Several substitutes have been utilized for pericardial closure after open heart surgery. A 55-year-old man was admitted to our hospital with a diagnosis of constrictive pericarditis 13 years after open mitral commissurotomy. At reoperation, the thickened pericardium was peeled off and the epicardium was covered with 0.1mm expanded polytetrafluoroethylene surgical membrane (Gore-tex^®, sheet thickness 0.1mm). At the 7th postoperative day, he complained of fatigue and dyspnea. Physical examination revealed jugular venous distension, hepatomegaly, ascites and peripheral edema. Cardiac catheterization suggested the suspicion of pericardial or epicardial constriction. On the 3rd-operation, the Gore-tex^® sheet was removed and multiple longitudinal and transverse incisions were made in the thickened epicardium, that is the waffle procedure, while protecting the myocardium and the coronary arteries. Perioperative hemodynamics improved remarkably. His cardiac index increased from 3.0 to 4.5l/min/m². The postoperative course was uneventful.

The purpose of this study is to investigate the prevalence of and to classify the types of silicosis patients who were working at that time as migrant workers in the eastern part of Toyama Prefecture. Migrant workers are known in Japanese as “dekasegi” This term refers to workers who migrate seasonally from their home towns to areas where work is more available.
Questionnaires were sent to all male inhabitants aged 30 or over in the selected five areas. Eighty-seven percent of the questionnaires were answered and returned. Based on the results, 482 inhabitants were selected as migrant workers with experience in jobs where they were exposed to large amount of dust. Chest roentgenography and subjective symptoms were examined in these subjects.
The results obtained were follows;
(1) Eight hundred and eighty-five of the respondents (41%) had worked as migrant workers.Of these, 580 men (66%) had worked in jobs with exposure to dust.
(2) Of the 482 migrant workers whose jobs exposed them to dust, 424 silicosis cases (88%) were found by chest roentgenographic examination. Silicosis is classified into four types according to the national Pneumoconiosis Law on the basis of chest roentgenographic findings. These patients included 195 cases of type 1, 123 cases of type 2, 59 cases of type 3 and 47 cases of type 4 silicosis.
(3) The prevalence of disease symptoms in the silicosis patients included ; cough 39%, phlegm 40%, shortness of breath 41%, palpitations 17% and wheezing in 20% of the cases. The silicosis patients showed a higher frequency of respiratory disease symptoms than those dust-exposed workers who did not evidence signs of silicosis.
(4) The silicosis patients were found in 98% of the migrant workers whose exposure to dust lasted a period of more than 20 years, 89% in men whose work was between 10 and 19 years and 76 % in men who had worked less than 10 years.
(5) The silicosis in 297 cases (70% of the total number of disease patients) was first detected during the examinations in the course of this research.

Of 225 patients who underwent surgery for abdominal aortic aneurysm from April 1995 to June 2002, 8 patients. or 3.6%, aged 90 years or more (mean age 90.8±1.4. range 90 to 94, 7 men and 1 woman) were the subjects of this study. Four of these patients (50%) underwent emergency surgery. Of these 4 patients, preoperative shock was found in 1 patient. Preoperative complications were hypertension in 4 (50%), ischemic heart disease in 1 (13%), disseminated intravascular coagulation syndrome in 1 (13%), and pleuritis in 1 (13%). The maximum diameter of AAA was 69.5±16.6mm (range 48 to 100mm). The surgical procedure was median laparotomy. Long-term follow-up by the attending physician, or questionnaire by phone was completed for all patients and range to 6.3 years (median, 2.4 years). There were no hospital deaths. Postoperative complications were delirium in 2 (25%), atelectasis in 1 (13%), and ileus in 1 (13%). There were 5 (63%) late deaths. The causes of death were pneumonia in 2, senescence in 1, cardiac failure in 1, and rupture of a pseudoaneurysm at the anastmotic site in 1. Long-term survivals at 1 year, 2 years, and 3 years were 88±12%, 63±17%, and 20±18%, respectively, whereas expected survivals at 1, 2, and 3 years were 82%, 65%, and 51%, respectively. Longterm survivals were not good, but no significant difference was found between long-term and expected survivals. Therefore, this surgical and long-term treatment can achieve satisfactory results. This result led us to recommend performing the operation for patients aged 90 years or more, except if they were bedridden, had severe dementia, or were at the end stage of a malignant disease.

We experienced a case of group mushroom poisoning. The victims were Chinese workers. They developed symptoms such as vomiting, diarrhea, and abdominal pain one hour after ingestion of wild mushrooms growing at a riverside. Generally, it is very difficult to identify quickly a species of wild mushroom. Therefore we were in trouble about the treatment because they might have taken deadly mushrooms, such as ‘Amanita versa’ and ‘Amanita virosa’. ‘Chlorophyllum molybdites’ looks like these mushrooms. In this case, the incubation period is different between Chlorophyllum molybdites and Amanita species, so we could know that the mushroom they had taken was not so dangerous. There are various folk believes about mushroom poisoning, but many of them are groundless. In this case, the Chinese workers also belived a wrong one. The problem is that a simple and easy method for distinguishing harmless mushrooms from poisonous one is yet to be established in society.

