We investigated the clinical effect of Juzen-taiho-to and macrophage-colony stimulating factor (M-CSF) on thrombocytopenia induced by anti-cancer chemotherapy in gynecologic malignancies. We discussed 31 courses in 20 patients. Juzen-taiho-to and/or M-CSF were given when indicated from serum platelet level. Twenty-eight courses (90.3%) in 17 patients did not need transfusion of platelet, and 3 courses in 3 patients needed it. It suggested that Juzen-taiho-to and M-CSF might be effective. As platelet-free plasma TGF-β1 level during the treatment of Juzen-taiho-to alone was remarkably increased, it might enhance the antitumoral action. Accordingly, combination treatments of Juzen-taiho-to and M-CSF might be effective for thrombocytopenia induced by anti-cancer chemotherapy.

Small group training, that is “A rehabilitation class to prepare patients for their return to society,” was created for 5 patients with higher brain dysfunction who had not yet returned to normal daily life after undergoing individual cognitive training, in order to provide them with a better insight into their disease, and to improve their communication abilities and interpersonal skills. The class consisted of 10 sessions (each session lasting 2 hours and 30 minutes) over a 4-month period, which consisted of an opening address, a short lecture, social skills training, tea time, and recreation. Before and after the class, the patients and their families were asked to complete the Dysexecutive Questionnaire, and any decrease in the difference in the scores between the patients and families suggested that the class had enhanced the patients' self awareness. The Baum test showed the patients having an increased interest in the outside world and a tendency to also have more internal energy. The Clinical Global Impression, as evaluated by the patients' families, indicated an improvement in all patients. We therefore consider this rehabilitation class to help prepare patients for their return to society to be useful as one step to encourage an increased social participation in patients suffering from a higher brain dysfunction.

We report a rare case of spontaneous thrombosis of a ruptured deep femoral artery aneurysm. An 85-year-old man presented two days after onset of acute swelling and pain in the left groin. Computed tomography demonstrated rupture of a deep femoral artery aneurysm and thrombosis of the aneurysm. After 1 month of observation, surgical intervention was performed as the local pain persisted. Opening of the aneurysm sac confirmed that thrombosis was complete. Simple ligation and drainage of the aneurysmal sac was performed. His postoperative course was uneventful.

Background: There has been debate over the indications for percutaneous endoscopic gastrostomy (PEG) in recent years in Japan. In addition, the level of satisfaction of patients and patient’s family after PEG remains unclear. The aim of this study was to investigate the current status of PEG and the level of satisfaction of patients and patients’ families after PEG in Japan.
Methods: We reviewed the existing data of all patients who underwent PEG tube insertion at Yuri Kumiai General Hospital (Akita, Japan) between February 2000 and December 2010. We examined the following points: underlying diseases requiring PEG, levels of consciousness, and performance status. We also sent a questionnaire to the patients and patient’s families to ask about their satisfaction with and thoughts about PEG.
Results: The data of 545 patients who underwent PEG were reviewed. There were 295 men and 250 women, with a mean age of 77.2 ± 11.4 years. PEG was indicated most frequently for cerebrovascular disorders (48.2%, 239/545). There were 515 (94.4%, 515/545) patients showing consciousness disturbance and 444 (81.5%, 444/545) bedridden patients. The questionnaire was answered by one patient himself and 316 patients’ families. When asked, “Was performing PEG a good decision?”, 57.5% (182/316) of the patients’ families answered yes. Meanwhile, when patients’ family members were asked if they would wish to undergo PEG if they were in the same condition as the patient, 28.4% (90/316) answered yes, whereas 55.3% (175/316) answered no.
Conclusions: Few patients were able to make their own decision about PEG tube placement because of consciousness disturbance. As a result, many family members of the patients did not want to experience PEG for themselves. Future studies should be performed to clarify the quality of life and ethical aspects associated with PEG.

We report a case of a chronic contained rupture of abdominal aortic aneurysm associated with spinal caries. A giant retroperitoneal mass with bony destruction of the anterior bodies of thoracic and lumber vertebrae was detected on computed tomography in a 72-year-old woman. The patient was asymptomatic but had a history of spinal tuberculosis complicated with cold abcess 44 years earlier. Magnetic resonance imaging suggested the presence of a paravertebral retroperitoneal abscess or organized hematoma. Surgery was performed through median laparotomy and an aortotomy revealed a punched-out defect, 17mm×17mm in size, in the posterior wall of the abdominal aorta, and the large cavity of an aneurysm with an organized thrombus was observed through the defect. The abdominal aorta and common iliac arteries were replaced with a bifurcated graft. The punched-out defect was closed with the anterior wall of the aorta for the purpose of isolating the prosthesis from the aneurysm. The postoperative course was uneventful and there were no signs of prolonged inflammatory reactions. In this case, it was considered that chronic contained rupture of the abdominal aortic aneurysm resulted from spinal tuberculous osteomyelitis eroding into the aorta.

We report a case of an overlapping ulcerative colitis and aortitis syndrome. A 28-year-old woman with ulcerative colitis in the region from the rectum to the sigmoid colon developed left anterior cervical pain. A cervical contrast-enhanced computed tomography and an arch aortography showed diffuse narrowing of the left common carotid artery and segmental stenosis of the left subclavian artery involving the orifice of the vertebral artery, which defined the diagnosis as aortitis syndrome. HLA was positive for BW 52, which is frequently found in patient with this type of overlapping syndrome. Treatment with prednisolone was begun at an initial dose of 20mg/day, with gradual tapering to 5mg/day at 11 months later, when her symptoms had subsided and laboratory findings of inflammation had disappeared. One year later, she became apathetic in mental activity, and had a poor memory. She also complained of numbness on the left side of her face. Angiography confirmed the progression of the left common carotid narrowing causing the deterioration of her cerebral ischemic symptom. A saphenous vein bypass graft was placed between the right subclavian artery and the left common carotid artery. The postoperative course was uneventful and she had complete symptomatic relief and recovered active ordinary life. Postoperative angiography revealed the well functioning bypass graft.

No abstract available.
Brain-Derived Neurotrophic Factor

No abstract available.
Depression* ; Ketamine*

No abstract available.
Dementia ; Indans ; Lewy Bodies ; Piperidines ; Receptors, sigma

No abstract available.
Depression* ; Isoflurane* ; Nitrous Oxide* ; Scopolamine Hydrobromide*