To understand the present situation of elderly patients with pneumonia, all 3,784 inpatients of our Department of Respiratory Medicine from April 2010 to March 2015 were analyzed. In total, 718 patients (pts) were diagnosed with pneumonia (median age, 78 years) and they were classified into two groups: those aged>65 years (elderly group, EG: 600 pts and those ≤d65 years (younger group, YG; 118 pts). Annual change in the ratio of EG/YG, mortality rate, respiratory assist mode, and number of hospital days were analyzed. The ratio of EG/YG was 0.11 in 2011 but was higher at 0.20 in 2014.The mortality rate was significantly higher in EG than in YG (147/600 vs 15/118; p<0.05). In the group of deaths, among patients who were intubated, 6 of 15 were in YG and 5 of 147 were in EG, respectively. The median number of hospital days was not significantly different between the groups for patients who died (EG 13, YG 14) or were discharged (EG 15, YG 12). In EG, the proportion of patients who changed hospitals for recuperation was up to 10% and the median hospital stay was 48 days, compared to 28 days in YG. With regard to pneumonia, because the guidelines are well established and because elderly individuals, in particular, often do not require additional treatment, it is possible to provide treatment at general hospitals or at home by strengthening the cooperation between clinic and hospital as well as hospital and hospital in the community through the incorporation of information technology.

Objective: To reduce the length of hospital stay for patients undergoing pacemaker surgery. Patient and Methods: We prevented the leads from dislodging by anchoring a screw-in type pacing lead in the right atrium/ventricle through a cephalic vein that was cut down. We retrospectively compared the cost and duration of the hospital stay for the subpectoral technique (35 cases; January 2005-March 2006) and conventional technique (subcutaneous pocket and subclavian vein puncture) (18 cases; October 2003-December 2004) groups. Results: The mean (± SD) duration of hospital stay was 5.1 ± 2.1 days for the subpectoral technique group and 22.2 ± 15.2 days for the conventional technique group (P < 0.001), and the cost was 2,167,883 ± 147,549 yen in the subpectoral technique group and 2,528,053 ± 217,810 yen in the conventional technique group (P < 0.001). We noted no major complications such as bleeding, lead dislodgement, or wound infection. Conclusion: Our novel subpectoral technique helped reduce the length and cost of the hospital stay associated with pacemaker surgery.
Hospitals ; Length ; Artificial cardiac pacemaker ; Cost aspects ; Conferences

Prognostic facfors were examined in 71 patients receiving home oxygen therapy under the direction of our hospital between 1984 and 1994. In 25 patients who had undergone right catheterization, relationships between pulmonary hemodynamics and prognosis were also discussed. Mean pulmonary arterial pressure (P_PA) were correlated negatively with PaO₂. This indicated that hypoxic pulmonary vasoconstriction was the major cause of pulmonary hypertention in these patients. Pulmonary hypertention was revealed in 80% of the patients with P_PA ≥20 Torr and in 52% of the patients with P_PA ≥25 Torr. Acute hemodynamic effects of low-flow oxygen administration were investigated in 17 patients. PPA decreased significantly from 25.5 Torr to 23.5 Torr after oxygen administration and pulmonary arteriolar resistance (PAR) decreased from 243 dynes ·ses ·cm^-5 to 225 dynes·sec·cm^-5, but this change was not significant.
In patients with pulmonary fibrosis and sequelae of tuberculosis, the survival rates were lower than that of the patients with pulmonary emphysema. The median survival time (MST) for patients with cor pulmonale was significantly lower than that for those without cor pulmonale. When background factors were compared between the group with % home stay≥90% and % home stay<90%, there were no significant differences in observation periods, arterial blood gases and spirometry. The factors influencing % home stay were considered to be an important subject in addition to improving the survival rate.

A gelatin-sealed knitted Dacron graft which has zero-porosity at implantation and does not require preclotting preparation has been developed. Gelatin-sealed aortic grafts were implanted into 39 patients and vascular surgery reconstruction was performed for thoracic aortic aneurysm (TAA) in 10, abdominal aortic aneurysm (AAA) in 19, and arteriosclerosis obliterans (ASO) and other conditions in 10. A total of 39 bifurcated or straight grafts were inserted. The Gelseal Dacron graft had superior handling characteristics and biocompatibility in comparison to conventional graft. There was no measurable blood loss from the body of the sealed graft at the time of implantation. The gelatin-sealed Dacron graft (n=10) was compared with an Intervascular Micron^® graft (n=10) implanted into the abdominal aorta. No problems were evident with regard to intraoperative bleeding, allogenic and autologous transfusion volume and blood parameters between the two groups. These results suggested that the Gelseal Dacron graft sealed with gelatin was a safe, zero-porosity implantable prosthesis for clinical use.

A 62-year-old woman with the tetralogy of Fallot (TOF) diagnosed at 24 years of age, was admitted with fever and dyspnea. She also had cyanosis and heart failure and was categorized as New York Heart Association (NYHA) functional class IV. Echocardiography showed TOF with a-grade III tricuspid valve regurgitation. Cardiac catheterization revealed major aorto-pulmonary collateral arteries (MAPCAs) for the left upper pulmonary circulation. After coil embolization of MAPCAs to reduce abnormal intracardiac return as well as postoperative left ventricular volume overload, the patient underwent total surgical correction (i.e., right ventricular outflow tract reconstruction using Medtronic FreeStyle Valve and transannular patch, ventricular septal defect closure, and tricuspid annuloplasty). Postoperatively, the patient had a satisfactory course during the 10-year follow-up period with a grade-I NYHA classification. In conclusion, intracardiac repair of TOF in case over 60 years of age can be performed safely by preoperative MAPCAs embolization and subsequent TOF repair with a strategy to abolish pulmonary and tricuspid valve regurgitation.

