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TAFRO syndrome is characterized by thrombocytopenia with unknown etiology. The assessment of immature platelet fraction (IPF) is useful for differential diagnoses that include thrombocytopenia. However, the significance of IPF in cases of TAFRO syndrome remains to be reported. We present a case of TAFRO syndrome wherein the patient demonstrated a marked increase in IPF without thrombocytopenia, which offers vital information concerning TAFRO diagnosis and the serial measurements of IPF during treatment. A 65-year-old man presenting with fever was admitted to our hospital. He exhibited mild splenomegaly and lymphadenopathy, as well as rapidly worsening renal failure and fluid retention. These indications prompted the initiation of corticosteroid therapy. A normal platelet count and aberrantly high IPF implied abnormal thrombopoiesis, and subsequent bone-marrow findings suggested TAFRO syndrome. The platelet counts started to decrease following the corticosteroid therapy, but the treatment refractoriness prompted the urgent administration of rituximab. Thereafter, the platelet count nadir remained for approximately one month, whereas the decreasing IPF trend preceded platelet recovery. In the present case, a high pre-treatment IPF was demonstrated before the emergence of thrombocytopenia, and a decreasing trend of IPF was observed before platelet recovery during treatment. Therefore, serial IPF measurements could be useful for the early diagnosis and prognostication of TAFRO syndrome.

Objective: The aim of this study was to detect prognostic factors in patients with locally advanced papillary thyroid carcinoma., Patients: The study included 72 patients (T4a/T4b 72/0, N0/N1a/N1b 25/15/32, M0/M1 68/4, mean follow-up 8.1 4.4 years) who underwent initial surgical treatment at Osaka Red Cross Hospital between April 1993 and April 2011., Results: Eleven patients died of PTC, 3 patients with recurrence died of unrelated disease and 10 patients are alive with recurrence. The overall 5-year survival rate was 88.3%, and the 10-year survival rate was 73.4%. The disease-specific 5-year survival rate was 91.4%, and the 10-year survival rate was 88.6%. The 5-year local control rate was 94.1%, and the 10-year local control rate was 85.4%. Patients with distant metastasis (M1), tracheal invasion and/or multiple organs invasion showed a significantly worse disease-specific survival rate based on a univariate analysis, which also revealed that tracheal invasion, laryngeal invasion, esophageal invasion and multiple organs invasion were risk factors linked to the development of distant metastasis during follow-up (recurrence as distant metastasis). The following were found to be clinically significant risk factors, based on the multivariate analysis among tracheal invasion, laryngeal invasion, esophageal invasion and recurrent laryngeal nerve invasion : Tracheal invasion was a risk factor for disease-specific survival, and tracheal invasion and laryngeal invasion were risk factors for recurrence as distant metastasis., Conclusions: In this study, distant metastasis, multiple organs invasion, tracheal invasion and/or laryngeal invasion were shown to be higher risk factors.

A 69-year-old man was admitted to our hospital with a chief complaint of lymphatic edema of left arm. He had a past history of transurethral resection of the bladder tumor 5 years ago, and pathological diagnosis was urothelial carcinoma with micropapillary variant, G3 = G2, pT1. CT scan revealed bladder tumor with invasion of the rectum, and multiple lymph nodes swelling in the axilla, retroperitoneum and pelvis (cT4bN3M1). The patient underwent biopsies of the bladder wall and the left axillary lymph nodes, and pathologic examination revealed micropapillary carcinoma. Five courses of gemcitabine plus cisplatin (GC therapy) were perfomed, and bladder tumor and lymph node metastases reduced remarkably, with serum CA19-9 level decreasing from 172,000 U/ml to 106 U/ml. However, the patient died from recurrence 23 months after the start of GC therapy.

