We report 3 cases of sudden death while the students are at school. In Japan 120-150 cases, mainly related to sports, are reported in a year. In Gifu Prefecture (population: 2, 000, 000), only 1 or 2 cases probably occur in a year. While here in Mizunami City (population: 40, 000), we had 3 cases for the last 10 years. This is a higher occurrence rate than in other cities.
The 1st case was caused by brain-stem bleeding; the 2nd, rupture of the wall of the aorta associated with Marfan syndrome, and the 3rd, fatal arrythmia related to Wolff-Parkinson-White syndrome.
Measures to prevent the incidence are summed up as follows:
(1) Teachers, school doctors and hospital staffs should have closer contact
(2) We should critically review the standards for cardiac disease management and make a thorough examination of the heart at the time of regular health screening by several ways, such as UCG, Holter ECG and treadmill ECG, to find high-risk students.
(3) 60% of the cases of sudden death were of cardiac origin, and 40% were due to central nervous system disorder, bronchial asthma etc., so we should also watch over these conditions.

A 24-year-old man with systemic lupus erythematosus (SLE) had received long term steroid therapy 10 years prior to this admission. He presented with sudden-onset chest pain. Enhanced CT scan showed the presence of an aortic arch aneurysm 63mm in maximum diameter and a hematoma surrounding the anterior mediastinum. The diameter of the descending thoracic aorta was also dilated to 5cm. We performed ascending and total arch replacement on December 8, 2005. From the 11th postoperative day, he developed fever, indicating mediastinitis. Open drainage was carried out for one week resulting in gradual lysis of fever and the levels of WBC and CRP returned to normal values. The omentum was transplanted to close the defect in the mediastinum. The rest of the postoperative course was uneventful. He was discharged from the hospital last January 25, 2006. Although close medical follow-up was implemented, he had severe chest pain in the morning on June 9, 2006. Enhanced CT showed an expanding descending aortic aneurysm 60mm in diameter. Since antihypertensive therapy was effective, we considered an elective operation. On the 3rd hospital day, he complained of a severe back pain wherein he rapidly progressed into a state of shock. He died due to rupture of the descending aortic aneurysm. We needed emergency operation or endovascular stent graft therapy because of the risk of rupture.

22q11.2 deletion syndrome (22qDS) resulting from a microdeletion of 22q11.2, is usually diagnosed in the postnatal period, and generally manifests as various combinations of cardiac defects, hypoparathyroidism, facial dysmorphism, palate deformity and cellular immunodeficiency. We report a case of a 32-year-old woman presenting with seizures and hypocalcemia, who was diagnosed with 22qDS, along with a literature review of adult cases. Physicians should recognize the 22qDS in adults presenting with any combinations of hypocalcemia, hypothyroidism, cardiac defects and psychiatric disorders. Pathognomonic facial dysmorphism or short stature can be the key to diagnosis.

We performed extraanatomic bypass from the thoracic aorta to bifemoral arteries for 4 aortoiliac occlusive disease (AIOD) patients (including 2 dialysis patients) with severe calcification of abdominal aorta and 5 high aortic occlusion (HAO) patients between January 2001 and September 2006. The average age was 69 years old (range 46-80) including 6 men. Two HAO cases were in the acute phase, one of whom had accompanying lower limb paralysis. Two of the AIOD cases showed small aorta syndrome. The mean operation time was 145min and intra- or postoperative bleeding was very low. We lost one peritoneal dialysis patient with AIOD in the 2nd postoperative week, due to infection from the CAPD tube. Perigraft seroma which is a complication of the artificial blood vessel itself was seen in 3 patients but graft patency was 100 percent at 2 years postoperatively.

