Objective: Patients with secondary hyperparathyroidism caused by chronic kidney disease (CKD) develop secondary osteoporosis, which increases fracture risk. We report a case of insufficiency fractures complicated by secondary osteoporosis caused by chronic renal failure and gastrectomy.
Patient: A 78-year-old man with a medical history of nephrotic syndrome and gastric cancer experienced an occult intertrochanteric fracture of his left femur after falling.
Results: Ten days after the first fracture, the patient was treated with hemodialysis for acute uremic symptoms. Eight weeks after this fracture, he sustained a right insufficiency acetabular fracture and was treated with total hip arthroplasty (THA).
Conclusion: For patients with CKD, effective fracture prevention is difficult. THA with reconstruction of the acetabulum was an effective therapy in a patient with nontraumatic central fracture dislocation of the hip.

A 76-year-old male was admitted to our hospital because of melena. However, no remarkable findings of rupture were shown by enhanced CT scan and angiography. On the 9th day of admission, he fell into a state of shock because of sudden massive bloody intestinal discharge. Colonofiberscopic findings revealed a primary arterio-enteric fistula. Therefore, an emergency operation was undertaken. Following aneurysmectomy, colostomy was performed in the descending colon. Right axillo-femoral artery bypass was finally performed as an extra-anatomical bypass to secure the right leg blood flow.

A 78-year-old woman had been undergoing medical treatment for hypertension since she delivered a son in her early twenties. Three months previously, she was admitted with heart failure. She had felt leg fatigue for a long time, and the pressure gradient between the upper and lower limbs was about 60 mmHg. On further examinations, she was found to have an atrial septal defect (ASD), tricuspid valve regurgitation, atrial fibrillation, and severe coarctation of the aorta (CoA) with well-developed collateral arteries. We performed ASD closure, tricuspid annuloplasty with a flexible ring, left atrial maze operation and extra-anatomic bypass from the ascending to the abdominal aorta through a median sternotomy and upper median laparotomy. She had no postoperative complications and the pressure gradient between the upper and lower limbs improved remarkably postoperatively. It is rare for a patient over 70 years old who for the first time was given a diagnosis of CoA and ASD with other heart disease and who underwent surgical correction. We think one stage surgery with extra-anatomic bypass from the ascending to the abdominal aorta is a safe and effective technique for patients suffering CoA with heart disease.

In order to investigate the effects of the concentration of chemical components of sea water on thermoregulatory functions, rectal, skin and mean body temperatures were measured continuously before, during total body bathing as well as during recovery period on land.
Eight healthy young men were subjected in the experiment. Their physical characteristics were in average 19.8±1.0yrs in age, 169.2±5.0cm in height, 57.1±3.1kg in weight and 14.0±2.6% in body fat fraction, respectively. Each subject bathed in sea water or in tap water for 15 minutes in the long-sitting position at 38.5°C of water temperature during bathing and took recovery on land for 60 minutes. Water bathing was conducted in individual subject with the concentration of chemical components of sea water at 0, 1, 3.5 and 7%, respectively.
The rectal temperature increased during bathing and decreased gradually during recovery period on land. Statistically significant difference (p<.05) between 0 and 7% of the concentration of sea water was detected in the rectal temperature during bathing and recovery period. The mean skin temperature showed a continuous increase during bathing and showed a rapid decrease during 20 minutes in recovery, and a gradual decrease after then. Statistically significant difference (p<.05) between 0 and 7% of the concentration of sea water was detected in the mean skin temperatures during recovery period. The mean body temperature also showed a continuous increase during bathing and rapid decrease during the first 20 minutes in the recovery period, and decreased gradually thereafter. Statistically significant difference (p<.01) between 0 and 7% of the concentration of sea water was detected in the mean body temperature during bathing and recovery period.

We report a case of massive endobronchial hemorrhage after cardiopulmonary bypass, and its successful treatment utilizing a bronchial blocker tube without circulatory support. An 85-year-old woman underwent mitral and tricuspid valves repair for mitral stenosis and regurgitation, and tricuspid regurgitation. The repairs were performed uneventfully. The patient was weaned from cardiopulmonary bypass. After protamine infusion, massive endobronchial hemorrhage occurred through the tracheal tube. On fiberoptic bronchoscopy, prompt identification and selective occlusion of the hemorrhage source was performed by a Coopdech endobronchial blocker tube (Daiken Medical Co., Ltd, Osaka, Japan). Postoperative contrast-enhanced computed tomography revealed thrombogenic pseudoaneurysm of the right middle lobe pulmonary artery. We speculated that Swan-Ganz catheters induced endobronchial hemorrhage. The patient did not experience any further hemorrhage. She was discharged from our hospital on the 25th postoperative day in good condition.

