Introduction: We report a very rare case of paraneoplastic chorea due to lung cancer that was ameliorated by administering tetrabenazine, the only agent used for treating the chorea of Huntington disease. Case: A 92-year-old woman was diagnosed with lung cancer but only followed up, based on advanced age and her own wishes. Given the absence of treatments such as chemotherapy, the lung cancer was not histologically diagnosed. During follow-up, involuntary movements appeared and paraneoplastic chorea was diagnosed. Therefore, she could not live alone and was admitted to a nursing home. Triple combination therapy with valproic acid, tiapride hydrochloride and risperidone was started, and showed efficacy for her symptoms. The symptoms showed amelioration but persisted in the upper extremities, face and neck. A neurologist suggested to her family that tetrabenazine, the only medication used for Huntington’s chorea, might be effective. After admission to our hospital, her family requested tetrabenazine. As both she and her family were suffering mental distress because “she was trapped in a body that moved regardless of her will”, we initiated tetrabenazine at a dose of 12.5 mg/day. After starting tetrabenazine, chorea of the upper extremities, face and neck almost disappeared. Moreover, her speech became clear and she spoke normally with her family. Discussion: Tetrabenazine is a drug receiving insurance reimbursement only for Huntington’s chorea, but was effective in this case. In our view, this treatment palliated the patient’s physical distress and the mental distress that she and her family were experiencing due to her paraneoplastic chorea.

1）Relationship between Japan and The Netherland in Medical Education started when Pompe van Meerdervoort visited Japan in 19th century.
2）Medical Education in The Netherland has been changing based on evidence in medical education since 1970s.
3）Utrecht University adapts Z type curriculum, spends 4 weeks for most of the clinical rotations, and has culture in which residents teach medical students.

The authors carried out neurometry and CMI investigation on 512 subjects in June and July '87. The subjects were devided into four groups according to the CMI criteria by Fukamachi: CMI. I Diagnosed to be normal, II Provisionally to be normal, III Provisionally diagnosed to be neurotic, IV Diagnosed to be neurotic. Comparison was done not only among these groups, but also among age groups and between male and female.
Although there were no great differences among the group I, II and III, each current through F2, F4, F5 and F6 significantly decreased from the group I to IV (p<0.01). A similar tendency was seen in F2 and F6 of the male subjects in each age group, but no tendency in the female subjects.

The lower one-third point of a line connecting the posterior superior iliac spine and the middle of the lower margin of the ischial tuberosity is used as the acupuncture point to the pudendal nerve. The present study anatomically examined the positional relation between a needle inserted in the acupuncture point and the pudendal nerve as well as examined the projection region of the nerve to the body surface, using the bilateral pudendal nerves of 18 Japanese cadavers.
The needle inseted in the acupuncture point to the pudendal nerve missed the nerve caudally or laterocaudally in many cases, but with twelve cases directly pricking the caudal portion of the nerve. The pudendal nerve lying on the sacrospinous ligament was projected just on or lateral to a line connecting the posterior superior iliac spine and the medial edge of the lower margin of the ischial tuberosity, and in rostro-caudal direction the pudendal nerve was situated in a range 50 to 60% from the top of that line. The height of the sacral cornua corresponded to that of the rostral half of the pudendal nerve lying on the sacrospinous ligament or that more rostral than the rostral tip of the nerve, and the height of the lower tip of the coccyx corresponded to that more caudal than the caudal tip of the nerve.

