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This review provides an overview of medications for the treatment of alcohol dependence. The medications were classified into three categories: medications for alcohol withdrawal, medications for maintaining abstinence from alcohol or reducing its consumption, and medications for insomnia in patients with alcohol dependence. Acamprosate is the first choice in maintaining abstinence, whereas to reduce drinking, nalmefene, which is available in Japan, is used. However, medications are not "stand-alone" treatments for alcohol dependence. Pharmacological treatments for maintaining abstinence and reducing drinking are effective only when used in conjunction with psychosocial treatment, such as cognitive and behavioral therapy for alcohol dependence.

A 65-year-old man had unresectable intrahepatic cholangiocarcinoma with a malignant biliary stricture. We used an endoscopic plastic stent to drain the bile. Despite receiving standard chemotherapy, the tumor eventually progressed and cancerous peritonitis developed. We had to exchange plastic stents frequently because of stent occlusion. We had a re-biopsy with EUS-FNA and tested for microsatellite instability, which came back as MSI-high. We administered pembrolizumab, which resulted in a significant reduction of tumor size. We were able to administer long-term chemotherapy without serious side effects by repeatedly exchanging plastic stents for stent occlusion. He has maintained partial response for more than 20 months after receiving pembrolizumab.

Immunogloblin A (IgA) vasculitis is the most common systematic vasculitis disorder characterized by leykocytoclastic vasculitis , for example, purpura with white blood cell destruction vasculitis caused by allergic mechanisms. The main symptoms of this disease are purpura, arthritis, abdominal pain, gastrointestinal bleeding, and nephritis. 　We report the case of a 66-year-old man with IgA vasculitis. He was diagnosed with hypopharyngeal cancer and underwent radio-chemotherapy at our department. On the following day, he underwent tracheotomy because of recurrent laryngeal nerve paralysis associated with cancer treatment. 　His wound infection remained after the tracheostomy, and he complained of purpura on both legs. On the basis of these clinical courses we diagnosed IgA vasculatis caused by wound infection. This case illustrates that it is important to consider the possibility of IgA vasculatis if skin eruption is observed concurrent with wound infection.

This article reviews studies examining the relationship between alcohol consumption and dementia. Several studies have found that light to moderate alcohol consumption might be associated with decreased dementia risk compared to alcohol abstention. However, not all studies drew the same conclusion and there is no consensus regarding decreased dementia risk related to light to moderate alcohol consumption. The methodological limitations of these studies also need to be considered. For example, definition of alcohol consumption varies with studies. Some studies defined no drinking as never consuming alcohol, while other studies defined it as currently not consuming alcohol. Estimates of dementia risk related to alcohol consumption should be significantly altered by these definitions. Therefore, based on the current evidence, alcohol should not be used as a means to decrease the risk of developing dementia. This article also describes the pathophysiology of alcohol-related dementia, the relationship between Wernicke-Korsakoff syndrome and alcohol-related dementia, clinical characteristics, and the prevalence of alcohol-related dementia. Finally, we document a couple of articles examining the relationship between mortality and alcohol consumption in patients with mild Alzheimer's disease and the impact of alcohol abstention on cognitive decline in patients with Alzheimer's disease.

Herein, we report a case of drug-induced Stevens Johnson syndrome. (SJS). A 56-year old female visited our hospital complaining of right cheek pain. Local examination revealed that the right ostium of the maxillary sinus was open and that the maxillary sinus mucosa was invaded by tumor. Biopsy revealed a histopathological diagnosis of squamous cell carcinoma. We therefore diagnosed the patient as a case of maxillary sinus carcinoma (T3N0M0) based on the CT, MRI and FDG-PET findings. During chemoradiotherapy for maxillary sinus cancer, the patient developed oral mucosal inflammation of progressively worsening severity; we initially thought that the symptom was a side effect of the treatment; however, several days later, skin lesions appeared throughout the body. We consulted a dermatologist, who suspected SJS. The patient was initiated on high-dose steroid therapy (steroid pulse therapy), and the symptoms improved. Because of SJS is a fatal drug eruption, early diagnosis and prompt treatment are important. In patients receiving chemoradiotherapy showing severe oral mucosal inflammation outside the irradiation area or oral mucosal inflammation associated with skin lesions throughout the body, it is necessary to bear in mind the possibility of SJS.

