Mamushi is a species of pit viper distributed throughout Japan excluling the Ryukyu Islands and sighted from spring to autumn. It is estimated that about ten people dies in a year. It is important in the rural medicine because a lot of people are bitten in mountains and fields. A total of 35 cases of mamushi viper bite were treated from 1999 to 2006 in our hospital. The patients were 17 men and 18 women ranging in age from 7 to 80 years old (average: 60). Local swelling and pain were manifest in all the cases. Sixteen patients had systemic symptoms, and toxic effects commonly appeared in the eyes. The blood tests revealed elevated CPK levels in 24 patients (69%). The elevation correlated to the seriousness of the clinical symptoms. In accordance with our manual for mamushi viper bites, all patients were hospitalized after incision for exclusion of the toxin. The median length of time before the worst symptoms began to subside was 3 days. The median length of hospitalization stays was 7 days. It took long before the patients fully recovered. The severity of envenomation was different from patient to patient and one case needed intensive care. The median of treatment period was 31 days. The quick and appropriate primary care for the mamushi viper bits is important to prevent serious complications.
Median Statistical Measurement ; symptoms <1> ; Agkistrodon halys blomhoffi ; Clinical ; Cases

Recently the evaluation of health-related quality of life (QOL) in cancer patients has become important in carrying out a treatment strategy. During a period between June and August 2004, we studied the QOL in 16 breast cancer patients with or without chemotherapy. The regimens of chemotherapy were EC (n=6), AT (n=1) and CMF (n=1). We made the Functional Assessment of Cancer Therapy Scale-General (FACT-G) in all patients. The patients treated without chemotherapy were superior to those with chemotherapy with respect to physical and emotional well-being (p<0.05). There were no differences in social well-being and relationship to families between the two groups. The patients treated without chemotherapy made significantly higher scores in the basic activities of daily living than those with chemotherapy (p<0.05). Compared with patients receiving chemotherapy, patients treated without chemotherapy had better quality of life (p<0.05). We concluded that it was important for us to assist in decision making about treatment and supportive care needs.
Chemotherapy-Oncologic Procedure ; lower case pea ; Lower case en ; Malignant neoplasm of breast ; Pulmonary evaluation

Recently, the incidence of pulmonary embolism (PE) after surgery began to increase in Japan and to prevent PE has become essentially important. During the period between July 2003 and August 2004, we placed 203 general surgical patients under our perioperative management using intermittent pneumatic compression (IPC) and compression stockings (CS). We evaluated the effect of our management on the prevention of postoperative PE in those patients. The incidence of PE, prognosis, complications, patient's complaints, cost-benefit were examined. No fatal PE occurred. One patient with low SpO2 had a chest pain and dyspnea but pulmonary scintigrams revealed no PE. Two other patients had contact dermatitis by CS and another patient using an epidural catheter suffered temporary paraplegia after heparin injection. The government has approved a fee for PE prophylaxis since April 2004. Our management using IPC and CS for PE prophylaxis after surgery proved to be an effective in reducing the risk of PE. However, we must take the atmost care in injecting heparin into patients with epidural catheters.
cisplatin/etoposide protocol ; Pulmonary Embolism ; Postoperative Period ; Patients ; Cesium

The degree of intermittent claudication is difficult to evaluate objectively; therefore, the therapeutic efficiency of a drug is difficult to test in patients suffering from intermittent claudication. The purpose of this paper is to know whether treadmill test is useful to evaluate objectively the degree of intermittent claudication. 20 patients suffering from a peripheral arterial occlusive disease with intermittent claudication (Stage II) were investigated. PGE₁ incorporated in lipid microspheres (Lipo PGE₁) was infused (10μg/day) with one shot on 7 consecutive days into the forearm vein of patients. Painfree walking distance and maximum walking distance were measured on treadmill (3.0km/h, 5% incline). Brachial systolic pressure and ankle pressures were measured before and after exercise, and ankle/arm pressure ratio and ankle pressure difference between the pre-exercise and post-exercise values were calculated. All measurements were performed before and 7 days after beginning of treatment. Painfree walking distance was prolonged from 72.5±41.4m before treatment to 92.0±53.7m after treatment, with significant difference (p<0.01). However, no significant changes of ankle/arm pressure ratio, ankle pressure difference and maximum walking distance were observed. It is concluded that measurement of painfree walking distance on treadmill was useful to evaluate objectively the degree of intermittent claudication.

