We treated 26 frozen shoulders in 26 cases separated into two groups by arthroscopic capsular release. Group A comprised 14 patients (male 7, female 7) with an average age of 53.7 (34-78) who underwent arthroscopic subacromial decompression (ASD). Group B consisted of 12 cases (male 5, female 7) with an average age of 58.2 (41-78) who were treated without ASD. The mean follow-up period was 14 (12-16) months. We compared the range of motion in the effected shoulders and the Japan Orthopaedic Association (JOA) scores between the two groups. We also investigated any improvement of ROM one month after operation in regards to rehabilitation being performed 3 times or under 2 times per week in order to acquire a greater ROM of external rotation. Group A led group B significantly with superior clinical results including ROM and JOA scores. Furthermore, rehabilitation administered 3 times per week increased the ROM of the shoulder after one month of operation. Therefore, it was found that in arthroscopic capsular release of frozen shoulder, additional treatment with ASD and frequent rehabilitation with ROM exercises for external rotation yielded clinical improvement in frozen shoulder outcomes.

A 37-year-old man had been hospitalized at another hospital where he was being treated for encephalitis. Early one morning, the patient had sudden precordial chest pain and dyspnea, so he was examined further. Contrast-enhanced CT revealed filling defects in both pulmonary arteries and in the right and left atria, indicating acute pulmonary embolism. Cardiac ultrasound revealed thrombi floating in the right and left atria, and the patient displayed pulmonary hypertension (estimated pressure : 50 mmHg). Since scattering of thrombi in the left atrium carried the risk of arterial embolism, emergency surgery was performed at this hospital. An incision was made in the right atrium with the heart stopped, revealing a tubular thrombus trapped in the foramen ovale. The trapped thrombus was completely removed, and the patient's life was saved since arterial embolism, e.g. paradoxical cerebral embolism, did not occur. This case involved a rare pathology and is thus reported here together with a discussion of the literature.

Since 1993, our hospital has been entrusted by the Gifu Prefectural Government with the operation of the home health care system in the region. Hospital healthnurses, keeping in close contact with other medical institutions and self-goverinig bodies, have endeavored to support the health and medical care of home patients.
Initially, there was much to be desired in the way some government offices were addressing to home health care and care coordination for patients when they were discharged from hospital. These inadequacies have largely been corrected and in 1998 a comprehensive home care system came into being.
Our effort to restructure the home care system has been crowned with success in many ways. Formerly there were many cases in which individual organizations rendered services separately, but now hospitals, local medical associations and government offices have come to play on the team, which has made it possible to provide home care effectively and efficiently. Moreover, the hospital staff have become fully aware of the importance of home care.

The objective of this study was to investigate the edema suppresive effect of single-dose crystalloid cardioplegia against immature myocardium. 50 puppies (3-21-day-old) were separated into 4 groups by the method of myocardial preservation, group A: preservation at 30°C, group B: topical cooling used only, group C: topical cooling with cardioplegia (St. Thomas Hospital solution: 4°C, pH 7.8, 350 mOsm/l), group D: topical cooling with oxygenated cardioplegia, and gravimetric water content of myocardium (%) was measured at control, 5, 30, 60, 90, 120, 150, and 180 min after aortic clamp. All hearts had elevated myocardial water content with linear change pattern, although which in groups A and B was consecutively increased while which in groups C and D was increased immediately after aortic clamp followed by slow increase thereafter. Increase of myocardial water content from 5 min after aortic clamp in group B at 90 min was significantly higher (p<0.01) than those in groups C and D, at 180 min that in group A was higher than that in group C and that in group B was higher than those in groups C and D (p<0.05, p<0.01, p<0.01, respectively). This study has shown that evolution of myocardial edema was suppressed by the administration of cardioplegia, while myocardial water content was seemingly higher because coronary vascular dilatation resulted in increase of intravascular water. We could not find the effect of the topical cooling only or oxygenated cardioplegia.

　　A 77-year-old woman was admitted to our hospital because of low-grade fever and lightheadedness 7 days after the removal of a carious broken tooth. Neurological examination revealed disturbed consciousness and meningeal sign with mild ophthalmoplegia. Cerebrospinal fluid examination showed elevated levels of polymorphonuclear cells and enhanced magnetic resonance imaging revealed a left masticator space abscess. On the basis of these findings, the diagnosis was meningitis complicated by a masticator space abscess. Although her symptoms were ameliorated after the administration of antibiotics, her consciousness deteriorated accompanied by bilateral total ophthalmoplegia. Enhanced head computed tomography revealed a filling defect of the superior orbital veins with enhancement of the cavernous sinus, suggesting cavernous sinus thrombosis. After the addition of anticoagulants to antibiotic therapy and surgical drainage of the abscess, she recovered without residual neurological impairment. Because cavernous sinus thrombosis is potentially life-threatening, early diagnosis and initiation of appropriate therapy are extremely important.

