Purpose: This retrospective study aims to evaluate the effectiveness and safety of morphine for the management of dyspnea in terminal cancer patients. Methods: 64 terminal cancer patients, who had morphine administered for dyspnea management, were investigated. Dyspnea was assessed daily on the numerical rating scale (NRS; 0-5) before and 48 hours after the administration, and at the point of dose modifications. Result: The medication period was 34.7 days and the daily dose of morphine was 93.0 mg. The mean NRS decreased from 3.5 to 1.6 (p<0.001). 46 patients (72%) were started with an oral administration of normal-release morphine when-required. The major side effects of morphine, such as hypoxemia or decrease in respiratory rate, were not observed. Conclusion: Morphine is effective and safe for the management of dyspnea even in terminal cancer patients with careful titration.

The objective of this study was to assess the possibility of developing a clinical minimally invasive and standardized method to evaluate the relationship between the microstructure of the jaw bone and systemic bone turnover. For this purpose, we performed standardized bone biopsy of the alveolar bone, and compared the 3D bone microstructure using micro-computed tomography (micro-CT) with bone mineral density (BMD) of the lumbar spine and biochemical markers of bone turnover. We evaluated a total of 9 samples taken from 6 patients by standardized biopsy using a trephine bur. BMD was evaluated using dual energy X-ray absorptiometry (DXA). Regarding the biochemical markers of bone turnover, serum bone-specific alkaline phosphatase (BAP) and serum osteocalcin (OC) were used as bone formation markers, and urinary cross-linked N-telopeptides of type I collagen (NTx) and urinary deoxypyridinoline (DPD) were selected as bone resorption markers. We scanned micro-CT images of these samples. Bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular spacing (Tb.Spac), fractal dimension, trabecular bone pattern factor (TBPf) and node-strut (Nd.Nd/TV, TSL/TV) were measured. Regarding the correlations between the parameters of bone microstructures, TB/TV, Tb.N, fractal dimension, and node-strut seemed to be positively correlated and Tb.Spac and TBPf seemed to be negatively correlated with each other, but Tb.Th seemed to have a low correlation with other parameters. OC and/or BAP showed a significantly high correlation with many structural parameters (p<0.05%). In conclusion, some microstructural parameters may change according to the systemic bone turnover.

Concerning the bone structures of the mandible reconstructed by particular cellular bone and marrow (PCBM), platelet rich plasma (PRP) and tray, we have examined the possibility of implant insertion by clarifying the morphological conditions in each compact and cancellous bone on computed tomography (CT), and by observing the differences in their CT values.Using the computer software program Sim Plant (Materialize Dental, Leuven, Belgium), we morphologically observed 6 cases of implant inserted area after mandibular reconstruction and 11 cases of native bone, and examined the differences in their CT values. The osseointegration rate of each inserted implant was also evaluated.Compared with the native bone group, the PCBM reconstruction group had generally thin compact bone. In the over-3cm-length PCBM reconstruction group, the average CT value was 259.7 ± 94.4 HU (n = 3) in the cancellous bone, whereas in the native bone group, the average CT value was 528.9 ± 140.1 HU (n = 10). Therefore, the PCBM reconstruction group showed significantly lower CT value than the native bone group. However, in the under-3cm-length group, the PCBM reconstruction group showed no significant difference compared with the native bone group. The osseointegration rate of the inserted implants almost 6 months after insertion was 100% in the PCBM reconstruction group and 94.1% in the native bone group.Although the PCBM reconstructed bone had thinner cortical bone and showed lower CT value compared with the native bone, implant insertion was possible.

