Search

A 63-year old man with fever, headache, aphasia, and right hemiparesis was admitted to our hospital one month after the initial burr-hole surgery for left chronic subdural hematoma. Computed tomography(CT)revealed no regrowth of residual subdural hematoma. However, on the basis of the findings from magnetic resonance imaging(MRI)with diffusion-weighted images(DWI), an infection due to residual subdural hematoma was suspected. A small craniotomy was performed, and a little fluid with pus was aspirated from the subdural space. Postoperative antibiotic therapy for subdural empyema was performed, and subsequent culture of pus revealed Propionibacterium acnes ( P. acnes ). The patient's symptoms resolved, and he returned to work two months later. Subdural empyema caused by P. acnes after burr-hole surgery for chronic subdural hematoma is rare. We should consider infection due to residual hematoma in patients with recurrent symptoms and signs of inflammation, even in the absence of apparent regrowth of residual hematoma after burr-hole surgery.

Since the introduction of direct-acting antiviral (DAA)-based combination therapies in September 2014 for patients with chronic hepatitis-C (CH-C), numerous patients have been diagnosed with hepatitis-C virus (HCV)-associated hepatocellular carcinomas (HCCs) during the screening performed prior to DAA therapy. The present study was conducted on the antiviral therapy for CH-C in two phases:i) the interferon (IFN) phase between January 2011 and August 2014 and ii) the DAA phase between September 2014 and September 2016. During the DAA phase, HCCs were detected in eight patients who were referred to our hospital for anti-HCV therapy. In contrast, HCCs were detected in only two patients during the IFN phase. The number of patients with newly detected HCC in the DAA phase (20.5%) who were referred for the anti-HCV therapy was significantly higher than that in the IFN phase (1.7%). Owing to the high efficacy and safety of the DAA therapy, the number of patients referred to our hospital for anti-HCV therapy increased from 40.5 persons/year in the IFN phase to 80.3 persons/year in the DAA phase. The average ages of patients in the DAA and IFN phases were 68 and 61 years, respectively. The increase in the number of patients with newly detected HCC referred for the anti-HCV therapy in the DAA phase could be attributed to the increase in the number of referred patients for anti-HCV therapy and the aging of these patients in the DAA phase. All the eight patients with newly detected HCC who were referred for anti-HCV therapy in the DAA phase received curative treatments. The median age, rate of liver cirrhosis, and median tumor size of the patients were 69 years, 13%, and 16mm. Therefore, the findings of this study indicate that DAA therapies not only eradicate HCV infection but also contribute to the early diagnosis of HCC by encouraging the HCV-infected patients to visit hospitals and by promoting active network between hepatologists and family physicians.

A 66-year-old man was transferred to our hospital on November 2010 owing to a diagnosis of miliary tuberculosis. Treatment was initially started with INH, RFP, PZA, and EB. However, PZA and EB were discontinued because of their adverse effects. Subsequently, chest radiographic and laboratory findings gradually improved. However, the patient experienced lumbago, which exacerbated towards the end of March 2011. An abdominal CT scan showed an abdominal mass at the L3-L5 level between the abdominal aorta and lumbar vertebra. On the basis of the findings of abdominal ultrasonography, MRI, and PET-CT, infectious abdominal aortic aneurysm was highly suspected. Therefore, vascular graft replacement surgery was performed at the beginning of May 2011. The result of histopathological analysis showed the presence of acid-fast bacteria in the aneurysm and the lymph nodes around it, revealing that the aneurysm was due to systemic miliary tuberculosis. After the surgery, the patient was administered LVFX in addition to INH and RFP for 18 months and showed no recurrence.

The uncertainty of the beam quality conversion factor (k(Q,Q0)) of standard dosimetry of absorbed dose to water in external beam radiotherapy 12 (JSMP12) is determined by combining the uncertainty of each beam quality conversion factor calculated for each type of ionization chamber. However, there is no guarantee that ionization chambers of the same type have the same structure and thickness, so there may be individual variations. We evaluated the uncertainty of k(Q,Q0) for JSMP12 using an ionization chamber dosimeter and linear accelerator without a specific device or technique in consideration of the individual variation of ionization chambers and in clinical radiation field. The cross calibration formula was modified and the beam quality conversion factor for the experimental values [(k(Q,Q0))field] determined using the modified formula. It's uncertainty was calculated to be 1.9%. The differences between (k(Q,Q0))field of experimental values and k(Q,Q0) for Japan Society of Medical Physics 12 (JSMP12) were 0.73% and 0.88% for 6- and 10-MV photon beams, respectively, remaining within ± 1.9%. This showed k(Q,Q0) for JSMP12 to be consistent with (k(Q,Q0))field of experimental values within the estimated uncertainty range. Although inter-individual differences may be generated, even when the same type of ionized chamber is used, k(Q,Q0) for JSMP12 appears to be consistent within the estimated uncertainty range of (k(Q,Q0)field.

In standard external beam radiotherapy dosimetry, which is based on absorbed dose by water, the absorbed dose at any calibration depth is calculated using the same beam quality conversion factor, regardless of the presence or absence of a waterproofing sleeve. In this study, we evaluated whether there were differences between absorbed doses at calibration depths calculated using a beam quality conversion factor including a wall correction factor that corresponds to a waterproofing sleeve thickness of 0.3 mm, and without a waterproofing sleeve. The Japan Society of Medical Physics (JSMP) has reported that the uncertainty of the results using a beam quality conversion factor that included a wall correction factor corresponding to a waterproofing sleeve thickness of 0.3 mm, regardless of the presence or absence of the sleeve, was 0.2%. This uncertainty proved to be in agreement with the reported range.