Many patients with mental disorders visit emergency departments (EDs). However, the majority of these patients do not receive psychiatric assessment. In the present study, we investigated the detailed proportion of patients with mental disorders visiting an urban ED in the largest northern city in Japan. A retrospective chart review study was performed at a University Hospital from January 2012 to December 2015. The reasons for psychiatric consultations made by ED staff, and the primary psychiatric diagnoses were investigated. Among all living patients, 20% of them received consultations. The most common reason for consultation was suicide attempt followed by agitation or insomnia. Of all diagnoses, organic mental disorder was the most frequent and the mean age was significantly higher than the other diagnostic groups. Our study indicated that the frequency of psychiatric consultation was high. This indicates the high demand for mental health services at the ED. A thorough psychiatric assessment can provide adequate psychiatric services to acute patients; thereby possibly preventing suicide attempters from later actually dying by suicide.
Diagnosis ; Dihydroergotamine ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Japan* ; Mental Disorders ; Mental Health Services ; Neurocognitive Disorders ; Referral and Consultation* ; Retrospective Studies ; Sleep Initiation and Maintenance Disorders ; Suicide

Background/Aims: Patients with achalasia-related esophageal motility disorders (AEMDs) frequently present with dilated and sigmoid esophagus, anddevelop esophageal diverticulum (ED), although the prevalence and patients characteristics require further elucidation. Methods: We conducted a multicenter cohort study of 3707 patients with AEMDs from 14 facilities in Japan. Esophagography on 3682 patients were analyzed. Results: Straight (n = 2798), sigmoid (n = 684), and advanced sigmoid esophagus (n = 200) were diagnosed. Multivariate analysis revealed that long disease duration, advanced age, obesity, and type I achalasia correlate positively, whereas severe symptoms and integrated relaxation pressure correlate negatively with development of sigmoid esophagus. In contrast, Grade II dilation (3.5-6.0 cm) was the most common (52.9%), while grade III dilation (≥ 6 cm) was rare (5.0%). We found early onset, male, obesity, and type I achalasia correlated positively, while advanced age correlated negatively with esophageal dilation. Dilated and sigmoid esophagus were found mostly in types I and II achalasia, but typically not found in spastic disorders. The prevalence of ED was low (n = 63, 1.7%), and non-dilated esophagus and advanced age correlated with ED development. Patients with right-sided ED (n = 35) had a long disease duration (P = 0.005) with low integrated relaxation pressure values (P = 0.008) compared with patients with left-sided ED (n = 22). Patients with multiple EDs (n = 6) had lower symptom severity than patients with a single ED (P = 0.022). Conclusions The etiologies of dilated esophagus, sigmoid esophagus, and ED are considered multifactorial and different. Early diagnosis and optimal treatment of AEMDs are necessary to prevent these conditions.

Background/Aims: ManoScan and Sandhill high-resolution manometry (HRM) systems are used worldwide; however, the diagnosis of achalasia on the Starlet HRM system is not fully characterized. Furthermore, the impact of calcium channel blockers and nitrites in treating achalasia has not been investigated using HRM. Management of recurrent cases is a priority issue, although few studies have examined patient characteristics. Methods: We conducted a multicenter, large-scale database analysis. First, the diagnosis of treatment-naive achalasia in each HRM system was investigated. Next, patient characteristics were compared between type I-III achalasia, and the impact of patient characteristics, including calcium channel blocker and nitrite use for integrated relaxation pressure (IRP) values, were analyzed. Finally, patient characteristics with recurrent achalasia were elucidated. Results: The frequency of type I achalasia with Starlet was significantly higher than that with ManoScan and Sandhill HRM systems. In achalasia, multivariate analysis identified male sex, advanced age, long disease duration, obesity, type I achalasia, and sigmoid type as risk factors related to normal IRP values (< 26 mmHg). Calcium channel blockers and nitrites use had no significant impact on the IRP values, although achalasia symptoms were indicated to be alleviated. In recurrent cases, the IRP value was significantly lower, and advanced age, long disease duration, and sigmoid type were more common than in treatment-naive patients. Conclusions We should cautiously interpret the type of achalasia and IRP values in the Starlet HRM system. Symptoms of recurrent cases are related to disease progression rather than IRP values, which should be considered in decision making.

Entrapment of an intravascular ultrasonography (IVUS) catheter is an infrequent but serious complication associated with percutaneous coronary intervention (PCI). We report a case of successful surgical treatment of an IVUS catheter entrapped in a coronary stent after PCI. An-80-year-old man was admitted to a hospital with sudden anterior chest pain. He underwent PCI to left circumflex branch (Cx) and left anterior descending artery (LAD), followed by IVUS to ascertain stent expansion of the LAD stent. The IVUS catheter became entangled in the stent and could not be withdrawn from the outside. The patient was transferred to our hospital for its surgical removal. For the emergent surgery, we opened the stent region in the LAD and directly removed the IVUS catheter with the twisted stent. The opened place in the LAD was directly closed. Additional coronary bypass grafting involving two vessels was performed. The postoperative course was uneventful with no graft occlusion.

Aortic dissection presents with acute chest or back pain. However, it can be asymptomatic in the acute phase with delayed symptomatic presentation or incidental diagnosis upon chest imaging. We report a case of acute type B aortic dissection subsequent to chronic type A aortic dissection which was difficult to distinguish from acute type A aortic dissection. A 45-year-old man was admitted to a hospital with sudden back pain. An enhanced chest CT revealed a suspected acute type A aortic dissection. The patient was transferred to our hospital and we performed an emergent total arch replacement. Intraoperative findings showed that there were two entries at the origin of the brachiocephalic artery and the left subclavian artery. The ascending aorta presented wall thickening but the descending aorta did not present wall thickening. Histopathologically, the adventitia was obviously thickened with dissection findings in the tunica media. Thus it was diagnosed as acute type B aortic dissection subsequent to chronic type A aortic dissection. Great caution should be taken in asymptomatic chronic aortic dissection.