Objective : To evaluate the effect of beraprost sodium (beraprost) on the vascular events occurring in patients with peripheral arterial disease (PAD) in a meta-analysis of placebo-controlled, randomized trials.
Design : Meta-analysis
Methods : Among the clinical trials of beraprost in patients with intermittent claudication associated with PAD, placebo-controlled, randomized trials with vascular events as outcome measures were selected. Two trials met the criteria, each of which was a comparative trial of beraprost (40 μg t.i.d.) and placebo (t.i.d.), with a six-month follow-up period.
Results : With both trials combined, the analysis included 594 patients in the beraprost group and 590 in the placebo group. The risk ratio was 0.608 (95%CI : 0.41 to 0.90, p =0.012), demonstrating the efficacy of beraprost on all vascular events. The risk ratio for lower limb deterioration was 0.598 (95% CI : 0.34 to 1.06, p =0.079), which was similar to that for all vascular events. A statistically insignificant but similar result was also obtained for cardio/cerebrovascular events with a risk ratio of 0.619 (95%CI : 0.36 to 1.07, p = 0.085). Heterogeneity between the two studies was not found for any of the events.
Conclusion : The results demonstrated the efficacy of beraprost on the vascular events in patients with PAD. The potential benefit of beraprost on vascular events will require evaluation in a larger prospective investigation.

We report the case of a 59-year-old man who presented with classical-type fever of unknown origin (FUO) during observation of hypertension and polycystic kidney. The presence of malignancy was suspected based on elevation of tumor marker levels. We examined the patient carefully and attempted diagnostic imaging, but definitive diagnosis was difficult due to the presence of multiple hepatic cysts. Hepatic biopsy detected adenocarcinoma, but identifying whether lesions were primary cholangiocellular carcinoma or metastases was difficult, and we were ultimately unable to diagnose the tumors as cholangiocellular carcinoma until autopsy. Polycystic kidney with hepatic cysts and complicated by cholangiocellular carcinoma is rare, but should be considered among the differential diagnosis for FUO, which itself is frequently encountered.

Aneurysms of the inferior left ventricular wall comprise only a small fraction of all aneurysms that have been reported in surgical series. Pseudo-false ventricular aneurysm is very rare and communicates with the left ventricule through a small orifice, and its wall contains myocardial tissue, unlike false ventricular aneurysm. A 53-year-old man was admitted to our hospital with chest pain. Echocardiography revealed left ventricular aneurysm, and the coronary arteriography subsequently revealed a complete occlusion of right coronary #2 and 75% and 90% stenosis of left anterior descending artery #7 and #8, respectively. Left ventriculography revealed an aneurysm of the inferior left ventricular wall, which communicated with the left ventricle through a small orifice and exhibited contraction. Surgical repair was indicated. Endoventricular circular patch repair (Dor operation) of the aneurysm of the inferior left ventricular wall and coronary artery bypass grafting to the left anterior descending artery and the right coronary artery were simultaneously performed under cardiopulmonary bypass with moderate hypothermia. The postoperative course was uneventful and the patient was discharged on the 22th day after surgery. Pseudo-false ventricular aneurysm of the inferior left ventricular wall was diagnosed by pathologic examination.

A 50-year-old man who had coronary artery bypass grafting (LITA-LAD, RA-RCA, SVG-OM-PL) 6 years previously was admitted with acute dissection of the aorta (DeBakey type I). Preoperative computed tomography showed that all coronary bypass grafts were patent. We replaced the graft of the ascending aorta and reconstructed the coronary artery bypass by re-sternotomy, circulatory arrest (rectal temperature: 23.6°C), retrograde cerebral perfusion, and intermittent retrograde cardioplegia. Because a radial artery (RA) graft and a saphenous vein graft (SVG) each had intact orifices, we detached them together and attached the grafts back to the aortic graft wall. He was weaned successfully from cardiopulmonary bypass without difficulty and postoperative transthoracic echocardiography (TTE) showed good left ventricle (LV) function. Postoperative multidetector-row computed tomography (MDCT) showed that the RA graft and SVG were patent. By performing circulatory arrest and intermittent retrograde cardioplegia, we successfully protected the myocardial function of a patient with acute aorta dissection after a CABG and we reconstructed the graft without needing further coronary anastomosis.

ABSTRACT: A case of infectious mononucleosis (IM) in a previously healthy 43-year-old male is presented. The patient complained of fever and a sore throat of 3 weeks' duration. Although blood tests showed a marked increase in atypical lymphocytes, tests for Epstein-Barr virus (EBV) and cytomegalovirus (CMV) were negative. Human immunodeficiency virus type 1 (HIV-1) antibody was positive on enzymelinked immunosorbent assay (ELISA), and the HIV-1 viral load was 6.4×10⁴copies/mL. Western blot (WB) analysis did not initially confirm HIV-1 infection ; however, HIV-1 infection was confirmed one month after presentation. Although several pathogens can cause infections presenting as IM, in Japan there have been few reports of acute retroviral syndrome presenting as IM. This case is being reported to stress the importance of the early diagnosis of acute retroviral syndrome.

