Ischemic heart disease (IHD) may coexist with aorto-iliac occlusive disease, and concomitant revascularization procedures may be required. This study reports our experience with ascending aorta to left femoral bypass grafting (Ao-ltFG) to prepare for intra-aortic balloon pumping (IABP). A 73-year-old man with chest pain was admitted to our hospital. Coronary angiography revealed coronary aneurysm and IHD. Enhanced computed tomography showed coronary aneurysm, complete left subclavian artery occlusion and bilateral external iliac artery occlusion. We planned a two-stage operation. In the first operation, we chose coronary artery bypass grafting, excision of the coronary aneurysm and simultaneously Ao-ltFG to prepare for IABP. In the second operation, we chose axillo-axillo bypass grafting and Ao-ltFG to right femoral artery bypass grafting. Although in the operative findings no coronary aneurysm was recognized, we performed the other operations and the postoperative course was uneventful without IABP.

We report a case of type A dissecting aneurysm occurring after aortic valve replacement (AVR). The patient was a 67-year-old man with a history of AVR 4 years previously. Preoperative CT scan revealed a type A dissecting aneurysm 10cm in diameter, close to the sternum. Under preparation for selective cerebral perfusion (SCP), re-do median sternotomy was safely performed using partial extracorporeal circulation (ECC) via a femoral artery and vein. Because of severe adhesion in the upper part of the ascending aorta and aortic arch, a graft replacement of the ascending aorta was impossible. Under SCP via bilateral common carotid arteries exposed in the neck, the entry of the dissection, which was located in the previous aortotomy line, was closed with an ePTFE patch. SCP via bilateral common carotid arteries exposed in the neck appeared to be very useful and safe for such patients at risk for injury to the aorta during re-do median sternotomy and with severe adhesion, which made it difficult to establish SCP via the usual operative field. Although graft replacement is the standard operation for the treatment of the ascending aortic dissection, patch closure of the entry should be considered as a second-choice method in some case.

BACKGROUND: physicians' awareness regarding evidence-based medicine (EBM), clinical practice guidelines, and clinical information resources were rarely examined in Japan. We need to know them prior to the initiation of the Medical Information Network Distribution Service (Minds) by the Japan Council for Quality Health Care (JCQHC) .
METHODS: A total of 10, 000 directors/owners of private clinics (CDs: clinic physicians) affiliated with the Japan Medical Association (JMA) and 8682 physicians working for hospitals certified by the JCQHC (HDs: hospital physicians) were randomly selected and surveyed by a mailed questionnaire.
RESULTS: The response rate to the questionnaire was 18.7% (n=1865) among CDs and 67.8% (n=5885) among HDs. The percentage of respondents who uses internet was 39.9% among CDs and 69.3% among HDs. The information resource most commonly used by all respondents was medical journals, followed by textbooks. The percentage of respondents who used medical literature database was 10.8% among CDs and 49.7% among HDs, respectively. Approximately 80% of all respondents approved implementing EBM in daily practice. Fifty percent of all respondents indicated to have used clinical practice guidelines, and 90% of all the guideline users replied that clinical practice guidelines are useful tools for clinical decision-making. Over half of HDs required to access to the abstracts of the literature cited in the guidelines.
CONCLUSIONS: Many physicians who responded to the survey acknowledged that EBM will contribute to improving the quality of medical services. They are positive in using clinical practice guidelines that include a series of recommendations proposed by specialists in the relevant field (s) in accordance to the reviewed evidence.

BACKGROUND: The purpose of our study was to compare the characteristics of medical practitioners who prefer using the Internet as their information resource and those who prefer using printed materials.
METHODS: From December 2002 to January 2003, a non-anonymous questionnaire was sent out by post to members of the Japanese Medical Association (JMA) and physicians working in hospitals. Contributing factors were examined by using logistic regression analysis.
RESULTS: The response rates for the questionnaires were 18.7% (n=1868) for JMA physicians and 68.0% (n=5901) for hospital physicians. Factors associated with the preference for using the Internet were: ‘younger age’; ‘use of the Internet to solve clinical problems and uncertainties’; ‘use of personal computers at work’; and, ‘use of personal computers at home’.
CONCLUSION: The results of this study show that, although some younger physicians prefer printed materials, providing medical information via the Internet is better suited for younger physicians who are making full use of computers. In contrast, older physicians prefer printed materials because they tend to be less familiar with using computers and may have limited accessibility to the Internet. Therefore, using both the Internet and printed materials to provide medical information is necessary to meet the needs of the larger physician population.

