This paper describes the clinical characteristics of 14 cases of malignant melanoma treated in our department during a period of five years from 1997 to 2001 and their prognosis. Excluding one case whose stage could not be defined, five cases recognized at the early stage have survived, and six cases out of eight at the progressive stages were dead within one year after their first visit. When it came to the clinical characteristics, nine cases were primary cutaneous melanomas and five cases were metastatic carcinomas. Acral lentiginous melanomas, histopathologically the most common type of melanoma in Japan, were found in seven cases of the total 14 (50%). Most of the patients were aware of the primary lesions but left them untreated. Generally speaking, malignant melanoma grow rapidly and prognosis is poor because the cure rate by chemotherapy is low. To realize earlier detection and treatment, we thought it is crucial to educate the public, have the general practitioners understanding more about the malignancy of the skin neoplasm and to build up a collaborative relationship between medical professionals.
Melanoma ; seconds ; clinical aspects ; prognostic ; Clinical

  The author reported 2 cases of traumatic ulcer on penis. One case showed a remarkable necrosis and infection on penis after the patient was kicked in the crotch during a fight. The other case revealed a massive necrosis of penile skin associated with purpuric change of scrotal skin after excessive exercise. Conservative treatment failed to improve the skin ulcer of both patients, therefore we carried out a debridment and mesh skin graft. Mesh skin grafts, instead of sheet skin grafts, were used. They proved to be applicable to the genital area, particularly to the penis without any post-operative functional troubles including difficulty in passing urine.

Objective: We performed a meta-analysis to examine the effectiveness of face masks for preventing influenza infection.
Methods: A literature search was conducted to identify clinical trials that compared the incidence of influenza infection among family members with and without the use of antiviral face masks; some trials also contained the use of hand hygiene in the intervention group. Data from each trial were combined using a random effects model with the DerSimonian-Laird method to calculate pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs).
Results: The meta-analysis included seven randomized controlled trials that met our inclusion criteria. With the use of antiviral face masks, the pooled ORs (95% CIs) of laboratory proven infection were 0.69 (0.22–2.18). The pooled ORs (95% CIs) of influenza-like illness (ILI) were 1.07 (0.65–1.78). With the use of antiviral face masks and concomitant hand hygiene, the pooled ORs (95% CIs) of laboratory proven infection were 0.70 (0.35–1.39) in early intervention cases, and 0.93 (0.66–1.30) in all cases. The pooled ORs (95% CIs) of ILI were 1.01 (0.47–2.19) in early intervention cases, and 1.06 (0.53–2.13) in all cases.
Conclusion: No statistically significant differences were detected in the incidence of influenza infection by wearing antiviral face masks, suggesting that distribution of face masks in primary care settings may not be enough to prevent influenza-like illnesses amongst family members.

The optimal timing of cardiac surgery for infective endocarditis in patients with severe brain complication remains unclear. We present here the successful surgical treatment of a case of infected mitral endocarditis with intractable heart failure, disseminated intravascular coagulation (DIC), and cerebral infarction with hemorrhage. A 37 year-old woman who received chemotherapy for breast cancer developed mitral infective endocarditis perhaps caused by infection of the implanted central venous access device and was referred to our hospital for an emergency operation. On admission, she had a mild fever and showed motor aphasia and right-sided hemiplegia. Brain CT scan findings revealed a cerebral infarction in the area of the left middle cerebral artery and a cerebral hemorrhage in the right occipital lobe. Echocardiography showed severe mitral regurgitation with huge mobile vegetation. Chest X-ray revealed severe pulmonary congestion and laboratory data showed DIC. After the mitral valve replacement with a bioprosthetic valve following complete excision of infected tissue, she was extubated on the first postoperative day with dramatic improvement of infectious signs and heart failure. Postoperative brain CT showed a new small brain hemorrhage, but no aggravation of the preoperative cerebral lesion. After she underwent surgical drainage for brain abscess on the 15th postoperative day, her postoperative course was uneventful. Even though this report is limited to a single case, only aggressive and prompt surgical intervention could relieve the intractable conditions in such a patient with extremely high risk.

[Objective] There are two types of image the students have towards elderly people, positive and negative, and it is thought to be difficult for students to interact with elderly people when negative images are the most powerful. Changes in the students' feelings towards elderly people during their time in a nursing home are of importance when assessing the project's educational effectiveness. Given this factor, we have researched the changes in the students' impression towards elderly people before and after the project.
[Method] We carried out a research questionnaire before and after the project.
[Results] Number of valid response was 106 before the project (response rate 89.8%), and 56 after the project (response rate 47.5%). Over half (56%) of the students said that their image of elderly people changed after the project. Negative image comes from realising elderly people's physical disability and difficulty in having conversations with them, and positive image comes from understanding elderly people more by interacting with them.
[Conclusions] Although there was a growing awareness of elderly people and some of the students changed their feeling towards them, there are still students who have a negative image. We think that it is important to provide methods of approaches before and during the project to minimise these negative images.

