We report a rare case of a giant celiac aneurysm complicated with nosocomial acute aortic dissection and idiopathic thrombocytonenic purpura (ITP). A 75-year-old man with ITP complained of abdominal swelling. Enhanced computed tomography (CT) showed a giant celiac aneurysm 72 mm in size. Surgery repair was scheduled and platelet count increased by intravenous administration of immunoglobulin. After admission, he complained of back pain. CT showed aortic dissection (DeBakey classification : IIIb) and a celiac aneurysm enlarged to 78 mm. He underwent surgical repair for a giant celiac aneurysm and splenectomy after management with medial therapy.

Introduction  The purpose of this study was to identify risk factors related to the mental health of technical intern trainees from the Philippines in Japan, which focus on the relationship between their acculturation strategies and mental health.Method  Mental health, acculturation strategies, acculturative stress, job stress, social support and demographic factors including Japanese language proficiency were used for the variables in the English version of self-administered questionnaire. A total of 180 (115 men, 47 women and 16 gender unreported) Filipino technical intern trainees participated in this study. The data of 132 (95 men, 37 women) participants who completely answered the questionnaires were analyzed.Results  Results showed that gender, marital status, existence of children, Japanese language proficiency, acculturation strategies and acculturative stress were significantly related to the mental health of Filipino technical intern trainees. Results also showed that social support was significantly related to Japanese language proficiency and acculturation strategies for acquisition of Japanese culture. Conclusions  Findings suggest that factors contributing to the worsening of mental health of Filipino technical intern trainees are (a) being male, (b) existence of a child/children, (c) single marital status, (d) low Japanese language proficiency, (e) low acquisition of Japanese culture, and (f) high acculturative stress. Findings also suggest low levels of social support are risk factors related to low Japanese language proficiency and low acquisition of Japanese culture. Support programs for improvement in Japanese language skill and familiarizing with Japanese culture may be an effective way to maintain positive mental health in Filipino technical intern trainees. In addition, an establishment of environment to be able to easily and adequately receive psychological support from their family members living in the Philippines may be important to their mental well-being.

Introduction  The purpose of this study was to identify risk factors related to the mental health of technical intern trainees from the Philippines in Japan, which focus on the relationship between their acculturation strategies and mental health.Method  Mental health, acculturation strategies, acculturative stress, job stress, social support and demographic factors including Japanese language proficiency were used for the variables in the English version of self-administered questionnaire. A total of 180 (115 men, 47 women and 16 gender unreported) Filipino technical intern trainees participated in this study. The data of 132 (95 men, 37 women) participants who completely answered the questionnaires were analyzed.Results  Results showed that gender, marital status, existence of children, Japanese language proficiency, acculturation strategies and acculturative stress were significantly related to the mental health of Filipino technical intern trainees. Results also showed that social support was significantly related to Japanese language proficiency and acculturation strategies for acquisition of Japanese culture. Conclusions  Findings suggest that factors contributing to the worsening of mental health of Filipino technical intern trainees are (a) being male, (b) existence of a child/children, (c) single marital status, (d) low Japanese language proficiency, (e) low acquisition of Japanese culture, and (f) high acculturative stress. Findings also suggest low levels of social support are risk factors related to low Japanese language proficiency and low acquisition of Japanese culture. Support programs for improvement in Japanese language skill and familiarizing with Japanese culture may be an effective way to maintain positive mental health in Filipino technical intern trainees. In addition, an establishment of environment to be able to easily and adequately receive psychological support from their family members living in the Philippines may be important to their mental well-being.

PURPOSE: Ticlopidine hydrochloride, an antiplatelet agent, is believed to have saved life years in many patients with ischemic cerebral vascular diseases in Japan. But severe adverse events have also been reported. The current investigation aimed to compare two hypothetical cohorts treated with and without ticlopidine in terms of risks and benefits of ticlopidine treatment using Markov model.
METHODS: We conducted Markov decision analysis to estimate the number of lives saved and the increase in quality-adjusted life years (QALYs) over the past 20 years by ticlopidine in Japan. Two cohorts of 60-year-old male patients with previous histories of cerebral infarction, one of which treated with ticlopidine and the other not treated with ticlopidine, were compared with respect to the number of deaths and quality of life (QOL) . Data incorporated were the probabilities of the recurrence of cerebral infarction and the associated mortality, adverse events of the drug, and the utility of health status treated with ticlopidine.
RESULTS: Approximately 1, 630, 000 patients were estimated to be on ticlopidine for variable periods of time during the past 20 years in Japan. With treatment, 17, 130 lives were saved, while 1, 338 patients died because of cerebral bleeding, agranulocytosis, severe hepatic dysfunction, or thrombotic thrombocytic purpura, resulting in a net benefit of 15, 792 lives saved by ticlopidine over the past 20 years. In terms of QOL, there was a total increase of 382, 191 QALYs. Sensitivity analyses showed that the older the patients when ticlopidine therapy was started, the smaller the benefits that were gained by treatment.
CONCLUSIONS: Ticlopidine is considered to have made a great contribution in savingmany lives and improving QALYs in the past 20 years in Japan. This kind of analysis based on Markov model can be employed to demonstrate effectiveness of drugs and medical technologies in terms of population health outcomes.

