We reported an operative case of bilateral coronary arteries to pulmonary artery fistula with giant saccular aneurysm. This 68 year-old female was admitted for evaluation of chest oppression and heart murmur. On coronary angiography, the diagnosis was made as a coronary artery fistula originating from right coronary artery and left anterior descending artery, and draining into the main pulmonary artery. The operation was indicated by giant saccular aneurysm, high shunt ratio, and positive finding of ischemic change on exercise electrocardiogram. The closure of coronary fistula and aneurysmorrhaphy were performed under cardiopulmonary bypass. The aneurysm was 25×30mm diamater, and not found arteriosclerotic change in operative finding. The fistula was completely disappeared by postopertive coronary angiography. We concluded that curative operation for coronary artery fistula with giant aneurysm can be done with minimal risk under cardiopulmonary bypass.

When serious emergency patients come to a 3rd-level emergency hospital, they are able to obtain optimal medical treatment for their condition. However, the emergency room of general hospitals are extremely crowded with many kinds of patients, ranging from 1st-to 3rd-level emergencies. Thus, a good training program in triage is necessary for emergency medicine doctors because of the risk of inappropriate management of patients.
In this study, we examined the number of 2nd-and 3rd-level emergency patients who came to our emergency room initially as walk-in 1st-level emergency patients in 1991 and 1992. Our results indicate that the education for emergency medicine doctors needs to cover a wide range of medical fields dealing with 1st-to 3rd-level emergency patients, and that ideal training in emergency medicine must be organized in hospitals that accept 1st-to 3rd-level emergency patients.

Objective: There are few reports of the long-term outcomes of elderlypatients with prostate cancer. We analyzed data from our institution from the past 12years, including the patient history, treatment methods, and prognosis of patients withprostate cancer aged 80 years or more.

Patients and Methods: A total of 179 cases of prostate cancer in patientsaged 80 years or more were retrospectively evaluated. We divided them chronologically intogroups A, B, C, and D: Group A included 40 cases from 2002–2004; Group B, 48 cases from2005–2007; Group C, 46 cases from 2008–2010; and Group D, 45 cases from 2011–2013.

Results: Sixty-one (30%) patients changed treatment course. Interestingly,no cancer deaths occurred in the patients who changed treatment course. Although 14 (7.8%)cancer deaths occurred (A: B: C: D = 4: 4: 6: 0, respectively), all occurred in 2011 orlater.

Conclusion: In our study, over 50 patients who underwent treatment survivedfor 5 years or more. By treating prostate cancer in elderly patients when appropriate, wecan lower the mortality rate due to prostate cancer. Our results support the activetreatment of prostate cancer in elderly patients.

Behcet's disease is generally recognized as a chronic multi-system disease. Approxymately 8% of patients with Behct's disease will have serious vascular compilcations which is called vasculo-Behcet's disease. A male patient of 41 year old was admitted to our clinic, complaining pain of left popliteal fossa and hypesthesia of left lower leg. A popliteal aneurysm was found. Resection of the aneurysm and a saphenous vein graft were successfully performed. Neuropathy disappeared after the surgery. Aneurysms in Behcet's disease mainly appear in major arteries, and rarely in peripheral arteries. Compression neuropathy in the popliteal aneurysm of Behcet's disease has been rarely reported. Early resection of aneurysm before completion of neuropathy is recommended for succsessful outcome.

The purpose of this study was to examine the effects of crocetin on the pupillary response during accommodation induced by visual display terminal (VDT) work. This clinical study was conducted as a randomized, double-blind, placebo-controlled, crossover trial in healthy adult volunteers with subjective symptoms of eye fatigue. In this study, the pupillary response during accommodation was evaluated using pupil constriction ratio (PCR). PCR was measured before and after VDT work, after rest at baseline, and at each intervention period. Following analysis of variations in PCR, the variation in PCR after rest significantly increased in the crocetin group. According to the visual analog scale questionnaire, subjective symptoms of eye fatigue significantly improved. These results show that ingestion of crocetin for 4 weeks is effective in mitigating the pupillary response during accommodation associated with VDT work.

Anjo Kosei General Hospital is a large-scale hospital having 692 beds and located in the central part of Aichi. When the hospital moved into the present adress in April 2002, we introduced an electronic chart system that was not common in Japan at that time. Hospital management changed dramatically because until then we were using exclusively papers, and had not possessed even an electronic ordering system. It was also true in the field of medical office work. We hereby report the changes in routines after the introduction of the electronic chart system and its usefulness.The characteristics of our medical work system are as follows.(1)Data refrieval function (Data Ware House)(2)Credit control system(3)Receipt imaging functionWe are evaluating the various effects of the system from seven points of view as follows.(1)Basic data of medical care(2)Staff placement and personnel expenses(3)Work accuracy and efficiency(4)Patients service(5)Storage space reduction(6)Paper reduction(7)In-house questionnaire survey
Work ; Hospitals ; chart ; System ; Reduction (chemical)

Objectives: To evaluate the efficacy of tegafur–uracil (UFT), a prodrug of 5-fluorouracil, plus cisplatin and dexamethasone in patients with docetaxel-refractory prostate cancers.

Methods: Twenty-five patients with docetaxel-refractory prostate cancer were administered oral UFT plus intravenous cisplatin (UFT-P therapy) and dexamethasone. Treatment responses were assessed monthly via prostate-specific antigen (PSA) level measurements. Treatment-related adverse events and overall survival were also assessed.

Results: UFT-P therapy resulted in decreased PSA levels in 14 (56%) patients and increased PSA levels in 11 (44%). In patients with increased PSA levels, 7 (64%) of the 11 patients displayed decreased PSA doubling times. The UFT-P therapy response rate was 84% (21/25 patients). Imaging studies revealed that tumor shrinkage during UFT-P therapy occurred in 1 patient in whom bilateral hydronephrosis caused by lymph node metastasis improved. The median survival time from docetaxel initiation was 36 months. In UFT-P-treated patients, the median PSA progression and overall survival times were 6 and 14 months, respectively. UFT-P treatment-related adverse events were mild diarrhea, general fatigue, and anorexia. Treatment was not discontinued for any of the patients. UFT-P therapy did not cause serious hepatic or renal dysfunction or pancytopenia.

Conclusions: UFT-P therapy is a safe and effective treatment for patients with docetaxel-refractory prostate cancer, although large-scale, multicenter, prospective studies are needed to validate these findings.