We report on a rare case of valvular regurgitation caused by methotrexate-associated lymphoproliferative disorder (MTX-LPD). A 60-year-old woman was on methotrexate (MTX) for rheumatoid arthritis. She had developed ulcerative lesions on her extremities, which were diagnosed as lymphoproliferative disorder (LPD) by skin biopsy. She had small intestinal perforation during the same time period, and underwent partial bowel resection. MTX was withdrawn perioperatively. The patient experienced congestive heart failure immediately after the operation and was diagnosed with severe mitral valve regurgitation and moderate-to-severe aortic valve regurgitation. She underwent mitral valve plasty and aortic valve replacement. We observed mitral valve perforation, surrounded by a cauliflower-shaped elevation. Meanwhile, the aortic valve leaflets degenerated into cauliflower-like structures. Pathological findings suggested infiltration of B lymphocytes and Epstein–Barr virus infection in the valve tissue. These findings were similar to those of the prior skin ulcer diagnosed as LPD, which healed spontaneously after MTX withdrawal. She was diagnosed with MTX-LPD based on the pathological findings and clinical history. The patient was discharged on postoperative day 19.

Background: and PurposeThe coast of Kyushu Island on Ariake Sea in Japan is known to be an accumulation area for patients with a proline-to-leucine substitution mutation at residue 102 (P102L) of the human prion protein gene (PRNP), which is associated with Gerstmann–Sträussler–Scheinker disease. We designated this geographical distribution as the “Ariake PRNP P102L variant.” The purpose of this study was to characterize the clinical features of this variant. Methods: We enrolled patients with the PRNP P102L variant who were followed up at the Saga University Hospital from April 2002 to November 2019. The clinical information of patients were obtained from medical records, including clinical histories, brain magnetic resonance imaging (MRI), and electroencephalography (EEG). A brain autopsy was performed on one of the participants. Results: We enrolled 24 patients from 19 family lines, including 12 males. The mean age at symptom onset was 60.6 years (range, 41–77 years). The incidence rate of the Ariake PRNP P102L variant was 3.32/1,000,000 people per year in Saga city. The initial symptoms were ataxia (ataxic gait or dysarthria) in 19 patients (79.2%), cognitive impairment in 3 (12.5%), and leg paresthesia in 2 (8.3%). The median survival time from symptom onset among the 18 fatal cases was 63 months (range, 23–105 months). Brain MRI revealed no localized cerebellar atrophy, but sparse diffusion-weighted imaging abnormalities were detected in 16.7% of the patients. No periodic sharp-wave complexes were identified in EEG. Neuropathological investigations revealed uni- and multicentric prion protein (PrP) plaques in the cerebral cortex, putamen, thalamus, and cerebellum of one patient. Western blot analysis revealed 8-kDa proteinase-K-resistant PrP. Conclusions This is the first report of the accumulation area of a PRNP P102L variant on the coast of Ariake Sea. The Ariake PRNP P102L variant can be characterized by a relatively long disease duration with sparse abnormalities in brain MRI and EEG relative to previous reports. Detailed interviews to obtain information on the birthplace and the family history of related symptoms are important to diagnosing a PRNP P102L variant.

BACKGROUND: Food allergy (FA) is a common disease in children, and its prevalence has increased in developed countries. The impact of overweight on children health also becomes an important social problem. However, the relationship between overweight and FA is still unclear. We examined the association between overweight and the prevalence of FA among Japanese children. METHODS: We analyzed data obtained using a self-administered questionnaire from 1772 Japanese children. Weight groups according to body mass index cutoff points proposed by the International Obesity Task Force were used to create two groups: overweight and non-overweight. Children were separated into four age groups (3-6 years, 6-9 years, 9-12 years, and 12-15 years) to examine age differences. We performed univariate and multivariate logistic models to examine the association between overweight and FA. RESULTS: The prevalence of FA was significantly higher in boys (10.6%, p = 0.014) than girls (4.5%) and girls (7.9%, p = 0.012) than boys (2.5%) for 6-9 and 12-15 age groups, respectively. While the prevalence of FA was significantly higher in overweight than non-overweight girls (26.1%, p = 0.005) in the 12-15 age group, no significant difference was found in boys. In girls, overweight was significantly associated with FA after adjustment for age and asthma (odds ratio 1.99, 95% confidence interval 1.01-3.89, p = 0.046). CONCLUSIONS Our results showed that being overweight was significantly associated with a higher prevalence of FA in girls, but not in boys. Further prospective studies are necessary to find the causal relationship between overweight and FA.
Adolescent ; Body Mass Index ; Child ; Child, Preschool ; Cross-Sectional Studies ; Female ; Food Hypersensitivity/epidemiology* ; Humans ; Japan/epidemiology* ; Male ; Overweight/epidemiology* ; Prevalence ; Sex Factors