The maintenance of life-supporting systems, such as respirators, has been the responsibillity of the central management unit since December 1991. The in-house unit was set up to ensure a high-quality level of maintenance and safety of medical equipment.
We analyzed the incidence of trouble with respirators between 1995 and 1999, based on the logs of the machines and check lists. Fifty-one percent of the incidence was found by medical engineers while they were making their rounds of inspection in the wards, thirty-four percent during periodical checkups at the central safety management unit, and fifteen percent upon request for examination. The faults in warmers and humidifiers attached to the respirators were found only at the wards or upon request for examination. The causes of trouble in the respirators were mechanical failures rather than human error. The mechanical factors was responsible for the incidence 2.9 times as much as human factors. The incidence of trouble associated with the warmers and humidifiers notably dropped after the types of instruments were unified in 1997. To ensure safety, we came to the conviction that the dual check system-the regular inspection at the central safety management unit and the engineers' rounds of inspection-is very effective. The selection of appropriate instruments was also important.

Since MR angiography (MR) can demonstrate the whole brain arterial system without introduction of contrast medium, it is very useful in screening for aneurysm, AVM and vascular occlusion in outpatients.
There are two methods in MRA-subtraction and non-subtraction methods (time of flight, TOF).
The magnetization transfer contrast (MTC) technique can demonstrate smaller vessels and slower blood flow than any conventional TOF-MRA.
Compared with the subtraction MRA, the MTC-TOF-MRA demonstrates smaller vessels clearly in a shorter time. By Gd-enhancement, the image of the arterial system can be also improved on the MTC method.

Background: We evaluated decreases in glycosylated hemoglobin (HbA1c) achieved by reducing carbohydrate from various sources in type 2 diabetes mellitus patients. Methods: We followed up 138 male and 107 female outpatients on a moderate low-carbohydrate diet without diabetic medication for 6 months. Changes in carbohydrate sources (Δcarbohydrate) were assessed from 3-day dietary records at baseline and 6 months, and associations with changes in HbA1c (ΔHbA1c) were examined with Spearman’s correlation coefficients (rs) and multiple regression analysis. Results: ΔHbA1c was –1.5%±1.6% in men and –0.9%±1.3% in women, while Δtotal carbohydrate was –115.3±103.7 g/day in men and –63.6±71.1 g/day in women. Positive associations with ΔHbA1c were found for Δtotal carbohydrate (rs =0.584), Δcarbohydrate from soft drinks (0.368), confectionery (0.361), rice (0.325), bread (0.221), Chinese soup noodles (0.199) in men, and Δtotal carbohydrate (0.547) and Δcarbohydrate from rice (0.376) and confectionery (0.195) in women. Reducing carbohydrate sources by 50 g achieved decreases in HbA1c of 0.43% for total carbohydrate, 1.33% for soft drinks, 0.88% for confectionery, 0.63% for bread, 0.82% for Chinese soup noodles and 0.34% for rice in men and 0.45% for total carbohydrate, 0.67% for confectionery and 0.34% for rice in women, although mean reductions in carbohydrate from these sources were much smaller than that from rice. Conclusion Decreases in HbA1c achieved by reducing carbohydrate from soft drinks, confectionery, bread and Chinese soup noodles were 2- to 4-fold greater than that for rice. Our results will enable patients to decrease HbA1c efficiently (UMIN000009866).

We evaluated decreases in glycosylated hemoglobin (HbA1c) achieved by reducing carbohydrate from various sources in type 2 diabetes mellitus patients.

We evaluated decreases in glycosylated hemoglobin (HbA1c) achieved by reducing carbohydrate from various sources in type 2 diabetes mellitus patients.

No abstract available.
Breast* ; Female ; Mammaplasty*