Takotsubo cardiomyopathy is a transient wall motion abnormality of the left ventricular apex, accompanied by emotional or physical stress. Although Takotsubo cardiomyopathy is generally considered a benign disease, severe clinical complications may occur, and early detection of the disease is important. In this report, we present the case of an 86-year-old bedridden woman with a history of bronchial asthma who was transferred to our hospital because of wheezing. She was diagnosed with Alzheimer’s disease and had communication difficulties. After an asthma attack and improvement, Takotsubo cardiomyopathy was identified via electrocardiography. She was unable to complain of any symptoms but showed serial electrocardiographic changes, elevated myocardial markers, and transient left ventricular apical ballooning. The prevalence of dementia increases dramatically with age. This case indicates that Takotsubo cardiomyopathy may occur even in patients with severe dementia, who are bedridden and show communication difficulties in a clinical setting.

Prophylaxis is sometimes offered to inpatients who share a room with, or individuals who have been in close contact with, patients who have contracted influenza. In our hospital, 5-day prophylactic oseltamivir has been used as a standard procedure. Here, we investigated the effectiveness of this post-exposure prophylaxis for inpatients and healthcare professionals, as well as its effect on hospital management. The study period was 5 years from fiscal year 2013 to fiscal year 2017, and the effectiveness outcome was the secondary infection rate. Medication costs for this prophylaxis were compared with those for oseltamivir used according to the package insert. The secondary infection rates were 3.0% and 0.5% in 133 inpatients and 434 healthcare professionals who had received post-exposure oseltamivir, respectively. The medication costs were reduced by 50% compared with the estimated costs for 10-day oseltamivir administration. The effectiveness of 5-day prophylactic oseltamivir was similar to or higher than that reported previously, indicating that this prophylaxis was effective. Moreover, 5-day post-exposure prophylactic oseltamivir is expected to reduce the prolongation of hospital stay and influenza outbreaks and thus contribute to hospital management.

Objective : In 2011, the Ishikawa Prefectural Joint Committee of Blood Transfusion Therapy was organized in Ishikawa Prefecture. Since 2012, pharmacists have promoted educational activities regarding the appropriate use of albumin products for different occupations based on a survey involving all medical institutions in Ishikawa Prefecture. We examined the effects of these activities with respect to the usage of albumin products. Methods : A questionnaire survey regarding blood transfusion therapy, including the total usage of albumin products, departments responsible for the management of albumin products, and health care professionals’ awareness of issues on the appropriate use of albumin products, was conducted from 2011 until 2014 involving all medical institutions where blood transfusion preparations were used in Ishikawa Prefecture. Results : The questionnaire collection rate was ≥70%. The results showed that, in middle- or small-scale medical institutions, departments/physicians other than the Department of Pharmacy were responsible for the management of albumin products. Furthermore, some health care professionals did not recognize/understand problems regarding the appropriate use of albumin products. Pharmacists newly increased educational activities by study meetings for various occupations or panel discussions involving participants. The participants’ occupations varied, and the number of institutions to which they belonged was 20 to 24. The total usage of albumin products in Ishikawa Prefecture decreased by approximately 20% between 2011, when these attempts were started, and 2014. Discussion : This study suggests that the educational activities by pharmacists and other health care professionals at the prefectural level reduced the total usage of albumin products.

A 69-year-old man was referred to our hospital because of a right upper mediastinal mass observed on chest roentgenogram. Computed tomography showed a dissecting aneurysm of the right subclavian artery and dissection of the ascending aorta. Furthermore, the ascending aorta was dilated. We subsequently reconstructed the right subclavian artery with a bypass graft and replaced the ascending aorta. Two-thirds of the aortic arch was placed in deep hypothermic circulatory arrest with retrograde cerebral perfusion. His postoperative course was uneventful with no neurological complications. While subclavian artery aneurysms are relatively rare in comparison to other peripheral artery aneurysms, subclavian artery aneurysms with aortic dissections are even rarer. The most important concerns during subclavian artery aneurysm repair are the method of surgical approach and the maintenance of sufficient cerebral flow. We suggested that deep hypothermic circulatory arrest with retrograde cerebral perfusion might prove useful in cases involving an intramural thrombus adherent to cerebral vessels. Therefore, patients with subclavian artery aneurysms must undergo extensive preoperative evaluation.

