We successfully performed one-stage definitive repair for 3 infants weighing 4.2, 6.1 and 5.2kg with complex coarctation without homologous blood transfusion. The priming volume of the bypass circuits was 195ml, and their lower hematocrit values during cardiopulmonary bypass were 15, 16 and 13%, respectively. In order to diminish the aortic cross clamp time, the aortic arch was repaired with the heart beating, using isolated cerebral and myocardial perfusion methods. The base excess in each patient decreased to -9.4, -8.0 and -4.9mEq/l during the rewarming phase, however, their postoperative hemodynamic and respiratory conditions were satisfactory. They have grown without any sequelae for at least 2 months.

Helicobacter pylori (HP) is associated with gastroduodenal disease. Although it has been reported that HP is highly sensitive to beta-lactams and macrolides, the efficacy of these monotherapies for eradicating HP is rather poor. Recent pharmacological studies have shown the effectiveness of combined therapy using PPI, antibiotics, and bismuth agents or metronidazole, but it has been known to lead to side effects and poor patient compliance. In Japan, mucosal protective agents are principally used for the treament of gastritis and gastric ulcers, and as previously reported, some mucosal protective agents, such as sofalcon and plaunotol, have anti-HP properties. Although they are not sufficiently effective to be used as monotherapy in the eradication of HP, in combination with antibiotics and PPI, eradication rates were elevated and side effects were uncommon.
Chinese medicinal formulas have been used for stomach disease in traditional Oriental medicine. The authors studied the effects of combined therapy with Omeprazole (OPZ), AMPC and Chinese medicine (Hangeshashin-to and Sanoshashin-to) instead of mucosal protective agents in the eradication of HP. The study was conducted on a total of 137 HP positive patients with endoscopic evidence of ulcers or gastritis. Dual therapy with OPZ and AMPC had a weak eradicating effect on HP (75%), but combined therapy using OPZ, AMPC and a Chinese medical formula was successful in eradicating HP in 20 out of 24 patients (85%).
The antibacterial effects of pharmaceutical preparations and crude drug extracts of Chinese medicine against HP were examined in an in vitro study. No antibacterial action against HP was demonstrated by these agents at concentrations of less than 2000μg/ml concentration. Chinese medicinal preparations should be used in combined therapy with antibiotics and PPI for optimum efficacy in eradicating HP.
This new eradication regimen including OPZ, AMPC and Hangeshashin-to is well tolerated; side effects are minimal and uncommon. This triple therapy may be useful in the treatment of HP infection, and is referred to as a “new Japanese regimen.”

We experienced a case that right massive pleural effusion was successfully controlled with Denver shunt from the right chest cavity to right femoral vein. A 80-years-old woman had received hemodialysis due to chronic renal failure twice in a week. She was diagnosed as right breast cancer and underwent right breast conserving surgery at December, 2008. In postoperative follow-up duration, she had difficulty in breathing and visited to the emergency room in our hospital. She was diagnosed as respiratory failure due to right massive pleural effusion from the X-ray result and the blood gas analysis. There was no pleural effusion within the left chest space. No malignant cell was detected in the effusion. We thought that diuretics and shunt tube from the right chest cavity to the abdominal cavity would be ineffective because of her chronic renal failure, and for that reason, we placed the shunt tuve from the chest cavity to the right femoral vein. Respiratory failure and the quality of life were successfully improved for about 7 months by using it. Palliat Care Res 2011; 6(1): 301-307

Thirty-nine years old woman had a severe renovascular hyper-tension with Takayasu's arteritis Her left renal artery stenosis was treated with percutaneous transluminal angioplasty (PTA) three times. Six months after the third PTA, the left renal artery was occluded, and left renal failure occurred. Aorto-renal bypass surgery with a prosthetic graft was performed. Blood pressure dropped to normal range, and left renal function began to recover. Although PTA is an effective method in the treatment of renovascular hypertension, an incidence of restenosis after PTA is higher in Takayasu's arteritis rather than atherosclerotic lesions. Five months after renal revascularization, hypertension recurred in this case. However the aorto-renal bypass graft was patent accompanied by no symptoms. This aorto-renal bypass surgery can be considered effective in this condition.

