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To apply the germanium (Ge) thin film for various electronic devices, energy band structure should be controlled by carbon (C) and/or Tin (Sn) doping. It is important to understand the stable atomic configurations of C and Sn atoms near the (001) surface of a Ge thin film. In this study, first principles calculation based on density functional theory was performed to obtain the formation energies and the thermal equilibrium concentrations of C and Sn atoms near the surface of Ge thin film. The results of the analysis are threefold. First, C and Sn atoms are most stable at the first atomic layer of the Ge thin film, and the surface does not affect the stability of C or Sn atoms deeper than the fifth layer. Second, C and Sn atoms at the second to fourth layer increase the thermal equilibrium concentration of newly arrived C and Sn atoms at the surface during film growth. Third, in the case of mono-doping, formation energy of C (Sn) at the (001) surface increases with increasing concentration of surface C (Sn). In the case of co-doping at C/Sn concentration ratio of 1:1, the increases of formation energies are suppressed in comparison to the case of mono-doping. It is concluded from these results that co-doping enhances the incorporation of C and Sn atoms in the Ge thin film. Furthermore, the doped atom near Si surface becomes more stable than that in the Si bulk, and it is more remarkable in comparison to Ge.

A 19-year-old woman, who had been receiving hormone replacement therapy for 13 months before the diagnosis of mosaic Turner syndrome (46XXp-/45X), developed Crohn's colitis and erythema nodosum of the lower legs. Colonoscopy revealed an anal fistula and the presence of deep longitudinal ulcers with cobblestoning in the colorectum. Therapy with prednisolone and adalimumab was effective for the intestinal and skin lesions. To date, all seven case reports of Turner syndrome in Japan have also developed Crohn's disease after hormone therapy, suggesting a possible association of sex hormones in the pathogenesis.

We successfully managed two fetuses complicated with suspected airway obstruction after birth by the EXIT (ex utero intrapartum treatment) procedure, whose placental circulation was maintained till their airway was secured during the cesarean section. The first fetus was suspected to have airway obstruction due to a large neck mass. At 36 weeks of gestation, the EXIT procedure was undertaken performing the tracheal intubation successfully by laryngoscope. The second fetus with micrognathia was expected to have airway obstruction after birth. The EXIT procedure was undertaken at 35 weeks of gestation. The tracheal intubation by laryngoscope or by stylet scope was impossible, and the airway was secured by tracheostomy. The direct roles of anesthesiologists in the EXIT procedure are to let the uterus relax enough, deal with bleeding, and manage the fetal airway. The EXIT procedure is a specialized operation in which various specialists are involved, and a variety of judgments are necessary within a short time. Therefore, all concerned personnel should discuss previously to make a concensus on the processes during the procedure. The organization may be also an important role of the anesthesiologists in the EXIT procedure.

A 77-year-old man was scheduled to undergo the resection of hepatoma. After the induction of general anesthesia, a central venous (CV) catheter was inserted from the right internal jugular vein under the echographic observation. Then, we noticed that the size of the vein was smaller than usual, which caused a little difficulty in the insertion. The post-insertion chest X-ray showed unusual placement of the catheter's tip toward the left side of the trachea. Re-evaluation of preoperative CT revealed the persistent left superior vena cava (PLSVC) with absent right superior vena cava. Post-operative examination with echography of the neck showed that the left internal jugular vein was much greater than the right. When noticing a small right internal jugular vein in pre-procedure echography, existence of PLSVC should be considered, and meticulous CV catheterization is necessary for safety.

A 16-year-old woman with MELAS developed fever and myoclonic epilepsy which improved with conventional anti-epileptic drugs. Since seizures recurred one month after successful treatment, the doses of phenobarbital, clonazepan, and valproate were increased. However, there was no improvement and status epilepticus continued. The addition of lamotrigine resulted in a decreased frequency and good control of seizures. This case is important, showing satisfactory results from the addition of lamotrigine for treatment-resistant status epilepticus.

A 45-year-old female was positive for anti-aquaporin-4 antibody with disturbance of consciousness, respiratory failure, and ophthalmoplegia associated with extensive brain stem involvement with intractable hiccup and nausea as an initial manifestation. Her level of consciousness and state of respiration worsened approximately one month later. There was no abnormality in the cerebrospinal fluid examination. A lesion was found in the medullary tegmentum on brain MRI. The patient received steroid pulse therapy and her level of consciousness improved the next day. However, her state of respiration worsened, and she had extensively clinical involvement of the brain stem. Her symptoms gradually improved with intravenous administration of prednisolone and intravenous immunoglobulin therapy (IVIg). The patient had almost completely recovered, but she relapsed with cervical myelitis extending over 3 vertebral segments approximately 10 months later. She underwent steroid pulse therapy, oral prednisolone, and IVIg again and improved.

