Post-myocardial infarction ventricular septal perforation (VSP) is one of the lethal complications of transmural myocardial infarction. Although the treatment of VSP mostly requires surgical procedures using heterologous pericardium, thromboembolism rarely occurs in patients who undergo VSP repair. Herein we report the case of a patient who died of sudden massive cerebral infarction two weeks after the surgery. The autopsy findings revealed concaved mural LV thrombus in the dissected heart. It is suspected that the patient died of extensive cerebral infarction due to thromboembolic occlusion of the carotid or central cerebral artery. In the postoperative period after VSP repair, several risk factors for thrombus formation may occur, such as postoperative hypercoagulability due to systemic inflammation by the high operative invasiveness, the presence of foreign material in the impaired left ventricle, or pericardial patch suturing methods. Our clinical experience indicates that meticulous postoperative management may be needed, keeping LV thrombus formation in mind after VSP repair.

Introduction: The purpose of this study was to examine the effects of cognitive rehabilitation for depression, cognitive function, ADL, and QOL in patients with post-stroke depression (PSD). In addition, we evaluated the effects of cognitive rehabilitation on customer satisfaction with long-term care facilities and rehabilitation.Methods: This study included 8 participants with PSD who were residents of a long-term care facility located in Ibaraki Prefecture, Japan. In addition to their ordinary rehabilitation (2 sessions per week, 20 minutes per session), participants underwent 36 sessions of cognitive rehabilitation (3 sessions per week, 20 minutes per session, for 12 weeks). Primary outcome measures: Depression severity was measured using the Geriatric Depression Scale (GDS), Zung Self Depression Scale (SDS), and the Depression Scale of the Japan Stroke Scale (JSS-D). Frontal lobe function was assessed using the Frontal Assessment Battery (FAB). Secondary outcome measures: QOL was assessed using SF-8. Customer Satisfaction with the rehabilitation was measured using the Customer Satisfaction Scale based on Need Satisfaction (CSSNS). Assessments were performed before and after the rehabilitation.Results: The severity scores of depression, frontal lobe function, and customer satisfaction with the rehabilitation all significantly improved after the cognitive rehabilitation sessions.Conclusions: The results obtained in this trial indicate that, for patients with PSD depressive symptoms, frontal lobe function, QOL, and rehabilitation customer satisfaction may be improved by the inclusion of cognitive rehabilitation sessions alongside regular rehabilitation.

Ulcerative colitis (UC) is 1 of the 2 major phenotypes of chronic inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms that impair function and quality of life. Further, IBD often affects women during childbearing age. Indeed, UC activity frequently increases during pregnancy, and the medications used to induce remission may adversely affect the health of the mother and the unborn child. We report successful induction of a remission in a UC case who experienced a flare-up in the first trimester of pregnancy. Upon relapse, she was treated with steroids and adsorptive granulomonocytapheresis (GMA) with the Adacolumn plus tacrolimus. This combination therapy induced a stable remission that was maintained during her entire pregnancy. She gave birth to a healthy child at 36 weeks of pregnancy with no maternal or fetal complications. Our experience indicates that GMA, as a non-drug therapeutic intervention with a favorable safety profile, plus tacrolimus might be a relevant treatment option for patients with active IBD during pregnancy. A future study of a large cohort of pregnant patients should strengthen our findings.
Child ; Cohort Studies ; Colitis, Ulcerative* ; Female ; Humans ; Inflammatory Bowel Diseases ; Mothers ; Parturition ; Phenotype ; Pregnancy Trimester, First ; Pregnancy* ; Quality of Life ; Recurrence ; Steroids ; Tacrolimus* ; Ulcer*

BACKGROUND: To improve postoperative outcomes associated with interstitial pneumonia (IP) in patients with lung cancer, the management of the postoperative a cute exacerbation of IP (PAEIP) was investigated. METHODS: Patients with primary lung cancer were considered to be at risk for PAEIP (possible PAEIP) based on a preoperative evaluation. The early phase of this study was from January 2001 to December 2008, and the late phase was from January 2009 to December 2014. In the early phase, chest computed tomography (CT) was performed for patients for whom PAEIP was suspected based on their symptoms, whereas in the late phase, chest CT was routinely performed within a few days postoperatively. The numbers of possible PAEIP cases, actual PAEIP cases, and deaths within 90 days due to PAEIP were compared between both phases. RESULTS: In the early and late phases, surgery was performed in 712 and 617 patients, 31 and 72 possible PAEIP cases were observed, nine and 12 actual PAEIP cases occurred, and the mean interval from the detection of PAEIP to starting treatment was 7.3±2.3 and 5.0±1.8 days, respectively. Five patients died in the early phase, and one patient died in the late phase. Significantly fewer PAEIP-related deaths were observed in the late phase (p<0.05). CONCLUSION: Identifying patients at risk for PAEIP by routine postoperative CT examinations led to the early diagnosis and treatment of PAEIP, resulting in the reduction of PAEIP-related mortality.
Early Diagnosis ; Humans ; Lung Diseases, Interstitial* ; Lung Neoplasms* ; Lung* ; Mortality ; Thorax* ; Tomography, X-Ray Computed

