The author made a check of the past five years' itinerary medical service to the islands scattered in the Inland Sea of Japan. All-inclusive, 15, 599 persons received such medical service, including more feinales than males. The diseases found inhigh frequencies were hypertension, neuralgia and diseases of digestive organs, as is also the case with the main land. The diseases found in higher frequencies than expected were anemia, hypotension and gastroptosis, which would have been caused from the peculiar working conditions handicapped by nature and from undernourishment.

  A 67-year-old man was admitted to our hospital because of right lower abdominal pain. Abdominal CT scan showed swelling and hypertrophy of the appendix wall and presence of a low density area near the appendix. We thus diagnosed this case as acute appendicitis with abscess and performed an emergency operation. When laparotomy was done, we observed the swelling of the appendix, and a mass bordered on the appendix which adhered tightly to the jejunum. The patient underwent appendectomy and partial resection of the jejunum. A pathological examination revealed mucinous adenoma of the appendix. The mass bordered on the appendix was mucocele. The mucocele adhered to the jejunum and the mucus infiltrated to the muscularis propria of the jejunum. He had an uneventful post operative course and was discharged from our hospital on the 12th postoperative day.Mucinous cystadenoma of the appendix adhered to the jejunum is very rare and we report our case with some literature review.

Objective: Patients treated with vinorelbine(VNR)-containing chemotherapy often suffer from injection site reactions.  VNR is a moderate vesicant that is well known to cause local venous damage.  We conducted this study to identify clinical risk factors related to the incidence of injection site reactions caused by VNR, and whether applying a hot compress was effective for preventing such reactions.
Methods: Medical records were retrospectively investigated for 48 patients treated with chemotherapy regimens containing VNR.  Injection site reactions were evaluated for every course and were graded according to the National Cancer Institute Common Toxicity Criteria (version 4.0).  Gender, age, body mass index, chemotherapy regimen, dose of VNR, and volume of fluid for flushing the vein were assessed as clinical variables.  A hot compress was applied to the vein proximal to the injection site during VNR injection.
Results: The injection site reactions occurred in 29 (60%) among 48 patients received intravenous VNR injection.  According to multivariate analysis, use of gemcitabine (GEM) in combination with VNR showed a significant independent correlation with an increased risk of injection site reactions (p=0.019).  When hot compress was applied to 21 patients, who experienced phlebitis of VNR, the injection site reaction was occurred to only three patients (p<0.001).
Conclusion: In this study, the risk factor of the injection site reaction by VNR seems to be combination of GEM.  Application of hot compresses was effective for preventing injection site reactions by VNR.

  A-77-old man was admitted to our hospital because of melena in August 2010. Colonoscopy was performed on him, and the case was diagnosed as ulcerative colitis. His symptoms did not abate despite the administration of mesaladine and steroid. He was thus diagnosed with reflactory ulcerative colitis, and underwent total proctocolectomy. The patient had an uneventaful postoperative course and was discharged from our hospital on the 31^st postoperative day. Total proctocolectomy was considerd one of the useful operative procedures for old patients with ulcerative colitis.

BACKGROUND: Mizoribine (MZR) is an immunosuppressive drug used in Japan for treating patients with lupus nephritis and nephrotic syndrome and has been also reportedly effective in patients with immunoglobulin A (IgA) nephropathy. However, to date, few randomized control studies of MZR are performed in patients with IgA nephropathy. Therefore, this prospective, open-label, randomized, controlled trial aimed to investigate the efficacy and safety of adding MZR to standard treatment in these patients, and was conducted between April 1, 2009, and March 31, 2016, as a multicenter study. METHODS: Patients were randomly assigned (1:1) to receiving standard treatment plus MZR (MZR group) or standard treatment (control group). MZR was administered orally at a dose of 150 mg once daily for 12 months. RESULTS: Primary outcomes were the percentage reduction in urinary protein excretion from baseline and the rate of patients with hematuria disappearance 36 months after study initiation. Secondary outcomes were the rate of patients with proteinuria disappearance, clinical remission rate, absolute changes in estimated glomerular filtration rate from baseline, and the change in daily dose of prednisolone. Forty-two patients were randomly assigned to MZR (n = 21) and control groups (n = 21). Nine patients in MZR group and 15 patients in the control group completed the study. No significant differences were observed between the two groups with respect to primary and secondary outcomes. CONCLUSION: The addition of MZR to standard treatment has no beneficial effect on reducing urinary protein excretion and hematuria when treating patients with IgA nephropathy.
Glomerular Filtration Rate ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Immunoglobulin A* ; Immunoglobulins* ; Japan ; Lupus Nephritis ; Nephrotic Syndrome ; Prednisolone ; Prospective Studies ; Proteinuria