We report a rare case of isolated intracavitary metastatic esophageal cancer of the right atrium and ventricle. A 67-year old woman had been treated for esophageal carcinoma for three years. Combined radiotherapy and chemotherapy had been performed, and partial remission had been achieved. Recent follow up computed tomography of the chest revealed intracavitary cardiac mass in her right atrium and right ventricle. On echocardiography a mobile, irregularly shaped large mass was detected in her right atrium. She was admitted for emergency operation. We resected the mass under cardiopulmonary bypass. The pathological examination revealed intracavitary metastasis of squamous cell carcinoma of the esophagus. She was discharged on the 29th postoperative day. Six months later, she died from multiple metastases of squamous cell carcinoma. Even though the operation was not curative, it might have been effective for preventing tumor embolism to the lung and elongating life expectancy.

Objective: The objective of this study was to clarify the light stability of cyclosporin fine granules 17%?? Mylan ??(CsA-FG) after packaging by a dividing and packing machine.
Methods: CsA-FG packaged within cellophane-laminate paper was stored under three different covering conditions: (stored uncovered, in a medicine bag, or in a light shielding bag).  In these covering conditions, we examined changes in the residual rate and elution pattern of CsA for up to 12 weeks in the differently covered samples stored at room temperature under fluorescent lighting.
Results: Under the light exposure condition, the residual rate decreased with time and fell below 95 percent at 12th week.  Although a slight decline in the residual rate was observed in samples stored in the medicine bag at 12th week, the rate was less than 5%.  On the other hand, no change in the residual rate was observed for samples stored in the light shielding bag storage for up to 12 weeks.  There was no change in the elution pattern of CsA in any group, except the decline in the elution rate caused as the resulting from the decline in the residual rate.
Conclusion: In this study, we have clarified that the packaged CsA-FG covered by stored in a medicine bag or light shielding bag is stable for up to 12 weeks under normal storage conditions.  However, CsA-FG should be stored in a light shielding bag or undergo the split dispensation, if it’s stored in a more severe lighting condition and/or if it is to be stored for more than three months.

To assess coronary artery disease in arteriosclerosis obliterans (ASO), the efficacy of a dipyridamole-loaded ECG was evaluated. Subjects consisted of 35 patients who underwent surgery for ASO between November 1988 and December 1989. A dose of 0.568mg/kg of dipyridamole was intravenously infused for over 4min. Changes of systemic blood pressure, heart rate and standard 12-lead ECG were accumulated. In eleven cases loaded ECG was considered to be positive and coronary arteriographies were performed. Stenotic lesions of 75% or over were observed in 10 cases, among them CABG was performed in one symptomatic case. In another positive but asymptomatic cases, only the existing ASO lesions were surgically treated. No intraoperative or postoperative ECG abnormality was observed and postoperative courses were uneventful. Negative cases (24 cases) underwent complete revascularization. These findings indicate that a dipyridamole-loaded ECG is a non-invasive preoperative means detecting coronary artery disease preoperatively is useful to decide operative procedure.

OBJECTIVETo evaluate the accuracy of Cercon CAD/CAM system and the influence of different spacer thickness and spacer coverage area on the internal and marginal fit of the copings.

METHODSA stainless steel master model of first molar was replicated. After scanning, designs of copings were made with different spacer thickness and spacer coverage area. There were six groups: S10C70, S10C90, S30C70, S30C90, S60C70, S60C90. Measurements of the adaptation were performed with silicone impression material and an image analysis system.

RESULTSUnivariate ANOVA showed that variation in the internal fit of copings was related to measuring location, spacer thickness and spacer coverage area. There was significant difference between different spacer coverage area groups, and significant difference between spacer thickness 10 microm and 30 microm groups, 10 microm and 60 microm groups, no significant difference between spacer thickness 30 microm and 60 microm groups. Mean marginal fit was (27.7+/-7.6) microm. There was statistically significant difference between both mesial, distal marginal gaps and both buccal, lingual marginal gaps. No difference between mesial and distal marginal gaps, and between buccal and lingual marginal gaps.

CONCLUSIONThe accuracy by Cercon CAD/CAM system for the marginal and internal fit of zirconium dioxide copings is well within the range of clinical acceptability. Spacer thickness and spacer coverage area have statistically significant influence on the internal fit.

The promotion of clinical research in Japan requires the establishment of a formal and systematic education and training program for clinicians to ensure they become effective clinician investigators. The first of its kind in Japan, a formal 1-year masters-degree-level training program (MCR course) was started at Kyoto University School of Medicine and Public Health. The first 28 students graduated in 2008, with most returning to their original clinical institutions.
1) As follow-up, we conducted a self-administered questionnaire survey of all 28 graduates (response rate, 86%) concerning the current status of clinical research and problems encountered at their institutions.
2) Almost 40% of respondents (n=24) reported "no time" or "no research collaborators" for clinical research.
3) Twenty respondents (83%) have attempted to promote clinical research at their hospital or workplace, but only 1 has received institutional support.
4) Over half of the respondents (54%) would like to be working in both clinical research and clinical practice at their hospital in the future (10-year timescale). Forty-two percent of respondents had a concrete image of the clinical researcher's career path.
5) Although open to improvement, the MCR program presents a concrete model for the education of clinical researchers. These findings suggest that promoting the conduct of clinical research requires the implementation of a support system and adjustment of personal and physical infrastructure.

