We report a successful case of aortic valve-sparing root replacement for dilated aortic root after a Ross procedure. A 29-year-old male underwent a Ross procedure when he was 11 years old for congenital aortic bicuspid valve. The right ventricular outflow tract was reconstructed using an autologous pericardium as a single leaflet valve. Aortic root dilatation and moderate aortic valve regurgitation were noted. Further investigation with enhanced computed tomography and ultrasonic cardiography revealed good quality of leaflets and sufficient geometric height, and aortic valve-sparing root replacement was performed. In addition, we performed pulmonary valve replacement with a biological valve. The post-operative course was uneventful and the patient was discharged after 8 days with a completely controlled aortic valve regurgitation. No recurrence of aortic valve regurgitation was observed 1 year later. Because surgical outcomes of congenital heart diseases have improved and more patients have an increasing life expectancy, several other problems were revealed, such as the occurrence of aortic root dilatation after a Ross procedure. Aortic roots may dilate due to arterial pressure; however, valve-sparing procedures may be performed if the volume of the leaflets is sufficient.

Cardiac metastasis from cervical cancer is rare. We herein present a case involving a 54-year-old woman with cervical cancer who was undergoing radiotherapy for left supraclavicular lymph node metastasis. The patient was admitted to the hospital because of shortness of breath. Transthoracic echocardiography showed a large mass in the right ventricle. To rescue the patient from circulatory collapse, we surgically resected the intracardiac mass via a right ventricular incision parallel to the posterior descending artery and left anterior descending artery. This approach prevented right ventricular outflow tract obstruction and perioperative pulmonary embolization, which could have led to death. The intracardiac mass was diagnosed as squamous cell carcinoma. After hospital discharge, the patient underwent chemotherapy. An echocardiography performed 3 months postoperatively showed recurrence of the cardiac metastasis, and the patient died 5 months later. Cardiac metastasis in the right ventricle can present as pulmonary embolization. Although rare, most cases of metastasis from cervical carcinoma to the heart have an extremely poor prognosis.

The patient was a 68-year-old woman. She was diagnosed with uterine cancer after experiencing irregular genital bleeding. Contrast-enhanced computed tomography showed a 30 mm left ventricular mass and splenic infarction, and head MRI showed multiple cerebral infarctions. The patient was suffering from systemic embolism caused by the cardiac mass, and we decided to perform cardiac mass removal prior to uterine cancer treatment. A yellowish-white thrombus-like mass attached to the mitral valve, subvalvular tissue, and left ventricular endocardium was removed by a trans-septal approach under cardiopulmonary bypass. Pathological examination revealed that the mass was a fibrin-based thrombus with almost no inflammatory findings, we diagnosised non-bacterial thrombotic endocarditis (NBTE). Postoperatively, the patient developed Takotsubo cardiomyopathy, and treatment for uterine cancer, was delayed. Hypercoagulability was not controlled well, and she developed recurrence of left ventricle vegitation, acute arterial occlusion of the lower extremities and inferior vena cava thrombosis, making active intervention for uterine cancer difficult. The patient was treated palliatively and died on POD 36. NBTE tends to be characterized by multiple small growths, but giant vegetation may also occur as in this case. Unless the primary disease causing the hypercoagulability is treated, recurrence of NBTE is possible, and prompt treatment of the primary disease is required.

Purpose：This study investigated the factors associated with rehabilitation service satisfaction in convalescent stroke patients.Methods：This cross-sectional study included 41 participants (mean age 50.5 ± 9.3 years；73.2％ were male). Patients with severe cognitive impairment who were unable to respond to questionnaires were excluded from the study. At discharge, patient satisfaction was assessed using the Customer Satisfaction Scale based on Need Satisfaction (CSSNS) tool. We also evaluated physical function using the Stroke Impairment Assessment Set-Motor (SIAS-M) gain tool, activities of daily living (ADL) using the Motor-Functional Independence Measure (M-FIM) effectiveness tool, depressive symptoms using the Japan Stroke Scale-Depression (JSS-D) tool, optimism using the revised Life Orientation Test (LOT-R), and service quality using the SERVPERF model. Stepwise regression analysis was performed to identify factors that were significantly associated with CSSNS scores.Results：The mean CSSNS score of participants was 55.5 ± 8.3 points. Stepwise multiple regression analysis showed that M-FIM effectiveness (β＝0.48, p＜0.01) and SERVPERF scores (β＝0.48, p＜0.01) were significantly associated with CSSNS scores.Conclusion：This study revealed that favorable improvements in ADL and better service quality were associated with higher rehabilitation service satisfaction in convalescent stroke patients.

