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Hereditary hemorrhagic telangiectasia (HHT) is characterized by telangiectasias in multiple organs. We experienced an infant with cerebral hemorrhaging and suspected HHT based on his family history of HHT. Computed tomography angiography confirmed a cerebral arteriovenous fistula. The onset of cerebral arteriovenous fistulas associated with HHT is relatively early, and the incidence of bleeding is relatively common. When HHT is suspected based on a family history, early imaging screening is recommended to improve the neurological prognosis, even in asymptomatic cases. (Received April 7, 2020; Accepted May 7, 2020; Published August 1, 2020).

Venous pain induced by oxaliplatin(L-OHP)is a clinical issue related to adherence to the Cape OX regimen. To prevent LOHP- induced venous pain, we provided nursing care to outpatients who were administered a preheated L -OHP diluted solution using a hot compress. We retrospectively evaluated the risk factors for colorectal cancer patients who had L -OHP induced phlebitis and venous pain. Furthermore, the preventive effect of nursing care was compared between inpatients and outpatients from January 2010 to March 2012. At the L-OHP administration site, any symptoms were defined as phlebitis, whereas pain was defined as venous pain. A total of 132 treatment courses among 31 patients were evaluated. Multivariate logistic regression analysis revealed that both phlebitis and venous pain were significantly more common in female patients (adjusted odds ratio, 2.357; 95%CI: 1.053-5.418; and adjusted odds ratio, 5.754; 95%CI: 2.119-18.567, respectively). The prevalence of phlebitis and venous pain did not differ between inpatients and outpatients (phlebitis, 61.3% vs 67.7%; venous pain, 29.0%vs 19.4%). These results suggest that administration of L-OHP via a central venous route should be considered in female patients.

We performed hyperbaric oxygen (HBO) therapy for 3 patients with delayed neuropsychiatric encephalopathy induced by carbon monoxide (CO) poisoning. All patients were male and around 50 years old, and they had not received HBO therapy within 24 h after CO poisoning, even though they showed severe consciousness disturbance. In these patients, delayed neuropsychiatric encephalopathy appeared about 25 days after acute CO poisoning, and HBO therapy was initiated within 8 days after disease onset. Although the condition of 2 of the patients worsened initially, they showed significant improvement of neurocognitive impairment after 30 sessions of HBO therapy. The clinical courses of these patients suggest that the effect of HBO therapy can be evaluated after 30 sessions. To evaluate the validity of the indices of the clinical effect of HBO therapy, we performed brain magnetic resonance imaging, single photon emission computed tomography, electroencephalography (EEG), and neurocognitive tests (HDS-R, and Wechsler Adult Intelligence Scale-Revised or III). Our results showed that changes in EEG signals and neurocognitive tests were closely correlated with the patients' clinical courses.

A 76-year-old man with hepatocellular carcinoma (HCC) was admitted to our hospital suffering from rapidly progressing dyspnea. Chest computed tomography on admission merely showed ground-glass patterns in both lung fields without thrombi in the pulmonary trunk. On the third day, pulmonary blood flow scintigraphy was performed because of progression of his dyspnea, and showed multiple defects indicating widespread thrombi in the peripheral pulmonary arteries. He died of respiratory failure on day 13. A needle necropsy revealed the presence of multiple foci of adenocarcinoma nests in the lungs, suggesting venous thrombi from the poorly differentiated HCC. Although HCC frequently metastasizes to the lung, patients with lung metastasis rarely result in respiratory failure. It is well known that some patients with adenocarcinoma including HCC can develop respiratory failure owing to pulmonary tumor thrombotic microangiopathy (PTTM). In our case, however, pathological examination showed widespread tumor microemboli in the lung, but no stenosis or fibrocellular intimal proliferation in the small arteries and arterioles, which are essential findings of PTTM. Although we concluded that the respiratory failure in this case was mainly caused by widespread tumor microemboli, it remains unclear why such dissemination rapidly developed.

This article analyses the Draft of Guidelines for Human Body Dissection for Clinical Anatomy Education and Research drawn by the Study Group for Future Training Systems of Surgical Skills and Procedures established by the Fiscal Year 2010 research program of the Ministry of Health, Labor and Welfare. The purpose of the Draft of Guidelines is: First, to lay out the required basic guidelines for human cadaver usage to allow medical and dental faculty to conduct clinical education and research in accordance with existing regulations. Second, the guidelines are expected to give physicians a regulatory framework to carry out cadaver training in accordance with the current legal framework. This article explains the Draft of Guidelines in detail, outlines the future of cadaver training, and describes issues which must still be solved.