Coping skills training (CST) and cue exposure treatment (CET) have yielded favorable outcomes when used to treat alcoholics. We conducted 6-week inpatient programs that consisted of 9 CST group sessions (n = 117) during 2005-2009 and 9 CST group sessions plus 4 CET group sessions (n = 49) during 2009-2011 and subsequent 1-year letter therapy for Japanese alcoholic men who had relapsed and been readmitted after standard cognitive-behavioral inpatient therapy. When patients received a letter containing encouraging words every 2 weeks, they were asked to reread their CST and CET records and to respond to the letter by marking drinking days on a calendar and naming the skills on a list of the 9 CST themes and CET that were useful for maintaining abstinence during that 2-week period. The estimated percentages of achievement of 30 or fewer drinking days during the one year of letter therapy were 36.1 - 45.8%. 'Non-smoking', '2nd admission', and 'After age-limit job retirement' were significant factors in achieving good outcomes. The 'usefulness' responses for 'Increasing pleasant activities', 'CET', 'Anger management', ' Managing negative thinking', 'Problem solving', and ' Seemingly irrelevant decisions' as percentages of overall responses to the letters were significantly higher, in order of decreasing percentages, in the achiever group than in the non-achiever group, but the differences between the groups in ' Managing urges to drink', ' Drink refusal skills', ' Planning for emergencies', and ' Receiving criticism about drinking' were not significant. The odds ratios for achievement of 30 or fewer drinking days during the 1-year period increased significantly by 1.15 -1.31 fold per 10% increment in the 'usefulness' ratio for 'Increasing pleasant activities'. The difference in percentage achievement between the group treated by CST alone and the group treated by CST plus CET was not significant. In conclusion, some coping skills were more useful for relapse prevention than others in this study population, and addition of CET to CST and subsequent letter therapy did not improve outcomes.

A total of 477 Salmonella strains isolated from retail domestic chicken meat during 1992-2012 in Tokyo, were examined regarding their serovars and drug-resistance. These strains were detected in 469 (29.8%) of 1,576 samples. The detection rate in every two years was 10.1% to 46.3% of the range. Serological typing results showed that 477 strains were classified into 22 serovars excepting 2 untypable strains. Among them, S. Infantis (312 strains) was the most prevalent, followed by II O4: b: [e, n, x] (S. II Sofia) (71 strains), S. Hadar (20 strains), S. Typhimurium (20 strains), S. Manhattan (12 strains), S. Schwarzengrund (9 strains), S. Agona (7 strains), and other 15 serovars (24 strains). Results of the antibacterial drug susceptibility test for 477 strains revealed that 89.9% was resistant to some of the 12 drugs tested, and multidrug-resistant strains accounted for 90.2% among them. The frequencies of resistance to each drug were 81.8%; 77.8%, 45.5%, 33.3%, 11.3%, 9.6%, 2.9%, 0.6%, 0.6% and 0.2%, in order with high frequency, for SM, TC, KM, ST, NA, ABPC, CP, FOM, CTX and CAZ, respectively. None of the strains was resistant to NFLX or IPM. Three CTX-resistant strains were CTX-M type extended-spectrum β-lactamase (ESBL) producers, and the group of CTX-M type ESBL genes were CTX-M-2 group (2 strains) and CTX-M-9 group (1 strain). CAZ-resistant 1 strain was an ESBL producer, but the ESBL gene was not determined.

