Background: Total pancreatectomy (TP) for pancreatic neoplasms has not been shown to confer any benefit over less aggressive resections, and is associated with high morbidity and mortality rates. Recently, clinical indications for TP are increasingly reported, with advances in surgical techniques, improvements in glycemic monitoring, and the development of synthetic insulin and pancreatic enzymes. TP is indicated for patients with large invasive tumors, multifocal intraductal papillary mucinous neoplasms, multifocal islet cell neoplasms, and longstanding chronic pancreatitis. Clinicophysiological findings after TP have only been reported in a small number of cases, however. The aim of this study was to evaluate clinicophysiological outcomes after TP. Methods: A total of 41 patients who underwent TP between 2007 and 2013 at Tokyo Women’s Medical University were examined retrospectively. Clinicophysiological parameters (BMI, HbA1c, albumin, creatinine, total cholesterol, triglycerides, WBC, lymphocytes, hemoglobin, HU level of the liver in CT) were collected and analyzed from preoperative state to 12 month after TP (preoperative condition,1 month, 3 months, 6 months, and 12 months after TP). Basal, bolus, and total insulin as well as pancreatic enzymes, were also measured 12 months after TP. Average values were compared with Student’s t-test, and numeric data are expressed as mean ± SD. Results: There were 23 male and 18 female patients. The mean age was 65.2 years (range, 47–77 years). There were 25 patients with intraductal papillary mucinous neoplasms (5 low grade, 8 high grade, and 12 invasive); 13 with invasive pancreatic ductal carcinoma; 1 with intraductal tubulopapillary neoplasm; and 2 with multiple pancreatic metastases from renal cell carcinoma. Twenty-eight patients underwent pylorus-preserving TP (PPTP); 8 underwent subtotal stomach-preserving TP (SSPTP); and 5 underwent duodenum-preserving TP (DPTP). Preoperative measurements were as follows: BMI, 21.02 ± 0.46 kg/m2; HbA1c, 6.42 ± 0.21% (29.3% of patients used insulin) and liver attenuation on CT, 63.05 ± 0.90 HU. No statistically significant differences in clinicophysiological parameters were observed, except in HbA1c, which was significantly different between the preoperative state and 12 months after TP. Albumin, creatinine, lymphocytes and hemoglobin were decreased at 1, 3, and 6 months after TP, but had normalized by 12 months. Basal insulin was 5.84 ± 0.55 U; bolus insulin, 24.79 ± 1.15 U; total insulin, 30.44 ± 1.48 U; and volume of pancreatic enzymes (lipase) was 18000 U, 12 month after TP. Conclusions: Several clinicophysiological parameters, with the exception of HbA1c, were temporarily decreased after TP, but had normalized by 12 months. Therefore, treatment of pancreatic neoplasms with the potential to spread across the entire pancreas by TP is feasible, and should be supplemented with adequate administration of synthetic insulin and pancreatic enzyme supplements.

Background: Total pancreatectomy (TP) for pancreatic neoplasms has not beenshown to confer any benefit over less aggressive resections, and is associatedwith high morbidity and mortality rates. Recently, clinical indications for TP areincreasingly reported, with advances in surgical techniques, improvements inglycemic monitoring, and the development of synthetic insulin and pancreaticenzymes. TP is indicated for patients with large invasive tumors, multifocalintraductal papillary mucinous neoplasms, multifocal islet cell neoplasms, andlongstanding chronic pancreatitis. Clinicophysiological findings after TP haveonly been reported in a small number of cases, however. The aim of this studywas to evaluate clinicophysiological outcomes after TP.Methods: A total of 41 patients who underwent TP between 2007 and 2013at Tokyo Women’s Medical University were examined retrospectively.Clinicophysiological parameters (BMI, HbA1c, albumin, creatinine, totalcholesterol, triglycerides, WBC, lymphocytes, hemoglobin, HU level of the liverin CT) were collected and analyzed from preoperative state to 12 month after TP(preoperative condition,1 month, 3 months, 6 months, and 12 months after TP).Basal, bolus, and total insulin as well as pancreatic enzymes, were also measured12 months after TP. Average values were compared with Student’s t-test, andnumeric data are expressed as mean ± SD.Results: There were 23 male and 18 female patients. The mean age was 65.2years (range, 47–77 years). There were 25 patients with intraductal papillarymucinous neoplasms (5 low grade, 8 high grade, and 12 invasive); 13 withinvasive pancreatic ductal carcinoma; 1 with intraductal tubulopapillaryneoplasm; and 2 with multiple pancreatic metastases from renal cell carcinoma.Twenty-eight patients underwent pylorus-preserving TP (PPTP); 8 underwentsubtotal stomach-preserving TP (SSPTP); and 5 underwent duodenum-preservingTP (DPTP). Preoperative measurements were as follows: BMI, 21.02 ± 0.46 kg/m2;HbA1c, 6.42 ± 0.21% (29.3% of patients used insulin) and liver attenuation on CT,63.05 ± 0.90 HU. No statistically significant differences in clinicophysiologicalparameters were observed, except in HbA1c, which was significantly differentbetween the preoperative state and 12 months after TP. Albumin, creatinine,lymphocytes and hemoglobin were decreased at 1, 3, and 6 months after TP, buthad normalized by 12 months. Basal insulin was 5.84 ± 0.55 U; bolus insulin,24.79 ± 1.15 U; total insulin, 30.44 ± 1.48 U; and volume of pancreatic enzymes(lipase) was 18000 U, 12 month after TP.Conclusions: Several clinicophysiological parameters, with the exception ofHbA1c, were temporarily decreased after TP, but had normalized by 12 months.Therefore, treatment of pancreatic neoplasms with the potential to spread acrossthe entire pancreas by TP is feasible, and should be supplemented with adequateadministration of synthetic insulin and pancreatic enzyme supplements.

