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.

[Aim] Acupuncture has traditionally been used in Japan in the treatment of bronchial asthma and is being increasingly applied. However, although there are many published studies on acupuncture and asthma, few meet the scientific criteria necessary to prove the effectiveness of acupuncture. Therefore, this study presents the clinical results of acupuncture treatment for adult bronchial asthma.
[Design] Single-subject research design (N-of-1 method).
[Setting] Department of Internal Medicine, Acupuncture and Moxibustion Center, Meiji University of Oriental Medicine, Japan.
[Participants] Six patients of both genders (mean age, 49.0 years old) with moderate-to-severe persistent bronchial asthma.
[Intervention] Six patients received 10 sessions of acupuncture treatment (once per week) for 10 weeks. The basic combination of meridian points for the treatment of the patients were LU 1 (Zhongfu), LU 5 (Chize), LU 9 (Taiyan), CV4 (Guanyuan), CV 12 (Zhongwan), BL 13 (Feishu), BL20 (Pishu) and BL23 (Shenshu).
[Measurements] Primary outcome was the symptom of asthma at the end of the 10 treatment sessions. Secondary outcomes were the Dyspnea Visual Analogue Scale (DVAS), respiratory function, Peak Expiratory Flow Rate (PEFR), blood, the use of asthma drugs. The effect of the intervention on eosinophils in blood was assessed.
[Main results] Late effects of asthma patients showed significantly better results compared with the base line on outcome measures after the 10 weeks. In this study, symptoms of asthma and dyspnea VAS in patients with asthma were significantly improved by acupuncture.
[Conclusion] This study indicated that acupuncture was effective in asthma symptoms and respiratory functions.

We report a rare case of a giant celiac aneurysm complicated with nosocomial acute aortic dissection and idiopathic thrombocytonenic purpura (ITP). A 75-year-old man with ITP complained of abdominal swelling. Enhanced computed tomography (CT) showed a giant celiac aneurysm 72 mm in size. Surgery repair was scheduled and platelet count increased by intravenous administration of immunoglobulin. After admission, he complained of back pain. CT showed aortic dissection (DeBakey classification : IIIb) and a celiac aneurysm enlarged to 78 mm. He underwent surgical repair for a giant celiac aneurysm and splenectomy after management with medial therapy.

Chronic obstructive pulmonary disease (COPD) causes severe respiratory dysfunction and severely limits patients' daily activities. We report a case of the patient with COPD whose respiratory symptoms were successfully improved by acupuncture. A 70-year-old man visited Meiji University of Oriental Medicine Hospital complaining of dyspnea during exercise on _??_. Despite strictly controlled medication and a regimen of home oxygen therapy (HOT), his general condition continued to worsen. Then a series of acupuncture treatment was started on _??_. The severity of dyspnea of the patient before acupuncture treatment was determined as level V according to Hugh-Jones classification, and spirometry showed severely disturbed respiratory functions (%VC: 63.5%, FEV₁%: 29.4%, PEFR: 84.8 1/min in the morning and 93.5 1/min at night). The basic combination of meridian points for the treatment of the case was LU1 (Zhongfu), CV12 (Zhongwan), CV4 (Guanyuan), LU5 (Chize), and BL13 (Feishu). The acupuncture needles were retained for ten minutes in each session. The single-subject research design (A-B-A method) was applied to detect the specific effect of the acupuncture treatment on the respiratory functions or the symptoms of the subject. “A” and “B” mean “treatment period” and “no treatment period” respectively. After 60 acupuncture treatments during a 14-month period, both the respiratory symptoms and the VAS for dyspnea showed improvement, which were specifically observed during the intervention period. Improvement was also reflected in the level of the Hugh-Jones classification and respiratory function test. It was suggested that acupuncture treatment might be effective for advanced cases of COPD.

