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Background:Human parvovirus B19(HPVB19) is a member of the largeParvoviridaefamily and, as a human pathogen, is responsible for various diseases.1)In children, HPVB19 infections usually presents as red rash, which is often described as a“slapped cheek.” However, the presentation varies in adults.2)HPVB19 outbreaks mostly occur in the winter and spring.1)The serum IgM test is the preferred means for diagnosing acute HPVB19 infections.2)Objectives:We investigated the epidemiology, clinical symptoms, and time course of HPVB19 infections in real-world practice by examining patients treated at a community hospital in Japan.Methods:We studied adult patients with HPVB19 infections at Suwa Central Hosptial from April 2010 to November2019. Patients who were age 18 years or older, anti HPV B19 IgM antibody-positive, and symptomatic were included. We retrospectively examined the patients’ medical records to determine onset days, clinical symptoms and antinuclear antibody(ANA)-postitive rates. We defiend day 1 as the day when clinical symptoms first appeared.Results:53 patients were included in the study. Patient characteritistics were mean age 43 years, female 79.2%, mean period from onset to diagnosis 13days. Epidemic season were 4year cycle. (Figure 1) Clinical symptoms and time course from onset day were upper respiratory symptoms(17.0%, 1.7days), fever(54.7%, 1.9days), abdominal symptoms(15.1%, 4.4days), edema(47.2%, 5.6days), arthralgia(71.7%, 6.6days), itching(15.1%, 6.9days), rash(62.3%, 8.9days) and lymphoadenopathy(30.2%, 10.2days). (Figure 2) ANA positive rate was 50%(13/26) and average was 92.3.Conclusion:53 adult patients infected HPVB19 in 10 years at community hospital in Japan. Epidemic season were 4year cycle and skin eruption and joint symptoms appeared 4-5 days after upper respiratory symptoms. Previous study show that a second-phase illness with rash and arthralgia appear 10-11 days after the appearance of upper respiratory sympotms.3)In our study, a second-phase symptoms appeared about one week earlier than in previous study. Half of the patients were weakly ANA positive.References:[1]Human Parvoviruses. Jianming Qie, Maria Soderlund-Venermo, Neal S. Young. Clinical Microbiology Reviews 2017; 30: 43-113[2]Clinical Presentations of Parvovirus B19 Infection. Jessica T. LT COL, etc. American Family Physician 2007; 75: 373-6[3]Experimental Parvoviral Infection in Humans. M J Anderson, etc. J Infect Dis 1985; 152: 257-65Disclosure of Interests:None declared

Background:Patients with rheumatoid arthritis (RA) who have metatarsophalangeal (MTP) joint involvement sometimes complain metatarsalgia without active sonographic inflammation1. Treatment of non-inflammatory metatarsalgia in RA is challenging and the pain sometimes lasts for years even though systemic inflammation completely resolves. On the other hand, intervention to fascia has increasingly attracted attention as a management of non-inflammatory pain2. Recently, we have invented a new technique called ultrasound-guided fascia hydrorelease (UGFHR), which injects fluid into “stacking fascia” (defined as high echoic and thickened fascia, often adhering to adjacent structures), making it unglued and instantaneously improving fascial pain.Objectives:This study is aiming for prospective evaluation of effectiveness and safety of UGFHR on metatarsalgia in patients with RA.Methods:We enrolled consecutive 11 patients with RA who came to rheumatology service in Suwa Central Hospital and satisfied the following inclusion and exclusion criteria:Inclusion criteria were having at least one MTP joint pain on which the patient has tenderness on the extensor side.Exclusion criteria were positive inflammation with ultrasound evaluation (defined as gray scale (GS) ≥2 and/or power doppler scale (PDS) ≥1) or having other cause of pain such as intermetacarpal bursitis, Morton’s neuroma.The patients received UGFHR on the fascia between the MTP joint capsule and the extensor tendon of the toe. We first searched for the stacking fascia between the two structures using ultrasound with longitudinal view of the extensor side of the MTP joint, and injected 2ml of normal saline into the stacking fascia, making it unglued (Fig. 1). If there was no stacking fascia, we injected on the fascia where the joint capsule and the extensor tendon became closest.Figure 1.The procedure of ultrasound-guided fascia hydrorelease (UGFHR)Numeric rating scale (NRS) of pain on walking and tenderness on the target MTP joint was measured on 3 occasions: before, immediately after, and one week after the UGFHR. Adverse events were also recorded.The data were analyzed longitudinally, using Friedman test.Results:The characteristics of the patients are shown in table 1. Female gender was dominant. Most of them were established RA. Simplified disease activity index (SDAI) were variable.Table 1.The characteristics of the 11 patients.The changes in NRS from before to immediately after and one week after the UGFHR are described in figure 2.Figure 2.The changes in NRS.Pain on walking and tenderness on the target joint both significantly decreased immediately after the procedure (ΔNRS from before to immediately after the UGFHR: -3.45 (95% confidence interval (CI) -2.32 to -4.59, p=In terms of safety, 7 out of 11 patients complained injection pain, all of which did not last for a week. Otherwise, there was no adverse event such as infection, nerve injury, bleeding, or tendon rupture.Conclusion:Ultrasound-guided fascia hydrorelease on MTP joint can be an effective and safe treatment option in patients with RA who have metatarsalgia but no sonographic evidence of MTP inflammation.References:[1]Garrigues, Florent, et al. “Concordance between clinical and ultrasound findings in rheumatoid arthritis.” Joint Bone Spine80.6 (2013): 597-603.[2]Kurosawa, Ayato, Tadashi Kobayashi, and Hirofumi Namiki. “Ultrasound-Guided Dry Needling for Abnormal Fascia Between the Deltoid Muscle and the Supraspinatus Tendon.” Pain Medicine (2019).Disclosure of Interests:None declared

