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.

Shigyakusan, a traditional Japanese prescription, has been prescribed for chronic diseases including gastritis, upper respiratory tract infection, hepatitis, irritable colon and so on. The effectiveness of shigyakusan against pain, however, has only been rarely reported. Here we report that shigyakusan was effective on pain such as intractable chronic and acute pain in 26 patients. Shigyakusan is composed of 7.5 g (dry weight/day) : saiko, shakuyaku, kijitsu and kanzo. Shigyakusan and kososan mimic the composition of saikosokanto. Pain alleviation periods were 3-90 days (26 ± 19). Pains were recognized in various regions including side of the flank and the thorax, the back, the tongue, the perineum, the elbow joint, the head and plantar areas. Abdominal findings as tension of the rectus abdominis, kyokyokuman (discomfort of the hypochondrium area) and sinkahiko (tenderness of the hypochondrium area) were recognized 58%, 46% and 38%, respectively. All patients were recognized with depressive conditions. Shigyakusan alleviated acute and chronic pain that had not been improved with Western medicine. Therefore, shigyakusan may be considered for prescription in patients with incurable pain.

[Purpose] The effects of experimental osteoporosis on the trabecular bone structure of the mandible in cynomolgus monkeys were examined by radiological bone morphometric analysis. [Methods] Ovariectomy (OVX) was performed on twelve 10-year-old female cynomolgus monkeys, which were fed a controlled diet for 2 years. Twelve monkeys in a sham control group were fed under the same conditions. Using a microfocus tube and computed radiography, the removed mandibular bone samples were imaged by standardized magnification radiography, and two-dimensional digital imaging data were obtained. The structural parameters, such as skeletal area, perimeter, number, complexity, continuity and anisotropy, were measured using radiological bone morphometric analysis. The bone mineral density (BMD) was measured by dual energy X-ray absorptiometry. The width of the cortical bone was measured using magnified radiographic images. [Results] There were no significant differences between the OVX and the sham control groups in the skeletal structure indicated by the skeletal volume, number, width, perimeter, complexity, continuity, separation and spacing. However, there were significant differences between the two groups in the BMD of the mandibular body, cortical bone width, anisotropy and some parameters of the skeletal continuity. Among these parameters, the difference in the thinning of the cortical bone was most significant. [Conclusions] Using two-dimensional digital radiographic image data, this study suggests that the cortical bone width is more useful than the trabecular bone structure as the morphologic parameter for diagnosis of osteoporosis in the mandibular body.

To investigate the effects of experimental osteoporosis on the trabecular structure of the mandibular condyle in cynomolgus monkeys by radiological bone morphometry, ovariectomy (OVX) was performed on 10-year-old female cynomolgus monkeys, which were fed a controlled diet for 2 years. Ten sham control groups were fed under the same conditions. Using a microfocus tube and computed radiography, the removed mandibular condyle samples were imaged by standardized magnification radiography. The structural parameters were measured using radiological bone morphometric analysis. The bone mineral density (BMD) was measured by dual energy X-ray absorptiometry. The thickness of the cortical bone was measured using magnified radiographic images. The thickness of the cortical bone and the BMD in the OVX group were significantly lower than in the sham group. In the results of skeletal structure of the mandibular condyle, the trabecular structure of the mandibular condyle was markedly deteriorated in the OVX group. The trabecular structure of the mandibular condyle for the OVX group was significantly decreased, thus it was suggested that osteoporosis is a potential risk factor of osteoarthritis of the temporomandibular joint.

Celiac artery aneurysm (CAA) is very rare. We report a case of CAA with type IIIb aortic dissection (DA) which was treated surgically. A 60-year-old man who had an abnormal enlargement of the aorta on abdominal ultrasonography was admitted to our hospital. Angiography and CT scan revealed CAA with type IIIb DA. His general condition was stable and surgery was performed electively. The CAA was exposed through a median laparotomy. It was found to be about 3cm in diameter. As vascular reconstruction seemed difficult and the proper hepatic artery showed good pulsation after clamping the common hepatic artery, we decided to perform celiac artery aneurysmectomy without vascular reconstruction. Except for transient liver dysfunction, there was no other complication and he was discharged on the 24th postoperative day. During surgery for CAA, when collateral perfusion from the SMA to the liver is adequate, it seems that vascular reconstruction is not always necessary as shown by this case.

A 52-year-old man presented with a pulsatile mass in the right groin. He had undergone lumbar sympathectomy and aorto-right femoral artery bypass using an 8mm Microvel double velour graft, 14 years previously, for aortoiliac occlusive disease caused by thromboangiitis obliterans. Based on a clinical diagnosis of an anastomotic aneurysm, an operation was performed. When the aneurysm was incised, it was found that the anastomosis of the graft to the femoral artery was intact and that the graft itself had a defect, 3cm in size on the anterior wall, 1.5cm proximal to the distal anastomosis. The final diagnosis was a nonanastomotic false aneurysm due to prosthetic graft failure. The failed portion of the graft was resected, and a 10mm Hemashield Gold woven double velour graft was interposed between the old graft and the right femoral artery. Generally, arterial grafts below the groin are subject to high levels of mechanical stress, and graft failure is not uncommon. Vascular surgeons should keep in mind that graft failure is not rare in patients with long-standing prosthetic grafts.

