The introduction of the 2005 American Heart Association Guidelines for Cardiopulmonary resuscitation, emergency care, and public access defibrillation (PAD) has improved the survival rate of patients with cardiopulmonary arrest in Japan. And as for the brain resuscitation, 2 randomized clinical trials explored that induced hypothermia improved outcomes in adults with coma after resuscitation from ventricular fibrillation. Another study also demonstrated improvement of patients' outcome after cardiac arrest with pulseless electrical activity or asystole. In our department, the indications for hypothermia in patients after the recovery of spontaneous circulation are: 1) witnessed arrest, 2) age 15 to 70 years, and 3) stable vital signs. Our series suggests that the outcome of patients with hypothermia after the recovery of spontaneous circulation is better than that of patients without hypothermia. The concept of brain resuscitation is extremely important for favorable outcomes after the resuscitation from cardiac arrest. And in the future the introduction of percutaneous cardiopulmonary support and of hypothermia to resuscitate the brain may help improve the outcomes of patients with cardiac arrest.
Most patients with anorexia nervosa are adolescent females. They are often exposed to extensive information about dieting, body shape, and food and are encouraged to diet to be thin. In addition, psychological stress born of coping with various adolescent issues seems to trigger anorexia nervosa. The present review discusses the neuroendocrinological pathophysiology of anorexia nervosa and new possible treatments for the disorder.
A 65-year-old man was referred to our hospital due to the recurrence of transient ischemic attacks (TIA). He has severe atherosclerosis of the cerebral arteries associated with metabolic syndrome and dyslipidemia. After substitution of a standard diet and combination drug therapy, such as anti-hypertensive drugs, stain, aspirin, and cilostasole, all laboratory findings improved. The patient did not present any symptoms of central nerve system after he was discharged. At 70 years he was diagnosed of angina pectoris and treated by nicorandil. Cognitive and psychiatric decline was observed from 71 years old. We diagnosed frontotemporal dementia on the basis of clinical feature and MRI findings at 72 years old.