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The purpose of the present study is to demonstrate the correlation between the force applied to a ball and the joint motion of the hip, trunk, shoulder and elbow in adolescent baseball players. The subjects were 15 adolescent baseball players (13.7±0.8 yrs) and 15 college-age baseball players (22.1±1.5). Pitching motion images were captured by three high-speed cameras, and 3D analysis established by the direct leaner translation method was performed to obtain the angles and the angular velocity of each joint, as well as the acceleration of the wrist toward the target at ball release (Acc). In the adolescent players, a significant linear correlation was found between Acc and trunk rotation angle (r=-0.59), elbow extension angle (r=-0.75), shoulder internal rotation velocity (r=-0.76) and elbow extension velocity (r=-0.61). In the college-age players, a significant linear correlation was found between Acc and hip adduction velocity (r=-0.51) and elbow extension velocity (r=-0.61). The finding indicates that adolescent players may depend more on the upper extremity motion than the hip joint motion when pitching. Coaches and athletic trainers may need to focus on the hip joint motion in order to prevent pitching injuries among adolescent baseball players. [ABSTRACT FROM AUTHOR]

A high prevalence of anterior cruciate ligament (ACL) injury has been reported in judo. However, there has been very little research concerning events preceding the injury. Therefore, the objective of this study was to determine the common situations and mechanisms of ACL injury in judo. A total of 60 cases of ACL injuries that had occurred during judo competitions or practice were investigated through interview conducted by a single certified athletic trainer who has 20 years of judo experience. We then obtained information regarding the situation and mechanism in which the ACL injury occurred. The direct contact mechanism was observed more frequently than the other injury mechanisms in the ACL incidence in judo. In addition, the number of ACL injuries was significantly higher when the subject was attacked by the opponent than when counterattacked or when attempting to attack. In addition, osoto-gari was the leading technique that directly caused ACL injury incident among the subjects. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to demonstrate the correlation between MER during throwing and each range of motion (ROM) of the shoulder complex, which consist of external rotation of glenohumeral joint and posterior tipping of the scapula in baseball players. The subjects were 19 collegiate baseball players. A three-dimensional analysis was performed to obtain the MER. The ROM of the external rotation of the shoulder complex (ER-ROM), ROM of the external rotation of the glenohumeral joint (GHE), and ROM of the posterior tipping of the scapula (SPT) were also passively measured. The mean (± SD) value of the MER was 150 ± 10°. The mean (± SD) values of the ER-ROM, GHE, and SPT were 135 ± 12°, 89 &plumsn; 12°, and 32 &plumsn; 7° respectively. Significant linear correlations were found between SPT and MER (r = 0.48), ER-ROM (r = 0.65). No significant correlations were found between GHE and MER and ER-ROM. The finding may indicate the importance of scapula motion more than glenohumeral joint motion for MER and ROM of the shoulder complex. [ABSTRACT FROM AUTHOR]

This study analyzes motions of the lower extremities and upper extremities during pitching, presents information on the kinetic linkage for pitching motion, and discusses the cause of the throwing injuries. The subjects involved were five elite-level baseball pitchers who were right-handed and over-hand styled. Fifty fastball pitchings were analyzed through a 3-dimensional video system. Analysis was made of the adduction angle of the left hip, the direction angle of the femur and the velocity of the right hand. Fifteen pitchings of 2nd to 16th, in the first third, 15 pitches of 35 - the 49th, as a latter third, were compared with the reappearance of each movement. In Subjects A and B, the motion of the hip joint, the thigh, and the right hand, were similar in the two periods. In Subject E, the hip joint, the thigh motion and the right hand were different at the latter third from the first third. These results suggest that there is a relationship between each movement of the lower extremities and upper extremities. The purpose of pitching is to throw a faster ball toward a fixed target. It is supposed that the disorder of the lower extremities is corrected in the upper extremities, which may result in injuries. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to elucidate the status of business continuity plan (BCP) formulation in businesses, focusing on different industries. It examined their preparation for natural disasters, such as earthquakes and tsunamis, and crisis events, such as emerging infectious diseases., Methods: A total of 1,583 businesses in Wakayama Prefecture, Japan, were randomly selected from the Wakayama Occupational Health Support Center workplace list. Anonymous self-administered questionnaires were distributed by mail. The questionnaire comprised questions on the business, awareness and formulation status of BCP, and business continuity capabilities in preparation for natural disasters and crisis events. It also explored reasons for the lack of progress in BCP formulation. Businesses were categorized into three groups based on the type of industry: manufacturing (114 companies), lifeline (66 companies), and others (207 companies)., Results: Questionnaires were collected from 412 businesses, and 387 of those that responded to the type of industry were analyzed (valid response rate: 24.3%). More than 50% of businesses in all industries were aware of BCP. Regarding the status of BCP formulation, 39.5% of the manufacturing, 34.8% of the lifeline, and 41.5% of others had already formulated or were formulating a BCP. Many lifeline businesses had not taken any measures to prepare facilities and allocate funds for emergencies. Additionally, 49% were at high risk of being forced to close down due to disasters. As the background to the lack of progress in formulating a BCP, 60.9% of lifeline businesses did not know what to develop or how to consider it. In addition, 44.2% of others had to secure the time and human resources necessary for formulation., Conclusions: Although awareness of BCPs is increasing, their formulation has not progressed significantly. In particular, BCP formulation has been delayed in lifeline industries, resulting in low business continuity capabilities. Given that many businesses do not know the contents or methods of formulating BCPs, it is suggested that educating relevant parties about using templates is necessary. This approach can reduce the time required for formulation and enable the creation of a BCP even without detailed human resources.

