A successful surgical correction of an incomplete endocardial cushion defect (ECD) with an ostium primum defect in a 63-year-old man is reported. Incomplete ECD with ostium primum defect often causes severe heart failure in infancy. Reports of its surgical correction in elderly patients are few. The patient had upper abdominal discomfort and grade 1 mitral valve regurgitation. The preoperative diagnosis was complete ECD (Rastelli type A) because we misdiagnosed a leakage from a cleft between the left superior leaflet and the left inferior leaflet for a flow through a ventricular septal defect when we analyzed a preoperative left ventriculography. The importance of not misdiagnosing the leakage and echocardiography in preoperative diagnosis of ECD was therefore realized. The operative procedure involved patch closure of the ostium primum defect and mitral valve annuloplasty by Kay's procedure and the mitral valve regurgitation completely disappeared. The postoperative course was uneventful. The upper abdominal discomfort and cardiomegaly improved. If there is no severe dysfunction of other organs, surgical correction of incomplete ECD should be recommended even for elderly patients.

Objective: This study aimed to investigate the effect of nutritional status on estimated fentanyl absorption in cancer patients being treated with a fentanyl transdermal patch (FP), by measuring the residual fentanyl content in used patches. Methods: 24 adult Japanese inpatients receiving FP treatment for chronic cancer-related pain were enrolled. During FP application, the nutritional risk of the patients was measured using the Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening 2002 (NRS 2002), both of which are nutrition screening tools used widely in Japan. We then classified the patients into low-, medium-, and high-risk groups according to the nutritional risk measured by MUST, and compared the transdermal fentanyl delivery efficiency (FE) between that groups. Results: The FE, which is estimated by the residual fentanyl content in used FPs collected from the patients, was found to be decreased in the high-risk group. According to NRS 2002, the mean transdermal fentanyl delivery efficiency in the high-risk group was significantly lower than that in the low-risk group. Conclusion: These results showed that changes in nutritional status affect FE, and that poor nutritional status might decrease transdermal fentanyl absorption in cancer patients.

The purpose of this study was to determine the physiological responses, stroke rate and stroke length of front crawl leg kick and arm stroke of age-group and college swimmers and to elucidate the characteristics of male age-group swimmers, which have not been highlighted adequately. The subjects were ten 11.8-to 12.4-year-old well-trained male elementary school swimmers (group E) and nine 20.1-to 21.1-year-old well-trained male college swimmers (group C) . All the subjects were categorized into similar swimming levels for their ages. All the experiments were performed in a swimming flume (AQUAGYM made by IHI) . The water velocities during leg kicking and arm stroking were 60 and 70%, respectively, of the maximal velocity at maximal oxygen uptake (Vmax) . The oxygen uptake (VO₂), heart rate (HR), pulmonary ventilation (V_E), tidal volume (TV), respiratory rate (RR) and blood lactate (BL) level of each group were significantly higher during leg kicking than arm stroking at both velocities. VO2, V_E; and TV were significantly higher in group C than group E during leg kicking and arm stroking at both velocities, but HR, RR and BL did not differ significantly. The leg kick to arm stroke VO₂ ratio at 70% Vmax was significantly higher in group E than group C. The stroke rate at the same velocity was significantly lower and the stroke length was significantly higher in group C than group E, but the kick rate and length did not differ significantly. VO₂·SR^-1 and VO₂ KR^-1 at both velocities were significantly higher in group C than group E. VO₂ Wt^-1 SR^-1 at 70% Vmax was significantly higher in group C than group E, but VO₂ Wt^-1 KR^-1 at both velocities was significantly lower in group C than group E. These results clarified the differences between group E and group C, which must be considered carefully when designing a training program for age-group swimmers.

