A secondary aorto-enteric fistula can directly communicate with the gastroduodenal tract, colonic tract and the aorta in patients undergoing major surgery on the aorta, and this phenomenon is observed particularly often in patients who have undergone abdominal aortic graft replacement. We encountered a case of secondary aortoduodenal fistula and colonic fistula. The patient was a 60-year-old man who had previously undergone a graft replacement for an infra-renal abdominal aortic aneurysm. His present admission was due to episodes of gastro-intestinal hemorrhaging and he had also undergone an abdominal aortic graft replacement 2 months previously. The patient's bleeding was managed conservatively. A scar was observed in the duodenum based on the endoscopic findings. At 10 days after admission, abdominal computed tomography (CT) showed active bleeding from the graft in the third portion of the duodenum. We therefore diagnosed secondary aorto-duodenal fistula. Since this pathogenic state may lead to serious massive gastroduodenal hemorrhaging, both an accurate diagnosis and emergency operation are therefore essential to successful treatment. We immediately inserted an intra-aortic occlusion balloon catheter (IABO). Thereafter, another aorto colonic fistula was detected after laparotomy, for the first time. First, the old graft was removed and the direct closure of the duodenum was performed, followed by omentopexy, colostomy, colostoma and then the extra-anatomical revascularization between the left axillary and bilateral femoral arteries was carried out. Finally, an intestinal feeding tube was inserted. The patient fell into a state of cardiac arrest during the operation due to the uncontrolled active bleeding in spite of the presence of IABO. An emergency thoracotomy was thus performed in the left 4th intercostal region. The descending aorta was clamped, and then all of the planned procedures were performed in order. The postoperative course was eventful, however, the patient's lower thigh eventually had to be amputated due to ischemia of the clamped descending aorta. We encountered a case of graft duodenal and colonic fistula with cardio pulmonary arrest due to delayed diagnosis based on the endoscopic findings after abdominal aortic graft replacement. This case was successfully treated despite various difficulties in making a timely and accurate diagnosis.

Objective : Post-marketing surveillance was conducted for the purpose of demonstrating the relationship between the therapeutic effect of natural IFN-β preparation on chronic active hepatitis C and HCV subtype or viral load as well as various predictors of its efficacy.
Design : Cohort studies.
Methods : Questionnaires were sent to all medical institutions at which IFN-β ('IFNβMochida') was administered to patients with chronic active hepatitis C once daily for at least 8 weeks and its therapeutic effect was judged based on the rate of virological sustained response (VSR) and the rate of biochemical (ALT) sustained response (BSR).
Results : Questionnaires for 2, 076 patients were collected from 244 medical institutions all over the country. Of these questionnaires, those for 1, 503 patients, 930 men (61.9%) and 573 women (38.1%), collected from 229 institutions could be evaluated regarding the therapeutic effect of IFNβ Mochida. The patients' mean age was 50.2 years. The average VSR were 31% for all of the patients (1, 503 patients), 61% for those with a low viral load (HCV-RNA level before IFN treatment ; <106 copies/ml) and 14% for those with a high viral load (≥106 copies/ml) ; with the subtypes 1 b, 2 a and 2 b accounting for 18, 55 and 29% respectively. BSR were 45, 69 and 32%, respectively ; with the subtypes 1 b, 2 a and 2 b accounting for 32, 66 and 56%. As for the therapeutic effect in patients with the same level of viral load but different viral subtype, at each level of viral load VSR was the highest in subtype 2 a, followed by 2 b and 1 b, showing a significant difference between 2 a and 1 b or 2 b, depending on the level of viral load. BSR of 2 a and 2 b were similarly high, showing a significant difference between 2 a or 2 b and 1 b, depending on the level of viral load. In patients with subtype 1 a or 1 b, patients who were administered IFN-β≥339 MU obtained a higher VSR than those who were administered IFN-β ≤336MU. Adverse drug reactions were observed in 89% of the total 2, 076 patients, however, these symptoms disappeared immediately after the completion of the treatment. Univariate and multivariate logistic regression analyses conducted to detect the predictors on the therapeutic effect (VSR) of IFN-β revealed that the subtype, viral load and age were significant factors for all the patients and that the viral load and NS5A mutation were significant factors for the patients with subtype 1 b. However, the NS5A mutant type viral load was significantly less than that of the other types, showing no difference in the therapeutic effect in the comparison at the same level of viral load.
Conclusion : It was confirmed that the therapeutic effect of the natural IFN-β preparation on chronic active hepatitis C varied widely depending on the viral load and viral subtype. This information will play an important role in the development of therapy for chronic hepatitis C in the future.

