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A 73-year-old woman visited our hospital due to carcinoembryonic antigen (CEA) level elevation (110ng/ml). She underwent an upper gastrointestinal endoscopy (EGD), enhanced computed tomography (CT), and positron emission tomography (PET) -CT. She was diagnosed with type 3 esophagogastric junction cancer with paraaortic lymph node (LN) metastases at stage IVA (cT3N4M0). She underwent triplet combination chemotherapy with itraconazole (ITCZ):nab-paclitaxel, oxaliplatin, and S-1 with ITCZ. After six cycles of this regimen, the CEA level was within normal range, and EGD and PET-CT showed no evidence of malignancy. She underwent laparoscopic proximal gastrectomy and lower esophagectomy. The surgical specimen revealed no residual tumor (pathological complete response). Three months later, her CEA level increased to 60.5ng/ml, and she had longitudinal LN recurrence. However, she took S-1 orally for 11 cycles, and the recurrent metastatic LNs improved. She received chemotherapy, including nivolumab followed by ramucirumab and nab-paclitaxel with ITCZ. The CEA level returned to the normal range, and PET-CT showed no evidence of malignancy. Her progression has been stable for 45 months after diagnosis. In summary, we encountered a case of unresectable gastric cancer with conversion surgery after triplet combination chemotherapy with ITCZ.

In recent years, the assessment of and support for the safety of driving for people with higher brain dysfunction to allow them to resume car driving have become issues to be addressed in Japan. It is difficult to determine whether or not people with higher brain dysfunction may safely resume car driving; in addition, methods of supporting this resumption have not been established. To support people with higher brain dysfunction and allow them to live at home in areas where public means of transportation may be insufficient, initiatives promoting the resumption of car driving are necessary in healthcare sectors, including day rehabilitation facilities. We provided support to a patient with an attention disorder due to left thalamic infarction, with the aim of achieving sufficient independence to drive a car, in a day rehabilitation facility. We herein report this case from the perspective of a speech-language-hearing therapist. The patient was a right-handed man in his 60s who had higher brain dysfunction with attention disorder as the main symptom. No marked motor paralysis of the extremities was observed. Use of a day rehabilitation service was started approximately two months after the onset of symptoms. Rehabilitation and support aimed at the resumption of car driving were provided approximately one month after the start of the day rehabilitation service use. To determine whether or not the patient was fit to drive a car, higher brain function tests for the intellectual function, attention function, and frontal function, as well as a theoretical evaluation based on the Stroke Drivers' Screening Assessment Japanese Version (J-SDSA) and monitoring of daily behaviors were performed. In addition, after the patient was given permission from an attending physician to drive a car on the condition that the patient did not drive fast and the patient's wife always accompanied him while driving, a safety assessment was also performed. As a result, approximately 10 months later, the J-SDSA theoretical evaluation score showed a passing grade, in contrast to the failing grade he had previously earned. Furthermore, errors in performing household activities due to a decreased attention function became unremarkable with respect to daily behaviors; therefore, we determined, together with the attending physician, that the patient now had sufficient independence to drive a car. In our day rehabilitation facility, the number of requests for advice on car driving from people with higher brain dysfunction living in the community had been increasing. Multisectoral assessments, training, and instruction should be continued in collaboration with attending physicians, other facilities located within the community, and driving schools in order to support people with higher brain dysfunction and help them once again be able to drive a car.

Purpose: It is important to prevent sarcopenia in community-dwelling elderly adults. Thus, we investigated the relationship between the swallowing function, nutritional status, and physical function in elderly outpatients., Methods: A total of 90 elderly outpatients (77.2±8.3 years) participated in the study. The investigation items included the Seirei dysphagia screening questionnaire, 20 masticable foods questionnaire, tongue pressure, grip strength, the skeletal muscle mass index (SMI), the questionnaire for sarcopenia screening (SARC-F), and the Mini Nutritional Assessment-Short Form (MNA-SF). The odds ratio for the swallowing function and six items was determined by a logistic regression analysis., Results: About 83.3% of the participants were at risk of dysphagia. The questions that detected the symptom in ≥30% of the participants were, "Do you cough during a meal?", "Have you become slower at eating?", and "Has it become more difficult to eat hard food?". The 20 masticable foods questionnaire, SARC-F, and MNA-SF were correlated with the Seirei dysphagia screening questionnaire. The results of the logistic regression analysis indicated that SARC-F was a significant predictor for a loss of the swallowing function., Conclusion: Because elderly outpatients have a decreased oral function, including chewing, they are at an increased risk of dysphagia. This study suggested that the swallowing function in elderly outpatients is related to the chewing ability, nutritional status, and sarcopenia. The swallowing function can thus be used to detect sarcopenia in elderly outpatients at an early stage and is important for preventing dysphagia.

