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Background: It past 4 years in 2018 after the first treatment of sublingual immunotherapy (SLIT) for Japanese cedar pollinosis. The purpose of this study is to clear the clinical efficacy of SLIT in a large amount of pollen dispersal in 2018 (total 5041 grain)., Methods: The subjects were 270 SLIT (83 forth year of treatment, 72 third year, 48 second year, 67 first year), 320 primary pharmacotherapy that started therapies before pollen dispersal, and 424 untreated. The clinical efficacy was evaluated with symptom scores of Japanese rhinoconjuctivitis quality of life questionnaire No1, medication scores and combined total nasal symptom-medication scores, and visual analog scale of nose, eye and total symptoms., Results: Each SLIT was significantly better than untreated in all assessments, and better than primary pharmacotherapy in assessments of total symptom. SLITs of third and forth year of treatment were also better than primary pharmacotherapy in nasal symptoms. SLIT patients, whose symptom scores of nose and eye were 0 and 1 point without any rescue drugs, accounted for 41.0%, 31.9%, 18.8%, 20.9% in the order from the fourth year to the first year. Of them, patients with score 0 occupied 12.0%, 12.5%, 4.2%, 4.5%, in order. There was no patient who needs treatments for adverse events., Conclusion: SLIT was significantly effective compared with primary pharmacotherapy or untreated group in a large amount of pollen dispersal. It was better to treat at least for 4 years.

Background: In Japan, the number of hemodialysis patients increases every year, along with the average age of this patient population. Further, certain complications of hemodialysis make the care of traumatic head injury(THI)patients particularly difficult., Objective: This study was aimed at investigating the occurrence of and risk factors for post-traumatic seizures in hemodialysis patients with a history of THI, and determining patient outcomes., Methods: Subjects were selected from patients who were admitted to Yaizu Municipal Hospital in Shizuoka, Japan for traumatic intracranial hemorrhage(TICH). Retrospective medical histories of TICH patients who were and were not receiving hemodialysis were reviewed to investigate the risk factors for seizures and to determine patient outcomes., Results: We identified 18 THI patients on hemodialysis and 86 THI patients not on hemodialysis treatment. We determined that predictive factors of post-traumatic seizure include:current hemodialysis treatment, enlargement of an existing hematoma, and an acute subdural hematoma. Moreover, 66.7% of seizures in our dialysis patients occurred during hemodialysis. Our data also suggest that Glasgow Coma Scale(GCS)scores on admission are a predictive factor for patient outcomes following discharge., Conclusion: Current hemodialysis treatment, enlargement of an existing hematoma, and an acute subdural hematoma are predictive factors of seizure occurrence in THI patients. As post-traumatic seizures triggered unfavorable outcomes in some dialysis patients, it is important to create appropriate plans for preventing dialysis disequilibrium syndrome that may lead to seizures in TICH/TIH patients on hemodialysis. We also determined that a low GCS score upon admission is a significant predictor of unfavorable outcomes.

It past 3 years in 2017 after the first purchase of the drug for sublingual immunotherapy (SLIT) for Japanese Cedar pollinosis (JCP). We reported the clinical efficacy of SLIT in the first and the second treated year., Purpose: The purpose of this study is to clear the clinical efficacy of SLIT in the third treated year by comparing with other therapies, such as subcutaneous immunotherapy (SCIT), or other pharmacotherapy., Methods: We compared the clinical efficacy in 2017, of 112 SLIT in the third treated year with 38 SCIT, 364 primary pharmacotherapy that started therapies before pollen dispersal, 254 pharmacotherapy that started therapies after pollen disposal, or 333 non-treatment. The clinical efficacy was evaluated with symptom scores, total nasal symptom scores and combined total nasal symptom-medication scores (TNSMS), symptoms of nose and eye by visual analog scale (VAS), quality of life (QOL) scores by Japanese rhino-conjunctivitis QOL questionnaire (JRQLQ No1)., Results: Both SCIT and SLIT showed good clinical efficacy without significant difference in every assessment. Both SCIT and SLIT were significantly better than other pharmacotherapy in most assessment. Patients, whose symptom scores of nose and eye were 0 and 1 point without any rescue drugs, accounted for 9 and 24% of total SLIT, respectively., Conclusion: SLIT in the third treated year showed good clinical efficacy in reducing symptoms and TNSMS of JCP, and in improving QOL. SLIT was significantly effective compared with other pharmacotherapies.

Sublingual immunotherapy (SLIT) is thought to have enhanced efficacy in the second year of treatment. We studied treatment efficacy in both the first and the second years of treatment (2015 and 2016, respectively) in patients who began SLIT in 2014. Methods: We compared 132 patients who underwent SLIT (age, 41.8 ± 17.5 years; male-to-female ratio, 75: 57) and a control group of 56 patients who underwent primary pharmacotherapy (age, 44.9 ± 13.5 years; male-to-female ratio, 25: 31). The study was performed during the peak pollen seasons of 2015 and 2016. Pollen dispersal was similar in 2015 and 2016 (2,509 grains/cm2 and 3,505 grains/cm2, respectively). The clinical efficacy of SLIT was evaluated by assessing nasal and eye symptoms and total symptoms with symptom scores and combined symptom-medication scores, visual analog scale scores, and quality of life (QOL) scores according to the Japanese rhino-conjunctivitis QOL questionnaire (JRQLQ No. 1). QOL was also evaluated with JRQLQ No. 1. The first endpoint was enhanced efficacy of SLIT in the second year compared with that in the first year. Results: With respect to nasal and eye symptoms, the assessments in the primary pharmacotherapy group were unchanged in the second year; however, most of these assessments in the SLIT group demonstrated significantly enhanced efficacy of SLIT in the second year. In QOL of SLIT, only 2 of 17 showed significantly enhanced efficacy of SLIT in the second year. Conclusion: SLIT shows enhanced efficacy in the second year.