Alcoholics have a high prevalence of nicotine dependence, and smoking is a major contributor to their high mortality. Three weeks after admission to an addiction center in Japan, 193 alcoholic men who were participating in an 11-week concurrent inpatient smoking cessation and alcohol abstinence programs filled out an anonymous self-report questionnaire regarding smoking and drinking, and 6 months after the completion of the programs, 83 patients were asked to respond to a mailed questionnaire about their smoking and drinking status. Of the 193 subjects, 73.3% were current smokers, but many were highly motivated in regard to both smoking cessation and alcohol abstinence. The subjects' scores on a 0 to 10 point scale for rating motivation and confidence in regard to smoking cessation and smoking urge were significantly correlated with each other and with their scores for motivation and confidence in regard to alcohol abstinence and drinking urge. Three weeks after admission, varenicline treatment was well-tolerated, and the varenicline group had a high rate of smoking cessation than the smoker group not treated with varenicline (67.7% vs. 44.6%, p = 0.012). Forty-six (55.4%) of the 83 subjects who were mailed the questionnaire responded, and the drinking category was 'totally abstinent' in 35 subjects (42.2%), and 'mostly abstinent' in another 4 subjects (4.8%). Seventeen (20.5%) of the 83 subjects were non-smokers before treatment, but after treatment, 23 (50.0%) of the 46 responders and 20 (51.3%) of the 'totally or mostly abstinent' 39 responders were total or almost non-smokers. The response rate of 'totally or mostly abstinent' was higher among the 17 non-smokers before treatment than among the 66 smokers before treatment (70.6% vs. 40.9%, p = 0.033), and the age-adjusted odds ratio (95% confidence interval) for the response of 'totally or mostly abstinent' was 3.30 (1.03-10.56) for the non-smokers before treatment (vs. the smokers before treatment). In conclusion, smoking status had a great impact on the drinking status of treatment-seeking alcoholic men, and smoking cessation should be recommended to smoking alcoholics.

Excessive alcohol use is associated with health problems for the elderly in combination with their chronic conditions. One such complication, alcohol-related dementia (ARD) is brought about by direct or indirect ethanol intoxication, and coexisting nutritional deficiency, liver disease, cerebrovascular disease and traumatic brain injury. The elderly people with ARD have been underestimated and underdiagnosed. In these older alcoholics, atrophic changes, lacunar infarcts and deep white matter lesions of the brain are evident and are associated not only with their cognitive decline, but also with their frailty, leading to high morbidity and mortality ratio. Although lifelong abstinence can recover patients with ARD to temporally lull, aging, the severity of alcohol dependence, and the concomitant nutritional, physical and environmental factors can all impact negatively their outcome. Therefore, a comprehensive approach to lifestyle factors is recommended so that they can minimize preventable risks and maintain health status. Nursing home placement may be an appropriate treatment option for some refractory, long-term patients with ARD.

The proportion of alcoholic patients aged 60 years or older is about 25% of the patients who visit medical institutions specializing in alcohol-related problems, and this rate has tended to increase gradually. Alcohol-use disorders among elderly people are frequently underdetected, but the Short Michigan Alcoholism Screening Test-Geriatric Version (SMAST-G) is reported to be a valid screening tool for elderly people. Alcohol withdrawal symptoms among the elderly are not conspicuous since comorbidities, such as amnesic syndrome and cancer, are more common in the elderly than among younger patients. Elderly alcoholics have better treatment outcomes than younger alcoholics, with a higher abstinent rate and a lower recurrence rate.

Alcohol-related dementia (ARD) is one of the most common dementing disorders in middle-aged people and occurs in heavy drinkers who are estimated to be 10 - 15 % of the adult men in a community. While the concept of ARD is multifactorial and includes all cognitive deficits in alcoholics, the central clinical manifestations are exemplified by Korsakoff's syndrome (KS), a persistent neuropsychiatric syndrome, characterized by amnesia and disorientation that is caused by thiamine deficiency along with excessive alcohol consumption. Antemortem detection of intracranial changes has been made possible by MRI and many studies have revealed that alcoholics have atrophic changes in frontal lobe, cerebellum, medial temporal lobe and hippocampus. However, these brain regions are vulnerable to excessive alcohol and seem to be independent of cognitive deficits in alcoholics. This review shows the regional differences in gray matter volumes between cognitively normal alcoholics and patients with KS. By employing a 3-dimensional MRI method for voxel-based morphometry that enables an automated, unbiased, comprehensive assessment, we demonstrate that parahippocampal/hippocampal atrophy is specific to KS and thalamic atrophy and the third ventricle enlargement are more severe in patients with KS than in cognitively normal alcoholics.

