The mitral-aortic intervalvular fibrosa (MAIF) is a fibrous skeleton between the mitral and aortic valves. We describe a case of a pseudoaneurysm of MAIF (MAIFPsA) 3 months after an aortic valve replacement. A 75-year-old man had undergone aortic valve replacement using a bioprosthesis (SJM Trifecta 23 mm). He developed congestive heart failure 3 months after surgery. Trans-esophageal echocardiography and multi-detector computed tomography detected a MAIFPsA and severe paravalvular leakage. The patient underwent a new operation. After the aortic prosthesis was removed, an orifice of the pseudoaneurysm, which was composed of the anterior mitral leaflet and the aortic annulus, were revealed. The defect was repaired with a bovine pericardial patch, sutured to the anterior mitral leaflet and aortic annulus. A new bioprosthesis (Carpentier-Edwards PERIMOUNT 21 mm) was implanted in the supra-annular position. His postoperative course was uneventful.

Objective: The sports community has placed its great hope on pharmacist since the establishment of the Accredited Sports Pharmacist System.  Thus, we constructed an anti-doping database for pharmacist so that pharmacist can support appropriate drug use and contribute to the sports community.
Methods: The database was constructed by using Microsoft®Access 2007, based on our previously prepared anti-doping list.
Results: 686 prescription drugs and 268 ingredients for non-prescription drug were registered in the data base.  It was able to retrieve the advisability of use for athlete, blood half-life and the other notes of the drugs easily and promptly.
Conclusion: We confirm that pharmacist can provide drug information easily, promptly and from the viewpoint of pharmaceutics by utilizing the database including necessary information for anti-doping.

Purpose : The aim of this study is to investigate inpatient rehabilitation outcomes in different ischemic stroke disease types. Subjects and methods : Subjects were 178 patients with ischemic stroke transferred from stroke units or emergency units for inpatient rehabilitation at Kami-iida Rehabilitation Hospital. For all patients, National Institutes of Health Stroke Scale (NIHSS) scores were measured on admission. Functional Independence Measure (FIM) scores were also measured both on admission and discharge, and FIM-gain (FIM-g) and FIM-efficiency (FIM-e) values were calculated. The disease types of ischemic stroke were : lacunar (LI) in 16 patients ; atherothrombosis (AI) in 23 ; branch-atheromatous-disease (BAD) in 59 ; artery to artery embolism (A to A) in 18; cardiogenic embolism (CE) in 34 ; undetermined embolism (unable to differentiate from A to A and cardiogenic embolism) in 22 ; the 6 remaining patients were not categorized. Results : There were no significant differences in the NIHSS scores and FIM scores on admission between disease types except for the NIHSS scores in the LI patients. The FIM-e value in A to A patients was significantly lower than those in other types (p<0.05). Moreover, A to A patients have a tendency of severe leukoaraiosis and their MRAs demonstrated high rates of stenosis (≥50%) or occlusion with intracranial arteries. Conclusion : In A to A embolism, significantly lower FIM-e values were found and FIMs at discharge were affected by leukoaraiosis on the basis of large-vessel arteriosclerosis. Our study revealed that inpatient rehabilitation outcomes differed for each ischemic stroke type and appeared to be influenced by leukoaraiosis.

This experimental study was conducted to histopathologically determine whether the low-dose irradiation of donor hearts before transplantation can inhibit graft vasculopathy. Immediately after donor F 344 rat hearts were removed, they were treated with a single dose of radiation using 7.5Gy, 15Gy, or no radiation (control group). The F 344 hearts were transplanted into Lewis rats heterotopically, and cyclosporine A was injected intramuscularly for 20 days after transplantation in all groups. The hearts were harvested 90 days after transplantation, and examined for intimal thickening using elastica van Gieson staining. Severe intimal thickening was observed in both the irradiated groups, the percent intimal area of the coronary arteries was significantly increased in both these groups, to 34.3±12.9 in the 7.5Gy group and 37.0±8.9 in the 15Gy group, compared with 23.1±9.8 in the control group (p<0.01). In conclusion, these findings show that low-dose irradiation to donor hearts before transplantation does not inhibit graft vasculopathy.

Case 1 was a 42-year-old woman who was admitted because of infective endocarditis. Pulmonary embolism occurred during medical treatment for infective endocarditis. Despite the acute infectious phase, surgical treatment was successfully performed. Case 2 was a 50-year-old man who was admitted because of infective endocarditis. Cardiac catheterization showed ventricular septal defect and atrial septal defect. Surgical treatment was performed successfuly. In both cases, and the postoperative courses were unventful.

Six cases without aortic reconstruction for 48 hours were encountered among 22 cases of Stanford type A acute aortic dissection from April, 1990 to July, 1996. They were one man and five women, with a mean age of 60.3 years old (from 52 to 82 years old). According to Hagiwara's definition, acute thrombotic aortic dissection (ATAD) was observed in four and acute opacified aortic dissection (AOAD) in two of six cases of Stanford type A acute aortic dissection without aortic reconstruction. One of the four ATAD cases was well-controlled by medical therapy, but the others could not be controlled and underwent aortic root reconstruction within 1 month. Two AOAD patients died due to rupture within 1 month. It is said in general that the patients with acute thrombotic aortic dissection can be treated medically, but we consider that they should be treated surgically because of the frequency of late rupture.

