We report a rare case of isolated intracavitary metastatic esophageal cancer of the right atrium and ventricle. A 67-year old woman had been treated for esophageal carcinoma for three years. Combined radiotherapy and chemotherapy had been performed, and partial remission had been achieved. Recent follow up computed tomography of the chest revealed intracavitary cardiac mass in her right atrium and right ventricle. On echocardiography a mobile, irregularly shaped large mass was detected in her right atrium. She was admitted for emergency operation. We resected the mass under cardiopulmonary bypass. The pathological examination revealed intracavitary metastasis of squamous cell carcinoma of the esophagus. She was discharged on the 29th postoperative day. Six months later, she died from multiple metastases of squamous cell carcinoma. Even though the operation was not curative, it might have been effective for preventing tumor embolism to the lung and elongating life expectancy.

Prompt and accurate diagnosis of malarial patients is a crucial factor in controlling the morbidity and mortality of the disease. Effective treatment decisions require a correct diagnosis among mixed-species malarial patients. Differential diagnosis is particularly important in cases of Plasmodium vivax, a species that shares endemicity with P. falciparum in most endemic areas. Moreover, it is difficult to identify P. knowlesi on the basis of morphology alone, and rapid diagnostic tests are still not available for this malaria species. Therefore, the development of diagnostic tests applicable to the field is urgently needed. 1-Cys peroxiredoxin (1-Cys-Prx) in P. falciparum is abundantly expressed in the mature asexual stages, making it a promising candidate as a diagnostic antigen. In this study, we produced five monoclonal antibodies (mAbs) against P. falciparum 1-Cys-Prx (Pf1-Cys-Prx) by immunizing BALB/c mice with recombinant Pf1-Cys-Prx and subsequent hybridoma production. Cross reactivity of established mAbs with the orthologous molecule of Pf1-Cys-Prx in P. vivax (Pv1-Cys-Prx) and P. knowlesi (Pk1-Cys-Prx) was examined. Western blot analyses showed that three mAbs reacted with Pv1-Cys-Prx and Pk1-Cys-Prx but two mAbs did not. These results indicate that the two mAbs were effective in differentiating P. falciparum from P. vivax and P. knowlesi and could be used in differential diagnosis as well as comparative molecular studies of human Plasmodium species.

A 74-year-old woman presented with shortness of breath. Cardiac ultrasonography showed that left-ventricular-wall motion was good (left ventricular ejection fraction, 70.2%). The left atrium and ventricle were enlarged (left anterior dimension, 53.4mm; left ventricular enddiastolic dimension, 58.5mm). The posterior cusp of the mitral valve was thickened; the flexibility was decreased. Color Doppler ultrasonography revealed a regurgitant jet toward the posterior cusp of the left atrium. However, there was no deviation of the anterior cusp. Severe mitral-valve insufficiency was diagnosed, and surgery was performed. The second heart sound (P2) of the posterior cusp was shortened because of localized calcification of the posterior mitral annulus. This site may have caused the regurgitation. Mitral annuloplasty with rectangular resection of the valve cusps and annulorrhaphy was performed. The patient had an uneventful recovery after surgery. Postoperative cardiac ultrasonography showed that mitral-valve insufficiency had improved and was regarded as trivial. Mitral annuloplasty is generally considered unsuitable for mitral-valve insufficiency with calcification of the valve annulus. In patients such as the present case who have localized calcification, however, mitral annuloplasty can be performed by resection of the valve cusps with annulorrhaphy.