Objective:It is well known that the use of benzodiazepines is associated with falling in elderly people, but there have been few researches focused on changes in the dose of benzodiazepines and falls. If the association between changes in the dose of benzodiazepines and falling becomes clear, we may take an action to prevent falling.In this study, we investigated the association between changes in the dose of benzodiazepines and falling among elderly inpatients in an acute-care hospital.
Design:Falling generally results from an interaction of multiple and diverse risk factors and situations, and medication history of each subject must be considered in this study. We conducted a case-crossover study in which a case was used as his/her own control at different time periods. Therefore covariates that were not time-dependent were automatically adjusted in this study.
Methods:Subjects were patients who had falling at one hospital between April 1, 2008 and November 30, 2009. Data were collected from incident report forms and medical records. Odds ratio for changes in the dose of benzodiazepines were calculated using conditional logistic regression analyses.
Results:A total of 422 falling by elderly people were eligible for this study. The odds ratio for increased amounts of benzodiazepines was 2.02(95% Confidence Interval(CI):1.15, 3.56). On the other hand, the odds ratio for decreased amounts of benzodiazepines was 1.11(95%CI:0.63,1.97).
Conclusion:There was an association between increased amounts of benzodiazepines and falling. Hence, it is considered meaningful to pay attention to falling when amounts of benzodiazepines are increased to prevent falling in hospitals.

Objective: We have used therapeutic drug monitoring (TDM) analysis software to set the initial dose of vancomycin in our hospital.  In contrast, the TDM guideline, in which the initial dose of vancomycin per body weight was set, was published in 2012.  We looked forward with utilizing the TDM guideline in the clinical setting, after which we conducted multiple surveys to determine the important points of the TDM guideline.
Methods: We surveyed patients treated with vancomycin, in whom the initial dose was set using the TDM analysis software and the concordance rate between the vancomycin dose set with the software and that set with the TDM guideline.
Results: The concordance rate of vancomycin dose was 42.1%.  The mean age of the high-dose group (vancomycin dose higher than that recommended by the TDM guideline), was younger than that of the recommended-dose group.  Additionally, the mean body weight of the high-dose group was significantly lower than that of the recommended-dose group.  The corrected creatinine clearance of the low-dose group was significantly lower than that of the recommended-dose group.
Conclusion: Our results suggest that when the initial dose is set after referring the TDM guideline in patients who are not very high age, and having low body weight and decreased renal function, the dose may differ from the dose set by using TDM analysis software.  In addition, since the recommended dose per body weight is a range and not a single value, setting the dose appropriate to target trough concentration is necessary.

The aim of this studv was to clarify the effects of water immersion on the cardiovascular recovery process following submaximal steady state exercise on land. Seven male subjects (23 yrs old) underwent experiments under four separate conditions on separate days (15 minutes of cycling exercise at 50% and 80% maximal oxygen consumption followed by 16 minutes of recovery in a sitting position in water and out of water) . Concerning conditions in water, mean water temperature was 29.4 degrees, and the immersion level was set at xiphoid. Mean room temperature in out of water conditions, and during all conditions of exercise, was 24.4 degrees. Oxygen consumption (VO₂), heart rate (HR) and blood pressure (systolic: SBP, diastolic: DBP) were measured under each condi tion. Mean blood pressure was calculated from SBP and DBP (MBP=1/3× ( SBP-DBP) +DBP) . Stroke volume (SV) was measured by Doppler echocardiography, and then cardiac output (CO=SV×HR), total peripheral resistance (TPR=NIBP/CO) and arteriaVmixed venous oxygen difference (a-v O₂diff=VO₂/CO) were calculated. In comparison with the same exercise intensity condition, there were no significant differences between recovery processes of VO₂, HR, SBP, DBP and MBP in and out of water. SV and CO were significantly higher (p<0.05) during the recovery process in water than out of water (SV: at 50 and 80% maximal oxygen consumption conditions, CO: at 80% condition) . The TPR and a-v O₂diff were significantly lower (p<0.05) during the recovery process in water than out of water at 80% oxygen consumption condition. These results indicate that water immersion facilitates circulating blood volume during the recovery process without increasing blood pressure, especially during recovery after high intensity exercise. Therefore, we suggest that increased left ventricular preload with immersion would be an important factor in cardiovascular regulation not only at rest but also during recovery after exercise.

