In this study, the author evaluated surgical results in 4 patients over 80 years old (3 males and one female) who were among 24 patients with ruptured abdominal aortic aneurysm (RAAA) who underwent operation at our medical center between November, 1985 and June, 1992. While three patients survived, one, who had preoperative profound shock, died due to mutiple organ failure. The post-operative course of two of the survivors was uneventful, and the other developed non-oliguric renal failure but recovered without hemodialysis. The Fitzgerald classification of the RAAA in the non-survivor was group 4 and that in the 3 survivors was group 2 or 3. The extent of preoperative shock and volume of blood loss were associated with increased operative risk. In conclusion, aggressive resection of RAAA should be performed not only in younger parients but also in elderly patients such as those over eighty years old.

This study aimed to determine the effects of wearing graduated elastic compression stockings (GCSs) on arterial stiffness. The study included 10 healthy men who were randomly assigned to undergo trials with and without GCSs on separate days. Baseline measurements of brachial-ankle pulse wave velocity (baPWV), heart rate, and brachial blood pressure (BP) were obtained in the supine position after the subjects had rested for 20 min without GCSs. The order of the trials (with or without GCSs) was set randomly. During both trials, data for these parameters were collected with the subjects in the supine position, after they had rested for 20 min. After both trials, the brachial BP did not significantly change from the baseline values. baPWV significantly decreased after trials with GCSs (from 1153.0 ± 123.4 to 1078.1 ± 134.3 cm/s, P < 0.05), but no significant difference was observed after trials without GCSs (from 1125.2 ± 118.7 to 1134.5 ± 100.9 cm/s). In addition, changes in volume after trials with GCSs (-74.9 ± 35.3 cm/s) were significantly lower than those after trials without GCSs (+9.3 ± 36.7 cm/s, P < 0.05). baPWV significantly decreased during supine rest on wearing GCSs. This decrease in baPWV was possibly caused by a decrease in arterial stiffness itself and/or a decrease in vascular transmural pressure that may have been due to increase in external pressure on the vasculature.

Several studies have shown that low cardiorespiratory fitness (CRF) or heavy alcohol consumption is risks of total or certain types of cancer death. However, the combined influence of CRF and drinking habits on total cancer mortality is not clear. The purpose of this study was to investigate the joint effect of CRF and drinking habits on total cancer mortality among Japanese men. We evaluated the CRF and drinking habits on risk of total cancer mortality in 8,760 Japanese men (age: 19-59 yr) who were given a submaximal exercise test, a medical examination test, and questionnaires on their health habits. CRF was measured using a cycle ergometer test, and the men were classified into two categories by CRF levels based on the reference value of CRF (R-CRF) in “Physical Activity Reference for Health Promotion 2013” (Under R-CRF and Over R-CRF). Also, the men were assigned to Non Drinking, Moderate Drinking, and Heavy Drinking categories. There were 178 cancer deaths during the 20-yr follow-up period. Relative risk and 95% confidence intervals for total cancer mortality were obtained using the Cox proportional hazards model while adjusting for age, body mass index, systolic blood pressure, and smoking habits. Using the Under R-CRF & Heavy Drinking group as reference, the relative risk and 95% confidence intervals were 0.37 (0.16–0.85) for the Over R-CRF & Non Drinking group. This result suggests that Japanese male with a high CRF and a low drinking habit have a lower risk of total cancer mortality.

The aim of this study is to validate the effect of a nutrition support team's (NST) interventions in convalescent stroke rehabilitation using the Functional Independence Measure (FIM). Three hundred and four patients were retrospectively divided into an NST-nourishment group, an NST-losing-weight group and a non-NST group. We then compared the FIM gain, the FIM efficiency and the change of body mass index during admission among these three groups. The FIM gain was 17.3±15.9 in the NST-nourishment group and 16.7±12.5 in the non-NST group and there was no significant difference. The FIM efficiency in the NST-nourishment group (0.20±0.19) was significantly lower than the one in the non-NST group (0.27±0.19). Patients with an FIM of 53 or less showed no significant difference in FIM gain and FIM efficiency between the two groups. Since those patients who received NST intervention would tend to have a poor prognosis in general, we assumed that our “no difference” results indicated the effectiveness of the NST intervention. There was no evident relationship between FIM gains and changes in the body mass index.