A 61-year-old woman was referred to our hospital for a double balloon endoscopy (DBE) examination of small intestine. She had undergone laparotomy for a perforated ulcer of the 3rd portion in the duodenum 3 years prior to this admission. Esophagogastroduodenoscopy at the previous hospital revealed multiple ulcers in the 2nd and 3rd portions in the duodenum. DBE revealed multiple ulcer scars in the proximal jejunum. Zollinger-Ellison syndrome was suspected from the distribution of the ulcers and scars. Serum gastrin was high and a selective arterial calcium injection test showed a step up of gastrin level only in the gastroduodenal artery area. We diagnosed a gastrinoma located on the ventral side of the 2nd portion of the duodenum from imaging studies. The tumor was extirpated and histologically found to be a neuroendocrine tumor in a lymph node. Serum gastrin level decreased to the normal range a day after surgery.

Antimicrobial agents sometimes cause the adverse effects of diarrhea and loose stool. Antibiotic-resistant lactic acid bacteria are used to prevent these adverse effects. The bacteria are not resistant to several antimicrobial agents, although the bacterium preparations are sometimes prescribed the antimicrobial agents concomitantly. Therefore this paper reports that the minimal inhibitory concentration of three new antimicrobial agents against antibiotic-resistant lactic acid bacteria were determined using a microdilution method with cation-adjusted Mueller-Hinton broth. Furthermore, we investigated antimicrobial agents that are prescribed concomitantly with antibiotic-resistant lactic acid bacterium preparations or a clostridium butyricum preparation. The bacteria were susceptible to the three new antimicrobial agents. Approximately 50% of the bacterium preparations were prescribed alone, and 30% were prescribed concomitantly with antimicrobial agents that show antimicrobial activity against the bacteria. Consequently, we suggest that pharmacists need to confirm prescriptions and to provide more drug information on antibiotic-resistant lactic acid bacterium preparations.

According to the Kidney disease outcomes quality initiative (K/DOQI) guideline, in order to decrease risk of beta2-microglobulin amyloidosis, noncuprophane (EVIDENCE), high-flux dialyzers (OPINION) should be used. No currently available therapy, except kidney transplantation, can stop disease progression of beta2-microglobulin amyloidosis or provide symptomatic relief (EVIDENCE). Screening for beta2-microglobulin amyloidosis, including measurement of serum levels of beta2-microglobulin, is not recommended (OPINION).

We report two cases of cerebral infarction in which swallowing function improved following swallowing rehabilitation. Patient 1 was an 82-year-old man, who was admitted due to rheumatoid arthritis and multiple cerebral infarction, suffering from aspiration pneumonia. The abnormality of swallowing was assessed by the water swallowing test and videofluorography. It has been reported that videofluorography is useful in the diagnosis of aspiration. Three weeks after the start of swallowing rehabilitation, the serum level of inflammatory markers and the chest X-ray had returned to normal. His score on the water swallowing test had improved. Patient 2 was a 68-year-old [correction of 62] man, who was admitted with severe hemiplegia, dysphagia and dysarthria. One month after the swallowing rehabilitation, videofluorography showed that the magnitude of aspiration into the trachea had decreased and the pooling of barium in the piriform sinus had disappeared. The patient could begin taking a little food by mouth. These results suggest that swallowing rehabilitation will be affect the clinical improvement of swallowing function and help preventing aspiration pneumonia in our hospital.

As our ward is a general surgical ward, we formerly had difficulties providing appropriate care for patients with terminal cancer. To solve the problem, we have formed a nursing study group in order to provide home care that would meet the wishes of such patients and their families. Our specific approach was as follows: 1) preparation of a form on which patient information is collected; 2) a support system for home care (such as pain control and home parenteral nutrition; and 3) a solid collaboration system between ward nurses and visiting nurses. Such a program enables us to understand the wishes of patients and families and to provide various support where needed. The project helps to lessen the anxiety and the burden that patients and families feel in home care, and improve the quality of life (QOL).

The anatomy of the portal vein branches in the caudate lobe of the liver was studied in 20 patients by double-phase CT arterial portography (DP-CTAP). DP-CTAP provided excellent images of the portal venous system in the first phase and the perfusion defects of intrahepatic tumors in the second phase. From DP-CTAP images of the first phase, a sufficient number of interpolated images were created for a smooth paging display. The ramifying structures of the portal system were traced on the monitor using the tracking ball. This method was found to be very effective and reliable for the anatomical assessment of the caudate lobe. The number and origins of the caudal portal branches were investigated in each case, and the caudate lobe of the liver could be divided into right and left segments.