Our surgical treatment for middle ear cholesteatoma is based on the following 2 concepts: (1) Preservation of the physiological morphology and function of the middle ear, that is, maximal preservation of the posterior wall of the external auditory meatus and the middle ear mucosa and (2) Careful resection of the matrix membrane of the cholesteatoma through the continuity of the matrix membrane. In case the cholesteatoma matrix membrane is ruptured, a staged operation should be performed to prevent the development of residual cholesteatoma from the residual matrix. In this study, we classified a total of 238 cases of the pars flaccida cholesteatoma primary operated on Osaka Red Cross Hospital between January 2006 and March 2008 according to the Classification and Staging of Cholesteatoma proposed in 2010. The age of the patients ranged from 4 to 79 years (average: 49.8 years) and there were 123 males and 115 females. Follow up ranged from 1 year to 5 years with a mean follow-up period of 47.8 months. Regarding the stage, 38 (16.0%) ears had stage I cholesteatoma, 155 (65.1%) ears had stage II, and 45 (18.9%) ears had stage III. The successful outcome rate was 97.4% for stage I, 78.7% for stage II and 60.0% for stage III. The rate of the residue and the postoperative recurrence was 2.5% and 4.2%.

The total number of patients with onchocerciasis on the African continent was estimated in 2008 at 25720000. The control strategy for onchocerciasis has dramatically changed during the last 30 years, resulting in a decrease of patients. Vector control was mainly used until around 1990. Since then, the strategy has been transferred to "Mass Drug Administration using Ivermectin". An "Integrated Approach" for several endemic diseases has become a popular control strategy since 2005. Several tasks remain for eliminating onchocerciais: improvement of the population coverage of drug distribution, construction of monitoring systems to inspect the emergence of drug resistance, invention of anti-macrofilarial drugs to replace anti-microfilarial drugs, and reinforcement of the health authorities in African countries. The possible elimination of onchocerciasis also depends on the continued political commitment to the program by the Ministry of Health. If the ongoing control program keeps producing results at the current pace, the elimination of onchocerciasis could be achieved in the near future.

Living system use many types of micro or nano-mechanical systems, which are called "motor protein". Those biological motors have unique features, such as nano-meter scaled molecular motor, high efficiently energy transduction from chemical energy or having a capacity of self-assembly. The realization of bio-hybrid micro-machines to integrate such motor proteins and micro-or nano-structures fabricated of inorganic materials, would have some potential values that are not achieved by traditional electronic, magnetic or optical devices. In this paper, we discuss a possibility of motor proteins to use as driving unit for micro analysis systems, such as Lab on a chip or microTAS (micro Total Analysis System) devices.

Purpose: We investigated whether vitreous cytology and the measurement of intravitreous cytokine were useful for the diagnosis of intraocular malignant lymphoma., Subjects and Methods: 8 eyes of 5 patients with suspected intraocular malignant lymphoma during the past 15 months. 3 vitreous samples were collected from 3 patients at the time of pars plana vitrectomy. Polymerase chain reaction(PCR) amplification and flowcytometric analysis(FACS) of the vitreous samples were performed. Interleukin (IL)-10 and IL-6 concentrations were measured., Results: Vitreous cytology showed increased atypical B lymphocytes. The vitreous IL-10/IL-6 ratio was higher than 1 in all cases. Monoclonal rearrangement of the immunoglobulin heavy chain gene and the light chain restriction of immunoglobulin were detected., Conclusion: The detection of the monoclonality of infiltrated cells into the vitreous by PCR amplification and FACS, and the measurements of IL-10 and IL-6 concentrations in the vitreous fluid may be useful in the diagnosis of intraocular malignant lymphoma.

