With respect to statistics on out patients with senile psychiatric disorders, a few reports have thus far been made available by university hospitals in major urban areas but none from any rural general hospitals. This study is an attempt to grasp the real status of senile psychiatric disorders as observed in outpatient clinics.
1) There have been signs for a yearly rise in the prevalence rate of senile psychiatric diseases, and there is the possibility of diagnosing new patients at a rate of one to six aged people (60 years of age and over).
2) Of all the patients, 45% came directly to our hospital, whereas 55% either were referrals from other clinics or came to the hospital after their consultation with other clinics. Of the latter group, 55% were referred by other departments of the hospital, 38% by outside physicians in our district, and 7% by local administrative offices. This finding appears to suggest that the incidence of hypertension and other somatic complications is high among aged people and also that phsychiatric disorders may sometimes manifest due to somatic disorders.
3) A check of the prevalence by month reveals that the prevalence is highest in March, high from spring to summer, lowest in autumn and low in winter. In this respect, there exists a difference between the organic diseases and the functional diseases. In the former group, the prevalence is concentrated in spring and summer, whereas in the latter, the prevalence remains high from spring to early summer, low in summer and transiently becomes high in early autumn.
4) By sex, the prevalence rate is 52% for males and 48% for females. By age, the prevalence decreases with age and takes a sharp downturn after the age of 75.
By type of disease, senile organic diseases (Group A) account for 54.4%, functional diseases (Group B) 40.0%, and other organic diseases (Group C) 14.5%. Group A increases with age among males, whereas it is concentratedly high among males of 75 years of age and over. Group C is significantly greater among males.
5) A check of the trend of each disease group in the past 15 years indicates that there have been signs for a rise for each group but the rises are significant particularly for Groups B and C. In the latter half period, the percentage of Group B is greater than that of Group A. Against this background, there seems to be a rise in the incidence of psychiatric diseases among rural females.
6) The hospitalization rate stood at 17.5%. By sex, the rate was 20% for males and 15% for females. By type of disease, the ratio stood at 21% for Group C, 17% for Group A and 16% for Group B.
By place of residence, differences between the towns and the villages (27% for the towns and 9% for the villages) were observed in Group A of females, suggesting that many females in the towns are placed in the circumstances where difficult problems tend to crop up with respect to their matrimony or their sharing the same house with other members of their families. As regards clinical symptoms, it was found that there are many patients with severe auxiliary symptoms, such as delirium, hallucination and paranoid symptoms, in addition to advanced dementia.

A 74-year-old woman presented to our hospital with complaints of dysphagia. On examination, we diagnosed extensive thoracic aortic aneurysm and esophageal compression due to a descending thoracic aortic aneurysm. We planned a two-stage approach for repairing the extensive thoracic aortic aneurysm ; the first stage involving the repair of the ascending and arch segments, and the second stage involving the repair of the descending aorta. In the first stage, we performed the Bentall procedure and total arch replacement with a long elephant trunk. Following this, her dysphagia resolved, although the size of the descending aortic aneurysm was the same as that before the procedure (49 mm in diameter). We decided to treat her conservatively in the outpatient clinic without the second stage, because the descending aorta was asymptomatic and not sufficiently large. One year later, she presented with a sudden recurrence of dysphagia and swelling of buttocks. She was diagnosed with an expansion of the descending aortic aneurysm (62 mm in diameter) and a hematoma in the gluteal muscle due to aneurysm-induced disseminated intravascular coagulation (DIC). After emergency admission, she underwent a successful thoracic endovascular aortic repair and was discharged following a smooth recovery from dysphagia and aneurysm-induced DIC. We report this case along with a review of the literature.

