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Purpose: In this study, we evaluated image quality and radiation dose reduction when a Copper (Cu) filter was added to hip joint X-ray imaging., Methods: We measured effective energy without (0 mm) and with (0.1/0.2 mm) Cu-added filter at 70 kV, and we calculated soft tissue-bone contrast and signal-difference-to-noise-ratio (SDNR) under constant entrance surface dose. After that, we estimated the dose reduction rate., Results: The effective energy was 32.07 keV for 0 mm Cu, 37.59 keV for 0.1 mm Cu, and 40.91 keV for 0.2 mm Cu. As the thickness of the Cu-added filter was increased, contrast decreased, but SDNR increased. The dose reduction rate in bone calculated measuring SDNR was 34% for 0.1 mm Cu and 47% for 0.2 mm Cu in max., Conclusion: It was suggested that adding Cu filter to hip-joint X-ray imaging could reduce entrance surface dose while maintaining the image quality based on SDNR.

Purpose: In recent years, there has been a growing movement in Western countries toward the abolition of gonadal protection during radiography. The reasons for this recommendation are that there are few reports of increased risk of genetic effects, that the ovarian dose is not due to direct X-rays but due to internally scattered X-rays that cannot be shielded, and that the presence of gonadal protection may adversely affect the automatic exposure control mechanism and may mask important findings. In addition, the gonadal protection is a large high absorber of X-rays, and its presence in the irradiation field may have some effect on image quality, but the effect of the gonadal protection on image quality has not been clarified. In addition, after the abolition of gonadal protection, the optimal irradiation field setting is expected to become even more important to avoid unnecessary exposure. In this study, we investigated the effect of gonadal protection on image quality in frontal hip radiographs of adults with different radiation qualities and clarified the image quality under conditions in which the irradiation field is appropriately narrowed., Method: Frontal hip radiographs were taken using a human phantom as the subject, and the image quality of the femoral head was evaluated. Two irradiation fields were used: (a) 14×17 inch field and (b) an appropriate field (11.6×15 inch) that does not impair the reference line and image information necessary for reading hip joint images. The imaging tube voltage was set at 70 kV, and conditions for adding a copper filter were also considered. The incident surface air kerma was set to 1.25 mGy. The incident surface dose at this time was sufficiently lower than the diagnostic reference level (2.5 mGy) in Japan and was judged to be appropriate for imaging using an indirect conversion flat panel detector. The image quality evaluation item was the signal difference to noise ratio (SdNR) including scatterers., Result: The SdNR decreased by 4.6% when a gonadal shield was placed, indicating that the gonadal shield reduced image quality. When the irradiation field size was appropriately narrowed down, SdNR slightly increased or decreased depending on the quality of the imaging material, but the change was small compared to the change in SdNR with and without the gonadal protection shield., Conclusion: The results of this study confirm that the elimination of gonadal protection in hip radiography has significant advantages, such as reducing unnecessary X-ray exposure while ensuring image quality, when the irradiation field is set appropriately.

The patient was a woman in her 70's was referred to our hospital because of an abnormal shadow on chest roentgenogram at an annual medical checkup. Since preoperative examinations suggested lung cancer in the right middle lobe, thoracoscopic right middle lobectomy was planned. However, pleural dissemination was detected at surgery and we changed the treatment plan to the intrapleural hyperthermic chemotherapy. During the postoperative course, facial edema, hypokalemia, and hyperglycemia developed, and the diagnosis of Cushing's syndrome was suggested based on an increase in serum level of adrenocorticotropic hormone (ACTH) and cortisol, and was confirmed by a dexamethasone suppression test. Intrapleural hyperthermic chemotherapy was likely to collapse the ACTH-producing tumor leading Cushing's syndrome.

Objective　Obesity associated with an increased consumption of ultra-processed foods (UPF) has been reported by studies abroad using the NOVA food classification system, an international framework for classifying food according to the degree of processing. However, no such study has been conducted in Japan. In this study, we evaluated the association between UPF consumption, nutrient intake, and obesity using the NOVA system.Method　In September 2017, we conducted a survey using a questionnaire of patients who had attended routine health checkups in Manazuru Town, Kanagawa Prefecture and collected their three-day dietary records as well as medical examination results. The final analysis included 169 patients (66 men, 103 women). Food consumed by the respondents were classified into four groups of NOVA systems. The dietary share of UPF (UPF energy ratio) was compared to total energy intake (except alcoholic beverages and eating out). Nutrient intake and obesity risk were compared across the UPF energy ratio tertile (low, middle, and high intake). Covariance and logistic regression analysis were conducted and adjusted based on age, sex, household structure, education, income, and total energy intake (except energy-providing nutrients, macronutrients, and protein intake per body weight) to analyze the association between UPF consumption and nutrient intake. Finally, for obesity, we adjusted for physical activity and smoking status using a similar analysis of the relationship between UPF consumption and energy providing nutrients and macronutrients.Result　Approximately 75% of patients investigated were older than 65 years. The average (standard deviation) UPF energy ratio was 29.7% (15.0). There were no significant differences in socioeconomic status among groups according to the UPF energy ratio. The high-UPF group had a significantly greater total energy intake. However, the protein energy ratio, protein intake per body weight, dietary fiber, and vitamins A, E, K, B 1 , B 6 , C, niacin, folic acid, potassium, magnesium, and iron intake were significantly lower in the high-UPF group. Moreover, the high-UPF group had a significantly higher BMI. The odds ratio for obesity was higher (4.51[1.50-13.57]) in the high-UPF group than in the low-UPF group (1.00).Conclusion　Those who consumed more UPF had lower protein intake and suffered from multiple vitamin and mineral deficiencies. Furthermore, their energy intake was greater, and the odds ratio for obesity was significantly higher. It has been suggested that excessive UPF consumption warrants further attention.