We treated a patient with mesenteric lymphoma who concomitantly developed amyotrophic lateral sclerosis (ALS). The patient died of urinary tract infection nine months after the onset of ALS. We herein report the changes in the patient's condition and the sequence of events until death from the viewpoint of a physiotherapist. The patient was a 69-year-old woman who developed mesenteric lymphoma in September of X year and perceived weakness in the toes in November of X year. She showed signs of upper and lower motor neuron disorders, and electrophysiologic testing revealed denervation in three areas of the spinal cord. In March of X+1 year, she was diagnosed with definite ALS based on the Awaji criteria. In April of X+1 year, she began to receive continuous home healthcare, specifically outpatient rehabilitation. No remarkable bulbar palsy was observed soon after the initiation of rehabilitation; however, manual muscle testing revealed strengths in the lower and upper limbs of 1 and 3-5, respectively, indicating muscle weakness and muscle atrophy. She developed exacerbation of neurological symptoms in the upper limbs, bulbar palsy, and respiratory muscle paralysis during rehabilitation. The ALS Functional Rating Scale-Revised indicated a decreased tendency to X [please define X]. In July of X+1 year, the mesenteric lymphoma had enlarged, resulting in the development of ureteric obstruction and ultimately causing hydronephrosis. Urinary tract infection and sepsis were diagnosed, and she was hospitalized. Although her fever temporarily subsided following ceftriaxone administration, she ultimately died due to a systemic inflammatory response syndrome three days after hospitalization. The mean period between the ALS onset and death is reportedly 40.6±33.1 months. The rate of ALS progression differs among individuals. Malignant tumors and paraneoplastic neurological syndrome may be involved in rapidly worsening neurological symptoms. Patients who concomitantly develop motor neuron disorders and malignant tumors are likely to have a higher risk of developing serious conditions associated with the exacerbation of neurological symptoms and complications. Our patient had several diseases that affected her survival prognosis; however, the sharing of information regarding her condition among healthcare professionals may have been insufficient. The primary physician responsible for treating each disease should cooperate with physiotherapists and other paramedical staff who have frequent opportunities to talk to patients in daily clinical practice. In geriatric patients in particular, such an environment is essential.

Purpose: To clarify the prevalence and risk factors of sarcopenia in commuting rehabilitation service users., Target: The 104 participants of the plant [Sorry, the English is unclear: please clarify the meaning of the highlighted text] (56 men, 48 women; average age 78.6±7.7 years)., Methods: The diagnosis of sarcopenia was classified based on the AWGS diagnostic algorithm. The following 10 items were investigated for their causal relationship with sarcopenia as risk factors: risk factor survey (1) cerebrovascular disease, (2) hypertension, (3) respiratory disease, (4) cardiovascular disease, (5) orthopedic disease, (6) fracture, (7) cancer, (8) intractable diseases, (9) diabetes mellitus, and (10) fall history in the past year., Results: The prevalence of sarcopenia was 51.9%. Significant differences were observed in the items of "cancer" and "fall history in the past year" as risk factors for sarcopenia., Conclusion: Elderly people needing support or care (especially those with cancer and a history of falling) have a very high risk of sarcopenia and are expected to require early intervention.

