Systolic Ejection Murmurs Due to Unruptured Aneurysm of the Sinus of Valsalva.

Aneurysm of the sinus of Valsalva is a rare condition with variable clinical presentation. We present a case of an unruptured aneurysm of the right sinus of Valsalva, in which a systolic ejection murmur was instrumental in the diagnosis. An asymptomatic 72-year-old man was referred to the cardiology department because of a heart murmur. Physical examination was unremarkable except for a grade 3 systolic murmur, loudest at the third left sternal border. Echocardiography revealed a sac-like structure protruding into the right ventricle and attached to the right sinus of Valsalva with a right ventricular outflow tract obstruction during end-systole. Multidetector computed tomography showed an aneurysm of the right sinus of Valsalva with a diameter of 28 × 19 mm; no contrast leakage from the aneurysm was detected. A diagnosis of an unruptured aneurysm of the right sinus of Valsalva was made. Surgical repair was successfully performed, and the murmur disappeared postoperatively. This case underscores the importance of physical examination even in the era of advanced imaging techniques and the need to recognize the wide range of causes of heart murmurs.

Rhabdomyolysis after High Intensity Resistance Training.

Rhabdomyolysis, which is a characteristic occurrence in associated with muscle cell necrosis, develops due to various causes. We herein report a rare case of a patient with rhabdomyolysis after high intensity resistance training, in which markedly elevated levels of serum creatine kinase (CK) and urine myoglobin were observed. A previously healthy 37-year-old man presented with severe myalgia and dark urine after performing high-intensity exercise. The patient's serum CK level was 95,100 U/L and his urine myoglobin level was 160,000 ng/mL. His symptoms and laboratory findings gradually improved with the intravenous administration of saline and no complications (including electrolyte imbalance and acute renal failure) developed.

Comparison of PPIs and H2-receptor antagonists plus prokinetics for dysmotility-like dyspepsia.

AIM: To compare efficacy of proton pump inhibitors (PPIs) with H(2)-receptor antagonists (H(2)RAs) plus prokinetics (Proks) for dysmotility-like symptoms in functional dyspepsia (FD). METHODS: Subjects were randomized to receive open-label treatment with either rabeprazole 10 mg od (n = 57) or famotidine 10 mg bid plus mosapride 5 mg tid (n = 57) for 4 wk. The primary efficacy endpoint was change (%) from baseline in total dysmotility-like dyspepsia symptom score. The secondary efficacy endpoint was patient satisfaction with treatment. RESULTS: The improvement in dysmotility-like dyspepsia symptom score on day 28 was significantly greater in the rabeprazole group (22.5% ± 29.2% of baseline) than the famotidine + mosapride group (53.2% ± 58.6% of baseline, P < 0.0001). The superior benefit of rabeprazole treatment after 28 d was consistent regardless of Helicobacter pylori status. Significantly more subjects in the rabeprazole group were satisfied or very satisfied with treatment on day 28 than in the famotidine + mosapride group (87.7% vs 59.6%, P = 0.0012). Rabeprazole therapy was the only significant predictor of treatment response (P < 0.0001), defined as a total symptom score improvement ≥ 50%. CONCLUSION: PPI monotherapy improves dysmotility-like symptoms significantly better than H(2)RAs plus Proks, and should be the treatment of first choice for Japanese FD.

[A case of advanced gastric cancer with pulmonary carcinomatous lymphangitis responding remarkably to combination chemotherapy of docetaxel, CDDP and S-1].

A 31-year-old woman suffering from stomach pain was admitted to our hospital, and diagnosed with unresectable advanced gastric cancer. She was initially treated with combination therapy of S-1 and CDDP, and a partial response was achieved. After two courses of the chemotherapy, however, she complained of dyspnea, and pulmonary carcinomatous lymphangitis was confirmed by computed tomography. As second-line chemo-therapy, we attempted combination therapy with docetaxel, CDDP and S-1(DCS). After one course of the combination therapy, a remarkable response in the pulmonary carcinomatous lymphangitis was achieved. Treatment of patients with advanced gastric cancer associated with pulmonary carcinomatous lymphangitis is quite difficult and there is no scientific evidence to select anti-cancer drugs for these patients. We concluded that DCF could be a useful regimen for patients with gastric cancer associated with pulmonary carcinomatous lymphangitis.