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Undifferentiated sarcoma of the liver is rare, especially in adults, and is an aggressive malignancy that originates from the primary mesenchymal tissues. A 53-year-old man was referred to our hospital for further evaluation of a low-grade fever. Contrast-enhanced CT revealed an 18-cm tumor in the right lobe of the liver. The tumor was characterized by low-density areas suspected of cystic components, a high-density area suspected of hemorrhage, and contrast enhancement in the thickened marginal and internal septa. MRI revealed a high-intensity tumor with a heterogeneous structure on T2-weighted images. Angiosarcoma of the liver with intratumoral hemorrhage was suspected, and right hepatectomy was performed. The pathological diagnosis was an undifferentiated sarcoma based on the presence of undifferentiated mesenchymal tumor cells with a stellate to spindle-shaped pleomorphism. Following a multidisciplinary discussion, 4 courses of the AI regimen (doxorubicin and ifosfamide)were administered as adjuvant chemotherapy, and no recurrence was confirmed at 2 years and 6 months follow-up. Our case suggests that radical resection followed by adjuvant chemotherapy may contribute to a favorable prognosis for undifferentiated sarcoma of the liver.

Because of the diversity of cancer biology and multiple treatment options, which include focal therapy(surgical resection and radiotherapy)and systemic therapy, oncology practice is complicated and always challenging for oncologists and patients. To decide on an evidence-based optimal therapy, clinical guideline has a crucial role for physicians. However, there are discrepancies in the contents and accessibility to the guidelines among each. This article mentions the role of guidelines and how they are adapted into practice from the viewpoint of a medical oncologist working at a community hospital.

Astroblastoma is an extremely rare primary brain tumor accounting for 0.45 to 2.8% of all neuroglial tumors and usually occurs in pediatrics and young adults. The natural history of astroblastoma still remains unknown. In the World Health Organization (WHO) classification of tumors of the central nervous system, astroblastoma is classified as other neuroepithelial tumors and standard treatment other than surgery has not been established. As molecular and genetic diagnosis becomes more important in the latest WHO classification of brain tumors, the development of therapeutic options based on the information of molecular genetics are expected. Here we report a case of astroblastoma in a 49-year-old male. Small tumor was discovered by coincidence during his check-up following traffic accident, but three months later, tumor bleeding with cystic enlargement resulted in disturbance of consciousness. Initial diagnosis of low grade astroblastoma with BRAF V600E mutation was made. After 1 year, local tumor recurrence was observed. The histological diagnosis at recurrence was high grade astroblastoma. We here, discuss about diagnosis, treatment and the possibility of usefulness of molecular genetic analysis for astroblastoma with some literature review. (Received 10 August, 2021; Accepted 15 December, 2021; Published 1 April, 2022).

We present the case of a 72‒year‒old male patient with anorexia who was diagnosed with advanced gastric cancer with multiple liver metastasis. He had marked hypoglycemia and lightheadedness from the time of admission. The serum insulin level was very low and other endocrinology test results were normal. He was finally diagnosed with non‒islet cell tumor hypoglycemia(NICTH)based on IHC findings that tumor cells expressed insulin‒like growth factor (IGF)Ⅱ. After the patient received intravenous glucocorticoid therapy along with S‒1 plus CDDP combination chemotherapy, the hypoglycemia was quickly resolved. However, he developed septic shock in reaction to the chemotherapy and died on the 35th day of hospitalization. The autopsy showed the presence of IGF‒Ⅱ in the liver metastasis, as well as in the primary tumor.

Sarcopenia is regarded with a negative prognostic or detrimental factor for several diseases, regardless of benign or malignant disease. The relationship between sarcopenia and resectable gastric cancer has been investigated gradually. On the contrary, the effect of sarcopenia in advanced gastric cancer is not apparent. In this article, firstly, we summarised the impact of sarcopenia in resectable stage, and then in advanced gastric cancer receiving chemotherapy. Finally, we discussed the nutrition support for advanced gastric cancer.

A 66-year-old male with bladder cancer underwent radical cystectomy and ileal conduit construction. The pathological diagnosis was urothelial carcinoma with squamous differentiation (pT3b). Computed tomography (CT) 18 months postoperatively revealed a right external iliac lymph node metastasis. He was treated with systemic chemotherapy after placement of bilateral ureteral stents, but CT following chemotherapy revealed an increase in the size of the metastasis, and the patient was diagnosed with progressive disease. Radiotherapy to the metastasis was selected as local therapy, but the patient was at risk of an uretero-arterial fistula because the right external iliac artery and the right ureter adjacent to the metastasis were involved in the irradiated field. The right external iliac lymph node metastasis was irradiated with a dose of 50 Gy after stent grafting for the right external iliac artery to prevent an ureteroarterial fistula. He had no adverse events, including hematuria after radiotherapy, but died of cancer cachexia 12 months after radiotherapy.

The current status and future prospects of glioblastoma treatment were explained through the understanding of the pivotal and important papers from the brain tumor guideline.

Objectives The Great East Japan Earthquake occurred in March 2011. As of November 2018, 1100 survivors of its still lived in the Miyagi prefecture's temporary housing. Previous studies revealed that the residential relocation to temporary housing from their own houses due to damages caused by the earthquake exacerbated the evacuees' health. However, there is a lack of long-term observation of the trajectory of their health conditions in temporary housing. To the best of our knowledge, there is no study involving residents in public disaster housing. The aim of the present study was to reveal the trajectory of health conditions of residents of temporary and public disaster housing.Method This repeated cross-sectional study included residents aged 20 years and older, residing in private rented housing, prefabricated temporary housing, and public disaster housing. The survey period lasted for six years (2011 to 2017). We used self-rated health as the dependent variable, the year of the survey and type of house as independent variables, and sex and age as covariates. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were calculated using multivariate logistic regression analysis.Results In total, 179,255 participants were included in this study. The average age was the highest among the residents of public disaster housing: 63.0 years in 2017. The number of residents who reported poor self-rated health declined yearly of private rented housing, but not of prefabricated temporary housing. The highest number of residents reporting poor self-rated health was from public disaster housing, compared to other temporary housing. Multivariate analysis showed that self-rated health improved in recent years (P for trend <0.001). Compared to the residents of private rented housing, those from public disaster housing reported poorer health conditions (aOR, 1.20 ; 95% CI, 1.15-1.27), although no significant difference was observed among the residents of prefabricated housing.Conclusion Health conditions of residents of temporary housing and public disaster housing tended to improve on a yearly basis. Residents of public disaster housing reported poor health. Therefore, monitoring and adequate intervention should be offered.

