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Basophils are the rarest granulocytes representing less than 1% of peripheral blood leukocytes. Even though basophils have been discovered more than 140 years ago, their roles in immune reactions had long been an enigma, partly because of their rarity and the similarity to tissue-resident mast cells. However, recent development of the analytical tools for basophil research, such as basophil-depletion antibody and basophil-related engineered mice, has uncovered the unique roles of basophils in various immune reactions. Basophils are now appreciated as a critical immune cell in various type 2-immune responses including the induction of chronic allergic inflammation and protective immunity against parasites. In this review, we summarize the recent understandings in the roles of basophils in allergic inflammation with especial focus on skin inflammation. We then focus on our recent findings in the differentiation and maturation pathways of basophils.

We surgeons have to achieve a good result for surgical valve replacement which is not inferior to trans-catheter heart valve treatments. This column aimed to learn fundamental skills for surgical valve implantation and to learn types of suturing techniques. For updated information, we mentioned about choice of valve and suturing technique for valve-in-valve procedure into surgical valve. We should take into consideration valve type, size, and how-to implantation of surgical valve which would affect the future valve-in-valve procedure.

A 41-year-old woman with type 3 advanced gastric cancer and Virchow lymph node, para-aortic lymph node, and multiple bone metastases was diagnosed with U-less cType 3 cT4aN3M1, cStage IV. We administered docetaxel, cisplatin, and S-1 (DCS)therapy for unresectable gastric cancer. After 11 courses of DCS, we confirmed that the distant lymph node metasta- ses were significantly reduced. We performed radiotherapy(30 Gy/10 Fr)on the thoracic lumber vertebrae. Because the patient was successfully downstaged, we performed total gastrectomy with Roux-en-Y reconstruction. The histopathological diagnosis was ypT3N2M0, ypStage III A. In this case, DCS therapy successfully treated gastric cancer with distant metastases, including multiple bone metastases.

A 51-year-old Brazilian female who had IgD-lambda type multiple myeloma presented with epigastralgia and obstructive jaundice during her follow-up. Contrast-enhanced computed tomography (CT) showed an enhanced mass of 25mm in the pancreatic head, and endoscopic retrograde cholangiopancreatography revealed smooth stenoses in the lower bile duct and main pancreatic duct (MPD) of the head. We diagnosed the patient with extramedullary pancreatic metastasis of multiple myelomas. Plastic stents were endoscopically placed into both the common bile duct and MPD. One week later, she suffered a repeat episode of epigastralgia. A subsequent CT scan showed obstructive pancreatitis due to another mass, 30mm in size, emerging rapidly in the pancreatic body. Pancreatitis improved after we replaced the plastic stent with a longer one so that the distal end reached beyond the stenosis at the MPD of the body. Although both the tumors were treated with radiotherapy and showed temporary reduction, the patient died 1 month later due to progression of the disease. While cases involving obstructive pancreatitis induced by extramedullary pancreatic metastasis of multiple myelomas are very rare, it is crucial that such patients are rapidly diagnosed and treated.

A 68-year-old woman with a 5-year history of an untreated left breast tumor presented to our hospital. She was admitted for untreated diabetes and severe anemia. The cause of the anemia was bleeding from the tumor, and she was referred to our department. She was diagnosed with T4bN0M0, stage IIIb breast cancer. First, we initiated hormonal therapy. However, the tumor did not decrease in size. We then administered chemotherapy. The tumor markedly decreased in size, and mastectomy and axillary lymph node dissection were performed. The response was a pathological complete response. She is currently undergoing hormonal therapy at the time of this writing.

Wilson's disease is one of many potential differential diagnoses in patients with unknown liver injury or liver cirrhosis. Many patients are diagnosed in early childhood, but rare cases may not be revealed until adulthood, and of these, most present with liver cirrhosis. While some patients can be diagnosed by the examination of serum ceruloplasmin and urinary copper levels, there are patients in whom ATP7B genetic testing and hepatic copper content measurement are indicated. Diagnostic guidelines for Wilson's disease were proposed by the American Association for the Study of Liver Diseases in 2008, the European Association for the Study of the Liver in 2012, and the Japan Society of Hepatology along with affiliated societies in 2015. Even in patients in whom making a diagnosis was problematic, we were able to establish confirmation of Wilson's disease in patients with unknown adulthood liver dysfunction using these established guidelines. In this paper, we present the cases of patients with Wilson's disease treated by the administration of copper chelating agents in our department using diagnostic criteria and further provide flow charts of each guideline. We also report the utility of this approach.