Animals ; Glutamic Acid ; analysis ; toxicity ; Guinea Pigs ; Microscopy, Immunoelectron ; Vestibule, Labyrinth ; chemistry

Two hundred and thirty adipose tissues were collected from inpatients, who had undergone an operation and an autopsy in the Saku Central Hospital from 1980 to 1982. Organochlorine pesticides were extracted from the adipose tissues and determined by gas-liquid chromatography with an electron-capture detector.
The mean value was 1, 429 ppm for total BHC among males, and 1.665 ppm among females, 4.893 ppm and 3.791 ppm for total DDT, 1.082 ppm and 0.782 ppm for PCB, respectively. Regression analysis between the total BHC residue and the ages of patients indicated a positive correlation for both sexs. As for the relation between the rate of obesity and the residues, low rates of obesity (-10%--19%) were most significantly correlated with high values of total BHC, total DDT and PCB.
We also discussed relations between cancerous diseases and the residues.

A 22-year-old man with dilated cardiomyopathy (DCM), who was a practicing Jehovah's Witness, was transferred to our hospital for surgical treatment of medically uncontrollable mitral regurgitation (MR). Our original mitral complex reconstruction procedure and permanent pacemaker implantation for biventricular pacing were successfully performed without transfusion of blood products. Blood conservation strategy included: 1) preoperative treatment with erythropoietin, 2) utilization of a shortened extracorporeal circuit and assisted venous drainage system, 3) the use of ultrafiltration to save the residual autoblood in the extracorporeal circuit. The preoperative hemoglobin level was 17.1g/dl and the postoperative lowest level was 9.5g/dl. MR decreased from grade III to none, and NYHA functional class improved from class II to class I postoperatively. He was moved to a cardiology ward on the 13th postoperative day without complications. Transfusion-free surgery for DCM should be performed before DCM advances and requires left ventriculoplasty at risk for major blood loss. A careful follow-up is needed to examine the long-term results of the operative procedure during his expected long survival.

We evaluated the interview skills of 46 sixth year medical students (32 men, 14 women) in our outpatient clinic. Six items were evaluated, including the manner in which students responded to patients, the number of times students interrupted patients' statements with closed-ended questions, and the extent to which students maintained eye contact with patients. We found that students interrupted patients every 46.2 seconds on average, and often did not make eye contact with tha patients. It became clear that, although we teach medical interview skills to students, students do not learn these skills very well. We suggest that in order to properly educate medical students, close cooperation between departments is needed.

In the present study, we instiuted a long-term mild aerobic training program for older patients with hypertension and investigated its effects on serum lipids and lipoprotein concentrations. The intensity of exercise in mild aerobic training was adjusted to the lactate threshold level (LT), i, e., the level at which the blood lactate concentration began to increase nonlinearly with increasing work intensity. The training group (15 patients, 7 men and 8 women) and control group (15 patients, 7 men and 8 women) were 65-83 year-old patients with mean ages of 75.5±5.6 and 73.7±4.4 (mean±S.D), respectively, who had never exercised regularly up to that time. Treadmill training at the LT was carried out for 30min/day 3-6 times/week and continued for 9 months under the supervision of exercise physiology specialists.
In the training group, LT speed significantly increased from 3.43±0.65 km/h to 3.73±0.67 km/h (9.0%) in men, and from 2.75±0.57 km/h to 3.05±0.61 km/h (11.8%) in women (both P<0.05) . HDL-c was significantly increased 9 months after training both in men (19.2%) and women (20.9%) (both P<0.05) . The TC/HDL-c ratio, an atherogenetic index, was significantly (P<0.05) decreased by training in women but not in men. The other serum lipid and lipoprotein profiles were unchanged in both men and women. In the control group, all serum lipid and lipoprotein profiles were unchanged in both men and women.
The HDL-c level in the training group was higher than in the control group after 9 months in both men and women (both P<0.02) . The TC/HDL-c ratio in the training group was lower only in women (P<0.02) . There were no significant differences in other values between the training group and the control group in either men or women.
These results suggest that mild aerobic training at the LT is an effective method of improving the level of serum HDL-c, the TC/HDL-c ratio and aerobic capacity in the older patients with hypertension.