When coronary artery bypass grafting (CABG) is to be done, we use the internal thoracic artery (ITA) as a graft conduit in order to obtain longer patency. When the ITA acts as a good collateral to the lower extremities, blood flow to the extremities may decrease after CABG with ITA. Simultaneous open heart surgery and laparotomy may cause pulmonary complication. We made an algorithm of treatment for patients with coronary artery disease (CAD) and aortoiliac occlusive disease including these problems. From July 1991 to March 1992, 6 patients were operated and reviewed. Four patients were operated on for CAD and AIOD simultaneously. Two patients were operated on for CAD or AIOD at first and for the other secondarily. All 6 cases were discharged without any complications and are now free from angina and intermittent claudication. When the therapeutic plan for the patients with CAD and AIOD is made, it is very important that coronary revascularization is planned at first with careful evaluation of the blood flow to the lower extremities in cases with AIOD.

PURPOSE: Comatose elderly patients with acute neurological illness have a great risk of deep vein thrombosis (DVT). In this study, the incidence of DVT and the effectiveness of early initiation of treatment were evaluated in those patients. MATERIALS AND METHODS: Total 323 patients were admitted to our ward due to neurological diseases in one year, and 43 patients, whose Glasgow Coma Scale was < or =11 and who was older than > or =60 years, were included in this study. D-dimer was measured on admission and day 7, and lower-extremity ultrasonography was performed on day 7. When DVT was positive, heparin treatment was initiated, and further evaluation of pulmonary embolism (PE) was conducted. Vena cava filter protection was inserted in PE-positive patients. Incidence of DVT and PE, alteration of D-dimer value, and effect of heparin treatment were analyzed. RESULTS: DVT was positive in 19 (44.2%) patients, and PE was in 4 (9.3%). D-dimer was significantly higher in DVT-positive group on day 7 (p<0.01). No DVT were identified in patients with ischemic disease, while 66.7% of intracerebral hemorrhage and 53.3% of brain contusion patients were DVT positive. Surgery was a definite risk factor for DVT, with an odds ratio of 5.25. DVT and PE disappeared by treatment in all cases, and no patients were succumbed to the thrombosis. CONCLUSION: Patients with hemorrhagic diseases or who undergo operation possess high risk of DVT, and initiation of heparin treatment in 7 days after admission is an effective prophylaxis for DVT in comatose elderly patients without causing bleeding.
Acute Disease ; Aged ; Anticoagulants/adverse effects/therapeutic use ; Antifibrinolytic Agents/therapeutic use ; *Coma ; Female ; Fibrin Fibrinogen Degradation Products/therapeutic use ; Hemorrhage/*epidemiology ; Heparin/adverse effects/therapeutic use ; Humans ; Incidence ; Japan/epidemiology ; Lower Extremity ; Male ; Middle Aged ; Nervous System Diseases/epidemiology ; Neurosurgical Procedures/*adverse effects ; Pulmonary Embolism/*complications/epidemiology/prevention & control ; Risk Factors ; Venous Thrombosis/epidemiology/*etiology/prevention & control

The median time of brain metastasis from the diagnosis of breast cancer is approximately 3 years. In this case report, a 69-year-old woman demonstrated cerebellar ataxia. Brain magnetic resonance imaging revealed enhanced lesions in bilateral cerebellar hemispheres. She had undergone surgery, radiation, and chemotherapy for uterine and breast cancer 24 years prior and 16 years prior, respectively. Although she had not received any anticancer treatment for 10 years, no recurrences were identified using whole body scans. A partial tumor resection was performed and the histological diagnosis was an adenocarcinoma from breast cancer. As no extracranial lesions were found, gamma-knife irradiation was performed, without additional systemic chemotherapy. One month posttreatment, the tumors dramatically reduced in size and the patient completely recovered from cerebellar ataxia. Systemic chemotherapy is not always required for brain metastasis from breast cancer with a long interval period, as long as no evidence of extracranial recurrence is detected.
Adenocarcinoma ; Aged ; Brain* ; Breast Neoplasms* ; Breast* ; Cerebellar Ataxia ; Diagnosis ; Drug Therapy ; Female ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Neoplasm Recurrence, Local ; Prognosis ; Recurrence* ; Whole Body Imaging

