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Aim: We investigated the relationship between playing position of body pain in high school baseball players. Materials Methods: We enrolled 1,024 high school baseball players. The numbers of players by position were 249 pitchers, 119 catchers, 432 infielders; and 143 of them played more than one position. After the fall baseball season ended, subjects were given questionnaires and were assessed quantitatively regarding their regions of body pain. Based on this information, we analyzed the relationship between playing position and region of body pain. Results: The incidence of shoulder and upper arm pain was the highest in catchers, the incidence of elbow and forearm pain was the highest in pitchers, and the incidence of wrist and hand pain was the highest in outfielders. Conclusion: Our results suggest that the incidence of upper extremity pain differs depending on the baseball playing position. [ABSTRACT FROM AUTHOR]

Aim: We developed a subjective assessment score for baseball throwing performance. The aim of this study was to investigate the usefulness of this subjective assessment score in high school baseball players. Materials and Methods: We evaluated 1,024 high school baseball players. They were assessed using the DASH sports module, KJOC score, and throwing performance score. The throwing performance score had a minimum value of 0% and a maximum value of 100%. Statistical correlations between these assessments were determined. Results: The mean DASH sports module score was 18.3 points, the mean throwing performance score was 71.2%. Significant correlations were found between the throwing performance and the DASH sports module score, between the throwing performance and the KJOC score, and between the DASH sports module and the KJOC score. Conclusion: All of these questionnaires are useful to assess throwing performance problems in baseball players. [ABSTRACT FROM AUTHOR]

Emphysematous pyelonephritis (EPN) is a severe necrotic urinary tract infection accompanied by retention of gas in the kidney and areas around it. Formerly, emergency nephrectomy was the primary treatment, but the trend is shifting to treatment with maximum conservation of the kidney. In this report, two cases of EPN successfully treated by transurethral drainage are presented. The first case was in a 63-year-old woman with a history of poorly controlled diabetes. She arrived at the hospital by ambulance with primary symptoms of vomiting and trembling of the hands, and computed tomography (CT) revealed gas in the right renal calix. The second case was in a 61-year-old woman who arrived by ambulance with difficulty of body movement as the primary symptom, and CT revealed a calculus in the right ureter accompanied by right hydronephrosis and retention of gas in the right renal pelvis and right upper ureter. Both patients were diagnosed with EPN and treated by transurethral drainage rather than percutaneous drainage or nephrectomy because of their poor general condition. The treatment was successful. Along with percutaneous drainage, transurethral drainage is considered to be an option of surgical treatment for EPN.

Medication support applications(apps)have been introduced to support oral anti-cancer drug management for outpatients with gastrointestinal cancer. It has been suggested that remote support using medication support apps contributes to improving the quality of life through adverse event management as well as medication management. However, it was evident that elderly patients could not install the apps due to barriers related to the network environments and device operations and medical problems such as information management and securing human resources.

(Objective) The aim of this study is to investigate the treatment outcome of laparoscopic radical prostatectomy (LRP). (Patients and methods) The study cohort consisted of 926 hormone-naïve patients with localized prostate cancer who underwent LRP at the Hiroshima Endourological Association from January 2007 to December 2016. (Results) The mean age was 69.4 years, the mean initial PSA was 9.1 ng/ml, and the mean follow-up period was 40.3 months. The D'Amico Risk Classification was Low: 232 cases, Intermediate: 344 cases, and High: 350 cases. Nerve preservation was performed bilaterally for 138 patients and unilaterally for 181 patients. The mean operative time was 181.0 minutes and the mean estimated blood loss was 360.7 ml. As the number of experienced cases increased, the operative time was significantly shorter and the estimated blood loss was significantly decreased. According to Clavien-Dindo classification, the ratio of perioperative complication degree IIIa or above was 4.0% (37 cases). The pathological results were Gleason score (GS) ≤6: 174 cases, GS7: 514 cases, GS ≥8: 232 cases, pT2≥: 704 cases, pT3a: 172 cases, pT3b: 47 cases, pT4: 3 cases, pN0: 917 cases, and pN1: 9 cases. Positive surgical margins were found in 278 cases (30.0%). The biochemical recurrence-free survival rate at 5 years was 78.1%. In multivariate analysis, age (≥70 yrs), initial PSA (≥10 ng/ml), biopsy GS (GS ≥8), cancer positive core ratio at biopsy (≥30%), pT (pT≥3), pathological GS (GS≥8), positive surgical margin and total number of patients in the facility were predictive factors of postoperative biochemical PSA recurrence. Younger age and nerve preservation were found to be predictive factors for the early recovery of urinary continence after surgery, with 88% regaining urinary continence at 12 months after surgery. (Conclusion) This study revealed the clinical outcome and appropriate candidates for LRP in Japanese patients.

