The purpose of this study was to analyze the socioeconomic factors influencing patient discharge destination and the length of their hospital stay. We investigated 83 consecutive stroke patients admitted to our rehabilitation ward between January 1 and December 31, 2008. The mean age was 68.1 years old, the mean length of stay was 86.1 days, and 57% were men. The outcome for this study was the patient discharge destination, defined as home or a nursing home type of facility. To examine the predictors of the discharge destination, we collected data including patient age, sex, total Functional Independence Measure (FIM) scores at discharge, ‘living alone’, ‘over 65 years old’, ‘requiring public assistance’, and ‘having a family member at home who requires nursing care’. In all, 69 patients were able to return home, and 14 patients were discharged to a nursing home type of facility. The home group showed a higher total FIM score (p<0.001). Logistic regression analysis showed that two factors, ‘living alone’ and ‘having a family member at home who requires nursing care’, adversely affected patient discharge to home. Also, the length of stay was longer among those patients who required public assistance (p<0.01). This study suggests that it is harder for patients to be discharged back to their homes who have these factors : ‘having a family member at home who requires nursing care’ and ‘living alone’. Additionally, having the patient characteristic of ‘requiring public assistance’ could prolong the length of hospital stay.

The influence of exercise on the endogenous levels of both β-endorphin (BE) and corticosteroid (CS) in the hypothalamus and plasma was examined in rats. F344 male rats, five weeks of age, were divided into three groups: involuntary exercised (IE), non-exercised (NE) and control (C) groups. Rats in the IE group were exercised every day for one hour at the speed of 20 m mm n for 7 to 28 days. After training, the hypothalamus and plasma were obtained from rats. BE levels in water soluble extracts of hypothalamus were examined by rat BE ELISA test kits; and CS contents in plasma was examined by RIA. The amount of BE in the hypothalamus obtained from rats in the IE group was much higher than that in the NE and C groups. Although there was no significant difference between rats exercised for 7, 14, and 21 days, BE levels in the hypothalamus from rats exercised for 28 days was significantly higher than for 7 days. The amount of BE in the hypothalamus of NE rats was nearly identical to that of C rats. On the other hand, there were no significant changes in plasma CS levels. These results may suggest that exercise, especially running, causes on increase in BE levels in the hypothalamus.

The influence of exercise on the endogenous levels of both β-endorphin (BE) and corticosteroid (CS) in the hypothalamus and plasma was examined in rats. F344 male rats, five weeks of age, were divided into three groups: involuntary exercised (IE), non-exercised (NE) and control (C) groups. Rats in the IE group were exercised every day for one hour at the speed of 20 m mm n for 7 to 28 days. After training, the hypothalamus and plasma were obtained from rats. BE levels in water soluble extracts of hypothalamus were examined by rat BE ELISA test kits; and CS contents in plasma was examined by RIA. The amount of BE in the hypothalamus obtained from rats in the IE group was much higher than that in the NE and C groups. Although there was no significant difference between rats exercised for 7, 14, and 21 days, BE levels in the hypothalamus from rats exercised for 28 days was significantly higher than for 7 days. The amount of BE in the hypothalamus of NE rats was nearly identical to that of C rats. On the other hand, there were no significant changes in plasma CS levels. These results may suggest that exercise, especially running, causes on increase in BE levels in the hypothalamus.

An 84-year-old man, who had been given a diagnosis of advanced aortoventricular block 2 years previously, underwent implantation of a pacemaker (PM) through the left subclavian vein. However, 7 months later a skin ulcer developed at the implantation site, but without any evidence of bacterial infection. Therefore, a PTFE-covered PM battery was reimplanted at the same site. Three months later, the skin ulcer recurred and he received a third implantation in the right side. However, another skin ulcer with infection developed in the right side. He was then transferred to our hospital for another PM reimplantation. We covered the battery and the entire lead with PTFE, then placed the PM lead directly into the cardiac muscle, and implanted the PM battery below the rectal muscle under general anesthesia. A patch test 4 months later revealed a positive reaction to nickel and silicon. Finally, we diagnosed pacemaker dermatitis. The patient has remained free of skin ulcers for over 1 year.

Background: Because generic medicines reduce the financial burden on patients and medical insurance providers, they become more popular year after year.  However, there are still few reports that analyze the efficacy and safety of generic medicines, especially in terms of their characteristics and side effects.
Methods: Paclitaxel is an antineoplastic frequently used with good results in the treatment of breast cancer, ovarian cancer, gastric cancer, and angiosarcoma, but fat solubility is high and various kinds of adverse events, such as myelosuppression and arthralgia, peripheral neuropathy, and alcohol hypersensitivity are known to develop.  We investigated the efficacy, characteristics, and the incidence of adverse events for the generic product of paclitaxel.
Results: Differences were found for the generic version in terms of the characteristics and preparation time.
Conclusion: The incidence of adverse events was not significant, suggesting that the generic version could be a reasonable substitute.