The patient was a 77-year-old man who underwent radical cystectomy and ileal conduit urinary diversion due to bladder cancer in 1989. A stenosis of the right uretero-ileal anastomosis occurred in 1992, and of the left uretero-ileal anastomosis in 1999. These were treated with indwelling of a ureteral stent and percutaneous nephrostomy, respectively. He was admitted to our hospital for progressive renal dysfunction due to frequent pyelonephritis. We performed a reconstruction of the ileal conduit urinary diversion and after the removal of the bilateral ureteral stent he complained of nausea and general malaise. The laboratory data showed hyponatremia, hyperkalemia and azotemia, which were diagnosed as complication liked jejunal conduit syndrome. He was treated with hydration and salt supplementation. With regard to this case, we considered that a long ileal conduit close to the jejunum and renal dysfunction caused the complication liked jejunal conduit syndrome. Careful observation and follow-up laboratory examination should be performed if the patient has renal dysfunction and a long conduit near the jejunum is used for the ileal conduit.

Fading of the imaging plate (IP) in computed radiography (CR) systems with photostimulable phosphors is known well. The relation between noise properties and the fading of the IP in a CR system was investigated. Uniform exposure for the IP with various times between exposure and readout for the same exposure was used for this study. The relative intensity of photostimulated emission and the digital Wiener spectra were calculated. The relative intensity of photostimulated emission decreased with increasing time, whereas Wiener spectral values showed no difference with increasing time. We concluded that noise properties were not affected by the fading of the IP in the CR system.

Bacillus Calmette-Guérin (BCG) immunotherapy is increasingly being accepted for management of some bladder transitional cell neoplastic lesions. Mild adverse reactions occur frequently. However, an unusual complication of tuberculous epididymitis is reported. A 64-year old man presented with bilateral epididymal mass. Four months earlier he had seven treatments with intravesical BCG instillation (Tokyo 172 strain) for a grade 2 transitional cell carcinoma in situ. Bilateral epididymectomy was performed. Microscopic examination of the epididymis revealed chronic inflammation and necrosis with granulomas and Langhans' giant cells. After the operation, there were no further complications.

Purpose: To investigate the present state of blindness around the world., Methods: The article reviews significant studies by WHO and literature on the topic., Results: Current global estimates indicate that blindness affects close to 45 million people, with nine out of ten blind people living in developing countries. Two-thirds or more of all blindness is avoidable, in that the causes are preventable or treatable. Cataract is the major cause of blindness in the world and the number of cases is increasing. The second cause is glaucoma, and the third is trachoma. The extent of disability of blindness itself is very high compared to that of other illnesses. Also, in terms of the burden of diseases in society, blindness is a relatively huge problem in the developing world., Conclusions: Intervention should be focused on the factors that have the higheat possibility of change. Manpower development is the most important countermeasure. The aid required to support developing countries is what can make them stand on their own in long term ophthalmic care.

Objective: Retrospective analysis was carried out to evaluate the prognostic value of urothelial dysplasia with superficial bladder cancer., Patients and Methods: 62 patients with bladder cancer of pTa or pT1 who had been treated by transurethral resection (TUR-Bt), underwent random mucosal biopsies in the urinary bladder. The results of random biopsies were classified into 3 groups: negative group, dysplasia group and CIS group. The recurrence rate, progression rate and type of recurrences (true recurrence/new occurrence) were compared among the 3 groups., Results: The results of random biopsies were as follows; negative group was found in 42 (68%), dysplasia group in 17 (27%) and CIS group in 3 (5%). There were no significant difference in the characteristics of the patients among the 3 groups. The recurrence rates at 1, 2 and 5 years after TUR-Bt were 3%, 12% and 21%, respectively, for negative group, and 37%, 51% and 67%, respectively, for dysplasia group (p < 0.01). For CIS group, 2 of 3 cases (67%) recurrenced within 1 year after TUR-Bt. Non of negative group progressed to muscle invasion, whereas 57% of dysplasia group invaded bladder muscle after 6 years post operatively (p < 0.001). No significant relationship was observed between the absence or presence of concomitant dysplasia and the rate of true recurrence. Dysplasia group revealed a higher rate (47.1%) of new occurrence than negative group (2.4%) (p = 0.0001)., Conclusion: The presence or absence of concomitant dysplasia of superficial bladder cancer seems to be an important prognostic factor for future new ocurrence and progression after TUR-Bt.

