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This study discusses the key microvascular decompression(MVD)techniques for the treatment of hemifacial spasm(HFS). The author's experience is based on their institution's cases, highlighting three critical techniques. (1)Vertebral artery(VA)repositioning: Repositioning the VA is essential in challenging cases. This article focuses on the relocation of the proximal portion of the VA and the importance of careful dissection. (2)Relocating vessels compressing the peripheral branches of the facial nerve: HFS can result from nerve compression at various locations, including the cisternal portion. This study addressed cisternal compression and considered the nearby nerves. (3)Considering the perforating branches during repositioning, cases may involve complex branching of the perforating arteries. This paper describes an approach that carefully repositions the vessels without damaging the perforating branches. The results from 100 VA-involved cases showed excellent outcomes, with 91.2% of patients experiencing T0(excellent)results. This study emphasized the need to adapt the surgical approach to each unique case to ensure the safety and effectiveness of MVD. This study provides insights into the critical MVD techniques for HFS, emphasizing the importance of continuous experience and knowledge accumulation. These techniques can be learned by other neurosurgeons, thereby expanding the availability of safe and successful MVD procedures for HFS.

The patient was a 77-year-old woman. She visited her family doctor with a complaint of bloody stools, and was pointed out a Type 3 colon cancer in the cecum with a colonoscopy. In addition, an enlarged lymph node(#203)was found on the right side of the superior mesenteric vein(SMV). Laparoscopic surgery was initiated, and when the patient was moved to vascular processing, a firm adhesion of the lymph node(#203)was observed on the right side of the SMV. A small laparotomy was added, and a partial combined resection of the SMV was performed en bloc to complete the ileal resection. Histopathological findings showed T4b(transverse colon)N3M0, pStage Ⅲc, and metastatic lymph node(#203)showed evidence of invasion to the SMV. Adjuvant chemotherapy was administered, but lung metastases appeared 4 months and liver metastasis appeared 29 months after surgery. The patient was transferred to a different hospital for best supportive care(BSC)at 34 months after surgery.

Endovascular recanalization is the primary strategy for the treatment of acute embolic stroke. However, atherosclerotic occlusions are often challenging to recanalize, and only medical therapy can be performed. In these cases, even the best medical treatment may not be effective, and the cerebral infarction progressively worsens. We believe that an emergency superficial temporal artery-middle cerebral artery(STA-MCA)bypass could be effective in these situations, after careful case selection. We use the following eligibility criteria: (1)atherosclerotic infarction; (2)cerebral ischemia with blood flow < 70% of the contralateral side; (3)progressively worsening symptoms or widening of the subcortical infarction despite medical treatment; and(4)surgery availability < 72 h from symptom onset. Among the 35 patients who underwent urgent STA-MCA bypass from 2014 to 2020, 27(77.1%)gained gait independence, and the National Institutes of Health Stroke Scale(NIHSS)scores improved from a preoperative median of 8 to 3 at discharge. The modified Rankin score(mRS)improved from a preoperative median of 5 to 2 at discharge. No intracerebral hemorrhages occurred due to hyper-perfusion syndrome. When we match it with other reports, this emergency surgery allows 76-90% of patients with progressive stroke to achieve gait independency.

Objectives　The proportion of Japanese women who maintain their employment during pregnancy and after delivery has been increasing. Previous studies from Western countries showed an association between the mother's occupation and birth outcomes; however, to the best of our knowledge, no epidemiological study has analyzed this association in Japan. Therefore, data from the national Vital Statistics: Occupational and Industrial Aspects were used to examine the association between the mother's occupation and (1) the risk of stillbirth at or after 12 weeks of gestation, and (2) the risk of infant death under 1 year of age after livebirth.Methods　Data from the Vital Statistics: Occupational and Industrial Aspects (Live Birth Form, and Foetal Death Form) for fiscal years (FYs) 1995, 2000, 2005, 2010, and 2015 and Vital Statistics data files (Death Form) from FYs 1995-96, 2000-01, 2005-06, 2010-11, and 2015-16 were analyzed. The study population consisted of (1) 5,355,881 infants who were born during the survey period, with (2) 5,290,808 live birth excluding still birth during the same period. The odds ratios (ORs) were estimated for (1) stillbirth (without stillbirth = livebirth) and (2) infant death (without infant death = alive at 1 year of age) by mother's occupation (managers/specialist/technical workers, clerical workers, sales workers, service workers, blue collar workers, and not employed) using logistic regression. Blue collar workers included workers in security, agriculture/forestry/fishing, manufacturing process, transport, and machine operation. The population attributable risk (PAR) for stillbirth attributed to mother's occupation among employed mothers was also calculated.Results　There were 61,179 (1.1%) stillbirths in the study population and 12,789 (0.2%) infant deaths among 5,290,808 live birth. Compared to managers/specialist/technical workers, the adjusted ORs (95% confidence interval) for stillbirth among clerical workers, sales workers, service workers, blue collar workers and not employed women were 1.24 (1.20-1.29), 1.48 (1.41-1.56), 1.76 (1.69-1.83), 1.54 (1.46-1.61), and 0.95 (0.92-0.98), respectively. There was no association between the mother's occupation and infant deaths. The PAR values for stillbirth among mothers employed as clerical workers and service workers were 7.4% and 12.3%.Conclusion　The risk of stillbirth differed according to the mother's occupation in our study. The OR and PAR of stillbirth were the highest for service workers. Mother's occupation was not associated with the risk of infant death; therefore, the mothers' occupation is likely to affect the children's condition only during pregnancy. Our study suggests the importance of understanding the causal linkage between pregnant women's occupation and birth outcomes.