Aim: The effects of alcohol consumption on Mild Cognitive Impairment (MCI) among the Japanese population had not been fully examined. Therefore, the objective of this study was to examine the association between alcohol consumption and MCI among the Japanese elderly population., Methods: In total, 421 men and 700 women aged 60-84 years participated in this cross-sectional study. Alcohol consumption was estimated according to frequency and amount of major alcoholic beverages (i.e., beer, Japanese sake, shochu, and wine) consumed by each individual using a self-administered questionnaire. MCI was assessed using the Japanese version of the Montreal Cognitive Assessment. Multivariable odds ratio (OR) and 95% confidence intervals (CIs) of MCI according to alcohol consumption were calculated using logistic models. We further analyzed the associations of the major alcoholic beverages with MCI., Results: The prevalence of MCI was 50.4% among the male participants and 31.4% among the females. A positive association between alcohol consumption and MCI was observed in men, but not in women. The multivariable OR (95% CI) of MCI for ≥ 2 go (46 g ethanol) /day vs. non-drinkers was 1.78 (0.93-3.40, p for trend = 0.045) in men and for ≥ 1 go (23 g ethanol) /day was 0.96 (0.39-2.38, p for trend = 0.92) in women, respectively. We also observed an association between shochu consumption and MCI in men, whereby the multivariable OR (95% CI) of MCI for each 1 go increment was 1.57 (1.18-2.07)., Conclusion: Our findings suggest that alcohol consumption in moderation may contribute to the prevention of MCI development in men.

We present herein a patient with rocuronium anaphylaxis, which had been identified using skin test, underwent conventional coronary artery bypass surgery without any neuromuscular blocking agent. Immobility was achieved with sedatives and analgesics.

SGLT2 is a low affinity, high capacity glucose co-transporter, almost exclusively expressed in the kidney cortex. Inhibition of SGLT2 has been shown to increase the daily 50g or more urinary glucose excretion, as compared to placebo, leading to a reduction in blood glucose levels and indicated only for the treatment of type 2 diabetes. In Japan 6 species of SGLT2 inhibitors have already been sold and reported to results in a decrease of FPG by 14.4 to 45.8 (mg/dL), in a reduction of HbA1c by 0.35 to 1.24% and in loss of body weight by 1.29 to 2.50(kg). There is less effect of the SGLT2 inhibitor in diabetic subjects with renal impairment and the reduction in HbA1c and FPG will be approximately half of the average in those with 30 ≤ eGFR ≤ 59. The position of SGLT2 inhibitors would be considered as the drug administered in combination or add-on therapy when the young obese type 2 diabetics without renal impairment has not yet reached to the glycemic target with other drugs although in AACE consensus statement of 2013, it has been shelved for inexperienced use with respect to the positioning of the SGLT2 inhibitors.

Purpose: To investigate serum antioxidant potential of patients with vitreoretinal diseases that require vitreous surgery and the antioxidant potential in vitreous fluids obtained intraoperatively., Subjects and Methods: Twenty seven eyes of 27 patients who had undergone vitrectomy for macular edema associated with branch retinal vein occlusion (BRVO), proliferative diabetic retinopathy (PDR), macular hole (MH)/epiretinal membrane (ERM) at Toho University Sakura Medical Center were studied. The biological anti-oxidant potential (BAP), as an index of anti-oxidant potential of serum and vitreous fluid was measured using a free radical elective evaluator (FREE)., Results: The vitreous BAP levels (microEq/l) in the PDR group was 1843 +/- 402 and in the BRVO group, 2120 +/- 413. The BAP levels in the vitreous fluid of the PDR and BRVO were significantly lower than those of control subjects. The serum BAP levels (microEq/l) in the PDR group was 2307 +/- 51.9 and in the BRVO group, 2390 +/- 149. The serum BAP levels in the PDR group were significantly lower than those in the control group. Only in the PDR group, the serum BAP was significantly lower than the vitreous BAP. The vitreous BAP levels were significantly positively correlated with those of the serum., Conclusions: A difference was shown between the antioxidant potentials of the vitreous fluid and serum in the patients with PDR. Antioxidant potential in the eye had possibly declined in patients with ischemic vitreoretinal disease compared with other vitreoretinal diseases.

Purpose: To evaluate the relationship between nocturnal dipping in heart rates and iris and/or angle neovascularization (NV) in patients with proliferative diabetic retinopathy(PDR)., Subjects and Method: One hundred fifty-one patients with PDR who underwent surgery were divided into groups based on either the presence or absence of iris and/or angle NV (NV group, 37; non-NV group, 114 patients). Pulse oximetry was conducted overnight and the heart rates were measured both before and during sleep; the resting and nocturnal heart rates and the resting-nocturnal heart rate dip ratio were calculated., Results: The resting and nocturnal heart rates did not differ significantly between the two groups. The resting-nocturnal heart rate dip ratio was significantly lower in the NV group than in the non-NV group (p = 0.006). In the NV group, the frequency of insulin therapy (p = 0.003) and a history of coronary artery disease were significantly (p = 0.033) higher than in the non-NV group. Pearson's correlation analysis showed that only the NV group was significantly negatively correlated with the resting-nocturnal heart rate dip ratio (r = -0.18, t value = -2.2, p = 0.028)., Conclusion: In patients with PDR, the non-occurrent of nocturnal dip in heart rate may be a related factor for iris and/or angle neovascularization.

