Multiple ileal ulcers and an ileal Dieulafoy's lesion induced by loxoprofen sodium

Loxoprofen sodium is one of the non‐steroidal anti‐inflammatory drugs (NSAIDs) that is a prodrug. Several adverse effects of the drug have been described, but ileal ulcer has not been reported so far. We experienced an 87‐year‐old male patient with disk herniation complicated with loxoprofen sodium‐induced multiple ileal ulcers and an ileal Dieulafoy's lesion that caused massive intestinal bleeding. The patient was saved by wedge resection of the Dieulafoy's lesion and discontinuance of the NSAID. ^99mTc‐red blood cell scintigraphy and intraoperative enteroscopy of the small bowel were useful in the diagnosis. This is the first case of multiple ileal ulcers with an ileal Dieulafoy's lesion induced by loxoprofen sodium.     

Novel Form of Atrial Tachycardia Originating at the Atrioventricular Annulus

We report two patients with reentrant atrial tachycardia that originated at the AV annulus. Atrial tachycardia originated in the posterior portion of mitral annulus in one patient (case 1) and the posterolateral portion of tricuspid annulus in one patient (case 2). Tachycardia was successfully eliminated by RF catheter ablation in both patients, with the catheter placed underneath the mitral valve in case 1 and on the tricuspid annulus in case 2. Spiky potentials were recorded in the diastolic phase of the atrium during tachycardia at the sites of successful ablation. Spiky potentials were also recorded after atrial electrogram during sinus rhythm, and showed decremental properties during atrial pacing. An accelerated atrial rhythm was observed during RF application, and tachycardia could not be induced after ablation in either patient. Tachycardia in these patients seemed to be due to reentrant tachycardia originating in the accessory AV node (Mahaim fiber) without ventricular connection.     

Biatrial Epicardial Pacing Prevents Atrial Fibrillation and Confers Hemodynamic Benefits After Coronary Artery Bypass Surgery

Biatrial pacing (BIP) can be more effective than standard right atrial pacing (RAP) in preventing atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG). However, the mechanisms and hemodynamic benefits of BIP have not been studied in detail. This study examined the efficacy and hemodynamic benefits conferred by overdrive epicardial BIP in preventing post-CABG AF. After undergoing CABG, 72 patients (mean age = 66 ± 12 years, 48 men) were randomly assigned to triggered BIP (BIP-AAT; n = 50) versus single RAP (RAP-AAI; n = 22). The hemodynamic effects of BIP were measured by right heart catheterization and echocardiography. The patients were monitored for 8.8 ± 2.4 days after CABG to detect episodes of AF. The incidence of AF was significantly lower in the BIP-AAT group (22.0%) than in the RAP-AAI group (59.1%, P < 0.01). Cardiac output was significantly higher and pulmonary artery wedge pressure (PAWP) significantly lower during BIP-AAT than during RAP-AAI. The E-wave (65.2 ± 37.8 vs 57.8 ± 37.8 cm/s, P < 0.05) was significantly higher during BIP-AAT, and the interval between atrial pacing spike and the end of A-wave (241 ± 18.4 vs 286 ± 17.2 ms, P < 0.001) was significantly shorter during BIP-AAT than during RAP-AAI. Triggered BIP was well tolerated and significantly reduced the incidence of post-CABG AF compared to single-site RAP. The hemodynamic improvements conferred by BIP-AAT were due to a shortening of the inter-atrial conduction delay and greater contribution of left atrial contraction. These hemodynamic benefits may play a role in lowering intra-atrial pressure and in preventing AF.     

Factors influencing gelation time of tissue conditioners

Summary To investigate the effects of the composition and structure on the gelation of tissue conditioners, we measured gelation time with an oscillating rheometer. Also, the plasticizer factor was determined using linear multiple regression equations with the dependent variable of gelation time and the independent variables of molecular weight, molar volume, solubility parameter and viscosity of plasticizers. The results obtained were (i) gelation time decreased as the average particle size of poly-ethyl-methacrylate was decreased and its weight average molecular weight increased; (ii) gelation time decreased as ethanol content in the liquid increased. It varied depending on the type of plasticizer; (iii) it was suggested that gelation time was explained by linear multiple regression equations with independent variable of molar volume, solubility parameter and viscosity of plasticizer. In particular, the most influential factor was suggested to be molar volume.     

A survey of Japanese physicians' attitudes and practice in caring for terminally ill cancer patients

Abstract To clarify the psychiatric liaison issues in cancer care, questionnaires were distributed to physicians at 31 teaching hospitals in Japan, including cancer centers and psychiatrists at 197 teaching hospitals. Data from 329 physicians and 156 psychiatrists showed that the majority of the physicians felt troubled by the psychiatric problems of terminally ill patients. However, actual psychiatric referrals were infrequent. An important factor that interferes with appropriate psychiatric referrals for cancer patients is that most physicians do not usually inform patients of a cancer diagnosis. Thus, it seems that close communication between physicians and psychiatrists is essential in caring for terminally ill cancer patients in the context of Japanese culture, when the psychiatric consultations are offered.     

Flexible Bronchofiberscope

The conventional rigid bronchoscope which has been used throughoutthe world for over 70 years is now being replaced by the flexiblebronchofiberscope which was developed by us. The benefits ofthe use of the flexible bronchofiberscope are as follows: (1) The visible range in the bronchus is remarkebly increased. (2) The discomfort of the patient is greatly diminished. By using the flexible bronchofiberscope, during the past threeyears, direct findings were obtained in 299 (83.1%) out of 360primary lung cancer cases. Direct findings in connection withthe early lung cancer in diameter of less than 2 cm. were alsoobtained in 12 (63.1%) out of 19 cases. Flexible bronchofiberscopyhas thus proved very effective in detection of lung cancer inan early stage. It was also found to be an excellent methodfor cytological diagnosis. Practical method of flexible bronchofiberscopyis explained in detail.     

Differential Diagnosis of Respiratory Dyskinesia: A Prevalence Study Using Computer Analysis of Spirograph Data

A survey of respiratory dyskinesia for 248 inpatients receiving neuroleptic drugs was undertaken to explore the prevalence and subtype of respiratory dyskinesia using computer analysis of spirograph data monitored by both a Somniprobe nasal thermistor and a strain-gauge. By clinical examination, 23 patients showing irregular respiratory rate, tachypnea, or grunting were suspected to have respiratory dyskinesia. These 23 patients were then examined by nasal thermister for air flow, and strain gauge for thoracic movement. The coefficient of variation (CV) in distance from bottom to bottom of respiratory movements over 3 min was measured for each patient. For seven patients, their CVs were +2 SD greater than the mean CV found among 10 normal controls. The number of bursts of air flow (thermistor) was subtracted from the number of respiratory movements (strain gauge) as an estimate of desynchronization or obstruction. For three patients, this difference was +2 SD greater than the mean difference found among 10 normal controls. All three of these ‘desynchronized’ or ‘obstructive’ patients were among the seven who met ‘irregularity’ criteria as above. The prevalence of respiratory dyskinesia was 2·8 per cent (seven out of 248 subjects surveyed) and 13 per cent among those with TD populations. Respiratory dyskinesia was classified into two subtypes: the obstructive type with irregular respiratory movement and the irregular respiratory type. A computer analysis of spirograph data will be useful for the investigation of respiratory dyskinesia. © 1997 by John Wiley & Sons, Ltd.