Objectives: The "Guidelines for Ensuring the Safety and Health of Older Workers (hereafter referred to as "Guidelines")," formulated in 2021, require employers to implement measures that proactively prevent occupational accidents among older workers. This study aimed to clarify the status of awareness of the Guidelines and workplace improvement efforts with consideration of older workers, focusing on company size., Methods: Overall, 780 businesses in Wakayama Prefecture, Japan, were randomly selected from a Wakayama Occupational Health Support Center workplace list. Anonymous self-administered questionnaires were distributed by mail. The questionnaires comprised questions about the workplace, status of awareness of the Guidelines, comprehensive management of safety and health, considerations for working conditions, workers, workload reduction, work posture, work environment, and safety and health., Results: One hundred and seventy-one businesses (effective response rate: 21.9%) provided questionnaires with complete responses. For the Guidelines, 39.0% of small-sized (less than 50 employees) businesses answered, "never even heard of the name," while many medium-sized (50-99 employees) and large-sized (100 or more employees) businesses answered that they had heard of the name but did not exactly know about it (33.3% of medium-sized businesses and 47.8% of large-sized businesses). Regarding the system that subsidizes the expenses required for the improvement of a working environment for older workers to work safely and securely (hereinafter referred to as the subsidy system), many businesses of all sizes answered that they had "never even heard of the name." In the comprehensive management of safety and health, half of the businesses of all sizes had developed a system that made it easy to consult about the risk against occupational accidents of older workers. Regardless of size, more than half of businesses were able to consider working conditions and workers. However, there were only a few items where more than half of the businesses considered workload reduction, work posture, work environment, and safety and health, regardless of business size. It became clear that workplace improvement had not progressed very much., Conclusions: These results suggest that to promote workplace improvement that considers older workers, it is necessary to disseminate the Guidelines and proactively take on workplace improvement by utilizing the subsidy system.

Objectives: The support from businesses to create a balance between work schedules and treatment regimens among employees suffering from illnesses, such as cancer and diabetes, seems to be insufficient. This study aimed to investigate efforts of businesses to support the balance of work schedules and treatment regimens among employees with illness, focusing on company size and to identify potential workplace improvements for such employees., Methods: Overall, 789 businesses in Wakayama Prefecture, Japan were randomly selected from a workplace list of the Wakayama Occupational Health Support Center. Anonymous questionnaires were distributed by mail. The questionnaires consisted of question items on workplace, current employees who had suffered or were suffering from cancer (employees with cancer), employees with illnesses (diseases such as cancer and diabetes), and support for businesses and employees., Results: Questionnaires with complete responses were collected from 187 businesses (response rate: 23.7%). The ratios of businesses where employees with cancer were engaged or had been engaged were 43.4% for small-sized (less than 50 employees), 70.9% for medium-sized (50-99 employees), and 83.1% for large-sized (100 and more employees) businesses. In all business sizes, the most common support in reinstatement or hiring employees with cancer was "absenteeism for treatment." The most common difficulty that occurred in the workplace due to the presence of employees with cancer was "the insufficient number of workers." The information from the attending physician, etc. necessary for deciding the reinstatement was mostly "the current health condition and physical strength." Additionally, in all business sizes, the most common support for employees with illness to balance work schedule and treatment regimens was "considering measures suitable to the situation such as hospital visits and physical condition." The most common challenge was "securing alternative personnel." The information from the attending physician, etc. necessary for deciding the reinstatement was "the current health condition and physical strength," similar to that for employees with cancer. More than 60% of the businesses of varying sizes reported being unaware of the work-treatment balance support coordinator., Conclusions: Considering measures suitable to the situation, such as hospital visits and physical condition, securing alternative personnel, and actively disseminating information regarding work-treatment balance support coordinators are recommended as workplace improvements for employees with illnesses.