During the period between January 1975 and April 1991, 37 patients with acute arterial occulusion of the extremities were admitted to our department and were classified into 2 groups according to their causative factors, including thrombosis and embolism. Among 16 thrombosis patients with involvement of 17 limbs, 4 patients died and 6 limbs were amputated at the time of discharge. On the contrary, among 21 embolism patients with involvement of 25 limbs, 2 patients died and only one limb was amputated. Sixteen of 17 limbs with thrombosis were operated on. Arterial reconstruction was carried out initially on 5 limbs, resulting in successful limb salvage; 3 of 6 limbs which had undergone thrombectomy initially were occluded again soon after the procedure. In the end, 1 limb had to be amputated. On the other hand, 22 of 25 limbs were operated on. Three arterial reconstructions, 18 embolectomies and 1 amputation were carried out initially. All arterial reconstructions and embolectomies were successful. From these results, it was concluded that arterial reconstruction must be done initially for thrombosis patients. For the embolism patients, embolectomy is preferable.

Changes of hemodynamics and chemical mediators before and after aortic clamping were investigated in 12 patients who underwent infrarenal abdominal aortic aneurysmectomy. Patients were divided into two groups; one with an aortic clamping time greater than 1 hour (the long group) and the other with aortic clamping time less than 1 hour (the short group). Cardiac output, mean pulmonary arterial pressure (MPAP), extravascular thermal volume (ETV), polymorphonuclear elastase (PMN-E), α₁ trypsin inhibitor (α₁-TI) superoxide dismutase (SOD), urine N-acetyl-β-D-glucosaminidase (NAG), were measured before and immediately after aortic clamping, immediately after, 1 and 4 hours after aortic declamping. In addition, serum GOT, GPT, creatinine and BUN were measured before and 1, 3 and 7 day after operation. These levels were expressed as ratios of the level before aortic clamping and operation. The MPAP ratio immediately after aortic clamping was 0.83±0.06 in the long group and 0.99±0.08 in the short group. There was statistical significant difference in the MPAP between both groups (p<0.01). In contrast, there was no significant difference in the cardiac output or ETV between the two groups. The PMN-E ratio immediately after aortic declamping was 2.24±0.81 in the long group and 1.19±0.45 in the short group. These ratios increased at 1 and 4 hours after aortic declamping. The PMN-E ratio following aortic clamping in the long group was greater than those in the short group (p<0.05). The SOD at 1 hour after aortic declamping was 0.78±0.13 in the long group and 1.01±0.11 in the short group (p<0.05). The NAG ratio immediately and at 1 hour after aortic declamping was significantly higher in the long group when compared with the short group (p<0.01, 0.1). Serum GOT, GPT, creatinine and BUN ratios showed no change through out this study. There was an increase in protease and a decrease of free radical scavengers in the long group. These findings are commonly known to be linked with organ damage. Through the findings of this study, we suggest that clamping time should be minimized; thus reducing the possible chance of postoperative organ damage.

We investigated the quality of life (QOL) after thoracic or thoraco-abdominal aneurysmectomy in patients who had undergone the procedure within the past 15 years. We compared preoperative to postoperative performance status (PS). Defining PS in the following manner: one increase in that PS grade indicated mild worsening while an increase is by 2 or more indicated severe worsening. Maintenance was indicated by no change of PS after surgery. The QOL maintenance rate was calculated based on the following formula.
QOL maintenance(%)=No. of no change case/No. of operated cases-No. of death×100
There were a total of 74 cases in whom follow-ups could be carried out after surgery. Among them, there were ascending and aortic arch aneurysms in 19 cases, descending aortic aneurysms in 20 cases, dissecting aneurysms in 27 cases and thoraco-abdominal aortic aneurysms in 8 cases. The QOL maintenance rate in the type B dissecting aneurysms was comparatively high (85.7%). There were cases of severe worsening of PS in the ascending and aortic arch aneurysms and type A dissecting aneurysms and the QOL maintenance rate was 50% in each other. We should obtain high operative results due to improve the QOL maintenance rate, and devise the operative procedure without functional disorders of the organs after surgery.

