To evaluate the extension of the indications for operation and up-to-date problems in the surgical therapy of the acquired valvular disease, 581 consecutive patients of prosthetic valve replacement from January 1974 through December 1987 were analysed. The age at operation was 39.1 years (range 22 to 68) at 1974, but increased to 51.9 years (range 9 to 75) at 1987 (p<0.05). Early mortality was 3 deaths in 9 patients (33.3%) who were older than 70 years old, but its range was 0% through 7.7% in the younger patient group (p<0.05). Hospital mortality of the combined valve procedure for aortic, miral and tricuspid valvular disease was analysed. It was higher in the group of tricuspid valve replacement (30.0%) than the group of tricuspid annuloplasty (8.3%) (p<0.01). The former group was in poor preoperative state (cachexia, total bilirubin>2mg/dl, mean right atrial pressure>10mmHg and systolic pulmonary artery pressure >75mmHg), compared to the latter group. The cases of re-replacement of the prosthetic valve increased since 1985. The incidence of poor prognosis after operation, that included early death, late death and retire from society, was 47.1% in NYHA Class TV, and from 0 to 15.8% in NYHA Class I to Class III (p<0.01). 60 cases underwent valve replacement for infective endo-carditis, and 16 urgent operations were required in 23 active stage operations. Total early and late mortality was higher in active stage operation (30.0%) than in healed stage operation (2.7%) (p<0.01). In these way, the extension of the indications for operation was carried on the patients of advanced age, combined valve procedure for multiple valve disease, valve re-replacement and infective endocarditis. The operative risk was high in the patients older than 70 years old, the patients who had the risk factors of multiple organ failure after operation, valve re-replacement in NYHA Class IV, and the urgent operation at active stage of infective endocarditis.

 In Horokanai town, Hokkaido, the policy of full subsidies for voluntary vaccinations against influenza, haemophilus influenzae type b (Hib), varicella, mumps, pneumococcal for children and human papillomavirus (HPV) was introduced between 2008 and 2010. A campaign for community education about vaccination was initiated.
 Vaccination coverage improved after the subsidy as follows : influenza vaccination increased from 57.4% to 60.1%, Hib from 2.9% to 52.2%, varicella from 0% to 30.0%, mumps from 2.8% to 38.2%, pneumococcal for children from 1.3% to 50.6%, and HPV from 0% to 81.3%.

The combined method of antegrade and retrograde administration of cardioplegic solution has been established for coronary bypass surgery. We applied this technique in patients undergoing aortic and mitral valve surgery. Between January 1989 and December 1990, 28 patients underwent both aortic and mitral valve replacements. To compare the myocardial protective effect according to the method of cardioplegic administration, they were divided into two groups; Ante group (antegrade, n=15) and Retro group (combined method of antegrade and retrograde, n=13). Aortic occlusion time and cardiopulmonary bypass time were shorter in Retro group. The mean interval of each cardioplegic administration was significantly shorter in Retro group (Ante group, 29.2±4.8min vs Retro group, 24.0±3.8min; p<0.01). These results suggest that retrograde cardioplegia method never disturbs ongoing operation during each delivery while antegrade method often does. Serum CPK-MB at 6hr of reperfusion tended to be less in Retro group (Ante group, 120±80IU/l vs Retro group, 78±50IU/l; p=0.09). The results of postoperative cardiac functions were the same in both groups. We therefore believe that this method is an optimal strategy even in patients with valvular heart disease.

PURPOSE: The purpose of this study is to evaluate the clinical results of treatment with a high dose of 3-dimensional conformal boost (3DCB) using a real-time tracking radiation therapy (RTRT) system in cervical cancer patients. MATERIALS AND METHODS: Between January 2001 and December 2004, 10 patients with cervical cancer were treated with a high dose 3DCB using RTRT system. Nine patients received whole pelvis radiation therapy (RT) with a median dose of 50 Gy (range, 40-50 Gy) before the 3DCB. The median dose of the 3DCB was 30 Gy (range, 25-30 Gy). Eight patients received the 3DCB twice a week with a daily fraction of 5 Gy. The determined endpoints were tumor response, overall survival, local failure free survival, and distant metastasis free survival. The duration of survival was calculated from the time of the start of radiotherapy. RESULTS: All patients were alive at the time of analysis and the median follow-up was 17.6 months (range, 4.9-27.3 months). Complete response was achieved in nine patients and one patient had a partial response. The 1- and 2-year local failure free survival was 78.8% and 54%, respectively. The 1- and 2-year distant metastasis free survival was 90% and 72%, respectively. Late toxicity of a grade 2 rectal hemorrhage was seen in one patient. A subcutaneous abscess was encountered in one patient. CONCLUSION: The use of the high dose 3DCB in the treatment of cervical cancer is safe and feasible where intracavitary brachytherapy (ICBT) is unable to be performed. The escalation of the 3DCB dose is currently under evaluation.
Adult ; Aged ; *Brachytherapy ; Female ; Humans ; Middle Aged ; Radiotherapy Planning, Computer-Assisted/adverse effects/*methods ; Treatment Outcome ; Uterine Cervical Neoplasms/mortality/pathology/*radiotherapy

Since late 2013 through March 2014, Japan experienced a rapid rise in measles cases. Here, we briefly report on the ongoing situation and share preliminarily findings, concerns and challenges and the public health actions needed over the coming months and years.

Measles is a notifiable disease in Japan based on nationwide case-based surveillance legally requiring physicians to report all clinically diagnosed and laboratory-confirmed cases within seven days, but preferably within 24 hours. After a large outbreak in 2007–2008 (more than 11 000 cases reported in 2008 alone) and a goal of elimination by April 2015, a catch-up programme using the bivalent measles-rubella (MR) vaccine was offered for grades seven and 12 (ages 12–13 and 17–18 years) from April 2008 through March 2013. During this period, there was an estimated 97% decline in measles notifications, and the cumulative number of reported cases has been steadily declining over the last five years (732 cases in 2009, 447 cases in 2010, 439 cases in 2011, 293 cases in 2012 and 232 cases in 2013). However, since late 2013 through March 2014, the country experienced a resurgence only a year after a large rubella outbreak.