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Objective: Carotid stenosis may occur as a late complication following cervical radiation therapy(RT);however, it may also progress in the early post-RT period. This study aimed to characterize the clinical features associated with the early progression of post-RT carotid stenosis., Methods: We retrospectively reviewed clinical records of 30 patients who had undergone unilateral or bilateral cervical RT between January 2010 and November 2014. We analyzed the pre- and post-RT stenosis of their carotid arteries using contrast-enhanced computed tomography images. The arteries were classified as progressive or non-progressive according to the presence or absence of stenosis progression within five years after RT. Using univariate and multivariate analyses, we evaluated the following potential clinical risk factors:age;gender;history of hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, or smoking habit;antiplatelet or statin use;radiation dose;and prior presence of carotid stenosis before RT., Results: In total, we reviewed 57 irradiated carotid arteries and identified 9 with early post-RT progression. Carotid stenosis before RT was observed in 88.9% of arteries in the progressive group but only 2% of arteries in the non-progressive group and it predicted progression(univariate and multiple logistic regression analyses, p<0.0001). No other clinical characteristics had a significant association with the progression of carotid stenosis., Conclusion: Prior presence of carotid stenosis may be a risk factor for its early progression after RT. Pre-RT screening of cervical arteries may be useful, and strict management of carotid stenosis is critical in patients with cervical radiation therapy.

Objective: Molecularly targeted therapy has been adopted to treat a number of cancers. Bevacizumab, a recombinant humanized monoclonal antibody against vascular endothelial growth factor, is a representative agent used in molecularly targeted therapeutic regimens. However, the therapeutic effect of bevacizumab for the treatment of brain metastases remains unknown. We report the clinical effects of low dose bevacizumab(≤2.5mg/kg/week)to treat recurrent brain metastases., Methods: We retrospectively analyzed patients with brain metastases who had been treated with bevacizumab between 2012 and 2016 at our institution. We identified clinical characteristics, including age, gender, primary tumor site, dose of bevacizumab, therapeutic and adverse effects, and magnetic resonance imaging results. The lesions were assessed with the RECIST criteria based on gadolinium-enhanced T1-weighted, T2-weighted, and FLAIR images. Statistical analysis was performed using t-test and Fisher's exact test., Results: The cohort comprised 26 patients(8 men, 18 women)with a median age of 61 years(range 39-82 years). There were no significant clinical differences between the low dose and non-low dose groups. Patients in the low dose group did not report any adverse effects from bevacizumab. Three patients with brain metastases from colon cancer are illustrated to report the clinical course of low dose bevacizumab., Conclusion: Low dose bevacizumab may be a safe and effective therapeutic option to treat recurrent brain metastases from bevacizumab-sensitive cancers.

A 12-year-old boy without any previous history and risk factors of cardiovascular disease presented to the emergency room with persisting general fatigue, bilateral shoulder pain and facial pallor. He was diagnosed as acute type A aortic dissection with cardiac tamponade by ultrasonic cardiogram (UCG) and computed tomography (CT) imaging, and the emergency surgery was indicated. He underwent hemiarch replacement because his aorta diameter was quite small but grafting as a large vascular prosthesis as possible was necessary in consideration of the growth. His postoperative course was uneventful and good, and he was discharged from our hospital in day 21 postoperatively. Acute aortic dissection in childhood is very rare but life-threatening. We should consider the particularity of children and make early diagnosis and treatment appropriately.

Two cases of partial anomalous pulmonary venous return were reported in whom right pulmonary veins were totally drained to the coronary sinus and to the right atrium respectively. Re-routing of pulmonary veins was done by dilated atrial septal defect and making intra-atrial tunnel using equine pericardial patch. Postoperative courses were uneventful. MRI was useful to identify the pathway from right pulmonary veins to the left atrium.