Aim: Fish oil is associated with decreased arteriosclerosis, cardiovascular disease and the prevention of cellular aging. Most studies of n-3 PUFA (polyunsaturated fatty acid) have been conducted in patients under 80 years of age, and there are few studies of subjects ≥80 years of age. This study investigated the relationship between eicosapentaenoic acid (EPA) or arachidonic acid (AA) and arteriosclerosis in elderly patients ≥80 years of age., Method: We enrolled 150 patients ≥80 years of age (average, 85±4 years) not taking EPA that presented or were admitted to our hospital. Their EPA or AA levels were measured to investigate the relationship between EPA or EPA/AA and cardiovascular disease or cerebrovascular disease. In addition, we investigated whether the ratio of EPA/AA was associated with estimated glomerular filtration rate (eGFR)., Results: The mean EPA level was 55.9±34.5 µg/dL, the mean AA level was 145.1±45.4 µg/dL and the mean EPA/AA was 0.40±0.24 (mean±SD). There were no significant differences between the EPA/AA and EPA values in patients with cardiovascular disease and those in patients without cardiovascular disease. Moreover, there were no significant differences between the EPA/AA and EPA values in patients with cerebrovascular disease and those in patients without cerebrovascular disease. There were no statistically significant correlations between EPA/AA or EPA and eGFR., Conclusion: Individuals may achieve a peak value of EPA or EPA/AA in their 70s and there is little change in those levels in patients aged over 80. No relationship was identified between EPA/AA and arteriosclerosis in subjects aged over 80 compared with those under 80 years of age.

Goldenhar syndrome is associated with difficult airway due to the characteristic craniofacial anomalies such as hypoplasia of the mandible and molar bones. We present our method of fiberoptic intubation using two tracheal tubes for a girl with Goldenhar syndrome undergoing cochlear implant surgery. She had received general anesthesia for dental treatment one year before, but the treatment had been cancelled because of the failure of tracheal intubation. We induced anesthesia for her with inhalation of sevoflurane and nitrous oxide. After obtaining a stable anesthetic level, we inserted two tracheal tubes from the right and left nostrils, one for a tracheal tube and the other for a nasopharyngeal airway. During the procedure, the fiberscope was advanced through the tracheal tube with a slit connector, and her ventilation was assisted through the nasopharyngeal airway with her mouth closed by a tape to avoid a leak of ventilating gas. Using this two-tube method, we successfully intubated the trachea of a patient Goldenhar syndrome.

We present a rare case of 26-year-old male patient without a history of epilepsy, who underwent a voice monitoring surgery under local anesthesia plus sedation using modified neuroleptanalgesia. As he developed generalized tonic-clonic seizure probably due to pentazocine, the operation was cancelled. Later, the same surgery was rescheduled. After a premedication with intramuscular phenobarbital, the patient was sedated with dexmedetomidine and locally anesthetized, showing sedation of high quality with no respiratory depression and no seizure. Dexmedetomidine was used succesfully for voice monitoring surgery.

We calculated and analyzed the profits from surgery and anaesthesia for a period of one month of September 2006 in Kyushu University Hospital. It was confirmed that 27% of surgery-related profits were earned by anaesthesia. We were also able to confirm that the profits vary significantly depending on the material cost and the length of stay in the operating rooms. We believe that all the surgical workers must realize such fact and each of them is responsible to carry out the operations quickly and efficiently.

