Search

In 2019, Showa University implemented a compulsory clinical English course for all 4th-year medical students that included a medical interview with an English-speaking standardized patient (ESSP), but since 2020 the interviews have been conducted online due to the novel coronavirus pandemic. These students reported difficulties with eye contact and reading body language/non-verbal cues of the ESSP. In this project report, we describe a telemedicine lecture that we included in the 2021 course and compare students’ reported difficulties during the online medical interview for two years. The 2021 cohort reported significantly less difficulties with eye contact than the 2020 cohort, and a similar trend was found for reading body language/nonverbal cues and creating rapport with the ESSP. While possible third variables, such as 2021 cohort’s greater comfort in using teleconference platforms, may limit the interpretation of these results, we conclude that Japanese medical students can clearly benefit from the inclusion of telemedicine education into the medical curriculum as online healthcare services become the “new normal” in Japan.

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

内戦終結後のカンボジア王国に対し、我が国は、日本開発援助を用いた医療協力活動として、1995年より現在に至るまでカンボジア国立母子保健センター(National Maternal and Child Health Center:NMCHC)の建設と医療技術支援を継続している。本研究ではNMCHCを対象として、診療と臨床検査室の活動を分析し、今後の医療支援の方策を検討した。その結果、(1)一人あたりの国民総所得は1998年の253($US)から2012年には984($US)と3倍以上増加し、経済発展を背景として、妊産婦死亡率は1998年の470/10万人から2012年には250/10万人に減少しており、保健衛生環境の改善が示され、更なる医療の質の向上が期待されている。(2)NMCHCでの検査利用率は、1999年から2011年まで20%前後でほぼ横ばいであり、診療科別では外来妊婦管理初診で診療時に血算(RBC/WBC/Hb/Plt)、尿検査、梅毒検査、HIV-Ab検査がパッケージとして料金に組み込まれているため検査利用率が100%近くあったが、入院を含む他科の臨床検査利用は低かった。(3)検査利用頻度の高い血算、Ht、尿検査、血液型、出血時間、HIV-Ab検査は医師からの信頼が高かったが、医師が検査室で行える検査を把握していないこともあり、臨床検査の利用を促すためには、臨床検査室から検査値の信頼性とデータと病態の関係を医師側へ伝える努力が必要であること明らかとなった。この結果より、NMCHCにおける医療の質の向上のためには、1)検査値および検査サービスを医師に信頼してもらうための精度管理を導入し、その結果を医師へ提供すること、2)医師が診療に用いる検査について学ぶこと、という2項を実施することが必要であり、これらの課題に対応した臨床検査室支援を行うことが効果的であるとことが示唆された。以上のことから、経済発展に伴う医療の質の変化に対応するためには、技術支援経年後に、現状の再分析を行い、技術フォローアップの実施を行うことが必須であることが明らかとなった。

It is important for the relocated elderly to create social networks within their new environment for their lives and their health. This research examined the reasons why the relocated elderly create social networks in the neighborhood. The research subject area is one snowfall town in Hokkaido, Japan. The subjects are 20 elderly people, who have been relocated to the town. The public health nurses individually conducted an interview and broke down the verbatim records into qualitative descriptions. The subjects ranged from 68 to 94 years old. Reasons why the elderly create social networks in their neighborhoods are to make their lives easier, to prepare for emergencies, to get rid of their loneliness, and to enjoy their lives. Community health providers should understand the need for neighboring social networks based on the elderly people’s condition, and support and create new networks in their community depending on their situations.

The strategy of international cooperation in the clinical laboratory field was analyzed to improve the quality of intervention by reviewing documents from international organizations and the Japanese government. Based on the world development agenda, the target of action for health has shifted from communicable diseases to non-communicable diseases (NCD). This emphasizes the importance of comprehensive clinical laboratories instead of disease-specific examinations in developing countries. To achieve this goal, the World Health Organization (WHO) has disseminated to the African and Asian regions the Laboratory Quality Management System (LQMS), which is based on the same principles of the International Organization of Standardization (ISO) 15189. To execute this strategy, international experts must have competence in project management, analyze information regarding the target country, and develop a strategy for management of the LQMS with an understanding of the technical aspects of laboratory work. However, there is no appropriate pre- and post-educational system of international health for Japanese international workers. Universities and academic organizations should cooperate with the government to establish a system of education for international workers. Objectives of this education system must include: (1) training for the organization and understanding of global health issues, (2) education of the principles regarding comprehensive management of clinical laboratories, and (3) understanding the LQMS which was employed based on WHO's initiative. Achievement of these objectives will help improve the quality of international cooperation in the clinical laboratory field.

