Hyperlexia and ambient echolalia are rare conditions, and investigations into their clinical course have not been reported in the literature thus far. Here we report the case of a 69-year-old woman with cerebral infarction of the left anterior cingulate cortex and corpus callosum, on whom we performed an echo induction test for studying her long-term hyperlexia and ambient echolalia. Her clinical features included symptoms of complex disorders such as visual groping, compulsive manipulation of tools and callosal disconnection syndrome. The patient did not have dementia or aphasia. Her most outstanding behavioral traits were the hyperlexia and ambient echolalia. We investigated the induction of her hyperlexia and ambient echolalia by subjecting the patient to 10 verbal questions using a background of visual (bookshelves were placed in front of her) and auditory (imitated hospital announcements) stimuli at periods of 1, 2 and 6 months after the stroke. Hyperlexia was induced at 1 and 2 months after stroke, whereas ambient echolalia was only induced at 1 month after stroke. The disappearance of the hyperlexia and ambient echolalia in this case might be due to a reduction in the disinhibition of response to external stimuli caused by damage sustained in the stroke to the left anterior cingulate cortex and corpus callosum.

The practical use of abdominal examination is a major characteristic of Kampo medicine. Although most Kampo medical texts describe an abdominal examination for a Kampo formula, comparative studies between texts have not contributed to any standardized descriptions for such examinations. We investigated descriptions of 147 prescription Kampo extract formulations in Kampo texts written after the Showa Era, and obtained the following results. Abdominal examinations were described differently by authors, even for the same prescription. Additionally, we examined the descriptions for anchusan (安中散) and kososan (香蘇散), which are called the Gosei school formulae (後世方). Descriptions of abdominal examinations for these drugs were not quoted from an original Chinese medical text, but were empirically constituted in Japan. As knowledge was accumulated, these various descriptions were created through limited personal connections, and/or the opinions of particular authorities. We suggest that a consensus on abdominal examinations would further studies on the viability of traditional medicines, and better characterize Kampo medicine.

A 66-year-old man with an unknown medical history developed chest pain and a diagnosis of acute myocardial infarction (AMI) was given by his physician. Percutaneous coronary intervention was performed in the left anterior descending artery. Echocardiography revealed ventricular septal perforation (VSP) ; therefore, the patient was transferred to our hospital. After admission, his platelet count dropped rapidly during heparin administration, and left ventricular thrombosis and deep vein thrombosis were noted, raising a suspicion of heparin-induced thrombocytopenia (HIT). To establish cardiopulmonary bypass, argatroban alone was insufficient to prolong the Powered by Editorial Manager^® and ProduXion Manager^® from the Aries Systems Corporation activated clotting time (ACT) ; thus, nafamostat mesilate was also used for coronary artery bypass grafting and surgical repair of VSP. It took many hours to normalize the ACT, requiring re-exploration for excessive bleeding. On the 37th postoperative day, the patient was transferred to another hospital. We performed cardiac surgical procedures using argatroban in a patient who developed HIT during the course of VSP following AMI ; however, we had difficulty in controlling the ACT. Since, to the best of our knowledge, there are no previous studies reporting surgical case of VSP complicated by HIT, we present this case with a review of the relevant literature.

Purpose: We report a case in which oral sodium valproate through a percutaneous endoscopic gastrostomy (PEG) tube for palliative decompression drainage in inoperable ileus achieved an effective drug concentration and ameliorated delirium and extrapyramidal side effects. Case Report: The patient was a male in his seventies who suffered from bladder cancer. He underwent PEG because of paralytic ileus with cancerous peritonitis. He had been receiving continuous intravenous infusion of haloperidol for the management of delirium, but needed to discontinue treatment with this agent due to tremor, an extrapyramidal side effect of haloperidol. Oral sodium valproate was therefore administered through the PEG tube for palliative decompression drainage. Plasma valproate concentrations showed effective levels, and his irritability was relieved. A good combination of sodium valproate and quetiapine fumarate allowed successful reduction of and eventual withdrawal from haloperidol, and tremor then improved. Conclusion: We often encounter difficulty with symptom control for patients who cannot use oral medications. When medication by other routes is difficult, this case suggests that sodium valproate through a PEG tube for palliative decompression drainage may be useful as a last resort for improving delirium.

Purpose: Pharmacists should play a positive role in palliative care. The pharmacy curriculum should also contain content promoting an appropriate attitude toward death. Hence, this study aims to gather fundamental information that can be used to understand the various death attitudes held by pharmacy students. Methods: We targeted 159 sixth-year students of the School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, in 2011. They studied "Up-to-date-Palliative-Care" (an elective subject). To investigate their overall perception of death, we used the Death Attitude Inventory (DAI), developed by Hirai and others (2000), and investigated their views of death on the basis of seven factors. We also classified students on the basis of type of death they had experienced, that is, the death of a household, relative, friend, or pet. We compared the scores obtained for each factor and conducted a logistic regression analysis. Results and Conclusion: We analyzed the data from 120 students (valid response rate: 75.5%). Students who had experienced the death of friend, had significantly higher scores on "Life Purpose" and "Death Concern" (p<0.05). Students who had experienced the death of household etc., statistical positive correlation with "Death Concern" and statistical negative correlation with "Death Anxiety" were recognized.