Echocardiographic and hemodynamic studies were obtained in 16 consecutive adult patients who underwent aortic valve replacement (AVR) with St. Jude Medical valve for aortic stenosis (AS). Three cases of congenital AS was included and two of them had undergone aortic valvotomy in childhood. One of 16 patients died due to late cardiac tamponade six weeks after AVR. Postoperative studies showed improved left ventricular (LV) functions. LV end diastolic and end systolic diameter (LVDs and LVDs) fell from 50.3 and 38.2 to 44.6 and 31.6 mm respectively (p less than 0.05). Fractional shortening (%FS) rose from 26.5 to 32.2% (p less than 0.05). End systolic wall stress (ESWS) fell from 126.2 to 69.6 k dynes/cm2 (p less than 0.01). Cardiac index and pulmonary arterial wedge pressure improved from 3.4 and 14.4 to 3.6 l/min/m2 and 10.5 mmHg respectively (ns). Preoperatively, six were functional class II, eight were class III and one was class IV (New York Heart Association classification). Postoperative improvement was as follows, eight: class I, seven: class II. In four cases, preoperative echocardiography revealed most depressed LV function in %FS (smaller than 21%) and ESWS (greater than 140). Postoperatively they improved from 18.3 and 164 to 26.0% and 72.8 k dynes/cm2 respectively. These results suggested that depressed LV function in the patients with longstanding AS was largely related to limited preload reserve due to LV enlargement and mechanical unloading of LV (correction of afterload mismatch) resulted in improvement of LV function. In conclusion, LV dysfunction owing to AS alone is reversible and AVR results in great clinical improvement.

A rare case of partial absence of the left pericardium was reported. The patient was a seventy-nine year old male and the cause of death was a gastric cancer. The pericardial absence was oval in shape, in egg-size with smooth margin and was located between the superior portion of the left pericardium and the pleural cavity. The pulmonary artery, left auricle and superior part of the left ventricle were visible through the absence. The left phrenic nerve descended along the anterior free margin of the absence.

To investigate the prognosis for patients with consciousness disturbance, we recorded auditory brain stem response (ABR) in 35 patients with primary or secondary brain damage. For patients with secondary brain damage, the first ABR recorded after admission could be used not only to differentiate consciousness level but also to predict prognosis. However, for the patients with primary brain damage, the first ABR could not be used for either differentiating consciousness level or predicting prognosis. In addition, in two patients with secondary brain damage, the series of ABR recordings indicated that brain stem damage was reversible.

The purpose of this study is to evaluate the relationships between the sectional forms of the mandible and the craniofacial morphology. Vertical sections were made at the symphysis (SY) and at the second molar region (M2R). Materials were dried human skulls which were measured in three dimensional co-ordinate system. The correlation matrix of 24 measurements was examined in the male and the female. The difference of these measurements between the low angle group and the high angle group of gonial angle was also examined. Results obtained were as follows: 1. Gonial angle was negatively correlated with the height, width, breadth of ramus and the breadth of second molars. SY form was related to the facial height and size of the mandible. On the other hand, M2R form was related to the height, width and breadth of ramus. 2. The differences of measurements between the low angle group and the high angle group of gonial angle were as follows: 1) The ramal height, ramal width, bicondylar width and breadth of second molars in the low angle group were significantly larger than those in the high angle group. 2) The measurements of SY in the high angle group and the low angle group showed no significant difference. 3) The height and area of M2R in the low angle group were significantly larger than those in the high angle group. This study demonstrated that SY form might relate to vertical factors of the face (facial height), the size of mandible and the types of occlusions. On the other hand, M2R form being nearer to the attachment of masseter and medial pterygoid muscles than SY was related to the form of ramus and the gonial angle.

The effect of Neurotropin on osteoarthritis was investigated in comparison with those of prednisolone and indomethacin. 1) There were remarkable decreases in the staining intensity to safranin-O and in the contents of uronic acid, total hexosamine and hexose in the articular cartilage of rabbits in which experimental osteoarthritis was induced by the injection of papain into the knee joint. In the Neurotropin-treated group, the decrease in the staining intensity to safranin-O and the contents of uronic acid, total hexosamine and hexose were evidently recovered. On the other hand, in the prednisolone- or indomethacin-treated group, the degeneration of the cartilage was even more pronounced than in the control group treated with papain alone. 2) Neurotropin had no effect on the autolytic degradation of cartilage, but promoted the incorporation of 14C-acetate into the proteoglycan in the articular cartilage of rabbits. 3) Both prednisolone and indomethacin inhibited the autolytic degradation and the incorporation of 14C-acetate into the proteoglycan. These results suggested that the therapeutic effect of Neurotropin on osteoarthritis may be due to the improvement of decreased proteoglycan content in the matrix of articular cartilage; and in this respect, it is different from anti-inflammatory drugs such as prednisolone and indomethacin.