This article reports the first longitudinal cohort study on Japanese adolescent alcohol use and abuse from 1997 to 2007. The purpose of the cohort study is to show that factors which promote adolescent problem drinking, will develop into the early alcohol dependence syndrome. A total of 802 subjects with a mean age 13.5 years old was recruited from four junior high schools in Kanagawa prefecture. The survey was conducted annually by mail using self-reported questionnaires concerning drinking status and alcohol-related problems. In the 2007 survey at 10 years after the first survey, the respondents numbered 493 with a mean age of 23.8 years old, and the follow-up rate was 61.5%. In the 2007 survey, 25.2% of male and 14.3% of female subjects were found to be problem drinkers from the scores of the Alcohol Use Disorder Identification Test (AUDIT). We divided the subjects into two groups according to the AUDIT scores, problem drinkers and non-problem drinkers. The two groups were compared concerning family relationships, first drinking age and drinking status of parents with the respons- es of the 1997 survey. A multiple regression analysis was performed to determine problem drink promoting factors. The factors determined were fathers with moderate to heavy drinking in male subjects and having drinking experiences at 13.5 years old at the start of the survey in female subjects. Furthermore, we confirmed a continuity of problem drinking from adolescents to young adults. Problem drinkers in the 2002 survey had significantly increased in the 2007 survey when compared with non-problem drinkers in the 2002 survey. We concluded that first drinking in junior high school and having moderate to heavy drinking fathers promote adult problem drinking, and problem drinking continued from adolescents to young adults.

Background and Purpose: Substance use disorder is one of the important mental health problems related to suicide, nearly equal with depressive disorder. However, it is unclear how differences of abused substances influence the suicide risk of individuals with substance use disorder in Japan. The purpose of the present study is to compare an estimated suicide risk among patients with alcohol, amphetamine, and sedative, hypnotic or anxiolytic use disorders., Methods: Subjects were 1082 outpatients with alcohol use disorder (AUD), 191 with amphetamine-like use disorder (AMUD), and 63 with sedative, hypnotic or anxiolytic use disorder (SUD), all of whom consecutively had consulted seven medical facilities specialized for treatment of substance use disorder during a month of December 2009. A self-reporting questionnaire including the items of Kessler 10 (K10) and the Mini International Neuropsychiatric Interview (M.I.N.I.) was administered, and scores of the K10 and M.I.N.I., and the other clinical information were compared among the patients with AUD, AMUD, and SUD., Results: Patients with AMUD and SUD showed significantly higher score on the M.I.N.I. than those with AUD, while those with SUD showed highest score on the K10, followed by those with AMUD. In either of patients with AUD, AMUD, or SUD, approximately 60% of the subjects who attempted suicide within a month reported to take any psychoactive substance in the attempted suicide. Additionally, a remarkable difference was found in histories of general psychiatric treatment before consulting medical facilities specialized for treatment of substance use disorder between these three groups. Most of outpatients with SUD reported such histories., Conclusions: Outpatients with SUD appeared to involve the highest risk for suicide of all patients with substance use disorder, probably because of the comorbid-severe depression. In our speculation, SUD which our subjects suffered from might be induced or accelerated by pharmacotherapy performed in general psychiatric facilities. Education on dependency of prescribed psychotropic drugs to general psychiatrists is required.

