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In general, the dimensional relation between the rafter placement and the bracket complex is well known as Rokushigake. However, there are a few non-Rokushigake that need to be examined further. This paper evaluates some problems that are connected to the positions of the rafter placement, gagyou and the bracket complex, especially are located on the corner pillars among the non-Rokushigake architecture. As a result, it became clear and can be classified, basically there are three ways, such as: to adjust the rafter placement to the centre on both sides of the gagyou, to adjust the bracket complex system, and without adjusting them to set the rafter in order or disorder.

OBJECTIVE—A1C levels have been shown to be elevated in relation to glycemia in late pregnancy, although the precise mechanisms remain undetermined. We hypothesized that iron deficiency is involved in the A1C increase in late pregnancy. RESEARCH DESIGN AND METHODS—In study 1, A1C, serum glycated albumin, erythrocyte indexes, and iron metabolism indexes were determined in 47 nondiabetic pregnant women not receiving iron supplementation who were divided into four groups according to gestational period (group I, 21–24 weeks; group II, 25–28 weeks; group III, 29–32 weeks; and group IV, 33–36 weeks). In study 2, these determinants were obtained at two gestational periods (20–23 weeks and 32–33 weeks) in 17 nondiabetic pregnant women. RESULTS—In study 1, A1C levels were higher in groups III and IV than those in groups I and II, whereas serum glycated albumin levels were not different among these four groups. Hemoglobin, mean corpuscular hemoglobin (MCH), serum transferrin saturation, and serum ferritin were lower in groups III and IV. A1C levels were negatively correlated with MCH, serum transferrin saturation, and serum ferritin. In study 2, A1C levels were significantly increased at gestational weeks 32–33 from those at weeks 20–23, whereas serum glycated albumin levels did not differ between the two gestational periods. MCH, serum transferrin saturation, and serum ferritin were decreased at gestational weeks 32–33. A1C levels showed a negative correlation with MCH, serum transferrin saturation, and serum ferritin. CONCLUSIONS—A1C levels were elevated in late pregnancy owing to iron deficiency. Serum glycated albumin may offer a better index for monitoring glycemic control in pregnancy.

The gastrointestinal stromal tumor cell line, GIST-T1, has a heterogenic 57-base pair deletion in exon 11 of the c-kit mutation, and the c-KIT protein in the GIST-T1 cells constitutively activated. We report that STI571 (Glivec; Novartis, Basel, Switzerland), a specific inhibitor of c-KIT, inhibits the clustering of c-KIT at the cell membrane of the GIST-T1 cells. Furthermore, STI571 prevents the interaction between c-KIT and the molecular chaperone, heat shock protein 90 (Hsp90). Geldanamycin, an inhibitor of Hsp90, also prevents interaction between c-KIT and Hsp90, and inhibits tyrosine phosphorylation of c-KIT. Our results indicate that c-KIT molecules are assembled on the cell surface of the GIST-T1 cells, and that the interaction between c-KIT and Hsp90 plays an important role in c-KIT activation.

We recently experienced a case of abdominal leiomyosarcoma which was preoperatively diagnosed as mesosigmoid origin. A 66-year-old woman was admitted to the department because of a lower abdominal mass. A computed tomography revealed a large solid mass and angiographically it's localization was detected as mesosigmoid. We performed an extirpation of the mass with segmental sigmoidectomy. The tumor was diagnosed as leiomyosarcoma with the pathological and immunohistochemical evaluation. Leiomyosarcoms originated in the mesenterium are rare, and so far 54 cases have been reported in the Japanese literature including ours.

陣仮性嚢胞内出血より腹腔内出血をきたし, 手術により救命しえた1例を経験した. 症例は84歳男性で突然, 悪心と左側腹部痛を訴えショックとなり近医に緊急入院した. 保存的治療でショック状態は改善したが腹腔試験穿刺で血性腹水を認め, 腹腔内出血と診断された. その後, 2度ショック状態となり, 当科紹介入院となった. 入院時ショック状態は輸血, 輸液により改善していたが腹部は膨満し, 全体に圧痛を認めた. 検査成績では貧血, 高血糖, 低蛋白血症を認めたが際酵素, 腫瘍マーカーは正常であった. 腹部超音波, CT検査で腹水と際尾部の腫瘤を認めた. 腹腔動脈造影で陣動脈より造影剤の血管外への漏出と貯留を認め悌仮性嚢胞内への出血が疑われ緊急開腹術を施行した. 開腹時約2,000mlの血性腹水と膵尾部に直径約10cm大で凝血塊が充満する腫瘤を認めた. 膵尾側切除と障摘出術を施行した. 膵仮性嚢胞内出血から腹腔内出血をきたした報告例7例の検討を加えて報告する.

