Purpose: This study aimed to analyze the terminal care attitudes of healthcare members engaged in palliative care and the factors associated with these attitudes. Methods: We conducted a survey for healthcare members engaging in palliative care including oncologists and palliative care doctors using the Japanese version of the Frommelt Attitudes Toward Care of the Dying (FATCOD B-J), a scale that measures the attitude of medical stuff toward the care of dying patients. Results: A total of 223 (response rate=42.2%) responses were obtained and analyzed. Multiple regression analysis using the FATCOD B-J total score as the objective variable showed that 30s had lower partial regression coefficients than 40s (−3.8). Higher “satisfaction from work” and “interest in palliative care” were associated with greater partial regression coefficients (+5.7, +6.2). Conclusion: A sense of satisfaction and interest in palliative care may be important to cultivate terminal care attitudes among health care providers involved in palliative care.

Results: The study included 101 patients (84 females) with a median follow-up period of 23.6±14.2 months. The persistence rate declined to 85.3%, 78.3%, 74.1%, 71.3%, and 69.3% at 12, 24, 36, 48, and 60 months, respectively. Age at the initiation of denosumab therapy differed significantly between non-persistent (n=31) and persistent (n=70) patients (81.3 vs. 72.8 years, p <0.01). Persistence was significantly lower in patients aged ≥80 years than in those aged <60 and 60–79 years (both p <0.01). The reasons for non-persistence of denosumab therapy were transfer to another hospital (n=13), interruption of outpatient visits (n=11), dental treatment (n=4), adverse events (n=2), and patient request (n=1). Conclusions Persistence was significantly lower in patients aged ≥80 years than in patients of other ages, and strategies promoting persistence are needed for these elderly patients.

Methods: The subjects were 23 children with LLD ≥20 mm (range, 27–65 mm) treated at Nagoya University Hospital between 2007 and 2017. Whole spine posteroanterior standing radiographs and whole lower limb radiographs in a supine position were recorded. Data were collected for demographics, LLD, Cobb angle, pelvic obliquity, and Nash/Moe index. Scoliosis was defined as a Cobb angle ≥10°. Leg length was measured from the top of the femoral head to the middle of the tibial plafond, and LLD was defined as the difference between the left and right leg lengths. Results: The patients (nine males and 14 females) had a mean age of 14.0 years (range, 5–18 years). The average LLD was 44.3±17.2 mm, with LLDs of 20 to 39 mm, 40 to 59 mm, and ≥60 mm in 13, five, and five subjects, respectively. The average Cobb angle was 13.0°±7.0°, and 15 subjects (65%) had scoliosis. Convexity of the scoliosis was to the short leg side in all cases. The Cobb angle was significantly related to the severity of the LLD (R=0.736, p<0.01), pelvic obliquity (R=0.966, p<0.01), and Nash/Moe index (p<0.05). Conclusions LLD is a common pediatric condition that can cause scoliosis of the spine. Severe scoliosis may develop if the LLD is ≥30 mm. Long-term studies are needed to examine the effect of LLD resolution on the elimination of scoliosis.

A 15-year-old boy with coronary sinus type atrial septal defect (CS-ASD) was surgically treated with 3-port totally endoscopic technique. The patient was set in a left semi-lateral position. A 3 cm skin incision retracted by a small wound protector, a trocar for the endoscope, and a trocar for left-handed instruments were placed in the right antero-lateral chest. Cardio-pulmonary bypass was established via groin cannulation. After cardioplegic arrest, the CS-ASD was favorably exposed through the left atriotomy, and closed using a bovine pericardial patch. The total operation time was 112 min. The post-operative course was uneventful. Instead of the traditional median sternotomy and right atriotomy, small right thoracotomy and left atriotomy may be a promising alternative for closure of CS-ASD.