Although the combined administration of glycyrrhizin (SNMC) and ursodeoxycholic acid (UDCA) is usually used for intractable patients with active HCV-associated chronic hepatitis (HCV-CH) or cirrhosis (LC), there are many cases that do not respond to this combination therapy. In this study, we examined the effects of adding Juzen-taiho-to (TJ-48) to lower the serum alanine aminotransferase (s-ALT=s-GPT) levels in such cases. Methods: The average s-ALT levels for 6 months were compared before and after 7.5g of Juzen-taiho-to was added to the combined therapy of SNMC and UDCA for 9 HCV-CH and 12 HCV-LC patients. In some cases, the effectiveness of the therapy over 12 months was also evaluated. Results: In the HCV-CH cases s-ALT levels were significantly decreased in 3 of 9 (33%) cases in 6 months (about 30 INU in average). In the HCV-LC cases, s-ALT levels were significantly decreased in 5 of 12 (42%) cases in 6 months (more than 40 INU in average). There were some patients whose s-ALT levels decreased significantly after 6 months. As to the improvement of clinical symptoms, general fatigability improved in 12 out of 20 cases (60%) and anorexia improved in 10 out of 19 cases (53%). Conclusions: Juzen-taiho-to (TJ-48, 7.5g daily) added to the combined therapy of SNMC and UDCA may be an effective therapy for intractable cases of active HCV-CH or LC.

To clarify the views and needs on Rx-to-OTC switches in patients afflicted with lifestyle-related diseases such as hypertension, diabetes and/or hyperlipidemia, our survey was conducted with 199 patients at a pharmacy in Tokyo, Japan.Of the 199 patients, 159 people were patients afflicted with lifestyle-related diseases.One hundred and ten patients afflicted with lifestyle-related diseases were seventy-year-old and older, and 149 of the patients have been to a hospital at least once in the past year.Thirty-six point five percent of the patients afflicted with lifestyle-related diseases replied that they wanted to use Rx-to-OTC switches when they had been ill and/or injured.The main reasons that they wanted to use Rx-to-OTC switches were “convenience” and “always the same drugs”.On the other hand, the main reason that they did not want to use Rx-to-OTC switches was “I want to have a detailed examination”.Twenty-three point nine percent of them replied that they wanted to switch their prescription drugs to Rx-to-OTC switches. We believe that the usage of Rx-to-OTC switches after the establishment of a support system to secure safety can be the answer to the issues of the rise in medical care expenditures and doctor shortage.

Loeys-Dietz syndrome (LDS) is characterized by vascular findings (aortic aneurysms and dissections) and skeletal manifestations. Since aortic dissection occurs at smaller aortic diameters than observed in Marfan syndrome, early and aggressive surgery is recommended for patients with LDS. A 45-year-old man who underwent aortic valve replacement for aortic regurgitation at the age of 33 was transferred to our hospital with the diagnosis of acute aortic dissection. We performed emergeny ascending aortic replacement, and suspected LDS because of his specific physical characteristics after surgery. His postoperative course was uneventful, however, computed tomography (CT) performed at 2 weeks after operation showed the new entry at the distal anastomotic site, patent false lumen of the descending aorta and rapid enlargement of the distal aortic arch. Therefore, we performed total arch replacement with the elephant trunk method at 3 weeks after the emergency operation. Mutation of the TGFBR2 gene was found and we finally diagnosed LDS. One year after, complete thrombosis of the false lumen of the descending aorta and decrease in size of the distal aortic arch was observed by CT.

We report a case of aortic valve replacement using a bioprosthesis after coronary artery stenting in the left coronary main trunk of a 76-year-old man with symptoms of heart failure. Pre-operation studies revealed severe aortic valve regurgitation and that the left main coronary stent protruded into the aorta. Cardiac arrest was obtained with retrograde cardioplegia. Careful observation was made to avoid injury to the aortic bioprosthesis. The postoperative course was uneventful and cardiac echo graphy showed good function of the aortic valve.

A 62-year-old woman was admitted to our hospital because of dextrocardia on her chest X-ray film. She had been in good health though the X-ray abnormality had been pointed out from her childhood. Echocardiogram, magnetic resonance imaging, and cardiac catheterization revealed situs inversus, congenitally corrected transposition of the great arteries, and severe tricuspid valve (systemic atrioventricular valve) regurgitation with mild systemic ventricular dysfunction. The surgeon stood on the patient's left side during the operation. On cardiopulmonary bypass, the tricuspid valve, facing almost dorsally, was exposed through a superior transseptal approach. Tricuspid valve replacement with a mechanical valve was performed with leaflet preservation. Systemic ventricular function is preserved at one year after operation.