We report a case of spindle cell type medullary carcinoma of the thyroid in a 77-year-old man. Fine needle aspiration cytology showed numerous spindle cells without inflammation and hemorrhage. The spindle cells were uniform and exhibited no malignant features. Immunocytochemistry was positive for carcinoembryonic antigen and calcitonin, and the tumor was diagnosed as spindle cell type medullary carcinoma. There are various histological subtypes of medullary carcinoma, and diagnosis by cytomorphology alone is difficult. Preservation with LBC fixative was helpful for diagnosis by immunocytochemistry in this case.

I. Purpose:
Individual differences in effects of acupunctual anesthesia during uterine endometrial biopsy were tested by means of the modified methods of Cornell Medical Index (CMI-test).
II. Methods:
Two hundred forty eight patients were examined for this tests for three years since Dec. 1982. Needles for acupuncture were applied into Ashisanri (Zusanli) and Saninko (Sanyinjiao.) After careful recognition of sufficient Tokkuki (The chih) following acupuncture, stick-points of needles were lead to Neurometer NAJ.
After approximately 30 minutes of electrical induction, biopsical operation were started. Anesthetical effectiveness of acupuncture were confirmed as follows:
(1) During biopsy, facial features what to speak, body movements, sweating, and condition of anesthesia of patients were observed and checked on the specialized score table in order from zero to 28 points. Acquired points less than 11 were indicated as effective anesthesia.
(2) Following operation the inquires about grade of pain feeling during biopsical procedures were carried out and then they were classified into four ranks: no pain, slight pain. moderate pain and strong one. The last two were considered as no effective.
(3) In addition to the above mentioned two, CMI-test was performed.
III. Results:
From score points; The effectiveness was as follows, normal type group, 79%; subnormal, 77%; breaking down of autonomic nerve system, 44%; neurosis, 86%; psychosomatic type, 68%.
On the other hand, from inquires the following were obtained: normal 65%; subnormal 50%; autonomic nervous disorder, 19%; neurosis, 41% and psychosomatic type, 37%.
There is no critical differences between both results from score points and inquiry system.
It is concluded from results that acupunctual anethesia were not much effective in patients who have disorders of autonomic nervous system and psychosomatic system, while much effective in patients with neurosis.

A 11-year-old boy was admitted to our hospital with a diagnosis of the progressive residual coarctation of the aorta, severe left ventricular hypertrophy and dilatation of the ascending aorta. He had previously undergone 3 operations for coarctation of the aorta. We performed ascending-to-descending aortic bypass through a median sternotomy for residual coarctation of the aorta. Partial cardiopulmonary bypass (CPB) was established via the right femoral artery and right atrium. A cephalad retraction of the heart with a heart positioner and a longitudinal pericardial incision over the descending aorta allowed excellent exposure of the aorta through the posterior pericardium. The graft was anastomosed to the ascending aorta and descending aorta. The graft was brought around the right lateral aspect of the right atrium and through to the anterior aspect of right pulmonary veins and inferior vena cava. The bypass graft size was 14 mm in diameter. The CPB time was 134 min, and operation time was 232 min. The postoperative course was uneventful, and he did not suffer from paraplegia. His blood pressure postoperatively normalized without medication. He was discharged 20 days after surgery. The ascending-descending aortic bypass through a posterior pericardium approach is a safe and effective option for relieving residual coarctation and improving hypertension, for patients who have complex coarctation requiring surgical correction. However, because of his young age (II) it is necessary to follow him up carefully.

The most common form of malignant transformation developing from a mature cystic teratoma is squamous cell carcinoma, representing 80% of malignant transformations, while adenocarcinoma accounts for approximately 5%. Because of this rarity, few reports exist of preoperative diagnosis of this tumor by magnetic resonance imaging, in particular with fat suppression techniques. Here, we report magnetic resonance imaging findings and clinical features of a 79-year-old woman with mucinous adenocarcinoma arising from a mature cystic teratoma (measuring 5x6 cm), classified as surgical stage IA. Because of the poor prognosis of malignant transformation, when mature cystic teratomas are detected (even smaller than 5 cm tumor size) in postmenopausal women, serum tumor marker carcinoembryonic antigen levels and fat-suppressed magnetic resonance imaging may be potential indicators of malignant transformation.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Aged ; Carcinoembryonic Antigen ; Carcinoma, Squamous Cell ; Early Diagnosis ; Female ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Teratoma

Studies have shown that postoperative disseminated intravascular coagulopathy (DIC) occurs in some patients with cardiac disease, acute aortic dissection, and ruptured abdominal aortic aneurysm. The specific pathophysiology of DIC in these settings are related to low cardiac function, shock, infection and sepsis as well as activation of coagulation cascade in the aneurysm sac or dissected aorta. A soluble form of recombinant human thrombomodulin (rhsTM) was approved in 2008 for the treatment of DIC. This report describes the safety and efficacy of rhsTM for the treatment of DIC in patients with cardiovascular disease operated in our department. Between October 2010 and March 2012, 35 patients with postoperative DIC were treated with rhsTM. Diagnosis of DIC was based on the diagnostic criteria for DIC of the Japanese Association for Acute Medicine (JAAM). During the first 6 months of the study period, after a diagnosis of DIC was made, the patients were treated with gabexate mesilate and antithrombin III, and if patients showed no improvement with conventional treatment, they received rhsTM for 6 days. During the last 10 months of the study period, patients received rhsTM soon after a diagnosis of DIC was made. Twenty seven patients survived for 28 days after rhsTM treatment, and the mortality rate was 22.9% (8/35). Patients who survived showed improvement in acute phase DIC scores, FDP levels, D-Dimer, fibrinogen and platelet counts during rhsTM treatment, but no improvement was observed in patients who died. No serious adverse events were found up to 28 days after the start of rhsTM administration. In conclusion, this study showed no adverse events of rhsTM, and further studies are needed to confirm that rhsTM administration is an effective therapeutic modality in the management of DIC after cardiovascular surgery.