Between September 1972 and December 1987, 808 gastric cancer patients were treated at our hospital. The male/female ratio was 1.7. Gastric resection was performed on 88% of the patients, while curative resection was performed on 59.2%. The operative mortarity rate was 1.8%.
In patients undergoing surgery, the cumulative 5-year survival rates according to stage were 96.4% for stage 1, 68.6% for stage 2, 48.7% for stage 3 and 4.5% for stage 4.
With the spread of a mass screening, many cases of early gastric cancer have been detected recently. However, the incidence of advance cancer increased with age. This suggests the necessity of encouraging the aged to participate in the mass screening. Though gastrectomy is safety procedure of encouraging the aged to participate in the mass screening. Though gastrectomy is safety procedure in old patients over 75 years of age, its indications should be evaluated taking into consideration the quality of the patient's life.

We reviewed 338 cases of colorectal cancer treated in our clinic since 1973. On these patients, 62% were aged 60 years or older.
By location, the malignant tumor was found most frequenty in the rectum, followed by the sigmoid colon.
Resection was perforoed in 94.3%, of the patients with curative resection accounted for 68.3%. In the curative resection group the cumulative 5-year and 10-year survival rates were 77% and 65, 9%, respectively.
Early colorectal cancer was detected in only 26 patients. Mass screening for colorectal cancer using occult blood tests of feces had just recently started in our communities. Thus, further efforts to detect early colorectal cancer are needed.

The in vitro antibacterial activities of oral cephem antibiotics and ketolide telithromycin against major respiratory pathogens possessing beta-lactam-resistant mutations (within the pbp gene) and/or macrolide-resistant genes (erm and mef) were examined in clinical isolates collected at 66 institutes in all over the Japan between 2002 and 2003. Telithromycin showed the strongest antibacterial activity against methicillinsusceptible Staphylococcus aureus strains with and without macrolide-resistant genes, such as ermA or ermC gene. All the cephem antibiotics showed potent antibacterial activity against Streptococcus pyogenes, with minimum inhibitory concentrations (MICs) of 0.015 mg/L or lower. Cefdinir had a much higher MIC90 against genotypic penicillin-resistant Streptococcus pneumoniae (gPRSP) than cefditoren and cefcapene (8 mg/L cefdinir vs. 1 mg/L cefditoren and cefcapene). The majority of gPRSP harbored either ermB or mefA, and the antibacterial activity of telithromycin against these strains was decreased however some susceptibility was still sustained. Cefditoren exerted the strongest antibacterial activity against beta-lactamase-negative ampicillin-resistant Haemophilus influenzae, with an MIC90 of 0.5 mg/L. These results underline the importance of checking the susceptibility and selecting an appropriate antibiotic against target pathogens.
Streptococcus pyogenes/*drug effects ; Streptococcus pneumoniae/*drug effects ; Staphylococcus aureus/*drug effects ; Microbial Sensitivity Tests ; Methicillin Resistance ; Ketolides/*pharmacology ; Humans ; Haemophilus influenzae/*drug effects ; Cephalosporins/*pharmacology ; Administration, Oral

In order to carry out mass examination for detection of stomach ailments effectively and improve screening accuracy, the Nagano Prefectural Welfare Federation of Agricultural Cooperatives, with its mass gastric examination committee as a driving force, has made every endeavor in close collaboration with Federation-affiliated hospitals.
The ratio of those receiving detailed examination to the total number of those who have undergone mass screenings, and the detection ratio of gastric cancer cases, especially those in early stages, have increased steadily over the past years.
This is due in the main to untiring effort exerted by public health nurses and other persons concerned with health problems.
However, the results of X-ray examination made on the basis of the diagnostic standards prepared by the Federation show that there is much need of improving examiners' ability to read mass miniature radiographs correctly.