Background/Purpose: The purpose of this study is to clarify the effectiveness of interventions for breast cancer patients with psychological distress by a clinical psychologist on the basis of the contents of the interventions and counseling. Methods: The participants were 20 inpatient and outpatient women aged from 33 to 73 years who had been diagnosed with breast cancer. The interventions were conducted on the basis of patients' complaints about anxiety and/or depression or by a medical doctor's request. The interventions employed unstructured, one-on-one interviews. Each interview usually lasted no more than 60 minutes. Results: The 20 cases were classified into the following categories: (1) 15 general (nonpsychiatric) cases, consisting of (1-1) 9 cases at the cancer-notification and progressive-therapeutic stages and (1-2) 6 cases at the progressive-relapse stage; and (2) 5 specific (psychiatric) cases, consisting of (2-1) 3 cases at the cancer-notification and progressive-therapeutic stages and (2-2) 2 cases at the progressive-relapsestage. As for the general cases, interventions were found to be effective in all 9 cases at the cancer-notification and progressive-therapeutic stages but in only 2 of 6 cases at the progressive-relapse stage. In specific cases, effective interventions were found at the cancer-notification, the progressive-therapeutic, and the progressive-relapsestages. Conclusion: This study suggested that interventions for breast cancer patients by a clinical psychologist are effective. The psychological interventions had two roles: to assess the patients properly and to interview the patients as purposefully as a medical team member would.

The effect of bathing with artificial sodium sulfate on changes in the systolic blood pressure and the level of atrial natriuretic polypeptide (ANP) in plasma or atrium of normotensive male rats was studied. The following results were obtained:
1) As a result of bathing for 20 minutes at a temperature of 37°C, the systolic blood pressure lowered and the plasma ANP level decreased. The blood pressure lowered most clearly after artificial sodium sulfate bathing at a prescribed concentration (p<0.5), while the plasma ANP level decreased significantly after plain water bathing (p<0.01).
2) The atrial ANP level showed no significant change. Presumably the reason was that the quantity of atrial ANP was so large that it was not affected by fluctuations in the peripheral ANP level.
3) The temperature and duration of bathing, the concentration of bath salts, and other factors might also influence the plasma ANP level.
These results suggest that the artificial sodium sulfate bathing lowers the blood pressure by preventing heat radiation from the skin and by delicate regulatory mechanisms on ANP secretion.

The effects of bathing with artificial sodium sulfate on the systolic blood pressure and the level of atrial natriuretic peptide (ANP) in plasma and or in atrium of spontaneously hypertensive rats (SHR) were studied. The following results were obtained:
1) As a result of bathing for 20 minutes at a temperature of 37°C, the systolic blood pressure lowered and the plasma ANP level increased. The blood pressure lowered with increasing concentration of sodium sulfate (p<0.01).
2) The plasma ANP level in a standing position for 20 minutes decreased than in a normal position.
3) The plasma ANP level in SHR was higher and increased more clearly by bathing, compared to the previous results in normotensive rats (WKA). The blood pressure lowered far more in SHR than in WKA.
4) The atrial ANP level was not significantly influenced by bathing nor by changing the posture.
These results indicate that the artificial sodium sulfate bathing has more potent hypotensive effect than plain water bathing probably due to prevent heat radiation, and affects the blood pressure and the plasma ANP more significantly in SHR than in WKA. In addition, the effects of mild bathing to cardiovascular and neurohumoral systems may modulate directly or indirectly the ANP secretion.

Change of digital blood flow during sodium sulfate bathing was studied using laser Doppler flowmeter. The 10 subjects were divided into two groups; group A and group B. In group A, digital bloood flow was measured in the following order; in the air→plain water→air→sodium sulfate bathing→air, while in group B, in the air→sodium sulfate bathing→air→plain water→air. The temperature of the water was kept at 40°C using thermostat. The 10g of sodium sulfate was dissolved in the 10L of water. In group A, the digital blood flow was 60.2±16.7 in the plain water and 70.6±35.0 in the sodium sulfate water, while in group B, 30.4±12.7 in the sodium sulfate water and 7.36±10.06 in the plain water (P<0.05).
Above results suggest an increase in digital blood flow in the sodium sulfate bathing, although there were great differences by individual and by the order of immersion.