Carcinoma arising from the remnant of branchial epithelium or branchial cleft cyst is known as branchiogenic carcinoma. It is very rare, and its existence is a matter of controversy. We report a case of cystic carcinoma of the upper neck that fully met Martin's criteria for branchiogenic carcinoma. A 53-year-old male visited Tsurumi University Dental Hospital with a swelling on the left side of the neck. Three tumors were excised from the neck, and histopathology revealed squamous cell carcinoma in a cystic lesion. As metastatic carcinoma of the cervical lymph nodes was suspected, the appropriate clinical tests and imaging were performed to determine the possible presence of a primary tumor. However, no primary carcinoma was found. These findings suggest that this was a case of branchiogenic carcinoma. The patient was treated with radiotherapy and followed up over an 8-year period. No evidence of recurrence was found.

A 3-month-old girl of univentricular heart of left ventricular type with atresia of left atrioventricular valve (LAVV) and coarctation of the aorta (Co/AO) is presented. UCG and angiography revealed concordant AV connection with straddling RAVV with transposed great arteries [SDDT]. The following pressures (in mmHg) were noted on catheterization: RA mean 1 (a=3, v=1), LA mean 12 (a=17, v=14), LV 84/0/8, Ao 81/41, and PA 74/39. Patent foramen ovale (PFO) was restrictive and balloon atrioseptostomy was not feasible. Blalock-Hanlon atrial septectomy (8×6mm), subclavian flap aortoplasy (SFA) and pulmonary arterial banding were performed simultaneously under bilateral thoracotomy. Acute renal failure occurred after surgery and the girl required peritoneal dialysis for 5 days. At 6 months after surgery, girl is doing well. There will be a predictable fall in pulmonary vascular resistance after atrial septectomy and SFA with a ligation of PDA may result transient increase in systemic resistance. Therefore, atrial septectomy and SFA in conjunction with pulmonary arterial banding should be done simultaneously.

There is still considerable risk when performing anastomotic procedures in the aorta and artificial vessels. The wrapping method is occasionally used as an alternative to solve the problems of hemostasis and reinforcement of the anastomotic portion, however, few data are available on the results of long-term follow up after anastomosis in this area. To define the long-term results for the wrapping method, we evaluated changes in the vascular walls of set intervals. The purpose of this study was to analyze the influence of technical factors and to sutisfy the prerequisites for an ideal wrapping method. A total of 26 mongrel dogs of both sexes were used in this study. We examined changes of the aortic walls microscopically of set intervals after a wrapping method using woven Dacron materials for 4 weeks and 4 months. Another 2 groups (Mesh group and E-PTFE group) were also included in this study. The cause of thinning phenomena of the aortic walls appears to be compression of the anastomotic portion. Wrapping materials resulting in excessively small diameters may cause deleterious compressions of the anastomotic site. Wrapping methods with materials ensuring a larger diameter may play an important role after anastomotic operations for reinforcement and hemostasis.

A 72-year-old man who suddenly felt an excessive thirst and developed pollakisuria and high fever on Sept. 29, 2001. A general practitioner initially diagnosed him as having urinary tract infection on the same day. Vomiting and unconscionsnes occurred on Oct. 3. He was brought to our hospital by ambulance. Laboratory data on admission showed plasma glucose of 1110 mg/dl, blood pH of 7.167 and HCO3- of 7.6mmol/L, and positive urinary ketone bodies, compatible with diabetic ketoacidosis. Serum amylase was elevated, but he had no symptoms of acute pancreatitis. Insulin therapy was started immediately and hyperglyvemia was improved. He has never had diabetes mellitus and his HbA1c was normal (5.3%). His urinary C-peptide was very low (2.4 μg/day) and diabetes-related autoantibodies including anti-GAD, IA-2 antibodies and ICA were negative. So his case was diagnosed as fulminant type 1 diabetes mellitus. Fulminant type 1 diabetes, which has been brought to light by Dr Imagawa’s group, is characterized by near-nomal HbA1c despite diabetic ketoacidosis, rapid loss of insulin secretion and absence of diabetes-related autoantibodies.Great care is needed to recognize the patients with fulminant type 1 diabetes among the elderly with symptoms of urinary tract infection. Here, we reported the case of an aged man who developed aypical fulminant type 1 diabetes.
Diabetes Mellitus, Insulin-Dependent ; Diabetes Mellitus ; symptoms <1> ; Type 1 ; Urinary tract infection

A 20-year-old man suddenly complained of back pain and bilateral lower limb weakness. Computed tomography showed acute type B aortic dissection. The patent false lumen extended from distal arch to the left common iliac artery. The true lumen was severely compressed by the false lumen and both legs were ischemic. He underwent emergency fenestration of the abdominal aorta and stenting of the left iliac artery. Although the lower limbs ischemia was improved, he developed myonephropathic metabolic syndrome and received plasma exchange, continuous hemodialysis and endotoxin absorption therapy. Thirteen days after the operation, intestinal ischemia occurred and he underwent emergency bowel resection with creation of a stoma. Development of dissection to the superior mesenteric artery (SMA) and the malperfusion of SMA by severe compression of the true lumen were thought to cause intestinal ischemia.