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Case 1: A 73-year-old man who had undergone neurolysis for right cubital tunnel syndrome complained of difficulty using chopsticks. Froment's sign test showed that the interphalangeal(IP)joint of the right thumb that had flexed preoperatively was extended. This finding was considered to indicate recovery from ulnar neuropathy, and the patient was closely followed up. One year later, the patient was unable to push a camera shutter button and was unable to flex the IP joint of the thumb and the distal interphalangeal(DIP)joint of the index finger, a characteristic symptom of anterior interosseous nerve(AIN)palsy. Therefore, the patient underwent AIN neurolysis and subsequently reported slight improvement in his condition. Case 2: A 60-year-old woman reported difficulty performing computer mouse clicks with her right hand. As flexing the index finger DIP joint was difficult, a local lesion was suspected, and the patient was closely followed up. One year later, the patient was unable to push the button of a ballpoint pen with her thumb. Extension of the thumb and index finger indicated AIN palsy. The patient refused treatment and was only followed up. The following year, the patient reported that the weakness improved. Simultaneous flexion palsy of the thumb and index finger can lead to a diagnosis of AIN palsy. However, flexion palsy of a single finger in incomplete AIN palsy, as reported here, is often overlooked because of its similarity to the flexor tendon rupture. Awareness regarding this incomplete form of AIN palsy is needed for early and correct diagnosis.

This 64-year-old woman had undergone endoscopic carpal tunnel release(ECTR)for right carpal tunnel syndrome 16 months earlier. Thereafter, she reported persistent dysesthesia in the thumb and index finger, developed burning pain in the middle and ring finger, paleness, coldness, and edema of the hand, a decreased range in hand motion, and a painful subcutaneous nodule just distal to the portal in the forearm. Based on physical, radiological, and electrophysiological studies, the diagnosis was incomplete carpal tunnel release associated with complex regional pain syndrome(CRPS). At open revision surgery, the carpal tunnel was released completely and the nodule was removed. Symptoms other than hypesthesia in the middle and ring fingers improved. Pathologically, the nodule was an amputation neuroma. Her CRPS was attributed to ECTR complications; i.e., persistence of median nerve compression and the formation of an amputation neuroma in the palmar cutaneous branch of the ulnar nerve at the portal. Surgeons must be aware that ECTR, a less invasive technique, may result in serious complications including CRPS.

In Japan, biochemical testing has been standardized by establishing secondary reference measurement procedures for each method under the leadership of the Japan Society of Clinical Chemistry (JSCC). This has led to the assignment of values to secondary calibration materials, enabling laboratories to manage the accuracy of measurement values using them. To promote the sharing of test data by standardizing base facilities on a nationwide basis, the Japanese As- sociation of Medical Technologists (JAMT) launched the Laboratory Test Data Standardization Project. The range of reference for biochemical testing was calculated, and the absence of regional differences in such a range was confirmed by standardized base facilities throughout Japan. Through collaboration between the JSCC and JAMT, the Clinical Chemistry and Immunochemistry Test Quality Assurance Manager Certification System was established in 2014, with a view to promoting quality assurance in laboratories. It is expected that medical technologists who are certified as such managers will contribute to the nationwide provision of high-quality medical services. [Review].

Objective: Suction is necessary during craniotomy, and intraoperative tumbling of the suction device interrupts operative procedures. To avoid this, we developed a technique that would fasten the device to an extendable cord as is used to secure cell phones., Surgical Technique: We used this technique in more than 300 craniotomies at the specific point of time when the suction device tends to tumble, i. e., during the opening and closure of a wound, which requires frequent instrument exchanges. Extendable cords fastened to the tip of the suction hose using a gift tie were attached to the drapes to secure the suction device next to the operative field. During the operation, the extendable cord followed the suction device manipulations. Consequently, although there was some tension in the cord during its extension, the maneuverability of the suction device was maintained. As the hanging suction device was closer to the operative field than devices stored in conventional pockets, its manipulation was easier and quicker. Upon release, the suction device automatically returned to its original position without distracting the surgeon. Tumbling of the device was prevented, and there were no procedure-related complications., Conclusions: Our simple modification using extendable cords prevented tumbling, avoided unnecessary replacements, and eased the manipulation of a suction device.

