Hyperlexia and ambient echolalia are rare conditions, and investigations into their clinical course have not been reported in the literature thus far. Here we report the case of a 69-year-old woman with cerebral infarction of the left anterior cingulate cortex and corpus callosum, on whom we performed an echo induction test for studying her long-term hyperlexia and ambient echolalia. Her clinical features included symptoms of complex disorders such as visual groping, compulsive manipulation of tools and callosal disconnection syndrome. The patient did not have dementia or aphasia. Her most outstanding behavioral traits were the hyperlexia and ambient echolalia. We investigated the induction of her hyperlexia and ambient echolalia by subjecting the patient to 10 verbal questions using a background of visual (bookshelves were placed in front of her) and auditory (imitated hospital announcements) stimuli at periods of 1, 2 and 6 months after the stroke. Hyperlexia was induced at 1 and 2 months after stroke, whereas ambient echolalia was only induced at 1 month after stroke. The disappearance of the hyperlexia and ambient echolalia in this case might be due to a reduction in the disinhibition of response to external stimuli caused by damage sustained in the stroke to the left anterior cingulate cortex and corpus callosum.

Stentless bioprosthetic valves have been implanted for treatment of aortic valve disease, especially in elderly patients ; these valves have the advantage of durability and excellent hemodynamics compared with stented bioprosthetic valves. Although good long-term results in patients with stentless bioprosthetic valves have been reported recently, reoperation has been gradually increasing. We performed reoperation for the SJM Toronto SPV and Medtronic Freestyle valves in one patient each. The SJM Toronto SPV was used in a 30-year-old woman ; however, 8 years later, the valve showed severe calcification and adhesions, and could not be completely removed (Case 1). The other reoperation case, wherein a 69-year-old man underwent aortic valve replacement with the Medtronic Freestyle 4 years previously, showed no adhesion around the implanted valve, which could be easily removed from the autologous aortic annulus. Consequently, the first patient required reimplantation of a small mechanical valve (SJM #19). In contrast, we were able to use a stentless bioprosthetic valve (Prima Plus #23) for the second patient. Further observations on stentless bioprosthetic valves are required.

The purpose of this study was to examine the effects of long-term habitual exercise on daily total energy expenditure (TEE) and its components, body composition and maximal oxygen uptake (VO₂max) in middle-aged Japanese women. Twenty-eight subjects aged 39 to 58 years were assigned either to a nonhabitual exercise group (Control ; n=12) or a habitual exercise group (Exercise ; n=16). TEE, physical activity level (PAL) and the daily physical activity energy expenditure (PAEE) were assessed by doubly labeled water (DLW) method. The exercise-induced energy expenditure (ExEE) and nonexercise-induced energy expenditure (NExEE) were evaluated based on the activity record investigation conducted simultaneously during the DLW measurement period. The result follows that TEE was significantly (p<0.01) higher in the Exercise group (2520 kcal · day^-1) than in the Control group (1921 kcal · day^-1). There was no significant difference in basal metabolic rate between the groups. PAEE and ExEE were significantly higher in the Exercise group than in the Control group (p<0.01). Habitual exercise induced an increase in TEE without resulting in a compensatory reduction of NExEE. The percentage body fat (fat%) was significantly lower in the Exercise group (25.5%) than in the Control group (30.9%). VO₂max was higher in the Exercise group (1788 ml · min^-1) than in the Control group (1417 ml. min^-1). After correction for body weight, fat% was negatively associated with TEE (p<0.01), PAEE (p<0.01) and ExEE (p=0.05), while VO₂max was positively associated with TEE (p<0.05), PAL (p<0.05), PAEE (p<0.05) and ExEE (p<0.01). These results suggest that habitual exercise is associated with the increase of TEE, the improvement of body composition and VO₂max. The improvement of VO₂max was mainly caused by the increase in ExEE, indicating that the exercise intensity is important to the improvement of cardiorespiratory endurance fitness.

