In 2011, during the Great East Japan Earthquake and tsunami, 90% of victims died from drowning. We report on two tsunami survivors with severe pneumonia potentially caused by Legionella pneumophila. Both victims aspirated a large quantity of contaminated water; sand, mud and a variety of microbes were thought to have entered into their lower respiratory tracts. One patient had a mycotic intracranial aneurysm; the other patient had co-infections with several organisms, including Scedosporium species. Although scedosporiosis is a relatively rare infectious disease, symptoms are progressive and prognosis is poor. These pathogens are not specific for tsunami lung, but are reported causative agents for pneumonia after near-drowning.

An investigation was conducted to clarify both the effect of water polo training on bone mass and the effect of training-induced menstrual disorders on bone. The subjects were 12 female college water polo players and 7 age-matched sedentary college women as a control group.
Menstrual condition was evaluated by 12 montes of basal body temperature measurement. Seven of the water polo players were eumenorrheic, and five had training-dependent (reversible) menstrual disorders (two with amenorrhea and three with cycle disturbances) .
Bone mineral measurement revealed differences between the water polo players and the sedentary women. The eumenorrheic water polo players had a higher bone mineral density (BMD) in the lumbar spine and total body skeleton than the sedentary control group, being 11.2% and 11.3% higher, respectively.
Effects of menstrual disorders (including cycle disturbance) were clear in the water polo players. The BMD of water polo players with menstrual disorders was 9.8% and 9.6% lower in the total body and lumbar spine that of eumenorrheic water polo players.
Hormonal examinations revealed a lower serum estradiol level in water polo players with menstrual disordsers in comparison with eumenorrheic water polo playes. Serum estradiol level showed a positive correlation with both total body BMD (r=0, 78, p<0.01) and lumbar spine BMD (r=0.71, p<0.01) .

The effect of lemon slices, as well as ascorbic and citric acid impregnated paper discs, on the growth of ten non-typhoidal Salmonella, six Citrobacter freundii and four Proteus mirabilis species on Desoxycholate Hydrogen Sulfide Lactose (DHL) agar were examined in comparison to controls without fruit slices or paper discs applied. After 24 h incubation, thick black rings were observed around fruit slices and impregnated discs growing on non-typhoidal Salmonella serovars and not around the other species. We named this the “MY Phenomenon”. We propose that the phenomenon can be used as a rapid, simple and inexpensive screening test that distinguishes non-typhoidal Salmonella species from other enterobacteriaceae in stool samples.

The long-term results of a “tighter” tricuspid annuloplasty (TAP) by De Vega's technique for secondary tricuspid regurgitation (TR) were studied. From June 1985 to July 1993, 122 patients underwent TAP following mitral valve surgery in our clinic. The analysis was performed on 50 patients who were followed up for more than 5 years (a mean of 75.1 months ranging from 60 to 96 months). The patients consisted of 13 males and 37 females with a mean age of 53.7 years (range from 28 to 71 years). The echocardiogram taken after long-term follow-up showed that the right ventricular inflow peak velocity at rest was a mean of 0.72m/s ranging from 0.53 to 1.04m/s, while the mean pressure half time was 76.7±14.9msec. Significant residual TR was observed in 16% at 1 month, 6% at 1 year, 10% at 3 years, and 12% at 5 years or more after operations. We conclude that a “tighter” TAP by De Vega's technique for secondary TR seems to be effective for the long-term reduction of residual TR and is not a causative factor for tricuspid stenosis.