Neurological injuries are widely known to promote neurogenesis in the adult hippocampal dentate gyrus. Our previous studies demonstrated that the granule cells in the hippocampal dentate gyrus are injured and eradicated by treatment with trimethyltin (TMT), with being regenerated in the dentate granule cell layer (GCL) after neuronal loss. Recent collective reports indicate that during brain injury and in neurodegenerative disorders, neurogenesis is controlled by cytokines, chemokines, neurotransmitters, and reactive oxygen/nitrogen species, which are released by dying neurons as well as by activated macrophages, micro-glia, and astrocytes. To elucidate the role of activated microglia in the neuroregeneration following the dentate granule cell loss, in this study, we evaluated the involvement of activated microglial cells and a related factor in the generation of newly-generated cells of the hippocampal dentate gyrus following neuronal loss induced by TMT. Our results support the possibility that pro-inflammatory cytokines released from activated microglial cells may be involved in promotion of the neurogenesis mechanism through activation of the NF-kappaB signaling pathway following the dentate neuronal loss induced by TMT treatment.

Background: We report a case of a severe corneal disorder after lung cancer treatment with the epidermal growth factor receptor (EGFR) inhibitor, erlotinib hydrochloride (Tarceva)., Case: A 59-year-old man, who was referred to our cornea service, presented with blurred vision and pain OD. Visual acuity was 6/20. Slit-lamp examination showed a severe corneal epithelial defect and ocular inflammation OD. Eighteen months previously, he had been diagnosed with lung cancer and had been undergoing treatment with erlotinib for 6 months. He had no history of ocular surgery, trauma or diabetes. After topical antibiotic therapy was started and the erlotinib treatment was discontinued for 1 week, the corneal findings resolved completely. The visual acuity recovered to 20/20 after 8 weeks., Conclusion: An EGFR inhibitor used to treat lung cancer can cause severe corneal disorders including severe corneal defects and ocular inflammation. Clinicians should consider the possibility of erlotinib in cases of corneal disorders of uncertain etiology.

Purpose: To investigate the prevalence of sleep-disordered breathing (SDB) in retinal vein occlusion (RVO) patients., Subject and Method: Forty RVO patients who had undergone either vitreous surgery or anti-coagulation therapy were included in this study. Pulse oximetry was conducted during the night and 4% oxygen desaturation index (4% ODI times/hour) and mean SpO2 (%) were calculated. If 4% ODI > or = 5, SDB was diagnosed. The results were compared between branch retinal vein occlusion (BRVO), and central retinal vein occlusion (CRVO). In addition, simple linear regression analyses were conducted to investigate whether 4% ODI related to systemic factors for RVO patients, i.e., incidences of hypertension and diabetes and body mass index(BMI kg/m2)., Results: Forty two percent of the men, 33% of the women and 37% of all the RVO patients were diagnosed as having SDB. The prevalence of SDB and 4% ODI, and the mean SpO2 were not significantly different between the BRVO and CRVO cases. The incidences of diabetes tended to correlate to the 4% ODI, however, neither proved significant. The BMI had a statistic correlation with the 4% ODI., Conclusion: The results of our study suggested that RVO cases have a high frequency of SDB. We believe that at the time of ophthalmic medical examinations or during the treatment of RVO, ophthalmologists should be aware of the possibility of SDB.

Purpose: To report a case of button battery-induced alkaline burn injury of the cornea and conjunctiva, with experimental findings of local damage., Case: A three-year-old girl had a hard and polished white opacity on the nasal lower cornea and conjunctival injection, caused by a button battery remaining in the conjunctival sac for several hours. The ocular surface was washed carefully with distilled water. The opacity improved gradually over several months and scarring was replaced by secondary pterygium., Experiment: A button battery was placed on an eyeball of a pig, with the cathode directed toward the cornea. Corneal opacity developed in five minutes and increased thereafter. Another battery was sanded with saline-soaked gauze and the gauze near the cathode turned dark brown. This change intensified when the gauze was in contact with the side of the battery., Conclusions: The cornea and conjunctiva of the patient were damaged by continuous exposure to alkaline solution (concentrated NaOH) after the button battery had entered the lacrimal sac causing fixation by chemosis. The recent development of smaller batteries increases the risk of similar accidents. Button battery-induced burn injuries may be severe and require immediate correct diagnosis and treatment, especially in small children who may be difficult to examine.