A 21-year-old woman was diagnosed with chronic myeloid leukemia in March 2014. The patient and her family did not wish to freeze eggs before dasatinib initiation. After 66 months of oral dasatinib administration and 40 months of MR4.5 maintenance, the patient requested to discontinue dasatinib due to a desire to conceive. MR4.5 maintenance was continued, and she achieved spontaneous pregnancy 6 months after dasatinib discontinuation. The patient gave birth to a normal baby 13 months later and was on MR4.5 maintenance 21 months after dasatinib discontinuation.

A 74-year-old man was administered nivolumab to treat recurrent squamous cell carcinoma of the lungs. He developed fatigue, redness on the front of his neck, muscle weakness, and difficulty in swallowing after receiving the third course of nivolumab. Physical and neurological examinations showed proximal limb muscle weakness, periorbital erythema, and erythema of the front of his neck as well as fingers. Laboratory investigations revealed elevated serum CK and aldolase levels, and he was diagnosed with dermatomyositis. We initiated steroid pulse therapy and intravenous immunoglobulin therapy; however, he died of advanced lung cancer. Immune checkpoint inhibitor-induced neuromuscular disease is increasingly being observed in clinical practice. We report a rare case of dermatomyositis with squamous cell carcinoma of the lungs secondary to nivolumab treatment.

Background: Stereotactic brain biopsy using a navigation system is minimally invasive because it can be performed under local anesthesia. However, there are problems due to the localization and accessibility of the tumor and instability of the airway under sedation. This study aimed to examine the differences in safety and surgical time between the supine and lateral position., Methods: This study included 25 cases which underwent navigation-guided brain biopsies from May 2015 to March 2018 in the Kanazawa University Hospital. We compared tumor localization, operation time, standby time, intraoperative difficulties, and final diagnosis acquisition rates between the supine and lateral positions. Puncture sites were then examined by visualizing all biopsy trajectories simultaneously on a three-dimensional cerebral template., Results: Biopsies of the tumor in all cerebrum lobes were possible in the lateral position. There were no significant differences in operating time or standby time between the supine and lateral positions. One case in the spine position required sedation by an anesthesiologist due to body movement, but there were no difficulties in any cases of lateral positioning. The final diagnosis acquisition rate was 100% in all cases. In the lateral position, stable breathing was maintained because the head and the trunk axes remined in the same line., Conclusion: Stereotactic brain biopsy in the lateral position can be safer and more useful than in the supine position under local anesthesia.

Objectives: The support from businesses to create a balance between work schedules and treatment regimens among employees suffering from cancer seems to be insufficient. The aims of this study were to investigate efforts to find a balance between work schedules and treatment regimens among cancer patients focusing on company size and to identify potential workplace improvements for these employees., Methods: Seven hundred and seventy businesses in Wakayama Prefecture, Japan, were randomly selected from a workplace list consisting of businesses that had received support from either the Wakayama Occupational Health Support Center or the Regional Occupational Health Center. An anonymous questionnaire was distributed by mail. It consisted of question items on the workplace, support systems, current employees who had suffered or were suffering from cancer (cancer patient employees), their reinstatement, promoting reinstatement and employment of cancer patient employees, and job description of respondents., Results: A completed questionnaire was collected from 188 businesses (response rate: 24.4%). Among small-sized businesses (less than 50 employees), 55% carried out or recommended consultation for cancer screening. This ratio was higher than that of medium-sized businesses (50-99 employees) or large-sized businesses (100 or more employees). Approximately 20% of the businesses had a support system for employees who were working while undergoing cancer treatment, and more small-sized businesses had a system of annual paid leave by the hour than the medium-sized or large-sized businesses. Among the small-sized businesses, 51% had a system of sick leave for regular employees, but this ratio was significantly lower than that among the large-sized businesses. Approximately 20% of businesses had established a system of paid sick leave for regular employees. Reinstatement of employment was possible in over 80% of the businesses. The condition for reinstatement that was most frequently stipulated was that the employee's doctor had provided a medical certificate stating that the employee was able to return to work. However, among small-sized businesses, the condition that colleagues at the workplace were willing to accept him/her was more frequently stipulated., Conclusions: Cancer screening, annual paid leave by the hour, and institutionalization of sick leave are recommended as workplace improvements for cancer patient employees.

A rare case of bilateral ventrolateral pontine infarction in a 70-year-old man who developed progressive dysarthria and bilateral sensory disturbance is reported with literature review. He had been diagnosed with hypertension, dyslipidemia, and impaired glucose tolerance 10 years earlier. Ten days before admission, he was aware of the difficulty in walking and speaking, which gradually worsened. On admission he showed bilateral thermal hypoalgesia of face and lower extremities, dysarthria, dysphagia, and ataxic gait. High resolution three-dimensional MRI revealed bilateral ventrolateral pontine infarction with a large atherosclerotic plaque in the ventral side of the basilar artery, which led to a diagnosis of atherothrombotic brain infarction. The atherosclerotic plaque in the basilar artery was thought to be responsible for simultaneous occlusion of the bilateral short circumflex arteries of the pons.