Current situations of schistosomiasis and echinococcosis as re-emerging helminthic infec- tions are reported. Because of their relatively complicated life-cycles, those infections are in- fluenced and drifted by social and/or natural changed. Schistosomiasis is a trematode infec- tion, for which snails are needed as intermediate hosts in the life-cycle, therefore, endemic situation of schistosomiasis reflect ecological condition of their intermediate snail hosts. Current changes in the global environmental and/or climate conditions affect distribution of snail hosts, and subsequently, schistosomiasis can be appeared or disappeared. On the other hand, echinococcosis is a cestode infection of which life-cycle is mainly maintained in the wild animals. Social or economical development affects their endemic situations. Risk evalu- ation and future prospect of those helminth infections are discussed.

Sublingual immunotherapy (SLIT) for Japanese cedar pollinosis is known to be effective. However, better SLIT adherence is needed to improve its safety and efficacy. 　Purpose: The purpose of this study was to evaluate SLIT adherence and its influence on clinical outcome. 　Methods: We conducted a detailed survey of 132 patients who have been receiving SLIT for 2 years on adherence at each visit using both questionnaires and direct calculation from prescription. Questionnaires on total symptoms using the visual analog scale (VAS), face scale, and total nasal symptom medication score (TNSMS) were obtained at the peak season for Japanese cedar pollinosis. 　Results: Good adherence by prescription for 2 years was observed in 83.1% ± 11.7% of patients. The adherence in the second year (80.8% ± 13.6%) was lower than that in the first year (88.5% ± 9.8%). However, adherence by questionnaire was 13.5% higher than that by prescription. VAS of total symptoms and adherence did not correlate; however, evaluations by VAS, face scale, and TNSMS were significantly improved if the adherence cut-off value was set to 70% or 75%. 　Conclusion: Our results suggest that SLIT adherence for Japanese cedar pollinosis is high and adequate adherence is required for better efficacy.

It past 2 years in 2016 after the first purchase of the drug for sublingual immunotherapy (SLIT) for Japanese Cedar pollinosis (JCP)., Purpose: The purpose of this study is to clear the clinical efficacy of SLIT in the second treated year by comparing with other therapies, such as subcutaneous immunotherapy (SCIT), or other pharmacotherapy., Methods: We started SLIT at our clinic in October-December, 2014. We compared the clinical efficacy in 2016, of 133 SLIT with 46 SCIT, 351 primary pharmacotherapy that started therapies before pollen dispersal, 221 pharmacotherapy that started therapies after pollen disposal, or 337 non-treatment. The clinical efficacy was evaluated with symptom scores and combined symptom-medication scores (SMS), symptoms of nose and eye by visual analog scale (VAS), quality of life (QOL) scores by Japanese rhino-conjunctivitis QOL questionnaire (JRQLQ No1)., Results: Fourteen cases by unknown reasons and 3 cases by inevitable reasons were dropped out for 2 years. Both SCIT and SLIT showed good clinical efficacy without significant difference in every assessment. Both SCIT and SLIT were significantly better than other pharmacotherapy in most assessment. Patients, whose symptom scores of nose and eye were 0 or 1 point without any rescue drugs, accounted for 26.3% of total SLIT., Conclusion: SLIT in the second treated year showed good clinical efficacy in reducing symptoms and SMS of JCP, and in improving QOL. SLIT was significantly effective compaired with other pharmacotherapies.

Unlabelled: Sublingual immunotherapy (SLIT) for Japanese cedar pollinosis is effective, however, caution must be exercised against allergen-specific adverse events (AEs) during SLIT., Purpose: The purpose of this study was to clarify the AEs of SLIT in a large cohort of patients with Japanese cedar pollinosis., Methods: We conducted a detailed survey, by both questionnaires and direct interviews, of 207 patients receiving SLIT at our clinic., Results: Eighty-four of the 207 patients (40.5%) developed AEs, with AEs involving the oral cavity and throat being the most common (56 patients; 27.1%). Sixteen patients (7.9%) had local mucosal swelling, but the swelling resolved in all the cases. Other allergen-induced symptoms such as nasal symptoms (29 events, 14.0%), eye symptoms (14 events, 6.8%) and ear symptoms (20 events, 9.7%) were also recognized. All the AEs were minor, and discontinuation of SLIT was not necessitated in any of the patients because of AEs. There were 52 AEs (25.0%) in the up-dose phase and 61 AEs (29.3%) in the maintenance phase. However, only 4 of the 161 patients (2.5%) developed AEs during the pollen season. Most AEs developing during the maintenance phase occurred in the first few weeks. In 60% of the cases, the AEs disappeared within 2 weeks, and in 6.0% (5 events), they persisted for longer than 2 months. There were no age-or sex-related differences in the prevalence of cedar pollen-specific IgE, or in the adherence to the treatment., Conclusion: AEs in SLIT were shown in many patients, however, the severity of AEs was mild and no events interfered SLIT.

