In Japan, infective endocarditis (IE) or prosthetic valve endocarditis (PVE) due to intravenous drug use (IDU) is rare. We report the case of a patient with PVE due to IDU who required mitral valve replacement (MVR) and tricuspid valvoplasty (TVP). A 21-year-old woman with an IDU history had earlier acquired IE, and had undergone MVR using a bioprosthetic valve and TVP in November, 2010. She was transferred to our institute because of fever and general fatigue in February, 2012. Echocardiography revealed vegetation on the mitral bioprosthetic valve, and antibiotic administration was started. Although the infectious condition improved, the vegetation became more mobile. A second MVR, using a bioprosthetic valve, and TVP were performed 18 days after admission. The patient's postoperative course was uneventful, and she was discharged on postoperative day 32. At one and a half years after the second surgery, the patient is currently followed-up regularly at our department, and PVE recurrence has not been observed.

A 74 year-old man visited our hospital complaining of increasing sensory disorder of the left lower extremity. On physical findings, a pulsatile mass was detected in abdomen, but he had been aware of it for 5 years. Further examination revealed on inferior mesenteric artery aneurysm 8 cm in diameter. It had no communication with other visceral arteries or veins. Surgical treatment was performed to resect the aneurysm without revascularization. The postoperative course was uneventful. The pathological examination of the aneurysm showed atherosclerotic change. The chief complaint on admission was unchanged following surgery and was thought to have no relation to the aneurysm. It was thought that to derive from lumbar vertebral disease. After operation, regular follow-up is necessary to check for pseudoaneurysms formation at the surgical margin and development of other visceral artery diseases.

We experienced a case of chronic pain responding to electrical acupuncture therapy while on spinal cord stimulation. A 35 year-old male presented with chronic neck pain. At 16 years of age, he had neck pain due to traffic accident with stellate ganglion block and epidural block. At 29 years of age, he sensed radiating pain in the 3rd to 5th digits of the left hand during epidural block. At 33 years of age, nerve root injury occurred after insertion of an epidural catheter, resulting in epidural abscess. Although the abscess resolved after antibiotic treatment, he had stiff fingers in the left hand together with neck pain and restricted range of motion of the neck. At 34 years of age, a spinal cord stimulation device was inserted which improved the stiff fingers in the left hand, but not the neck pain and restricted neck motion. He therefore visited our institute. At presentation, neck pain together with dysphagia and mastication pain were observed, and the patient was on a liquid diet. He was given electrical acupuncture treatment in additional to trigger point block and stellate ganglion laser. After two treatments, he was able to resume a normal diet. With reduced neck pain, he also undergo rehabilitation mainly through voluntary neck movements. This case demonstrates that electrical acupuncture treatment may be safe and effective for patients fitted with spinal cord stimulation device.

Objective : Post-marketing surveillance was conducted for the purpose of demonstrating the relationship between the therapeutic effect of natural IFN-β preparation on chronic active hepatitis C and HCV subtype or viral load as well as various predictors of its efficacy.
Design : Cohort studies.
Methods : Questionnaires were sent to all medical institutions at which IFN-β ('IFNβMochida') was administered to patients with chronic active hepatitis C once daily for at least 8 weeks and its therapeutic effect was judged based on the rate of virological sustained response (VSR) and the rate of biochemical (ALT) sustained response (BSR).
Results : Questionnaires for 2, 076 patients were collected from 244 medical institutions all over the country. Of these questionnaires, those for 1, 503 patients, 930 men (61.9%) and 573 women (38.1%), collected from 229 institutions could be evaluated regarding the therapeutic effect of IFNβ Mochida. The patients' mean age was 50.2 years. The average VSR were 31% for all of the patients (1, 503 patients), 61% for those with a low viral load (HCV-RNA level before IFN treatment ; <106 copies/ml) and 14% for those with a high viral load (≥106 copies/ml) ; with the subtypes 1 b, 2 a and 2 b accounting for 18, 55 and 29% respectively. BSR were 45, 69 and 32%, respectively ; with the subtypes 1 b, 2 a and 2 b accounting for 32, 66 and 56%. As for the therapeutic effect in patients with the same level of viral load but different viral subtype, at each level of viral load VSR was the highest in subtype 2 a, followed by 2 b and 1 b, showing a significant difference between 2 a and 1 b or 2 b, depending on the level of viral load. BSR of 2 a and 2 b were similarly high, showing a significant difference between 2 a or 2 b and 1 b, depending on the level of viral load. In patients with subtype 1 a or 1 b, patients who were administered IFN-β≥339 MU obtained a higher VSR than those who were administered IFN-β ≤336MU. Adverse drug reactions were observed in 89% of the total 2, 076 patients, however, these symptoms disappeared immediately after the completion of the treatment. Univariate and multivariate logistic regression analyses conducted to detect the predictors on the therapeutic effect (VSR) of IFN-β revealed that the subtype, viral load and age were significant factors for all the patients and that the viral load and NS5A mutation were significant factors for the patients with subtype 1 b. However, the NS5A mutant type viral load was significantly less than that of the other types, showing no difference in the therapeutic effect in the comparison at the same level of viral load.
Conclusion : It was confirmed that the therapeutic effect of the natural IFN-β preparation on chronic active hepatitis C varied widely depending on the viral load and viral subtype. This information will play an important role in the development of therapy for chronic hepatitis C in the future.

