A 66-year-old man underwent percutaneous transcatheter ablation of the myocardium to treat chronic atrial fibrillation. Fifteen days after the procedure, he visited our hospital with a chief complaint of hematemesis. At that time, upper gastrointestinal endoscopy led to a diagnosis of esophageal ulcer. Oral food intake was suspended for approximately 1 month. Subsequently, 4 days after resumption of oral intake, he developed multiple cerebral infarcts. Moreover, massive hematemesis occurred, with resultant shock and cardiopulmonary arrest. At this point, a definitive diagnosis of left atrio-esophageal fistula resulting from the injury relating to the transcatheter ablation was made. Cardiopulmonary resuscitation was carried out, followed by emergency surgery. The operation was performed via median sternotomy and was done under cardiac arrest using complete extracorporeal bypass, and the fistula in the posterior left atrial wall and the middle esophagus were directly sutured for closure. Unfortunately, 3 days after this open heart surgery, the patient died from low cardiac output syndrome and multiple organ failure. Although rare, this complication may be fatal when it develops then its prevention is important. Once atrio-esophageal fistula develops after percutaneous transcatheter ablation, immediate surgical intervention seems essential.

A 65-year-old man presented to our hospital with a chief complaint of hoarseness. Chest radiography and computed tomography detected a right subclavian artery aneurysm. The aneurysm had a maximum diameter of 85 mm, and was associated with a mural thrombus and displacement of the trachea to the left, which led to airway stenosis. In case ventilatory insufficiency developed during anesthesia induction, an extracorporeal membrane oxygenator was prepared, followed by administration of anesthesia. Careful administration of anesthesia allowed for anesthesia management without the extracorporeal membrane oxygenator. We approached the periphery and the proximal portion of the aneurysm through a right subclavicular incision and partial median sternotomy, respectively. After excision of the aneurysm, we performed EPTFE prosthesis implantation. The patient's postoperative course was uneventful, which led to postoperative improvement of the airway stenosis. The combination of a right subclavicular incision and partial median sternotomy is useful for the surgical treatment of large subclavian artery aneurysms such as the one in this case. Moreover, careful anesthesia management after close consultation with anesthesiologists is important for patients who exhibit preoperative airway stenosis.

By means of indirect sphygmomanometer called “volume compensation technique” systolic and diastolic blood pressure in finger arteries were noninvasively and continuously measured during and after the “doshi” which is the acupuncture of the carotid sinus. After 15-min resting, 2-min puncture of the right and left carotid sinus was carried out in 23 healthy subjects (8 males and 15 females, aged 18-55). Finger arterial blood pressure was measured during the rest and the in-situ puncture, and then at 30 minutes after the withdrawing. For the control the dodged puncture of the carotid sinus was also made in other 6 healthy subjects (2 males and 4 females, aged 23-55).
Decreasing in blood pressure were observed during and after the doshi in 87% of the subjects. The mean magnitude of the decrease in the systolic and diastolic pressure at 15-21 minutes after the withdrawal of the needle were 12 and 10mmHg, respectively. Pulse pressure and heart rate showed little changes during the experiment. To the control dodged puncture, the maximum change in the systolic and diastolic pressure were 3.4 and 5.0mmHg, respectively, which were within the range of the physiological blood pressure variation. These data suggests that the blood pressure response to the “doshi” may not be induced by the vagal cardiac inhibition but by the change in peripheral vascular resistance.

During and after the “Toshi” which is the acupuncture of the carotid sinus, systolic and diastolic blood pressure were measured in the basal pharanx of finger arteries by means of indirect sphygmomanometer called the “volume compensation method”. After 15 minutes resting, 2 minutes acupuncture on both sides of the carotid sinus was carried out in 16 hypertensive subjects. Finger arterial pressure showed a significant decrease by about 14mmHg (mean) in systolic pressure and by 9mmHg (mean) in diastolic pressure during and after the acupuncture (p<0.05). The decrease in blood pressure showed a maximum at 15-20 minutes after the withdrawal of needles. Pulse pressure and heart rate did not show a significant change. These results were almost similar to those obtained in normotensive subjects. These data suggests that hypertensive subjects are also responsible to “Toshi” and that this effect may not be caused by the cardiac inhibition refrex but the change in vascular tonus.

During and after the LI4 and LI10 Acupuncture, the volume elastic modulus Ev in the basal phalanx of finger arteries were measured. Ev values were noninvasively obtained using a new type of plethysmograph called the “electric impedance-cuff” which can detect indirect arterial pressure and volume change in the artery. After 15 minutes of rest, 2 minutes acupuncture on LI4 and LI10 were carried out in 16 healthy subjects, respectively. Volume elastic modulus showed a significant decrease (p<0.01) during and after the LI10 Acupuncture. Its decrease were maintained at least 20 minutes after the withdrawal of the needle. While the Ev values did not show the typical change during and after the LI4 acupuncture. These date suggest that the elasticity of the peripheral wall was lagely affected by the LI10 acupuncture, and the effect was caused not only by peripheral reflex but by other factors.