The acute micro cerebral infarction phantom was created to evaluate the detectability of acute micro cerebral infarction and optimize scan conditions in magnetic resonance imaging (MRI) examinations. The creation of the brain parenchyma phantom requires a hot stirrer that can be heated and stirred simultaneously. However, few hospitals and facilities have hot stirrers. The aim of our study was to use a microwave oven instead of a hot stirrer for the creation of a brain parenchyma phantom. Five phantoms using a hot stirrer and five phantoms using a microwave oven were created. The phantom creation time, T 2 value, apparent diffusion coefficient (ADC) value, uniformity, and reproducibility of MR images were compared between the two creation methods. The phantom creation time, when using a microwave oven was 108±8 minutes, which was significantly shorter than that of 213± 48 minutes when using a hot stirrer. T 2 values, ADC values, uniformity, and reproducibility were not significantly different. Therefore, it is easier to create an acute micro cerebral infarction phantom using a microwave oven compared to a hot stirrer.

It is reported that vinblastine monotherapy has promising activity in patients with pediatric optic pathway/hypothalamic glioma(OPHG)who experienced treatment failure after initial treatment with standard chemotherapy. However, there have been no reports on vinblastine monotherapy against OPHG in Japan. Since vinblastine is an unauthorized drug under the Ministry of Health and Welfare, we used it after completing an in-hospital institutional review board application for each case. In the first case, a 6-year-old boy with recurrent OPHG with hydrocephalus was referred to our hospital. Weekly vinblastine was started at a dose of 6mg/m 2 and was then reduced to 5mg/m 2 and 4mg/m 2 sequentially due to hematotoxicity. After 11 cycles of vinblastine, improvement in hydrocephalus was observed. After 22 cycles of vinblastine, the best response was observed, and we continued treatment up to 35 cycles. Progression of the disease was observed after 47 cycles and then we changed treatment to another regimen after 48 cycles of vinblastine. In the second case, a 6-year-old boy with chemotherapy-naïve recurrent OPHG underwent chemotherapy with vincristine and carboplatin. After 9 treatment cycles with carboplatin, hypersensitivity was observed. Subsequently, he was treated using weekly vinblastine as per the same protocol as that in our first case. A moderate response was observed after 18 cycles of vinblastine. After 48 cycles of vinblastine, the best response was observed, and we completed treatment. In both cases, severe adverse events were not observed and the treatment was well-tolerated. Vinblastine administered once per week is well-tolerated and maintains quality of life in children with OPHG.

The patient was a 63-year-old man. Computed tomography(CT)showed a 99mm in diameter low-density mass in hepatic segments 4 and 8 as the main locus. This tumor was diagnosed as intrahepatic cholangiocarcinoma and was suspected to invade to left and right Gleason's sheath, and radical cure was judged impossible. After hepatic arterial chemotherapy and radiotherapy were performed, tumor shrinkage was confirmed, and tumor markers also became negative. So he was referred to our hospital for surgical indication. CT revealed that the tumor did not invade to the left Gleason's sheath. After percutaneous transhepatic portal embolization, hepatic right trisectionectomy was performed. He was administered gemcitabine as an adjuvant chemotherapy for 1 year. One year 5 months after surgery, the patient is alive without relapse. Preoperative hepatic arterial chemotherapy and radiotherapy could be an effective treatment for unresectable locally advanced intrahepatic cholangiocarcinoma.

Aim: Atrial fibrillation (AF), which can lead to cardioembolic stroke, is often not properly diagnosed in hospital outpatient departments or medical clinics. We therefore used a pulse analysis to screen patients for AF, and examined the benefits of using this method in screening., Methods: We performed screening of the hospital's first-visit and ambulatory patients during the afternoon in 2014 (total number, 50,875; true number, 16,356), mainly targeting patients older than 65 years of age. Among the true number of outpatients, the device was used on 5,013 patients, 8,656 times. We independently developed a pulse analysis software application which analyzed the pulse interval variation. We assessed the accuracy of this analytical method in the detection of AF., Results: AF was detected in 56 patients, who were considered for or introduced to anticoagulation treatment. In their cases, the method was considered useful for detecting undiagnosed or untreated AF. This figure amounts to 0.34% of all outpatients and 1.1% of the patients who were screened in 2014. The average age was 76.9±7.7 years, 67.9% of the patients had a CHADS 2 score of more than 2, half had a history of arrhythmia in the past, and 37.5% were first-visit patients. The sensitivity of the device used was 89.7%., Conclusions: Using the method described in this study, we detected asymptomatic AF in numerous patients, and demonstrated that this method is potentially useful in screening outpatients for asymptomatic AF.

Gliomatosis cerebri is a rare subtype of glioma involving more than three lobes of the central nervous system. Currently, diagnosis of gliomatosis cerebri can be confirmed pathologically, surgically, or with magnetic resonance imaging that shows high-signal areas expanding to the cerebral hemisphere, brain stem, cerebellum, and spinal cord. Although this disease has great clinical importance, it has recently been removed from the revised WHO classification of Tumors of the Central Nervous System (2016) owing to divergence between its morphological features and molecular profiles.

A 62-year-old male was diagnosed with large cell lung cancer(c-Stage IV)based on pathological examination of an anterior chest tumor. He received chemotherapy with cisplatin, pemetrexed, and bevacizumab. He suffered from persistent hiccups from day 2 of the first course of chemotherapy. He was unsuccessfully treated with chlorpromazine, shakuyakukanzoto, and gabapentin. Therefore, we administered pregabalin to him, and his hiccups subsided immediately. To prevent hiccups, he subsequently took pregabalin along with his chemotherapy regimen, and was able to receive 4 courses of chemotherapy without persistent hiccups. Pregabalin is a possible therapeutic option for treating persistent chemotherapy-induced hiccups.

Purpose: Ｗe conducted a survey to evaluate the current status of glaucoma-related medical data management and standardization, aiming to improve the development of glaucoma care and research in Japan. Materials and methods: The survey was performed as a paper-based questionnaire of 14 universities that both participate in the glaucoma-related data standardization committee, established by the Japan Glaucoma Society in 2014, and actively perform glaucoma care. Results: All enrolled university hospitals installed an electronic hospital information system and used any of three ophthalmology-limited electronic chart systems. However, only 30.8% of the hospitals established a data extraction system from an electronic medical chart system, and only 14.3% could practically apply medical data for secondary research purposes. In all, 35.7% of the hospitals operate a medical cooperation system with local medical institutions and 42.9% electronically managed medical data inside their departments. Conclusion: This survey clarified the current state of medical data management and standardization.