Venous thromboembolism (VTE) is a common complication in patients with cancer, particularly those with gastrointestinal cancers. In addition, patients with distant metastasis of gastrointestinal cancer often require palliative surgery. Here we report on the current status of VTE in patients with gastrointestinal cancers at our hospital, where we treated 20 patients with gastrointestinal cancers who developed VTE between January 2009 and December 2018. Nine patients had gastric cancer, 6 had colorectal cancer, 3 had biliary cancer, and 2 had pancreatic cancer. Fifteen of the 20 patients had distant metastasis as well. Median survival was 9 months, but VTE was not the direct cause of death in any patient. Although many of these patients had advanced cancer with distant metastasis, 16 still required gastrointestinal surgery. Our findings indicate that gastrointestinal surgeons need to be proficient in the diagnosis and treatment of VTE in patients with malignancy.

Morphology, location, timing of operation, and complications of multiple aortic aneurysms were investigated in 14 patients (10 men and 4 women with a mean age of 66 years). The locations of the aneurysms were as follows: aortic arch and thoracoabdominal aorta in 1, aortic arch and infrarenal abdominal aorta in 6, descending thoracic aorta and suprarenal abdominal aorta in 1, descending thoracic aorta and infrarenal abdominal aorta in 5, and thoracoabdominal aorta and infrarenal abdominal aorta in 1. Thoracic aortic aneurysms had a mean diameter of 63±13mm. The mean diameter of the abdominal aortic aneurysms was 54±13mm. In 1 patient, thoracoabdominal and infrarenal abdominal aortic aneurysms were operated on simultaneously. Eight patients, 5 with aneurysms of the aortic arch and infrarenal abdominal aorta, 2 with aneurysms of the descending aorta and infrarenal abdominal aorta, and 1 with aneurysms of the aortic arch and thoracoabdominal aorta, underwent two-staged operation. Aortic arch aneurysm was operated first in 3 patients, and abdominal aortic aneurysm in 5. Postoperative complications included spinal cord injury in 1 patient, bowel necrosis in 1, renal impairment in 2, respiratory impairment in 2, and hepatic impairment in 1. There was no perioperative death. Three late deaths occurred. Two staged operation is better for multiple aortic aneurysms. The first operation should be performed for the larger aneurysm.

Pregnancy and childbearing are important issues for female survivors of childhood, adolescent, and young adult (CAYA) cancer. Here, we report the case of a 38-year-old primiparous woman who had been treated with multimodal therapy for ovarian dysgerminoma in childhood. During junior high school, she had been admitted to our hospital complaining of abdominal distension, fever, and dyspnea. A massive abdominal tumor was found, and she was referred to a university hospital for treatment. Ovarian tumors suspected to be ovarian dysgerminoma were diagnosed, and right oophorectomy with lymph node dissection was performed. The left ovary was preserved. Postoperative histologic examination revealed ovarian dysgerminoma with class V ascites cytology, indicating Stage IIIc disease. The postoperative course was uneventful. Following surgery, she received bleomycin, etoposide phosphate, and cisplatin chemotherapy. Menarche occurred 12 years after surgery. She visited a gynecology clinic 24 years and 9 months after surgery because of suspected pregnancy. Pregnancy was confirmed, and she gave birth by vaginal delivery at a gestational age of 35 weeks + 1 day. Both the patient and child are now in good health. Fertility is an important consideration for CAYA cancer survivors. In cases of CAYA cancer, it is important to make treatment decisions together with patients with due consideration given to survival and fertility.