Search

PURPOSE Screening with prostate specific antigen (PSA) only to detect prostate cancer was started in Tokushima City from 2001 as one of health check lists. We evaluated the first year result. MATERIALS AND METHODS Fifty-five years old or elder men living in Tokushima City who wants to measure serum PSA level to screen for prostate cancer were entered to screening program. The men whose PSA levels detected as over normal; range were recommended to visit to urologists for further examination to detect prostate cancer include prostate biopsy. The results of further examination were reported to Tokushima City and evaluated. RESULTS The population of fifty-five or elder men in Tokushima City was 25,416 and 9,019 (35.5%) men were measured serum PSA levels. In 801 (8.9%) men, PSA levels were over normal range, and recommended further examination to detect prostate cancer. 451 (56.3%) men visited to urologists for further examination, and prostate biopsy was performed in 231 (51.2%) men. Finally, 121 men were diagnosed as prostate cancer, 52.1% of 231 men performed prostate biopsy, 26.7% of 451 men visited to urologist for further examination, 1.34% of 9,019 men measured serum PSA levels. Patient number for each clinical stages were 49 in B0, 16 in B1, 16 in B2, 29 in C, one in D1, and 10 in D2. Patients number in each age range were 3 in 55-59, 11 in 60-64, 22 in 65-69, 37 in 70-74, 33 in 75-79, 15 in 80 or elder. Patient number of Stage B and 74 years old or younger was 48 (39.7%). CONCLUSION Prostate cancer was detected in 1.34% of 9,019 men who measured serum PSA levels, and early stage B was two thirds. PSA screening to detect prostate cancer as one of health check-lists in Tokushima City was useful to detect early prostate cancer.

This paper describes a fault diagnosis expert system installed at the Tohoku Electric Power Company. The main features of this system are careful selection of the inferencing input data, rapid inferencing, integration of the expert system with other systems in a practical structure, and the adoption of a domain shell. This system aims for improved practicability by using time-tagged data from circuit breakers, protective relays, and automatic reclosing relays in addition to the input data used in earlier systems. Furthermore, this system also uses data from fault detection systems that locate fault points within electric stations. This system uses an AI-specific back-end processor to perform inferencing rapidly. Additionally, this fault diagnosis expert system is interfaced and integrated with a restorative operations expert system, an intelligent alarm processing system, and a protective relay setting and management system. The authors developed and adopted a power system fault diagnosis domain shell to ease system development, and used the protective relay operation simulation function of a protective relay setting and management system for system verification. >

Kampou medicine is a traditional Japanese therapeutic system which originated in China and was used to treat various diseases for hundreds of years until it was superseded by Western medicine. In recent years, there has been a resurgence of interest in Kampou medicine among many physicians. Unfortunately, however, little evaluation has been performed using objective scientific methods until now, and the pharmacodynamics of Kampou medicine are still unclear. Generally speaking, Kampou medicine has been shown to have fewer side-effects than Western medicine based on the experience gained from its long usage. We first selected 16 Kampou extracts for screening as possible calcium oxalate stone prophylactic agents in vitro. This resulted in the selection of two kinds of Kampou extracts, Takusya and Kagosou, as potential Kampou extracts for stone prophylaxis. Next, these two Kampou extracts were tested in vivo for their effects on stone formation in an animal model. Takusya showed significant stone prophylaxis, while Kagosou did not. Lastly, Chorei-to, which contains Takusya and has been approved for prescription as a Kampou medicine for urolithiasis patients in Japan, was examined in vivo at two different concentrations. As a result, a low dose of Chorei-to which corresponded to the human daily dose per unit of body weight exhibited apparent stone prophylaxis, despite the disadvantage of decreasing citrate excretion. In contrast, high doses of Chorei-to did not exhibit stone prophylaxis in viva These results suggest that Chorei-to has conflicting effects on stone prevention as a whole, but the Takusya extract in Chorei-to seems to play a major role in stone prophylaxis and the remaining four Kampou extracts seemed to interfere with the prophylactic effect of Takusya on calcium oxalate stone formation.

Alkali therapy is widely accepted as a treatment for recurrent calcium stone patients with distal renal tubular acidosis (dRTA). Nine patients, five with complete and four with incomplete type of dRTA, were treated with alkali agents for more than three years; an average period of 10.8 years. In five patients, new stone formation and stone growth were completely prevented by this treatment. Among the four failed cases, three did not take enough alkali agents (in spite of our medication), and the other had recurrent urinary tract infection resulting in infectious stone formation. In conclusion, the long-term efficacy of alkali therapy for prevention of recurrent stone formation with dRTA is confirmed when the patient takes enough alkali agents and the urinary tract infection is well controlled.

