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.

Background : A vitamin K₂ agent has recently been approved and is going to be marketed for the treatment of osteoporosis. Since vitamin K₂ agents are known to cause rebound of blood coagulation capacity lowered by an anticoagulant warfarin, a great caution is necessary for the concomitant use of these agents.
Objective and Design : A drug utilization survey to examine the use of warfarin and drugs for osteoporosis.
Methods : Fukui Medical School Database was surveyed to identify patients who used warfarin and/or drugs for osteoporosis during the period between January 1, 1988 and July 31, 1995. Patients with a diagnosis osteoporosis made between December 1, 1983 and July 31, 1995, were also identified and their prescription data were extracted to examine the combined use of warfarin and drugs for osteoporosis. In addition, 53 outpatients with cardiovascular diseases were interviewed to know the treatments and medications given by other clinics.
Results : Concomitant drug therapy for osteoporosis was given to 6.9% (56/813) of warfarin users. The proportion of concomitant use was 15% (36/234) in women, much higher than 3.5% (20/579) in men. More than 10% of the interviewed patients were receiving some treatments in other orthopedic clinics for osteoporosis or other diseases but few patients were aware of their medication.
Conclusion : Old female users of warfarin, especially those having osteoporosis concomitantly, are likely to berome a high risk group for the possible interaction between warfarin and the vitamin K₂ agent. Useful information on the safety associated with the interaction between these two drugs should be given to this group of patients as well as to the prescribers and dispensers.

OBJECTIVETo identify the ankyrin-B gene mutations that cause long QT syndrome (LQTS) and determine the prevalence of such mutations in Japanese patients with LQTS.

METHODSWe conducted a search for ankyrin-B gene mutation in 78 unrelated patients with LQTS (28 males and 50 females, aged 2 to 89 years). With informed consent from all the subjects and/or their parents, genomic DNA was purified from the white blood cells of the patients and amplified using polymerase chain reaction (PCR). Single-strand conformational polymorphism (SSCP) analysis of the amplified DNA was performed to screen for mutations and aberrant SSCP products were isolated and sequenced by dye terminator cycle sequencing method using an automated fluorescent sequencer. PCR and restriction fragment length polymorphism (PCR-RFLP) analysis was carried out to further confirm the missense mutations by comparison with samples from 150 normal healthy individuals.

RESULTSWe identified a T to A transition mutation at position 4,603 in exon 40, resulting in the substitution of arginine for a tryptophan at amino acid residue 1,535 (W1535R) in the regulatory domain of 220-kD ankyrin-B, which is a highly conserved domain shared by different species.

CONCLUSIONThis novel missense mutation in the ankyrin-B gene may be a cause of type 4 LQTS. Ankyrin-B gene mutation might not play the major role in LQTS in Japanese.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Amino Acid Substitution ; Ankyrins ; genetics ; Base Sequence ; Child ; Child, Preschool ; Exons ; Female ; Humans ; Long QT Syndrome ; genetics ; Male ; Middle Aged ; Molecular Sequence Data ; Mutation, Missense ; Point Mutation

Objective : The objective of this study was to assess the safety and efficacy of left atrial appendage (LAA) amputation during cardiovascular surgery. Methods : Fifty-seven patients underwent LAA amputation using a stapler from 2016 to 2017. The presence of remnant LAA was estimated by transesophageal echocardiography (TEE). Results : All LAA amputations were performed with the heart beating, without collapse. Additional amputation for remnant LAA was required in 14 patients. Sutures were needed to control bleeding in 7 patients. There was one case in which the coronary artery ended up being clamped with the LAA. The average duration for LAA amputation was 6.1±3.2 (1.5-15.2) min. There were 25 cases with postoperative atrial fibrillation (POAF), one case of cerebral infarction without POAF and one case of re-exploration for bleeding. Three patients died during hospitalization. Conclusion : LAA amputation using a stapler does not require cardiac arrest, and rarely requires an extended operation time. However, sufficient caution is required as there is the possibility that the coronary artery is obstructed and that remnant LAA is present.

BACKGROUND: Food allergy (FA) is a common disease in children, and its prevalence has increased in developed countries. The impact of overweight on children health also becomes an important social problem. However, the relationship between overweight and FA is still unclear. We examined the association between overweight and the prevalence of FA among Japanese children. METHODS: We analyzed data obtained using a self-administered questionnaire from 1772 Japanese children. Weight groups according to body mass index cutoff points proposed by the International Obesity Task Force were used to create two groups: overweight and non-overweight. Children were separated into four age groups (3-6 years, 6-9 years, 9-12 years, and 12-15 years) to examine age differences. We performed univariate and multivariate logistic models to examine the association between overweight and FA. RESULTS: The prevalence of FA was significantly higher in boys (10.6%, p = 0.014) than girls (4.5%) and girls (7.9%, p = 0.012) than boys (2.5%) for 6-9 and 12-15 age groups, respectively. While the prevalence of FA was significantly higher in overweight than non-overweight girls (26.1%, p = 0.005) in the 12-15 age group, no significant difference was found in boys. In girls, overweight was significantly associated with FA after adjustment for age and asthma (odds ratio 1.99, 95% confidence interval 1.01-3.89, p = 0.046). CONCLUSIONS Our results showed that being overweight was significantly associated with a higher prevalence of FA in girls, but not in boys. Further prospective studies are necessary to find the causal relationship between overweight and FA.
Adolescent ; Body Mass Index ; Child ; Child, Preschool ; Cross-Sectional Studies ; Female ; Food Hypersensitivity/epidemiology* ; Humans ; Japan/epidemiology* ; Male ; Overweight/epidemiology* ; Prevalence ; Sex Factors

BACKGROUND: An increase in cardiovascular diseases has been reported following major disasters. Previous work has shown that ultrasonographic findings from ultrasound cardiography examination (UCG) increased until the 44th month after the tsunami caused by the Great East Japan Earthquake. The present study conducted UCG among victims in the tsunami disaster area and investigated the frequency of disaster-related cardiovascular diseases and changes over time until the 55th month after the disaster. METHODS: The subjects were residents of temporary housing complexes and neighboring housing in Watari-gun, Miyagi Prefecture, Japan. There were 207 subjects in the 18th month, 125 in the 30th month, 121 in the 44th month, and 106 in the 55th month after the disaster. Data were collected through UCG and self-report questionnaire. RESULTS: Significant changes were observed among subjects with clinical findings from the UCG, which increased over the study period-from 42.0 to 60.8, 72.7, and 73.6% beginning in the 18th month after the disaster (p < 0.0001). CONCLUSIONS: It is possible that the UCG can become a useful examination to visualize the potential impact of a major disaster on the cardiac function of victims. Victims with clinical findings continued increasing not only during the acute phase after a disaster but also in the long term. We therefore need to keep this in mind, and note that it is important to establish a support system to control cardiovascular diseases from the early stage of disaster. TRIAL REGISTRATION UMIN; ID000029802. R000034050 . 2 November 2017.
Aged ; Aged, 80 and over ; Cardiovascular Diseases ; diagnosis ; diagnostic imaging ; Case-Control Studies ; Disasters ; statistics & numerical data ; Earthquakes ; Female ; Health Behavior ; Humans ; Japan ; Male ; Middle Aged ; Tsunamis