We report a case of pulmonary artery catheter (PAC) injury by radio frequency device for maze procedure. A 64-year-old female with severe mitral insufficiency, tricuspid insufficiency and paroxysmal atrial fibrillation was scheduled for mitral valve repair, tricuspid annulo- plasty and maze procedure including right-sided maze. Under general anesthesia, a PAC was inserted to pul- monary artery (PA) uneventfully. After radio frequency maze procedure and mitral valve repair, PAC was removed from right atrium by the surgeon for tricus- pid annuloplasty. Thereafter, the surgeon reinserted the PAC under transesophageal echocardiographic guidance since PAC balloon could not be inflated. PA pressure and cardiac output were not shown despite other parameters were correct We removed the PAC and reinserted a new one after the surgery. The PAC was compressed at about 25 cm from the tip and it appears to have been injured during right-sided maze procedure with radio frequency device. Complications of PAC are well known, including PA rupture and suture entrapment to the right atrium. To best of our knowledge, this is the first reported case of PAC injury by radio frequency device. Fortunately the PAC was not torn in our case ; however, there might have been a risk of infection through the thermodilu- tion cable.

Background and Aims: Asthma is a chronic disease characterized by airway inflammation; it is sometimes difficult to diagnose. For clinical diagnosis, forced oscillation technique (FOT) measures airway reactance and resistance. By FOT, we investigated respiratory resistance and ventilation perfusion ratio inequality in adults with mild asthma., Methods: We examined 58 adult patients with mild asthma having no inhaled corticosteroid treatment, and 10 adult patients with post-infectious prolonged cough. Using a MostGraph-01 FOT instrument, we evaluated these patients before and after bronchial hyperresponsiveness to acetylcholine (ACh) or histamine (Hist). We measured the following conditions: change of resistance at 5Hz (R5) and 20Hz (R20), R5-R20, reactance at 5Hz, frequency of resonance (Fres), low-frequency reactance area (ALX), and forced expiratory volume in 1 second (FEV1)., Results: There were significant changes of R5, R20, R5-R20, X5, Fres, ALX after provocations for ACh or Hist in all patients with asthma, but not in patients with post-infectious prolonged cough. We calculated the percent decrease in FEV1 after provocation with ACh or Hist. For Ach, this decrease in FEV1 correlated with changes in R20 and Fres for all patients. For Hist, the percent decrease in FEV1 correlated with changes in R5, R20, Fres, and ALX for all patients. Furthermore, we investigated these correlations in patients with normalized bronchial hyperresponsiveness to ACh or Hist. For Ach, the percent decrease in FEV1 correlated with changes in Fres or R5-R20. For Hist, this decrease in FEV1 correlated with changes in R5, R20, and Fres. ROC analysis was used to evaluate the diagnostic value of the ratio of change of Fres in BHR to Hist. The area under the curve was 0.7808 (95% CI=0.657-0.904). A reasonably high specificity (100.0%) and a high sensitivity (53.8%) with a cut-off point of 1.5 in the ratio before and after of Fres were obtained., Conclusion: The changes in FOT parameters (before and after bronchial airway responses) may detect airway resistance and ventilation perfusion ratio inequality even in adult patients with asthma having normalized bronchial hyperresponsiveness to ACh or Hist. That results may be useful for an early diagnosis of asthma.

Background: The fraction of exhaled nitric oxide (FeNO) is a useful marker of eosinophilic airway inflammation in asthmatics. Clinical application of FeNO measurement in Japan is expected increase because the procedure is now covered through health insurance. However, the measurement system used is known to affect FeNO results, and it remains unknown whether results from offline methods correlate with those from traditional online methods, such as NO breath®., Methods: The study population comprised 48 patients at our hospital. FeNO levels were measured by using two offline methods (Sievers and CEIS) and a standard online method, NO breath®, Results: FeNONO breath levels were significantly correlated with FeNOSievers(r=0.875) and FeNOCEIS(r=0.888) levels. FeNONO breath levels were nearly equal to FeNOSievers results (FeNONO breath=1.05×FeNOSievers), but both of these levels were lower (p=0.02) than FeNOCEIS data (FeNONO breath=0.74×FeNOCEIS). A Bland-Altman plot of values obtained by the NO breath® and Sievers methods revealed that the NO breath® result was lower than the Sievers level when FeNO was low but was higher than the Sievers level when FeNO was high., Conclusion: Differences exist in the levels of FeNO measurement by three methods (two offline methods and NO breath®): conversion equations are needed to compare the FeNO levels obtained by using these three methods. In addition, NO breath® may be more useful to distinguish asthmatic patients from non-asthmatics, compared with Sievers method.