A 23-year-old man with xeroderma pigmentosum underwent laparoscopic cholecystectomy. He experienced transient worsening of the neurological symptom after anesthesia with volatile agents in the previous surgery. Because volatile anesthetics potentially cause genotoxic effects in patients with xeroderma pigmentosum, this time we chose total ir.travenous anesthesia (TIVA). The intraoperative management and the post-operative course were uneventful this time. From these two anesthesia experiences in one patient, we suggest that TIVA is more appropriate than anesthesia with volatile agents as a method for general anesthesia for xeroderma pigmentosum patients. Minimum usage of muscle relaxants under the monitoring of neuromuscular blockade is also recommended, since xeroderma pigmentosum patients are sensitive to muscle relaxants due to the neuronal dysfunction and muscle

We herein report a case of advanced gastric small cell carcinoma treated by chemotherapy and radiotherapy. A 69-year-old man was admitted to our hospital presenting with appetite loss and body weight loss. He was diagnosed to have an inoperable gastric small cell carcinoma with severe lymph node metastases and left adrenal gland metastasis. Chemotherapy with TS-1/paclitaxel, cisplatin/irinotecan and cisplatin/etoposide was sequentially performed. Primary and metastatic foci had obviously diminished. Eighteen months after the initial therapy, he had dysarthrosis and multiple brain metastases were found. Metastatic foci were decreased and his symptom was improved by successful radiotherapy. We conclude that chemotherapy and radiotherapy are effective for primary and metastatic lesions of gastric small cell carcinoma.

A 71-year-old man was admitted with high fever, thirst, polyposia and polyuria. After examination, lung cancer (adenocarcinoma T1NOM1, Stage IV) and central diabitus insipidus caused by pituitary metastasis of lung cancer, were diagnosed. We gave him desmopressin acetate, gamma knife surgery for pituitary metastasis and chemotherapy with paclitaxel and carboplatin, and his symptoms improved. However, his lung cancer progressed. Diabitus insipidus caused by lung cancer is rare.

Background: To clarify the prognosis of facial nerve palsy, electroneuronal tests, including electrogustometry and stapedial reflex, have been utilized. But, the relationship among these tests and patients' prognosis is not clear., Methods: Sixty five patients with peripheral facial nerve palsy were investigated. Electrogustometry (EG), stapedial reflex (SR) and blink reflex (BR) were performed at the first visit on the consult of facial nerve palsy. The palsy scale (full score is 100 points) was evaluated 8 weeks after the onset, and we defined cure cases if score became over 90 points. The cure ratio was examined on each group of EG positive or negative, SR positive or negative and BR R1 wave positive or negative, respectively. The relationship among these three examinations was also investigated., Results: There were no significant differences between the cure ratio of EG positive and negative groups. However, the cure ratio of SR positive group was significantly larger than that of SR negative group. The cure ratio of BR positive group was 100%, regardless of the result of other two tests., Conclusions: The present study suggests that SR is a more useful parameter than EG for the evaluation of the prognosis of patients with facial nerve palsy, and the pathological meaning of these 2 tests is different from that of BR.

Background: Central nervous system dysfunction after cardiopulmonary bypass (CPB) is an important cause of morbidity and mortality after cardiac surgery. Perfusion pressure (PP) during CPB could be one of the important determinants of cerebral blood flow (CBF). The objective of the present study was to determine the effect of PP on CBF and cerebral oxgenation during normothermic CPB., Methods: Twelve adult patients undergoing coronary artery bypass graft surgery were randomly assigned to one of two groups based on PP (High and Low group). Patients in High group received phenylephrine immediately after the onset of CPB to maintain PP between 60 and 80 mmHg. Oxyhemoglobin (O2Hb), deoxyhemoglobin (HHb), tissue oxygenation index (TOI), and oxidized cytochrome aa3 (CtOx) were measured by near-infrared spectroscopy, and internal jugular venous bulb blood oxygen saturation (SjvO2) was measured simultaneously. S-100 beta protein concentrations were also measured before and after CPB., Results: SjvO2 in High group increased significantly during CPB. CtOx in Low group decreased significantly during CPB, whereas TOI was unchanged. Although S-100 beta increased significantly at the end of CPB, there was no difference between the groups., Conclusions: These results suggest that maintaining high PP is benefical for CBF during normothermic CPB.

The patient, who is received home enteral nutrition (HEN) for a long time in a day, has problems on moving all days. Now, we tried Portermate, which is new portable devices for HEN, in his clinical care. The patient is chronic pancreatitis, and his clinical problems becomes to be worse after he ate. He was under total enteral nutrition via jejunostomy. His clinical complications were almost controlled after HEN, but he has a few complains receiving enteral nutrition. He would not move easily, for an old HEN system was not compact to move. Portermate made him go everywhere he wanted any time. It extremely improved his QOL under HEN. He continues to use Portermate.

