This report documents two rare cases we encountered in which paraplegia developed as a postoperative complication following elective operations for an unruptured abdominal aortic aneurysm (AAA). Case1: A 80-year-old man receiving dialysis therapy was found to have 75% occlusion of the left anterior descending branch by preoperative coronary arteriography but, as the cardiac function was satisfactory, replacement of the aneurysm with a tube graft was performed through a retroperitoneal approach for treatment of the AAA. Symptoms of paraplegia developed immediately following the operation and a diagnosis of anterior spinal artery syndrome was made based on the postoperative MRI findings. Case 2: A 62-year-old man underwent a coronary artery bypass operation (3 sites in 2 branches) using the bilateral internal thoracic artery with the breast beating prior to elective surgery for an unruptured AAA, and subsequently underwent an aneurysm replacement with a Y-graft through a midline incision. At the same time, the celiac artery and superior mesenteric artery cure found to be stenotic at their roots were also bypassed via vascular prostheses to the right arm of the Y-graft. Paraplegia was evident after emerging from anesthesia. In both cases, there were complicating coronary arterial lesions and significant atherosclerotic changes in the thoracic descending aorta. A CT scan demonstrated an artery coursing from the iliolumbar artery, a branch of the internal iliac artery, to the spinal cord in Case 2, indicating that intraoperative clamping of the internal iliac artery might have caused the paraplegia. In patients with marked arteriosclerosis of the thoracic descending aorta, there is the possibility of occlusion of spinal root arteries originating from that affected region. Blood supply to the spinal cord via a collateral vascular route is important in such cases.

We report surgically treated case of tricuspid valve endocarditis in a non-drug addict. A 35-year-old man with no history of cardiac disease was admitted to our institution for persistent fever. His blood culture was positive for methicillin-sensitive Staphylococcus aureus (MSSA). Echocardiography showed friable vegetations attached to the tricuspid valve with moderate tricuspid regurgitation. No other valves were affected. Chest computed tomography revealed multiple septic pulmonary emboli in both lungs. The infection was uncontrollable, so despite 6 weeks' of appropriate intravenous antibiotics therapy, he required surgery. Infected lesions had extended to parts of the septal leaflet and the posterior leaflet of the tricuspid valve. Valve repair with the resection-suture technique was performed. Half of the septal leaflet and a part of the posterior leaflet were excised with the vegetations, and the remaining septal leaflet was sutured to the posterior leaflet after annular plication without implanting an artificial ring. The postoperative course was uneventful, without further tricuspid regurgitation or stenosis. He was discharged after additional antibiotic administration for 4 weeks postoperatively, and he has remained free from endocarditis for over 1 year.

Cardiac surgery using heparin was performed in a patient in whom AST and ALT had been increased due to continuous drip infusion of heparin sodium. Here, we report postoperative changes in AST and ALT in the patient. The patient was a 59-year-old man with a past medical history of left internal carotid artery constriction and right cerebral infarction. Because of his previous medical history, continuous drip infusion of heparin was initiated upon discontinuation of preoperative antithrombotic agents. AST and ALT increased, but returned to normal levels when heparin was discontinued. Heparin was used to avoid aggravation of the symptoms, and bypass of 3 branches was performed with pulsation. Postoperative respiration and circulatory dynamics were stable, and the courses of AST and ALT were similar to those after general surgery, without abnormally high levels. Although the cause of heparin-induced increases in AST and ALT is unknown, the absence of postoperative increases may have been due to transient use at a high dose and neutralization by protamine.

We prescribed Hyakugokokinto for four patients suffering from dryness in the throat. Dry throat improvements were observed in all patients, while improvements in insomnia were observed as well. Thus, insomnia may be a further indication for the use of Hyakugokokinto.

Prostaglandin D2 (PGD2) is a major prostanoid, produced mainly by mast cells, in allergic diseases, including bronchial asthma. PGD2-induced vasodilatation and increased permeability are well-known classical effects that may be involved in allergic inflammation. Recently, novel functions of PGD2 have been identified. To date, D prostanoid receptor (DP) and chemoattractant receptor homologous molecule expressed on TH2 cells (CRTH2) have been shown to be major PGD2-related receptors. These two receptors have pivotal roles mediating allergic diseases by regulating the functions of various cell types, such as TH2 cells, eosinophils, basophils, mast cells, dendritic cells, and epithelial cells. This review will focus on the current understanding of the roles of PGD2 and its metabolites in TH2 inflammation and the pathogenesis of bronchial asthma.
Asthma/*etiology/immunology ; Basophils/physiology ; Eosinophils/physiology ; Humans ; Mast Cells/physiology ; Prostaglandin D2/*physiology ; Receptors, Immunologic/physiology ; Receptors, Prostaglandin/physiology ; Th2 Cells/*immunology

Computer-based testing (CBT) has been used in Japan since 2002 to assess medical students' basic and clinical medical knowledge, based on the model core-curriculum, before they start clinical clerkships. For effective CBT, multiplechoice questions must accurately assess the knowledge of students. Questions for CBT are submitted by all medical schools in Japan. However, only 40% of questions are chosen for CBT and used at random; the other 60% of questions are rejected because of poor quality. Toimprove the ability of medical staff to devise questions, workshops were held at 30 medical schools. The acceptance rate of questions from schools where workshops were held was significantly increased. The workshops were extremely effbctive for improving the quality of questions.

