Plasma concentrations of tumor necrosis factor α (TNFα), interleukin-1β (IL-1β) and interleukin-6 (IL-6) were measured successively during and after open heart surgery (13 cases). Plasma concentrations of TNFα did not increase during surgery but increased gradually after the 1st operative day reached the maximum level at the 7th operative day (128±15pg/ml, which was a 3-fold increase compared with the previous value). Plasma concentrations of IL-1β remained at the previous level during surgery and increased only once at 6 hours after operation. Conversely, plasma concentrations of IL-6 increased dramatically during cardiopulmonary bypass (CPB) reaching a peak at the end of CPB (260±200pg/ml, which was a 15-fold increase over the previous value) and recovered to previous values rapidly thereafter. Plasma IL-6 concentrations changed rapidly during surgery, while plasma concentrations of TNFα and IL-1β did not increase sharply. This may indicate that IL-6 may play a role as a mediator of acute inflammatory reaction.

  A 55-year-old man visited his neighborhood general practitioner complaining of headache, fever and wet cough on July 7, 2003, but there were no sigins that his symptoms would subside. Since an abnormal shadow was found on chest X-ray on July 11, he was referred to our department and hospitalized on the same day. We started to treat him on the assumption that he had community-acquired pneumonia due-to common pathogens. However, he developed severe hypoxemia, and abnormal shadows rapidly progressed to affect both lungs, which led us to suspect that he had acute respiratory distress syndrome (ARDS). We identified the pathogen by examining urinary antigens and serum antibodies and diagnosed of his case as Legionella pneumonia. Although he suffered complications of acute renal failure and shock, the respirator was withdrawn after 11 days of controlled mechanical ventilation, as he was steadily recovering from his illness. The patient was discharged from the hospital on September 9. Although the mortality of legionella pneumonia, when complicated by ARDS, acute renal failure and shock as in the present case, has been reported to be as high as 50 to 80%, we consider that the administration of neutrophil elastase inhibitors and steroids was effective against this disorder.

Magnification of the surgical field is considered an essential technique for performing accurate surgery on small caliber arteries. For this reason, we use the transmicroscopic technique of vascular surgery on the tibial arteries. We obtained good results in long term patency. Our experience and results in bypass grafting to the tibial artery using a microscope are reported. Forty-four tibial artery bypasses using transmicroscopic techniques were performed in 38 consecutive patients between June 1984 and December 1992. Twenty-seven patients had arteriosclerosis obliterans, 5 had thromboangitis obliterans, 5 had acute arterial occlusion and 1 had traumatic vascular injury. Patient ages ranged from 37 to 78 years old. Thirty-five were men and 3 were women. Twenty-six surgeries were performed for limb threatening and 14 were for disabling claudication. All patients were examined with conventional aortic lower extremity angiography preoperatively. The reversed saphenous vein was used in 38, in-situ saphenous vein in 3 and composite vein to vein graft in 2. All distal anastomoses were performed by the transmicroscopic technique. Continuous sutures were used for recipient vessels larger than 1.0mm in diameter. However interrupted 8-0 sutures were chosen for smaller vessels. Distal anastomosis was made at the proximal portion of the tibial artery in 24 cases, while the distal portion of the tibial artery was used in 20 cases. On preoperative angiography, the condition of the tibial arteries affected the patency rate when runoff was poor or fair. Nine cases were judged to have “poor” runoff. Three of these became occluded during the early postoperative period, and 1 during the late phase. Eight cases were judged to have “fair” runoff. One of these became occluded during the early postoperative period, and 3 during the late phase. There were no graft failures identified throughout the follow-up period in patients with good runoff. Cumulative patency rates were 86.2% after 1 year, 79.0% after 5 years, and 67.7% after 8 years, respectively. The patency rate of the 24 grafts in which distal anastomosis was performed on the proximal tibial artery was 71. 4% after 5 years. The patency rate of the 20 grafts on the distal tibial artery was 93.3% after 5 years. There was no significant difference observed in the patency of these two groups. Hospital mortality was 2.6%. Femorotibial bypass using transmicroscopic technique could save severely ischemic limbs while maintaining hospital mortality at a low level and reducing limb loss. The advantage of microscopic surgery is achieving fine observation because the magnification level is changeable, depending on the field needed. In anastomosis of small caliber vessels like the tibial artery, magnification by 10 times is important to observe the characteristics of the intima of the recipient artery. Subsequently, the procedure is performed by transmicroscopic techniques under magnification by 5 times, which provides much higher accuracy for suture than surgical loupe. High magnification prevents intraoperative technical error and unexpected injury.