The effects of artificial sodium sulfate bathing on cardiopulmonary and neurohumoral systems as compared to plain water bathing were studied on five healthy subjects. The results of bathing tests made for 10 minutes at 42°C were as follows:
1) The body surface temperature was higher in three of the five subjects in artificial sodium sulfate bathing than in plain water bathing. The forehead temperature of all subjects in artificial sodium sulfate bathing was higher than in plain water bathing (p<0.05: at 17, 18min. after bathing). The change in oral temperature also showed the same tendency (p<0.05: at 27min. after bathing).
2) The frequency of respiration was less in artificial sodium sulfate bathing than in plain water bathing. Although the heart rate decreased during artificial sodium sulfate bathing as compared to the case of plain water bathing, a clear difference was not observed after bathing. The systolic blood pressure in four of the five subjects decreased in artificial sodium sulfate bathing compared to plain water bathing. One subject, who exhibited low blood pressure before bathing, was restored to his normal blood pressure after artificial sodium sulfate bathing. The sysytolic blood pressure was lower in artificial sodium sulfate bathing than in plain water bathing. (p<0.03: at 20min. after bathing).
3) The serum levels of noradrenalin, adrenalin, serotonin, ADH, renin, aldoster-one, cortisol, β-endorphine, Na⁺, K⁺, and Cl^- showed no significant differences between the two types of bathing.
4) All subjects felt increased warmth and smoothness of the skin after the artificial sodium sulfate bathing compared to plain water bathing.
The above results suggest that the artificial sodium sulfate bathing is superior to plain water bathing in maintaining body temperature, decreasing blood pressure, and feeling (i. e., body warmth and skin texture) after bathing. These effects result from not only the direct action on the skin but also the indirect action due to absorption of the substance through the skin by the mechanism of artificial sodium sulfate bathing.

Background: We evaluated the effectiveness of gemcitabine and paclitaxel therapy in patients with metastatic urothelial carcinoma for whom two lines of sequential chemotherapy had been unsuccessful.

Methods: A total number of 105 patients who had previously received first-line chemotherapy consisting of gemcitabine and cisplatin or carboplatin, were treated with second-line gemcitabine and docetaxel therapy between June 2006 and May 2015. Of these patients, 15 with an Eastern Cooperative Oncology Group Performance Status of 0 or 1 were administered gemcitabine and paclitaxel as third-line treatment from 2013 after failure of the second-line therapy. For each 21-day cycle, gemcitabine (1000 mg/m²) was administered on days 1, 8, and 15, and paclitaxel (200 mg/m²) on day 1. Patients were assessed for each cycle and any adverse events were noted. Furthermore, a Short Form Health Survey questionnaire was used to assess each patient’s quality of life.

Results: Third-line gemcitabine and paclitaxel treatment cycles were undertaken for a median of four times (range 2–9). The disease control rate was 80.0%. After second-line gemcitabine and docetaxel therapy was completed, median progression-free survival and median overall survival were determined as 9.8 and 13.0 months, respectively. The only prognostic factor for overall survival, as determined by univariate and multivariate analyses, was third-line gemcitabine and paclitaxel therapy. Neutropenia (66.7%) and thrombocytopenia (53.3%) were noted as the grade 3 treatment-related toxicities. After two cycles of third-line gemcitabine and paclitaxel therapy, the pre- and post-treatment quality of life scores did not differ significantly.

Conclusions: Results demonstrate that third-line combination therapy using gemcitabine and paclitaxel is a feasible option for metastatic urothelial carcinoma patients.