【目的】本研究の目的は,認知症理解の啓発と地域づくりのために登録された認知症キャラバンメイトの活動促進要因を明らかにすることである.【方法】自記式アンケートを北海道内の全1996人のキャラバンメイトに送付し,960件を回収した.そのうち,啓発のための講師経験があり,かつ自由記載のあった132人(専門職114人,非専門職18人)の記述を対象とし,質的帰納的に分析した.活動の推進に関する記載を抽出し,類似内容をカテゴリ化した.【結果】活動の推進要因として,活動目的の再確認,他の活動とリンクした啓発と地域づくり,キャラバンメイトの組織化,地域毎の活動マネジメント,行政とのパートナーシップ,キャラバンメイトとしての知識とスキルの向上,サポーターの活動に有用な講座,個人の活動継続の秘訣,多様な役割の選択の保障,が抽出された.【考察】活動促進要因の中でもキャラバンメイトの組織化は中核的要因であり,組織化により,学習,話し合い,行政との連携,個人の事情に合わせた活動が可能となると考えられた., [Purpose] The purpose of this research is to clarify effective methods of promoting Caravan-Mate-Volunteer project that was based on the national project called One-Million-Dementia-Caravan-Promotion. The registered volunteers participate in various activities provided by the project to enhance understanding of dementia and community development. [Methods] The questionnaire was sent to 1996 Caravan-Mate-Volunteers and 960 were collected. One hundred thirty two responses had experiences as the lecturer was extracted as data. This research utilized qualitative data analysis, to extract the text that seems to be necessary for promoting the project. Data was categorized according to the content. [Results] About 70 percent of the participants were women. The participants consist of both health professionals and volunteers. Data was analyzed into nine categories as follows ; Reconfirming the purpose of activity, Linking to other activity for community development, Organizing Caravan-Mate-Volunteer system, Management Caravan-mate-volunteer activities, Creating a partnership with administration, Developing knowledge and skills as Caravan-Mate-volunteers, Useful lectures, Listening from active volunteers, Securing diverse role for volunteers. [Discussion] Volunteers who experienced as lecturer were able to identify several concrete ideas for promotion. This research found Organizing Caravan-Mate-Volunteer system as a core category that can provide opportunities for learning and discussing management matter in order to enhance quality of their activity.

AIM: To assess a condom use educational program developed using the Information-Motivation-Behavioral Skills (IMB) model to enable Japanese young people to use condoms. METHODS: The program was implemented in two sessions of approximately 90 min each over a 2 day period. The participants underwent the program in small same-sex groups. The study participants were divided into the intervention group (n=94) and the control group (n=186). Knowledge relating to HIV/sexually-transmitted diseases (STDs) attitudes towards contraception and sex the risk perceptions of pregnancy and HIV/STD infection anticipated reaction to proposed condom use self-efficacy of condom use and sexual behaviors were assessed. Data were obtained at baseline immediately after the program and 1 and 3 months after the program or baseline survey. RESULTS: Intervention group participants with experience of sexual intercourse (n=14) had significantly higher scores for knowledge relating to HIV/STDs self-efficacy of condom use and relief/confusion associated with condom use than the control group (n=13) at the 1 and 3 month surveys. Intervention group participants with no experience of sexual intercourse (n=14) had significantly higher scores for knowledge relating to HIV/STDs and self-efficacy of condom use and significantly lower scores for condom avoidance than the control group (n=116). Condom use behavior was not changed in either group. CONCLUSION: The program used in this study did not promote condom use but it increased knowledge relating to HIV/STDs and self-efficacy of condom use and reduced resistance to condom use. (c) 2012 The Author. Japan Journal of Nursing Science (c) 2012 Japan Academy of Nursing Science.

