Background: It is difficult to distinguish clinically between leiomyoma and leiomyosarcoma. The prognosis of the latter is poor. In patients with uterine leiomyosarcomas, high serum lactate dehydrogenase (LDH) levels have been reported to be elevated. However, little is known about serum LDH levels in patients with benign leiomyomas, or about the relationship between serum LDH levels and ultrasonographic findings. We therefore explored serum LDH levels and degenerative patterns of the tumor in ultrasonography (USG) in patients with various smooth muscle tumors of the uterus.
Methods: Clinical history, serum LDH and alkaline phosphatase (ALP) levels, images produced by USG, and pathological findings were reviewed in 232 patients with uterine leiomyoma, three with uterine leiomyosarcoma, one with lipoleiomyoma, and one with metastasis of the breast cancer into uterine leiomyoma treated, at Kochi Nokyo General Hospital from September 1988 to August 1996. Relationship between serum LDH levels and the presence of degenerative pattern in USG or uterine weight was also analyzed.
Results: Serum LDH levels were abnormally elevated preoperatively in one of 232 patients with uterine leiomyoma, two of three with leiomyosarcoma, one with lipoleiomyoma and one with metastasis of the breast cancer into uterine leiomyoma. A degenerative pattern in USG was found in 15/232 of leiomyomas, 2/3 leiomyosarcomas, 1/1 lipoleiomyoma and 1/1 metastasis of the breast cancer into uterine leiomyoma. All cases with abnormally elevated serum LDH levels showed a degenerative pattern in USG. There was a significant difference in serum LDH levels between leiomyoma with degenerative pattern in USG and without it (p=0.0320). No significant relationship was found between the weight of the uterus and serum LDH levels in patients with leiomyoma.
Conclusion: The uterine tumor associated with both degenerative pattern in USG and elevated LDH levels in the patients' serum is strongly suspected to be leiomyosarcoma. The patients with presumed uterine leiomyoma should be examined for not only degenerative patterns in USG, but also serum LDH levels.

The purpose of this study was to clarify the application range and utility of an ADL index for disabled elderly people (Demura et al., 2000), by examining the ADL characteristics of an elderly population when this index was applied to disabled and independent elderly people. Subjects of this study were 697 Japanese institutionalized disabled elderly people and 482 independent elderly people (ID) living at home. Disabled elderly people were classified into four groups based on conditions of use of assisting devices for movement; D1 did not use assisting devices; D2 used a stick or a walker; D3 used a wheelchair; D4 was immobile. From the findings of comparing achievement proportions, ADL score and the distribution of total score among elderly groups, it was suggested that this ADL index can assess gradually from disabled elderly people who cannot move to independent elderly people. Since this index classifies independent elderly people and disabled elderly people with high probability, it can evaluate if elderly people can maintain a functional level needed for independent living, and can recognize the symptoms of disability. Furthermore, this study proposed useful activities to discriminate the functional level for each elderly group. Although it is important to comprehensively assess ADL ability, further use of this ADL index to discriminate the functional level of an elderly population, by making use of these useful activities, is expected.
Elderly ; Activities of Daily Living ; Disabled Persons ; Persons ; livin

Objectives: This study aimed to determine the activity groupings reflecting functional characteristics required in daily life for the institutionalized dependent females in the old-old elderly group, by examining the interrelationships of activities based on actual achievement characteristics. Methods: The participants were 697 dependent elderly living at welfare institutions in Japan and 344 old-old females were used for analysis. Factor analysis, based on Promax with the Kaiser Normalization method, was conducted using 74 activities of daily living (ADL) items to determine activity groups. Furthermore, whether each activity group could be classified into sub-groups was confirmed by applying factor analysis to the activities consisting of each activity group. Results: Four activity groups of lower extremity activities, manual activities, changing and holding posture activities, and upper extremity and dexterous manual activities were interpreted. Except for the manual activity group, these activity groups were classified into two sub-groups. Conclusions: These activity groupings were characterized by similarities of the body parts used in achievement and the difficulty of activity. The activity groupings obtained in this study are considered to be useful in ADL assessment focusing on evaluating functional characteristics of the dependent elderly.
Elderly ; Old episode ; Manuals ; livin ; g <3>

