The patient is a 47-year-old male who was rushed to the hospital after experiencing fainting during exertion. Head magnetic resonance imaging (MRI) and electroencephalography showed no abnormalities. Elevated myocardial biomarkers indicated cardiogenic syncope. Coronary angiography (CAG) and coronary computed tomography (CT) revealed that the right coronary artery originated above the right-left coronary cusp commissure and coursed between the aorta and pulmonary artery. While no definitive ischemia was observed in various tests, elevated cardiac enzymes upon admission suggested transient ischemia of the right coronary artery as a likely cause of the syncope. Consequently, right coronary reimplantation surgery was performed after thorough discussion with the patient. His recovery has been favorable, with no recurrence of symptoms observed during follow-up. Anomalous origin of the right coronary artery has been reported in asymptomatic cases or cases where ischemia cannot be confirmed, leading to varying treatment approaches. This report describes a case where successful coronary artery reimplantation was performed following syncope which triggered the discovery of anomalous right coronary artery origin. It includes a literature review to further explore this case.

A 74-year-old man, with a medical background of cryoglobulinemia, had been undergone nonbacterial thrombotic endocarditis with immunotherapy spanning three months. Following a year and three months, he has presented to our institution experiencing acute decompensated heart failure attributable to severe aortic regurgitation （AR），moderate mitral regurgitation （MR），and severe tricuspid regurgitation （TR）．Transesophageal echocardiography revealed aortic valve cusps destruction and anterior mitral valve leaflet vegetation. The potential complications of leukocytoclastic or necrotizing vasculitis due to hypothermic cardiopulmonary bypass in cryoglobulinemia patients were addressed preemptively through preoperative plasmapheresis. During the procedure, tepid core cooling cardiopulmonary bypass at 33℃ and tepid blood cardioplegia solution at 30℃ were employed to mitigate the risk of vasculitis. Urgent aortic valve replacement, mitral vegetation resection, and tricuspid annuloplasty were performed, and the patient was discharged on the 23rd postoperative day without any untoward events.

Methods: Consecutive patients diagnosed with OFs at Fujieda Heisei Memorial Hospital were divided into three groups: nonsurgical therapy, balloon kyphoplasty (BKP), and open surgery groups. The mOF score was calculated, and the levels of independence and posttreatment imaging data were compared between patients treated and not treated according to the mOF score-based treatment recommendation. Results: In total, 118 patients were included (nonsurgical therapy, n=57; BKP, n=48; open surgery, n=13), of whom 100 (85%) received treatment consistent with the mOF score-based treatment recommendation. In the BKP and open surgery groups, the mOF scorebased treatment recommendations were consistent with the actual treatment in 93% of the patients. However, in the nonsurgical group, the mOF score-based treatment recommendation was not consistent with the actual treatment in 25% of the patients. In this group, patients not treated according to the mOF score had significantly shorter vertebral body height, greater local kyphosis, and smaller sacral slope after treatment than patients treated according to the mOF score-based treatment recommendation. Conclusions In the BKP and open surgery groups, the mOF scores were consistent with actual clinical selection. In the nonsurgical therapy group, patients not treated according to the mOF score-based treatment recommendation exhibited severe vertebral body deformity and a less well-balanced spine shape after treatment. The mOF score may help in selecting suitable treatments for OFs.

A 51-year-old man presented to our hospital with general fatigue and lower extremity edema due to right heart failure with severe coagulation disorder. He had undergone ascending aortic and total arch replacement for type A acute aortic dissection when he was 49 years old and had diagnosed with anastomotic pseudoaneurysm in the ascending aorta by computed tomography 1 year after the operation. Preoperative computed tomography showed an enlargement of the pseudoaneurysm. Since re-median sternotomy seemed to be high risk strategy for bleeding due to severe coagulation disorder, we decided to perform ascending aortic replacement through right thoracotomy. We opened the pseudoaneurysm and found an aorto-right atrium fistula. Redo ascending aortic replacement with direct closure of the fistula was successfully performed. The postoperative course was uneventful.