Objectives To examine the prevalence of health consciousness regarding "Health Japan 21" (2nd edition) among the Japanese population, we conducted a telephone survey of a sample extracted randomly from the whole nation in 2013 and 2014.Methods We extracted 1800 men and women with 150 persons for each gender and 10-year age group (6 age groups ranging from 20 years to 70 years and older) using Random Digital Dialing sampling. Each participant was asked about 1) recognition of the following items: "Health Japan 21," "healthy life expectancy," "metabolic syndrome (MetS)," "chronic obstructive pulmonary disease (COPD)," "locomotive syndrome," "Active Guide," "WHO Framework Convention on Tobacco Control," and "Smart Life Project" and 2) health consciousness toward the following: "health examination taken within the past one year," "smoking status," and "the amount of vegetables considered desirable to consume per day for health." We performed simple tabulation of the collected answers and cross-tabulation by sex and age groups, respectively. For each question about recognition, we categorized "I know the name and meaning" and "I know the name but not the meaning" as "awareness." We compared data between 2013 and 2014, sexes, and age groups, using chi-squared test.Results In 2013, the top 5 items with high awareness were "MetS" (96.2%), "COPD" (51.1%), "healthy life expectancy" (34.2%), "locomotive syndrome" (30.2%), and "WHO Framework Convention on Tobacco Control" (28.0%). Moreover, awareness of "healthy life expectancy," "locomotive syndrome," and "Active Guide" were significantly higher in 2014 than in 2013. Meanwhile, the proportion of participants who correctly chose "350 grams" as "the desirable amount of vegetables to consume per day" was 41.6% in 2013 and became significantly higher at 50.1% in 2014. In 2013, awareness of "healthy life expectancy," "COPD," and "locomotive syndrome" and the proportion of correct answers for "the desirable amount of vegetables to consume per day" were significantly higher among women than among men. In 2013, there were significant differences among age groups in awareness of "MetS," "COPD," "healthy life expectancy," and "locomotive syndrome" and the proportion of correct answers for "the desirable amount of vegetables to consume per day."Conclusion Awareness of "healthy life expectancy," "locomotive syndrome," and health consciousness of "the desirable amount of vegetables to consume per day" were significantly higher in 2014 than in 2013. There were discrepancies on respective items among both sexes and age groups. Therefore, interventions for groups with lower awareness or health consciousness may be required.

To detect Vibrio parahaemolyticus in seafood, we evaluated efficient combinations of molecular methods with DNA extraction methods using heat extraction and alkaline heat extraction, and PCR, real-time PCR and loop-mediated isothermal amplification (LAMP) assays were performed targeting V parahaemolyticus species-specific genes (tlh and rpoD) and pathogenic factors genes (tdh and trh). The species-specific genes were detected in all combinations of two strains (a tdh * trh1-positive strain and a trh2-positive strain), two kinds of shellfish (oyster and bloody clams) and molecular methods with tlh-real time PCR or rpoD-LAMP assays with DNA of alkaline heat extraction at 85-145cfu/test level. tdh was detected in both seafoods with real time PCR assay with DNA of heat extraction at 85cfu/test level, and detected with the LAMP and real time PCR assays with DNA of alkaline heat extraction at 85cfu/test level. Detection of both trh1 and trh2 with the PCR assay with DNA of alkaline heat extraction was comparatively high though trh2 was detected with the LAMP assay with DNA of alkaline heat extraction at 145cfu/test level. It, however, is necessary to investigate more sensitive trh-detection methods. In this study, the results indicated that tlh-real time PCR or rpoD-LAMP, tdh-real time PCR and tdh-LAMP assays with DNA of alkaline heat extraction are relatively-sensitive methods to detect V. parahaemolyticus in seafood.

Purpose: We report two cases of Vogt-Koyanagi-Harada disease (VKH) in which shallow anterior chambers were improved after steroid pulse therapy., Case: The patients were women aged 65 and 72. They had headaches, decreased visual acuity and shallow anterior chamber in both eyes. There was no inflammation in the anterior chamber. Ultrasound biomicroscopy (UBM) showed ciliary edema, ciliochoroidal detachment, and angle closure. One case showed high intraocular pressure (IOP), and a diagnosis of acute primary angle closure was made. Although cataract surgery was performed in the left eye, postoperative optical coherence tomography (OCT) revealed serous retinal detachment in both eyes. The shallow anterior chamber and UBM findings were improved and serous retinal detachment disappeared after steroid pulse therapy in both cases., Conclusion: VKH may cause shallow anterior chamber and angle closure. The inflammatory changes of VKH in the anterior segment, i. e. ciliary edema and ciliochoroidal detachment, may exacerbate the shallow anterior chambers and narrow angles and result in an acute increase in IOP in eyes with short axial length. VKH associated with shallow anterior chamber may be misdiagnosed as acute primary angle closure. For differential diagnosis, examinations of the ocular fundus including OCT are useful.

Objectives: Interventions that promote physical activity to prevent psychological distress and disuse syndromes were carried out in disaster-stricken areas. However, the effect of these interventions to promote physical activity in disaster-stricken areas has not yet been fully clarified. The purpose of this study was to examine the health effects of promoting physical activity in a disaster-stricken area., Methods: We conducted an exercise intervention as part of a health survey project among residents of Ishinomaki-city, Miyagi, Japan in 2012. To determine if changes in health condition differed between intervention participants and nonparticipants, health condition data from 81 participants were compared with data from 81 nonparticipants selected by propensity score matching. Factors including sex, age, original address (pre-quake), and six outcome variables (psychological distress [K6 score], subjective health status, sleep duration, sleep quality, frequency of outings, and time spent walking) were used for matching. A linear mixed model was used for statistical analysis., Results: There were no significant differences in K6 score between participants and nonparticipants (P=0.913). Significant improvements were observed in subjective health status (P=0.011) and outing frequency (P=0.002), but not in other outcome variables., Conclusion: Subjective health status and outing frequency were significantly improved among participants of the exercise intervention. Exercise intervention may be an effective public health strategy in disaster-stricken areas.

It is known that morphine is less effective for patients with neuropathic pain, accounting for approximately 70% of cancer patients with severe pain. One of the causes of the decline is reported as a decreased function of the μ-opioid receptor, which binds to the active metabolites of morphine in the mesencephalic ventral tegmental area. However, the details of this mechanism are not understood. We hypothesized that a decrease in the concentration of morphine in the brain reduces its analgesic effect on neuropathic pain, and found that the analgesic effect of morphine was correlated with its concentration in the brain. We examined the reason for the decreased concentration of morphine in the brain in case of neuropathic pain. We discovered increased P-glycoprotein (P-gp) expression in the small intestine, increased expression and activity of UGT2B in the liver, and increased P-gp expression in the brain under conditions of neuropathic pain. In this symposium, we argue that low brain morphine concentration is considered one of the causes of lower sensitivity to morphine in neuropathic pain patients.