Understanding the symptoms of the general population has an important role in assessing and improving the quality of palliative care systems. However, there are no reliable epidemiological data on the symptoms of the general population in Japan. The aim of this study was to survey the actual status of the symptoms experienced by the general population in Japan. A large nationwide postal survey was conducted from January through February 2013 in Japan. A total of 2400 subjects were selected randomly from among members of the general population who were 20 to 79 years of age and lived in Japan. The Memorial Symptom Assessment Scale (MSAS) was used to multi-dimensionally evaluate symptoms experienced within the past week, and the Short Form 8™ (SF-8™) was used to assess the health-related quality of life (QOL). A total of 978 (41.1%) self-completed questionnaires were analyzed. The prevalences, severity rates, and distress rates of 35 physical and psychological symptoms were analyzed according to sex and age group. In addition, the relation between symptom severity and the health-related QOL score was evaluated. From the perspectives of public health and administrative policy, the results of this survey will most likely provide important basic data, with the ultimate goal of establishing a palliative care system in Japan.

Purpose: The aim of this study was to develop a nursing intervention program for use in enhancing the self-care abilities of cancer patients receiving treatment on an outpatient basis. Method: Four-week-long combined group therapies were conducted on 15 subjects. The effects of these therapies were then examined. Results: Subjects' mean age was 56.86±11.52 years; mean duration of disease was 28.6±18.14 months. Between before and after the intervention, two scales showed significant improvements: EORTC QLQ-C30 Global health status (p<0.023) and STAI state anxiety scale (p<0.022). As a result of field note data analysis, "change of attitude toward cancer treatment at home" and "response to the program" were identified. Conclusion: Because the subjects were highly motivated individuals, with substantial self-care ability from the beginning, their ESCA scores did not show any change between before and after intervention. Nevertheless, the inner changes that occurred to the subjects indicated that their self-care ability had improved. Palliat Care Res 2009; 4(1): 201-206

Objective: The purpose of this study is to compare the clinical efficacy between original drugs and generic products.  Candidate drugs included two types of hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors, simvastatin and pravastatin, because of their importance at reducing the health expenditure for hyperlipidemia.
Design: We retrospectively evaluated the efficacy (total cholesterol, triglyceride, low-density lipoprotein and high-density lipoprotein levels), safety (biochemical parameters), and medication adherence based on patient data.  We set the follow-up period at 6 months before and after substitution.  Data were analyzed by paired-sample t-tests (statistical significance level of 0.05).
Methods: The subjects included in this study were ambulatory patients visiting Nakajima Hospital for dyslipidemia treatment.  Selected patients included those taking both the original drug and the generic product; i.e., patients who had substituted the original drug Lipovas® for the generic product Simvastatin OHARA, or those who had substituted the original drug Mevalotin® for the generic drug Pravatin®.
Results: A total of 118 patients in the simvastatin study and 43 patients in the pravastatin study were candidates for the present study.  We found that there were no significant differences before and after substitution.  Even though there were differences in some of the biochemical parameters, the range remained within normal levels.  With regard to medication adherence, we found no significant differences.
Conclusion: In this study, we found no significant differences before and after substituting medications with generic drugs.  Additionally, we found no subjective symptom changes after substitution.  To develop clinical information on generic products and to store such information, it is important that pharmaceutical products be used appropriately.

Afferent loop syndrome is often difficult to resolve. Among patients with afferent loop syndrome whose data were extracted from databases, 5 patients in whom metal stent placement was attempted were included and evaluated in this study. The procedure was technically successful without any adverse events in all patients. Metal stent(s) was placed with an endoscope in the through-the-scope manner in 4 patients and via a percutaneous route in 1 patient. Obvious clinical efficacy was observed in all patients. Adverse events related to the procedure and stent occlusion during the follow-up period were not observed. Metal stent placement for malignant obstruction of the afferent loop was found to be safe and feasible.
Afferent Loop Syndrome ; Endoscopes ; Follow-Up Studies ; Humans ; Intestinal Obstruction ; Palliative Care ; Self Expandable Metallic Stents ; Stents* ; Treatment Outcome

OBJECTIVE: Traditional Japanese food appears to be healthy but contains a small amount of milk products. Type 2 diabetes (T2DM) patients commonly reduce their energy intake to control their blood glucose levels. However, nutritional guidance for diabetes does not emphasize calcium (Ca) consumption. The aim of this study is to estimate the nutritional status of Ca and other nutrients, which affect bone and Ca metabolism, in T2DM patients. METHODS: This observational study was conducted with Japanese T2DM patients (n = 96; M/F = 50/46; age: 61.6 ± 10.1 years). We estimated nutrient intake using a simple food frequency questionnaire. RESULTS: Median total energy intake was 1750 kcal/day (1440-1970). Their median daily intake of Ca, vitamin D, and vitamin K was 451 mg (336-560), 10.2 µg (8.5-12), and 206 µg (84-261), respectively. Only 17.7% of the study subjects were found to take more than 600 mg/day of Ca. Protein and salt intake was 78 (64-90) and 10.6 (9.3-12.2) g/day, respectively. Male subjects had more salt, less Ca and vitamin K than female. Daily Ca intake was positively associated with total energy, protein, and lipid intake but not with carbohydrates. Vitamin D intake correlated only with protein intake. CONCLUSION: The daily Ca intake of Japanese T2DM patients appears to be insufficient and could depend on protein and lipid intake. Additionally, these patients should have specific recommendations to ensure sufficient intake of Ca with protein and lipid during energy restriction.
Asian Continental Ancestry Group* ; Blood Glucose ; Calcium* ; Carbohydrates ; Energy Intake ; Female ; Humans ; Male ; Metabolism ; Milk ; Nutritional Status* ; Observational Study ; Vitamin D ; Vitamin K