We describe the case of a 1-year and 7-month-old girl who was born at 36 weeks and 6 days of pregnancy weighing 1,351 g. In addition to the diagnosis of Cornelia de Lange syndrome and Tetralogy of Fallot, we confirmed shunt blood flow from the lesser curvature of the aortic arch to the main pulmonary artery. Thus, we additionally diagnosed ectopic patent ductus arteriosus (PDA). Ultrasonography showed interruption and retrograde flow of the diastolic blood flow in the anterior cerebral artery. Therefore, we made a diagnosis of blood stealing due to an ectopic PDA, and we performed surgical intervention via a median sternotomy at 25 days. When we ligated the shunt blood vessel, the percutaneous oxygen saturation decreased from the high 90% range to the low 70% range, thus we temporarily released the ligation. We narrowed the ectopic PDA so that the percutaneous oxygen saturation could be maintained the high 80% range. Postoperative ultrasonography showed improvement of the pressure waveform in the anterior cerebral artery. After discharge, oxygen demand increased gradually with weight gain, and we performed intracardiac repair using a monocusp valve patch at 1 year and 7 months. We report a rare case of Cornelia de Lange syndrome wherein we achieved intracardiac repair of Tetralogy of Fallot after ectopic PDA banding in the neonatal period.

Cisternography was performed using three weighted imaging techniques─constructive interference in steady state (CISS), sampling perfection with application optimized contrasts using different flip angle evolution (T2-SPACE), and T2-weighted imaging─in 15 patients with no history of intracranial lesions to determine which techniques are useful in diagnosis. Images were acquired using 1.5T and 3.0T magnetic resonance imaging (MRI) machines. The contrastnoise ratio (CNR) and the presence and number of artifacts were evaluated. CNR was highest for T2-SPACE and CISS. There were no significant differences in artifacts between the techniques with 1.5T MRI but significantly more artifacts in CISS images with 3.0T MRI. In conclusion, T2-SPACE imaging can produce cisternographic images with high contrast and few artifacts.

Most people who go to fitness clubs or sports gyms for weight control, and many co-medicals and physicians believe that an increase in muscle mass and/or basal metabolic rate (BMR) is possible through a combination of regular exercise and optimal protein intake during weight loss. This seems a myth, and the reasons are discussed in this article. First, muscle mass is quite difficult to quantify. The limitations of body composition measurement should be well understood. Second, increasing muscle mass during weight loss is difficult. This might be attained through strict implementation of a protein-rich, low-carbohydrate diet; high-intensity resistance training; and aerobic exercise for a long duration. However, such a strict regimen is not feasible for most people. Finally, a 1-kg increase in muscle mass corresponds to an increase of only 13 kcal of BMR per day. Thus, an increase in muscle mass of 1 kg is difficult to achieve, while the gained BMR is approximately equivalent to a decrease of 13.5 kcal of BMR according to a 3-kg decrease of adipose tissue. Weight loss, unless through an extremely sophisticated weight control program, contributes to a decrease in BMR. However, it is an accomplished fact that women with significantly less muscle mass and lower BMR live longer than men with more muscle mass and higher BMR, regardless of ethnicity. Maintaining activities of daily living and daily activity function might be more essential.

BACKGROUND/AIMS: Few studies are available that have investigated the risk factors for overlapping irritable bowel syndrome (IBS)-like symptoms in patients with inactive inflammatory bowel disease (IBD). The present study has 3 objectives: (1) to assess the prevalence of IBS-like symptoms in Japanese patients with inactive IBD using Rome III criteria, (2) to examine the relationship of IBS-like symptoms to health related quality of life (HR-QOL), and (3) to investigate associations for developing IBS-like symptoms in patients with inactive IBD. METHODS: IBS-like symptoms were evaluated using the Rome III questionnaire for functional gastrointestinal disorders. HR-QOL and hospital anxiety and depression scale were evaluated. RESULTS: IBS-like symptoms were found in 17.5% (7/40) of patients with inactive ulcerative colitis, 27.1% (29/107) of patients with inactive Crohn’s disease (CD), and 5.3% (23/438) of healthy control subjects. The QOL level was significantly lower and anxiety score was significantly higher in inactive CD patients with IBS-like symptoms than in those without such symptoms (P = 0.003, P = 0.009). Use of anti-anxiety drugs was associated with the presence of IBS symptoms (P = 0.045). HR-QOL score was lower and anxiety score was higher in patients with inactive ulcerative colitis, but the difference was not statistically significant. CONCLUSIONS: The prevalence of IBS-like symptoms in inactive IBD patients was significantly higher than in healthy controls. Inactive CD patients with IBS-like symptoms has low QOL and anxiety; suggesting that anxiety may be associated with symptom development in such patients.
Anti-Anxiety Agents ; Anxiety ; Asian Continental Ancestry Group* ; Colitis, Ulcerative ; Depression ; Gastrointestinal Diseases ; Humans ; Inflammatory Bowel Diseases* ; Irritable Bowel Syndrome ; Prevalence* ; Quality of Life ; Risk Factors