Gelatinous transformation of the bone marrow is a rare disease characterised by a focal marrow hypoplasia, fat atrophy and accumulation of extracellular mucopolysaccharides abundant in hyaluronic acid, which is often associated with extreme malnutrition and weight loss. There are only two reports describing its association with systemic lupus erythematosus (SLE). One described underlying diseases in 155 cases of gelatinous transformation of the bone marrow and found one case with clinical diagnosis of SLE, but no clinical details were provided. The other described three SLE patients with gelatinous transformation of the bone marrow; however, two of these were cachectic and one was diagnosed with concomitant tuberculosis. We describe one active SLE patient without other comorbidities whose pancytopaenia was histologically confirmed as gelatinous transformation. The combination of high-dose steroid, intravenous immunoglobulin and mycophenolate mofetil improved the peripheral blood cytopaenia and reversed the bone marrow abnormalities.

Clinical results of ESWL for renal and ureteral stone with MPL-9000 were presented. We also reviewed correlation between stone burden and shock wave energy. We studied 210 cases (295 sessions) of renal stone and 109 cases (154 sessions) of ureteral stone that were treated from November 1988 till January 1989 and from November 1989 till May 1990. Of those sessions, 76 sessions of renal stone cases and 53 of ureteral stone cases were carried out ambulatorily. Successful disintegration (within 4 mm) rate was 86% of renal stones, 84% of ureteral stones, and stone free rate after 6 months was 72% of renal stones and 84% of ureteral stones. As for the complications, brain infarction occurred in one case, subcapsular hematoma of the kidney in one, and arythmia in 5. No other severe side effects were observed. Between shock wave energy (the number of shock wave shots x voltage) and stone burden (long axis x short axis of the stone), a significant correlation was found in renal stone cases, but not in ureteral stone cases. E/B (shock wave energy/stone burden) was 33,100 (kv.shots/cm2) for the renal stone and 56,000 (kv.shots/cm2) for the ureteral stone. These results suggest that there is still another unknown factor, which is not related with renal stone, for successful disintegration of ureteral stone. We also confirmed that more energy is necessary for destruction of ureteral stone than for that of renal stone.(ABSTRACT TRUNCATED AT 250 WORDS)

This paper studies a multi-functional power conversion system (PCS) combined with the functions of energy storage and power quality. The multi-functional PCS controls active power and reactive power simultaneously, and it has nine functions. Furthermore, the functions of PCS are divided into normal mode and faulted mode to make use of the rated power of the PCS efficiently. Further, in order to achieve the multi-functions, the well-known coordinate transformations from static coordinate system to rotational one is used, and the control system is designed by classical control theory. Finally, the effectiveness of the multi functions is confirmed by several SCAT simulations and experiments.

Simple mechanical disintegration of cystine calculi by extracorporeal shock wave lithotripsy and/or percutaneous nephrolithotomy is being performed widely around the world. However, it cannot be denied that the cystine calculus is one of the most difficult stones for mechanical disintegration. We previously reported the oral medical chemolysis of cystine calculi in 1982 and a third of the patients became stone-free. In another third of the patients the cystine component was replaced by apatite during the medical treatment and apatite stones formed in this manner are easily disintegrated. In view of the complications of mechanical disintegration, oral medical treatment for chemolysis should be recommended before simple destruction of cystine calculi.

Background Much emphasis has been placed on early diagnosis and treatment of rheumatoid arthritis (RA) 1 . In order to achieve the better outcome, the timing of referral and diagnosis of early arthritis should be optimized 2 . Objectives To examine the time to referral of patients with early arthritis, and diagnosis delay of RA in a rural community medical center in Japan. Methods A total of 296 who visited Kameda Medical Center from January 2009 to December 2010 with at least one swelling joint without any previous treatment were included. In the patients diagnosed as RA, the time intervals from the onset of symptom to primary care physician (PCP) (patient delay), from PCP referral to a rheumatologist (PCP delay), from the onset of symptoms to rheumatology visit (total delay) were determined. Results Ninety-four patients were diagnosed as having RA. The median patient, PCP, total delays [interquartile range [IQR]] were 8.8 weeks [3.4-30.1], 5 weeks [1.9-20.1], 26.9 weeks [10.9-69.4] respectively. The patient delay was significantly longer than PCP delay (p=0.046). Twenty-seven (29%) RA patients were assessed within 12 weeks from onset. At baseline, these patients had less bone erosion on radiograph, as compared with those assessed after≥12 weeks (7% vs 30%, p=0.03). Conclusions In a rural community medical center in Japan, the patient delay is longer than the PCP delay, which is comparable to earlier reports from Europe 3 . This study indicates the key delay in early arthritis diagnosis in Japan. References P, et al. Ann Rheum Dis 2002;61:290-7. Van der Linden MP, et al. Arthritis Rheum 2010;62:3537-46. K.Raza, et al. Ann Rheum Dis 2011;70:1822-1825 Disclosure of Interest None Declared