Introduction : While the number of women physicians is increasing in Japan, there is a tendency for these physicians to leave the workforce during their child-rearing years, contributing to an overall physician shortage. In order to create effective policies to ameliorate these shortages, it is important to assess women medical students' views on their careers after marriage and the factors that lead to a low motivation for continuation of their careers..
Methods : From 2010 to 2012, we conducted questionnaire surveys using visual analog scale (VAS) based and multiple choice questions on medical students at the University of Tokushima regarding these issues in women physicians. We analyzed the results of questions included in each of these three-year surveys for women medical students in the first, third and sixth year and men in their sixth year..
Results : VAS results for “intention to continue career after marriage” showed shorter measurements in sixth year women (median 86.5mm, interquartile range (IQR) 64-97mm) compared to sixth year men (median 98mm, IQR 92.5-100mm) (p<0.001). Sixth year women with a VAS of 75mm or under for “intention to continue career” showed less “interest in a medical career” than those with a VAS of 80mm or greater (median 79.5mm (IQR 64.5-88.5) vs. 90.5mm (IQR 82-100)) (p=0.001). All student groups analyzed indicated that a “sense of purpose” was the most important factor in their future careers.
Conclusion : Lower VAS levels for “the intention to continue career after marriage” were related to a lower level for “interest in a medical career” in women medical students, which has implications for education and guidance in the undergraduate years.

PURPOSE: Posterior root repair of the medial meniscus (MM) can prevent rapid progression of knee osteoarthritis in patients with a MM posterior root tear (MMPRT). The anatomic reattachment of the MM posterior root is considered to be critical in a transtibial pullout repair. However, tibial tunnel creation at the anatomic attachment is technically difficult. We hypothesized that a newly developed point-contact aiming guide [Unicorn Meniscal Root (UMR) guide] can create the tibial tunnel at a better position rather than a previously designed MMPRT guide. The aim of this study was to compare the position of the created tibial tunnel between the two meniscal root repair guides. MATERIALS AND METHODS: Thirty-eight patients underwent transtibial pullout repairs. Tibial tunnel creation was performed using the UMR guide (19 cases) or MMPRT guide (19 cases). Three-dimensional computed tomography images of the tibial surface were evaluated using the Tsukada's measurement method postoperatively. The expected anatomic center of the MM posterior root attachment was defined as the center of three tangential lines referring to three anatomic bony landmarks (anterior border of the posterior cruciate ligament, lateral margin of the medial tibial plateau, and retro-eminence ridge). The expected anatomic center and tibial tunnel center were evaluated using the percentage-based posterolateral location on the tibial surface. The distance between the anatomic center and tunnel center was calculated. RESULTS: The anatomic center of the MM posterior root footprint was located at a position of 79.2% posterior and 39.5% lateral. The mean of the tunnel center in the UMR guide was similar to that in the MMPRT guide (posterior direction, P = 0.096; lateral direction, P = 0.280). The mean distances between the tunnel center and the anatomic center were 4.06 and 3.99mm in the UMR and MMPRT guide group, respectively (P = 0.455). CONCLUSIONS The UMR guide, as well as the MMPRT guide, is a useful device to create favorable tibial tunnels at the MM posterior root attachment for pullout repairs in patients with MMPRTs.LEVEL OF EVIDENCE: IV

The case was a 70-year-old female. Atrioventricular septal defect was diagnosed in her childhood, however, surgical treatment had not been performed. The patient had suffered from heart failure at the age of 69, and she was referred to our hospital for treatment. Her diagnosis was intermediate type atrioventricular septal defect, moderate left atrioventricular valve regurgitation, membranous ventricular septal aneurysm and atrial flutter. An autologous pericardial patch was used to close the ostium primum type atrial septal defect associated with simultaneous covering of membranous ventricular septal aneurysmal wall. Concomitant left and right atrioventricular valvuloplasty and arrhythmia surgery were performed. Her postoperative course was uneventful and the patient was discharged from our department on the 16th postoperative day. To our knowledge, there are few reports of surgery for incomplete type atrioventricular septal defect in the elderly and no report for intermediate type atrioventricular septal defect in Japan. In incomplete type atrioventricular septal defect, symptoms such as supraventricular arrhythmia and heart failure develop according to aging. Reported surgical results in the elderly are quite good, and improvement of excise tolerance is expected. Precise evaluation and proper indication of surgical treatment is mandatory even in older patients.