The patient was a 74-year-old man who was brought to the emergency room with severe chest pain and shock. Transthoracic echocardiography showed moderate pericardial effusion, and contrast-enhanced computed tomography (CT) showed a dilated ascending aorta with hematoma. However, no evidence of an intimal flap in the aorta was found. Bloody pericardial effusion was suggested by the CT attenuation value ; therefore, type A aortic dissection was highly suspected. At surgery, an extramural hematoma was observed on the ascending aorta. An 8-mm dehiscence that had penetrated the adventitia was identified just above the commissure between the right and left coronary cusps of the aortic valve, without dissection in the ascending aorta, and thus spontaneous aortic root rupture was diagnosed. The dehiscence was closed directly with a mattress suture from outside of the sinus, and the dilated ascending aorta was replaced. The patient's postoperative course was unremarkable, and he was discharged 14 days after surgery.

A study was made on and-ATLA antibody among general inhabitants, those with hematologic disease and those with hepatic disease in Nagano Prefecture.
Among 2, 299 inhabitants (990 males and 1, 309 females), anti-ATLA antibody was found to be positive in two males (0.1 %)
The number of patients with hematologic disease was 155. Of them, malignant lymphoma accounted for 50 (T: 24.3 %, B: 37.8 %), acute leukemia 32 and other hematologic malignancy 28. No ATL was found among them. It was revealed that 56 of them underwent transfusion ranging from 2 to 346 units of blood, averaging at 49.7 units. The number of person whose anti-ATLA antibody was positive was one only, who was diagnosed as AML and was transfused 170 units.
Of 42 patients with hepatic disease, HB virus-related liver disease (hepatitis, cirrhosis, hepatocellular carcinoma) accounted for 10, non-B group HBAg (-) for 18, alcoholic liver dysfunction 5 and other hepatic disorders 9. Three out of these 42 patients were found to be positive for anti-ATLA antibody, each three patients belonged to the “non-B” group (3/18, 16.6 %).
The total number of positivist was thus six. Of them, five had a history of transfusion, and all five positivists excluding the one with AML were suffering from hepatic disease with HBAg (-).
From the above, it was considered that in Nagano Prefecture, those whose anti-ATLA antibody was positive were conspicuously small in number, but main cause of the positivity was attributable to the transfusion. Most of the positivists were suffered from non-B hepatic disease with a history of transfusion, and the number of positivist was significantly greater even when compared with patients with hematologic disease with frequent transfusion. Accordingly, it is suggested that some of the hepatic diseases with HBAg (-) might be associated with HTLV.

STUDY DESIGN: Retrospective cross-sectional study. PURPOSE: To investigate the relationship between ligamentum flavum (LF) hypertrophy and lumbar segmental motion. OVERVIEW OF LITERATURE: The pathogenesis of LF thickening is unclear and whether the thickening results from tissue hypertrophy or buckling remains controversial. METHODS: 296 consecutive patients underwent assessment of the lumbar spine by radiographic and magnetic resonance imaging (MRI). Of these patients, 39 with normal L4-L5 disc height were selected to exclude LF buckling as one component of LF hypertrophy. The study group included 27 men and 12 women, with an average age of 61.2 years (range, 23-81 years). Disc degeneration and LF thickness were quantified on MRI. Lumbar segmental spine instability and presence of a vacuum phenomenon were identified on radiographic images. RESULTS: The distribution of disc degeneration and LF thickness included grade II degeneration in 4 patients, with a mean LF thickness of 2.43±0.20 mm; grade III in 10 patients, 3.01±0.41 mm; and grade IV in 25 patients, 4.16±1.12 mm. LF thickness significantly increased with grade of disc degeneration and was significantly correlated with age (r=0.55, p<0.01). Logistic regression analysis identified predictive effects of segmental angulation (odds ratio [OR]=1.55, p=0.014) and age (OR=1.16, p=0.008). CONCLUSIONS: Age-related increases in disc degeneration, combined with continuous lumbar segmental flexion-extension motion, leads to the development of LF hypertrophy.
Aging* ; Cross-Sectional Studies ; Female ; Humans ; Hypertrophy* ; Intervertebral Disc Degeneration ; Ligamentum Flavum* ; Logistic Models ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Spine ; Vacuum