The purpose of this study was to develop a simple and easy predictive model of leg, spine and whole body bone mineral density (BMD) from anthropometric, physical fitness, body composition and quantitative ultrasound (QUS) variables. Participants were 138 Japanese overweight and obese men (50.9 ± 9.6 yr, body mass index [BMI] 29.1 ± 2.6 kg/m²). We measured anthropometric variables (height, weight, BMI, chest, waist, hip, upper arm, thigh circumferences), physical fitness (grip strength, side steps, vertical jump, forced vital capacity), body composition (fat-free mass) and QUS. BMD was measured by dual energy X-ray absorptiometry. Multiple linear regression analyses showed that all predictive models for BMD were significant. As a result, the predictive model for leg BMD showed the highest model fitting. The Bland & Altman approaches demonstrated the (positive or negative) systematic error even though most plots were placed within ideal range. Predictive model from physical fitness, body composition and QUS would be useful for estimating whole body and regional BMD. Because these predictive models are likely to have some systemic errors, further research is needed to improve the predictive accuracy.

The purpose of this study was to investigate the interaction of habitual exercise and candidate gene polymorphisms related to bone on osteo sono-assessment index (OSI) by quantitative ultrasound (QUS) in middle-aged and elderly Japanese. Participants were classified into exercise group (E; n=172, 62.3 ± 7.7 yr) and sedentary group (S; n=65, 58.6 ± 9.2 yr). The OSI was measured with AOS-100. DNA was extracted from blood, and single nucleotide polymorphism in vitamin D receptor, estrogen receptor α, and transforming growth factor-βI were genotyped by TaqMan assay. Group E had significantly lower body weight and body mass index (BMI) than Group S. In men, although Group E was older than Group S, Group E had significantly higher OSI rather than Group S. There was no significant interaction between habitual exercise and each gene polymorphism on OSI. These results essentially remained unchanged even when analysis of covariance was applied after adjustment for age, body weight, and BMI. These results suggest habitual exercise and genetic factors have no interaction on OSI in middle-aged and elderly Japanese. Further investigations are needed to prove the interaction of other gene polymorphisms and exercise.

It has been reported that visceral fat (VF) is an independent predictor of the incidence for coronary heart disease, and is associated with its risk factors. The independent effects of exercise or dietary modification on VF remain to be fully elucidated, especially in obese middle-aged men. The purpose of this study was to investigate effects of exercise on VF compared to dietary modification. Thirty-five obese middle-aged men participated in this study. They consisted of exercise group (n=22, 51.4±11.6 yr, Group E) and diet group (n=13, 48.8±12.2 yr, Group D). Participants in Group E followed 90-min exercise sessions on a regular basis 3 days per week for 12 weeks. Participants in Group D attended weekly classes aimed at maintaining well-balanced 1,680 kcal/d diet for 12 weeks. Body weight decreased significantly in both groups (Group E : −2.9 kg, Group D : −5.4 kg). Visceral fat area (VFA) determined by computed tomography also decreased significantly (Group E : −32.0 cm², Group D : −39.4 cm²). An analysis of covariance adjusted by weight change revealed no significant group difference in VFA change. These results suggest that exercise-induced negative energy balance does not result in greater decrease in VFA as compared with dietary modification alone.

The aim of this study was to examine a weight reduction program and residual effects, through confirming the relationship between changes in the morphological and psychological indices including personality and self-efficacy (SE) of the participants. Twenty-five middle-aged women were divided into two groups based on type of weight reduction program intervention. Thirteen women participated in a 3-month diet-only weight reduction program (DO group, 53.3±7.4 yr), and 12 women took part in a 3-month diet and aerobic exercise program (DE group, 48.3±9.6 yr). After the programs, the compatibility score of personality in the DO group was negatively correlated to SE that is indicated as confidence in ability to maintain decreased body weight at 2, 3, and 4 years after the program (r=-0.69, -0.58, and -0.60). It can be seen that personality has an effect on the results of the DO group weight reduction program. Additionally, despite a significant decrease in body-weight and %fat in both groups, only the change of %fat significantly correlated with SE. On the basis of these correlations, the changes of %fat that related to the movability perception of body movements has a greater effect on SE after the program than the information only of weight loss. The results of this study suggest that personality and SE accounted for weight maintenance, and were associated with the results of the weight reduction program.