母親の肯定的な感情を支持する支援のための基礎資料を得ることをねらいに,1歳6ヵ月児の父親の労働時間・育児参加時間からみた母親の育児幸福感を明らかにすることを目的とした.対象は1歳6ヵ月児健診を受診した母親である.健診時に,説明と同意のうえ,母親の育児幸福感(清水ら,2006)と父親の労働時間・育児参加時間に関するアンケートを配布し,郵送法で回収した.全122人に配布し,59件の有効回答を得た.分析は単純集計の後,両親・子ども・父親の労働時間などの各変数ごとに母親の育児幸福感尺度の平均点を算出した.その結果,父親の帰宅時間は20～21時が42.4%であった.父親の過の労働時間は平均59.2±15.0時間であり,50時間以下が33.9%であった.父親の育児参加時間は,平日は1～2時間が40.7%と多く,ほとんどなしが全体の4分の1を占め,休日は半日ぐらいが55.9%と多かった.父親に子どもを任せて母親が外出できる時間は,ほとんどなしが54.2%であった.両親・子ども・家族の特性別及び父親の労働時間・帰宅時間・育児参加時間別にみた母親の育児幸福感得点に有意な差はみられなかった.父親に任せて母親が1人で外出できる時間において,「ほとんどなし」または「半日以上」の場合に母親の育児幸福感は高く,「1～2時間」の場合に育児幸福感は低く,有意な差がみられた., The present study was conducted in order to clarify correlations between child care happiness of mothers whose children was 1 year and 6 months old and fathers' working and child care hours. Questionnaires were handed to 122 mothers who came to health check at the health center of A city. Analysis was performed on valid responses obtained from 59 individuals. From the analysis of correlations between child care happiness of mothers and fathers' working and child care hours, the following results were obtained. Forty two percent of fathers return to home at 20 ～ 21 o'clock. Mean of working hours of fathers were 59.2±15.0. Forty percent of fathers spend on 1～2 hours for child care on weekday, and 55.9% spend with children on half of day on weekend. There were no correlations between characteristic of parents, working and child care hours of fathers and child care happiness of mothers. Child care happiness of Mothers who could not go out and who could go out among half of day were higher than who could go out about 1～2 hours.

介護保険の居宅サービス利用者の生活満足感とその関連要因を明らかにすることを目的に,要支援・要介護に認定されている居宅サービス利用者を対象に調査を行った.人口約2万人のA町において,担当ケアマネージャーによる介護保険記録からの基本属性,認定程度,サービス利用等の転記と,ケアマネージャーによる訪問面接調査により生活満足感,家族形態,既往,受診,日常生活機能,健康度自己評価等が把握された.居宅サービス利用の全333人のうち,入院等を除く計238人のデータが得られた.分析は,満足群,非満足群別にχ^2検定,t検定を行い,有意差のみられた項目についてロジスティック回帰分析を行った.その結果,満足群と非満足群では,介護度やサービス利用の種類や量に違いはみられなかった.満足群の割合が高かったのは,女性,80歳以上,子(世帯)との同居,健康度自己評価が高い者であった(p, Purpose : The purpose of the study was to clarify life satisfaction and related factors among the elderly who use home care services in long-term care insurance system. Methods : Care managers transfered data about demographic characteristic and home care services from records of care insurance system. Care managers carried out an interview survey using questionnaire asking about life satisfaction, self-rated health, living arrangement, IADL, frequency of going out and conversation with friends and others. Analysis was performed on valid responses obtained from 238 elderly. From the analysis of correlations between level of life satisfaction, self-rated health, living arrangement,IADL,frequency of going out and conversation with friends and others, the following results were obtained. Results : Higher life satisfaction group were 88%. There were no differences in degree of difficulties in ADL and recognition,frequency and kinds of home care services between higher life satisfaction group and lowers. There were differences in sex, age, time of acknowledgement of long-term care insurance system, living arrangement, self-rated health between 2 groups. Results of multivariate logistic analysis showed that the factors correlated with degree of life satisfaction were self-rated health.

要支援・要介護状態の高齢者が引越した場合、引越先が都市か都市近郊かによって本人の状況や引越後の慣れの感覚や生活満足感が異なるかを明らかにすることを目的として、都市A市と都市近郊B町において訪問面接調査を行った。引越5年以内の要支援・要介護高齢者を対象として、A市81人とB町31人を比較した結果、性別、年齢、介護保険の認定の程度、家族形態、引越の意思決定、引越準備期間に差はみられなかったが、B町のほうが居住年数が長く、引越後「慣れた」という者、生活満足感が高い者が有意に多かった。2地域別の、慣れの程度、生活満足感別の平均居住年数に差はみられなかった。都市部に引越した高齢者では、年数を経ても慣れない、満足でないという場合があり、身体的な介護だけではない精神面のケアの必要性が示唆された。, The present study was conducted in order to clarify life satisfaction of elderly individuals requiring assistance or care who moved to city A or rural town B. Interviews were conducted on 81 elderly individuals in A city and 31 elderly individuals in B rural town, and the following results were obtained. Caracteristics of sex, mean age, family member, decision of relocation were not significant between A city and B town. Life satisfaction of individuals in B rural town were higher than in A city. These findings suggest that elderly individuals requiring assistance or care may be able to positively accept a move if they move to rural town. It is important that they move to the city communicate with their family about moving before moving.

