A 59-year-old man was referred to our department for the treatment of cellulitis and skin necrosis after a bruise of the left lower leg. He had suffered from intermittent claudication of the left calf for a year and arterial pulses in the left lower limb were absent. Arteriogram showed hypoplasty of the left external iliac artery and aplasty of the left superficial femoral artery. A persistent sciatic artery was noted to be the dominant blood supply to the left lower extremity. Left ilio-popliteal artery bypass using 6mm ringed ePTFE graft was performed. After arterial reconstruction, skin transplantation was performed and the intermittent claudication disappeared completely.

A hypothetical community of one million people where birth rate and death rate are equal was applied to the modified deferential equations Lipsitch and Nowak published in 1995 in order to examine the impact of partner acquisition change on the HIV epidemic over a relatively short term. The results showed that if the partner exchange rate increases from two to three per year in the population, the epidemic caused by a more virulent strain would overweigh that caused by a less virulent strain within a century. This result reveals that an increase in the rate of partner acquisition gives the more virulent strain an advantage in terms of propagating the virus in a given population, at least over a relatively short term of several decades. The partner acquisition rate also exerts an influence on the magnitude of the HIV epidemic and the time it needs to reach a peak in the hypothetical community.
These results indicate that increased sexual contact may be even more important than expected and thus shed a new light on the present HIV epidemic.

An 81-year-old patient, who had a postinfarction left ventricular aneurysm with thrombus underwent left ventricular aneurysmectomy with right coronary artery bypass grafting (CABG). Preoperative examination showed 99% stenosis of the left coronary artery (#7) and 90% stenosis of the right coronary artery (#3). The operation was performed because angina was not improved and formation of thrombus was suspected on the wall of the aneurysm. The operation was performed under cardiopulmonary bypass and by antegrade and continuous retrograde cardioplegia. The aneurysm was resected and a relatively fresh thrombus which was detected on the endocardium of the aneurysm was extracted. The left ventricle was closed by direct linear suture with felt reinforcement. Because the area of resection included part of the left anterior descending artery, only right CABG (#3) with a saphenous vein was done. Weaning from bypass was very easy and the postoperative course was uneventful.

Using the DDG-2001 pulse dye densitometer, cardiac output (CO) and circulating blood volume (BV) were determined before and after the operation, and its accuracy and the significance of postoperative management were studied. Referring to 14 cases undergoing open heart surgery, CO and BV were determined using the DDG-2001 before application of the cardiopulmonary bypass and immediately, 4h and 12h after the operation. The level of CO was compared with that determined by the thermodilution method, and the level of BV with that calculated from hemoglobin levels determined before and after the cardiopulmonary bypass application and the priming volume in the circuit. Further, body fluid balance after the operation was calculated, and its relation to BV was studied. As to the correlation coefficient and inclination of the regression line, they were 0.77 and 0.849 with CO, and 0.821 and 0.844 with BV, respectively. Upon completion of the operation BV decreased, but increased again 4h and 12h later, although the body fluid balance was negative. CO and BV determined by the pulse dye densitometry favorably correlated with those determined by other methods. Immediately after the operation BV decreased, but then increased in the course of time, although the body fluid balance was negative.

Aneurysms of the inferior left ventricular wall comprise only a small fraction of all aneurysms that have been reported in surgical series. Pseudo-false ventricular aneurysm is very rare and communicates with the left ventricule through a small orifice, and its wall contains myocardial tissue, unlike false ventricular aneurysm. A 53-year-old man was admitted to our hospital with chest pain. Echocardiography revealed left ventricular aneurysm, and the coronary arteriography subsequently revealed a complete occlusion of right coronary #2 and 75% and 90% stenosis of left anterior descending artery #7 and #8, respectively. Left ventriculography revealed an aneurysm of the inferior left ventricular wall, which communicated with the left ventricle through a small orifice and exhibited contraction. Surgical repair was indicated. Endoventricular circular patch repair (Dor operation) of the aneurysm of the inferior left ventricular wall and coronary artery bypass grafting to the left anterior descending artery and the right coronary artery were simultaneously performed under cardiopulmonary bypass with moderate hypothermia. The postoperative course was uneventful and the patient was discharged on the 22th day after surgery. Pseudo-false ventricular aneurysm of the inferior left ventricular wall was diagnosed by pathologic examination.

