Effects of hot bathing on blood coagulation and fibrinolysis were studied in 35 patients with various diseases by measuring pulse rate and blood pressure and performing peripheral blood and hemostatic examinations before and after a 10-minute hot bath at 40 to 42°C.
Pluse rate increased significantly during the hot bath (p<0.001) However, no changes were observed in the results of blood pressure and perpheral blood examinations.
APTT, PT, fibrinogen, factor II, V, VII, VIII, IX, X, XI, XII, von Willebrand factor, prekallikrein, and antithrombin III were measured during coagulation examinations, but no significant changes were observed between those factors before and after hot bathing.
Although no significant changes were shown in plasminogen and antiplasmin during hot bathing, euglobulin lysis time (ELT) was significantly (p<0.001) reduced during the hot bath. It remains to be determined whether the reduction in ELT is due to the release of a tissue-type plasminogen activator from the vascular endothelial cells.
The reduction rate of ELT was studied in patients with each type of disease. The reduction rate of ELT in the patients with hypertension (HT) was larger than that in the patients without HT, and that in the patients with cerebral vascular accident (CVA) was also larger than that in the patients without CVA. However, the reduction rate of ELT in the patients with diabetes mellitus (DM) was smaller than that in the patients without DM. The patients with CVA, HT or DM are considered to have vascular damages. In the effect of hot bathing on fibrinolysis, however, there is a difference in reduction rate of ELT between patients with HT or CVA and those with DM.
This study indicates that pulse rate is increased during hot bathing and fibrinolysis is accelerated.

Objective: The mechanism underlying the development of neuropsychiatric symptoms such as unconsciousness, abnormal behavior, delirium, hallucinations, and convulsions in influenza has not been thoroughly investigated. The relationship between drug administration and neuropsychiatric symptoms during influenza is also poorly understood. This study is the first pharmacoepidemiologic study focused on investigating the relationship between drug administration and neuropsychiatric symptoms.
Design: Cohort study
Methods: Study subjects were patients under 18 years old who had influenza during the 2006/07 season. We prepared two kinds of questionnaires for doctor and for patient's family, and carried out the survey between January and March, 2007. Using data from 9,389 patients, we analyzed the relationship between neuropsychiatric symptoms, such as delirium, unconsciousness and convulsion, and drug administration of acetaminophen and oseltamivir.
Results: Analysis of the relationship between delirium and drug administration provided hazard ratios of 1.55(p=0.061)for acetaminophen and 1.51(p=0.084)for oseltamivir. These hazard ratios, which were adjusted for risk factors by multivariate analysis of the proportional hazard model, showed an increasing tendency of delirium after administration of each drug. In patients who received oseltamivir, a high incidence of delirium was observed between 6 and 12 hours after onset of fever. Furthermore, delirium was found to develop in a shorter time following oseltamivir use than it did after acetaminophen use. There was no relationship between unconsciousness and acetaminophen administration, as demonstrated by a hazard ratio of 1.06(p=0.839). The incidence of unconsciousness increased significantly with oseltamivir use with a hazard ratio of 1.79(p=0.0389), and unconsciousness was found to occur in a short time after oseltamivir use.
Conclusion: The results obtained from this study suggest that there are increased risks of delirium and unconsciousness with drug administration. Further pharmacoepidemiologic studies for hypothesis testing are required to study the relationship between abnormal behavior and drug administration.

　The objective of our study was to examine delays between onset of symptoms and treatment for malignant spinal cord compression （MSCC） and to investigate outcomes of neurological function. We performed a retrospective study of clinical records for 25 patients who had been diagnosed with MSCC at a regional center hospital. Thirteen patients had a history of malignancy at the onset of MSCC and 12 patients had no history. For most patients, pain was the first symptom of MSCC. Pain preceded neurologic symptoms by approximately 2 months. The median delays from onset of symptoms of MSCC to treatment were 49 days for all patients, 79 days for those without a history of malignancy and 41.5 days for those with a history of malignancy. It took 39 days from onset to consultation at the hospital, 7 days from consultation to diagnosis and 11 days from diagnosis to treatment. Neurological status was not exacerbated in 8 of 9 patients who had no other neurologic dysfunction at the time of treatment, while only 4 of 10 patients who had deterioration of motor or sensory function at the time of treatment showed improvement in neurological status. In conclusion, there were many delays in all processes from onset to treatment for MSCC and these delays resulted in poor outcome of neurological function.