The aim of this study was to examine the effects of fibroblast growth factor-2 (FGF-2) on cancer cell invasion and on fibroblast proliferation in an in vitro model of invasion. Three kinds of human oral squamous cell carcinoma cell lines with different invasive activity were used: OSC-20, OSC-19 (lower invasive type), and HOC313 (higher invasive type). FGF-2 and its high-affinity receptors FGFR-1 and FGFR-2 were detected by western blotting. The expression of FGF-2 and FGFRs mRNA was examined in cultured human oral squamous cell carcinoma cells by reverse transcriptase polymerase chain reaction (RT-PCR). Furthermore, recombinant human FGF-2 (rhFGF-2) was reacted with each cell line, and the invasion rate was determined by invasion assay. We also observed the behavior of cancer cell invasion in the collagen gel invasion model in the presence or absence of FGF-2-neutralizing antibody (anti-FGF-2). HOC313 cells showed higher expression of FGF-2 than OSC-20 and OSC-19 cells. The addition of rhFGF-2 promoted not only the proliferation of fibroblasts, but also the invasion of all cancer cell lines. In contrast, the addition of anti-FGF-2 completely inhibited the invasion of OSC-20 and OSC-19 cells. These results suggest that a higher invasiveness of squamous carcinoma cells is associated with higher production of FGF-2, which acts in an autocrine fashion to promote cancer cell invasion, and in a paracrine fashion to promote fibroblast proliferation.

Objective: Difficulty in extracting tablets from a press through pack (PTP) is believed to reduce prescription drug compliance.　This is a particularly serious issue for the elderly or for those who have physical disabilities affecting the fingers.　In this study, the squeezing force necessary to extract tablets from PTPs was measured for 33 commercial tablet products using a force gauge (FG).　Additionally, a sensory test was conducted to determine the degree of difficulty in extracting tablets from PTPs by squeezing, and the correlation between the difficulty measure and squeezing force was evaluated.Methods: The squeezing force for 33 products was measured by FG.　The sensory test was conducted with 64 subjects.　Four products, each with a different squeezing force, were used for the sensory test.　In the test, each subject ranked the products in order according to the amount of force required to extract the tablets.　Each product's total score was used in the statistical analysis.Results: The average squeezing force of the 33 products was 33.1 ± 6.9 〔N〕, and significant differences were observed among the products.　The sensory test revealed that each subject could significantly distinguish the amount of force required to extract the tablets from each product.Conclusion: A positive correlation was observed between the squeezing force obtained using FG and the results from the sensory test.　This suggests that squeezing force can be used as an indicator for the usability of the product.　Therefore, the degree of difficulty in extracting tablets from PTPs should be considered when selecting drugs for the elderly.

Objective: The Sequential Organ Failure Assessment (SOFA) score is a useful tool in defining the clinical conditions and describing the acute morbidity of patient populations with critical illness. This study was performed to assess the usefulness of the SOFA score in predicting the prognosis among cardiac or thoracic aortic postoperative patients. Methods: In total, 123 patients who entered the intensive care unit after a cardiac or thoracic aortic operation from August 2019 to December 2020 were retrospectively investigated. The SOFA score cut-off value from the admission day to postoperative day 3 calculated in the first 60 patients (derivation group) was validated in the latter 63 patients (validation group). Additionally, the Japan SCORE cut-off value calculated in the derivation group was validated in the validation group. Results: The perioperative mortality rate, in-hospital mortality rate and hospital transfer rate were 4.9, 7.3, and 13.2%, respectively. A SOFA score cut-off value of ≥7 for prediction of in-hospital mortality resulted in a sensitivity of 100% and specificity of 81% on postoperative day 2, followed by high sensitivity of 100% and specificity of 95% on postoperative day 3. A SOFA score cut-off value of ≥6 for prediction of hospital transfer resulted in a sensitivity of 57% and a specificity of 67% on postoperative day 2. Conclusion: The SOFA score on postoperative day 2 provides good discriminatory power for in-hospital mortality among cardiac or thoracic aortic postoperative patients. The SOFA scoring system could be useful for predicting short-term prognosis of patients who undergo cardiac or thoracic aortic surgery.

Purpose: This study investigated the effects of preoperative nutritional status on postoperative outcomes in older adult patients with pancreatic adenocarcinoma. Methods: The background and perioperative factors of patients who underwent pancreatectomy for pancreatic adenocarcinoma between 2007 and 2020 were retrospectively analyzed. Results: Patients aged 75 years or over (older adults) were significantly associated with hypertension, upfront surgery, and lower prognostic nutritional index. In addition, these patients had a significantly lower rate of portal vein resection, less blood loss, and shorter operation time than patients aged less than 75 years (non-older adults). During the postoperative course, older adult patients had a higher rate of pneumonia and lower overall survival than younger patients, although recurrence‐free survival was comparable. In addition, older adult patients showed preoperative malnutrition as a risk factor for postoperative in‐hospital death. Conclusion Surgical treatment for pancreatic cancer in older adult patients was performed safely. However, preoperative malnutrition is a risk factor for in‐hospital death and such patients require nutritional support and less‐invasive surgery.