The use of illicit drugs among young people is a growing social problem in Japan. All healthcare professionals are expected to play a role in preventing drug abuse; thus, it is important to give lectures to paramedical students not only to acquire accurate knowledge about illicit drugs but also to promote their self-awareness as future health care workers. To evaluate effective education for drug abuse prevention, we conducted an awareness survey of students in the Faculty of Pharmaceutical Sciences, Kyushu University and the College of Healthcare Management, Fukuoka. Over 90% of students were affected by drug abuse resistance education in elementary, junior high, and high schools. According to this, most of the students tended to have an understanding of health hazards such as central nervous system toxicity. A normative consciousness of avoiding drug usage was high but in response to dealing with friends involved in drug abuse, 14.5% of students answered “it depends on their decision” and 9.1% answered “no idea.” The reasons for drug abuse given included easy availability (63.6%), fear of exclusion from the group (60.0%), and escaping distress (41.8%). The nature of this problem in young people might be attributed to their relationship with family or friends. In this survey, we obtained information regarding knowledge and awareness of drug abuse among paramedical students. We think that it is necessary to focus the education on understanding of factors leading to the use of illicit drugs, such as psychological problems, rather than their harmful effects on health.

The publisher wishes to apologize for the incorrectly inputted arrow in the figure.

BACKGROUND/AIMS: Poor suction ability through a narrow working channel prolongs esophagogastroduodenoscopy (EGD). The aim of this study was to evaluate suction with a new ultrathin endoscope (EG-580NW2; Fujifilm Corp.) having a 2.4-mm working channel in clinical practice. METHODS: To evaluate in vitro suction, 200 mL water was suctioned and the suction time was measured. The clinical data of 117 patients who underwent EGD were retrospectively reviewed on the basis of recorded video, and the suction time was measured by using a stopwatch. RESULTS: In vitro, the suction time with the EG-580NW2 endoscope was significantly shorter than that with the use of an ultrathin endoscope with a 2.0-mm working channel (EG-580NW; mean +/- standard deviation, 22.7+/-1.1 seconds vs. 34.7+/-2.2 seconds; p<0.001). We analyzed the total time and the suction time for routine EGD in 117 patients (50 in the EG-580NW2 group and 67 in the EG-580NW group). In the EG-580NW2 group, the total time for EGD was significantly shorter than that in the EG-580NW group (275.3+/-42.0 seconds vs. 300.6+/-46.5 seconds, p=0.003). In the EG-580NW2 group, the suction time was significantly shorter than that in the EG-580NW group (19.2+/-7.6 seconds vs. 38.0+/-15.9 seconds, p<0.001). CONCLUSIONS: An ultrathin endoscope with a 2.4-mm working channel considerably shortens the routine EGD time by shortening the suction time, in comparison with an endoscope with a 2.0-mm working channel.
Diagnosis ; Early Detection of Cancer ; Endoscopes* ; Endoscopy, Digestive System* ; Humans ; Retrospective Studies ; Suction* ; Water

Objectives: We developed versions 2 and 3 of the Biological Prognostic Score (BPS) for advanced cancer patients and confirmed the prediction accuracy. Methods: We conducted a parametric survival analysis using blood test data, performance status (PS), clinical symptoms, age, sex, and cancer type as variables for advanced cancer patients who completed or suspended cancer treatment, in the development of BPS2 and BPS3. We then prospectively compared the accuracy between BPS2/BPS3 and the Palliative Prognostic Index (PPI). Results: We developed the BPS2 and BPS3 based on the data from 589 patients in a development cohort. While the former version was calculated based on the cholinesterase, blood urea nitrogen, and white blood cell counts, the latter was calculated based on the BPS2, ECOG PS and edema. For 206 patients in a validation cohort, the overall accuracy in prediction of survival for 3 and 6 weeks using the BPS2 and BPS3 were significantly higher than those for the PPI. Conclusion: The usefulness of BPS2 and BPS3 was suggested.