Despite their wide clinical application and success, our understanding of the effects of insoles is relatively limited. The purpose of this study was to assess the biomechanical effects of wearing lateral/medial wedged insoles on subtalar and knee joints during normal walking. Motion analysis was conducted with a 3D motion-analysis system and a ground reaction force analysis using force plate when subjects walked with three different insole conditions : 5-degree medial wedge, no wedge, and 5-degree lateral wedge. Significant differences were found in subtalar or ankle joint motion in coronal and sagittal planes compared with the no-wedge condition. No differences were found in knee joint motion in the coronal and axial planes. The lateral-wedge insole reduced the knee varus moment and increased subtalar pronation moment in mid-stance during walking. At footstrike, however, the lateral wedge increased the knee varus moment and reduced the subtalar supination moment. The medial-wedge insole increased the knee varus moment and decreased subtalar pronation moment during the mid-stance phase. However, the medial wedge reduced the knee varus moment and increased subtalar supination moment at footstrike. The results of this study indicate that the influence of the insoles varied during the stance phase. Therefore, it is requested to select the shape of insole based on the injury mechanism, the location of the pain and the injury prevention.

1) We visited 4 universities in Germany, from where medical systems were once introduced to Japan as a model of modern medicine, and investigated the present conditions of medical education.2) The reform of curricula and methods of medical education has been actively performed in Germany, as it has been in Japan.

An attack of Raynaud's Phenomenon (RP) is characterized by blanching of the fingers in response to cold or emotional stimuli.
We analyzed the effect of ninjinyouei-to on RP in patients with MCTD. Subjects in this study comprised 19 patients, two males and 17 females, with a mean age of 38 years, and a mean duration of disease of 57.6 months. The study was performed at a time when RP occurred frequently in our country, that is in the period from November 1992 to March 1993.
We administered 9.0g of ninjinyouei-to to each case for four weeks and measured the surface skin temperature of the hands before and after medication with a thermograph using a Thermoviewer-JTG 3300.
There was a significantly higher temperature on the left first finger-tip after medication. Our thermographic findings in this study demonstrate a quantitative efficacy of ninjinyouei-to on RP in MCTD.

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

We experienced a case of polymyalgia rheumatica (PMR) which responded to Kampo medicine. A 53-year-old female patient first complained of stiffness and pain in the neck. Myalgia was severe and gradually eypanded to both shoulders and both upper extremities. Body weight decreased, and the erythrocyte sedimentation rate (ESR) was greater than 100mm/hour. Because her condition tended to improve when treated with prednisolone 10mg/day, she was diagnosed as having PMR. Her condition was well controlled until the dose of prednisolone decreased. Myalgia then recurred, and the ESR increased to 83mm/hour. The patient visited our outpatient department for treatment with Kampo therapy. Two months after treatment with Sairei-to plus Yokuinin-to, all signs and symptoms disappeared other than the stiff neck. Her body weight showed a tendency to increase. Six months after she first visited us, prednisolone was decreased and then stopped. Her condition still remains well controlled with this Kampo therapy alone. She has no clinical signs and symptoms, and the ESR has improved to 16mm/hour.