Background/Aims: Endoscopic self-expandable metal stent (SEMS) placement is currently the standard technique for treating unresectable malignant distal biliary obstructions (MDBO). Therefore, covered SEMS with longer stent patency and fewer migrations are required. This study aimed to assess the clinical performance of a novel, fully covered SEMS for unresectable MDBO. Methods: This was a multicenter single-arm prospective study. The primary outcome was a non-obstruction rate at 6 months. The secondary outcomes were overall survival (OS), recurrent biliary obstruction (RBO), time to RBO (TRBO), technical and clinical success, and adverse events. Results: A total of 73 patients were enrolled in this study. The non-obstruction rate at 6 months was 61%. The median OS and TRBO were 233 and 216 days, respectively. The technical and clinical success rates were 100% and 97%, respectively. Furthermore, the rate of occurrence of RBO and adverse events was 49% and 21%, respectively. The length of bile duct stenosis (<2.2 cm) was the only significant risk factor for stent migration. Conclusions The non-obstruction rate of a novel fully covered SEMS for MDBO is comparable to that reported earlier but shorter than expected. Short bile duct stenosis is a significant risk factor for stent migration.

Objective: This study aimed to assess gynecologic oncologists (GOs)’ perceptions and attitudes toward cancer survivorship to help improve survivor care. Methods: We conducted a web-based questionnaire survey about survivorship issues for the GOs belonging to the Japan Gynecologic Oncology Group. We analyzed the proactiveness of the participants toward addressing 25 survivor issues. In addition, the practice patterns and barriers to care for survivors’ long-term health issues, such as second primary cancer (SPC) and lifestyle-related diseases (LSRD), and return-to-work (RTW) support were assessed. Results: We received 313 responses. The respondents had a mean of 22 years of physician experience. The ratio of men to women was approximately 7:3, and 84.7% worked at facilities for multidisciplinary cancer treatment. The respondents’ proactiveness for addressing psychosocial problems was significantly lower than physical and gynecological issues (p<0.01 by χ2 test). However, most GOs tried to contribute to such issues according to patients’ demands. Women GOs were more proactively involved in some survivorship issues than the men (p<0.05 by logistic regression analysis). The rates of the respondents who proactively discussed SPC, LSRD, and RTW were unexpectedly high (60.7%, 36.1%, and 52.4%, respectively). However, the GOs only provided verbal support for these issues in many cases. Conclusion The Japanese GOs were enthusiastic about survivorship care. However, their tendency to deal with survivors’ problems through their own knowledge and judgments raises concerns about the quality of care. Therefore, creating survivorship care guidelines and enhancing multidisciplinary collaboration should be prioritized.

In patients with epidermal growth factor receptor (EGFR) mutation-positive lung cancer (LC) who have acquired resistance to first and/or second-generation EGFR-tyrosine kinase inhibitors (EGFR-TKIs), detection of EGFR T790M (T790M) mutation is essential before administration of osimertinib. Tissue sample is the main specimen used to detect the T790M mutation, and so cell block preparation using pleural or pericardial fluid should be considered. The utility of body cavity effusion cell block methods in T790M mutation detection have not yet been fully evaluated. This study aimed to evaluate the clinical background and treatment course of LC patients harboring the T790M mutation by using body cavity effusion cell block methods at our hospital. All patients were treated with first and/or second-generation EGFR-TKIs and had developed malignant pleural or pericardial fluid as a result of progressive disease. T790M mutation status was evaluated using body cavity effusion cell block method in 9 patients, from April 2016 to August 2017. We retrospectively evaluated the clinical characteristics and treatment course of these 9 patients (3 males and 6 females; median age 76 years). At the first diagnosis of LC, 7 patients had stage IV cancer; 4 patients were diagnosed by bronchial fibroscopy and 3 were diagnosed from pleural fluid examination. Regarding EGFR mutation, 3 and 6 patients carried the exon 19 deletion and L858R mutation, respectively. Median time interval between the first diagnosis of LC and T790M mutation evaluation was 30.8 months; 7 patients were diagnosed with positive T790M mutation by using body cavity effusion cell block methods. The T790M mutation was highly detected by examination of body cavity effusion cell blocks. Further evaluation is necessary with respect to variations in T790M detection rate based on the specimen collection site and/or progressive disease pattern in different patients.