To improve the long-term clinical results of coronary artery bypass grafting, we evaluated our graft selections and the designs that were used, in relation to the quality of the anastomoses and patient backgrounds. We retrospectively reviewed the records of 505 patients who underwent isolated coronary artery bypass grafting involving more than 3 vessel reconstructions between May 1999 and March 2007. Neither the selection of a saphenous vein graft nor that of an internal thoracic artery graft was a statistically significant cardiac event factor. The cardiac event-free rates (at 1 and 5 years) according to anastomotic site were as follows : a) 92.9% and 76.6% for a radial artery graft and 93.2% and 83.9% for a saphenous vein graft at the right coronary artery ; b) 93.0% and 70.3% for a radial artery graft and 95.1% and 80.4% for a saphenous vein graft at the distal right coronary artery ; c) 94.5% and 77.8% for a left internal thoracic artery graft and 93.0% and available for a right internal thoracic artery graft at the left anterior descending artery ; d) 96.5% and 79.8% for a radial artery graft, 93.0% and 78.0% for a saphenous vein graft, and 91.3% and 75.6% for an internal thoracic artery graft at the left circumflex artery. Significant cardiac event factors were dialysis (risk ratio, 5.28 ; p<0.001), the use of a right gastroepiploic artery graft as the inflow blood vessel of a radial artery graft (risk ratio, 5.75 ; p=0.02), and off-pump coronary artery bypass grafting (risk ratio, 1.62 ; p=0.03). As a tendency toward more frequent early-stage cardiac events among patients with radial artery grafts was confirmed, careful follow-up is important for this group of patients. Right gastroepiploic artery grafts should be chosen carefully with full consideration of the anastomotic site quality and the flow demand, as the blood supply capability of such grafts is limited. For dialysis patients, although the mid-term clinical results are still being evaluated, a saphenous vein grafts have bwer early-stage of cardiac events. In younger patients, off-pump bypass is not the only treatment method available, and revascularization with extracorporeal circulation can reliably achieve good long-term results. To improve the long-term clinical results for coronary artery bypass grafts, graft selection and design should be carefully considered on a case-by-case basis. The quality of the anastomotic site and the patient background are important factors, especially with regard to the selection of a saphenous vein graft or a right gastroepiploic artery graft. A radial artery graft should be selected for use in relatively young patients because of its superior patency. Off-pump bypass may not necessarily be the treatment of choice in some cases because revascularization using extracorporeal circulation can reliably achieve better long-term results.

Periannular abscess and mycotic aneurysm due to infective endocarditis are very difficult conditions to treat surgically. Beginning in 1983, we introduced a translocation technique on 9 such cases. In particular, 7 patients who underwent a new sutureless translocation technique all showed an uneventful course and were discharged. There was no hospital death, but four patients died in the late period (2 heart failure, 1 ventricular tachycardia and 1 thrombotic valve). The sutureless translocation method consists of insertion of a composite valve into the ascending aorta (a ring was detached from an intraluminal ringed graft and a prosthetic valve was sutured to it at that point) and coronary artery bypass grafting to the right and left coronary arteries. Our new technique was simple, required only a short aortic clamping time (mean 173.9min) and there was no significant bleeding. This new translocation technique provides a solution for the treatment of periannular abscess and mycotic aneurysm due to infective endocarditis.

Nonvariceal upper gastrointestinal (GI) bleeding is one of the most common reasons for hospitalization and a major cause of morbidity and mortality worldwide. Recently developed endoscopic devices and supporting apparatuses can achieve endoscopic hemostasis with greater safety and efficiency. With these advancements in technology and technique, gastroenterologists should have no concerns regarding the management of acute upper GI bleeding, provided that they are well prepared and trained. However, when endoscopic hemostasis fails, endoscopy should not be continued. Rather, endoscopists should refer patients to radiologists and surgeons without any delay for evaluation regarding the appropriateness of emergency interventional radiology or surgery.
Emergencies ; Endoscopy ; Equipment and Supplies ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Hospitalization ; Humans ; Mortality ; Radiology, Interventional

We have used two methods for education of pathology at the Yokohama City University School of Medicine: 1) clinicopathological conferences on autopsy cases and 2) journal club using “Case Records of the Massachusetts General Hospital” published in the New England Journal of Medicine. Both methods are extremely effective for stimulating students' enthusiasm for learning, improving presentation skills, and consolidating the minds of students as future medical staff members. Furthermore, journal club enhances the affinity for reading medical English.

The rectal tonsil is a rare polypoid lesion exclusively found in the rectum and is considered a reactive proliferation of the lymphoid tissue. Although this lesion is benign, we recommend that it should be differentiated from carcinoid or polypoid type of mucosa-associated lymphoid tissue lymphomas, based on gross findings. In this case report, we describe a case of rectal lesions with a unique appearance in a 41-year-old man. Colonoscopy revealed two 5-mm-sized nodules located opposite from each other on the left and right sides of the lower rectum. Endoscopic mucosal resection was conducted. Histopathologically, both lesions were mainly located in the submucosa and consisted of prominent lymphoid follicles with germinal centers of various sizes. No immunoreactivity of Bcl-2 was seen in the germinal centers. Immunohistochemical staining for kappa and lambda light chains revealed a polyclonal pattern. Therefore, these lesions were diagnosed as rectal tonsils.
Adult ; Carcinoid Tumor* ; Colonoscopy ; Germinal Center ; Humans ; Lymphoid Tissue ; Lymphoma, B-Cell, Marginal Zone* ; Palatine Tonsil* ; Rectum ; Twins*