This case report describes a 20-year-old man, who was a drug abuser, and was treated surgically for tricuspid valve endocarditis. He presented with fever, caused by tricuspid valve endocarditis with a lung abscess. Blood culture detected Staphylococcus aureus and cardiac ultrasonography showed tricuspid insufficiency and tricuspid valve vegetation. He was treated with intravenous antibacterial agents, but the inflammation signs did not improve. He had a large number of puncture scars, as a consequence of self-injection of drugs in his lower arm. He underwent tricuspid valve plasty, and recovered successfully. He was discharged 2 weeks after surgery, and we instructed him to return for follow-up examination in our hospital. However, he did not return to our hospital because he was arrested for drug possession. In such cases, it is necessary to consider the operative method relative to reuse of drugs in the postoperative management of medication.

We report two cases of pseudoaneurysms occurring at the anastomotic sites that had to be repaired several times after the original Bentall and Cabrol procedure. Case 1. A 62-year-old man had surgery to repair pseudoaneurysms at the anastomotic sites of the distal ascending aorta and right coronary artery 22 years after undergoing the original Bentall procedure. The anastomosis of the left coronary artery was normal at the time of the operation ; however, he was given a diagnosis of a pseudoaneurysm at the anastomotic site of the left coronary artery 2 years after the operation. Case 2. A 61-year-old man with Marfan syndrome underwent surgery twice to repair pseudoaneurysms at the anastomotic sites of the aortic annulus and the left coronary artery 2 and 11 years, respectively, after the original Cabrol procedure. In addition, 23 years after the Cabrol procedure, he was given a diagnosis of a pseudoaneurysm at the anastomotic site of the distal ascending aorta. Their pseudoaneurysms were successfully treated by the reanastomosis of new grafts. Computed tomography detected no recurrence of the pseudoaneurysm in the follow-up period. However, continual close observation for the recurrence of a pseudoaneurysm in the remaining anastomotic sites is necessary.

OBJECTIVE: In the present study, we evaluated changes in CA-125 cut-off values predictive of complete interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) using receiver operating characteristic (ROC) analysis. METHODS: This retrospective single-institution study included patients with International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer and a pre-NAC serum CA-125 level of greater than 40 U/mL who were treated with neoadjuvant platinum-based chemotherapy followed by IDS between 1994 and 2009. Logistic regression analysis was used to evaluate univariate and independent multivariate associations with the effect of clinical, pathological, and CA-125 parameters on complete IDS, and ROC analysis was used to determine potential cut-off values of CA-125 for prediction of the possibility of complete IDS. RESULTS: Seventy-five patients were identified. Complete IDS was achieved in 46 (61.3%) patients and non-complete IDS was observed 29 (38.7%). Median pre-NAC CA-125 level was 639 U/mL (range, 57 to 6,539 U/mL) in the complete IDS group and 1,427 U/mL (range, 45 to 10,989 U/mL) in the non-complete IDS group. Median pre-IDS CA-125 level was 15 U/mL (range, 2 to 60 U/mL) in the complete IDS group and 53 U/mL (range, 5 to 980 U/mL) in the non-complete IDS group (p<0.001). Multivariate analyses performed with complete IDS as the endpoint revealed only pre-IDS CA-125 as an independent predictor. The odds ratio of non-complete IDS was 10.861 when the pre-IDS CA-125 level was greater than 20 U/mL. CONCLUSION: The present data suggest that in the setting of IDS after platinum-based NAC for advanced ovarian cancer, a pre-IDS CA-125 level less than 20 U/mL is an independent predictor of complete IDS.
Gynecology ; Humans ; Logistic Models ; Multivariate Analysis ; Neoplasms, Glandular and Epithelial ; Obstetrics ; Odds Ratio ; Ovarian Neoplasms ; Retrospective Studies ; ROC Curve

Purpose: To clarify the family-perceived usefulness of a pamphlet for families of imminently dying patients. Methods: Physicians and/or nurses provided medical and practical information about the dying process using a pamphlet for families of imminently dying patients. We surveyed family members 6 months after the death of the patient about the perceived usefulness. Results: We sent out a questionnaire to 325 bereaved, and obtained an answer from 260 (response rate: 85%). Overall, 81% reported the pamphlet to be “very useful” or “useful”. The experience reported by the bereaved included: “Helped me to understand the dying process” (84%); “Helped me to understand how symptoms and changes occur” (76%), “Useful in preparation for patient's death“ (75%), “Helped me to understand the physical conditions of the patient” (75%), “Helped me to know what I can do for the patient” (74%). Conclusion: “A pamphlet for families of imminently dying patients” may be useful for members of an imminently dying patient's family.