A comparison of absorbed doses to water at a calibration depth determined by Japan Society of Medical Physics (JSMP) 12 and 01 was conducted, using a farmer type ionization chamber. The absorbed dose to water calibration factor (ND,W,Q0) and beam quality conversion factor (kQ,Q0) for JSMP 12 were smaller than the absorbed dose to water calibration factor and beam quality conversion factor for JSMP 01. Differences in absorbed doses at a calibration depth were -0.78% for 6 MV photon beam and -0.94% for 10 MV photon beam. In the present experiment, absorbed doses at a calibration depth were measured, using a farmer type ionization chamber. Further experiments at a larger number of facilities should be conducted to reveal the status of measurement of absorbed doses at a calibration depth using JSMP 12.

Severe urinary tract infection occasionally causes urosepsis and disseminated intravascular coagulation (DIC). We experienced six cases of DIC with severe urinary tract infection from July 2009 to January 2011. Patients comprised two men and four women, ranging in age from 67-84 years old. In all cases, urinary tract infection was caused by pyelonephritis. The results of analysis of bacterial culture from blood and urine revealed E. faecalis in 2 cases, E. coli in 1 case, P. mirabilis in 1 case and Candida tripicalis in 1 case. Percutaneous nephrostomy in 1 case and ureteral stent indwelling in 3 cases and ureteral stent exchange in 2 cases were used for the drainage of the origin of infection. Under the diagnosis of DIC, the administration of antibiotics and anti-DIC treatment with recombinant thrombomodulin (rTM) were performed. rTM isa new drug for the treatment of DIC. rTM binds to thrombin to inactivate coagulation, and the thrombinrTM complex activates protein C to form activated protein C. Therefore, rTM actsasa negative feedback regulator of blood coagulation. Treatment with rTM improved in 5 of the 6 patients.

Package insert of pharmaceutical drug is one of the most prioritized information for pharmacists to secure safety of patients. However, the color of character, size, font and so on are various company by company product to product from a viewpoint of visibility. It may be cause a serious accident in case visibility is unclear, although it is the most important information. Moreover, package insert with high visibility is required for color vision defectives from a viewpoint of a universal design. Then, the authors selected the package insert which has the boxed warning in the ethical pharmaceutical currently stored mostly in the present health insurance pharmacy and quantified the red color using the color meter. We advocate the state of a suitable package insert from a viewpoint of a universal design, whether the red color is high visible or not for color vision defectives using simulator.

Purpose: To evaluate the effectiveness of radiofrequency ablation (RFA) for liver metastases of colorectal cancer., Methods: RFA was used to treat 31 tumors (median diameter 1.5 cm, range 0.5-3.9 cm) in 13 patients of liver metastases of colorectal cancer. The median number of tumors treated per patient was 2. 9 (range, 1-10)., Results: Two patients had complications; bleeding and liver dysfunction. Four (12.9%) of 31 lesions developed a local recurrence after the treatment. We achieved a local control in 2 (92.6%) of 27 lesions <3.0 cm in diameter. In 4 (30.8%) of 13 patients, new metastases were observed at follow-up. One year survival rate from the initial ablation was 92.3% and 2-year was 46.2%. One year total local recurrence rate from the initial ablation was 55.6%., Conclusion: In the case of tumor greater than 3 cm, RF ablation is an effective method to treat hepatic metastases from colorectal carcinoma.

Kim introduced the geometric weighting factor concept into the field mapping method, and estimated collimator scatter factors of rectangular fields by correcting collimator exchange effects. The source plane is present at a specific position in the field mapping method, and, accordingly, the geometric weighting factor is constant. In this study, we changed the position of the source plane based on the measurement results, and we estimated the collimator factors of rectangular fields using the field mapping method. A geometric weighting factor at which the measured collimator scatter factors optimally fitted a square collimator scatter factor was calculated in each field. Collimator scatter factors can be accurately calculated recursively by changing the geometric weighting factor, resulting in altering the position of the source plane, as in this method.

Recently, we reported the effectiveness of a health education activity for multi-risk workers. In this study, we investigated whether or not the efficacy of the 1-year health education program persists in the medium run. BMI, systolic blood pressure and triglyceride out of 5 items which improved significantly after a 1-year health education program, persisted after 3-5 years. Total cholesterol improved additionally while systolic blood pressure deteriorated. A gamma-GTP, which did not show betterment significantly, was enhanced after 3-5 years. The percentage of those who are following a good lifestyle regarding excise, alcohol and nutrition, increased after 3-5 years than before the education program. The efficacy of the health education activity for multi-risk workers continues in the medium run.

The health of factory workers is a resource of business activity. However, at present, the rate of positive findings in the periodic medical checkups of factory workers is still increasing in Japan. After a 1-year health education program, we investigated the health awareness, a behavioral survey, and the data of the periodic medical checkups of factory workers. Most survey items of physical activities and mental health were significantly improved, and those of dietary habits and knowledge of lifestyle-related diseases also had a beneficial change. As an effective result, there was an improvement in most data of the physical examinations.

Objectives: This study investigated the tissue characterization of human coronary artery plaque using Virtual Histology intravascular ultrasound (VH-IVUS) and temperature guide wire., Methods and Results: Between August 2005 and December 2005, VH-IVUS examination and guide wire based measurement of coronary temperature were performed in 66 patients: 39 with stable angina pectoris (SAP), and 27 with unstable angina pectoris(UAP). Patients in the acute myocardial infarction with necrotic tissue and thrombus were excluded. After measurement of distal coronary pressure and coronary temperature, the following tissue types of atherosclerotic plaque were evaluated by VH-IVUS: fibrotic, fibro-fatty, dense calcium and necrotic core. Occurrence of fibro-fatty tissue was significantly higher in UAP patients than in SAP patients (17.4 +/- 7.0% vs 11.2 +/- 5.2%, p = 0.04), and coronary temperature was significantly higher in UAP patients than in SAP patients (0.08 +/- 0.05 vs 0.03 +/- 0.02 degrees C, p = 0.01)., Conclusions: These results suggest that the combination of VH-IVUS analysis and measurement of coronary temperature may be able to predict the progression of lesions.