Caseous calcification of mitral annulus is a rare disease characterized by tumors of the mitral cusps. Operative case reports, however, are rare because this lesion seldom negatively affects hemodynamics. We encountered a 67-year-old female case of mitral regurgitation with caseous calcification of mitral posterior annulus due to ischemic heart disease and performed mitral valve replacement and CABG. The excision of the mitral thickened lesion resulted in a defect of the mitral annulus, which needed to be repaired with an autologous pericardial patch. We mainly report the intraoperative findings of this case.

BACKGROUND/AIMS: The aim of this study was to examine the convenience of the quality of life and utility evaluation survey technology (QUEST) questionnaire and the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) questionnaire as self-assessment diagnostic instrument. METHODS: This was a two-way crossover study conducted over 6 weeks from September 2010 to November 2010. The subjects were 60 consecutive patients admitted to the Hiratsuka city hospital with a gastrointestinal condition, regardless of the coexistence of heartburn. They were assigned to fill in both the QUEST and FSSG questionnaires in random order. We analyzed the time taken to complete the questionnaires, whether subjects asked any questions as they filled in the questionnaire, and the questionnaire scores. RESULTS: Comparison of the QUEST and the FSSG revealed significant differences in the completion time (196.5 vs. 97.5 seconds, respectively; P < 0.0001) and in whether subjects asked any questions (37 vs. 15 subjects, respectively; P < 0.0001). Completion time in QUEST scores of > or = 4 was lower than < 4 (170.5 vs. 214.0 seconds, respectively; P = 0.022), and the QUEST score was significantly higher without questions than with question (3 vs. 1 points, respectively; P = 0.025). CONCLUSIONS: This study revealed that the FSSG questionnaire may be easier for Japanese subjects to complete than the QUEST questionnaire.
Asian Continental Ancestry Group ; Cross-Over Studies ; Gastroesophageal Reflux ; Heartburn ; Hospitals, Urban ; Humans ; Quality of Life ; Surveys and Questionnaires ; Self-Assessment

BACKGROUND/AIMS: The administration of liquid nutrients to patients is often accompanied by complications such as gastroesophageal reflux. To prevent gastroesophageal reflux, high-viscosity liquid meals are used widely, however, it still remains controversial whether high-viscosity liquid meals have any effect on the rate of gastric emptying. The present study was conducted with the aim of determining whether high-viscosity liquid meals had any effect on the rate of gastric emptying and mosapride might accelerate the rate of gastric emptying of high-viscosity liquid meals. METHODS: Six healthy male volunteers underwent 3 tests at intervals of > 1 week. After fasting for > 8 hours, each subject received one of three test meals (liquid meal only, high-viscosity liquid meal [liquid meal plus pectin] only, or high-viscosity liquid meal 30 minutes after intake of mosapride). A 13C-acetic acid breath test was performed, which monitored the rate of gastric emptying for 4 hours. Using the Oridion Research Software (beta version), breath test parameters were calculated. The study parameters were examined for all the 3 test conditions and compared using the Freidman test. RESULTS: Gastric emptying was significantly delayed following intake of a high-viscosity liquid meal alone as compared with a liquid meal alone; however, intake of mosapride prior to a high-viscosity liquid meal was associated with a significantly accelerated rate of gastric emptying as compared with a high-viscosity liquid meal alone. CONCLUSIONS: This study showed that high-viscosity liquid meals delayed gastric emptying: however, mosapride recovered the delayed rate of gastric emptying by high-viscosity liquid meals.
Benzamides ; Breath Tests ; Cross-Over Studies ; Fasting ; Gastric Emptying ; Gastroesophageal Reflux ; Humans ; Male ; Meals ; Morpholines ; Pectins