A 69-year-old man had undergone left ureteronephrectomy because of a left renal pelvic tumor, however the pathological diagnosis was inflammatory pseudotumor. About 1 year later, computed tomography showed a mass at the right kidney near the hilar. Ureterorenoscopy and urine cytology were performed, and their results showed no evidence of malignancy. He had been followed closely without therapy. The mass increased in size during follow-up, and we reviewed the surgical specimen of the left ureteronephrectomy. Immunohistochemical studies revealed diffuse infiltration by IgG4 positive plasma cell. His serum IgG4 was high. We diagnosed him as IgG4-related kidney disease. In response to treatment with corticosteroid, the size of the tumor and serum IgG4 levels decreased. Most reported cases of IgG4-related disease involving kidney have a history of prior pancreatic involvement. We report a rare long term follow-up case of IgG4-related kidney disease without pancreatic involvement.

We report a 68-years-old woman with systemic sclerosis and interstitial pneumonia (IP). She had developed subacute progressively encephalopathy and dementia while treated with oral cyclophosphamide and prednisolone. She admitted to our hospital because of syncope. Laboratory tests indicated slight elevated cerebrospinal fluid protein, and levels of serum C-reactive protein (CRP), levels of soluble IL-2 receptor was normal. But, magnetic resonance imaging (MRI) of the brain showed multiple infarct-like lesions mainly in the white matter, which mimics progressive multiple leukoencephalopathy (PML). Twenty days after admission, the retested MRI of the brain disclosed initial lesions progressively enlarged and numbers of the lesions were increased. The polymerase chain reaction (PCR) for JC virus of cerebrospinal fluid was negative. To make diagnosis, brain biopsy was performed. Microscopic examination revealed that small vessels were filled with lymphoma cells (CD20+, CD79+, CD3-), and intravascular lymphoma (IVL) was diagnosed. She treated with regimens of R-CHOP. After chemotherapy her consciousness and dementia were gradually improved. IVL of central nerve system (CNS) is a rare disease, and its common symptoms are ischemia, infarction and dementia. Diagnosis of IVL of CNS is difficult when the lesion mimics PML, and patient with similar laboratory examinations and radiographic findings of PML should undergo brain biopsy detected malignant cell in small vessels, which is a value of diagnosis.

Objectives: An earlier study using the data from the Japanese Long-term Care Insurance (LTCI) system reported a scenario for achieving the target of Health Japan 21 (the second term): future gains in health expectancy from 2011 to 2020 must be larger than gains in expectancy. According to this scenario (the Healthy Life Expectancy Extension Scenario), the proportion of disability (cases≥Care Level 2 in LTCI disability certification) will gradually decrease by 1% per year from 2011. The purpose of this study was to estimate the cost savings in long-term care and medical care if the Healthy Life Expectancy Extension Scenario is achieved., Methods: We used data from Japanese national statistics and a survey conducted in Osaki city, Miyagi. The natural course of disability cases (≥Care Level 2) was estimated under the assumption that the future population composition would be equal to the population projections for Japan and the future proportion of disabilities for each age grade would be equal to that of 2010. Then, the decrease in the number of disabilities based on the Healthy Life Expectancy Extension Scenario was calculated. Finally, the cost savings in long-term care and medical care associated with the assumed decrease in the number of disability cases was calculated., Results: When the disability cases (≥Care Level 2) were shifted to "no disability certification (not requiring care)," a total estimated cost reduction of 5,291 billion yen was achieved from 2011 to 2020. Furthermore, a total estimated reduction of 2,491 billion yen was achieved for the same period when all disability shifts to "Care Level 1" were accounted for., Conclusion: As a rough calculation, if the Health Japan 21 (second term) target is achieved, approximately 2,500-5,300 billion yen will be saved in the cost of long-term care and medical care.

Purpose: Approximately 30-59% of patients undergoing cranial or craniospinal radiotherapy experience nausea and/or vomiting. Here, we evaluated the effectiveness of granisetron for controlling emesis in patients treated with cranial or craniospinal radiotherapy., Patients and Methods: Between December 2011 and January 2013, 34 patients(19 males, 15 females;age range, 3-80 years)received cranial or craniospinal radiotherapy at our department. All but one male patient, who developed meningitis during the irradiation period were enrolled in this retrospective study. Patients who experienced irradiation-induced vomiting(grade 1)or nausea(grade 2)were treated with granisetron as a rescue anti-emetic. Episodes were graded as(1)no vomiting, no nausea, no anti-emetic;(2)no vomiting, nausea, no anti-emetic;(3)no vomiting, nausea with anti-emetic;and(4)vomiting., Results: Of the 9 patients who underwent whole-brain or whole neural-axis irradiation, 5(55.6%)experienced grade 2 nausea or vomiting. Two of 6 patients(33.3%)treated with whole ventricle irradiation experienced grade 2 nausea or vomiting. Three of 18 patients(16.7%)who underwent local-field irradiation experienced grade 2 nausea or vomiting. Patients who underwent wide-field irradiation experienced nausea, vomiting, and anorexia(p<0.05). Complete response(no vomiting, no additional rescue anti-emetic, and no nausea)was observed in 5 of 9 patients treated with granisetron. Four of 9 patients(44.4%)treated with granisetron experienced constipation(grade 1 or 2);its administration had no major adverse effects in our study population., Conclusion: Rescue therapy with granisetron is safe and effective to treat nausea and vomiting in patients subjected to cranial or craniospinal irradiation.

A 64-year-old male presented with an incidental tumor in the sella turcica during a brain medical checkup. Because he lacked any neurological symptoms or signs of pituitary dysfunction, the patient did not undergo surgery. Three years later, visual disturbances developed, including poor eyesight and visual field defects. The response to the growth hormone(GH)releasing peptide-2 demonstrated severe GH deficiency. MRI revealed an enlarged tumor appearing as a mosaic pattern of high and very low intensity on T2-weighted imaging. The region of very low intensity on T2-weighted imaging exhibited enhancement after T1 gadolinium-DTPA administration. The tumor was totally removed via the microscopic trans-sphenoidal approach in combination with endoscopic observation. The hard tumor adhered to the dura of the sella turcica and the medial wall of the left cavernous sinus. Histological verification confirmed a solitary fibrous tumor(SFT). Fourteen months after the operation, MRI revealed no recurrent tumors. SFT infrequently occurs in the sella turcica; however it should be included in the differential diagnosis in cases of enhanced tumors with marked low intensity on T2-weighted imaging.

We report a 68-year-old, American Society of Anesthesiologists Class I (ASA I), female patient scheduled for malignant uterine adnexal tumor surgery and revascularization for ovarian cancer. An epidural catheter was inserted at T12-L1 for 5 cm. Anesthesia was induced with remifentanil (0.25 microg x kg(-1) x min(-1)), sevoflurane (5%) and rocuronium (30 mg). Anesthesia was satisfactorily maintained after intubation with sevoflurane (1.5%) and remifentanil (0.2 microg x kg(-1) x min(-1)). We extubated the patient because spontaneous breathing and consciousness were observed. We intubated the patient immediately for apnea that occurred after extubation. The patient made an uneventful recovery after naloxone administration. In pharmacokinetic simulation, on the assumption that epidural administrated fentanyl was carried to blood content promptly, effect concentration to cause respiratory depression was not reached. Postoperative apnea was rationalized as follows; tardy respiratory depression with the epidural administration, and unexpected dosage of the residual fentanyl in the catheter.

