We report on a rare case of a left subclavian artery aneurysm concomitant with Loeys-Dietz Syndrome (LDS) which required us to operate in childhood. A 12-year-old female, who had been diagnosed with LDS by genetic examination one year eariler, was revealed to be suffering from a left subclavian artery aneurysm (25 mm in diameter) by follow up chest MRI scan. Hybrid surgery consisting of coil embolization of aneurysm and surgical revascularization of the left subclavian artery and left vertebral artery was performed successfully. The patient was discharged on postoperative day 8.

Background/Aims: Since the usefulness of neoadjuvant chemo(radiation) therapy (NAT) for pancreatic cancer has been demonstrated, recurrent biliary obstruction (RBO) in patients with pancreatic cancer with a fully covered self-expandable metal stent (FCSEMS) during NAT is expected to increase. This study investigated the impact of sarcopenia on RBO in this setting. Methods: Patients were divided into normal and low skeletal muscle index (SMI) groups and retrospectively analyzed. Patient characteristics, overall survival, time to RBO (TRBO), stent-related adverse events, and postoperative complications were compared between the two groups. A Cox proportional hazard model was used to identify the risk factors for short TRBO. Results: A few significant differences were observed in patient characteristics, overall survival, stent-related adverse events, and postoperative complications between 38 patients in the normal SMI group and 17 in the low SMI group. The median TRBO was not reached in the normal SMI group and was 112 days in the low SMI group (p=0.004). In multivariate analysis, low SMI was the only risk factor for short TRBO, with a hazard ratio of 5.707 (95% confidence interval, 1.148–28.381; p=0.033). Conclusions Sarcopenia was identified as an independent risk factor for RBO in patients with pancreatic cancer with FCSEMS during NAT.

BACKGROUND: Despite the huge burden of domestic work on women in Japan, its effects on their health have been poorly investigated. We aimed to assess the association between domestic work stress and self-rated psychological health among women. METHODS: We conducted a cross-sectional survey using an online social research panel in February 2018. Participants were 2,000 women with paid work (the "workers" group) and 1,000 women without paid work (the "homemakers" group), aged between 25 and 59 years old and living with a partner. Self-rated psychological health (Mental Health and Vitality scales of the Japanese SF-36), occupational and domestic work stress (the Brief Job Stress Questionnaire), the 10-item Work-Family Conflict Scale, and sociodemographic factors were assessed. RESULTS: The workers had lower domestic job control and higher support from a partner and their parents than the homemakers (p < 0.001), whereas domestic job demand and psychological health were similar between the groups. After adjustment for the covariates using multiple linear regression models, better psychological health was significantly associated with lower domestic job demand, higher domestic job control, and having a young child in both groups. In addition, work-family conflicts and occupational job stress among the workers and caregiving among the homemakers showed negative associations with psychological health. CONCLUSION Self-rated psychological health in women was associated with domestic work stress regardless of employment status. To promote women's health, we need to take into account the effects of domestic work, work-family conflicts, and social support from families, as well as occupational factors.

BACKGROUND: An increase in cardiovascular diseases has been reported following major disasters. Previous work has shown that ultrasonographic findings from ultrasound cardiography examination (UCG) increased until the 44th month after the tsunami caused by the Great East Japan Earthquake. The present study conducted UCG among victims in the tsunami disaster area and investigated the frequency of disaster-related cardiovascular diseases and changes over time until the 55th month after the disaster. METHODS: The subjects were residents of temporary housing complexes and neighboring housing in Watari-gun, Miyagi Prefecture, Japan. There were 207 subjects in the 18th month, 125 in the 30th month, 121 in the 44th month, and 106 in the 55th month after the disaster. Data were collected through UCG and self-report questionnaire. RESULTS: Significant changes were observed among subjects with clinical findings from the UCG, which increased over the study period-from 42.0 to 60.8, 72.7, and 73.6% beginning in the 18th month after the disaster (p < 0.0001). CONCLUSIONS: It is possible that the UCG can become a useful examination to visualize the potential impact of a major disaster on the cardiac function of victims. Victims with clinical findings continued increasing not only during the acute phase after a disaster but also in the long term. We therefore need to keep this in mind, and note that it is important to establish a support system to control cardiovascular diseases from the early stage of disaster. TRIAL REGISTRATION UMIN; ID000029802. R000034050 . 2 November 2017.
Aged ; Aged, 80 and over ; Cardiovascular Diseases ; diagnosis ; diagnostic imaging ; Case-Control Studies ; Disasters ; statistics & numerical data ; Earthquakes ; Female ; Health Behavior ; Humans ; Japan ; Male ; Middle Aged ; Tsunamis