We report a case of ascending aortic thrombus with acute arterial occlusion of the brachial artery. A 49-year-old woman had sudden pain in her right arm due to acute occlusion of the right brachial artery. Contrast-enhanced computed tomography and echocardiography revealed a large mobile thrombus in the ascending aorta, which prompted surgical intervention. The thrombi were removed via aortotomy under circulatory arrest. Trans-esophageal echocardiography was useful for watching a potential detachment of the thrombus in the aorta during surgical manipulations or systemic perfusion. Despite no evidence of either inherited or acquired thrombotic predisposition, thrombosis in the right atrium and deep veins of the lower extremities was found postoperatively. Since antiplatelet and anticoagulant therapy was started, she has suffered from no thrombotic event.

An 87-year-old woman with a 4-month history of postprandial gastrointestinal obstruction was admitted to our facility after suddenly vomiting black matter. Computed tomography and esophagogastroduodenoscopy revealed gastric prolapse and prolapse of the duodenum and transverse colon. Morgagni hernia combined with esophageal hiatal hernia was diagnosed. Gastric and duodenal obstructions were successfully repaired by endoscopy, followed by laparoscopic repair. Endoscopic repair helped the patient avoid fasting before surgery. The patient had a history of several chest bruises, which were detected by chest X-rays and suspected to be the cause of the hernias over time.

Adequate management of hyperleukocytosis in patients with acute myeloid leukemia (AML) is essential for the prevention of life-threatening complications related to leukostasis and tumor lysis syndrome, but the optimal therapeutic strategy remains unclear. We report a 15-year-old girl with newly diagnosed AML who had extreme hyperleukocytosis (leukocyte count at diagnosis, 733,000/μl) leading to a brain hemorrhage. She was initially treated with hydroxyurea, but presented with brain hemorrhage due to leukostasis and underwent leukapheresis emergently with intensive care and mechanical ventilation. Full-dose standard induction chemotherapy was initiated after achieving gradual cytoreduction (leukocyte count, 465,000/μl) within five days after the initiation of therapy with hydroxyurea and leukapheresis. These treatments were successful and she experienced no complications. The patient ultimately recovered fully and was discharged with complete remission of AML. Although the effects of hydroxyurea and leukapheresis in the setting of hyperleukocytosis are still controversial, these initial treatments may contribute to successful bridging therapy followed by subsequent induction chemotherapy, especially in AML cases with extreme hyperleukocytosis or life-threatening leukostasis.

The purpose of this study was to evaluate the detection performance of simulated nodules in chest computed tomography (CT) images and nuclear medicine images with an ordinary liquid crystal display (LCD) and a medical LCD (grayscale standard display function: GSDF) and gamma 2.2. We collected 72 chest CT image slices obtained from an LSCT phantom with simulated signals composed of various sizes and CT values and 78 slices of monochrome and color nuclear medicine images obtained from a digital phantom with a simulated signal composed of various sizes and radiation levels. Six observers performed receiver operating characteristic (ROC) analysis using a continuous scale. The area under the ROC curve (AUC) was calculated for each monitor. The average AUC values for detection of chest CT images on a medical LCD (GSDF), medical LCD (gamma 2.2), and ordinary LCD were 0.71, 0.67, and 0.73, respectively. The average AUC values for detection of monochrome nuclear medicine images using a medical LCD (GSDF), medical LCD (gamma 2.2), and ordinary LCD were 0.81, 0.75, and 0.72, respectively. The average AUC values for detection of color nuclear medicine images on a medical LCD (GSDF), medical LCD (gamma 2.2), and ordinary LCD were 0.88, 0.86, and 0.90, respectively. Observer performance for detection of simulated nodules in chest CT images and nuclear medicine images was not significantly different between the three LCD monitors. We therefore conclude that an ordinary LCD monitor can be used to detect simulated nodules in chest CT images and nuclear medicine images.

The peritonsillar abscess (PTA) is one of the most common infectious diseases in the head and neck area and is treated with puncture, incision, or abscess tonsillectomy. In the present study, we performed a retrospective study for the patients who were diagnosed as having PTA on the basis of CT findings at the Kagoshima University Hospital between January 2007 and April 2012. The clinical characteristics were compared with the CT images and the indication of abscess tonsillectomy was discussed. In total, 145 patients (152 sides), mean age of 41 years (range: 5-80 years) were enrolled in the study. Patients having any surgical treatment such as puncture and incision before visiting our hospital were excluded. The CT findings revealed that PTA could be classified into two categories by the shapes of the abscess: the Oval type and Cap type. Further, the location of the abscess was differentiated superior and inferior, and classified into 4 categories: superior Oval type, superior Cap type, inferior Oval type, and inferior Cap type. The results showed that the number of the superior Oval type PTA was largest and followed by superior Cap type, inferior Cap type, and inferior Oval type in this order. When the CT classifications were compared with clinical findings, patients with the inferior Cap type abscess had laryngeal edema and airway obstruction more frequently than the other categories of PTA. Histological examination of the specimens obtained during surgery showed that the Cap type abscess tended to include more muscular tissue compared to the Oval type, indicating that inflammation might be more severe and wider in the Cap type than the Oval type. Those findings suggest that the inferior Cap type of PTAs need more intensive and reliable treatments such as abscess tonsillectomy.

