Case 1 was a 48-year-old mother who was under observation for Marfan syndrome and thoracic aortic dilation. She was brought to the hospital with chest pain, and a CT scan revealed acute aortic dissection (Stanford A). Aortic incompetence was also observed, and an emergency Bentall procedure was performed. Case 2, her daughter, was a 26 years old and 39 weeks pregnant. She did not meet the diagnostic criteria for Marfan syndrome. She experienced severe back pain on the same day that her mother was admitted for aortic dissection. Because the patient did not agree to the use of a contrast agent due to concern about its effect on the fetus, emergency cesarean section was performed. Subsequently, a CT scan performed on the patient showed acute aortic dissection (Stanford B). Accordingly, antihypertensive therapy was commenced. In both cases, the patients were discharged after they recovered. Although case 2 did not meet criteria for Marfan syndrome, because of the hereditary disposition, we strongly suspect this was a Marfan syndrome pregnancy. This type of case is included in the case literature on cesarean and vigilant perinatal care is thought to be necessary.

The present study aimed to investigate whether daily steps in male college students have actually decreased in the last decade. If the decline in steps is found, we additionally aimed to examine whether the decline in steps is attributed to a reduction of exercise or, rather, to a reduction of non-exercise activity. A serial cross-sectional study was performed from 2003 to 2012 at the Osaka Institute of Technology. A total of 1,215 male college freshmen were analyzed. Every year, scores of the physical activity levels were evaluated by a questionnaire, and we measured daily steps of participants using a pedometer during usual 1 week. Daily behavior record was also analyzed (n = 69). There were no significant trends or differences in characteristics of participants and the scores of physical activity levels throughout the 10 years. However, interestingly, significant decreasing trends were observed in the steps of average and weekend. In addition, daily behavior record analyses indicate that a cell-phone or a PC usage increased significantly in both weekday and weekend and that playing video games increased significantly in weekday. Therefore, these data support the view that daily steps have actually reduced in the last decade. Our findings also raise the possibility that the decline in steps may be related to the decline in non-exercise activity associated with the increase in a cell-phone or a PC usage and playing the video games.

The present study aimed to examine the effects of Internet addiction on daily steps. A cross-sectional study was performed at the Osaka Institute of Technology. A total of 334 male college freshmen were analyzed. The participants were assigned to five groups according to Internet addiction levels. Internet addiction levels were assessed by Diagnostic Questionnaire, which has been reported by Young (1998), and we measured daily steps of the participants using a pedometer during usual 1 week. There were no significant trends or differences among five groups in physical characteristics of the participants, sleep duration, frequency of eating breakfast, and walking during commute time. However, with the level of Internet addiction increasing, daily steps showed a statistically significant decreasing trend. Therefore, Internet addiction levels might be related to reductions in steps in a dose-response manner. To clarify this point, further investigations will be required after considering confounding factors.

Purpose: With the aim of improving the efficiency of smoking cessation treatment, we analyzed and classified various factors to identify the relationships between the background of patients and effects of treatment, and examine their characteristics.
Methods: We conducted a questionnaire survey to collect information on the situation of patients, and obtained their treatment data from medical records.  Decision tree analysis, a data mining method, was employed to examine these data.
Results: According to the results of the survey, the smoking cessation rate was 80.4%.  The rate was associated with CO concentrations in the breath at the initial examination, nicotine content in cigarettes smoked by patients, and the daily and total number of cigarettes smoked.  The smoking cessation rate among patients under emotional stress was 76.2%; the rate was higher when patients were able to reduce their mental stress levels.
Conclusion: We identified characteristic relationships between the background of patients and the effects of treatment, and they proved to be useful for the improvement of the smoking cessation rate.

Objective: Optimizing the time of ingestion and avoiding overdose are important aspects of medication therapy.  However, seeking explanations for selecting the time of ingestion and maximum dose for a certain drug is time consuming.  The aim of this study is to develop a database (DB) that enables a rapid search of the basis for the time of ingestion and maximum dose setting.
Methods: The basis for the time of ingestion and maximum dose setting were surveyed for 38 and 184 drugs, respectively.  Package inserts, interview forms, and other documents preserved in our department were surveyed, and this was followed by an inquiry of the staff of pharmaceutical companies.  Standard responses to a prescription with incorrect timing or dosage were determined and included into a DB together with information whose quality was dissected.  The efficiency of DB was evaluated: the time taken to obtain information and consistency of inquiries to clarify doubts concerning prescription with the use of DB and without the use DB were compared.
Results: The information of newer drugs, but not of the older drugs, were easily obtained without the need to inquire the staff of the pharmaceutical companies.  Operation of the DB was convenient and was acceptable for most pharmacists working in our department.  The DB markedly reduced the time taken to obtain information.  Further, with the aid of DB, the consistency in the responses to inquiries to clarify doubts concerning a pharmacist’s recommendation was remarkably increased.
Conclusion: The DB developed in the present study may contribute to the improvement of not only the efficiency but also the quality of dispensation.

Septic pulmonary embolism is a rare condition, the common sources of which are bacterial endocarditis and infected venous catheters. Septic pulmonary embolism ascribed to dental infection is extremely rare. The present report describes a case of septic pulmonary embolism attributed to periapical periodontitis in a 39-year-old patient, who was admitted with persistent toothache, fever, and chest pain. Chest CT showed a feeding vessel sign and a target sign. A panoramic radiograph of the left maxillary bone showed alveolar bone loss in a horizontal pattern typical of periodontitis and periapical periodontitis. The patient was treated with intravenous antibiotics and teeth extraction. To our knowledge, only 4 cases of septic pulmonary embolism ascribed to dental infection have been reported in the English literature. These patients repeatedly developed dental infections but did not receive appropriate dental treatment including extraction of the causative teeth, leading to the development of septic pulmonary embolism. This paper may contribute to the limited clinical knowledge base regarding septic pulmonary embolism ascribed to periapical periodontitis. Effective oral care and removal of the primary source of infection, including extraction of the causative teeth, are important to prevent septic pulmonary embolism.

　　We describe a case of Inose-type hepatic encephalopathy due to congenital gastro-renal shunt that was effectively treated with balloon-occluded retrograde transvenous obliteration (B-RTO). An 80-year-old woman repeatedly experienced syncope. Her plasma concentration of NH₃ was elevated to 2363 level and syncope attacks improved after the gastro-renal shunt was closed by B-RTO. Although a congenital gastro-renal shunt is usually treated by surgical ligation, B-RTO is can be effective and less invasive treatment for such cases.

A 57-year-old man underwent subtotal graft replacement of the thoracic aorta for aneurysms of both the ascending and descending aorta. On the 20th post-operative day, pus was found to be draining from the sternotomy wound. The wound was opened and irrigated with 2% Povidoneiodine solution for a total of 3 months. Culture of the pus from the irrigation revealed Staphylococcus epidermidis. When there were no clinical indications of infection and wound cultures were negative, the necrotic sternum and surrounding tissue were debrided and an omental graft was placed in the cavity. Upon follow-up examination, the patient is doing well 10 months after the initial surgery.