Objectives To assess real-life practice patterns of biologic discontinuation, including tocilizumab, for good response and factors associated with retreatment, we conducted a research on the Cohort of Arthritis, Biologic Users at Kameda Institute (CABUKI) registry [1]. Methods Proportions of patients who discontinued biologic agents for physician-perceived good response were calculated for each biologic agent. Baseline characteristics were compared to patients whose biologics were withdrawn for ineffectiveness or side effects. Disease and treatment characteristics at discontinuation for good response were compared to recommendations. Survival of biologic-free status and predictors of retreatment were analyzed. Results Among 265 eligible patients, 161 patients (ADA 3, ETN 58, IFX 77, TCZ 23) who discontinued their biologics during the study period were identified: 35 for good response (ADA1, ETN9, IFX22, TCZ3), 53 for side effects (ADA2, ETN21, IFX22, TCZ8), 39 for ineffectiveness (ETN11, IFX21, TCZ7), and 34 for other reasons [patient’s preference 24 (ETN11, IFX10, TCZ3), physician preference 9 (ETN5, IFX2, TCZ2), and unspecified 1 (ETN1)]. Age at initiation was lowest in the good response group and highest in the side effects group, and baseline prednisolone dose was highest in the ineffectiveness group. Patients in the good response group had been treated with biologics for 20 months on average, topping other groups. Prednisolone was used at the lowest dose in this group. Methotrexate doses were significantly lower in the side effects group. Among 35 patients in the good response group, 21 (60%) met DAS28-ESR criteria (5 patient lacked patient’s global assessment required for DAS28-ESR, thus were regarded as non-responders), and 27 (77%) met the DAS28-ESR low disease activity criteria ( 1 and patient global assessment >10 out of 100. First-line infliximab and adalimumab achieved the highest good response discontinuation rates at 22.5% and 25.0%, respectively, whereas first-line tocilizumab and etanercept achieved 10.5% and 7.6%, respectively. Among those who became biologic-free, 70.5% remained so at 6 months. Achievement of prednisolone-free status six or more months before biologic discontinuation was associated with longer biologic-free status (Table). Conclusions Biologic-free status is an achievable goal in routine practice. Stabilization of disease activity without prednisolone for more than six months is an important factor. References Yoshida K, et al. An observational study of tocilizumab and TNF-alpha inhibitor use in a Japanese community hospital: different remission rates, similar drug survival and safety. Rheumatology (Oxford). 2011;50:2093-2099. Disclosure of Interest None Declared

Background Clinical phenotype of ANCA-associated vasculitis (AAV) is different between Japan and European countries with microscopic polyangiitis (MPA) predominating in Japan.1 Objectives To investigate the diagnosis and prognosis of AAV in a community-based teaching hospital in Japan. Methods We performed a retrospective chart review of adult patients with AAV who admitted to Kameda Medical Center from January 2003 to July 2011. We evaluated the diagnoses by applying the European Medicines Agency (EMEA) algorithm2 and examined the remission rates. Remission is defined as symptom free, normal CRP/ESR and absence of renal disease activity. Results Forty-eight patients were included [33females; mean age at the time of diagnosis, 70.5 years (range, 23–92)]. The mean follow-up was 31.2 months (range, 0.5–92). The original diagnoses of 48 patients were Churg-Strauss syndrome (CSS) (n=7), granulomatosis with polyangitis (GPA) (n=9), MPA (n=32). After applying the EMEA algorithm, 4 of 32 patients with MPA were classified as GPA, and 4 as unclassified vasculitis. One patient with GPA was classified as MPA. ANCA tests were performed by enzyme-linked immunosorbent assay (for MPO-ANCA and PR3–ANCA) for all patients. Thirty-five (72.9%) and 5 (10.4%) patients were MPO-ANCA and PR3–ANCA positive respectively, and other one patient was both MPO-ANCA and PR3–ANCA positive. Among all, 34 patients received glucocorticoid (GC) alone (GC group), and 11 patients were treated with GC/cyclophosphamide (CYC) combination (CYC group). There were no difference in 6 months remission rates and GC dose at 12 months between two groups; however, remission rate at 12 months was numerically higher in CYC group (45.8% GC group vs. 87.5% CYC group). A total of 13 deaths were observed. These deaths were predominantly vasculitis-related, explaining 8/13 (62%) of them and comprised the following: acute renal failure for 3, interstitial lung disease for 2, alveolar hemorrhage for 1, cerebral infarction for 1, and cardiomyopathy for 1. Three of 13 (23%) deaths were attributed to infection: septic shock for 2 (1 with pyelonephritis and 1 with cholecystitis), and pneumonia for 1. The remaining 2 (15%) deaths were attributed to miscellaneous causes: congestive heart failure for 1 and sudden death for 1.Overall estimated 5 year survival rate was 63.2% by using Kaplan-Meier method, and it was 78.3% in patients with the Five-Factors Score (FFS)3 =0 (54.1% FFS ≥1, 54.5% FFS ≥2). Conclusions MPA accounted for the large part of AAV, as in previous studies. It is the same also after applying EMEA algorithm. At one year, more patients tend to be in remission in CYC group compared to GC group. 1. Ntatsaki E, Watts RA, Scott DG. Rheum Dis Clin North Am. 2010;36:447 2. Watts R, Lane S, Hanslik T, et al. Ann Rheum Dis. 2007;66:222 3. Guillevin L, Lhote F, Gayraud M, et al. Medicine (Baltimore). 1996;75:17 Disclosure of Interest None Declared

