A 62-year-old man was referred to us because of acute aortic dissection (Stanford type A). He had had liver cirrhosis (Child-Pugh class B) and hepatic cell carcinoma in the left lateral lobe, which had been resected 3 years ago. On admission he was drowsy and was in shock. CT showed dissection from the ascending aorta to the abdominal aorta. Echocardiography revealed severe aortic regurgitation. An emergency operation was indicated although it was a very high risk procedure. Under cardiopulmonary bypass with moderate hypothermia, the aortic root was replaced with a Freestyle valve (23mm). Then the ascending aorta was replaced with a woven Dacron graft (28mm) under cardiac arrest and isolated cerebral perfusion. Postoperatively, he had cardiac tamponade and cerebral infarction (perhaps due to the preoperative events). However, he was successfully discharged on the 34th postoperative day.

A 73-year-old woman was referred to our hospital for angina pectoris due to triple-vessel-disease. She underwent off-pump coronary artery bypass grafting ×3 (RITA-LAD, LITA-OM, SV-PDA). Her vital signs were stable during the operation and the postoperative status was steady in the ICU. However, on the next day, she suddenly had severe back pain with markedly elevated blood pressure. Urine output immediately shut down and respiratory failure progressed with time. An enhanced CT scan revealed aortic dissection (DeBakey type I and Stanford type A). An emergency operation was performed via re-sternotomy. Cardiopulmonary bypass was initiated and the body was cooled down to 20°C. Under circulatory arrest with isolated cerebral perfusion, the ascending aorta was replaced using a one-branched Hemashield graft (26mm in diameter). The entry of the dissection was located at the proximal anastomosis site of the vein graft. The postoperative course was uneventful and she was discharged on the 24th postoperative day.

A 68-year-old man was referred to our hospital with an abnormal shadow on chest X-ray film. Enhanced chest CT scan revealed intrathoracic left subclavian artery aneurysm (maximum diameter 4cm) just above the aortic arch. Surgery was indicated considering the risks of aneurysm rupture and distal embolism, although he was asymptomatic. Under left 4th posterolateral thoracotomy, the aneurysm was exposed. Cardiopulmonary bypass was initiated with cannulation of the left femoral artery and vein (to the right atrium). Circulatory arrest and isolated cerebral perfusion were achieved at 25°C core-temperature. The distal arch was replaced using a 26mm Hemashield graft and the left subclavian artery was reconstructed interposing an 8mm graft. The postoperative course was uneventful: he was extubated at 8h and was sent to the ward the next day. He was given an ambulatory discharge on the 13th postoperative day.

A 92-year-old woman was referred to our hospital with lower abdominal pain and lumbago. Her vital signs were stable at an emergency outpatient-clinic. An enhanced CT scan showed a sealed rupture of a right internal iliac artery aneurysm (85×73mm in diameter). An emergency operation was performed via median laparotomy. As predicted pre-operatively, a large hematoma was found in the retroperitoneal space and mesenterium surrounding the right internal iliac artery aneurysm (sealed rupture). Y-grafting was performed using a 16×8mm Intergard: proximal and distal ends of the graft were the abdominal aorta and bilateral femoral arteries, respectively. Left common iliac artery, right external iliac artery and right internal arterial aneurysm were suture-closed. The postoperative course was uneventful and she was discharged on the 13th postoperative day on foot.

A 73-year-old woman was referred to our hospital with a feeling of chest compression. Coronary angiography revealed a giant coronary artery aneurysm, located in the middle of a coronarypulmonary artery fistula originating at the left anterior descending artery. Also another fistula was shown between the right coronary artery and the pulmonary artery. Surgical correction was indicated due to the risks of the aneurysm rupture and coronary events. Under cardiopulmonary bypass, suture-closure of the coronary artery aneurysm and ligation of the fistulae were carried out with success. Transesophageal echocardiography was useful to confirm disappearance of the abnormal shunts after the operative procedures. The postoperative course was uneventful. Postoperative coronary angiography showed no aneurysm or fistula. She was discharged on the 11th postoperative day on foot.

The prevalence of human immunodeficiency virus (HIV) infection is lower in Madagascar than in continental African countries, but recently it has steadily risen. To identify factors that facilitate or deter condom use among married couples in Madagascar, a cross-sectional study was conducted by means of a questionnaire survey of 977 women attending 10 health facilities for antenatal care and child care. Information on reproductive and socioeconomic factors was obtained, and logistic regression analysis was used to identify factors contributing to condom use. Child death and women’s earnings were statistically significant factors for condom use, with an odds ratio of 2.0 (95% confidence interval (CI): 1.2-3.5) for the former and 1.6 (95% CI: 1.1-2.3) for the latter in the logistic regression analysis. The promotion of economic independence among women and the reduction of child mortality deserve greater attention in the planning of HIV prevention policy in Madagascar.