A 76-year-old woman with a sudden onset of chest and back pain was admitted to our hospital. Computed tomography (CT) showed a giant thoracoabdominal aortic aneurysm. Therefore, the patient underwent emergency operation. Under a left anterolateral thoracotomy and pararectal laparotomy with left heart bypass, we performed graft replacement of the thoracoabdominal aorta and reconstruction of the celiac artery, superior mesenteric artery and renal arteries. The left lung was tightly adhered to the aneurysm because of the contained rupture. Copious pulmonary bleeding and air leakage occurred due to thrombectomy of the aneurysm. During the operation, critical air leakage was repaired using the remaining aneurysmal wall. The postoperative course was uneventful. The patient was discharged 16 days after surgery. Copious air leakage due to lung injury was a potentially life-threating condition in the postoperative course of this case of thoracoabdominal aortic aneurysm. Surgical treatment of critical air leakage due to lung injury is very important in thoracic surgery.

Congenital quadricuspid aortic valve is a very rare malformation. We report two cases with severe aortic regurgitation due to isolated quadricuspid aortic valve. It consisted of three equal cusps and one smaller cusp, which was identified at the time of valve replacement surgery for severe aortic regurgitation.

In a 63-year-old male patient Jehovah's witness, IABP was introduced due to acute myocardial infarction and cardiogenic shock, and PCI (BMS) was carried out to CAG #7 100%. Stent placement was carried out and his hemodynamics stabilized. A left-to-right shunt was observed upon carrying out LVG, so the patient was referred to our hospital for surgery purposes due to a diagnosis of ventricular septal perforation (VSP). Upon transferring the patient to hospital, his PA pressure elevated to 53 mmHg although the blood pressure was maintained, and no findings of right heart failure were observed. His respiratory condition was stable. Emergency surgery was considered, but the patient was taking Clopidogrel following PCI, and so VSP repair (extended endocardial repair) was carried out following 4 days discontinuation of Clopidogrel. Preoperative anemia was not observed ; however, postoperative hemorrhagic anemia improved due to iron preparation administration, and the patient was discharged from hospital 22 days following surgery without blood transfusion.

We report a rare case of primary cardiac angiosarcoma in the right atrium. A 47-year-old man was admitted to our hospital with cardiac tamponade. Echocardiography and computed tomography revealed a tumor in the right atrial cavity. We performed tumor resection to confirm the histological diagnosis, to prevent tumor embolism, and to increase the possibility of improving the prognosis. The tumor was resected with the right atrial wall and right pericardium. The right atrium was then reconstructed with a bovine pericardial patch. The pathological diagnosis was angiosarcoma. The patient survived only about 6 months after surgical resection, but there was no local recurrence. This report presents a very rare case of cardiac angiosarcoma associated with cardiac tamponade.

STUDY DESIGN: Retrospective study. PURPOSE: We experienced the situation wherein some patients had new-onset pain or dysesthesia around the ring and little fingers (C8 symptom) or ulnar aspect of the forearm (T1 symptom) after cervical laminoplasty (LP). We investigated the incidence and the cause of new C8 or T1 symptoms and the clinical outcomes after C3–C6 LP or C3–C7 LP. OVERVIEW OF LITERATURE: There were some reports regarding complications after cervical LP. However, there was no report regarding C8 or T1 symptoms after cervical LP. METHODS: Among the 33 patients enrolled in this study, 11 and 22 patients were treated with C3–C6 LP and C3–C7 LP, respectively. We prospectively evaluated C8 or T1 symptoms daily postoperatively for 1 week. The distance of the posterior spinal cord shifting and posterior subarachnoid space from C2 to T1 was measured by T2-weighted midsagittal magnetic resonance imaging (MRI). We evaluated pre- and postoperative axial neck pain, Japanese Orthopaedic Association (JOA) score, and JOA score improvement rate. RESULTS: C8 or T1 symptoms occurred in five and three patients with C3–C6 LP (45.5%) and C3–C7 LP (13.6%), respectively. The distance of the posterior subarachnoid space in C3–C6 LP at C7 was significantly shorter than that in C3–C7 LP at T1 on MRI 24 hours postoperatively (p=0.0448). Postoperative axial neck pain, pre- and postoperative JOA scores, and JOA score improvement rate were not significantly different. CONCLUSIONS: The incidence of C8 or T1 symptoms in C3–C6 LP was higher than that in C3–C7 LP. C8 or T1 symptoms would be caused by the posterior fila radicularia and spinal cord impingement on the intact lower end of the lamina.
Asian Continental Ancestry Group ; Fingers ; Forearm ; Humans ; Incidence ; Laminoplasty ; Magnetic Resonance Imaging ; Neck Pain ; Paresthesia ; Prospective Studies ; Retrospective Studies ; Spinal Cord ; Subarachnoid Space