Aneurysms of the inferior left ventricular wall comprise only a small fraction of all aneurysms that have been reported in surgical series. Pseudo-false ventricular aneurysm is very rare and communicates with the left ventricule through a small orifice, and its wall contains myocardial tissue, unlike false ventricular aneurysm. A 53-year-old man was admitted to our hospital with chest pain. Echocardiography revealed left ventricular aneurysm, and the coronary arteriography subsequently revealed a complete occlusion of right coronary #2 and 75% and 90% stenosis of left anterior descending artery #7 and #8, respectively. Left ventriculography revealed an aneurysm of the inferior left ventricular wall, which communicated with the left ventricle through a small orifice and exhibited contraction. Surgical repair was indicated. Endoventricular circular patch repair (Dor operation) of the aneurysm of the inferior left ventricular wall and coronary artery bypass grafting to the left anterior descending artery and the right coronary artery were simultaneously performed under cardiopulmonary bypass with moderate hypothermia. The postoperative course was uneventful and the patient was discharged on the 22th day after surgery. Pseudo-false ventricular aneurysm of the inferior left ventricular wall was diagnosed by pathologic examination.

Background: Borderline resectable pancreatic adenocarcinoma (BR-PAC) isdefined as locally advanced tumor of the pancreas without metastasis that is,although potentially resectable (R), at high risk for positive resection marginfollowing surgery. The therapeutic strategy has remained unestablished becauseBR-PAC is biologically a heterogeneous subset in which the preoperativeprognostic factors are undetermined. Recently, several prognostic factors relatedto systemic inflammation have been explored in various kinds of cancers: thecombination of serum C-reactive protein (CRP) and albumin as the modifiedGlasgow prognostic factor; a combination of CRP and white blood cell countin the prognostic index; a combination of albumin and lymphocyte counts inOnodera’s prognostic nutritional index; the neutrophil-lymphocyte ratio (NLR);and the platelet-lymphocyte ratio (PLR). Although these prognostic factors havebeen explored in some small cohort studies of PAC patients, the results still remaincontroversial especially because PAC patients with diverse clinical stages wereincluded in the cohorts. It has never been reported whether or not the systemicinflammatory response is validated as a predictive risk factor in cohorts of onlyadvanced BR-PAC patients.Method: Between January 2003 and June 2012 at Kobe University Hospital,136 consecutive pancreatic adenocarcinoma (PAC) patients who underwentsurgical curative resection were retrospectively studied. Prior to surgery, the PACpatients were stratified into R- and BR-PAC patients according to the NationalComprehensive Cancer Network guidelines. To evaluate the independentprognostic significance of NLR and PLR, univariate and multivariate Coxproportional-hazard models were applied.Results: The median survival in PAC patients with preoperative NLR > 3 (n=45)and NLR < 3 (n=91) was 17.5 months and 31.1 months, respectively (P=0.0037).However, the median survival in PAC patients with PLR > 225 (n=32) and PLR< 225 (n=104) was 21.8 months and 26.2 months, showing no significantdifference in overall survival between the two groups (P=0.2526). The mediansurvival in the R-PAC patients with NLR > 3 (n=38) and NLR < 3 (n=70) was 18.1months and 33.1 months, respectively (P=0.0138). However, the median survivalin the R-PAC patients with PLR > 225 (n=27) and PLR < 225 (n=81) was 24.1months and 25.8 months, showing no significant difference in overall survivalbetween the two groups (P=0.6533). The median survival in BR-PAC patientswith preoperative NLR > 3 (n=7) and NLR < 3 (n=21) was 14.8 months and 27.2months, respectively (P=0.0068). In addition, median survival in BR-PAC patientswith preoperative PLR > 225 (n=5) and PLR < 225 (n=23) was 14.8 months and26.2 months, respectively (P=0.0050). Preoperative NLR > 3 (HR=21.437, 95%CI=4.119-142.980; P=0.0002) and PLR > 225 (HR=30.993, 95% CI=3.844-384.831; P=0.0009) were the only independent prognostic factors in BR-PACpatients.Conclusion: Preoperative NLR and PLR offer independent prognostic informationregarding overall survival in BR-PAC patients following curative resection. Theworkup is only to obtain a blood sample of 3 mL from PAC patients immediatelybefore treatment. In the near future, these factors associated with the systemicinflammatory response may have the potential to become criteria for BRPACcandidates to undergo neoadjuvant chemotherapy and/or neoadjuvantchemoradiation followed by surgical resection.