At the Niigata University School of Medicine, objective structured clinical examinations (OSCEs) were performed for the first time in 2001 for 92 fourth-year medical students. The average evaluation scores students received from instructors were summarized, and the differences between scores given by different instructors were examined. We found that practice methods for the medical interview and physical examination before OSCE and the question topics and evaluation methods of OSCE were appropriate, but scores on some items were extremely low. The standardization and objectivity of the evaluation were satisfactory, perhaps because one explanatory conference and two training conferences were held for instructors before OSCE. However, some questions tended to produce differences between instructors, as did some topics, especially in the medical interview. The scores with standardized patients and those by teachers were strongly correlated, but those with the former were lower than those by the latter.

We evaluated the efficacy, usefulness and safety of acupuncture and moxibustion treatment in rheumatoid arthritis (RA), by the randomized, parallel-group, multi-center study with the drug-treated outpatient group as the control. The endpoints, important in the clinical assessment of acupuncture treatment, included the improvement criteria in ACR core set variables and the Japanese version of the Arthritis Impact Measurement Scales Version 2 (AIMS-2), a system of evaluation of the quality of life (QOL) of patients with RA.
Regarding intervention (therapy), a therapy chart for each stage of disease was drawn up to give local and systemic treatment in consideration of the patient's activity and disability in each stage of RA, so that generally consistent therapy adapted to the patient's condition would be provided. Result 1. Patients eligible for analysis were 80 patients of A-group (drug therapy group) (80 females, 2 males) and 90 patients of B-group (drug plus acupuncture and moxibustion group), total 170 patients. 2. Patients who satisfied the improvement criteria in ACR core set variables (improved patients) were 8 of 80 patients in A-group and 20 of 90 patients in B-group. The improvement rate was significantly higher for B-group treated by drug plus acupuncture and moxibustion versus A-group, with P=0.04 in 2 (2 table chi square test. 3. In QOL change investigated by AIMS-2 questionnaire, the improvement occurred significantly more frequently in the drug plus acupuncture and moxibustion group, with difference between groups at 12 months after the initiation of clinical study at P=0.001. 4. Changes in the subjects included in AIMS-2 questionnaire : Improvement was significantly more frequent in the drug plus acupuncture and moxibustion group versus drug therapy group in respect to the ability to walk, finger function, housework, sociableness, pain, mood, and the degree of subjective improvement. In the present randomized, parallel-group, multicenter study, a significant improvement was detected in the drug plus acupuncture and moxibustion group versus the drug therapy group in the aforesaid respect, which suggested that the use of acupuncture and moxibustion combined with the conventional therapy would prevent deterioration of physical functions, improve blood circulation, stabilize mental status, and thereby contribute to the improvement of QOL in patients with rheumatoid arthritis.

We treated 472 patients with lung cancer from 1983 though 1993. Of the total number of the cases, early lung cancer accounted for 31 caces (6.6%), 6 of the hilar and 25 of the peripheral type. Of the 6 hilar type early lung cancer cases, 3 cases were detected by mass screening (2 cases were detected by sputum cytology). On the other hand, of the 25 cases of the peripheral type early lung cancer, 10 cases were detected by mass screening. All the 10 peripheral type early lung cancer cases detected by mass screening were detected by chest roentogenography. The 5-year survival rates for the hilar and peripheral type early lung cancer were 100% and 94.4%, respectively. For the improvement of prognosis of lung cancer, every effort should be made to detect lung cancer at an early stage. Careful lung cancer screening such as sputum cytology and bronchoscopy in a highrisk group and modern techniques such as helical X-ray CT are recommended for the increase in the detection of early lung cancer.

It has been proposed that transgenic mosquitoes can be used as a “flying syringe” for infectious disease control. We succeeded in generating a transgenic (TG) mosquito, Anopheles stephensi, excreting and discharging DsRed in saliva. DsRed was deposited on the membrane where the TG mosquito probed with its proboscis. Repeated feeding by the TG mosquitoes induced anti-DeRed as well as anti-SG antibodies in mice. This indicates that the TG mosquitoes can immunize the animal. Moreover, in this report, we employed a pre-immunization method before exposing mice to the TG mosquitoes. We injected DsRed to mice to prepare memory B cells and exposed the mice to bites by the TG mosquitoes excreting DsRed. The mice produced a higher titer of antibody to DsRed, suggesting that the bites from TG mosquitoes act as a booster and that primary immunization with a vaccine protein and exposure to TG mosquitoes excreting the vaccine protein in the saliva produces a synergistic effect.

Pure autonomic failure (PAF) is a degenerative disorder with diverse autonomic nervous symptoms, but without somatic nervous symptoms. We encountered a patient with PAF who was successfully treated with keishikashakuyakuto. A 61-year-old man complained of diarrhea, abdominal pain, dysuria and orthostatic hypotension. PAF was strongly suspected, based on a low level of plasma noradrenalin at rest and a finding of severe diffuse sympathetic nerve injury on ¹²³I MIBG myocardial scintigraphy. Various Kampo formulas were not effective, or could not be administered continually. Urinary retention was treated with self-catheterization. After the extract of keishikashakuyakuto was administered, his complaints of diarrhea and abdominal pain gradually decreased, and he was able to eat various kinds of food. His daily living activities improved.Moreover, he could urinate by himself, so the self-catheterization was stopped. Five years later, the diagnosis of PAF was clinically confirmed, but his daily living activities did not deteriorate. This suggests that keishikashakuyakuto can be effective for diseases with diverse autonomic nervous symptoms, such as the present case.