The nerve systems affect immune functions by releasing neurotransmitters through lymphocyte cell-surface receptors. A major neurotransmitter dopamine transmits signals via five different seven-transmembrane G protein-coupled receptors termed D1 to D5. There is wide evidence for a decreased risk of rheumatoid arthritis (RA) in patients with schizophrenia which is associated with the excessive stimulation of D2-like receptors by dopamine. However, the reason for the negative association between RA and schizophrenia is unknown. We previously demonstrated that dendritic cells (DCs) could synthesize and store dopamine, DC released dopamine to naive CD4 T cells upon DC-T cell interaction and affected helper T-cell differentiation. Because DCs have been proposed to play a pivotal role in the initiation and perpetuation of RA by presentation of arthritogenic antigens to T cells, we here assessed effects and functions of dopamine on immune cells during the pathogenesis of RA. In this paper, we overview the series of our research findings, and present the possibility of drug discovery which target at dopamine receptors.

Since 1998, more than 30,000 people have committed suicide each year, and suicide has become one of the most serious social problems in Japan. It is well-established that both acute and chronic alcohol intake are associated with suicidal behavior. However, the relationship between alcohol consumption and suicide has received less attention than that of depression in Japan. We showed the following: 1) Many suicide cases were heavy drinkers. 2) A positive correlation exists between per capita alcohol intake and the suicide rate. 3) Heavy drinking is a risk factor for suicide. Consequently, we reviewed the literature concerning the association between alcohol dependence and suicide.

We report a case of cerebral infarction developed either during or immediately after an operation. A 71-year-old man with esophageal cancer and a history of hypertension and asymptomatic cerebral infarction underwent right thoracolaparotomy for a subtotal esophagectomy. Anesthesia was maintained with a combination of 2% sevoflurane in oxygen and epidural analgesia using 2% mepivacaine. The operation was uneventful and the patient was transferred to ICU with the tracheal tube in place. On removal of the tracheal tube the next day the patient was unable to speak and his grip power of the right hand was weak. On CT a cerebral infarction was found in the left frontal lobe. A left carotid echogram showed a 90% constriction. The occlusion of the middle cerebral artery by an embolus detached from the constricted origin of the carotid artery was thought a most probable cause of the cerebral infarction. The presence of a carotid constriction must be explored preoperatively in aged patients scheduled to undergo extensive manipulations in the neck

This study is the first prospective study correlating smoking and drinking among Japanese adolescents. The aim of the study is to determine if adolescent smoking experience predicts future adult alcohol abuse. We conducted a longitudinal prospective study on adolescent drinking from 1997 to 2007. The study subjects were about 800 male and female junior high school students. Their mean age was 13.5 years old at the starting point. We conducted surveys by post on the subjects concerning drinking status, alcohol-related problems and smoking experience once a year for 10 years. This study attempted to determine if smoking experiences in 1999 (mean age, 15.8 years old) correlated with alcohol abuse in 2005 (mean age, 22 years old) among the subjects of the prospective study. The result showed that male students who had had smoking experiences in 1999 were more likely to become alcohol abusers in 2005 than those without smoking experiences according to the AUDIT. On the other hand, females with smoking experiences as teenagers showed no correlation with alcohol abuse as young adults. Adolescent tobacco use could be called a gateway drug to adult alcohol abuse among Japanese males, but not among females.

