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Leptospirosis remains a major public health threat in Cambodia. In this study, we aimed at facilitating the development of preventive strategies against leptospirosis in Cambodia by conducting molecular epidemiological surveys of Leptospira infection among wild rodents.One hundred sixty-three wild rodents were captured in the capital Phnom Penh and surrounding areas, and their kidneys and bladders were collected for analysis. Identification of wild rodent species was determined by using the cytochrome c oxidase I gene. TaqMan PCR of the flagellin B gene (flaB) was performed to detect Leptospira, and species of the isolates were identified by flaB sequencing analysis.The species and respective number of rodents collected were as follows: Rattus norvegicus, 80 (49.1%); Rattus argentiventer, 53 (32.5%); Rattus exulans, 6 (3.7%); Rattus indica, 15 (9.2%); Maxomys surifer, 3 (1.8%); and Rattus sp., 6 (3.7%). Leptospira was detected in 20 out of the 163 rodents (12.3%) and was categorized as either Leptospira interrogans or Leptospira noguchii. R. norvegicus had the highest prevalence of Leptospira (17.5%), and R. argentiventer and Rattus sp. showed infection rates of 9.4% and 16.7%, respectively.Based on these results, wild rodents living in urban areas of Cambodia were found to be important reservoirs of highly virulent Leptospira. The flaB sequence results of our study provided information regarding the prevalence of Leptospira species, which was dependent on the rodent species. This study is the first study on leptospirosis in wild rodents in the urban areas of Cambodia, where there is limited information on leptospirosis.

Rapid response systems (RRS) have been introduced worldwide to reduce unpredicted in-hospital cardiac arrest (IHCA) and in-hospital mortality. The role of advance care planning (ACP) in the management of critical patients has not yet been fully determined in Japan.We retrospectively assessed the characteristics of all inpatients with unpredicted IHCA in our hospital between 2016 and 2018. Yearly changes in the number of RRS activations and the incidence of unpredicted IHCA with or without code status discussion were evaluated from 2014 to 2018. Hospital standardized mortality ratios were assessed from the data reported in the annual reports by the National Hospital Organization.A total of 81 patients (age: 70.9 ± 13.3 years) suffered an unpredicted IHCA and had multiple background diseases, including heart disease (75.3%), chronic kidney disease (25.9%), and postoperative status (cardiovascular surgery, 18.5%). Most of the patients manifested non-shockable rhythms (69.1%); survival to hospital discharge rate was markedly lower than that with shockable rhythms (26.8% vs 72.0%, P

Objective: To analyze maternal death cases and their risk factors at the top referral hospital in Cambodia in order to develop appropriate strategies to reduce the maternal mortality ratio (MMR) in Cambodia. Methods: A total of 47 maternal deaths among 6089 delivery cases were analyzed retrospectively through patient documents. Results: The MMR in the top referral hospital was 785 per 100 000 live births. Three main direct causes of maternal mortality were hemorrhage, infection and hypertensive disorders. Risk factors for maternal death were age (older than 35 years), parity (four or more), no antenatal care attendance and residence in the provinces. The major characteristic of cases of maternal death was delayed arrival at the referral hospital. Conclusions: Necessary strategies to reduce MMR are: (i) to avoid delayed arrival at the referral hospital (i.e. health promotion for awareness in the community, risk detection and early transfer by skilled personnel after competency based training); and (ii) provision of adequate health-care facilities in the country with human resources and materials, including blood transfusion.

