ABSTRACT
Background: Extensive calcification of the mitral annulus (MAC) represents a problem for mitral surgery due to a technical difficulty for implanting prosthetic valves, because the calcium does not allow placing direct sutures through the annulus and para-prosthetic leakage or cardiac rupture may result. We describe our experience with mitral valve surgery with or without decalcification of the annulus. Methods: Since 2005, we performed mitral valve operations in 1,327 patients and among them, severe mitral annular calcification was present in 25 (1.9%). Results: The mean age was 75±9 years and there were 6 men and 19 women, with hemodialysis in 4. Mitral valve replacement (MVR) was performed in all patients. A concomitant operation was aortic valve replacement in 19 and coronary artery bypass grafting in 4 patients. The MAC was resected in 14 (Group-R) and was excluded in 11 (Group-E). In-hospital mortality was four patients in Group-R. The cause of death was congestive heart failure in two, cerebellar infarction in one, and respiratory failure in one. Postoperative morbidity included one patient with reexploration and one with prolonged respiratory failure The aortic cross clamp time was a mean of 180±44 min (range 108∼266 min) in Group-R and 139±32 min (range 61∼186 min) in Group-E (p=0.009). The size of the prosthetic mitral valve was 24.3±1.0 mm in Group-R and 24.6±0.8 mm in Group-E (p=0.618). The postoperative echocardiography showed no abnormal mean pressure gradient of mitral valve prosthesis nor para-valvular leak in any patients in either group. Conclusions: The mitral valve replacement without annular decalcification in a severely calcified mitral annulus is a safe and an effective approach in an elderly patient.
ABSTRACT
A 71-year-old woman was referred to our hospital with complaints of gross hematuria. She had been administered 50mg/day of cyclophosphamide for 13 years to treat idiopathic thrombocytopenic purpura (ITP). Cystoscopy revealed irregular surface of bladder mucosa. On suspicion of bladder cancer, we performed transurethral resection of bladder tumor (TURBT). The pathological examination showed polypoid cyst, and we diagnosed hemorrhagic cystitis. Two months after the operation, gross hematuria was observed again. Although we administered choreitogoshimotsuto and then saireito, both were ineffective. Then we administered kamikihito, considering the findings of deficiency of ki (qi) and ketsu (blood) in Kampo diagnosis and the underlying disease ITP. One month after administering kamikihito, gross hematuria disappeared, urinary sediment test showed RBC 1-4/HPF. After one year of follow-up, bladder tumor was suspected by cystoscopy, but the pathological result of the second TUR-BT was inflammatory change. Since then, kamikihito was continued during the 44-month observation period, and no gross hematuria was observed.
ABSTRACT
Four interstitial cystitis/chronic pelvic pain syndrome (IC/CPPS) patients presenting with pain and autonomic imbatances were improved by Kampo medicine. (Case 1) a 42 year old female : Her bladder and perinial pain were relieved by ryutanshakanto and her autonomic imbalances were improved by Kamishoyosan. (Case 2) a 51 year old female : She was given anchusan which warmed the internal organs. (Case 3) a 49 year old female : Her general hypothermia was relieved by shinbuto and ninjinto. (Case 4) a 27 year old female :She was given tokishigyakukagoshuyushokyoto which warmed the lower body half. These Kampo medicines for autonomic imbalance in IC/CPPS were drugs that adjusted general condition on the basis of diagnostic processes, and logic based on states of vital energy and blood.
ABSTRACT
Maobushisaishinto was given to 10 elderly female patients with stress urinary incontinence (SUI) for 4 weeks. Five patients showed SUI improvement with its herbs. The mean age for the effective group was higher than that for the non-effective group (73.2 vs 50.2 yrs old ; p = 0.08). In former group, 2 cases demonstrated a remarkable effect ; one with the number of pads used decreasing from 8 to 2 and the other decreasing from 4 to 1.<br>Because of the possibilities of urethral pressure elevation with ma huang (the mao component) and improvement of detrusor overactivity with Fu zi (the bushi component), maobushisaishinto may be applicable for the aged female suffering from SUI.
ABSTRACT
A 79-year-old woman had undergone mitral valve replacement (Omnicarbon (OC) valve : 31 mm) due to rheumatic mitral stenosis with regurgitation and tricuspid annuloplasty at the age of 54. The patient developed anemia and congestive heart failure with pleural effusion and an elevated LDH level in 25 years late up without any valve-related cardiac event. Echocardiography revealed perivalvular leakage near the anterolateral commissure. The patient received re-mitral valve replacement (CEP valve : 25 mm) and a tricuspid valve ring annuloplasty (MC<sup>3</sup> Tricuspid ring : 28 mm). The annulus was covered with marked calcification and fibrosis with a partial deficit at the anterior part of antero-lateral commissure. Despite the thorough pathological examination, we could not clarify the etiology of sudden onset of hemolysis.The patient was discharged uneventfully on the 28th day after operation. In general, the OC valve can work without serious complications for a long time. We report a rare case of perivalvular leakage 25 years after mitral valve replacement with hemolysis and congestive heart failure.