転居高齢者の支援のあり方を検討するために、民生委員の転居高齢者への関わりと困ったこと、関わりの工夫、活動に対する思いを明らかにすることを目的とした。民生委員46人へのアンケートと7人のグループインタビューを行い、質的分析を行った。困ったこととして、情報把握が大変、訪問しにくいこと、転入者を阻む地域や組織があることが明らかとなった。転入高齢者に関わる際の工夫として、情報把握の仕方、連携する、関係をつくる、有事に備える、安否を確認する、地域の組織に誘い出し仲間に入れるための具体的な工夫が明らかとなった。活動に対する思いでは、行政から最低限の情報は欲しいこと、誇りを持って地域のために活動したいこと、活動の負担感と限界が明らかとなった。

銚子市は、「健康スポーツ文化都市宣言」を掲げ、事業の一つとして市民の健康意識の向上を目的に5年前から「健康まつり」を実施している。本学の臨床検査学コースの教員や学生も第1回から、臨床検査技師教育の一翼を担う方法の一つとして参加してきた。この結果、学生からは、検査を受ける人たちへの応対の難しさや、検査値から得られる情報の重要性を再認識したなどの感想が得られ、一方、参加している市民からのアンケートでは、対応が親切で良かったなどの感想が得られた。この「健康まつり」の体験学習を通して、学生は、コミュニケーション能力や臨床病態に関する知識、そして問題解決能力の必要性を短時間で学んだと思われる。また、参加している市民からの感想を得ることができたことは客観的な評価を受けることで体験学習ばかりでなく教育の一環としてフィードバックすることができ、より充実した健康教育につなげることができたと考えられる。

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.

To assess a condom use educational program developed using the Information-Motivation-Behavioral Skills (IMB) model to enable Japanese young people to use condoms.The program was implemented in two sessions of approximately 90 min each over a 2 day period. The participants underwent the program in small same-sex groups. The study participants were divided into the intervention group (n=94) and the control group (n=186). Knowledge relating to HIV/sexually-transmitted diseases (STDs), attitudes towards contraception and sex, the risk perceptions of pregnancy and HIV/STD infection, anticipated reaction to proposed condom use, self-efficacy of condom use, and sexual behaviors were assessed. Data were obtained at baseline, immediately after the program, and 1 and 3 months after the program or baseline survey.Intervention group participants with experience of sexual intercourse (n=14) had significantly higher scores for knowledge relating to HIV/STDs, self-efficacy of condom use, and relief/confusion associated with condom use than the control group (n=13) at the 1 and 3 month surveys. Intervention group participants with no experience of sexual intercourse (n=14) had significantly higher scores for knowledge relating to HIV/STDs and self-efficacy of condom use, and significantly lower scores for condom avoidance, than the control group (n=116). Condom use behavior was not changed in either group.The program used in this study did not promote condom use, but it increased knowledge relating to HIV/STDs and self-efficacy of condom use and reduced resistance to condom use.

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。

40年前の仙骨部外傷の後に多発性瘻孔を形成し, 有棘細胞癌が続発した62歳の男性を報告した。腫瘍の大部分は感染を伴い, 仙骨, 腸骨を中心に拡大する特徴があり, 外傷の既往を考え合わせると, 骨髄炎に続発したものと推測された。放射線療法, 化学療法を行ったところ, 潰瘍, 腐骨の生検では腫瘍細胞を認めなくなった。同時にSCC関連抗原も2ヵ月間正常域を維持したため, 感染病巣除去を目的として手術を施行した。しかし, 骨内の感染病巣は広範囲におよび, 十分に除去できなかった。その後, 残存した有棘細胞癌が再び増大し, 入院21ヵ月後に死亡した。治癒を目指すには徹底的な手術療法が必要であったと考えられるが, 病変の広さと持続する感染を考えると, その適応の決定は困難である。

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.

