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To investigate the prevalence and factors associated with uncorrected presbyopia among rural community dwellers in Japan. A population-based cross-sectional study was conducted in 2011 among community dwellers aged 40–74 years who received specific health checkups in Minamiaizu and Tadami, Fukushima Prefecture, Japan. Uncorrected presbyopia was considered as when the distance-corrected visual acuity in the better eye was ≥0.5 and the near-presenting visual acuity in the better eye was

Objective: IgG4-related sclerosing cholecystitis is generally associated with IgG4-related sclerosing cholangitis and presents with diffuse, circumferential thickening of the gallbladder wall. We report a rare case of localized IgG4-related sclerosing cholecystitis without IgG4-related sclerosing cholangitis, which was difficult to differentiate from gallbladder cancer preoperatively. Patient: A 56-year-old man with suspected IgG4-related disease or gallbladder cancer was admitted to our ward. The serum IgG4 level was elevated at 721 mg/dL. Computed tomography (CT) demonstrated focal wall thickening of the gallbladder fundus. Drip infusion cholecystocholangiography with CT revealed no dilation, stenosis, or border irregularity of the bile duct. Results: For diagnostic and treatment purposes, cholecystectomy with wedge resection of the gallbladder bed was performed. The pathological diagnosis was IgG4-related sclerosing cholecystitis. Conclusion: It is difficult to differentiate IgG4-related sclerosing cholecystitis from gallbladder cancer in cases involving localized thickening of the gallbladder wall. In similar cases, surgical resection with cancer in mind might be performed based on present clinical knowledge.

The ProGrip™ laparoscopic self-fixating mesh provides advantages such as low cost and reduced pain following tack-free fixation in laparoscopic hernia repair through a transabdominal preperitoneal approach. Obturator hernia repair needs adequate fixation around the hernial orifice without the use of tacking, and ProGrip™ mesh provides options for secure fixation. However, it is often difficult to adequately adjust the mesh placement to cover the obturator hernia orifice with a ProGrip™ mesh, due to adhesion of the grips to the surrounding tissues. We introduce our technique to avoid unintentional adhesion during ProGrip mesh repair and discuss its utility in the treatment of obturator hernias. We repaired seven obturator hernia lesions in five patients using this technique without any complications. The biggest advantage of our technique is that the position of the mesh can be adjusted after it is expanded, unless the sheet is completely removed, allowing the surgeons to fix the mesh without any unintended adhesion to surrounding tissue.

To compare the intraocular pressure (IOP)-lowering effects of ripasudil, a rho-kinase inhibitor, and selective laser trabeculoplasty (SLT) as adjuvant therapy in Japanese glaucoma patients and to identify the factors associated with treatment success. We performed a retrospective medical chart review of patients with glaucoma who received ripasudil or SLT as an adjuvant therapy. We collected data on 65 eyes (65 patients) with primary open-angle glaucoma, normal-tension glaucoma, or exfoliation glaucoma with at least 12 months of follow-up. IOP and number of glaucoma medications at 0, 1, 3, 6, 9, and 12 months were compared between and within groups. A repeated-measures mixed model was used to perform statistical analysis. We also investigated factors associated with treatment success, which was defined as ≥ 20% reduction in IOP at all follow-up periods, using univariate and multivariate logistic regression analysis. Significant IOP reduction was observed at all time-points after treatment in the ripasudil group (n = 33) and in the SLT group (n = 32), with no statistically significant difference between the groups before or after treatment. Patients in the SLT group used more anti-glaucoma medications before treatment, but fewer during follow-up, than those in the ripasudil group. Regardless of treatment, higher baseline IOP was associated with treatment success [crude odds ratio: 1.21 (95% confidence interval: 1.06–1.38), adjusted odds ratio: 1.37 (95% confidence interval: 1.06–1.77)]. Adjuvant SLT or ripasudil in patients with inadequately controlled glaucoma both reduced IOP to a similar degree, but SLT contributed to reducing the number of medications used.