We examined the prevalence of anti-nuclear antibodies (ANA) in 32 consecutive patients with premature ovarian failure with and without chromosomal abnormalities. Blood samples were taken for karyotype determination as well as detection of autoantibodies, X-terminal microdeletions and spontaneous follicular growth. The correlation between ANA positivity and the age at onset of amenorrhoea, as well as the presence of karyotype abnormalities, X-terminal microdeletions and follicular growth was determined. Ten of the 24 patients with normal karyotype and none of the 8 patients with karyotype abnormalities were ANA positive. ANA were found more frequently in patients with premature ovarian failure with normal karyotypes than in control amenorrhoeic patients (42 versus 6, P < 0.01). ANA were found in 77% (10/13) of premature ovarian failure patients with normal karyotypes who developed amenorrhoea at or under the age of 30 years, but not in the patients who developed amenorrhoea later in life. Follicular growth was evident in 50% (5/10) of karyotypically normal patients with ANA, 71% (10/14) of karyotypically normal patients without ANA and 38% (3/8) of patients with karyotype abnormalities. X-terminal microdeletions were not found in any of the patients studied. These results suggest that patients with premature ovarian failure and ANA are an aetiologically and clinically distinct group.

Objective: To report successful ovulation induction in a woman with premature ovarian failure (POF) resulting from a partial Xq deletion. Design: An uncontrolled study. Setting: University hospital. Patient(s): A 27-year-old woman with 46,X,del(X)(q22) who had hypergonadotropic secondary amenorrhea. Intervention(s): Injections of hMG (225 IU/d) for 8 consecutive days after endogenous gonadotropin suppression with a long-acting GnRH agonist (900 μg/d) for 12 weeks, together with cyclic sex steroid replacement therapy. Main Outcome Measures: Serum concentrations of E 2 and P as well as ultrasonography. Result(s): Folliculogenesis and ovulation. Conclusion(s): Ovulation induction is possible in patients with POF caused by X chromosome aberrations.

50歳の男性の皮膚筋炎に合併した肝細胞癌の1例を報告した。4∼7時間の日光暴露後に露光部に紅斑を認め全身倦怠感が出現した。筋原性酵素の上昇を認め, 皮膚·筋生検は典型的な皮膚筋炎の所見を呈した。入院後プレドニゾロン70mg/日より開始し漸減。3ヵ月後にプレドニゾロン35mgにて退院。しかし血沈は中等度亢進したままであり5ヵ月後高熱のため再入院となった。腹部CTにて肝実質にlow density areaを多数認め肝生検により肝癌と診断した。発症8ヵ月後に多臓器不全にて死亡。剖検では骨髄·胃·心など多臓器の転移が認められた。RT-PCR法により肝及び初回入院時の患者血清よりHCVが検出された。皮膚筋炎と悪性腫瘍の合併については多くの報告があるが肝癌との合併はまれである。両疾患の関連について皮膚筋炎の再燃が腫瘍の進展と平行して生じたことからHCV感染が肝細胞癌を惹起しウイルス及び腫瘍抗原が皮膚筋炎を誘発したのではないかと推測した。

8ヵ月の女児(体重8.9kg)。生後1ヵ月ごろより右頬部に海綿状血管腫があった。同部が急速に腫脹し, また血小板数10000/mm3を指摘され, 緊急入院となった。入院時, 右頬部全体が腫脹し境界明瞭な暗赤褐色斑に加え, 点状出血と皮下硬結を認めた。MRではT1強調で皮下に帯状に低信号域を, T2強調で高信号域をみた。以上よりKasabach-Merritt症候群の中期∼極期と診断した。入院翌日には血小板数が7000/mm3まで低下したため, ベタメサゾン3mg/day(0.34mg/kg/day)内服を開始したところ, その直後より腫脹は著明に改善し, 6日後(ベタメサゾン総投与量15mg)には血小板数は正常化した。その後血小板数と皮疹を指標として, ベタメサゾンを漸次減量し, 約7ヵ月後(ベタメサゾン総投与量91.2mg)に中止したが, 以後再発はみられていない。軽度の高血圧以外には副作用は認められなかった。Kasabach-Merritt症候群における副腎皮質ステロイド全身投与の有用性について報告した。

