There is Bartonella henselae (B. henselae) leads to cat-scratch disease and causes infective endocarditis, but shows as negative in blood cultures. We performed aortic valve replacement in a patient with aortic valve infective endocarditis which was regative on blood cultures. The patient had a contact history with a cat prior to admission. Thus, we suspected B. henselae and made a definitive diagnosis by PCR method and Warthin-Starry (WS) stain. A correct diagnosis was possible by detailed history taking and the use of appropriate antibiotics.

A 9-year-old boy with multisaccular thoracic aortic aneurysm associated with coarctation of the aorta underwent definitive repair under partial cardiopulmonary bypass. The operation consisted of resection of the aneurysm and reconstruction of the descending aorta. Aortic reconstruction was done without an artificial graft, and extended end-to-end anastomosis was performed successfully. He has been doing well and there was no significant restenosis at the repair site 5 years after the operation. Some authors reported that untreated coarctation of the aorta frequently developed aneerysm, which usually has multisaccular lesions. Surgical strategy of aortic reconstruction for coarctation of the aorta in boyhood should be decided prudently to avoid postoperative complications.

We describe two cases of a 9-day-old male and a 5-year-10-month-old female who had congestive heart failure due to severe mitral regurgitation. Preoperative echocardiogram revealed severe mitral regurgitation due to dysplasia of the leaflet, chordae and papillary muscle. Because the leaflet area was not enough for the valve orifice, we performed double orifice repair by suturing the free edge to the corresponding edge of the opposite leaflet. The mitral regurgitation was found to be significantly reduced on postoperative echocardiogram. Double orifice repair is simple and can be performed rapidly. However, although this technique has been performed in adults, it has not been commonly performed in infants. Our results suggest that this procedure can be useful for the congenital mitral regurgitation. Long-term follow-up is needed to confirm the result.

We reviewed 632 cases which had undergone ultrasonograpy for thyroid disorders.(1) The sonographic examination found nodular lesions in 157 cases (including 52 solid tumor cases) and diffuse enlargement in 38 cases. No abnormalities were found in the remaining437 cases.(2) Further examination revealed that the cases of nodular lesions included 7 thyroid cancer cases (6 papillary carcinomas and 1 follicular carcinoma), 2 cases of hyperthyroidism, and 3 cases of hypothyroidism.(3) Diffuse enlargement cases included 5 cases of overactive thyroid (1 subacute thyroiditis and 5 Graves' diseases), 2 cases of underactive thyroid (chronic thyroiditis). Assays for antithyroid autoantibodies showed positive results even in the 31 cases of normal thyroid function.(4) Four in 7 cases diagnosed as thyroid cancer and 5 in 12 cases diagnosed as thyroid dysfunction (4 of 5 cases were elderly people 60 years of age or over) were screened by ultrasonography.
We concluded that ultrasonography is a valuable diagnostic procedure for early detection of not only thyroid malignancies but also disordered thyroid function. Abdominal sonography is often used for screening. The use of ultrasound for the thyroid gland is recommended as a standard procedure in the regular health screening program.

Objective : Serum albumin is important marker in all aspects of stroke care including rehabilitation. We examined the serum albumin level of stroke patients, and investigated the relation between their serum albumin level and their prognosis. Methods : The serum albumin levels of 295 patients enrolled from 2008 to 2014 were sequentially checked in our hospital and in subsequent rehabilitation hospitals. Functional outcome was measured by functional independence measure (FIM) at the time of discharge from the rehabilitation hospital. Results : In all types (cerebral infarction, cerebral hemorrhage and subarachnoid hemorrhage (SAH)) of apoplexy, serum albumin levels were the highest at the time of admission, temporarily declined after admission, and almost recovered at the time of discharge. In SAH, the serum albumin levels deteriorated at a greater rate than in other types of stroke. In cerebral infarction and cerebral hemorrhage, the lowest serum albumin level was positively correlated with FIM at the time of discharge from the rehabilitation hospital (p<0.001). But, in SAH, there was no significant correlation between the lowest serum albumin level and FIM at the time of discharge (p=0.844). Conclusion : Our data suggest that serum albumin level is associated with the outcome of stroke patients, except for SAH patients. Serum albumin level should be one of the prognostic factors used in stroke patients, but we should consider that SAH patients are exceptional because of other neurological complications.

Proteases play important roles in parasite development and host parasite interactions. The protease of Kudoa spp. has been recognized as a key factor of severe proteolysis of fish muscle post-mortem; however, there is little information available regarding the protease of Kudoa (K.) septempunctata, which was recently identified as a cause of food poisoning in humans. The present study was conducted to isolate and characterize proteases to elucidate the type of protease contained in the parasite and determine the optimal pH for protease activity. We confirmed the cysteine protease and metalloprotease produced by K. septempunctata. While the cysteine protease showed optimal activity at pH 5 that decreased rapidly with increasing pH, the optimal activity of metalloprotease was pH 7, and it remained stable from pH 6 to pH 8. These results indicate that the pH of cysteine protease is not proper for fish muscle postmortem, and that metalloprotease can act in human intestines. Overall, the present study provides important information that improves our understanding of the role of protease physiology and the subsequent food poisoning caused by K. septempunctata.
Cysteine Proteases ; Foodborne Diseases ; Host-Parasite Interactions ; Humans ; Hydrogen-Ion Concentration ; Intestines ; Parasites ; Peptide Hydrolases* ; Physiology ; Proteolysis

The Ministry of Health and Welfare of Japan is planning a pooling system for multiple-choice questions (MCQs) for the national examination for medical practitioners. To clarify possible problems of such a system, a field study was performed by 10 medical schools in Japan using 90 MCQs from previous examinations. Nine hundred twenty-four 6th-year students participated in the field test. For each MCQ, the correct-response rates at the originating school and those obtained in the field test were significantly correlated. Thus, the correct-response rates to questions on the field test could be predicted from the rates at the originating schools. However, for each question the correct-response rate was significantly higher for students of the originating school than for students of other schools. In the national examination, care should be taken to prevent differences in scores on the basis of question sources.

No abstract available.
Crohn Disease* ; Food, Formulated* ; Humans ; Infliximab*

　The education program in all medical schools in Japan has been studied and analyzed every 2 years since 1974 by the curriculum committee of the Association of Japan Medical Colleges. Based on the most recent analysis in 2015, the marked innovation of medical education, such as an integrated curriculum, active learning, and clinical clerkship, was recognized.