Background: Borderline resectable pancreatic adenocarcinoma (BR-PAC) is defined as locally advanced tumor of the pancreas without metastasis that is, although potentially resectable (R), at high risk for positive resection margin following surgery. The therapeutic strategy has remained unestablished because BR-PAC is biologically a heterogeneous subset in which the preoperative prognostic factors are undetermined. Recently, several prognostic factors related to systemic inflammation have been explored in various kinds of cancers: the combination of serum C-reactive protein (CRP) and albumin as the modified Glasgow prognostic factor; a combination of CRP and white blood cell count in the prognostic index; a combination of albumin and lymphocyte counts in Onodera’s prognostic nutritional index; the neutrophil-lymphocyte ratio (NLR); and the platelet-lymphocyte ratio (PLR). Although these prognostic factors have been explored in some small cohort studies of PAC patients, the results still remain controversial especially because PAC patients with diverse clinical stages were included in the cohorts. It has never been reported whether or not the systemic inflammatory response is validated as a predictive risk factor in cohorts of only advanced BR-PAC patients. Method: Between January 2003 and June 2012 at Kobe University Hospital, 136 consecutive pancreatic adenocarcinoma (PAC) patients who underwent surgical curative resection were retrospectively studied. Prior to surgery, the PAC patients were stratified into R- and BR-PAC patients according to the National Comprehensive Cancer Network guidelines. To evaluate the independent prognostic significance of NLR and PLR, univariate and multivariate Cox proportional-hazard models were applied. Results: The median survival in PAC patients with preoperative NLR > 3 (n=45) and NLR < 3 (n=91) was 17.5 months and 31.1 months, respectively (P=0.0037). However, the median survival in PAC patients with PLR > 225 (n=32) and PLR < 225 (n=104) was 21.8 months and 26.2 months, showing no significant difference in overall survival between the two groups (P=0.2526). The median survival in the R-PAC patients with NLR > 3 (n=38) and NLR < 3 (n=70) was 18.1 months and 33.1 months, respectively (P=0.0138). However, the median survival in the R-PAC patients with PLR > 225 (n=27) and PLR < 225 (n=81) was 24.1 months and 25.8 months, showing no significant difference in overall survival between the two groups (P=0.6533). The median survival in BR-PAC patients with preoperative NLR > 3 (n=7) and NLR < 3 (n=21) was 14.8 months and 27.2 months, respectively (P=0.0068). In addition, median survival in BR-PAC patients with preoperative PLR > 225 (n=5) and PLR < 225 (n=23) was 14.8 months and 26.2 months, respectively (P=0.0050). Preoperative NLR > 3 (HR=21.437, 95% CI=4.119-142.980; P=0.0002) and PLR > 225 (HR=30.993, 95% CI=3.844- 384.831; P=0.0009) were the only independent prognostic factors in BR-PAC patients. Conclusion: Preoperative NLR and PLR offer independent prognostic information regarding overall survival in BR-PAC patients following curative resection. The workup is only to obtain a blood sample of 3 mL from PAC patients immediately before treatment. In the near future, these factors associated with the systemic inflammatory response may have the potential to become criteria for BRPAC candidates to undergo neoadjuvant chemotherapy and/or neoadjuvant chemoradiation followed by surgical resection.