We investigated the outcomes of nephron-sparing surgery in patients with small renal cell carcinomas by retrospectively reviewing the records of 20 elective cases of nephron-sparing surgery performed from 1994 to 2003. All patients had low pathologic stage, localized, unilateral tumors smaller than 4 cm and sporadic renal cell carcinomas. There were no significant differences between mean preoperative serum creatinine levels and postoperative levels. Nephron-sparing surgery may be safe and curative treatment for low pathologic stage, localized, unilateral tumors smaller than 4 cm and sporadic renal cell carcinomas.
Surgical aspects ; Carcinoma, Renal Cell ; Nephron brand of racepinephrine hydrochloride ; seconds ; Small

In order to carry out mass examination for detection of stomach ailments effectively and improve screening accuracy, the Nagano Prefectural Welfare Federation of Agricultural Cooperatives, with its mass gastric examination committee as a driving force, has made every endeavor in close collaboration with Federation-affiliated hospitals.
The ratio of those receiving detailed examination to the total number of those who have undergone mass screenings, and the detection ratio of gastric cancer cases, especially those in early stages, have increased steadily over the past years.
This is due in the main to untiring effort exerted by public health nurses and other persons concerned with health problems.
However, the results of X-ray examination made on the basis of the diagnostic standards prepared by the Federation show that there is much need of improving examiners' ability to read mass miniature radiographs correctly.

Methods: We reviewed 125 patients (79 men and 46 women) who had lumbar spinous process splitting laminectomy (LSPSL) for LSS. We assessed the following clinical information: Japanese Orthopedic Association (JOA) score; numerical rating scale (NRS) for low back pain (LBP), leg pain, and leg numbness; Zurich Claudication Questionnaire; JOA Back Pain Evaluation Questionnaire; Roland- Morris Disability Questionnaire (RMDQ); and Short Form 8 (SF-8) as HRQOL. We compared the HRQOLs of men and women pre- and postoperatively. Results: Although the preoperative NRS results for LBP were significantly higher in women (p <0.05), there were no significant differences in clinical outcomes between men and women postoperatively. For HRQOL, the RMDQ scores were significantly worse in women preoperatively (p <0.05), but no significant differences were found postoperatively between men and women. Similarly, the SF-8 mental health score was also significantly lower in women preoperatively (p <0.05), but no significant differences were noted between the two groups postoperatively. Conclusions LSPSL greatly reduced LBP, leg pain, and leg numbness in both genders. There were limited differences in pain and several HRQOL questionnaire responses between men and women after surgery. We found that women had greater sensitivity to and/or lower tolerance for pain than men, which led to lower HRQOL mental health scores preoperatively.

OBJECTIVETo explore the diagnostic feasibility of noninvasive assessment of coronary atherosclerotic plaques with MSCT in comparison with IVUS.

METHODSContrast-enhanced MSCT angiography (Sensation 64, Siemens Medical Solutions) was performed before percutaneous coronary intervention (PCI), and three-vessel IVUS (Boston Scientific, Natick, MA) was performed during procedure in 12 patients with stable angina pectoris. Complete investigation was digitally stored, and assessed offline with EchoPlaque (Indec Systems, Mountain View, CA). The comparison of MSCT with IVUS was performed based on segment at plaque site (American Heart Association 15-segment model).

RESULTSA total of 88 segments in 31 vessels (left anterior descending: 12, left circumflex: 10, and right coronary artery: 9) were investigated by both IVUS and MSCT. Among 68 assessable segments (54 proximal-middle segments and 14 distal segments) by MSCT (20 segments were excluded for poor image quality: 16 for severe calcification, 2 for motion artifact, 2 for poor opacification), MSCT correctly detected 47 of the 51 segments with plaques (sensitivity: 92%), and correctly evaluated 16 of 17 segments without plaques (specificity: 94%). Concerning plaque quantification, MSCT correlated well with IVUS in grading whether the vessel obstruction was less or more than 50% (simple kappa: 0.63, 95% CI: from 0.47 to 0.78). Plaque area by MSCT also correlated with that by IVUS (r = 0.53, P < 0.01), but overestimated plaque area [(9.09 +/- 3.89) mm(2) vs. (6.80 +/- 2.81) mm(2), P < 0.01]. In addition, 30 of 43 hypoechoic compositions were detected as low-density compositions by MSCT with average CT number as 67.39 HU.