BACKGROUND: In daily clinical practice, it is essential to properly evaluate the postoperative sliding distance of various femoral head fixation devices (HFD) for trochanteric fractures. Although it is necessary to develop an accurate and reproducible method that is unaffected by inconsistent postoperative limb position on radiography, few studies have examined which method is optimal. Therefore, the purpose of this study is to prospectively compare the accuracy and reproducibility of our four original methods in the measurement of sliding distance of the HFD. METHODS: Radiographs of plastic simulated bone implanted with Japanese proximal femoral nail antirotation were taken in five limb postures: neutral, flexion, minute internal rotation, greater external rotation, and flexion with external rotation. Orthopedic surgeons performed five measurements of the sliding distance of the HFD in each of the flowing four methods: nail axis reference (NAR), modified NAR, inner edge reference, and nail tip reference. We also assessed two clinical cases by using these methods and evaluated the intraclass correlation coefficients. RESULTS: The measured values were consistent in the NAR method regardless of limb posture, with an even smaller error when using the modified NAR method. The standard deviation (SD) was high in the nail tip reference method and extremely low in the modified NAR method. In the two clinical cases, the SD was the lowest in the modified NAR method, similar to the results using plastic simulated bone. The intraclass correlation coefficients showed the highest value in the modified NAR method. CONCLUSIONS: We conclude that the modified NAR method should be the most recommended based on its accuracy, reproducibility, and usefulness.
*Bone Nails ; *Dimensional Measurement Accuracy ; Fracture Fixation, Intramedullary/instrumentation/*methods ; Hip Fractures/*surgery ; Prospective Studies ; Reproducibility of Results

Objective: In the intensive care unit (ICU), drugs are administered in sequence as the conditions of the patient change rapidly, and there are often cases where many injections are administered simultaneously.  For this reason, it is important to quickly select the appropriate administration route.  In this study, we prepared a quick reference table for incompatibilities of frequently used and highly important injections in the ICU (referred to as the “quick reference table”) that will enable selection of the appropriate administration route, and we investigated the status of use and usefulness of this quick reference table.
Methods: The drugs included in the quick reference table were extracted from prescription records from May to October 2009, and these were finalized by discussions with the nurses in the ICU.  Three reference materials were used: Manual on the Supervision of Injection Preparation (3rd Edition), Data Search on Injection Incompatibilities 2009, and MICROMEDEX®.  The survey was conducted with all 12 nurses in the ICU after 4 months of distributing the quick reference table.
Results: The quick reference table included 57 pharmaceutical items, and compatibility was classified into 10 categories.  The quick reference table was prepared as one A3 page for convenience.  The retrieval rate of the survey was 100%.  The average number of years of practical experience as a nurse was 12.2 years, and 11 out of 12 nurses used the quick reference table.  Of the 11 nurses who used the table, 6 answered that it was “very useful,” while 4 answered that it was “useful.”  All 11 nurses who used the quick reference table answered that they “consulted the pharmacists less frequently.”
Conclusion: Satisfactory evaluations were obtained with regard to the details included in the quick reference table, and the table was estimated to be highly useful and important even for ICU nurses with many years of experience.  Furthermore, it was suggested that the quick reference table was also useful in reducing the workloads of the pharmacists.

The source of the herbal mixture named Jiin-koka-to is Wan bing hui chun. Jiin-koka-to has been used mainly as a decoction for the treatment of bronchitis and tuberculosis. The cases of bronchial asthma treated with Jiin-koka-to in this report had similar symptoms: abnormal sensations in the throat and irritation. We investigated the efficacy of Jiin-koka-to in 11 asthma patients having both symptoms. Improvements were observed in all patients; these improvements included reduction of peripheral eosinophil count and serum IgE, loss in quantity of prednisolone, increment of peak expiratory flow rate, and cessation or decrease of asthma attacks. Thus, it is possible that Jiin-koka-to is a controller rather than a reliever in the treatment of bronchial asthma. Abnormal sensations in the throat and irritation might be one of the indications for Jiin-koka-to.

