Aortic pseudoaneurysm is a rare but life-threatening complication after graft replacement. One of the main challenges of surgery is the appropriate and safe method of re-entering the chest cavity. Therefore, it is necessary to consider a strategy which includes cardiopulmonary bypass. The patient was a 64-year-old man who had undergone hemi-arch replacement for pseudoaneurysm of the native thoracic aorta 17 years previously. The exact surgical details of the previous operation were unknown. He experienced progressive chest pain for 1 month, and noticed a parasternal pulsatile mass. An enhanced computed tomographic scan revealed a pseudoaneurysm originating from the thoracic aortic artificial graft itself, which had eroded the left parasternum and which would possibly rupture out of the skin. Preoperative examinations suggested a high risk of bleeding if redo sternotomy was performed. Therefore, we decided to perform open surgical repair with a cardiopulmonary bypass with cannulation through the femoral artery and vein before resternotomy. In addition, we performed a transthoracic left ventricular venting and selective cerebral perfusion using bilateral axillary arteries, which enabled core cooling in case of uncontrollable hemorrhage. He successfully underwent redo graft replacement of the thoracic aorta, and his postoperative course was uneventful.

We report a 30-year-old man with an extensive cerebral contusion. He presented with severe left upper and lower limb paralysis and mild right lower limb palsy. He was diagnosed with severe sleep apnea syndrome and was treated with nighttime nCPAP (nasal Continuous Positive Airway Pressure). Four years after the injury, he was able to walk with Lofstrand crutches. However, he gradually began to have difficulty standing, walking and driving his wheelchair because his spasticity developed markedly. He received ITB (intrathecal baclofen) therapy and noted a reduction in spasticity. He was once again able to drive his wheelchair and to walk with support. In addition, his respiratory function didn't show any deterioration. Spasticity is a common complication after cerebral or spinal cord injury, for which treatment has been difficult. ITB therapy can dramatically reduce spasticity, but has been demonstrated that it may also depress respiratory function in patients with respiratory insufficiency. This case suggests that ITB therapy may reduce spasticity without affecting respiratory function even in patients with a respiratory disorder.

A 19-year-old girl was admitted to our hospital with nausea, vomiting, hiccups, constipation and syncope. After hiccups or vomiting sinus arrest developed and lasted more than 5-8 seconds. She lost consciousness every one hour. Based on an electrocardiographic diagnosis of sick sinus syndrome (SSS), a temporary pacemaker was implanted. The next day, although her syncope and bradycardia disappeared, she had orthostatic tachycardia of over 120 beats/minute and swelling of the legs, which led to a diagnosis of postural orthostatic tachycardia syndrome (POTS). Neurologically, she showed the right-sided tongue deviation and parasympathetic system disorders revealed by coefficient of variation of R-R interval (CV_R-R), the Achner eye-ball pressure test, the valsalva ratio, and the head-up-tilt test. Brain MRI disclosed a small hyperintense lesion on a T2-weighted image with gadolinium enhancement in the right dorsal medulla including the hypoglottis nucleus and the posterior nucleus of vagus. After steroid pulse therapy (methyl prednisolone 1 g/day×3 days, 5 times) was administered, this lesion became smaller and finally disappeared. Before the lesion disappeared, she was able to begin rehabilitation by wearing elastic stockings and treatment with midodrine hydrochloride. The following year, she developed other MRI-proven brain lesions, suggestive of demyelination. Such a spinal and temporal distribution of lesions led to a diagnosis of multiple sclerosis (MS). A case of POTS caused by MS has not been reported previously, however, MS often affects the medullary paraventricular regions associated with autonomic failures. Autonomic failures often prevent patients from experiencing early rehabilitations. We should promptly give symptomatic treatment against autonomic failures, which leads to good patient recovery not only in patient vitality but also functionality.

From 1986 to 1991, 49 malignancies were found in sonographic examination of 53, 788 subjects carried out by the Kumamoto Prefectual Welfare Federation of Agricultural Cooperatives. The cases were composed of 12 hepatocellular carcinomas, 11 metastatic liver tumors, 11 renal cell carcinomas, 6 gall bladder carcinomas, 3 gastric carcinomas and 6 ether malignancies including metastatic pancreas tumors and ovarian tumors. A follow-up survey was made in 37 cases. All the case of renal cell carcinoma were found in an early stage and showed the best prognosis; the 2-year survival rate was 100%(n=7). In hepatocellular carcinomas 1-year and 2-year survival rates were 85% and 33%, respectively. Eight of 11 metastatic liver tumors were f rom gastrointestinal malignancies, and prognosis was poor; 1-and 2-year survival rates were 44% and 37%, respectively. Gastric carcinomas were found with lymphadenopathy or the thickening of the gastric wall, so prognosis was quite poor. Abdominal sonography has proved to be a very convenient and safe procedure to find out malignancies in the early stage. In detected (asymptomatic) cases of renal cell carcinoma, prognosis was excellent.