Purpose: In Japan, only a few studies reported self-management systems of narcotic drugs among hospitalized patients. Our purpose was to develop a self-management system for patients and assess its effectiveness. Methods: Based on the results of a questionnaire administered to our hospital medical staff, methods of selecting eligible patients and methods of self-management of narcotic drugs were determined by a multi-professional team. Selection criteria for eligible patients were: 1) satisfactory results on assessment of the patient's ability to self-manage orally-administered drugs; 2) satisfactory results on assessment of the patient's ability to self-manage narcotic drugs; 3) physician's consent was obtained; and 4) the patient wanted to participate in this program. After the period of self-management of drug administration, questionnaires were distributed to the patients and medical staff in the general ward. Results: One hundred hospitalized patients used narcotic drugs between April 2008 and March 2009. Among them, 26 patients met the criteria for self-management of narcotic drugs, and 20 voluntarily participated in the program. There were no reports of missing or stolen drugs. There were no reports of administration of incorrect dose of the drug during the self-management period (average 15.0 days). Ninety-four percent of the self-managing patients provided positive feedback about self-management of narcotic drugs, such as mental stability by having drugs on hand and no problems in self-management. Seventy-five percent of staff members answered that the self-management system of narcotic drugs should be continued. Conclusion: Our results suggest that this system of narcotic drug self-management is safe and appropriate. Palliat Care Res 2010; 5(1): 114-126

Prosthetic and bioprosthetic materials currently in use lack growth potential and therefore must be repeatedly replaced in pediatric patients as they grow. Tissue engineering is a new discipline that offers the potential for creating replacement structures from autologous cells and biodegradable polymer scaffolds. In May 2000, we initiated clinical application of tissue-engineered vascular grafts seeded with cultured cells. However, cell culturing is time-consuming, and xenoserum must be used. To overcome these disadvantages, we began to use bone marrow cells, readily available on the day of surgery, as a cell source. Since September 2001, tissue-engineered grafts seeded with autologous bone marrow cells have been implanted in 44 patients. The patients or their parents were fully informed and had given consent to the procedure. A 3 to 10ml/kg specimen of bone marrow was aspirated with the patient under general anesthesia before the skin incision. The polymer tube serving as a scaffold for the cells was composed of a copolymer of lactide and ε-caprolactone (50: 50) which degrades by hydrolysis. Polyglycolic or poly-l-lactic acid woven fabric was used for reinforcement. Twenty-six tissue-engineered conduits and 19 tissue-engineered patches were used for the repair of congenital heart defects. The patients' ages ranged from 1 to 24 years (median 7.4 years). All patients underwent a catheterization study, CT scan, or both, for evaluation after the operation. There were 4 late deaths due to heart failure with or without multiple organ failure or brain bleeding in this series; these were unrelated to the tissue-engineered graft function. One patient required percutaneous balloon angioplasty for tubular graft-stenosis and 4 patients for the stenosis of the patch-shaped tissue engineered material. Two patients required re-do operation; one for recurrent pulmonary stenosis and another for a resulting R-L shunt after the lateral tunnel method. Kaplan-Meier analysis in relation to patients' survival was 95% within 3 years. There was only 1 patient (who underwent a total cavo-pulmonary connection procedure) requiring re-intervention in the tubular graft group and the material-related event-free rate was 96% within 3 years. This tissueengineering approach may provide an important alternative to the use of prosthetic materials in the field of pediatric cardiovascular surgery. As it is living tissue, these vascular structures may have the potential for growth, repair, and remodeling. However, this approach is still in its infancy, further studies to resolve the problems presented, and longer follow-up in patients are necessary to confirm the durability of this approach.