Background: Hyperventilation is a well-known risk factor of ischemic events in pediatric patients with moyamoya disease. For young children, it is important to avoid crying to prevent ischemic events because of their unstable postoperative hemodynamics. To prevent crying in pediatric patients, we used dexmedetomidine(DEX)for sedation immediately after revascularization surgery., Objective: We investigated the effects of postoperative DEX use on hemodynamic changes and the avoidance of crying and hypocapnia in pediatric patients with moyamoya disease., Case: Ten consecutive patients(5 boys and 5 girls)who underwent surgical revascularization were enrolled, and 16 hemispheres(8 boys and 8 girls)were sedated with DEX postoperatively between August 2011 and August 2016., Methods: During extubation after revascularization, DEX was started at 0.4μg/kg/hr under spontaneous breathing and its dose was increased depending on the degree of consciousness, to maintain sedation of at least 3 on the Ramsay scale. DEX administration was terminated the next morning., Results: Sedation was maintained well in all patients without hypocapnia, and no ischemic complications were observed. One patient cried and needed additional intravenous DEX injections and was immediately re-sedated;no hypocapnia developed. Respiratory depression did not occur and changes in respiratory rate and decreases in SpO 2 were not observed. No significant changes in systolic blood pressure and heart rate were observed., Conclusion: Dexmedetomidine is safe and useful for postoperative sedation in children with moyamoya disease.

A 65-year-old woman with a history of constipation presented at our hospital and was subsequently diagnosed with advanced cecum cancer. We performed laparoscopic right hemicolectomy in January 2009, with pathological findings reveal- ing the presence of Stage III b (pT3, pN3, cM0, Cur A) disease. The patient was treated with a uracil/tegafur plus Leucovorin (UFT/LV) adjuvant chemotherapy regimen for six months. In June 2010, bold examination indicated an elevated level of tumor marker CA19-9. Computed tomography (CT) and positron emission tomography (PET)/CT revealed Virchow's and para-aortic lymph node metastasis. Therapy with XELOX and bevacizumab (Bmab) was administered and continued for 10 cycles. Capecitabine+Bmab treatment was also administered for 11 courses due to an adverse event of peripheral neuropathy. Follow-up revealed both the Virchow's and para-aortic lymph node metastasis had disappeared upon completion of treatment. In November, 2011 the patient was considered to have achieved a clinical complete response (CR) and continues to be followed with no further disease progression.

We report a case of carotid endarterectomy preceding distal plaque-end dissection followed by internal shunt insertion. A 60-year-old man was admitted to hospital with right hemiparesis. Magnetic resonance imaging detected multiple fresh infarcts in the left hemisphere, and the patient was transferred to our hospital. Angiography revealed high-grade stenosis in the left internal carotid artery at the level of the second cervical vertebra. Computed tomography angiography showed calcification in the proximal and the distal side of the stenotic lesion in the left carotid artery. The lesion was thought to be high position though an accurate assessment of the distal tip was difficult. The patient also received a blood transfusion for advanced anemia due to gross hematuria associated with bladder cancer. Carotid endarterectomy was performed one month after onset. Because atheromatous plaque had progressed far from the incision, we considered that arterial shunt insertion would induce embolic complications. Thus, we proceeded with distal plaque-end dissection, and then inserted the internal shunt and removed the plaque. This procedure resulted in successful revascularization.