Bronchial artery aneurysm(BAA) is quite rare, but its rupture is often lethal. Once it is found, treatments should be aggressively considered. A 67-year-old woman was diagnosed to have a 26 mm mediastinal BAA on computed tomography (CT) which was performed for screening. CT revealed a very short inflow vessel of the BAA and arteriovenous fistula at the outflow. Considering these features of the aneurysm, endovascular interventions deemed difficult and surgery was carried out. Because of the fragility, the aneurysm was resected together with the descending aorta and the graft replacement was performed under partial extracorporeal circulation. The patient has no untoward event for 1 year postoperatively. Although most recent reports advocate endovascular interventions, we think surgical treatment is a variable option in selected patients. Careful evaluation for each BAA case would be essential to determine the treatment strategy.

In 2009, the Japan Anti-Doping Agency (JADA) established the "Sports Pharmacist Accreditation Program" to prevent doping in sports. Since then, anti-doping activities in Japan have been attracting attention. In this study, we investigated research about the current status of doping from 2007 to 2014 in Japan to make anti-doping activities more concrete, and we also discussed future anti-doping activities by pharmacists. In Japan, bodybuilding was the sporting event with the highest number and rate of doping from 2007 to 2014. Many of the positive doping cases were detected for class S1 (anabolic agents), S5 (diuretics and masking agents), and S6 (stimulants). Within class S1, supplements were the main cause of positive doping. Within class S5, medicines prescribed by medical doctors were the main cause of positive doping. Within class S6, non-prescription medicines (e.g., OTC) were the main cause of positive doping. When we looked at the global statistics on doping, many of the positive doping cases were detected for class S1. On comparing the Japanese statistics with the global statistics, the rate of positive doping caused by class S1 was significantly lower, but that caused by classes S5 and S6 was significantly higher in Japan than in the world. In conclusion, pharmacists in Japan should pay attention to class S1, S5, and S6 prohibited substances and to the sport events of bodybuilding. Based on this study, sports pharmacists as well as common pharmacists should suggest new anti-doping activities to prevent doping in the future.

An 85-year-old woman was hospitalized by emergency for an acute Stanford type A aortic dissection. Computed tomography showed a primary entry on the ascending aorta and pericardial effusion. Although her hemodynamics was unstable due to cardiac shock, her family wished no open surgery considering her age and frailty. A couple of days later, her condition became stabilized with antihypertensive therapy. Since the dissection was limited within the ascending aorta, closure of the entry with the stentgraft was considered appropriate and much less invasive as compared with an open surgery. After obtaining informed consent with her family, thoracic endovascular aortic repair was performed with Gore C-TAG with 2-debranch. The procedure was completed without complications and the entry closure was confirmed by aortography. Her postoperative course was uneventful. Her physical activity restored to the preoperative level and she was discharged.

Objectives Aiming at improvement of the Japan Health Insurance Association's Specific Health Guidance initiatives and human resource development, we conducted a qualitative study to clarify the features necessary for and the challenges hindering the achievement of good performance of the initiatives.Methods From November 2014 to January 2015, we conducted 10 focus group interviews, each 90 minutes long, with 64 public health nurses from 10 Japan Health Insurance Association branches. In addition, self-administered questionnaires were administered to obtain the participants' basic characteristics. After we excluded one group for failing to meet our performance targets, we divided the remaining nine focus groups according to two patterns: Maintenance and Progress. The four focus groups fitting the Maintenance pattern had a well-established track record, and the five focus groups fitting the Progress pattern had a track record of good growth. Using open coding of the interview transcripts, we extracted efforts or needs in two domains, individual and branch, Then, we placed codes in eight main categories: [quality], [general practice], [dietary guidance practice], [success factor], [branch system], [training and skill development], [approach to the member office], and [past efforts]. We further extracted important subcategories based on their rates of appearance within branches.Results Data from 56 female public health nurses working at nine branches were included in the analysis. With respect to the individual domain, subcategories such as "building rapport," "creating the physical environment," and "taking the initiative in evaluating one's own lifestyle" in the 〈high emphasis〉 segment of the [general practice] category were common to both patterns. In addition, "increasing opportunities for training" and "enhancement of training program content" were found for both patterns in relation to the 〈demand〉 segment of the [training and skill development] category. However, most participants chose "yes" in response to whether there was ample training opportunity.Conclusion This study showed some common efforts and practices among public health nurses in both patterns, which indicates good performance of the Specific Health Guidance initiatives. However, there is a need to further enhance the training program to strengthen the entire organization. Future studies should focus on understanding the characteristics of and factors involved in low-performing branches.

Here, we report a case of pyoderma gangrenosum of the penis which was difficult to distinguish from Fournier gangrene. The patient was a 54-year-old male who was aware of redness and swelling of the glanspenis for 1 month prior to a consultation at our department. Although he was diagnosed with herpes and treated at a nearby hospital, his symptoms did not improve. Subsequently, the patient visited our department following the onset of pain and fever. During his initial consultation, he had a fever of 39 °C as well as redness and swelling of the glans penis with partial spontaneous purulent discharge. His blood test revealed an elevated white blood cell count (20, 000/μl) and C-reactive protein (19.1 mg/dl). Because Fournier gangrene was suspected, administration of broad-spectrum antimicrobial agents was initiated but proved to be ineffective. An abscess (2 cm in diameter) was also noted in the umbilical region.Enterococcus faecalis was detected by the bacterial culture ; and therefore, Fournier gangrene was diagnosed. A partial penectomy was performed to control the infection. Pathological findings showed only non-specific inflammation ; however, fever persisted postoperatively and blood test results showed no improvement. Furthermore, new abscess lesions emerged on the right heel and back. Because the re-performed abscess bacterial culture test result was negative, pyoderma gangrenosum was suspected, and he was started on oral prednisolone (20 mg/day). On the following day, his fever subsided and his blood test results also showed improvement. A final diagnosis of pyoderma gangrenosum was ultimately made.