Background: The purpose of this study were to investigate the survival rate of patients with cervical cancer who were treated at our institution and to analyse its prognostic factors.Methods: One hundred twenty-two patients who underwent treatment for primary cervical cancer at Kochi Municipal Hospital between January 1996 and August 2003 (7 years 8 months) were retrospectively reviewed. There were 59 patients (48.4%) with stage 0 disease. Sixty-three patients (51.6%) had stage I-IV cervical cancer. The mean age was 56.7±15.6 years, and the median follow-up period was 31 months.Results: The overall 5-year suvival rate was 96.4% and 77.1% in stage I and II, respectively. The overall 3-year survival rate was 56.3% in stage III, and the 30-month survival rate was 0% in stage IV. Among the risk factors of histologic cell type, clinical parametrial involvement, clinical vaginal involvement and pelvic lymph node metastasis, clinical parametrial involvement had the lowest p value (p=0.0717) in a multivariate Cox proportional hazards regression analysis.;;Multivariate analysis using the Cox proportional hazard regression model showed that among the risk factors of histologic cell type, clinical parametrial involvement, clinical vaginal involvement and pelvic lymph mode metastasts, the lowest p value (p=0.0717) was for clinical parametrial involvement.Conclusion: Although there was no statistical significance comparing the prognostic factors in multivariate analysis, it was presumed that clinical parametrial involvement was the most influential factor among those which were analyzed in this study on the prognosis of patients with stage I-IV cervical cancer.
Clinical ; Diagnostic Neoplasm Staging ; Cervical Cancer ; lower case pea ; Roman Numeral IV

OBJECTIVESThis study aimed to determine the activity groupings reflecting functional characteristics required in daily life for the institutionalized dependent females in the old-old elderly group, by examining the interrelationships of activities based on actual achievement characteristics.

METHODSThe participants were 697 dependent elderly living at welfare institutions in Japan and 344 old-old females were used for analysis. Factor analysis, based on Promax with the Kaiser Normalization method, was conducted using 74 activities of daily living (ADL) items to determine activity groups. Furthermore, whether each activity group could be classified into sub-groups was confirmed by applying factor analysis to the activities consisting of each activity group.

RESULTSFour activity groups of lower extremity activities, manual activities, changing and holding posture activities, and upper extremity and dexterous manual activities were interpreted. Except for the manual activity group, these activity groups were classified into two sub-groups.

CONCLUSIONSThese activity groupings were characterized by similarities of the body parts used in achievement and the difficulty of activity. The activity groupings obtained in this study are considered to be useful in ADL assessment focusing on evaluating functional characteristics of the dependent elderly.

A study was performed to examine sex and age differences in physique and physical fitness and the sex differences in the change of these parameters with age, and to clarify the relationship between the amount of exercise and fundamental physical fitness in 326 healthy elderly individuals over 60 years of age.
A total of 22 variables consisting of 9 items concerning body linearity, quantitative growth, circumference growth and posture, and 13 items representing 4 domains (muscular, joint, neural, and cardiorespiratory functions) were selected. The exercise performance index (EPI) was calculated as the product of frequency and duration (yr) of exercise. The sex and age differences in physique and physical fitness were examined using two-way ANOVA (sex × age group) . Post hoc tests using Ryan's procedure were carried out when the main effect of these factors proved significant. To examine the characteristics of changes in physique and physical fitness with age, Pearson's correlation coefficient was calculated, and linear regression analysis [test item was the dependent variable (X) and age was the independent variable (Y) ] was applied. Then significant differences in the regression coefficient and intercept between males and females were examined. Furthermore, curved-line regression analysis was executed for the above variables. Applying principal component analysis for 13 physical fitness items, the first principal component was interpreted as fundamental physical fitness for performance, and the above analysis was applied to the fundamental physical fitness score (FPS) . To examine the relationship between EPI and FPS, the difference in FPS among the three EPI groups was examined using analysis of co-variance (ANCOVA) with age as the co-variable.
The main findings of this study can be summarized as follows.
1. With regard to physique, males showed greater body linearity, and females had more skinfold. Sex differences in circumference growth were not as significant as those in body linearity and quantitative growth. Changes in physique with age were greater in females than in males, the change becoming obvious in individuals over 80 years of age.
2. With regard to physical fitness, males had superior muscular function and vital capacity, while females outperformed males in standing-reach. However, there was little sex difference in neural function. The trend for deterioration in physical fitness with age differed between the sexes among 4 domains of physical fitness. For example, in males muscular, neural, and joint functions deterioration significantly with age, while in females, all physical fitness variable did so. In addition, the age-related trends of deterioration in muscular function (grip strength and vertical jump), cardiorespiratory function (duration of breath-holding and vital capacity), and neural function (stepping) were differed between the sexes.
3. The FPS was higher in males than in females. However, FPS decreased significantly with age in both sexes.
4. It was inferred that among active and healthy elderly males and females who exercised regularly, FPS was not influenced by EPI.