In this article, we reviewed brain damage seen in patients with alcohol dependence briefly focusing on neuroimaging studies. In uncomplicated alcoholic patients, a high incidence of cortical shrinkage and ventricular dilatation were reported using brain CT scans. In older alcoholics, prefrontal gray matter deficits were especially marked when compared with younger alcoholics. Reversibility of brain shrinkage is a common neuroimaging finding in patients with alcohol dependence and a study by Gazdinski et al. reported more rapid brain tissue gain during the first month of sobriety than in the following months. Another MRI study using deformation-based morphometry revealed significant shrinkage in the frontal and temporal lobes within 1 week of abstinence of alcoholic patients. This study followed participants for 8 months longitudinally and revealed that abstaining alcoholics recovered tissue volumes significantly faster than nonalcoholic controls in the parietal and frontal lobes and this study also revealed that when abstaining alcoholics were compared with relapsed alcoholics, additional regions with significantly greater recovery in abstainers were the temporal lobes, thalamus, brainstem, cerebellum, corpus callosum, anterior cingulate, insula, and subcortical white matter. Finally we introduced a MR spectroscopy (MRS) study on alcoholic patients. This study using proton MRS indicated that with short-term abstinence, cerebellar choline and frontomesial N-acetylaspartate (NAA) were significantly increased. Findings showing that a cerebellar choline increase and a frontomesial NAA increase were detected at stable water integrals and creatine concentrations, serum electrolytes and red blood cell indices suggest that early brain recovery through abstinence does not simply reflect rehydration. This might indicate that even the adult brain has capacities for regrowth and further understanding of the mechanisms of recovery of alcoholics' brains may result in a valuable model of brain regeneration with relevance for other disorders.

We conducted three national surveys to clarify the drinking status of Japanese junior and senior high school students in 1996, 2000 and 2004. The total numbers of subjects in each survey were about 50 thousands junior high school students and 70 thousands senior high school students. The present study compares drinking status and alcohol related problems of the subjects of the three surveys. The results were as follows. First, drinking experiences of the subjects decreased over the three surveys. Those of junior high school students dropped from 60% to 40%, and those of senior high school students from 75% to 60%. Second, drinking behavior of the subjects has changed, e.g., the amount of drinking on each occasion has decreased, failures due to drunkenness have also decreased, compliance with the Law Prohibiting Minors Drinking has increased, their buying alcoholic drinks has decreased and experiences of being offered alcohol by parents have decreased. Third, male problem drinkers among the subjects decreased slightly but female problem drinkers did not decrease. We discussed the reasons why Japanese adolescent drinking has decreased. Over the past 10 years, Japanese society started to prohibit adolescent drinking, by revising the Law Prohibiting Minors Drinking, penalties for driving while intoxicated became more severe and Japanese alcohol consumption started to decrease.

Good performance was observed over 10 years after implantation of bipolar epicardial atrial pacing using an active fixation bipolar endocardial lead in 3 pediatric patients with congenital heart block. The bipolar endocardial lead which was supposed to be fixed transvenously was implanted on the atrial surface by first screwing the lead's helix into the myocardium. The catheter was then laid down on the atrial surface, and both electrodes were wrapped by the atrial tissue. The good performance of this pacing lead seemed to depend on stable positioning of the electrode. This lead is superior to the commercially available, and steroid eluting epicardial bipolar pacing lead, on the point of its small size in head and body, and could be applied to dual chamber pacing in smaller children.

This report outlines factors promoting adolescent problem drinking at 5 years after the start of a cohort study. We started the first longitudinal cohort study on Japanese adolescent alcohol use and misuse in 1997. The purpose of the cohort study was to show factors that promote adolescent drinking and whether adolescent problem drinking will develop into the early alcohol dependence syndrome. Eight hundred and two subjects whose mean age was 13.5 years old were recruited from four junior high schools in Kanagawa prefecture. The survey was conducted annually by mail using self-reported questionnaires concerning adolescent drinking and alcohol-related problems. In the 2002 survey at 5 years after the starting point, the respondents numbered 557 with a mean age of 18.8 year old, and the follow-up rate was 70%. In the 2002 survey, 17.5% of the subjects were found to be problem drinkers from the scores of the core-AUDIT. We divided the subjects into three groups according to the scores of the core-, Audit: problem drinkers, drinkers and abstainers. The three groups were compared concerning family relationships, first drinking age and drinking status of parents with the responses of the 1997 survey. In the comparison of the three groups, many factors were significantly different, and a logistic regression analysis was performed on these factors to determine drink promoting factors. Three factors were determined: having drinking experiences at 13.5 years old at the start of the survey, not refusing friends' temptations to drink and less communication with their parents. The results were very important because these three factors were described by many authors as adolescent drinking promoting factors.

