A 55-year-old man presented with exertional dyspnea. He was found to have an incomplete atrioventricular septal defect (AVSD), mitral regurgitation, a patent foramen ovale (PFO), atrial fibrillation, and pectus excavatum. A one-stage operation including thoracoplasty in addition to the intracardiac repair was preferred in order to obtain a good view of the operative field and control the postoperative hemodynamics. Therefore, we performed autologous pericardial patch closure of the AVSD, mitral valve plasty with closure of the mitral cleft, direct closure of the PFO, and a modified maze procedure, followed by sternal elevation (modified Ravitch procedure) during chest closure. Postoperatively, his respiratory status on a respirator improved slowly and he was extubated on the 17th postoperative day. Dysphagia developed because of the prolonged intubation, but improved with deglutition rehabilitation. The subsequent postoperative course was uneventful and he was discharged on the 59th postoperative day. We performed a modified Ravitch procedure, instead of sternal turnover, because the latter requires exfoliating a broad area, which could increase the total blood loss and the risk of infection, and make it difficult to maintain the blood flow of the plastron. We obtained a good view of the operative field and stable hemodynamics postoperatively with sternal elevation in pectus excavatum accompanied by heart disease.

Purpose: Head and neck cancer patients receiving chemoradiation therapy often suffer from severe mucositis. Chemoradiation therapy-induced mucositis is usually accompanied by severe and intractable pain that impairs quality of life. To establish an effective method for treatment of mucositis pain, we retrospectively investigated the relationships of radiation dose with severity of mucositis and opioid consumption. We also conducted a survey on satisfaction of pain treatment. Methods: Study 1: Fourteen patients who underwent chemoradiation therapy of 70 Gy for head and neck cancer from 2005 to 2009 participated in the study. The relationship of severity of mucositis with opioid use was studied. Study 2: Seven patients who had mucositis of over grade 3 and had completed radiation therapy participated in the study. We carried out a questionnaire survey about satisfaction of each pain treatment. Results: Study 1: Increase of radiation dose significantly worsened the severity of mucositis. Opioid consumption for treating pain was significantly greater in the pharynx cancer group than in the oral cancer group. Study 2: Oral care treatment was preferred to systemic administration of analgesics including opioids. Conclusions: In the oral cancer group, oral care treatment was thought to be useful for pain treatment. Oral cancer patients needed less opioids than did pharynx cancer patients.

Objective: To investigate the factors that induce strong contractions during repetitive peripheral magnetic stimulation (rPMS) and compare the muscle torque induced by two stimulators (Stim A and Stim B) with different coil properties. Methods: rPMS was applied to the right vastus lateralis of 30 healthy young adults. Stim A contained a 10.1 cm2 rectangular iron core coil, while Stim B contained a 191 cm2 round coil. The knee extensor torque (KET) induced by rPMS at 30 Hz was measured isometrically and divided by the maximum voluntary contraction (MVC) to obtain a relative value of MVC (%MVC). KET at 100% intensity of Stim A (A100%, 1.08 T) was compared to those at 100% or 70% intensity of Stim B (B100%, 1.47 T vs. B70%, 1.07 T). Additionally, we conducted a comprehensive literature search for studies that measured the KET during rPMS. Results: Both the mean values of %MVC using B100% and B70% were significantly greater than that using A100%. Furthermore, the KET induced by Stim B was found to be larger than that described in previous reports, unless booster units were used to directly stimulate the main trunk of the femoral nerve. Conclusion Stim B induced a stronger muscle contraction force than Stim A did. This may be because the larger the coil area, the wider the area that can be stimulated. Additionally, a circular coil allows for deeper stimulation.