CONCLUSIONSIn segments without severe calcification, contrast-enhanced 64-slice CT angiography could detect plaques in coronary artery with high accuracy. Plaque area quantification by MSCT correlated with that of IVUS though with limited accuracy.

In patients with unilateral mandibular condyle hyperplasia, whether to perform condylectomy and orthognathic surgical procedures at the same time or orthognathic surgery in two stages for remains controversial. Reported here is a case of facial asymmetry with mandibular condyle hyperplasia, for which condylectomy and orthognathic surgery procedures were performed at the same time. A 28-year-old woman was presented to our department with chief complaints of left deviation of the mandible and right temporomandibular joint (TMJ) noise. Findings obtained in several imaging examinations led to a diagnosis of facial asymmetry associated with right mandibular condyle hyperplasia. Following 3 months of preoperative orthodontic treatment, in October 2018 under general anesthesia the patient underwent a right mandibular condylectomy, Le Fort I osteotomy, right mandibular sagittal split ramus osteotomy, and left mandibular inverted L ramus osteotomy. In examinations up to 3 years after surgery, good results were noted.For this case of severe facial asymmetry with mandibular condyle hyperplasia, early surgery and condylectomy were performed simultaneously to significantly shorten the total treatment time. The effectiveness of a surgery-early approach was confirmed by no postoperative findings indicating abnormalities in the TMJ or retroversion.

In patients with unilateral mandibular condyle hyperplasia, whether to perform condylectomy and orthognathic surgical procedures at the same time or orthognathic surgery in two stages for remains controversial. Reported here is a case of facial asymmetry with mandibular condyle hyperplasia, for which condylectomy and orthognathic surgery procedures were performed at the same time. A 28-year-old woman was presented to our department with chief complaints of left deviation of the mandible and right temporomandibular joint (TMJ) noise. Findings obtained in several imaging examinations led to a diagnosis of facial asymmetry associated with right mandibular condyle hyperplasia. Following 3 months of preoperative orthodontic treatment, in October 2018 under general anesthesia the patient underwent a right mandibular condylectomy, Le Fort I osteotomy, right mandibular sagittal split ramus osteotomy, and left mandibular inverted L ramus osteotomy. In examinations up to 3 years after surgery, good results were noted.For this case of severe facial asymmetry with mandibular condyle hyperplasia, early surgery and condylectomy were performed simultaneously to significantly shorten the total treatment time. The effectiveness of a surgery-early approach was confirmed by no postoperative findings indicating abnormalities in the TMJ or retroversion.

In patients with unilateral mandibular condyle hyperplasia, whether to perform condylectomy and orthognathic surgical procedures at the same time or orthognathic surgery in two stages for remains controversial. Reported here is a case of facial asymmetry with mandibular condyle hyperplasia, for which condylectomy and orthognathic surgery procedures were performed at the same time. A 28-year-old woman was presented to our department with chief complaints of left deviation of the mandible and right temporomandibular joint (TMJ) noise. Findings obtained in several imaging examinations led to a diagnosis of facial asymmetry associated with right mandibular condyle hyperplasia. Following 3 months of preoperative orthodontic treatment, in October 2018 under general anesthesia the patient underwent a right mandibular condylectomy, Le Fort I osteotomy, right mandibular sagittal split ramus osteotomy, and left mandibular inverted L ramus osteotomy. In examinations up to 3 years after surgery, good results were noted.For this case of severe facial asymmetry with mandibular condyle hyperplasia, early surgery and condylectomy were performed simultaneously to significantly shorten the total treatment time. The effectiveness of a surgery-early approach was confirmed by no postoperative findings indicating abnormalities in the TMJ or retroversion.