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7-valent pneumococcal conjugate vaccine (PCV7) has been included in the routine immunization schedule since April 2013 in Japan. Serotype replacement - a phenomenon by which serotypes are replaced by non-vaccine serotypes after vaccine introduction - has been reported in invasive pneumococcal disease (IPD). Pneumococcus in sputum samples is one of the major causes of bronchopulmonary infection in children. We tried to verify whether serotype replacement of Pneumococcus occurs in sputum samples in a similar manner as in IPD. From August 2014 to September 2015, we performed antimicrobial susceptibility testing and serotyping of Streptococcus pneumoniae from sputum samples and investigated the history of PCV from hospitalized children with S. pneumoniae bronchopulmonary infection. From the results of our investigation, 80.3% of children have received PCV at least once. Serotypes of Pneumococcus were determined in 92.4% of tested strains and PCV13 strains accounted for only 9.8%. Major isolated serotypes were 15A (21.3%), 35B (19.7%), and 6C (13.1%). Those were not included in PCV13, i.e. serotype replacement occurs in bronchopulmonary infection just as in IPD. The results of antimicrobial susceptibility testing for Penicillin G indicated that penicillin-resistant S. pneumoniae (PRSP) accounted for 4.5%, penicillin-intermediate resistant S. pneumoniae (PISP) accounted for 47.0% and penicillin-susceptible S. pneumoniae (PSSP) accounted for 48.5%. When examining the drug susceptibility by serotypes, 15A, 19A, 23A and 35B showed a high percentage of non-susceptibility. This means there is a difference in the resistant trend by serotypes. In our study, it became clear that verifying of the serotypes of Pneumococcus in sputum is meaningful and surveillance of serotypes is important for evaluation of vaccination as IPD.

The standard treatment for ovarian cancer is cytoreductive surgery followed by platinum-based combination chemotherapy. Although high response rates of this treatment are reported, 40-60% of patients achieving a complete response may relapse. Therefore, second-line chemotherapy is required. Second-line chemotherapy of patients with recurrent ovarian cancer should be based on their sensitivity to first-line chemotherapy and the platina-free interval. Patients who respond to the platina-based chemotherapy still may be sensitive to further platina-based chemotherapy. Patients who do not respond to the platina-based chemotherapy or who have relapses shortly after first-line chemotherapy should be considered clinically resistant to further platina-based chemotherapy. For such patients the chemotherapy regimen should be changed. These regimens include paclitaxel and hexamethylmelamine. The effect of intraperitoneal chemotherapy may depend on the size of the largest residual tumor nodule and the patient's sensitivity to previous chemotherapy.

To study the pathophysiology of bone disorder after gastrectomy, 320 patients and 40 Wistar male rats were used. Clinically, patients who had received gastrectomy 1-15 years previously, were examined for skeletal symptoms, serum biochemistry, microdensitometry of second metacarpal bone, and 20 of them were then studied in a calcium infusion test. Using microdensitometry, abnormality of bone metabolism was observed in 38% of the patients. In severe cases, a significant decrease of serum Ca. and increase of alkaline phosphatase were observed (p less than 0.05), 65% complained of joint pain. In the calcium infusion test, severe cases showed a low urinary excretion of Ca, like osteomalacia, and unlike osteoporosis. Experimentally, body weight & amount of food intake decreased and fatty diarrhea was observed in rats after total gastrectomy. Skeletal changes including thinning of the cortex, loss of medullary trabeculation & decrease of bone ash and biochemical changes such as low serum Ca. 25(OH)D3, 24, 25(OH)2D3 and high iPTH levels were observed. Also the bone formation rate was lower than control as detected by tetracycline double labelling method. As low food intake & fatty diarrhea after gastrectomy which result in Ca. & vit. D insufficiency may be the major etiology of bone disorder.

Unlabelled: Sixty two total gastrectomized patients were studied in serum biochemistry, bone microdensitometry, Calcium infusion test and clinical symptoms related to bone disorder. Thirty total gastrectomized Wistar rats were studied in food-intake amount, serum biochemistry, bone histological changes and intestinal absorption of 45Ca. I. Clinical: 63% of the patients showed bone abnormality by microdensitometry, and 52% showed hypocalcemia and 47% showed high A1-P. Urinary excretion of calcium in bone disordered patients was below 28% by calcium infusion test, which suggested that the change of bone seemed to be osteomalacia. II., Experiment: The longer of time after gastrectomy, the thinner of cortex and lesser of trabeculation was observed in femoral bone of rats. Food-intake, serum calcium and vitamin D levels decreased, but on the other hand, the lipid content in feces increased, and disturbance of intestinal 45Ca absorption was marked in total gastrectomized rats., Conclusions: 1. After total gastrectomy, bone disorder was observed in 63% of patients and in all of rats. 2. The longer after operation, the worse of the bone change. 3. It resembled osteomalacia rather than osteoporosis. 4. Vitamin D and calcium malabsorption due to low food intake and fatty diarrhea may be the major etiologies.

Pulmonary artery sling is an uncommon congenital vascular anomaly, which may cause significant respiratory morbidity resulting from an external tracheal compression during early infancy. This condition should be considered on finding a mass interposed between the trachea and the esophagus showing an anterior indentation on the esophagograms. The diagnosis is usually made by invasive methods such as bronchography, bronchoscopy, cardiac catheterization, and angiography. Magnetic resonance imaging (MRI) has now become an excellent method for diagnosing cardiovascular anomalies, but the use of MRI as a means of diagnosing pulmonary artery sling is rare. In 1988, Malmgren et al, first reported the use of MRI in three cases. Their findings suggested that two overlaping sets of axial sections might be necessary for depicting the anomaly because different parts of the left pulmonary artery are imaged in different slices. In this paper, we report a diagnostic scan image which utilizes a single axial scan and reveals the pulmonary artery sling arising aberrantly from the right pulmonary artery. We also found (a) when the pulmonary artery sling interposed between the esophagus and trachea; the trachea become stenotic below the upper one-third in LAO equivalent sagittal section; (b) the right pulmonary artery compresses the proximal part of right pulmonary bronchus, and the right upper lobe bronchus arises from the trachea independently in the coronal section. Thus, we conclude that MRI, if available, should be the first choice modality for further examination when a pulmonary artery sling is suggested by conventional radiography.