Introduction : We report the effect of adaptive servo ventilation (ASV) treatment on heart failure in a home care setting.
Methods : For eight home care patients aged ≥75 with heart failure, we diagnosed sleep-disordered breathing (SDB) by using a simplified monitor and implemented ASV treatment. We assessed its effect on heart failure by using NT-proBNP. We also assessed its effects on SDB by using apnea hypopnea index (AHI).
Results : Three patients dropped out because they felt fear of putting on the mask. Among the other five patients, we observed a significant decrease rate of NT-proBNP (mean : -0.43, 95% confidence interval (CI) : -0.64, -0.22) after the ASV treatment. With regard to AHI, we observed a decreasing tendency (mean : -20.4 /hour, 95% CI : -41.2/hour, 0.4/hour).
Conclusion : This study suggests that ASV treatment is effective for a treatment of heart failure in a home care setting.

Effects of environmental (cold) stress and aging on cells in monocyte/macrophage lineage were investigated. We demonstrated that immune suppressive states seen in acute cold-stressed mice (8-10 weeks of age) is attributable to FcγRIIbright suppressor macrophages. Serum corticosterone levels were markedly increased in acute cold-stressed mice. In addition, expression of glucocorticoids (GC) receptor mRNA was observed in FcγRIIbright cells from these mice. The increase of FcγRIIbright cells in peritoneal exudate cells caused by acute cold stress was inhibited by adrenalectomy or administration of a saturating amount of the GC antagonist RU 38486 (mifepristone). On the contrary, administration of the GC agonist, dexamethasone, markedly increased the proportion of FcγRIIbright cells in peritoneal exudate cells of control mice. These results suggest that the generation of FcγRIIbright suppressor cells of monocyte/macrophage lineage by acute cold stress was mediated by action of GC through the GC receptor. We likewise found that the proportion of FcγRIIbright suppressor macrophages is increased in aged mice (22-24 months of age). Meanwhile, activated macrophages which function as antigen presenting cells were decreased in aged rats. Both the basal corticosterone concentrations in serum and the expression of mRNA for GC receptor in peritoneal macrophages increased significantly in aged animals, suggesting that these populational and functional changes of macrophages in aged animals were mediated, in part, by the increased basal levels of GC. This is probably being responsible for immunosenescence.
Neisseria gonorrhoeae ; Laboratory mice ; Acute ; Macrophages ; receptor

A 60-year-old male patient visited the Oriental Medicine Research Institute of the Kitasato on ***** because of abdominal discomfort. Hangeshashin-to was administered to him and the abdominal discomfort was relieved. He continued to take Hangeshashin-to from June to August 1997. He had chills, high fever, and fatigue from ********. He stopped Hangeshashin-to and took Shosaiko-to for five days because of liver dysfunction. He was admitted to our hospital on ********. Antibiotics and stronger neo-minophagen C were administered to him. A chest roentgenogram revealed a ground-glass shadow on the left upper lung, and Shosaiko-to was discontinued. The patient began to complain of dyspnea and had fine crackles on the chest. A chest roentgenogram and chest CT showed interstitial pneumonitis. Oral predonisolone therapy was started for hypoxemia and the patient improved. A drug lymphocytes stimulation test revealed that lymphocytes were stimulated by Shosaiko-to and its components, Saiko and Ogon. A chest roentgenogram just before ingesting Hangeshashin-to revealed the interstitial change of the lung. Taken all together, this patient suffered from druginduced hepatitis and pneumonitis as a result of ingesting Hangeshashin-to and Shosaiko-to.