An 86-year-old man with chest pain was admitted to our hospital. Coronary angiography revealed 99% stenosis of the mid segment of the left anterior descending coronary artery, therefore, a coronary stent was implanted. Immediately after the stent implantation, 99% stenosis occurred at the proximal site of the 1st diagonal artery because of stent jeal. On the 4th hospital day, ECG-gated 201TL/99mTc-PYP dual myocardial quantitative gated SPECT was performed at rest and during low-dose dobutamine loading. The 201Tl scintigraphy revealed moderately reduced uptake in the anterior, septal and apical walls, and 99mTc-PYP uptake was observed in the mid-anterior wall. A three-dimensional surface display of gated 201Tl SPECT images showed severe hypokinesis in the anterior, septal and apical walls at rest. On the other hand, during low-dose dobutamine loading, improved wall motion was observed in the basal anterior and septal walls, while no change was observed in the midanterior and apical wall movements. Three-dimensional surface display of gated 201Tl/99mTc-PYP dual SPECT images revealed similar patterns of wall motion as those of gated 201Tl SPECT images at rest. During low-dose dobutamine loading, on the other hand, a three-dimensional surface display of gated 201Tl/99mTc-PYP dual SPECT images revealed improved wall motion in the basal anterior, septal and apical walls, but worsened wall motion of the mid-anterior wall. After 6 months, a follow-up coronary angiography revealed no re-stenosis of the stent, but 99% stenosis at the proximal aspect of the 1st diagonal artery. Left ventriculography revealed improved wall motion in the apex and akinesis of the mid-anterior wall. These wall motion findings were similar to those visualized in the three-dimensional surface display of gated 201Tl/99mTc-PYP dual SPECT images during low-dose dobutamine loading in the acute phase. These results suggest that 201Tl/99mTc-PYP dual myocardial quantitative gated SPECT using low-dose dobutamine loading could be useful for the assessment of myocardial viability after reperfusion therapy in patients with acute myocardial infarction.

A 97-year-old woman was provoked a convulsion after taking a new quinolone antibiotic drug Levofloxacin and a non-steroidal anti-inflammatory drug Loxoprofen. At a later time, she was suffered from severe chest pain. An electrocardiogram showed ST segment elevation in leads II, III and aVF, and T-wave inversion in leads V1 to V4. Coronary angiography demonstrated no organic stenosis, however biventriculography revealed apical ballooning akinesis and basal hyperkinesis. Positron emission tomography was also performed to assess the uptake of 18F-fluorodeoxyglucose (FDG) after 75 g oral glucose loading for evaluating myocardial glucose metabolism at 10th day. Severely reduced uptake of FDG was observed in the apical ballooning region. Left ventriculography showed normal wall motion at 19th day. Thallium-201 myocardial single-photon emission computed tomography (SPECT) to determine the status of myocardial perfusion at the 20th hospital day showed normal perfusion. Iodine-123-beta-methyl-p-iodophenyl penta-decanoic acid myocardial SPECT to evaluate myocardial fatty acid metabolism at the 23rd day revealed severely reduced uptake in the apical ballooning region. These findings suggested that the coronary microcirculation was impaired in the apical ballooning region.

This patient was a 64-year-old man with chest pain at rest. An electrocardiogram showed depression of the ST segment in V2-V5 leads during chest pain. 123I-BMIPP myocardial SPECT revealed reduced uptake in the apex. Coronary angiographies revealed severely delayed filling of contrast medium without narrowing of epicardial coronary arteries. An intracoronary infusion of isosorbide dinitrate did not improve the delayed filling of contrast medium or the ST segment depression. After an intracoronary infusion of nicorandil, coronary arterial flows were remarkably improved, chest symptoms disappeared, and electrocardiographic findings were improved. Left ventriculography showed severe hypokinesis in the apex. After the medication with nicorandil, reduced 123I-BMIPP myocardial uptake and reduced wall motion on echocardiography were improved. These findings suggest that myocardial ischemia in this case might be explained as having been caused by microcirculation disturbance.

Unlabelled: Patients with coronary ectasia often develop chest pain and reveal ischemic changes on electrocardiograms and reduced left ventricular wall motion on left ventriculography, in the absence of epicardial coronary artery stenotic regions. We examined the disturbances in the coronary microcirculation in patients with coronary ectasia using left ventriculography and ATP loading 99mTc-tetrofosmin myocardial single photon emission computed tomography (SPECT) before and after administration of a coronary vasodilator and antiplatelet agents., Methods: Twenty patients in whom coronary angiography revealed diffuse coronary artery ectasia but no stenotic regions were enrolled in this study. Left ventriculography and ATP loading 99mTc-tetrofosmin myocardial SPECT were performed before and after administration of the coronary vasodilator, nicorandil, as well as that of the antiplatelet agents, aspirin and ticlopidine., Results: (1) The ejection fraction in left ventriculography was 48.3 +/- 17.4% before, and 56.6 +/- 18.3% after the drug administration, the ejection fraction was improved after the drug administration (p < 0.05). (2) Before the drug administration, the total defect scores on 99mTc-tetrofosmin myocardial SPECT were 5.9 +/- 3.1 and 8.8 +/- 2.7 in the ATP-loading and rest images, respectively (p < 0.05), and the corresponding scores after the drug administration were 4.1 +/- 3.0 and 5.4 +/- 3.1, respectively (N.S.). Thus, the total defect scores in the ATP-loading and rest images improved after the drug administration (p < 0.05)., Conclusion: Myocardial damage in patients with coronary ectasia might be induced by microthrombotic embolism and microcirculation disturbance.