Unlabelled: The first drug of sublingual immunotherapy (SLIT) for Japanese Cedar pollinosis (JCP) was purchased in 2014.  , Purpose: The purpose of this study is to clear the clinical efficacy of SLIT by comparing with other therapies, such as subcutaneous immunotherapy (SCIT), or other pharmacotherapy.  , Methods: We started SLIT at our clinic in October-December, 2014. We compared the clinical efficacy of 191 SLIT with 48 SCIT, 191 primary pharmacotherapy that started therapies before pollen dispersal, 141 pharmacotherapy that started therapies after pollen disposal, or 169 non-treatment in the first follow-up year. The clinical efficacy was evaluated with quality of life (QOL) scores by Japanese rhino-conjunctivitis QOL questionnaire (JRQLQ No1), symptoms of nose and eye by visual analog scale (VAS), symptom scores and combined symptom-medication scores (SMS).  , Results: Mild adverse events (AEs) were observed in many cases, but no patient was discontinued by AEs in SLIT patients. Five cases by unknown reasons and 3 cases by inevitable reasons were dropped out before pollen. Adherence of SLIT was 89±12%. SCIT was better than SLIT in most assessments, but not significant. Both SCIT and SLIT were significantly better than other pharmacotherapy. Patients, whose symptom scores of nose and eye were 0 or 1 point without any rescue drugs, accounted for 16.8% of total SLIT in the first follow-up year.  , Conclusion: SCIT was slightly better than SLIT in reducing symptoms and SMS of JCP, and in improving QOL. However, the differences were not significant. SLIT was significantly effective than other pharmacotherapies.

Background: We performed a multicenter study in order to clarify the present conditions of the childhood allergic rhinitis treatment in many departments of otorhinolaryngology and pediatrics/internal medicine in the Tohoku region, northern Japan., Methods: We performed a questionnaire survey about patient backgrounds, nasal symptoms, QOL disturbance, and treatment agents, for childhood allergic rhinitis patients under age 12., Results: The total number of cases was 814, the mean age of the patients seen in pediatrics/internal medicine departments was significantly lower than that in otorhinolaryngology. The merger rate of bronchial asthma of the patients seen in pediatrics/internal medicine was significantly higher, and nasal symptoms and QOL disturbance of the patients seen in otorhinolaryngology were significantly more severe. For therapeutic agents, antihistamines were most prescribed, and the combination of LT receptor antagonist and intranasal steroids was used for the cases in which nasal symptoms were severe. The nasal symptoms in the combination group were significantly improved compared with the antihistamine monotherapy group., Conclusion: It was indicated that the combination therapy was useful in the severe cases of childhood allergic rhinitis.

Background: Japanese cedars and grass are famous for causing pollen allergy with antigen. But recently, many other antigens causing pollen allergy are coming to the front. We investigated positive ratios of pollen antigens of the consultation patients., Methods: 151 subjects (90 males and 61 females) were examined for allergic reactions by a scratch test. We used Yasueda's method to take pollen extracts., Results: A positive ratio of Cocksfoot (Dactylis glomerata) (51%) was higher than that of cedar (Cryptomeria japonica) (45%). Each positive ratio of birch (Betula platyphylla var. japonica), walnut (Juglans mandshurica), sheep sorrel (Rumex acetosella), oak (Quercus serrata) and willow (Salix spp.) was 13%, 8%, 9%, 11%, 10%, respectively. These were lower than that of Cocksfoot or cedar, but higher than that of Fungi: Alternaria, Candida and Aspergillus., Conclusion: Grass (Gramineae) pollens and pollens of birch, walnut, sheep sorrel, oak and willow, which are in the air around the same time as grass pollens, are important in clinical medicine, because of their high positive ratio. And in this research, each positive ratio is overlapping, so it is necessary to search an antigen hemology.

Respiratory complication is common after a repair of thoracic aneurysm, although tracheal compression caused by hematoma and felt strips following surgery is a rare cause. We report the case of a patient who experienced difficult weaning from ventilator after a repair of a thoracic aortic aneurysm and was diagnosed as a tracheal compression outside of trachea revealed by bronchoscopy and chest CT scan. Re-operation was successfully performed to relieve the compression under monitoring by bronchoscopy. Patient was disconnected from the ventilator three weeks after the reoperation and transferred to a rehabilitation hospital.

Transfusion-related acute lung injury (TRALI) is a serious complication of transfusion of blood and blood components. TRALI is reported to be the most common cause of transfusion-associated death. TRALI has increasingly become known in the medical community. However, TRALI has been overlooked frequently because of poor knowledge of medical staffs. We report two cases of TRALI after massive transfusion due to massive bleeding during cardiovascular surgery. In the perioperative period, the diagnosis of TRALI is difficult to make because of coexistence of various factors leading to hypoxia. Thus, in this report, we discuss the management of these two cases focusing upon the differential diagnosis of TRALI.