We measured the polarization of the β-emitting 23Ne (I π =5/2+, T 1/2=37.24 s) and 25Al(I π =5/2+, T 1/2=7.18 s) produced through the one nucleon pickup reactions and 24mAl(I π =1+, T 1/2=131 ms, E ex=426keV) and 28P(I π =3+, T 1/2=270 ms) produced through charge-exchange reactions in the intermediate energy heavy ion collisions. We compared them with those from the projectile fragmentation process. The larger polarization seems to persistently be positive throughout the momentum distribution, and sharper momentum distributions suggest that nuclear friction mechanism is responsible for the polarization phenomena.

PURPOSE: To test an experimental model of chemical mammary carcinogenesis induction in rats. METHODS: Twenty young virgin Sprague-Dawley female rats, aged 47 days, received 20 mg of 7,12-dimethylbenz(a)anthracene (DMBA) intragastrically by gavage. Afterwards, at 8 and 13 weeks, their mammary glands were examined. At the end of the experiment, the animals were sacrificed, and the mammary tumors were measured and weighed. Tumor fragments were analyzed using light microscopy. RESULTS: Eight weeks after DMBA injection, 16 rats presented at least 1 breast tumor (80%). After 13 weeks, all of them (100%) developed breast carcinomas that were confirmed by histopathological analysis. CONCLUSION: This experimental animal model of chemical mammary induced carcinogenesis is feasible and can be used in further experiments on the role of tumorigenic biomodulator substances.OBJETIVO: Testar um modelo experimental de indução química de carcinogênese mamária em ratas. MATERIAL E MÉTODOS: Com 47 dias de vida, 20 ratas Sprague-Dawley, jovens e virgens, receberam por gavagem intragástrica 20 mg de 7,12-dimetilbenz(a)antraceno (DMBA). Oito e 13 semanas depois da injeção de droga as mamas das ratas foram examinadas. Ao final os animais foram sacrificados e fragmentos dos tumores foram estudados ao microscópio. RESULTADO: Oito semanas depois da injeção de DMBA 16 ratas apresentavam tumor nas mamas (80%). Com 13 semanas todas desenvolveram carcinomas de mama (100%), que foram confirmados por análise histopatológica. CONCLUSÃO: Este modelo experimental de indução química de carcinogênese mamária é factível e pode ser empregado em futuras pesquisas para avaliar o papel de substâncias biomoduladoras da tumorigênese.

Ho/sub 1/Ba/sub 2/Cu/sub 3/O/sub x/ (HoBCO) tapes by using pulsed laser deposition (PLD) have been developed on flexible Ni-alloy substrates. Inclined substrate deposition (ISD) was developed to introduce in-plane alignment for buffer layers. YSZ was deposited by PLD combined with ISD as a buffer layer on Ni-alloy tape. The advantage of ISD is a high growth rate due to the self in-plane alignment without any other assistance. This was demonstrated by using a CeO/sub 2/ buffer layer. A CeO/sub 2/ buffer layer shows high growth rates of 1 - 2 /spl mu/m/min. As for the growth rate of HoBCO, 4 /spl mu/m/min. was confirmed. Scale-up of the PLD system for making a long tape was performed. In this system, a 200 W-KrF excimer laser over 100 h continuous operation, a large deposition chamber including long ramp heater and three 10-in target system, and a reel to reel tape transfer system up to several hundred meters were introduced and combined. The continuous sputtering system for silver layer and O/sub 2/ annealing system were also introduced. By using these systems, a 50 m CeO/sub 2/ buffer was continuously deposited on a Ni-alloy tape. The deposition tape speed was 0.75 m/h, thickness was 2 /spl mu/m, and full-width at half-maximum was 23/spl deg/ in average. By depositing HoBCO on a part of this CeO/sub 2//Ni-alloy tape, Ic = 29 A/cm-width and Jc = 0.27 MA/cm/sup 2/ were demonstrated.

In this study, the angular dependence of Jc is investigated in detail for YBa2Cu3Oy (YBCO) tape fabricated by the inclined substrate deposition method. The result shows that Jc has a notable peak when the magnetic field is perpendicular to the plane of the tape, which indicates that the tape has lower Jc at medium degrees of the angle of the field to the tape's plane. The peak gradually diminishes as the field increases. This study confirms that data of the perpendicular and the parallel field dependence of Jc, as such, are not sufficient for evaluation of practical performance of YBCO tape.

A new deposition technique, `reverse' inclined substrate deposition (RISD), was introduced to reduce the 〈1 0 0〉 tilt angle of the buffer layer against the substrate normal, originated by the conventional ISD method. The tilt angles of both superconducting layer and cap layer were successfully reduced. The Jc values were enhanced by the RISD method. The Jc values of RISD samples were approximately two times as high as those of ISD samples. The cap layer was also deposited on both ISD and RISD buffer layers. Both 〈1 0 0〉 tilt angle and in-plane orientation were improved by the RISD.