Fournier's gangrene (FG) is rapidly progressing acute gangrenous infection of the anorectal and urogenital area. FG needs precocious diagnosis and aggressive treatment with the use of wide spectrum antibioticus and surgical debridement. In our case, a 91-year-old Japanese female who had rehabilitation after treatment of pneumonia and her past history was rheumatoid arthritis treated with steroid and chronic heart failure. Her activities of daily living was bedridden with dementia. Necrotic skin was observed in urogenital and anorectal area and skin redness enlarged to the hip with high fever. Surgical debridement was performed. Both Peptostreptococcus Sp. and Fusobacterium Sp. was cultured from resected necrotic tissue. We used antibioticus, PAPM and PIPC, which had sensitivity for them. But unfortunately, disseminated intravascular coagulation occurred after 4th day of operation, and finally she died after 10th day of operation. We discussed the treatment for FG in patient with complication.

Acute appendicitis often presents as right lower quadrant (RLQ) pain, severe tenderness at the point of McBurny or Lanz, and Blumberg's sign. Scrotal events with appendicitis are very rare. In our case, a 63-year-old Japanese man presented with severe RLQ pain and high fever. Physical examination revealed severe tenderness (including both points of McBurny and Lanz) and Blumberg's sign. The scrotum was slightly swollen and showed local heat with severe testicular pain. Abdominal computed tomography revealed ascites in a pelvic space and the right side of the spermatic cord was swollen. Emergency operation was performed and the final diagnosis was catarrhal appendicitis and acute epididymitis. This is the first report of acute appendicitis concomitant with acute epididymitis.

We experienced a case of chronic pancreatitis causing extensive retroperitoneal abscess due to acute relapse of the disease, which was successfully managed by ultrasonic retroperitoneal drainage and conservative treatment. A 61-year-old man had been treated at elsewhere for chronic pancreatitis for the past ten years. He had experienced 3 episodes of acute relapse of the disease during the same period, and on each occasion, the conservative treatment was effective. Recently, the patient was transfered to the hospital because of epigastralgia, back pain and fever, and probable suspicion of having a retroperitoneal abscess caused by an acute relapse of chronic pancreatitis. Ultrasonography and CT allowed a diagnosis of extensive retroperitoneal abscess extending to the pelvic cavity. Because surgery was judged to involve a high risk, he was treated with ultrasonic drainage and conservative therapy. About two months after the admission, the abscess has completely disappeared on ultrasonic and CT images, consequently cured.

肝細胞癌の十二指腸浸潤を内視鏡的に診断しえた1例を経験したので報告する. 症例は47歳の男性で, 全身倦怠感を主訴に近医受診. 上部消化管透視, CTにて十二指腸平滑筋肉腫とその多発性肝転移の疑いで当科紹介入院となる. 貧血と肝機能障害を認め, HBs Ag (+), α-fetoprotein高値で血管造影で肝細胞癌と診断された. 内視鏡で十二指腸球部前壁に茶褐色の不整な潰瘍を認め, 生検でEdmondson III型程度に相当する肝細胞癌の所見が得られた. 以上より肝細胞癌の十二指腸浸潤と診断し十二指腸球部の潰瘍からの出血のため開腹術が施行された. 肝左葉より肝外性に発育した腫瘍が十二指腸球部に直接浸潤していた. 術後38日目に肝不全で死亡した. 剖検所見では肝細胞癌が肝左葉を中心として発育し, 両葉に多数の肝内転移を認め連続性に十二指腸へ浸潤し瘻孔様になっていた. 十二指腸への転移, 浸潤例はまれで, 本邦での報告例はわずか11例のみである. 文献的考察を加えた.

OBJECTIVESThe purpose of this study was to evaluate whether higher coronary blood flow, estimated by the corrected Thrombolysis In Myocardial Infarction (TIMI) frame count (CTFC), is related to better functional and clinical outcome after successful percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI).BACKGROUNDExperimental studies have found that functional recovery of the infarcted myocardium was associated with increased blood flow (reactive hyperemia) to the infarcted bed shortly after reperfusion.METHODSWe measured CTFC immediately after successful (TIMI 3) primary PTCA in 104 consecutive patients with their first AMI. Wall motion score index (WMSI) and the presence of pericardial effusion were assessed by two-dimensional echocardiography before and one month after PTCA.RESULTSThe patients were divided into two groups according to mean CTFC for corresponding coronary artery of the control group: TIMI 3 slow group (45 patients, 40 > CTFC ≥ 23) and TIMI 3 fast group (59 patients, CTFC < 23). There were no significant differences in the baseline characteristics and WMSI before reperfusion between the two groups. Improvement of WMSI in the TIMI 3 fast group was significantly greater than that of the TIMI 3 slow group (1.33 ± 0.52 vs. 0.60 ± 0.34, p < 0.001). Pericardial effusion and intractable heart failure were observed more frequently in the TIMI 3 slow group than in the TIMI 3 fast group (27 vs. 10%; p < 0.05, 36 vs. 17%; p < 0.05). Corrected TIMI frame count, assessed as a continuous variable, had a significant correlation with the change in WMSI (r = 0.60, p < 0.001) after adjusting for age, gender, history of hypertension, history of diabetes, elapsed time to PTCA, collateral grade, presence of antegrade flow before PTCA and number of diseased vessels.CONCLUSIONSLower CTFC of the infarct-related artery immediately after PTCA was associated with greater functional recovery; and hence, CTFC can predict clinical and functional outcome in patients with successful PTCA.