A 68-year-old man was referred to our hospital for mitral valve stenosis, tricuspid valve insufficiency and atrial fibrillation. We performed mitral valve replacement, tricuspid valve plasty, and the MAZE operation through a right small thoracotomy under endoscopic assistance. He was discharged uneventfully 7 days after the operation. However, about 2 months later, he developed pericardial effusion, right pleural effusion, and leg edema implying as having right heart failure. Although he was treated with diuretics and steroids, improvement was temporary and he was hospitalized repeatedly. Cardiac catheterization demonstrated dip and plateau pattern of the right ventricular pressure curve. We diagnosed that he has constrictive pericarditis, although the finding of the chest CT was non-specific without remarkable thickening or calcification of the pericardium. We performed pericardiectomy through median sternotomy without pump assist. Leather-like thickening of the pericardium was recognized in the right, anterior, and inferior portion. Resection of the thickened pericardium led to instantaneous improvement of right ventricular motion and drop of central venous pressure. The patient is in NYHA Class I, one year after pericardiectomy. Constrictive pericarditis could occur even after minimally invasive surgery, and that possibility should be kept in mind if intractable right heart failure persists.

In order to investigate the effects of fruits granola intake on defecation and quality of life (QOL), 20 females (mean age: 20.0 ± 1.1 y.o.) with frequency of defecation of less than 5 times per week were selected for this open study. Daily intake of 50 g of fruits granola was used as a substitute staple food for 2 weeks, and changes in defecation and QOL were compared before and after the procedure. The results showed that, compared with the pre-intake period, the frequency of defecation and the amount of defecation increased after fruits granola intake (p = 0.014, p = 0.024), and improvement of QOL (p = 0.011) was also observed. We conclude that, a continuous intake of fruits granola can improve defecation, and also improve quality of life.

No abstract available.
Aortic Valve Insufficiency* ; Aortic Valve* ; Echocardiography, Transesophageal ; Vena Cava, Inferior*

The purpose of this study was to examine the health-related Quality of Life (QOL) of women and the effects of “fruits granola” on women’s health. It was based on an Internet questionnaire survey on QOL (using a QOL questionnaire for women that was prepared by LSTT Co., Ltd.) of 3,460 subjects who answered questions concerning physical and mental matters. It also had 165 subjects, 108 of whom had mild constipation and 57 of whom did not, consume fruits granola freely for a period of time and then compared their QOL before and after consumption.The results of the screening survey showed significantly higher scores in all categories among women who did not have constipation than women who did. Additionally, the mental QOL score was significantly higher among women who had the habit of eating fruits granola.Moreover, the overall QOL score significantly increased after consumption of fruits granola. These results suggest that consumption of fruits granola may be effective in improving women’s QOL.

A 58-year-old man was admitted with a complaint of exertional chest discomfort. A mass, 53×55×66 mm in size, was detected in the transverse sinus of the pericardium, just cranial to the inter-atrial septum with enhanced chest CT. We performed resection of the tumor under cardiopulmonary bypass. Histopathological findings showed that the tumor was angiomyolipoma originated from the heart. Angiomyolipoma is a benign tumor, most frequently found in the kidney or liver and usually associated with tuberous sclerosis. Extra-cardiac growth of the cardiac angiomyolipoma is extremely rare, and only few have been reported previously.

STUDY DESIGN: Animal study. PURPOSE: To review the present warning point criteria of the compound muscle action potential (CMAP) and investigate new criteria for spinal surgery safety using an animal model. OVERVIEW OF LITERATURE: Little is known about correlation palesis and amplitude of spinal cord monitoring. METHODS: After laminectomy of the tenth thoracic spinal lamina, 2-140 g force was delivered to the spinal cord with a tension gage to create a bilateral contusion injury. The study morphology change of the CMAP wave and locomotor scale were evaluated for one month. RESULTS: Four different types of wave morphology changes were observed: no change, amplitude decrease only, morphology change only, and amplitude and morphology change. Amplitude and morphology changed simultaneously and significantly as the injury force increased (p<0.05) Locomotor scale in the amplitude and morphology group worsened more than the other groups. CONCLUSIONS: Amplitude and morphology change of the CMAP wave exists and could be the key of the alarm point in CMAP.
Action Potentials* ; Animals* ; Contusions ; Gravitation ; Laminectomy ; Models, Animal* ; Spinal Cord