Preoperative definitive diagnosis of intradural lumbar disc herniation (ILDH) is difficult despite the availability of various neuroradiological investigative tools. We present a case of ILDH diagnosed preoperatively by discography and computed tomography-discography (disco-CT).The patient was a 63-year-old man with acute excruciating right leg pain. Discography and disco-CT demonstrated leakage of the contrast medium into the intradural space. Based on these findings, a right L5 nerve root disturbance caused by ILDH was diagnosed. A right L5 hemi-laminectomy and a dorsal durotomy were performed. The herniated disc was carefully dissected and then completely removed. Three months after surgery, the patient had fully recovered. This report highlights the importance of making a definitive diagnosis of ILDH preoperatively for better surgical planning and improved clinical outcomes. Furthermore, discography and disco-CT are both useful preoperative diagnostic tools for the diagnosis of ILDH.
Diagnosis ; Humans ; Intervertebral Disc Displacement ; Leg ; Middle Aged

To evaluate the association of serum BDNF concentration with high-intensity interval training, 12 healthy male volunteers, aged 28-48 years, completed 16-week high-intensity interval training (HIIT) using ergometer. Training program consisted of >90% VO₂ peak for 60 sec separated by 60 sec active rest period for 8-12 sets twice weekly for 16-week. Maximal exercise tolerance tests were performed before (0-week), 4-week, and 16-week after the intervention program. VO₂ peak as well as peak watt was linearly increased after 4-week (9% for both VO₂ peak and peak watt) and 16-week HIIT training (15% for VO₂ peak and 18% for peak watt, p<0.01). However, there was no change in serum BDNF concentration by HIIT. On the other hand, there was a positive association of serum BDNF concentration at baseline with % increase in peak watt after the intervention (ρ=0.60, p<0.05). The association between BDNF and exercise training is still unclear, and more studies are needed to clarify the above positive association.

Methods: This study included 42 patients with ASD (two men and 40 women; 112 segments; mean, 68.5±8.4 years; and mean follow-up, 31.6±17.0 months) who underwent LIF and posterior correction surgery. The concave slot of the LIF cage was filled with an autologous iliac crest bone graft (IBG), and the convex slot with a porous hydroxyapatite/collagen (HAp/Col) composite was soaked with bone marrow aspirate. Endplate injury, the gap between vertebral endplate and cage in the coronal or sagittal plane, and fusion status were evaluated using computed tomography multiplanar reconstruction at 12 months after surgery. Moreover, the associated risk factors for pseudoarthrosis were analyzed. Results: Fusion at LIF segments were observed in 71.4% segments at 12 months after surgery. Fusion on the concave slot (autologous IBG side), convex slot (porous HAp/Col composite side), and both concave and convex slots were observed in 66.1%, 37.5%, and 36.6% of patients, respectively. Moreover, pseudoarthrosis was observed in 28.6% at 12 months after surgery. Consequently, logistic regression analysis of the fusion at the LIF segment revealed that the gap between the LIF cage and endplate in the coronal plane (p=0.030; odds ratio, 0.183; 95% confidence interval, 0.030–0.183) was significantly associated with pseudoarthrosis at the LIF segments. Conclusions ASD surgery fusion rate using LIF cages was 71.4% at 12 months after surgery. The fusion rate was higher on the concave slot filled with autologous IBG than on the convex slot filled with a porous HAp/Col composite. The gap in the coronal plane was a risk factor for pseudoarthrosis at the LIF segment.

SUMMARY OF EVENT: Bacterial, mycotic peritonitis and Candida fungemia developed in a patient with moderate ascites who had undergone endoscopic ultrasound-guided biliary drainage (EUS-BD). Antibiotics and antifungal agent were administered and ascites drainage was performed. Although the infection improved, the patient's general condition gradually deteriorated due to aggravation of the primary cancer and he died. TEACHING POINT: This is the first report to describe infectious peritonitis after EUS-BD. Ascites carries the potential risk of severe complications. As such, in patients with ascites, endoscopic retrograde cholangiopancreatography (ERCP) is typically preferred over EUS-BD or percutaneous drainage to prevent bile leakage. However, ERCP may not be possible in some patients with tumor invasion of the duodenum or with surgically altered anatomy. Thus, in patients with ascites who require EUS-BD, we recommend inserting the drainage tube percutaneously and draining the ascites before and after the intervention in order to prevent severe infection.
Anti-Bacterial Agents ; Ascites ; Bile ; Candida ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage ; Duodenum ; Endosonography ; Fungemia ; Humans ; Peritonitis