A natural history of apical hypertrophic cardiomyopathy with development of an apical aneurysm formation: A case report following a quarter century.

We report the definite long-term natural history of a man with apical hypertrophic cardiomyopathy (ApHCM), who developed an apical aneurysm by the age of 60 years. At 33 years, his electrocardiogram (ECG) was nearly normal. T-wave inversions were first identified in leads V5-6 of an ECG at 36 years of age. Echocardiography first demonstrated a left ventricular (LV) lateral wall hypertrophy at 37 years of age. At 42 years, echocardiography showed the pattern of diastolic spade-like appearance of the LV cavity, confirming the ApHCM diagnosis. At 54 years, a late-peaking apical systolic gradient of 10 mmHg (velocity: 1.6 m/s) emerged. At 60 years, he had developed an apical aneurysm. Cardiac computed tomography revealed no significant major coronary artery stenosis. Thus, in our case, LV hypertrophy and apical high pressure in ApHCM advanced the formation of an apical aneurysm in the absence of coronary artery disease. .

[Direct low-dose fentanyl patch (2.1mg) introduction for opioid naïve outpatients with cancer pain].

BACKGROUND: The administration of opioids to outpatients with cancer pain can be difficult because the constant dose modification and treatments of side effects involved are occasionally impossible. Therefore, more effective and safer drugs with better patients compliance are needed to complete a successful opioid introduction. Compared with other opioids, low-dose fentanyl has been suggested to produce milder side effects such as nausea, constipation, and somnolence. Further more, compliance can be improved because the drug is a patch,administered transdermally. METHODS: Between July 2008 and December 2009, we investigated the safety and analgesic effect of a fentanyl patch (2.1 mg) as a direct opioid introduction for 36 outpatients with cancer pain without titrations of other opioids. RESULTS: Side effects of constipation, nausea, somnolence, and dizziness were observed in 17 (47%), 6 (17%), 4 (11%), and 3 (8%) patients, respectively, and no respiratory suppression was observed. Regarding the analgesic effect, 23 (64%) patients reported improvement on pain scales one week after the initiation of the fentanyl patch. CONCLUSIONS: Opioid introduction to opioid-naÏve outpatients with cancer pain using the low-dose fentanyl patch (2.1 mg) may be effective.

Consumption of uncooked deer meat as a risk factor for hepatitis E virus infection: an age- and sex-matched case-control study.

It was reported previously food-borne transmission of hepatitis E virus (HEV) to humans from deer meat. The present study attempted to clarify whether eating uncooked deer meat is a major epidemiological risk factor for HEV infection in Kasai, a city in western Japan. In total, 45 volunteer subjects with experience of eating raw deer meat were enrolled. An equivalent number of people from the same area who had never eaten raw deer meat served as controls. The subjects and controls had comparable age and sex distributions. Serum anti-HEV IgG and anti-hepatitis A virus (HAV) IgG levels were measured in all 90 volunteers. There was no significant difference in age, overseas travel history, or rate of anti-HAV antibody positivity between the subjects and controls. Eight (17.7%) of the subjects but only one (2.2%) of the controls had measurable serum anti-HEV IgG levels (P = 0.014). Anti-HAV prevalence did not differ between the anti-HEV-positive and negative groups. The results suggest that eating uncooked deer meat is an epidemiological risk factor for HEV infection in the studied area. In countries such as Japan where deer meat is sometimes eaten raw, attention must be paid to this route of HEV infection.