The strategy of international cooperation in the clinical laboratory field was analyzed to improve the quality of intervention by reviewing documents from international organizations and the Japanese government. Based on the world development agenda, the target of action for health has shifted from communicable diseases to non-communicable diseases (NCD). This emphasizes the importance of comprehensive clinical laboratories instead of disease-specific examinations in developing countries. To achieve this goal, the World Health Organization (WHO) has disseminated to the African and Asian regions the Laboratory Quality Management System (LQMS), which is based on the same principles of the International Organization of Standardization (ISO) 15189. To execute this strategy, international experts must have competence in project management, analyze information regarding the target country, and develop a strategy for management of the LQMS with an understanding of the technical aspects of laboratory work. However, there is no appropriate pre- and post-educational system of international health for Japanese international workers. Universities and academic organizations should cooperate with the government to establish a system of education for international workers. Objectives of this education system must include: (1) training for the organization and understanding of global health issues, (2) education of the principles regarding comprehensive management of clinical laboratories, and (3) understanding the LQMS which was employed based on WHO's initiative. Achievement of these objectives will help improve the quality of international cooperation in the clinical laboratory field.

Objective: When employing the lateral suboccipital approach, the thin dura shrinks due to the drying effect of illumination and air exposure, and dural substitutes are often needed for closure. We developed a new technique involving dural moisturizing with fibrin glue coating that facilitates primary dural closure., Patients and Methods: We used this technique in 12 adults who underwent the lateral suboccipital approach for 5 hemifacial spasms, 3 trigeminal neuralgias, 2 cerebellopontine meningiomas, 1 vestibular schwannoma, and 1 vertebral artery aneurysm. Fibrin glue was sprayed on the outer surface before opening the dura, and additionally sprayed on the inner surface of the reflected dural flap after opening the dura. After the intradural procedures the dura was closed with the usual knotted sutures., Results: Dural closure was performed 65-340 minutes (mean: 161.9 minutes) post-durotomy. This technique resulted in primary dural closure with a sufficient area of preserved dura in all but one patient. In this patient, the dura shrank due to coagulation of the dural attachment to the meningioma for which a small autologous substitute was required. There were no procedure-related complications such as cerebrospinal fluid leakage and meningitis., Conclusions: Dural moisturizing with fibrin glue coating is simple, protects the dura from drying and shrinkage, and facilitates primary dural closure in patients undergoing the lateral suboccipital approach.

A 6 1-year-old man who was admitted to our hospital because of obstructive jaundice. He was diagnosed with locally advanced cancer of the pancreatic head on computed tomography. Gemcitabine (1,000 mg/m² on days 8 and 15, every 21 days) + S-1 (6 0 mg/m² on day 1-15, every 21 days) chemotherapy was administered because the tumor had invaded the common hepatic artery and portal vein. The tumor was reduced following 9 months of chemotherapy. Thus, subtotal stomach- preserving pancreaticoduodenectomy (SSPPD)was performed. The histopathological findings indicated no invasion of the cancer into the surrounding tissues. No recurrence has occurred 7 months after surgery. Neoadjuvant chemotherapy is important for effective treatment of locally advanced pancreatic cancer.

Basilar invagination is a developmental anomaly of the craniovertebral junction in which the odontoid abnormally prolapses into the foramen magnum. It is also associated with Chiari malformation, syringomyelia, and hydrocephalus. Patients require surgical treatment to prevent progression of neurological symptoms, but assessment of anterior or posterior decompression can be difficult owing to bone instability and ambiguous compression of neural structures. Here, we describe a case of basilar invagination in a young adult. He presented with neurological symptoms, including syringomyelia, 3 months after a traffic trauma that might have led to instability of the bony structures. Since it was unclear whether the instability of the bony structures contributed to the clinical deterioration, the patient was first treated using halo-vest fixation. Significant improvements were observed in both neurological symptoms and magnetic resonance images. These results justified the invasive fixation and the patient was treated further with an occipito-cervical fusion ; good results were achieved in this case. Owing to the invasiveness of the procedure, occipito-cervical fixation should only be adopted following strict indication criteria. Halo-vest fixation was effective in treating the instability of the bony structures and as a trial treatment for permanent fixation.