We analyzed the clinical efficacy of pre-operative combination chemotherapy using docetaxel, cisplatin and S-1 for advanced gastric cancer. Four patients were enrolled and staging laparoscopy was performed. Patients received intravenous docetaxel and cisplatin (35 mg/m2) on day 1 and 15, and oral S-1 80 mg/m2 on day 1-14 every 4 weeks. Two patients received two courses of chemotherapy and two patients received three courses of chemotherapy. Neutropenia of more than grade 3 was found in 3 cases. All cases were PR on preoperative imaging. Curative operation was performed on three cases. Histological anti-tumor effect was judged to be grade 2 in 1 case and grade 1a in 3 cases. In the postoperative period, all patients received S-1-based adjuvant chemotherapy. The combination chemotherapy using docetaxel, cisplatin and S-1 plus operation was a candidate for the standard treatment strategy for advanced gastric cancer.

Objective: To clarify ambiguous areas in interpreting MR images of Japanese eyelids, a histological examination was conducted on cadavers after the MRI for a comparative evaluation., Subjects and Methods: Orbital sections including the unilateral upper and lower palpebrae of two Japanese cadavers (an 87-year-old woman and a 49-year-old man) were examined. Following MRI, the specimens of the same cadavers were examined histologically for a comparative evaluation., Results: In both cadavers, a high signal intensity area with a hazy appearance unlike the orbital fat--fibroadipose tissue rich with connective tissue--was recognized between the orbicularis muscle and orbital septum. The same high signal intensity area that appeared to encase the posterior section of the descending orbital fat was also composed of fibroadipose tissue. Because of the presence of this intervening fibroadipose tissue, the posterior surface of the orbicularis muscle and the orbital septum could not come into contact with each other., Conclusion: Although limited to only two subjects, the current observation proved that fibroadipose tissue exists not only in the superficial layer of the orbital fat but that it further descends to surround the lowest portion of the orbital fat. As already reported, it was mainly the fibroadipose tissue, but not the orbital fat, that descends into the palpebral space.

Purposes: To investigate the prevalence of sleep-disordered breathing (SDB) in proliferative diabetic retinopathy (PDR) patients and clarify the relationship between SDB and PDR., Subject and Methods: Sixty-four PDR patients who had undergone vitrectomy in our hospital were included in this study. Forty-two patients were male, and 22 were female. Pulseoximetry was conducted during the nighttime; the sleeping 3% oxygen desaturation index (ODI/h) was calculated. If ODI was > or = 10/h, SDB was diagnosed. Blood glucose control and the presence of hypertension and albuminuria were evaluated and compared between the SDB and non-SDB groups., Results: Fifty percent of male patients, 27% of female patients and 42% of all PDR patients were diagnosed as having SDB. The presence of hypertension and albuminuria was 96% and 74%, respectively, in the SDB group, both significantly higher than in the non-SDB group. There were no significant differences between the two groups in preoperative HbAlc levels. However, compared with the non-SDB group, the prevalence of insulin therapy was significantly higher in the SDB group., Conclusion: PDR cases had a high frequency of SDB. It appears that SDB might hamper blood glucose control, raise the occurrence of hypertension and albuminuria, and is thus related to the progression of diabetic retinopathy.

