Effects of a dietary supplement of carp gallbladder powders, New-Eyereturn^®, on visual functions were investigated in elder ophthalmic patients. The tablets (12 tablets/day) were taken by 15 and 12 subjects for one-month and three-month period, respectively. In comparison with the visual function data at baseline and thereafter, improvements of subjective symptoms by questionnaire was observed in a three-month intake group, although no significant difference of the values of visual acuity and intraocular pressure was recognized. These results suggest intake of this dietary supplement has a possibility to improve visual functions of elder people.

Congenital heart disease of partial anomalous pulmonary venous drainage of entire left lung without other cardiac anomaly was very rare. 21-year-old man, who was pointed out heart disease 6 months ago, was diagnosed as partial anomalous pulmonary venous drainage of entire left lung without other cardiac anomaly by cardiac catheterization and angiography. The patient underwent surgery through the left forth intercostal incision without cardiopulmonary bypass. The end-to-side anastomosis was made between the vertical vein and the left atrial appendage following ligation of the vertical vein near the innominate vein. Surgical treatment was satisfactory in the postoperative angiography which was shown widely patent anastomosis. He was discharged with uneventful postoperative course and returned to full activity.

A 68-year-old man was taken to our hospital by ambulance due to syncope. He was in shock with cardiac tamponade. Pericardial drainage was performed. Aortic valve regurgitation gradually increased and surgery was performed at 25 days after onset. Surgical finding showed that there was a detachment of the commissure between the right and non coronary cusps of the aortic valve. An intimal tear was detected in the same place and aortic root replacement was required. The patient had a good recovery and he was discharged 14 days after surgery.

In a consecutive series of 160 surgically treated abdominal aortic aneurysm, four patients with acute aortic thrombotic occlusion of an abdominal aortic or iliac aneurysm were encountered. Three of four aneurysms were 7cm in diameter or smaller. Also, 3 of 4 patients had chronic occlusive disease of legs. Our mortality rate was 75%. The recommendation is made that all abdominal aortic aneurysms be resected if there is substantial associated distal occlusive disease.

A 44-year-old woman with over 20 years history of rheumatic heart disease developed progressive heart failure from aortic stenosis and mitral restenosis after open mitral commissurotomy. In December, 1986, she underwent aortic and mitral valve replacements with Medtronic Hall prosthesis (aortic: 21mm, mitral: 27mm). Following an eventful recovery, she was discharged from the hospital and continued on a regimen of Coumadin. In February, 1991, the patient developed chest and back pain, which necessitated her emergency admission to our clinic. During the coronary examination, the aortic prosthetic occluder was not moving, fixed in the opening position, lasting from one to several minutes. She underwent emergency operation for replacement of the defective valve. At operation, we noted the pannus formation into the valve orifice on the inflow side of aortic prosthesis. She made a satisfactory recovery and has enjoyed good health since that time.

This is a case report of a rare combination of a single coronary artery and a coronary artery fistula. An 8-year-old girl was asymptomatic with a grade II continuous murmur in the third left intercostal space. Selective coronary angio-graphy revealed that a single coronary artery arising from the left aortic sinus was dilated and ended as a fistula to the outflow tract of the right ventricle. At operation, the fistula could not be exposed on the surface of the heart. On cardiopulmonary bypass, the aorta was clamped, and the fistula was closed by direct suture in the right ventricle. The postoperative course was uneventful with no complications.