A 55-year-old man visited his neighborhood general practitioner complaining of headache, fever and wet cough on July 7, 2003, but there were no sigins that his symptoms would subside. Since an abnormal shadow was found on chest X-ray on July 11, he was referred to our department and hospitalized on the same day. We started to treat him on the assumption that he had community-acquired pneumonia due-to common pathogens. However, he developed severe hypoxemia, and abnormal shadows rapidly progressed to affect both lungs, which led us to suspect that he had acute respiratory distress syndrome (ARDS). We identified the pathogen by examining urinary antigens and serum antibodies and diagnosed of his case as Legionella pneumonia. Although he suffered complications of acute renal failure and shock, the respirator was withdrawn after 11 days of controlled mechanical ventilation, as he was steadily recovering from his illness. The patient was discharged from the hospital on September 9. Although the mortality of legionella pneumonia, when complicated by ARDS, acute renal failure and shock as in the present case, has been reported to be as high as 50 to 80%, we consider that the administration of neutrophil elastase inhibitors and steroids was effective against this disorder.
Shock ; Respiratory Distress Syndrome, Adult ; Pneumonia ; Kidney Failure, Acute ; Complicated

The present study was performed to describe 2 human cases infected by the horsehair worm, Parachordodes sp., in Japan. Two gordiid worms were collected in the vomit and excreta of an 80-year-old woman in November 2009 in Kyoto city, and in the mouth of 1-year-old boy in December 2009 in Nara city, Japan, respectively. Both worms were males having bifurcated posterior ends and male gonads in cross sectional specimens. They were identified as Parachordodes sp. (Nematomorpha: Chordodidae) based on the characteristic morphologies of cross sections and areoles in the cuticle. DNA analysis on 18S rRNA partial sequence arrangements was also carried out and both worms were assumed to be close to the genus Paragordionus based on tree analysis, and far from Gordius sp. which has already been reported in humans in Japan. DNA sequencing of the Parachordodes worm does not appear on the database; therefore, more information on the gene sequences of the genus Parachordodes from humans, animals, or intermediates is required.
Aged, 80 and over ; Animals ; Cluster Analysis ; DNA, Helminth/chemistry/genetics ; DNA, Ribosomal/chemistry/genetics ; Female ; Helminthiasis/*diagnosis/*parasitology/pathology ; Helminths/anatomy & histology/classification/genetics/*isolation & purification ; Humans ; Infant ; Japan ; Male ; Microscopy ; Phylogeny ; RNA, Ribosomal, 18S/genetics ; Sequence Analysis, DNA

The objective of this case report is to introduce a simple technique for simultaneously taking a closed-mouth impression and functionally generated path (FGP) for a full coverage crown restoration. A monolithic zirconia crown was the restoration of choice. An alginate impression of the abutment tooth was taken to fabricate a custom-made closed-mouth impression tray covering the abutment tooth and the adjacent teeth. The tray had an FGP table and an abutment tray in cameo and intaglio surfaces, respectively. The impression was taken with silicone impression material after adjusting the abutment tray and inscribing the FGP using self-curing acrylic resins. Plaster casts were made from the impression, and a zirconia crown was fabricated. The crown was cemented to the abutment tooth with minimal adjustments. This simple technique resulted in a well-fitting crown that accounted for mandibular movements. Using the custom closed-mouth impression tray incorporating an FGP table simultaneously aids in fabricating an accurately fitting restoration that incorporates harmonious mandibular movements using a single impression capture.
Acrylic Resins ; Casts, Surgical ; Crowns ; Dental Impression Technique ; Dental Occlusion ; Jaw Relation Record ; Silicon ; Silicones ; Tooth

