Left ventricular non-compaction (LVNC) is a congenital abnormality caused by arrest of the normal process of myocardial compaction, and the prognosis of LVNC is poor with progressing heart failure. Reports of cardiac operations in patients with LVNC are rare. We resected a right atrial myxoma in a 69-year-woman, who had suffered from severe heart failure and in whom echocardiogram indicated LVNC. Using myocardial protection for the immature myocardium, the postoperative course was uneventful and the patient was discharged 19 days after the operation. We must pay attention to cardiac function after discharge because of the poor prognosis.

We reviewed twenty patients with mechanical prosthetic heart valves who underwent noncardiac operations which were performed in the presence of continual anticoagulant therapy. Prosthetic valves used were the SJM valve in nineteen patients and the Björk-Shiley valve in one. Twenty dental extractions in ten patients were performed with no reduction of warfarin, or the mean thrombotest value of 16%. Seven nonlaparotomy operations (polypectomy of the vocal cord in one patient, total hip joint replacement in one, insertion of a CAPD tube in one, pacemaker implantation in one, cataract operation in two and repair of tibial fracture in one) and three laparotomy operations (partial gastrectomy in two and hysterectomy in one) were performed under the thrombotest value of around 40% with partial reduction of warfarin. There was no difficulty in hemostasis during these operations. The only hemorrhagic complication in this series was bleeding from the abdominal wound in one patient two days after the gastrectomy when subcutaneous injections of heparin prolonged the ACT over 200sec. There were no thromboembolic complications. We conclude that dental extractions in patients with prosthetic heart valves can be safely performed with no reduction of warfarin and that the coagulability of thrombotest value of 40% is sufficient for hemostasis even in laparotomy operations.

In coronary artery bypass grafting (CABG), a portable suction unit was used in the superior mediastinum to evaluate whether it is effective in decreasing the amount of mediastinal hematoma and the incidence of hematoma-related postoperative complications. Out of 179 consecutive patients who underwent CABG at the Matsuyama Red Cross Hospital, in 97 patients (Group 1), two drainage tubes were placed as usual in the inferior mediastinum, while in 82 patients (Group 2), a small drainage tube of the portable suction unit was additionally placed in the superior mediastinum. The total amount of postoperative drainage in Group 2 was larger than that in Group 1 but there was no statistically significant difference. The postoperative mediastinothoracic ratio expressed in comparison with the preoperative value was 134±22% in Group 1 and 123±15% in Group 2 on the first postoperative day (POD), and 133±20% and 122±14%, respectively on the seventh POD (p<0.001). Regarding postoperative complications, there were two cases of mediastinitis and five cases of late cardiac tamponade in Group 1 but none in Group 2. The difference in the incidence of these complications between the two groups was statistically significant (p<0.02). We conclude that the portable suction unit effectively decreased the amount of mediastinal hematomas and the incidence of mediastinitis and cardiac tamponade following CABG.

1) To examine the significance and problems of medical interview training, self-administered questionnaires were completed by 90 students who took part in medical interview training with simulated patients in clinical training after objective structured clinical examinations.2) Most students thought that medical interview training was meaningful and thanked the simulated patients for their useful comments. On the other hand, some students felt that to improve their interviewing skills stricter feedback from simulated patients and instructors might be needed.3) Our results suggest that repeated training in medical interviewing in clinical training after objective structured clinical examinations is an effective method for teaching communication skills. However, in the future the scenarios should be improved and the frequency of medical interview training should be increased.

Risk factors for developing hemolytic uremic syndrome among patients with enterohemorrhagic Escherichia coli O157: H7 (EHEC) infection include age. The young, especially those under the age of five, face an increased risk, as do the elderly. In the present study, we evaluated the protective effects of Hochu-ekki-to (HET) on intraperitoneal infection with EHEC, using immunosuppressant, dexamethasone (Dex)-treated mice.
It was found that HET induced improvement of Dex-induced leukopenia. Similarly, the IgM-plaque forming cell responses to sheep red blood cell (SRBC) were restored by the administration of HET to the normal-mice level in Dex-treated mice. Consequently, HET was administered orally into the Dex-treated mice before infection with EHEC to observe the therapeutic effect. With the oral administration of 500mg/kg/head of HET into the Dex-treated mice, prolonged survival was shown: the 50% survival time in the HET-administered mice was four days, compared with one day in the non-administered controls. In addition, the number of bacteria in the liver was reduced by the administration of HET in the Dex-treated mice.
The results indicate that orally administered-HET protects against EHEC infection in Dex-treated mice, and such protective effects appear to be due to the restorative effects of HET against the Dex-induced immunosuppression.