We examined the incidence of sleep-apnea syndrome (SAS; 5 or more episodes of apnea/hypopnea in 1 hour) in 213 patients (152 male, 67.8 +/- 10.9 years) with various cardiac diseases by a modified sleep polygraph (morpheus; Teijin Pharma, Tokyo) from July 2005 to April 2007. Mild sleep disturbance was defined as 5< or = AHI<20, moderate sleep disturbance as 20< or = AHI<40, and severe sleep disturbance as 40< or = AHI. SAS was seen in 87.3% of the patients. This high incidence sharply contrasts with 7.5% reported in factory workers in Japan. Body mass index, though significant, was scarcely correlated with the severity of SAS (p<0.01). As sleep disturbance became severe, the proportion of an obstructive, central, and eventually mixed obstructive-central SAS increased. Although the overall severity was not different between different categories of cardiac diseases, obstructive-central SAS was seen far more frequent in congestive heart failure. Hypertension was closely associated with apnea/hypopnea. A tight correlation between SAS and various cardiac diseases was suggested.

There are two kinds of infectious diseases in the world; diseases being paid attention and neglected diseases. The former diseases include HIV/AIDS, tuberculosis and malaria, the latter group include many parasitic, fungal, bacterial and some of viral infections. "Neglected Infectious Diseases", which have been renamed as Endemic Tropical Diseases by WHO, are endemic in the developing world are not newly appeared diseases, but diseases affecting humans in these decades. In fact, DALYs for several diseases in the category are big enough; more than 300 millions for soil-transmitted helminthiasis, 5 millions for lymphatic filariasis, 4-5 millions for schistosomiasis and so forth. However, those diseases were not recognized as serious health problems because of socio-economical and/or scientific reasons. Furthermore, those diseases are no fatal in the acute phases; therefore, no big attention is raised by policy makers in the world. From the view point of basic medical sciences, however, there is no enough reason for neglecting the issues of those diseases: no improved diagnostics and therapeutics have been developed in spite of the urgent necessities in endemic areas. Considering those situations, WHO has started to take action for solving the problems since beginning of the 21st century. Recently, many of developed countries are recognizing that the imbalanced input of human and financial resources only for 3 major infectious diseases, HIV/AIDS, tuberculosis and malaria, and then, various international schemes for supporting research on Neglected diseases. DNDi, Drugs for Neglected Diseases initiative, is one of the examples and it's scope is only focusing on drug development for Neglected diseases. African trypanosomiasis is one of Neglected diseases and causing serious health problem both for humans and domestic animals in Africa. No safe and effective medicine has been available but a drug with serious side effects is only the drug of choice even nowadays. Under the grant support from DNDi, a Japanese group is developing a new drug, ascofuranone, for African trypanosomiasis without any detectable side effects. Developing new prophylactic drugs for schistosomiasis and new diagnostic tools for lymphatic filariasis are underway under the support of grant for Neglected or Re-emerging infectious diseases in Japan. Considering that issues of "Neglected Infectious Diseases" are urgent to be solved and also are challenging for modern medicine and medical sciences, researchers in the developed countries including Japan should make efforts to promote more active researches in this field.

We encountered a baby who was diagnosed with anal atresia, interruption of aortic arch (type B), aortic stenosis, mitral stenosis, single atrium, large ventricular septal defects, aberrant origin right subclavian artery. We operated on him using the Norwood procedure after a colostomy. Aortic arch was reconstructed by interposing with an 8 mm graft and the right ventricular-pulmonary artery (RV-PA) conduit was chosen for pulmonary flow. We closed the sternum 6 days after the Norwood procedure. We extubated him 16 days after delayed sternal closure. There was no trouble with his stoma and no sign of infection. The postoperative echocardiography didn't show the finding which left pulmonary artery was stenotic, but the lung perfusion schintigraphy revealed an imbalance in the distribution of lung perfusion. He was discharged 70 days after undergoing the Norwood procedure.

Brugada syndrome is an arrhythmia syndrome characterized by typical electrocardiogram (Brugada-type ECG) and development of ventricular fibrillation (Vf) without any distinct structural heart diseases. The essential goal in the management of Brugada syndrome is to avoid the development of Vf. However, there has been no established consensus on pre-operative risk assessment of patients with Brugada-type ECG. We recently experienced two cases of anesthetic managements for patients with Brugada-type ECG. Based on these experiences and recent cardiological progress on the risk stratification of Brugada syndrome, we thoroughly discuss on the peri-operative managements for patients with Brugada-type ECG.

Unilateral pulmonary arterial hypoplasia and/or pulmonary venous obstruction are serious hazards for Fontan candidates. For these patients, we have started new surgical approach "intrapulmonary septation technic". This consists of 3 components; (A) partial right heart bypass to well-grown side, (B) mandatory pulmonary blood flow to low-capacity side, (aorto-pulmonary shunt or others) and (C) a patch between partial right heart bypass and mandatory pulmonary blood flow. Thirteen patients underwent the approach. The source of partial right heart bypass was brought from superior vena cava (11 patients), inferior vena cava (1 patient) and fenestrated Fontan (1 patient). The mandatory pulmonary blood flow was supplied by aorto-pulmonary shunt (11 patients), pulmonary arterial banding (1 patient) and native pulmonary valve stenosis (1 patient). We added pulmonary artery enlargement (9 patients), release of pulmonary venous obstruction (8 patients) and/or atrio-ventricular valve plasty (5 patients), simultaneously. No hospital death. Early post-operative course was uneventful in all cases except 1, as pulmonary blood flow to low-capacity side had increased gradually after this intervention. Eight patients had reached Fontan operation. In this approach, nearly whole pulmonary artery can grow without any affect of volume overload through well-grown side from collateral arteries of low-capacity side. All procedures of "intrapulmonary septation technic" and reconstruction of pulmonary artery in Fontan operation can be easily performed in larger pulmonary artery of well-grown side, eliminating need for extensive dissection.