Objective: The aim of this study was to determine whether self-assessed health changed over the last decade in association with menopausal symptoms among community-dwelling Japanese women. Methods: Cross-sectional surveys of 50-year-old women living in Northern Kawasaki were conducted in 1998 (n = 1,492) and 2008 (n = 1,274). Data obtained from a questionnaire were self-assessed health, menopause awareness, 1-year recall of 10 subjective symptoms (Simplified Menopausal Index), and sociodemographic, lifestyle, and health characteristics. The prevalence of poor self-assessed health, menopause awareness, and subjective symptoms was compared between the surveys. Results: The percentage of premenopausal women increased from 51.7% in the 1998 survey to 64.8% in the 2008 survey (P < 0.001). The prevalence of menopause awareness decreased from 36.8% in the 1998 survey to 31.7% in the 2008 survey (P = 0.006). The prevalence of poor self-assessed health decreased from 13.9% in the 1998 survey to 10.8% in the 2008 survey (P = 0.013). Multiple logistic regression analysis showed that participants of the 2008 survey had a significantly lower risk for having poor self-assessed health than did participants of the 1998 survey. Menopause awareness, comorbidity, and body mass index of 18.5 kg/m 2 or lower or 25.0 kg/m 2 or greater were significantly associated with increased risk for having poor self-assessed health. The impact of menopause awareness on self-assessed health was 2.2 to 2.4 times greater in participants without comorbidity than in those with comorbidity. Conclusions: There was a significant improvement in self-assessed health in parallel with a significant downward secular trend in the prevalence of menopause awareness among community-dwelling Japanese women. Women who felt themselves affected by menopause tended to perceive their own health as poor.

Objectives To determine the prevalence and characteristics of climacteric symptoms and related factors among 50-year-old Japanese women. Methods A self-administered questionnaire was mailed to all 50-year-old women ( n = 3166) in three northern wards of Kawasaki City regarding 10 menopausal symptoms (hot flashes, sweats, insomnia, depression, palpitation, chills, irritation, headache, fatigue, and stiff shoulders) as well as demographic, lifestyle, psychological, socio-economic and physical factors. The questionnaire included closed-ended questions about symptoms over a 1-year recall time frame. The response rate was 55%, and women with current illness, a history of gynecological or endocrinological disorders and those on HRT were eliminated. We finally analyzed data from 1169 (37%) women. Results The prevalence of hot flashes was 36.9%. These, together with sweats, insomnia and depression, were associated with menstrual status. All four symptoms were also associated with lifestyle and socio-psychological factors. Psychological stress (unease or anxiety) was associated with all 10 symptoms investigated. The two most prevalent symptoms, namely, fatigue (64.7%) and stiff shoulders (75.4%) were associated with psychological and lifestyle factors. Conclusions Hot flashes were experienced by more women in the present community-based study than in most previous studies of Japanese women. We found that hot flashes (‘hoteri’ in Japanese) are related to menstrual status. Symptoms both related and unrelated to menstrual status were associated with lifestyle, psychological factors and BMI.

Study Objective: To compare adrenergic-sympathetic responses during pelvic laparoscopic surgery with CO 2 insufflation0259 0201 with those during laparotomy. Design. Propective study (Canadian Task Force classification II-1). Setting. Tertiary care university hospital. Patients. Twenty-one infertile women with a clinical diagnosis of endometriosis. Interventions. Plasma norepinephrine (NE) and epinephrine (E) levels were measured in patients undergoing laparoscopic or open pelvic surgery. Measurements and Main Results. During laparoscopic surgery, increases in NE and E levels were correlated with arterial tension of CO 2 (PaCO 2 ) and were greater in patients with a larger increase in PaCO 2 than in those undergoing laparotomy. Hemodynamic changes were also more evident during laparoscopic surgery, with larger PaCO 2 increases. Conclusions. The PaCO 2 increases due to CO 2 insufflation are associated with adrenergic-sympathetic activation and hemodynamic changes during laparoscopic pelvic surgery.