Plasma concentrations of tumor necrosis factor α (TNFα), interleukin-1β (IL-1β) and interleukin-6 (IL-6) were measured successively during and after open heart surgery (13 cases). Plasma concentrations of TNFα did not increase during surgery but increased gradually after the 1st operative day reached the maximum level at the 7th operative day (128±15pg/ml, which was a 3-fold increase compared with the previous value). Plasma concentrations of IL-1β remained at the previous level during surgery and increased only once at 6 hours after operation. Conversely, plasma concentrations of IL-6 increased dramatically during cardiopulmonary bypass (CPB) reaching a peak at the end of CPB (260±200pg/ml, which was a 15-fold increase over the previous value) and recovered to previous values rapidly thereafter. Plasma IL-6 concentrations changed rapidly during surgery, while plasma concentrations of TNFα and IL-1β did not increase sharply. This may indicate that IL-6 may play a role as a mediator of acute inflammatory reaction.

OBJECTIVESTesticular toxicities of antimony compounds were evaluated in rats and mice. The slightly water-soluble antimony compound antimony trioxide (ATO) and the highly water-soluble antimony compound antimony potassium tartrate (APT) were examined.

METHODSDaily doses of the compounds were 27.4, 12.0 and 1,200 mg/kg body weight in the APT group, low-ATO group and high-ATO group, respectively. The corresponding daily doses of antimony were 10, 10 and 1,000 mg/kg body weight, in the APT group, low-ATO group and high-ATO group, respectively. Both compounds were administered by gavage: rats, 3 days per week for 4 weeks; mice, 5 days per week for 4 weeks.

RESULTSNeither compound reduced the weights of reproductive organs or accessory sex organs nor affected sperm parameters. Few marked histopathologic changes were found in the testes of the treated animals. Even at 1,200 mg/kg body weight, which is greater than the LD(50) of APT, ATO produced no effects.

CONCLUSIONSIn this study, it was found that ATO and APT are not toxic to testes in rodents.

We controlled the hemodilution and electrolyte levels during coronary artery revascularization in chronic hemodialysis patients by hemofiltration during the period of extracorporeal circulation. Subjects comprised 7 chronic hemodialysis patients (males, average age 53) undergoing coronary artery revascularization in our department from January 1988 to December 1989. All patients had been undergoing hemodialysis for chronic renal failure and in one patient, after admission, continuous ambulatory peritoneal dialysis (CAPD) was additionally performed. During surgery, the dialyzer was equipped with an extracorporeal circulation circuit and the electrolyte level and hemodilution were adjusted using transfusion (1, 270±372ml). A large infusion volume (12, 657± 3, 966ml) was maintained and removal of water was carried out by ultrafiltration. After surgery, all patients underwent hemodialysis twice or more by the 3rd day of recovery. Concentrations of electrolytes were maintained at appropriate levels throughout the day of surgery except for one case of postoperative hypokalemia, but no marked changes in hemodynamics were observed during and after surgery. Hemofiltration during extracorporeal circulation is safe and useful in coronary surgery because it is simpler and requires less time than hemodialysis.

A 60-year-old woman underwent surgical treatment of postinfarction ventricular septal perforation (VSP) in the early phase after receiving total cardiopulmonary bypass without aortic occlusion. VSP developed four days after anterior myocardial infarction. On admission, inraaortic balloon pumping was used to obtain hemodynamic stabilization. On the day of admission, emergency total cardiopulmonary bypass was performed. VSP was closed with a Dacron felt patch positioned on the left side of the septum. The anterior wall of the left ventricle was closed with Dacron felt strips and reinforced using a Gore-Tex sheet. Postoperative hemodynamics improved significantly. Although the operation while the heart was beating was difficult technically, the total cardiopulmonary bypass time of this method was not longer than that of operations under cardioplegic arrest. Further more, the area of infarction was easily distinguished by color and bleeding. The surgery during normothermic heart beat was effective in preventing further ischemia of the myocardium. The surgical treatment of VSP in the early phase during normothermic heart beat under total cardiopulmonary bypass was considered to be more effective and safer than operations under cardioplegic arrest.

The purpose of present study was to examine validity of accelerometer (Lifecorder ; LC) and to assess the free-living physical activity (PA) in Japanese elementary school students used by LC method. Firstly, to examine validity of LC, twelve children, aged 11.2±1.0 years, were measured total energy expenditure (TEE) by doubly labeled water method and resting energy expenditure (REE) by the expired gas analysis. Physical activity energy expenditure (PAEE) is calculated as 0.9 TEE minus REE. At the same time, PA was evaluated by both daily walk count (WC) and vigorous activity time (LC7-9) using LC method. PAEE per 1 kg body weight significantly correlated with WC (r=0.785, p<0.005) and LC7-9 (r=0.828, p<0.001). Secondly, 140 boys and 167 girls, aged 8-11 years were measured PA by LC method. WC and LC7-9 each were 13000-18000 counts and 16-32 minutes in week-day, and 8000-12500 counts and 8-18 minutes in week-end. PA analyzed by MANOVA were significantly higher in boys than in girls, and lower in week-end than in week-day, and decreased in proportion as grade. Present study suggests that LC method is a good measure of PA in free-living condition for elementary school students.