For simple examination of blood disorders such as anemia, the results of blood cell counting using a small volume of blood sampled from a finger were evaluated. Because the sampling volume varies, tyramine was added to the blood dilution buffer as an internal standard. When blood is added to a tyramine-containing buffer, tyramine is diluted according to the blood volume regardless of the hematocrit. The degree of blood dilution can be calculated from the difference in the tyramine concentration. The diluted blood was measured for blood cell count items using XE-2100. After cell counting, the diluted blood was centrifuged, and the concentration of the internal standard in the supernatant was measured using the automated biochemical analyzer JCA-BM2250. Correlation coefficients of 0.824-0.995 were obtained in the blood cell counts between fingertip and venous blood samples from 48 volunteers. However, as platelet aggregation was observed by fingertip blood sampling, the correlation coefficient for the platelet count was 0.450. This method is considered to be useful for screening of blood disorders. It may also be applicable to medical care in remote areas and during disasters.

We encountered a very rare case of eosinophilic gastroenteritis accompanied with fasciitis of the extremities. The patient was a 28-year-old woman with epigastralgia, eosinophilia plus leukocytosis, massive pleural effusion and ascites, and thickening of the walls of the intestine. Increase of the eosinophilic fraction in her ascites led to a diagnosis of eosinophilic gastroenteritis. She soon developed resting pain in all limbs and MRI revealed fasciitis. Prednisolone was effective in treating both gastroenteritis and fasciitis.

When methotrexate (MTX) salvage chemotherapy is performed for primary brain malignant lymphoma, use of leucovonrin rescue must often be extended due to delays in the degradation of blood concentration. We examined whether delay in MTX blood concentration degradation could be prevented by chai-ling-tang (Sairei-to) which has diuretic action. In the five cases examined were MTX blood concentration 72 hours after MTX administration was more than 1 x 10(-7) M. A single dose of 3 g of chai-ling-tang was administered three times on the day the MTX salvage chemotherapy was subsequently performed. MTX blood concentration at 72 hours post MTX administration and subsequent chai-ling-tang administration was less than 1 x 10(-7) M in all five cases. In addition, urea nitrogen and creatinine levels in serum increased and creatinine clearance decreased following MTX administration, however these changes induced by MTX administration were reduced by chai-ling-tang administration. Chai-ling-tang was effective in preventing an MTX deferent delay in MTX high-dose therapy by improving renal blood flow.

We report an elderly patient with esophageal adenocarcinoma in whom a complete response (CR) was obtained by chemoradiotherapy using daily low-dose nedaplatin (CDGP) and continuous infusion of 5-FU. A 86-year-old man who had non-tuberculous mycobacterial infection was admitted for dysphagia, and diagnosed with Stage II A (T2N0M0) esophageal adenocarcinoma of the lower esophagus according to the TNM classification (sixth edition) of the International Union against Cancer (UICC). Chemoradiotherapy using daily low-dose CDGP and continuous infusion of 5- FU was performed, and thereafter one cycle of chemotherapy using CDGP and 5-FU was added. As the side effects of treatment, grade 3 leucopenia was observed while he was receiving chemoradiotherapy. A year later, he presented with grade 2 pericardial and pleural effusion and recovered with conservative treatment. CR was obtained and has been continued for two years. Definitive chemoradiotherapy using daily low-dose CDGP and continuous infusion of 5-FU is an effective choice for elderly and high-risk patients with esophageal adenocarcinoma.

A method of calibrating unquantified samples was developed in order to conduct tests from approximately 65 microl or less of self-collected whole blood from the finger. In this method, the dilution ratio is estimated by absorption analysis of an internal standard substance in the blood dilution buffer. Good results for replication of the dilution ratio were obtained, with a CV value of 0.99-2.78% and a rate of concordance with the theoretical dilution ratio of 99.4-99.8%. Evaluations of the utility of this system (Demecal System) were performed using total cholesterol measurement, and excellent correlation with the measurement value in plasma was achieved, with a correlation coefficient of r=0.975 at n=40 and a regression equation of y=1.02x-2.83. Dilution of 7-fold or less is required to assure accuracy with this system.