Background: Anesthetic management for cesarean section of patients with placenta previa accreta is challenging. The aim of this retrospective study was to review past placenta previa accreta cases in our hospital to propose a better strategy for anesthetic management for this difficult condition., Methods: Cases of placenta previa accreta were identified in our anesthesia database. The diagnosis, surgical procedure, amount of blood loss and anesthetic management were reviewed., Results: Eight cases of placenta previa accreta were identified. Four of the eight cases underwent stepwise treatment, and in one of the four cases, intra-aortic balloon occlusion (IABO) was performed. The amount of blood loss in the four cases ranged from 840 to 1,150 ml. The remaining four cases underwent cesarean hysterectomy. The amount of blood loss in the four cases ranged from 2,400 to 5,200 ml. Neuraxial anesthesia alone was planned in four cases, but in two of which anesthesia was converted to general anesthesia due to massive bleeding., Conclusions: The present retrospective study showed that stepwise treatment and using IABO could be an effective aid for management of plasenta previa accreta. It is necessary to compare the effectiveness of IABO with that of common iliac artery occlusion in reducing the amount of blood loss.

Objectives: The effects of a comprehensive intervention program for community-dwelling elderly on frailty and dietary habits were examined., Methods: We conducted randomized control trials to examine the efficacy of the intervention. To examine lasting changes, we made paired comparisons between pre- and post- intervention and at a three-month follow-up. The subjects were recruited in Hatoyama town, Saitama prefecture. The program was composed of exercise, nutritional education, and social participation and was held from October to December 2011. The exercise program aimed at fall prevention and took place twice per week for 60 min. The nutritional education aimed at prevention of malnutrition, and the social participation program aimed at prevention of "homeboundness"; both were held once per week for 30 min. Questionnaires inquired about frailty and dietary variety. A blood test was conducted to ascertain nutritional state, and a brief self-administered diet history questionnaire was used to estimate food and nutrient intake. To examine the efficacy of the intervention, 22 control subjects (CR) and 21 subjects in the intervention group (IV) were analyzed with intention to treat. To examine lasting changes, 16 subjects in IV who correctly completed surveys at each of the three time points were analyzed, using repeated ANOVA and a multiple comparison procedure., Results: 1. Men comprised 70-80% of subjects, and the average age was 75.7±5.4 and 74.7±5.4 years in IV and CR, respectively. 2. There was no significant difference in pre- and post-intervention changes between IV and CR in frailty, which was the main outcome of the study. 3. A significant difference in pre- and post-intervention values was noted in ① "homeboundness", one of the components of frailty (median [25-75%tile]): IV 0 [0-0] and CR 0 [0-1] (P=0.023); ② nutrient intake (mean±standard deviation [SD], energy ratio [%E]): protein, IV 2.3±0.7 and CR -0.3±2.0 (P=0.002); animal protein, IV 2.4±1.5 and CR -0.5±1.5 (P=0.002); and ③ food intake (mean±SD, g/1000 kcal): fish, IV 18.1±25.1 and CR -4.1±21.9 (P=0.004); egg, IV 5.0±11.2 and CR -2.1±11.3 (P=0.046). All variables improved in IV. 4. Lasting improvement was observed in "homeboundness" and protein intake [%E]., Conclusion: Although the intervention did not improve frailty, it may improve frailty and dietary habits by improving homeboundness and increasing protein intake.

We report a case of a 64-year-old Japanese man with adenoid cystic carcinoma. An elevated lesion covered by intact epithelium in the thoracic esophagus was found in September, 2007 and been followed. After dysphagia appeared follow-up endoscopy was performed in January, 2010, and morphological change into a protruding tumor was recognized. Since adenoid cystic carcinoma was detected by endoscopic biopsy, the patient underwent esophageal resection. The resected specimen showed a cribriform pattern and a certain amount of mucous substance which was positive for Alcian blue, within a solid nest. The tumor cells were positive for S-100 protein and negative for αSMA, so the tumor was diagnosed as an adenoid cystic carcinoma.

We report the case of a 15-year-old Japanese boy with eosinophilic gastroenteritis. The patient complained of abdominal pain and watery diarrhea and had a history of allergic rhinitis. Laboratory data on admission showed leukocytosis with remarkable eosinophilia. Microscopic examination of the biopsied specimens taken from the esophagus, stomach, duodenum, lower ileum and colon showed eosinophilic infiltration. Especially in the lower esophagus, there was a ring-like discoloration with remarkable eosinophil infiltration. We diagnosed eosinophilic gastroenteritis and his clinical symptoms and eosinophilia improved following starting corticosteroid therapy. After 5 months therapy with prednisolone, discoloration of upper digestive tract disappeared. There have been no reports describing discoloration in the lower end of the esophagus seen by gastroscopy.

A 33-year old man was admitted to our hospital because of an abnormal shadow on the chest radiograph, dry cough, and exertional dyspnea. Chest radiograph and high-resolution computed tomography (HRCT) on admission showed ground-glass opacities and bronchiectasis with volume loss in the bilateral dorsal areas. Thoracoscopic lung biopsy specimens showed mainly a pattern of NSIP (nonspecific interstitial pneumonia). We considered this case as hypersensitivity pneumonia or interstitial pneumonia (IP) associated with collagen disease. Oral prednisolone (PSL) was initiated at 55 mg/day (1 mg/kg). However he complained of proximal muscle weakness and pain and difficulty of breathing. He had heart failure due to the myocarditis. We established a diagnosis of IP associated with polymyositis and it was confirmed by his symptoms, muscle biopsy findings and elevation of serum CPK. We considered this case as the myocarditis due to polymyositis.

A 36-year-old man who often ate raw chicken meat had abnormal chest radiograph findings on a health check-up in July 2009, and visited our department. A chest computed tomographic scan revealed 6 nodular shadows in both lungs, and a hematologic examination revealed eosinophilia and elevation of IgE. Because of his history of eating raw chicken meat, antiparasite antibody testing was performed which revealed antibodies to Toxocara canis, leading to the diagnosis of pulmonary toxocariasis due to Toxocara canis. Although treatment with albendazole was performed, it was discontinued because of hepatic impairment. However, hematological examination showed that his eosinophil count and IgE increased again, and chest image findings were exacerbated. Therefore, ivermectin, reported as effective in cases outside Japan, was administered, resulting in decreased peripheral eosinophils, normalized IgE level, and disappearance of the shadows on chest images. In Japan, no cases of pulmonary toxocariasis responding well to ivermectin have previously been reported. Administration of ivermectin should be considered when albendazol cannot be used due to hepatic impairment or related problems.