To estimate the blood compatibility during extracorporeal circulation, we designed mock circulation system consisted of a membrane oxygenator and vinyl circuit with roller pump. Primed with 200ml Ringer's acetate and 200ml of fresh whole human blood, mock circulation was worked at flow rate 0.5l/min for 6hr. Heparin was not primed, oxygenator did not fill any gases and circulation was keeping at 37°C. The thrombin-antthrombin complex and fibrinopeptide-A showed progressive increase and fibrinogen correspondingly decrease. Nevertheless, the plasmin α2 plasmin inhibitor complex and D-dimer showed minimal changes within normal range in spite of increasing fibrinopeptide B β 15-42. We can not find any signs of secondary fibrinolytic activity. On the other hand, the platelet was persistently activated as shown statistically significant increase in β-thrombogloblin and platelet factor IV. Significant elevations of complement 3a and 4a were seen with increase of complement 5a and activated oxygen productivity by neutrophilic leucocytes. In conclusion, moderate and limited blood alterations occurred in mock cardiopulmonary bypass circuit.

OBJECTIVE: Galvanic vestibular stimulation (GVS) activates the vestibular afferents, and these changes in vestibular input exert a strong influence on the subject's posture or standing balance. In patients with Parkinson's disease (PD), vestibular dysfunction might contribute to postural instability and gait disorders. METHODS: Current intensity was increased to 0.7 mA, and the current was applied to the patients for 20 minutes. To perform a sham stimulation, the current intensity was increased as described and then decreased to 0 mA over the course of 10 seconds. The patient's status was recorded continuously for 20 minutes with the patient in the supine position. RESULTS: Three out of 5 patients diagnosed with PD with postural instability and/or abnormal axial posture showed a reduction in postural instability after GVS. The score for item 12 of the revised Unified Parkinson's Disease Rating Scale part 3 was decreased in these patients. CONCLUSIONS: The mechanism of postural instability is complex and not completely understood. In 2 out of the 5 patients, postural instability was not changed in response to GVS. Nonetheless, the GVS-induced change in postural instability for 3 patients in our study suggests that GVS might be a therapeutic option for postural instability.
Gait ; Humans ; Parkinson Disease* ; Posture ; Supine Position

Purpose: Patients with head and neck cancer (HNC) who undergo dental procedures during radiotherapy (RT) face an increased risk of developing osteoradionecrosis (ORN). Accordingly, new tools must be developed to extract critical information regarding the dose delivered to the teeth and mandible. This article proposes a novel approach for visualizing 3-dimensional planned dose distributions on panoramic reconstruction computed tomography (pCT) images. Materials and Methods: Four patients with HNC who underwent volumetric modulated arc therapy were included. One patient experienced ORN and required the extraction of teeth after RT. In the study approach, the dental arch curve (DAC) was defined using an open-source platform. Subsequently, pCT images and dose distributions were generated based on the new coordinate system. All teeth and mandibles were delineated on both the original CT and pCT images. To evaluate the consistency of dose metrics, the Mann-Whitney U test and Student t-test were employed. Results: A total of 61 teeth and 4 mandibles were evaluated. The correlation coefficient between the 2 methods was 0.999, and no statistically significant difference was observed (P>0.05). This method facilitated a straightforward and intuitive understanding of the delivered dose. In 1 patient, ORN corresponded to the region of the root and the gum receiving a high dosage (approximately 70 Gy). Conclusion The proposed method particularly benefits dentists involved in the management of patients with HNC. It enables the visualization of a 3-dimensional dose distribution in the teeth and mandible on pCT, enhancing the understanding of the dose delivered during RT.

Purpose: The purpose of this study is to evaluate hangeshashinto rinse for oral discomfort in terminally-ill cancer patients and to compare the effectiveness of hangeshashinto rinse with or without honey rinse. Methods: Patients with oral discomfort were randomized to receive either hangeshashinto rinse or hangeshashinto with honey rinse as first-line treatment. Patients performed oral rinse three to five times a day for 2 weeks. Further, oral wetness, halitosis, oral mucositis, mouth discomfort, compliance of rinse were then evaluated before and after the intervention. Results: 144 patients were enrolled during this period and 22 patients completed the study (hangeshashinto 13 / hangeshashinto with honey 9). After the intervention, oral wetness was improved, and end-tidal concentration of hydrogen sulfide was decreased in both cases. Although there was no statistically significant difference, oral discomfort by subjective and objective evaluations, also and symptom of oral mucositis were improved. Other volatile sulfur compounds decreased. Frequency of rinsing between groups receiving hangeshashinto or hangeshashinto with honey did not differ, however, the acceptability was slightly better in the honey combination group. Conclusion: Both hangeshashinto rinse and hangeshashinto with honey rinse reduced end-tidal concentration of hydrogen sulfide and improved oral wetness. Oral rinse by hangeshashinto or hangeshashinto with honey may be effective for oral discomfort in terminally-ill cancer patients.

This document reports the results of a questionnaire survey conducted among pharmaceutical companies that are members of the Japan Pharmaceutical Manufacturers Association as part of a collaborative research project within the AMED Research on Regulatory Science of Pharmaceuticals and Medical Devices ‘Research for the promotion of the utilization of real-world evidence in the pharmaceutical regulatory system and the harmonization of international regulations, and for the proposal of an ideal system in Japan’ (Principal Investigator： Harumasa Nakamura, National Center of Neurology and Psychiatry). This survey is the first domestic attempt to clarify the current state of development and utilization of data for companion applications (CPs) in pharmaceuticals. It is expected that the widespread development and use of pharmaceutical CPs will enhance the collection of patient-reported outcomes (PROs), which in turn will foster the utilization of real-world data (RWD) under pharmaceutical regulations. In anticipation that the results of this survey will contribute to this promotion, we are publishing the entire questionnaire results in this report.