A 32-years-old man with a past history of hemorrhoids presenting with hemiparesis was diagnosed as having sagittal sinus thrombosis with hemorrtagic infarction. Laboratory data revealed macrocytic anemia (Hb 11.2 g/d/) with hypoproteinernia (5.5 g/d). After discharge the patient developed abdominal pain, diarrhea, edema in the leg and sustained anemia. Final diagnosis through colon fiberscope findings was Crohn's disease Macrocytic anemia seemed to be induced by Vit. B12 deficiency due to malabsorption. The mechanism and causal relationship between Crohn's disease and sinus thrombosis is discussed.

Papillary fibroelastoma is a rare benign tumor commonly arising from a heart valve. We describe an unusual papillary fibroelastoma that arose from the right side of the interatrial septum. An intracardiac tumor was discovered by routine echocardiography in an asymptomatic 68-year-old woman. The echocardiographic examination revealed a 20 mm mobile tumor in the right atrium. Tricuspid obstruction was not observed, nor was regurgitation. The tumor was resected through a right atriotomy. It had multiple papillary fronds and arose from the interatrial septum. Pathologic examination confirmed papillary fibroelastoma. The postoperative course was uneventful, and the patient was discharged on postoperative day 13.

Background: Epidural ropivacaine is now a common drug used for postoperative analgesia. However, little information is available concerning regression of sensory blockade and analgesia following prolonged epidural infusion of ropivacaine. We investigated the efficacy of ropivacaine and fentanyl for postoperative analgesia after thoracic surgery., Methods: Thirty patients undergoing thoracic surgery were enrolled. After surgery with general and thoracic epidural anesthesia, continuous epidural infusion of 0.2% ropivacaine+fentanyl (1.67 microg x ml(-1)) was started at a rate of 6 ml x h(-1) for patients whose height was more than 155 cm and 4 ml x h(-1) for those below 155 cm with possibility of an additional bolus injection of 3 ml at least every 60 min., Results: An additional epidural injection of 3 ml produced a decrease in VAS without significant changes of vital signs. The greatest VAS was 10+/-25 mm in the incision site and 36+/-38 mm in the ipsilateral shoulder. Sensory blockade was sustained until the morning after the day of surgery. Also blood pressure and heart rate were stable throughout the observation period. There were no adverse effects except for slight nausea in three patients., Conclusions: A bolus of 3 ml with continuous 4-6 ml x h(-1) epidural injection of ropivacaine plus a small dose of fentanyl would decrease postoperative pain with stable vital signs in patients after thoracic surgery.

External quality control survey of JAMT (Japanese Association of Medical Technologists) carries out 9 sections of clinical chemistry, hematology, bacteriology, serology, cytology, urology, physiology-pathology, blood transfusion and genetics. In two sections of biochemistry and urology, the control survey sample have been certified which was target value and allowance limits of error by the reference method. These standardized items are utilized in order to know the degree of the accuracy of the participation laboratories. We carried out the investigation for putting the focus at 2 sections of biochemistry and serology in order to execute the standardization of the external quality control. The multiple laboratories were carried out certified using both of common pooled serum and the reference serum for a proficiency test. On the standardization items, the result showed that the external quality survey assessment was possible by the accuracy. On items of biochemistry and serology test, there have compatibility which the results of same control survey of other group. It judged possible the standardization of the external quality control assessment by the integration of the research method.

Considering good laboratory management in highly specialized and sophisticated medical services, I here focus on university hospitals, so-called special functioning hospitals and other hospitals of equivalent size. I describe my personal view as a medical technologist on laboratory management, which is pretty much affected by difficult financial condition surrounding medical services. Also, I touch upon quality assurance of laboratory tests and technologies, how to support clinical practices and conduct business management. Of particular importance may be cost and labor saving in laboratory practices and to develop advanced and sophisticated medical technologies. Furthermore, it will be essential to educate and produce excellent and multidisciplinary medical technologists competent at laboratory practices and management so that we medical technologists contribute to daily clinical practices and progress in medical sciences.