Objectives: The severe inflammatory reaction caused by acute myocardial infarction and reperfusion affects both the heart and other remote organs. The occurrence of retinopathy was evaluated in patients with acute myocardial infarction who underwent reperfusion therapy., Methods: We investigated 29 patients with first acute myocardial infarction who underwent successful reperfusion therapy within 24 hr of the onset. Ophthalmic examinations including visual acuity test and ocular fundoscopy were performed within 3 days, 2 weeks, and then monthly up to 3 months after the onset of acute myocardial infarction. Plasma levels of intercellular adhesion molecule-1(ICAM-1), interleukin-6 and high sensitivity C-reactive protein were measured on admission., Results: Soft exudates around the optic disc appeared in 17(58.6%) of the 29 patients, among whom 5 also developed superficial hemorrhages(17.2%). The retinopathy became most remarkable between 1 to 2 months after the onset of acute myocardial infarction and then faded away without any specific treatment. None of the patients had impairment of visual acuity, although 4 of the 17 patients with retinopathy complained of either blurred vision or metamorphopsia. Hypertension and/or diabetes mellitus tended to be more common in the retinopathy group than in the non-retinopathy group(59% vs 33%, p = 0.096). Plasma ICAM-1 levels were significantly higher than in the non-retinopathy group than in the retinopathy group(p = 0.017). There was no significant difference in plasma levels of interleukin-6 and high sensitivity C-reactive protein between the two groups., Conclusions: Retinopathy may occur after reperfusion for acute myocardial infarction. The dominant manifestation is transient soft exudates reflecting spotty retinal ischemia, probably due to microvascular obstruction.

Purpose: This study was conducted to address change in smoking behavior of cancer patients when admitted to a cancer center, and elucidate factors associated with long-term smoking abstinence after discharge., Methods: The subjects were 97 patients with stomach cancer and 93 with head and neck cancer (cancer in the oral cavity, pharynx and/or larynx that did not require total laryngectomy) who were current smokers at the time of first visit to a cancer center. In order to obtain detailed information on their smoking behavior, a self-administered questionnaire was mailed to each patient at least 18 months after the patient was discharged. Seventy-three percent (138/190) of the subjects returned the completed questionnaire by mail., Results: The smoking cessation rates at five different time points, namely, 1) one day before admission, 2) the first day of admission, 3) the last day of admission, 4) one day after discharge, and 5) at the time the patient received the questionnaire, indicating long-term smoking abstinence after discharge, were 10.4%, 32.6%, 71.9%, 40.0% and 51.0%, respectively. Multivariate logistic regression analysis revealed that patients who had stopped smoking by the first day of admission had a significantly higher probability of long-term smoking abstinence than their counterparts who smoked up to the last day of admission. The patients who received doctors' and/or nurses' advice for smoking cessation at our medical center did not have significantly higher probability of long-term smoking abstinence than those who did not receive it., Conclusion: With patients suffering from stomach or head and neck cancer admitted to a cancer center, multivariate analysis indicated that smoking behavior in the pre-admission period influences long-term smoking abstinence after discharge.

Case 1 involved a 62-year-old woman with complete atrioventricular block and case 2 involved a 70-year-old woman with sick sinus syndrome. In both cases, echocardiography, 123I-15-(p-iodophenyl)-3-R,S-methyl pentadecanoic acid (BMIPP) and 99mTc-tetrofosmin myocardial single photon emission computed tomographic (SPECT) findings were normal. Coronary arteriography and left ventriculography also revealed normal in both cases. After pacemaker implantation (DDD-type in case 1 and VVI-type in case 2), both patient's electrocardiograms revealed left bundle branch block-type conduction disturbance, and echocardiography showed asynchronous hypokinesia in the septal region. One year later, although both patient's ATP loading tetrofosmin SPECT were normal, BMIPP SPECT showed reduced uptake and increased washout in the septal region. These findings suggest that these changes of BMIPP SPECT might be caused by left bundle branch block-type conduction disturbance after pacemaker implantation.

With the improvement in survival of cancer patients, the incidence of second primaries has been increasing. Data from the Osaka Cancer Registry showed that the incidence of metachronous second primaries was associated with gender (male), age and calendar year at diagnosis of the first cancer. The 10-year cumulative risk was estimated at around 10% for those who developed their first cancer in their sixties in 1978-83. The observed number (O) of second primaries (including synchronous) was compared with the expected number (E). The O/E ratios among those who developed their first cancer at ages 0-14 and 15-29 years old were much higher than the ratios among all age groups. Patients who had developed cancer of the colon, larynx, lung, bladder, or breast (1978-86) showed a significantly higher than expected risk of developing second primaries during the 1-4 years after diagnosis of the first cancer. Based on the hospital cancer registry data from Osaka Medical Center for Cancer and Cardiovascular Diseases, associations between adjuvant chemo-immunotherapy and the risk of second primaries were examined among 1,925 gastric cancer patients who underwent curative gastrectomy. The sex-, age-, and stage-adjusted hazard rate ratio of second primaries was 1.04 for patients who underwent chemotherapy and 0.70 for patients who underwent chemo-immunotherapy, when compared with the risk for patients who did not receive adjuvant chemo-immunotherapy. Some chemotherapeutic agents appeared to increase the risk of second primaries. Second primaries among 2,824 breast cancer patients were examined and their associations with adjuvant chemo-immuno-radiotherapy were analyzed. The O/E ratio for cancers of all sites was 1.28, significantly higher than 1.0. Cancer of the stomach, colon, lung and ovary were frequently observed as a second primary among them. Among 117 patients who developed second primaries, 4 developed cancer of the corpus uteri. This corresponded to 1.89 times the expected, however, only one of the 4 patients underwent tamoxifen treatment. The O/E ratio for non-Hodgkin's lymphoma was 3.40, significantly higher than 1.0. These results suggest associations between the risk for non-Hodgkin's lymphoma and chemotherapy.

This study aims at describing smoking behavior and cognition for smoking cessation among Japanese men after the diagnosis of cancer. Subjects were 144 patients with head and neck cancer (oral cavity, pharynx and larynx without requirement of total laryngectomy) and 104 patients with stomach cancer who were current or ex-smokers at time of diagnosis. A self-administered questionnaire was mailed at least 1.5 years alter diagnosis. Response was by mail and 72% (248/344) of completed questionnaires were returned. Among 164 patients who were smokers at the time of diagnosis, 59(36%) reported that they continued to smoke after the diagnosis of cancer. Stomach cancer patients (53%) had significantly higher (p < 0.01) continuance rate of smoking than head and neck cancer patients (24%), and patients in fifties (53%) had the highest continuance rate of smoking in the study participants. Among 105 patients who were abstinent, 83(79%) had stopped smoking within 6 months after the diagnosis of cancer. Interest in smoking cessation among the current smokers was high (83%), and they preferred a smoking cessation class with multiple participants to "person to person" counseling provided by health care practitioners.

