Large sinus of Valsalva aneurysm causing myocardial infarction.

A 41-year-old man was urgently admitted with sudden onset of chest pain. Emergency coronary angiography revealed a large aneurysm of the sinus of Valsalva and reduced blood flow in the left coronary artery. A modified Bentall operation and coronary artery bypass were performed successfully.

Efficacy and safety of nilotinib in Japanese patients with imatinib-resistant or -intolerant Ph+ CML or relapsed/refractory Ph+ ALL: a 36-month analysis of a phase I and II study.

Although the tyrosine kinase inhibitor (TKI) imatinib is often used as first-line therapy for newly diagnosed chronic myelogenous leukemia (CML), some patients fail to respond, or become intolerant to imatinib. Nilotinib is a potent and selective second-generation TKI, with confirmed efficacy and tolerability in patients with imatinib-resistant or -intolerant CML. A phase I/II study was conducted in Japanese patients with imatinib-resistant or -intolerant CML or relapsed/refractory Ph+ acute lymphoblastic leukemia.

Utility of preoperative small-bowel endoscopy for hemorrhagic lesions in the small intestine.

Purpose: We evaluated a small group of patients with hemorrhagic lesions in the small intestine diagnosed preoperatively by video capsule endoscopy (VCE) and/or double-balloon endoscopy (DBE), who underwent surgery in our hospital.

Methods: The subjects were 20 patients with hemorrhagic lesions in the small intestine diagnosed preoperatively by VCE and/or DBE, who underwent surgery between April 2004 and December 2008.

Results: VCE, DBE, and computed tomography were performed in 12, 17, and 20 patients, respectively.

Partial anomalous pulmonary venous connection and partial atrioventricular septal defect in an adult: Report of a case.

A partial anomalous pulmonary venous connection (PAPVC) associated with partial atrioventricular septal defect (AVSD) is a rare combination. A 51-year-old man who experienced dyspnea on exertion was found to have a PAPVC with the middle portion of the superior vena cava and a comorbid partial AVSD. A patch diversion was successfully performed using an expanded polytetrafluoroethylene patch to create a pulmonary venous drainage route while preserving the cavoatrial junction.

[Group B streptococcus meningitis and infection surrounding the spinal canal caused by bacterial transmission from rectal ulcer via Batson's plexus].

A 62-year-old man was admitted to our hospital because of fever and disturbed consciousness. He suffered from persistent constipation due to diabetic autonomic neuropathy. On admission, neck stiffness and weakness of the lower extremities were observed.

Impact of immediate aortic repair on early and midterm neurologic status in patients with acute type a aortic dissection complicated by cerebral malperfusion.

Surgical treatment for acute type A aortic dissection (AAD) complicated by cerebral malperfusion (CM) remains debatable. Worsening of neurologic symptoms and poor quality of life after immediate surgery continue to be cause for concern. We performed immediate aortic repair followed by early rehabilitation in 10 patients with AAD complicated by CM.

Romiplostim for the treatment of chronic immune thrombocytopenia in adult Japanese patients: a double-blind, randomized Phase III clinical trial.

The efficacy and safety of romiplostim, a thrombopoietin-mimetic peptibody, were evaluated in a double-blind, placebo-controlled, randomized trial of Japanese patients with chronic immune thrombocytopenia (ITP). Thirty-four ITP patients received romiplostim (n = 22) or placebo (n = 12) for 12 weeks, with a starting romiplostim dose of 3 μg/kg weekly. The primary end point was the number of weeks with platelet response, defined as a platelet count ≥50 × 10(9)/L (not including the 4 weeks after rescue medication administration).

Alcohol consumption is inversely correlated with insulin resistance, independent of metabolic syndrome factors and fatty liver diseases.

Background And Aim: The role of alcohol consumption in insulin resistance remains unclear. The aim of this study was to examine the association between alcohol consumption and insulin resistance in a large asymptomatic population.

Methods: A total of 2463 asymptomatic Japanese men aged 28 years or above undergoing a comprehensive health checkup including an oral glucose tolerance test between May 2007 and April 2010 were recruited.

Risk factors for erosive esophagitis: a cross-sectional study of a large number of Japanese males.

Background: The impact of obesity on gastroesophageal reflux disease remains controversial. We undertook this study, with a large sample size, to investigate risk factors for endoscopic erosive esophagitis by multivariate analysis, including visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) as covariates.

Methods: Japanese males who visited our institute for a comprehensive medical survey between 2007 and 2010 were enrolled.

A prospective randomized trial of lafutidine vs rabeprazole on post-ESD gastric ulcers.

Aim: To compare the effects of rabeprazole and lafutidine on post-endoscopic submucosal dissection (ESD) gastric ulcers.

Methods: Patients with gastric tumors indicated for ESD were prospectively studied. After ESD, all patients were treated with intravenous omeprazole for the first 3 d.

Fat replacement of the distal pancreas in a case of advanced gastric cancer.