Objectives: Although a few studies have investigated the relationship between kidney and oral function (number of remaining teeth), their results remain inconclusive. Therefore, this study aimed to investigate the relationship between kidney function and oral health in community-dwelling healthy elderlies and examine the factors associated with kidney function. Materials and Methods: We used cross-sectional data from the Shimane prefecture cohort recruited by the Center for Community-Based Health Research and Education in 2019. We collected clinical data on dental status, background factors and kidney function (estimated glomerular filtration rate [eGFR], mL/min/1.73 m2 and creatinine levels, mg/dL). Results: The study enrolled 481 participants, whose mean age was 66.7±7.4 years, and 223 (46.4%) participants were men. Multivariate analysis revealed significant correlations between eGFR (B=0.17, P=0.04), creatinine (B=–0.54, P<0.01), and the number of remaining teeth. The number of remaining teeth was associated with creatinine and eGFR, which are indicators of kidney function. Conclusion This study suggests that preserving the teeth may prevent decline in kidney function. Dental professionals should provide instructions and professional care to reduce the risk of systemic diseases such as kidney dysfunction.

Fatigue is a common symptom of long COVID. Fatigue can majorly disrupt daily life and be challenging to treat. Herein, we describe the effect of saikokeishito, a Kampo medicine, on fatigue in patients with long COVID.Between October 2020 and March 2023, we prescribed saikokeishito to 22 patients with long COVID in the general medicine outpatient department of our hospital. Among them, seven patients (age: 15-58 years, two females) had fatigue, a previously confirmed diagnosis of COVID-19, and no concomitant use of other Kampo formulas. We compared their condition at the start of saikokeishito administration to that 3 months later. Five patients had a slight fever, and four had inflammatory findings on blood tests. Within 3 months, all patients had a 20% or greater reduction in fatigue on a visual analogue scale. Six patients had a 20% or greater increase in health-related QOL and were able to return to society. On the other hand, one patient required a transition to an alternative medication, and one patient's follow-up was prematurely discontinued. Fatigue after COVID-19 may be improved by saikokeishito, especially for the treatment of patients with slight fever or inflammatory findings.

Since students who would like to study Kampo medicine more have no opportunity to communicate each other in Northern Japanese Universities, we newly started joint study conferences held by medical students in 2013. The objectives of this paper are to report on these annually held student-based Kampo study conferences in the Hokkaido and Tohoku areas, and the ways each university studies Kampo medicine. In the conference, the students reported on their club activities. Then they studied the history of Kampo medicine and simulation of abdominal diagnosis, and performed group work on case reports together. The number of student participants in these conferences has tripled over 3 years from 18 to 58 (for a total of 111 participants). All members were satisfied with the content. And this reflects medical students' need for a wider perception of Kampo medicine, rather than a limited one gained in their university club activities. We hope this conference will play a major role in other nationwide student-based Kampo study conferences in the years to come.

BACKGROUND/AIMS: Although the risk of bleeding after endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is low, the safety of EUS-FNA in patients prescribed antithrom-botic agents is unclear. Therefore, this study evaluated the incidence of bleeding after EUS-FNA in those patients. METHODS: Between September 2012 and September 2015, patients who were prescribed antithrombotic agents underwent EUS-FNA at 13 institutions in Japan were prospectively enrolled in the study. The antithrombotic agents were managed according to the guidelines of the Japanese Gastrointestinal Endoscopy Society. The rate of bleeding events, thromboembolic events and other complications within 2 weeks after EUS-FNA were analyzed. RESULTS: Of the 2,629 patients who underwent EUS-FNA during the study period, 85 (62 males; median age, 74 years) patients were included in this stduy. Two patients (2.4%; 95% confidence interval [CI], 0.6% to 8.3%) experienced bleeding events. One patient required surgical intervention for hemothorax 5 hours after EUS-FNA, and the other experienced melena 8 days after EUS-FNA and required red blood cell transfusions. No thromboembolic events occurred (0%; 95% CI, 0.0% to 4.4%). Three patients (3.5%; 95% CI, 1.2% to 10.0%) experienced peri-puncture abscess formation. CONCLUSIONS: The rate of bleeding after EUS-FNA in patients prescribed antithrombotic agents might be considerable.
Abscess ; Asian Continental Ancestry Group ; Endoscopic Ultrasound-Guided Fine Needle Aspiration* ; Endoscopy, Gastrointestinal ; Erythrocyte Transfusion ; Fibrinolytic Agents* ; Hemorrhage* ; Hemothorax ; Humans ; Incidence ; Japan ; Male ; Melena ; Prospective Studies*