To evaluate the association between vision-related quality of life (QoL), physical inactivity, and locomotor dysfunction in subjects with visual impairment.This cross-sectional study included 215 visually impaired subjects recruited from six ophthalmology departments in Japan. The physical inactivity and locomotor dysfunction associated with their visual impairment was investigated. The physical activity level was assessed using the short form of the International Physical Activity Questionnaire and classified as high, moderate, or low. Locomotor function was evaluated with the Geriatric Locomotive Function Scale. Vision-related QoL was evaluated using the 25-item National Eye Institute Visual Function Questionnaire. Background data, including for age, sex, best-corrected visual acuity for each eye, causative eye diseases, systemic comorbidities, and body mass index, were also collected.The average patient age was 69.6 (range, 20–93 years; standard deviation, 14.5 years) and 118 patients (54.9%) were men. Multivariate analysis showed that vision-related QoL and best-corrected visual acuity in the worse eye were significantly associated with physical inactivity and that vision-related QoL, female sex, age, and presence of systemic comorbidity were significantly associated with locomotor dysfunction. Vision-related quality of life is associated with physical inactivity and locomotor dysfunction.

Aim To investigate the association between the use of proton pump inhibitors (PPI) and nosocomial pneumonia and gastrointestinal bleeding in bedridden patients receiving tube feeding. Methods A total of 116 bedridden hospitalized patients receiving tube feeding, of which 80 were supported by percutaneous endoscopic gastrostomy and 36 by nasogastric tube, were included in the present study. The patients were divided into two groups: 62 patients treated with PPI (PPI group) and 54 patients without PPI (non-PPI group). Mortality due to nosocomial pneumonia was evaluated using the Kaplan-Meier approach and the log-rank test. Results A total of 36 patients (31%) died of nosocomial pneumonia during the observation period; the mortality rate due to nosocomial pneumonia was significantly higher in the PPI group than in the non-PPI group (P = 0.0395). Cox proportional hazard analysis showed that the use of PPI and lower levels of serum albumin were independent predictors of 2-year mortality due to nosocomial pneumonia. Gastrointestinal bleeding was observed in four patients in the non-PPI group (7.7%) and in one patient in the PPI group (1.6%); there was no significant difference between the two groups. Conclusion The use of PPI in bedridden tube-fed patients was independently associated with mortality due to nosocomial pneumonia, and the PPI group had a non-significant lower incidence of gastrointestinal bleeding than the non-PPI group. Geriatr Gerontol Int 2018; 18: 1215-1218.

Both esophageal rupture and esophageal cancer are life-threatening diseases. We report a case of esophageal cancer that occurred after esophageal rupture was treated with thoracoscopic and laparoscopic surgery. A 76-year-old man presented with vomiting followed by epigastric pain and was diagnosed with spontaneous esophageal rupture. Laparoscopic and thoracoscopic surgery were performed. Primary closure was completed with a fundic patch, and thoracic lavage was performed. Ten months later, his condition was diagnosed as squamous cell carcinoma of the abdominal esophagus. He underwent thoracoscopic esophageal resection in the prone position, and a gastric conduit was created laparoscopically. The pathological finding was superficial esophageal carcinoma without lymph node metastasis. The patient's postoperative course was uneventful, and there was no recurrence at 21 months of follow-up.

We report a case of painless thyroiditis that occurred during adjuvant chemotherapy for breast cancer. A 41-year-old woman was diagnosed with right breast cancer and underwent surgery followed by adjuvant chemotherapy, given the tumor size and relatively high ratio of Ki-67-positive cells. Three weeks after the first intravenous administration of fluorouracil (500 mg/m(2)), epirubicin (100 mg/m(2)), cyclophosphamide (500 mg/m(2)), and dexamethasone (6.6 mg/body), followed by 3 days of oral dexamethasone (8 mg/day), she complained of continued palpitations. Although Graves’ disease was initially suspected, she was diagnosed with painless thyroiditis because of a low free T3:free T4 ratio and low thyroid uptake of iodine. The mechanism of painless thyroiditis, in this case, remains unclear, although supposed etiologic event was the use of cytotoxic drugs (including fluorouracil) or the withdrawal of short-term steroid administration. Painless thyroiditis very rarely occurs during chemotherapy. However, we should consider painless thyroiditis when a patient undergoing cytotoxic chemotherapy for breast cancer experiences continued palpitations. The appropriate diagnosis and treatment of symptoms might avoid an unnecessary dose reduction or discontinuation of chemotherapy and, moreover, may prevent adverse effects associated with the metabolism of anticancer agents.

