The HCV antibody positive rates of blood donors were studied in Yamaguchi Prefecture. C100-3 antibody was examined by the method of the 1st generation. The subjects were 146, 792 people who donated blood from Nov. 1989 to Dec. 1990. The average positive rate was 1.01% in Yamaguchi Prefecture. The positive rates of more than 3% were registered in four towns. In one town out of these four, the average positive rate was 22.0% It was extremely higher than the other three towns. Further study will be required to elucidate such regional differences in the HCV positive rate in the prefecture.

The purpose of this study was to examine the effects of anthropometric measures, including body height, body weight, body mass index (BMI), fat mass (FM), and lean body mass (LBM), on quantitative ultrasound (QUS) parameters of calcaneus in 358 Japanese university women. Ultrasonic bone densitometer (Achilles, Lunar corp.) was utilized to measure broadband ultrasound attenuation (BUA), speed of sound (SOS), and stiffness index (SI) of the right calcaneus. The average of SI in this study showed a slight lower value (84, 3±12.1, mean±SD) compared with that in age-matched university women as previously reported. The contradictive finding may suggest the need for a large-scale further investigation on SI in young women. Correlation analysis revealed that both BUA and SI are significantly correlated with all anthropometric measures. However SOS had only weak correlation with LBM. In consideration of the high colinearities of body weight and BMI with FM and LBM, the multiple liner regression analysis was conducted with BUA, SOS, and SI as dependent variables. Body height, FM, and LBM were then entered to a forward stepwise regression model. The analysis proved that the significant predictor of BUA, SOS, and SI is LBM. It also suggested BUA to be stronger correlated with LBM than the other QUS parameters, SOS and SI. In conclusion, our re sults support the view that QUS parameters appear to be influenced by anthropometric measures, especially by LBM in Japanese university women. It is conceivable that an increase in skeletal mus cle mass chiefly induced by physical exercise contributes to the improvement of bone mass as measured by QUS in young women.

Coronary artery obstruction, pulmonary stenosis, aortic valve regurgitation, and enlargement of the neo-aortic root are major complications of arterial switch operation (ASO) for transposition of the great arteries (TGA). Supravalvular aortic stenosis following ASO is rarely reported, and technical factors should be considered as causes in such cases. We report a case of supravalvular aortic stenosis following ASO, in which we speculated that the cause of the stenosis was tissue overgrowth caused by the surgical suture. The patient was a 4-month-old girl with TGA (II) who had undergone ASO on the 12th day after birth. Neo-aortic anastomosis was performed with 7-0 polydioxanone absorbable suture (PDS^®, Ethicon, Somerville, NJ, USA). Transthoracic echocardiography performed 1 month after the surgery showed severe stenosis at the aortic anastomosis which worsened progressively. Therefore, the patient was reoperated 4 months after the previous surgery. The concentrically stenosed aortic wall at the anastomotic site was resected and aortic reanastomosis was performed using an interrupted suture pattern with 7-0 polypropylene (Prolene^®, Ethicon). The histological findings showed proliferation of collagenous fibers around the PDS^® suture. Because of the worsening stenosis over time and the histological findings, we speculated that the tissue overgrowth in reaction to the PDS^® suture was the main cause of the stenosis. Absorbable sutures are useful because they do not leave a foreign substance in the body ; however, the possibility of tissue overgrowth leading to anastomotic stenosis cannot be denied. When using absorbable suture, careful observation is mandatory until the material is completely absorbed.

The college years are an opportune timepoint of intervention in the primary prevention of osteoporosis. However, the effects of anthropometrical measures and lifestyle-related factors on the changes in bone mass during college years are unclear. The purpose of this study was thus to identify the determinants of the changes in calcaneal quantitative ultrasound (QUS) bone parameters (stiffness index: SI, speed of sound: SOS, broadband ultrasound attenuation: BUA) over 2 years in healthy Japanese college women (n=128). Correlation analysis revealed several significant relationships between the change rates in QUS parameters and anthropometry. Particularly, the changes in SI and BUA are highly correlated with the 2-year change in lean body mass (LBM). The subsequent multiple liner regression analysis also supported that the change in LBM was the significant predictor for the incremental rate of SI and BUA. All subjects then categorized into some grades, concerning about following lifestyle-related and physical variables during the last 2 years, living condition, sleeping time, alcohol consumption, smoking, meal skipping, dairy foods intake, instant foods intake, regular physical activity, regularity of menstruation, history of fracture, and history of dieting to reduce body weight. The incremental rates of all QUS parameters (i. e., SI, SOS, BUA) were positively associated with participation in regular physical activity. In addition, women who have continuously participated in regular physical activity from high school to college showed significant increases in SI and SOS compared with those who are not physically active or whose level of physical activity decline during college years. In conclusion, our study indicates that changes in QUS parameters in college-aged women were influenced by changes in anthropometric measures, especially LBM. It might suggest the importance of participation in regular physical activity to increase skeletal muscle mass. Our results also support the view that college women should maintain or increase regular physical activity before and after entering the college to maximize peak bone mass or lessen the age-related loss in bone mass in adulthood.