A 57-year-old woman was diagnosed as in the chronic myeloid leukemia-chronic phase. Imatinib mesylate(IM)was initiated at 400 mg daily. She achieved complete cytogenetic response at 3 months, and major molecular response at 10 months. IM was reduced to 300 mg daily at 12 months because of grade 1 nausea. IM was reduced to 300 mg for 5 days per week by her demand at 22 months. Major molecular response was maintained with 300 mg of IM for 3 days per week at 77 months. The intermittent IM therapy might be useful for CML patients who cannot tolerate the standard dose of IM.

Objectives: Compared to other public employees, police officers have higher absence rates due to heart diseases, and ischemic heart disease (IHD) is one of the most frequent causes of death in their occupational life. The aim of this study was to investigate the prevalence of the risk factors for IHD among police officers and to examine its association with working conditions and lifestyles., Methods: First, 58 male police officers who developed IHD from 1996 to 2011 and 116 age- and rank-matched controls who were free from cerebro- and cardiovascular diseases were compared with respect to the prevalence of traditional risk factors five years before the onset of IHD. Then, the prevalence of IHD risk factors, and the frequency of metabolic syndrome (MetS) by age group, working condition and lifestyle were investigated in a cross-sectional survey of data of 1,539 male police officers and 153 male office workers in a prefectural police force., Results: In the case control study, the IHD cases had significantly higher prevalences of hypertension (p<0.001), hyper-LDL-cholesterolemia (p<0.05), glucose intolerance (p<0.05), and hyperuricemia (p<0.05) before the onset of IHD. Multiple logistic regression analysis revealed that hypertension (odds ratio [95% confidence interval] : 3.96 [1.82-8.59]), glucose intolerance (3.28 [1.34-8.03]), hypo-HDL-cholesterolemia (2.26 [1.03-4.97]), and hyper-LDL-cholesterolemia (2.18 [1.03-4.61]) were independently associated with the development of IHD (model chi-square, p<0.001; correct classification rate, 77.0%). In the cross sectional analyses, among the police officers, abdominal obesity (waist circumference of ≥ 85 cm) was significantly more frequent (57.3% vs. 35.3%, p<0.001) and the prevalence of dyslipidemia and glucose intolerance increased with age more remarkably than in the general office workers. In the age-group of 45-59 years, the clustering number of risk factors in individuals (1.8 vs. 1.4, p<0.01) and the frequency of MetS (25.0 vs. 15.5, p<0.1) were greater in the police officers than the office workers. Among the police officers, subjects with MetS had significantly higher rates of shift work (33.6% vs. 25.4%, p<0.01), lack of sound sleep (42.5% vs. 33.7%, p<0.01), and heavy drinking (12.8 vs. 6.3%, p<0.01) than those without MetS., Conclusions: In this study, the development of IHD in police officers was significantly associated with traditional risk factors, especially with hypertension, dyslipidemia and glucose intolerance. The increase with age of the prevalence of IHD risk factors and the frequency of MetS were greater in police officers than office workers. Irregular working conditions, such as shift work, long working time, and unfavorable lifestyles, e.g. alcohol drinking and poor sleeping conditions, may influence the higher prevalence of risk factors for IHD in police officers.

We report a case of a 41-year-old woman who underwent mastectomy and axillary lymph node dissection for right breast cancer(T3N3cM0) in 2004. She was treated with chemotherapy for multiple bone metastases and recurrence in the iliopsoas from January 2008. Right chest wall recurrence was observed in May 2010 and it progressed to ulcer. She was admitted to our hospital complaining of dyspnea on December 2, 2011. We diagnosed open pneumothorax and inserted a chest tube, and then packed the ulcer. No recurrence was observed in the liver and lungs. After stabilization of her general condition, we performed chest wall resection and reconstruction with a latissimus dorsi flap. She was discharged 2 weeks after surgery without severe complications. Although there were distant metastases, this surgical procedure may be effective for patients with open pneumothorax from recurrent breast cancer in order to maintain quality of life.

Neuronal stem cells are mobilized after cerebral infarction. We had shown that appropriate support of these stem cells, achieved by therapeutic angiogenesis, enhances neurological recovery in experimental stroke model. Based on these observations, we started cell based therapy using autologous bone marrow mononuclear cells for patients after cerebral embolism as phase 1/2a clinical trial. We have treated 6 patients in low dose group (harvest 25 ml of bone marrow cells) and none of them showed treatment-related adverse effects. We are now recruiting another 6 patients in high dose group (harvest 50 ml of bone marrow cells) and are planning to evaluate the effectiveness and safety of the therapy after obtaining the results of all 12 patients.