Patients with chronic type B aortic dissection usually require surgical repair due to aortic dissection-related complications, whereas those with uncomplicated type B acute aortic dissection can usually be managed with medical therapy. Disseminated intravascular coagulopathy (DIC), as well as aortic enlargement, visceral or limb ischemia and recurrent dissection, has been reported as one of the rare complications of type B aortic dissection which require surgical treatment in the chronic phase. DIC is a severe complication which can result in catastrophic events such as gastrointestinal and cerebral bleeding. The management of DIC as a complication of chronic aortic dissection is still controversial, as medical treatment involving anticoagulants and the supplementation of coagulation factors via a transfusion of fresh frozen plasma is not completely reliable. Surgical treatment to close a false lumen can be corrective, but carries the risk of excessive bleeding due to DIC. We report a patient with chronic type B dissection with a patent false lumen complicated by overt DIC. This patient had frequent occurrences of purpura on the upper and lower extremities. Contrast computed tomography in the late phase showed stagnation of contrast medium in the thoracic false lumen, which strongly idicated this false lumen to be the origin of the DIC. We gave the patient a continuous drip infusion of heparin (12,000 U/day) for 1 week before the operation, after which we performed total aortic replacement in order to thrombose the false lumen. His coagulation profile, including platelet count, prothrombin time, international normalized ratio and clinical symptoms improved immediately after the operation. Computed tomography (CT) performed 3 months after the operation showed complete thrombosis and obstruction of the false lumen in the thoracic aorta. The patient is currently well and has resumed routine activities. The continuous infusion of heparin for 1 week was highly effective to improve the coagulopathy in the present case. This case underscores the importance of conducting follow-up to evaluate coagulation-fibrinolysis system function and to measure the aortic diameter by CT in patients with chronic type B aortic dissection with a patent false lumen. Comparison of the early and late phases of contrast-enhanced CT was extremely useful to determine the cause of coagulopathy in this case. Furthermore, the coagulopathy was successfully treated by total aortic arch replacement to close the entry of the false lumen.

BACKGROUND/AIMS: There are few reports on the correlation between chewing gum and the gastrointestinal functions. But previous report showed use of chewing gum to be an effective method for controlling gastrointestinal symptoms. The aim of this study was to determine the correlation between chewing gum and gastric emptying using the continuous real time 13C breath test (BreathID system). METHODS: Ten healthy male volunteers participated in this randomized, 2-way crossover study. The subjects fasted overnight and were randomly assigned to chewing gum (Xylish, 2-3/1 tablet) for an hour following intake of a test meal (200 kcal/200 mL) or intake of the test meal alone. Gastric emptying was monitored for 4 hours after administration of the test meal by the 13C-acetic acid breath test performed continually using the BreathID system. RESULTS: No significant differences in the calculated parameters, namely, T1/2 (median, 111.82 vs 109.26 minutes; P = 0.575), Tlag (median, 53.28 vs 56.53 minutes; P = 0.333), gastric emptying coefficient (median, 3.58 vs 3.65; P = 0.285), regression-estimated constant beta (median, 1.85 vs 1.80; P = 0.575) and regression-estimated constant kappa (median, 0.61 vs 0.62; P = 0.959) were observed between the test meal alone group and the test meal and chewing gum group. CONCLUSIONS: This study showed that chewing gum had no effect on the rate of gastric emptying. Therefore, since chewing gum did not enhance the speed of gastric emptying, it may ameliorate gastrointestinal symptoms through other mechanisms, such as saliva and autonomic nervous system.
Autonomic Nervous System ; Breath Tests ; Chewing Gum ; Cross-Over Studies ; Gastric Emptying ; Humans ; Male ; Mastication ; Meals ; Saliva

BACKGROUND/AIMS: The effects of Histamine-2 receptor antagonists and proton pump inhibitors on the gastrointestinal motility have not yet been sufficiently investigated. The aim of this study was to determine the effects of intravenous bolus administration of famotidine and omeprazole on the rate of gastric emptying using the continuous 13C breath test (BreathID system, Exalenz Bioscience Ltd, Israel). METHODS: Twelve healthy male volunteers participated in this randomized, 3-way crossover study. After fasting overnight, the subjects were randomly assigned to receive 20 mg of famotidine, 20 mg of omeprazole or 20 mL of saline alone by intravenous bolus injection before a test meal (200 kcal per 200 mL, containing 100 mg of 13C-acetate). Gastric emptying was monitored for 4 hours after the ingestion of test meal by the 13C-acetic acid breath test performed using the BreathID system. RESULTS: No significant differences in the calculated parameters, namely, the T1/2, Tlag, GEC, beta and kappa, were observed among the 3 test conditions. CONCLUSIONS: The study revealed that intravenous administration of gastric acid suppressant drugs had no significant influence on the rate of gastric emptying in comparison with that of saline alone as a placebo. Our results indicating the absence of any effect of either famotidine or omeprazole on accelerating the rate of gastric emptying suggest that both medications can be administered safely to patients suffering from hemorrhagic peptic ulcers who need to be kept nil by mouth from the viewpoint of possible acceleration of gastrointestinal motility in the clinical setting.
Acceleration ; Administration, Intravenous ; Breath Tests ; Cross-Over Studies ; Eating ; Famotidine ; Fasting ; Gastric Acid ; Gastric Emptying ; Gastrointestinal Motility ; Humans ; Male ; Meals ; Mouth ; Omeprazole ; Peptic Ulcer ; Proton Pump Inhibitors ; Proton Pumps ; Protons ; Stress, Psychological