Echocardiography was performed in two gruops of patients with impaired renal function excluding those with diabetic renal failure. Group A was comprised of 19 patients who had recieved hemodialysis from 1 year to 5 years, and Group B, of 32 patients who had been undergoing hemodialysis for more than 10 years. Significant reductions in left ventricular diastolic dimensions and cardiac output were found in Group B. In these two groups, there were no statistically significant differences in left ventricular wall thickness and left ventricular ejection fraction. Left ventricular diastolic function was assessd by the ratio of the peak atrial velosity (A) to early diastolic velosity (E). 15 patients (83%) in Group A and 19 patients (76%) in Group B had left ventricular diastolic dysfunction. A high incidence of left ventricular diastolic dysfunction was revealed. Moreover, dilated and hypertrophic cardiomyopathy like patterns were observed in both groups. In Group B, significantly increased left ventricular wall thickness in patients with hypertension and reduced left ventricular systolic function in patients with dialysis hypotension were found.

Two months ago, a 9-year-old boy experienced intermittent abdominal pain regardless of food intake, without diarrhea, bloody stool, or nausea. Blood test results revealed a peripheral blood eosinophil count of 660 cells /µL, which was marginally elevated, without inflammatory reaction, occult blood, or enteric pathogens. The intestinal mucosa from the terminal ileum to the rectum was endoscopically normal, but mucosal biopsy revealed eosinophilic infiltration of the terminal ileum and whole colon with ≥20 eosinophils/high power field (HPF). Subsequent upper gastrointestinal endoscopy revealed normal endoscopic mucosa from the esophagus to the second part of the duodenum, but mucosal biopsy showed an eosinophil infiltration of ≥20 eosinophils/HPF. Based on the above findings, he was diagnosed with eosinophilic gastroenteritis (EGE). The cause of EGE and mechanisms of eosinophil infiltration have yet to be fully elucidated. For these nonspecific abdominal symptoms, evidence of eosinophilic infiltration of the gastrointestinal mucosa, specifically 20 eosinophils/HPF in each intestinal mucosa, is required for the definitive diagnosis of EGE. Even if only persistent abdominal pain develops, EGE diagnosis should be confirmed with the analysis of mucosal biopsy in addition to the review of allergic disease history and peripheral blood eosinophil counts.

Pyogenic liver abscess in patients with malignant disease is a fatal state and is easily diagnosed. We presented a rare case of sudden fatal septicemia following anticancer treatment for recurred gastric cancer due to multiple liver abscesses which could not be diagnosed. A 72-year-old male with recurred gastric cancer received anticancer agents. He had a history of distal gastrectomy with right hepatic lobectomy for hepatic metastasis. He received anticancer treatment in the outpatient's service center periodically, and his performance status was preserved with nothing in particular. After administrating docetaxel, he suddenly developed septicemia and multiple organ failure and died 5 days after strong medical supports. Pathological autopsy revealed that multiple minute abscesses of the liver which could not be detected macroscopically were the causes of fatal septicemia. The etiology, therapies and prognosis of rare entity are being discussed.
Abscess ; Antineoplastic Agents ; Autopsy ; Gastrectomy ; Hepatectomy ; Humans ; Liver ; Liver Abscess ; Liver Abscess, Pyogenic ; Male ; Multiple Organ Failure ; Neoplasm Metastasis ; Prognosis ; Sepsis ; Stomach Neoplasms ; Taxoids

A 78-year-old man was diagnosed with adult T-cell leukemia/lymphoma (ATL) and was started on standard chemotherapy 1 year earlier. However, treatment was discontinued because of adverse drug reactions and worsening delirium. Thereafter, he remained stable and was followed up while receiving etoposide. He then visited our hospital because of acute abdominal pain and underwent surgery with a diagnosis of gastrointestinal perforation. Intraoperative observation showed a reddened, concentric wall thickening measuring 4 cm and a perforation site in the ileum, and thus partial resection of the small bowel was performed. The histological diagnosis was small bowel perforation due to tumor cell invasion. Two months postoperatively, he started a less intensive chemotherapy regimen along with palliative care, and died due to the primary disease approximately 5 months postoperatively. ATL involves systemic organs because of its high organ-affinity. Once it involves the gastrointestinal tract, various gastrointestinal symptoms can occur. Patients with ATL are at risk of developing gastrointestinal perforation at any time during the clinical course. Therefore, clinicians should be aware that once gastrointestinal perforation develops, the prognosis becomes extremely poor. Assessment of the disease state, early detection of gastrointestinal lesions, and prevention of opportunistic infections appear to be important in the management of patients with ATL.

The importance of promoting self-medication is increasing, and the active participation of pharmacies is required to support this. We developed a training program based on the Attention, Relevance, Confidence, and Satisfaction (ARCS) model, which is a motivational design process to train pharmacists who support the proper use of OTC drugs, and for insurance pharmacists who usually perform dispensing work. In the six months of training, we conducted six sessions for insurance pharmacists on the subject of colds and constipation. In addition to conducting lectures and exercises on OTC drugs, we provided pharmacists with an opportunity to practice the training content during their daily work, and discuss solutions to the problems that they encountered. Of the eight participants who attended all workshops and were part of the final evaluation, seven provided OTC drugs after considering whether it was necessary to provide them. A total of six advised patients who came to the pharmacy to have their prescription medications dispensed that there were OTC medications that they should be careful about taking. These results suggest the usefulness of this training program based on the ARCS motivational design model.

A fungal carotid aneurysm is an infrequently occurring infectious aneurysm that is usually treated by antifungal therapy plus surgical debridement of the infected vessel. We herein report an extremely rare case involving a patient with a medical history of bladder cancer treated by Bacillus Calmette– Guérin (BCG) who developed a fungal aneurysm of the internal carotid artery and thrombosis of the superior ophthalmic vein caused by maxillary Aspergillus sinusitis. The patient was successfully treated by antifungal, anticoagulant, and antiplatelet drugs combined with internal carotid artery ligation therapy. Internal carotid artery fungal aneurysm is associated with a high mortality rate, but the present case suggests that it can be successfully treated by antifungal therapy combined with a less invasive endovascular therapy.