BACKGROUND Malignant skin tumors rarely spread along nerves. Complete resection of involved nerves is often unsuccessful. OBJECTIVE In the treatment of tumors with perineural invasion, surgeons should accurately estimate the extent of distant spread. METHODS We report six cases of skin cancers, including two basal cell carcinomas, two squamous cell carcinomas, and two neurotropic malignant melanomas, that invaded nerve or perineural spaces. RESULTS In three of the cases, the tumors developed on the face and involved the infraorbital nerves or its branches. Two patients suffered from tumors on aid burn scars of lower legs. Branches of posttibal nerves were involved in both cases. In the last case, tumor invasion of a branch of the greater occipital nerve was detected. CONCLUSION The extent of surgical excision should include the area of skin supplied by the affected nerve, which must be resected in continuity.

We report a 48-year-old woman who developed necrotizing groin fasciitis with insidious onset. Before she visited us, she had been unsuccessfully treated with several kinds of antibiotics by other doctors for one month, because of a small ulcer covered by blackish necrotic tissue. She was referred to us because of high fever, an ulcer on the left labium majus, and a cellulitis-like lesion with severe pain on the lower abdomen. Methicillin-resistant Staphylococcus aureus (MRSA), Streptococcus intermedius, and Bacteroides uniformis were isolated from the wound. After aggressive debridement on the eighth day after admission of the whole indurated area and the fascia of the underlying muscle, healthy granulation tissue covered the defect, and the wound was finally closed with a skin graft Long-term administration of antibiotics along with insufficient and delayed surgical treatment were considered to have caused the full development of this disease.

3歳8ヵ月男児の神経節芽細胞腫と, 16歳男性の神経節細胞腫の2症例を経験した.2例とも術中細胞診で正診できた.これらの腫瘍は, 非クローム親和性の交感神経系腫瘍で, 成熟型が神経節細胞腫, 末熟型が神経芽細胞腫で, その中間型が神経節芽細胞腫であり, 縦隔や後腹膜に発生することが多い.神経節芽細胞腫の塗抹細胞所見の特徴は, 紡錘形のシュワン細胞の間に, 散在性に神経節細胞が認められ, さらに神経芽細胞も存在することである.神経節細胞は, 大型多辺形で細胞質が豊富で, 時に突起や胞体内に顆粒を持ち, 核は大型で, クロマチンは細顆粒状均等分布で, 核小体は1個で著明である.神経芽細胞は, 小型楕円形で細胞質は少なく, 核は濃染し, 核小体は1～2個認められる.神経節細胞腫の特徴は, シュワン細胞と神経節細胞が認められるが, 神経芽細胞が存在しないことである.近年, 術中細胞診や超音波誘導下穿刺細胞診が盛んになってきたので, 今後交感神経系腫瘍に遭遇する機会が多くなるものと推定されるが, 上述の特徴的な細胞像より, 本腫瘍の細胞診断は可能と思われる.

高分化肝細胞癌 (HCC) と肝硬変症 (LC) の細胞診による鑑別診断は, ときに困難な場合がある.そこで, これらの鑑別にどのような細胞所見が重要かを知る目的で, 病理組織学的に確認された, HCC7例とLC8例の圧挫塗抹標本について, 各症例100個の細胞を油浸1,000倍の拡大率で観察計測し, 比較検討した.その結果,(1) N/C比の増大と核の濃染は0.1%以下, クロマチンの不均一分布は1%以下の危険率でHCCに有意に多く, これらの所見は両群間で最も大きな差がみられた.(2) HCCでは, 核の長径は大きく, 細胞の長径, 短径, 面積は小さく, 粗顆粒状クロマチンが多く, 胞体内空胞は少なく, これらの所見は5%以下の危険率で有意差が認められた.(3) HCCでは, 核の短径, 面積, それらの標準偏差, 核小体の長径と個数, 高度の核形不整, 胞体内顆粒性の低下, 核内封入体は, 大きいかあるいは多く, また, 明瞭な胆汁色素, 2核細胞の頻度は, 少ない傾向がみられたが, これらの所見には有意差がなかった.(4) 核縁の肥厚は両群間に全く差がなかった.以上の結果より, 高分化肝細胞癌と肝硬変症の細胞診による鑑別診断には, N/C比, 核染色性, クロマチン分布が最も重要である.