Most studies with conventional ECG lead system have emphasized the reduction of electrical forces of the heart under physical exercise. However, there have been few systematic vectorcardiographic observations in the graded exercise. This study represents vectorcardiographic and cardiodynamic analyses in exercise by a bicycle ergometer performed on 51 subjects comprising 18 normal controls, 10 normal seniles, 7 hypertensives and 16 patients with ischemic heart disease. Vectorcardiogram with Frank orthogonal lead system was recorded before and after each exercise trial and X-Z component electrocardiogrms were monitored throughout whole procedure. Electrical systole, isometric and isotonic contraction periods during exercise were evaluated by simultaneous recordings of ECG with Nehb-D, PCG and externally recorded carotid artery pulse wave.
As a control, graded interrupted exercise with the doses of 50, 75 and 100 watts for 6 minutes were given to 12 normal subjects. saQRS showed parallel increase in the magnitudes to increased exercise doses and directed to the right anterior and superior octant. Spatial angles between saQRS and saT represented by delta' showed gradual increase on each step of the graded exercise.
A single exercise dose of 1.0/kg given to other subjects including normal seniles, hypertensives and patients with ischemic heart disease. Vectorcardiographic changes in normal seniles over 60 years of age were essentially same to normal control subjects. In the group with ischemic heart disease, there were two different types of VCG changes. In one, abnormally small saT and sVG were characteristically increased after the exerise. In the other with almost normal saT and sVG, changes in VCG were similar to the control.
Cardiac dynamics during exercise revealed decreased isometric and isotonic contraction periods and increased ATZ/ASZ ratio in each group. No characteristic cardiodynamic changes were observed in normal seniles or patients with ischemic heart disease.

Purpose: Patients who receive chemotherapy for colorectal cancer with the prophylactic dexamethasone (DEX) for antiemesis may experience an abnormal elevation in their casual blood glucose levels. The purpose of this study was to determine the frequency of such a DEX-induced elevation in patients with metastatic colorectal cancer, and to emphasize the importance of pharmaceutical care in improving the quality of life of patients. Methods: We retrospectively analyzed data from 50 patients who had received chemotherapy with or without DEX. Results: Of the 30 patients who received DEX, 8 exhibited abnormally high blood glucose levels (>200 mg/dl on more than 2 occasions); 3 of these patients also had diabetes mellitus. None of the 20 patients who did not receive DEX exhibited a remarkable elevation in the blood glucose levels. Conclusions: We confirm that patients receiving concomitant administration of DEX with chemotherapy may exhibit elevated blood glucose levels. Because an increase in the blood glucose levels may produce symptoms indicative of diabetes such as fatigue, appropriate pharmaceutical care for early detection of the abnormal elevation in the blood glucose levels may be important in preventing complications in such patients.

Objectives: This study evaluates the relationship between the various words expressing pain and the efficacy of opioid analgesics, in order to provide information on the appropriate selection of analgesic drugs for cancer pain relief. A new and simplified evaluation list for the assessment of pain, including the common words used to express pain, was developed accordingly. Methods: The words expressing pain were classified into three categories based on the Guidelines for Drug Therapy in Cancer Pain. These words were grouped into clusters according to the efficacy of opioid drugs, as expressed by the patients. On the basis of these results, an evaluation list was developed, and its validity was assessed by clinical pharmacists and cancer patients experiencing pain. Results: On the basis of the classification of the words, their relationship with opioid efficacy was summarized, and the results of the cluster analysis were found to be helpful for the development of a new pain evaluation list. Conclusion: Patients use various words to express their pain. By classifying and clustering these words according to the guidelines and the efficacy of opioid drugs, we proposed a practical pain evaluation list for appropriate selection of analgesic drugs in patients with cancer.

  In order to intervene in the management of pain of cancer from an early stage. Our palliative care team (PCT), including pharmacists, makes the ward rounds (screening rounds) of the patients receiving opioids at our hospital. The purpose of this study was to analyze the effects of screening rounds activity by the PCT and its current problems, and to explore how to resolve the problems. We retrospectively studied the records of 196 patients who had receivede interventions by the PCT, with regard to intervention status and prescription proposal (228 subjects) about drug therapy by us. Study groups were as follows: 103 patients to whom interventions were deliveed at the request of medical doctors (intervention request group) and 93 patients who had interventions by the PCT after PCT-screening rounds (screening group). PCT-screening rounds caused to increase the number of interventions by the PCT. After PCT-screening rounds, the cases of intervention started by the request of medical doctors, who had given no heed to PCT intervention, also increased in numher. In this study, some problems with palliative intervention were also brought to light. Even in the screening group where the PCT largely intervened, 33% of prescription proposal by the PCT was ignored. This problem may be, at least in part, due to inadequate communication between PCT and ward staff through an electronic medical recording card, leading to poor relationship between PCT and ward staff. In the future, the PCT needs to work cooperatively with ward staff through direct communication such as medical conference to perform better intervention.