The purpose of this investigation is to study the frequency and penetrance of BRCA1 and BRCA2 germline mutations in Japanese familial breast cancer patients. Mutation analysis of BRCA1 and BRCA2 by protein truncation test was conducted on the 120 breast cancer patients (probands) with at least one breast cancer (site-specific breast cancer families, n=105) or one ovarian cancer (breast/ovarian cancer families, n=15) patient in their first-degree relatives. Eight BRCA1 (7.6%) and ten BRCA2 (9.5%) mutations were found in site-specific breast cancer families (n=105), and seven BRCA1 (46.7%) but no BRCA2 (0%) mutations were found in breast/ovarian cancer families (n=15). In site-specific breast cancer families, mutation frequency of BRCA1 and BRCA2 was high in families with more than three breast cancer patients (30%, 6/20), early onset (40< or = years old) breast cancer patients (41.1%, 14/34), or bilateral breast cancer patients (40%, 6/15). Cumulative incidence of breast cancer by age 70 was estimated to be 78% and 80% for BRCA1 and BRCA2 mutation carriers, respectively, and that of ovarian cancer was 40% and 0% for BRCA1 and BRCA2 mutation carriers, respectively. Family profiles are important determinants of risk for carrying a BRCA1 or BRCA2 mutation. Japanese women with BRCA1 mutation have a high risk of breast and ovarian cancer and those with BRCA2 mutation have a high risk of breast cancer but not ovarian cancer.
Asian Continental Ancestry Group* ; Breast Neoplasms* ; Breast* ; Female ; Germ-Line Mutation* ; Humans ; Incidence ; Mutation Rate ; Ovarian Neoplasms* ; Penetrance

No abstract available.
Melanoma

A study was conducted to clarify the effect of hyperoxia (HO) on exercise tolerance andhemodynamics in patients with ischemic heart disease (IHD) . The subjects were 10 patients with serious IHD who showed ischemic ST depression during low-intensity exercise testing. In all subjects, cardiopulmonary exercise testing (CPX) was performed using two types of inhalation : normoxia (NO) and HO (O₂: 60%, N₂: 40%) . Heart rate (HR), blood pressure (BP), rating of perceived exertion (RPE), elapsed exercise duration and pressure rate product (PRP) were measured, and ECG was recorded during CPX according to the Bruce protocol. The peak oxygen uptake (VO₂peak) was calculated using the appropriate formula. These data were compared between the NO and HO groups, and the following results were obtained.
ST depressions on ECG, BP, HR and PRP after 20 min of rest showed no changes under NO. The other hand, only ST depression was improved after 20 min of rest under HO. The exercise duration in HO group was longer than in the NO group, and the VO₂peak in the HO group was higher than in the NO group. However, peak RPE showed no significant difference between the HO and NO groups. The incidence of ST depression as an endpoint of CPX showed no significant difference between the two groups. BP, HR and PRP at the CPX endpoint showed no significant differences between the HO and NO groups. In patients whose exercise duration was prolonged beyond the mean value by HO, peak HR and PRP were increased significantly. However, this tendency was not seen in patients whose exercise was prolonged for less than the mean value.
In conclusion, these results suggest that an increase in the oxygen supply to peripheral working muscles may play an important role in increasing exercise tolerance under HO in IHD patients.

Objective: We conducted a questionnaire survey to comprehend the situation regarding the collection, provision, and utilization of drug safety information at hospitals.  In addition, we asked pharmaceutical companies how they select medical institutions to provide drug safety information.  We also investigated the current situation of information provision to Tokyo Medial Center by pharmaceutical companies.
Method: A questionnaire was mailed to all hospitals in Japan.  The survey was conducted between January 13 and February 10, 2011.  Moreover, we asked thirteen pharmaceutical companies by telephone and e-mail about the implementation status of the provision of information and performed a survey at Tokyo Medical Center on the current situation of information provision by pharmaceutical companies regarding revisions to precaution sections in package inserts.
Results: The results of the questionnaire survey (response rate: 41.2%) showed that the major information sources for hospitals were medical representatives (77.8%), Drug Safety Update (50.3%) and direct mails (49.3%).  Furthermore, in the case of drugs prescribed exclusively for extramural dispensing, fewer hospitals responded that medical representatives of the pharmaceutical companies provided drug safety information and more hospitals responded that they did not obtain any drug safety information at all, compared with drugs listed in the hospital formularies.
Conclusion: To minimize the risks of drugs, healthcare professionals must collect a wide range of drug safety information and must utilize this information in their medical practice.  Therefore, it is important that pharmaceutical companies and regulatory authorities make an effort to provide suitable information dissemination to medical institutions.  Furthermore, medical institutions must also strengthen their systems for collecting drug safety information and providing such information to healthcare professionals.