Like the "day hospices" for cancer patients in England, Japanese day care services may be an effective resource for home-based palliative care. A questionnaire survey was done to investigate what medical services are available to cancer patients in existing day care centers in Japan. Methods: In November 2004, the questionnaire was sent to 108 day care centers in Okayama Prefecture, and there were 49 responses. Results: Out of the 49 day care centers, 36 had been used by cancer patients, 28 (56%) of those centers actually had cancer patients attending at the time of survey, and 4 (8%) of those centers provided special programs for cancer patients. The results of the questionnaire showed that day care centers should provide the following services to enhance domiciliary palliative care for cancer patients: 1) medical palliative treatment; 2) medically supervised special day care services, such as bathing; 3) resting periods to meet the client's needs; 4) medical function support therapy, such as stoma-care, parenteral nutrition, and infusion; and 5) psycho-social support for the patients as well as their families. Conclusion: Existing day care centers in Japan could be effective in functioning as day hospices, similar to those that exist in England.

In the present research, first we evaluated the association between urban area size and commuting modes with physical activity among working people. Then we investigated the longitudinal effects of urban area size and commuting modes on increased physical activity due to health guidance intervention. The subjects were 401 male employees (aged 46.3±7.8) of A corporation, and were split into two groups, metropolitan area group (N=235) and local area group (N=166), based on the population density of place of work. IPAQ-E was used for evaluation of walking environments, and physical activity was assessed using pedometers. The intervention consisted of an exercise-focused health guidance over the course of one year. The cross-sectional study admitted that in comparison with the local area group the metropolitan area group had more than physical activity (p<0.01). Not only the size of urban area but commuting modes were significantly related to the level of daily physical activity (p<0.001). In longitudinal study, regarding the effects of the intervention for the physical activity, the study showed the possibility that urban area size was not directly effective but traffic safety in residential area (p<0.05) and willingness to take a walk (p<0.01) were effective. The cross-sectional study suggested that the size of the urban area and commuting modes had independently an effect on the physical activity of working people. The longitudinal study, on the other hand, suggested that the size of the urban area and commuting modes may not any direct influence on the effects of physical activity intervention.

A 9-year-old boy with multisaccular thoracic aortic aneurysm associated with coarctation of the aorta underwent definitive repair under partial cardiopulmonary bypass. The operation consisted of resection of the aneurysm and reconstruction of the descending aorta. Aortic reconstruction was done without an artificial graft, and extended end-to-end anastomosis was performed successfully. He has been doing well and there was no significant restenosis at the repair site 5 years after the operation. Some authors reported that untreated coarctation of the aorta frequently developed aneerysm, which usually has multisaccular lesions. Surgical strategy of aortic reconstruction for coarctation of the aorta in boyhood should be decided prudently to avoid postoperative complications.

A 38-year-old man underwent surgery for impending rupture of an inflammatory celiac artery aneurysm with a maximum diameter of about 50 mm. First, an extra-anatomical bypass was performed from the iliac arteries to the celiac artery, superior mesenteric artery and bilateral renal artery using ringed ePTFE grafts. Second, the celiac artery aneurysm at the distal site was directly closed and then a stent graft was placed in the abdominal aorta to cover the orifice of the celiac artery. An endovascular stent graft treatment combined with extra-anatomical bypass is useful for the treatment of inflammatory aneurysm to avoid the various surgical complications in Behçet syndrome.

A 46-year-old man was given a diagnosis of hypertension about 20 years previously. At age 41, aortitis syndrome was diagnosed, with descending thoracic aortic aneurysm and the coarctation of abdominal aorta by CT scan. He then underwent surgery to replace the descending thoracic aortic aneurysm and right axillo-bifemoral bypass. Recently, a thoraco-abdominal aortic aneurysm was pointed out at the distal site of the graft and, he was referred to our institute. We occluded the distal end of the aneurysm using an endoluminal occlusion stent graft. Today, in most cases of aortopathy associated with aortitis syndrome, surgical replacement of the aneurysms and extra-anatomical bypass is performed. An endovascular stent graft treatment combined with extra-anatomical bypass could be useful for various aortic disorders.

