Search

Trichophyton tonsurans infection has been prevalent among individuals involved in contact sports in Japan since about 2000. The present review focuses on its diagnosis, molecular epidemiology, drug susceptibility, and infection control. The most commonly observed lesions of T. tonsurans, an anthropogenic dermatophyte, are tinea corporis and tinea capitis. However, the presence of asymptomatic carriers must be considered for infection control. Genotypic epidemiology using restriction fragment length polymorphisms (RFLP) in the non-transcribed spacer (NTS) region of the ribosomal RNA gene showed a lack of diversity of genotypes, and only the NTS I genotype is detected at present. In regard to drug susceptibility, terbinafine drug resistance has not been found to be associated with the RFLP genotypes, and it is assumed that there are no terbinafine-resistant strains in Japan. T. tonsurans coexisted with other fungi and bacteria in the scalp of asymptomatic carriers without affecting species diversity. T. tonsurans is an anthropogenic dermatophyte and may be difficult for the human immune system to eliminate. During an infection outbreak, screening of infection and treatment including asymptomatic carriers are essential to eradicate the infection.

Here, we have reported a case pertaining to a 59-year-old man with bilateral traumatic carotid artery injury caused by vinyl umbrella penetration who was successfully treated. The patient fell from the stairs while holding an umbrella, which penetrated his neck. On admission, the patient was in a comatose state and the umbrella had been removed. Active bleeding was observed on the left side of the neck. Hence, tracheal intubation was performed to support respiration. Neck and head contrast-enhanced CT revealed bilateral extravasations from the carotid arteries and right middle cerebral artery(MCA)occlusion. Left carotid angiography showed extravasation from the external carotid artery(ECA), which was treated with coil embolization. Right carotid angiography revealed bleeding from the ECA and internal carotid artery(ICA)and occlusion of the MCA. The ECA and ICA were occluded by coil and n-butyl-2-cyanoacrylate embolization. After the procedures, the patient developed a large right cerebral infarction with massive brain swelling; therefore, external decompression was performed. Subsequently, the patient became alert and was able to walk with support within a month. Bilateral carotid injury is severe and difficult to treat. Endovascular therapy may be effective for the management of bilateral carotid injuries.

Case 1: A 73-year-old man who had undergone neurolysis for right cubital tunnel syndrome complained of difficulty using chopsticks. Froment's sign test showed that the interphalangeal(IP)joint of the right thumb that had flexed preoperatively was extended. This finding was considered to indicate recovery from ulnar neuropathy, and the patient was closely followed up. One year later, the patient was unable to push a camera shutter button and was unable to flex the IP joint of the thumb and the distal interphalangeal(DIP)joint of the index finger, a characteristic symptom of anterior interosseous nerve(AIN)palsy. Therefore, the patient underwent AIN neurolysis and subsequently reported slight improvement in his condition. Case 2: A 60-year-old woman reported difficulty performing computer mouse clicks with her right hand. As flexing the index finger DIP joint was difficult, a local lesion was suspected, and the patient was closely followed up. One year later, the patient was unable to push the button of a ballpoint pen with her thumb. Extension of the thumb and index finger indicated AIN palsy. The patient refused treatment and was only followed up. The following year, the patient reported that the weakness improved. Simultaneous flexion palsy of the thumb and index finger can lead to a diagnosis of AIN palsy. However, flexion palsy of a single finger in incomplete AIN palsy, as reported here, is often overlooked because of its similarity to the flexor tendon rupture. Awareness regarding this incomplete form of AIN palsy is needed for early and correct diagnosis.

This 74-year-old man had undergone a third re-operation for anaplastic meningioma in the convexity six weeks before he was referred to us. He presented with a bulge on the lateral aspect of the left thigh. We observed a fresh fascia lata harvesting scar that extended peripherally from an old proximal scar. The bulge was colorless. The aspirated subcutaneous fluid(more than 200mL)was watery and yellowish;there was no evidence of abscess or hematoma. Although the bulge shrank after aspiration and the placement of a compression bandage, it recurred in three days. Surgery-associated lymphorrhea was the diagnosis given. Goreisan, a herbal medicine for hydrostatic modulation, was administered. One week later, the bulge diminished in size. Harvesting of the fascia lata in the lateral aspect of the thigh is usually safe. However, additional dissection and peripheral extension due to repeated harvesting risks damaging the superficial lymphatic pathways because of scar formation after earlier surgeries and the hyperdense distribution of the lymphatic pathways in the peripheral part. When subcutaneous fluid collection after fascia lata harvesting is refractory, lymphorrhea must be considered in the differential diagnosis.