Purpose：This study investigated the factors associated with rehabilitation service satisfaction in convalescent stroke patients.Methods：This cross-sectional study included 41 participants (mean age 50.5 ± 9.3 years；73.2％ were male). Patients with severe cognitive impairment who were unable to respond to questionnaires were excluded from the study. At discharge, patient satisfaction was assessed using the Customer Satisfaction Scale based on Need Satisfaction (CSSNS) tool. We also evaluated physical function using the Stroke Impairment Assessment Set-Motor (SIAS-M) gain tool, activities of daily living (ADL) using the Motor-Functional Independence Measure (M-FIM) effectiveness tool, depressive symptoms using the Japan Stroke Scale-Depression (JSS-D) tool, optimism using the revised Life Orientation Test (LOT-R), and service quality using the SERVPERF model. Stepwise regression analysis was performed to identify factors that were significantly associated with CSSNS scores.Results：The mean CSSNS score of participants was 55.5 ± 8.3 points. Stepwise multiple regression analysis showed that M-FIM effectiveness (β＝0.48, p＜0.01) and SERVPERF scores (β＝0.48, p＜0.01) were significantly associated with CSSNS scores.Conclusion：This study revealed that favorable improvements in ADL and better service quality were associated with higher rehabilitation service satisfaction in convalescent stroke patients.

A 69-year-old woman complained of general malaise. Chest X-ray film revealed massive left-sided pleural effusion and CT detected a giant aneurysm of the aortic arch. A diagnosis of ruptured aortic arch aneurysm was made and she underwent total arch replacement as emergency surgery. The intraoperative diagnosis was not a ruptured arch aneurysm but an arch aneurysm penetrating into the left pulmonary artery. The postoperative course was uneventful and the patient was discharged home on the 16th postoperative day.

The prevention of dementia is an important issue that should be addressed in Japan. To prevent dementia, it is important to implement interventions (e.g., exercise or cognitive training) for the healthy community-dwelling elderly. However, such interventions are not always evidence-based. In this review, we evaluated exercise and cognitive training intervention protocols for the prevention of dementia based on recent findings. In addition, we proposed specific methods for implementing such interventions in the community.

Introduction: We experienced a case in which acetazolamide proved to be effective for the symptoms of increased intracranial pressure due to carcinomatous meningitis. Case: The patient was a male in his fifties who was diagnosed lung adenocarcinoma. He was suffered from headache and vomiting due to carcinomatous meningitis after his admission to our palliative care unit, so he was prescribed steroids and a glycerin infusion. But only morning headache remained, and we added acetazolamide 500 mg per day and his morning headache improved. Conclusion: This morning headache is thought to reflect exacerbation of raised intracranial pressure through nocturnal hypoventilation with a rise in PaCO2, so it was thought that acetazolamide decreased PaCO2 and relieved morning headache.

We experienced a case in which a blood transfusion proved to be effective for the treatment of symptomatic restless legs syndrome that occurred in a patient demonstrating terminal stage cancer with iron-deficiency anemia due to hemorrhaging as a result of carcinomatous peritonitis. The patient was a female in her seventies who suffered from hepatocellular carcinoma. After undergoing blood transfusion, the symptoms of discomfort in her lower limbs dramatically improved. It was thought that it was expected the symptomatic restless leg syndrome was frequently amalgamated, and a positive diagnosis and appropriate treatment were necessary in the terminal stage of cancer. Palliat Care Res 2011; 6(2): 344-349

A 25-year-old man crashed his car into an electric light pole, and was brought to our hospital. Pericardial effusion inducing cardiac tamponade was detected on computed tomography, but there was no findings suggesting traumatic injuries of any other organs. Since he demonstrated shock during the examination, we performed pericardial drainage following pericardiocentesis to eliminate the cardiac tamponade. After approximately 150 ml of blood was drained, his blood pressure increased and stabilized. Blunt cardiac rupture was diagnosed after blood drainage, and midsternotomy was then performed. Percutaneous cardiopulmonary support was established for exploration and confirmation of the injured site. The injured site was confirmed at the junction of the right lower pulmonary vein and right basal pulmonary vein. However, surgical repair under partial circulatory support was impossible because the injury was complicated and hemorrhage was not controllable. Furthermore, there was a risk of air embolization during the process of repair. Therefore, an additional drainage tube was inserted into the superior vena cava, and then the injury was repaired by direct closure under total perfusion using another circulatory circuit with a venous reservoir. No cases of isolated injury of intrapericardial pulmonary vein injury have been reported previously. It was suspected that the development of this injury was related to air bag deployment. This case could be saved by surgical repair under total perfusion using cardiopulmonary bypass.