Sustained left ventricular systolic dysfunction after transient myocardial ischemia is well known as "myocardial stunning", but little is known about the recovery in left ventricular diastolic function. Changes in left ventricular systolic and diastolic performance following dobutamine-induced ischemia were investigated in 13 patients with chest pain syndrome and normal coronary arteries (control) and 34 patients with coronary artery disease. Two-dimensional echocardiography and pulsed wave Doppler transmitral flow velocity curves were recorded at baseline, after infusion of a peak dose of dobutamine and at 20 min and 2 hours after dobutamine infusion. In control subjects, left ventricular ejection fraction and the peak early diastolic filling velocity increased at the peak dose of dobutamine. At 20 min after the cessation of dobutamine infusion, these values were restored to the baseline levels. In patients with coronary artery disease, ejection fraction and peak velocity increased at the peak dose of dobutamine but decreased at 20 min after infusion compared with baseline values despite the restoration of heart rate and blood pressure. Although ejection fraction increased at 2 hours compared with 20 min after infusion, peak velocity did not increase. Left ventricular diastolic dysfunction may be sustained longer than systolic dysfunction after transient myocardial ischemia.

We reported a 47-year-old female with congestive heart failure (CHF) of unknown origin. In this case, it was suggested that 123I-BMIPP and 99mTc-tetrofosmin myocardial SPECT images were useful in the diagnosis of CHF of unknown origin. She had complained of easy fatigability and dyspnea on effort since Sep. 1995. She was admitted to our hospital because of worsening of symptoms in Dec. 1995. Slightly decreased uptake in anterior, lateral and apical walls was recognized in 99mTc-tetrofosmin SPECT images, meanwhile 123I-BMIPP SPECT images showed markedly reduced uptake in the same areas. This discordance in the distribution between 123I-BMIPP and 99mTc-tetrofosmin myocardial SPECT suggested that CHF was not due to dilated cardiomyopathy, but ischemic myocardial disease. Coronary angiography revealed 90% stenosis at the just proximal of left coronary artery. This case was diagnosed an isolated coronary ostial stenosis with CHF, because she was menstruated middle aged woman and did not have a history of aortitis syndrome, syphilis and coronary risk factor before.

A 67-year-old woman was admitted with aching pain in her left flank and nausea. Bilateral renal infarctions were noticed by CT scan and arteriography. Selective intra-arterial thrombolytic therapy was performed. Urokinase (UK) was administered through a balloon catheter embedded into the occlusive segment of the left renal artery selectively. UK (20,000 units/hour) was continuously infused after short-term high dose UK (360,000) infusion. In spite of recanalization of the occluded artery, CT scan and renoscintigraphy image did not suggest recovery of renal function. Conservative intra-arterial thrombolytic therapy is considered to be the most effective treatment for renal infarction.

Echocardiographic findings, clinical features, and pathophysiology of mitral and aortic valve aneurysms were evaluated in four patients with pathologically proven aneurysms of the mitral and/or aortic valves associated with infective endocarditis. These four were selected from 20 patients hospitalized in our institute from April 1990 to May 1995 because of infective endocarditis. All four patients had received repeated, inadequate antibiotic treatments at other medical institutions prior to admission, and underwent surgical repair because of acute hemodynamic exacerbation associated with aneurysmal perforation. Six aneurysms (three mitral and three aortic valve aneurysms) were detected before surgery, including two by transthoracic echocardiography and four by transesophageal echocardiography. The echocardiographic findings typical of aortic valve aneurysm were: ringed echo at the level of the aortic annulus in the short-axis view; turbulent flow within the ringed echo; and dome formation of the aortic valve that persisted throughout the cardiac cycle. All mitral valve aneurysms were true aneurysms without active inflammatory changes or significant destructive lesions, and were associated with severe infective aortic regurgitation. Histologic examination of the aortic valve in these patients showed active inflammation and extensive destruction, suggesting that these valves were the primary focus of infection. One patient had an aortic valve aneurysm without apparent mitral involvement, indicating that another mechanism had mediated aneurysmal formation. We conclude that: diagnosis of mitral or aortic valve aneurysms in patients with infective endocarditis has important therapeutic implications, and therefore, transesophageal echocardiographic examination should be done in such patients: there are three key echocardiographically diagnostic findings of aortic valve aneurysm as mentioned above; and several unknown factors may contribute to aneurysmal formation of the mitral or aortic valve in patients with infective endocarditis.

We experienced a case of 64-year-old man with stunned myocardium caused by vasospasm. Without enzymatic evidence of an acute myocardial infarction, the patient developed a prolonged chest pain with ST elevation in the electrocardiogram in the midnight before the day of coronary angiography. Coronary angiogram revealed no significant stenosis and left ventriculography demonstrated akinesis in the apico-anteroseptal region. Although initial images of 123I-BMIPP myocardium SPECT showed no significant decrease of uptake, delayed images revealed marked decrease of tracer uptake in the apico-anteroseptal region in which left ventriculography showed abnormal wall motion. After 3 months of medication, left ventriculography disclosed a marked improvement, and coronary spasm was evoked in the proximal portion of left anterior descending artery after intracoronary ergonovine provocations. At the same time, both initial and delayed images of 123I-BMIPP myocardial SPECT showed no significant decrease of tracer uptake. This patients was considered as a noteworthy case to understand the kinetics and metabolism of 123I-BMIPP in stunned myocardium.