The purpose of this study was to examine sex differences in subjective symptoms of fatigue (SSF) in high school and college students by considering the relationship between subjective feeling of fatigue and life habits.
A questionnaire on SSF (54 items), dealing with subjective feeling of fatigue and life habits (frequency of exercise, going to sleep, waking in the morning and physical condition) was administered to 5622 healthy students aged 15-20 yr, and data of 5335 properly completed questionnaires was analyzed.
The following was determined :
1) Sex differences were confirmed in most SSF items. SSF complaints for females was generally higher than that of males.
2) The relationship between SSF and the age was low in both sexes.
3) Subjective feeling of fatigue is somewhat related to SSF.
4) The going to sleep last night influence on SSF was different in both sexes and related largely to the next day SSF in males.
5) Waking this morning and today's physical condition are related to SSF in both sexes.
6) In males, the influence of exercise habits on SSF regarding drowsiness is relatively large.

The purposes of this study were to examine reliability and validity of ADL index for older people at home, and relationships between ADL score and various factors (ex. self-assessment of health status and physical fitness level, and exercise frequency/week), and to examine the screening basis for execution of physical fitness test based on distribution of ADL score. A questionnaire consisting of 12 ADL items and a physical fitness test of Ministry of Education, Science and Clture were administered to 5, 715 subjects 65 years or more age (male: 2, 745; female: 2, 970) . As a result of examining test-retest reliability of the ADL index, significant high correlations were shown among 12 ADL items (0.674≤r≤0.886), and in overall score (r=0.943) . The ADL score was significantly related to age and physical fitness test scores, and tended to be higher in subjects with a higher self-assessment of health status and physical fitness level, and with more frequency. It was suggested that these results prove the utility of the present ADL index. Further, as the result of examining relationships between distribution of overall ADL score and physical fitness test scores, the following screening bases were considered to be valid for judgement whether the physical fitness tests could be executed. The three screening bases using overall ADL score were: 1) 12 or under; 2) over 13 to under 24; 3) 24 and over. The four bases using item score were: 1) a category 1 response for items 1, 5 and 6; 2) a category 2 or 3 response for items 1, 5 and 6, and a category 1 response for items 3 and 4; 3) a category 3 response for items 2 and 14; 4) a category 1 response for items 10 and 12.

A 57-year-old man underwent subtotal graft replacement of the thoracic aorta for aneurysms of both the ascending and descending aorta. On the 20th post-operative day, pus was found to be draining from the sternotomy wound. The wound was opened and irrigated with 2% Povidoneiodine solution for a total of 3 months. Culture of the pus from the irrigation revealed Staphylococcus epidermidis. When there were no clinical indications of infection and wound cultures were negative, the necrotic sternum and surrounding tissue were debrided and an omental graft was placed in the cavity. Upon follow-up examination, the patient is doing well 10 months after the initial surgery.

We performed a video-assisted thoracoscopic surgery (VATS) to clip the patent ductus arteriosus (PDA), which was 5mm in internal diameter, in an 11-year-old girl, who first underwent a coil embolization ending in failure. Under general anesthesia with one-lung ventilation in a right lateral decubitus position, four thoracostomies were made in the left hemithorax. The PDA was clipped by two titanium clips, the length of which is 11mm at closing. Transesophageal echocardiography confirmed the location of the PDA and the absence of a residual shunt. The patient showed neither left recurrent laryngeal nerve dysfunction nor hemorrhage after operation, and was discharged on the 9th postoperative day. The clipping of the PDA by VATS can be applied for PDA without calcification if the external diameter is up to 7mm. This technique was minimally invasive and reliable. It was excellent in terms of the high quality of life achieved by the patient.