Purpose: A 3-year prospective study was performed to evaluate treatment outcomes following selective laser trabeculoplasty (SLT) used as initial treatment for normal tension glaucoma (NTG)., Subjects and Methods: SLT was performed as initial treatment in 42 NTG patients (42 eyes). Thirty-seven of the patients were untreated and 5 patients had discontinued antiglaucoma medications. Two patients were excluded because they did not visit our clinic during the study period. The study was conducted on the remaining subjects (40 eyes of 40 patients)., Results: The intraocular pressure (IOP) was 15.8 +/- 1.8 mmHg before SLT, 13.2 1.9 mmHg after one year, 13.5 +/- 1.9 mmHg after two years, and 13.5 +/- 1.9 mmHg after three years. The IOP after SLT was significantly lower than that before SLT. One month after SLT, the outflow pressure was improved at least 20% (deltaOP) in 92.5% of the patients. The success rate for the effect of IOP reduction at three years after SLT was 40.0% by Kaplan-Meier survival analysis. 27.5% of the patients who had two consecutive deltaOP less than 20%, 25.0% of the patients who had begun antiglaucoma ophthalmic solution, and 15.0% of the patients who had undergone repeated SLT were judged to have reached the endpoint. Kaplan-Meier survival analysis revealed that the success rate for the visual field at three years after SLT was 82.4% (the visual field loss progression was judged to have reached its endpoint when a significant sensitivity loss was first detected in two consecutive points of the same adjacent test points of at least 3 points in the Glaucoma Progressive Analysis for the Humphrey Visual Field Analyzer). Complications included conjunctival hyperemia (52.5%), eye discomfort (12.5%), visual disturbance (blurry vision and photophobia) (10.0%), and eye pain (5.0%). These complications resolved within a few days, and there were no severe complications such as increased IOP or iritis., Conclusion: Our results suggest that SLT is an effective initial treatment for NTG.

Aim: Assessment of the nutritional state is important in comprehensive geriatric assessment (CGA). Several standardized screening tests for malnutrition are available such as the Mini-Nutritional Assessment (MNA) and MNA-Short Form (MNA-SF). However, it takes more than 10 minutes to perform the MNA-SF alone. We have developed a CGA initiative named 'Dr. SUPERMAN', which is designed to accomplish CGA within 10 minutes. In this study, we evaluated a short-form screening test for malnutrition preceding the MNA., Methods: The MNA-SF, which consists of 6 items (A-F), was administered to 163 elderly outpatients (mean age: 83.4 years, 80 men) with various diseases. Using the results of the MNA-SF score (normal ≥ 12 and abnormal ≤ 11) as a gold standard, the sensitivity, specificity, and positive predictive values (PPVs) of each item were calculated and the best combination of 2 items for identifying malnutrition among the elderly outpatients was selected. According to the combination of 2 items (item B: weight loss during the last 3 months; item F: body mass index (BMI)/calf circumference (CC) in cm), they were divided into 2 groups: the normal control (NC) group (neither items B nor F) and the malnutrition/at risk (MN) group (either items B or D, or both). Findings of the clinical feature, anthropometric measurement, and nutritional biomarker between the 2 groups were examined to clarify the characteristics of each., Results: The MNA-SF score was distributed as follows: 3-7 in 12 cases, 8-11 in 68 cases, and 12-14 in 83 cases. Based on the MNA-SF score, the combination of items B and F revealed the highest sensitivity (91.3%), specificity (63.9%), and PPV (70.9%), resulting in 103 cases in the MN group and 60 cases in the NC group. A high frequency of anorexia, living alone, hypoprealbuminemia, lymphocytopenia, and dehydration was observed in the MN group, whereas a high frequency of leg edema was observed in the NC group. Cases showing a positive wall-occiput test, which compelled the alternation of CC with BMI, accounted for 24% of all cases., Conclusions: The combination of 'weight loss during the last 3 months' and initial BMI ≥ 23/CC <31 cm along with a positive wall-occiput test was a useful and valuable SF screening test for malnutrition in elderly outpatients.

Objective: To compare the intraocular pressure (IOP)-lowering effect and safety of topical brimonidine to that of timolol, and to study the additive effect of topical brimonidine to topical prostaglandin (PG) analogues in 475 patients with either ocular hypertension or primary open angle glaucoma., Methods: The primary endpoint was the mean IOP change from the baseline at 0 and 2 hours at week 4., Results: The mean changes were -4.7 +/- 2.1 (S. D.) in the timolol and -4.0 +/- 2.0 mmHg in the brimonidine group (p = 0.0138). The 95% confidence interval of the inter-group difference was greater than the pre-determined criterion of non-inferiority of brimonidine to timolol. When added to PG analogues, the IOP-lowering effect of brimonidine (-2.9 +/- 1.8 mmHg) was greater than that of the placebo (-2.1 +/- 1.8 mmHg) (p = 0.0010). No appreciable adverse side effects were encountered., Conclusion: Topical brimonidine showed an additive IOP-lowering effect to topical PG analogues, although its IOP-lowering effect was inferior to topical timolol as monotherapy.

Objectives: In the absence of guidelines on the use of corticosteroids in children with cancer and brain tumors, neurosurgeons (neurosurgical oncologists) and pediatricians administer these drugs based on their own experience. We surveyed Japanese neurosurgeons and pediatricians with regard to their policies for the use of corticosteroids in pediatric patients., Methods: This survey was performed in November, 2010. Questionnaires designed for neurosurgeons and pediatricians were mailed to institutions registered with the Japanese Society of Pediatric Hematology (pediatricians) and to departments and hospitals providing training under the auspices of the Japan Neurosurgical Society (neurosurgeons)., Results: The questionnaire focused on identifying the adverse effects of corticosteroids delivered for longer than 3 months to pediatric patients. Members of both specialties considered it important to avoid the development of infection, gastrointestinal ulcer, moon face/obesity, and abnormal glucose tolerance. Pediatricians but not neurosurgeons cited osteoporosis, aseptic bone necrosis, hypertension, and glaucoma as adverse effects that concerned them with respect to the prolonged administration of corticosteroids. Physicians working in high-volume centers tended to differentiate between adverse effects elicited in patients under palliative care and those receiving long-term corticosteroid treatment for other reasons; clinicians who encountered fewer patients did not., Conclusions: As their experience of treating children with cancer increased, clinicians began to focus on quality-of-life issues raised by the administration of corticosteroids rather than the avoidance of adverse effects. This survey may help to develop guidelines regarding the use of corticosteroids in pediatric patients, especially those needing palliative care.