We treated two patients with rheumatoid arthritis (RA) who demonstrated different signs from the perspective of traditional medicine. The first case was a 73-year-old woman. In 1977, she consulted a nearby hospital due to bilateral knee joint pain. Her condition was diagnosed as RA. In 1984, she consulted our department for Stage IV and Class III disease. She was treated with Keishi-ni-eppi-itto-ka-ryojutsubu-kagen, and her condition stabilized. In 1994, she received total replacement of the bilateral knee joints. Her ADL increased, but pain at her bilateral wrist, elbow, shoulder and ankle joints persisted. Although she was treated with Yokuininto, as well as bucillamine and salazosulfapyridine, arthralgia persisted. In 1996, her condition was as follows: general malaise, pain at the bilateral shoulder and elbow joints, severe deformity at the wrist joints, dry skin and slender limbs. She walked with a cane. Therefore, we changed the formula from Keishi-shakuyaku-chimoto to Daibofu-to. Thereafter, her symptoms significantly decreased. The second case was a 50-year-old woman. In 1994, she suffered from pain in the right hand, bilateral feet and knee joints. Her condition was diagnosed as RA at a local hospital. In 1996, polyarthralgia increased and she consulted the department of orthopaedic surgery in our hospital. She was administrated bucillamine, but it was discontinued due to eruptions. Then she consulted our department. She was first treated with Keishi-ni-eppi-itto-ka-ryojutsubu, and then with Yokuininto, which did not change her symptoms. Therefore, we tried several DMARDs; however, her condition worsened. In June 2000, her laboratory data were as follows: RF 860U/ml, ESR 72mm/hr, CRP 4.0mg/dl. Although she complained of pain at the bilateral wrist, elbow and ankle joints, there was no deformity in the bilateral wrist or finger joints of either hand. She was a medium-sized person, and without dry skin or edema at the limbs. The administration of Daibofu-to improved her symptoms as well as laboratory data after 3 months of treatment.
The clinical signs of case 1 were in accordance with the traditional indications for Daibofu-to. In contrast, those of case 2 differed from these indications with regard to blood-deficiency, since there was no dry skin, change in the nail, dizziness or deformity of the joints. These observations suggest that a subset of patients with RA, who have poor deficiency of blood or Ki, may be another population that can be successfully treated with Daibofu-to.

Three cases of dermatosis successfully treated with modified Mao-rensho-shakushozu-to are reported. Case 1 was a 45-year-old male who had been suffering from atopic dermatitis since childhood. He came to our clinic for treatment with Kampo formulas for unchanging symptoms. At first we prescribed Mao-rensho-shakushozu-to-go-byakko-ka-keishi-to, but this formula was not effective. After prescribing Mao-rensho-shakushozu-to-go-eppi-ka-jutsu-to, the dermatitis improved. Case 2 was a 25-year-old male student who had been suffering from atopic dermatitis since he was 19 years old. He responded to steroid ointment, but relapsed frequently after the repeated reduction of steroids. Some Kampo formulas were not effective, but the dermatitis improved after the patient used Mao-rensho-shakushozu-to-go-eppi-ka jutsu-to. Case 3 was a 65-year-old male who had been suffering from psoriasis vulgaris since he was 57. Shakushozu-to-go-byakko-ka-ninjin-to was effective for his psoriasis.
We used modified Mao-rensho-shakushozu-to in the three cases described above be cause the patients had strong itching. It is possible to apply this Kampo formula for dermatitis with strong itching.

We performed a preliminary study of the reliability of the lymphocyte stimulating test (LST) for Kampo medicine. LST for three kinds of Kampo medicines was performed in both a Kampo-administrated group and a non-administrated group. LST for each of the medicines was negative for seven of eight subjects in the non-administrated group, but was negative for four of 11 subjects in the Kampo-administrated group. The LST-positive participants had no allergic state, and some among them were negative in challenge test. This preliminary study suggests that LST for Kampo medicine is likely to be false-positive.

We encountered a case of far advanced hepatomas involving the lungs and portal veins. The patient was a 38-year-old woman. Chemoembolization had transient effects. Cachexia occurred. After repeated episodes of upper gastrointestinal bleeding, she died. An autopsy revealed a deep gastric ulcer to which a nodule of the hepatocellular carcinoma adhered. Histopathologically, the infiltration of the hepatoma was not evident. These findings suggested that circulatory distarbances of the gastric wall due to the adhesion of the growing hematoma had caused the ulceration.