The diagnostic efficacy of CT arterial portography (CTAP) for the hepatic tumors has been established. We developed the double-phase incremental CTAP (DP-CTAP) using a fast CT scanner, by which the double-phase scanning of the whole liver was made during a single contrast administration. The DP-CTAP was performed in 9 cases of hepatic diseases, and was useful for the lesion detection and improvement of the visualization of the liver vasculatures. The maximum density projection angiogram of the portal and hepatic veins was easily made by DP-CTAP images, and useful for three dimensional understanding of the liver vasculatures and the detection of the vascular abnormalities.

The purpose of this study was to investigate the biting pressure and masticatory efficiency of 3, 4 and 5 year old children. Some of them had trouble regarding their feeding behavior, either saying that they were not able to bite hard food or that they didn't want to bite hard food. A new method using A.T.P. (Adenosine Triphosphate) granules introduced with rubber finger protectors was used for measurement of the masticatory efficiency. 69 healthy 3, 4 and 5 year old children who had normal occlusion and were caries free were the subject. The results obtained were as follows. 1) The mean of the biting pressure for the 2nd primary molars for 69 children was 21.7 Kg. As for the data of the biting pressure for each age group, it was shown to increase with age (3 to 5 year old). 2) The mean of the masticatory efficiency for 69 children was 0.201 abs. As for the data of the masticatory efficiency for each age, it were shown to increase with age (3 to 5 year old). 3) The coefficient of the correlation of the biting pressure and the masticatory efficiency for 69 children was 0.410 which was considered statistically significant. (P less than 0.05) The coefficient of the correlation of the biting pressure and the masticatory efficiency for 3 year old children was 0.461, the coefficient of the correlation for the same items for 4 year old children was 0.395 and the coefficient of the correlation for 5 year old children was 0.353. All of these were considered statistically significant. (P less than 0.05)

From January 1976 to April 1987, 325 cases of carcinoma of the thoracic esophagus were resected in our department. Among these cases, 25 cases were not included because of direct operative deaths or early hospital deaths, and 300 cases were selected for clinical analysis of postoperative recurrent nerve palsy, which occurred in 75 cases (25.0%). The rate of occurrence of this palsy in the last 6-year period was higher than that in the first 6-year period (34.0% and 15.3%, respectively). It was suggested that the extension of surgical procedures to the cervix and upper mediastinum had contributed to this increase in rate. The sides affected by palsy were as follows: left, 56.0%, right 12.0%, bilateral, 24.0%; unknown, 8.0%. The importance of gentle handling of the left recurrent nerve during operation should be emphasized. The rate of occurrence of palsy in the cases of "Iu" was higher than in cases of "Im" and "Ei" (53.3%, 31.6%, 26.8%, respectively). The rate of occurrence of this palsy was significantly higher in the cases in which cervical anastomosis was performed than in cases in which intrathoracic anastomosis was performed (31.9% and 2.8%, respectively; p less than 0.01). Of the cases complicated by this palsy (Group A), tracheostomy was done in 12.0% of the cases and long-term transnasal tracheal tube cannulation or tube reinsertion done in 29.3%. These rates were significantly higher than the rates for cases who did not develop this palsy (Group B). The rates of occurrence of postoperative pulmonary complications within one month after surgery in Group A and Group B were almost same (24.3% and 21.8%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Obese diabetes was induced by monosodium aspartate (MSA) administration in KK male mice and the diabetic KK mice were divided into two groups, younger (12-week-old) and older (35-week-old). The diabetic KK mice were castrated and administered with androgen and effect of androgen on glycosuria appearance was investigated. Androgen dependent tear proteins (Mtp-M) were detected by the method of polyacrylamide gel electrophoresis. Blood androgen level was estimated by observation of change of the pattern of Mtp-M. In the younger mice group, glycosuria disappeared temporarily after castration and then appeared naturally again. The Mtp-M declined with castration, but did not disappear in this experimental period. In the older mice group, glycosuria and Mtp-M disappeared completely and blood glucose level decreased considerably after castration. However, in the castrated older mice, the glycosuria and the Mtp-M appeared again after the administration of dehydroepiandrosterone (DHEA), and the increasing of blood glucose level was observed. These results strongly suggested that androgen had an important role in the onset of diabetes in the KK mice treated with MSA.