Cataract is the leading cause of blindness in the world. As the world's population ages, visual impairment due to cataract is on the increase. This is a significant global problem. The stimulating challenges are to prevent or delay cataract formation. The causes of cataract include age, hereditary factors, smoking, diabetes and ultraviolet (UV) exposure. There are some epidemiologic studies to investigate the relationship between alcohol drinking and cataract. However, the findings on the association between cataract and alcohol consumption are inconsistent. Although the pathophysiologic mechanisms between alcohol and cataract have not been adequately understood, there is some evidence to suggest the relation between alcohol and cataract. Information on a patient's drinking history can be valuable to general physicians when there is a diagnosis of cataract and should be collected on a routine basis.

The role of plasma levels of oxidized low density lipoprotein (OxLDL) in the development of coronary heart disease (CHD) has not been fully elucidated. We examined the relationship among plasma levels of OxLDL, measured by an enzyme immunoassay using an antibody against OxLDL (FOH1a/DLH3) and apolipoprotein B, CHD, and modalities at the onset of acute coronary syndrome (ACS). A total of 115 individuals who underwent coronary angiography were studied. Of these, 21 patients complicated with extracoronary cardiovascular diseases were excluded. Consequently, 94 patients (63 men) (ACS: 23, stable angina pectoris (SAP): 46, and normal coronary artery (NCA):25) were eligible for inclusion in the study. Elevated plasma levels of OxLDL were associated with CHD, especially with ACS. In patients with NCA, hypertension was associated with plasma OxLDL. Plasma levels of OxLDL were significantly higher in patients with new-onset type ACS than in those with worsening type ACS (2.98 versus 1.53 mg/dL, P = 0.002). In conclusion, plasma levels of OxLDL are associated with CHD and significantly higher in patients with new-onset ACS. The findings of the present study suggest that plasma OxLDL can be a marker of the development of CHD and modalities of ACS.

von Recklinghausen病 (VRD) に小腸GISTおよび褐色細胞腫を合併した症例を経験した. 症例は30歳時にVRDと診断された33歳, 女性. 顔色不良および腹痛を訴え産婦人科受診. CT上, 骨盤内に石灰化を伴う13cm大の腫瘍, 左副腎に3cm大の腫瘍を認めた. 精査にて骨盤内腫瘍はGISTの疑い, 左副腎腫瘍は褐色細胞腫と診断され, 当科へ転科後手術が施行された. 骨盤内の腫瘍は空腸が起始部であり, 小腸部分切除, さらに左副腎摘出術を施行した. 小腸腫瘍は病理学的に悪性GISTの診断, また副腎の褐色細胞腫にも悪性を示唆する所見を認めた. 術後1年現在再発を認めていない. VRDに合併した複数の悪性腫瘍の報告が散見され, 予後に関与する可能性があるため, 早期発見のための全身検索が重要であると考える.

症例は60歳, 男性. 平成6年に胃癌にて胃全摘, Roux-enY再建術を施行されている. 腹痛にて当院受診. 初診時所見が軽度であったため一時帰宅経過観察となったが, 症状が増悪し再受診. 精査の結果, 輸入脚の著明な拡張および, 胆管炎, 膵炎をきたしており, 輸入脚閉塞症と診断した. 上部消化管内視鏡検査にて内腔からの減圧は不可能と判断し, 緊急手術を施行した. 開腹すると輸入脚は吻合部の閉塞により著明な拡張をきたしていた. 狭窄した吻合部を含め輸入脚を約8cm切除し, 側々吻合にて輸入脚の再吻合を施行した. 術後は重症膵炎によるDIC, 急性循環不全, 急性呼吸不全を合併し, 人工呼吸器管理下に8日間の集中治療を要したが, 徐々に全身状態は改善し術後46日目に軽快退院となった.胃癌全摘後の輸入脚閉塞症は稀であるが, 発症後は早期に胆管炎, 膵炎を合併し, 治療の遅れは全身状態の重篤化につながる. 早期診断, 治療が必要な病態の1例としてここに報告する.

