A 69-year-old woman had dysphagia, hoarseness, and asthma-like symptoms such as cough and wheeze. Inhaled corticosteroids and long-acting β₂ stimulants was not effective. Gastrointestinal endoscopy showed compression of the esophagus wall from outside. Enhanced computed tomography (CT) showed thoracic descending aortic aneurysm compressing esophagus and left lower lobe bronchus. Immediately thoracic endovascular aortic repair (TEVAR) was performed. After surgery, significant improvement of hoarseness and asthma-like attack was obtained at the time of 1 month after surgery. This is the first reported case of TEVAR which improved compression symptoms of both esophagus and bronchus due to thoracic aortic aneurysm in Japan.

OBJECTThe purposes of this study were to investigate the actual status in subjective symptoms of fatigue (SSF) and lifestyles of young male students living in two different life spheres of the Tokyo metropolitan area and a rural area, and to find, regional differences in these characteristics and relations between SSF and lifestyles in school life.

METHODSA questionnaire regarding SSF and lifestyle was administered to 412 healthy male students (16-18 yr) attending the two National Colleges of Technology located in the Tokyo metropolitan area (MA) and a local city (LC). Statistical techniques such as a chi-square test and Hayashi's Quantification Theory I analysis were used to examine relations between SSF and lifestyles.

RESULTS AND CONCLUSIONA significant difference was found only in "feeling of physical disintegration,", and the MA group was higher than the LC group. The MA students showed shorter sleeping hours and earlier awaken time compared with LC students. In the relations between SSF and lifestyles, sleeping habit was an important factor significantly relating to SSF in both groups. Paying attention to good sleeping habits is an important countermeasure for preventing SSF in the male students.

PURPOSEThe present study aimed to determine the problems of the Japanese version of the Center for Epidemiologic Studies Depression (CES-D) scale when applied to Japanese independent community-dwelling elderly focusing on its factor structure.

METHODSThe subjects were 1791 community-dwelling independent elderly aged 60 and over (848 males and 943 females). This study used the Japanese version of the CES-D scale to assess depression in the elderly.

RESULTSFrom the results of an exploratory factor analysis, the four factors of somatic symptoms, depression affect, positive affect and relation with others were interpreted.These factors were the same as those in the previous study, but the items making up each subscale differed. Therefore, the construct validity of each subscale was not necessarily assured. In the confirmatory factor analysis, goodness-offit was high for both the first and second-order factor models. In examining the validity by Akaike's information criterion (AIC), the second-order factor model assuming depression as a higher-order factor among the four factors was a better fit than the first-order factor model. Although the reliability of each subscale was not sufficient, adequate reliability was assured in the total scale.

CONCLUSIONAn assessment of depression using the Japanese version of the CES-D scale should be conducted using the total score, while a re-examination of items making up each subscale is needed.

The efficacy of Landiolol hydrochloride (Onoact^®) for the treatment of arrhythmia was studied in 10 adult patients who underwent cardiovascular surgery. Onoact was continuously infused at a mean rate of 0.018 mg/kg/min initially and followed by 0.01 mg/kg/min. After the initiation of Onoact infusion, supra-ventricular tachycardia was eliminated in 5 out of 6 patients, and ventricular tachycardia disappeared in all 4 patients. The decrease in systemic blood pressure was not significant. Low-dose continuous infusion of Onoact was safe and effective even in patients just after cardiovascular surgery.

The efficacy of Landiolol hydrochloride (Onoact^®) for the treatment of arrhythmia was studied in 10 adult patients who underwent cardiovascular surgery. Onoact was continuously infused at a mean rate of 0.018 mg/kg/min initially and followed by 0.01 mg/kg/min. After the initiation of Onoact infusion, supra-ventricular tachycardia was eliminated in 5 out of 6 patients, and ventricular tachycardia disappeared in all 4 patients. The decrease in systemic blood pressure was not significant. Low-dose continuous infusion of Onoact was safe and effective even in patients just after cardiovascular surgery.

A 60-year-old man was admitted to our hospital due to cerebellum infarction. He had undergone replacement of the aortic valve and ascending aorta because of aortitis syndrome 2 years ago. Electrocardiogram showed complete atrioventricular block. Echocardiography showed aortic annular abscess and vegetation on the prosthetic aortic valve. A pulmonary autograft was transplanted of the aortic root (Ross operation) after complete resection of the infected sites. The postoperative course was uneventful. The ross operation was considered to be a treatment of choice for prosthetic aortic valve endocarditis.

Out of 104 patients with perimembranous or infundibular-isolated ventricular septal defect (VSD), causative factors of Prol and AR, and the operative indication were studied in 17 with prolapse of the aortic cusp (Prol) and 10 with aortic valve regurgitation (AR). The left to right shunt ratio and the size of VSD were smaller in patients with Prol or AR than in those with the normal aortic cusp, suggesting that hemodynamics might take part in the cause of Prol or AR. Twenty-two patients underwent VSD closure only, four valvuloplasty and one aortic valve replacement. Residual AR was occurred in three out of ten patients. After surgery, AR was disappeared in six out of seven patients with the first grade preoperative AR, but AR remained in all two patients with the second grade preoperative AR. Careful preoperative observation and early operation before the appearance of AR are the important factors for avoiding residual regurgitation after aortic valvuloplasty.

An 83-year-old female was referred to our hospital because of a swelling and pain of the left lower extremity. An endoaneurysmorrhaphy and bypass surgery between the left common iliac artery and the external iliac artery were performed under the diagnosis of deep vein thrombosis associated with a left isolated internal iliac aneurysm. Forty patients with isolated internal iliac aneurysm were reported in Japan and deep vein thrombosis occurred only in our patient. The external growth of the aneurysm behind the external iliac artery might cause compression, congestion and phlebitis of the common iliac vein, resulting in deep vein thrombosis.

A 50-year-old man was diagnosed as having aortic valve insufficiency, complete occlusion of the right coronary artery and 75% stenosis of the left main trunk due to syphilitic aortitis. Aortic valve replacement and coronary artery bypass grafting to three vessels were successfully performed. The selection of surgical procedures for the coronary lesion with syphilitic aortitis should be made carefully, since the progression of aortic root inflammation in the acute phase and the development of atherosclerotic changes are not preventable in the future. It is most important to select effective and safe surgical interventions, especially for patients with such a low cardiac function as our patient.