A 61 year-old man complaining of asymptomatic gross hematuria was admitted to our hospital in May 2005. Transurethral resection of bladder tumor (TUR-BT) was performed for a bladder tumor (urothelial carcinoma (UC), pTa, G2). The TUR-BT was performed again because cystoscopy revealed a nonpapillary bladder tumor on the posterior bladder wall in September 2007. The pathological findings showed a UC, pTa, G2 and an inflammatory myofibroblastic tumor (IMT), pT1. The TUR-BT was performed two more times for tumor recurrences. We considered a total cystectomy because of the possibility of a pathologically low grade sarcoma and the considerable enlargement of the tumor size for a month after the TUR-BT. Ultimately, a malignant sarcoma was not diagnosed from the pathological findings. We practiced conservative therapy with a steroid and the tumor was reduced.

Objectives: Previous data have indicated that the erythrocyte membrane may be the preferred sample type for assessing long-chain polyunsaturated fatty acid (LCPUFA) contents in cardiac and cerebral membranes. In this epidemiological study, we examined whether plasma phospholipids can be used for accurate biological monitoring of the LCPUFA state or whether analysis of erythrocyte membrane phospholipids is indispensable., Methods: (1) The analysis of LCPUFA contents in erythrocyte membrane phospholipids was conducted at baseline and after 1 and 3 days at 4°C, and 21 days at -40°C, after blood drawing, and the changes in LCPUFA content were examined. (2) The LCPUFA compositions of plasma and erythrocyte phospholipids in 133 young women (18-30 years old) were examined and the relationships between the sample type and the levels of LCPUFAs were determined., Results: Eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and DHA/arachidonic acid (AA) and (EPA+DHA)/AA ratios in erythrocyte membrane phospholipids after 21 days of blood drawing significantly decreased compared with the corresponding baseline data. Regarding AA, EPA and DHA, a significant positive correlation was shown between levels of erythrocyte membrane phospholipids and plasma phospholipids (AA, r=0.364; EPA, r=0.709; DHA, r=0.653). The predictive value of plasma phospholipids for determining the highest concentration quartile in erythrocyte phospholipids was better in EPA (70%) than in DHA (55%) and AA (42%)., Conclusions: The measurement of LCPUFA content in erythrocyte membrane phospholipids is necessary for accurate biological monitoring. We also found that LCPUFA in erythrocyte membrane phospholipids is stable in cold storage (4°C) for 3 days after blood drawing.

We report a rare case of a thigh abscess which appeared during treatment of miliary tuberculosis. A 72-year-old woman with a history of diabetes mellitus was being treated for systemic sclerosis with prednisolone. She was then admitted to our hospital with fever, and chest computed tomography showed an abnormal shadow. She was given a diagnosis of miliary tuberculosis, and antituberculous therapy was initiated with isoniazid, rifampicin, ethambutol and pyrazinamide. Although this combination of antituberculous drugs was effective, 3 months after the initiation of treatment, a collection of fluid appeared in her left thigh. Further examination revealed the fluid to be positive for Mycobacterium tuberculosis on PCR and negative on mycobacterial culture. We thus diagnosed this phenomenon to be a paradoxical reaction.

Application of microTAS (micro Total Analysis Systems) technologies utilizing chips with microfluidic channels to clinical diagnostic testing has drawn a lot of attention since it is expected to contribute to shortening reaction time, reduction of reagent/sample consumption, reducing instrument size, and other advantages of microchip electrophoresis. We have developed a fully automated immunoassay system by employing isotachophoresis followed by capillary gel electrophoresis for immunoreaction and B/F separation in microfluidic channels on polymer microchips. Laser-Induced Fluorescence (LIF) was used for detection of the sandwich immunocomplex composed of DNA-conjugate antibody, antigen and fluorescent dye-conjugated antibody. An immunoassay for PIVKA II was demonstrated on this new microTAS system utilizing the DNA-conjugated anti PIVKA II antibody and the fluorescent-dye labeled anti-prothrombin antibody. The resulting assay showed good assay performance with high sensitivity (LOD = 5mAU/mL), good reproducibility(CV = 1.0 - 5.7%) and good correlation with the commercially available PIVKA II assay kit (regression curve of y = 1.04x + 11.1, r = 0.991). The assay turn around time (TAT) was about 9 min. The PIVKA II assay will be useful for the diagnosis and prognosis of hepatocellular carcinoma.

A 63-year-old woman underwent right upper lobectomy for small cell carcinoma. She received a total of 2 courses of carboplatin and etoposide infusion as adjuvant therapy. One year after the operation, because of elevated serum Pro GRP levels and a metastatic brain tumor revealed by CT, 4 courses of IP therapy (irinotecan 60 mg/m(2), day 1, 8, 15 and cisplatin 60 mg/m(2), day 1, every 4 weeks) and whole brain radiotherapy (2 Gy f, 5 f/week, total 40 Gy) were given. A complete response was obtained, but a tumor relapse occurred ten months after the last chemotherapy. We then performed a stereotactic radiosurgery (marginal dose: 22 Gy, maximum dose 44 Gy), and one month later MRI showed the tumor had shrunk markedly. FDG-PET showed no intensive uptake, suggesting that there was no remaining viable tumor. No severe side effects were observed during these treatments. Currently, the patient has been alive with good performance status and no signs of relapse.

A 70-year-old man presented with a deteriorating fever and productive cough after the administration of drugs including L-carbocisteine against the common cold. Since chest radiograph revealed pulmonary infiltrates in the right lower lung field, he was admitted to our hospital, then L-carbocisteine was continued and antibiotics started. However, his symptoms, laboratory findings, and hypoxia worsened. Pulmonary infiltrates on his chest radiograph increased and chest CT demonstrated pulmonary consolidation with traction bronchiectasis and ground glass opacity with thickened of interlobular septae in the right lung field. Analysis of bronchoalveolar lavage fluid showed elevated numbers of total cells, neutrophils and eosinophils, and the CD4/CD8 ratio was 5.65. Under a suspected diagnosis of drug-induced pneumonia, we halted L-carbocisteine administration stopped and began corticosteroid therapy. Subsequently his symptoms and findings markedly improved. The drug lymphocyte stimulation test for L-carbocisteine using peripheral blood lymphocytes showed positive results. On the basis of the clinical course, laboratory and radiographic findings, we considered this case to possibly be drug-induced pneumonia due to L-carbocisteine. To our knowledge, this is possibly the first case of L-carbocisteine-induced pneumonia to be reported.