症例は61歳, 女性. 平成17年6月直腸癌に対し直腸高位前方切除を施行されている. 病理学的所見はRs, 3型, 43×50mm, 中分化型腺癌, SE, N2, H0, P0, M0, Stage IIIbであった. 術後7カ月目にCEA値が上昇したが, 腹部CTでは明らかな再発所見を認めなかった. 全身検索目的にFDG-PETを施行したところ右副腎に集積を認め, その後の腹部CTにて右副腎に約2.5cmの腫瘍を認めた. 血液生化学検査ではカテコラミン, 副腎皮質由来ホルモン活性値等は正常値を示し, 機能性副腎腫瘍は否定された. 以上より直腸癌孤立性副腎転移と診断し, 右副腎摘出術を施行した. 腫瘍は病理組織学的に直腸癌副腎転移と診断された. 術後CEA値は正常化した.大腸直腸癌孤立性副腎転移は稀であり, 特徴的臨床症状を呈さないことから, 早期に画像所見にて診断することは困難である. われわれはFDG-PETにて診断し, 外科的切除をしえた症例を経験したため報告する.

Purpose: An amino acid-containing elemental diet (ED) does not require digestion for nutritional absorption, making it a good option for patients with gastrointestinal malabsorption. We conducted a randomized trial to confirm that perioperative ED enhanced the recovery of patients undergoing laparoscopic colectomy. Methods: Patients in the intervention arm received commercially available ED from the day prior to surgery until postoperative day (POD) 3, whereas patients in the control group received a conventional perioperative diet program. To verify the endpoints, "estimated minimum length of stay in hospital after surgery" (emLOS) was defined as the number of days necessary to reach all the five criteria; namely, "sufficient oral intake", "sufficient pain control", "withdrawal of intravenous alimentation", "no abnormal findings in routine examinations", and "no rise in fever". Results: A total of 102 patients were randomized, 94 of whom were analyzed (ED 45, control 49). There was no morbidity or mortality. Shorter emLOS (POD 4 vs. POD 7; p = 0.018), earlier resumption of sufficient oral intake (POD 3 vs. POD 4; p = 0.034) and faster recovery to defecation (2.2 vs. 3.1 days; p = 0.005) were observed in the ED group vs. the control group. Conclusions: The perioperative ingestion of ED by patients undergoing laparoscopic colectomy is safe and can reduce the postoperative hospital stay by supporting the acceleration of oral intake.

A 37-year-old man with beta-thalassemia intermedia (betaTI), a rare disease caused by partial or complete deficiency of beta-globin chain synthesis, fell into a hemolytic crisis. Severe anemia persisted despite frequent transfusions. Therefore, he was scheduled for splenectomy to alleviate the anemia. The preoperative laboratory data showed marked anemia and liver dysfunction. Echocardiography revealed hyperkinetic left ventricular motion and increased cardiac index (CI), indicating a compensatory hyperdynamic circulation induced by persistent, severe anemia. Our strategy during general anesthesia was to keep the hyperkinetic cardiovascular system steady. Hence, the hemodynamic parameters including the CI were measured using a Swan-Ganz catheter, and other physiological parameters were monitored perioperatively. Anesthesia was maintained with balanced anesthesia: isoflurane at low concentrations and fentanyl to avoid cardiovascular depression. Throughout the operation, vital signs were kept stable and the lactate/pyruvate ratio was unchanged, indicating that anaerobic metabolism did not increase. We report successful anesthetic management with attention to hemodynamic changes in a patient with betaTI.

症例は64歳,男性.約30年前にvon Recklinghausen病と診断された.平成14年6月16日,左側胸部から背部にかけての激痛を訴え当院に搬送された.胸部X線で左肺に胸水および左第6～8肋間に病的骨変形を,胸部CTにて肋間動脈の出血像を認めたため,緊急手術を施行した.第7肋骨床を開胸すると,胸腔内に約3,200mlの出血を認めた.原因は第6肋間神経の神経鞘腫からの動脈性出血であった.その他,第7肋間にも多数の神経鞘腫を認めたが,腫瘍全体の摘出は困難であり,第6肋間の腫瘍を可及的に摘出し,肋間動静脈・肋間神経を結紮した. von Recklinghausen病は3,000人に1人と常染色体優性遺伝疾患としては最も多いものの一つであるが,血胸を合併した症例はわれわれの調べ得た限りでは本邦で10例報告されているのみである.そのうち5例は死の転帰をとっており,迅速な診断と手術が必要と考える.