Sixteen cases of malignant soft tissue sarcoma (STS; 10 canines and six felines) were treated with a novel triple therapy that combined photodynamic therapy, hyperthermia using indocyanine green with a broadband light source, and local chemotherapy after surgical tumor resection. This triple therapy was called photodynamic hyperthermal chemotherapy (PHCT). In all cases, the surgical margin was insufficient. In one feline case, PHCT was performed without surgical resection. PHCT was performed over an interval of 1 to 2 weeks and was repeated three to 21 times. No severe side effects, including severe skin burns, necrosis, or skin suture rupture, were observed in any of the animals. No disease recurrence was observed in seven out of 10 (70.0%) dogs and three out of six (50.0%) cats over the follow-up periods ranging from 238 to 1901 days. These results suggest that PHCT decreases the risk of STS recurrence. PHCT should therefore be considered an adjuvant therapy for treating companion animals with STS in veterinary medicine.
Animals ; Antineoplastic Agents/*therapeutic use ; Cat Diseases/drug therapy/surgery/*therapy ; Cats ; Combined Modality Therapy/veterinary ; Dog Diseases/drug therapy/surgery/*therapy ; Dogs ; Hyperthermia, Induced/veterinary ; Indocyanine Green/*therapeutic use ; Photochemotherapy/veterinary ; Photosensitizing Agents/*therapeutic use ; Sarcoma/drug therapy/surgery/therapy/*veterinary

PURPOSE: Although the technical developments of radiotherapy have been remarkable, there are currently few reports on the treatment results of radiotherapy for local recurrence of rectal cancer treated with surgery alone as initial treatment in this three-dimensional conformal radiotherapy era. Thus, we retrospectively evaluated the treatment results of radiotherapy for local recurrence of rectal cancer treated with surgery alone as the initial treatment. MATERIALS AND METHODS: Thirty-two patients who underwent radiotherapy were enrolled in this study. The dose per fraction was 2.0–3.5 Gy. Because the treatment schedule was variable, the biological effective dose (BED) was calculated. RESULTS: Local control (LC) and overall survival (OS) rates from the completion of radiotherapy were calculated. The 1-, 2-, 3-, 4-, and 5-year LC rates were 51.5%, 24.5%, 19.6%, 19.6%, and 13.1%, respectively. LC rates were significantly higher for the high BED group (≥75 Gy10) than for the lower BED group (<75 Gy10). All patients who reported pain achieved pain relief. The duration of pain relief was significantly higher for the high BED group than for the lower BED group. The 1-, 2-, 3-, 4-, and 5-year OS rates were 82.6%, 56.5%, 45.2%, 38.7%, and 23.2%, respectively. There was a trend toward higher OS rates in with higher BED group compared to lower BED group. CONCLUSION: For patients with unresectable locally recurrent rectal cancer treated with surgery alone, radiotherapy is effective treatment. The prescribed BED should be more than 75 Gy10, if the dose to the organ at risk is within acceptable levels.
Appointments and Schedules ; Humans ; Radiotherapy* ; Radiotherapy, Conformal ; Rectal Neoplasms* ; Recurrence ; Retrospective Studies

The purpose of this study was to evaluate the effect of keishibukuryogan (KB) against the cognitive symptoms associated with silent brain infarction in a prospective cohort study. The subjects were 93 patients with silent brain infarcts who visited the Department of Japanese Oriental Medicine, University of Toyama, and its allied hospitals. They consisted of 24 males and 69 females, mean age (± S.E.) 70.0±0.8.Group SK (n=51) consisted of patients who used KB extract for more than6months per year. Group SC (n=42) consisted of patients who did not use Kampo formulas. The NS group (n=44) consisted of elderly subjects who had no silent brain infarction, 21 males and 23 females, with a mean age (± S.E.) of 70.7±0.7 years. Among the three groups, the revised version of Hasegawa's dementia scale, apathy scale and self-rating depression scale were compared between the study start and after three years. In the SK and SC groups, these scores, and the subjective symptom levels (head heaviness, headache, dizziness or vertigo, stiff shoulder) were also studied. The results showed that the self-rating depression scales at study start for the SK and SC groups were significantly higher compared to the NS group. In spite of the scores for the NS group increasing after three years, the SK group scores were significantly decreased compared to the SC and NS groups. KB was effective against head heaviness, which often complicates silent brain infarction. In the above mentioned, KB was effective in treating cognitive disorders and subjective symptoms related to silent brain infarction.
Infarction ; Brain ; seconds ; Ions ; symptoms <1>

