A 78-year-old male was referred to our facility due to persistent fever and arthralgia. Transesophageal echocardiography revealed fragile vegetations measuring 26 mm in length attached to the mitral valve (MV), along with severe mitral regurgitation. Magnetic resonance imaging showed multiple cerebral infarctions. He also had an abscess at his left sternoclavicular joint caused by Streptococcus agalactiae, which was identical to the strain identified in his blood culture. He was diagnosed with active infective endocarditis due to Streptococcus agalactiae and severe mitral regurgitation. To prevent postoperative mediastinitis, which could be a complication of median sternotomy in the presence of a left sternoclavicular joint abscess, he underwent urgent minimally invasive mitral valve surgery. Intraoperative Findings: The MV exhibited massive vegetation and partial valve destruction on the medial side of P2 and throughout P3, along with an annular abscess. The MV and annular abscess were debrided down to the left ventricular muscular layer. Mitral valve replacement was performed with reconstruction of the mitral posterior annulus using a bovine pericardial patch. The postoperative course was uneventful, and the left sternoclavicular joint abscess diminished with intravenous antibiotic therapy. He was discharged on the 36th day after surgery, and no relapse has been observed.

Cerebral air embolism caused by lung cancer is extremely rare, especially if not associated with invasive procedures such as needle biopsy. We describe the case of an 86-year-old man with squamous cell lung carcinoma of the left lung. He developed a bad cough and subsequently suffered left hemiplegia. Brain computed tomography (CT) on admission showed no abnormal findings. Diffusion-weighted magnetic resonance (MR) imaging revealed high intensity lesions in the right frontal lobe and right parietal lobes. Repeated brain CT revealed air densities around the high intensity lesions on previous MR imaging, compatible with air embolism causing cerebral infarction. Chest CT confirmed a left pulmonary hilar mass invading the left pulmonary vein, left atrium, and main bronchus. Air densities were found in the left heart ventricle. These radiological findings were attributed to cerebral air embolism associated with advanced lung cancer. Shortly afterwards he died of progressive respiratory failure. Our case reveals two important aspects. First, cerebral air embolism can be caused by lung cancer invading the pulmonary vein, left atrium, and main bronchus without iatrogenic causes. Therefore, we should pay special attention to the etiology when the patients with lung cancer in the advanced stage developed cerebral infarction. Second, repeated CT is recommended if cerebral air embolism is suspected because initial head CT does not always reveal air bubbles.

BACKGROUND/AIMS: The influences of Helicobacter pylori eradication therapy on the disease course of inflammatory bowel disease (IBD) are still unclear. We therefore conducted a multicenter, retrospective cohort study to evaluate the safety of H. pylori eradication therapy for IBD patients. METHODS: IBD patients with H. pylori eradication from 2005 to 2015 (eradication group) and control patients (non-eradication group; 2 paired IBD patients without H. pylori eradication matched with each eradicated patient) were included. IBD exacerbation (increased/additional IBD drug or IBD-associated hospitalization/surgery) and disease improvement based on the physicians’ global assessment were investigated at baseline, and at 2 and 6 months after eradication or observation. RESULTS: A total of 429 IBD (378 ulcerative colitis, 51 Crohn’s disease) patients, comprising 144 patients in the eradication group and 285 patients in the non-eradication group, were enrolled at 25 institutions. IBD exacerbation was comparable between groups (eradication group: 8.3% at 2 months [odds ratio, 1.76; 95% confidence interval, 0.78–3.92; P=0.170], 11.8% at 6 months [odds ratio, 1.60; 95% confidence interval, 0.81–3.11; P=0.172]). Based on the physicians’ global assessment at 2 months, none of the patients in the eradication group improved, whereas 3.2% of the patients in the non-eradication group improved (P=0.019). Multivariate analysis revealed that active disease at baseline, but not H. pylori eradication, was an independent factor for IBD exacerbation during 2 months’ observation period. The overall eradication rate was 84.0%–comparable to previous reports in non-IBD patients. CONCLUSIONS: H. pylori eradication therapy does not alter the short-term disease activity of IBD.
Clarithromycin ; Cohort Studies ; Colitis, Ulcerative ; Helicobacter pylori* ; Helicobacter* ; Humans ; Inflammatory Bowel Diseases* ; Metronidazole ; Multivariate Analysis ; Retrospective Studies