Open-angle glaucoma associated with severe atopic dermatitis (atopic glaucoma) tends to be severe and difficult to treat because of ocular surface/eye lid inflammation. To determine the validity of regarding atopic glaucoma as a clinical entity, we carried out retrospective analysis and pathologic investigations.Forty-five cases (62 eyes) of atopic glaucoma were reviewed retrospectively. During surgical treatment, aqueous humor and trabeculectomy specimens were obtained. The aqueous humor samples were analyzed by multiplex cytokine assay. The surgical specimens were analyzed histologically.Atopic glaucoma was often associated with atopic cataracts (43 eyes) and retinal detachments (19 eyes). A history of glucocorticoid medications was absent in 12 cases. A total of 50 eyes required surgical interventions because of advanced visual field defects and/or high intraocular pressures. Bleb-associated postsurgical infections were observed in 7 eyes. Elevated levels of inflammatory cytokines (IL-8 and CCL2) were observed in the aqueous humor samples obtained from atopic glaucoma patients compared with those from senile cataract patients. Ultrastructural analysis of trabecular meshwork tissues obtained from atopic glaucoma patients showed abnormal accumulation of 10 to 30 nm fibers in the corneoscleral meshwork.We would like to propose atopic glaucoma as a new clinical entity, ranging from pure atopic glaucoma to a mixed type of atopic/steroid-induced glaucoma that should be considered as one of the clinical features of atopic ocular complications.

Background: We have performed total pharyngolaryngoesophagectomy in case of double cancer, head–neck and thoracic esophageal cancer, or cervical esophageal cancer that extended down to the level of aortic arch. The procedure is very challenging. Methods: From April 1984 to May 1998, 14 patients underwent the procedures for double cancer of head–neck and thoracic esophagus (n=10), hypopharyngeal or cervical esophageal cancer (n=3), and synchronous esophageal cancer (n=1). The grafts used were whole stomach (n=6), elongated stomach roll (n=5), and stomach roll with free jejunum (n=3). The routes of reconstruction were posterior mediastinum (n=10), antesternal (n=3), and retrosternal (n=1). Results: Elongated stomach roll with microvascular anastomoses was long enough for reconstruction and the blood supply of the graft was sufficient. There was no fatal complication in this procedure. Oral feeding was achieved in 13 (93%) patients. Conclusions: The elongated stomach roll with microvascular anastomosis is efficient and the placement of the conduit in the posterior mediastinum is recommended to allow a better alimentary comfort in total pharyngolaryngoesophagectomy.

Recent experience with 4 cases of adult intussusception is described with a review of the literature. Case 1: A 79-year-old man was admitted to the hospital because of a right under abdominal pain and diarrhea. Barium enema, abdominal ultrasonography and CT indicated an intussusception at the ileocecal region. On laparotomy, intussusception extending to the ascending colon was noticed, and right hemicolectomy was carried out. The leading point was the ileum, which was 14cm oral side from the terminal ileum. There was no tumor in this area. Case 2: A 33-year-old woman had an ileocecal intussusce-ption due to a cecal malignant lymphoma, and underwent right hemicolectomy. Case 3: A 52-year-old man had a colonic intussusception due to a cancer of the ascending colon, and underwent right hemicolectomy. Case 4: A 63-year-old man had a colonic intussusception due to a rectal cancer, and underwent low anterior resection.

Takatoshi Tano1, Yoshimune Hiratsuka2, Koichi Ono1, Akira Murakami11Department of Ophthalmology, Juntendo University School of Medicine, Tokyo; 2National Institute of Public Health, Tokyo, JapanPurpose: To investigate the impact of cataract surgery and blood pressure changes induced by one week of sodium restriction on retinal vascular diameter.Methods: Fundus photographs of 200 patients were obtained before and one week after cataract surgery. For one week after admission, 100 patients received sodium restriction and 100 patients (ie, the control group) did not receive sodium restriction. The diameter of the retinal vessels and blood pressure were compared between the sodium restriction group and the control group. The vascular diameter was measured using an objective computer-based method.Results: Neither group had a significant change in the diameter of the retinal vessels after cataract surgery. Although there was no significant change in retinal arterial and venular diameter in the sodium restriction group, one-week sodium restriction significantly reduced mean blood pressure. However, multiple linear regression analyses indicated that an increase in retinal arteriolar diameter was significantly associated with diabetes, hyperlipidemia, and alcohol intake.Conclusion: Cataract surgery and blood pressure reduction induced by one week of sodium restriction resulted in no significant change in retinal arteriolar diameter.Keywords: cataract surgery, hypertension, retinal blood vessel diameter, retinal fundus camera, sodium restriction.