High temperature superconducting thin film tapes, which consist of a flexible metal substrate, buffer layer, and Y 1 Ba 2 Cu 3 O x (YBCO) layer have been developed for power application. Ni-alloy tape was used as the substrate. Both the YBCO layer and the buffer layer were formed by pulsed laser deposition (PLD) because of an advantageous of high deposition rate. Inclined substrate deposition (ISD) was developed to introduce in-plane alignment for the buffer layer on the non-textured metal substrate. YBCO films epitaxially deposited on the ISD buffer layer by normal PLD had high J c values over 10 5 A/cm 2 at 77 K. For verification of high rate productivity of the PLD/ISD method, we demonstrated high rate deposition of the yttria stabilized zirconia buffer layer and YBCO superconducting layer. We also performed continuous deposition of over 10 m YBCO thin film tapes with a reel-to-reel substrate transfer system combined with 200 W high power laser equipment.

We have been developing YBa 2 Cu 3 O y (YBCO) wire fabricated by the inclined substrate deposition method. For investigation of advantages of these wires, electrical properties were studied. The J c measured as a function of the temperature and the magnetic field reveals that the YBCO wire has good J c – B – T property. The current–voltage characteristics of a 1 m-long wire shows that the worst section tends to dominate the performance of the wire. Transport ac losses were measured for the 1 m-long wire and were found to be consistent with the values derived by Norris's ellipse model.

YBa/sub 2/Cu/sub 3/O/sub y/ (YBCO) wire has higher critical current density (J/sub c/) and less degradation in J/sub c/ upon application of a magnetic field than (Bi,Pb)/sub 2/Sr/sub 2/Ca/sub 2/Cu/sub 3/O/sub x/ (Bi2223) powder-in-tube wire. It has good potential for use as a high temperature superconducting (HTS) wire following Bi2223. For many years, we have been studying a process to form biaxially aligned YBCO film on metal-based tape by the inclined substrate deposition (ISD). To date, we have succeeded in fabricating a 6 m-long YBCO wire by a continuous process of the ISD method. We have also investigated performance of the fabricated YBCO wire and the advantages of YBCO wire in its applications to rectifier-type fault current limiter (FCL) and HTS cable.

Y 1 Ba 2 Cu 3 O x films were grown on MgO(100) substrates by liquid phase epitaxy and their structural and electrical properties were examined. From transmission electron microscopy (TEM) plan-view images, it was found that the films consisted of large grains whose misorientation angles were less than 1°. Although d.c. critical current density values decreased with increasing film thickness, even a 7 μ m-thick film showed the value of 9×10 5 A/cm 2 at 77 K. An rf first penetration field of the film is estimated to be 30 Oe at 10.8 GHz and 77 K, by using a microstrip line resonator with a resonant frequency of 10.8 GHz. The third-order intercept point of the resonator is at an input power of +43 dBm and output power of +30 dBm at 77 K. These results suggest that LPE grown Y 1 Ba 2 Cu 3 O x films have superior d.c. and rf electrical properties.

Background Treat-to-target (T2T) is recommended and a widely accepted management strategy for rheumatoid arthritis (RA), which aims for remission or low disease activity. Disease activity is valuated by some composite measures which includes patient9s and physician9s global assessment, finding of joints and C reactive protein (CRP) etc. Patient9s global assessment (PGA) is often the limiting factor for achieving remission. It remains unclear what is the factor contributing to elevation of PGA when finding of 28 joints and CRP implement the Boolean remission criteria. Objectives To detect the factor contributing to elevation of PGA among Japanese RA patients whose scores on the tender joint count, swollen joint count and CRP (in mg/dl) are all 1 or less. Methods We performed an analysis of data from 15032 RA patients registered in the large database (NinJa: National Database of Rheumatic Diseases by iR-net in Japan) of 2014 (1). Patients whose scores of the tender joint count, swollen joint count and CRP (in mg/dl) were all 1 or less were included. Patients whose PGA was 1 or less and patients whose PGA was more than 1 were compared with a probabilistic approach employing logistic regression to investigate factor contributing to elevation of PGA among Japanese RA patients whose scores on the tender joint count, swollen joint count and CRP are all 1 or less. Results Seven thousand and two hundred and twenty-four patients were included; 5754 were women (79.7%) with a median age 65 years, a median disease duration 9 years, 826 (11.4%) had swelling or tenderness of forefoot joints which are not included in 28 joints (forefoot disease activity), 2313 (32.0%) were prescribed glucocorticoid, methotrexate 4993 (69.1%), biologic DMARDs 1986 (27.5%). In two groups; PGA ≤1 3584 (49.6%) and PGA >1 3640 (50.4%), the median modified health assessment questionnaire (mHAQ) was 0 (interquartile range: 0–0) and 0.13 (0–0.63), hospital anxiety and depression scale (HADS)-anxiety (A) was 2 (1–4) and 4 (2–7), HADS-depression (D) was 4 (2–6) and 5 (3–8), forefoot disease activity was 226 (6.3%) and 600 (16.5%), respectively. We performed the logistic regression analysis with age, Steinbrocker9s stage, mHAQ, HADS-A, HADS-D and forefoot disease activity. Thereafter all variables were found factors of associating to elevation of PGA (Table). Conclusions Forefoot disease activity, mHAQ, HADS-A and HADS-D contribute to elevation of PGA in patients who implement the Boolean remission criteria except PGA in Japanese rheumatoid arthritis patients. We should care about the foot joints in addition to functional disability and psychological distress for implementation of T2T strategy. References Matsui T, Kuga Y, Kaneko A, et al. Disease Activity Score 28 (DAS28) using C-reactive protein underestimates disease activity and overestimates EULAR response criteria compared with DAS28 using erythrocyte sedimentation rate in a large observational cohort of rheumatoid arthritis patients in Japan. Ann Rheum Dis 2007;66(9):1221–6. Acknowledgement NinJa has been supported in part by a Health and Labor Sciences Research Grant from the Ministry of Health, Labor, and Welfare of Japan. Disclosure of Interest K. Tokunaga Paid instructor for: AbbVie, Eisai Co. Ltd., and Mitsubishi Tanabe Pharma, A. Shiraishi: None declared, S. Takenouchi: None declared, R. Yokochi: None declared, K. Muranaka: None declared, M. Shinozaki: None declared, N. Hagino Grant/research support from: Mitsubishi Tanabe Pharma, Chugai Pharmaceutical Co. Ltd., and Bristol Meyers Squibb, Paid instructor for: Santen Pharmaceutical Co. Ltd. and Takeda Pharmaceutical Co. Ltd., J. Nishino: None declared, S. Tohma Grant/research support from: Pfizer Japan Inc., Eisai Co., Ltd and Chugai Pharmaceutical Co. Ltd.