We report a case of postoperative multiple pulmonary metastases of NSCLC successfully treated with S-1. A 72-year-old man underwent rt. lower lobectomy + ND 2 a by VATS. The histopathological examination showed squamous cell carcinoma, pT4 (satellite nodules in same lobe) N0M0. Multiple pulmonary metastases appeared 3 months after operation. We started combination chemotherapy with S-1 and CBDCA. S-1 (100 mg/body) was administered on days 1-21. CBDCA (AUC=5.0) was administered on day 8. Multiple pulmonary metastases almost disappeared after 2 courses of combination chemotherapy. After 6 courses of combination chemotherapy with S-1 and CBDCA, we then converted to S-1 only. Every cycle was repeated every 5 weeks. One year later, there was no sign of disease progression. S-1 is considered to be effective and safely administered in patients with NSCLC.

We report a case of bronchial asthma attack with lactic acidosis and hypokalemia in a patient receiving high-dose inhalation of procaterol hydrochloride. A 28-year-old man was transferred to our hospital because of adynamia, nausea and dyspnea. He had used inhaled procaterol hydrochloride with a pressurized metered dose inhaler about 20 times before admission. On admission, there were no signs of shock state or hypoxemia and laboratory data showed hypokalemia, hyperglycemia and metabolic acidosis with elevated anion gap. Lactic acidosis was identified as the reason for the metabolic acidosis with elevated anion gap. Lactic acidosis improved after 12 hours. Lactic acidosis due to high dose inhalation of procaterol hydrochloride was suggested.

It is well known that lung cancer patients with severe chronic obstructive pulmonary disease (COPD) have a higher risk of postoperative complications than patients without COPD. However, the information regarding preoperative treatment to improve pulmonary function of the lung cancer patients with severe COPD is limited. Here, we report 3 lung cancer cases with severe COPD. Although all patients received medication without tiotropium bromide in combination with pulmonary rehabilitation for 1 or 2 months, their pulmonary function did not improve and the predicted postoperative FEV1/predicted FEV1 was below 40% in all cases. After the approval in Japan for use of tiotropium bromide in the treatment of COPD, all patients were treated with tiotropium bromide. The pulmonary function in all patients improved 2-4 weeks after the start of tiotropium bromide, and we performed lobectomy safely. Currently all patients maintain good pulmonary function without recurrence of lung cancer. We propose that treatment of tiotropium bromide might be one of the effective preoperative methods to improve pulmonary function of lung cancer patients with severe COPD.

We have developed an efficient synthesis method for optically active oligonaphthalenes (from 2 mer to 16 mer), which are connected at their 1,4-positions, under oxidative homo coupling with a stoichiometric amount of CuCl(2) and amines. The absolute configuration of the newly formed axis bond was determined based on the CD spectra of oligonaphthalenes with 1) two pyrene rings on the central naphthalenes or 2) two tetraphenylporphyrins (TPP) on the top and bottom naphthalenes. The fluorescence quantum yields increased as the number of naphthalene units increased in methoxy derivatives 10-12, and the intramolecular energy transfer quantum yields of bispyrene derivatives 7-9 were around 20% regardless of the number of naphthalene units. Furthermore, the hexadecanaphthalene derivative 4b with two TPPs exhibited a clear exciton coupling over an interchromophore distance to ca. 66 A.

We report a 53-year-old woman with severe Graves' ophthalmopathy accompanied by uncontrolled myasthenia gravis. She presented remarkable exophthalmos, chemosis, and restriction of eye movement. Despite plasma exchange, steroid pulse therapy, local injection of steroid, and irradiation, ocular symptoms did not ameliorate. Since optic neuropathy was seen, orbital decompression surgery was performed in the left eye. Bilateral chemosis was improved after the surgery. Five years after surgery, there was no ocular palsy in the operated left eye, but in the contralateral eye. For the good prognosis of the eye movement, orbital decompression might be recommended in the severe Graves' ophthalmopathy accompanied by the optic neuropathy and/or ophthalmoplegia with proptosis.

An 80-year-old woman was scheduled to have an operation for uterus cancer. Echocardiography revealed a giant mobile mass in the left atrium with a stalk at posterior wall of the left atrium. There was no significant mitral disease. Due to the risks of sudden circulatory collapse and systemic emboli, an emergency operation was indicated. Right side of the left atrium was opened under cardiopulmonary bypass following median sternotomy. The mass was attached to the posterior wall, 1.5 cm medial to the right upper pulmonary vein, with a thin stalk as diagnosed preoperatively. The mass (4.2 x 3.4 x 3.4 cm) was removed very easily. Pathological analysis revealed that the mass was a thrombus mixed with fibrin. A possible cause would be paroxysmal atrial fibrillation and/or hypercoagulative status due to malignancy. Anti-coagulation therapy was initiated postoperatively to prevent recurrence of thrombus. The patient recovered and discharged uneventfully.

Juvenile nasopharyngeal angiofibromas (JNAs) are benign tumors that occasionally invade the pterygopalatine fossa, infratemporal fossa, or middle cranial fossa. Several surgical approaches have been used based on the location of the tumor, including transpalatal, transmaxillary, and lateral rhinotomy, midfacial degloving, and Le Fort type I osteotomy. We reviewed 4 cases of JNA that had been treated by resection in the Department of Otolaryngology of Kagoshima City Hospital and 31 cases of JNA reported in the Japanese literature between 1990 and 2003. We analyzed the outcome of the surgical treatment of JNA in these cases to identify the surgical approaches that were most effective in removing tumors at several different stages. Radkowski staging showed that 17 (48.6%), 2 (5.7%), 4 (11.4%), 9 (25.7%) and 3 (8.6%) patients had stage IA, IB, IIA, IIC, and IIIA tumors, respectively. A transpalatal approach was employed in 11 cases (31.4%), a transmaxillary approach in 9 cases (25.7%), a transnasal approach in 6 cases (17.1%), and other approaches, (25.7%). The recurrence rate was, 5% in the stage I cases, 38% in the stage II cases, and 33% in the stage III cases. The transpalatal approach was followed by a high recurrence rate in the cases of stage II and higher stage. Several factors are critical when choosing the surgical approach to JNA: adequate exposure of the tumor, ability to control bleeding, prevention of postoperative facial deformity, and avoidance of interference with growth of the face.