Background: We evaluated the effectiveness of low-dose patient-controlled epidural analgesia (PCEA) in the patients undergoing laparoscopic gynecological surgery, and investigated the difference of postoperative pain between patients for laparoscopic ovarian cystectomy and those for myomectomy., Methods: Thirteen patients (ASA PS 1 or 2), scheduled for laparoscopic surgery, were enrolled in this study. They were divided into two groups of ovarian cystectomy (group C, n=17) and myomectomy (group M, n=13). After administering epidural bolus of 0.2% ropivacaine 6 ml, droperidol 2.5 mg, and buprenorphine hydrochloride 0.1 mg, PCEA was started: 1 ml x hr(-1) background infusion; 0.2% ropivacaine 54 ml, droperidol 5 mg, and buprenorphine hydrochloride 0.3 mg; 1 ml epidural bolus with a 30-minute lockout interval. We evaluated postoperative pain using visual analogue scale (VAS) at rest and on movement, adverse effects such as respiratory and cardiovascular depression, nausea and vomiting for 48 hours after surgery., Results: VAS at rest with group M was significantly higher than that of group C (11 +/- 2 vs. 6 +/- 2, P=0.048), and VAS on movement of group M was also higher than that of group C (25 +/- 3 vs. 18 +/- 2, P=0.023): however, we found good analgesic effect of less than VAS 3 in both groups. Severe adverse effects were not observed., Conclusions: These findings suggest that low dose PCEA is effective for patients who undergo laparoscopic gynecological surgery.

A 71-year-old man receiving maintenance dialysis because of diabetic nephropathy presented with hematemesis at another hospital in January 2008. A gastrointestinal endoscopy demonstrated a II a-like lesion in the angle of the stomach, and he was admitted to our hospital. A diagnosis of gastric adenocarcinoma (cT2N2M0, Stage IIIA) was made. An operation could not be performed because of the high risk, so combination chemotherapy with 5-FU and l-LV was initiated. After 3 courses of treatment, the size of the primary tumor was markedly reduced. After 6 courses, the primary lesion had changed to a scar, and an endoscopic biopsy revealed no cancer cells. His performance status did not deteriorate, and no serious adverse events occurred during the course of treatment. Chemotherapy was continued because the overall response was SD. 5-FU/l-LV therapy should be considered as a safe and useful treatment for a hemodialysis patient with advanced gastric cancer.

As an acute hospital specialized in elderly patient, we utilized an integrated function screening sheet in order for doctors and nurses to start early in the discharge support at the inpatient ward. However, due to inadequate assessment, it consumed a lot of time until the request of discharge arrangement was made. Thus, as one of activities of discharge support team within the hospital, we started the inpatient ward round by team members aiming to begin a discharge support from inpatient ward. As a result of the activity, the round seems to be effective in deciding the direction of discharge, creating co-operative framework, etc. However, it revealed several problems as well. We need to study further identifying a better way of the inpatient ward round.

Metabolic syndrome, which is consisted of hypertension, dyslipidemia and impaired glucose tolerance, is one of the most significant lifestyle-related disorders that lead to cardiovascular diseases. Among many upstream factors that are related to metabolic syndrome, obesity, especially visceral obesity, plays an essential role in its pathogenesis. In recent studies, possible mechanisms which connect obesity to metabolic syndrome have been elucidated, such as inflammation, abnormal secretion of adipokines and mitochondrial dysfunction. In this review, we focus on the relationship between obesity and metabolic syndrome; and illustrate how visceral obesity contributes to, and how the treatments for obesity act on metabolic syndrome.

Surgical intervention on cardiovascular disorders in patients with hemodialysis dependent renal failure improves their life expectancy, but carries high surgical mortality. Decision on the indication of surgery as well as on its timing has crucial impact on surgical outcome. We retrospectively analyzed the data of 21 hemodialysis dependent patients who had undergone cardiovascular surgery in our institution from May 2001 to May 2005 to elucidate the appropriate indication and timing of surgical intervention. The study revealed early mortality (< 30 days) of 4.8% and 5 year survival rate of 83.5%. Risk factors for poor prognosis were older age, and longer hemodialysis history. Despite the opinions advocating early surgery in these patients, we adopted a surgical strategy to wait until patients' condition is optimized. Low surgical mortality and high long-term survival of our surgical series indicated appropriateness of our strategy on the timing of surgery. However, extremely low long-term mortality rate raised the concern that our surgical indication might have been too conservative.