Newborn hearing screening (NHS) has been conducted widely in Japan in the last decade, however, there seems to be some confusion regarding the significance of NHS or management of the results obtained from NHS among clinics and practitioners. The system of NHS in Japan should be improved and refined through continuous evaluation of NHS, in terms of cost effectiveness in particular, so that NHS can be conducted more efficiently and effectively. To achieve this goal, the authors thought it important to clarify the current status and roles of our department as a facility for infants with congenital hearing impairment. In the present study, we studied 106 infant cases who were referred to the Department of Otolaryngology in Kyoto University Hospital after NHS before the age of twelve months in a period of seven years from 2006 to 2012 via retrospective chart reviewing. 79.2% of 96 infants who were qualified as referred either unilaterally or bilaterally following NHS were diagnosed as having hearing impairment in any form, either unilateral or bilateral, or conductive and/or sensorineural. The positive agreement rate was 88.7% in 53 cases who were qualified as referred bilaterally in NHS, demonstrating a high reliability of the NHS system. Twenty-four cases were diagnosed as having the need for hearing aids and were assigned to treatment and education. All the infants who underwent cochlear implantation in our department had severe bilateral hearing impairment of more than 105 dBnHL in both ears at the first examination. Moreover, a number of infants who were qualified as having passed in both ears in NHS or who had failed to receive NHS at birth were revealed as having hearing impairment and needed treatment later in the first year of their life, suggesting that NHS should be conducted in combination with periodical health checkups by family practitioners in order to identify infants with hearing impairment earlier in their life with higher efficacy.

In Japan, some agencies have begun to provide a multi-disciplinary outreach team for people with severe mental illnesses. A medical fee system specially designed for the outreach team has not been developed, so existing fees cannot cover all activities of the team. This undeveloped legal system for the outreach team and inadequate finances are the main obstacles to dissemination in Japan. In order to plan and realize a valid medical fee system for the multi-disciplinary outreach team, we described the financial conditions of such activities in Japan.

As aging and disease structure has changed mainly in accordance with adult disease, general medical treatment has been expected to take a role as a part of the"Comprehensive Care" that contributes to improve the quality of life. The similar paradigm change is needed for the treatment for the people with severe mental illness. The goal of this change is to realize the dissemination of prevention, early intervention, and comprehensive treatment in the community for the people with severe mental illness. The challenge for this change is reform on traditional structure of hospital based treatment and immaturity of staff skill. This article discuss the recent reforms of "Day care" and outreach team in National Center of Neurology and Psychiatry, focusing on these system-wide change and improvement of clinical skills of the staff. The key points of reforms are summarized as follows: (1) strongly focusing on the consumers' needs in their daily life, (2) establishing case management by the mental health staff, and (3) transforming the hierarchy system from in which psychiatrists are at the top of the multidisciplinary team to in which all staff are as equal members of the team. Some areas for necessary improvement required for the future are indicated in the end of this article.

A 63-year-old woman developed laryngopharyngeal edema after a cervical spinal tumor resection in prone position. The tracheal tube was removed after 11 hours of general anesthesia and nasal airway was inserted because stridor was audible. Blisters were found on the skin of the anterior neck of the patient. Examinations at 3 h after the extubation suggested upper airway stenosis including stridor, increased work of breathing, oxygenation impairment, and hypercapnia. The trachea of the patient was intubated and the examination of the upper airway by inserting a fiberoptic bronchoscope through the patient's mouth revealed laryngopharyngeal edema. It was considered that the disturbance of venous and/or lymphatic flow of anterior neck due to extensive neck anteflexion during the surgery in prone position had induced the laryngopharyngeal edema; however, we could not verify the cause of the edema. The edema persisted for weeks. We conclude that we should avoid extensive neck anteflexion during surgery in prone position and it is recommended to observe the upper airway for a few hours after extubation because there could be airway obstruction due to delayed and/ or progressive laryngopharyngeal edema.