OBJECTIVE: To analyze patient characteristics of cancer rehabilitation and outcomes at our hospital. METHODS: This retrospective study analyzed 580 patients, who underwent cancer rehabilitation at our hospital and rehabilitation outcome after therapy were investigated. The relationship between the initial Barthel index and discharge outcomes was investigated, with a special focus on cancer patients with bone metastasis. The Barthel index and performance status (Eastern Cooperative Oncology Group) before and after rehabilitation were analyzed, and threshold value of home discharge was calculated from a receiver operating characteristic curve (ROC). General criteria for home discharge from our hospital included independence in performing basic activities of daily living such as bathing, feeding, and toileting or availability of home support from a family member/caregiver. RESULTS: The outcomes after rehabilitation among all the patients were as follows: discharge home 59%, death 13%, and others 27%. Statistical differences were observed between the initial and final values of the Barthel index in patients with bone metastasis, who could be discharged home (p=0.012). ROC analysis of the initial Barthel index for predicting home discharge revealed a threshold value of 60, sensitivity of 0.76, and specificity of 0.72. CONCLUSION: The patients with bone metastasis had a lower rate of home discharge and a higher rate of mortality than all the study patients who underwent cancer rehabilitation at our hospital. It is proposed that at the time of initiation of rehabilitation for patients with bone metastasis, an initial Barthel index lower than 60 might predict a worse outcome than home discharge.
Activities of Daily Living ; Asian Continental Ancestry Group* ; Baths ; Humans ; Mortality ; Neoplasm Metastasis* ; Rehabilitation ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Treatment Outcome

OBJECTIVESThe aim of this study was to determine whether the serum nitrite plus nitrate (NO( x )) level correlates with biomarkers that are known components of the metabolic syndrome (MetS).

METHODSSerum NO( x ) levels were measured using a commercial kit in 608 Japanese men and women between the ages of 39 and 85 years. Multivariate adjustments for age, smoking status, alcohol consumption and exercise were made in the analysis of covariance (ANCOVA). The components of the metabolic syndrome were defined based on the following criteria: body mass index (BMI) >/=25.0 kg/m(2), glycated hemoglobin (HbA1c) >/=5.6%, systolic blood pressure >/=130 mmHg or diastolic blood pressure >/=85 mmHg, high-density lipoprotein-cholesterol (HDL-C) /=1.69 mmol/l.

RESULTSThe logarithmically transformed age-adjusted serum NO( x ) (lnNO( x )) value was significantly higher in the low HDL-C group (1.76 +/- 0.05 mumol/l; p < 0.05) than MetS component groups (1.65 +/- 0.01 mumol/l) in men, but no difference was found in women. The means of serum lnNO( x ) after multivariate adjustment were 1.64, 1.65, 1.64, 1.66, and 1.81 mumol/l for 0, 1, 2, 3, and 4-5 MetS components for all subjects, respectively. The results of ANCOVA confirmed that the serum lnNO( x ) level was significantly correlated with the clustering of MetS components in both men and women (p < 0.0001 for trend).

CONCLUSIONOur results suggest that an increase in the clustering of MetS components was associated with the increase in serum NO levels in our general population.

The transcatheter left atrial appendage occluding device, WATCHMAN, can be used to prevent thromboembolism in patients with nonvalvular atrial fibrillation who are at high risk of bleeding during anticoagulation. We report an emergent surgical case of cardiac tamponade due to the left atrial appendage perforation with the WATCHMAN device implantation. An 83-year-old woman with recurrent paroxysmal atrial fibrillation (CHA2DS2-VASc score 4, HAS-BLED score 3) after catheter ablation was scheduled for the WATCHMAN device implantation. During implantation, the patient developed cardiac tamponade and underwent emergent surgery with cardiopulmonary bypass for active bleeding despite pericardial drainage. The bleeding was caused by the left atrial appendage perforation, and suture exclusion of the left atrial appendage was performed.