Background: On receiving chemotherapy, extravasation of drugs is a severe problem. The extravasations occur more commonly in patients who are elderly, have a poor performance status, have diabetes mellitus complications or have repeatedly received chemotherapy. Also, cancer patients usually require repeated venous punctures for this treatment. Purpose and methods: For the purpose of evaluating the efficacy and safety of peripherally inserted central catheters (PICCs) for intravenous chemotherapy, we retrospectively reviewed all the cancer patients for whom PICC were inserted for chemotherapy from April 2008 to December 2010. Patients' background, duration of PICC insertion and complications were evaluated in this study. Results: Ten patients (male 4, female 6) were reviewed in this study. The median age was 59 years (17∼69). A total of 13 PICCs were inserted in 10 patients. The most common underlying disease was abdominal rhabdomyosarcoma (n=3, 30%) followed by lung cancer (n=2, 20%) and hematologic tumor (n=2, 20%). The average catheter span was 46 days. Catheter-related infections were seen in 2 cases (15.4%). No phlebitis or thrombosis usually associated with venous route was detected in PICC used for chemotherapy. Conclusions: PICC might reduce patients' discomfort such as repeated venous punctures or complications associated with chemotherapy. We suggest that PICC would be one of the effective tools in chemotherapy. Palliat Care Res 2011; 6(2): 233-236

Background/Aims: Many Japanese institutions use electromagnetic extracorporeal shock wave lithotripsy (ESWL) systems for treating pancreatic duct stones. However, there are no reports on direct comparisons between recent electromagnetic lithotripters. This study aimed to verify whether the new electromagnetic lithotripter can improve the efficiency of pancreatic stone fragmentation, and to clarify the role of combined endoscopic treatment on the clearance of pancreatic duct stones. Methods: We retrospectively identified 208 patients with pancreatolithiasis who underwent endoscopic adjunctive treatment after pancreatic ESWL at a single Japanese center over a 17-year period. We evaluated the outcome data of this procedure performed with SLX-F2 (last 2 years; group A) and Lithostar/Lithoskop (first 15 years; group B), as well as additional endoscopic treatments for pancreatolithiasis. We also performed logistic regression analysis to detect various factors associated with the procedure. Results: For pancreatic head stones, ESWL disintegration was achieved in 93.7% of group A patients and 69.0% of group B patients (p=0.004), and adjunctive endoscopic treatment removed stones in 96.8% of group A patients and 73.0% of group B patients (p=0.003). Multivariate analysis revealed that lithotripter type (odds ratio, 6.99; 95% confidence interval, 1.56 to 31.33; p<0.01) and main pancreatic duct stricture (odds ratio, 2.87; 95% confidence interval, 1.27 to 6.45; p<0.01) were significant factors for ESWL fragmentation. Conclusions The SLX F2 showed high performance in fragmenting the pancreatic duct stones.In addition, endoscopic adjunctive treatment improved the overall success rate of the procedure. The improved ESWL lithotripter has many advantages for patients undergoing pancreatic lithotripsy treatment.

Background/Aims: Endoscopic evaluation of intraductal papillary mucinous neoplasms (IPMNs) is useful in determining whether the lesions are benign or malignant. This study aimed to examine the usefulness of peroral pancreatoscopy (POPS) in determining the prognosis of IPMNs. Methods: POPS with videoscopy was performed using the mother–baby scope technique. After surgery, computed tomography/magnetic resonance cholangiopancreatography or ultrasonography and blood tests were performed every 6 months during the follow-up. Results: A total of 39 patients with main pancreatic duct (MPD)–type IPMNs underwent POPS using a videoscope, and the protrusions in the MPD were observed in 36 patients. The sensitivity and specificity of cytology/biopsy performed at the time of POPS were 85% and 87.5%, respectively. Of 19 patients who underwent surgery, 18 (95%) patients had negative surgical margins and 1 (5%) patient had a positive margin. Conclusions In IPMNs with dilatation of the MPD, POPS is considered effective if the lesions can be directly observed. The diagnosis of benign and malignant lesions is possible depending on the degree of lesion elevation. However, in some cases, slightly elevated lesions may increase in size during the follow-up or multiple lesions may be simultaneously present; therefore, careful follow-up is necessary.

Background/Aims: Bleeding is a complication of endoscopic snare papillectomy for ampullary tumors. This study aimed to investigate the clinical efficacy of hypertonic saline-epinephrine (HSE) local injection before endoscopic papillectomy for prevention of bleeding. Methods: We retrospectively reviewed the data of 107 consecutive patients with ampullary tumors who underwent endoscopic papillectomy. The rates of en bloc resection, pathological resection margins, and prevention of immediate or delayed bleeding in the simple snaring resection group (Group A) and the HSE injection group (Group B) were compared. Results: A total of 44 and 63 patients were enrolled in Groups A and B, respectively. The total complete resection rate was 89.7% (96/107); the clinical complete resection rates in Group A and Group B were 86.3% (38/44) and 92.1% (58/63), respectively (p=0.354). Post-papillectomy bleeding occurred in 22 patients. In Groups A and B, the immediate bleeding rates were 20.5% (9/44) and 4.8% (3/63), respectively (p=0.0255), while the delayed bleeding rates were 7% (3/44) and 11% (7/63), respectively (p=0.52). The rates of positive horizontal and vertical pathological margin in both groups were 27% and 16%, respectively. Conclusions HSE local injection was effective in preventing immediate bleeding and was useful for safely performing endoscopic papillectomy for ampullary tumors.