Objectives. We assessed global inequality in eye health by using data on the global burden of disease measured in disability-adjusted life years (DALYs). Methods. We estimated the burden of eye disease by calculating the sum of DALYs (from the Global Burden of Disease study, 2004 update) due to trachoma, vitamin A deficiency, glaucoma, cataract, refractive errors, and macular degeneration. We assessed the geographic distribution of eye disease in relation to economic status and etiology by calculating the Gini coefficient, the Theil index, and the Atkinson index. Results. The global burden of eye disease was estimated at 61.4 million DALYs worldwide (4.0% of total DALYs). Vitamin A deficiency and trachoma were distributed more unevenly than were noncommunicable eye diseases, regardless of economic status. For noncommunicable eye diseases, the major contributor was refractive errors, regardless of economic status. The most uneven distribution was observed for cataract (high-income countries) and refractive errors (middle- and low-income countries). Conclusions. Creating new eye health service for refractive errors and reducing the unacceptable eye health disparity in refractive errors should be the highest priorities for international public health services in eye care and eye health.

Background Small bowel obstruction (SBO) after abdominal surgery is usually treated successfully with intestinal decompression using a long nasointestinal tube (LT), but some cases fail to respond. Methods Clinical background and laboratory data on admission were evaluated retrospectively for 53 patients with adhesive SBO to determine predictive factors for failure of LT decompression, and the appropriate timing of laparotomy was investigated. Results Complete SBO (no evidence of air within the large bowel) and increased serum creatine phosphokinase (≥130 IU/L) were independent predictive factors for LT decompression failure. Laparotomy was indicated in 14 patients (9 and 5 with complete and partial SBO, respectively), whereas successful LT decompression occurred in 39 patients (9 and 30, respectively). Resolution of SBO took significantly longer for complete SBO (6.3 days) than for partial SBO (2.6 days). Conclusions Patients with complete SBO or high serum creatine phosphokinase (CPK) may not respond to LT decompression. Laparotomy is appropriate after non-response for 7 and 3 days for complete and partial SBO, respectively.

Goblet cell carcinoid of the appendix is a rare clinical entity exhibiting features of both carcinoid and adenocarcinoma. Here, we present the first report of laparoscopic 2-stage surgery for goblet cell carcinoid with a review of the Japanese literature. A 49-year-old man underwent laparoscopic appendectomy under the diagnosis of acute appendicitis. A pathologic diagnosis of goblet cell carcinoid, accompanied by the aggressive proliferation, with acute appendicitis was made. Subsequent laparoscopic ileocecal resection was performed, and it was verified that there were neither residual tumor nor lymph node metastases. The postoperative course was uneventful. Because goblet cell carcinoid may be difficult to clinically distinguish from acute appendicitis, pathologic examination is essential. Depending upon the grade of tumor proliferation, additional resection should be considered, and our experience with this case suggests that laparoscopic 2-stage surgery is feasible for the adequate treatment of goblet cell carcinoid without complications.

Background Lymph node metastasis is the most important prognostic factor for colon cancer patients. Survival is also related to the number and level of positive lymph nodes (PLNs). Definitions of degree of PLNs for colon cancer differ greatly between the number and level of PLNs. Study design The aim of this study is to compare number and level of PLNs to see which is a better predictor of prognosis for node-positive colon cancer. One hundred eighteen patients underwent histologically curative resection for node-positive colon cancer. We calculated the cumulative 5-year survival rates and examined prognostic factors for multivariate analysis based on the number and level of PLNs and additional factors. The number of PLNs was classified as either one to three PLNs or more than four PLNs, and level of PLNs was classified as either Level I (pericolic lymph node metastasis) or Level II (lymph node metastasis along the major named vessel supplying the tumor, and that around the origin of a main artery). Results Cumulative 5-year survival rates were statistically different between the 1 to 3 PLNs group and the more than 4 PLNs group, but not significantly different between Level I group and Level II group. Multivariate analysis showed that number, not level, of PLNs was an independent prognostic factor. Conclusions In node-positive colon cancer, number of PLNs predicted prognosis better than level of PLNs.