Purpose: To investigate the characteristics of alcohol use among Japanese adults and prevalence of alcohol dependence in Japan, we conducted a nationwide survey on alcohol drinking behavior and alcohol dependence among Japanese adults using a representative sampling method., Methods: We sampled 3500 adults from throughout the entire country using a stratified random sampling method with two-step stratification, and carried out a home visit interview survey. A total of 2547 people (72.8%) responded to the survey. The survey period was June, 2003. The questionnaire contained questions about the frequency and quantity of alcohol use, 'hazardous use of alcohol' and 'alcohol dependence' according to the ICD-10 definition, several screening scales on problem use of alcohol (CAGE, KAST, AUDIT), life-time prevalence of 24 alcohol related diseases, smoking status, dysgryphia, and nightcap drinking., Results: The number of respondents was, 1184 males, and 1363 females. Lifetime alcohol drinking, and weekly drinking, and daily drinking rates were 95.1%, 64.4%, and 36.2% for males, 79.0%, 27.5%, and 7.5% for females, respectively. Average daily alcohol consumption was 3.7 units for males, and 2.0 units for females (1 unit = 10 g pure alcohol). The proportion of drinkers who drank alcohol 4 units or more daily was 28.9% for males, and 7.6% for females, and that for 6 units or more was 12.7% for males, and 3.4% for females. The proportion of flasher was 41.2% for males, and 35.0% for females. Among screening questions, problem drinking was most frequently identified using AUDIT (score 12 points or more, 150 persons), followed by KAST (2 points or more, 100 persons) and CAGE (2 points or more, 98 persons). The number of subjects who met the ICD-10 criteria for alcohol dependence was 24, while the number who engaged in hazardous alcohol use was 64., Conclusions: This study revealed that problem drinking and alcohol dependence are a serious problem in Japanese general population. The problem of females drinking may be growing. The government should emphasize the prevention of alcohol drinking problems in adults and continue the conduct of nationwide prevalence surveys to monitor the problem.

Cor triatriatum is a rare congenital cardiac anomaly especially in adulthood. A 68-year-old female was diagnosed as a cor triatriatum classified to Lucas-Schmidt IA, severe degree of mitral regurgitation and atrial fibrillation. Resection of the abnormal diaphragm in the left atrium and miral valve replacement were performed. Although the reason of sudden death of this patient after discharge is unknown, surgical intervention for atrial fibrillation should have performed to prevent a thromboembolism in such cases.

A shiga toxin-producing Escherichia coli (STEC) O26 strain resistant to cefotaxime (CTX) and cefpodoxime (but not ceftazidime) was isolated from the faecal sample of a 17-year-old outpatient with diarrhea. The double disk synergy test, twin test, polymerase chain reaction and sequence analysis confirmed that the strain produced CTX-M-3 type extended-spectrum beta-lactamase (ESBL). Conjugation experiment results suggested that the CTX resistance in this strain was determined by an approximately 85kbp plasmid that was readily transferable to a susceptible recipient E. coli strain. This is the first report from Japan of CTX-M-3type ESBL-producing STEC O26.

Three patients of asplenia syndrome with total anomalous pulmonary venous connection (TAPVC) were reported. Case 1 with exceeding pulmonary blood flow, underwent TAPVC repair and pulmonary artery banding as a first palliation before bi-directional Glenn shunt. Case 2 did not require any surgery to control the pulmonary blood flow before the simultaneous procedure of TAPVC repair and bi-directional Glenn shunt. Case 3 with decreased pulmonary blood flow underwent a complicated course with 3 times of Blalock-Taussig shunts and the repair of TAPVC to prepare for bi-directional Glenn shunt. Simultaneous repair of TAPVC with the procedure which aimed to control the pulmonary blood flow at the first palliation surgery will simplify the control of pulmonary blood flow and prepare good condition of the lung for the Fontan operation in the future.

