Japan has entered an era of a super-aging population, and given the importance of oral nutrition, the need to evaluate swallowing function has increased. Herein, we contribute to continued developments in evaluating eating and swallowing functions by describing current videoendoscopy (VE) usage and trends to evaluate and diagnose causes of dysphagia. In all, 100 patients (58 men and 42 women; mean age: 79 years) with suspected dysphagia were enrolled; 15 of these were re-examinations. Examinations were conducted according to the Japanese Society of Dysphagia Rehabilitation VE examination guidelines for swallowing. In this study, several patients (77.8 %) with poor vocalization and a saliva reservoir were unable to eat. While evaluating the relationship between aspiration and pharyngeal or laryngeal influx, we found that when pharyngeal and laryngeal influx were present, the risk of aspiration was high. Some patients (38.9 %) were able to eat despite lacking a cough reflex; thus, the absence of a cough reflex does not necessarily equate to an inability to eat, even in patients unable to ingest nutrition orally. One case could ingest nutrition, even with no cough reflex. The 6-month survival rate after the examination of patients on nil per os status was 57.1 %, specifically in patients unable to ingest nutrition orally. These results suggest that decreased eating and swallowing functions indicate a poor prognosis for the patient's quality of life, as eating and swallowing require smooth passage in the oral phase. Therefore, actively requesting a dental intervention and oral rehabilitation is important for a patient presenting these issues.

ilated cardiomyopathy (DCM) is generally considered to be accompanied by both left and right ventricular dysfunction, 1,2 but in most studies only the function of the left ventricle (LV) has been analyzed, with less attention paid to the right ventricle (RV). One of the reasons is that the shape of the RV is complex and it is not easy to estimate RV volume and regional function. However, the RV ejection fraction (RVEF) is related to the capacity for exercise tolerance and to the prognosis in patients with severe LV failure such as an old myocardial infarction or dilated cardiomyopathy, 3-5 and therefore it is necessary to evaluate the RV function in such patients. Recently, we reported that RV angiography could be used to estimate the volume, ejection fraction (EF) and dimensional function of the chamber 6-9 and our aim in the present study was to examine the hemodynamics and dimensional function of the RV using this method in clinically well-controlled patients with DCM. Methods SubjectsTwenty-six patients underwent diagnostic catheterization: 13 (7 males, 6 females; mean age, 59.3 years (range, 16-75)) had chest pain and normal hemodynamics without Circulation Journal Vol. 68, October 2004 significant coronary artery stenosis, 13 (7 males, 6 females; mean age, 54.2 years (range, 22-73)) had DCM. DCM was diagnosed on the basis of exclusion of other causes of LV dysfunction, such as acute myocarditis, significant coronary artery stenosis, valvular disease and other secondary myocardial diseases. All patients were in normal sinus rhythm and New York Heart Association (NYHA) functional class II at catheter examination. Seven of the DCM patients had a past history of NYHA functional class IV. ProcedureRoutine left and right catheterization was performed using a standard technique. After LV cineangiography (right anterior oblique 30°) and coronary angiography, biplane RV cineangiography was performed with 35-mm cine film at a rate of 50 frames/s in a steep left anterior oblique view projection perpendicular to this projection using a Nishiya's catheter via the right femoral vein as previously reported. [6][7][8][9] We chose an angle for the left anterior oblique view in which the interventricular septum was seen best by biventriculography and in all patients it was 45°. In this projection, the 2 bent portions of the Nishiya's catheter appeared to overlap closely as if in a straight line. Shallow spontaneous breathing was permitted to avoid the Valsalva maneuver. Contrast medium (iopamidol 75.52%) was injected into the RV through the catheter at a rate of 12-13 ml/s for 3 s. Data AnalysisFrames from 1 cardiac cycle of the right ventriculogram from before the electrocardiographic P wave to behind the next P wave were analyzed. The RV silhouette on each frame of the biplane right ventriculogram was projected. Its Circ J 2004; 68: 933 -937 (Received April 26, 2004; revised manuscript received June 23, 2004; accepted July 6, 2004 Methods and ResultsBiplane right ventriculography was performed in 13 control subject...

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BackgroundSarcoidosis is a systemic disease of unknown etiology, in which granulomas develop in various organs, including the skin, lungs, eyes, or heart. It has been reported that patients with sarcoidosis are more likely to develop panic disorder than members of the general population. However, there are many unknown factors concerning the causal relationship between these conditions.Case presentationWe present the case of a 57-year-old woman who appeared to have panic disorder, as she experienced repeated panic attacks induced by transient complete atrioventricular block, associated with cardiac sarcoidosis. Psychotherapy and pharmacotherapy were not effective in the treatment of her panic attacks. However, when we implanted a permanent pacemaker and initiated steroid treatment for cardiac sarcoidosis, panic attacks were ameliorated. Based on these findings, we diagnosed the patient’s symptoms as an anxiety disorder associated with cardiac sarcoidosis, rather than panic disorder.ConclusionsThis report highlights the importance of considering cardiac sarcoidosis in the differential diagnosis of panic disorder. This cardiac disease should be considered especially in patients have a history of cardiac disease (e.g., arrhythmia) and atypical presentations of panic symptoms. Panic disorder is a psychiatric condition that is typically diagnosed after other medical conditions have been excluded. Because the diagnosis of sarcoidosis is difficult in some patients, caution is required. The palpitations and symptoms of heart failure associated with cardiac sarcoidosis can be misdiagnosed as psychiatric symptoms of panic disorder. The condition described in the current case study appears to constitute a physical disease, the diagnosis of which requires significant consideration and caution.

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