We observed 6 cases of secondary keratoconus with Fleischer's ring pattern corneal epithelial iron ring. These 6 cases were 2 males and 4 females. The causes of secondary keratoconus were 2 cases of trachoma, 2 cases of trauma, 1 case of keratitis, and 1 case of unknown origin. All showed thinning of the cornea and Fleischer's ring pattern corneal epithelial iron ring. After penetrating keratoplasty of 1 case, the button of the recipient showed the deposition of hemosiderin in the corneal epithelium stained blue by Prussian blue. At the same time we confirmed the existence of iron in the corneal epithelium by the X-ray ultimate analysis. Fleischer's ring is considered to be characteristic of keratoconus, but we have found that Fleischer's ring is also seen in secondary keratoconus in which the cornea becomes thinner secondarily for some reason.

A total of 29 patients with advanced renal cell carcinoma entered a pilot study of combination therapy with interferon alpha (IFN-alpha) and interferon gamma (IFN-gamma). IFN-alpha (HLBI: 3 x 10(6) IU, BALL 1:5 x 10(6) IU, IFN-alpha-2a: 9 x 10(6) IU or IFN-alpha-2b: 6 x 10(6) IU) was given intramuscularly every day and IFN-gamma (IFN-gamma-1a: 3 x 10(6) JRU) was given intravenously by drip infusion 3 times a week (every 2-3 days). The treatment was continued for 3 months as the induction therapy, and then the tumor response was evaluated. Of the 22 evaluable patients, 4 achieved a partial response (PR), 10 showed no change (NC), and in 8 the disease had progressed (PD) during the therapy. Thus, the overall response rate was 18.2% [95% confidence interval (CI) 2.1-34.3%]. A favorable response tended to be obtained in patients with good performance status or small pulmonary metastases, or in those who had no prior therapy with IFN-alpha, who received this treatment immediately subsequent to radical nephrectomy, or who received IFN-gamma as much as possible according to this regimen. Toxicity was evaluated in 28 patients: fever, general fatigue, anorexia, leukocytopenia and impaired liver function were frequently noted, and 3 patients were withdrawn from the study because of such adverse effects. In patients who had a PR or NC, the same dosage of IFN-alpha was continued to be given intramuscularly 2-3 times a week (every 2-4 days) as the maintenance therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

A series of 185 patients, 133 males and 52 females, were treated by ileal conduit urinary diversion in the past 17 years. The patients ranged in age from 7 months to 81 years with an average of 59 years. Diversions were performed for malignant diseases in 174 patients, 85% of whom underwent a simultaneous radical surgery. The follow-up covered the postoperative period from 4 months to 16 years 8 months with an average of 4 years 8 months. Six patients (3%) died within 1 month of operation, and 43 of a total of 58 mortal cases died of cancer thereafter. The survival rates of 143 patients with bladder cancer were 84% for 1 year, 72% for 3 years, 67% for 5 years, 62% for 10 years and 54% for 15 years. Early complications were noticed in 38% of the patients. Delayed wound healing due to local infection (20%) and intestinal obstruction (10%) were the two major complications in this period. Late complications were encountered in 51% of the patients. Mild peristomal dermatitis (22%) and gradually developing renal complications (22%) are two major problems in the standard ileal conduit urinary diversion. The latter was significantly more frequent in patients who underwent the operation between 1973 and 1981 than in those who had the surgery between 1982 and 1989. Postoperative hydronephrosis was observed in 15 (13%) of 117 patients who showed normal urograms preoperatively. Ileoureteral reflux was observed in 50% of the cases with nonobstructing conduits, while it increased up to 70% along with obstruction of the conduit.(ABSTRACT TRUNCATED AT 250 WORDS)