A Surgical Case of Infective Endocarditis with Annular Abscess into Mitral Annulus Calcification / 日本心臓血管外科学会雑誌

<p>A 79-year-old man, who had undergone aortic valve replacement due to severe aortic stenosis 2.5 years previously and permanent pacemaker implantation for sick sinus syndrome 2 months after aortic valve replacement, was admitted for congestive heart failure and suspicion of prosthetic valve endocarditis. However, he had a fever in spite of medical therapy, and transthoracic echocardiography revealed a 20 mm vegetation on the posterior mitral valve leaflet. He underwent emergency surgery on a diagnosis of infective endocarditis. The intraoperative examination showed annular abscess on the calcified mitral annulus, and a part of abscess had disintegrated, from which the vegetation arose. We performed maximal possible debridement of the infected tissue and mitral annulus reconstruction with a bovine pericardium. Subsequently, mitral valve replacement and annulus reinforcement with a prosthetic valve collared with a bovine pericardium were performed to prevent perivalvular leakage. The patient showed no recurrence of infection and perivalvular leakage at 1.5 years of follow-up.</p>

Effects of a walking program using a physical activity monitoring device on elderly requiring support or low-level care / 体力科学

This study was a nonrandomized controlled trial, aimed to identify the effects of a walking program designed to improve the physical functions of elderly people requiring support or low-level care and receiving rehabilitation services at day care centers. Participants were 28 elderly people (mean age: 77.9±7.5 years). Twelve participants agreed to wear a physical activity monitoring device. Their daily walking goals were updated every week. Sixteen subjects designated as a control group only underwent personalized rehabilitation programs. The gait functions of all subjects were evaluated by several gait parameters before and after the 4-week intervention. ADL and QOL were assessed using the Tokyo Metropolitan Institute Gerontology Index of Competence and 8-Item Short-Form Health Survey (SF-8), respectively. The step length, walking angle, the stance phase ratio and the double-support phase ratio significantly improved in the intervention group after the walking program. Interaction effects of the stance phase ratio, the double-support phase ratio and QOL (mental component summery) were observed between the two groups. The walking program, combined with rehabilitation services, showed favorable effects on the gait functions, and QOL of elderly people, suggesting that it may be useful for preventing functional deterioration of the elderly requiring support or low-level care.