Object: The purpose of this study was to clarify factors related to eating breakfast among elementary school children., Method: The subjects were 196 fifth-grade pupils from two elementary schools in Osaka Prefecture. The main survey items were as follows: Number of eating breakfast days in the last week, appetite for breakfast, sleeping habits, knowledge on food, attitude related to eating breakfast, self-esteem, social skills, and eating behavior of family members. The Rosenberg Scale was used to measure global self-esteem and the Pope Scale for estimation of family-related self-esteem. Social skills were assessed using the scale developed by Shimada et al., which consists of subscales for pro-social skills, withdrawal behavior, and aggressive behavior., Results: The main results were as follows: (1) The percentages of children who ate breakfast everyday in the last week were 78.3% for boys and 70.2% for girls, who no significant difference between the sexes. (2) The children who ate breakfast everyday in the last week (everyday-eating group) had more appetite for breakfast and went to bed earlier than the children who one or more days without eating (lack-of-eating group). (3) Compared with the lack-of-eating group, the everyday-eating group showed higher scores in family-related self-esteem and pro-social skills, and lower scores for aggressive behavior. (4) Regarding knowledge on food except influence of sugar for health, there were no differences between the everyday-eating and lack-of-eating groups. However, the former included more children who thought that eating every breakfast was very important, compared with the latter. (5) Children who expressed the following answers were more abundant in the everyday-eating group than in the lack-of-eating group: (1) Family members prepare breakfast every day; (2) They ate breakfast with family members everyday in the last week; (3) They often talk with family members during meals and snacks., Conclusions: From the above results, the following are suggested in relation to the development of eating breakfast for elementary school children: (1) Only providing knowledge on nutrition is insufficient; (2) Development of a positive attitude toward the significance of breakfast is necessary; (3) Development of a daily living rhythm, including sleeping behavior, is important; (4) Encouraging the development of family-related self-esteem and the social skills is important. Therefore, especially in the elementary school stage, not only conducting eating behavior education at school, but also intervention to affect family members' behavior and attitudes has an important role.

Combined effects of arbekacin (ABK) with biapenem (BIPM) were examined on both in vitro and in vivo model of a mixture of MRSA and Pseudomonas aeruginosa. As a result, significant effect in vitro was observed in combined use of ABK (1/2 MIC) with BIPM (1/4 and 1/2 MIC) against MRSA as compared with ABK or BIPM alone. Against P. aeruginosa combined effect was also observed, showing reduction of viable cells to the limitation of detection within 2 hours. Moreover, with respect to the protective effect on mixed systemic infection of MRSA and P. aeruginosa, the combined treatment with ABK and BIPM showed more excellent efficacy as compared with the single use of each drug.

We describe a case of allergic fungal sinusitis (AFS) caused by Bipolaris spicifera, the first case reported in Japan. A 70-year-old man was admitted to our hospital because of diplopia following bilateral nasal obstruction and discharge. Radiological studies using computed tomographic scan showed a large soft tissue mass occupying the right frontal, bilateral ethmoid and sphenoid sinuses. He underwent drainage surgery and histopathological examination of the contents of the paranasal sinuses revealed scattered fungal hyphae within "allergic mucin". By cytological examination, these hyphae showed septation at irregular intervals, and were swollen to various sizes. Microbiological studies identified the fungus as Bipolaris spicifera. The presence of allergic mucin and scattered fungal hyphae were very important findings in making a diagnosis of AFS histopathologically, so squash cytology of the contents of the paranasal sinuses was quite useful to observe fungal elements and identify the strain in this case.

The aim of the present study was to investigate current problems of snacking behavior and their relationship to stress coping among 1,486 fourth through ninth grade students from 10 elementary schools and six junior high schools. An anonymous self-completed questionnaire was utilized which included items about 1) selection of snack foods, which were classified into healthy, popular, complementary and western-style snacks, 2) problems of snacking behavior, which included external and emotional eating scores, and 3) stress coping scale. The stress coping scale contained two sub-scales; problem-focused and emotion-focused coping. The results were as follows: 1) Students who frequently went without breakfast did not select healthy foods, i.e., fruits and dairy products, but popular snacks, i.e., potato chips, pop corn and sweet beverage. 2) Both external and emotional eating scores increased by age in girls but was not apparent in boys. 3) Students who preferred either western-style or popular snacks showed higher score of external and emotional eating. 4) The score of problem-focused coping was positively correlated with preference for health snacks, but emotion-focused coping was positively correlated with external and emotional eating scores. The close relationship between snack food selection and problematic aspects of eating behavior suggests that modification of eating behavior is necessary to develop healthy snack habits in early adolescents. Also, it is interesting that snacking behavior is closely related to stress coping, which suggested the behavioral intervention for healthy eating habit should be included in development of stress-coping skills against various kinds of demands in life.