From October, 1997 through July, 1998, an outbreak of aseptic meningitis due to echovirus type 30 occurred in the northern part of Kyushu area in Japan. In this outbreak, clinical and virologic observations were carried out on 157 in-patients with aseptic meningitis at our hospital. The age of the patients ranged from 1 year and 9 months to 57-year old. One hundred and twenty out of 157 cases were the children under 15 years of age, and in this age group, male/female ratio was 2:1. The largest proportion of cases occurred in the 5- to 9-year age group. The number of cases reached a peak in December, 1997, but the epidemic extended to the next summer. In 12 families, more than one person became ill (total 22 cases). Virus isolation from cerebrospinal fluid (CSF) was tried on 130 out of 157 cases. Echovirus 30 was isolated in 74 cases (58 children, 16 adults), and echovirus 18 in 9 cases from June, 1998 until the end of the study. Paired acute and convalescent sera were available from the 25 patients with negative virus isolation, and 7 out of 25 patients had a fourfold or greater rise in neutralizing antibodies. Headache, fever, vomiting, nuchal rigidity were detectable in most cases, but in this outbreak, continued severe headache was characteristic. Eye pain was experienced by 2% of the total cases. In children, gastrointestinal symptoms were noted in 12% of the cases, but were not in adult patients. The CSF cell counts ranged from 2 to 3,478 cells per cubic millimeter. Fifty-eight percent were predominantly lymphocytic, while 42% were polymorphonuclear predominant. Virus was highly isolated from the CSF when the specimens were obtained within three days after the onset of the acute illness, but in one case, virus was isolated on day 7. In a few cases, virus was isolated without pleocytosis in CSF.

The effects of locally administered alpha 1- and beta 2-stimulants (naphazoline and salbutamol) on the nasal nitric oxide (NO) level were investigated. Twenty-four healthy volunteers (except nasal allergy) were subjected to the examination. First, nasal cavity air was sampled continuously from the right nostril for 20 seconds at the rate of 3.5 l/m, and NO-free air was supplied passively to the left nostril. During the sampling time, subjects were made to hold their breath at deep inspiration, which obviated the effect of lower airways by closing their glottises. The sampled air was analyzed using a chemiluminescence technique for NO detection. In addition, nasal airway resistances (NAR) were estimated by a rhinomanometer, and minimum cross-section area (MCA) and nasal cavity volume (NCV) were estimated by an acoustic rhinometer. After these estimations, 12 subjects received naphazoline nitrate 15 micrograms per nostril, and the other 12 subjects received salbutamol sulfate 100 micrograms per nostril. Finally, after 15 minutes rest, these four parameters were reviewed. The results demonstrated that naphazoline significantly decreased NO concentration and NAR, and increased NCV. Furthermore, salbutamol significantly increased NO concentration and NAR, and decreased MCA and NCV. The changes in NAR, MCA and NCV indicated that nasal mucosa became contracted and swollen by topical naphazoline and salbutamol application. Naphazoline, a nasal decongestant, contract nasal vessels by stimulating alpha 1-adrenoceptors, whereas salbutamol dilates then by stimulating beta 2-adrenoceptors, and this vasodilation does not intervene NO and cyclic GMP. Thus, nasal NO concentration is significantly affected by the change of blood supply caused simply by vasocontraction and vasodilation. In conclusion, it appeared that nasal NO concentration was possibly altered by the change of nasal blood supply, moreover, by the change in the supply of NO substrate.

A 25-year-old man was admitted for evaluation of pancytopenia on May 2, 1997. On admission, he had pancytopenia with a normal reticulocyte count. Bone marrow aspirate specimens displayed a normal karyotype and hypocellularity without myelodysplasia. Although total bilirubin and lactate dehydrogenase levels were within their normal ranges, the haptoglobin level was low; additionally, two-color flow cytometric analysis determined that 3.3% of erythrocytes were double-negative for CD55 and CD59 expression. Atypical paroxysmal nocturnal hemoglobinuria with bone marrow hypoplasia was diagnosed. Because initial treatment with cyclosporin A was not effective, the patient was subsequently given a combination of antithymocyte globulin, cyclosporin A, and granulocyte colony-stimulating factor. Although the pancytopenia subsided, the percentage of double-negative erythrocytes in the patient's blood remained almost unchanged compared to findings obtained on admission.