HoBa/sub 2/Cu/sub 3/O/sub y/ (HoBCO) films on the bi-axially textured buffer layer prepared by Inclined Substrate Deposition method are studied. The HoBCO and buffer layers are supported by Ni-based-alloy substrate to form superconducting tape. Critical current density (J/sub c/) of this tape exceeds about 1/spl times/10/sup 9/ A/m/sup 2/ at 77 K in the self-field. To investigate practical performance of this tape, various dependences of J/sub c/, such as the magnetic-field dependence is measured. For the measurement of J/sub c/ in the magnetic field, its dependence of the angle of the field and the tape's plane is taken into account. The result shows that J/sub c/ has a notable peak when the magnetic field is perpendicular to the angle of the field to the tape's plane. The J/sub c/ peak gradually diminishes as the field increases. Similar magnetic field dependence of J/sub c/ is observed in a YBa/sub 2/Cu/sub 3/O/sub y/ (YBCO) sample. This study confirms that data of the perpendicular and parallel field dependence of J/sub c/, as such, are not sufficient for evaluation of practical performance of HoBCO tape.

We measured the polarization of the β‐emitting 23Ne (Iπ = 5/2+, T1/2 = 37.24 s) and 25Al(Iπ = 5/2+, T1/2 = 7.18 s), produced through the one nucleon pickup reactions in the intermediate energy heavy ion collisions, and was compared with those from the projectile fragmentation process. The larger polarization which seems to persistently be positive throughout the momentum distribution, and sharper momentum distributions suggest nuclear friction mechanism to be responsible for the polarization phenomena. Using such a large polarization, magnetic moment of 23Ne and the quadrupole moment of 25Al were measured. The obtained values are |μ(23Ne)| = 1.0817(9) μN and |Q(25Al)| = (240 ± 20) mb.

β‐NMR spectra have been observed for 33Cl, 23Al and 23Ne. As a result, the magnetic moment of 33Cl was determined as |μ(33Cl)| = 0.7549(3) μN. Combined with the known magnetic moment of 33S and the ft‐value of the 33Cl β decay, the orbital angular momenta and the intrinsic spins for proton and neutron groups, are deduced separately as 〈lp〉 = 1.3, 〈n〉 = 0.3, 〈Sp〉 = −0.12 and 〈Sn〉 = −0.02. The magnetic moment of 23Al, and that of 23Ne were determined as |μ(23Al)| = 3.89(22) μN and |μ(23Ne)| = 1.0817(9) μN, respectively. As a result, the orbital angular momentum 〈lz〉 and the intrinsic spin 〈Sz〉 were deduced to be 2.09(29) and 0.41(29), respectively. Combined with the ft‐value of the β transition from the ground state of 23Al to the excited state of 23Mg, proton and neutron contributions are separated. The obtained expectation values 〈lp〉, 〈ln〉, 〈Sp〉 and 〈Sn〉 are compared with the shell model predictions.

PURPOSE: To test an experimental model of chemical mammary carcinogenesis induction in rats. METHODS: Twenty young virgin Sprague-Dawley female rats, aged 47 days, received 20 mg of 7,12-dimethylbenz(a)anthracene (DMBA) intragastrically by gavage. Afterwards, at 8 and 13 weeks, their mammary glands were examined. At the end of the experiment, the animals were sacrificed, and the mammary tumors were measured and weighed. Tumor fragments were analyzed using light microscopy. RESULTS: Eight weeks after DMBA injection, 16 rats presented at least 1 breast tumor (80%). After 13 weeks, all of them (100%) developed breast carcinomas that were confirmed by histopathological analysis. CONCLUSION: This experimental animal model of chemical mammary induced carcinogenesis is feasible and can be used in further experiments on the role of tumorigenic biomodulator substances. OBJETIVO: Testar um modelo experimental de indução química de carcinogênese mamária em ratas. MATERIAL E MÉTODOS: Com 47 dias de vida, 20 ratas Sprague-Dawley, jovens e virgens, receberam por gavagem intragástrica 20 mg de 7,12-dimetilbenz(a)antraceno (DMBA). Oito e 13 semanas depois da injeção de droga as mamas das ratas foram examinadas. Ao final os animais foram sacrificados e fragmentos dos tumores foram estudados ao microscópio. RESULTADO: Oito semanas depois da injeção de DMBA 16 ratas apresentavam tumor nas mamas (80%). Com 13 semanas todas desenvolveram carcinomas de mama (100%), que foram confirmados por análise histopatológica. CONCLUSÃO: Este modelo experimental de indução química de carcinogênese mamária é factível e pode ser empregado em futuras pesquisas para avaliar o papel de substâncias biomoduladoras da tumorigênese.