We evaluated the risk of development of a second primary cancer in 669 patients diagnosed with cancers of the mouth and meso-hypo pharynx at Osaka Medical Center for Cancer and Cardiovascular Diseases. During 1978-93, 70 of the patients developed a second primary cancer, yielding on observed to expected ratio (O/E) of 2.92 [95% confidence interval (CI) = 2.27-3.69]. Significant excess risk was noted for cancers of mouth and pharynx (O/E = 12.01, 95% CI = 3.87-28.04), esophagus (O/E = 25.22, 95% CI = 14.94-39.86), colon (O/E = 3.85, 95% CI = 1.41-8.39), larynx (O/E = 9.93, 95% CI = 2.00-29.02) and lung (O/E = 2.58, 95% CI = 1.24-4.75). The risks of esophageal cancer and colon cancer were significantly elevated after five years had elapsed from the initial cancer diagnoses. The risk of cancers of the oral cavity, pharynx, larynx and esophagus in patients who had a history of current smoking without current daily drinking at the initial diagnosis was elevated past one year after the initial diagnosis (less than 20 cigarettes/ day; O/E = 12.50, 95% CI = 0.16-69.55, 20 cigarettes or more; O/E = 10.00, 95% CI = 1.12-36.10). The risk of cancers of the oral cavity, pharynx, larynx and esophagus in patients who had a history of current smoking with current daily drinking at the initial diagnosis was around two times higher than those who had a history of current smoking without current daily drinking (less than 20 cigarettes/day; O/E = 20.00, 95% CI = 2.25-72.21, 20 cigarettes or more; O/ E = 19.51, 95% CI = 8.40-38.45).

We designed a new method to evaluate the rate of change of myocardial 99mTc-tetrofosmin (TF) uptake between exercise and rest images with a 1-day protocol. Fifteen normal cases were studied. A 370 MBq of TF was injected at peak exercise. Initial (TF1) and delayed (TF2) exercise SPECT images were acquired 30 min and 3 hr after the injection. A 740 MBq of TF was reinjected soon after TF2 acquisition, and rest SPECT images (TF3) were obtained 30 min after the reinjection. Myocardial counts of TF1, TF2 and TF3 were defined C1, C2 and C3 respectively. Then, the rate of change of myocardial TF uptake between exercise and rest (delta MTU: delta myocardial TF uptake) was determined by the following formula. delta MTU = [(C1/(C3-C2)] x R-1] x 100 (%) (R: dose ratio). delta MTU was 57.8 +/- 9.9% in normal cases and roughly correlated with maximal heart rates and double product. If the extraction fraction of TF is not changed under the exercise and resting condition, delta MTU may have some relation with the coronary flow/cardiac output ratio at exercise. In conclusion, delta MTU is a useful index to evaluate coronary flow reserve non-invasively.

The effect of medical treatment without reperfusion therapy on the long-term recovery of regional wall motion was evaluated retrospectively in 28 patients with transmural acute anterior myocardial infarction who had coronary angiography and left ventriculography at 1-6 months after the onset of the episode and were followed for a mean of 65 months. In all patients, initial coronary angiography revealed significant stenosis in only the left anterior descending artery (LAD). All patients were treated medically without reperfusion therapy (such as thrombolytic therapy, angioplasty, or bypass grafting). The regional wall motion in the LAD territory was measured by the centerline method using the right anterior oblique projection. Long-term improvement in anterior wall motion is unlikely in patients with patent LAD or underdeveloped collaterals to the LAD (38%). However, subsequent anterior wall motion frequently improved among patients with severely stenotic or occluded LAD (63%) and well-developed collaterals (73%). Therefore, the anterior wall motion of some LAD-related infarctions improves spontaneously, the extent of coronary collaterals is an important determinant of long-term improvement, and the improvement in wall motion is completed within the early period of acute anterior infarction in patients with patent LAD.

Mesalazine microgranules (Pentasa) were developed as a drug for idiopathic inflammatory bowel diseases such as ulcerative colitis and Crohn's disease. In this study, we examined the effect of mesalazine on radical scavenging, lipid peroxidation and the formation of LTB4. Mesalazine reduced the free radical 1,1-diphenyl-2-picrylhydrazyl with an IC50 value of 9.5 microM. It scavenged hydrogen peroxide and hypochlorite (IC50: 0.7 microM and 37.0 microM, respectively), but had no effect on superoxide. Lipid peroxidation in rat liver microsomes was inhibited by mesalazine (IC50: 12.6 microM). Mesalazine significantly inhibited (P < 0.01) gastric mucosal lipid peroxidation induced by ischemia and reperfusion in rats at a dose of 50 mg/kg, p.o. Mesalazine also inhibited the formation of LTB4 in rat peritoneal neutrophils (IC50: 44.9 microM). N-Acetyl-mesalazine, the metabolite of mesalazine, had no effect on radical scavenging and lipid peroxidation. Only a high concentration (1 mM) of the metabolite inhibited the formation of LTB4. These studies suggest that mesalazine inhibits cell injury in the inflamed mucosa by scavenging reactive oxygen metabolites and prevents the invasion of neutrophils by inhibition of LTB4 formation.

99mTc-DMSA renal scintigraphy was utilized to investigate the influence of ESWL on renal function in comparison with that of PNL. In the beginning, the reproducibility of renal uptake rate by the scintigraphy was examined in eleven healthy volunteers under both non-diuretic and diuretic states. The renal uptake rate was shown to be sufficiently reproducible in the same person in the two different trials. However, the differences and the standard deviations were shown to be a few percentages, which were not statistically significant. Changes in the repeated renal uptake rate seem to indicate not only changes of renal function with the treatment but also some technical errors. Herein, to investigate changes in renal function of the therapeutic side, the uptake ratio rate (rate of uptake rate in the therapeutic side/uptake rate in the contral lateral side) was utilized instead of uptake rate. Renal scintigraphy was carried out in 48 patients with unilateral renal stones before and after ESWL or PNL monotherapy or the combined ESWL and PNL therapies. Within one week of treatment, the uptake ratio rate significantly decreased in patients with PNL or the combined ESWL and PNL, although DMSA uptake rate in the therapeutic side did not significantly changes. Neither renal uptake rate nor uptake ratio rate significantly changed after ESWL treatment. There was no significant difference in changes of uptake ratio rate between Siemens Lithostars Plus and the improved Dornier HM-3 lithotriptors. This study indicated that ESWL monotherapy did not affect the uptake ratio rate, although PNL monotherapy and the combined ESWL and PNL therapies may affect the uptake ratio rate to some extent.

