A 25-year-old man crashed his car into an electric light pole, and was brought to our hospital. Pericardial effusion inducing cardiac tamponade was detected on computed tomography, but there was no findings suggesting traumatic injuries of any other organs. Since he demonstrated shock during the examination, we performed pericardial drainage following pericardiocentesis to eliminate the cardiac tamponade. After approximately 150 ml of blood was drained, his blood pressure increased and stabilized. Blunt cardiac rupture was diagnosed after blood drainage, and midsternotomy was then performed. Percutaneous cardiopulmonary support was established for exploration and confirmation of the injured site. The injured site was confirmed at the junction of the right lower pulmonary vein and right basal pulmonary vein. However, surgical repair under partial circulatory support was impossible because the injury was complicated and hemorrhage was not controllable. Furthermore, there was a risk of air embolization during the process of repair. Therefore, an additional drainage tube was inserted into the superior vena cava, and then the injury was repaired by direct closure under total perfusion using another circulatory circuit with a venous reservoir. No cases of isolated injury of intrapericardial pulmonary vein injury have been reported previously. It was suspected that the development of this injury was related to air bag deployment. This case could be saved by surgical repair under total perfusion using cardiopulmonary bypass.

The prevention of dementia is an important issue that should be addressed in Japan. To prevent dementia, it is important to implement interventions (e.g., exercise or cognitive training) for the healthy community-dwelling elderly. However, such interventions are not always evidence-based. In this review, we evaluated exercise and cognitive training intervention protocols for the prevention of dementia based on recent findings. In addition, we proposed specific methods for implementing such interventions in the community.

This study analyzed the effects of various body surface areas being cooled by water-perfused suits (WPS) on thermoregulatory response during exercise in a hot environment. Seven male subjects, dressed in clothing with low moisture permeability (rain coats) over WPS covering the whole body surface except for the face, hands, and feet, performed three sessions of 20-min cycling at low intensity (250w/m²) in a room maintained at 30℃ under six conditions of body surface cooling : whole body (WB), upper body (UB), lower body (LB), lower body except lower legs (LBEL), head and neck (HN), and no body cooling (NBC). The coolant temperature at the inlet was 20℃ for all conditions, and heat extraction (HE) was estimated by the difference between inlet and outlet water temperatures and water flow rate. Esophageal (Tes) and deep thigh temperatures (T-d.thigh) and heart rate (HR) during exercise were significantly (p＜0.01) higher for NBC and HN, and forearm skin blood flow (SkBF) and dehydration (DEH) were significantly (p＜0.01) lower for WB than for other conditions. There was a similar tendency concerning Tes and T-d.thigh among WB, LBEL, and LB ; however, T-d.thigh for UB was significantly (p＜0.01) higher than for WB, LBEL, and LB. In comparison with resting levels, the mean skin temperature (Tsk) and thermal sensation (TS) significantly (p＜0.01) increased for NBC and HN, and decreased for UB and WB, but remained constant for LBEL and LB during exercise. Under all conditions, increases in Tes (ΔTes) and T-d.thigh (ΔT-d.thigh) at the end of exercise were significantly (p＜0.01) increased when less than 40% of the body surface was cooled (Tsk : above 35.8℃, HE : less than 110W). Furthermore, ΔTes at the end of the exercise was related to ΔTsk×SkBF, while the slope of the regression line between those parameters was steeper when ΔTsk×SkBF values were negative, as opposed to positive values. These results suggest that during light exercise under different body surface cooling conditions : 1) UB leads to a high T-d.thigh while Tes, Tsk, and TS are as low as those for WB, 2) critical levels of body surface cooling area causing a decrease in core temperature elevation might exist, and 3) changes in blood circulation due to body cooling might be affecting temperature responses at the end of exercise.

We experienced a case in which a blood transfusion proved to be effective for the treatment of symptomatic restless legs syndrome that occurred in a patient demonstrating terminal stage cancer with iron-deficiency anemia due to hemorrhaging as a result of carcinomatous peritonitis. The patient was a female in her seventies who suffered from hepatocellular carcinoma. After undergoing blood transfusion, the symptoms of discomfort in her lower limbs dramatically improved. It was thought that it was expected the symptomatic restless leg syndrome was frequently amalgamated, and a positive diagnosis and appropriate treatment were necessary in the terminal stage of cancer. Palliat Care Res 2011; 6(2): 344-349

Introduction: We experienced a case in which acetazolamide proved to be effective for the symptoms of increased intracranial pressure due to carcinomatous meningitis. Case: The patient was a male in his fifties who was diagnosed lung adenocarcinoma. He was suffered from headache and vomiting due to carcinomatous meningitis after his admission to our palliative care unit, so he was prescribed steroids and a glycerin infusion. But only morning headache remained, and we added acetazolamide 500 mg per day and his morning headache improved. Conclusion: This morning headache is thought to reflect exacerbation of raised intracranial pressure through nocturnal hypoventilation with a rise in PaCO2, so it was thought that acetazolamide decreased PaCO2 and relieved morning headache.