Methods: We performed 3T MRI in 10 healthy volunteers and 13 patients with LSS. The ADC values in the spinal canal were evaluated at 46 vertebrae (L4/5 and L5/S1 for each participant), and the reduced and conventional fields of view were compared. Results: The ADC values were 2.72±0.12 at L4/5 in healthy volunteers, 2.76±0.19 at L5/S1 in healthy volunteers, 1.77±0.58 at L4/5 in patients with LSS, and 2.35±0.29 at L5/S1 in patients with LSS. The ADC value at L4/5 in patients with LSS was significantly lower than that at L5/S1 in patients with LSS and that at L4/5 and L5/S1 in healthy volunteers (p <0.05). With an ADC cutoff value of 2.46 to identify LSS, this approach provided an area under the curve of 0.81, sensitivity of 0.92, and specificity of 0.76 (p <0.05). Conclusions Preoperative examination using ADC maps permits visualization and quantification of spinal canal lesions, thus proving the utility of ADC maps in the selection of decompression surgery for LSS.

Background: Acetaminophen, an antipyretic analgesic, is one of the main pain relief medications for cancer according to the World Health Organization guidelines. Design: A case report of a 75-year-old woman who had been taking acetaminophen to relieve cancer pain caused by recurrence after surgery for left upper-lobe cancer and multiple bone metastases. Following a formulation change, the participant experienced allergy-like symptoms. Results: After switching to a different formulation, the allergic symptoms disappeared. Conclusion: The results obtained from this case report suggest that pharmaceutical additives in the acetaminophen formulation caused the allergic reaction, and not the acetaminophen itself. The woman’s pain was successfully controlled by changing to a different type of formulation. If allergic reaction symptoms appear after taking acetaminophen, switching to a different formulation of the drug may enable the continued use of acetaminophen to treat the patient’s pain.

Although evidence of Western therapy for heart failure has been established, evidence of treatment for heart failure with chronic kidney disease (CKD) has still not been established. The efficacy of additional Oriental medicine to standard therapy for heart failure with CKD is unclear. To address this issue, we retrospectively evaluated 20 consecutive heart failure patients with CKD (≧stage 3) who were orally administered goreisan (7.5 g/day) due to insufficient efficacy of standard therapy in our hospital from November 2015 to December 2017. We assessed symptoms, chest X-ray, BNP concentration, serum electrolytes, eGRF, plasma osmolality, and side effects. Goreisan improved heart failure in 11 of 20 patients, did not significantly deteriorate renal function, plasma osmolality, and did not clinically affect electrolytes. In conclusion, the present study suggested that additional use of goreisan to Western standard therapy is safe and useful for heart failure with CKD.

STUDY DESIGN: A retrospective observational study was performed. PURPOSE: We investigated the prevalence of sarcopenia in dropped head syndrome (DHS), and the relationship between biochemical markers, including major advanced glycation end products (AGEs), pentosidine, and DHS in older women. OVERVIEW OF LITERATURE: AGEs have been implicated in the pathogenesis of sarcopenia. METHODS: We studied 13 elderly women with idiopathic DHS (mean age, 77.2 years) and 20 healthy volunteers (mean age, 74.8 years). We used a bioelectrical impedance analyzer to analyze body composition, including appendicular skeletal muscle mass index (SMI; appendicular lean mass [kg]/[height (m)]2). Cervical sagittal plane alignment, including C2–C7 sagittal vertical axis (C2–C7SVA), C2–C7 angle, and C2 slope (C2S), was measured. Biochemical markers, such as serum and urinary pentosidine, serum homocysteine, 1, 25-dihydroxyvitamin D, and 25-hydroxyvitamin D, were measured. The level of each variable was compared between DHS and controls. The relationship between biochemical markers and DHS was examined. RESULTS: Sarcopenia (SMI < 5.75) was observed at a high prevalence in participants with DHS (77% compared to 22% of healthy controls). Height, weight, femoral bone mineral density, appendicular lean mass, total lean mass, and SMI all had significantly lower values in the DHS group. Serum and urinary pentosidine, and serum homocysteine were significantly higher in the DHS group compared to controls. Analysis of cervical alignment revealed a significant positive correlation of serum pentosidine with C2–C7SVA and C2S. CONCLUSIONS: Sarcopenia was involved in DHS, and high serum pentosidine levels are associated with severity of DHS in older women.
Aged ; Biomarkers ; Body Composition ; Bone Density ; Electric Impedance ; Female ; Glycosylation End Products, Advanced ; Head ; Healthy Volunteers ; Homocysteine ; Humans ; Muscle, Skeletal ; Neck Muscles ; Observational Study ; Prevalence ; Retrospective Studies ; Sarcopenia

