We report a case of metastasis to the right ventricle from uterine stromal sarcoma. A 61-year-old woman was admitted to our hospital because of abdominal pain due to gallbladder stones. Preoperative transthoracic echocardiography showed a tumor in the right ventricle and tricuspid regurgitation. The tumor was multilocular and had grown in the right atrium over the tricuspid valve. We performed tumor resection and tricuspid valve plasty. Postoperative transthoracic echocardiography showed the tricuspid regurgitation had resolved.

A 25-year-old woman with a history of atopic dermatitis was admitted to hospital with shortness of breath, high fever, cough, and bloody sputum. Chest X-ray showed a diffuse infiltrative shadow. We diagnosed pneumonia, and antibacterial therapy was started ; however, the treatment was ineffective. Echocardiography showed tricuspid endocarditis, and she was thus transferred to our hospital. We selected medical treatment because the case was complicated with severe lung abscesses and pulmonary failure. As a result of appropriate antibacterial medication for 4 weeks, her symptoms and lung abscesses were improved ; however, tricuspid regurgitation and right heart failure continued to worsen. Therefore, the patient underwent vegetectomy and tricuspid valve plasty. No perioperative pulmonary complication was observed. She continued to receive the same antibacterial treatment after 2 weeks. In preceding antibacterial treatment before surgical treatment, it is effective for tricuspid endocarditis complicated with severe lung abscess.

A 62-year-old woman who had suffered from malignant articular rheumatism since 2000 felt fatigue, exertional dyspnea and edema was admitted in May 2009. Cardiac catheterization demonstrated a dip-and-plateau pattern of the pressure curve of RV. Therefore we diagnosed constrictive pericarditis. She decided to have surgery as soon as possible. As she had also been troubled with constrictive pulmonary damage, chronic renal failure, and was taking an inotropic agent, we concluded that the use of extracorporeal circulation was risky. After median sternotomy, we recognized diastolic insufficiency of the heart due to hypertrophy of the epicardium. Using an ultrasonic scalpel and electrotome, we incised the thickened epicardium with a waffle procedure. The dip-and-plateau disappeared and as a result the cardiac index was improved immediately (1.9 l/min/m²→2.6 l/min/m²). She was discharged on postoperative day 25. In this way waffle procedure for constrictive pericarditis can an effective surgical procedure for a high risk patient.

Students and general long distance runners carried out 1600m run for 24 hours and their physical functions were measured with lapse of the relay. Following results were obtained.
1) Prolongation of mean running time of student long distance runners in 1600m runs appeared at about 8th-10th runs, 12.8-16.0km, but that of general long distance runners did at 5th-6th runs, 8-9.6km.
2) There was plus correlation between mean of running time and its standard deviation in 1600m runs. It was r=0.55 and its regression equation was Y=0.58X-162.3. But these of general long distance runners were r=0.53 and Y=0.358X-97.3, respectively.
3) Decreased body weight from 1st-8th run was great and succesive, and occupied about 30%-70% of final decreased body weight. Thereafter, increase or decrease of the body weight was repeated and the time course became slow. There were some runners who showed large and succesive decreased body weight with the runs through the competition. The decreased body weight during the competition was influenced by the wind velocity, which supressed it considerably.
4) Heart rate of a student long distance runner during 1600m run reached 180-189 beats per minute every run. Resting heart rate of general and student long distance groups showed circadian rhythm during the competition, but that of student runners was higher through the competition and their systolic pressure shows a tendency to below in later period of the competition.
5) Threshold of knee jerk was low in the initial few runs and thereafter showed circadian rhythm. Reaction time to light was also facilitated in the initial runs and there-after prolonged about 30msec and maintained till the end of the competition. Frequency of subjective symptoms increased with number of the runs. At middle of the competition, it came over Sakai's standard and the A, B and C symptoms at the end of the competition were 33.0%, 20.0% and 25.0%, respectively.
6) Calorie intake per day of the student long distance runners was in the range of 1240-2540Cal. Total energy consumption was estimated 7457Cal. per day.
7) Blood glucose of the student long distance runners mostly unchanged through the competition, but serum triglyceride and total phospholipids significantly decreased and inversely serum free fatty acids prolongly mobilized.

Introduction: The current author encountered a patient with end-stage bladder cancer who developed hyperammonemia and impaired consciousness. Case: A 90-year-old man had repeated bleeding from a bladder tumor, so a urethral catheter was placed. During admission to the Palliative Care Unit, impaired consciousness and hyperammonemia were noted. Liver metastasis was not noted. Urinalysis revealed alkaluria and ammonium magnesium phosphate crystals, so production of ammonia by bacteria with the ability to hydrolyze urea was suspected. Levofloxacin was inefficacious. As a result of administration of metronidazole, however, consciousness improved, blood ammonia levels returned to normal, urine was acidic, and ammonium magnesium phosphate crystals disappeared. The bacterium with the ability to hydrolyze urea could not be identified. Discussion: In patients with advanced or end-stage bladder cancer like the current patient, ammonia produced by bacteria with the ability to hydrolyze urea can cause hyperammonemia and impaired consciousness even if the urinary tract is unobstructed.