A 59-year-old man with amyotrophic lateral sclerosis (ALS) received lumbar epidural and sympathetic ganglion blocks to increase regional blood flow and improve his clinical symptoms. After a lumbar epidural block (0.5% mepivacaine), the skin temperature of his affected lower extremities rose by 7.0 degrees C and became close to that of the intact side, and the distance he was able to walk with his cane increased from 2 to 8 m. The clinical effects produced by the lumbar sympathetic ganglion block (99.5% alcohol) were sustained for approximately 8 weeks after the first block and for approximately 6 weeks after the second block. There were no particular adverse effects or complications associated with these nerve block procedures. Epidural and sympathetic ganglion blocks for an ALS patient, albeit their effects are of a transient nature, may improve related clinical symptoms, and were thought to play a contributory role in improving our patient's quality of life.

CYFRA 21-1, a soluble fragment of cytokeratin 19, is increased in serum in some patients with hepatocellular carcinoma, but the clinical significance of this increase is still unknown.Serum concentrations of CYFRA 21-1 were measured in 240 patients with hepatocellular carcinoma prior to hepatic resection. The relationships between serum CYFRA 21-1 concentrations and clinicopathologic features were analyzed.The sensitivity of CYFRA 21-1 as a test for hepatocellular carcinoma was 18.8%. Serum CYFRA 21-1 was significantly higher in patients with portal vein tumor thrombus, and serum CYFRA 21-1 increased with the progression of portal vein tumor thrombus. Tumor size was related to serum CYFRA 21-1, but there were no significant correlations between serum CYFRA 21-1 concentrations and tumor differentiation or number of tumors. Although patients with stage IV tumor had significantly higher CYFRA 21-1 concentrations than those with stages I, II, and III, CYFRA 21-1 was not associated with postoperative prognosis.Although high concentrations of CYFRA 21-1 were often detected in patients with a tumor diameter greater than 5 cm or tumor thrombus in the major portal vein, CYFRA 21-1 is not a useful diagnostic tool for hepatocellular carcinoma because of its low sensitivity.

Objective: Increased low-density lipoprotein (LDL) glycation in diabetics could facilitate LDL oxidation, which is proatherogenic. I studied plasma oxidized LDL (OxLDL) levels in diabetics and non-diabetics, their relation to glycemic control, and their circadian variations. Methods: OxLDL in diabetics (n=32) and in non-diabetics without coronary artery diseases (n=20) were compared. OxLDL in diabetics (n=24) was measured on Days 2, 3, 4, 8 and the last day of hospitalization. Circadian variation in OxLDL in diabetics (n=18) was also examined. Glycemic control was implemented during hospitalization. Patients: The diabetics were divided into two groups; moderately-controlled (MC) group (HbA1c < 9.0% at admission, n = 15) and poorly-controlled (PC) group (HbA1c ≧ 9.0% at admission, n = 9). Results： In the MC group, OxLDL decreased by 20.8% after glycemic control (p = 0.0139), but not in the PC group. OxLDL is correlated with LDL on Days 3, 4, 8 (r = 0.837, 0.864, 0.801, respectively), TG on Day 8(r = 0.932), and Lp(a) at discharge (r = 0.871). In the PC group, OxLDL was 15.8% higher on the average in the daytime than at night (p = 0.0024). Conclusion： Plasma OxLDL is decreased by glycemic control, particularly in moderately glycemic controlled patients. OxLDL has a circadian variation, particularly in poorly glycemic controlled patients. Long-term glycemic control could reduce the progression of atherosclerosis, by reducing OxLDL levels.