The intermediate and long-term supports for suffered places of the Higashi-Nihon Huge Earthquake were discussed from the viewpoint of the community living and psychiatric rehabilitation. It might be useful to prevent from exacerbation of psychiatric disorders that gathering information, communication skills, relation with neighborhood, and joining training for disaster defense, and so on are acquired by persons with psychiatric disorders in the community living. If persons with psychiatric disorders are cared as disabled against disaster without empowering them with these skills, they cannot contribute to new society after disaster and worse estrangement from the society might appear. The Japanese Association of Psychiatric Rehabilitation proposed two models of one-stop service combining psychiatric service, mental health, and welfare from the viewpoint to support the community living; multi-disciplinary outreach team based temporary psychiatric clinic focusing psychiatric services, and comprehensive community living support center focusing mental health and welfare. It depends on demands of the suffered places which model is better adjusted, and hybrid model is possible. The important need to build long-term support system for people of supporting suffered persons from this huge earthquake was mentioned.

Outreach services in the context of a policy, "from hospital based to community based", are intended to know more about community living situation of patients, and provide supports so that they can bring their life back as citizens. Therefore, these outreach services are completely different from traditional monitoring based outreach services. These supports require skills which are different from those in psychiatric hospitals. Those differences would be visible in terms of skills because staff will be exposed to "life" of patients. Furthermore, those differences in skills would come up from necessity of facing negative feeling of people who receive outreach services often have toward medical care and support. Based on this standpoint, the author proposed tentative plan which divided necessary skills for outreach into five phases from the viewpoint of the training as follows: Level 1: Shifting perspectives from illness management to community living based, Level 2: Knowing their living situations and strengths. Building trusting relationship as staying present to the person. Level 3: Staying on top of skills in strength model, case management, and psychoeducation. Level 4: Being able to work in a team setting smoothly. Level 5: Even if the paternalism is necessary in the particular situation, staff needs to be able to face that situation without escaping. In addition, the author called the attitude of psychiatric facilities toward community psychiatry as "regionalization" and divided "regionalization" into six stages while showing necessary skills for each stage.

To clarify the clinical features of cochlear reimplantation and surgical changes in auditory performance, we retrospectively reviewed 10 of 252 cochlear implantation surgeries-6 adults and 4 children-among 129 children and 123 adults done between April 1987 and May 2009. Mean duration from initial implantation to reimplantation was 50.3 months in children and 89 months in adults, most commonly due to hard failure and implant exposure/infection (33%) in children and to hard failure (75%) in adults. The initial device implanted was the Nucleus multichannel implant (CI22M, CI24M, or CI24R). The second implant in 7 was the same or an upgrade of the same manufacturer's device, and in 2 children the HiRes 90K (Hifocus 1j) and in 1 adult the Clarion 1.2. Full initial and reinsertion succeeded in 8 cases but reinsertion proved difficult in 2 due to severe intracochlear granulation and osteoneogenseis. Auditory performance analyzed in 7 cases was mostly equal to or better than before reimplantation, although differences were not statistically significant. Reinsertion is rarely difficult, but electrode choice is important in preparing for difficult reinsertion. Post reinsertion auditory performance is satisfactory with some exceptions.

Objectives: To determine the age-, period-, and cohort-specific effects on the male proportion in Japanese newborns, we performed an age-period-cohort (APC) analysis in this study. In addition, projections for the male proportion were analyzed., Methods: We obtained data on live births of newborns for Japanese women in 1947-2007 from the National Vital Statistics. Cohort tables containing data on the male proportion were analyzed using a Bayesian APC model. Projections of the male proportion (2008-2027) were calculated., Results: The age effect decreased when the mothers were 40-44 years old; however, the effect was relatively limited as compared with the period and cohort effects. The period effect increased from 1947 to 1969 and decreased thereafter. Analysis of the cohort effect on male proportion trends revealed a decreasing slope for birth cohorts born between 1905 and 1945 and a subsequent increase after 1958. The projections for male proportion indicated that the male proportion in 2027 would be similar to that in the 1970s., Conclusions: The age of the mother hardly affected the male proportion. The period effect started decreasing from the latter half of the 1960s. This may be attributable to the high economic growth since 1965 that promoted industrial development that led to environmental pollution, which in turn may have lead to the deterioration of the intrauterine environment. Cohort effects changed from 1958 and exhibited trends toward increase in male proportion; this may be due to improvements in obstetric care. Our results suggest that the male proportion in Japanese newborns will increase in the future.

Long-term result of the maze operation is unknown. Anticoagulation therapy is controversial even after success of the maze operation. Between 1997 and 2008, 213 patients underwent the maze procedure. Atrial fibrillation (Af) was chronic in 151 patients and paroxysmal in 62. Concomitant mitral valve procedure were performed in 72%. Early mortality was 1.9%. By dismissal electrocardiography 157 patients (74%) wes free from Af. At the last follow-up (mean 38 +/- 30 months), late Af recurrence had occurred in 16 patients. Af recurrence had occurred within 1-year in 15 patients. Risk factors for late Af recurrence was left atrial dimension of 50 mm or greater (P<0.001). There was no difference in 5-year freedom from Af between the Cox maze procedure versions. Anticoagulation for patients with large left atrium is mandatory for 1-year after surgery.