An 80-year-old man felt a loss of strength and sharp pain in both lower limbs while playing gate-ball, consulted a nearby doctor, and was followed up. Because the sharp pains in both lower limbs became aggravated the next day, he was given a previously prescribed medication. Both femoral pulses were absent and acute arterial obstruction of the lower limbs was suspected. A contrast-enhanced CT scan showed a thrombosed infrarenal abdominal aortic aneurysm with a maximum transverse diameter of 37 mm, and both external iliac arteries were contrast imaged by collateral circulation pathways. We diagnosed acute thrombosis of an abdominal aortic aneurysm, and was urgently transported to our hospital. We classified his lower limbs as Balas grade III and TASC classification grade IIb and Rutherford classification grade IIb. He exhibited no abdominal symptoms and since we confirmed the blood flow of his lower limbs, we decided to perform revascularization. An extra-anatomical bypass (axillo-bifemoral bypass) was conducted because he had dementia, and was old. After the operation, myonephropathic metabolic syndrome (MNMS) did not develop, and the patient was discharged on foot on the 16th postoperative day. Acute thrombosis of an abdominal aortic aneurysm is a rare disease. Because the ischemic area widens, often causing serious MNMS after the revascularization, it has a poor prognosis. Here, we report a case in which one such patient was rescued.

The primary aim of this study was to collect the views of physicians and nurses in the regions where community-based palliative care intervention trial, the OPTIM-study, was performed. A content analysis of free comments of the questionnaire survey was conducted. Questionnaires were mailed to 1,763 physicians and 3,156 nurses after the intervention, and 706 and 2,236 responses were obtained, respectively. A content analysis identified 327 free comments from physicians and 737 from nurses. As favorable effects, the categories [Multidisciplinary teams and community networks were established] [Home-based care is widespread] [Medical knowledge and skills are acquired just as those involved in palliative care] emerged. The main effects of the community palliative care program included the establishment of multidisciplinary teams and community networks, development of home-based care, and increasing knowledge, skills, and awareness about palliative care.

The purpose of this clinical investigation is to analyse the growth of the ventricular volumes and the changes of indices of cardiac performance during infancy and childhood. The materials were composed of 129 healthy infants and children (4 months to 13 years of age), who had a history of Kawasaki disease and without any evidence of coronary artery lesion. All the cases underwent cardiac catheterization and cineangiography under sedation. Volumes of the left and right ventricles were calculated by integration methods in tow frames for end-diastole and end-systole from biplane cineangiograms. Left ventricular mass was calculated in 120 infants and children by Rackley's method.
All the volumes and masses were deviled by body surface area in order to normalize the crude values for infants and children of different size. The mean values of left ventricular end-diastolic volume index (LVEDVI), right ventricular end-diastolic volume index (RVEDVI) and stroke index (SI) for each age were less in the younger children than those in the older children, and abrupt stepwise increase was observed at 1 year, 6 years and 10-11 years of age in the values of LVEDVI, RVEDVI and SI.
The infants and chidren were divided into four groups according to age (under 1 year, 1 to 5 years, 6 to 10 years and more than 11 years) . The values of LVEDVI, RVEDVI, SI and LVmass index were less in the younger age groups than those in the older age groups, and the difference of each age groups was statistically significant. The value of left ventricular ejection fraction (LVEF) was less in the youngest group (under 1 year) than those in the another groups (p<0.01) . The value for right ventricular ejection fraction (RVEF) was not significantly different in the age groups. End-systolic pressure-volume ratio was normalized with left ventricular mass (LVESP/ (LVESV/LVmass) ) . This normalized ratio was the lowest in the youngest group (under 1 year) and the highest in the oldest group (more than 11 years) .
As mentioned before, abrupt stepwise increase was observed in the“normal”values of LVEDVI, RVEDVI and SI in infancts and children. The explanation of this fact may be difficult at present. By the evidence of the normalized end-systolic pressure-volume ratio, it can be said that the contractility of the left ventricle in“healthy”infants and children was increased according to age. The reason why the value of LVEF was less in the youngest group than those in the another groups can be attributed to the lower contrac-tility in the youngest group. A possible factor that the value of RVEF was not significantly different between the youngest group and the another groups is; because the right ventricle works under higher pressure during fetal and neonatal period, then the right ventricular performance developed already in infancy.