Oral leukoplakia and its malignant transformation are reviewed in this article. Oral leukoplakia is defined as a predominantly white lesion of the oral mucosa that can not be characterized as any other definable lesion; however, the lesion must be confirmed histopathologically by biopsy in order to discuss malignant transformation of oral leukoplakia. Malignant transformation rates of oral leukoplakia range from 0.13 to 17.5%, while the rates of five-year cumulative malignant transformation range from 1.2 to 14.5%. Some reports found a high incidence of malignant transformation in older patients. Chewing tobacco and smoking are distinct risk factors particularly among males in certain countries; however, other countries have noted that females or non-smokers may be at risk of malignant transformation. HPV has been detected in oral dysplasia lesions and cancer in non-smokers. Conflicting reports have been presented regarding the malignant transformation of oral leukoplakia with epithelial dysplasia; however, we and some authors believe that epithelial dysplasia is an important factor in the malignant transformation of oral leukoplakia. The majority of researchers showed non-homogenous leukoplakia as a risk factor, although different terms have been used to describe these lesions. There may be several routes to malignant transformation of oral leukoplakia, including transformations induced by carcinogenesis due to betel quid chewing or smoking, or by HPV infection. While no definite treatment modalities for oral leukoplakia have been established, we suggest surgical therapy with an adequate safety-margin and well-timed evaluation as an appropriate treatment in preventing malignant transformation.

To estimate the prognosis of bilateral cervical metastases from tongue carcinoma, we studied twelve patients (24-72 years old) who underwent neck dissections at our hospital to judge whether we should have performed radical treatment or not for those patients of tongue carcinoma who had bilateral metastatic nodes.The five-year survival rate of bilateral neck metastasis patients was 58% (the Kaplan-Meier method). On the other hand, the five-year survival rate of patients with only unilateral neck metastases of squamous cell carcinoma of the tongue was 56%. Thus, there was no statistical significant difference in survival rate.We conclude that even if a patient has metastatic lymph nodes on both sides of the neck, radical therapy should be done.

The aim of this study was to develop a new method for the determination of NO2 levels encountered in clinical settings as well as in environmental studies, using a bi−component atmospheric pressure ionization mass spectrometry(APIMS). Hydrogen (1%) diluted in pure argon was ionized by corona discharge in the first ionization component. Fifty ml of the analyte diluted in 250ml of composite air or carbon dioxide (CO2) was introduced into the second ionization component and analyzed. When composite air was used as the sample carrier gas, NO in the analyte was oxygenated and there was an increase in the NO2 content from that in the original analyte. However, when CO2 was used as the sample carrier gas, the level of NO2 in the analyte could be determined because CO2 did not change the NO2 content from that in the original analyte. A calibration curve with good linearity was obtained using the UG−410 APIMS system, with a regression equation of Y(%)=5.513*10-2 X(ppb) and a detection limit of 0.9ppb. Since APIMS detects NO2 directly within its system, the concentration of NO does not need to be measured. This system may be of great help in the accurate detection and determination of the concentration of low levels of NO2 during inhaled NO therapy
Carbon Dioxide ; ionization ; Spectrum Analysis, Mass ; Direct type of resin cement ; Adjudication

We report two cases of an abdominal aortic aneurysm, one with congestive heart failure, and the other with a dissecting aortic aneurysm (type IIIb), who underwent an aorto-bifemoral bypass operation under a temporary external axillofemoral bypass. In one patient (Case 1, a 74-year-old male), who had an abdominal aortic aneurysm with congestive heart failure due to aortic valve insufficiency and stenosis, perioperative transesophageal echocardiography demonstrated that, with a temporary external axillofemoral bypass, the regurgitant doppler signal was unchanged during the cross-clamping period of the abdominal aorta. In the other patient (Case 2, a 71-year-old male), who had a dissecting thoracoabdominal aortic aneurysm with the lower abdominal aorta having a true aneurysm formation, the transesophageal echocardiography demonstrated that, with a temporary external axillofemoral bypass, the false lumen of the dissecting thoracic aneurysm had no change in size during the cross-clamping period of the abdominal aorta. Thus, a temporary external axillofemoral bypass might avoid any unfavorable hemodynamic effect during and after the abdominal aortic clamping in patients suffering from an abdominal aortic aneurysm with cardiovascular complications.