A 2-year and 4-month-old boy developed Langerhans cell histiocytosis (LCH) at the left parietal region of the skull. After treatment with chemotherapy, the patient achieved remission but experienced three relapses. After 3 years, he complained of headache, blurred vision, and lethargy. Brain magnetic resonance imaging revealed multiple dura-based meningeal masses. Biopsy was performed, and the patient was then diagnosed with juvenile xanthogranuloma (JXG). The analysis of both LCH/JXG tissues revealed BRAF V600E mutation. The JXG masses were not responsive to prednisolone, which was injected locally, radiotherapy (24 Gy), and chemotherapy (2-chlorodeoxy-adenosine). In addition, since the patient developed macrophage activation syndrome associated with systemic JXG progression, he received unrelated cord blood transplantation (u-CBT) at the age of 10 years and 11 months. Engraftment was performed at day 42, and significant GVHD was not observed. Four months after CBT, the patient was treated with infliximab (Remicade ® ) and dexamethasone palmitate (Limethasone ® ). The size of the intracranial JXG masses gradually decreased after u-CBT and disappeared after 4 years. Currently, the patient is doing well at the age of 25 years and is receiving androgen replacement therapy.

A 43-year-old man fell from a 1m-high truck loading platform and sustained an injury in the occiput. On admission, he was alert and neurologically intact. Computed tomography(CT)showed hemorrhage in the right sylvian fissure and parenchyma adjacent to the sphenoid wing. Magnetic resonance angiography detected no abnormalities. The course was uneventful for 11 days. However, on the 12th day, he spontaneously manifested with stupor. CT and CT angiography revealed expansion of the hemorrhage and an aneurysm arising from the origin of the M2 segment of the right middle cerebral artery. After superficial temporal artery to middle cerebral artery bypass, the aneurysm, a reddish pulsatile mass, was removed from the origin of the torn M2 segment, and the laceration was sutured. The histological diagnosis was false aneurysm. He recovered and was discharged 4 months after the trauma. Traumatic cerebral aneurysms are rare in the proximal segment of the middle cerebral artery. However, they should be distinguished from nontraumatic true aneurysms in the same region and treated as false aneurysms, which are major and critical traumatic aneurysms, for favorable outcomes.

This 64-year-old woman had undergone endoscopic carpal tunnel release(ECTR)for right carpal tunnel syndrome 16 months earlier. Thereafter, she reported persistent dysesthesia in the thumb and index finger, developed burning pain in the middle and ring finger, paleness, coldness, and edema of the hand, a decreased range in hand motion, and a painful subcutaneous nodule just distal to the portal in the forearm. Based on physical, radiological, and electrophysiological studies, the diagnosis was incomplete carpal tunnel release associated with complex regional pain syndrome(CRPS). At open revision surgery, the carpal tunnel was released completely and the nodule was removed. Symptoms other than hypesthesia in the middle and ring fingers improved. Pathologically, the nodule was an amputation neuroma. Her CRPS was attributed to ECTR complications; i.e., persistence of median nerve compression and the formation of an amputation neuroma in the palmar cutaneous branch of the ulnar nerve at the portal. Surgeons must be aware that ECTR, a less invasive technique, may result in serious complications including CRPS.

Several recent reports have described the administration of preoperative chemotherapy for locally advanced rectal cancer. In our hospital, preoperative chemotherapy based on oxaliplatin was administered for locally advanced rectal cancer with a tumor diameter of 5 cm or more and half semicircularity or more, and curative resection with laparoscopic surgery was performed after tumor shrinkage. We have experienced 25 cases that underwent preoperative chemotherapy for local advanced rectal cancer in our hospital from May 2012 to April 2016. No tumor increased in size during preoperative chemotherapy and there were no cases where R0 resection was impossible. In addition, no distant metastasis during chemotherapy was observed. Postoperative complications were observed in 3 cases(12%), and anastomotic leakage was observed in 1 case (4%), but conservative treatment was possible. Multidisciplinary treatment of preoperative chemotherapy and surgery should be considered as a therapeutic strategy for locally advanced rectal cancer, mainly in medical institutions without radiation treatment facilities.