A 59-year-old male was performed right pneumonectomy with R 2 b lymph node dissection and intercostal muscle flap to the bronchial stump for squamous cell carcinoma of right upper lobe of the lung (cT 2 N 2 M 0-stage III A). But four weeks later bronchial stump was suddenly reopened and he developed empyema. Omentopexy for bronchopleural fistula (15 x 11 mm in size) and thoracoplasty for empyema was performed. Bronchoscopically the fistula is 2 mm in diameter and reepithelization is started around the fistula at 14 POD and the fistula is completely closed and covered with reepithelized mucosa without inflammation at 100 POD. We think omentopexy for bronchopleural fistula after pneumonectomy is very effective procedure, so we should be considered this method at first. But if the fistula is accompanying empyema as our case thoracoplasty should be added.

In order to determine whether or not the lidocaine metabolism, monoethylglycinexylidide (MEGX) formation, could be used as a liver function test, we measured the serum levels of MEGX in 38 patients. There were significant correlations between values of MEGX (MEGX15, MEGX30, AUC15-30, AUC0-180) and conventional liver function tests (ICG R15, AT III, T. Bil). It appeared that value of MEGX 30 had maximum factor loading on conventional liver function tests by using principal component analysis. The advantage of adapting the MEGX formation as a liver function test of drug metabolism is simplicity of the method. MEGX formation could be useful index of the total liver function.

The hens' egg-sized tumor connecting from anterior mediastinum to the hilus by chest radiography and chest CT was noted in a 63 year old female who complained of facial swelling and cough. The defect of the thumb tip-sized shadow was noted in the superior vena cava by superior vena cavography, and polyp covered with white coating obstructing the right apical bronchus was noted by fibrotic bronchoscopy, and malignant finding was obtained by biopsy of this polyp. After midsternotomy, a mass invaded to the superior vena cava and the right upper lobe was resected, and then superior vena cava was reconstructed by using supported polytetrafluoroethylene. The resected specimen revealed that the tumor extended not only to the pulmonary parenchyma with polypoid growth into the lumina of bronchi but also to the superior vena cava with polypoid growth. The patient was discharged at the postoperative radiotherapy with 40 Gy, and he is still alive free from the disease 3 years and 11 months after operation.

Between 1973 and 1989, 16 children with non-Hodgkins lymphoma (NHL) with a mediastinal mass (MM) were treated at our institution with multi-agent chemotherapy and radiotherapy. They also received central nervous system (CNS) prophylaxis including intrathecal methotrexate administration (14 cases) and cranial irradiation (7 cases). Twelve were boys and 4 girls. Median age was 11 +/- 3. One patient died of air way obstruction one day after admission. Fourteen of 15 patients entered into complete remission (CR) and one patient partial remission. Five remains in CR 7 to 175 months after diagnosis (median 76 months). Nine patients relapsed in the bone marrow (3 cases), CNS (3), testicles (1), neck lymph node (1) and bones plus kidneys (1). Of these, 7 patients died within 13 months after initial relapse. The disease free survival (DFS) and overall survival of all patients were 27% and 33%, respectively. Analysis of the prognostic factors among patients with MM+ -NHL revealed that the serum LDH level below 1,000IU/l was a good prognostic sign. Other factors such as age, stage, initial WBC count, size of MM and response of the MM to the initial treatment did not correlate with DFS. Because of its rarity and the poor treatment result, we need more aggressive treatment program by a multiinstitutional study for MM+ -NHL.

The esophagectomy and total left pneumonectomy were carried out in a 53-year-old male who had developed pyothorax in the pleural fistula of the bronchi and esophagus due to esophageal cancer, and then reconstruction of the esophagus by route of the anterior thoracic wall was performed using stomach tube biphasically. The postoperative course was favorable, and oral intake was possible, and his physical condition recovered as the patient could repeat stopping out from hospital while he died by pneumonia after 7 months. The remote metastasis or metastasis to the mediastinal lymph-node were not noted by autopsy. It is considered that there are cases having indication for active resection among A3-esophageal cancers.

The tensile bond strength of new bonding agents on human dentin treated with 37% phosphoric acid solution for 60 sec to a photocurable composite resin was measured and the fractured surface was then observed by SEM. The new bonding agents consisted of various 20 wt% high molecular monomers (MW. 1500, 5000, urethane acrylate oligomer) as a base monomer. The best bonding agent was a mixture of 20 wt% 1500 molecular monomer as a base monomer and the value of the tensile bond strength was 91 +/- 17 kgf/cm2. The tensile bond test and SEM image of the fracture surface suggested that a high molecular monomer as a base monomer promoted the adhesive efficiency to human dentin.