Objective : Carvedilol is a non-selective β blocker with an α blocking activity. Since this drug is highly fat-soluble, it can pass through the blood-brain barrier, and thus may induce depression and lower QOL. In the present study, physicians and pharmacists collaborated to evaluate the antihypertension effect of carvedilol and post-administration changes in QOL. Furthermore, the relationship between QOL and antihypertension effect was analyzed.
Design : Self-controlled study.
Patients and Methods : Subjects were outpatients with hypertension above the age of 70 years who visited one of 42 medical institutions in Japan between April 1995 and March 1996. A total of 243 patients were registered, and 10-20 mg of carvedilol was administered once a day for six months. Pharmacists assessed the QOL of these patients by asking 82 questions on three separate occasions : before administration and one and six months after administration. The antihypertensive effect of this drug was investigated in patients in whom all three QOL questionnaires were collected. The main test items were antihypertensive effect, changes in QOL (subjective QOL with a special emphasis on patient psychology), and the relationship between antihypertensive effect and QOL. The antihypertensive effect of this drug was statistically analyzed by a paired t-test, and changes in QOL were statistically analyzed using generalized estimating equations.
Results : All three QOL questionnaires were collected from a total of 146 patients. Their pre-administration systolic blood pressure was 159.6±1.4 mmHg, and diastolic blood pressure 94.0±0.9 mmHg, and their blood pressure decreased significantly one month after the start of administration. This antihypertensive effect of carvedilol persisted, and the systolic and diastolic blood pressure of these patients six months after the start of administration was 141.1±1.2 and 85.2±0.7 mmHg, respectively (significant decreases when compared to pre-administration levels ; both p<0.05).
Subjective QOL improved significantly after carvedilol administration. And, changes were not seen in sexual function. Changes in the five categories of subjective QOL were as follows : psychological stability, disease-induced inconvenience, and independence improved significantly after carvedilol administration, but changes were not seen in gratification or vitality. However, improvements in subjective QOL did not correlate with improvements in blood pressure.
Conclusions : The results of the present study showed that carvedilol improved QOL without negatively affecting sexual function. Subjective QOL reflects the psychological well-being of patients. In the present study, psychological stability, disease-induced inconvenience, and independence improved significantly, but changes were not seen in gratification or vitality. Since β blockers can suppress the central nervous system, they can reduce psychological stability, gratification and vitality. Even though carvedilol is highly fat-soluble, the results of non-clinical studies have shown that it does not suppress the central nervous system as much as propranolol. The results of the present study showed that carvedilol does not strongly suppress the central nervous system of humans. Moreover, significant changes in QOL were not seen between one and six months after the start of administration of carvedilol, suggesting that it is possible to estimate the QOL of patients on antihypertensive therapy after six months of administration by assessing their QOL one month after administration.

BACKGROUND: In view of the increasing prevalence of food allergies, there has been an associated increase in frequency of situations requiring an emergency response for anaphylaxis at the home, childcare facilities and educational institutions. OBJECTIVE: To clarify the situation of adrenaline auto-injector administration in nursery/kindergarten/school, we carried out a questionnaire survey on pediatric physicians in Western Japan. METHODS: In 2015, self-reported questionnaires were mailed to 421 physicians who are members of the West Japan Research Society Pediatric Clinical Allergy and Shikoku Research Society Pediatric Clinical Allergy. RESULTS: The response rate was 44% (185 physicians) where 160 physicians had a prescription registration for the adrenaline auto-injector. In the past year, 1,330 patients were prescribed the adrenaline auto-injector where 83 patients (6% of the prescribed patients) actually administered the adrenaline auto-injector, of which 14 patients (17% of the administered patients) self-administered the adrenaline auto-injector. “Guardians” at the nursery/kindergarten and elementary school were found to have administered the adrenaline auto-injector the most. Among 117 adrenaline auto-injector prescription-registered physicians, 79% had experienced nonadministration of adrenaline auto-injector at nursery/kindergarten/school when anaphylaxis has occurred. The most frequent reason cited for not administering the adrenaline auto-injector was “hesitation about the timing of administration.” CONCLUSION: If the adrenaline auto-injector was administered after the guardian arrived at the nursery/kindergarten/school, it may lead to delayed treatment of anaphylaxis in which symptoms develop in minutes. Education and cooperation among physicians and nursery/kindergarten/school staff will reduce the number of children suffering unfortunate outcomes due to anaphylaxis.
Anaphylaxis ; Child ; Education ; Emergencies ; Epinephrine ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Japan ; Nurseries ; Postal Service ; Prescriptions ; Prevalence

In this study, we aimed to clarify awareness regarding genetic testing among pharmacists in Hiroshima City to contribute to regional medical care provided in pharmacies. Pharmacists should consider the advantages and disadvantages of being able to easily receive genetic tests. We conducted an awareness survey on genetic testing among pharmacists belonging to the Hiroshima Pharmaceutical Association, at 645 pharmacies in Hiroshima City. Responses were received from 674 pharmacists, yielding a response rate of 43.4% (280 pharmacies). In response to the question, “Can you perform genetic testing at a pharmacy?”, 6.7% of pharmacists answered yes and 65.4% said this was impossible. Among the 92.4% of pharmacists other than those available, 79.6% answered “I am worried about my knowledge of genetic testing,” followed by 39.3% “cannot take the time,” 29.2% “hurdles for new business,” 28.1% “problems such as pharmacy facilities to protect personal information,” and 15.7% “ethical difficulties.” From the age difference, pharmacists do not carry out genetic testing even if they have knowledge; they need to make an ethical judgment to determine whether to conduct genetic testing. Additionally, although pharmacies provide medication guidance and protect personal information, 28.1% of pharmacists answered that there are problems with their pharmacy’s ability to protect personal information when handling “genetic information.” Pharmacists should consider it critical to treat “genetic information” as personal information, with the utmost care and understanding.

