nine out of the 20 subjects were dehydrated to reduce 3 % of body weight by an intermittent sauna exposure and rehydrated by giving the dehydrated amount of plain water. Dehydration significantly increased the susceptibility to EIMC, and rehydration did not contribute to decrease the susceptibility. These results suggest that the susceptibility to EIMC would be estimated by using the tests, and dehydration is associated with EIMC, but muscle fatigue does not seem to be a direct factor for EIMC.