We investigated the influences of the treatment environment, in terms of the increased number of treatments, introduction of regimen assessment and registration system, and the levels of specialization of the concerned medical professionals on patient satisfaction. We compared our results with those of a previous survey conducted in the outpatient chemotherapy unit of Hirosaki University Hospital. The patients were satisfied with respect to the privacy considerations and waiting time. However, a decrease in the patient instruction time led to slightly lower patient satisfaction. We concluded that it is useful to evaluate the quality of treatment in terms of patient satisfaction in a hospital.

Background: Recently, aromatase inhibitors (AI) are widely used in postoperative adjuvant therapy for breast cancer. Nevertheless, studies of postoperative therapeutic strategies for recurrent breast cancer are insufficient., Subjects and Method: Data on 12 post-menopausal advanced/recurrent breast cancer patients in our department during June 2003- April 2007 were used for this study. No patient had responded to high-dose toremifene (TOR), a third-generation AI. Their therapeutic outcomes were analyzed retrospectively. The median observation period of the subjects was 16.1 months (4.0-40.9 months). Subjects were all hormone-sensitive. Overexpression of HER2 protein was found in only one case. During AI therapy immediately prior, exemestane (EXE) and anastrozole (ANA) had been given in nine and three cases, respectively., Results: The complete response rate of AI therapy was 16.7% (2/12). The clinical benefit rate was 58.3% (7/12). The median of time to progression (TTP) was 33.8 weeks. Neither the presence nor absence of past history of treatment with tamoxifen (TAM) or other chemotherapies affected the anti-tumor effect. Analysis by the site of metastasis or recurrence revealed that the therapeutic effects were better for non-life-threatening cases in the lung, pleura, soft tissue, etc. The severities of adverse effects were all less than grade 2; the major ones were flushing and sweating., Conclusion: Results show that high-dose TOR given at an early stage can provide clinical benefits for post-menopausal advanced/recurrent breast cancer not responding to AI.

We report a case of chronic hepatitis C complicated with idiopathic thrombocytopenic purpura (ITP), successfully treated with interferon (IFN) beta. A 65-year-old woman was admitted to our hospital for the treatment of chronic hepatitis C with IFN beta. ITP was also diagnosed because of the presence of platelet associated IgG and the findings of bone marrow examination. We started IFN therapy, which resulted in normalization of transaminases, complete HCV eradication, and increased number of platelet.

This report describes our experience with two cases of pyogenic spondylitis with chronic hepatitis C during combination therapy of interferon alfa and ribavirin. The first patient, a 59-year-old man, was treated conservatively and improved, but the second patient, a 69-year-old woman, was not improved by conservative therapy and reconstructive operation was performed. The combination therapy of interferon alfa and ribavirin has a high risk of severe infectious diseases as side effects. CT scan and MRI are recommended immediately to diagnose pyogenic spondylitis, when patients has pyrexia and lumbago with laboratory data suspected inflammation during interferon therapy.

A 51-year-old man underwent left upper lobectomy due to pulmonary adenocarcinoma (cT2N1M0, stage IIB) in August, 2003. Since he turned out pT2N3M0 stage IIIB, he received combination chemotherapy with carboplatin and gemcitabine. During a second course chemotherapy, he was admitted again because of dyspnea and the deterioration of diffuse interstitial shadows in both lungs. He was treated with various antibiotics and corticosteroids. Unfortunately, he could not recover. An autopsy was performed. Microscopic features of the lung revealed diffuse alveolar damage and pulmonary hemorrhage. In this case, pulmonary hemorrhage should be considered as a complication of gemcitabine-induced lung injury.