We gathered and analyzed date on respiratory diseases suffered by Japanese adults treated in Ram Hospital in Chiang Mai and Subang Jaya Medical Center in Kuala Lumpur. In both hospitals, the percentages of patients undergoing treatment for respiratory diseases was the greatest. Of these, relatively mild symptoms such as upper respiratory tract infection account for the majority of the diseases, but also included are instances of lower respiratory tract infection or chronic respiratory diseases such as chronic sinusitis and COPD⁄bronchial asthma. In Kuala Lumpur, we conducted a questionnaire-based survey targeted on Japanese people living there, in order to detemine the currnt status of respiratory deseases. The date showed that many Japanese had symptoms of respiratory diseases and felt that air pollution was serious.
It is important for Japanese people living in Asia to be aware of preventative measures to prevent respiratory diseases, such as those caused by air pollution and infection.

Students' interviewing skills are now commonly evaluated with standardized patient-based assessment methods. Four pairs of instructors at Nihon University School of Medicine used objective structured clinical examinations to evaluate the medical interviewing skills of 122 fifth-year medical students. The results were then analyzed to improve the accuracy of rating with objective structured clinical examinations. Interrater variability was significant among the two pairs of instructors. Variability was greatest when instructors evaluated a student's performance but was minimal when they judged whether a student had carried out a task. The number of standardized patients was 8, with the average score of each standardized patient ranging from 52.5 to 73.3 (full score, 100). These results suggest that the rating process for each item should be further refined and that the standard for evaluation should be clarified.

Locally advanced breast cancer (tumor > 5 cm, widespread infiltration of the skin and muscle, or metastases to lymph nodes) is difficult to resect by surgery, and even when it is resectable, there is a high probability of local recurrence and distant metastasis. Therefore, systemic therapy should be administered first. However, as cutaneous infiltration progresses, the patient's quality of life is impaired by pain, bleeding, presence of exudates, and a foulsmelling odor. Treatment with Mohs paste with systemic therapy can control symptoms associated with skin infiltration and can also be expected to decrease tumor volume.Herein, we report a case in which a tumor was resected following Mohs paste and systemic chemotherapy administration, and the skin defect was reconstructed with a latissimus dorsi myocutaneous flap. We also review the literature for previously reported cases of breast cancer involving Mohs paste.

We report a successful case of aortic valve-sparing root replacement for dilated aortic root after a Ross procedure. A 29-year-old male underwent a Ross procedure when he was 11 years old for congenital aortic bicuspid valve. The right ventricular outflow tract was reconstructed using an autologous pericardium as a single leaflet valve. Aortic root dilatation and moderate aortic valve regurgitation were noted. Further investigation with enhanced computed tomography and ultrasonic cardiography revealed good quality of leaflets and sufficient geometric height, and aortic valve-sparing root replacement was performed. In addition, we performed pulmonary valve replacement with a biological valve. The post-operative course was uneventful and the patient was discharged after 8 days with a completely controlled aortic valve regurgitation. No recurrence of aortic valve regurgitation was observed 1 year later. Because surgical outcomes of congenital heart diseases have improved and more patients have an increasing life expectancy, several other problems were revealed, such as the occurrence of aortic root dilatation after a Ross procedure. Aortic roots may dilate due to arterial pressure; however, valve-sparing procedures may be performed if the volume of the leaflets is sufficient.

Cardiac metastasis from cervical cancer is rare. We herein present a case involving a 54-year-old woman with cervical cancer who was undergoing radiotherapy for left supraclavicular lymph node metastasis. The patient was admitted to the hospital because of shortness of breath. Transthoracic echocardiography showed a large mass in the right ventricle. To rescue the patient from circulatory collapse, we surgically resected the intracardiac mass via a right ventricular incision parallel to the posterior descending artery and left anterior descending artery. This approach prevented right ventricular outflow tract obstruction and perioperative pulmonary embolization, which could have led to death. The intracardiac mass was diagnosed as squamous cell carcinoma. After hospital discharge, the patient underwent chemotherapy. An echocardiography performed 3 months postoperatively showed recurrence of the cardiac metastasis, and the patient died 5 months later. Cardiac metastasis in the right ventricle can present as pulmonary embolization. Although rare, most cases of metastasis from cervical carcinoma to the heart have an extremely poor prognosis.