Objective: Many patients in Kagawa University Hospital are administered medicines prepared by the simple suspension method.  Pharmacists in charge of these patients receive inquiries from doctors and nurses regarding the suitability of medicines for the simple suspension method.  Answering these inquiries is complicated and time-consuming as multiple data sources need to be searched.  In order to simplify these complicated procedures, we herein attempted to develop a novel database to provide valuable information that could contribute to the safe performance of the simple suspension method, and evaluated its usefulness.
Method: The specifications of the database were determined by analyzing previously answered inquiries.  To evaluate the usefulness of the database, we used test prescriptions and compared the amount of time required to gather information using the database and the conventional method, i.e., using books alone.  We also analyzed previous prescriptions with the database in order to determine what kinds of problems could be detected.
Results: The investigation of previous prescriptions indicated that some medicines needed to be examined not only for their suitability for the simple suspension method, but also their incompatibility.  Therefore, we added a feature regarding the incompatibility of medicines to the database.  The time required to gather the information needed to answer the test prescription was shorter with our database than with the conventional method.  Furthermore, the database improved the detection of medicines that require particular attention for their properties including incompatibility.  An analysis of previous prescriptions using our database indicated the possibility of incompatibility in half of the previous prescriptions examined.
Conclusion: Our database could rapidly provide information related to the simple suspension method, including the incompatibility of medicines.

PURPOSE: Since oncological outcomes of transanal colorectal tube (TCT) placement, an endoscopic treatment for colorectal cancer (CRC) with acute colorectal obstruction (ACO), remain unknown, this study analyzed long-term outcomes of TCT placement for stage II/III CRC with ACO. MATERIALS AND METHODS: Data were retrospectively reviewed from consecutive patients with distal stage II/III CRC who underwent surgery between January 2007 and December 2011 at two Japanese hospitals. One hospital conducted emergency surgery and the other performed TCT placement as the standard treatment for all CRCs with ACO. Propensity score (PS) matching was used to adjust baseline characteristics between two groups. RESULTS: Among 754 patients with distal stage II/III CRC, 680 did not have ACO (non-ACO group) and 74 had ACO (ACO group). The PS matching between both hospitals identified 234 pairs in the non-ACO group and 23 pairs in the ACO group. In the non-ACO group, the surgical quality was equivalent between the two institutions, with no significant differences in overall survival (OS) and disease-free survival (DFS). In the ACO group, the rate of primary resection/anastomosis was higher in the TCT group than in the surgery group (87.0% vs. 26.1%, p < 0.001). No significant differences were noted between the surgery and the TCT groups in OS (5-year OS, 61.9% vs. 51.5%; p=0.490) and DFS (5-year DFS, 45.9% vs. 38.3%; p=0.658). CONCLUSION: TCT placement can achieve similar long-term outcomes to emergency surgery, with a high rate of primary resection/anastomosis for distal stage II/III colon cancer with ACO.
Asian Continental Ancestry Group ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Disease-Free Survival ; Emergencies ; Humans ; Propensity Score ; Retrospective Studies

Background/Aims: Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is performed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing perforation. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of rescue hybrid ESD (RH-ESD). Methods: We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group (SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes. Results: Resection time was significantly shorter in the following order: RH-ESD (149 [90–197] minutes) >C-ESD (90 [60–140] minutes) >SH-ESD (52 [29–80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dissection rate was significantly lower in the piecemeal resection group (25% [20%–30%]) than in the en bloc resection group (40% [20%–60%]). Conclusions RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoiding surgery.