STUDY DESIGN: Retrospective review. PURPOSE: To describe a safe and effective surgical procedure for old distractive flexion (DF) injuries of the subaxial cervical spine. OVERVIEW OF LITERATURE: Surgical treatment is required in old cases when a progression of the kyphotic deformity and/or persistent neck pain and/or the appearance of new neurological symptoms are observed. Since surgical treatment is more complicated and dangerous in old cases than in acute distractive-flexion cases, the indications for surgery and the selection of the surgical procedure must be carefully conducted. METHODS: To identify a safe and effective surgical procedure, the procedure selected, reason(s) for its selection, and associated neurological complications were investigated in 13 patients with old cervical DF injuries. RESULTS: No neurological complications were observed in nine patients (DF stage 2 or 3) who underwent the anterior-posterior-anterior (A-P-A) method and two patients (DF stage 1) who underwent the posterior method. It was initially planned that two patients (DF stage 2) who underwent the P-A method would be treated using the Posterior method alone; however, anterior discectomy was added to the procedure after the development of a severe spinal cord disorder. CONCLUSIONS: The A-P-A method (anterior discectomy, posterior release and/or partial facetectomy, reduction and instrumentation, anterior bone grafting) is considered to be a suitable surgical procedure for old cervical DF injuries.
Congenital Abnormalities ; Diskectomy ; Humans ; Methods ; Neck Pain ; Retrospective Studies ; Spinal Cord Diseases ; Spine*

STUDY DESIGN: Retrospective case series. PURPOSE: To clarify the influence of cervical spinal canal stenosis (CSCS) on neurological functional recovery after traumatic cervical spinal cord injury (CSCI) without major fracture or dislocation. OVERVIEW OF LITERATURE: The biomechanical etiology of traumatic CSCI remains under discussion and its relationship with CSCS is one of the most controversial issues in the clinical management of traumatic CSCI. METHODS: To obtain a relatively uniform background, patients non-surgically treated for an acute C3-4 level CSCI without major fracture or dislocation were selected. We analyzed 58 subjects with traumatic CSCI using T2-weighted mid-sagittal magnetic resonance imaging. The sagittal diameter of the cerebrospinal fluid (CSF) column, degree of canal stenosis, and neurologic outcomes in motor function, including improvement rate, were assessed. RESULTS: There were no significant relationships between sagittal diameter of the CSF column at the C3-4 segment and their American Spinal Injury Association motor scores at both admission and discharge. Moreover, no significant relationships were observed between the sagittal diameter of the CSF column at the C3-4 segment and their neurological recovery during the following period. CONCLUSIONS: No relationships between pre-existing CSCS and neurological outcomes were evident after traumatic CSCI. These results suggest that decompression surgery might not be recommended for traumatic CSCI without major fracture or dislocation despite pre-existing CSCS.
Cerebrospinal Fluid ; Cervical Cord* ; Constriction, Pathologic* ; Decompression ; Dislocations* ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Spinal Canal* ; Spinal Injuries

A 65-year-old woman was referred for progressive dyspnea and leg edema. Physical examination revealed a continuous murmur along the right sternal border. Enhanced computed tomography showed an aneurysm that extended to the right atrium. Aortic angiography confirmed the rupture of the valsalva aneurysm into the right atrium. The patient underwent emergency surgery to close the aneurysm ostium and suture closure of the right atrial fistula. The patient's postoperative course was uneventful.