Background: The effect of the intraoperative volume load on the circulating blood volume is unclear. Therefore, we investigated the changes of the perioperative blood volume in patients undergoing major surgery., Methods: In 16 patients undergoing abdominal aortic aneurysm repair, we measured the circulating blood volume (BV x kg(-1)) with the pulse dyedensitometry method (DDG analyzer) before operation, just after operation, on the first postoperative day (1POD) and 2POD. Anesthesia was maintained with general anesthesia and epidural analgesia. The volume of infusion depended on empiric judgment by an anesthesiologist., Results: Mean anesthesia time was 390 minutes, the mean volume of infusion 4225 ml, transfusion 1329 g, blood loss 1567 g, urine output 729 ml, and mean water balance +3287 ml. The mean body weight (BW) was 59.2 +/- 13.7 (before), 60.2 +/- 14.4 (just after), 60.5 +/- 14.3 (1POD), and 60.3 +/- 14.3 (2POD) kg, respectively. The mean BV x kg(-1) was 78.0 +/- 19.0 (before), 65.6 +/- 13.4 (just after), 70.4 +/- 15.7 (1POD), and 76.5 +/- 18.2 (2POD) ml x kg(-1), respectively. The mean BW after operation increased significantly from the value before surgery. However, the mean BV x kg(-1) decreased significantly. There was a significant correlation between the intraoperative increase in BW and intraanesthetic water balance (Y = -2.91 + 0.071X; R = 0.66, P = 0.0412), but there was no significant correlation between the change in BV x kg(-1) and intraanesthetic water balance., Conclusions: Intraoperative water balance influenced a change of BW significantly, but did not affect BV x kg(-1).

Herein we describe the case of a patient with focal segmental glomerulosclerosis (FSGS) following polycythemia vera (PV) on whom hemodialysis was started 7 years later. A 66-year-old woman who had been treated for PV with hydroxyurea and phlebotomy for three years was referred to our hospital because of nephrotic syndrome. Renal biopsy performed at her local hospital revealed FSGS. Although she had received prednisolone at an initial dose of 45 mg/day, no significant improvement of proteinuria was achieved. The dose of prednisolone was tapered because the second renal biopsy revealed sclerosing glomerulopathy. We considered that FSGS was associated with PV because renal hemodynamic alterations in PV could result in FSGS as in any other secondary FSGS and there was no proteinuria at the initial detection of PV. On January 29, 1999, she developed massive proteinuria (9.6 g/day) and the findings of the third renal biopsy worsened in comparison with that of the first renal biopsy. Thereafter, hydroxyurea or ranimustine was used in treating PV at an outpatient clinic. However severe thrombocytosis was difficult to control, and progressive renal dysfunction finally necessitated hemodialysis on January 18, 2005. In conclusion, physicians should be aware of the risk of progressive renal failure in patients with FSGS following PV, particularly in patients with persistent thrombocytosis.

A 27-year-old patient with asymptomatic idiopathic prolonged QT interval syndrome underwent elective caesarean section. We selected combined spinal-epidural anesthesia to avoid excessive sympathetic stimulation. Bupivacaine 9 mg and lidocaine 100 mg were used for spinal anesthesia and epidural anesthesia, respectively. The anesthetic course was uneventful, and the infant showed no complication during the perioperative period. In conclusion, we consider combined spinal-epidural anesthesia as a safe anesthetic strategy for caesarean section in a patient with asymptomatic idiopathic prolonged QT interval syndrome.

Purpose: We investigated seasonal allergic conjunctivitis in Hakodate., Materials and Methods: The clinical records of 293 patients with allergy-like symptoms who were seen at the Departments of Ophthalmology and Otolaryngology of Hakodate Municipal Hospital in 2001 and 2002 were examined for pollinosis, and evaluated. The general severity of conjunctivitis was graded as (+), (++), and (+++). The allergen was identified by AlaSTAT and nasal provocation test., Results: In March, June, and September 2001, and in March, April, and June 2002, many patients were examined. In 2001, 134 patients (87.0%) had allergic conjunctivitis, and 126 patients (90.6%) had it in 2002. The severity of allergic conjunctivitis in May, June, and September was significantly (p<0.05) more severe than in February, March, and April. The major antigen rates for Cryptomeria japonica, Gramineae, Artemisia, and Betula platyphyia var. japonica were 22, 21, 8, and 3%. The specific IgE positive rates for Cryptomeria japonica, Betula platyphyia var. japonica, Gramineae and Artemisia were higher in March and April, in May, in June, and in September., Conclusion: The allergens of conjunctivitis in Hakodate were not the same as in the Kansai. We should consider the dispersion of pollens area by area.

