We worked out TTR values in patients receiving warfarin treatment in Abashiri-Kosei General Hospital. The patients were divided into two groups - those with satisfactory TTR values and those with poor TTR values - and associations between patient factors and average dosing interval were examined in the two groups. A total of 178 patients joined this study. The average TTR value worked out at 65.1±24.8%. It was found that the average TTR value for those patients aged at 70 and above came to 72.7±21.4%, which was significantly high as compared with 51.06plusmn;24.6% for those under 70 years of age. When the average TTR value was calculated after the optimal PT-range for the group of those below the age of 70 was changed from 2.0～3.0 to 1.6～2.6, it rose from 51.0% to 74.9%. These findings made it clear that PT-INR, regardless of age, was under control within the range from 1.6 to 2.6 in this hospital in accordance with the results of the J-RHYTHM Registry analysis.

We aimed to elucidate the impact of the conducting state in exercise programs and the degree of improvement in sit-to-stand power index (STS-PI) on the continuation of Chokin exercise by participants one year from the completion of the intervention period. Subjects participated in a 12-week Chokin exercise class for the elderly, which consisted of 10 body mass-based exercises. As variables indicating exercise conditions, the number of exercise days weekly and the total number of sets performed during the intervention period were adopted. STS-PI was calculated using the time required to perform 10-times-repeated sit-to-stand task, and its relative change (%∆STS-PI) was used to represent the degree of improvement in physical function. Among 52 men and 129 women who responded to the inquiry about the continuation of Chokin exercise one year from the completion of the intervention period, 32 men and 93 women confirmed continuation of the exercise program. Logistic regression analysis showed that %∆STS-PI for men, as well as %∆STS-PI and the number of exercise days weekly for women, were factors associated with the decision of subjects to continue the Chokin exercise. These results indicate that the degree of improvement in STS-PI associated with the Chokin exercise class is a factor for continuing the exercise program one year from the completion of the intervention period, at least in elderly men and women. Furthermore, high exercise frequency during the intervention period may be associated with the decision to continue Chokin exercise after the completion of the intervention among women.

Objective: We investigated the incidence of side effects related to contrast medium employed in our hospital based on monitoring materials to improve the safety of contrast-enhanced examinations.  Furthermore, we compared the incidence of side effects between the original product and generic drugs to confirm the safety of each preparation.
Methods: The survey period was from April 2007 until March 2011.  Based on the number of patients who underwent contrast-enhanced examinations and that of patients with side effects, we calculated the incidence of side effects in our hospital, and confirmed its annual changes.  Subsequently, we again collected the incidence of side effects per each manufacturer’s preparation employed, and confirmed the state of side effects of individual preparations.  Furthermore, we evaluated the symptoms as side effects, interval until appearance, and treatment for side effects during the data collection period, as well as the subsequent state, symptoms as side effects, and interval until appearance.  The chi square independence test was employed to compare the results among groups.  p<0.05 was regarded as significant (paired test).
Results: There were no changes in the annual incidence of side effects.  There were also no significant differences in the annual incidence of side effects among the preparations.  Furthermore, there were no marked differences in the symptoms, interval until appearance, treatment for side effects, or subsequent state among the preparations.
Conclusion: We investigated the appearance of side effects regarding contrast-enhanced examinations for 4 years.  We confirmed that there were no differences in the incidence of side effects among the preparations.

Retrograde cardioplegia is now an alternative or adjunctive method used worldwide as a cardiac protection during open heart surgery. However, its use involves some limitation. We operated on a patient suffering from aortic stenosis associated with PLSVC. During the operation on this patient for aortic valve replacement, retrograde infusion of cardioplegic solution could not be performed because the coronary sinus was excessively dilated and prevented the balloon from occluding it. Other anomalous lesion of the coronary sinus make the retrograde infusion of the cardioplegic solution difficult and these must always be kept in mind when cardioplegia is infused from the coronary sinus.

A 64-year-old man with a history of anterior blunt trauma 10 years previously was admitted to our hospital complaining of general fatigue. A plain chest roentgenogram showed pericardial calcification. Computed tomography and echocardiography showed the mass to be a calcified capsule in the anterior mediastinum compressing the right side of the heart. He underwent an operation through a median sternotomy. The mass was an organized hematoma encapsulated by a calcified fibrous and serous layer of the pericardium. The hematoma was resected together with the calcified pericardium under cardiopulmonary bypass. His postoperative course was uneventful. He had no history of hemopericardium but had experienced blunt chest trauma that seemed to have induced the subsequent localized constrictive pericarditis.

