About some knee joint pains we treat at clinic every day, toward the old people who have been in knee joint pain for a long time, I considered about the alignment of lower extremity, and the connection between the mobility of patella and knee joint pains.
I had three kinds of ways to measure the alignment of lower extremity. F-T angle means degrees of genu-varum and genu-valgum about lower extremity. Q angle means the deviation of patella at the frontal plane. E angle means the extension limitted of the knee. I measured each angle. I examined the mobility of patella up and down, left and right. In addition, I selected two points from six points where knee joint pains often happened, after that I made these two points.
As a result, only the worse of F-T angle had an influence on the continuance of pains and mainly the pain place tended to gather in Nai-shitugan and Kyokusen. The change in Q angle and E angle didn't participate in a continuance of pains. I could suppose that the limitation about the mobility of patella also had an influence on the occurence of pains.

We have used absorbable suture material for the repair of pediatric cardiovascular anomalies where subsequent growth of the suture line was requied since 1986. We reviewed long-term results of three groups of patients using absorbable suture (1. cardiovascular surgery in the high-pressure areas, 2. semicircular annuloplasty for mitral regurgitation, 3. cardiovascular surgery in the low pressure areas). In group 1, six patients after Jatene procedure using PDS^® were examined. Subsequent growth of the neo-aortic anastomotis were well preserved without formation of pseudoaneurysm 6-56 (average 18.6) months after the operation. In group 2, seven patients with mitral regurgitation (mitral valve regurgitation 4, endocardial cushion defect 3) were examined. The semicircular annuloplasty was applied using Vicryl^® and Dexon^® and mitral regurgitation was improved and in two patients normal growth of the mitral annulus was recognized 4 and half years after the operation. In group 3, sixteen patients in the repair of total anomalous pulmonary venous drainage (Darling type I, III) using PDS^® were examined. Pulmonary venous obstruction were encountered 1 and 5 months after the anastomotis between common pulmonary vein and left atrium in two patients and anastomotic stenosis was thought to be induced by tissue overgrowth. On the basis of our clinical experiences, we believe that application of absorbable suture in pediatric cardiovascular surgery in the high-pressure areas could be recommended as an alternative treatment, but that should be avoided in the neonatal small low-pressure areas on the assumption that anastomotic stenosis might be induced by tissue overgrowth.

Irreversible electroporation (IRE) is a novel form of soft tissue ablation therapy that uses highcurrent electrical pulses to induce the formation of pores in the cell membrane, leading to cell death. Although outcome data for the ablation of hepatocellular carcinoma (HCC) by IRE are limited, early results are encouraging and may suggest equivalency to the outcomes achieved by thermal ablation methods such as radiofrequency ablation (RFA) and microwave ablation (MWA). However, IRE can be a challenging and very time-consuming procedure compared to RFA and MWA. In this review article, we not only evaluate the efficacy and safety of IRE for the treatment of HCC, but also discuss imaging guidance, ablation monitoring, and endpoint assessment, with a particular focus on ultrasonography.

  In order to intervene in the management of pain of cancer from an early stage. Our palliative care team (PCT), including pharmacists, makes the ward rounds (screening rounds) of the patients receiving opioids at our hospital. The purpose of this study was to analyze the effects of screening rounds activity by the PCT and its current problems, and to explore how to resolve the problems. We retrospectively studied the records of 196 patients who had receivede interventions by the PCT, with regard to intervention status and prescription proposal (228 subjects) about drug therapy by us. Study groups were as follows: 103 patients to whom interventions were deliveed at the request of medical doctors (intervention request group) and 93 patients who had interventions by the PCT after PCT-screening rounds (screening group). PCT-screening rounds caused to increase the number of interventions by the PCT. After PCT-screening rounds, the cases of intervention started by the request of medical doctors, who had given no heed to PCT intervention, also increased in numher. In this study, some problems with palliative intervention were also brought to light. Even in the screening group where the PCT largely intervened, 33% of prescription proposal by the PCT was ignored. This problem may be, at least in part, due to inadequate communication between PCT and ward staff through an electronic medical recording card, leading to poor relationship between PCT and ward staff. In the future, the PCT needs to work cooperatively with ward staff through direct communication such as medical conference to perform better intervention.

Shear wave (SW) dispersion imaging is a newly developed imaging technology for assessing the dispersion slope of SWs, which is related to tissue viscosity in diffuse liver disease. Our preclinical and preliminary clinical studies have shown that SW speed is more useful than dispersion slope for predicting the degree of fibrosis and that dispersion slope is more useful than SW speed for predicting the degree of necroinflammation. Thus, dispersion slope, which reflects viscosity, may provide additional pathophysiological insight into diffuse liver disease.