Papillary fibroelastoma (PFE) is a benign tumor accounting for approximately 8% of cardiac tumors. We report a 64-year-old woman with pulmonary valve PFE associated with atrial septal defect. It was detected by a transesophageal echocardiography as a fluttering mass clinging to the pulmonary valve, and was simply removed concomitantly with a patch closure of atrial septal defect. In a review of the past literature, 43 surgical cases of PFE have been reported in Japan, and aortic valve, mitral valve and left ventricle PFE was commonly encountered in 81%. Pulmonary PFE is very rare, and only one case has been reported apart from the present one.

The purpose of the present study was to determine whetehr differences exist between nine experimental conditions mixing 10°, 40°and 70°of hip joint angles with knee joint angles, when thirteen subjects performed the same response task. In the experiment 1, each subject was asked to stand on the inside two of the four mat switches (500×700 mm) and keep the assigned joint angles during a second of preparatory period. After the period, each subject was asked to respond with a step out on either the right or the left outside mat switch as quickly as possible. Then the data was collected analyzing the whole body choice response time (RESPONSE TIME) defined as the interval time from the signal to respond with step out, the whole body choice reaction time (REACTION TIME) defined as the interval time from the signal to reaction with lifting the leg for responding to the step out, and the movement time (MOVEMENT TIME) defined as the interval time subtracting RESPONSE TIME from REACTION TIME. Moreover, in the experiment 2, the data was collected and analyzed from the onset time of various forces from the two force platforms on which each subject stood instead of the mat switch and EMG which was led from the right side of m. rectus femoris, m, biceps femoris, m. gastrocnemius, m. tibialis anterior and the left side of m. quardriceps femoris, during performance of the response task. The results were as follows:
1. The subjects' posture with each 70°flexion of the hip and the knee joint revealed the shortest RESPONSE TIME, because of the shortened MOVEMNT TIME, compared with the other posture. Conversely, the posture with 70° flexion of the knee joint showed an expanded REACTION TIME.
2. The knee joint angle was an important factor effecting both REACTION TIME and MOVEMENT TIME, rather than the hip joint angle for the task of the experiment, since flexion of the knee joint expanded the REACTION TIME, but shortened the MOVEMENT TIME.
3. The result of the force platform measurements indicated that the posture with each 70°flexion of the hip and the knee joint was shorter than that with each 10°flexion of them at the onset time of the first reaction force after the reaction signal, and that the order of response for the task was beginning at the leg for responding, followed by the other leg for keeping stability.
4. Conclusive evidence for a shortened RESPONSE TIME was found in the facilitation of the central nervous system, which revealed the preliminary muscle activity and the stabilizing of the posture.

The purpose of this study was to investigate the differences and effects of positional loading (arm position change) and image loading in Budo (martial arts) competitors, mainly kendo (Japanese fencing) masters. The microcirculatory responses were measured by differential digital photoplethys-mography (ΔDPG) using the characteristics of Budo mental attitude, experience and skill as para-meters.
The subjects were 7 kendo masters of the fifth grade or higher with mean experience of 29 years, 7 kendo athletes, 7 kyudo (Japanese archery) athletes, 5 karate athletes in university sports clubs and 9 middle-aged controls. Positional loading induced myogenic responses and image loading for examining sympathetic effects via the central nervous system on peripheral circulation were mea-sured in the subjects at rest in a sitting position. The following results were obtained
The increase in the . ΔPG-P wave height in response to positional loading was markedly larger in the kendo masters. In particular, the increase when raising the right arm was significantly higher in the kendo masters than in the kyudo and karate athletes (P<0.05) . The decrease in the ΔDPG-P wave height when lowering the right arm was smallest in the kendo masters. There were differences in the peripheral vascular responses between kinds of Budo and levels of skill, which were induced by differences at the time of arm raising.
The DPG-P wave height was significantly lower during stress imaging than before loading in all subjects. The effect of stress imaging was smallest in the kendo masters, and markedly large in the kyudo athletes (P<0.05) . During relaxation imaging, an increase in the ΔDPG-P wave height was observed in the kendo masters alone, and the occurrence of vascular dilation was confirmed.
These results suggest that arteriolar responses of kendo masters are flexible and stable despite their long training period ; and the control and regulation of muscle vascular tone is well-maintained via the central nerve-sympathetic and myogenic coupling.

Pulmonary vein isolation procedure was performed for atrial fibrillation associated with mitral valve disease in twelve patients. This simple procedure consisted of only isolation of the four pulmonary veins. Combined mitral valve surgery consisted of mitral valve plasty, mitral valve replacement with or without aortic valve replacement and tricuspid annuloplasty. Ten patients returned to a sinus rhythm. Two patients required DDD pacemaker implant for sick sinus syndrome. Left atrial contraction was detected in eight cases by trans-esophageal echography. Compared with the maze procedure, this operation was less invasive and preserved atrial appendage, helping to maintain normal secretion of atrial natriuretic peptide. This study suggests that the pulmonary vein isolation procedure may be an effective and simple maneuver for atrial fibrillation associated with mitral valvular disease.

