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Benign metastasizing leiomyoma (BML) is a rare condition that affects other organs out of the uterus. Recently, a few case reports in which 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) has been used to distinguish the malignancy have been published. Here, the authors present a case of BML with metabolic activity on PET, in which needle biopsy of the uterus was efficient to make diagnosis.

Primary retroperitoneal transitional cell carcinomas (TCCs) are extremely rare neoplasms for which prognosis is very poor. We present a case that underwent complete remission after radiotherapy and concurrent oral chemotherapy. A 68-year-old woman presented with acute onset of bloody stool. Urgent colonoscopy only detected haemorrhoids. Subsequent abdominal ultrasonography revealed a mass of 7cm in maximal diameter in the left iliac fossa. Laparotomy disclosed a retroperitoneal mass that could not be dissected and therefore only incision biopsy was performed. After a final diagnosis of primary retroperitoneal TCC, chemotherapy with tegafur-uracil (UFT) was initiated but was not effective. Subsequently, radiotherapy was initiated concurrently with UFT at a total dose of 50Gy in 25 fractions. At 20 months after radiotherapy, the tumour seemed to have completely remitted. At the last follow-up, ten years from radiotherapy, computed tomography revealed no recurrence. We identified only three single case reports regarding primary retroperitoneal TCC over the last five decades. All patients died from the tumour 8−24 months after diagnosis or treatment. Based on the success of our case, radiotherapy with concurrent oral chemotherapy should be considered as an option for unresected cases.

A 39-yr-old Japanese man underwent living related kidney transplantation. Because the graft was ABO-incompatible, he was treated with double filtration plasmapheresis before transplantation and his immunosuppressive therapy was stronger than usual. However, immunoglobulin A nephropathy, accompanied by cellular crescents and necrotizing lesions, developed after 18 months. To our knowledge, the association of IgA nephropathy with ABO-incompatible kidney transplantation has not been reported previously.

A case of renal malignant lymphoma is reported. A 74-year-old man was admitted to our hospital on September 8, 1995, complainning of right flank pain, abdominal mass, and anorexia for two months. Physical examination revealed an enlarged right axillary lymph node and abdominal mass of child's head size. Computerized tomography showed a tumor (11 x 7 cm) encompassing the right kidney parenchym, and enlarged paraaprtoc lymph nodes with invasion of the left iliac creat. Transcutaneous echo-guided needle biopsy revealed that the tumor was non-Hodgkin's malignant lymphoma, diffuse large cell type, positive for B cell marker. The patient was treated with full dose of CHOP regimen. However, adriamycin was replaced with pirarubicin and the dose of the other drugs were reduced for the subsequent 4 courses because of severe leukocytopenia, thrombocytopenia, hepatotoxicity, and alopecia after the first course of the treatment. The patient showed complete remission and discharged on March 12, 1996. He, after 17 months, has no signs of recurrence. We reviewed 43 Japanese cases previously reported as renal malignant lymphoma. It is increasing in Japan especially in elderly. The 2-year survival is 26.6%.

(PURPOSE). To determine the efficacy of extraperitoneal laparoscopic adrenalectomy for patients with adrenal tumor, the clinical results of 9 patients treated with this procedure were analysed. (PATIENT AND METHOD). Between July 1994 and March 1995, we have performed extraperitoneal laparoscopic adrenalectomy using the modified Gaur technique of balloon dilatation of the retroperitoneum in 4 men and 5 women with unilaterla small adrenal tumor who were 30 to 79 years old (mean age 56 years). Preoperative diagnosis was primary aldosteronism in 2, 18-hydroxycorticosterone producing adnoma in 1, pre-Cushing syndrome in 5, and nonfunctioning adrenal tumor in 1 patient. The operations were performed with the patients on lateral position and 4 torocars were positioned. The retroperitoneal space was first dissected bluntly by the index finger and a balloon dissector through a small skin incision, and the retroperitoneal space was insufflated with carbon dioxide at the pressure of 10 to 12 mmHg. After the dissection of the adrenal gland, adrenal vein was clipped and transected. The completely freed adrenal gland was enclosed in an entrapment sack and removed en bloc through the open laparoscopy wound. (RESULTS). All 9 procedures were successfully performed. The mean estimated blood loss and the mean operating time were 53 ml and 168 min respectively. There was no intraoperative complication. A postoperative retroperitoneal hematoma was observed in one patient, however it spontaneously resolved without surgical management. (CONCLUSION). In open adrenalectomy, the benefit of the extraperitoneal approach (excluding patients with pheochromocytoma or bilateral lesions) have already been established elsewhere. Although the working space is smaller than that of peritoneal approach, and the surgical techniques are slightly more difficult, extraperitoneal laparoscopic adrenalectomy promises to be safe and a minimally invasive treatment for patients with unilateral small adrenal tumors except for pheochromocytoma.

An autoclavable air turbine handpiece, Air Flushing Clean System (AFCS) (Osada Electric Co., Ltd., Tokyo, Japan) was developed for use in dentistry with the objective of reducing cross-contamination. Its potential for bacterial contamination was investigated in vitro using two bacterial strains (Streptococcus mutants ATCC 25175 and Staphylococcus aureus FDA 209 P). In theory, this device should prevent cross-contamination of the internal water and air lines of the handpiece, by maintaining an internal positive pressure even after the turbine is stopped. In the present study, this AFCS device was found to reduce the bacterial contamination within the air turbine handpiece more effectively than the conventional handpiece used according to accepted protocol. The reduction of such contamination by the AFCS is in keeping with the recent objective of the American Dental Association to reduce cross-contamination during dental procedures.

