The most common mandibular fractures involve the condyloid process. It is necessary to diagnose and treat the cases of mandibular condylar fracture carefully, because the temporomandibular joint is complicated anatomically and functionally.
A clinical study was made in 72 patients with mandibular condylar fracture referred to the Department of Oral and Maxillofacial Surgery, Gunma University Hospital from April 1991 to March 1995.
The results were as follows:
1. Mandibular condylar fracture occurred in 42.6% of the mandibular fractures. The male-to-female ratio was 2 to 1. The largest age group of patients was from 10 to 19 years (31.9%).
2. The most frequent cause of the injury was falls (50.0%). Of all the patients 84.7% visited our department within 2 weeks after injury.
3. Fifty-nine cases (81.9%) were unilateral fractures and 13 (18.1%) were bilateral. Of the total, thirty-six cases (50.0%) were combined with other fractures of the mandible and/or maxillofacial fractures.
4. As for the fracture level and position of fragment, fractures with deviation were most frequently observed in the subcondylar region (20.5%).
5. Of the 67 cases treated at our department, 62 (92.5%) were treated with a conservative therapy for mandibular condylar fracture, primarily by maxillomandibular fixation followed by functional rehabilitation. The remaining 5 (7.5%) cases were treated surgically.
6. Fifty-nine patients were recalled after more than 6 months. As for the treatment outcome in 54 nonsurgical cases, 46 cases (85.2%) showed excellent prognosis, 6 (11.1%) had disorder I and 2 (3.7%) had disorder II. In 5 surgical cases, 3 cases showed excellent prognosis and 2 had disorder II. Most of the patients treated nonsurgically had relatively good results.

　　Serious aggravation of de novo hepatitis B caused by revitalization of the hepatitis B virus in HBs antigen negative, HBs antibody or HBc antibody positive patients has recently been reported. The incidence of de novo hepatitis B infection which occurs in patients undergoing immunosuppression or chemotherapy develops at times into a medical lawsuit. To cope with the situation, the Ministry of Health, Labour and Welfare (MHLW) issued the guideline for the management of hepatitis B infective occurring in patients treated with immunosuppressive therapy or chemotherapy (the revised edition). In our institution, the Chemotherapy Committee discussed our measures against de novo hepatitis B, and determined to carry out the in-hospital examination of the HBc antibody to provide reliable safe and speed medicine.　　During the investigation period, HBc antibody was examined for confirmation of anamnesis of Hepatitis B in patients receiving chemotherapy, immunosuppressive medicine, examination of infectious disease before blood transfusion and examination of viral hepatitis. In our institution, the number of cases which are adapted for the MHLW guideline (the revised edition) was 15 of 218 examples, and as a result HBs antigen negative, HBs antibody or HBc antibody positive patients, who could not be found in the routine screening for HB infection turned out to be not a few.　　Since it was expected that the number of patients undergoing immunosuppression and chemotherapy would continue to increase in the future, the necessity for observance of guideline was suggested to provide relief, safety in medical treatment.

Thymic epithelial tumors are treated with reference to the Masaoka staging system. In 1999, the World Health Organization published a histologic classification of thymomas. The WHO classification was revised in 2004. There is a general consensus that it is as important a prognostic factor in primary thymoma and thymic carcinoma patients as the Masaoka staging system. In the present study, a total of 25 cases of thymic epithelial tumors (21 thymoma cases and 4 thymic carcinoma cases) treated from 1991 through 2005 in our hospital were reclassified based on the new WHO classification. The thymoma cases consisted of four at Masaoka's stage I, 11 cases at stage II and six cases at stage III, whereas according to the WHO classification they were categorized into seven B1 type tumors, eight B2 type, four B3 type and two unclassifiable cases. Of the four thymic carcinoma cases, one belonged under Masaoka's stage II, another under stage III and two under stage IV. One thymic carcinoma case resulted in death. There were no fatalities from thymomas. Most of the thymomas at Masaoka's stage III came under WHO type B2 and B3, showing a high incidence of local infiltration. Since either the WHO classification or the Masaoka staging system is an important factor for determining the course of treatment, we concluded that both should be utilized clinically.
Diagnostic Neoplasm Staging ; Classification of information ; seconds ; Carcinoma ; Thymic