Background: Poor lifestyle habits may worsen nonalcoholic fatty liver disease (NAFLD), with progression to nonalcoholic steatohepatitis (NASH) and cirrhosis. This study investigated the association between glycemic control status and hepatic histological findings to elucidate the effect of glycemic control on NAFLD. Methods: This observational study included 331 patients diagnosed with NAFLD by liver biopsy. Effects of the glycemic control status on histological findings of NAFLD were evaluated by comparing the following four glycemic status groups defined by the glycosylated hemoglobin (HbA1c) level at the time of NAFLD diagnosis: ≤5.4%, 5.5%–6.4%, 6.5%–7.4%, and ≥7.5%. Results: Compared with the lowest HbA1c group (≤5.4%), the higher HbA1c groups (5.5%–6.4%, 6.5%–7.4%, and ≥7.5%) were associated with advanced liver fibrosis and high NAFLD activity score (NAS). On multivariate analysis, an HbA1c level of 6.5%– 7.4% group was significantly associated with advanced fibrosis compared with the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index and uric acid, total cholesterol, and triglyceride levels, the higher HbA1c groups were significantly associated with advanced fibrosis compared with the lowest HbA1c group. On the other hand, compared with the lowest HbA1c group, the higher HbA1c groups were also associated with a high NAS in both multivariate analyses. Conclusion Glycemic control is associated with NAFLD exacerbation, with even a mild deterioration in glycemic control, especially a HbA1c level of 6.5%–7.4%, contributing to NAFLD progression.

Background: Poor lifestyle habits may worsen nonalcoholic fatty liver disease (NAFLD), with progression to nonalcoholic steatohepatitis (NASH) and cirrhosis. This study investigated the association between glycemic control status and hepatic histological findings to elucidate the effect of glycemic control on NAFLD. Methods: This observational study included 331 patients diagnosed with NAFLD by liver biopsy. Effects of the glycemic control status on histological findings of NAFLD were evaluated by comparing the following four glycemic status groups defined by the glycosylated hemoglobin (HbA1c) level at the time of NAFLD diagnosis: ≤5.4%, 5.5%–6.4%, 6.5%–7.4%, and ≥7.5%. Results: Compared with the lowest HbA1c group (≤5.4%), the higher HbA1c groups (5.5%–6.4%, 6.5%–7.4%, and ≥7.5%) were associated with advanced liver fibrosis and high NAFLD activity score (NAS). On multivariate analysis, an HbA1c level of 6.5%– 7.4% group was significantly associated with advanced fibrosis compared with the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index and uric acid, total cholesterol, and triglyceride levels, the higher HbA1c groups were significantly associated with advanced fibrosis compared with the lowest HbA1c group. On the other hand, compared with the lowest HbA1c group, the higher HbA1c groups were also associated with a high NAS in both multivariate analyses. Conclusion Glycemic control is associated with NAFLD exacerbation, with even a mild deterioration in glycemic control, especially a HbA1c level of 6.5%–7.4%, contributing to NAFLD progression.

Background: Poor lifestyle habits may worsen nonalcoholic fatty liver disease (NAFLD), with progression to nonalcoholic steatohepatitis (NASH) and cirrhosis. This study investigated the association between glycemic control status and hepatic histological findings to elucidate the effect of glycemic control on NAFLD. Methods: This observational study included 331 patients diagnosed with NAFLD by liver biopsy. Effects of the glycemic control status on histological findings of NAFLD were evaluated by comparing the following four glycemic status groups defined by the glycosylated hemoglobin (HbA1c) level at the time of NAFLD diagnosis: ≤5.4%, 5.5%–6.4%, 6.5%–7.4%, and ≥7.5%. Results: Compared with the lowest HbA1c group (≤5.4%), the higher HbA1c groups (5.5%–6.4%, 6.5%–7.4%, and ≥7.5%) were associated with advanced liver fibrosis and high NAFLD activity score (NAS). On multivariate analysis, an HbA1c level of 6.5%– 7.4% group was significantly associated with advanced fibrosis compared with the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index and uric acid, total cholesterol, and triglyceride levels, the higher HbA1c groups were significantly associated with advanced fibrosis compared with the lowest HbA1c group. On the other hand, compared with the lowest HbA1c group, the higher HbA1c groups were also associated with a high NAS in both multivariate analyses. Conclusion Glycemic control is associated with NAFLD exacerbation, with even a mild deterioration in glycemic control, especially a HbA1c level of 6.5%–7.4%, contributing to NAFLD progression.