An 83-year-old man had acute type B aortic dissection combined with a large athelosclerotic abdominal aortic aneurysm (AAA) over 8cm in diameter. The dissection advanced into the wall of the AAA. The patient was treated with strict medical therapy for two months and successfully underwent an early elective abdominal aortic repair concomitant with off-pump aortocoronary bypass grafting. This strategy of meticulous medical management may improve clinical outcome for the acute phase in such rare cases.

I) In most medical schools, the diseases of organ systems are divided within an integrated curriculum and are not taught in order, however, this situation will improve if several conditions are fulfilled.
2) The conditions that should be fulfilled are maintaining sufficient time for teaching general pathology and for bedside learning in the hospital's department of pathology.
3) Examples of training methods in the pathology of organ systems devised at various medical schools include the use of a virtual slide system, the presentation of surgically resected material, and practical training at a hospital's department of pathology.

We have checked into the function of konjak, or the devil's-tongue (Hydrosme vivieri) to reduce cholesterol in order to cast light on its significance as a health food. We processed chipped glucomannan into crackers (hereinafter referred to as “mannan crackers”) and examined its impacts on lipid metabolism. Enrolled for this study were hospital staff members whose total cholesterol exceeded 200mg/dl and students boarding in the hospital's nursing college.
The findings attested to the fact that the intake of mannan crackers may serve to reduce the values of total cholesterol. The higher the value of total cholesterol before this study, the greater the drop. Since we could not detect any effect on either HDLcholesterol or triglyceride, the mannan crackers were considered capable of specifically reducing LDL-cholesterol. We observed no numerical changes in the complete blood cell count (CBCC) and blood chemistry, either. Some of the subjects had abdominal swelling, diarrhea and other digestive problems but theirs were not serious cases. Yet in another aspect, there was no difference in body weight between before and after this study, but the intake of energy and lipid dropped during the period, suggesting that the intake of mannan crackers would produce an effect on the dietary pattern. Having said that, konjak (mannan crackers) may be considered capable of directly or indirectly reducing cholesterol, particularly LDL-cholesterol, suggesting that mannan crackers are of significance as a health food.
The significance of this study for agriculture and rural community must not go unmarked. This study will contribute to the development of agriculture as an industry, while the farm product by the name of konjak has something to do for health, and will be instrumental in protecting the rural environment, not to mention the lives of farm workers engaged in its production. It is a task for us to grapple with by associating itself with farm work and rural villages with the close collaboration of those farm producers.

STUDY DESIGN: In vivo biomechanical study using a three-dimensional (3D) musculoskeletal model for elderly individuals with or without pelvic retroversion. PURPOSE: To evaluate the effect of pelvic retroversion on the sagittal alignment of the spine, pelvis, and lower limb in elderly females while standing and walking. OVERVIEW OF LITERATURE: Patients with hip–spine syndrome have concurrent hip-joint and spine diseases. However, the dynamic sagittal alignment between the hip joint and spine has rarely been investigated. We used a 3D musculoskeletal model to evaluate global spinopelvic parameters, including spinal inclination and pelvic tilt (PT). METHODS: A total of 32 ambulant females (mean age=78 years) without assistance were enrolled in the study. On the basis of the radiographic measurement for PT, participants were divided into the pelvic retroversion group (R-group; PT≥20°) and the normal group (N-group; PT<20°). A 3D musculoskeletal motion analysis system was used to analyze the calculated value for the alignment of spine, pelvis, and lower limb, including calculated (C)-PT, sagittal vertical axis (C-SVA), pelvic incidence, lumbar lordosis, T1 pelvic angle (C-TPA), as well as knee and hip flexion angles while standing and walking. RESULTS: While standing, C-PT and C-TPA in the R-group were significantly larger than those in the N-group. Hip angle was significantly smaller in the R-group than in the N-group, unlike knee angle, which did not show difference. While walking, C-SVA and C-TPA were significantly increased, whereas C-PT decreased compared with those while standing. The maximum hip-flexion angle was significantly smaller in the R-group than in the N-group. There was a significant correlation between the radiographic and calculated parameters. CONCLUSIONS: The 3D musculoskeletal model was useful in evaluating the sagittal alignment of the spine, pelvis, and leg. Spinopelvic sagittal alignment showed deterioration while walking. C-PT was significantly decreased while walking in the R-group, indicating possible compensatory mechanisms attempting to increase coverage of the femoral head. The reduction in the hip flexion angle in the R-group was also considered as a compensatory mechanism.
Aged* ; Animals ; Extremities* ; Female ; Head ; Hip ; Hip Joint ; Humans ; Incidence ; Knee ; Leg ; Lordosis ; Lower Extremity ; Pelvis ; Spine ; Walking*