Cardiac papillary fibroelastoma (PFE) is a benign cardiac tumor that mainly occurs in the valve leaflets of the left heart. The patient was a 72-year-old man diagnosed with cerebral infarction. Contrast-enhanced computed tomography and transesophageal echocardiography revealed a 12-mm mass in the left atrial appendage (LAA), and we decided to undergo emergency cardiac tumor resection due to embolism onset. Postoperative pathological examination revealed an extremely rare cardiac PFE originating in the LAA.

Background: Extensive calcification of the mitral annulus (MAC) represents a problem for mitral surgery due to a technical difficulty for implanting prosthetic valves, because the calcium does not allow placing direct sutures through the annulus and para-prosthetic leakage or cardiac rupture may result. We describe our experience with mitral valve surgery with or without decalcification of the annulus. Methods: Since 2005, we performed mitral valve operations in 1,327 patients and among them, severe mitral annular calcification was present in 25 (1.9%). Results: The mean age was 75±9 years and there were 6 men and 19 women, with hemodialysis in 4. Mitral valve replacement (MVR) was performed in all patients. A concomitant operation was aortic valve replacement in 19 and coronary artery bypass grafting in 4 patients. The MAC was resected in 14 (Group-R) and was excluded in 11 (Group-E). In-hospital mortality was four patients in Group-R. The cause of death was congestive heart failure in two, cerebellar infarction in one, and respiratory failure in one. Postoperative morbidity included one patient with reexploration and one with prolonged respiratory failure The aortic cross clamp time was a mean of 180±44 min (range 108∼266 min) in Group-R and 139±32 min (range 61∼186 min) in Group-E (p=0.009). The size of the prosthetic mitral valve was 24.3±1.0 mm in Group-R and 24.6±0.8 mm in Group-E (p=0.618). The postoperative echocardiography showed no abnormal mean pressure gradient of mitral valve prosthesis nor para-valvular leak in any patients in either group. Conclusions: The mitral valve replacement without annular decalcification in a severely calcified mitral annulus is a safe and an effective approach in an elderly patient.

At our institution, various herbal medicines have been prescribed under the supervision of a herbal medicine supervisor for a wide range of clinical conditions in children with pediatric surgical diseases. At present, we continue to prescribe herbal medicines even in the absence of a herbal medicine supervisor. The aim of study is to continue and improve herbal medicines in pediatric surgery. A questionnaire survey was conducted among doctors prescribing herbal medicines in our department, and 14 doctors responded. All doctors agreed on their realization of the efficacy of herbal medicines and their willingness to study herbal medicines. Almost doctors obtained information on herbal medicine from the literature and decided on prescriptions based on the name of the disease and the symptoms. This survey showed that many doctors are aware of the effectiveness of herbal medicines and they prescribe herbal medicines to some extent in their own departments. As a result of this survey, three doctors from our department have received training in outpatient herbal medicine. Investigation of current problems through a fixed-point questionnaire survey would help to recognize the need for herbal medicine treatment in each department.

A 71-year-old woman was referred to our hospital with complaints of gross hematuria. She had been administered 50mg/day of cyclophosphamide for 13 years to treat idiopathic thrombocytopenic purpura (ITP). Cystoscopy revealed irregular surface of bladder mucosa. On suspicion of bladder cancer, we performed transurethral resection of bladder tumor (TURBT). The pathological examination showed polypoid cyst, and we diagnosed hemorrhagic cystitis. Two months after the operation, gross hematuria was observed again. Although we administered choreitogoshimotsuto and then saireito, both were ineffective. Then we administered kamikihito, considering the findings of deficiency of ki (qi) and ketsu (blood) in Kampo diagnosis and the underlying disease ITP. One month after administering kamikihito, gross hematuria disappeared, urinary sediment test showed RBC 1-4/HPF. After one year of follow-up, bladder tumor was suspected by cystoscopy, but the pathological result of the second TUR-BT was inflammatory change. Since then, kamikihito was continued during the 44-month observation period, and no gross hematuria was observed.

BACKGROUND: The burden of dementia is growing rapidly and has become a medical and social problem in Japan. Prospective cohort studies have been considered an effective methodology to clarify the risk factors and the etiology of dementia. We aimed to perform a large-scale dementia cohort study to elucidate environmental and genetic risk factors for dementia, as well as their interaction. METHODS: The Japan Prospective Studies Collaboration for Aging and Dementia (JPSC-AD) is a multisite, population-based prospective cohort study of dementia, which was designed to enroll approximately 10,000 community-dwelling residents aged 65 years or older from 8 sites in Japan and to follow them up prospectively for at least 5 years. Baseline exposure data, including lifestyles, medical information, diets, physical activities, blood pressure, cognitive function, blood test, brain magnetic resonance imaging (MRI), and DNA samples, were collected with a pre-specified protocol and standardized measurement methods. The primary outcome was the development of dementia and its subtypes. The diagnosis of dementia was adjudicated by an endpoint adjudication committee using standard criteria and clinical information according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd Revised Edition. For brain MRI, three-dimensional acquisition of T1-weighted images was performed. Individual participant data were pooled for data analyses. RESULTS: The baseline survey was conducted from 2016 to 2018. The follow-up surveys are ongoing. A total of 11,410 individuals aged 65 years or older participated in the study. The mean age was 74.4 years, and 41.9% were male. The prevalence of dementia at baseline was 8.5% in overall participants. However, it was 16.4% among three sites where additional home visit and/or nursing home visit surveys were performed. Approximately two-thirds of dementia cases at baseline were Alzheimer's disease. CONCLUSIONS The prospective cohort data from the JPSC-AD will provide valuable insights regarding the risk factors and etiology of dementia as well as for the development of predictive models and diagnostic markers for the future onset of dementia. The findings of this study will improve our understanding of dementia and provide helpful information to establish effective preventive strategies for dementia in Japan.
Aged ; Alzheimer Disease/genetics* ; Dementia/genetics* ; Environment ; Female ; Humans ; Incidence ; Japan/epidemiology* ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Risk Factors