Between August, 1987 and December, 1991, 84 patients with 87 staghorn calculi were treated mainly with extracorporeal shockwave lithotripsy (ESWL) using a Dornier HM-3 improved lithotriptor. Patients were 38 men (38 renal units, mean age 54.9 years) and 46 women (49 renal units, mean age 54.3 years). Staghorn calculi were divided into 2 types; 54 units of complete type (mean stone area 9.2 cm2) and 34 units of incomplete type (mean stone area 5.5 cm2). Patients with complete type were treated with 3.6 sessions and 7,779 shock waves on average and 31.6 days for hospitalization was required, while patients with incomplete type were treated with 2.4 sessions and 5,288 shock waves on average and 15.7 days for hospitalization was required. After treatment, the excellent rate was 47.2% for the complete type and 44.1% for the incomplete type. After the monotherapy of ESWL the excellent rate was 46.9% and after the combined therapy with percutaneous nephrolithotripsy (PNL) and/or percutaneous nephrostomy (PCN) it was 43.5%. We considered that the ESWL monotherapy for staghorn calculi was not feasible in patients with a large stone volume, with severe hydrocalices, with cystine stones and with so-called "complex staghorn calculi".

A dual tracer technique using 111In labeled platelets and 99mTc labeled human serum albumin was applied to evaluate the in vivo thrombogenicity in 12 cases with abdominal aortic aneurysm (AAA) and the effect of antiplatelet drug on the thrombogenicity. The magnitude of platelet accumulation at AAA was expressed as the ratio of radioactivity of 111In platelets on the vascular wall to those in the blood pool (PAI; platelet accumulation index). Of the 12 patients with AAA, 11 had positive studies on baseline imaging and 1 had equivocally positive image. The PAI value (Mean +/- SD) over the AAA was 53.8 +/- 34.1% as compared to -8.6 +/- 4.4% in the control group (p less than 0.01). Seven patients with an AAA and positive baseline images were restudied during platelet active drug with 325 mg of aspirin. During treatment with aspirin, of 7 patients, 5 had positive images, of which 3 were decreased and others unchanged compared to baseline studies, 1 equivocally positive one and one negative one. The PAI value during treatment (21.9 +/- 18.6%) was significantly decreased compared to those in baseline study (52.1 +/- 23.9%). Our results suggest that the method used for platelet imaging in the present study may be useful for studying the in vivo thrombogenicity and the effect of platelet active drugs in AAA.

We report a new operative technique for plastic correction of uretero-pelvic junction (UPJ) obstruction: dismembered spiral flap pyeloplasty. It is similar to the method described by Culp & DeWeerd in that a flap is made spirally but different in that UPJ is detached. Relatively a long and wide spiral (oblique) flap, the apex of which directs cranioventrally or craniodorsally, is made using the dilated pelvis. The apex of the flap is reflected downward and anastomosed to the split ureteral end. Because the flap is made obliquely, one side of the flap base is approximated to the opposite pelvic margin; this helps to make gradual funnelling of pelvio-ureteric transition. The method seems to be fit for cases with considerably long stenosis of UPJ and with the UPJ locating relatively close to the medial margin of the renal parenchyma. Seven of 26 pyeloplasties were done by this method in our institute, and all the 7 cases had satisfactory results.

Transcranial Doppler method (TCD), newly developed in 1982, is ultrasound technology that measures physiologic parameters of blood flow in the major intracranial arteries. A major limitation of TCD is that, in some individuals, satisfactory recording is not possible, especially through the temporal windows. The purpose of the present study is to assess the rate of successful recording in TCD through the temporal ultrasonic windows in Japanese with special reference to aging and sex. In 423 Japanese (244 males and 179 females) aged from 25 to 93 years, measurement of blood flow velocity in basal cerebral arteries was performed by transcranial Doppler velocimeter with a 2 MHz pulsed wave Doppler probe. The signal was successfully recorded in 299 of 423 Japanese (71%). In Japanese males, successful measurement was more frequent (206/244; 84%) than in Japanese females (93/179; 52%). The rate of successful recording was evaluated in every decade from the twenties to the eighties, and it was found to decrease significantly according to age (100%, 94%, 91%, 74%, 66%, 67%, and 46%, respectively). In females, it significantly decreased in those older than 50 years old (100%, 100%, 93%, 61%, 36% 43%, and 27%, respectively), but not in males (100%, 88%, 89%, 81%, 88%, 83%, and 69%, respectively). These findings suggest that this noninvasive method has clinical usefulness for evaluating intracranial circulation but has limitation for assessing the intracranial lesions of elderly Japanese women.

To determine the current status of urolithiasis in 1988, in comparison with that in 1985, we analyzed the 1937 patients of urolithiasis at 17 departments of urology in Mie Prefecture and 2 departments of urology in Wakayama Prefecture. The ratio of male to female patients was 2.6 to 1.0. Geographically, the number of urolithiasis patients was most frequently distributed in Matsusaka City. The frequency of urolithiasis in the urban area was almost the same as that in the rural area. Most of the stones (96.3%) were in the upper urinary tract. The frequency of lower urinary tract calculi tended to be high in southern Mie Prefecture. The ratio of the upper urinary tract calculi to the lower urinary tract calculi in the urban area was higher than in the rural area. The age distribution in males was in the forties, while that in females was in the fifties. The average age was 46.4 years old. The surgical treatment was performed in 671 patients (34.6%) and the extracorporeal shock wave lithotripsy (ESWL) was the most frequent mode of treatment (85.0%), followed by cysto-lithotripsy (4.2%) and percutaneous nephro-uretero-lithotripsy (2.4%). The most frequent component of the urinary tract calculi was calcium oxalate and/or calcium phosphate (81.7%). The stone patient increased in the number during the summer season (July, August and September). In conclusion, in 1988 when the ESWL treatment started in Mie Prefecture, the epidemiologic features of urolithiasis was characterized as follows: the number of patients increased and the broad application of the ESWL treatment resulted in the decreased number of patients with spontaneous discharge and the increased number of patients with recurrent stones and with bilateral or multiple complex stones.