　　Among visceral artery aneurysms, those arising in the region of the pancreatic duodenal artery due to celiac artery stenosis are rare. We report a surgical case with stenosis caused by dissecting celiac artery aneurysms and multiple aortic aneurysm rupture in the pancreaticoduodenal region. A 72-year-old man with a history of distal gastrectomy for gastric cancer was carried into our hospital by ambulance for acute abdominal pain. CT scans showed dissected aneurysms of the root of the celiac artery and hepatic artery as well as massive retroperitoneal hematoma around the pancreaticoduodenum and intraperitoneal hemorrhage. Arteriography of the superior mesenteric artery revealed multiple aneurysms of the pancreaticoduodenal artery that might have caused rupture. In the late phase, retrograde flows in the gastroduodenal, hepatic, celiac, and splenic arteries from the pancreaticoduodenal artery were contrast-enhanced. Because it was thought that transcatheter arterial embolization or surgical aneurysmectomy for pancreaticoduodenal aneurysms could prevent blood flow in all circulating branch arteries of the celiac artery, leading to extensive organ ischemia, the gastric pouch, spleen, entire pancreas, and gallbladder were resected. The patient has been doing well.

　　Pancreatic neuroendocrine tumors, relatively rare cancers, mostly arise in the pancreatic parenchyma with infrequent involvement of the main pancreatic duct. Now and then, however, case reports have been published on pancreatic neuroendocrine carcinoma in which the main pancreatic duct is obstructed by tumor cells with severely fibrous stromal cells. Here, in this paper, we report a case of pancreatic neuroendocrine carcinoma with obstruction of the main pancreatic duct. A 59-year-old man complained of right upper abdominal pain. Magnetic resonance cholangiopancreatography and fat-suppressed T1-weighted magnetic resonance imaging showed gallbladder stones, a low-intensity-area measuring 8 mm in diameter in the pancreatic body, and club-shaped dilatation at the distal end of the pancreatic duct. The patient was thus diagnosed with a tumor in the pancreatic body and cholecystolithiasis, and underwent distal pancreatectomy and cholecystectomy. HE-staining showed tumor cells with eosinophilic cytoplasm and nuclear atypia. The infiltrative growth of the cells with severe fibrosis caused stenosis of the pancreatic duct. Based on the positive results of immunohistochemical staining for chromogranin A and synaptophysin and the Ki-67 index, the tumor was finally identified as pancreatic neuroendocrine carcinoma. The patient has been under follow-up with no additional treatment for >3 years since the surgery, without evidence of tumor recurrence.

A 47-year-old man was admitted with symptoms of angina pectoris. After evaluating the patient, coronary artery bypass grafting (CABG) was performed. First, the left internal thoracic artery (LITA) was grafted to the obtuse marginal branch (OM), and then the right gastroepiploic artery (RGEA) was grafted to the posterior descending branch (PD). Just after completing anastomosis, we performed intraoperative thermal coronary angiography. The RGEA-PD was patent. However, the LITA-OM was not patent on thermal coronary angiography. After a re-anastomosis was done at the LITA-OM, thermal coronary angiography was again performed and the LITA-OM was found to be patent. The postoperative course was uneventful, and all grafts were patent on postoperative angiography. In conclusion, intraoperative thermal coronary angiography was found to be useful for CABG.

We studied maxillofacial fractures treated by departments of oral and maxillofacial surgery in Tokyo. A retrospective review of records and radiographs for patients admitted during the 5-year period from 2000 to 2004 was conducted at five departments in Tokyo. Date, age, gender, cause of injury, fracture site, concomitant injury, domestic violence against women, and treatment were reviewed. 674 patients with maxillofacial fractures were admitted. Male-to-female ratio was 3.6:1. The most frequent age group was 21-25 years. Fractures of the mandible were most frequent (87%), followed by the maxilla (14%) and the zygomatic bone (12%). Thirty-one percent of fractures were due to traffic accidents, 29% to accidental falls, 23% to violence and 14% to sports. The incidence of maxillofacial fractures caused by traffic accidents was lower, and that caused by falls and violence were higher than in other countries. Seventeen percent of the maxillofacial fracture patients had concomitant injuries. The incidence of domestic violence-related maxillofacial fracture was 1.6% of all cases. These cases were mainly caused by a husband (55%) or a sexual partner (36%). Most patients (67%) were treated by open reduction surgery. However, condylar fracture alone was usually treated by closed reduction surgery.