Preoperative computed tomography in a 67-year-old man admitted with type 2 advanced gastric cancer involving the upper body of the stomach revealed marked atrophy of the left lobe of the liver and atrophy of the distal pancreas. Total gastrectomy with D2 lymph node dissection was planned; however, additional distal pancreatectomy with splenectomy was also performed during the operation because of direct invasion of the pancreas by the gastric cancer. Histopathologic examination of the resected pancreas revealed the absence of lobules, acini, conduits, and pancreatic ducts, with only islets of Langerhans found scattered in the adipose tissue.

[Clinical analysis of 12 cases of pneumothorax during intensive chemotherapy for malignant neoplasms].

Twelve cases of pneumothorax during intensive chemotherapy for malignant neoplasms were found in a retrospective study of patients being treated at our hospital in the period 2001-2009. All of the patients were men, and their diseases were lung cancer (9 cases), gastric cancer (2 cases) and esophageal cancer (one case). Operation for pneumothorax was performed 9 times in 7 patients(twice in two patients).

Effects of large-balloon dilation on the major duodenal papilla and the lower bile duct: histological evaluation by using an ex vivo adult porcine model.

Background: Several articles have reported the usefulness of large-balloon dilation after endoscopic sphincterotomy in removing bile duct stones. Its histological effect on the duodenal papilla and the lower bile duct, however, is not well established.

Objective: To elucidate the histological consequence of large-balloon dilation.

Risk factors for bleeding after endoscopic submucosal dissection for gastric lesions.

Aim: To assess risk factors for bleeding after gastric endoscopic submucosal dissection (ESD) and to develop preventive measures.

Methods: This retrospective study was performed in a tertiary referral center. A total of 328 patients underwent ESD for 398 gastric neoplasms between July 2007 and June 2009.

[Ultrasound guided T2 intercostal nerve block: a comparison with stellate ganglion block under the blind technique and ultrasound guided technique].

Background: The aim of this study is to compare the efficacy of stellate ganglion block, performed by ultrasound guided technique and blind technique, and ultrasound guided T2 intercostal nerve block.

Methods: In the present study, we evaluated the changes in upper arm skin temperature, and the development of Horner syndrome after stellate ganglion block (blind technique and ultrasound guided technique) and ultrasound guided T2 intercostal nerve block in 12, 11 and 10 patients scheduled for each block. Stellate ganglion blocks (blind technique) were performed via an anterior paratracheal approach at C6 using 1% mepivacaine 5 ml.

[Effectiveness of antimicrobial prophylaxis in prevention of surgical site infections].

Preventing surgical site infection (SSI) is important in providing safe and high-quality surgical care. Antimicrobial prophylaxis is given to prevent SSI. Many reports revealed that antimicrobial prophylaxis is effective to reduce SSI rates, when its initial dose is given at proper timing and additional dose is properly given in longer operations.

Risk factors for serum alanine aminotransferase elevation: A cross-sectional study of healthy adult males in Tokyo, Japan.

Background: Liver-protective effects of light-to-moderate alcohol consumption have been suggested.

Aims: To determine predictors of ALT elevation in asymptomatic subjects with and without ultrasonographical evidence of fatty liver.

Methods: Cross-sectional survey of 9703 healthy males.

Fusiform aneurysm of the anterior communicating artery treated by vascular reconstruction: case report.

Objective: Fusiform aneurysm of the anterior cerebral artery is rare and difficult to treat because of perforators. We encountered a patient with subarachnoid hemorrhage due to rupture of a fusiform aneurysm of the anterior communicating artery complex, and treated this patient with cerebral revascularization.

Case Presentation: A 39-year-old man presented with sudden severe headache resulting from subarachnoid hemorrhage.

AA-type amyloidosis in association with non-Hodgkin's lymphoma following CMV viremia: Autopsy case.

Amyloidosis in non-Hodgkin's lymphoma (NHL) is known to be of the AL type, and AA-type amyloidosis in NHL is extremely rare. Herein is reported an autopsy case of follicular lymphoma that transformed to diffuse large B-cell lymphoma (DLBCL) in a relapse associated with systemic AA amyloidosis. CMV infection in an immunocompromised state with chemotherapy against DLBCL may have been involved in amyloid accumulation.

Treatment of unruptured aneurysm of duplication of the middle cerebral artery--case report.

A 60-year-old woman presented with a rare unruptured aneurysm of duplication of the middle cerebral artery (DMCA) identified at examination for headache. Preoperative cerebral angiography revealed the DMCA and a small aneurysm at its origin. Surgical clipping was performed successfully via the trans-sylvian approach.

Tumor-induced osteomalacia originating from the temporal bone: a case report.

Background: Tumor-induced osteomalacia (TIO) is a rare clinical entity in which secondary osteomalacia is induced by tumor-related products. Fibroblast growth factor 23 (FGF-23) mRNA is overexpressed in the tumor tissue, leading to impaired reabsorption of phosphorus in the renal tubules and hypophosphatemia. Curative treatment is considered to be total resection of the tumor.