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.

Fruits of Brucea javanica (L.) Merr. (“Ratchadad” in Thai) and roots of Eurycoma longifolia Jack (“Plalaipeag” in Thai) are used as traditional medicines for the treatment of malarial fever. Ethanol, methanol, ethyl acetate, ethyl alcohol and aqueous extracts were tested against the multidrug-resistant Plasmodium falciparum strain K1. Ethanol and methanol-ethanol extracts, together with methanol residue, from fruits of B. javanica (L.) Merr. showed the highest antiplasmodial activities with IC₅₀ values of 0.5 ± 0.3, 0.3 ± 0.1 and 0.3 ± 0.05 Μg⁄mL, respectively, comparable to the IC₅₀ values of chloroquine (0.17 ± 0.02 Μg⁄mL) and quinine (0.3 ± 0.1 Μg⁄mL). Similarly, ethanol and methanol-ethanol extracts of roots of E. longifolia Jack showed higher activities than those of the other solvent extracts, but their activities were about 10-fold lower than those of extracts from B. javanica (L.) Merr. fruit. In drug combination tests, B. javanica (L.) Merr. and E. longifolia Jack extracts did not appear to antagonize antiplasmodial activity of chloroquine and quinine. Not only well-known quassinoid glycosides but also coumarins and flavonoids identified by thin-layer chromatography in ethanol and methanol-ethanol extracts and in methanol residue of B. javanica (L.) Merr fruit and E. longifolia roots may be responsible for the antimalarial activity. Taken together, our extraction conditions provided extracts containing novel active compounds that did not antagonize the inhibitory effects of the two widely used antimalarials. This finding could lend support to the future discovery of active antimalaria compounds of Brucea javanica (L.) Merr. and Eurycoma longifolia Jack as drugs for the treatment of malaria that could be employed as drug combinations in order to delay the onset of parasite drug resistance.

The aim of this study was to understand the use of complementary and alternative medicine (CAM) in cancer patients in Japan. This study was part of the Japan Hospice and Palliative care Evaluation 2016 (J-HOPE2016) Study. A multicenter questionnaire survey was conducted on a sample of bereaved family members of cancer patients who died at palliative care units. Data suggest that 54% of cancer patients use CAM. In comparison with a previous study in 2005 in Japan, categories of CAM vary widely; CAM previously included supplements mostly, but now exercise and mind and body therapy are also used. Most cancer patients use CAM without any harmful influence on their household economy and cancer treatment; however, in some patients, CAM incurs a large expense and a delay in starting cancer treatment. Therefore, it is important for medical staff and patients to have an opportunity to discuss CAM use. Multiple logistic regression analysis shows that CAM use is significantly associated with younger patients and highly educated families; moreover, there is a possibility that family members who use CAM have a high level of psychological distress. We must pay attention to the physical and the psychological aspects of cancer patients who use CAM and their families. Further studies are needed to investigate the use of each category of CAM, and to understand patients who use CAM and who die at home or in hospitals other than palliative care units.

BACKGROUND/AIMS: The therapeutic effect of mesalamine is considered to be dose-dependent; however, no consensus has been reached regarding the optimal doses for individual patients. This study aimed to provide new insight for dose optimization using two doses of pH-dependent release mesalamine for induction of remission of moderately active ulcerative colitis (UC). METHODS: In a multicenter, double-blind, randomized study, 110 patients with moderately active UC were assigned to two groups after treatment with a constant dose of mesalamine. Fifty-five patients were treated with a pH-dependent release formulation of 3.6 or 4.8 g/day for 8 weeks. The primary endpoint was a decrease in the UC disease activity index (UCDAI) adjusted by covariates. RESULTS: In the full analysis set (n=110), the mean decrease in UCDAI was 3.1 in the 3.6 g/day group and 3.4 in the 4.8 g/day group (P>0.05). In a subgroup analysis, the effectiveness of the 4.8 g/day dose was greater in particular populations, such as those who had been previously treated with a lower dose of mesalamine and those with more severe disease. The safety was comparable between the two groups. CONCLUSIONS: The results suggest that treatment with pH-dependent release mesalamine at either 3.6 or 4.8 g/day was effective and safe for the induction of remission in patients with moderately active UC. However, the patients receiving mesalamine at 2.4 g/day but in whom the therapeutic effect is not sufficient and having more severe symptoms (UCDAI 9-10), benefit from higher doses of mesalamine compared to others.
Colitis, Ulcerative* ; Consensus ; Double-Blind Method ; Humans ; Mesalamine* ; Remission Induction ; Ulcer*

Surgical results in eight octogenarians who were operated upon for abdominal aortic aneurysms were compared to those of 42 patients under 80 years of age. Seven of eight octogenarians were operated on an emergency basis, and four of them were ruptured aneurysms. The size of the ruptured aneurysms was over 6cm in all cases of both groups. Postoperative complications occurred more frequently and postoperative mortality were significantly higher in octogenarians than in patients under 80. Early surgical intervention is recommended for elderly cases with large abdominal aortic aneurysms.

A 51-year-old woman, who had undergone mitral valve replacement with the Starr-Edwards ball valve 21 years ago, was hospitalized with cardiac failure. Preoperative cineangiograms showed delay of the ball movement during the early diastolic phase. Re-replacement of the mitral prosthetic valve with a CarboMedics prosthetic valve and tricuspid annuloplasty was successfully performed. The postoperative period after the initial implantation of the Starr-Edwards ball valve is the longest among patients reported in Japan. The cause of prosthetic valve insufficiency may have been granulomatous hyperplasia on the valve seat.

A 78-year-old man underwent successful removal of a contaminated pacemaker in a case of methicillin-resistant Staphylococcus aureus (MRSA) septicemia. Septicemia was due to a subcutaneous abscess at the site of old cut electrodes. Following debridement of the infected pacemaker pocket, residual leads and the pacemaker system were removed under cardiopulmonary bypass. Bacterial examination of arterial blood and vegetation attached to the leads showed septicemia caused by MRSA. After the operation, antibiotic therapy with vancomycin, arbekacin and minocycline was performed for several weeks. His postoperative course was uneventful without the recurrence of infection. In cases of pacemaker contamination, with septicemia, total removal of the pacemaker system and adequate antibiotic therapy are necessary.