A 78-year-old man was diagnosed with adult T-cell leukemia/lymphoma (ATL) and was started on standard chemotherapy 1 year earlier. However, treatment was discontinued because of adverse drug reactions and worsening delirium. Thereafter, he remained stable and was followed up while receiving etoposide. He then visited our hospital because of acute abdominal pain and underwent surgery with a diagnosis of gastrointestinal perforation. Intraoperative observation showed a reddened, concentric wall thickening measuring 4 cm and a perforation site in the ileum, and thus partial resection of the small bowel was performed. The histological diagnosis was small bowel perforation due to tumor cell invasion. Two months postoperatively, he started a less intensive chemotherapy regimen along with palliative care, and died due to the primary disease approximately 5 months postoperatively. ATL involves systemic organs because of its high organ-affinity. Once it involves the gastrointestinal tract, various gastrointestinal symptoms can occur. Patients with ATL are at risk of developing gastrointestinal perforation at any time during the clinical course. Therefore, clinicians should be aware that once gastrointestinal perforation develops, the prognosis becomes extremely poor. Assessment of the disease state, early detection of gastrointestinal lesions, and prevention of opportunistic infections appear to be important in the management of patients with ATL.

Many patients with mental disorders visit emergency departments (EDs). However, the majority of these patients do not receive psychiatric assessment. In the present study, we investigated the detailed proportion of patients with mental disorders visiting an urban ED in the largest northern city in Japan. A retrospective chart review study was performed at a University Hospital from January 2012 to December 2015. The reasons for psychiatric consultations made by ED staff, and the primary psychiatric diagnoses were investigated. Among all living patients, 20% of them received consultations. The most common reason for consultation was suicide attempt followed by agitation or insomnia. Of all diagnoses, organic mental disorder was the most frequent and the mean age was significantly higher than the other diagnostic groups. Our study indicated that the frequency of psychiatric consultation was high. This indicates the high demand for mental health services at the ED. A thorough psychiatric assessment can provide adequate psychiatric services to acute patients; thereby possibly preventing suicide attempters from later actually dying by suicide.
Diagnosis ; Dihydroergotamine ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Japan* ; Mental Disorders ; Mental Health Services ; Neurocognitive Disorders ; Referral and Consultation* ; Retrospective Studies ; Sleep Initiation and Maintenance Disorders ; Suicide

Cardiac tumors are rare, and multiple myxomas are even rarer. The latter phenomenon is mostly associated with the Carney complex, a dominantly inherited disease characterized by multiple primary cardiac myxomas, endocrinopathy, and spotty pigmentation of the skin. We report the rare case of a patient who did not have the Carney complex but had multiple primary cardiac tumors. A 78-year-old woman with a past history of breast cancer was referred to our hospital for further examination of multiple cardiac tumors. Echocardiography showed 4 tumors in the left atrium and left ventricle. We could not diagnose them preoperatively and decided to resect them surgically because they were mobile and could have caused embolism and obstruction. The postoperative pathological findings of all 4 tumors were myxomas, although the patient did not meet the diagnostic criteria of the Carney complex. Therefore, a rare case of multiple primary cardiac myxomas was diagnosed.
Aged ; Breast Neoplasms ; Carney Complex* ; Echocardiography ; Embolism ; Female ; Heart Atria ; Heart Neoplasms ; Heart Ventricles ; Humans ; Myxoma* ; Pigmentation ; Skin

Background: Although community-based training is included in medical undergraduate education in Japan, little assessment of the outcomes of community-based education programs has been performed. The aim of this study was to investigate the outcomes of a community-based education program using a mixed method.
Methods: The study design utilized both qualitative and quantitative methods (mixed method). The subjects (n = 278) were fifth-grade medical students who were involved in the program from 2008 to 2010 inclusive. We collected two types of data: a six-item pre-and-post questionnaire (quantitative) and an open-ended questionnaire (qualitative) to evaluate the impressions this experience left on the students.
Results: Pre-and-post questionnaires were completed by 263 (95%) of 278 subjects; on all items, the scores of the post- data were significantly higher than that of pre- data (P < 0.001). From the responses given by 139 respondents (total 181, 77%) in the open-ended questionnaire survey, 10 themes were extracted: 1. Inter-professional cooperation; 2. Role and cooperation among university hospitals, community hospitals, clinics, and welfare facilities; 3. Patient-centered medicine; 4. Trust-based relationships; 5. Competency in general medicine; 6. Professionalism; 7. Medical management; 8. Communication; 9. Common diseases; and 10. Long-term care.
Conclusions: We found that medical students gained four major perspectives from their experiences: Inter-professional cooperation, trust based relationships, roles of community hospitals and clinics, and patient-centered medicine, respectively. Our findings suggest this program contributed significantly to their understanding of community medicine.