Two new thiodiketopiperazines (TDKPs), designated graphiumins I (1) and J (2), were isolated from the culture broth of the marine-derived fungus Graphium sp. OPMF00224 by solvent extraction, silica gel column chromatography, and HPLC. Their absolute structures were elucidated by spectroscopic analyses (1D and 2D NMR data, ROESY correlations, and CD data) and chemical methods. They were found to be structurally rare TDKPs with a phenylalanine-derived indolin substructure. Compounds 1 and 2 inhibited yellow pigment production by methicillin-resistant Staphylococcus aureus (MRSA) with IC50 values of 63.5 and 76.5 microg/ml, respectively, without inhibiting its growth, even at 250 microg/ml.
Chromatography ; Chromatography, High Pressure Liquid ; Fungi* ; Inhibitory Concentration 50 ; Methicillin-Resistant Staphylococcus aureus ; Silica Gel

Objectives: Gauze remnants form gauzeomas after surgery, if infection has not occurred. We present a case of gauzeoma diagnosed after surgery.Patient: A 72-year-old man noticed a mass in his lower abdomen. He had undergone surgery for left inguinal hernia 21 years ago. A retroperitoneal mass was found on computed tomography (CT) and magnetic resonance imaging (MRI), and he was then referred to our hospital. A detailed abdominal ultrasonography, CT, and MRI revealed a cystic mass with a bulkhead-like structure near the bladder. These findings indicated the possibility of a malignant cyst; hence, an open surgery was performed to excise the mass. Macroscopically, the specimen was clearly bound, covered with a capsule, and filled with pus and had a gauze inside.Results: Based on the patient history and position of the mass, it was diagnosed as gauzeoma, which had strayed into the retroperitoneal cavity during the surgery for inguinal hernia.Conclusion: The imaging findings of gauzeoma are diverse; hence, it is often difficult to diagnose without surgery. However, gauzeoma can be lethal if the cystic mass is infected; thus, it is important to diagnose it correctly.

Objective: Most cases of severe metabolic alkalosis have many causes that may result in renal failure and death. Therefore, these should be treated promptly for successful recovery.Patient: A 61-year-old man was hospitalized due to an acute kidney injury (creatinine level of 4.36 mg/dL) after a 3-month history of anorexia and recurrent vomiting. He had been treated for tuberculosis in the past.Results: Blood gas analysis revealed severe metabolic alkalosis with pH=7.66, HCO3=94 mmol/L, and pCO2=82.0 mmHg. Routine biochemical examination revealed severe hypokalemia (K 2.9 mEq/L) that was associated with prolonged QTc interval (0.52 seconds) on the electrocardiogram. Gastrofiberscopic examination also revealed severe stenosis and ulcerated scarring of the gastric pylorus and severe esophagitis. Intravenous hydration and correction of hypokalemia improved renal function and resolved metabolic alkalosis. An investigation that was repeated after 6 days revealed a creatinine level of 1.58 mg/dL, pH=7.47, HCO3=23.4 mmol/L, K=3.6 mEq/L, and QTc of 0.45 seconds. The patient underwent gastrectomy and adenocarcinoma was observed.Conclusion: We described a resolved case of severe metabolic alkalosis and acute kidney injury in a rural medical setting following conservative management.

A 76-year-old Japanese man visited a nearby medical clinic complaining of abdominal distention. He had undergone extraperitoneal laparoscopic prostatectomy at our institution 5 months before the onset of abdominal distention. An imaging study revealed a large cystic lesion, and biochemical examination of a sample obtained via cyst puncture led to a diagnosis of lymphocele. As the lymphocele was resistant to puncture, drainage, and sclerotherapy with minomycin, laparoscopic fenestration was performed. Although the patient developed an adhesive ileus postoperatively, the cyst has not recurred. Fenestration surgery is a feasible option for lymphocele refractory to various conservative therapies.