We report a case of successful saphenous vein bypass grafting for superior mesenteric artery stenosis. A 50-year-old man complained of abdominal pain which was not induced by either eating or defecation. He was admitted to our hospital and examinations of the gastrointestinal tract revealed no abnormality. Angiography showed stenosis of the superior mesenteric artery (SMA), but not of the celiac artery (CA) or inferior mesenteric artery (IMA). We speculated that his symptom was due to SMA stenosis and poor collateral circulations from the CA, IMA and internal iliac arteries. Saphenous vein bypass grafting for SMA was undertaken successfully and abdominal pain disappeared completely.

An increase of aortic valvular disease associated with congenital bicuspid aortic valve is observed due to the relative decrease of rheumatic valvular diseases. A total of 24 patients with aortic valvular disease associated with congenital bicuspid aortic valve underwent surgical treatment at our institution during the period from January, 1997 to December, 1999. These 24 patients constituted 46.2% (24/52) of all cases of surgical operations for aortic valvular disease. The age of the patients ranged from 17 to 83 years (mean 62 years). They consisted of 16 men (66.7%) and 8 women. Two patients had infective endocarditis. The classification of congenital bicuspid aortic valve was right-left cusp type in 15 patients (raphe+: 11), anterior-posterior cusp type in 9 patients (raphe+: 9). We performed aortic valve replacement in 22 patients, aortic root replacement in 1 patient and aortic root remodeling in 1 patient in combination with mitral valve plasty in 3 patients, coronary artery bypass grafting in 3 patients and closure of the atrial septal defect (ASD) in 1 patient. We detected ASD in 1 patient, ventricular septal defect in 1 patient and high-posterior take-off right coronary artery in 1 patient. Patients with stenosis often have a small aortic annulus and severe post-stenotic aortic dilation. Preoperative and intraoperative evaluation is important in cases of aortic valvular disease associated with congenital bicuspid aortic valve.

Objective : Although current preventative care policies consider the issue of the homebound elderly to be important, effective means of intervention have not been established. Therefore, it is necessary to elucidate the relevant causes of the poorly understood “homebound” problem. As little expertise exists on the social and psychological factors of those who are homebound, this study focuses on the sense of coherence (SOC) —a new estimate of the psychosocial factors involved in being homebound—and examines the connection between being homebound and SOC.
Methods : A mail survey was conducted among 1,895 elderly adults, none of whom had been issued a Certification of Long-Term Care Need. Survey items included basic attributes, physical characteristics, psychological and socioenvironmental characteristics, and the condition of being homebound. Furthermore, SOC was investigated as part of the psychosocial and environmental evaluation. The 853 respondents chosen for the analysis were divided into three groups depending on their level of homeboundedness, and an ordered logistic regression analysis was conducted using homeboundedness as the dependent variable.
Results : The following items were found to have a significant association with homeboundedness : age, sex, low motor function, depressive tendencies, low SOC, and the low TMIG Index of Competence.
Discussion : This study identified a relation between being homebound and SOC, suggesting that in addition to interventions for depression and motor function, new SOC focused aid must be considered in the prevention of homeboundedness.

There are many published studies on postoperative deep venous thrombosis (DVT) which can develop after hip joint arthroplasty, but very few reports are available on the incidence of thigh DVT following or thopedic treatment of transcervical fractures. In this study, therefore, we tried to find out a screening method just right for the early detection of clots that develop in the deep femoral veins after treatment of the feactures in the neck of femurs. Between March and September 1999, a total of 24 patients were operated on for fractures on the cervix of thighbone in our hospital. Of the total, 19 were recruited for this study. The five cases were excluded because some of them were on medication that could affect the coagulation/ fibrinogenolysis factors and some were under management of other departments. After surgery, a series of blood biochemical tests were performed, and changes in the partial pressure of arterial blood oxygen and D-dimer (??) level were examined with the passage of time. In the cases which were suspected to have thrombosis in the veins in the lower extremities by ultrasonography performed six to 18 days after surgery, definitive diagnosis was made by the aid of venography. DVT was found in three in the 19 cases. Routine blood biochemical tests and measurements of oxygen partial pressure in the artery were not so much helpful as were expected in the early detection of thrombosis, whereas measurements of D-dimer levels were considered useful because the levels were well over 20μg/ml one week after surgery in the positive-DVT cases.