Data from the first trial of the computer-based nationwide common achievement test in medicine, carried out from February through July in 2002, were analyzed to evaluate the applicability of the item-response theory. The trial test was designed to cover 6 areas of the core curriculum and included a total of 2791 items. For each area, 3 to 40 items were chosen randomly and administered to 5693 students in the fourth to sixth years; the responses of 5676 of these students were analyzed with specifically designed computer systems. Each student was presented with 100 items. The itemresponse patterns were analyzed with a 3-parameter logistic model (item discrimination, item difficulty, and guessing parameter). The main findings were: 1) Item difficulty and the percentage of correct answers were strongly correlated (r=-0.969to-0.982). 2) Item discrimination and the point-biserial correlation were moderately strongly correlated (r=0.304 to 0.511). 3) The estimated abilities and the percentage of correct answers were strongly correlated (r=0.810 to 0.945). 4) The mean ability increased with school year. 5) The correlation coefficients among the 6 curriculum area ability scores were less than 0.6. Because the nationwide common achievement test was designed to randomly present items to each student, the item-response theory can be used to adjust the differences among test sets. The first trial test was designed without considering the item-response theory, but the second trial test was administered with a design better suited for comparison. Results of an analysis of the second trial will be reported soon.

BACKGROUND: Exacerbation of asthma has a negative impact on quality of life and increases the risk of fatal asthma. One of the known risk factors for patients with a history of near-fatal asthma is reduced sensitivity to dyspnea. OBJECTIVE: We aimed to identify patients with such risk before they experienced severe exacerbation of asthma. METHODS: We analyzed asthma symptoms and peak expiratory flow rate (PEFR) values of 53 patients recorded daily in a diary over a mean period of 274 days. Patients matched their symptoms to one of eight categories ranging in severity from 'absent' to 'severe attack'. We then analyzed the relationship between PEFR and asthma symptoms by dividing the PEFR value by the values of clinical parameters, including asthma symptom level.
Asthma ; Dyspnea ; Forced Expiratory Volume ; Humans ; Peak Expiratory Flow Rate ; Quality of Life ; Risk Factors

BACKGROUND: Patients may receive negative results from a specific IgE (sIgE) test such as the ImmunoCAP (CAP) despite a documented history of systemic reaction to a Hymenoptera sting. Thus, further testing may be required using another serological method or venom skin prick tests to confirm allergy diagnosis and correct species. OBJECTIVE: To evaluate the sensitivity and the specificity of CAP and IMMULITE 3gAllergy (IMMULITE) for detecting sIgE to Paper wasp (WA) and Yellow Jacket (YJ) venoms using patient clinical history as the comparator. METHODS: Sera from 70 participants with a history of systemic reactions (SR) to WA and/or YJ stings were tested using CAP and IMMULITE. Fifty participants from this group had negative results on CAP. To assess specificity, sera from 71 participants who had never experienced either a WA or YJ sting were tested using CAP and IMMULITE. Fifty participants from this group tested positive using CAP. RESULTS: In participants with a history of systemic reaction to a Hymenoptera sting, yet who tested negative for WA and/or YJ sIgE according to CAP, the positivity rate according to IMMULITE was 20-42% using 0.10 IUA/mL as the limit of detection (LoD), per the manufacturer's specification. When the LoD for CAP (0.35 IUA/mL) was applied to the IMMULITE results, positivity according to IMMULITE was 14-26%. Overall, sensitivity, specificity, and agreement with SR were greater for IMMULITE than for CAP. For YJ: sensitivity (IMMULITE:CAP), 42.8%:28.5%; specificity, 53.5%:39.4%; agreement, 48.2%:34%. For WA, sensitivity (IMMULITE:CAP), 58.6%:28.5%; specificity, 49.3%:47.8%; agreement, 43.9%:38.3%. CONCLUSION: The IMMULITE performed well for detecting sIgE to Hymenoptera venom
Bites and Stings ; Diagnosis ; Humans ; Hymenoptera ; Hypersensitivity ; Immunoglobulin E ; Limit of Detection ; Methods ; Sensitivity and Specificity ; Skin ; Venoms ; Wasps