The purpose of this study was to evaluate the safety and advantage of intra-operative patient-controlled sedation (PCS) in elderly patients. Propofol PCS was compared with anesthesiologist-controlled sedation (ACS) during knee arthroplasty under epidural anesthesia. Eleven elderly patients scheduled for unilateral knee total or partial arthroplasty were divided randomly into PCS group (n = 6) and ACS group (n = 5). Epidural anesthesia was performed to produce an appropriate level of sensory block (T 10 through S). Firstly a mixture of pentazocine 0.2 mg.kg-1 and 2% mepivacaine 6-9 ml was injected to the epidural space, and anaesthesia was maintained using 2% mepivacaine afterward. Patients in both groups received propofol 0.3 mg.kg-1 i.v. as a loading dose and 0.6 mg.kg-1.h-1 continuous infusion. Furthermore patients in PCS group received propofol PCS (bolus: 0.2 mg.kg-1, lockout time: 3 min). Patients in ACS group were administered propofol continuously and infusion rates were regulated to maintain a sedation score 3 (Wilson et al) by anesthesiologist. Respiratory rate, blood pressure, heart rate, SpO2, arterial blood gas analysis and plasma levels of propofol were measured 4 times during and after the surgery. Satisfaction of patients and surgeons was questioned. Patients in PCS group received a mean propofol dose of 1.9 +/- 0.1 mg.kg-1 during procedures with a mean duration of 147 min. On the other hand patients in ACS group received propofol 2.9 +/- 0.3 mg.kg-1 with 142 min of procedures. Satisfaction of patients and surgeons, the incidence of complication were similar between the groups. For elderly patients who undergo epidural anesthesia, PCS is a safe and effective technique providing similar good sedation as with ACS.

Object: This study examined the relationship between smoking behavior and self-esteem among Japanese early adolescents., Method: The study sample comprised 1,486 fourth through ninth grade students from 10 elementary schools and six junior high schools throughout nine prefectures. Data were collected using an anonymous self-administered questionnaire which included items measuring smoking behavior, self-esteem, intention to smoke in the future, self-efficacy to refuse peer pressure to smoke, the smoking behaviors of their parents, siblings and friends. Self-esteem was measured using the Harter Perceived Competence Scale which includes four areas: cognitive, social, physical, and general., Results: The main results were as follows: 1) Ever smokers had lower cognitive and general competence scores, but a higher physical competence score than never smokers, especially among males. 2) Ever smokers had more smoking parents, siblings and friends than never smokers. 3) Ever smokers had stronger intention to smoke in the future than never smokers. 4) Ever smokers had lower self-efficacy to refuse peer pressure to smoke than never smokers., Conclusion: The results of this study about the relationship between smoking behavior and self-esteem were consistent with those of some previous studies in the U.S. Therefore, it is suggested that effective smoking prevention programs for Japanese early adolescents should include strategies to enhance self-esteem.

The purpose of this study was to evaluate the short-term effect of a smoking prevention program for Japanese elementary school-children in the fifth and sixth grades. The program was developed with concepts found in the Know Your Body Program and the conclusions of a National Cancer Institute-convened Expert Advisory Panel, and focused on teaching about the short-term effects of smoking and on resistance to social pressures to smoke. The study was conducted with a quasi-experimental design. An intervention group (52 boys and 54 girls) received three sessions for both the fifth grade in 1992 and the sixth grade in 1993. Moreover, the intervention group received a pre-test before the first session and a post-test after the third session in each grade. A comparison group (102 boys and 91 girls) received the same tests at the same time as the intervention group, but did not receive any program on smoking prevention. The short-term effect of the program were evaluated using the results of the pre-test in the fifth grade and of the post-test in the sixth grade in both groups. The results were as follows: 1) Remarkable short-term effects of the intervention were seen in respect to awareness of the importance of not smoking in girls, and also in the knowledge of the short-term effects of smoking in both sexes. 2) The intervention was not effective with respect to intention to smoke at the age of 20 and self-efficacy of refusing to smoke in both sexes. 3) The short-term effects were not clear in the smoking behavior in both sexes because the rates of ever smokers and of monthly smokers were almost the same for two years between the intervention group and the comparison group. 4) The smoking behaviors of children, their parents and their best friends had little influence on the results of the post-test in the sixth grade.

Neobladder using a detubularized intestinal segment was constructed in 74 cystectomized patients between October 1986 and July 1994. There were 65 males (87.8%) and 9 females (12.2%) with an average age of 63 years (range 36 to 77 years). The mean follow-up period was 35 months (range 7 to 85). Problems of postoperative care assessed were continence, renal function, metabolic consequences, neoplasms and other complications. Moreover, the impact of these problems on the quality of life was evaluated by a self-administered questionnaire. Continence in the daytime was achieved in 70/74 (94.6%) patients. Nocturnal incontinence was noted in 15/74 (20.3%) patients. Serum BUN and creatinine levels were maintained within normal limits. Metabolic acidosis (base excess < -5.0 occurred in 7/74 (9.5%) patients, 4 patients of whom needed alkalizing agents. Colon adenomas in neobladder were found and resected in 3 patients. The other postoperative complications were stone formation in neobladder in 4 (5.4%), urethral stricture in 7 (9.5%) and ureteral stenosis in 3 (4.1%) patients respectively, which were satisfactorily corrected by endourological procedures. As to quality of life assessment, the majority was satisfied, whereas 11% of the patients reported emotional distress and limitations in the usual physical activities by nocturnal incontinence. Our finding suggest that nocturnal incontinence is the most important problem and we need longer follow-up to evaluate the problems of metabolic consequences and neoplasms of the urinary tract.

The effect of intraoperative gastric juice retention on the incidence of nausea and vomiting during the first 24 h after anesthesia was studied prospectively in 166 patients (ASA PS I-II) for elective surgery, excluding the patients requiring gastric tube (NG tube) postoperatively. The incidences of postoperative nausea and vomiting in the recovery room and during the first 24 h after operation were 5.7 and 10.0% in NG group, in which NG tube was inserted after intubation and taken off after gastric suction at the end of operation; 15.8 and 7.9% in RA group, in which ranitidine 1 mg.kg-1 was premedicated; and 12.1 and 6.9% in NN group, in which NG tube or ranitidine was not used, respectively. There were no statistical differences in the incidence between these three groups and between NG + RA group and NN group. Other factors such as age, duration of anesthesia and operative procedure also did not influence the incidence. The results suggest that the retention of gastric juice during operation has little effect on the incidence of postoperative nausea and vomiting.