Recently, it has become important to diagnose Alzheimer's Disease (AD) at an early stage due to the development of AD therapy. Also, there is increasing recognition of a class of elderly people with complaints of memory loss but who nevertheless do not meet the criteria for dementia. "Mild cognitive impairment" (MCI) is the term used for this disorder, and amnestic MCI is highly converted to AD. In this study we evaluated the accuracy of diagnosis of amnestic MCI by cerebrospinal fluid total-tau protein (CSF/total-tau), cerebrospinal fluid amyloid beta 1-42 protein (CSF/A beta 1-42), and cerebral blood flow in the posterior cingulate cortex using SPECT. CSF/total-tau was the most appropriate to discriminate between normal cognitive individuals and those with amnestic MCI. We also evaluated the CSF/total-tau and MRI images between patients with stable MCI and those with progressive MCI, including those who converted to AD in the following two years. The stable type was characterized by normal CSF/total-tau levels and relatively high grade periventricular white matter lesions (PWML). Conversely, the progressive type was characterized by high CSF-tau levels and relatively low grade PWML. We speculate that stable MCI is due to ischemic change with in the white matter lesion, while progressive MCI may represent a previous stage of AD.

Drug resistance trends were investigated for 271 Vibrio cholerae O1 (V.c O1) and 401 V. cholerae non-O1 (V.c non-O1) strains isolated from mainly imported diarrheal cases during 1981-2001 in Japan. The results of drug resistance test using 8 drugs (CP, TC, SM, KM, ABPC, ST, NA, and NFLX) showed that 34.7% of the V. c O1 strains and 15.7% of V.c non-O1 strains were multi-drug or mono-drug resistant. The incidence of drug resistant strains has increased since 1991, and it has been remarkable in V.c O1 strains that increased from 1.2% in 1981-1985 to 70.8% in 1996-2001. The drug resistance patterns of the resistant strains classified into 6 types in V.c O1 and 21 types in V.c non-O1. The prevalent patterns recognized were SM (75.5%), CP.TC.SM.ST (10.6%) and CP.SM.ST (8.5%) in V.c O1, and SM (25.4%) and ABPC (25.4%) in V.c non-O1. Ten V.c O1 strains (3.7%) and 10 V.c non-O1 strains (2.5%) were multi-drug resistant including TC. Among those, 13 strains were isolated from travelers who returned to Japan from Thailand. One V.c O1 strain (0.4%) and 6 V.c non-O1 strains (1.5%) were NA high-resistant and fluoroquinolones low-sensitive. Among those, 4 strains were isolated from travelers who returned to Japan from India.

Japanese adolescent drinking has increased during the past 20 years. Two national surveys on adolescent drinking problems were conducted, but no prospective study has been performed in Japan. We started the first longitudinal cohort study on Japanese adolescent alcohol use and misuse in 1997. The purpose of the cohort study was to show factors that promote adolescent drinking, and whether adolescent problem drinkers will develop the early alcohol dependence syndrome. Eight hundred and two subjects were recruited from four junior high schools in Kanagawa prefecture. They were in grades 7 to 9, and the mean age was 13.5 years in 1997. The survey was conducted annually by mail using self reported questionnaires concerning adolescent drinking and alcohol-related problems. This report indicates the sociodemographic backgrounds of the subjects and showed increasing of drinking of the subjects from 1997 to 1999. At 1999 survey from 2 years after the starting point, the respondents numbered 629, and the follow-up rate was 78%. Drinking frequencies and quantities of the subjects increased year by year, and alcohol-related problems also increased. We divided the subjects into two groups based on changes in drinking status from the 1997 to the 1999 survey, the increased drinking group and no increased group, and compared these two groups concerning their family relationships, first drinking age and drinking status of parents with the responses of the 1997 survey. In the comparison of the two groups, many factors were significantly different, and logistic regression analyses were performed on these factors to determine drink promoting factors. Three factors were determined: earlier age of the first drink, not refusing friends' temptations to drink and less communication with their parents. We will continue the longitudinal cohort study to determine if these three factors promote adolescent drinking in the future.