[Purpose] We report a case treated by acupuncture in a health care facility for the elderly to evaluate the effect of acupuncture on severe pulmonary emphysema.
[Case and methods] A 88 year-old man visited Meiji University of Oriental Medicine Hospital with dyspnea in March 2000 and was diagnosed with pulmonary emphysema. He was hospitalized in October 2002 because his chronic respiratory failure was worsening : oxygen therapy was started. After discharge from hospital, he entered a health care facility for the elderly and acupuncture treatment for lumbago was initiated. Thereafter, acupuncture treatment for dyspnea and stiff shoulder started. He was determined to be grade V according to Fletcher-Hugh-Jones classification of dyspnea. Spirometry of the patient before acupuncture for dyspnea showed 88.0 % in %VC, 38.2 % in FEV 1 %, and 30 % in %FEV 1, and the patient was diagnosed with chronic obstructive pulmonary disease of serious grade. Acupuncture treatment was performed once or twice a week, and acupuncture treatment for dyspnea was performed 21 times (total of 33 treatments).
[Results] Subjective symptoms of lumbago, stagger of the legs, and shoulder stiffness were evaluated with Numerical Scale or Pain Scale. The state of dyspnea was evaluated with Numerical Scale and Borg Scale, and exercise tolerance was evaluated with 6 min of walking. After 33 acupuncture treatments, dyspnea on exertion, exercise tolerance, and the findings of spirometry were not improved. But dyspnea on rest had disappeared with improvement in lumbago, stagger of the legs, and shoulder stiffness. These results indicate that acupuncture as a general treatment is effective for the improvement of dyspnea, especially in elderly patients whose general state of health is not good because of restriction in their ability to exercise in the course of daily life due to dyspnea of exercise such as lumbago, stagger of the legs, and shoulder stiffness.

[Objective] The effect of indirect moxibustion on cold symptoms was examined in elderly subjects living in a nursing home.
[Design] A single-case experimental design that enables clinical trials in small a number of subjects was used in this study.
[Methods] Two elderly subjects living in a nursing house participated for 16 weeks. The experimental periods were allocated at random as treatment periods and control periods of eight weeks each. During the treatment periods, subjects were treated with indirect moxibustion GV 14 and BL 12 (both sides) 3 units each, 3 times a week. Rating scores with 4 and/or 5 grades were used to evaluate common cold symptoms.
[Results] Concerning the presence of common cold, there were no significant differences between the treatment and control periods. Moreover, concerning common cold symptoms, there were no significant differences between treatment and control periods.
[Conclusion] Effects of an indirect moxibustion on the common cold symptoms were not detected in this study. We speculated that the living environment of these subjects and the intensity of stimulation were factors. Furthermore, we suspected that a single-case experimental design was unsuitable for common cold research.

We propose a new video system with four cameras aimed in different directions for use in objective structured clinical examinations (OSCEs) to 1) minimize the examiner's burden and 2) standardize the examiner's evaluation. The system consists of four charge-coupled device video cameras, several microphones, and a video tape recorder. The OSCE of each student was recorded with four cameras simultaneously aimed in different directions so that the student's performance could be viewed and evaluated at the examiner's convenience. Two trials for this system were undertaken at different times. More than 80% of those participating in the trials thought that this system was useful for examining the basic skills of medical students as part of the OSCE, and more than 70% thought that the system would increase educational efficacy. This system may improve the reliability and efficiency of OSCE.

Allergological characteristics were studied on 36 patients with respiratory diseases (30 cases of bronchial asthma, 3 cases of diffuse panbronchiolitis, 3 cases of allergic granulomatous angitis, and 1 case of bronchiectasia) who received spa therapy at Misasa Branch Hospital.
1. The results obtained in patients with bronchial asthma were as follows:
Serum IgE levels were generally low, and many cases with less than 301IU/ml were observed (185±184/ml in female patients and 469±532IU/ml in male patients). The rate of positive skin reactions to various allergens was low in these asthma cases. A rather low rate of positive skin reaction to house dust, in particular, was characteristic. In regard to the rate of releasing chemical mediators such as bistamine and leukotrienes from leukocytes stimulated by Ca ionophore A 23187, a wide variety of cases were observed (histamine, 3.4-51.1%; LT B₄ 9.8-119.8ng/10⁶ cell; LT C₄, 3.5-43.8ng/10⁶ cells). By analyzing cell components in bronchoalveolar lavage fluids (BALF), notable increase in the number of eosinophils were observed especially in male patients, although no other significant differences were shown between the two groups.
2. In those patients with respiratory diseases other than asthma, a remarkable increase in the number of neutrophils in BALF was seen in diffuse panbronchiolitis cases and a remarkable increase in the number of eosinophils in BALF was seen in the cases of allergic granulomatous angities. Serum IgE levels were low in both of these cases.

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.