A 64-year-old female who had suffered from rheumatoid arthritis (RA) for many years was admitted to our hospital because of acute abdominal pain and diarrhea. She was diagnosed with RA, Sjögren syndrome and protein-losing enteropathy (PLE) with GI tract amyloidosis. She was treated with total parenteral nutrition, prednisolone, tranexamic acid and a variety of Kampo medicines, for example: kanzo-syashin-to, keishi-kashakuyaku-shoukyou-ninjin-to, and bushi-kobei-to. However, diarrhea continued and paralytic ileus occurred. Then she was treated with Ubai-en, which is known as an anti-ascarid drug or anti-diarrheic drug. Ubai-en was effective on her diarrhea in 2 weeks. This suggests that Ubai-en may be an effective treatment for PLE.

Extracardiac Conduit Repair (ECCR) is conventionally selected for the Tetralogy of Fallot (TOF) with unusual coronary artery distribution. However, in recent years conduit obstruction has been an important factor. Recently, we select the Right Ventricle Outflow Tract Reconstruction (RVOTR) using direct anastomosis between PA and RV as much as possible. In this paper, RVTOR was compared with ECCR. RVOT stenosis was relieved sufficiently and the ventricular function was well maintained after both surgical methods. We concluded that RVOTR should be selected instead of the ECCR because of the conduit obstruction.

We reported that Interferon (IFN) induces the analogous state of the initial stage of Yang disease with ectodermal symptoms (tai yang bing). Flu-like symptoms from IFN treatment were reduced or disappeared with Mao-to and Dai-seiryu-to. We consider that flu-like symptoms induced by IFN can be a symptomatic model of hyper-functioning condition of tai yang bing. Pulse of sinking and deficiency was seen in all five patients with the symptoms of having caught a chill. These results suggest that there is the possibility that pulse of sinking and deficiency is seen in the very early stage of tai yang bing.

This study was designed to clarify the usefulness and pitfalls of hypothermic management after Fontan's operation. Twenty-five patients who underwent Fontan's operation and received hypothermic management in an acute postoperative phase from 1974 to 1991 were divided into two groups; the alive (S) group and the dead (D) group. The lowest rectal temperature during the procedure was 32°C on average. There were no significant differences in preoperative indices of pulmonary circulation and renal function. After rewarming, PaO₂ and daily urinary output were increased and central venous pressure decreased significantly in the S group. In all S group patients, urinary output was increased during hypothermia irrespective of peritoneal dialysis. Anuria occurred 2 days on average after induction of hypothermia in D group. Urinary output in D group decreased significantly for 4 days compared to S group. On the other hand, it was possible to save two patients who underwent take-down of Fontan's operation within 6 hours after the onset of anuria. We conclude that hypothermic management is useful in serious cases after Fontan's operation and that daily urinary output in relation to body weight during hypothermia is most important as an index of post operative circulation.

Fifth-year medical students at the Yamaguchi University School of Medicine must pass an objective structured clinical examination (OSCE) before beginning bedside learning. Because the OSCE is performed over 3 days, examinees on later days are suspected of having an advantage over those tested on early days. In this study, mean values for each day's scores by one examiner were statistically compared in stations of the medical interview to investigate the difference in scores obtained on each of the OSCE days. In addition, for stations at which one student was evaluated by two examiners, their scores for each student were compared statistically in the same manner. We found no significant day-todaydifferences in mean values of the scores over the 3 examination days. However, significant differences were found between the two examiners' scores in 2 of 3 stations for the medical interview. Although there were no differences in scores among participants during the 3-day communication OSCE, examiner's evaluations and formats should be standardized for OSCE stations.

OBJECTIVE: Optimal debulking in interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) has been reported as a prognostic factor for patients with ovarian cancer. However, the identification of microscopic residual disease (MRD) using visualization and palpation is subjective. Peritoneal washing cytology (PWC) during IDS is an easy-to-implement, objective approach for assessing disease status, although its clinical relevance and association with MRD is not known. The aim of this study was to evaluate the efficacy of PWC during IDS. METHODS: In total, 164 patients diagnosed with ovarian cancer at our institution were retrospectively evaluated, including 64 who had received NAC. Seventeen patients had undergone an exploratory laparotomy followed by NAC, while the remaining patients were diagnosed based on imaging, peritoneal cytology, and tumor markers. The PWC was performed before intraperitoneal observation at laparotomy during IDS. RESULTS: NAC-treated patients had stage III–IV disease. IDS was performed in 78.1% of NAC-treated patients. Seventeen patients (26.6%) were PWC-negative and 33 patients (51.6%) were PWC-positive. Fourteen patients (21.9%) had progressive disease and were ineligible for IDS. The median overall survival of the PWC-negative, PWC-positive, and non-IDS groups was 47, 18, and 5 months, respectively. The differences were significant (p < 0.01). PWC was an independent prognostic factor in the multivariate Cox regression analysis (p < 0.001). CONCLUSION: PWC during IDS may be a prognostic factor for NAC-treated patients with ovarian cancer. PWC may be more useful than visualization and palpation in IDS for determining the presence of MRD.
Biomarkers, Tumor ; Drug Therapy* ; Humans ; Laparotomy ; Neoadjuvant Therapy ; Ovarian Neoplasms* ; Palpation ; Prognosis ; Retrospective Studies