An 80-year-old man felt a loss of strength and sharp pain in both lower limbs while playing gate-ball, consulted a nearby doctor, and was followed up. Because the sharp pains in both lower limbs became aggravated the next day, he was given a previously prescribed medication. Both femoral pulses were absent and acute arterial obstruction of the lower limbs was suspected. A contrast-enhanced CT scan showed a thrombosed infrarenal abdominal aortic aneurysm with a maximum transverse diameter of 37 mm, and both external iliac arteries were contrast imaged by collateral circulation pathways. We diagnosed acute thrombosis of an abdominal aortic aneurysm, and was urgently transported to our hospital. We classified his lower limbs as Balas grade III and TASC classification grade IIb and Rutherford classification grade IIb. He exhibited no abdominal symptoms and since we confirmed the blood flow of his lower limbs, we decided to perform revascularization. An extra-anatomical bypass (axillo-bifemoral bypass) was conducted because he had dementia, and was old. After the operation, myonephropathic metabolic syndrome (MNMS) did not develop, and the patient was discharged on foot on the 16th postoperative day. Acute thrombosis of an abdominal aortic aneurysm is a rare disease. Because the ischemic area widens, often causing serious MNMS after the revascularization, it has a poor prognosis. Here, we report a case in which one such patient was rescued.

Effects of three plant extracts (Hordeum vulgare L., Apocynum Venetum L., Brasenia schreberi J.F.G mel.) on human gingival fibroblasts were examined. As a result, we observed the promoting effect of the extract of Hordeum vulgare L. and the extract of Apocynum Venetum L. respectively on FGF2 and FGF7 production. Moreover, the mixture of the three plant extracts showed the effect of improving the changes in type I collagen gene expression and matrix metalloproteinase 1 gene expression by LPS addition. Next, a dentifrice containing the three plant extracts was subjected to human efficacy trials. We measured periodontal pocket depth, attachment level, bleeding on probing and saliva TNFα as an indicator of periodontal disease. The results suggest that the dentifrice formulated with the three plant extracts were effective for the improvement of periodontal disease.

PURPOSE: The purpose of this retrospective study was to determine the effects of resistance training (RT) on myocardial infarction (MI) patients in phase II cardiac rehabilitation (CR) in our hospital.
METHODS: Twenty two outpatients who had participated in the phase II CR program more than three months at least were enrolled in this study. They were divided into control group (n＝8) and RT group (n＝14). We examined changes in the exercise capacity of these two groups. The traditional exercise programs which included aerobics and muscle strength exercise were run on the control group. Changes in exercise load for target heart rate measured with a bicycle ergometer as an indicator of exercise capacity were assessed in each patient 1,3 and 5 months after AMI onset.
RESULTS: The amounts of load and target heart rates recorded 1 month after the onset were not significantly different between the two groups. After 3,5 months of CR, the RT group showed no changes in the target heart rate but significant increase of the amount of load. The control group showed no change in the amount of load and target heart rate. In the amount of each load 3 and 5 months after, the RT group was significantly out did the control group.
CONCLUSIONS: These results suggested that RT was useful in the improvement of exercise capacity for patients with MI who participated in the phase II CR program provided by our hospital.

Purpose: Bone is one of the most common sites of metastases in patients with advanced lung cancer. Skeletal complications may cause significant morbidity and decrease performance status (PS). Such complications, referred to as skeletal related events (SREs), include severe bone pain, pathological fractures, spinal cord compression, and hypercalcemia of malignancy. We assessed the clinical impact of SREs in non-small lung cancer (NSCLC) patients with bone metastases. Methods: We retrospectively investigated the clinical records of all 120 patients who were diagnosed advanced NSCLC with bone metastases between June 1998 and March 2009. Results: A total of 23 patients (26.7%) were found to have SREs at the time of initial diagnosis. The median survival time (MST) was 123 days for patients with SREs, while it increased to 276 days for those without SREs. The MST of the patients with SREs were significantly shorter than that of the patients without SREs (p<0.001). We also studied the SREs during clinical courses of 89 patients whose records were available over 3 months. A total of 39 patients (43.8%) were found to have SREs during clinical courses. Conclusion: The patients in NSCLC with bone metastases were often found to have SREs. SREs cause significant morbidity and deterioration of PS. Systemic chemotherapy could not decrease SREs during their clinical courses. Further studies evaluating bisphosphonates in combination with chemotherapy are warranted. Palliat Care Res 2010; 5(2): 145-151