A 72-year-old woman on dialysis acutely developed disturbed consciousness and severe hypertension. Head computed tomography (CT) demonstrated only ventriculomegaly without bleeding. Her consciousness level further deteriorated after dialysis using heparin, and subsequent head CT revealed a new, minor intraventricular hemorrhage. Hemorrhage-associated hydrocephalus was diagnosed, and the installation of a ventriculoperitoneal shunt resulted in good recovery. The patient might have experienced minor repeated bleeding and developed latent post-hemorrhagic hydrocephalus. Even minor bleeding could cause acute exacerbation of hydrocephalus; therefore, clinicians should be alert to hydrocephalus when a dialysis patient develops disturbed consciousness without any evidence of stroke on head CT.

Background : Perioperative care in congenital heart surgery has evolved in recent years, and it was considered a contributive factor to improve surgical outcome and prognosis. Objective : To extract perioperative clinical protocols that have been applied in our hospital, then assess their usefulness for better clinical outcome. Methods : We retrospectively reviewed our patients' records to analyze representative perioperative protocols that might have contributed to surgical outcome, such as intraoperative transesophageal echocardiography (ITEE), extubation in the operating room on patients of atrial septal defect (ASD), ventricular septal defect (VSD), tetralogy of Fallot (TOF), Glenn procedure and Fontan procedure. We also assessed clinical pathway of ASD and VSD, and each protocol was individually explored to calculate achievement ratio in order to show its adequacy. Results : This study included 482 of on-pump surgery patients and 146 of off-pump surgery patients from June 2007 to June 2014. ITEE was performed in 474 of on-pump surgery patients and 102 of off-pump surgery patients. No case had a residual lesion immediately after operation. Extubation in the operating room was performed in cases without severe pulmonary hypertension (PH). The extubation ratio was 94.7% (ASD repair), 60.0% (VSD repair), 50.0% (TOF repair), 42.5% (Glenn procedure), and 45.2% (Fontan procedure), respectively. Clinical pathways of ASD and VSD included patients without severe PH. Achievement ratio of the clinical pathway was 98.2% in ASD and 94.2% in VSD patients, respectively. Four patients were excluded because of high c-reactive protein (CRP), and one patient because of familial circumstance. Conclusion : ITEE was useful in evaluation of cardiac function, residual issue and residual air at weaning of cardiopulmonary bypass. Reintubation did not occur in any clinical course of extubation in the operating room, but the extubation rate was not high because of safety concerns. Achievement ratio of the clinical pathways of both ASD and VSD was more than 90%, therefore, application of the clinical pathway was considered appropriate.

Background：Although octreotide is effective in the relief of symptoms of gastrointestinal obstruction, it is also effective for gastrointestinal bleeding. It has been reported that octreotide reduced the splanchnic blood flow, and reduced the bleeding from esophageal varices, peptic ulcer and the tumor of gastrointestinal tract. We experienced four cases of end―stage cancer patients admitted to a palliative care unit whose symptoms of gastrointestinal bleeding were alleviated by octreotide（300μg／day）. Case：Case 1；A 75―year―old woman with gastric cancer developed melena and received octreotide. After octreotide was discontinued, melena and hematemesis recurred. Octreotide was restarted subsequently, and hematemesis resolved. Case 2；An 87―year―old woman with gastric cancer received octreotide for increase of bloody drainage from a stomach tube. She had epigastric pain and emotional distress from the blood. These symptoms were alleviated following the administration of octreotide. Cases 3 and 4；A 76―year―old man with gastric cancer and a 62―year―old man with bile duct cancer received octreotide for massive vomiting of blood. After the administration of octreotide, there was no reoccurrence of hematemesis in both patients. Conclusion：Octreotide may alleviate symptoms of gastrointestinal bleeding in end―stage cancer patients.

Videofluoroscopic examination of swallowing (VF) is widely used for evaluating swallowing function. However, pulmonary complications after VF are seldom evaluated. We checked residual barium sulfate on chest X-rays and early pulmonary complication after VF. One hundred and ninety-eight patients underwent VF and chest X-rays. Eighty-six patients who did not aspirate during VF had no residual barium on their chest X-rays. One hundred and twelve patients aspirated during VF, but only 40 of these patients showed residual barium on their chest X-rays. Ten patients had fever after VF, but no significant relationship was observed between fever and residual barium on chest X-rays or aspiration. Aspiration was not correlated with mobility or cognitive status. One case had pneumonia after VF, but VF did not seem to be the cause of the pneumonia. In conclusion, no severe early pulmonary complications after VF were observed. It is difficult to predict early pulmonary complications from chest X-rays.

Background : Menstrual migraine is more resistant to treatment than that of nonmenstrual episodes. Hormonal progesterone changes may cause sui (water/fluid) disturbance, in Kampo medicine terms. We therefore treated patients with menstrual migraine in which goshuyuto was ineffective, with the combination of goreisan and goshuyuto.
Subjects & Methods : Subjects were 37 female patients with coldness (mean age 37 years, age range 23-48 years), whose migraine during their intra-menstrual periods was successfully treated with goshuyuto for 3 months. In order to treat migraine in the menstrual period, goreisan was added to goshuyuto from 1 week before onset, until the end of their menstrual period. Results : Among 37 patients, the treatment was effective in 26 patients (70%). Significant variables were found to be dull headache (p = 0.003), edema (p = 0.006), vertigo (p = 0.014) and oliguria (p = 0.014) during attacks, as well as worsening before rain (p = 0.004). Conclusion : The periodical combination of goreisan and goshuyuto seems to be effective in patients with menstrual migraine who report symptoms of sui disturbance, such as dull headache and oliguria during their attacks.