A multicenter trial of extracorporeal cardiac shock wave therapy for refractory angina pectoris: report of the highly advanced medical treatment in Japan.

We have previously demonstrated that cardiac shock wave therapy (CSWT) effectively improves myocardial ischemia through coronary neovascularization both in a porcine model of chronic myocardial ischemia and in patients with refractory angina pectoris (AP). In this study, we further addressed the efficacy and safety of CSWT in a single-arm multicenter study approved as a highly advanced medical treatment by the Japanese Ministry of Health, Labour and Welfare. Fifty patients with refractory AP [mean age 70.

Clinical and molecular epidemiological features of tuberculosis after the 2011 Japan earthquake and tsunami.

Objective: To investigate clinical characteristics and prognosis in tuberculosis (TB) patients and the transmission dynamics of TB after the 2011 Japan earthquake and tsunami.

Method: This was a retrospective observational cohort study. Data were analyzed among 93 pulmonary TB patients (tsunami-affected areas 25, non-tsunami areas 68) hospitalized during March 2011-March 2012 with 1-year follow-up since treatment commencement.

A case of Manila type Mycobacterium tuberculosis infection in Japan.

A 76-year-old Japanese woman contracted a Mycobacterium tuberculosis (TB, Manila type) infection in Japan, despite never having traveled. However, her son was treated for TB in the Philippines 3 years before he stayed at her house. Spoligotyping allows us to identify the TB genotype and identify the route of infection.

Clinical impacts of additive use of olmesartan in hypertensive patients with chronic heart failure: the supplemental benefit of an angiotensin receptor blocker in hypertensive patients with stable heart failure using olmesartan (SUPPORT) trial.

We examined whether an additive treatment with an angiotensin receptor blocker, olmesartan, reduces the mortality and morbidity in hypertensive patients with chronic heart failure (CHF) treated with angiotensin-converting enzyme (ACE) inhibitors, β-blockers, or both. In this prospective, randomized, open-label, blinded endpoint study, a total of 1147 hypertensive patients with symptomatic CHF (mean age 66 years, 75% male) were randomized to the addition of olmesartan (n = 578) to baseline therapy vs. control (n = 569).

One-year overview of deep vein thrombosis prevalence in the ishinomaki area since the great East Japan earthquake.

After the Great East-Japan Earthquake, the prevalence of deep vein thrombosis (DVT) in disaster shelters in Ishinomaki (Pacific coast, Miyagi, Japan) was found much higher than that ever reported in Japan. In Ishinomaki, twelve patients were found to have pulmonary thromboembolism for one month since the earthquake and DVT was found in 10 of those patients. The calf DVT was examined using ultrasonography in the shelters (from March to July 2011) and in temporary emergency housings (from August to December 2011).

Numerical analysis of hemodynamic changes in the left atrium due to atrial fibrillation.

Atrial fibrillation (AF) disrupts movement of the left atrium (LA) and worsens the vital prognosis by causing thromboembolism. Ultrasound Doppler measurement, phase-contrast magnetic resonance imaging (PC MRI), as well as computational fluid dynamics (CFD) have revealed hemodynamic changes in the LA due to AF, such as stagnation of blood flow in the left atrial appendage (LAA). However, quantitative evaluation of the hemodynamics during AF has not been conducted, and the effects of important AF characteristics, such as a lack of active contraction of the LA (atrial kick) in late diastole and the occurrence of high-frequency fibrillation (>400bpm) of the atrial wall, on blood flow field and concomitant hemodynamic stresses have not been completely understood.

Lessons learned from earthquake-related tuberculosis exposures in a community shelter, Japan, 2011.

Background: Refugees and displaced populations after natural disasters have been vulnerable to tuberculosis. We report an active pulmonary tuberculosis case at a shelter and the subsequent contact investigation and review lessons learned from the 2011 Great East Japan Earthquake.

Methods: The contact investigation was conducted to identify latent tuberculosis infection among a total of 95 contact persons, including 78 evacuees at the shelter, who were exposed to the index tuberculosis patient.

Tuberculosis exposure among evacuees at a shelter after earthquake, Japan, 2011.

Tuberculosis was diagnosed in a person who had stayed in a shelter after the 2011 Great East Japan Earthquake. A contact investigation showed that the prevalence of latent tuberculosis infection among other evacuees at the shelter was 20%. Our report underscores the importance of tuberculosis prevention and control after natural disasters.

Deep venous thrombosis among disaster shelter inhabitants following the March 2011 earthquake and tsunami in Japan: a descriptive study.

Objectives: A retrospective analysis of data collected during subject screening following Japan's March 2011 earthquake and tsunami was performed. We aimed to determine the incidence of deep venous thrombosis (DVT) among screened subjects and to identify risk factors associated with the development of DVT as independent variables.

Methods: Calf ultrasonography was undertaken in 269 subjects living in 21 shelters in Miyagi prefecture during the one-month period immediately following the March 2011 disaster.

Chest wall abscess due to Mycobacterium bovis BCG after intravesical BCG therapy.

We report a case of chest wall abscess caused by Mycobacterium bovis BCG that arose as a complication 1 year after intravesical BCG instillation. We identified M. bovis BCG Tokyo 172 in the abscess by PCR-based typing of Mycobacterium tuberculosis complex and analysis of variable number of tandem repeats data.