Objective : To examine the relation between psychoactive drugs and the outcome of dysphagia in patients with psychiatric disorders. Methods : We examined 53 inpatients who were prescribed speech therapy in the psychiatry ward of our hospital from January 2011 to April 2012. We categorized the patients into a poor outcome group and a good outcome group by the necessity for alternative nutrition at discharge and analyzed the number and kind of typical antipsychotic, atypical antipsychotic, hypnotic, antidepressant and mood stabilizer, total amount of typical antipsychotic, atypical antipsychotic used at admission and at discharge, sex, psychiatric disorder, central nervous system disease, aspiration pneumonia, duration of hospitalization, psychiatric disorder disease period, speech therapy intervention period and GAF scale at admission. Results : The outcome of dysphagia had a significant relation with the number and kind of antipsychotic used, especially typical antipsychotic used at admission. The good outcome group had a higher total amount of antipsychotic use, especially atypical antipsychotics. Conclusion : Long-term practical oral intake should not comprise antipsychotic polypharmacy, especially typical antipsychotics before onset of dysphagia, but should instead consist of a monopharmacy approach with atypical antipsychotics.

Introduction: The purpose of this study was to examine the effects of cognitive rehabilitation for depression, cognitive function, ADL, and QOL in patients with post-stroke depression (PSD). In addition, we evaluated the effects of cognitive rehabilitation on customer satisfaction with long-term care facilities and rehabilitation.Methods: This study included 8 participants with PSD who were residents of a long-term care facility located in Ibaraki Prefecture, Japan. In addition to their ordinary rehabilitation (2 sessions per week, 20 minutes per session), participants underwent 36 sessions of cognitive rehabilitation (3 sessions per week, 20 minutes per session, for 12 weeks). Primary outcome measures: Depression severity was measured using the Geriatric Depression Scale (GDS), Zung Self Depression Scale (SDS), and the Depression Scale of the Japan Stroke Scale (JSS-D). Frontal lobe function was assessed using the Frontal Assessment Battery (FAB). Secondary outcome measures: QOL was assessed using SF-8. Customer Satisfaction with the rehabilitation was measured using the Customer Satisfaction Scale based on Need Satisfaction (CSSNS). Assessments were performed before and after the rehabilitation.Results: The severity scores of depression, frontal lobe function, and customer satisfaction with the rehabilitation all significantly improved after the cognitive rehabilitation sessions.Conclusions: The results obtained in this trial indicate that, for patients with PSD depressive symptoms, frontal lobe function, QOL, and rehabilitation customer satisfaction may be improved by the inclusion of cognitive rehabilitation sessions alongside regular rehabilitation.

  In Japan, few health care professionals have a basic understanding（core competency）of the design of clinical research and statistical analysis. We developed a blended distance–learning program comprising face–to–face lectures with e–learning for busy health care professionals who work in the clinical settings to achieve core competency in clinical research. The purpose of this study was to examine the educational effects of this program.
1）Four months after the end of the program, 64％ of the participants had started to conduct clinical research.
2）This program may increase the number of research colleagues that can discuss clinical research.
3）This program could enhance the confidence（self–efficacy）of health care professionals in clinical research.

Objective: To examine how best to provide information on over-the-counter (OTC) drugs in the future, the Japan Self-Medication Industry (JSMI) conducted an online survey on public attitudes toward changes in the system for controlling the sales of OTC drugs specified by the revised Pharmaceutical Affairs Act effective since June 2009.
Methods: A secure web-based questionnaire system was developed and linked to the JSMI website.  The survey was conducted between July 17 and August 31, 2009.
Results: Of the 4,257 people who responded to the questionnaire, 56.8% indicated they understood the provisions of the revised Pharmaceutical Affairs Act.  More than half of the responders had positive opinions of the revision.  They welcomed the improvement in convenience resulting from the availability of drugs at convenience stores, but “Druggists,” who are responsible for sales of the drugs, were not sufficiently represented among responders.  It was inferred that the general public feels that they should be able to purchase OTC drugs for self-medication after receiving sufficient information about the drugs from qualified sources.

Cardiac Imaging Techniques ; Cohort Studies ; Cytidine Triphosphate ; Humans ; Image Enhancement ; Multidetector Computed Tomography ; Myocardial Perfusion Imaging ; Myocardium ; Perfusion Imaging ; Radiation Dosage ; Radiation Exposure ; Retrospective Studies