BACKGROUND/AIMS: The aim of this study is to investigate the degree of delayed gastric emptying (DGE) and evaluate how the severity of DGE affects gastroesophageal reflux disease (GERD) in neurologically impaired (NI) patients utilizing 24-hour multichannel intraluminal impedance pH measurements (pH/MII) and ¹³C-acetate breath test (¹³C-ABT) analyses. METHODS: ¹³C-ABT and pH/MII were conducted in 26 NI patients who were referred to our institution due to suspected GERD. At first, correlation analyses were performed to investigate the correlation between the ¹³C-ABT parameters and the clinical or pH/MII parameters. Thereafter, all patients were divided into 2 groups (DGE and severe DGE [SDGE] group) according to each cut off half emptying time (t(1/2), 90–170 minutes). Each pH/MII parameter was compared between the 2 groups in each set-up cutoff t(1/2). RESULTS: The mean t(1/2) of all patients was 215.5 ± 237.2 minutes and the t(1/2) of 24 (92.3%) patients were > 100 minutes. Significant moderate positive correlations were observed between both t(1/2) and lag phase time and the non-acid reflux related parameters. Furthermore, the patients in the SDGE group demonstrated higher non-acid reflux related parameters than those of the DGE groups when the cutoff was t(1/2) ≥ 140 minutes. CONCLUSION: The present study demonstrated that GE with t(1/2) ≥ 140 minutes was related to an increase of non-acid exposure reaching up to the proximal esophagus in NI patients, and indicating that NI patients with SDGE might have a high risk of non-acid GERD.
Breath Tests ; Electric Impedance ; Esophagus* ; Gastric Emptying* ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration

BACKGROUND/AIMS: Endoscopic placement of self-expandable metal stents (SEMSs) has emerged as a palliative treatment for malignant gastric outlet obstruction (GOO). Although covered SEMSs can prevent tumor ingrowth, frequent migration of covered SEMSs may offset their advantages in preventing tumor ingrowth. METHODS: We conducted this multicenter, single-arm, retrospective study at six tertiary referral centers to evaluate the safety and efficacy of a partially covered SEMS with an uncovered large-bore flare at the proximal end as an antimigration system in 41 patients with symptomatic malignant GOO. The primary outcome was clinical success, and the secondary outcomes were technical success, stent dysfunction, adverse events, and survival after stent placement. RESULTS: The technical and clinical success rates were 100% and 95%, respectively. Stent dysfunctions occurred in 17 patients (41%), including stent migration in nine (23%), tumor ingrowth in one (2%), and tumor overgrowth in four (10%). Two patients (5%) developed adverse events: one pancreatitis and one perforation. No procedure-related death was observed. CONCLUSIONS: A novel partially covered SEMS with a large-bore flare proximal end was safe and effective for malignant GOO but failed to prevent stent migration. Further research is warranted to develop a covered SEMS with an optimal antimigration system.
Gastric Outlet Obstruction* ; Humans ; Palliative Care ; Pancreatitis ; Retrospective Studies ; Self Expandable Metallic Stents ; Stents* ; Tertiary Care Centers

Four interstitial cystitis/chronic pelvic pain syndrome (IC/CPPS) patients presenting with pain and autonomic imbatances were improved by Kampo medicine. (Case 1) a 42 year old female : Her bladder and perinial pain were relieved by ryutanshakanto and her autonomic imbalances were improved by Kamishoyosan. (Case 2) a 51 year old female : She was given anchusan which warmed the internal organs. (Case 3) a 49 year old female : Her general hypothermia was relieved by shinbuto and ninjinto. (Case 4) a 27 year old female :She was given tokishigyakukagoshuyushokyoto which warmed the lower body half. These Kampo medicines for autonomic imbalance in IC/CPPS were drugs that adjusted general condition on the basis of diagnostic processes, and logic based on states of vital energy and blood.

A 79-year-old woman had undergone mitral valve replacement (Omnicarbon (OC) valve : 31 mm) due to rheumatic mitral stenosis with regurgitation and tricuspid annuloplasty at the age of 54. The patient developed anemia and congestive heart failure with pleural effusion and an elevated LDH level in 25 years late up without any valve-related cardiac event. Echocardiography revealed perivalvular leakage near the anterolateral commissure. The patient received re-mitral valve replacement (CEP valve : 25 mm) and a tricuspid valve ring annuloplasty (MC³ Tricuspid ring : 28 mm). The annulus was covered with marked calcification and fibrosis with a partial deficit at the anterior part of antero-lateral commissure. Despite the thorough pathological examination, we could not clarify the etiology of sudden onset of hemolysis.The patient was discharged uneventfully on the 28th day after operation. In general, the OC valve can work without serious complications for a long time. We report a rare case of perivalvular leakage 25 years after mitral valve replacement with hemolysis and congestive heart failure.