The purpose of a therapeutic clinical trial is to determine the value of a treatment. The main objectives of phase I trials have been to determine a dose that is appropriate for use in phase II and III trials and to determine information about the pharmacokinetics of distribution of the drug. Phase II trials have been performed to determine whether a particular regimen or drug is worthy of phase III evaluation. Phase III trials attempt to prove the usefulness of treatment and determine the new treatment strategy.

A 70-year-old man was referred to our hospital because of elevated CA19-9. Magnetic resonance imaging revealed a jejunal tumor having duct and retention cyst-like structures, which suggested ectopic pancreatic cancer. We resected that part of the jejunum and the lymph nodes around the tumor. Pathological examination revealed an adenocarcinoma originating from a Heinrich type I ectopic pancreas in the jejunum. Adjuvant chemotherapy with gemcitabine was performed for half a year. After 8 months, CA19-9 remained elevated, and liver metastasis occurred. We began treatment with tegafur/gimeracil/oteracil potassium (S-1) and particle beam therapy. After 7 months, CA19-9 was normal, and the patient has remained in partial remission with S-1 treatment. Ectopic pancreas tissues typically occur in the stomach and duodenum and rarely become cancerous. Here, we report the features of a rare and illustrative case of jejunal ectopic pancreatic cancer.

We report 12 renal cell carcinomas in 6 patients with Von Hippel-Lindau (VHL) disease treated with radiofrequency ablation (RFA). The mean age of the patients was 46 (range 38-53) years (male : 4, female : 2). Computed tomography (CT)-guided transcutaneous RFA was performed under conscious sedation with local anesthetics. The mean size of the tumors was 2.4 (range 0.7-8.1) cm. Nine of the 12 tumors (75%) were locally well controlled. However, 3 tumors in 2 patients developed visceral metastases after RFA. While minimal flank pain, nausea, perinephritic hematoma and lumbago were observed, there was no major complication during or after the procedure. The therapy with CT-guided transcutaneous RFA is efficient and minimal invasive for renal cell carcinoma in patients with VHL, leading to preservation of renal function.

Purpose: We determined whether laparoscopic radical cystectomy (LRC) was useful for the patients with bladder cancer., Materials and Methods: We investigated the surgical outcome of LRC in the initial 30 patients with bladder cancer., Results: Mean patients age was 68 (54-81) years old. Twenty six male and 4 female were enrolled. Lymphnode dissection was variably performed under aeroperitoneum. Twenty six patients were undergone ileal conduit and 4 patients were undergone ileal neobladder as urinary diversion. The urinary diversion of all cases was undergone extra-corporeally. Seventeen patients were received platinum based neo and adjivant-chemotherapy. Mean surgical time was 684 (398-950) min, and mean aeroperitoneum time was 418 (235-660) min. Intraoperative major complications were ureter injury and blood loss. Mean blood loss was 1,063 (150-2,730) ml intraoperatively. Ileus and acute pyeronephritis were observed in the 3 patients postoperatively. Seven patients relapsed and 2 patients died with bladder cancer in 14.9 months of median follow-up period (0.7-35.9) after the surgery. Progression free survival rate and overall survival rate at a year after surgery were 75.2% and 100%, respectively., Conclusions: The surgical therapy with LRC was well tolerated and successful in the patients with bladder cancer.

Diffusion-weighted imaging (DWI) is a magnetic resonance imaging (MRI) method and is considered potentially useful for detecting prostate cancer. We evaluated the clinical value of DWI with apparent diffusion coefficient (ADC) maps in addition to T2-weighted imaging (T2WI) using 3 tesla (3 T) MRI. Thirty-three patients with elevated prostate specific antigen were evaluated by MRI with T2WI and DWI prior to transperineal template-guided mapping biopsy. The MRI findings were compared with the pathology of biopsy specimens in six parts of prostate : both sides of outer peripheral zones, inner peripheral zones, and transition zones. The sensitivities, specificities and accuracies were 42.1, 84.4 and 76.3％ in T2WI, 57.1, 84.7 and 80.8% in T2WI/DWI, and 87.5, 85.2 and 85.4% in DWI/ADC using 0.951×10 -3 mm2/s as cutoff ADC value. The hazard ratio of patients whose ADC values were under the cutoff was 25.86 by multivariate analysis. Mean ADC values were significantly different between cancer positive and negative cores (p＜0.001). The ADC value showed a negative correlation with increasing tumor length (p＝0.0047). Although further study with a large number of patients is necessary, DWI/ADC using 3 T MRI is a useful tool for detecting prostate cancer.