Predictive factors for adolescent smoking behavior were examined prospectively in a cohort of 199 adolescents who participated in a survey in March 1983 and were followed up about 7 years later. In 1983, as junior high school students (grades 1-3), subjects completed a questionnaire which consisted of variables on smoking behaviors of subjects' family and friends, attitudes toward smoking, knowledge about the effects of smoking on health, and self-prediction of future smoking behavior. In 1990, a similar survey including variables on subjects' smoking behavior was again carried out. At that time, all were 20 years or older. It was found that the number of friends in 1983 who smoke was strongly associated with smoking behavior in 1983, and for both sexes smoking behavior in 1983 and self-prediction of future smoking behavior in 1983 were the factors which were associated with smoking behavior in 1990. Furthermore, a model for predicting smoking behavior was deduced from the foregoing results and the findings of prior studies. The covariance structure analysis supported the validity of the model and revealed that smoking behavior in 1983, number of friends who smoke, and self-prediction of future smoking behavior were important in predicting smoking behavior 7 years later.

As part of a longitudinal study dealing with the effects of the noise from the Tohoku Shinkansen on the living environment of school children, social surveys were conducted on children in an elementary school near the Tohoku Shinkansen line in Saitama prefecture, by means of a questionnaire from July 1984 through February 1986. Between October and November in 1986, noise levels were also measured adjacent to the houses of subjects who lived within one hundred meters of the railroad track. The present paper is devoted to the examination by multiple regression analysis of factors related to the degree of annoyance at home resulting from the Tohoku Shinkansen noise expressed by subjects. The main results were as follows: 1. Multiple correlation coefficients between the degree of annoyance of the Tohoku Shinkansen noise at home and noise levels were less than 0.3. 2. When annoyance at school from the noise and the self-rated quality of sleep were incorporated in multiple correlations, the values of multiple correlation coefficients exceeded 0.5. These results suggest that so far as individual responses are considered, non-physical factors such as sensitivity to noise and quality of sleep account for a considerable part of the total variance of individual responses.

A 60-year-old male patient visited our hospital for evaluation of positive sputum cytology. A chest X-ray film revealed no abnormal shadows. Bronchofiberscopy showed a protruding lesion at the spur between left B8 and B9. Histological findings indicated squamous cell carcinoma. Left lower lobectomy with hilar and mediastinal lymph node dissection was performed. The tumor did not infiltrate beyond the bronchial cartilage on postoperative histologic examination. However, hilar lymph node (#12 l) metastasis was identified. Surgical resection with lymph node dissection is mandatory even in the hilar type lung cancer confined within the bronchial wall.

As part of developing the Know Your Body (KYB) program for Japan, a questionnaire survey was administered assessing knowledge, attitudes, and behavior regarding cigarette smoking, alcohol drinking, dietary lifestyle and exercise. The subjects, about 13,000 in total, were students in elementary, junior and senior high schools in 9 prefectures. The main results concerning knowledge of foods that cause or prevent adult diseases are as follows: 1) Correct responses on the relationship of excessive salt intake and hypertension were made by 39% of males and 41% of female in the fifth grade of elementary school. In the third grade of junior high school, the percentage of correct answer for the same question increased to 80% of males and females, and in the third grade of senior high school, it rose to 90% of males and 91% of females. No clear sex difference was seen in all the grades of school. 2) Less than 23% of the students from the first to fourth grade of elementary school knew the word "cholesterol" and could distinguish high cholesterol foods. In the sixth grade of elementary school, more than 50% of students knew the word "cholesterol". In the third grade of junior high school, more than 50% of students could distinguish high cholesterol foods correctly and recognized the relationship of excessive cholesterol intake to heart disease. These results provide a basis for determination of the age for introducing nutrition education. 3) The percentage of correct answers for distinguishing green-yellow vegetables, showed a clear sex differential. The percentage of correct answers concerning dietary fiber was 75% for males and 81% for females in senior high school.

Combination effects were studied with arbekacin (ABK) and beta-lactam antibiotics including imipenem/cilastatin (IPM/CS), flomoxef (FMOX), and cefotiam (CTM) for bactericidal activities, post-antibiotic effects (PAE's) and bactericidal activities of beta-lactam antibiotics after removal of ABK using methicillin-resistant Staphylococcus aureus (MRSA) strain 1936. The following results were obtained. 1. When ABK was administered in combination with IPM/CS, FMOX or CTM against MRSA strain 1936, low FIC index was not obtained. 2. Higher bactericidal activity was observed when ABK was given before beta-lactam than when beta-lactam was given before ABK. 3. Combination of ABK and each of beta-lactam antibiotic led a longer PAE than ABK alone. 4. When each beta-lactam antibiotic was administered after a treatment and removal of ABK, greater bactericidal activity and growth inhibition were observed than when administered each beta-lactam alone. These findings basically demonstrated that ABK was effectively bactericidal against MRSA when administered in combination with beta-lactam antibiotic such as IPM/CS, FMOX or CTM, even when the FIC index did not indicate a favorable effect.

The "Japan Know Your Body Study" (JKYB) is an example of collaborative activities of technology transfer carried out in Japan in several phases. The first phase is a needs assessment and data collection survey and it was administered during 1989. A survey was conducted throughout 9 prefectures in Japan with participation by 49 schools. Subjects were students in elementary, junior and senior high schools who ranged in age from 6 to 18 years. Participants, 12,892 in total, completed a survey on knowledge, attitude and behavior regarding cigarette smoking, alcohol drinking, diet, exercise and so on. The main results concerning cigarette smoking and alcohol drinking behavior were as follows: 1) The percentage of monthly male smokers rose remarkably from 8% in the third grade of junior high school to 37% in the third grade of senior high school, while that of female smokers showed a slow rise from 3% to 15%. The sex difference for smoking behavior was clear among senior high school students. 2) Smoking rates increased in proportion to the numbers of parents, siblings and friends who smoked. Above all, smoking behavior of friends was strongly related. Among senior high school students, for example, 50% of males and 46% of females who had two or more smoking friends were smokers, as compared to 5% of males and 2% of females with no smoking friends. 3) The percentage of monthly drinkers rose at a steady pace from 13% of males and 7% of females in the fifth grade of elementary schools to 59% of males and 50% of females in the third grade of senior high schools. The sex difference for alcohol drinking behavior among senior high school students, while statistically significant, was not as pronounced as that for smoking behavior. These results suggest that tobacco- and alcohol-use prevention programs should be introduced in elementary schools and those programs should include components relating to the social influences of parents, siblings and friends.