Although several medicines are administered to prevent new stone formation or stone growth, we have not obtained a satisfactory result. The Kanpou medicines, whose safety has become well established during a long history of use, may be useful as new prophylactic agents if they exhibit strong inhibitory activity. In this study, we examined the inhibitory effect of Kanpou medicines on calcium oxalate crystallization in vitro.

We investigated the influence of ionic strength on both the binding ability of macromolecules onto calcium oxalate crystals and the inhibitory activity of macromolecules related to calcium oxalate crystal growth and aggregation in vitro. The amount of heparin sodium salt adsorbed onto calcium oxalate crystals was studied in both a seed and a non-seed crystal system at various ionic strengths with the aid of radiolabelled heparin. In both adsorption models, adsorption of heparin was greater in the buffered solutions of lower ionic strength, and significantly so in the range of physiological ionic strength. The inhibitory activity of heparin in the non-seed crystal system, which was determined using a Coulter Multisizer, increased as the adsorbed dose increased. The naturally existing urinary macromolecules showed a similar change in their inhibitory activity on calcium oxalate crystal growth and/or aggregation in accordance with changes in ionic strength. These results indicate that macromolecular inhibitory activity seems to be enhanced in urine of lower ionic strength as a result of an increased adsorption of macromolecules on the surface of calcium oxalate crystals.

Summary— Between March 1981 and March 1990, 15 patients with locally advanced transitional cell carcinoma of the bladder were treated concurrently with cisplatin and radiotherapy. Treatment comprised a radiation dose of 40-50 Gy in 20-25 fractions over 4-5 weeks and intravenous infusion of cisplatin with hydration during days 1-5 and 22-26. The total scheduled dose of cisplatin was 200 mg. A complete response (CR) was seen in 3 patients (2 T2 tumours and 1 T3) and the other 12 were regarded as partial responders. Two of the 12 partial responders (1 T2 tumour and 1 T4) underwent cystectomy after treatment, but 9 patients (2 T2,6 T3 and 1 T4) underwent only transurethral resection. The remaining patient (with a T4 tumour) died from systemic disease, further treatment not being possible because of unrelated heart failure. In 3 CR patients and 9 with a partial response (PR), bladder function was preserved and they have survived for a mean of 18.3 months (range 5-47) after therapy. Although 4 patients in this group had recurrent bladder tumours and 1 died from cancer in another part of the body, 7 have survived with normal bladder function and no recurrence. It is concluded that concurrent cisplatin and radiation therapy is a safe and viable regimen and may be considered as a means of preserving the bladder in patients with locally advanced transitional cell carcinoma.

A plastic ankle foot orthosis (AFO) was developed, referred to as functional ankle foot orthosis Type 2 (FAFO (II)), which can deal with genu recurvatum and the severe spastic foot in walking. Clinical trials were successful for all varus and drop feet, and for most cases of genu recurvatum. Electromyogram studies showed that the FAFO (II) reduced the spasticity of gastrocnemius and hamstring muscles and activated the quadricep muscles. Gait analysis revealed a reduction of the knee angles in the stance phase on the affected side when using the FAFO (II). Mechanical stress tests showed excellent durability of the orthosis and demonstrated its effectiveness for controlling spasticity in comparison with other types of plastic AFOs.