The shortage of physicians in Japan has been a social issue since the new postgraduate clinical training system started in 2004.The difficult working conditions of hospital physicians may influence this problem.We used a questionnaire to investigate the working hours, on-call frequency, work contents, and mental health of supervisors at various residency training hospitals in Japan.
1) We surveyed 479 physicians who worked at hospitals certified as residency-training facilities and who participated in a development workshop for supervisors or for residency training program managers held at 8 locations in 2004.
2) We found that supervisors worked, on average, more than 100 hours longer than statutory working hours per month and that more than one-fifth of supervisors worked more than 160 hours longer.
3) As for mental health, more than one-fifth of supervisors showed a depressive tendency.
4) These results suggest that the working conditions of supervisors at residency-training hospitals in Japan should be improved by reducing their clinical duties or managing their work content.

The new postgraduate clinical training system that started in 2004 is expected to have positive effects on the health of residents and the quality of treatment they provide.We performed a survey to examine the effects of this training system on the mental health of residents.
1) The subjects were first-year residents (458 in 2003 and 549 in 2004) who had started postgraduate clinical training at 38 hospitals in Japan.Self-administered questionnaires, which included items about working conditions and mental health, were mailed to each subject.
2) The mean score on the 12-item version of the General Health Questionnaire was 4.8 both before and after the new training system was introduced.The mean Center for Epidemiologic Studies Depression Scale score was 15.3 before and 14.4 after the system's introduction.The results showed no significant difference in mental health of residents before and after the system was changed.
3) The results suggest that the new training system has a positive effect on residents' mental health by increasing sleep time and decreasing occupational stress; however, the new system has also decreased job satisfaction and negatively affected their mental health.
4) Job satisfaction may significantly affect the mental health of residents.

Background/Aims: The adenoma detection rate (ADR) of screening colonoscopies performed by trainees is often lower than that of colonoscopies performed by experts. The effcacy of cap-assisted colonoscopy (CAC) in adenoma detection is well documented, especially that of CACs performed by trainees. Endocuff, a new endoscopic cap, is reportedly useful for adenoma detection; however, no trials have compared the effcacy of Endocuff-assisted colonoscopy (EAC) and CAC conducted by trainees. Therefore, the present study retrospectively compared the effcacy between EAC and CAC in trainees. Methods: This was a single-center, retrospective study involving 305 patients who underwent either EAC or CAC performed by three trainees between January and December 2018. We evaluated the ADR, mean number of adenomas detected per patient (MAP), cecal intubation rate, cecal intubation time, and occurrence of complications between the EAC and CAC groups. Results: The ADR was significantly higher in the EAC group than in the CAC group (54.3% vs. 37.3%, p=0.019), as was the MAP (1.36 vs. 0.74, p=0.003). No significant differences were found between the groups with respect to the cecal intubation rate or cecal intubation time. No major complications occurred in either group. Conclusions Our results suggest that EAC exhibits increased ADR and MAP compared to CAC when performed by trainees.

Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) using a 19-gauge needle is an efficient sampling method for the diagnosis of lymphadenopathy. This study compared 19-gauge conventional and Franseen needles for the diagnosis of lymphadenopathy and classification of malignant lymphoma (ML). Methods: Patient characteristics, number of needle passes, puncture route, sensitivity, specificity, and accuracy of cytology/histology for lymphadenopathy were analyzed in patients diagnosed with lymphadenopathy by EUS-FNA using conventional or Franseen needles. Results: Between 2012 and 2022, 146 patients met the inclusion criteria (conventional [n=70] and Franseen [n=76]). The median number of needle passes was significantly lower in the conventional group than in the Franseen group (3 [1–6] vs. 4 [1–6], p=0.023). There were no significant differences in cytological/histological diagnoses between the two groups. For ML, the immunohistochemical evaluation rate, sensitivity of flow cytometry, and cytogenetic assessment were not significantly different in either group. Bleeding as adverse events (AEs) were observed in three patients in the Franseen group. Conclusions Both the 19-gauge conventional and Franseen needles showed high accuracy in lymphadenopathy and ML classification. Considering sufficient tissue collection and the avoidance of AEs, the use of 19-gauge conventional needles seems to be a good option for the diagnosis of lymphadenopathy.