A 40-year-old man with Marfan's syndrome had annulo aortic ectasia with Sellers grade 4 aortic valve regurgitation and Wada grade 3 pectus excavatum. Simultaneous operation was successfully performed by aortic valve composite graft insertion and sternal turnover with the rectus muscle pedicles. Following a midline skin incision, the cost-sterno complex (plastron) was dissected together with the bilateral rectus muscle pedicles, and the sternum was divided transversely through the second intercostal space. The plastron with muscle pedicles was retracted away from the anterior chest toward the abdomen and was covered by the moistened sternal bag made of polyethylene to prevent dryness and contamination during the composite graft insertion. The aortic root was replaced with a composite graft consisting of a 25 mm SJM valve and a 26 mm Hemashield graft. A short interposed 10 mm Hemashield graft was inserted between the ostia of the left coronary artery and the composite graft. The right coronary artery was reimplanted in the aortic conduit using the button technique with a doughnut pledget. This one stage method offered excellent operative exposure and enabled us to prevent possible necrosis of the sternum, infection of the mediastinal sinus, and postoperative cardiac failure resulting from chest wall compression. In this procedure, active usage of the rapid autologous transfusion system effectively reduced the total amount of blood transfusion.

Radioactive strontium chloride (89Sr) was administered for pain relief in 6 patients with bone metastases (4 prostate cancer and 2 breast cancer patients). Out of 6 patients, 2 showed apparent relief of bone pain and improvement of QOL, and 3 showed slight relief of the pain with or without improvement of QOL; that is, 83% was effective. Side effects were seen in 2 patients; transient deterioration of bone pain in one patient and bone marrow suppression in the other patient. The patient who showed bone marrow suppression had rather more lesions of bone metastasis (diffuse metastasis) and least urinary excretion of the radioactivity. Urinary excretion for 2 days varied 5 to 40% of the administered dose and was less in the patients with more metastatic lesions.

To evaluate the efficacy of adjuvant immunochemotherapy, especially the long-term administration of HCFU to patients with noncuratively resected and unresected gastric cancer, a randomized controlled study was conducted by 16 institutions in Hokkaido. After surgery, 185 patients were divided into two groups using the envelope method; group A (84 patients) treated by MMC (4 mg, twice a week, total 1 mg/kg)+OK-432 (or PSK): group B (101 patients) treated with MMC+OK-432+HCFU (600 mg, per day). The 5- and 10-year survival rates were 9.8 and 3.1% in group A, and 11.1 and 11.1% in group B (p=0.062). Better survival rates were obtained in those cases with unresected, S3, or peritoneal dissemination in group B. These results suggested the long-term administration of HCFU was effective for noncuratively resected and unresected gastric cancer.

Automated analyzers for enzyme immunoassay can be classified by several points of view: the kind of labeled antibodies or enzymes, detection methods, the number of tests per unit time, analytical time and speed per run. In practice, it is important for us consider the several points such as detection limits, the number of tests per unit time, analytical range, and precision. Most of the automated analyzers on the market can randomly access and measure samples. I will describe the recent advance of automated analyzers reviewing their labeling antibodies and enzymes, the detection methods, the number of test per unit time and analytical time and speed per test.

Recently, measurement systems in clinical chemistry have been improved to be more precise in analysis than those in 1980s. As a result, several advances in instruments and reagents have been brought such as incorporating microprocessors into hardwares of instruments and developing ready-to-use reagents, and the precision level of measurement systems is now sufficient for routine analysis. In the near future, however, we will have to focus on the accuracy of measurement systems to obtain accurate and commutable laboratory data. We report a present status of the precision in routine analysis and our activity in data maintenance for accurate analysis by reference methods.

Since the dental environment at a living place could potentially become a factor causing a need for dental care, all 33 elderly homes (27 of which responded to the survey) in Tokyo were investigated for the purpose of identifying the present status of dental care service and the problems existing at these homes. The following are the obtained conclusions. 1. The rate of homes with dental care facilities is as low as 19.2%, and cooperation by dental care institutions, including house calls, is ensured only at the low rate of 11.1%. As a result, usually patients visit the dental institutions. 2. The involvement of the dental staff, including part-time, was 44.4%, less than half of the homes surveyed. The homes wishing to employ or receive service from dental staff accounted for 76.9%. The homes also expected them to be engaged in the activities of overall oral hygiene, including not only dental treatment, but also participation in the planning of oral hygienic management. However, 23.1% of the respondents did not wish to employ any dental staff or receive any such service. 3. Specific programs for the guidance and management of oral hygiene were not observed. Homes that conducted dental examination periodically and those that carried out activities related to oral hygiene during Dental Health Week were also lacking. In addition, the homes which had assigned personnel responsibility for oral hygiene represented only 12.0%.(ABSTRACT TRUNCATED AT 250 WORDS)