A 75-year-old man was admitted to our hospital with sudden onset of vomiting and abdominal distension. The patient was taking medication for arrhythmia. Computed tomography showed stenosis of the ileum and a small bowel dilatation on the oral side from the region of stenosis. A transnasal ileus tube was placed. Enteroclysis using contrast medium revealed an approximately 6-cm afferent tubular stenosis 10 cm from the terminal ileum and thumbprinting in the proximal bowel. Transanal double-balloon enteroscopy showed a circumferential shallow ulcer with a smooth margin and edema of the surrounding mucosa. The stenosis was so extensive that we could not perform endoscopic balloon dilation therapy. During hospitalization, the patient's nutritional status deteriorated. In response, we surgically resected the region of stenosis. Histologic examination revealed disappearance of the mucosal layer and transmural ulceration with marked fibrosis, especially in the submucosal layer. Hemosiderin staining revealed sideroferous cells in the submucosal layers. Based on the pathologic findings, the patient was diagnosed with ischemic enteritis. The patient's postoperative course was uneventful.
Aged ; Arrhythmias, Cardiac ; Constriction, Pathologic* ; Dilatation ; Double-Balloon Enteroscopy ; Edema ; Enteritis* ; Fibrosis ; Hemosiderin ; Hospitalization ; Humans ; Ileum ; Ileus ; Intestines ; Ischemia ; Mucous Membrane ; Nutritional Status ; Ulcer ; Vomiting

　　It is said that diabetes is one of the factors contributing to the onset of dementia and accelerating its progression. The number of dementia cases is expected to increase steadily year by year. Such being the circumstances, we encountered an elderly woman with diabetes and dementia, who managed to lower her blood glucose values to a proper level somehow or other, thus lightening the burden of caregivers. We shall hereby report the case because we thought it would make a good example for care in the region where the population is rapidly graying. The woman, then at age 80, visited our hospital complaining of languidness. Her blood sugar level was so high (random blood glucose level: 1,096 mg/dl) that she was hospitalized at once. By a stepwise insulin reinforcement therapy, the blood glucose levels were under control. During the stay in hospital, she was also diagnosed as having senile dementia. She was provided with effective health care and education for the control of blood sugar levels. Having snacks between meals was strictly prohibited. Considering that she was an elderly person living alone, only internal medicines were given. As a result, her blood glucose levels were elevated to about 300 mg/dl, but the combined use of GLP-1 injection and internal medicine once a week had good control over blood glucose levels. So, the patient was discharged from the hospital.

In Korea, mass mortality of Quercus mongolica trees has become obvious since 2004. Raffaelea quercus-mongolicae is believed to be a causal fungus contributing the mortality. To evaluate the pathogenicity of the fungus to the trees, the fungus was multiple- and single-inoculated to the seedlings and twigs of the mature trees, respectively. In both the inoculations, the fungus was reisolated from more than 50% of inoculated twigs and seedlings. In the single inoculations, proportions of the transverse area of non-conductive sapwood at inoculation points and vertical lengths of discoloration expanded from the points were significantly different between the inoculation treatment and the control. In the multiple inoculations, no mortality was confirmed among the seedlings examined. These results showed that R. quercus-mongolicae can colonize sapwood, contribute to sapwood discoloration and disrupt sap flows around inoculation sites of Q. mongolica, although the pathogenicity of the fungus was not proven.
Colon ; Fungi ; Korea ; Mortality ; Quercus* ; Seedlings ; Trees ; Virulence