　　Procalcitonin (PCT) is a diagnostic marker of severe bacterial infection and sepsis. Sepsis can lead to shock, multiple organ dysfunction syndrome, DIC and death, thus making the early diagnosis of sepsis very important. Many markers (e.g., CRP, blood culture, endotoxin) of infection largely lack in clinically important property. Therefore, clinical PCT-level measurement has been accepted worldwide in the last five years. Our hospital reports PCT within 30 minutes after the collection of blood samples all day long. In this study, we assess the clinical utility of PCT for early diagnosis and treatment with specimens tested by both PCT and blood cultures. PCT assay and blood culture demonstrated the diagnostic concordance rate stood at 58.96%. We presume that the cause of its discrepancy is a lack of sensitivity of blood culture and an increase in PCT by the invasiveness of other factors. On the other hand, patients with PCT‹0.5 ng/mL are unlikely to suffer from severe bacterial infection and sepsis. Thus, PCT could be one of Vital Signs and useful for early diagnosis in the emergency care.

Objective: In this study, we surveyed the attitudes of community pharmacists regarding oral antidiabetic drugs that need to be continuously administered, focusing especially on recently available oral‐combination antidiabetic drugs, in terms of their positioning and medication adherence.　In addition, we identified relevant problems from the survey results and discussed the proper use of the combination drugs.Methods: We conducted a questionnaire‐based survey on health insurance‐covered dispensing pharmacies belonging to Kanazawa, Koga, Takasaki, Hitachi, and Hitachinaka Pharmaceutical Associations via fax or post from September 1, 2017 to November 30, 2017.Results: The overall response rate to the survey was 29.8%.　Although combination drugs were considered useful in terms of improved motivation to take medication, i.e., medication adherence, there were also opinions claiming that combination drugs are not particularly useful due to the following reasons: there are problems in discarding residual drugs, they are less economical than individual drugs, it is difficult to ingest tablets of combination drugs because of their large size, it is difficult to adjust doses of combination drugs, and medication adherence does not change because of concomitant drug use.Conclusion: Based on the results there was the opinion that a combination oral diabetes drug improves medication adherence but problems such as the generation of leftover unused drugs due to switching and an increase in the risk of overuse when taking medication was pointed out.　It is necessary for pharmacists to give advice in recognition of the risks with each active ingredient of the oral diabetes combination drug and to continuously monitor any development of side effects.　Furthermore, as with other diabetes remedies, pharmacists need to advise regarding the patient's lifestyle as well as monitor laboratory test results such as kidney function.　The patient's swallowing ability is also an important consideration at the time of medication instruction.

Objectives: “Adverse Drug Reaction Relief System” (hereinafter called the Relief System) has been established to provide prompt relief to patients experiencing health damage caused by adverse drug reactions. Since 2018, the Relief System has required community pharmacies that acquire additional points as local support system to actively report adverse drug reactions. Here, we investigated the recognition and utilization of the relief system among community pharmacists.Method: A questionnaire survey was conducted among community pharmacists between August 1 and September 30, 2019.Results: The survey achieved a response rate of 58.1%. The recognition rates of the relief system and Pharmaceuticals and Medical Devices Agency (PMDA) as its application destination were 98.9 and 74.5%, respectively. Of the community pharmacists, 2.6% had experience in utilizing the relief system; and 8.8% did not want to recommend the utilization of the relief system for patients mainly because of the “low recognition of the system” and “the complicated and troublesome preparation of the necessary documents such as medical certificates.” The community pharmacists who acquire additional points as local support system, compared with those who do not, achieved significantly higher rates in two items, including that for preparation of the documented procedures pertaining to adverse drug reactions.Conclusion: Despite the high recognition of the relief system among community pharmacists, the percentage of pharmacists with experience in actually utilizing the relief system and applying to the PMDA was low. One reason that the use of the relief system was not widespread was the low recognition particularly of the destination and procedures of reports on adverse drug reactions. In the future, educational campaigns to improve pharmacists’ comprehension of the relief system will be needed. Moreover, pharmacists must play a central role in enhancing the recognition of the public relief system and promoting medical safety.