Background/Aims: Adalimumab has been shown to induce and maintain clinical remission in patients with moderate to severe ulcerative colitis (UC). However, no large-scale population-based studies have been performed in Japan. This study was conducted to evaluate the safety and effectiveness of adalimumab in clinical practice in Japanese patients with UC. Methods: In this 52-week, prospective, multicenter, single-cohort, noninterventional, observational, postmarketing surveillance study, patients with moderate to severe UC received an initial subcutaneous injection of adalimumab 160 mg, followed by 80 mg at 2 weeks, and then 40 mg every other week. Safety assessments were the incidence of adverse drug reactions (ADRs) and serious ADRs. Effectiveness assessments were clinical remission, corticosteroid-free remission, mucosal healing, and change in C-reactive protein (CRP) levels from baseline. Results: Of 1,593 registered patients, 1,523 (male, 57.6%; mean age, 41.8 years) and 1,241 patients were included in the safety and effectiveness populations, respectively. ADRs were reported in 18.1% and serious ADRs in 4.9% of patients. Clinical remission was achieved in 49.7% of patients at week 4, increasing to 74.4% at week 52. Corticosteroid-free remission rates increased over time, from 10.4% at week 4 to 53.1% at week 52. More than 60% of patients demonstrated mucosal healing at weeks 24 and 52. Mean CRP levels (mg/dL) decreased from 1.2 at baseline to 0.6 at week 4 and 0.3 at week 52. Conclusions This large real-world study confirmed the safety and effectiveness of adalimumab in patients with UC in Japan. No new safety concerns were identified.

Objective: The feasibility of peri-orbital electrodes, which are not invasive and do not induce pain, as a supplemental electrode for detection of ictal discharges in medial temporal lobe epilepsy (MTLE) was examined. Methods: Patients with MTLE, who underwent video-EEG monitoring with simultaneous peri-orbital and sphenoidal electrodes and obtained good outcome following standard anterior temporal lobectomy, were subjects in this study. Initial ictal discharge amplitudes were compared between sphenoidal (Sp1/ 2), standard anterior temporal in 10-20 system (F7/ 8), peri-orbital (superior orbital lateral: SOL, inferior orbital medial: IOM), frontopolar (Fp1/ 2), frontal (F3/4) and ear (A1/ 2) electrodes. Results: A total of 34 consecutive seizures from 20 patients were analyzed, with a maximum amplitude observed at Sp1/2 (57.57±5.59), followed by F7/8 (54.89±5.59), SOL (50.97±5.59), IOM (46.95±5.59), A1/2 (45.07±5.69), Fp1/2 (44.78±5.62), and F3/4 (37.75±5.66) (mean±standard error, μV). There was no statistical difference between Sp1/2, F7/8, SOL, and IOM values. When the sphenoidal electrode was omitted, 13 seizures (13/34, 38.2%) resulted in the highest amplitude at peri-orbital electrodes and 10 seizures (10/ 34, 29.4%) at F7/8. Conclusions: Peri-orbital electrodes could detect ictal discharges in MTLE as well as sphenoidal and standard anterior temporal electrodes in 10-20 system and are useful for supplemental recording for detecting ictal epileptiform discharges in MTLE.

Background/Aims: Crohn’s disease is a chronic disorder; therefore, it is essential to investigate long-term safety and efficacy of treatments. This study assessed the safety and effectiveness of adalimumab for up to 3 years in Japanese patients with Crohn’s disease in real-world settings. Methods: This was a multicenter, single-cohort, observational study of patients with Crohn’s disease. Safety assessments included incidence of adverse drug reactions. Effectiveness assessments included clinical remission, mucosal healing, and Work Productivity and Activity Impairment (WPAI). Results: The safety and effectiveness analysis populations comprised 389 and 310 patients, respectively. Mean (standard deviation) exposure to adalimumab in the safety analysis population was 793.4 (402.8) days, with a 58.1% retention rate. A total of 105 patients (27.0%) and 43 patients (11.1%) experienced adverse drug reactions and serious adverse drug reactions, respectively, with no patient reporting tuberculosis or hepatitis B. Infections and serious infections were reported in 37 patients (9.5%) and 17 patients (4.4%), respectively. Malignancy was reported as an adverse drug reaction in 2 patients (0.5%). Remission rate increased from 37.8% (98/259) at baseline to 73.9% (167/226) at week 4 and remained > 70% over 3 years. Proportion of patients without mucosal ulcerations increased from 2.7% (2/73) at baseline to 42.3% (11/26) between years > 2 to ≤ 3. WPAI improvement started at 4 weeks, with the overall work impairment score improving from 42.7 (n = 102) at baseline to 26.9 (n = 84) at 4 weeks. Conclusions Results from this study confirm the long-term safety and effectiveness of adalimumab treatment in Japanese patients with Crohn’s disease in the real-world setting.