Background : The improvement in surgical results for congenital heart disease has resulted in an increase in the number of adult congenital heart disease (ACHD) cases. Some ACHD patients are known to develop thoracic aortic aneurysm (TAA) at a young age, so we examined TAA in ACHD patients presenting at our institute over a 10-year interval. Methods : From 2002 to 2011, we performed 32 cases of surgery for TAA in ACHD patients. We excluded 5 cases of adult bicuspid aortic valve, 2 of TAA with untreated congenital heart disease (CHD), 1 of Marfan syndrome with CHD, and 9 of coarctation of the aorta (CoA) repair for the same site ; 15 patients were included. Results : The male/female ratio was 13/2, and the age of reoperation was 33.3±10.8 years. The 15 ACHD patients included 5 cases of the tetralogy of Fallot (TOF), 4 of congenital aortic stenosis (AS), 3 of ventricular septal defect (VSD), and 1 of each CoA complex, polysplenia/double outlet right ventricle (DORV), and polysplenia/corrected transposition of the great arteries (cTGA). Twelve cases of root dilatation and 2 of ascending aortic aneurysm were observed and 10 cases were concomitant with moderate to severe aortic regurgitation. Thirteen cases underwent elective surgery and the other two cases were emergency surgeries : a Bentall procedure for type 2 acute aortic dissection of polysplenia/DORV, and a Bentall and right ventricular outflow reconstruction (RVOTR) for ascending aorta/right ventricle rupture due to Konno patch detachment in congenital AS. The 13 elective cases included 11 cases of Bentall procedure, 1 of ascending aorta/hemi arch replacement, and 1 of ascending aorta replacement. Concomitant procedures were 1 case of aortic valve replacement, 1 of mitral valve replacement, 1 of subaortic stenosis release, and 2 of RVOTR. Operation time was 572.8+/-101.4 min, cardiopulmonary bypass time was 295.8+/-100.2 min, and aorta clamp time was 188.1+/-58.8 min. One hospital death was observed in 1 emergency case due to methicillin-resistant Staphylococcus aureus (MRSA) sepsis, but no 30-day mortality was observed. Intensive care unit (ICU) stay was 9.4+/-10.1 days and hospital stay was 34.4+/-18.2 days. Conclusion : The most common ACHD found during TAA surgery in our institute was Tetralogy of Fallot. ACHD had various complications and restrictions for surgery but TAA surgery in ACHD patients was safe and feasible.

OBJECTIVE: Agonists of alpha7-nicotinic acetylcholine receptors (nAChRs) have been developed as potential therapeutic drugs for neuropsychiatric diseases such as schizophrenia and Alzheimer's disease. Positron emission tomography (PET) is a noninvasive brain imaging technique to measure receptor occupancy in the living human brain. Although much effort has been expended to create specific PET radioligands for alpha7-nAChRs in the brain, only 4-[11C]methylphenyl-1,4-diazabicyclo[3.2.2.]nonane-4-carboxylate ([11C]CHIBA-1001) is currently available for clinical studies. In contrast, two 5-hydroxytryptamine-3 (5-HT3) receptor antagonists, tropisetron and ondansetron, have been used to treat patients with chemotherapy-induced or postoperative nausea and vomiting. Furthermore, tropisetron, but not ondansetron, possesses high affinity for alpha7-nAChRs. In the present study, we evaluated the receptor occupancy in the human brain after a single oral administration of tropisetron and ondansetron using [11C]CHIBA-1001 and PET. METHODS: Two serial dynamic PET scans using [11C]CHIBA-1001 in healthy non-smoking male subjects were performed before and after receiving an oral administration of these medications. RESULTS: A single oral administration of tropisetron, but not ondansetron, decreased the total distribution volume of [11C]CHIBA-1001 in the human brain. CONCLUSION: This study shows that tropisetron, but not ondansetron, could bind to alpha7-nAChRs in the human brain after a single oral administration. Therefore, [11C]CHIBA-1001 may be a useful PET radioligand to measure the occupancy of alpha7-nAChRs in the human brain.
Administration, Oral ; Alzheimer Disease ; Brain ; Electrons ; Humans ; Indoles ; Male ; Neuroimaging ; Ondansetron ; Positron-Emission Tomography ; Postoperative Nausea and Vomiting ; Receptors, Cholinergic ; Receptors, Nicotinic ; Schizophrenia