Fournier's gangrene is a rare disease of rapidly progressive necrotising fasciitis of the genital, perineal and perianal regions and leads to sepsis and death. We report 8 cases of Fournier's gangrene treated at our hospital and affiliated hospitals from 1997 to 2007. There were seven males and one female in the series, and the age range was 23-89 years (mean age 56.6 years). Four patients among them had diabetes mellitus. We rescued all patients by broad-spectrum antibacterial chemotherapy and debridement. Good management should be based on broad-spectrum antibacterial chemotherapy, debridement and intensive care.

The pathogenesis of pulmonary fibrosis (PF) induced by bleomycin and its derivative, peplomycin (PEP), is insufficiently understood. To prevent PF and to administer PEP safely, we examined the influence of PEP on pulmonary function in 135 patients who underwent concomitant chemo (PEP + 5-FU)-radio (60Co) therapy and pulmonary function tests. In the inductive therapy, 5 mg of PEP was intramuscularly injected three times a week and a total of 41.6 +/- 14.3 mg was administered. Of the patients, 98 received oral azelastine hydrochloride (AZH, 4 mg/day) during the inductive therapy with the aim of prophylaxis of PF. The oxygen partial pressure in arterial blood (PaO2) only slightly decreased from 84.2 +/- 12.1 mmHg before treatment to 82.8 +/- 12.5 mmHg after treatment, while, carbon oxide diffusion (%DLco) decreased after treatment in most patients (p < 0.001, by paired t test) with mean values before treatment of 106.3 +/- 24.5% and after treatment 99.5 +/- 24.9%. The decrease of %DLco was associated with the dose of PEP until about 40 mg but further decreases of %DLco were not prominent. In the patients who underwent oral AZH, the decrease of %DLco weaker than that in patients without AZH: the decrease rates of %DLco in the former and latter were 4.3 +/- 9.4% and 14.1 +/- 15.9%, respectively. From the chest X-ray examination, mild PF was suspected in three patients but no advancement of PF or clinical symptoms were observed. From these results, it was concluded first that %DLco is more useful than PaO2 as the predisposing risk factor for PF, second that the decrease of %DLco depends on the dose of PEP until about 40 mg, third that AZH is expected to inhibit PEP-induced PF, and fourth that a small dose (20-40 mg) of PEP can be administered without inducing PF if care is exercised as to the patient's age, general condition and the value of %DLco in the use of PEP.

Traumatic rupture of the testis is rare because of the protection afforded by surrounding structures. Moreover, it is difficult to accurately diagnose preoperatively. A 17-year-old man was referred to our department with the complaint of painful swelling of the left testis after being hit by a basketball. Although ultrasonography and computed tomography did not reveal the rupture of the tunica albuginea, we preoperatively diagnosed the rupture of the left testis by magnetic resonance imaging (MRI). We repaired the tunica albuginea and preserved the left testis. In this report, the advantages of MRI for preoperative diagnosis of traumatic rupture of the testis are discussed. In addition, previous cases with traumatic rupture of the testis in the Japanese literature are also reviewed.

MR-cholangiopancreatography (MRCP) is a new and non-invasive method. With the three-dimensional Fourier transform fast asymmetric spin-echo (3DFT-FASE) method that allows data collection as volume and three-dimensional expression, a higher spatial resolution can be obtained in the direction of both slab thickness and in-plane. In this method, analysis by multi planar reconstruction (MPR) and observation from various angle by maximum intensity projection (MIP) are available. Although further studies are required to shorten the imaging time to stop breathing only once, to use the respiratory gating or navigator echo, clinically useful diagnosis are possible utilizing by the advantages of the 3DFT method.

The detectability of various abnormal findings in helical screening CT(HSCT) with low-dose and single-breath-hold scanning of the lung was examined using conventional CT as a gold standard. In 75 patients, HSCT was obtained with scanning parameters of 120kVp, 50 mA, 10 mm-collimation. 20 mm/second and 1 sec/rotation. Conventional CT was obtained with 150 mA and 10 mm-slice contiguous scanning HSCT depicted 141 of 159 focal lesions in nodules and masses (65 of 69 lesions more than 5mm in size), 44 of 47 in infiltrative lesions, 11 of 11 in reticular lesions and 23 of 39 in bullae and blebs. There were only 3 false positive lesions in nodule and mass. Sensitivity, specificity and accuracy of HSCT for diffuse lesions were 100% (11/11), 95% (61/64) and 96% (72/75) for fibrotic change and 75% (9/12), 100% (63/63) and 96% (72/75) for emphysematous change, respectively. Since the detectability of HSCT was good for abnormal findings, showing increased attenuation in comparison with the lung parenchyma, it was considered to be a promising method for lung-cancer screening.