Abstract
Objective : In this study, we conducted a survey on both the use of supplements by customers and information provided by pharmacists, to clarify customer understanding. We also sought to ascertain the actual current state of information provided by pharmacists to customers, as well as investigating both how, and to what extent, pharmacists should be involved in customers 'use of supplements.
Methodology : During regular pharmacy visits, pharmacists used a questionnaire to interview 1,253 customers, in 14 community pharmacies, in Tokyo and Hokkaido, respectively. A different questionnaire, designed for pharmacists, was also given to 289 pharmacists who were either working in those same pharmacies, or who attended the Conference on Pharmaceutical Sciences in Hokkaido (2011, Sapporo).
Results : The results of the survey showed that approximately 50％ of consumers greatly desired the provision of safety and efficacy information about supplements by pharmacists. However, few pharmacists answered customers' questions satisfactorily (only 7.3％ of total responses).
 The results also indicated that only 30％ of pharmacists actively gathered information about supplements, despite the fact that 67.5％ of pharmacists were aware that they were expected to do so by customers, in their roles as primary information providers regarding such treatments. Furthermore, even those pharmacists who checked information regarding supplements depended mostly on information acquired from the Internet.
Conclusion : There is a large gap between customers' expectations for explanation of supplements and the reality of such explanations, and the information actually provided by pharmacists. In order to live up to their customers' expectations, pharmacists should foster both wider dissemination and better understanding of evidence-based information about supplements. Pharmacists should also provide integrated management of drugs and supplements for patients.

Between 1987 and 2002, 22 internal iliac artery aneurysms in 14 patients were repaired. In 13 we performed aneurysm excision or reconstruction. There were 3 cases in which simple proximal ligation of the internal iliac artery was performed; in 2 of these CT scans confirmed that the reduction of the internal iliac artery aneurysms was not recognized, but blood flow was not shown in the aneurysm. However, 6 years postoperatively 1 patient was confirmed with an expansion of the aneurysm, and blood flow was seen on a CT scan. In the 2 latest patients, the blood pressure of the internal iliac artery was measured before and after proximal clamping of the internal iliac artery, but the blood pressure of aneurysms could not be fully lowered by proximal ligation of the internal iliac artery. Therefore, endoaneurysmorrhaphy seemed to be the operative method of choice for treatment of the internal iliac artery aneurysms.

A 72-year-old man who suddenly felt an excessive thirst and developed pollakisuria and high fever on Sept. 29, 2001. A general practitioner initially diagnosed him as having urinary tract infection on the same day. Vomiting and unconscionsnes occurred on Oct. 3. He was brought to our hospital by ambulance. Laboratory data on admission showed plasma glucose of 1110 mg/dl, blood pH of 7.167 and HCO3- of 7.6mmol/L, and positive urinary ketone bodies, compatible with diabetic ketoacidosis. Serum amylase was elevated, but he had no symptoms of acute pancreatitis. Insulin therapy was started immediately and hyperglyvemia was improved. He has never had diabetes mellitus and his HbA1c was normal (5.3%). His urinary C-peptide was very low (2.4 μg/day) and diabetes-related autoantibodies including anti-GAD, IA-2 antibodies and ICA were negative. So his case was diagnosed as fulminant type 1 diabetes mellitus. Fulminant type 1 diabetes, which has been brought to light by Dr Imagawa’s group, is characterized by near-nomal HbA1c despite diabetic ketoacidosis, rapid loss of insulin secretion and absence of diabetes-related autoantibodies.Great care is needed to recognize the patients with fulminant type 1 diabetes among the elderly with symptoms of urinary tract infection. Here, we reported the case of an aged man who developed aypical fulminant type 1 diabetes.
Diabetes Mellitus, Insulin-Dependent ; Diabetes Mellitus ; symptoms <1> ; Type 1 ; Urinary tract infection