Objective: ESWL is now widely used for the treatment of renal stone disease. Although ESWL has many advantages for patients' quality of life, few reports have demonstrated the long-term outcomes of the alterations of renal morphology after ESWL. We reported renal scarring after ESWL monotherapy in patients with renal calyceal stones. In this study, we evaluated a large series of patients' cohort treated at our institution, and assessed the causal effect of ESWL on the late occurrence of renal scar formation., Patients and Methods: ESWL was performed with EDAP (LT-01,02) that generates shock wave energy by piezoelectric discharge. We analyzed the records of 285 kidneys treated between Dec. 1986 and Nov. 1998. Renal scarring was noted in 44 kidneys and not in 241 kidneys with periodical ultrasonography. We compared the backgrounds of the two groups using chi-square or non-parametric analysis. The Kaplan-Meier method and Cox regression model determined the analysis of renal scar formation., Results: Univariate and multiple regression analysis revealed that the total amount of ESWL emission and hyperuricemia independently affected the probability of renal scar formation., Conclusions: Over-emission of ESWL (over 10,000 shots) must be care for the prevention of renal scarring in patients with renal calyceal calculi, especially when associated with hyperuricemia. After ESWL, periodical checkups with ultrasonography will provide useful information for the clinical diagnosis of renal scarring.

After collection of airborne particles with a seven-day recording volumetric spore trap (Burkard model) using optically clear, pressure sensitive acrylic adhesive tapes, a dry PVDF membrane was pressed down firmly onto the adhesive tape, antigen-antibody reaction was performed in full contact with the tapes and PVDF membrane. Dark purple spots from airborne pollen allergens were examined under a light microscope to evaluate the form of pollens and particles wit h the antigenicity. It is clarified that identification of the form of pollens with the antigencity is possible not only pollens with the antigenicity but a pollen has already lost its shape, and it is also clarified that some airborne particular matters have the pollen antigencity. Airborne samples were collected during the Cryptomeria japonica or grass pollen season. Samples collected during the C. japonica pollen season were treated with anti-Cry j 1 monoclonal antibody, and those during the grass pollen season with anti-Dac g rabbit IgG. Samples collected during the C. japonica and the grass pollen peak season were treated with antibodies from sera of pollinosis patients. Spots originated not only from relevant pollen grains but also from parts of airborne particular matter have the pollen antigenicity and some spots could not observed for any kind of particles.

Purpose: We retrospectively assessed the surgical outcomes of nephron-sparing surgery (NSS) for patients with renal tumors., Patients and Methods: From 1985 to March 2001, a total of 99 NSSs were performed on 94 patients with renal tumors. The patients were divided into three groups. Group I comprised of 22 patients who underwent imperative surgeries for renal cell carcinoma (RCC). The tumors were found in 18 patients bilaterally (including 8 patients with von Hippel-Lindau disease), in 3 with solitary kidney, and in 1 with chronic renal failure. The mean +/- standard deviation of patient age and tumor diameter was 46 +/- 23 years and 36 +/- 23 mm, respectively. Twenty-three in situ NSSs were performed on 18 patients in Group I, and the remaining 4 patients were treated with 3 simultaneous operations for bilateral renal tumors with or without 2 ex vivo surgeries. Group II consisted of 49 patients who had small RCCs with the normal contralateral kidney and underwent NSSs (elective indication). The mean age and tumor diameter was 54 +/- 10 years and 28 +/- 11 mm, respectively. Group III consisted of 23 patients with non-RCC tumor (10 angiomyolipomas, 8 cystic tumors, 2 adenomas, 2 metastatic tumors, and 1 degenerative lesion), all of whom were treated with NSS. The mean age and tumor diameter was 47 +/- 14 years and 41 +/- 29 mm, respectively., Results: In Group I, 3 patients died of cancer including 2 patients who had had multiple lung metastases preoperatively. The five-year tumor specific survival rate was 87.3% with a postoperative follow-up of 49 +/- 36 months. In Group II, there were few peri-operative complications or no local recurrence at follow-up of 52 +/- 38 months. A patient developed lung metastasis, which was removed surgically with no evidence of recurrence at 159 months after NSS. Postoperative renal scintigraphy on 35 patients showed well-preserved renal function of the operated kidney. Improvement in surgical techniques resulted in less-invasive surgery in 22 operations during the last 4 years. The patients of Group III were also operated uneventfully, although 1 experienced postoperative bleeding. In 12 patients with solitary kidney (11 in Group I and 1 in Group III) serum creatinine level increased transiently, decreased to 1.3 times of preoperative values within 3 months, and almost recovered at 1-year follow-up., Conclusion: Excellent outcomes in cancer control and preservation of renal function support the validity of nephron-sparing surgery to treat renal tumors. The candidate patients may include those with bilateral kidney tumors, tumor occuring in the solitary kidney or small renal cell carcinomas with the normal contralateral kidney. Earlier detection of small lesions and less invasive surgical techniques will facilitate a wider indication of NSS.

