In the future, we will have more aged patients, more cases of bilateral total hip arthroplasty (THA) and more cases of bilateral revision THA. There are not, however, many reports of long-term follow-up of bilateral revision THA. We report a case of bilateral revision THA followed up for 11 years. A 74-year-old woman presented with bilateral painful hip in 1996. She had undergone left THA in 1984 and right THA in 1986 at another hospital. Her JOA(Japan Orthopaedic Association) scores on her first visit (right/left) were 32 points/31 points. Plain radiographs revealed a clear zone in her bilateral proximal femur. We diagnosed her as having looseness of bilateral THA. She required bilateral revision THA and underwent left revision THA (Charnley) in January 1997 (14 years after the original operation) and right revision THA (Charnley) in July 1997 (12 years after the original operation). After bilateral revision THA, we were able to follow up this patient for 11 years. She had no complaints about her bilateral hip joints, and X-ray examination showed no looseness. The JOA scores and range of motion illustrate the good result achieved for this case.
Right and left ; Tacrine ; Hip ; Arthroplasty ; Serotype eleven

Purpose: The simple conversion ratio of 1：1：1/50 between oxycodone injection (OXJ), morphine injection and fentanyl injection is used at Saga－Ken Medical Centre Koseikan. However, there are no studies on the validity of the simple conversion ratio. Methods: A total of 18 patients with opioid switching to OXJ using the simple conversion ratio were reviewed in this investigation. We surveyed the change in the numeric rating scale (NRS) and adverse effects before and after opioid switching. Result: The average period needed to reach a stable dose of OXJ was 0.6 days. The reasons of opioid switching to OXJ were the uncontrolled cancer pain in 11 patients, the impossibility of oral administration in 6 patients, the drowsiness in 1 patient. The average NRS decreased from 3.3 to 1.1 in 11 patients with uncontrolled cancer pain (p＝0.007). No obvious change in the NRS was observed in 6 patients with the impossibility of oral administration. In 18 patients, there was no significant difference in adverse effects before and after opioid switching. Conclusion: These results indicate that the simple conversion ratio could be safety for opioid switching between OXJ and other opioid in cancer pain treatment.

A total of 78 patients were operated on for senile cataract in our hospital in 1985. The number almost doubled to 142 in 1992, more than 90 percent of whom received the intraocular lens. We asked each patient postoperatively to submit a questionnaire, and found the greatest inconvenience suffered before surgery was the difficulty in reading the letters. Patients with senile cataract have anxiety due to extremely weak eyesight, therefore, we believe it is very important for them to receive orientation before the operation. Until recently, we used the B5-sized (10.12″×7.17″) leaflet for a guide to the operation, but the type was too small for them to read. We renewed the guide by using a F8-sized (17.95″× 14.96″) sketch book. We put them in the sickrooms Just before they patients left our hospital, we asked them for their opinion about the guide. 90 percent of the patients said that they were satisfied with the size of the type, all of them said that the contents are easy to understand, and 50 percent said they read the guide more than twice.
In conclusion, we found that the sketch book, full of illustrations, was quite convenient for senile patients and read repeatedly. It was also a great help to them, because it gave them encouragement and made it easy for them to prepare themselves for the operation.

Background/Aims: Image-enhanced endoscopy can detect superficial oro-hypopharyngeal squamous cell carcinoma; however, reliable endoscopy of the pharyngeal region is challenging. Endoscopy under general anesthesia during transoral surgery occasionally reveals multiple synchronous lesions that remained undetected on preoperative endoscopy. Therefore, we aimed to determine the lesion detection capability of endoscopy under general anesthesia for superficial oro-hypopharyngeal squamous cell carcinoma. Methods: This retrospective study included 63 patients who underwent transoral surgery for superficial oropharyngeal squamous cell carcinoma between April 2005 and December 2020. The primary endpoint was to compare the lesion detection capabilities of preoperative endoscopy and endoscopy under general anesthesia. Other endpoints included the comparison of clinicopathological findings between lesions detected using preoperative endoscopy and those newly detected using endoscopy under general anesthesia. Results: Fifty-eight patients (85 lesions) were analyzed. The mean number of lesions per patient detected was 1.17 for preoperative endoscopy and 1.47 for endoscopy under general anesthesia. Endoscopy under general anesthesia helped detect more lesions than preoperative endoscopy did (p<0.001). The lesions that were newly detected on endoscopy under general anesthesia were small and characterized by few changes in color and surface ruggedness. Conclusions Endoscopy under general anesthesia for superficial squamous cell carcinoma is helpful for detecting multiple synchronous lesions.

To help medical doctors practicing Kampo medicine suggest appropriate acupuncture treatments for individ­ual patients, a study group made up of 7 acupuncturists and 5 medical doctors developed an acupuncture cur­riculum. The group provided a learning program based on the curriculum for 16 medical doctors in charge of outpatient Kampo services in a research institute. The learning program consisted of a lecture and practical training, and a total of 4 sessions were held. At the end of each session, a test was conducted to examine the participants' level of understanding. After the completion of the learning program, a questionnaire survey was conducted to confirm the usefulness of the acupuncture curriculum for the practice of Kampo medicine. The mean number of participants per session was 10.8 ± 1.3. The mean test score was 9.3 ± 0.5 (full score : 10). In the questionnaire, 14 out of the 16 (88%) answered that the acupuncture curriculum was useful or relatively useful for the practice of Kampo medicine. On comparing the numbers of new acupuncture patients with a his­tory of outpatient Kampo service use before and after the acupuncture curriculum, there was a 1.8-fold increase after it. The results support the usefulness of the acupuncture curriculum to understand acupuncture and practice Kampo medicine. Further evaluation is necessary.