Hyponatremia is one of the common electrolyte disorders associated with cisplatin (CDDP) administration. We report here two cases of hyponatremia associated with CDDP. Case 1 : A 75-year-old man with urothelial carcinoma of bladder (cT3N1M0) underwent neoadjuvant chemotherapy with CDDP and gemcitabine. He lost consciousness on the eighth day after the chemotherapy. Blood tests showed severe hyponatremia (Na 113 mEq/l), low plasma osmolality and high level of plasma vasopressin. Urine tests showed low osmolality. These findings were consistent with the syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH). His consciousness level was improved after saline infusion and fluid restriction. Case 2 : A 54-year-old man with penile cancer (cT3N2M0) underwent neoadjuvant chemotherapy with CDDP, paclitaxel and fluorouracil. He lost consciousness on the seventh day after the chemotherapy. Blood tests showed hyponatremia(Na 121 mEq/l) with renal dysfunction. We concluded that the hyponatremia is due to the renal salt wasting syndrome (RSWS) based on renal dysfunction and high urinary sodium excretion. His consciousness level was improved after saline infusion. Although it is difficult to distinguish between SIADH and RSWS, correct evaluation is necessary for appropriate management of hyponatremia after CDDP administration.

Objective: Suction is necessary during craniotomy, and intraoperative tumbling of the suction device interrupts operative procedures. To avoid this, we developed a technique that would fasten the device to an extendable cord as is used to secure cell phones., Surgical Technique: We used this technique in more than 300 craniotomies at the specific point of time when the suction device tends to tumble, i. e., during the opening and closure of a wound, which requires frequent instrument exchanges. Extendable cords fastened to the tip of the suction hose using a gift tie were attached to the drapes to secure the suction device next to the operative field. During the operation, the extendable cord followed the suction device manipulations. Consequently, although there was some tension in the cord during its extension, the maneuverability of the suction device was maintained. As the hanging suction device was closer to the operative field than devices stored in conventional pockets, its manipulation was easier and quicker. Upon release, the suction device automatically returned to its original position without distracting the surgeon. Tumbling of the device was prevented, and there were no procedure-related complications., Conclusions: Our simple modification using extendable cords prevented tumbling, avoided unnecessary replacements, and eased the manipulation of a suction device.

In May 2015, information on the current status of mycological examinations in university clinics, and the education of students, and junior and senior residents in Japanese universities was gathered using a questionnaire, which was completed by 98 of the 117 (83.8%) professors or directors in charge of dermatology departments in Japan that were included in the survey.The questionnaire items were divided into three parts; namely, Part A, inspection methods used for diagnosis of cutaneous mycoses in each university clinic; Part B, need for a network and construction of a support system for medical care and education; and Part C, status of education of undergraduate students and residents. Some of these questions are based on a similar survey in 2007. In Part A, it was found that only 3% of university clinics performed fungal culture for all or most cases, indicating a drop from the previous study (9% in 2007). Meanwhile, responses indicating that fungal culture was almost or completely done away with accounted for about 36%. Based on type of mycoses, fungal culture for deep mycoses was performed in about 83% of the facilities. However, the percentage for superficial mycoses was very low, wherein only 39% of the facilities performed cultures even for tinea capitis. Trichophyton tonsurans infection was "often" or "sometimes" diagnosed in 22% of the facilities, with the other 78% reporting "no" or "almost no cases" of T. tonsurans infection diagnosed. In Part B, it was found that 96% of respondents (up from 89% in 2007) desired help from the university network, including aid in identifying fungal isolates, diagnosing rare fungal infections, and basic training in medical mycology of young doctors (senior residents in university hospitals). In Part C, it was found that education in direct KOH preparation for senior residents was satisfactory in about 80% of the facilities. However, about 45% of respondents reported that majority or all of the senior residents in their institutes had no opportunity to perform fungal culture. The results indicate that respondents desire a diagnostic laboratory for medical mycology, especially for rare (deep) mycoses, and a database for diagnosis and management of deep mycoses. It is still therefore necessary to continue an educational program targeted at leaders to educate those in charge of each department.

Objective: When employing the lateral suboccipital approach, the thin dura shrinks due to the drying effect of illumination and air exposure, and dural substitutes are often needed for closure. We developed a new technique involving dural moisturizing with fibrin glue coating that facilitates primary dural closure., Patients and Methods: We used this technique in 12 adults who underwent the lateral suboccipital approach for 5 hemifacial spasms, 3 trigeminal neuralgias, 2 cerebellopontine meningiomas, 1 vestibular schwannoma, and 1 vertebral artery aneurysm. Fibrin glue was sprayed on the outer surface before opening the dura, and additionally sprayed on the inner surface of the reflected dural flap after opening the dura. After the intradural procedures the dura was closed with the usual knotted sutures., Results: Dural closure was performed 65-340 minutes (mean: 161.9 minutes) post-durotomy. This technique resulted in primary dural closure with a sufficient area of preserved dura in all but one patient. In this patient, the dura shrank due to coagulation of the dural attachment to the meningioma for which a small autologous substitute was required. There were no procedure-related complications such as cerebrospinal fluid leakage and meningitis., Conclusions: Dural moisturizing with fibrin glue coating is simple, protects the dura from drying and shrinkage, and facilitates primary dural closure in patients undergoing the lateral suboccipital approach.