In order to develop ultra-low-dose helical CT for lung cancer screening, the effect of reduction of the tube current to 20mA and application of a 10mm thick aluminium filter upon radiation dose and image quality was evaluated with a phantom. Exposure dose at the center of a gantry and absorbed dose at the center of an acrylic phantom at 20mA with the filter were 15% and 29% of the dose at 50mA without the filter, respectively. For reduction of absorbed dose, reduction of the tube current was more useful than application of the filter. Image noise at 20mA with the filter was double that at 50mA without the filter. Neither reduction of the tube current nor application of the filter changed full width at half maximum on section sensitivity of the Z-axis. Although reduction of the tube current did not affect the difference in CT values between an acrylic sphere and styroform, application of the filter caused a reduction of 4.5% in the difference in CT values. Neither reduction of the tube current nor application of the filter affected the contrast resolution of the high-contrast phantom; however, that of the low-contrast phantom deteriorated. Although improvement of the filter and evaluation of clinical images are necessary, reduction of the tube current to 20mA and application of the aluminium filter appear to be a promising method for ultra-low-dose helical CT of the lung.

The combined effect of hormone and cytotoxic therapy on the growth of prostate cancer PC-3 in nude mice was investigated. PC-3 cell was derived from the bone metastasis of a hormone-refractory prostate cancer. Each group consisted of seven animals. After the inoculation of cancer cells, diethylstilbestrol (DES: 20 mg/kg) and futraful with uracil (UFT: 20 mg/kg) were administered for 25 days. DES and UFT synergically inhibited the growth. DES had no effect as a single agent on the growth of a hormone-independent cell line (KM20C) derived from human colon cancer. It also had no additive effect when given with UFT.

Combined treatment of UFT with cisplatin (CDDP) achieved remarkable elongation of survival time of BDF1 mice, which were intravenously transplanted with Lewis lung carcinoma (LLC). Three cycles of weekly iv administration of CDDP and vindesine (VDS), and daily oral administration of UFT were scheduled. Combination UFT (18 mg/kg/day) with CDDP (6.0 mg/kg/day) yielded tumor-free survivors in all of the treated animals with slight body weight loss. Its efficacy was superior to that of the combination of CDDP with VDS. Supra-additive cytotoxic activity against LLC cells was observed by Isobologram method on the schedule of the exposure to 5-fluorouracil preceding the exposure to CDDP. Additive effect was observed by the reversed schedule of the treatment. Using human non-small-cell lung cancer (NSCLC) cell lines which derived from histologically different type, additive or greater additive sensitivity to both of the sequential treatment schedules with 5-FU and CDDP was observed. These results suggest that the combination chemotherapy of UFT with CDDP for lung cancer may show high antitumor efficacy with low toxicity in a clinical setting.

3H channel count rate of 3 background samples were measured for 8 days. Sample A and C were different scintillators in 100 ml teflon vials and sample B in a 20 ml glass vial. Count rate of sample A fluctuated from 3 to 7 cpm, and that of C from 6 to 12 cpm, respectively. However, count rate of sample B was about 6 cpm and rather constant. Trend of fluctuation in count rate of sample A and C were observed to be similar. On weekdays, count rate increased at night and decreased in day time. At weekend, count rate increased from Saturday evening and was constant from Sunday noon till Monday morning. Tritium Research Center where LSC is placed is ventilated from 9 a.m. to 6 p.m. on weekdays, and the ventilation is suspended on Sunday. The observed fluctuation of background was apparently related to the operation and suspension of ventilation. When ventilation was operated continuously, count rates of sample A (4 cpm) and sample C (6 cpm) became constant and corresponded to their minimum value. The fluctuation of background may be caused by radon, concentration of which varies in association with the operation and suspension of ventilation.

The effect and toxicities of Cis-containing combination chemotherapy were tested in 28 patients with primary lung cancer. All patients were treated with 80 mg/m2 Cisplatinum on the first day and 750 mg ftorafur p.o. every day. In addition to these drugs, patients with squamous cell cancer were treated with continuous subcutaneous infusion of 4 mg/m2 Peplomycin for 5 days and one shot i.v. of 4 mg MMC. Patients with adeno- and large cell cancer were treated with 30 mg/m2 Adriamycin and 4 mg MMC, while patients with small cell cancer were given 150 mg/m2 VP-16 p.o. for 5 days. The following results were obtained. Of 22 evaluable patients, overall response rate was 50%. In each histologic type, response rate was 50% (5/10) for squamous cell carcinoma 50% (4/8) for adenocarcinoma 33% (1/3) for large cell carcinoma and 100% (1/1) for small cell carcinoma. No CR was obtained in this series. Main side effects due to Cisplatinum were nausea, vomiting, loss of appetite, mild leukopenia and thrombocytopenia, mild elevation of serum creatinine and BUN and alopecia, all of which were transient. Interstitial pneumonitis was observed in 40% of patients with squamous cell cancer. Two patients with adenocarcinoma died within 3 weeks after treatment due to embolism of the abdominal aorta and myocardial infarction probably caused by treatment with Adriamycin.