Background: Alopecia areata (AA) is considered complex genetic and tissue-specific autoimmune disease. We recently discovered a nonsynonymous variant in the coiled-coil alphahelical rod protein 1 (CCHCR1) gene within the AA risk haplotype. And a water avoidance stress test on CCHCR1 knockout mice induced AA-like lesions. Objective: To investigate the difference clinical findings of AA in patients with the CCHCR1 variant and without. Methods: We conducted a retrospective analysis of the data from 142 AA patients. Among these patients, 20 (14.1%) had a variant of CCHCR1. We evaluated the sex distribution of the patients, age at onset, distribution of the clinical types, prevalence of a positive family history of AA, prevalence of association of AA with atopic dermatitis, response to steroid therapy, and recurrence rate. We used multivariate logistic regression analysis and Fisher’s exact test for statistical analysis. We also investigate electron microscopic observations of hair samples with the CCHCR1 variant and without. Results: The results showed a significant correlation between the CCHCR1 variant and the recurrence rate compared with the variant-negative group (p=0.0072). Electron microscopy revealed abnormalities in the hair shaft structure and hair cuticle in patients with the CCHCR1 variant (p=0.00174). Conclusion Our results suggest that AA with CCHCR1 variant is clinically characterized by a high recurrence rate and hair morphological abnormality.

BACKGROUND/AIMS: The administration of liquid nutrients to patients is often accompanied by complications such as gastroesophageal reflux. To prevent gastroesophageal reflux, high-viscosity liquid meals are used widely, however, it still remains controversial whether high-viscosity liquid meals have any effect on the rate of gastric emptying. The present study was conducted with the aim of determining whether high-viscosity liquid meals had any effect on the rate of gastric emptying and mosapride might accelerate the rate of gastric emptying of high-viscosity liquid meals. METHODS: Six healthy male volunteers underwent 3 tests at intervals of > 1 week. After fasting for > 8 hours, each subject received one of three test meals (liquid meal only, high-viscosity liquid meal [liquid meal plus pectin] only, or high-viscosity liquid meal 30 minutes after intake of mosapride). A 13C-acetic acid breath test was performed, which monitored the rate of gastric emptying for 4 hours. Using the Oridion Research Software (beta version), breath test parameters were calculated. The study parameters were examined for all the 3 test conditions and compared using the Freidman test. RESULTS: Gastric emptying was significantly delayed following intake of a high-viscosity liquid meal alone as compared with a liquid meal alone; however, intake of mosapride prior to a high-viscosity liquid meal was associated with a significantly accelerated rate of gastric emptying as compared with a high-viscosity liquid meal alone. CONCLUSIONS: This study showed that high-viscosity liquid meals delayed gastric emptying: however, mosapride recovered the delayed rate of gastric emptying by high-viscosity liquid meals.
Benzamides ; Breath Tests ; Cross-Over Studies ; Fasting ; Gastric Emptying ; Gastroesophageal Reflux ; Humans ; Male ; Meals ; Morpholines ; Pectins

Objectives：This study investigated the perceptions of regenerative medicine among individuals with spinal cord injury (SCI).Methods：Between October 2019 and February 2020, we interviewed individuals with SCI who had a history of inpatient or outpatient visits to our hospital using a structured questionnaire on regenerative medicine.Results：Ninety-nine participants completed the questionnaires. The mean age was 52.8±14.8 years, with 9.1％ of them being females. The majority of cases included cervical SCI (54.5％), AIS A lesion (63.6％), and traumatic causes (90.9％), and 93.9％ of the individuals had some interest in regenerative medicine for SCI, which is well known to individuals with SCI in the following order：induced pluripotent stem cells (n＝89), bone marrow mesenchymal stem cells (n＝25), and autologous olfactory mucosal transplantation (n＝16). Individuals with SCI chose motor function (65.7％), bladder and bowel function (24.3％), and sensory function (9.0％）when asked to choose only one symptom that required improvement. Individuals with cervical SCI had more interest in regenerative medicine than those with SCI (46.3％ vs. 26.7％). In contrast, the majority of respondents with SCI were concerned about the effectiveness (n＝59) and cost (n＝53) of the treatment. Most participants obtained information about regenerative medicine on television (n＝73), followed by the Internet and/or social networking services (n＝54).Conclusion：Approximately half of individuals with SCI hope that regenerative medicine will restore their ability to walk.

Objective: IgG4-related sclerosing cholecystitis is generally associated with IgG4-related sclerosing cholangitis and presents with diffuse, circumferential thickening of the gallbladder wall. We report a rare case of localized IgG4-related sclerosing cholecystitis without IgG4-related sclerosing cholangitis, which was difficult to differentiate from gallbladder cancer preoperatively.Patient: A 56-year-old man with suspected IgG4-related disease or gallbladder cancer was admitted to our ward. The serum IgG4 level was elevated at 721 mg/dL. Computed tomography (CT) demonstrated focal wall thickening of the gallbladder fundus. Drip infusion cholecystocholangiography with CT revealed no dilation, stenosis, or border irregularity of the bile duct.Results: For diagnostic and treatment purposes, cholecystectomy with wedge resection of the gallbladder bed was performed. The pathological diagnosis was IgG4-related sclerosing cholecystitis.Conclusion: It is difficult to differentiate IgG4-related sclerosing cholecystitis from gallbladder cancer in cases involving localized thickening of the gallbladder wall. In similar cases, surgical resection with cancer in mind might be performed based on present clinical knowledge.