The present study was designed to investigate the effects of prophylactic antibiotic therapy and the cost-effectiveness of Cefazolin (CEZ) and Sulbactam/Ampicillin (SBT/ABPC) in gastric cancer surgery employing clinical pathway. 157 patients (62 in the CEZ group and 95 in the SBT/ABPC group), who underwent surgery for gastric cancer at the First Department of Surgery of our hospital, were investigated. There was no significant difference between the groups with regard to sex, age, incidence of complication, stage of cancer, surgical method, operative time and blood loss, length of hospitalization, the appearance of systemic inflammatory response syndrome (SIRS), changes body temperature, white blood cell count (WBC), C-reactive protein (CRP), or clinical outcome of postoperative care by a nurse during post-operation for 7 days. The prophylactic effect of infection was also no different between the CEZ (69.4%) and SBT/ABPC (69.5%) groups. In contrast, decision analysis strongly indicated that the anticipate cost of antibiotics was higher in the latter group (yen 20402) than in the CEZ group (yen 15556), suggesting that the prophylactic effect of CEZ may be more cost-effective. Thus, evaluations of pharmacotherapy from the aspect of cost may be one of the important responsibility of hospital pharmacists in the future.

The aim of the present study was to ascertain the pharmacoeconomical efficacy of a clinical pathway (CP) employing medication management and instruction tasks (i. e. pharmaceutical care and counseling for inpatients) in gastrectomy patients. Pharmaceutical services of a uniform quality were provided. These included a CP check sheet, medication management, and a history of the drugs chiefly prescribed by pharmacists. As a result, the average number of hospitalized days among the patients who were offered pharmaceutical care compared with those who were not was significantly shortened from 35.4 days to 26.1 days (P<0.001). Moreover, the average cost of medication was also significantly reduced from 270,631 yen to 190,331 yen (P<0.05). These data provide the first evidence that a CP employing medication management and instruction tasks for gastrectomy patients may play a substantial role in saving on medical costs.

A 68-year-old woman was admitted with dysesthesia on both soles, hands and buttocks. She first noticed the dysesthesia in the left first toe two years before admission. One year before admission, serum creatine kinase and lactate dehydrogenase levels were elevated but she had no clinical symptoms suggesting myopathy. Nerve conduction study showed no apparent abnormalities, and an electromyogram showed mild myogenic change. Computed tomography of the muscle showed fatty degeneration of the trunk, major gluteus muscle, and biceps femoris muscle and atrophic change of the biceps femoris muscle. Muscle biopsy revealed a slight variation in fiber size, the presence of cytochrome c oxidase (CCO)-negative fibers by CCO staining, ragged-red fibers by Gomori trichrome staining, and mild denervation fiber by neuron specific enolase (NSE) staining. Analysis of her mitochondrial DNA (mtDNA) revealed a large deletion of mtDNA (approximately 8.5 Kb), and mitochondrial neuromyophy was diagnosed. The frequency of mtDNA deletion increases with aging. Although her mtDNA abnormality was compatible with chronic progressive external ophthalmoplegia (CPEO), we speculate that the aging process may be contributed to the mtDNA abnormality, which would be related to the late onset of her symptoms. As the phenotype of this mitochondrial disorder shows a wide variation and mtDNA abnormality is more frequent among elderly people, we should consider the possibility of mitochondrial disorders even in elderly people.

These studies were designed to evaluate the efficacy, toxicity, and resulting quality of life (QOL) of outpatient chemotherapy with infusional 5-FU for advanced gastrointestinal cancer. Schedule, sch. A: Treatment consisted of CI 5-FU 200 mg/m2/day, days 1-28, IVB Leucovorin 20 mg/m2 q week. Fifteen patients with advanced gastrointestinal cancer were treated to maintain the efficacy of prior inpatient chemotherapy. Twenty-one patients treated with adjuvant chemotherapy were added to evaluate toxicity and QOL. The mean time to progression (TTP) was 2.6 months. Grade 2 toxicities were seen, including mucositis (23%) and diarrhea (7%). Hand-foot syndrome was seen 60% of patients. The mean QOL score was 89.5 +/- 7.8. Sch.B: Treatment consisted of weekly 24 h infusion of 5-FU 2,600 mg/m2. 5-FU was administered using a Groshong catheter and Baxter infusor LV5 (5 ml/hr). Nine patients with advanced gastrointestinal cancer were treated. Twenty-one patients were treated with adjuvant chemotherapy. The mean TTP was 3.6 month. Grade 2 toxicities were seen, including leucocytopenia (7%), mucositis (3%), diarrhea (10%), and nausea and vomiting (10%). The mean QOL score was 82.6 +/- 10.7. In conclusion, both 5-FU schedules are feasible for outpatient chemotherapy for advanced gastrointestinal cancer.