We report herein the rare case of a 33-year-old man found to have a multiple endocrine neoplasia type 1 (MEN1)-associated carcinoid tumor in the thymus. A chest roentgenogram demonstrated an asymptomatic anterior mediastinal mass, 7 cm in diameter, and ultrasound-guided percutaneous Tru-Cut biopsy revealed a carcinoid tumor of the thymus. An extended thymectomy was performed through a median sternotomy and pathological examination confirmed the diagnosis of a thymic carcinoid tumor, which was mainly encapsulated with locally invasive growth into the pleura. Despite the absence of a family history of MEN1, he was treated for two pancreatic islet cell tumors, hyperparathyroidism, an adrenal tumor, and a retroperitoneal lipoma. MEN1 mutations were detected both in blood samples and pancreatic tumor tissues. He is now well without any evidence of tumor recurrence 27 months after the operation for the thymic carcinoid. MEN1 mutations were screened by direct nucleotide sequencing of all protein-coding regions of exons 2–10 of the MEN1 gene. Heterozygous germline mutation was detected in the blood sample analyses. Moreover, fresh-frozen pancreatic tumor tissues showed a loss of heterozygosity in the MEN1 region.

Chick embryo fibroblasts and chorioallantoic membranes infected with fowlpox virus (FWPV) or pigeonpox virus (PPV) were examined by transmission and scanning electron microscopy. Immature virus particles were observed in finely granular areas, i.e. virus factories, of the cytoplasm. These particles had various forms depending on their stages of development. Many tubular structures were also seen in these regions. Mature virus particles with ellipsoidal or brick-shaped forms enclosing electron-dense cores were detected throughout the cytoplasm. Notably, there was a high frequency of virus budding at the cell surface, but only occasional virus wrapping in the cytoplasm. Another remarkable feature of the infected cells was accumulation of many virions just beneath the plasma membrane, indicating that this phenomenon is closely related to virus budding. Based on the observed frequency of budding, this mechanism seems to be the predominant way for FWPV and PPV to exit the cell.

BACKGROUND Directional coronary atherectomy (DCA) and balloon angioplasty (percutaneous transluminal coronary angioplasty, PTCA) differ in their method of dilating stenotic vessels. It is not known whether there is any morphologic difference between restenotic lesions that occur after DCA and those occurring after PTCA. METHODS To evaluate histopathologic differences between restenotic lesions after DCA or PTCA, we reviewed coronary atherectomy specimens excised from 37 patients with stable angina. Patients were classified into three groups: those with restenotic lesions after DCA (n = 8), those with restenotic lesions after PTCA (n = 14), and those with primary lesions (n = 15). Specimens were analyzed immunohistochemically using monoclonal antibodies specific for smooth muscle cells (HHF35), endothelial cells (CD31), macrophage-derived foam cells (CD6B) and cell replication activity (Ki-67). In seven patients undergoing repeat DCA, de novo plaques and restenotic plaques were compared. RESULTS Stellate smooth muscle cell (S-SMC) content in restenotic lesions after DCA (87%) was significantly greater than that in primary lesions (40%; P = 0.032) and that in restenotic lesions after PTCA (43%; P = 0.045). Foam cells tended to be more prevalent in primary lesions (67%) than in restenotic lesions after DCA (25%; P = 0.062) or after PTCA (36%; P = 0.10). Restenotic lesions after DCA had more S-SMC proliferation and fewer foam cells than did primary lesions. There were no differences in the presence of thrombus, calcification, cholesterin, hemosiderin, the percentage of HHF35-positive cells or Ki-67-positive cells, or neovascularization among the three groups. CONCLUSIONS Smooth muscle cell proliferation may have an important role in the development of restenosis after DCA. Fewer foam cells are present in restenotic lesions after DCA or PTCA than are present in primary lesions.

A 79-year-old female patient was placed with diagnosis of idiopathic trigeminal neuralgia. On oral carbamazepine and right mental nerve block with lidocaine and alcohol were given for about 8 years from July 1975, and as the result the pain was abolished. But in September 1983, the pain recurred, and subsequently eating became difficult. During the attack of the pain, right facial clonic muscle spasm was observed, and dysacousia was shown by audiogram. Intracranial tumor was suspected, and CT scanner disclosed the presence of tumor in the right cerebellopontile angle. In October, the tumor was removed at the Department of Cerebral Surgery of our University Hospitad and pathological examination gave the diagnosis of psammoma meningioma. After the operation, the pain disappeared, and now at 2 1/4 postoperative years, she shows favorable prognosis.Since trigeminal neuralgia of unknown cause may sometimes be ascribable, like in the present case, to tumor near semilunar ganglion, it will be necessary to examine by CT scan and symptoms derived from the 7th and 8th cerebral nerves which are adjacent to trigeminal nerve.