Alleles ; Gene Frequency ; Genetic Association Studies ; Genetic Predisposition to Disease ; Histones/genetics* ; Humans ; Japan ; Male ; Polymorphism, Single Nucleotide ; Sertoli Cell-Only Syndrome/genetics* ; Testis

The rectal tonsil is a rare polypoid lesion exclusively found in the rectum and is considered a reactive proliferation of the lymphoid tissue. Although this lesion is benign, we recommend that it should be differentiated from carcinoid or polypoid type of mucosa-associated lymphoid tissue lymphomas, based on gross findings. In this case report, we describe a case of rectal lesions with a unique appearance in a 41-year-old man. Colonoscopy revealed two 5-mm-sized nodules located opposite from each other on the left and right sides of the lower rectum. Endoscopic mucosal resection was conducted. Histopathologically, both lesions were mainly located in the submucosa and consisted of prominent lymphoid follicles with germinal centers of various sizes. No immunoreactivity of Bcl-2 was seen in the germinal centers. Immunohistochemical staining for kappa and lambda light chains revealed a polyclonal pattern. Therefore, these lesions were diagnosed as rectal tonsils.
Adult ; Carcinoid Tumor* ; Colonoscopy ; Germinal Center ; Humans ; Lymphoid Tissue ; Lymphoma, B-Cell, Marginal Zone* ; Palatine Tonsil* ; Rectum ; Twins*

　The education program in all medical schools in Japan has been studied and analyzed every 2 years since 1974 by the curriculum committee of the Association of Japan Medical Colleges. Based on the most recent analysis in 2015, the marked innovation of medical education, such as an integrated curriculum, active learning, and clinical clerkship, was recognized.

Nonvariceal upper gastrointestinal (GI) bleeding is one of the most common reasons for hospitalization and a major cause of morbidity and mortality worldwide. Recently developed endoscopic devices and supporting apparatuses can achieve endoscopic hemostasis with greater safety and efficiency. With these advancements in technology and technique, gastroenterologists should have no concerns regarding the management of acute upper GI bleeding, provided that they are well prepared and trained. However, when endoscopic hemostasis fails, endoscopy should not be continued. Rather, endoscopists should refer patients to radiologists and surgeons without any delay for evaluation regarding the appropriateness of emergency interventional radiology or surgery.
Emergencies ; Endoscopy ; Equipment and Supplies ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Hospitalization ; Humans ; Mortality ; Radiology, Interventional

Background: Blood culture is an essential examination for diagnosis of causative microorganisms and determination of optimal antimicrobials in serious cases of infectious diseases. We examined temporal trends in the number and multiplicities of blood culture submission, two pre-analytic parameters indicating quality of the examination, in the Minami Ibaraki Area.
Methods: We reviewed all computerized and available paper-based laboratory records of microbiological examination in five hospitals in the area between 2002 and 2011.
Results: Blood culture submissions, estimated to be 2.4–7.3 (median: 5.1) sets per hospital bed, 8.6–23 (17) per 1,000 inpatient-days, and 0.13–0.41 (0.25) per newly admission in 2011, almost constantly increased during the study period in all hospitals. Proportions of blood specimens to all materials for microbiological cultures also increased up to 15–30% (20%) in 2011. In contrast, it was not until the latter half of the study period that solitary submission, accounting for 26–56% (35%) in 2011, decreased. Positive blood cultures were between 11 and 28% through the study period. Coagulase-negative staphylococci accounted for approximately one fourth of recovered organisms in 2006 and 2011.
Conclusion: Frequency and multiplicity of blood culture submission markedly increased in hospitals in the Minami-Ibaraki Area of Japan.

Objective To investigate the clinical characteristics of inferior acute myocardial infarction (IAMI) with different inferior ST segment change.Methods The clinical data of 64 cases with acute anterior wall myocardial infarction from January 2010 to February 2012 in the hospital were prospectivly analyzed.According to wall leads ECG ST segment in the change situation,they were divided into three groups,group A (16 cases),under the wall (]Ⅱ,Ⅲ,aVF) of at least two lead ST segment elevation ≥0.1mV,group B(26 cases) under the wall(Ⅱ,Ⅲ,aVF) of at least two lead ST segment depression,group C (22 cases) under the wall(Ⅱ,Ⅲ,aVF) only a lead or no ST segment change.The infarct related artery,acute anterior wall myocardial infarction with different inferior ST-T change (infarction related coronary artery,IRCA),the infarct size and heart function were studied.Results IRCA in the three groups was consistent.The comparison of IRCA among the three groups showed that,A group of patients with “around the apical LAD” COSCO segment,accounting for 81.25％,and 26 cases in B group were not “around the apical LAD”,which was not “around the apical LAD” in 18 cases,8 cases of non-“ around the apex” COSCO LAD,of 22 patients in C group,21 cases non-“ around the apical LAD”,1 case was “around the apical LAD” COSCO,and the difference was statistically significant(F =6.32,5.92,7.08,4.11,all P ＜ 0.05).Conclusion IRCA is the LAD of acute anterior wall myocardial infarction of inferior ST segment changes may be related with the length of LAD and the lesion site,changes of inferior ST segment of anterior wall AMI can predict the IRCA position and LAD morphology,consistent with most studies.Patients with anterior wall and inferior wall ST segment elevation if IRCA is “around the apical LAD”,the infarction area is smaller,better heart function.