We report the case of a 59-year-old man who presented with classical-type fever of unknown origin (FUO) during observation of hypertension and polycystic kidney. The presence of malignancy was suspected based on elevation of tumor marker levels. We examined the patient carefully and attempted diagnostic imaging, but definitive diagnosis was difficult due to the presence of multiple hepatic cysts. Hepatic biopsy detected adenocarcinoma, but identifying whether lesions were primary cholangiocellular carcinoma or metastases was difficult, and we were ultimately unable to diagnose the tumors as cholangiocellular carcinoma until autopsy. Polycystic kidney with hepatic cysts and complicated by cholangiocellular carcinoma is rare, but should be considered among the differential diagnosis for FUO, which itself is frequently encountered.

The regulatory effects of Gorei-san (Wu-Ling-San) on circulatory, metabolic and diuretic function were investigated analyzing the perioperative transition of serum sodium levels, peripheral platelet counts and urinary 6-keto-prostaglandin F₁α levels in fifty-eight female patients who underwent cholecystectomy because of cholelithiasis or gallbladder polyps.
The endothelial cells were considered to be activated by administration of Goreisan as shown by an increase of prostaglandin I₂ production, resulting in circulatory and metabolic stimulation and partly promotion of diuretic function by a dilatation of the renal vessels. The urinary 6-keto-prostaglandin F₁α, a metabolite of serum prostaglandin I₂ and also excreted by the interstitial cells in the renal medulla or by the epithelial cells of the renal collecting tubules, was considered to regulate diuretic function through suppressing the antidiuretic hormone.
The phenomena mentioned above were not recognized when Sho-saiko-to (Xiao-Chai-Hu-Tang) was administered instead of Gorei-san.

Female patients suffering from gallbladder stone disease were administered Sho-saiko-to (Xiao-Chai-Hu-Tang), Gorei-san (Wu-Ling-San) or Toki-shakuyaku-san (Dang-Gui-Shao-Yao-San) preoperatively, and were examined by cholangiomanometry during operation. Perfusion pressure was significantly elevated, when Sho-saiko-to or Gorei-san were administered, meaning that the pressure threshold of the sphincter of Oddi for volume load in the bile duct was lowered. This phenomenon tended to be more obvious in Gorei-san group, and will prevent duodenal fluid from transpapillary reflux. Parameters concerning the declining curve (T_1/2, T_1/4, T_1/5) showed a significantly rapid relaxation of the sphincter of Oddi only in Sho-saiko-to group, which will result in a prevention of stasis of bile. These modulating functions of Sho-saiko-to and Gorei-san for the sphincter of Oddi would be one of the main reasons why these formulas are used for hypochondriac fullness and distress or excessively accumulated intestinal fluid. Toki-shakuyaku-san showed no such effects on the sphincter of Oddi.

 SHARE started Health Education Promotion Project in East Timor in 2002 and has been actively engaged for over 4 years. The political and social unrest in the spring of 2006 produced as many as 150,000 internally displaced persons (IDPs), almost one sixth of the total population of the country. Viewing a dire situation in which people were placed, SHARE launched humanitarian assistance in 20 camps from August through December 2006. The interventions carried out were, among others, monitoring malnourished children with UNICEF, health education/promotion and mobile clinic in IDP camps, and supportive activities for Bairo Pite Clinic.
 The health education cumulatively reached 753 persons in 20 camps. Main health topics covered were sanitation, nutrition and skin infections. The mobile clinic in the Metinaro Camp was carried out 12 times seeing 1,227 persons. Main diseases identified were upper respiratory tract infections, skin infections and acute watery diarrhoea.
 We think that; i) coordination with donors in compliance with East Timorese national policy on IDPs is essential, ii) NGOs with experience in long-term health promotion can have an important role to play in emergencies, iii) even in an emergency situation, focusing on primary health care is important from the early stage of humanitarian assistance, iv) it is vital to take sustainability of those activities into account from the planning stage.

OBJECTIVE: Directional leads are used for deep brain stimulation (DBS). Two of the four contacts of the leads are divided into three parts, enabling controlled stimulation in a circumferential direction. The direction of adverse effects evoked by DBS in the subthalamic nucleus (STN) and stimulation strategies using directional leads were evaluated. METHODS: Directional leads were implanted into the bilateral STN of six parkinsonian patients (1 man, 5 women; mean age 66.2 years). The contact centers were located within the upper border of the STN, and the locations were identified electrically using microrecordings. Adverse effects were evaluated with electrical stimulation (30 μs, 130 Hz, limit 11 mA) using the directional part of each lead after surgery, and the final stimulation direction was investigated. Unified Parkinson's disease rating scale (UPDRS) scores were evaluated before and after DBS. RESULTS: Fifty-six motor and four sensory symptoms were evoked by stimulation; no adverse effect was evoked in 14 contacts. Motor and sensory symptoms were evoked by stimulation in the anterolateral direction and medial to posterolateral direction, respectively. Stimulation in the posteromedial direction produced adverse effects less frequently. The most frequently used contacts were located above the STN (63%), followed by the upper part of the STN (32%). The mean UPDRS part III and dyskinesia scores decreased after DBS from 30.2 ± 11.7 to 7.2 ± 2.9 and 3.3 ± 2.4 to 0.5 ± 0.8, respectively. CONCLUSION: The incidence of adverse effects was low for the posteromedial stimulation of the STN. Placing the directional part of the lead above the STN may facilitate the control of dyskinesia.
Deep Brain Stimulation ; Dyskinesias ; Electric Stimulation ; Female ; Humans ; Incidence ; Parkinson Disease ; Pilot Projects ; Subthalamic Nucleus

ABSTRACT: A case of infectious mononucleosis (IM) in a previously healthy 43-year-old male is presented. The patient complained of fever and a sore throat of 3 weeks' duration. Although blood tests showed a marked increase in atypical lymphocytes, tests for Epstein-Barr virus (EBV) and cytomegalovirus (CMV) were negative. Human immunodeficiency virus type 1 (HIV-1) antibody was positive on enzymelinked immunosorbent assay (ELISA), and the HIV-1 viral load was 6.4×10⁴copies/mL. Western blot (WB) analysis did not initially confirm HIV-1 infection ; however, HIV-1 infection was confirmed one month after presentation. Although several pathogens can cause infections presenting as IM, in Japan there have been few reports of acute retroviral syndrome presenting as IM. This case is being reported to stress the importance of the early diagnosis of acute retroviral syndrome.

Median sternotomy is commonly used for suture fixation of a myocardial lead. Instead of this conventional technique, we used the technique of resecting the 5th costal cartilage through a small horizontal skin incision at the left 5th sternocostal junction in 33 patients, between 1980 and 2001. Here we describe this procedure, as well as the outcome of patients who underwent this myocardial lead fixation procedure. A skin incision of about 6 to 8cm was made in the left 5th intercostal space. Approximately 5cm of the 5th costal cartilage was resected through the skin incision. Then, a myocardial lead was sutured on to the anterior wall of the right ventricle. The generator was generally placed in the upper subcutaneous space of abdomen. Additional costal cartilages were removed in 7 patients in whom a larger operating field could not be obtained initially. The electrode was sutured to the right ventricular wall in 28 patients, right atrial wall in 6 patients, and the left ventricular wall in 5 patients. The mean operation time was 150min and mean bleeding during operation was 82ml. Long-term results (258 months at the longest, at the time of writing) showed that all the patients did well, except for one adult who suffered cerebral infarction, and one child with pacing failure. Based on these findings, we believe that this procedure is minimally invasive method, and is good for fixation of a myocardial lead.