Laparoscopic surgery for abdominal parenchymatous organs such as the liver and pancreas presents unique technical challenges and anatomic difficulties although laparoscopic splenectomy has become the standard procedure in some hospitals. The advances in laparoscopic technology have encouraged expert hands to extend the procedure to parenchymatous organs. Clinical cases of laparoscopic hepatectomy, as well as laparoscopic thermal ablation, for patients with hepatic tumor have been increasing recently. The most important considerations for laparoscopic hepatectomy are the clinical characteristics of the tumor. Tumors that are smaller than 5 cm and located in the lower or left lateral segment are good candidates. At present, partial hepatectomy and left lateral segmentectomy are appropriate operative procedures. The laparoscopic approach is considered the treatment of choice, as it is less invasive in selected patients. Laparoscopic pancreatectomy is difficult to evaluate at present because of the scarcity of clinical cases. Laparoscopic pancreatectomy is indicated for distal, enucleated tumors. Another procedure, pancreatic cystogastrostomy, utilizes an intragastric approach. Laproscopic splenectomy will be the standard procedure in patients suffering hematologic disease, although it remains controversial in cases of splenomegaly due to the possibility of portal hypertension or hematologic malignancy. The incidence of conversion to open laparotomy due to uncontrollable bleeding is closely related to the technical skill of the surgeon. Safer laparoscopic procedures for abdominal parenchymatous organs depends on further refinement of endoscopic technology and improved training in endoscopic techniques.

What should be the standard treatment for taxane-refractory metastatic breast cancer remains controversial. In this paper, a case in which the 5'-DFUR + CPA + THP therapy was effective for paclitaxel-refractory metastatic breast cancer is reported. A 41-year-old female received pectoral muscle preserved mastectomy under diagnosis of the left breast cancer in May 1996. In June, 1999, a coin lesion of 2.2 cm diameter was found in the left middle lung field with chest X-ray. Paclitaxel 210 mg/m2 (once for three weeks, 8 cycles in total) resulted in marked improvement. The regimen of paclitaxel 70 mg/m2 (medication consecutive once-weekly for three weeks, and withdrawal for next week; 1 cycle) was carried out continuously with the patient ambulatory. Because resistance to the treatment appeared at the time the total dose reached 2,700 mg, 5'-DFUR + CPA + THP therapy (THP 30 mg/m2 (i.v.) x day 1, CPA 77 mg/m2 (p.o.) x 14 days, 5'-DFUR 460 mg/m2 (p.o.) x 14 days; 3 weeks with 1 cycle) was carried out, and definite improvement in the lung findings were observed. 5'-DFUR + CPA + THP therapy may be of use as a second-line therapy in paclitaxel-refractory recurrent breast cancer.

Purpose: We studied the change in wound temperature during phacoemulsification(PEA) through an ultrasmall incision using an ultrasound tip with the infusion sleeve removed., Methods: We observed an increase in the ultrasound tip temperature on thermographs when it was turned on under various conditions. We also measured the wound temperature using a thermometer during the use of ultrasound in PEA by occlusion when a 20 gauge ultrasound tip was inserted without an infusion sleeve into postmortem porcine eyes through a 19 gauge incision and when the infusion cannula was inserted through the side port., Results: The ultrasound tip temperature did not rise if sufficient infusion liquid was circulated around the tip. When the 20 gauge ultrasound tip was used and the incision width was more than 1.5 mm, there was no thermal burn in the wound., Conclusion: Ultrasmall incision cataract surgery was conducted using a sleeveless ultrasound tip without the occurrence of a thermal burn in or around the incision wound.

In order to develop a new anti-bacterial urethral catheter, we studied anti-bacterial and anti-adherent coating material suitable for silicon catheters. Several aspects of various silver compounds were examined, including anti-bacterial activity, chemical property and toxicity. Among silver citrate, silver phosphate and silver oxide, which were found to have excellent anti-bacterial activities, silver citrate was regarded as the material of choice for anti-bacterial coating in terms of durable activity and biological safety. It was also found that several surfactants inhibited bacterial adherence to the surface of silicon catheters. Among them soybean lecithin exhibited excellent anti-adherent activity in a dose dependent manner. Finally, a mixture of silver citrate, soybean lecithin and liquid silicon at the ratio of 2:2:8 was regarded as an ideal anti-bacterial coating material for silicon catheters.

The potency and effectiveness of an anti-bacterial catheter coated with a mixture of silver citrate, soybean lecithin and liquid silicon at the ratio of 2:2:8 were compared with those of commercially available anti-bacterial and conventional urethral catheters. This new anti-bacterial catheter showed a strong activity and excellent durability in ordinary in vitro experimental studies. In the present series we have developed new in vitro experimental models for the evaluation of anti-bacterial catheters in inhibiting bacterial ascent via intraluminal or extraluminal route. The characteristic features of the silver citrate/lecithin catheter, namely strong activity and excellent durability, were confirmed using these new models that mimic urinary catheter-associated clinical infections.