We investigated the clinical results of coronary arterial bypass grafting (CABG), using a terminal warm blood cardioplegia (TWBCP) for myocardial preservation. In the past 6 years, 102 cases of CABG have been performed at our institution. These 102 cases were divided into the following two groups; (1) Group T, consisting of 41 cases, in which TWBCP was employed; (2) Group non-T, consisting of 61 cases, in which TWBCP was not employed. We performed a comparative study between the groups on the perioperative cardiac function and so on. Between the two groups, there were no significant differences in age, gender, preoperative ejection fraction (EF), operative time, cardiopulmonary bypass time (CPBT) and the level of CPK-MB. In group T, the number of grafts was significantly more than that in group non-T (p=0.002). Aortic cross-clamp time was significantly longer in group T. However, the duration of assisted circulation after aortic declamp was significantly longer in group non-T than that of group T (p=0.01). The incidence of ventricular fibrillation after release of aortic clamp in group T was 9.8%, while it was 67.2% in group non-T, showing a significant difference. Furthermore, the postoperative cardiac index in group T was significantly higher than that in group non-T. These results suggest that it is important for the myocardium, to recover from its ischemic damage caused by VF after release of aortic cross-clamp. In conclusion, we consider it effective to employ TWBCP in CABG to improve postoperative cardiac function.

STUDY DESIGN: Retrospective case series. PURPOSE: To calculate the prevalence of L5-S1 intervertebral disc degeneration (IDD) by evaluating gynecological disease findings, obtained by pelvic magnetic resonance imaging (MRI), and reveal the risk factors for IDD by analyzing its relationship with age, sacral structure, body mass index (BMI), number of deliveries, and intrapelvic space-occupying lesions. OVERVIEW OF LITERATURE: Age, obesity, height, smoking history, occupation, and lumbosacral structure are reportedly the main factors of lumbar IDD. However, in women, the relationship of IDD with obstetric and gynecological history is unclear. METHODS: The presence of L5-S1 IDD was evaluated on sagittal T2-weighted pelvic MRI during gynecological evaluations in 660 Japanese women. We measured the sacral table angle (STA), sacral kyphosis angle (SKA), and intrapelvic space-occupying lesion size. Age, height, weight, BMI, number of deliveries, lumbosacral structure, size of space-occupying lesions, and presence of uterine leiomyoma based on medical records were compared between the IDD-positive and IDD-negative groups. RESULTS: Lumbosacral IDD was observed in 405 cases (61.4%), and its prevalence increased with age. Differences in age, height, weight, BMI, and number of deliveries between the IDD-positive and -negative groups were significant, but differences in STA, SKA, and presence of uterine leiomyoma and space-occupying lesion size were not. Logistic regression analysis indicated that age, BMI, and STA were risk factors for lumbosacral IDD. CONCLUSIONS: Age is the biggest risk factor for lumbosacral IDD in Japanese women, with BMI and STA also contributing to its development. However, SKA and obstetric and gynecological history were not significantly involved.
Asian Continental Ancestry Group* ; Body Mass Index ; Female ; Humans ; Intervertebral Disc Degeneration* ; Kyphosis ; Leiomyoma ; Logistic Models ; Magnetic Resonance Imaging* ; Medical Records ; Obesity ; Occupations ; Prevalence ; Reproductive History ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking

We report a case of an obstinate belch successfully treated with goshuyuto. The patient was a 74-year-old female. She had been hospitalized seven times in the past due to the belch, abdominal distention and anorexia, and had been prescribed various Kampo formulas. But her symptoms fluctuated up and down. The obstinate belch essentially disappeared after administering goshuyuto, and her appetite improved. Many of Kampo formulas that treat belchs are related to Shoyobyo (shao yang bing), but we consider that goshuyuto may be effective for a belch, which is yin-related and accompanied with stiffness and rigidity below the heart, and fullness in the chest and hypochondrium.
Medicine, Kampo ; Treated with ; Case Report ; plastic property - rigidity ; symptoms <1>

We report a case of recurring adhesive ileus that was successfully treated with shojokito (decoction) without inserting a nasogastric tube. The patient was a 75-year-old male who had been treated for abdominal symptoms in our department after a laparotomy. He visited our hospital mainly for complaints of abdominal pain and distention, was diagnosed with adhesive ileus because of a niveau image upon abdominal X-ray, and was hospitalized the same day. We diagnosed him as Yang syndrome and excess syndrome because he had thick yellow fur of the tongue, and administered shojokito. He broke wind at 40 minutes after administration of shojokito, and had bowel movement two hours later. Furthermore, he had mass diarrhea after another administration of this formula, and the niveau image disappeared the next day. It is often considered that an ileus develops with Cold, for which daikenchuto is prescribed frequently. However, in some cases cold purgative formulas such as jokito group may be effective, if such cases are Yang syndrome and excess syndrome, and present with yellow fur of the tongue.
Intestinal Obstruction ; Syndrome ; Treated with ; Yellow color ; Yang