There were 16 patients who developed acute renal failure (ARF) follwing cardiovascular operation using extracorporeal circulation. They were treated by either CPD or CAVH because their ARF were resistant to medical treatment. These patients were divided into three groups according to their treatment; 7 patients treated by CPD (Group A), 5 patients treated both CPD and CAVH (Group B), 4 patients treated by CAVH (Group C). The survival rate was 33% in Group A, 20% in Group B, and 0% in Group C. The prognosis of the each group was poor. CPD and CAVH were effective to control the concentration of serum potasium and water removing. But CPD and CAVH were not very effective to control the concentrations of serum creatinine and blood urea nitrogen. There were three patients who developed low proteinemia which was one of the side effects of CPD. Seven of nine patients treated by CAVH, developed bleeding. The side effects of CAVH were seemed to be more severe than those of CPD.

The purpose of this study was to consider the cause of the prolonged inflammatory reaction that sometimes appears after endovascular stent-graft repair for dissecting aortic aneurysm. Endovascular stent-grafting was performed in 12 patients (11 men and 1 woman, mean age 60±9.8). Endovascular stent-grafting was indicated to close the entry of type B dissections in 10 patients and to exclude ulcer-like projections (ULP) in 2 patients. On the 7th postoperative day (POD), aortography showed no endoleak in 7 type B cases (A-group), remaining endoleak in 3 type B cases (B-group), and complete exclusion in 2 ULP cases (C-group). The value of FDP-E in the A-group was high on the first POD and then decreased gradually. FDP-E also increased up to the 7th POD in the B-group, and increased very slightly after the operation in the C-group. The values of WBC and CRP increased up to the 3rd POD in all groups, but in the A-group it was still high on the 7th POD. On contrast-enhanced CT performed after the procedure and on the 7th POD, edema (over 10mm in thickness) around the descending thoracic aorta was demonstrated in 5 out of 7 cases in the A-group, but in none of the cases in the B- and C-groups. A segmental atelectasis in the left lung was detected in 6 out of 7 cases in the A-group, but in none of the cases in the Band C-groups. In the A-group, endovascular stent-grafting influenced thrombus formation, and the thickened edema around the descending thoracic aorta and the atelectasis produced in the left lung were prominent more than in the other groups. These results suggest that the Inflammation around aortic wall induced by thrombosis in the false lumen, might contribute to the development of the edema around the descending thoracic aorta and the atelectasis in the left lung. We conclude that the inflammatory reaction might have prolonged the postoperative course in the A-group patients.

BACKGROUND/AIMS: Changes in lipid profiles in patients infected with hepatitis C virus (HCV) during direct-acting antiviral therapy have been reported in recent years. However, the clinical aspects of disturbed lipid metabolism in chronic HCV infection have not been fully elucidated. METHODS: Dynamic changes in serum total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol and apolipoprotein levels in patients infected with HCV genotype 1b were examined during combination therapy with daclatasvir (DCV) and asunaprevir (ASV). RESULTS: Total, LDL−, and HDL-cholesterol levels increased rapidly and persistently after week 4. Apolipoprotein (apo) A-I, apo B, apo C-II, and apo C-III levels were significantly higher at week 4 than at week 0. In contrast, apo A-II and apo E levels were significantly lower. The differences in LDL− and HDL-cholesterol levels were positively correlated with those of apo B and apo A-I, respectively. Interestingly, in patients with non-sustained virological response, these cholesterol levels decreased rapidly after viral breakthrough or viral relapse. Furthermore, similar changes were observed for apo A-I, apo B and apo C-III levels. CONCLUSIONS: Clearance of HCV using combination therapy with DCV and ASV results in rapid changes in serum lipid profiles, suggesting an influence of HCV infection on disturbed lipid metabolism.
Apolipoprotein A-I ; Apolipoprotein A-II ; Apolipoprotein C-II ; Apolipoprotein C-III ; Apolipoproteins ; Apolipoproteins B ; Apolipoproteins E ; Cholesterol ; Genotype ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Humans ; Lipid Metabolism ; Lipoproteins ; Recurrence

BACKGROUND: The Japan Environment and Children's Study (JECS) is a nation-wide birth cohort study investigating environmental effects on children's health and development. In this study, the exposure characteristics of the JECS participating mothers were summarized using two questionnaires administered during pregnancy. METHODS: Women were recruited during the early period of their pregnancy. We intended to administer the questionnaire during the first trimester (MT1) and the second/third trimester (MT2). The total number of registered pregnancies was 103,099. RESULTS: The response rates of the MT1 and MT2 questionnaires were 96.8% and 95.1%, respectively. The mean gestational ages (SDs) at the time of the MT1 and MT2 questionnaire responses were 16.4 (8.0) and 27.9 (6.5) weeks, respectively. The frequency of participants who reported "lifting something weighing more than 20 kg" during pregnancy was 5.3% for MT1 and 3.9% for MT2. The Cohen kappa scores ranged from 0.07 to 0.54 (median 0.31) about the occupational chemical use between MT1 and MT2 questionnaires. Most of the participants (80%) lived in either wooden detached houses or steel-frame collective housing. More than half of the questionnaire respondents answered that they had "mold growing somewhere in the house". Insect repellents and insecticides were used widely in households: about 60% used "moth repellent for clothes in the closet," whereas 32% applied "spray insecticide indoors" or "mosquito coil or an electric mosquito repellent mat." CONCLUSIONS We summarized the exposure characteristics of the JECS participants using two maternal questionnaires during pregnancy.
Adult ; Child Health ; Cohort Studies ; Female ; Gestational Age ; Humans ; Japan ; Maternal Exposure ; statistics & numerical data ; Mothers ; statistics & numerical data ; Pregnancy ; Surveys and Questionnaires ; Young Adult