ABSTRACT
A 61-year-old woman who presented with symptoms of dysphagia was hospitalized after right subclavian artery aneurysm was diagnosed. A selective right subclavian arteriogram revealed the presence of two large subclavian arterial aneurysms. The operative procedure consisted of aneurysmectomy through a right supuraclavian incision followed by the reconstruction of the blood vessel by end-to-end anastomosis of the right subclavian artery. The postoperative course was uneventful. Multiple subclavian artery aneurysms are rare among peripheral aneurysms. This case was found by the symptoms of dysphagia caused by compression of the esophagus. The etiology of this case is unclear, but most likely was due to trauma.
ABSTRACT
“Mengen” is defined as the rapid improvement of signs and symptoms of a chronic disease after a kampo formulation has induced unexpected reactions<sup>1</sup>. This phenomenon is occasionally encountered in the daily practice of Kampo medicine. The question here is how to determine whether the reactions are a result of mistreatment or “Mengen”. I recently experienced an incidence which was considered to be “Mengen” in a patient with progressive palmoplantar keratoderma of both hands and feet. With the appearance of facial acne-like rash which was considered to be “Mengen”, the main sgin, namely, keratinization, somewhat improved. It was reconfirmed that in Kampo medicine the case should be diagnosed as one where Unkei-to is indicated, and this formulation was continued. About one month later, both keratinization and facial rash disappeared. At the same time, liver spots on the face which had persisted for a long time, also disappeared. The results indicate that when unexpected reactions occur during treatment with a Kampo formulation, improvement of main signs or symptoms may give a clue to determining whether or not the reactions are a result of “Mengen”, while judgement of whether Kampo diagnosis is correct or not, is, of course, important.