75-year-old man had the right lower lobe resected because of pulmonary adenocarcinoma (stage IIB) and received 4 courses of postoperative chemotherapy 4 years earlier. Thereafter, he continued to complain of cough, sputum, and progressive exertional breathlessness. The preoperative chest CT showed ground glass opacity (GGO) at the bottom of both lung fields, and over time the GGO changed to honeycombing with traction bronchiectasis. He was administered prednisolone, clarithromycin, and pirfenidone but with little improvement. He exhibited hypoxemia (PaO₂ 56 mmHg) and was admitted. An interview revealed that he had worked in the poultry farming business for 45 years having had contact with and breeding 3,000 game fowl at the time of hospitalization. We suspected bird-related hypersensitivity pneumonitis. Results of the reaction to pigeon dropping extracts (PDE) were high, with PDE IgG 0.697 and PDE IgA 0.445. He was diagnosed with chronic bird-related hypersensitivity pneumonitis. Although the chest CT appearance was difficult to distinguish from that of idiopathic interstitial pneumonia, the test for PDE and the interview were useful for reaching a diagnosis.

Large and ptotic breast reconstruction in patients who are not candidates for a transverse rectus abdominalis myocutaneous flap and revision surgery for the contralateral breast remains challenging. We developed a novel breast reconstruction technique using a latissimus dorsi myocutaneous (LD m-c) flap set at the posterior aspect of the reconstructed breast, combined with an anatomical silicone breast implant (SBI), following tissue expander surgery. We performed the proposed technique in four patients, in whom the weight of the resected tissue during mastectomy was >500 g and the depth of the inframammary fold (IMF) was >3 cm. After over-expansion of the lower portion of the skin envelope by a tissue expander, the LD m-c flap was transferred to cover the lower portion of the breast defect and to achieve a ptotic contour, with the skin paddle set at the posterior aspect of the reconstructed breast. An SBI was then placed in the rest of the breast defect after setting the LD m-c flap. No major complications were observed during the follow-up period. The proposed technique resulted in symmetrical and aesthetically satisfactory breasts with deep IMFs, which allowed proper fitting of the brassiere, following large and ptotic breast reconstruction.
Breast Implants ; Breast* ; Female ; Follow-Up Studies ; Humans ; Mammaplasty* ; Mastectomy ; Myocutaneous Flap* ; Reconstructive Surgical Procedures ; Silicon* ; Silicones* ; Skin ; Superficial Back Muscles* ; Surgery, Plastic ; Tissue Expansion Devices* ; Tissue Transplantation

No abstract available.
Breast ; Female ; Mammaplasty ; Tissue Expansion Devices

BACKGROUND/AIMS: Venous thromboembolism (VTE) is a major extraintestinal manifestation in inflammatory bowel disease (IBD), regarded as an independent risk factor for VTE according to reports from Western countries. However, the incidence and risk factors of VTE in Asian IBD patients are not fully understood. We aimed to reveal the incidence and risk factors of VTE in Japanese IBD inpatients. METHODS: The incidence of VTE in inpatients with IBD (n=340), gastrointestinal cancers (n=557), and other gastrointestinal diseases (n=569) treated at our hospital from 2009 to 2013 was retrospectively investigated. The characteristics and laboratory data of IBD inpatients with and without VTE were compared in univariate and multivariate analyses. Clinical courses of VTE in IBD were surveyed. RESULTS: VTE was detected in 7.1% of IBD inpatients, significantly higher than in gastrointestinal cancer inpatients (2.5%) and inpatients with other gastrointestinal diseases (0.88%). The incidence of VTE in ulcerative colitis (UC) patients (16.7%) was much higher than that in those with Crohn's disease (3.6%). In the univariate analysis, the risk factors were an older age, central venous catheter, prednisolone, surgery, low serum albumin, high serum C-reactive protein and D-dimer. According to a multivariate analysis, >50 years of age and surgery were the only risk factors. The in-hospital mortality rate of IBD inpatients with VTE was 4.2%. CONCLUSIONS: The incidence of VTE with IBD, especially UC, was found to be high compared with other digestive disease, which was almost equivalent to that of Western countries. The efficacy of prophylaxis needs to be investigated in Asian IBD patients.
Asian Continental Ancestry Group* ; C-Reactive Protein ; Central Venous Catheters ; Cohort Studies* ; Colitis, Ulcerative ; Crohn Disease ; Gastrointestinal Diseases ; Gastrointestinal Neoplasms ; Hospital Mortality ; Humans ; Incidence* ; Inflammatory Bowel Diseases* ; Inpatients* ; Multivariate Analysis ; Prednisolone ; Retrospective Studies* ; Risk Factors* ; Serum Albumin ; Venous Thromboembolism*

To clarify nursing practices in pain management of community-dwelling older adults with dementia by visiting nurses, we conducted semi-structured interviews with 10 visiting nurses and analyzed their responses qualitatively and inductively. As a result, 24 subcategories and 8 categories were identified. Visiting nurses were found to conduct pain assessment and assessment based on behavioral changes in usual daily life because of characteristics of health assessment in home care, in which the goal is to comprehensively support clients as living people, in addition to standard pain management of older people with dementia. The results suggest that the viewpoint to integrate information from other professionals and family members and assess daily life comprehensively is important, and some mechanism to facilitate multidisciplinary information sharing is required. When visiting nurses were unsure of whether a patient is in pain, they evaluated the patient’s pain on the basis of behavioral changes in his or her normal daily life after medication or nondrug treatment. A nationwide survey is necessary for further clarification.