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

Purpose: Twenty five years have passed since the first national survey on erectile dysfunction (ED) in Japan. The Japanese Society for Sexual Medicine conducted a nationwide survey on the actual status of sexual function targeting men over 20 years old in Japan using validated questionnaires commonly used in clinical practice. Materials and Methods: Japanese men aged 20 to 79 years participated in our online epidemiological study on sexual dysfunction. Erectile status was assessed by direct questioning and specific questionnaires. Risk factors and frequencies of sexual intercourse, masturbation, nocturnal erections, and feeling sexual desire were assessed. The prevalence of these risk factors was compared between men with and without ED. Prevalence and frequencies were calculated for each 5-year age group. Main outcomes were the prevalence and number of patients with ED and simultaneous evaluation of age-related variations. Results: Direct questioning of the men revealed that 13.0% felt troubled by ED. Although 81.0% of them had at least some ED symptoms based on a Sexual Health Inventory For Men score of ≤21, the prevalence of men with ED by Erection Hardness Score (EHS), the most appropriate questionnaire for Japanese with low sexual activity, was 30.9%, indicating that 14,012,596 men have ED. Most risk factors were related with ED, whereas frequencies of sexual intercourse, masturbation, nocturnal erections, and feeling sexual desire were affected by aging. However, the low frequency of these factors in the young generation was surprising. Conclusions The EHS-based assessment revealed a prevalence of ED of 30.9%, which affected approximately 14 million men, and that the sexual desire, erection stiffness, orgasms, and satisfaction were lower than expected in young Japanese men, especially those aged 20 to 24 years, although those factors tended to worsen with aging. We believe that these findings actually reveal the current sexual status of men in Japan.

Purpose: Twenty five years have passed since the first national survey on erectile dysfunction (ED) in Japan. The Japanese Society for Sexual Medicine conducted a nationwide survey on the actual status of sexual function targeting men over 20 years old in Japan using validated questionnaires commonly used in clinical practice. Materials and Methods: Japanese men aged 20 to 79 years participated in our online epidemiological study on sexual dysfunction. Erectile status was assessed by direct questioning and specific questionnaires. Risk factors and frequencies of sexual intercourse, masturbation, nocturnal erections, and feeling sexual desire were assessed. The prevalence of these risk factors was compared between men with and without ED. Prevalence and frequencies were calculated for each 5-year age group. Main outcomes were the prevalence and number of patients with ED and simultaneous evaluation of age-related variations. Results: Direct questioning of the men revealed that 13.0% felt troubled by ED. Although 81.0% of them had at least some ED symptoms based on a Sexual Health Inventory For Men score of ≤21, the prevalence of men with ED by Erection Hardness Score (EHS), the most appropriate questionnaire for Japanese with low sexual activity, was 30.9%, indicating that 14,012,596 men have ED. Most risk factors were related with ED, whereas frequencies of sexual intercourse, masturbation, nocturnal erections, and feeling sexual desire were affected by aging. However, the low frequency of these factors in the young generation was surprising. Conclusions The EHS-based assessment revealed a prevalence of ED of 30.9%, which affected approximately 14 million men, and that the sexual desire, erection stiffness, orgasms, and satisfaction were lower than expected in young Japanese men, especially those aged 20 to 24 years, although those factors tended to worsen with aging. We believe that these findings actually reveal the current sexual status of men in Japan.

Purpose: Twenty five years have passed since the first national survey on erectile dysfunction (ED) in Japan. The Japanese Society for Sexual Medicine conducted a nationwide survey on the actual status of sexual function targeting men over 20 years old in Japan using validated questionnaires commonly used in clinical practice. Materials and Methods: Japanese men aged 20 to 79 years participated in our online epidemiological study on sexual dysfunction. Erectile status was assessed by direct questioning and specific questionnaires. Risk factors and frequencies of sexual intercourse, masturbation, nocturnal erections, and feeling sexual desire were assessed. The prevalence of these risk factors was compared between men with and without ED. Prevalence and frequencies were calculated for each 5-year age group. Main outcomes were the prevalence and number of patients with ED and simultaneous evaluation of age-related variations. Results: Direct questioning of the men revealed that 13.0% felt troubled by ED. Although 81.0% of them had at least some ED symptoms based on a Sexual Health Inventory For Men score of ≤21, the prevalence of men with ED by Erection Hardness Score (EHS), the most appropriate questionnaire for Japanese with low sexual activity, was 30.9%, indicating that 14,012,596 men have ED. Most risk factors were related with ED, whereas frequencies of sexual intercourse, masturbation, nocturnal erections, and feeling sexual desire were affected by aging. However, the low frequency of these factors in the young generation was surprising. Conclusions The EHS-based assessment revealed a prevalence of ED of 30.9%, which affected approximately 14 million men, and that the sexual desire, erection stiffness, orgasms, and satisfaction were lower than expected in young Japanese men, especially those aged 20 to 24 years, although those factors tended to worsen with aging. We believe that these findings actually reveal the current sexual status of men in Japan.