Marked Streptococcus pneumoniae tolerance is attributed to a penicillin and macrolide resistance genotypes, yet no report has, to our knowledge, compared the ability of these two genotypes to grow. Deviations in the number of clinical appearances of Streptococcus pneumoniae depend on the combination of these genotypes, thought primarily due to the individual strain growth. To test this, we compared ATCC6303 and a strain of each genotype with an absorption spectrophotometer. Time points-T0, T2, T4, T8, T10, T12, and T24-were compared to each of the following factors: initial value, dullness time, doubling time (D.B.T.), peak attainment, peak value, and stationary value. ATCC6303 and the clinical strain (PSSP8) showed no difference in time points or tested factors. Penicillin susceptible Streptcoccus pneumoniae (PSSP) 8 and Penicillin intermediately resistant Streptcoccus pneumoniae (PISP) (2b, mefA) strains showed significant differences in some time pointsT8, T10, and T12-and in certain factors-dullness time, D.B.T., and peak attainment-. In penicillin-resistant genotypes, the sequential growth rate priority was PSSP>PISP>PRSP, while in macrolide-resistant genotypes, it was mefA>non-mefA, and non-ermB>ermB. PISP (2x) and PISP (2x+2b, mefA) begin doubling immediately, suggesting that they proliferate earlier than other strains. Differences in the start of doubling time and doubling speed suggest that different strains are distributed among clinical resistant S. pneumoniae strains.

Objective: To investigate the relationships of self-reported physical health, social and spiritual satisfactions with subjective mental health according to gender and life stage., Methods: Self-reported questionnaires with questions regarding subjective health status and lifestyles were sent to 1905 community residents aged 20 years or older selected by random sampling in Wakayama Prefecture, Japan. Subjective mental health, physical health, social and spiritual satisfactions as measures of subjective health status were assessed using a visual analogue scale. Multiple logistic regression analysis was used to evaluate the relationships between the subjective mental health and the other three components of the subjective health status with adjustment for life style factors related to the subjective mental health in the subjects without missing values of relevant factors (n=1,752). The subjects were divided into three life stages depending on their ages: young (20-39), middle (40-59), and old (60 or more)., Results: Overall, the poor statuses of the three components, namely, physical health, social and spiritual satisfactions, were significantly associated with poor mental health in both genders at any life stage. However, detailed analysis revealed some interesting characteristics. In young men, social dissatisfaction was strongly associated with poor mental health whereas spiritual dissatisfaction in addition to social dissatisfaction was strongly associated with poor mental health in young women. In the middle aged group, both social and spiritual dissatisfactions were strongly associated with poor mental health in both genders. On the other hand, poor physical health status was strongly associated with poor mental health in the old aged group., Conclusions: These results suggest the importance of the mental health interventions under consideration for each life stage and gender.

Background: Retractions of the heart required for exposure and construction of distal anastomoses often decrease R-wave amplitude of ECG and interfere with intraaortic balloon pump (IABP) trigger during off-pump coronary artery bypass (OPCAB). Missing R wave trigger results in asynchronous work of IABP and probably produces hemodynamic instability. We report our early experience with a new interface BPI 202 (Osypka Medical, Inc., USA) for sensing accurate ECG trigger for IABP during OPCAB procedure., Cases: Six high-risk patients undergoing multivessel OPCAB using BPI 202 are described., Results: With the new interface BPI 202, simulated R wave signal could be processed from an external dual chamber pacemaker sensing surface R wave. The simulated R wave was successfully used for controlling IABP and secured a synchronous work between the heart and IABP during heart retraction maneuver. BPI 202, an interface for IABP appeared to facilitate the intraoperative management of our series of patients., Conclusions: We believe BPI 202 can produce a synchronous work of IABP during OPCAB procedures to high-risk patients and avoid dangerous hemodynamic instability.

Attention deficit/hyperactivity disorder (ADHD) is characterized by inattentiveness and/or impulsiveness and hyperactivity, which are unsuited for the developmental stage or age. Although mechanisms leading to the onset of the disease are unclear, this condition seriously hinders childrens' social or learning functions, and recently it was selected as a target disease for a special supporting education program by the Minitry of Education, Culture, Sports, Science and Technology, together with learning disorders and high-functioning pervasive developmental disorders in Japan. In spite of the increasing social interest in ADHD, the epidemiological evidence including data for incidence, prevalence, gender differences, and etiology remain insufficient. In Western countries, as represented by the United States, operational diagnostic criteria such as DSM-IV are widely used and several diagnostic processes using structured interviews have been established. However, the diagnostic criteria have not been consistent even within DSM as shown by DSM-IV and DSM-III-R, and therefore basic epidemiological evidence was not consistent in the previous studies. Regarding the etiology of ADHD, exposure to addictive substances during the pregnancy period caused by maternal smoking or drinking, and familial socioeconomic status are considered important environmental factors. In addition, a family history of mental disorders and polymorphisms of dopamine-related genes such as DRD4 or SLC6A3 have been noted as genetic factors concerning the development of ADHD. However, in Japan, no studies of these subjects or gene-environment interactions have so far been performed. Thus, epidemiological assessment of other than Western populations is needed. In the clinical situation, it is important to grasp the timing of treatment and target problems on the basis of changes of children's ability to control their attention or behavior, and environmental factors associated with growth processes. Especially, comorbidity such as conduct disorder or oppositional defiant disorder is a critical problem. Thus, considering that ADHD is a multifactorial disease, a comprehensive therapic strategy involving medication, education, judicature, and administration should be established for primary and secondary prevention.