A 7-year-old boy suffered from isolated interruption of the aortic arch without any other complications or cardiovascular malformations. Cardiac murmur, which had been apparent since one month of age, had been left untreated because of the absence of any symptoms of heart failure. Isolated interruption of the aortic arch was noted during a routine physical examination at school and the patient was referred to our hospital for a complete medical evaluation. Blood-pressure difference was recognized not only between the right side and the left side of the upper extremities but also between the upper and lower extremities. On the basis of the results obtained via magnetic resonance angiography (MRA) and aortography, a definitive diagnosis of isolated interruption of the aortic arch was made. Reconstruction of the aortic arch by synthetic implant was indicated. The blood-pressure difference disappeared and the postoperative course was satisfactory.

A 57-year-old man underwent subtotal graft replacement of the thoracic aorta for aneurysms of both the ascending and descending aorta. On the 20th post-operative day, pus was found to be draining from the sternotomy wound. The wound was opened and irrigated with 2% Povidoneiodine solution for a total of 3 months. Culture of the pus from the irrigation revealed Staphylococcus epidermidis. When there were no clinical indications of infection and wound cultures were negative, the necrotic sternum and surrounding tissue were debrided and an omental graft was placed in the cavity. Upon follow-up examination, the patient is doing well 10 months after the initial surgery.

We performed a video-assisted thoracoscopic surgery (VATS) to clip the patent ductus arteriosus (PDA), which was 5mm in internal diameter, in an 11-year-old girl, who first underwent a coil embolization ending in failure. Under general anesthesia with one-lung ventilation in a right lateral decubitus position, four thoracostomies were made in the left hemithorax. The PDA was clipped by two titanium clips, the length of which is 11mm at closing. Transesophageal echocardiography confirmed the location of the PDA and the absence of a residual shunt. The patient showed neither left recurrent laryngeal nerve dysfunction nor hemorrhage after operation, and was discharged on the 9th postoperative day. The clipping of the PDA by VATS can be applied for PDA without calcification if the external diameter is up to 7mm. This technique was minimally invasive and reliable. It was excellent in terms of the high quality of life achieved by the patient.

Malignant hyperthermia (MH) and antithrombin III (AT III) deficiency are both rare, but once they occur, the patient's prognosis is very poor. A 67-year-old man was referred to our hospital with a diagnosis of unstable angina. A coronary angiography revealed stenosis of LMT and triple vessels. The patient was considered a candidate for CABG. He had been prescribed 50mg/day of dantrolene for frequent muscular convulsions of the lower extremities. He had had a high CK level for a few years. Therefore he was considered to be at high risk for malignant hyperthermia (MH). He underwent CABG (×4). Dantrolene was administered orally at a dose of 25mg and then 160mg intravenously before anesthesia and modified NLA was performed in order to avoid probable MH. During the operation, AT III deficiency was suspected because the reaction of ACT after heparinization was poor. AT III preparation (1, 500 units) was used and CABG under cardiopulmonary bypass was completed without any events. It was proved after the surgery that the AT III volume had been almost normal but its activity had decreased. His postoperative course was good. For possibly fatal MH and AT III deficiency, it is necessary and important to predict, prevent and diagnose as early as possible.

There have been many reports radial artery grafts (RA) are useful in CABG, but there were very few reports about hand grasping power (GP), edema and sensory disturbance after surgery. From January to April, 1999, RA were used for 14 patients (R group) and were not in 16 patients (C group) among a total of 30 coronary artery bypass grafting procedures. The patients in the two groups were statistically similar. RA were anastomosed to #12 in 9 patients and #14 in 5. GP and the circumference of forearms were examined and sensory disturbance was also checked preoperatively and at 1, 2 and 4 weeks postoperatively. In both groups, left GP decreased slightly after surgery but gradually recovered. Four weeks after surgery, it was 26.2±9.6kg in the R group and 26.2±7.5kg in the C group (NS). The difference between left and right circumference of forearms, which indicates the degree of edema, was significantly larger in the R group than in the C group (3.5±3.6mm vs. -0.5±3.8mm, 1 week postoperatively, p<0.05). However, it gradually improved in the R group (2.1±2.6mm at 2 weeks and 1.9±2.6mm at 4 weeks postoperatively). No sensory disturbance was seen at any time. Therefore we conclude that using RA in CABG is not only useful but is also safe and does not increase postoperative risk.

Excellent outcomes were achieved with spinal cord stimulation (SCS) for 7 to 10 days on 2 patients who developed postherpetic neuralgia. Both patients were within 2 to 3 months of the onset of the condition, and nerve blocks provided only temporary pain relief and drug therapies had poor efficacy. The authors believe that limited-duration SCS for subacute postherpetic neuralgia is a useful treatment approach that may prevent the pain from progressing to chronic postherpetic neuralgia.
Aged ; Electric Stimulation Therapy ; methods ; Female ; Herpes Zoster ; complications ; Humans ; Neuralgia, Postherpetic ; etiology ; physiopathology ; therapy ; Outcome Assessment (Health Care) ; Pain, Intractable ; therapy ; Spinal Cord ; physiology