We compared midline approach with paramedian approach for combined spinal-epidural anesthesia (CSEA) by needle through needle technique. Seventy patients undergoing elective gynecological surgery received CSEA with a 27 G Whitacre spinal needle, which protrudes 12 mm beyond the tip of the Tuohy needle. The successful subarachnoid puncture with first attempt was noted in 33 patients (94%) of midline group (M group), in 31 patients (89%) of paramedian group (P group). At the subarachnoid puncture, skin to epidural space distance (43.2 mm vs 53.4 mm) and protrusion length of spinal needle (5.5 mm vs 8 mm) were significantly longer in the P group than in the M group. Abdominal radiography revealed the flexion of epidural catheter in 19 patients (54%) of M group and in 2 patients (6%) of P group. The choice of midline or paramedian approach for CSEA did not affect the success rate of the subarachnoid puncture, but paramedian approach required longer protrusion length of the spinal needle than midline approach. To raise the success rate of subarachnoid puncture by paramedian approach, a long protruded spinal needle is recommended.

The patient was a 74-year-old man who was referred to our hospital with a complaint of left flank pain. Laboratory data were almost within normal limits and urine cytology was positive. X-ray examination revealed a calcification in the left kidney and abdominal CT scan confirmed the presence of a heterogenous renal pelvic mass which contained a calcification. Based on these examinations, a diagnosis of a renal pelvic cancer with heterotopic bone formation was made. Subsequently, left nephroureterectomy was performed. Grossly, the renal pelvis of the resected kidney was filled with a mass which had a white cut surface and bone-like tendency. Histopathologically, a poorly differentiated transitional cell carcinoma with massive bone formation was found. Fifty five cases of heterotopic bone formation in the kidney have been reported in Japan. Among the cases, 4 cases were complicated with renal pelvic tumor and our case was the second case of heterotopic bone formation complicated with a transitional cell carcinoma of the renal pelvis in Japan.

We reported a case of successful simultaneous mitral and aortic valvuloplasty using rasping procedure. A 55-year-old woman with combined valvular disease received this operation. Postoperatively, the mitral valve area increased from 1.15 cm2 to 2.03 cm2. Mitral regurgitation improved. Aortic valve pressure gradient decreased from 21 mmHg to 0 mmHg. Aortic regurgitation also improved. Cardiac Index (CI) increased from 1.94 l/min./m2 to 2.59 l/min./m2. Ejection fraction (EF) also increased from 60% to 82%. The postoperative course was uneventful. Excellent postoperative results of this procedure may be expected, not only in single valvular disease but also in combined valvular disease.

We report two cases of a nephrogenic adenoma in the bladder diverticulum. The first patient was an 81-year-old man with gross hematuria. Cystoscopy revealed bladder diverticulum and a papillary tumor within. Bladder diverticulectomy was performed and the histopathological diagnosis was a nephrogenic adenoma. The second patient was a 50-year-old man with gross hematuria and dysuria. Transabdominal ultrasound revealed bladder diverticulum. Transurethral coagulation of the bladder diverticulum was performed. Then three papillary tumors were detected, and were resected transurethrally. The histopathological diagnosis was a nephrogenic adenoma. These are the first and second cases of a nephrogenic adenoma in the bladder diverticulum reported in Japan.

Two cases of testicular tumors with lymph node involvement and multiple lung and liver metastases were treated successfully with intra-arterial infusion chemotherapy. Case 1: A 30-year-old man presented with right scrotal swelling and an abdominal mass. He had a large retroperitoneal mass and multiple lung and liver metastases on computed tomographic (CT) scan and chest X-ray. Right inguinal orchiectomy was performed. Histopathological diagnosis revealed embryonal cell carcinoma and choriocarcinoma. Cisplatin, vinblastine, VP-16 and pepleomycin combination chemotherapy (PVeBV) was started and repeated for 2 courses. The retroperitoneal mass and lung tumors decreased in size, but liver tumors enlarged. Systemic and intrahepatic arterial infusion combined with chemotherapy was administered, and intra-arterial chemotherapy (cisplatin, VP-16) was added. The patient also received systemic chemotherapy (carboplatin, VP-16, ifosfamide). After chemotherapy, retroperitoneal lymph node dissection was performed. Microscopic examination revealed no viable cancer cells. On CT scan, no retroperitoneal, liver, or lung tumor was detected. Case 2: A 43-year-old man presented with right scrotal swelling and an abdominal mass. CT scan revealed a large retroperitoneal mass as well as lung and multiple liver metastases. Right inguinal orchiectomy was performed. Histopathological diagnosis revealed seminoma. Cisplatin, vinblastine, VP-16 and pepleomycin combination chemotherapy (PVeBV) was administered, but the liver tumors ware enlarged on CT scan. Intrahepatic arterial infusion chemotherapy (cisplatin, VP-16) was started and repeated for 4 courses. On CT scan, the lung metastasis seemed to have disappeared, and the retroperitoneal mass and liver metastases were decreased in size.