[Intraoperative right-to-left shunting induced by supine position in simultaneous lung resection with repair of atrial septal defect].

This report describes the case of a 49-year-old woman, who was suffered severe hypoxemia attributable to right-to-left shunting through an atrial septal defect (ASD) during the combined surgery for lung cancer and ASD in supine position. Right-to-left shunting has been reported to occur after lung resection but not during it. According to our continuous measurement of pulmonary arterial pressure and oxygen saturation, changes in hemodynamics during lobectomy in supine position was supposed to differ from that in lateral position, which may contribute to right-to-left shunting.

Double-chambered right ventricle associated with infective endocarditis complication of the pulmonary valve: surgical management.

Double-chambered right ventricle (DCRV) is a rare congenital heart disease characterized by the presence of anomalous muscle bundles, which divide the right ventricle into two chambers: a high-pressure proximal chamber and a low-pressure distal chamber. Most DCRV patients are diagnosed and treated during childhood, and presentation in adulthood is not common. Many congenital heart diseases are often associated with other complications such as infective endocarditis (IE).

Recurrent thymoma: radiological (CT and FDG-PET) and histological (WHO criteria) features.

A 66-year-old man, who had undergone surgical resection of a primary noninvasive thymoma (type B1) in the right anterolateral mediastinum 6 years before, underwent follow-up computed tomography (CT) scanning. The CT scan revealed a few nodules located at the posterior portion of the right thoracic base and just behind the right upper anterior chest wall. Subsequent fluorodeoxyglucose positron emission tomography (FDG-PET) scans showed multiple foci with high [standard uptake value (SUV) 4.

Double aortic arch with atresia, tapering and aneurysm of the left arch.

An adult male underwent chest radiography for a health check-up. This disclosed both thoracic vascular anomalies and a small nodular shadow in the left side of the superior mediastinum. Axial MRI and three-dimensional volume-rendering MR angiography revealed both a double aortic arch with left atretic arch proximal to the left common carotid artery (subtype 4), and also tapering and aneurysm of the left arch distal to the left subclavian artery.

Systemic to pulmonary venous shunt in lung cancer with obstruction of superior vena cava: case report with review of the literature.

We describe the CT features of an unusual collateral pathway of systemic to pulmonary venous shunt in a patient with lung cancer that obstructed the superior vena cava (SVC). Spiral CT scan with rapid injection of contrast medium from a right arm vein revealed a systemic to pulmonary venous shunt (SPVS), passing through thick pleural effusion, which was the direct transpleural communication between right upper chest wall veins and right superior pulmonary veins. Three-dimensional CT angiography revealed the entire shunt.

Successfully treated lingual tonsillar metastasis from bronchial adenocarcinoma.

Tonsillar metastasis from neoplasms, including lung cancer, are extremely rare, and the prognosis for patients with tonsillar metastases is rather poor. We herein describe a case of long-term survival following radiation for lingual tonsillar metastasis from a bronchial adenocarcinoma. A 39-year-old male was diagnosed with adenocarcinoma of the right lung and was surgically treated.

Fatal delayed esophageal rupture following aortic clamping for treatment of Stanford type B dissection.

A 65-year-old man underwent a thromboexclusion operation for management of chronic Stanford type B dissecting aneurysm in 1991. However, long-term follow-up CT scans after the operation revealed that the ascending aorta gradually enlarged and was eventually complicated by recurrent aortic dissection. The patient complained of frequent bloody sputum, whereas chest roentogenography showed no pulmonary abnormalities.

Heterotaxy syndrome with pancreatic malrotation: CT features.

We report the case of an asymptomatic elderly man with heterotaxy syndrome who presented with incomplete pancreatic rotation and an aplastic pancreatic uncinate process, polysplenia, nonrotation of the intestine, a midline liver, a midline gallbladder, a right-sided stomach, and interruption of the inferior vena cava with azygos continuation. To our knowledge, pancreatic malrotation with resultant oblique placement has not been described in patients with heterotaxy syndrome, and we speculate that the pancreatic rotation was interfered with by the left lobe of the midline liver in the embryo.

[The establishment of the styles of video-assisted thoracoscopic surgery for spontaneous pneumothorax].

Video-assisted thoracoscopic surgery (VATS) has been widely used in the treatment of a pneumothorax, but the high incidence of recurrence from spontaneous pneumothorax after VATS is an important problem. In this study, we classified the groups into two categories from the thoracoscopic observations, and discussed whether or not there was reappearance of pneumothorax. In addition, we examined whether adjunctive procedure contributes to recurrent of pneumothorax after operation or not.

Extensive pulmonary arterial thrombi in situ in association with atrial septal defect.

A 48-year-old woman with cyanosis was referred for investigation of atrial septal defect (ASD). Blood gas analysis on admission revealed moderate hypoxemia, and a pressure study during right heart catheterization revealed pulmonary hypertension (PH). Spiral computed tomography (CT) scan disclosed extensive thrombi in dilated large symmetrical pulmonary arteries with clear lung fields, and large strand-like thrombi on the inner surface of the pulmonary arterial wall along the vascular curvature were visualized by virtual CT angioscopic imaging.