The patient was a 68-year-old woman. She was diagnosed with uterine cancer after experiencing irregular genital bleeding. Contrast-enhanced computed tomography showed a 30 mm left ventricular mass and splenic infarction, and head MRI showed multiple cerebral infarctions. The patient was suffering from systemic embolism caused by the cardiac mass, and we decided to perform cardiac mass removal prior to uterine cancer treatment. A yellowish-white thrombus-like mass attached to the mitral valve, subvalvular tissue, and left ventricular endocardium was removed by a trans-septal approach under cardiopulmonary bypass. Pathological examination revealed that the mass was a fibrin-based thrombus with almost no inflammatory findings, we diagnosised non-bacterial thrombotic endocarditis (NBTE). Postoperatively, the patient developed Takotsubo cardiomyopathy, and treatment for uterine cancer, was delayed. Hypercoagulability was not controlled well, and she developed recurrence of left ventricle vegitation, acute arterial occlusion of the lower extremities and inferior vena cava thrombosis, making active intervention for uterine cancer difficult. The patient was treated palliatively and died on POD 36. NBTE tends to be characterized by multiple small growths, but giant vegetation may also occur as in this case. Unless the primary disease causing the hypercoagulability is treated, recurrence of NBTE is possible, and prompt treatment of the primary disease is required.

Purpose：This study investigated the factors associated with rehabilitation service satisfaction in convalescent stroke patients.Methods：This cross-sectional study included 41 participants (mean age 50.5 ± 9.3 years；73.2％ were male). Patients with severe cognitive impairment who were unable to respond to questionnaires were excluded from the study. At discharge, patient satisfaction was assessed using the Customer Satisfaction Scale based on Need Satisfaction (CSSNS) tool. We also evaluated physical function using the Stroke Impairment Assessment Set-Motor (SIAS-M) gain tool, activities of daily living (ADL) using the Motor-Functional Independence Measure (M-FIM) effectiveness tool, depressive symptoms using the Japan Stroke Scale-Depression (JSS-D) tool, optimism using the revised Life Orientation Test (LOT-R), and service quality using the SERVPERF model. Stepwise regression analysis was performed to identify factors that were significantly associated with CSSNS scores.Results：The mean CSSNS score of participants was 55.5 ± 8.3 points. Stepwise multiple regression analysis showed that M-FIM effectiveness (β＝0.48, p＜0.01) and SERVPERF scores (β＝0.48, p＜0.01) were significantly associated with CSSNS scores.Conclusion：This study revealed that favorable improvements in ADL and better service quality were associated with higher rehabilitation service satisfaction in convalescent stroke patients.

Purpose：This study investigated the factors associated with rehabilitation service satisfaction in convalescent stroke patients.Methods：This cross-sectional study included 41 participants (mean age 50.5 ± 9.3 years；73.2％ were male). Patients with severe cognitive impairment who were unable to respond to questionnaires were excluded from the study. At discharge, patient satisfaction was assessed using the Customer Satisfaction Scale based on Need Satisfaction (CSSNS) tool. We also evaluated physical function using the Stroke Impairment Assessment Set-Motor (SIAS-M) gain tool, activities of daily living (ADL) using the Motor-Functional Independence Measure (M-FIM) effectiveness tool, depressive symptoms using the Japan Stroke Scale-Depression (JSS-D) tool, optimism using the revised Life Orientation Test (LOT-R), and service quality using the SERVPERF model. Stepwise regression analysis was performed to identify factors that were significantly associated with CSSNS scores.Results：The mean CSSNS score of participants was 55.5 ± 8.3 points. Stepwise multiple regression analysis showed that M-FIM effectiveness (β＝0.48, p＜0.01) and SERVPERF scores (β＝0.48, p＜0.01) were significantly associated with CSSNS scores.Conclusion：This study revealed that favorable improvements in ADL and better service quality were associated with higher rehabilitation service satisfaction in convalescent stroke patients.

A 69-year-old woman complained of general malaise. Chest X-ray film revealed massive left-sided pleural effusion and CT detected a giant aneurysm of the aortic arch. A diagnosis of ruptured aortic arch aneurysm was made and she underwent total arch replacement as emergency surgery. The intraoperative diagnosis was not a ruptured arch aneurysm but an arch aneurysm penetrating into the left pulmonary artery. The postoperative course was uneventful and the patient was discharged home on the 16th postoperative day.

We report a successful case of aortic valve-sparing root replacement for dilated aortic root after a Ross procedure. A 29-year-old male underwent a Ross procedure when he was 11 years old for congenital aortic bicuspid valve. The right ventricular outflow tract was reconstructed using an autologous pericardium as a single leaflet valve. Aortic root dilatation and moderate aortic valve regurgitation were noted. Further investigation with enhanced computed tomography and ultrasonic cardiography revealed good quality of leaflets and sufficient geometric height, and aortic valve-sparing root replacement was performed. In addition, we performed pulmonary valve replacement with a biological valve. The post-operative course was uneventful and the patient was discharged after 8 days with a completely controlled aortic valve regurgitation. No recurrence of aortic valve regurgitation was observed 1 year later. Because surgical outcomes of congenital heart diseases have improved and more patients have an increasing life expectancy, several other problems were revealed, such as the occurrence of aortic root dilatation after a Ross procedure. Aortic roots may dilate due to arterial pressure; however, valve-sparing procedures may be performed if the volume of the leaflets is sufficient.