Computed tomography (CT) performed for a 75-year-old man as a follow-up examination for deep vein thrombosis in October 2010 revealed a left adrenal mass (diameter, 8 mm). In December 2012, the adrenal mass increased to 28 mm in diameter, and he was referred to our department. Several blood examinations revealed that the adrenal mass was non-functioning, and only peripheral lesions were observed to be enhanced by using CT in the arterial phase. Malignancy was suspected due to the irregular shape and growth of the mass, and left adrenalectomy was performed in February 2013. The histopathological diagnosis was adrenal mycobacteriosis, and clinical diagnosis was adrenal tuberculosis. No other tuberculosis infection-related lesion was detected, and the patient was treated with multidrug antituberculous chemotherapy.

We describe differentiation of a spinal intramedullary lipoma from an intramedullary hematoma on magnetic resonance images (MRI) with fast spin-echo (FSE) sequences. A 60-year-old man with dysesthesia in the legs and gait disturbance, was suspected of having myelopathy at a middle thoracic lesion. MRI with FSE sequences revealed an intramedullary lesion at T7 to T8. On the basis of hyperintensity on both T1-and T2-weighted images and a perilesional hypointense rim on T2-weighted images we made a diagnosis of subacute hematoma and planned observation. However, computed tomography for associated vertebral degeneration revealed a hypodense area (-97 Hounsfield units) in the region corresponding to the lesion depicted by MRI. We revised our diagnosis to an intramedullary lipoma and debulked the lesion. The lipoma was surrounded by a thick whitish capsule. Histopathologically, the capsule contained mature fat tissue and abundant collagen. The initial diagnosis was mainly attributable to specific FSE characteristics, i. e., the depiction of fat tissue as hyperintense on both T1-and T2-weighted images. Conventional spin-echo MRI depicts fat tissue as hyperintense on T1-and as hypointense on T2-weighted images. Other factors contributing to our initial diagnosis were MRI findings suggestive of an intramedullary hematoma, i. e., the intrinsic location of the lesion and the perilesional hypointense rim on T2-weighted images ascribable to collagen present in the capsule. The accurate diagnosis of an intramedullary lipoma on FSE requires correct interpretation of the signal, which is different from the signal on conventional spin-echo MRI.

We experienced a case of ascending aortic stenosis after interrupted aortic arch repair. At the first operation in the neonatal period, diameter of the aortic annulus was 4.8 mm and no subvalvular stenosis was presented. Aortic arch was reconstructed with conventional technique of extended end-to-end anastomosis. Although ascending aortic stenosis was observed at the time, that had not been severe, however, the stenosis was exacerbated with time. At the catheterization 9 months after the operation, pressure gradient between aortic root and descending aorta was 72 mmHg. Therefore reoperation was carried out. Ascending aortoplasty using aoutologous pulmonary patch was performed. Pulmonary artery was repaired with aotologous pericardial patch. Despite mild pulmonary stenosis was observed, the postoperative course was favorable.

In black fungal infections, Exophiala species are frequently encountered as causative agents of human mycosis, particularly in immunocompromised patients. Among them, Exophiala jenselmei was previously reported as the most common etiological agent. Advances in molecular taxonomy proved this taxon to be heterogeneous, and led to newly introduced or redefined species. Exophiala xenobiotica is one of the novel species differentiated from E. jenselmei on the basis of molecular phylogeny.Here, we report a case of pheomycotic cyst caused by E. xenobiotica, which was well controlled via drainage and local thermotherapy. A 70-year-old man developed a cystic nodular lesion on the dorsum of his right thumb over the previous 3 months. He had been treated with prednisolone and methotrexate for 4 years for rheumatoid arthritis. The patient also had lung cancer with vertebral bone metastasis. Direct microscopic examination of the greenish pus aspirated from the cyst revealed mycelial elements. Culture of the pus on blood and Sabouraud dextrose agar yielded numerous black colonies multiple times. Histopathological examination of a biopsy specimen showed subcutaneous abscess formation surrounded by granulomatous tissues. Faintly pigmented pseudohyphae were seen within the abscess. The presence of melanin in the fungal cells was determined by Fontana-Masson staining. Initial microscopic examination of the isolate revealed annellidic conidiogenous cells, suggestive of E. jenselmei. This strain was further identified as E. xenobiotica by sequence analysis of the internal transcribed spacer (ITS) region of ribosomal RNA, showing a 100% sequence homology with the strain type.Pheomycotic cysts should be considered on identifying a slowly developing chronic subcutaneous abscess in immunocompromised patients. Sequencing is recommended for accurate species identification of causative pathogens.