In order to investigate an effects of the hot spring within a short period on immune system of human, the leukocyte, monocytes, lymphocyte and lymphocyte surface markers: CD2, CD4, CD8, CD16, CD19 and CD57 were tested in the human peripheral blood of twenty-three healthy volunteers by hot spring bathing. The results were as follows: Total number of leukocytes and lymphocytes in the peripheral blood significantly increased in an older group after hot spring bathing (p<0.01). However, we obtained a clear decrease in the number of granulocyte after hot spring bathing in the younger group (p<0.01). In addition, we found greater increase of the CD16⁺ cell counts and a clear decrease of the CD19⁺ cell counts in older group. But in younger group, we also obtained an increase of CD8⁺, CD16⁺ cells after hot spring bathing. These results indicated that hot spring bathing can regulate the physical immune system.
According to the percentage of lymphocytes or granulocytes in the total leukocytes, volunteers were divided into two types, more than 70% of granulocyte were recognized as G type and more than 40% of lymphocyte were divided in the L type. We found an increase of lymphocyte and lymphocyte subsets as well as a decrease in granulocyte in G group by hot spring bathing. But in L group, especially, indicated a greater increase in granulocyte and a decrease in lymphocyte subsets. We suggest that hot sping bathing can regulate by an autonomic nerve system, making it suitable.

We have simultaneously proved that cell populations taking charge of immunity in human peripheral blood can be regulated quantitatively by hot spring bathing. Now, we investigated the effect of hot spring bathing qualitatively on cytokine production by lymphocyte cell in human peripheral blood estimating by cytokine containing cell by FACScan. We found a significant increase in IFN-γ containing cells after hot spring bathing and an increase in IL-4 with no statistical significance after hot spring bathing. In addition, we found significant negative relationship between the level of IFN-γ, IL-4 and IL-1β before hot spring bathing and the ratio of cytokine that increased in variation after hot spring bathing. Namely, after hot spring bathing, there was a decrease of cytokine producing cells in subjects who had higher level before hot spring bathing. But an increase in subjects who had lower level before hot spring bathing, the trend was concentrated toward average levels in the cytokine production by lymphocyte in peripheral blood. So we suggest that hot spring bathing can promote acquired immunity to make it possible more suitable as immune reaction.

BACKGROUND: The immunological mechanisms of asthma remission remain unclear although several reports have suggested that balance between T helper (Th) 2 cytokines and regulatory cytokines is related. OBJECTIVE: To study the balance between interleukin (IL) 10 and IL-5 in asthma clinical remission. METHODS: We measured the numbers of IL-5 and IL-10 producing cells in peripheral blood mononuclear cells stimulated with mite antigen obtained from patients with active asthma (group A, n = 18), patients in clinical remission (group R, n = 15) and nonatopic healthy controls (group H, n = 14). RESULTS: The numbers of IL-5 producing cells in groups A and R were significantly higher than in group H. The number of IL-5 producing cells was lower in group R than in group A, although the difference was not statistically significant. The number of IL-10 producing cells was higher in group R than in group A, although again the difference was not statistically significant. There was a significant difference in the number of IL-10 producing cells between groups A and H but not between groups R and H. The ratio of the number of IL-10 to IL-5 producing cells was highest in group H followed by groups R and A, and the differences were statistically significant for each pair of groups. CONCLUSION: Our study suggests that the IL-10/IL-5 balance is related to clinical asthma. The balance differs between patients in clinical remission and healthy controls, suggesting that allergic inflammation may continue even after clinical asthma remission.
Asthma ; Child ; Cytokines ; Humans ; Inflammation ; Interleukin-10 ; Interleukin-5 ; Interleukins ; Mites ; Prognosis

BACKGROUND: Leukotriene receptor antagonists have been used to prevent virus-induced asthma exacerbations in autumn. Its efficacy, however, might differ with age and sex. OBJECTIVE: This study aimed to investigate whether pranlukast added to usual asthma therapy in Japanese children during autumn, season associated with the peak of asthma, reduces asthma exacerbations. It was also evaluated the effect of age and sex on pranlukast's efficacy. METHODS: A total of 121 asthmatic children aged 1 to 14 years were randomly assigned to receive regular pranlukast or not according to sex, and were divided in 2 age groups, 1–5 years and 6–14 years. The primary outcome was total asthma score calculated during 8 weeks by using a sticker calendar related to the days in which a child experienced a worsening of asthma symptoms. This open study lasted 60 days from September 15 to November 14, 2007. RESULTS: Significant differences in pranlukast efficacy were observed between sex and age groups. Boys aged 1 to 5 years had the lower total asthma score at 8 weeks (p = 0.002), and experienced fewer cold episodes (p = 0.007). There were no significant differences between pranlukast and control group in total asthma score at 8 weeks (p = 0.35), and in the days in which a child experienced a worsening of asthma symptoms (p = 0.67). CONCLUSION: There was a substantial benefit of adding pranlukast to usual therapy in asthmatic children, especially in boys aged 1 to 5 years, during autumn season.
Asian Continental Ancestry Group ; Asthma ; Child ; Child, Preschool ; Humans ; Leukotriene Antagonists ; Seasons