Between September 1997 and December 2000, 29 patients with pulmonary atresia associated with ventricular septal defect were undergone corrective surgery. The age at operation ranged from 24 days to 14.7 years. The 5 patients were younger than 3 months. The body weight at operation ranged from 1.5 kg to 35.8 kg. 10 patients had MAPCAs. 21 patients had been undergone modified Blolock-Taussig shunt and/or uniforcalization of pulmonary artery (PA). We could perform right ventricular outflow tract reconstruction with ventriculo-arterial direct anastomosis in 19 patients (65%) (4/10; patients with MAPCAs, 3/5; younger than 3 months). We performed pulmonary angioplasty on stenotic and/or underdeveloped leasions as a concomitant procedure in 13/19 cases. Our technique is composed of 4 points, (1) fully mobilizing central and distal pulmonary artery (PA), (2) dissecting the PA with connective tissue together, (3) pulmonary arterial wall flap, (4) right ventricular outflow tract reconstruction during cardiac arrest.

We retrospectively summarized the peri-operative hemodynamic status and respiratory function in patients with thoracic aneurysms complicated with cardiac tamponade (Tamponade Group; n = 6) in comparison with patients complicated with hemorrhagic pericardial effusion without symptom of cardiac tamponade (Effusion Group; n = 10). There were no difference with regard to preoperative heart rate, pericardial effusion quantity, frequency of emergent operation and operation time. Preoperative hemodynamic status was worse in Tamponade Group than in Effusion Group. The cardiac indices of 12 h, 24 h, 48 h after operation in Tamponade Group were 2.60 +/- 0.60, 2.29 +/- 0.42, 1.95 +/- 0.33 l/min/m2 respectively, those were not different in Effusion Group. The differences between O2 tension in alveolar and arterial blood O2 tension (A-aDO2) and oxygenation indices (OI) of 12 h and 24 h after operation were significantly worse in Tamponade Group than in Effusion Group, but those of 48 h were not different. The operative mortality was 50% in Tamponade Group, and none in Effusion Group. It is very important to maintain hemodynamic status before operation, to perform complete repair (graft replacement) as early as possible and to care intensively after operation for thoracic aortic aneurysm complicated with cardiac tamponade.

We experienced arytenoid dislocation in a 17-year-old man with no significant medical history, who underwent anterior cruciate ligament reconstruction under general anesthesia. After induction of anesthesia, the trachea was easily intubated with an 8.0 mm cuffed endotracheal tube. The operation lasted approximately four hours. The patient was extubated uneventfully. On the first operative day, the patient complained of hoarseness. Four weeks had passed before the diagnosis of right arytenoid cartilage dislocation was made by fiberoptic laryngoscopy. Voice therapy was started. Three weeks after starting voice therapy, the patient's voice was restored almost to the preoperative status.

We have been performing intranasal procedures and postoperative nasal treatments in patients undergoing microscopic transseptal pituitary surgery for the past twenty years. This surgery is safe and minimally invasive and has become the standard procedure for removing pituitary adenomas. Recent advances in optical technology have increased the use of endoscopy in endonasal sinus surgery. Several methods for endoscopic transnasal pituitary surgery have been reported. Here, we report the results for 31 patients (34 operations) who were treated with endoscopic transnasal pituitary surgery. This technique enables the area of surgery to be visualized without requiring a sublabial incision or septal ablation to be performed. Five of the cases were for recurrences after microscopic surgery. A transsphenoidal surgical approach via a unilateral nasal cavity was used in 32 cases. For the remaining two cases, a transsphenoidal surgical approach via bilateral nasal cavities was used in 1 case, and a transethmoidal-transsphenoidal surgical approach via a unilateral nasal cavity was used in 1 case. Excellent results comparable to those of microscopic transseptal surgery were obtained. Endoscopic transnasal transsphenoidal surgery was found to have the following advantages: low-invasiveness, a wide and clear surgical view, and a relatively short operating time in the nose and sinus, especially for recurrent cases. This endoscopic procedure should therefore be considered as the first choice for pituitary surgery.

Increasing interest has been focused on the role of apoptosis in pathogenesis of idiopathic cardiomyopathy. Interactions between soluble Fas, tumor necrosis factor-alpha (TNF-alpha) and Fas ligand have been reported to play a pivotal part in signal transduction of apoptosis. Thus, we measured serum levels of apoptosis-related markers, namely sFas, TNF-alpha and two types of its receptor TNF-RI and TNF-RII in the patients with idiopathic cardiomyopathy. Serum level of TNF-alpha was higher in dilated cardiomyopathy (DCM) group as well as in hypertrophic cardiomyopathy (HCM) group than in the control group. There were significant correlation among TNF-alpha, TNF-RI and TNF-RII in DCM group. However, only slight tendencies among these parameters in HCM group, indicating different pathogenesis from DCM. No transcardiac production of TNF-alpha, TNF-RI and TNF-RII was found in cardiomyopathies in the present study. These data suggested that apoptosis-related markers could be used for the detailed classification of cardiomyopathy. Furthermore, the simultaneous measurement of receptors and their ligands of apoptosis-related markers might underscore clinical implications.

A 70-year-old woman was admitted to our hospital complaining of epigastralgia. Computed tomography, ultrasonography and magnetic resonance imaging revealed a round tumor measuring 6 cm in diameter, which was located in the medial side of the right kidney. It was successfully removed without injury to the surrounding large vessels and organs. Histological diagnosis was benign neurofibroma. This is the 27th case of solitary retroperitoneal neurofibroma reported in Japan.