Our purpose is to develop a QA/QC (quality assurance/quality control) web system using a server-side script language such as HTML (HyperText Markup Language) and PHP (Hypertext Preprocessor), which can be useful as a tool to share information about QA/QC in radiotherapy. The system proposed in this study can be easily built in one's own institute, because HTML can be easily handled. There are two desired functions in a QA/QC web system: (i) To review the results of QA/QC for a radiotherapy machine, manuals, and reports necessary for routinely performing radiotherapy through this system. By disclosing the results, transparency can be maintained, (ii) To reveal a protocol for QA/QC in one's own institute using pictures and movies relating to QA/QC for simplicity's sake, which can also be used as an educational tool for junior radiation technologists and medical physicists. By using this system, not only administrators, but also all staff involved in radiotherapy, can obtain information about the conditions and accuracy of treatment machines through the QA/QC web system.

We encountered a case of total anomalous pulmonary venous connection with a drainage vein following an unusual course. The drainage vein, after emerging from the right lung, crossed the midline and drained into the innominate vein. Along the course of this vein, severe stenosis was present in the region wedged between the aortic arch and pulmonary artery, leading to severe pulmonary congestion. The common pulmonary vein was well developed. There was no other intracardiac malformation except atrial septal defect. No heterotaxy syndrome associated. Because echocardiography was unable to provide a complete picture of the pulmonary veins and drainage veins, multidetector-row computed tomography was performed to ascertain the anatomy. Emergency surgical intervention was carried out and anastomosis of the common pulmonary vein to the left atrium was performed. The postoperative course was favorable.

We experienced a case of unexpected difficult nasal intubation due to lingual tonsil hyperplasia. A 43-year-old man was scheduled for pharyngoplasty because of sleep apnea syndrome. After induction of general anesthesia, Macintosh laryngoscopy failed to expose his glottis by two experienced anesthesiologists. We also found that the view of his larynx by fiberoptic bronchoscope (FOB) was poor, and nasal intubation guided by FOB was difficult. Finally, we made an oral intubation with Macintosh laryngoscopy under a gum elastic bougie guide. Ventilation and oxygenation were maintained throughout the procedure. A FOB guided intubation under general anesthesia is often difficult, because identification of glottis is interfered by deviated pharyngeal tissue and epiglottis, which are affected by the use of muscle relaxants. At present, a selective relaxant binding agent, sugammadex, is available in anesthesia, to reverse the effect of non-depolarizing muscle relaxant and to restore spontaneous breathing in this situation.

A 70-year-old man presented in December, 2010 with priapism persistent for over a month. The patient had no history of medications for erectile dysfunction, penis trauma, or traumatic sexual activities. A blood gas measurement of the cavernosum was performed, but only fibrosis tissue was aspirated and no blood was obtained. Color-flow Doppler imaging of the penis revealed blood flow in the corpora cavernosa of the penis, suggesting the occurrence of nonischemic priapism. Enhanced chest and abdominal computed tomography revealed a left renal cyst, and the wall of the cyst showed contrast enhancement. No other obvious obstructive mass or tumor was detected in the pelvic cavity. Gradually, necrotic changes of the glans penis appeared, and total penectomy was performed. Histopathological examination of penectomy tissue specimens suggested papillary renal cell carcinoma metastases to the penis. Consequently, open left radical nephrectomy was performed. Pathological diagnosis revealed papillary renal cell carcinoma pT2, and the patient was diagnosed with stage IV (pT2N0M1) renal cell carcinoma. Treatment was provided by intravenous temsirolimus therapy that resulted in partial remission and stable disease, which in turn relieved cancer pain.

To improve the ability of dermatologists to diagnose cutaneous mycoses, we have proposed a list of the minimum mycological knowledge and skills required by senior residents of dermatology. The list includes ability to select the most appropriate sampling method, knowledge of the basic method of potassium hydroxide (KOH) examination and skill in performing fungal cultures and identifying the most prevalent fungal species isolated from skin lesions. It is not possible for the Japanese Society of Medical Mycology to train every senior resident directly, and it is difficult for them to acquire sufficient expertise independently. Consequently, training and advice given by instructors in residents' home institutes is essential. A project of an advanced course for instructors, who are in charge of educating senior residents in their own institute, may be possible. Therefore, we have proposed here a list for instructors of the knowledge and skills required to educate senior residents. Employing this list should realize improved skill in dermatologists.

