A diver with immersion pulmonary oedema and prolonged respiratory symptoms.

Immersion pulmonary oedema (IPE) is particularly associated with an excessive reaction to exercise and/or cold stress. IPE usually resolves without recompression therapy within a day or two. Herein we report a diver diagnosed with IPE, in whom symptoms persisted for five days. A 58-year-old man presented with sudden onset of dyspnoea, cough and haemoptysis after surfacing. He was an experienced diving instructor with a history of moderate mitral valve regurgitation. While IPE was diagnosed and oxygen administered, respiratory symptoms deteriorated, and serum C-reactive protein elevated. No evidence of infection was seen. Three hyperbaric oxygen treatments were given on the basis of suspected decompression sickness, and symptoms subsequently resolved. The recently diagnosed mitral valve regurgitation and inflammatory response were considered to have contributed to the prolongation of symptoms.

Echocardiographic characteristics predicting efficacy of drug therapy in patients with hypertrophic obstructive cardiomyopathy.

BACKGROUND: The efficacy of long-term drug therapy for patients with hypertrophic obstructive cardiomyopathy (HOCM) remains unclear. This study was performed to characterize the echocardiographic findings of patients responsive to drug therapy. METHODS: Left ventricular outflow tract (LVOT) gradient and morphologic characteristics of the septum, posterior wall, and mitral valve were measured echocardiographically in 35 Japanese patients. The mean follow-up time was 41+/-22 months. RESULTS: Long-term drug therapy was effective in 14 patients and ineffective in 21 patients. Five of the refractory patients required mitral valve replacement to become free of symptoms. Only 5 of 21 patients whose LVOT gradient was 100 mm Hg were responsive to drug therapy, whereas 9 of 14 patients whose LVOT gradient was <100 mm Hg were responsive to drug therapy. Seven of eight patients with an asymmetric septal hypertrophy (ASH) ratio >==1.3 and LVOT gradient <100 mm Hg were responsive to drug therapy. Only 3 of 16 patients with an ASH ratio <1.3 were responsive to drug therapy. There was no correlation between the efficacy of drug therapy and the morphology of the mitral valve or the width of the LVOT. CONCLUSION: Our results demonstrate that drug therapy effectively reduces the LVOT gradient in patients with asymmetric septal hypertrophy and a less severe LVOT gradient.

[Preservation of quality of life and its relation to lifestyle in centenarians in Japan: a visitation interview survey].

PURPOSE: To investigate quality of life (QOL) and associated factors in centenarians, we conducted a visitation interview survey for all male and one half of the female centenarians living in Japan, and studied QOL, lifestyle and health status. METHODS: All the male centenarians and a randomly-sampled half of the female centenarians living in Japan were included in the study based on the National Census. Finally, 556 male and 1341 female centenarians participated in the present visitation interview survey and were studied using a structured questionnaire. QOL was assessed from 3 aspects; activities of daily life (ADL), cognitive function (CF) and mental health (MH). RESULTS: Individuals having superior ADL accounted for 30.9% of the male and 13.6% of the female centenarians, those with superior CF were 58.1% and 35.6%, respectively, and those with superior MH were 39.2% and 26.8%, providing evidence that superior QOL was more dominant in males than in females. There were no effects of residential areas (north, east, middle, west, southwest and south of Japan) on the prevalence of ADL, CF and MH. Multiple logistic regression analyses conducted independently, for ADL, CF and MH as dependent valuables revealed that habitual exercise, less decline in visual ability and preservation of masticating ability were associated with better results for these 3 aspects of male centenarians' QOL, and that habitual exercise, less decline in visual ability, spontaneous awakening in the morning, good appetite and having cohabitating family members were associated with superior QOL in the females, suggesting that more factors are operating in the latter. CONCLUSIONS: Several lifestyle factors were found to be associated with preservation of QOL in centenarians in Japan. These results should facilitate establishing a public health and welfare policy for the most senior citizens, a group that has been increasing in Japan.