We analyzed retrospectively the technical and clinical consequences of combined spinal-epidural anesthesia by needle-through-needle approach over the last two years. A Tuohy-type 18-gauge epidural needle (Perican; B. Braun Co.) and long pencil-pointed 27-gauge spinal needle (Whitacre; Becton-Dikinson Co.) were selected. Spinal anesthesia was administered with 0.5% tetracaine. A total of 485 anesthesia cases included 144 cases for lower abdominal, 193 cases for gynecological and 148 cases for orthopedic surgeries. The successful subarachnoid puncture with only one attempt was recorded in 89% of abdominal, 71% of gynecological and 72% of orthopedic cases. On the other hand, in three (0.6%) cases even with several attempts, the puncture was not possible. Inadvertent dural puncture and subarachnoid catheterization occurred in six (1.2%) and four (0.6%) cases, respectively. Inadequate spinal anesthesia was supplemented with epidural anesthesia in 13% of abdominal, 21% of gynecological and 7% of orthopedic cases. No serious complication occurred. We conclude that this needle-through-needle approach facilitates subarachnoid puncture with an ultra-fine spinal needle and subsequent epidural catheterization serves for supplemental and post-operative analgesia unless inappropriate subarachnoid indwelling occurs.

Bradycardia during propofol anesthesia is well known, but bradycardia after propofol anesthesia has not been studied well. We compared perioperative heart rates in patients who had undergone gynecological surgery under lumbar epidural anesthesia supplemented with light general anesthesia using isoflurane and nitrous oxide in oxygen (Group Iso, n = 25) with those who had received lumbar epidural anesthesia supplemented with propofol (Group Prop, n = 25). The heart rates for the Group Prop were significantly lower (P0.05) than those for the Group Iso after the induction of anesthesia up to 2 hours after surgery. Two patients in the Group Prop developed bradycardia below 50 bpm 1 and 2 hours after surgery. In one of them intravenous atropine was necessary to treat bradycardia. We conclude that more attention should be paid to postoperative as well as intraoperative bradycardia in patients who receive propofol.

We evaluated the physical or psychosocial states of testicular cancer patients receiving orchiectomy, radiation therapy and chemotherapy to assess their quality of life during and after treatment. The subjects were 33 post-treatment patients with testicular cancer who responded to the questionnaire we mailed to them. The quality of life score during chemotherapy showed a decrease, which was accompanied by gastrointestinal symptoms induced by anti-cancer drugs. With regard to the difference in adjuvant treatment types, the surveillance group showed the highest score in the satisfaction of daily life. Moreover, married patients tended to be satisfied with daily life more than non-married patients. With regard to sexual or erectile function, scores of testicular cancer patients, especially in the retroperitoneal lymph node dissection group, were inferior to these of normal volunteers. In conclusion, the physical or psychosocial states after treatment for testicular cancer depend not only on treatment type but also marriage status.

A case of retrovesical liposarcoma is reported. The patient was a 41-year-old man who complained of left scrotal pain and of hip discomfort. Digital rectal examination revealed a hen's egg-sized mass with an elastic hard consistency at the left side of the normal prostate. Pelvic CT and MRI showed a heterogeneous tumor in the retrovesical region. Transperineal biopsy revealed liposarcoma. Pelvic exenteration, colostomy and ileal conduit were performed. The resected weight was 1,680 grams, and the histopathological diagnosis was myxoid type of liposarcoma, grade II. Postoperatively, a metastatic lesion to vertebrae thoracicae I developed causing radiculoneuropathy of the left superior limb. Spot radiation (50 Gy) was administered to the lesion, but there was no response. Currently, the patient is being treated with combination chemotherapy consisting of dacarbazine, vincristine, adriamycin, and cyclophosphamide. Cases of retrovesical liposarcomas reported in Japan are reviewed and discussed.

The treatment outcome was evaluated in 63 patients with bladder cancer more than 2 years after cystectomy. Cisplatin-based combination chemotherapies were given to 40 patients after the operation as an adjuvant therapy and two patients with T4 or N2 bladder cancer received chemotherapy before the operation as a neoadjuvant therapy. The extent of infiltration of the removed tumors was pTa in 5, pT1 in 18, pT2 in 8, pT3a in 6, pT3b in 17, and pT4 in 9 cases. Regional lymph node metastases were present in 10 cases (16%). Nineteen patients died of tumor recurrences. The 5-year acturial survival rates at each stage were 60% for stage pTa, 78% for stage pT1, 63% for stage pT2, 83% for stage pT3a, 33% for stage pT3b and 38% for stage pT4, respectively. A significant difference (p0.05) in survival curve was observed between pT3a and pT3b. The prognosis of patients with tumors extending beyond the bladder muscles is extremely unfavourable, with the exception of bladder cancers infiltrating the neighboring organ (pT4a), the removal of which may result in lasting survival in a part of the cases. Effective adjuvant treatment is required for patients with bladder tumors penetrating the bladder wall.

We reviewed 40 patients with renal pelvic and/or ureteral transitional cell carcinomas, consisting of 24 males and 16 females with a mean age of 65 years. The histopathological stage of surgically removed specimen was pTa in 6 patients, pT1 in 7, pT2 in 5, pT3 in 11 and pT4 in 6. Three patients with Tis and 2 with T3 did not undergo surgery. Of 35 patients pathologically examined, lymphatic and venous invasions were detected in 22 (63%) and 16 (46%), respectively, and were associated with pathological stage and grade. Overall the 5-year actuarial survival rate was 57.1%. Tumor staging and vascular invasion had a prognostic significance on the treatment outcome, but not metachronous or synchronous bladder cancer, identified in 55% of the patients. Adjuvant chemotherapy appeared to improve the survival of the patients with tumors pT2 or higher, grade 3 or vascular invasion without metastases.