ART (Assisted Reproductive Technology) is making impressive advancements. However, not all patients will successfully conceive even with this technique. Patients undergoing infertility treatment are predominantly in a state of mental stress for being unable to conceive, and the importance of stress care in treating infertility has been reported. This time, to investigate the relationship between infertility, mental stress and Kampo treatment, we have conducted a retrospective study on 7 patients who achieved conception by a combination treatment of Kampo medicine and ovulation day prediction. Patients'occupation, menstruation history, pregnancy history, premenstrual symptoms, and oriental medical examination findings were extracted from their medical records. The clinical background were age (mean age: 36 [29-39]), time to pregnancy (mean: 6 months [2-9 months]), and outcome (normal vaginal delivery [3 cases], caesarean section [2 cases], abortion [1 case], transfer to other facility [1 case]). The oriental medical diagnosis in all cases found stagnation of liver qi. Two cases had only stagnation of liver qi. As comorbidities, kidney deficiency (3 cases), blood stasis syndrome (1 case), and blood stasis syndrome with syndrome of dual deficiency of qi and blood (1 case) were found. The Kampo prescriptions were as follows: nyoshinsan (2), kamishoyosan (2), tsudosan (1), shigyakusan (1) and kyukichoketsuin (1). Stagnation of liver (TM) qi was considered to play a role in infertility and is one of the important factors in Kampo prescriptions.

STUDY DESIGN: Retrospective observational study. PURPOSE: We considered the relationship between spinal alignment and skeletal muscle mass on clinical outcomes following a surgery for lumbar spinal stenosis (LSS). OVERVIEW OF LITERATURE: There are no reports of preoperative factors predicting residual low back pain following surgery for LSS. METHODS: Our target population included 34 women (mean age, 74.4 years) who underwent surgery for LSS. Prior to and 6 months after the surgery, systemic bone mineral density and lean soft tissue mass were measured using dual-energy X-ray absorptiometry. Skeletal muscle mass index (SMI) was calculated as the sum of the arm and leg lean mass in kilograms divided by height in meters squared. The spinal alignment was also measured. Clinical outcomes were evaluated using the Japanese Orthopedic Association scoring system, leg and low back pain Visual Analog Scale, and Roland–Morris Disability Questionnaire (RDQ). Additionally, we examined the bone mineral density, skeletal muscle mass, and spinal alignment before and after the surgery. We used the Spearman correlation coefficient to examine the associations among clinical outcomes, preoperative muscle mass, and spinal alignment. RESULTS: Sarcopenia (SMI <5.46) was observed in nine subjects (26.5%). Compared with normal subjects (SMI >6.12), RDQ was significantly higher in subjects with sarcopenia (p=0.04). RDQ was significantly negatively correlated with SMI (r=−0.42, p<0.05). There was a significant positive correlation between postoperative RDQ and pelvic tilt (PT; r=0.41, p<0.05). SMI and PT were significantly negatively correlated (r=−0.39, r<0.05). CONCLUSIONS: Good postoperative outcomes were negatively correlated with low preoperative appendicular muscle mass, suggesting that postoperative outcomes were inferior in cases of decreased appendicular muscle mass (sarcopenia). Posterior PT due to decreased limb muscle mass may contribute to postoperative back pain, showing that preoperatively reduced limb muscle mass and posterior PT are predictive factors in the persistence of postoperative low back pain.
Absorptiometry, Photon ; Arm ; Asian Continental Ancestry Group ; Back Pain ; Bone Density ; Extremities ; Female ; Health Services Needs and Demand ; Humans ; Leg ; Low Back Pain ; Muscle, Skeletal ; Observational Study ; Orthopedics ; Retrospective Studies ; Sarcopenia ; Spinal Stenosis ; Visual Analog Scale