A case of gastric cancer with liver metastasis who responded well to low-dose PMUE (CDDP, MMC, UFT, etoposide) therapy is reported. A 65-year-old man underwent distal partial gastrectomy with D2 lymph node dissection under the diagnosis of type 5 gastric cancer with multiple liver metastases. Pathological findings revealed papillary adenocarcinoma in the primary lesion and metastatic lymph nodes (No. 8a). Low-dose PMUE therapy after resection of primary lesion was effective for the liver metastases. Exacerbation was suspected, so the lesions of metastases were resected again after 2 years and 11 months postoperative course. All 4 resected lesions of metastases became old fibrous tissue with hyalinization, and 2 of 4 lesions were necrotic and surrounded by fibrous connective tissue. None of these 4 lesions included viable cancer cells. The patient has now been followed with no evidence of exacerbation. It was suggested that low-dose PMUE therapy was effective for liver metastasis of gastric cancer, especially the differentiated type.

Since 1977, we have operated on 18 nonfunctioning adrenal tumors. The pathological diagnosis included seven adrenocortical adenomas, three adrenocortical hypeplasias, three ganglioneuromas two adrenal cysts, two myelolipomas and one metastatic cancer. We successfully performed laparoscopic adrenalectomy in 11 of these patients and open surgery in the other 7 patients. In the patients undergoing laparoscopic adrenalectomy, post-operative recovery (fist oral intake, first ambulation, and total convalescence) was remarkably rapid. The indication of adrenalectomy for nonfunctioning adrenal tumors is controversial, but we can not exclude the possibility of malignancy even in small tumors. Therefore, because of the minimally invasive nature of laparoscopic surgery, the indications for operating on nonfunctioning adrenal tumors will be widened by introducing laparoscopic adrenalectomy.

Clinical characterization of patients with allergy to Chamaecyparis obtusa (Cypress) pollen and their specific IgE antibody was investigated by using AlaSTAT assay, a new method for measurement of antigen-specific IgE antibody. Positive rate of antigen-specific antibody in patients with allergic pollinosis was 83.5% for Japanese cedar pollen and 80.0% for Chamaecyparis obtusa pollen. 76.4% of patients were sensitized both to Japanese cedar and Chamaecyparis obtusa pollen, however, 7.9% were sensitized only to the latter. As for clinical symptoms, duration of attack was short and severity was mild or moderate in the patients sensitized only to Chamaecyparis obtusa pollen. Patients who visited hospital in April, in that Chamaecyparis obtusa pollen disseminated in the air predominantly, showed significant elevation in AlaSTAT scores compared with patients who visited in February and March (p < 0.05).

Recently, the detection of anti-neutrophil cytoplasmic antibodies (ANCA) has gained worldwide acceptance as an important additional diagnostic tool of Wegener's granulomatosis (WG). A possible pathogenic role of ANCA has been suggested by the finding that the addition of purified IgG-ANCA to healthy neutrophils in vitro causes activation of these cells. But, investigation on neutrophil functions of patients with WG has been rare. To clarify this point, peripheral neutrophil functions (adherence, chemiluminescence and chemotaxis) of patients with active WG were examined. Adherence, chemiluminescence and chemotaxis of patients with WG were significantly suppressed when compared with control subjects. The effects of ANCA positive serum on neutrophil chemiluminescence were also examined. ANCA positive serum did not affect neutrophil chemiluminescence. These results indicate that the mechanism of WG is not simply due to neutrophil activation by ANCA.

The prophylactic effect of hydrochlorothiazide on stone formation was studied in 66 patients with calcium urolithiasis, (49 men and 17 women between 25 and 76 years old, mean 52.2 +/- 11.7 years) due to idiopathic hypercalciuria. Urinary calcium excretion was significantly decreased during treatment when compared to the baseline value. The stone formation rate was also significantly reduced when compared with that before treatment. With regard to side effects, hyperuricemia was observed in 21 patients, hypokalemia in 9 patients, hypotension in 3 patients, and glycosuria in 4 patients. Thiazide treatment was concluded to be effective for preventing the recurrence of calcium stones in patients with idiopathic hypercalciuria. However, this therapy should be used only in conjunction with the careful monitoring of possible adverse reactions.

We performed fiber-urethroscopy and cystometry recording simultaneously in 15 male patients. Fifteen patients were consisted of 12 complaining of micturition difficulty (such as BPH, NB, BNS) and 3 normal control. Fiberscope, Olympus CYF-1 and BF3C10, and cystometry were connected the DISA system. Firstly, we insert fiberscope from the urethra to bladder careful, and then cystometry recording using carbon dioxide gas started under direct vision of fiberscope. We compared cystometrical parameters based on our original method to these on conventional one. There were slight statistical significances in the pressure at the first desire to void and the maximum desire to void. But these differences as well as the frequently and the size of uninhibited contraction were not induced by the caliber of the urethroscopy. In conclusion, cystometric recording and urethroscopic observation using fiberscope are simultaneously carried out safely without reducing their diagnostic accuracy.

Primary tumor in the ureteral stump is rare. A 66-year-old woman visited our hospital because of microscopic hematuria. She had undergone right nephrectomy for the contracted kidney 36 years ago. Intravenous pyelography and cystoscopy showed no positive findings for hematuria. But urine cytology indicated class V. The flexible ureterorenoscopy disclosed a nonpapillary sessile tumor in the ureteral stump. We also did the biopsy of the tumor under the direct vision before open surgery. The specimen showed transitional cell carcinoma, grade 3. The ureteral stump was successfully removed. The flexible ureterorenoscopy was most useful for the diagnosis in this case.