Purpose: Single-port laparoscopic surgery is anticipated to become the future of minimally invasive surgery. We have devised an alternative approach for laparoscopic cholecystectomy by inserting a single por t at t he umbi licus and using t he abdomina l wa l l-lif ting met hod, w it hout establishing pneumoperitoneum. Methods: Retrospective analysis of 130 patients undergoing laparoscopic cholecystectomy was done to compare the conventional laparoscopic cholecystectomy (CLC) (n = 69) and the novel single-port laparoscopic cholecystectomy (SLC) using the abdominal wall-lifting method (n = 61). The surgical procedures were as follows. A 2- to 3-cm transumbilical incision was made, and a wound retractor was inserted into the abdomen without difficulty. Abdominal distension was obtained using a fan-shaped retractor without the use of carbon dioxide insufflations. A 5-mm flexible scope and modified curved graspers and dissectors were used to give the feeling of triangulation during dissection. Results: The SLC group consisted of 25 males and 36 females with a mean age of 58.1 ± 7.2 years and a mean body mass index of 23.1 ± 3.2 kg/m 2 . The two groups were comparable for mean age, sex, disease, American Society of Anesthesiologists physical status classification, and comorbidity. Likewise, the duration of operation, postoperative hospital stays, complications, the number of use of analgesics, and conversion rate to open technique were not significantly different in the two groups. Conclusion The impaired view in single-port laparoscopic surgery can be improved by using articulating instruments that can be rotated out of the field of view. This novel gasless method is cost-effective and produces minimal postoperative discomfort with no additional scars.

Purpose: Single-port laparoscopic surgery is anticipated to become the future of minimally invasive surgery. We have devised an alternative approach for laparoscopic cholecystectomy by inserting a single por t at t he umbi licus and using t he abdomina l wa l l-lif ting met hod, w it hout establishing pneumoperitoneum. Methods: Retrospective analysis of 130 patients undergoing laparoscopic cholecystectomy was done to compare the conventional laparoscopic cholecystectomy (CLC) (n = 69) and the novel single-port laparoscopic cholecystectomy (SLC) using the abdominal wall-lifting method (n = 61). The surgical procedures were as follows. A 2- to 3-cm transumbilical incision was made, and a wound retractor was inserted into the abdomen without difficulty. Abdominal distension was obtained using a fan-shaped retractor without the use of carbon dioxide insufflations. A 5-mm flexible scope and modified curved graspers and dissectors were used to give the feeling of triangulation during dissection. Results: The SLC group consisted of 25 males and 36 females with a mean age of 58.1 ± 7.2 years and a mean body mass index of 23.1 ± 3.2 kg/m 2 . The two groups were comparable for mean age, sex, disease, American Society of Anesthesiologists physical status classification, and comorbidity. Likewise, the duration of operation, postoperative hospital stays, complications, the number of use of analgesics, and conversion rate to open technique were not significantly different in the two groups. Conclusion The impaired view in single-port laparoscopic surgery can be improved by using articulating instruments that can be rotated out of the field of view. This novel gasless method is cost-effective and produces minimal postoperative discomfort with no additional scars.

At Nippon Medical School, a "Basic Clinical Training Course" is provided as an introduction to clinical medicine. Medical students undergo initial clinical skills training with simulators. We describe the technique of effective training to acquire clinical skills and the results of student evaluations and a questionnaire survey.1) The training consisted of 8 practicums, including internal examination, funduscopic examination, otoscopic examination, breast examination, auscultation (heart sounds and lung sounds), and collection of blood samples. Medical students moved in rotation once per time period (45 minutes) and performed practical training in each unit, which comprised 2 practicums.2) The training with the prescribed number of 50 students in 4 time periods was efficiently performed for 2 days and required 9 trainers per day. Student evaluations and a questionnaire survey revealed the interest and enthusiasm of medical students and showed they thought highly of the training.3) The training was efficiently performed and was thought to help reduce the teaching load of instructors. The educational effect of the training can be strengthened by increasing the convenience of the clinical simulation laboratory, by reinforcing the education of clinical skills and attitudes in clinical clerkship, and by evaluating these factors after the completion of the clinical clerkship.