This study was designed to evaluate the efficacy, toxicity, and quality of life (QOL) of outpatient chemotherapy with weekly HD-FU in advanced gastrointestinal cancer. Treatment consisted of weekly 24-h infusion of 5-FU 2,600 mg/m2, 5-FU was administered using the Groshong catheter and the Baxter infusor LV 5 (5 ml/hr). Eight patients (pts) with advanced gastrointestinal cancer were treated 64 times (mean 8.0 times), and 21 pts were treated 168 times (mean 8.0 times) with adjuvant chemotherapy. Grade 3 or 4 toxicities were not observed. Catheter occlusions and balloon rupture were observed in 1 case each. Responses were PR 2 and NC 6. Mean times to progression were 2.0 and 3.5 months, respectively. Mean scores of QOL were: 70.5 +/- 8.2 before treatment, 78.0 +/- 13.0 after 3 weeks, 79.8 +/- 7.9 after 5 weeks, and 75.8 +/- 11.3 after treatment completion. In adjuvant cases, these scores were 80.6 +/- 11.4, 83.1 +/- 10.7, 85.1 +/- 11.5, and 91.8 +/- 6.9, respectively. In conclusion, a schedule of 5-FU is feasible for outpatient chemotherapy in advanced gastrointestinal cancer.

Pancreatobiliary system has complex and thin structure except for gallbladder, thereby MRCP having lower spatial resolution gives sufficient information compared with the direct cholangiopancreatography. Multidirection MRCP using HASTE sequence obtains the data in plane to compensate the lower spatial resolution, thus high detectability of all over pancreatobiliary system is performed in a few minutes. This technique overcomes the demerits pointed by former investigators and gives sufficient information to diagnose the pancreatobiliary diseases.

In this article, a comparative study in the diagnostic ability of a breath-hold MRCP between thin slice half-Fourier acquisition single-shot turbo spin-echo (HASTE) and thick slice rapid acquisition with relaxation enhancement (RARE), and between 1.5T and 1.0T units was made. Although thin slice HASTE sequence might be more excellent in the diagnostic ability than thick slice RARE, the ability of depiction of pancreaticobiliary system on MRCP was not statistically different between these two sequences and between 1.0T and 1.5T units. Thick slice RARE sequence was inferior to thin slice HASTE in the depiction of gallbladder stone. However, thick slice RARE sequence was useful for MRCP because a projection image of pancreaticobiliary system could be easily obtained without postprocessing and without misregistration. Thick slice RARE sequence should be used in combination with thin slice HASTE sequence for the diagnosis of pancreaticobiliary system.

The purpose of this study was to develop the instrument to measure self-care agency for the Japanese chronic ill in later adulthood and to test reliability and validity of that. First, the Self-Care Agency instrument draft which consists of 56 items rated along a 5-point Likert scale was developed. This draft was based upon the work of Orem (1991) and qualitative data of the Japanese chronic patients. Second, reliability and validity of this instrument was tested. The instrument was reviewed by 5 expert nurses and 16 nursing researchers for content validity. And this instrument was reviewed by 19 Japanese chronic patients for face validity. By result of content validity and face validity, this draft was refined. Next, the internal consistency, stability, and construct validity of this refined instrument was tested. The internal consistency of the instrument, as measured by the Cronbach's alpha, was 0.90 for a sample of 200 Japanese chronic patients. This instrument had a test-retest coefficient of r = 0.86 for a sample of 104 Japanese chronic patients. Using factor analytic techniques, five subscales emerged. These subscales gave some agreement with subscales that had been obtained before factor analysis. Therefore, construct validity of the instrument was established in some degree. And the subscale 'get a valid support' which emerged in this instrument was reflect Japanese cultural factor. Reliability and validity of this instrument were obtained in some degree. Further, it is necessary to refine this instrument, considering this research result.