Objectives: Mainstream smoke from cigarettes contains tobacco-specific N'-nitrosamines (TSNAs) listed as Group 1 and 3 carcinogens by the International Agency for Research on Cancer (IARC). Herein, we report on a method of measuring the concentrations of TSNAs in mainstream smoke from the ten top-selling Japanese cigarette brands using an ISO regime by International Organization for Standardization (ISO) and HCI regime of Health Canada., Methods: Tar in mainstream smoke was collected on a Cambridge filter pad using a smoking machine. The filter pad was immersed in 40 mL of ammonium acetate (pH 6.8) and shaken for 30 min. The extract was then loaded into a C18 column. After washing with 5 mL of 10% methanol and eluting with 5 mL of 70% methanol, the eluate was concentrated to 1 mL for LC-MS/MS analysis., Results: The concentrations of TSNAs in all cigarette brands were higher when determined using the HCI regime than when determined using the ISO regime. Furthermore, the concentrations of TSNAs measured using both the ISO and HCI regimes showed negligible correlation to the tar and nicotine concentrations indicated on package labels. The cigarette samples used in the study were categorized into four classes: ultralow-, low-, medium-, and high-yield brands, which corresponded to 1, 3-6, 8-10, and 14 mg tar/cigarette, respectively. The concentration of TSNAs in ultralow-yield cigarettes was 210 ng/cigarette, as measured using the HCI regime, which was nearly equal to that in high-yield cigarettes (180 ng/cigarette)., Conclusions: Exposure to TSNAs from mainstream smoke from ultralow-yield cigarettes is comparable to that from high-yield cigarettes. To properly evaluate the risk of smoking, not only the concentrations of tar and nicotine but also those of other chemicals, including TSNAs, should be printed on package labels.

Primary open-angle glaucoma (POAG), including normal-tension glaucoma (NTG), is reported by the Tajimi Study to afflict 3.9% of the total population, and this represents about 80% of all total glaucoma cases which, in total, afflict 5.0% of the population. We tried to analyze the clinical problems relating to POAG by looking at the pathogenesis, intraocular pressure (IOP), therapy, neuroprotection and surgery of the disease. To elucidate the pathogenesis of glaucoma progression, we measured retinal nerve fiber layer defect (RNFLD) angles', and divided the NTG cases into 2 groups, enlarged RNFLD and stable RNFLD. Disc hemorrhages were found to be significantly more frequent in the enlarged group than in the stable group. RNFLD was enlarged in the direction of disc hemorrhage in over 80% of the eyes. In the majority of the eyes of the enlarged group, the enlargement of RNFLD was toward the fovea. The enlargement of RNFLD in NTG was closely associated with disc hemorrhage and the deterioration of the visual field. We developed a simultaneous structure and function evaluation technique combining spectral-domain (SD) optical coherence tomography (OCT) and fundus-oriented perimeters for the detection of visual field abnormalities in the RNFLD area. We superimposed the ganglion cell complex map obtained by SD-OCT on the fundus-oriented perimeter image. We observed very early or preperimetric normal pressure glaucoma as well as disc hemorrhage adjacent to the borders of the RNFLD. The borderline of the RNFLD seemed to be the thinnest RNFL and had the lowest retinal sensitivity (Active site for RNFLD progression). To clarify the role of the circadian clock genes in the generation of a 24-hour IOP rhythm, we used the microneedle method to measure the IOP at eight time points daily, both in wild type mice and Cry-deficient (Cry 1-/-Cry 2-/-) mice. In the wild-type mice living in light-dark conditions, the pressure measured in the light phase was significantly lower than in the dark phase. This biphasic daily rhythm was maintained under dark-dark conditions. In contrast, the Cry-deficient mice did not show significant circadian changes in their IOP, regardless of the environmental light conditions. These findings demonstrate that clock genes are essential for the generation of the circadian rhythm of IOP. We evaluated the relationship between the genetic polymorphisms of the adrenergic receptor (ADR) and the diurnal IOP in untreated NTG patients. For Del 301-303 in α2B-ADR, De1322-325 in α2C-ADR, and S 49G (A/G) in βl-ADR, the major homozygotes and minor carriers had parallel diurnal IOP curves, but significantly different diurnal IOP levels. Polymorphisms of the ADR gene may predict the diurnal IOP level of patients with NTG. Looking toward the future, tailor-made medicine in glaucoma therapy, we evaluated the relationship between the polymorphisms of the prostaglandin F2α, receptor (FP receptor) gene and the effectiveness of topical latanoprost treatment in 100 normal volunteers. One SNP(rs3753380) was located in the promoter region of the FP receptor gene and was significantly correlated with % IOP reduction. Two SNPs, rs3753380 and rs3766355 (an SNP in intron 1), were associated with the degree of response to latanoprost. The genotype of these SNPs may be an important determinant of variability in response to latanoprost. To investigate the predictability of IOP response of the fellow eye in a one-eye trials, we compared the correlation of the fellow-eye's IOP response in one-eye trials performed separately for each eye with that of bilateral treatment in 41 normal subjects. Correlation of mean diurnal IOP reduction between 2 one-eye trials was poor (r2 = 0.102), even after subtracting the nontreated eye IOP fluctuations from the treated eye IOPs (r2 = 0.097), but that between fellow eyes in bilateral treatment was excellent (r2 = 0.849). Therefore, we examined the effects of multiple IOP measurements on the correlation of response to glaucoma medication between fellow eyes. Latanoprost was applied to the first eye and then to both eyes of POAG or ocular hypertension patients. IOP measurements were performed twice on different days at baseline, during treatment of the first eye only and for both eyes. No significant correlations of ΔIOP 1 (IOP at baseline-IOP after treatment) between fellow eyes were found. ΔIOP 2 (ΔIOP 1-IOP fluctuation of the contralateral eye) was significantly correlated between the fellow eyes using two post-treatment IOP measurements. Using multiple IOP measurements may improve the prediction of a fellow eye's response to glaucoma medication in one-eye trials. We used a scanning laser ophthalmoscope (SLO) for in vivo imaging and counting of rat retinal ganglion cells (RGCs). RGC survival decreased gradually after crushing the optic nerve. RGC counts by SLO were comparable to those in retinal flat mounts. We developed OCT system for rat eyes. The mean retinal nerve fiber layer (RNFL) thicknesses in the circumpapillary OCT scans were unchanged 1 week after crushing the optic nerve, but then decreased significantly and progressively after the second week. RNFL thicknesses in OCT images correlated significantly with thicknesses determined histologically. SLO and OCT will be useful for evaluating the effects of neuroprotective drugs. We developed a new glaucoma filtration surgery system using a thin honeycomb-patterned biodegradable film in rabbits. The film had a honeycomb-patterned surface that faced the subconjunctival Tenon tissue, while the other side was smooth. Postoperative IOPs of the film-treated eyes were significantly lower than those of the control eyes, but were not significantly different from those of the MMC-treated eyes. The thin honeycomb-patterned film that was attached to the inner bleb wall worked as an adhesion barrier in glaucoma filtration surgery in rabbits.