A 65-year-old man was admitted with subacute myocardial infarction. During medical treatment, the patient lost consciousness as a result of an atrioventricular block and underwent an operation for an emergency percutaneous coronary intervention in the right coronary artery. In a follow-up examination, transthoracic echocardiography and computed tomography showed a left ventricular pseudo-false aneurysm, and therefore another operation was carried out. The operative findings showed that the heart markedly adhered to the pericardium and the aneurysm at the apex. The patient then underwent a double-patch closure of the ruptured point using an equine pericardial patch and a Dacron patch. No perioperative complication was observed. Left ventricular pseudo-false aneurysm is a rare complication following myocardial infarction. Here, we report a successful case of a double-patch closure of a pseudo-false aneurysm.

We encountered a case of pseudoaneurysm of the ascending aorta, aortic stenosis and regurgitation, and infected popliteal aneurysm discovered 24 years after cardiac operation. A 34-year-old male who had undergone radical operation for subaortic stenosis at age 10 had infectious endocarditis. Pseudoaneurysm of the ascending aorta and aortic stenosis and regurgitation were noticed after diagnosis of a popliteal aneuyrsm, and operation was performed in two stages. Resection of the popliteal aneurysm, direct suturing of the entry as well as resection of the pseudoaneurysm of the ascending aorta, patch plasty of the defect and replacement of aortic valve were performed with satisfactory results.

A 61-year-old man with consciousness disorder was transferred to our hospital. Computed tomography found acute type A aortic dissection and cardiac tamponade, and an emergency operation was performed. Operation findings indicated dissection above the commissure between the left coronary cusp and the right coronary cusp, to the ostium of the right coronary. An ascending aorta replacement and coronary aorta bypass grafting were performed. The postoperative course was good, but he did not regain clear consciousness. Results of magnetic resonance imaging showed multiple cerebral infarctions. At the same time, the platelet count had decreased and we suspected heparin-induced thrombocytopenia (HIT). Following detection of an heparin-dependent antibody, administration of an heparin was discontinued. However, the platelet count still tended to decrease. Therefore, we started continuous administration of argatroban, which resulted in the gradual increase in platelet count to within normal limits on postoperative day 26. The results indicate that in patients continuously and repeatedly treated with heparin, there is a possibility of the development of HIT and thrombosis with HIT.

We report a rare case of vasculo-Behçet's disease complicated by an intracardiac thrombus. A 48-year-old woman with a history of Behçet's disease and deep vein thrombosis in a lower limb, and who had been treated with colchicine and warfarin, was given a diagnosis of an appendectal tumor by colonoscopy. Preoperative examinations, including chest computed tomography, showed a pedunculated mobile tumor from her inferior vena cava (IVC) to the right atrium (RA). Urgent surgery was performed to prevent pulmonary embolism. We exposed the RA through a median sternotomy under cardiopulmonary bypass and extirpated the tumor that appeared macroscopically to be an organized thrombus attached to the IVC wall. The pathological diagnosis was organized thrombus. A month later, she underwent ileocecal resection and was given a pathological diagnosis of mucinous cystadenoma. Her postoperative course was uneventful. Intracardiac thrombus complicated by vasculo-Behçet's disease is rare, and it is important in the differential diagnosis of intracardiac tumor.

A 34-year-old woman had received a diagnosis of X-linked hypophosphatemic osteomalacia when she was born. As an adult she complained of general fatigue, palpitations dyspnea exertional and leg edema. Transthoracic echocardiography showed aortic stenosis and regurgitation with severe aortic valve calcification. Chest computed tomography revealed her ascending aorta to be circumferentially calcified. Surgery was performed through a median sternotomy via cardiopulmonary bypass, with perfusion from the right subclavian artery and the right femoral artery and drainage from the superior and the inferior venae cavae. A left ventricular venting cannula was inserted from the right superior pulmonary vein. When her bladder temperature had dropped to 28°C by central cooling, we stopped the perfusion from the right femoral artery and performed aortotomy. We examined the lumen and clamped the aorta at the usual site, while flushing with blood by femoral perfusion. Aortic valve calcification was observed to extend from the sinus of valsalva to the outflow tract of the left ventricle on the non-coronary cusp side. He was necessary to repair the aortic annulus due to a defect resulting from careful removal of the calcified valve. We then performed aortic valve replacement using a 19-mm Carpentier-Edwards perimount Magna. Her postoperative course was uneventful without any sign of neurological complications, and she was discharged 13 days after surgery. On pathological examination, localized ossification with calcification was observed in her aortic valve which seemed to be characteristic of X-linked hypophosphatemic osteomalacia.