The aim of this study was to investigate the end of life care provided by long-term care facilities and nursing homes. A cross-sectional survey of all long-term care facilities and nursing homes in Kobe was performed in July 2013. Questionnaires were sent to 350 facilities with an 89.7％ response rate. In total, 121（39％）of respondents stated that end of life care was available, and 151（48％）responded that facilities were willing to provide end of life care for terminally ill residents. One hundred fifty-two（48％）and 183（58％）of respondents answered that facilities were available for managing residents with percutaneous endoscopic gastrostomy, and transfusion, respectively. Seventy-two（23％）of respondents reported that facilities for managing the use of narcotics were available. In conclusion, a minority of long-term care facilities and nursing homes ware available for providing end of life care for residents, though approximately 50％ were willing to do so.

PURPOSE: Sacroiliac fixation using iliac screws for highly unstable lumbar spine has been reported with an improved fusion rate and clinical results. On the other hand, there is a potential for clinical problems related to iliac fixation, including late sacroiliac joint arthritis and pain. MATERIALS AND METHODS: Twenty patients were evaluated. Degenerative scoliosis was diagnosed in 7 patients, failed back syndrome in 6 patients, destructive spondyloarthropathy in 4 patients, and Charcot spine in 3 patients. All patients underwent posterolateral fusion surgery incorporating lumbar, S1 and iliac screws. We evaluated the pain scores, bone union, and degeneration of sacroiliac joints by X-ray imaging and computed tomography before and 3 years after surgery. For evaluation of low back and buttock pain from sacroiliac joints 3 years after surgery, lidocaine was administered in order to examine pain relief thereafter. RESULTS: Pain scores significantly improved after surgery. All patients showed bone union at final follow-up. Degeneration of sacroiliac joints was not seen in the 20 patients 3 years after surgery. Patients showed slight low back and buttock pain 3 years after surgery. However, not all patients showed relief of the low back and buttock pain after injection of lidocaine into the sacroiliac joint, indicating that their pain did not originate from sacroiliac joints. CONCLUSION: The fusion rate and clinical results were excellent. Also, degeneration and pain from sacroiliac joints were not seen within 3 years after surgery. We recommend sacroiliac fixation using iliac screws for highly unstable lumbar spine.
Aged ; Arthritis/*surgery ; Bone Screws ; Female ; Humans ; Low Back Pain/diagnosis/epidemiology ; Lumbar Vertebrae/*surgery ; Male ; Middle Aged ; Pain/diagnosis/*epidemiology ; Sacroiliac Joint/*immunology/*pathology

PURPOSE: Chronic low back pain is a common clinical problem. As medication, non-steroidal anti-inflammatory drugs are generally used; however, they are sometimes non-effective. Recently, opioids have been used for the treatment of chronic low back pain, and since 2010, transdermal fentanyl has been used to treat chronic non-cancer pain in Japan. The purpose of the current study was to examine the efficacy of transdermal fentanyl in the treatment of chronic low back pain. MATERIALS AND METHODS: This study included patients (n=62) that suffered from chronic low back pain and were non-responsive to non-steroidal anti-inflammatory drugs. Their conditions consisted of non-specific low back pain, multiple back operations, and specific low back pain awaiting surgery. Patients were given transdermal fentanyl for chronic low back pain. Scores of the visual analogue scale and the Oswestry Disability Index, as well as adverse events were evaluated before and after therapy. RESULTS: Overall, visual analogue scale scores and Oswestry Disability Index scores improved significantly after treatment. Transdermal fentanyl (12.5 to 50 microg/h) was effective in reducing low back pain in 45 of 62 patients; however, it was not effective in 17 patients. Patients who experienced the most improvement were those with specific low back pain awaiting surgery. Adverse events were seen in 40% of patients (constipation, 29%; nausea, 24%; itching, 24%). CONCLUSION: Disability Index scores in 73% of patients, especially those with specific low back pain awaiting surgery; however, it did not decrease pain in 27% of patients, including patients with non-specific low back pain or multiple back operations.
Administration, Cutaneous ; Adult ; Aged ; Aged, 80 and over ; Chronic Disease ; Female ; Fentanyl/*administration & dosage/*therapeutic use ; Humans ; Low Back Pain/*drug therapy ; Male ; Middle Aged ; Young Adult