The case was 74-year-old woman. A tumor at the aortic window was found while retrieving the cause of the hoarseness, and the surgical biopsy was performed. The diagnosis of the leiomyosarcoma was obtained by pathology, and it probably originated from the middle mediastinal tissue. The radical operation was not selected, and the radiation therapy was performed. She did not suffered from symptoms associated with cardiopulmonary dysfunction, but she died of the cerebral metastasis in 5 months after the biopsy.

Cell transplantation has shown to be a promising strategy to repair cartilage defects. Mesenchymal stem cells derived from synovium have been shown to be a superior cell source for cartilage regeneration to those from other mesenchymal tissues due to their higher rates of colony formation, proliferation potential with autologous serum, and in vitro/vivo chondrogenic potentials. We have found that approximately 60% of synovial mesenchymal stem cells placed on cartilage defects adhered to the defect within 10 min, and the addition of magnesium enhanced this percentage further, which resulted in better cartilage regeneration. Based upon several basic research studies performed in our lab, we have begun the transplantation of synovial stem cells arthroscopically in a clinical study for the treatment of cartilage defects. To date, no adverse events have been reported in the study. Regeneration of cartilage, reduction in defect size and an improvement of symptoms have been obtained in most patients over the last 3 years.

The number of hematopoietic stem cell transplantations and recipients with late complications from transplantation are both increasing; therefore, we investigated the status of the long-term follow-up system for hematopoietic stem cell transplantation survivors in Japan using a mail questionnaire; 100 of 194 institutions replied. The median examination time for each patient was 12.5 min. Five percent of institutions had an outpatient transplantation clinic, 1% had a manual for long-term follow-up after stem cell transplantation, and 11% used NIH criteria for the diagnosis of chronic GVHD. The lack of human resources, such as doctors, nurses, and other co-medical staff for transplant patients, was a structural problem. In addition, the development of guidelines for Japanese patients and staff education are also required in the clinical process. Thus, a long-term follow-up system, training of human resources, and appropriate reallocation of funds for medical services are required.

There is a general consensus that patients who attempt suicide require intervention for psychological as well as physical problems. However, among the institutions accepting patients who attempt suicide, there are few institutions employing a full-time psychiatrist in the emergency department. Therefore, it is difficult to conduct a suicide re-attempt risk evaluation in the presence of a psychiatric specialist. We developed a suicide re-attempt risk evaluation scale to be used by non-professional staff. We asked the medical staff that cared for patients who had attempted suicide to record all the evaluation items in the patient's medical record. We utilized an interview method and highlighted the types of answers that needed special attention. When there were two or more answers that needed special attention, we defined the patient as high risk. The number of days of hospitalization did not change as a result of the use of the suicide re-attempt risk estimate scale; however, the quantity of medical records addressing suicide intention and the rate of psychiatric intervention significantly increased. It is unclear whether this score directly led to the prevention of repeat suicide attempts. However, it is notable that use of the scale has led to a change in the behavior of medical staff by mandating a fixed-format risk evaluation.

A78-year-old female was admitted to our hospital with anorexia due to ascites. We were not able to diagnose by cytological diagnosis. For a definite diagnosis she underwent an open biopsy. Histological findings revealed observable papillary adenocarcinoma with psammoma body, carcinoma cells were positive for Ber-EP4 on immunostaining, and ovaries were normal. Thus, we made a diagnosis of peritoneal serous papillary adenocarcinoma. She was treated by intraperitoneal administration of CDDP(20 mg/day: day 1, every four weeks). Ascites vanished and CA125 was within the normal range. There was no recurrence after 3 years, but Virchow's lymph node metastasis occurred. The patient is still alive 12 months after metastasis with CDDP intraperitoneal administration.

The Japanese Dermatological Association produced some guidelines for the management of cutaneous fungal infection in cooperation with the Japanese Society for Medical Mycology, in which the importance of an accurate diagnosis of the fungal infection before antifungal treatment is emphasized. Here I comment on conventional mycological tests including direct microscopic examination and fungal cultures, which have been listed in the guidelines. Sampling of the clinical specimen is the most important step in mycological tests, so dermatologists should be aware of how and where good specimens are obtained. Direct microscopic examination of a KOH (potassium hydroxide) mounted preparation is the most simple and important test for diagnosing superficial fungal infection and dematiaceous fungal infection, which requires that dermatologists be skilled. The fungal culture is important in determining the therapeutic strategy and prophylaxis of the fungal infection, especially in cases of tinea capitis, tinea corporis, and deep mycoses. It is imperative that dermatologists be fully trained and prepared in order to implement these procedures when the occasion demands.