The educational system and the introduction of legislation of clinical medicine are both still in developing stage in Cambodia where only 10 years have passed since the establishment of a new government. In order to maintain good health of all Cambodian citizens and to improve the quality of care in health services, it should be necessary to implement an appropriate educational system for both laboratory technologists and technicians. To conduct refreshment training course for laboratory workers with provision of the instruments, material and reagents is another way to make improvement of it in public hospitals. It should be also required to overcome economic problems how to absorb medical expense and to understand the importance for doctors to diagnose with scientific data of clinical examinations. Maturation of the total medical system in this country should be necessary and suggestions from neighboring countries with views toward the world standard would be expected.

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.

Melatonin (N-acetyl-5-methoxytryptamine) and the activities of two melatonin-synthesizing enzymes, serotonin N-acetyltransferase (acetyl coenzyme A: arylalkylamine N-acetyltransferase EC 2.3.1.87; NAT) and hydroxyindole-O-methyltransferase (S-adenosyl- l -methionine: N-acetylserotonin-O-methyltransferase EC 2.1.1.4; HIOMT), were assayed in extracts of ovaries obtained from virgin Wistar-derived rats (7–9 week-old) during the light period of a 12 h light/12 h dark cycle. Melatonin was detected in the rat ovary using reverse-phase high-performance liquid chromatography (HPLC) coupled with fluorometric detection and radioimmunoassay (RIA). In addition, NAT and HIOMT activities were found in rat ovary. The apparent Michaelis constants (Km) for the substrates of NAT and HIOMT in the rat ovary were similar to those reported for the pineal gland and retina. These data suggest that the rat ovary, like the pineal gland and the retina, may synthesize melatonin from serotonin by the sequential action of NAT and HIOMT.

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.

background It is difficult to reconstruct a satisfactory ala. Axial frontonasal flap has been common in reconstruction of nasal tip. We modified this flap to reconstruct nasal ala. objective A modified axial frontonasal flap was applied for reconstruction of complete unilateral alar defects in two patients. methods Skin from an intact nasal tip covered the alar defect. The resulting defect in the nasal tip was covered with dorsal skin from the nose. Extended mucosa or a hinged nasolabial flap was used to line the mucosal side of the reconstructed ala. results The outcome judged by shape, and texture, was satisfactory. This technique can be employed under field block. conclusion The modified frontonasal flap is one of the ideal techniques to reconstruct an entire nasal ala.

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.

肝穿刺細胞診199例, 延234回のうち, 最終診断の明らかな175例, 延209回を対象として, その成績と, 細胞診と最終診断の不一致例の検討を行った.成績: 悪性100例中陽性は88例 (88%) で, 高率であったが, 良性75例中4例 (5%) の偽陽性があり, 正診率は90%であった.不一致例の検討: 偽陰性例26回中良性細胞のみのものは20回, 変性細胞あるいは細胞数が少ないものが4回で, 細胞採取技術の向上が望まれる.一方高分化肝細胞癌と肝硬変の細胞鑑別が問題で, 比較的異型軽度のため陰性あるいは疑陽性にされていたものが3例あり, 逆に, 核の重積性, 大小不同性, あるいは核内封入体から陽性とされていた偽陽性が2例あった.また, 異型裸核細胞だけで陽性と判定するのは危険で, 注意を要すると思われた.肝穿刺細胞診は, 安全で正診率も高く, 肝限局性病変の有用な検査法であることが再確認された.また, 不一致例の検討より, 細胞採取技術の改善と, 高分化肝細胞癌と肝硬変の細胞鑑別について, 症例を重ねて検討する必要があると思われた.

Technical grade dinitrotoluene (DNT), an important industrial nitroaromatic compound, not only induces methemoglobinemia but is a potent hepatocarcinogen in man and rats. The purpose of the present study was to identify the metabolites produced from five DNT isomers (2, 3-, 2, 4-, 2, 5-, 2, 6-and 3, 4-DNT) by Escherichia coli (E. coli) strain W3110, isolated from human intestine. Data obtained from thin-layer and gas chromatographies or liquid scintillation counting indicated that the metabolites produced by the E. coli were two monoaminonitrotoluenes and hydroxylaminonitrotoluenes in all cases. This finding indicates that DNT is reduced via hydroxylaminonitrotoluenes to monoaminonitrotoluenes in E. coli. In addition, it was found that the reduction reactivities of DNT isomers were 3->2-for 2, 3-DNT, 4->2-for 2, 4-DNT, 5->2-for 2, 5-DNT and 3->4-for 3, 4-DNT. The role of bacterial reduction in the toxic actions of DNT is discussed.

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.