  Less than 0.5% of hot springs in Japan is natural carbonated hot springs.   Therefore, the spread of artificial bicarbonate (CO2) water in Japan starts by developing the gas-permeable membrane.   There are two methods to produce artificial CO2 water. The first is gas-permeable membrane method and the second is pressurizing stir method. Both are widespread. Because the gas-permeable membrane method is provided by stable concentration in medical treatment, generally the stirring methods spread because a price is cheap.   There is a custom of whole body bathing in Japan from old days, and the CO2 warm water bathing has spread all over Japan in about ten years recently.   The vasodilation effect can be caused by the CO2 in warm water of 41 degrees Celsius (approximately 1,000ppm: max saturation under conditions of atmospheric pressure), which is the temperature favored by Japanese people. This differs from the vasodilation caused by the nitric oxide (NO) by thermal, and the reason is thought to be the participation of hormone from a blood vessel endothelium such as prostaglandin E2.   When CO2 penetrates from the epidermis and it reaches the dermis, it enhances the entering blood vessel to the capillary of the dermis.   The blood vessel is enhanced according to the concentration of CO2.   A wide capillary increases volume flow of blood, sends the tissue oxygen and nourishment, and accentuates the renewal of the skin.   By the use of this mechanism, arteriosclerosis obliterans using the footbath and the pressure sore treatment in the medical, and cosmetics with CO2 water are widespread in the beauty industry in Japan.   Moreover, a vasodilated vessel carries the febris easily from the warm water to the inside of the body, and raises the body temperature high early.   Body temperature increases CO2 water 1.5 degrees Celsius, tap water 1.0 degrees Celsius by the warm water hole body bathing of 41 degrees Celsius 15 minutes from before bathing.   　This phenomenon of CO2 warm water raises the body temperature easier than the tap water, and works as a heat stress for the human body.   It provides to increasing of the immunity (natural killer cell activities) and the heat shock protein (HSP) caused by this stress, and it consequentially enhances health promotion.   In addition, using the bulla from unstable CO2 to clean the hair and the hair root and to improve the blood circulation of the scalp is becoming popular in Japanese hair salon. Though custom of the drinking CO2 water has been performed in Europe from long ago, it became popular in Japan several years ago, for the appetite increase with small and for the diet with large amount. These spread as one of the dieting methods of a woman from last 2 years.   Japan is a country that can use the favor of high concentrate artificial CO2 warm water anywhere, for the development and the widespread of the high concentrated artificial CO2 producting apparatus.

BACKGROUND : This survey examined how a physician's specialty may influence attitudes towards blood glucose control in diabetic patients.
METHODS : A questionnaire was mailed to all members of the Ishikawa Medical Association (n=1,610) as well as diabetic specialists (n=36) querying their specialties, confidence in offering diabetic treatment, and treatment goals/change levels of plasma glucose levels for 5 theoretical cases.
RESULTS : 301 physicians responded. The percentage answering treatment goal/change levels was 93% of internal medicine physicians (n=145), 72% of surgeons (n=29), 52% of pediatricians (n=23) and 20% in other specialties (n=99). The percentage answering “I am confident in offering diabetic treatment” was 57% of internal medicine physicians, 14% of surgeons, 13% of pediatricians and 3% in other specialties. There were significant differences among specialties in the fasting plasma glucose levels in the treatment goal, and the postprandial plasma glucose change levels. Internal medicine specialists tended to give higher glucose levels than other specialties.
CONCLUSIONS : The majority of physicians interested in diabetes care appear to be internal medicine specialists. Physician's specialty may influence their attitude toward glucose control in diabetic patients.