Diabetic patients are known to be susceptible to infectious diseases including opportunistic fungal infections, such as mucocutaneous candidosis, dematiaceous fungal infection and cryptococcosis. Rapid and accurate diagnosis of these often life threatening fungal diseases is of clinical importance. In addition, skin diseases of the foot including tinea pedis are exacerbation factors of diabetic foot and management of such conditions are important to prevention of severe bacterial infections among these patients. Here I comment on conventional mycological tests including direct microscopic examination and fungal cultures, which are standard and inexpensive tools for diagnosis of these fungal diseases.

A-46-year-old male with advanced-stage IV multicentric gastric cancer was treated with S-1/CDDP as neoadjuvant chemotherapy. S-1 (initially 100 mg/day, up to 120 mg/day) was orally administered for 3 weeks (day 1-21) followed by 1 drug-free week as a course, and CDDP (initially 60 mg/day, up to 100 mg/day) was administered by intravenous drip on day 8. After the fourth course, a significant tumor reduction was obtained and curative surgery was performed. Thereafter, S-1 therapy was continued. There has not been any recurrence for 19 months postoperatively.

In July 2007, information on the current status of mycological examinations in Japanese university clinics and requests for a university network system was gathered by a questionnaire completed by 98 of 112 professors or directors of those clinics. A summary of the findings follows: only 9% of the hospitals performed fungal culture studies for all or most cases, indicating a drop of 7% from 2000 (16% in 2000, reported by Kasai) . Also, just 55% of relevant departments maintained the ability to identify most or all clinical isolates in-house, which down 27% from 2000 (83% in 2000, reported by Kasai). These findings indicate that mycological diagnoses by many departments have been rapidly decreasing. Eighty-nine percent of respondents indicated a desire for some help from the university network including: basic training in medical mycology of young doctors (senior residents in university hospitals); aid in diagnosing rare fungal infections; and support in obtaining knowledge and new technologies. The basic training of senior residents in each department is not possible in the network system so each department is required to take responsibility for training their own. However, a project of an advanced course at the leader level, which educates the person in charge of each department, may be possible in the network system. Employing this would make it realistic for the educated leaders to train the senior residents in their departments.

This paper presents the results of an examination for Trichophyton tonsurans(T. tonsurans)performed by the hairbrush (HB; 90 bristles)method at the All Japan Inter High School Championships, Saga 2007. Samples were taken from 487 Judo practitioners (265 males and 222 females) out of a total of 951. The areas with the highest positive rates were: Kyushu 21%(15 participants out of 73 sampled), Tohoku 17% (13 out of 77), Kinki 16% (14 out of 89), and Chubu 13% (12 out of 89). Four participants from Kyushu, four from Tohoku, two from Kinki, and two from Chubu were strongly positive carriers, their samples developing more than 30 colonies per dish. This finding is in concordance with the high HB-positive rates in these areas. The results of a questionnaire distributed during sampling showed that 90% of the examinees had heard of T. tonsurans infection, 11% had been sampled by the HB method previously, and 37% declined to receive the results of the medical examination. The low percentage of participants who had experienced a HB sampling before could be explained by the insufficient penetration of this test among dermatologists, as well as by the fact that team trainers are reluctant to expose their athletes to sampling. Although trainers' education concerning T. tonsurans is also an important factor, we strongly recommend that dermatologists take the initiative to perform medical examinations such as HB sampling in schools or at other public organizations. As for the reason why so many practitioners refused to be informed about the diagnosis, many of them mentioned being afraid that it might be overheard by trainers or fellow practitioners. It can be easily inferred that this type of concern leads Judo practitioners to avoid participation in sampling. Therefore, we concluded that substantial care to protect personal information is essential when communicating the results of the examination.

We developed a nutritional pathway for autologous stem cell transplantation (SCT) to be applied in our transplantation unit. We performed autologous SCT for 37 patients with malignant lymphoma and multiple myeloma during from April 2003 to July 2005. For 10 of them who underwent SCT since 2005,we intervened with nutritional support using our original nutritional pathway,to monitor the clinical course of SCT from the aspect of dietetics with a dietician making assessments of the individual nutrition status. From comparing the 2 groups with (n=27) or without (n=10) the nutritional pathway, oral intake at day 14 was significantly increased from 1,038 kcal to 1,440 kcal,and at discharge developed from 1,167 kcal to 1,446 kcal without statistical significance. Patients whose body weight decreased more than 5% were reduced from 52%(14/27) to 10%(1/10),and 3 days reduction of the CVC insertion period was observed after the intervention. Although the long-term clinical outcome was not fully evaluated, the efficacy of nutritional pathway for autologous SCT was suggested.