In order to investigate the possibility of the treatment of sensorineural hearing disturbance, experiments were performed using animals. First, the central cochlear pathway in the brain stem to pons was transected in adult rats. Tissue from embryos was transplanted to the lesion site. In 20% of the rats examined, the axons regrew beyond the transected site and regenerated into the denervated side and terminated at the normal targets. The hearing function of animals was also recovered. Those findings contradict the widely held view that the adult mammalian central auditory system cannot be restored following damage. Then, adult rat hippocampus-derived neural stem cells(NSC) were grafted into newborn rat cochlea. Within two to four weeks of grafting to the cochlea, some NSC survived in the cochlear cavity. Some of them had adopted the morphologies and positions of hair cells. This suggests that NSC can adapt to the environment of the cochlea and gives hope for treatment of the damaged cochlea and sensorineural hearing loss.

Shoulder pain is a common symptom, resulting not only from bone and shoulder joint diseases, but also from neurogenic lesions. Entrapment neuropathy of the suprascapular nerve also causes shoulder symptoms. Conduction of the suprascapular nerve was studied in 12 healthy control subjects and 25 patients suffering from shoulder pain and/or dysfunction. Surface stimulation was performed at Erb's point, and compound muscle action potentials(M waves) were recorded from the supraspinatus and the infraspinatus muscles with concentric needle electrodes. To determine the optimal site for recording M waves from the infraspinatus muscle, simultaneous multi-channel recordings of M waves using pairs of surface electrodes were obtained from different sites over the infraspinatus muscle. In two patients, latency of the M waves to the infraspinatus muscle was prolonged, whereas that to the supraspinatus muscle was normal. These findings indicate entrapment neuropathy at the spinoglenoid notch. In three patients, the latency to the infraspinatus and supraspinatus muscles was prolonged. These findings are compatible with entrapment neuropathy at the suprascapular notch. The latency to the supraspinatus and infraspinatus muscles was prolonged in patients with brachial plexus injury and in those with suprascapular nerve injury. In patients with myopathy, those with neuralgic amyotrophy and those with cervical radiculopathy, the latency was normal. Thus, conduction studies of the suprascapular nerve using multiple-channel recordings are useful, especially for the diagnosis of entrapment neuropathy of the suprascapular nerve.

We report a SAH case of a ruptured dissecting aneurysm of the middle cerebral artery following parietooccipital subcortical hemorrhage. A 68-year-old woman was admitted to our hospital, complaining of headache. On admission she was alert with left homonymous hemianopsia. A CT scan disclosed subcortical hemorrhage in the right parieto-occipital lobe. An angiogram revealed no abnormal vessels. Seven days after admission, she suddenly lapsed into unconsciousness with left hemiparesis. A CT scan demonstrated subarachnoid hemorrhage with a right sylvian hematoma. A second angiogram revealed fusiform dilatation of the M2 branches and aneurysmal dilatation at the M1-M2 bifurcation. Following conservative therapy, she died 21 days after admission. The relationship between subcortical hemorrhage and the subsequent subarachnoid hemorrhage was not certain. We discuss and review the treatment of a dissecting aneurysm of the middle cerebral artery.

F-waves are routinely evaluated in nerve conduction studies on proximal peripheral nerves. However, unusual late responses other than F-waves that show variation in latency and configuration sometimes confound evaluation of the F-waves. The unusual late responses were analyzed in this study. In two patients with cervical radiculopathy, two patients with brachial plexus injury and 9 patients with polyneuropathy, A-waves showing constant latency and configuration were recorded in addition to temporally dispersed F-waves. The A-waves in these patients persisted after supramaximal stimulation of the peripheral nerves, although the A-waves should normally disappear in response to supramaximal stimulation. The supramaximally stimulated A-waves were prominent in polyneuropathy and nerve lesions with demyelinating pathology. A patient with Guillain-Barré syndrome showed unusual repetitive discharges that might be important electrodiagnostic findings in the early stage of illness. In patients with myotonic dystrophy, electrical stimulation elicited repetitive discharges that continued from the M-waves. Recordings with a concentric needle electrode showed characteristics similar to those of myotonic discharges recorded during needle electrode insertion. When the repetitive discharges were mild, the F-waves were recorded. Absence of the F-waves in myotonic dystrophy might be related to the myotonic discharges elicited by electrical stimulation, and may not imply impaired conduction of the peripheral nerves. A patient with myokymia showed repetitive discharges with constant configuration but variable latency, although the F-waves were normal. These repetitive discharges may be evoked by ephaptic transmission resulting from abnormal excitability of the peripheral nerves or muscles of different etiologies.