This study was designed to evaluate the efficacy, toxicity, and quality of life (QOL) of outpatient chemotherapy with 5-FU and LV in advanced gastrointestinal cancer. Treatment consisted of CI 5-FU 450 mg/body/day, days 1-28, IVB LV 30 mg/body q wk (schedule, sch. A) and CI 5-FU 200 mg/m2/day, days 1-28, IVB LV 20 mg/m2 q wk (sch. B). 5-FU was administered with the Baxter infusor (0.5 ml/hr). Oral UFT (400-600 mg/day) was administered after these chemotherapy. Sixteen patients (pts) (sch. A 9 pts, sch. B 7 pts) with advanced gastrointestinal cancer have been treated to maintain the efficacy of prior inpatient chemotherapy. Twenty pts treated as adjuvant chemotherapy were added to evaluate toxicity and QOL. The median time to progression in sch. A was 3.0 months and sch. B was 2.4 months. Grade 3 or 4 toxicities of mucositis were seen 40% in sch. A and 0% in sch. B. Grade 1 or 2 skin toxicities were seen 100% in sch. A and 52% in sch. B. Mean score of QOL in sch. A was 78.0 +/- 11.5, sch. B was 89.5 +/- 7.8 ranked between inpatient chemotherapy (5-FU + CDDP 59.0 +/- 13.8) and UFT (91.8 +/- 6.1). In conclusion, these schedule of 5-FU and LV combination offers a high patient QOL and is suitable for advanced gastrointestinal cancer treatment.

This study was designed to evaluate the efficacy, toxicity, and quality of life (QOL) of outpatient chemotherapy with 5-FU and LV in advanced gastrointestinal cancer. Treatment consisted of CI 5-FU 450-500 mg/body/day, days 1-28, IVB LV 30 mg/body q wk. 5-FU was administered with the Baxter infusor (0.5 ml/hr). LV was not administered if Grade 2 mucositis occurred. Seven patients (pts) with advanced gastrointestinal cancer (esophageal -2, gastric -1, colorectal -4) have been treated to maintain the efficacy of prior inpatient chemotherapy, and two pts with colorectal cancer instead of oral UFT. And to evaluate toxicity and QOL, six pts (bile duct -1, gastric -2, colorectal -3) treated as adjuvant chemotherapy were added. The median duration of response of the nine pts was 3.03 months. Because of mucositis, the administration of LV was restricted. The mean administration of it was 2.1 times (62 mg). Grade 3 or 4 toxicities of mucositis were seen in 40% of the cases. Grade 1 or 2 skin toxicities were seen in all pts. Mean score of QOL in these outpatients chemotherapy was 78.0 +/- 11.5, ranked between inpatient chemotherapy (5-FU+CDDP 59.0 +/- 13.8) and oral UFT (91.8 +/- 6.1). In conclusion, this schedule of 5-FU and LV combination offers a high patient QOL and is suitable for advanced gastrointestinal cancer treatment.

The breath-hold multislice dynamic study (BMDS) in MRI, which can scan the entire liver during a single breath-holding, was applied to 16 patients with 30 focal lesions of hepatocellular carcinoma (HCC). The BMDS was performed at 20 seconds and 3 minutes after the bolus injection of Gd-DTPA, by gradient echo pulse sequence (FLASH). 29 nodules were detected in the BMDS, showing rapid enhancement on early phase and decline on delayed phase images. The BMDS was more sensitive than conventional MR images. Therefore, the BMDS seems to be useful for the diagnosis of HCC with multiple as well as solitary nodules.

The terminal oxygenase of the NADH-depending lathosterol (cholest-7-en-3 beta-ol) 5-desaturase system was partially purified from rat liver microsomes, by Triton X-100 solubilization, DEAE-cellulose column chromatography, and hydrophobic affinity chromatography with Aminohexyl-Sepharose. The terminal oxygenase activity was approximately 18 fold greater than the starting microsome, and the yield was 18.4%, nevertheless, the terminal enzyme activity was almost free from other electron transfer components in microsomes. It was demonstrated that NADH, molecular oxygen, phospholipid, and three enzymes: NADH-cytochrome b5 reductase, cytochrome b5, and the terminal oxygenase, were absolutely essential for lathosterol 5-desaturation in the reconstituted system. Furthermore, the rate of the NADH-depending lathosterol 5-desaturation in the reconstitution system, was proportional to the concentration either of the terminal desaturase, cytochrome b5, or NADH-cytochrome b5 reductase, under conditions in which other enzymes were present in excess.

A 54-year-old male complaining mainly of pain in the right terminal rib area was admitted to hospital for hepatic tumor examination. Cholangiocarcinoma was diagnosed by various imaging techniques, and the patient was started on a program of daily oral administrations of 600 mg of UFT after abdominal arterial injection of 30 mmg of MMC. The tumor continued to decrease in size on CT image during two years of UFT administration. The patient continues to be monitored as an outpatient. A marked reduction in the size of a cholangiocarcinoma was observed in the case, and administration of UFT has proved effective in prolonging life for over two years.