Background: The posterior transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) were developed for postoperative pain control after lower abdominal surgery. However, there is little data regarding their effects. Their analgesic effects and the distribution of the cutaneous sensory blockade were observed in patients undergoing laparoscopic gynecologic surgery. Methods: After an induction of general anesthesia, patients alternately received bilateral ultrasound-guided QLB type 2 (QLB2) or posterior TAPB using 20 ml of 0.375% levobupivacaine on each side. The measurements included visual analogue pain scores (VAS), cutaneous sensory blockade in each dermatome, demands for postoperative analgesics, and complications for up to 48 h after the block. Our primary endpoint was VAS at 24 h after the block. Results: Forty patients completed the study. The VAS at rest was significantly lower after QLB2 than that after TAPB at 48 h, but not at 24 h. Neither group differed in VAS when coughing at any point in time. Postoperative demands for fentanyl and other analgesics also did not differ for either block. The majority of injections produced a cutaneous sensory blockade in the T11 and T12 dermatomes in both groups. The median number of dermatomes blocked was limited to three dermatomes after either block. No severe complication related to either block was observed. Conclusions The analgesic effects of QLB2 and posterior TAPB did not differ in patients undergoing laparoscopic gynecologic surgery. The cutaneous sensory blockade produced was limited to three dermatomal levels in the majority of patients. However, these findings need to be confirmed through a larger comparative study.

A 75-year-old Japanese man with chronic hepatitis C was found to have a large liver tumor and multiple nodules in the bilateral lungs. We diagnosed the tumor as hepatocellular carcinoma (HCC) with multiple lung metastases based on imaging studies and high titers of HCC tumor markers. Remarkably, without any anticancer treatment or medication, including herbal preparations, the liver tumor decreased in size, and the tumor makers diminished. Moreover, after 1 year, the multiple nodules in the bilateral lungs had disappeared. Fifteen months after the first medical examination, transcatheter arterial chemoembolization (TACE) was performed for the residual HCC. Because local relapse was observed on follow-up computed tomography, a second TACE was performed 13 months after the first one. At 4 years after the second TACE (7 years after the initial medical examination), there was no recurrence of primary or metastatic lesions. Spontaneous regression of HCC is very rare, and its mechanism remains unclear. Understanding the underlying mechanism of this rare phenomenon may offer some hope of finding new therapies, even in advanced metastatic cases.
Aged ; Carcinoma, Hepatocellular/pathology/*secondary ; Chemoembolization, Therapeutic ; Humans ; Liver Neoplasms/*pathology ; Lung Neoplasms/*secondary ; Male ; Neoplasm Recurrence, Local/pathology ; Neoplasm Regression, Spontaneous/*pathology ; Tomography, X-Ray Computed

1）Palliative care education by means e–learning was performed from December 3 to 25, 2009, for 1256 hospital medical staff. We used the same true–or–false questions to assess their understanding before and after the e–learning course.
2）Regardless of the staff member’s experience, the total scores on the test were higher after the course than before the course. Therefore, this e–learning course had an effect on basic knowledge for multiple types of medical staff.
3）The percentage of correct answers was particularly improved for questions about topics we had emphasized: drug dependence and side effects.

OBJECTIVESThe purpose of this study was to examine the relation between exercise intensity and immune function.

METHODSTen healthy young males underwent a constant work rate exercise of three levels, 90%, 80% and 70% ventilatory threshold (VT) work rate, for 20 min on a bicycle ergometer. These work rates were calculated for each individual based on his VT work rate obtained by the incremental exercise tests. Blood samples were collected before and after the exercise, and immune function indices were measured.

RESULTSCompared with the obtained[Formula: see text] at[Formula: see text] in the incremental test, the[Formula: see text] with the exercise of 70% VT work rate was at a similar level and the one with the exercise of 90% or 80% VT work rate had a significantly greater value. The numbers of leukocytes and neutrophils significantly increased in the 90% and 70% VT work rate groups. In 80% VT work rate group, the CD4/CD8 ratio was significantly depressed. The CD16(+)CD57(-) (%), natural killer cell populations, had a tendency to increase at 80% VT work rate, and also the CD16(+)CD57(-) (%) had a similar tendency at 90% or 80% VT work rate.

CONCLUSIONSThis study shows that moderate exercise reaching or exceeding the VT level acutely affects T cell and NK cell subsets.