Abstract
 Sometimes experienced doctors and nurses have an intuitive sense of alarm about an apparently stable patient, a sense which may be expressed as, for instance, ‘He/she seems seriously ill.’ However, this intuitive sense of alarm remains a rule of thumb, even though it is recognized as an important “diagnostic” indicator in clinical decision-making. In this review, we have attempted to clarify the meaning of the phrase by proposing a pathophysiologic/symptomatologic model that suggests that the sense of alarm is a premonitory sign of a homeostatic crisis characterized by acute systemic autonomic symptoms and acute sickness behavior. The model proposed here may help novices to avoid missing potentially critical diseases.

Purpose: Escitalopram has been inadequately evaluated in cancer patients. Here, we report two patients with advanced cancer who benefited from escitalopram for depression. Case 1: A man aged in his 50s had postoperative recurrence of rectal cancer. He was diagnosed with a major depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The score of the Hamilton Rating Scale for Depression (HAMD-17) was 20 points. He began treatment with 10 mg/day of escitalopram. His symptoms began to improve at about 14 days, and the HAMD-17 score was 4 points at 23 days, suggesting a marked improvement. Case 2: A woman aged in her 50s had cancer of the external auditory canal. She was diagnosed with a major depressive episode according to DSM-IV-TR. The score of HAMD-17 was 26 points. She began treatment with 10 mg/day of escitalopram. Her symptoms began to improve at 15 days, and the HAMD-17 score at 28 days was 13 points, suggesting a marked improvement. In both cases, serious side effects, clear exacerbation of depression, and withdrawal syndrome due to acute drug deprivation associated with worsening of the symptoms were not noted. Conclusion: Escitalopram is considered a useful drug for depression in patients with advanced cancer.

A 41-year-old woman was given a diagnosis of Behçet's disease at age 25. When she was 31, a large aortic pseudoaneurysm developed near the left renal artery. Isolation of the aneurysm and anatomical grafting and ancillary bypass were performed. Ten years later, a graft duodenal fistula developed. Extra-anatomical reconstruction was done after complete resection of the original graft and the infectious lesion. It was found that the intra-abdominal organs were receiving blood supply only from the inferiol mesenteric artery. Moreover, severe ischemia of the intra-abdominal organs was a concern during surgery. Therefore, hepatic vein oxygen saturation was monitored continuously with a Swan-Ganz catheter for ischemia of the intra-abdominal organs. It proved to be a very effective indicator and we could perform this operation safely. Reoperation of grafting is often inevitable in patients with Behçet's disease. Also, two stumps of abdominal aorta were left in this patient because of the extra-anatomical reconstruction. Pseudoaneurysm may later occur at the site of the stumps, thus necessitating careful follow-up observations.

A simple method of evaluation and measurement of endurance of the whole body for exercise prescription for sportsmen was previously reported. In the present study, a method of loading for general population was deviced and is the subject of the present communication.
The site of loading was divided into relatively localized portions of the lower extremity, upper extremity and trunk.
By substituting the kneeling exercise with step test, individual difference in body height was corrected.

A 52-year-old man was referred to our institution because of a solitary aneurysm of the left common iliac artery. The presence of the aneurysm was demonstrated by CT and angiography. The aneurysm had a diameter of about 30mm. The walls of the bilateral external iliac arteries were irregular, like a string of beads. The aneurysm was resected and replaced with a vascular prosthesis. Histological examination of the aneurysm and a part of the left external iliac artery indicated a diagnosis compatible with fibromuscular dysplasia (FMD: medial fibroplasia). A solitary iliac aneurysm is rare, and is usually due to atherosclerosis. However, the aneurysm in this case was related to FMD. To the best of our knowledge, only one other case of a solitary common iliac aneurysm caused by FMD has so far been described.

Intravenous leiomyomatosis (IVL) is defined as the extension into the venous channels of histologically benign smooth muscle tumors originating either from a uterine myoma or from the walls of a uterine vessel. We report a case of IVL extending to the right atrium and right ventricle through the right internal iliac vein and the inferior vena cava. The patient was a 43-year-old woman. The tumor was extirpated by simultaneous median sternotomy and laparotomy with the use of cardiopulmonary bypass. It was necessary to use cardiopulmonary bypass in order to open the right atrium. However, it proved difficult to insert the venous cannulae into the inferior vena cava due to the presence of the tumors. In order to perform the cannulation, a trans-right atrial excision of this tumor was necessary. Nevertheless, hemodynamic deterioration tended to occur during the procedure because of unexpected bleeding. We believe that to safely carry out this operation, it would be better to ensure circulatory arrest before trans-right atrial excision of the tumor. We have been continuing preventive antiestrogen therapy because recurrence would be very likely if any tumorous tissue remained after surgery. Fortunately, no intravenous infiltration of the tumor has been detected by either pelvic computed tomography or ultrasonography during the 26-month follow-up period. Surgical excision of the tumors and postoperative medication are now believed to have been effective.

Introduction  The objective of this study was to identify measures Japan should take to achieve health (goal 3) and gender (goal 5) goals of the Sustainable Development Goals (SDGs) in synergy by comparing the status of health and gender in Japan and the United Kingdom based on gender analysis.Methods  In-depth interviews were conducted with 8 gender experts and 2 obstetrician/gynecologists in Japan and 9 informants in government, civil society and academia in the UK. The status of sexual and reproductive health and rights (SRHR) and measures against gender-based violence were elaborated. Qualitative content analysis was conducted on the transcripts of the interview audio-records.Results  We have compared contraception and abortion, control of sexually transmitted infections, sexuality education, measures against breast and cervical cancers and measures against gender-based violence in Japan and the UK. Significant differences were noted in contraception and abortion, sexuality education and measures against gender-based violence. There were four areas where the UK applied gender-transformative measures (measures that address not only the condition of women but also the gender relations between men and women and social status of women) whereas Japan has not yet applied such measures: 1) Ensuring selection of a wide range of contraceptive methods with low price, 2) Enabling abortion solely based on the decision by women, 3)Comprehensive sexuality education that includes gender and human relationship, and 4) Setting an integrated strategy against gender-based violence. Conclusion  Japan can strive for both health and gender goals of the SDGs by addressing above four aspects. Promotion of civil society participation in policy decision and increased proportion of female parliamentarians will help address these aspects.

Objective: In 2020, coronavirus disease-2019 (COVID-19) became the cause of a pandemic. In response, the Japan Sports Agency issued warnings about secondary damage to health, such as the threat to physical and mental well-being due to the lack of exercise in this situation. In this study, we report on cross-sectional and longitudinal examinations of standing trunk flexion to evaluate how temporary long-term school closures affected musculoskeletal function in elementary school students.Patients and Methods: All children in one public elementary school in T-city during the school years 2019 and 2020 were included in this study. A digital forward flexion meter was used to measure standing trunk flexion.Results: In this study, 284 (284/289: 98.3%) and 266 (266/274: 97.1%) children in school years 2020 and 2019, respectively, were found to have valid data for cross-sectional analysis. The standing trunk flexion did not show significant differences between grades or sexes. In the longitudinal analysis, the results of the comparison of standing trunk flexion in children for two consecutive years revealed significant differences only between grades 3 and 4 (P<0.05) and between girls in grades 3 and 4 (P<0.01), but no significant differences in other grades or among boys or girls were observed.Conclusion: Initially, we expected that there would be a difference in the results of functional assessment using standing trunk flexion depending on the period of absence from school. However, the results of this study showed no significant changes in standing trunk flexion. Moreover, since children’s musculoskeletal functions may be affected by various factors during the COVID-19 pandemic, they should be carefully monitored in the future.