The g-factor of the extremely proton-rich nucleus 23Al (T1/2 = 0.47 s) has been measured by means of the β-NMR method for the first time. The g-factor were determined as |g| = 1.557(88) from the obtained NMR spectra. From the comparison between the experimental value and the shell model calculation, the spin parity of the ground state of 23Al was determined as Iπ = 5/2+. Thus, the magnetic moment of 23Al was determined as |μ| = 3.89(22)μN.

Four patients with upper urinary tract transitional cell carcinoma were treated with bacillus Calmette-Guerin (BCG) via a percutaneous nephrostomy tube or a retrograde ureteral catheter. A 68-year-old female and an 80-year-old male had carcinoma in situ (CIS) in the left upper urinary tract (cases 1 and 2). A man aged 47 had CIS in the left upper urinary tract, bladder, and prostatic urethra (case 3). CIS in the left upper urinary tract was identified in a woman aged 63 with chronic renal insufficiency (case 4). Two patients (cases 1 and 2) responded to this therapy. In the other two patients nephrectomy was performed due to residual tumor. There were extensive tuberculous granulomas in the kidneys. In one resected kidney (case 4) carcinoma had invaded the renal parenchyma. The reviewed literature showed that BCG perfusion therapy was effective in 71% (27 of 38 renal units) for the upper urinary tract tumors and that there were 5 cases of severe complication, including sepsis in 2, high fever in 2, and ureteral stricture in 1. Based on the fact that the kidney receives a profuse blood supply and that the renal pelvis and ureter have a thin wall, careful management is mandatory to prevent severe adverse effects and insidious tumor progression.

The Kock continent urinary reservoir was constructed in 12 patients from 1988 to 1990 followed by the Indiana continent urinary reservoir in 14 patients thereafter. There were no perioperative death in either group. The period of postoperative follow-up was 11 approximately 70 months, with a mean of 58.9 months. Several modifications of the operative technique were made to the original Kock pouch, but stone formation was observed in 5 patients (42%), resulting from foreign materials permanently in contact with urine. In the Indiana pouch group with a mean postoperative follow-up period of 26.8 months (range 11 approximately 43 months), wound infection occurred in the initial 4 patients and difficulty of catheterization in the other 4 patients. The serum electrolyte values were found to be within the normal limits during the follow-up period in both groups, but, mild acidosis occurred in 2 patients. Patients with urinary diversion demonstrated mild azotemia (P = 0.02) despite similar serum creatinine levels and an increase in urine pH (P = 0.006) postoperatively. Asymptomatic bacteriuria was demonstrated in 22 of the 26 (83%) patients with the reservoir, but only 5 patients had significant pyuria. Our clinical experience suggests that the Indiana pouch is a more reliable method than the Kock pouch to construct a continent urinary reservoir.

A clinical statistic survey was carried out on the patients and disease experienced at the outpatient clinic of our Department of Urology, between 1983 and 1993. Although the number of newly diagnosed patients was rather constant, the total number of outpatients gradually increased every year, and the average and median age of newly diagnosed patients became higher. The major disease categories were infectious and neoplastic disorders.

99mTc-MAG3 (mercaptacetyl glycilglycilglycine) is a newly developed radiopharmaceutical for the functional imaging of kidneys. We evaluated the clinical usefulness of 99mTc-MAG3 in 12 cases (7 men and 5 women, aged from 18 to 57 years old) with transplanted kidney, and compared it with 123I-OIH (o-iodohippurate). Immediately after bolus injection of 300 MBq of 99mTc-MAG3, first pass images (1 frame/3 sec for 1 min) and dynamic renal images (1 frame/60 sec for 30 min) were recorded. In 10 of 12 cases, the same examination was carried out using 37 MBq of 123I-OIH within 2 weeks. Because of its larger dose and suitable gamma-ray energy, 99mTc-MAG3 provided much better images than 123I-OIH, particulary among first pass images. Effective renal plasma flow (ERPF) calculated from the clearance of 99mTc-MAG3 was less (about 70%) than that of 123I-OIH, however, a strong correlation (r = 0.98, p0.001) was observed between the ERPF values of the two radiotracers. No adverse effects were caused by 99mTc-MAG3. Our data suggested that 99mTc-MAG3 was a promising radiopharmaceutical with which to evaluate regional dynamic renal function.

The clinical usefulness of Combined Spinal-Epidural (CSE) needles, Portex Spinal/Epidural set (P needles) and Hakko Disposable Needles set type H (H needles) was compared on 30 patients undergoing elective orthopedic lower limb surgeries. Although the calibers of the epidural needles were a little different, both needles were introduced quite easily in the epidural space. The spinal needles were inserted successfully to the subarachnoid space in 27 out of 30 cases by the P needles and 23 out of 30 cases by the H needles. The average trial times for successful insertion of the spinal needles were 1.3 and 2.6 by the P needles and the H needles, respectively. this was statistically significant (P0.05). Adequate spinal anesthesia was established in 26 patients (87%) and 19 patients (63%) by the P needles and the H needles, respectively. One case of the accidental location of the epidural catheter in the subarachnoid space was observed in each group. As the CSE device, the P needles were more sophisticatedly designed for easier insertion to the subarachnoid space than the H needles.