Expanded polytetrafluoroethylene (ePTFE) as a dural substitute is sometimes associated with leakage of cerebrospinal fluid through the suture line. We have developed a new technique to seal the suture line with an absorbable mesh and fibrin glue. It is named as the mesh-and-glue technique. In this paper, the basic background of the efficacy of this technique was examined using in vitro and in vivo experimental models. The sealing effect was estimated on water leakage through 1 cm of suture line on the ePTFE sutured with 4-0 braided nylon at intervals of 2mm. The burst pressure of the non-sealed, conventional fibrin glue, simple glue spray, mesh-and-glue, and mesh-and-glue combined with spray was 2.8 +/- 0.4, 4.3 +/- 1.2, 64.4 +/- 21.4, 142.7 +/- 22.2 and 406.1 +/- 29.7 cm H2O respectively. It was worth noting that mesh-and-glue combined with the spray method can tolerate even arterial pressure. It was also observed that mesh-and-glue can seal a small dural defect. Long-term pathological changes of the mesh-and-glue was examined in a murine craniotomy model. Implanted mesh and fibrin glue was gradually transformed into a tight connective tissue firmly adhering to the surrounding structure within two months. These experimental results well support the clinical efficacy of the mesh-and-glue technique. This technique can also be applied to seal the arachnoid membrane after spinal surgery or to seal the suture line of arteriotomy in carotid endoarterectomy.

Oral glucose tolerance test (OGTT) has been accepted as the standard test for screening of glucose intolerance in spite of its poor reproducibility, especially, in the impaired glucose intolerance (IGT). There have been widely assessed the diagnosis of diabetes mellitus with using glycemic control markers such as HbA1c, 1,5-AG, and FRA as an alternative method, which are not so much affected by sampling conditions. However, it has been found a wide overlap of the glycemic control marker's values between the normal and the IGT. In OGTT, subjects with lower blood glucose values 2 hours after glucose load turned out to be the normal glucose tolerance at the second examination as well. Therefore, it might be reasonable to identify people with a higher blood glucose value 2 hours after glucose load as a high risk group by the screening with fasting blood samples. We have evaluated the combination test of FBG, HbA1c and 1,5-AG for screening of the diabetes and the high risk IGT, and this combination revealed to be durable for screening. But it would be important to elucidate the natural history and the extent of the risk of the IGT, and select a proper test with a clear cut-off value for screening of impaired glucose intolerance at risk.

A 68-year-old female presented ventricular septal perforation (VAP) 3 days after acute myocardial infarction. The patient, supported with intraaortic balloon pumping, underwent surgical repair with success on day 15. At operation, the VAP, measuring 2.5 x 1.5 cm, was repaired using a composite patch consisting of Dacron felt and xenopericardium attached each other with fibrin glue. The composite patch was found really useful for repair of VSP in such early phase as when VSP-sorrounding myocardium was very fragile, particularly in respect to the prevention of residual and/or recurrent shunt. This was because the composite patch was considered to have such excellent characteristics as: 1) toughness with sufficient compressibility and extensibility, 2) high antithrombogenesity and good tissue compatibility, 3) zero porosity, and 4) easy handling because of unification of two materials.

We assessed the Quality of Life (QOL) of 116 patients with inoperable esophageal cancer who were mainly treated with radiotherapy between 1978 and 1993. Factors including dysphagia, weight loss, side effects of radiotherapy,P.S. and psychological status were assessed retrospectively. Dysphagia was assessed using a swallowing-function scoring system. Initial improvement in dysphagia occurred in 68% of the 71 assessable patients. Radiotherapy was also effective for the other symptoms, including swallowing pain, anterior chest pain and vomiting. Improvement rates were 73%, 60% and 82%, respectively. The major side effects were pain of the pharynx, general fatigue, epigastralgia and appetite loss. But most side effects resolved within 10 days after the end of radiotherapy. Improvement of dysphagia resulted in reduced weight loss of the patients. Average weight loss was about 3 kg/month before radiotherapy. This was reduced after radiotherapy to 0.78 kg/month in patients who had improvement of dysphagia and 1.69 kg/month for those without improvement. Improvement of dysphagia also affected favorably the psychological state of the patients. There were fewer cases of patient distrust of staff and less despair in those patients with improved dysphagia. Radiotherapy appears to contribute to better QOL in patients with inoperable esophageal cancer.