[Purpose] To investigate the relation between isotonic leg extension strength (ILES) and the prevalence of metabolic syndrome (MS) in Japanese male adults.[Methods] This cross-sectional study included 395 Japanese men. Metabolic syndrome was determined according to the criteria of International Diabetes Federation (IDF), Japan Society for the Study of Obesity (JASSO), or National Cholesterol Education Program's Adults Treatment Panel III (NCEP-ATPIII). Muscular strength was measured on a horizontal dynamometer. Subjects were divided into tertile levels according to ILES (watts/kg). Multiple logistic regression analysis was used to examine the relation between ILES levels and the prevalence of MS.[Results] The prevalence of MS were 14.4% (IDF), 17.0%(JASSO), and 20.0% (NCEP-ATPIII). After adjustment for confounding factors, the odd's ratios (95% confidence interval) of MS (IDF) compared with the lowest ILES level were 0.90 (0.48-1.68) and 0.31 (0.13-0.64) in the middle and high levels of ILES (p for trend=0.03). The association between the level of ILES and the prevalence of MS by JASSO and NCEP-ATPIIIcriteria were similar.[Conclusion] The prevalence of MS was associated with the level of ILES.

Objective: In 2000, the Ministry of Health and Welfare issued an advisory that recommended intake of 0.4mg of folic acid in dietary supplements to reduce the risk of development of neural tube defects.  Since subsequent reports of questionnaire surveys by various investigators showed a low in the intake rate, we surveyed and evaluated the folic acid intake rate among the pregnant women consulting the Japan Drug Information Institute in Pregnancy.
Methods: We evaluated differences in folic acid intake rate according to the consulting women’s background factors. i.e., age, pregnancy planning, pregnancy history, and taking of anticonvulsant drugs in the 1053 women capable of participating in the survey among the 1061 pregnant women who requested a consultation with the Japan Drug Information Institute in Pregnancy between April 2006 and August 2008.
Results: According to the result of our survey, the intake rate of folic acid was 29% of the 1053 pregnant women.  The only 3 women of the 42 pregnant women taking anticonvulsant drugs took folic acid before they got pregnant.
Conclusion: Even now, 8 years after the Ministry of Health and Welfare advisory, the folic acid intake rate is low.  Drawing upon successful measures promoting intake in the U.S. and Canada,we play a vital role in delivering this critical health information to pregnant women.

Kampo medicines have been used for treatment by an increasing number of doctors in recent years, and are becoming more frequently prescribed in combination with Western drugs. In the present study, we conducted a questionnaire of outpatients at the Kampo Clinic of Keio University Hospital in order to determine their perceptions and compliance regarding Kampo medicines.Ninety eight percent of patients used Kampo medicines in granular form, and approximately 30% of these patients reported difficulty in taking medicine due to reasons such as “bad taste”. Sixty percent of patients used Kampo medicines three times daily. Patients most often forgot to take afternoon doses, and so desired doses once daily. Furthermore, the same number of patients preferred Kampo medicines in tablet form as those who preferred Kampo medicines in granular form.The present findings clarified patients' perceptions toward Kampo medicines. Doctors and pharmacists must provide suitable treatment for patients by recognizing their perceptions of Kampo medicines.
Medicine, Kampo ; Clinic ; Use of ; percent ; therapeutic aspects

Background : Since 2002, Keio University Hospital's Kampo Clinic has promoted itself actively through the media, public presentations, faculty outreach and an internet home page. However, the relative value of these promotions is unknown. Additionally, the range and prevalence of presenting concerns, and the ages and the gender ratio of the patients served at Keio is unknown.Objective and Methods : To better understand and better serve the patients, the medical charts of every new patient who presented to Keio University Hospital's Kampo Clinic from November 2004 to November 2005 (n=791) were retrospectively analyzed for 1) referral source, 2) age, 3) gender, and, 4) disease category.Results : The internet webpage was by far the best source of new patient referrals. The out-of-hospital referral rate to the clinic was remarkably low. Women exceeded men by a 3 : 1 ratio. Most women were in their thirties but male patients were fairly evenly distributed across the age spectrum. Patients under 16 and over 70 were gender-balanced. The vast majority of patients presented with general medicine/pediatric, dermatological or gynecological problems.Conclusion : A patient-oriented internet home page provides a good source of new patient referrals. Given the low rate of referrals from outside hospitals and physicians, additional outreach directed at internal medicine, dermatology or obstetrics/gynecology physicians appears warranted.
Clinic ; Hospitals ; Medicine, Kampo ; seconds ; Universities