Steroidogenic responsiveness and amelioration of sperm number and motility following long-term intramuscular hCG and hMG administration were evaluated in 18 males with hypogonadotrophic hypogonadism (HH). The patients consisted of 13 patients with isolated gonadotrophin deficiency (IGD) and 5 patients hypophysectomized at an early or middle pubertal period. Basal serum levels of testosterone and 17 beta-estradiol were within prepubertal range in all patients before the treatment. Serum testosterone levels reached the normal adult male levels within 12-24 months of the treatment in only 2 of 7 younger patients and 1 of 6 older patients with IGD, whereas in all hypophysectomized patients serum levels of both testosterone and 17 beta-estradiol increased to the levels found in normal adult males within 6 months of the treatment. The mean peak levels of serum testosterone and 17 beta-estradiol, respectively, during the treatment were 2.1 +/- 0.8 (SD) ng/ml and 10.8 +/- 4.9 (SD) pg/ml in younger patients with IGD, 1.4 +/- 0.9 ng/ml and 9.7 +/- 5.1 pg/ml in older patients with IGD and 6.0 +/- 1.2 ng/ml and 34.2 +/- 14.8 pg/ml in hypophysectomized patients. Quantitative improvement in both sperm density and sperm motility were found in 4 of 7 younger patients, 1 of 6 older patients with IGD and all hypophysectomized patients, but only 3 of hypophysectomized patients (3 of 18 patients) could become fertile.

A Japanese boy with Lesch-Nyhan syndrome who passed xanthine calculi is reported. After pyelolithotomy for a left renal stone, made up of ammonium urate, associated with urinary tract infection, a high dose of allopurinol was given because of the persistence of pyuria. In the present case, the administration of a high dose of allopurinol, given for the prevention of ammonium urate stone formation in infected urine, induced xanthine calculi formation and we had difficulty in the management of this patient with Lesch-Nyhan syndrome associated with urinary tract infection. However, we believe it a basic necessity to cure our patient of his urinary tract infection and prevent recurrent ammonium urate stone formation because of the risk of renal deterioration.

Renal dysplasia with a single vaginal ectopic ureter is relatively common in Japan. We report 2 cases in which delayed enhanced computerized tomography (1.5 hours later) contributed in detecting a dysplastic kidney that had been nonfunctioning on excretory urography. We believe that computerized tomography is a useful technique for the diagnosis of renal dysplasia with a single vaginal ectopic ureter.

In 40 pubertal boys with a varicocele a comparative followup study was performed to evaluate the efficacy of surgical correction of the varicocele in this age group in regard to improvement of fertility after completion of sexual maturation. The varicocele was corrected surgically in 24 patients and it was left uncorrected in 16. Testicular atrophy was noted in all cases at the initial visit and after followup. Of the 24 corrected patients 16 had atrophy of at least 1 testis before surgical treatment, whereas only 7 demonstrated atrophy after followup. Of the 16 uncorrected patients testicular atrophy was noted in 8 at the initial visit but 12 had atrophy after followup. Semen examination of 23 patients who had completed sexual maturation demonstrated a higher quality of routine seminal parameters, for example sperm density, sperm motility and percentage of morphologically normal spermatozoa, in the corrected group than in the uncorrected group.

Eighteen patients were identified in whom ultrasound (US) of the kidney demonstrated a hyperechoic medulla. Diagnoses in the patients included gout in seven; Sjogren syndrome in two; medullary sponge kidney in two; primary aldosteronism in two; and Lesch-Nyhan syndrome, hyperparathyroidism, glycogen storage disease type XI, Wilson disease, and pseudo-Bartter syndrome in one each. The pathogenesis of the echogenicity was evaluated by comparing the findings from computed tomography and conventional radiography. It appears that a hyperechoic medulla is caused by hyperuricemia, medullary nephrocalcinosis, or hypokalemia. US is considered to be useful in evaluating renal involvement in patients with these diseases.

Summary— The role of Tamm-Horsfall glycoprotein (THGP) in the crystallisation of calcium oxalate was investigated. The results showed THGP to have a weak inhibitory effect on crystal growth. In contrast, urinary macromolecules showed a strong inhibitory effect. THGP should, therefore, not be considered the main component of urinary macromolecules which have a strong inhibitory effect on crystal growth. However, THGP did enhance crystal production in the early phase of crystallisation. It appears that THGP should be viewed as a promoter rather than an inhibitor of calcium oxalate crystallisation at physiological concentrations.