Ultrasound (US) hyperthermia is a local heating method that has recently been introduced into clinical practice. A prototype and modified version of this system using a phantom model (agar with bone inserted) were evaluated. The prototype system consists of a power delivery unit (0.5 MHz frequency) with a circulating cooled water bolus. This system heats a shallow area irrespective of power output, but has a tendency to overheat the phantom surface. We incorporated three modifications into the prototype. The modified type has three frequency applicators (0.5, 1.0, 1.5MHz) and a secondary bolus. Aluminum-urethane shields were used to cover the phantom surface located over bone preventing overheating of bone. By changing the applicator's US frequency, we could change the depth of the heating area. Overheating of the phantom surface and bone thus was avoided. These results suggest that our modified US hyperthermia system with multiple frequency applicators, a secondary bolus and aluminum-urethane shields provided a good heating pattern.

We studied clinically ultrasound (US) hyperthermia system developed in Japan. The prototype system consists of a power delivery unit (0.5MHz frequency) and a coolded water bolus. The modified type has three frequency applicators (0.5, 1.0, 1.5MHz) with a secondary bolus. Thirty-four patients with recurrent or metastatic tumors located in the shallow tissues were treated. Fourteen patients (Group I) were treated with the prototype system and 20 patients (Group II) with the modified type. In 13 of the Group II patients, aluminum-urethane shields were used to protect nearby bone from overheating. The heating goal was 42.0 degrees C for at least 30 minutes in the tumor's center. The temperature was raised to 42.0 degrees C in 7 of 14 cases (50%) and in 17 of 41 sessions (41.5%) in Group I. In Group II the temperature was raised in 19 of 20 cases (95.0%) and in 67 of 80 sessions (83.7%). Response rates were 50.0% and 75.0% respectively in Groups I and II. The incidence of side effects including burn and ostalgia were 100% and 20% respectively in Groups I and II. These results suggest that the modified US hyperthermia system was valuable in clinical use.

Renal cell carcinoma accompanied with ossification reported in Japan is very rare. We report a case of renal cell carcinoma with ossification pathologically in a 61-year-old woman. She suddenly presented with hypercalcemia that caused acute renal failure, 6 months after the operation and died shortly thereafter. We discuss the relationship between the tumor and the hypercalcemia.

A 70-year-old woman underwent a left radical nephrectomy. The pathological examination revealed renal cell carcinoma (RCC), grade 1 and no lymph node metastasis. She suffered a recurrence in the renal fossa 11 years after the operation. The doubling time of the recurrent lesion was calculated to be very long for the cancer; about 1.3 years. Another case was in a 61-year-old woman, who underwent a right radical nephrectomy. The pathological examination revealed RCC, grade 1 with vascular invasion and no lymph node metastasis. Eleven years postoperatively she developed metastases in both lungs. The other case was in a 39-year-old woman, who underwent right radical nephrectomy. The pathological examination revealed RCC, grade 1 with vascular invasion and no lymph node metastasis. Eight years postoperatively she developed a recurrence in the left kidney. The doubling time of the recurrent lesion was about 0.9 year. All three patients responded to conservative therapy including interferon. Taking those doubling times into account, the recurrent lesions in the first and third cases seemed to have been growing very slowly and not rapidly immediately before clinically evident recurrence. Patients with a low grade RCC must have life-long followup.

The efficacy and safety of allylestrenol were studied in 22 patients with benign prostatic hypertrophy. A 25 mg allylestrenol tablet (Perselin tablet) was administered twice a day. A significant decrease in frequency of nocturnal urination was observed and improvement rates of subjective symptoms, such as sensation of residual urine, delay in start of urination, straining during urination and strength of urinary stream, were 59.1-68.2%. The rate of decrease of maximum area of transverse plane of prostate estimated by transrectal sonography was 13.2% and presumed circle area ratio (PCAR) improved significantly. The incidence of total side effects was 22.7%, whereas a decrease in sexual potency was observed in only 4.5% of the cases. The final global improvement rating of allylestrenol was 72.2% and the rate of usefulness was estimated in 63.6% of the patients. The present findings confirmed that allylestrenol is a useful and safe drug for the treatment of benign prostatic hypertrophy.