The following analgesic effects have resulted from irradiating each finger joint (DIP, PIP, and MCP) of patients with rheumatoid arthritis for 20 seconds using the semiconductor laser, “uni-Laser” (10mw, 790nm) from ITO company.
1) Comparison of the post-exposure state with the pre-exposure state in the open test
i) Of 13 cases of joint pain, 7 cases showed improvement and 6 cases showed no change with no case showing aggravation.
ii) Duration of analgesic effect was less than 48 hours in 2 cases, less than 72 hours in 1 case, and more than 96 hours in 3 cases.
2) Comparison of the post-exposure state with the pre-exposure state in the single blind test on a total of 25 patients with rheumatoid arthritis. Twelve patients were exposed to the irradiation twice per week, 10 times a session (irradiated group) and 13 were exposed to the dummy of the above (control group).
i) The irradiated group improved considerably in the number of painful joints, frequency of joint pain, and grasping power. The rate of improvement was superior to that of the control group (P<0.05).
ii) No significant improvement in duration of morning stiffness was shown in either group.

We investigated the outcomes of nephron-sparing surgery in patients with small renal cell carcinomas by retrospectively reviewing the records of 20 elective cases of nephron-sparing surgery performed from 1994 to 2003. All patients had low pathologic stage, localized, unilateral tumors smaller than 4 cm and sporadic renal cell carcinomas. There were no significant differences between mean preoperative serum creatinine levels and postoperative levels. Nephron-sparing surgery may be safe and curative treatment for low pathologic stage, localized, unilateral tumors smaller than 4 cm and sporadic renal cell carcinomas.
Surgical aspects ; Carcinoma, Renal Cell ; Nephron brand of racepinephrine hydrochloride ; seconds ; Small

Six (1.2%) of 501 patients sustained phrenic nerve injury during operation for congenital heart disease at our institutions between 1992 and 1998. The diagnosis was confirmed by percutaneous stimulation of the phrenic nerve. All but 1 patient were less than 9 months old, and the average weight was 3.6kg. All 6 patients underwent diaphragmatic plication and were extubated by 7 days after operation. Percutaneous stimulation of the phrenic nerve allowed direct assessment of phrenic nerve function which was difficult to detect by clinical and radiological evidence. This method can be non-invasively used at the bedside to facilitate early and accurate diagnosis of phrenic nerve palsy.

Helicobacter pylori (HP) is associated with gastroduodenal disease. Although it has been reported that HP is highly sensitive to beta-lactams and macrolides, the efficacy of these monotherapies for eradicating HP is rather poor. Recent pharmacological studies have shown the effectiveness of combined therapy using PPI, antibiotics, and bismuth agents or metronidazole, but it has been known to lead to side effects and poor patient compliance. In Japan, mucosal protective agents are principally used for the treament of gastritis and gastric ulcers, and as previously reported, some mucosal protective agents, such as sofalcon and plaunotol, have anti-HP properties. Although they are not sufficiently effective to be used as monotherapy in the eradication of HP, in combination with antibiotics and PPI, eradication rates were elevated and side effects were uncommon.
Chinese medicinal formulas have been used for stomach disease in traditional Oriental medicine. The authors studied the effects of combined therapy with Omeprazole (OPZ), AMPC and Chinese medicine (Hangeshashin-to and Sanoshashin-to) instead of mucosal protective agents in the eradication of HP. The study was conducted on a total of 137 HP positive patients with endoscopic evidence of ulcers or gastritis. Dual therapy with OPZ and AMPC had a weak eradicating effect on HP (75%), but combined therapy using OPZ, AMPC and a Chinese medical formula was successful in eradicating HP in 20 out of 24 patients (85%).
The antibacterial effects of pharmaceutical preparations and crude drug extracts of Chinese medicine against HP were examined in an in vitro study. No antibacterial action against HP was demonstrated by these agents at concentrations of less than 2000μg/ml concentration. Chinese medicinal preparations should be used in combined therapy with antibiotics and PPI for optimum efficacy in eradicating HP.
This new eradication regimen including OPZ, AMPC and Hangeshashin-to is well tolerated; side effects are minimal and uncommon. This triple therapy may be useful in the treatment of HP infection, and is referred to as a “new Japanese regimen.”