Circulatory system examinations performed on first-grade pupils of junior high schools (12 years old; N = 1,204), identified 105 high-risk pupils with arteriosclerosis-promoting factors. These pupils were consulted on life-style modification, emphasizing nutrition and exercise, and encouraged to practice personal health management and self-monitoring. Reduction and correction of high risk factors were studied in these subjects, based on review of results of health examinations performed regularly up to the time of their graduation. Results are as follows: 1. Averages for obesity grade (for both sexes) in the second and the third years were significantly lower than that in the first year. Based on a general reference valueor = 20%, improvements were observed in 22.5% of males and 50.0% of females. 2. In both sexes average total cholesterol (TC) and triglyceride (TG) were lower in the second and the third years than in the first year, and a significant increase in HDL cholesterol was seen. With regard to a general reference valueor = 3.0 for AI (Atherogenic Index) calculated using TC and HDL cholesterol, improvements (reduction) were observed in 29.4%, of males and 46.2% of females. 3. While the numbers of subjects with elevated SBP, DBP, GPT, FPG and BUN were few, there were significant decreases in averages in the second and third years compared with those in the first year. Using general reference values, improvements in these risks were seen in 100% for all values except for GPT where 75.0% showed improvement. 4. Comparison of grouped distribution of summed values of examination results between the first year and the third year, showed improvements (reduction and correction of risks) in 69 pupils (65.7%), while 30 pupils (28.6%) remained in the same group with no improvement and 6 pupils (5.7%) turned for the worse, dropping one rank.(ABSTRACT TRUNCATED AT 250 WORDS)

A significant number of youth have obesity, hypertension, hypercholesterolemia and diabetes mellitus which are major risk factors for C.V.D and I.H.D. and which frequently occur after maturity. Analysis of lifestyle factors show a strong relationship between a series of these factors, and life style practices as typified by time-saving, dietary practice such as convenience foods, insufficient exercises, as well as family history of C.V.D. Prompt establish next of a system for screening high risk children with these factors and a corresponding support system for guiding and instructing them, is indicated. Studies should be performed from the viewpoint of life-cycle health management for establishing an integrated examination system for circulatory diseases for screening to follow-up.

Causes and risk factors of deaths from subacute myelo-optico neuropathy (SMON) were studied in a prospective cohort of 4,329 SMON patients followed for 3 years and 7 months (Sept. 1985-March 1989) with the following findings: (1) Recent excess deaths of SMON patients was estimated as 4% from ratio of O/E (SMR = 104) and deaths due to SMON itself was 6.4%. (2) The ratio of O/E was significantly higher for deaths from cancer of colon/rectum in females, cancer of pancreas in males, hypertension in males, pneumonia/influenza in females, chronic obstructive pulmonary diseases in males, tuberculosis and intestinal obstructive disease in males and females. (3) The ratio of O/E was 1.8 times or greater for those SMON patients with complications of cerebrovascular disease, severe blindness, complete loss of ambulation, and who were bedridden, and who are unable to receive home care from family members or trained home helpers.

In order to improve maintenance of weight reduction, a long-term (5 month) weight reduction class for obese women consisting of repeated group learning three times a month in areas of dietary regimen and practice of physical exercise, and self-help group activities was conducted at a health center. Maintenance of achieved weight reduction was studied six months and one year after completion of the class. The results are as follows. 1) Among 30 alumni, percentages of rebound, regaining weight of more than half of reduction during the class, were 18% at six months and 48% at one year after the class. These results appear to indicate the difficulty in maintaining weight loss. 2) However, when changes were studied in terms of fat mass and lean body mass, rebound of fat mass, regaining fat mass of more than half of reduction, was very small--only 5%, through the follow-up periods--while lean body mass increased gradually. These results indicate very good maintenance of fat mass reduction, and from the view point of the objective of weight reduction which is principally fat mass reduction, this objective was supported. 3) The attendees were divided into two groups, diet group and exercise group. There were almost no differences in the follow-up results for weight maintenance between the two groups. This can be attributed to the fact that since the combination of dieting and exercise was emphasized in both groups, with moderate energy restriction and balanced food intake in the dietary regimen and aerobic walking for exercise in addition to the classroom learning, instructions for lifestyle changes were rather similar for both groups.

From November 1985 through September 1986, 20 cases of upper urinary tract calculi (14 kidney, 7 ureter) were treated by the one-stage procedure percutaneous nephrolithotripsy. Renal and ureteral calculi were successfully removed in all 20 cases (100%). After the procedure, a few small stone fragments remained in 3 cases (the rate of remnant stone : 14%). High fever was noted in 7 patients but did not last longer than 3 days. No patients required blood transfusion. The one-stage percutaneous procedure was considered a more efficient procedure to remove the upper urinary tract calculi, than open surgery or two stage percutaneous nephrolithotripsy. In one-stage percutaneous nephrolithotripsy, however, serum sodium concentration was lowered significantly after the procedure, although the hematocrit remained unchanged throughout. This should be carefully corrected by the supplement of irrigation fluid and intravenous infusion during the procedure.