The purpose of this study was to determine the effectiveness of combined aerobic and resistance training circuit on daily physical activity, motor function, and health-related QOL among community-dwelling women aged over 65. Of 102 subjects recruited from the local community, 60 met the inclusion criteria. The subjects were randomly divided into two groups: intervention and control. The intervention group was asked to participate in 60 minutes of combined aerobic and resistance training circuit three times a week for 3 months, while the control group was asked to participate in a study circle once a month for 3 months. Daily physical activity was measured by an activity monitor, and questionnaire, physical functioning, and health related QOL were measured before and after intervention. Daily physical activity as measured by the activity monitor increased significantly in the intervention group but not in the control group, although daily physical activity as measured by questionnaire did not significantly differ between groups. Distance walked over 6 minutes significantly increased in the intervention group than in the control group. No significant difference was found in health related QOL between groups. We conclude that combined aerobic and resistance training circuit is effective for increasing daily activity in community-dwelling older women and for enhancing physical function.

Objectives: The aim of this study was to identify characteristic lifestyles in children with obese parents. Methods: 8,030 children (4,072 males and 3,958 females) aged 6 to 7 years were investigated. A questionnaire relating to the lifestyles of children was distributed through elementary schools for completion by parents. The heights and weights of parents were self-reported. A parent with a body mass index (weight in kilograms divided by the square of height in meters) greater than the 90th percentile for gender (26.7 kg/m2 for fathers and 24.3 kg/m2 for mothers) was defined as an obese parent. A chi-square test for each trend was applied to evaluate an increasing trend in the frequency or level of each lifestyle in children with obese parents. Results: Children with obese parents were significantly associated with increasing trends in the proportions categorized by irregular intake of breakfast, faster eating, longer TV watching, and shorter sleeping hours. Conclusions: These lifestyles are considered to be possible risk factors for the development of obesity. These characteristic lifestyles observed in children with obese parents could strengthen the relationship between child and parental body compositions, in addition to the genetic predisposition to obesity in children with obese parents. These findings indicate that education with lifestyle modification for obese parents will be required to prevent further weight gain in children with obese parents.
Child ; Parents ; Life Style ; seconds ; trends

The peritoneum is the most frequent site of recurrence for gastric cancer after gastrectomy, followed by the liver and lymph nodes. In contrast, metastasis to the thymus is rare. Annual surveillance with computed tomography was performed on a 67-year-old man who previously underwent a distal gastrectomy and D2 lymph node dissection for gastric cancer at Tottori University. Five years after the initial operation, an anterior mediastinal tumor was detected by computed tomography. The patient underwent video-assisted thoracic surgery to remove the tumor. Histopathology revealed adenocarcinoma cells similar to those of the gastric cancer resected 5 years previously. Thymic metastasis was considered likely based on the location of the tumor. The recognition that gastric cancer can metastasize to unusual anatomic locations, such as the thymus, can facilitate an accurate, prompt diagnosis and appropriate treatment.
Adenocarcinoma* ; Aged ; Diagnosis ; Gastrectomy ; Humans ; Liver ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis* ; Peritoneum ; Recurrence ; Stomach Neoplasms ; Thoracic Surgery, Video-Assisted ; Thymus Gland

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic disease characterized by suprapubic pain and lower urinary tract symptoms. Perhaps because of the heterogeneous nature of this disease and its multifactorial etiology, clinical trials in allinclusive populations of IC/BPS patients without phenotyping in the last decade have mainly failed to discover new therapeutic modalities of IC/BPS. Thus, phenotyping IC/BPS, aimed at identifying bladder-centric and/or bladder-beyond pathologies, including cystoscopic observation of Hunner or non-Hunner lesions of the bladder mucosa, is particularly important for the future of IC/BPS management. Based on recent discussions at international conferences, including the International Consultation on IC, Japan, it has been proposed that Hunner-lesion IC should be separated from other non-Hunner IC/BPS because of its distinct inflammatory profiles and epithelial denudation compared with non-Hunner IC/BPS. However, there are still no standard criteria for the diagnosis of Hunner lesions other than typical lesions, while conventional cystoscopic observations may miss atypical or small Hunner lesions. Furthermore, diagnosis of the bladder-centric phenotype of IC/BPS requires confirmation that identified mucosal lesions are truly a cause of bladder pain in IC/BPS patients. This review article discusses the current status of IC/BPS pathophysiology and diagnosis, as well as future directions of the proper diagnosis of bladder-centric IC/BPS, in which pathophysiological mechanisms other than those in inflammatory pathways, such as angiogenic and immunogenic abnormalities, could also be involved in both Hunner-lesion IC and non-Hunner IC/BPS. It is hoped that this new paradigm in the pathophysiological evaluation and diagnosis of IC/BPS could lead to pathology-based phenotyping and new treatments for this heterogeneous disease.