From August 1989 through September 1991 we performed percutaneous nephrostomy under ultrasonic guidance in 26 kidneys of 25 patients. We also indwelled double pigtail ureteral stents by endoscopy in 14 kidneys of 13 patients. No patients died because of renal failure. The survival was dependent on progression of primary disease and performance status. Neither significant nor life-threatening complications were encountered. The difference in the improvement of renal function between nephrostomy group and stent group was not statistically significant. Although the indwelling ureteral stent method requires no external drainage bag, this method has certain drawback such as occasional obstruction of stent. Especially in poor risk patients, percutaneous nephrostomy technique seems to be better than placement of double pigtail ureteral stent in the treatment of postrenal failure secondary to malignancies.

From November to December in 1990, 7 cases of tsutsugamushi disease were found first in the southern foot of Mt. Haruna of Gunma Pref., Japan. The present study was conducted to clarify the clinical features and the outbreak pattern of rickettsial infection in this area. All the patients consisting of 6 males and 1 female farmers were admitted to our hospital, complaining of high fever, chills and skin rash on 5-12 days after working in the field. Based on laboratory examinations and one (or two) typical eschar, a tentative diagnosis of tsutsugamushi disease was made and all patients became better soon after the therapy with intravenous administration of minocyclin (200 mg/day). The high titer of serum antibody to Karp type Rickettsia (Orientia?) tsustugamushi was detected by an immunoperoxidase test (IP) in most of the patients, and also a Karp-like strain was isolated from only one patient, probably due to low virulence to mice. The agricultural areas along the Agatuma and Nakuta rivers in the northern foot of Mt. Haruna have been well known as the most endemic foci of the disease in Gunma Pref. Nevertheless, it was suggested that outbreaks of the disease might be potentially wide-spread throughout this Pref., when the prevalences of the disease were evaluated as incidences to a hundred thousand inhabitants or adjusted by the density of agricultural populations of each administrative divisions. As most of the patients in Gunma Pref. have been officially reported in autumn, a statistical trial indicates that there is a significant correlation between the levels of temperature and outbreaks of the disease in autumn.(ABSTRACT TRUNCATED AT 250 WORDS)

To elucidate the relationship between cyclosporine (Cs) nephrotoxicity and renal blood flow (RBF), we carried our experiments using rats. Adult male Wistar strain rats each weighing about 100 g were used. Rats were divided into 2 groups; the Cs group (Cs 50 mg/kg/day was intraperitoneally given for 10 consecutive days) and the control group (normal saline solution for 10 consecutive days). The renal cortical blood flow was measured in each group by electrolytic hydrogen gas clearance method. We also carried out renal angiography with barium sulfate (BaSO4). Then we measured blood vessel area/renal sagittal section area ratio and the diameter of interlobar arteries. The Cs group showed a significant decrease of renal cortical blood flow compared with the control group. On the other hand there was no significant change in renal angiogram. In conclusion, Cs decreased renal cortical blood flow. We suppose that vascular resistance increased following afferent arteriolopathy caused by Cs administration.

To elucidate the relationship between Cyclosporine (Cs) induced nephrotoxicity and juxtaglomerular (JG) apparatus, we carried out biochemical and morphological experiments using mice. Adult male ICR strain mice weighing about 40 g were used. The mice were divided into 2 groups: the Cs group (Cs 50 mg/kg/day was orally given for 14 consecutive days) and the control group (olive oil for 14 days). Urine was stored for 24 hours on the day 0, 7 and 14 and urine volume and concentrations of urinary creatinine (u-Cr) and urinary potassium (u-K) were measured in each group. All the mice were sacrificed and examined on the 15th day. Concentrations of serum creatinine (s-Cr), serum potassium (s-K), plasma renin activity (PRA), plasma aldosterone (Ald) were noted in each group. The kidneys were also examined histologically with light and electron microscopes. The Cs group showed significant increases of s-K, PRA and Ald and a significant decrease of creatinine clearance compared with the control group. Histologically, the Cs group demonstrated focal vacuolar changes in the proximal tubular cells and an increase in the number of granules in the JG cells. Each granule of the Cs group was larger than that of the control group. Cs certainly stimulates the renin-angiotensin-aldosterone system and causes consequently a secondary aldosteronism.

The purposes of this article are to review literature on direct priming (or repetition priming) and to comment on the current literature and its perspectives. Among a number of studies concerning direct priming, two categories of studies were mainly discussed: One is concerned with longevity of priming effects, and the other is concerned with variables which influence direct priming. Most of the former research has demonstrated long-lasting priming effects, but the theoretical account remains unclear. The latter has presented a variety of inconsistent findings. Finally three directions for future research were pointed out: methodological investigation, expanding research targets, and interaction among different approaches.

Tracheobroncho plasty is currently carried out by a number of surgical techniques. Extraordinal plastic modes require special techniques. We prefer to anastomose the posterior site by tying sutures respectively, but at the anterior site by tying sutures after placing them. However, this procedure is difficult to apply in extraordinal plastic modes. Our preference in such cases is to place all anastomotic sutures clipped to field drapes, and then tie them down from front to back of the anastomotic site. This anastomotic technique was carried out in cases of 1) extreme tension in approximation of both anastomotic stumps, 2) subaortic arch anastomosis, and 3) end to side anastomosis. This technique prevents cutting with a suture through cartilage rings with a suture and enables anastomosis to be carried out even in the deep and narrow operative field. The usefulness of this technique was discussed.