ABSTRACT
We evaluated the effect of Kampo (Japanese herbal) medicine for overactive bladder (OAB), exacerbated by coldness. There were 258 OAB patients who visited our clinic between October and November. Thirty-one percent (79 out of 258) of those patients began Kampo treatment with their OAB drugs. Furthermore Kampo medicines for 49% of cases (39 out of 79) were for coldness. The prognosis of coldnesses which were treated by Kampo medicine at the next spring were as follows. An “effective and continued” group accounted for 54%, and an “effective but discontinued” group for 25%. An “ineffective and discontinued” group accounted for21%. There was a significant difference in mean age between the “effective and continued” group (63 ± 7.3) and “effective but discontinued” group (44 ± 11) (p < 0.01). Thus, the QOL of OAB patients should improve with Kampo medicine co-administered with OAB drugs.
ABSTRACT
Objective: The aim of this study was to determine the level of exposure of mercury (Hg) miners and smelter workers to elemental mercury (Hg0) vapor in China, who work in Hg mines without using protective equipment against Hg0 vapor. In addition, the level of methylmercury (MeHg) intake by the workers was estimated from the MeHg concentration in their hair. Methods: Urinary total mercury (THg) and hair THg and MeHg concentrations were measured in 26 Hg miners and smelter workers (i.e., exposed group), and 48 unexposed people (unexposed group). Results: The exposed group showed high geometric mean THg concentrations in urine (258 ng/ml, 226 μg/g creatinine) and hair (20.0 μg/g). The urinary THg concentration of the smelter workers in particular was extremely high (338 μg/g creatinine in urine). The highest urine THg concentration reached 4577 μg/g creatinine. THg concentrations in urine and hair showed a significant correlation in the exposed group (r=0.62), indicating the adhesion of Hg0 vapor to hair. However, no such significant correlation was found in the unexposed group. Hair MeHg concentration in the exposed group (1.97 μg/g) was about threefold higher than that in the unexposed group (0.60 μg/g). Conclusions: This study shows that smelter workers in a Chinese Hg mine are exposed to extremely high levels of Hg0 vapor, and that Hg miners are exposed to higher levels of MeHg than the unexposed subjects. Further study is needed to determine the cause of the higher hair MeHg concentration in the exposed group.
Subject(s)
Hair , Mercury , WorkforceABSTRACT
<p><b>OBJECTIVE</b>The aim of this study was to determine the level of exposure of mercury (Hg) miners and smelter workers to elemental mercury (Hg(0)) vapor in China, who work in Hg mines without using protective equipment against Hg(0) vapor. In addition, the level of methylmercury (MeHg) intake by the workers was estimated from the MeHg concentration in their hair.</p><p><b>METHODS</b>Urinary total mercury (THg) and hair THg and MeHg concentrations were measured in 26 Hg miners and smelter workers (i.e., exposed group), and 48 unexposed people (unexposed group).</p><p><b>RESULTS</b>The exposed group showed high geometric mean THg concentrations in urine (258 ng/ml, 226 μg/g creatinine) and hair (20.0 μg/g). The urinary THg concentration of the smelter workers in particular was extremely high (338 μg/g creatinine in urine). The highest urine THg concentration reached 4577 μg/g creatinine. THg concentrations in urine and hair showed a significant correlation in the exposed group (r=0.62), indicating the adhesion of Hg(0) vapor to hair. However, no such significant correlation was found in the unexposed group. Hair MeHg concentration in the exposed group (1.97 μg/g) was about threefold higher than that in the unexposed group (0.60 μg/g).</p><p><b>CONCLUSIONS</b>This study shows that smelter workers in a Chinese Hg mine are exposed to extremely high levels of Hg(0) vapor, and that Hg miners are exposed to higher levels of MeHg than the unexposed subjects. Further study is needed to determine the cause of the higher hair MeHg concentration in the exposed group.</p>
ABSTRACT
We evaluated the clinical efficacy of Goshajinkigan in patients complaining of lower urinary tract symptoms (LUTS). A total of 109 patients (86 males and 23 females) who were orally administered Goshajinkigan at a dose of 5 to 7.5g/day for 4 to 8 weeks, were studied retrospectively. Improvements of symptoms were confirmed in 50 patients. Multivariate analysis showed the response rates were significantly higher among patients with urgency, residual feeling, myocardial ischemia and brain infarction respectively, and were significantly lower among patients with hesitancy. Our findings suggest that Gosha jinki-gan mainly improves urgency and/or residual feeling of lower urinary tract symptoms, and that these symptoms are the main LUTS associated with jinkyo.
ABSTRACT
The authors investigated the efficacy, safety and usefulness of the Kampo extract Shoseiryu-to (TJ-19) in the treatment of adult bronchial asthma. The multi-center study used the same methods presently in use in Japan for clinical evaluation of Western drugs and included a total of 69 patients in an open trial.<br>After long-term (4-8 weeks) administration of the Kampo formula in conjunction with conventional bronchial dilators, a significant improvement was seen in the frequency score, clinical score and asthma score. Significant improvement was observed in individual symptoms such as phlegm viscosity and amount, daily life, sleep, sneezing and nasal discharge. Overall, the results indicated marked improvement in 13 patients (18.8%), moderate improvement in 23 patients (33.3%) and slight improvement in 19 patients (27.5%). Thus, the authors obtained the favorable results of moderate or better improvement in 52.2% and slight or better improvement in 79.9% of the patients. We observed almost no abnormal findings in laboratory examinations due to the drugs. Side effects developed only in a few patients in the form of a slight cough. Symptoms of nasal allergy improved most frequently according to the impressions of the physicians in charge. Recently, combination therapy using various Kampo extracts has increased in Japan in order to improve treatment quality.