Background: In surgical graft replacement of the descending aorta graft, one-lung ventilation (OLV) is required to provide adequate surgical view and to allow removal of blood from the left lung. It is best to use a double-lumen tube (DLT) to assure OLV but it is sometimes difficult to place the left-sided DLT due to thoracic aneurysm or the dissection lumen. We retrospectively investigated tracheobronchial anatomy by chest X-ray and chest computed tomography (CT) in 29 cases of descending aorta replacement to determine how best to manage difficult placement of the left-sided DLT., Methods: From our database of 29 patients who had undergone descending aorta replacement between February 1, 2005, and December 31, 2009, we investigated the association between difficulty in placing the left-sided DLT and tracheobronchial anatomy by chest X-ray and CT., Results: We could not place a left-sided DLT in 3 of 29 cases. Two of these cases were planned surgery for aortic aneurysm and the other was an emergency operation for acute aortic dissection. We could manage the two cases safely using a right-sided DLT. We compared chest X-ray and chest CT images of these 3 cases with the other 26 cases and found that compression of the tracheobronchial tree was prevalent in the cases of difficult placement of the left-sided DLT., Conclusions: We experienced difficulty in placement of the left-sided DLT in 3 of 29 cases of descending aorta replacement. We can predict difficulty of left-sided DLT placement by the presence of compression of the tracheobronchial tree on chest CT.

Living organisms eliminate foreign low-antigenic substances, such as drugs and environmental pollutants, by detoxification mediated by metabolizing cytochrome P450 (CYP). We have examined the possible regulation of CYP expression by enteric bacteria. Cyp mRNA expression levels, Cyp3a protein expression level, and the activity of Cyp3a in hepatic microsomal fractions were compared in germ-free (GF) and specific pathogen-free (SPF) mice. We evaluated hepatic Cyp3a11 mRNA expression levels and Cyp3a metabolic activity in GF and SPF mice after five days of antibiotic administration. The fecal levels of lithocholic acid (LCA)-producing bacteria and hepatic taurolithocholic acid (TLCA) were also measured. Cyp mRNA expression levels, Cyp3a protein expression level, and the activity of Cyp3a in SPF mice were higher than those in GF mice, indicating that enteric bacteria increases hepatic Cyp3a expression. The effects of enteric bacteria-reducing antibiotics on Cyp3a expression were examined. We observed that decreasing enteric bacteria with antibiotics in SPF mice caused a significant decrease in the hepatic Cyp3a11 mRNA expression, TLCA, and fecal LCA-producing bacteria compared to the group that did not receive antibiotics. No change in Cyp3a11 expression was observed in GF mice that were treated with antibiotics. Administration of LCA to GF mice showed an increase in Cyp3a11 expression similar to that of SPF mice. The enzymes of the enteric bacteria are believed to metabolize and detoxify drugs by either reduction or hydrolysis. The results of this study indicate that changes in enteric bacteria may alter the expression and activity of hepatic drug metabolizing enzymes and pharmacokinetics. Therefore, enteric bacteria should be closely monitored to ensure the safe use of drugs.

In the 20-years from 1991 to 2010, we pathologically diagnosed 24 subjects with parapharyngeal space tumors by biopsying and/or resecting of 24 tumors. Of these, 18 were benign and 6 malignant. Pleomorphic adenoma and schwannoma predominated, accounting for 7 cases each. Enhanced CT and MRI were very useful in diagnosis, judging involvement and localization, and assessing radiological and pathological tumor diagnosis. Important radiological factors are determining whether tumor origin is pre-or post-styloid, and how the tumor is enhanced in CT or MRI. We treated 15 subjects surgically, telling 9 the diagnosis, and used only biopsy or scans. It is vital in follow-up to determine long-term treatment response.

Purpose: To examine progressive visual field loss in relation to disc hemorrhage (DH) and enlarged nerve fiber layer defects (NFLDs) in normal-tension glaucoma (NTG)., Subjects and Methods: There were 106 eyes of 106 NTG patients (mean follow-up: 9.1 years) with well-defined NFLD borders and at least 3 years of follow-up. Examination was performed on their rate of visual field loss (MD slope and hemifield TD slope) and their rate of NFLD angle enlargement. For the NFLD angle, we took color fundus photographs and converted color photos into black-white photos extracted the blue ingredient. The midpoint between the fovea and the disc center was determined. The center was established as the disc, and the distance to the midpoint was established as the radius of a circle. The NFLD angle was defined as the angle formed by the two points where this circle intersected the NFLD and a third point which was the disc center., Results: DH was seen in 51/106 (48.1%)cases and it occurred 1.28 +/- 1.99 times. In the DH group, the MD slope was -0.30 dB/year, indicating a significantly faster rate of visual field loss than that of the non-DH group (-0.13 dB/year); the rate of NFLD enlargement was 1.90 degrees/year, indicating a significantly faster rate than that of the non-DH group at 0.64 degrees/year. As the occurrence of DH increased, the TD slope (r = -0.263, p = 0.0056) and the rate of NFLD enlargement (r = 0.410, p<0.0001) increased significantly., Conclusion: Examination was performed on NTG eyes with well-defined NFLD borders which were divided into the groups of with and without DH. The DH eyes had a faster rate of NFLD enlargement and faster progression of visual field loss compared with the non-DH eyes. In addition, the rate of NFLD enlargement and progression of visual field loss increased in the cases with frequent DHs.

We report a case of fulminant-malignant hyperthermia that occurred after five uneventful sevoflurane anesthetic procedures. A 7-year-old girl with bronchial asthma was scheduled for closure of palatal fistula under general anesthesia, after five previous uneventful operations under sevoflurane anesthesia. Anesthesia was induced with propofol and vecuronium, and maintained with nitrous oxide, oxygen, and sevoflurane. Body temperature at the beginning of operation was 37.0 degrees C. After 5 hr 10 min, sudden tachycardia and elevations in body temperature and PET(CO2) were noticed. Sevoflurane was discontinued and body surface cooling, hyperventilation with 100% oxygen, and administration of dantrolene sodium 2 mg x kg(-1), furosemide 4 mg, and 7% NaHCO3 solution 10 ml were started on a suspicion of malignant hyperthermia. Body temperature, heart rate, and PET(CO2) reached to 40.1 degrees C, 190 beats x min(-1), and 60 mmHg, respectively, with metabolic acidosis. Twenty minutes after starting dantrolene infusion, these values decreased to 38 degrees C, 150 beats x min(-1), and 39 mmHg, respectively. Laboratory examination showed that serum potassium, CK, AST, ALT, and LDH concentrations and urine myoglobin level were within normal ranges. Clinical symptoms of this patient fulfilled the diagnostic criteria of fulminant-malignant hyperthermia. The trigger drug was considered to be sevoflurane despite the five previous uneventful sevoflurane anesthetic procedures.