This present study was conducted among the nine centers of Akita prefectural Welfare Federation of Agricultural Cooperatives. This applied to women over 30 years of age, and carried out following to the standard method of the Japan Cancer Society.
The total of women examined by the first screening from April 1983 to January 1985 amounted to 15903, of which the number of women over 60 years of age was only 7 per cent of the total. According to the type of screening, the number of women slightly more in the center screening than in the local screening. However, in both types of screening, the number of women examined by the combination method, for example, anemia or uteric cancer, was much higher than that of the mass screening for breast cancer alone.
The second screening rates indicaded a marked difference of 0.4 to 21.7 per cent depending on the location of the center. The over-all average for the second screening was 3.8 per cent. As a result of the second screening, breast cancers were detected in 12 cases (0.07%). The breast cancer detection rate increased with age. It is notable that the breast cancer detection rate for women over 60 years of age was 5 times higher than for women over 40 years of age. Among other diseases detected in the second screening were mastpathy (233 cases), fibroadenoma (15 cases), mastitis (40 cases) and others.
As far the stage distribution and screening history for detected breast cancers, 60 per cent of all cancer cases were diagnosed as stage I, and 70 per cent were the initial screening. Seven out of 12 cases were aware the breast lump themselves before the first screening. From this point of view, it was suggested that every women should be educated in order to perform selfexamination.

Fifty-five adult patients with atrial septal defect (ASD) were surgically treated. In the preoperative study, 6 patients showed high pulmonary artery systolic pressure (>50mmHg). However, there was no linear relation between PAP and age, nor between Q_p/Q_s and PAP. As for the additional surgical procedures, MVR (1), MAP (1), TAP (3), OPC (2) were carried out with ASD closure in 7 patients. Post-operative evaluation with echocardiography revealed increase in the left ventricular chamber size, decrease in the severity of tricuspid regurgitation and same grade mitral regurgitation compaired with pre-operative level. From these data, the prediction of the atrioventricular valve regurgitation after ASD closure seemed to be difficult just from the preoperative evaluation, Transesophageal echocardiography was useful for the evaluation of residual atrioventricular valve regurgitation during operation in the cases of ASD with over II grade regurgitation preoperatively.

No abstract available.

Based on two years working of “the enlarged working group for the curriculum of chemistry for medical education”, a provisional plan of the curriculum of chemistry for medical students is proposed. The article is consist of four sections; namely A: general problems, B: “chemistry” as a general education, C: purpose and specific problems of the general education for medical students, D: a provisional plan of the curriculum of chemistry for medical students.
The main part D is consist of three subsections: namely (1) a plan of the curriculum of physical and inorganic chemistry, (2) a plan of the curriculum of organic chemistry, (3) a plan of the curriculum of experiments.

Background/Aims: Intestinal fibrosis is a major complication of Crohn’s disease (CD). The profibrotic protein transforming growth factor-β (TGF-β) has been considered to be critical for the induction of the fibrotic program. TGF-β has the ability to induce not only the expression of extracellular matrix (ECM) including collagen, but also the production of plasminogen activator inhibitor-1 (PAI-1) that prevents enzymatic degradation of the ECM during the onset of fibrotic diseases. However, the significance of PAI-1 in the developing intestinal fibrosis has not been fully understood. In the present study, we examined the actual expression of PAI-1 in fibrotic legion of intestinal inflammation and its correlation with the abnormal ECM deposition. Methods: Chronic intestinal inflammation was induced in BALB/c mice using 8 repeated intrarectal injections of 2,4,6-trinitrobenzene sulfonic acid (TNBS). TM5275, a PAI-1 inhibitor, was orally administered as a carboxymethyl cellulose suspension each day for 2 weeks after the sixth TNBS injection. Results: Using a publicly available dataset (accession number, GSE75214) and TNBS-treated mice, we observed increases in PAI-1 transcripts at active fibrotic lesions in both patients with CD and mice with chronic intestinal inflammation. Oral administration of TM5275 immediately after the onset of intestinal fibrosis upregulated MMP-9 (matrix metalloproteinase 9) and decreased collagen accumulation, resulting in attenuation of the fibrogenesis in TNBS-treated mice. Conclusions PAI-1-mediated fibrinolytic system facilitates collagen degradation suppression. Hence, PAI-1 inhibitor could be applied as an anti-fibrotic drug in CD treatment.

The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract cancers (cholangiocarcinoma, gallbladder cancer, and ampullary cancer) in 2007, then published the 2nd version in 2014. In this 3rd version, clinical questions (CQs) were proposed on six topics. The recommendation, grade for recommendation, and statement for each CQ were discussed and finalized by an evidence-based approach. Recommendations were graded as grade 1 (strong) or grade 2 (weak) according to the concepts of the grading of recommendations assessment, development, and evaluation system. The 31 CQs covered the six topics: (1) prophylactic treatment, (2) diagnosis, (3) biliary drainage, (4) surgical treatment, (5) chemotherapy, and (6) radiation therapy. In the 31 CQs, 14 recommendations were rated strong and 14 recommendations weak. The remaining three CQs had no recommendation. Each CQ includes a statement of how the recommendations were graded. This latest guideline provides recommendations for important clinical aspects based on evidence. Future collaboration with the cancer registry will be key for assessing the guidelines and establishing new evidence.