This 57-year-old female of MS had been treated by MVR with a 25 mm Omniscience valve on October 26, 1983. She was doing well until November 1984 when she developed general malaise and dyspnea. She was hospitalized again on June 3, 1985. Studies including echocardiogram and cardiac catheterization revealed mitral stenosis. The echocardiogram showed rapid blood stream toward the interventricular septum. The maximum opening angle of the disc was measured 30 degrees on the cine film. The cardiac catheterization showed increased PA and PA wedge pressures. The Omniscience valve was replaced with a 25 mm SJM valve on July 19, 1985. The postoperative course was uneventful. The postoperative echocardiogram and cardiac catheterization showed significant improvements in flow pattern and intracardiac pressure. She is doing well as an instructor of Japanese dancing after discharge from the hospital.

It has been already reported that ketoprofen (KP) has a potent anti-inflammatory action comparable to indomethacin, but with oral administration, gastric mucous membrane disturbances occur. In the present work, we administered the Na salt of KP (KP-Na) subcutaneously and found that the anti-inflammatory action was more potent in subacute and chronic inflammations than in the acute one. As an acidic compound, KP-Na had a relatively potent analgesic-antipyretic action and a medical efficacy comparable to the usual non-steroidal anti-inflammatory drugs given orally. The efficacy in case of subcutaneous administration was 2 to 3 times stronger over both acute and chronic inflammations than in case of oral administration. On the other hand, the gastric mucous membrane disturbance was decreased to about 1/3 in case of subcutaneous administration, thus the gastric disturbance could be abated and the medical efficacy can be increased when KP-Na is given subcutaneously. As KP-Na was less irritative at the injection site, the compound could be used clinically for a subcutaneous administration.

In a previous paper, we reported that PZ-177 had potent anti-inflammatory and analgesic activities. In the present work, acute toxicity and action of PZ-177 on the central nervous system were tested in comparison with PZ-222, one of metabolites of PZ-177, and mepirizole. Acute toxicity of PZ-177 was slightly less than that of aminopyrine and the same as that of mepirizole in mice and rats. PZ-177 produced from sedation to loss of righting reflex with the increase of dose. At a low dose with which the righting reflex was hot lost, PZ-177 decreased spontaneous locomotion of mice in the Animex test, produced muscle relaxation in rotarod and inclined screen tests, produced sleeping-pattern in electroencephalogram of rabbit, potentiated hypnosis of barbiturates and exerted an anti-convulsive effect in mice. In these depressive effects on the central nervous system, PZ-222 was very much lower and mepirizole slightly lower than PZ-177. It would thus appear that PZ-177 has more potent analgesic, antipyretic and anti-tussive actions than do PZ-222 and mepirizole.

The changes of the dental arch form after the tooth movement and the sequential changes occurred on the palate during orthodontic treatment were examined in the coordinate system based on the standard point at the palatal vault. The subjects selected for this study were 20 patients of Angle Class II div. 1. Both left and right maxillary premolars were extracted and an edgewise appliance had been treated. The plaster models prepared before and after treatment were used for materials. Only suitable materials were measured as a result of an examination of the reproducibility of the palatal core at the palatal vault. Results obtained were as follows: 1. It was suggested that the dental arch and the palate was mutually effected on each other in the arch length and the arch width. 2. The morphological changes in the dental arch and the palate due to orthodontic treatment was discussed on the basis of the results of Fourier analysis. The dental arch and the area from F division to J division were significantly smaller after orthodontic treatment than before it. The shape became closer to a semicircle. 3. Values representing morphological changes in the dental arch and J division were similar and values representing morphological changes in the other division were getting smaller as the area being close to the palatal vault.

Interferon (IFN)-gamma, though having the same titer as that of IFN-alpha or -beta, is several time more effective against cancer. However, it is impossible to obtain IFN-gamma as a drug at present. OK-432 is known to be an inducer of IFN-gamma, but the titer of IFN-gamma is very low in the blood after injection of OK-432. Therefore, for the purpose of high titer IFN-gamma production, a combination of OK-432 and IFN-alpha was investigated. In 30 patients with head and neck cancer, OK-432 was administered singly or combined with IFN-alpha at intervals of 2 weeks, and the amount of IFN in the blood induced by OK-432 was compared. In the group of cases combined with a high titer of IFN-alpha (5 x 10(6) units or 3 x 10(6) units), enhancement of IFN production induced by OK-432 was noted in 9 out of 20 cases. In the group treated with a low titer of IFN-alpha (7 x 10(3) units), no enhancement effect was seen. IFN induced by OK-432 contained both gamma and alpha types, as did the IFN enhanced by the combination with IFN-alpha.