The effect of intravesical combination chemotherapy on superficial bladder tumors was analyzed. Seventy-two patients were treated with intravesical instillation of the following anticancer drugs. MMC group: Mitomycin C (MMC) 10 mg and cytosine arabinoside (CA) 300 mg. ADM group: Adriamycin (ADM) 30 mg and CA 300 mg. PEP group: Peplomycin (PEP) 30 mg and CA 300 mg. MAC group: MMC 10 mg, ADM 30 mg and CA 300 mg. Antitumor effects in the MMC, ADM, PEP and MAC groups were evaluated in 16, 18, 17 and 21 patients and objective response (CR + PR) of tumor was observed in 87.5%, 50.0%, 35.3% and 28.6% of these patients. The papillary tumors, small tumors and low grade tumors responded better to these intravesical chemotherapies than the non-papillary tumors, the middle grade tumors and the high grade tumors. The recurrence rate in 72 patients was 6.9, 14.6 and 26.8% within 1, 2 and 3 years. No significant difference in the recurrence rate was observed between the MMC, ADM, PEP and MAC group, but the MMC group tended to have a lower recurrence rate than the other groups. The recurrence rate for the low grade tumors and the middle grade tumors was significantly lower than that for the high grade tumors and the small tumors. The major side effect of instillation therapy with these drugs was bladder irritation which appeared in 16.7% of all the patients (78 cases). In conclusion, intravesical chemotherapy is a useful approach for controlling superficial urinary bladder tumors, especially the combination of MMC and CA.

Noninvasive determination of the ratio of the pulmonary to systemic blood flow (Qp/Qs) was attempted in 31 cases with intracardiac shunt using two-dimensional pulsed Doppler echocardiography. The Qp/Qs of these cases was ranged from 0.99 to 4.55 with an average of 2.63 by cardiac catheterization. Technical problems in the measurement were also studied. Seventeen cases with no shunt were served as controls. Systemic and pulmonary flow volumes, Qp and Qs (ml/min), were calculated by the following equation: Q (ml/min) = mean flow velocity (cm/sec) X cross sectional area of the semilunar valve ring (cm2) X 60 Here, the sample volume was set in the center of the valve ring at the phase when the flow velocity attained its peak in a pulse period. The mean velocity was obtained by dividing the integration of instantaneous mean frequency in the sample volume for a pulse period by RR interval. The ultrasonic incident angle was measured on the echocardiogram. The velocity profile at the valve ring was assumed to be a plane wave. The diameter (D) of the valve ring was measured on the echocardiograms of the long-axis view of the outflow tract. To make a correction referring to the value obtained by angiocardiography, 0.22 cm was added to the value obtained on the echocardiogram (D). The cross sectional area of the valve ring was calculated according to the following formula: Cross sectional area (cm2) = pi X [(D + 0.22/2)]2 The Qp/Qs ratio by the Doppler method in the cases with no intracardiac shunt was 1.11 (S.D. = 0.21) on an average and the Qp/Qs in the cases with an intracardiac shunt was well correlated with that by catheterization (r = 0.82). These results suggested the feasibility of the clinical application of the Doppler method for noninvasive determination of Qp/Qs. In 17 cases, pulmonary and systemic flow volumes measured by the direct Fick method were compared with those by the Doppler method, respectively. Considerable differences were observed between them. There was a tendency that both pulmonary and systemic flow volumes were under-estimated by the Doppler method in cases with a large shunt.(ABSTRACT TRUNCATED AT 400 WORDS)

To determine the present status of urolithiasis in Mie Prefecture, we analyzed the 1,314 patients of urolithiasis at 17 Departments of Urology and 2 Departments of Medicine in 1985. The ratio of male patients to female patients was 2.6 to 1. The most frequent incidence of urolithiasis was observed in Iinan county. The incidence of urolithiasis in the urban area was the same as that in the country. Most of the stones (96.9%) were in the upper urinary tract. The incidence of lower urinary tract calculi tended to be high in southern Mie Prefecture. The ratio of upper urinary tract calculi to lower urinary tract calculi in the urban area was the same as that in the country. The peak incidence in males was in the forties, while that in females was in the fifties. The average age was 44.5 years old. Ureterolithotomy was the most frequent (37.5%) surgical therapy, percutaneous nephrolithotomy and shock wave lithotomy done in 8.0% and 6.3%, respectively. The most frequent component of the urinary tract calculi was calcium oxalate and/or calcium phosphate (84.0%). The incidence increased in summer (April through September).

Evoked response of bulbocavernosus reflex was taken in 8 normal control individuals and in 15 abnormal voiding patients (8 benign prostatic hyperplasia, 4 diabetic neuropathy, 3 supranuclear neurogenic bladder). the latency in control group showed 31.5 +/- 5.0 msec duration after penile stimulation and 65.4 +/- 11.0 msec duration after posterior urethral stimulation. The latency in diabetic neuropathy group was obviously prolonged but not that in the supranuclear neurogenic bladder group. This modern neurophysiological electrostimulation method provides simple and accurate information of bulbocavernosus reflex.

A 55-year-old man was admitted to our hospital because of pollakisuria and dysuria. Rectal examination revealed a normal prostate and did not show fluctuation or tenderness. Cystography and cystoscopic examination revealed a lesion projecting into the bladder cavity. An echogram showed an irregular internal echo at the left lobe of the prostate, but prostatic biopsy revealed benign prostatic hypertrophy. Transvesical removal of the prostatic cyst was performed. The cyst was about 3 cm in diameter and filled with yellow fluid (5.8 ml). The fluid contained no sperm and its acid phosphatase and zinc levels were high. The cystic wall was lined by cubo-collumnar cells and partly by flattened epithelium.