Titanium dioxide (TiO2) photocatalysis causes oxidative destruction dependent on electrons excited by < or = 400 nm ultraviolet (UV) rays. Many studies have covered the destruction of organics and bacteria and bacteriophage inactivation by photocatalysis. We studied the inactivation by new nonwoven siliconized titanium dioxide fabric of the feline calicivirus F9 (FCV-F9), human adenovirus GB (HAdv3-GB), and influenza A and B virus (A/New Caledonia, B/Shandong, and 5 clinical strains). We spotted 10 microL of viral suspensions containing infectious 5 log10 50% tissue culture doses (TCID50) onto 1 cm2 pieces of TiO2-coated nonwoven control fabric treated or not treated with UV light (lambda(max), 365 nm, 1,100-1,300 microW/cm2). We then measured the virus titers of 50 microL of viral suspension recovered from these fabrics. FCV-F9 and HAdv3-GB infectivity titers were reduced by over 3.5 log10 TCID50 after 30 min of irradiation, but influenza viral titer was reduced to where it was undetectable even without UV irradiation. Comparing individual viral titer reduction due to nonwoven fabric contact without UV irradiation exposure, showed that FCV-F9 and HAdv3-GB titer infectivity was not reduced. In contrast, influenza A and B titer infectivity was reduced to 2 log10 TCID50 after 5 min of contact with the nonwoven fabric and to 3 log10 TCID50 after 30 min of contact. Titers of 6 of 7 influenza A and B strains were reduced by over 4 log10 TCID50 within 30 min. Siliconized TiO2-coated nonwoven fabric thus efficiently inactivated FCV-F9 and HAdV-GB and absorbed influenza viruses.

Background: Inhaled corticosteroid (ICS) therapy has been reported to improve relapses of asthma following emergency room (ER) discharge, but the benefits of ICS prescription at discharge from the ER are unclear., Objective: To assess background of the patients who visit ER, and determine whether the prescription of ICS at ER reduces relapses in the patients with asthma., Methods: A prospective multi-center cohort study was conducted at 32 Japanese ERs. Patients aged two to 82 years who visited ER with moderate to severe exacerbation of asthma underwent questionnaire and follow-up three and six months later. The primary observations were of the asthma-related hospitalizations, ER visits, and unscheduled visits., Results: Among 343 asthma patients (Children: 120, Adults: 223), 33% of children and 12% of adult patients were classified as intermittent asthma, retrospectively. The patients with intermittent had the same rates of hospitalization (29.6%) and ER visits (46.2%) as those with persistent (hospitalization rate: 24.7%, ER visits: 53.1%, ns) before enrolled. The odds ratio for hospitalization in the patients received ICS at the discharge from the ER, compared with the patients who did not received ICS, yielded 0.256 (95% confidence interval, 0.069 to 0.942; p=0.040) by multinomial logistic regression model., Conclusion: Prescribing ICS at discharge from the ER to asthma patients is associated with the reduction of risk for asthma-related hospitalization. For patients discharged from the ER, including mild intermittent asthma, ICS might be prescribed.

Purpose: To report two familial cases of optic nerve hypoplasia including superior segmental optic hypoplasia (SSOH)., Cases: In Family 1, case 1 and case 2 were sisters. In Family 2, case 3 was the mother of case 4 and the younger sister of case 5. The cases in Family 1 had SSOH in one eye, whereas Family 2 showed various patterns of SSOH, as well as nasal optic nerve hypoplasia, and a wide range of optic nerve hypoplasia. Case 1 and case 3 were diagnosed as normal tension glaucoma and treated with eye drops at a previous hospital. None of the cases had any systemic illness. The father of cases 1 and 2, and the father of Cases 3 and 5 were under treatment for type 2 diabetes mellitus., Conclusion: In this study, SSOH seemed to be prevalent among family members. In addition, as the cases in Family 2 illustrate, hypoplasia of the optic nerve showed various patterns in the superior segment, nasal segment, and over a wide range of the optic nerve. Therefore SSOH was just one part of the overall optic nerve hypoplasia.

Background: Orthognathic surgery for maxillofacial deformities and open reduction of mandibular fractures may require intermaxillary fixation during the surgical procedure. Extubation with intraoperative intermaxillary fixation is highly dangerous, because nasal bleeding and postoperative vomiting can cause airway obstruction and aspiration pneumonia. To prevent these complications, we routinely use an S-shaped suction catheter in patients with intraoperative intermaxillary fixation. The purpose of this study was to determine the optimal location for fixation of a catheter to allow effective suctioning., Methods: Fourteen adult volunteers participated in this study. A suction catheter was inserted into the oral cavity proper through the retromolar space in an intercuspal position. When the catheter could suction distilled water in the mouth, the distance from the tip of the catheter to the angle of the mouth was measured., Results: The distances of straight type catheters were 68+/-7 and 57+/-7 mm in males and females, respectively. The distances of angle type catheters were 72+/-10 and 58+/-7 mm in males and females, respectively., Conclusions: The present study suggests that an S-shaped suction catheter is useful to suction oral secretions in patients with intraoperative intermaxillary fixation.

We previously demonstrated that ciprofloxacin (CPX), a new quinolone antibiotic, suppresses Cyp3a in the mouse liver by reducing the hepatic level of lithocholic acid (LCA) produced by intestinal flora. The present study investigated the possibility that other antibiotics with antibacterial activity against LCA-producing bacteria also cause a decrease in the LCA level in the liver, leading to reduced expression of Cyp3a11. While the mRNA expression of Cyp3a11 in the liver was significantly reduced when SPF mice were administered antibiotics such as ampicillin, CPX, levofloxacin, or a combination of vancomycin and imipenem, no significant changes were observed after antibiotic treatment of GF mice lacking intestinal flora. LCA-producing bacteria in the feces as well as the hepatic level of the taurine conjugate of LCA were significantly reduced in the antibiotic-treated SPF mice, suggesting that the decrease in Cyp3a11 expression can be attributed to the reduction in LCA-producing intestinal flora following antibiotic administration. These results suggest that the administration of antibiotics with activity against LCA-producing bacteria can also cause a decrease in the LCA level in humans, which may lower CYP3A4 expression. The intestinal flora are reported to be altered not only by drugs, such as antibiotics, but also by stress, disease, and age. The findings of the present study suggest that these changes in intestinal flora could modify CYP expression and contribute to the individual differences in pharmacokinetics.