We report a case of Cushing disease whose microadenoma was not identified by MRI with dynamic study and whose sphenoid sinus was conchal in type. Venous sampling test in the bilateral inferior petrosal sinus demonstrated ACTH hypersecretion on the right side. The patient underwent transsphenoidal surgery. A poorly pneumatized sphenoid sinus was drilled effectively, guided by the STEALTH navigation system. After the first operation, the patient's serum ACTH concentration was still high, suggesting that tumor removal was incomplete. Then she underwent the second operation and the residual tumor was completely removed with the assistance of the STEALTH navigation system again. Postoperatively, her serum ACTH concentration dropped below 5 pg/ml. In this case, inferior petrosal sinus sampling was extremely helpful for the diagnosis of Cushing disease, and operations were able to be performed safely using the neuronavigation system in drilling of the incompletely pneumatized sphenoid sinus.

We evaluated the effect of intra-arterial infusion chemotherapy associated with radiotherapy for two cases of local recurrence of rectal cancer. We performed an intra-arterial infusion chemotherapy (5-FU was injected continuously: 250 mg/day/body x 28 days, CDDP was injected weekly: 5 mg/day x 5 days) associated with radiotherapy (2-3 Gy/day x 20-30 days) for local recurrence of rectal cancer with the aim of pain-relief. Both patients markedly tended to feel less pain after the radiotherapy. Radiotherapy has been useful for pain-relief of the localized bone metastasis. The present intra-arterial infusion chemotherapy associated with radiotherapy was a possible local therapy for local recurrence of rectal cancer in the pelvis. Although the survival benefit depends on the presence of other site of recurrence, this procedure is useful for the improvement of QOL by relieving the pain of the patients.

The use of neoadjuvant chemotherapy for pancreatic cancer has been advocated for its potential ability to optimize patient selection for surgical resection and to downstage locally advanced tumors, especially for patients with Stage IV b (Japan criteria). We report our experience with a six-drug chemotherapeutic regimen that resulted in sufficient downstaging of the tumor in some patients to justify surgical resection. From Jan. 2001 through December 2003, 6 patients received 5-FU as a continuous infusion (200 mg/m2/day), calcium leucovorin weekly by intravenous bolus injection (30 mg/m2), mitomycin-C every 6 weeks (10 mg/m2 intravenously), and dipyridamole daily orally (75 mg), according to the UCLA regimen and gemcitabine weekly (600 mg/m2) and heparin as a continuous infusion (0-3,000 U/day) for locally advanced unresected pancreatic cancer. All of these patients were evaluable for response and survival. There were 5 partial responses (83% response rate) and 1 no response. Four of 5 responding patients had sufficient tumor regression to meet clinical criteria for resectability, three of whom underwent a curative resection. All patients who underwent downstage operation were still alive for the follow-up period (4-23 months).

We report a 46-year-old woman with Buerger's disease who presented vascular dementia. In her early thirties, she began to feel cold sensation and pain in the lower extremities and later developed Raynaud's phenomenon in the upper extremities. The diagnosis of Buerger's disease was established on the basis of angiographic findings which showed the obstruction of peripheral vessels in both anterior tibial arteries. She was admitted to our hospital because of a transient attack of left brachial monoparesis and two episodes of epileptic seizure with progressive cognitive impairment for preceding five years. Neurological examination revealed acalculia, constructional apraxia, recent memory disturbance, and hyperreflexia of the left limbs without motor disturbance. Brain MRI revealed multiple infarctions mainly located in the border zone territories of the major cerebral arteries. Conventional angiography failed to detect abnormalities of cerebral vessels. She had no cardiovascular abnormality or coagulopathy. Cerebrovascular complications, so-called cerebral thoromboangiitis obliterans (CTAO), occur approximately in 2% of patients with Buerger's disease. CTAO has two types. Type 1 is associated with large artery changes and type 2 is associated with medium and small artery changes. Patients with type 2 CTAO usually have multiple infarcts in the cerebral arterial border zones and may develop progressive cognitive decline without motor deficit. Her clinical features are compatible with type 2 CTAO. While CTAO is a relatively rare manifestation of Buerger's disease, it should be suspected in cases of Buerger's disease in association with cognitive impairment of unknown onset.