A 61-year-old man suffering from compression fracture of the first lumbar vertebra was scheduled for anterior and posterior spinal fusion. Anesthesia was maintained with enflurane, nitrous oxide in oxygen and fentanyl. When his position was changed from right lateral to supine position, ventricular fibrillation (VF) occurred. The operation was discontinued and he was taken into ICU receiving cardiopulmonary resuscitation. Despite ordinary therapies including DC-shock and lidocaine infusion, Vf and defibrillation recurred more than 20 times for the first two hours. Electrocardiogram showed elevation of ST-T segments in II, III, aVF and V1-V3 leads. Because no effective treatment was found, we attempted to use glucose-insulin-potassium mixture, by which Vf stopped. Electrocardiogram taken on the following day showed abnormal Q wave in II, III and aVF leads, and the patient was diagnosed as having had acute myocardial infarction. On the fifth postoperative day, the patient was returned to the ward without neurological deficits. We conclude that glucose-insulin-potassium infusion is a beneficial therapy for Vf, which is resistant to ordinary treatments.

For the first time, we obtained the g factor for the ground state of {sup 23}Al by use of a {beta}-NMR measurement. {sup 23}Al has a small proton separation energy and is a potential proton-halo candidate. The obtained g factor, vertical bar g vertical bar =1.557{+-}0.088, clearly shows the spin and parity, J{sup {pi}}=5/2{sup +}, for {sup 23}Al, which is the same as that of its mirror partner, {sup 23}Ne. The possible nuclear structure of {sup 23}Al is also discussed.

Heating of 3,5-disubstituted 4-bromo-3-methoxycarbonyldihydro-2(3H)-furanones with NaI in 3-pentanone gave 3,5-disubstituted 2(5H)-furanones in 55.8–93.3% isolated yields. A total synthesis of (±)-acarenoic acid was established in 33% overall yield via 4 steps.

Obtention des (alcene-1'yl alkyl) malonates par alkylation avec des composes halogenes en presence de diisopropylamidure de lithium dans THF-HMPT

A case of intrascrotal leiomyoma originating from tunica vaginalis is reported. The patient was a 63-year-old male who complained of painless tumor of the right scrotal contents. The tumor was surgically removed easily. The histological examination of the tumor revealed leiomyoma. Seven cases of intrascrotal leiomyoma reported in Japan were reviewed.

The effect of the antispasmodic agent, SA-504 subtle granules, was studied. Ninety mg per day of timepidium bromide subtle granules was given orally to 17 patients with renal or ureteral calculi for no less than fourteen days. SA-504 subtle granules as well as the capsule showed good antispasmodic effect and stimulated spontaneous passage of ureteral calculi. No subjective or objective side effects were observed.

A case of vesicosigmoidal fistula secondary to the diverticulitis of colon is reported. A 63-year-old man was admitted to our clinic with the chief complaint of pneumaturia. Cystoscopy revealed an edematous, papillomatous lesion at the left posterior bladder wall. Although multiple diverticulosis of descending and sigmoid colon were demonstrated by barium enema, the presence of a fistula from the intestine to bladder was not confirmed. The presence of fistula was confirmed by detecting the orally administered charcoal in the urine. Resection of sigmoid colon with partial cystectomy was performed. Removed specimen revealed multiple sigmoidal diverticula and a fistula from a sigmoidal diverticulum to bladder through a firm mass. Histological examination of mass demonstrated inflammatory changes. This was the 58th case of vesicosigmoidal fistula due to diverticulitis of colon reported in the Japanese literature.

A facile synthesis of γ-butyrolactones by the lactonization of γ-halo esters with silica gel catalyst and its application to the stereoselective synthesis of (±)-canadensolide are described.

A 68-year-old female patient was admitted for the examination of duplication of right ureter and right hydronephrosis. Antegrade pyelography showed multiple, small, round defects in the ureter from the upper pole of right kidney. Ureteroureterostomy was performed under the diagnosis of ureteritis. Including our case, 25 cases of pyeloureteritis cystica have been reported in Japan.

The T-cell bearing Fc receptor (IgG-FcR+ T cell) has been considered as a suppressor or a part of the killer cell, as determined by its function. The population of IgG-FcR+ T cells was determined by Moretta 's method in patients with urinary bladder cancer, urological benign diseases and in normal subjects. The population of IgG-FcR+ T cells in the peripheral lymphocytes of 16 patients with urinary bladder cancer was 20.5 +/- 10.1%, that of 7 patients with urological benign diseases was 9.5 +/- 3.2%, and that of 8 normal subjects was 9.0 +/- 2.1. The population of IgG-FcR+ T cells in the peripheral lymphocytes patients with high stage bladder cancer was significantly higher than that of patients with low stage cancer. In low stage bladder cancer cases, the population of IgG-FcR+ T cells was decreased to the normal range at three weeks after removal of the tumor. But in high stage bladder cancer cases, it was not changed at 3 weeks.

The terminology of megaureters, their histological findings and etiology vary greatly in the literature. We encountered an obstructed megaureter in a 39-year-old man. He complained of epigastral and left flank pain. X-ray examination showed a right marked hydronephroureter which compressed the bladder and left ureter. We performed right nephroureterectomy. Postoperative course was uneventful and his clinical condition improved.