Four patients with fulminant myocarditis (two males and two females, age 21-67 years old) were examined during 1995-2001. Fulminant myocarditis was diagnosed based on clinical features, abnormal electrocardiographic and echocardiographic findings, and increased serum enzyme levels. In three of four cases, the diagnoses were confirmed histologically in autopsy. All four patients had flu-like symptoms and fever at the start. One patient died suddenly next day. Other three patients went into cardiogenic shock five and seven days after the onset of symptoms and hospitalized, and treated with temporary pacing, steroid pulse therapy, catecholamine (in all three patients) and percutaneous cardiopulmonary support : PCPS (in one patient), but they died within ten days. Electrocardigrams showed ventricular escape rhythm, ST elevation associated with Q wave, and low voltage of the QRS complex. Markedly increased serum enzyme levels, severe metabolic acidosis and disseminated intravascular coagulation were thought to be indicative of poor prognosis. Early recognition of cardiac involvement and using of PCPS without hesitation in an acute phase could improve the outcome of fulminant myocarditis.
Myocarditis ; Clinical ; Therapeutic brand of coal tar ; symptoms <1> ; Serum

As part of the outreach program of the Welfare Federation of Agricultural Cooperatives in Kumamoto Prefecture, ultrasonographic examinations for abdominal diseases were carried out in rural communities from the beginning of April 1986 to the end of March 1994. A total of 119, 172 people went through the abdomen checkup during the period. In this study, we reviewed the results of the examinations with respect to the followings.
The percentage of those examinees who were found to have some impairment increased from a range of 40% to upwards 50% during the period under review. Those who were told to receive followup examinations accounted for as high as 10% of the total initially, but the percentage dropped to 2. 9%. The percentage of those actually underwent followup examinations once fell to a range of 70%, but later rose to 85%. The rate of detection of malignancies went up steadily from 0. 08 to 0. 12% year by year.
To decrease the percentage of the patients having to receive followup examinations and to increase the malignancy detection ratio, it was deemed necessary to improve echographers' skills, and establish a nost-examination care/guidance system.

Adipose triglyceride lipase (ATGL) catalyzes the first step of triglyceride hydrolysis. The gene mutations cause neutral lipid storage disease with myopathy (NLSDM) and/or triglyceride deposit cardiomyovasculopathy (TGCV) . Here we give the first report on rehabilitation of a patient with NLSDM and TGCV. The 62-years-old patient was admitted to our hospital for rehabilitation for skeletal myopathy and rehabilitation for cardiac dysfunction (NYHA class Ⅲ , ejection fraction 20%) . He complaint of dyspnea during the activity of daily life and exercise torelance was low. Our rehabilitation program consisted of physical therapy, occupational therapy, nutrition and cardiac education. We had paid a special attention to the intensity of exercise (aerobic training and resistance training) due to the low cardiac function, energy dysfunction and myopathy. After rehabilitation for two months, muscle strength had increased and 6MWT, ATVO₂ had improved. Importantly, the reduction of dyspnea on exertion as well as the increase in exercise capacity are considered to have led to improvement of quality of life.

The difference in cardiopulmonary response between supine exercise and sitting exercise was assessed by the following protocols.
1) Cardiopulmonary exercise testing utilizing the ramp protocol with a bicycle ergometer (20 W/min) was performed by nine healthy Japanese men (mean age, 19.9 yr) in a sitting and a supine position. Oxygen uptake, heart rate and blood pressure were measured during the test. Blood was sampled in order to measure noradrenaline (NA) and angiotensin II (ANG II) in the resting control state and immediately after exercise.
2) Single-level exercise testing at 100 W was performed on another day. The cardiac index (CI) was computed from the cardiac output, which was measured using the dye-dilution method in the resting control state and during exercise.
The results were as follows:
1) Heart rate and blood pressure during exercise had a tendency to be lower in the supine position compared to the sitting position, although not significantly.
2) Anaerobic threshold (AT) was lower in the supine position than in the sitting position exercise, (18.3±2.6 ml/kg/min and 21.7±1.9 ml/kg/min, respectively) .
3) NA and ANG II in the supine position were slightly lower than in the sitting position.
4) At rest, the CI in the sitting position was significantly less than in the supine position; however, the CI during the 100 W exercises was the same in both the supine and sitting positions.
It is concluded that blood flow to active muscle during 100W exercise is lower in the supine than in the sitting position. This is thought to be due to changes in blood redistribution and lowered blood flow to active muscle in the supine position, creating a lower AT.

A rare surgical case of chronic expanding hematoma in the pericardial cavity is reported. A 78-year-old man had undergone coronary artery bypass grafting 2 years previously. He had suffered from general malaise, increasing shortness of breath and systemic edema from 18 months after the operation. Echocardiography revealed an intrapericardial mass compressing the cardiac chambers resulting in insufficiency of the ventricular expansion. Under extracardiopulmonary bypass and cardiac beating, resection of the mass and additional coronary artery surgery were implemented. The mass was encapsulated with thick fibrous membrane containing old degenerated coagula the bacterial culture of which was negative and was histopathologically diagnosed as chronic expanding hematoma. The patient's postoperative course was uneventful and symptoms with cardiac failure were relieved. There has been no recurrence for more than 18 months.