The present study aims to examine whether depth perception based on pictorial cues in the peripheral visual field is improved by compensating for the peripheral reduction of visual sensitivity. Figures that partially overlapped or had apparent transparency over a background figure were presented on a CRT monitor at the central-peripheral retinal regions of 2.5-10 degrees eccentricity under the two conditions of same size or size adjusted for the Cortical Magnification Scale (Virsu & Rovamo, 1979). In Experiment 1 the subjects could discriminate the depth relationship of two cortically magnified figures when these were presented within the retinal eccentricity of 10 degrees, even when solutions for the tasks were not dependent on a single visual attribute (brightness, shape). But discrimination in the peripheral visual field became difficult when the number of visual attributes of the stimuli increased (Experiment 2). We conclude that even for peripheral vision, depth perception based on pictorial cues is possible when cortically magnified stimuli are used. However, it should be further study whether or not the visual acuity is an only determinant for the difference between central and peripheral depth perception.

An amendment concerning the enforcement of the law on the prevention of radiation hazards due to radioisotopes, etc., and the medical service law enforcement regulations were promulgated on June 1, 2005. This amendment concerned international basic safety standards and the sealing of radiation sources. Sealed radiation sources < or =3.7 MBq, which had been excluded from regulation, were newly included as an object of regulation. Investigation of the SPECT system instituted in hospitals indicated that almost all institutions adhere to the new amendment, and the calibration source, the checking source, etc., corresponding to this amendment were maintained appropriately. Any institutions planning to return sealed radioisotopes should refer to this report.

We report a case of black dot ringworm on the right forearm caused by Trichophyton (T.) tonsurans. A 16-year-old male high school Judo-wrestler visited our clinic on September 30, 2005, complaining of a round erythematosquamous eruption with a distinct margin on the right forearm. Black dots were observed in the lesion. KOH-Parker ink prepared direct microscopy revealed abundant large endotrix arthroconidia in the hair shaft. Culture yielded yellowish-brown colonies. The isolate produced numerous round, short club-shaped microconidia along the hyphae unstained with lactophenol cotton blue (resembling matchsticks) and chlamydospores. PCR-RFLP analysis of internal transcribed spacer regions of ribosomal DNA revealed a banding pattern compatible with T. tonsurans. The lesion was cured by daily administration of 125 mg of terbinafine for 13 weeks.

At the 48th Annual Meeting of The Society for Japanese Medical Mycology, held in October, 2004, we reported our findings from a survey on Trichophyton tonsurans infections in the Hokuriku and Kinki regions of Japan. The survey revealed that a few epidemics had occurred across these regions. In this article, we introduce our subsequent studies relating to 1) molecular epidemiology of isolates taken from people in many parts of Japan and 2) factors affecting adequate sampling of the scalp with hairbrushes, essential for surveying and monitoring the infection. In total, 198 isolates of Trichophyton tonsurans were analyzed using restriction fragment length polymorphisms of the non-transcribed spacer regions of ribosomal RNA genes. The restriction enzyme Mva I indicated two molecular types of strains, implying that the causative agents of the epidemic had different origins. None of the isolates obtained from the epidemic showed the same restriction profile as that of isolates from aged and sporadic cases. The published hairbrush method suitable for obtaining samples from the scalp of Judo trainees was reevaluated by changing several factors. We found that sampling should not be done soon after the students' physical training because other fungal elements may give a false positive, samples should not be obtained from students who have recently applied topical antimycotics, and samples should be taken under the guidance of qualified instructors familiar with the sampling method.

Purpose: To investigate the usefulness of MRI for predicting pelvic control (PC) of cervical cancer treated with radiation therapy (RT)., Materials and Methods: Forty-four cervical cancer patients treated with definitive RT were retrospectively analyzed. MRIs were completed before and after RT, and the longest diameter (LD) of the residual tumor was measured on post-RT MRI. Pathologic evaluation for residual tumor was also performed. Therapeutic response was assessed using MRI. Median follow-up time for the 44 patients was 34 months. The correlations between PC rate, MRI, and pathological findings were investigated., Results: The 3-year PC rates of LD = 0 cm (n = 23) after RT, 0 < LD 2 cm (n = 6) were 85%, 80%, and 0%, respectively (p < 0.0001). There was no significant difference in PC according to the presence (n = 8) or absence (n = 36) of residue in the pathologic materials (3-year PC rate: 63% vs. 77%). Three-year PC rates according to therapeutic responses were 85% in complete response (n = 23), 72% in partial response (n = 18), and 0% in stable disease or progressive disease (n = 3) (p < 0.0001)., Conclusion: MRI is useful for predicting PC in cervical cancer treated with RT, and LD greater than 2 cm after RT is a good marker for poor PC.