A previously healthy 15-year-old female was admitted to our hospital complaining of nausea and vomiting. She did not complain of diarrhea. A physical examination revealed a lower right quadrant abdominal tenderness without rebound or spontaneous pain and a knocking pain of the costovertebral angle. A high fever, knocking pain of costovertebral angle, and urinary findings including Gram's stain, lead us to suspect a urinary tract infection, cefotiam was administered intravenously. Spiking fever with shaking chills continued for three days, and three sets of blood cultures were positive for Salmonella Oranienburg, but her urine culture was negative. Her history was taken again, revealing an intake of a processed squid product. The product was confirmed by the local public health center to be Salmonella Oranienburg. Finally food poisoning by Salmonella Oranienburg with sepsis was diagnosed. With cefotiam she became better and was discharged from the hospital on the 10th hospital day. During admission to the hospital she did not experience any diarrhea, and her stool culture was negative. Epidemics of Salmonella Oranienburg food poisoning are relatively rare in the literature. In Japan, one has arisen as a result of contamination of a processed squid product in March 1999. However, there have been no cases without so-called gastroenteritic symptoms (abdominal pain and diarrhea) who were previously healthy and developed sepsis caused by Salmonella Oranienburg, reported in Japan. Even in previously healthy patients, with an epidemic situation of non-typhoidal salmonellosis, salmonella sepsis must be ruled out. Among such cases, those who present with spiking fever and shaking chills should be given antibiotic therapy after taking appropriate cultures.

A case with unusual type of aneurysms in the distal posterior inferior cerebellar artery (PICA) is reported here. Though only two cases with a single aneurysm of the PICA communicating artery have been reported previously, the present case is the first one with multiple aneurysms in the PICA communicating artery. A 61-year-old woman with a sudden onset of severe headache, vomiting and unconsciousness was transferred to our hospital. CT scan revealed a hematoma in the fourth, third, and lateral ventricles, and a mild subarachnoid hemorrhage at the posterior fossa. Cerebral angiogram showed the right PICA supplying the hypoplastic left PICA territory through an anastomotic vessel. Two small aneurysms were seen at the tips of hairpin curves of an anastomotic vessel, "the PICA communicating artery". Suboccipital craniotomy was performed, and the ruptured aneurysm was clipped and the unruptured one was wrapped with cotton-sheet. After the operation, her clinical recovery went well and she was discharged on foot.

Infections caused by Schizophyllum commune have recently been on the increase. We analyzed cases in which this fungus was isolated from clinical samples from 1991 to 1995. Regular morphological methods were first employed in the identification of S. commune, and when necessary, mating was made with a known S. commune isolate. IgG antibodies against S. commune in the patients' serum were determined by the ELISA method. Profiles of the cases were analyzed and the English-language medical literature was reviewed. S. commune was isolated from 12 patients. Eighty three percent of the patients were female, most of which presented with allergy-related pulmonary diseases, i. e. allergic bronchopulmonary mycosis or mucoid impaction of bronchi. IgG antibodies were detectable in nine of eleven patients examined (82%). Fifty eight percent of the isolates were monokaryotic, and therefore, unidentifiable by regular morphological methods. In contrast, analysis of the English literature disclosed that sinusitis is the most common form of infection, and that hyphal invasion into the tissue was seen in 50% of reported cases. Our study shows that S. commune should be regarded as a pathogenic fungus, and is infecting humans much more frequently than previously assumed. Further investigation is warranted.

Two elder cases in whom infected pacemaker leads were removed under extracorporeal circulation (ECC) are reported. The leads could not be with drawn without direct sharp dissection under ECC because they had become firmly encased with fibrous tissue within the right ventricle. Postoperative courses were uneventful and neither of these patients has experienced recurrent infection to date. Removal with ECC seems to be a safe and effective procedure even in the elderly, provided that cardiac function is good.

A multichannel cochlear implant was performed in 8 children, and the following results were obtained. The surgical procedures were not as difficult as in adults, and there were few postoperative complications. The results of testing postoperative speech comprehension ability were examined in three children whose course was followed for more than one year postoperatively. Some patients had good speech comprehension ability postoperatively, and we expect to continue performing cochlear implant in children. Postoperative rehabilitation takes longer. The cooperation of physicians, audiologists, speech therapists, school teachers and family members is essential, and establishing a cochlear implant center for children would be desirable.

We have performed cochlear implants on 6 adult prelingually deaf patients and obtained the following results. 1) The speech comprehension ability of the adult prelingually deaf patients was poorer than in postlingually deaf patients, but some patients showed better results than expected. 2) The adult prelingually deaf patients required a longer period of rehabilitation than the postlingually deaf patients. There were considerable variations in performance among the adult prelingually deaf patients.