OBJECTIVE: This study aimed to evaluate the efficacy of magnetic resonance (MR) imaging in differentiating between cutaneous basal cell carcinoma (cBCC) and cutaneous squamous cell carcinoma (cSCC) in the head and neck region.MATERIALS AND METHODS: Among patients with cutaneous head and neck cancers, 14 with primary cBCCs and 15 with primary cSCCs with a histologic tumor height of ≥ 4 mm underwent MR examinations; the findings were then examined for correlations.RESULTS: cBCCs (71%) occurred more frequently on the nose than cSCCs (13%) (p < 0.01). The maximum diameter (23.5 ± 7.2 mm vs. 12.7 ± 4.5 mm; p < 0.01) and diameter-to-height ratio (2.8 ± 0.9 vs. 1.7 ± 0.4; p < 0.01) were significantly greater in cSCCs than in cBCCs. Superficial ulcer formation (67% vs. 21%; p < 0.05), protrusion into the subcutaneous tissue (60% vs. 21%; p < 0.05), ill-demarcated deep tumor margins (60% vs. 7%; p < 0.01), and peritumoral fat stranding (93% vs. 7%; p < 0.01) were more frequently observed in cSCCs than in cBCCs. Intratumoral T2-hyperintense foci (57% vs. 13%; p < 0.05) were more frequently observed in cBCCs than in cSCCs.CONCLUSION: cBCCs predominantly occurred on the nose with intratumoral T2-hyperintense foci, whereas cSCCs predominantly exhibited a flattened configuration, superficial ulcer formation, protrusion into the subcutaneous tissue, ill-demarcated deep tumor margin, and peritumoral fat stranding.
Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Epithelial Cells ; Head ; Humans ; Magnetic Resonance Imaging ; Neck ; Nose ; Skin Neoplasms ; Subcutaneous Tissue ; Ulcer

No abstract available.
Abscess* ; Mycoplasma hominis* ; Mycoplasma*

Background: To investigate the effect of high-voltage alternating current (AC) electric field exposure on muscle extensibility. Methods: The study design was a crossover comparison. Fifteen healthy men were randomly divided into two groups. The interventions were exposure and no exposure to a high-voltage AC electric field (18 kV, 30 min). Subjects then performed bilateral self-stretching of the trapezius, hamstrings, and rectus femoris. Skin temperature, blood flow rate, blood pressure, heart rate, muscle rigidity, and muscle extensibility were measured before and after the intervention, and muscle rigidity and muscle extensibility were measured again after stretching. Skin temperature was measured bilaterally on the palms, shoulder girdle, anterior thigh, and dorsum of foot. Blood flow rate was measured in the right radial artery and dorsal artery of the foot. Muscle rigidity was measured bilaterally in the trapezius, rectus femoris, and biceps femoris. Muscle extensibility indices were determined for the left and right angle of lateral neck flexion, heel-buttock distance, straight leg raise angle, and sit-and-reach distance. Skin temperature, blood flow rate, blood pressure, and heart rate were compared between before and after the intervention, and muscle rigidity and muscle extensibility were compared before and after the intervention and after stretching. Results: A significant improvement was found in muscle extensibility in the intervention group but not in the controls. Muscle extensibility improvements due to stretching were noted regardless of electric field exposure, but the degree and percentage of change in muscle extensibility was significantly higher after stretching following electric field exposure. Electric field exposure had no effect on muscle rigidity or circulatory dynamics. Conclusions: Exposure to the high-voltage AC electric field appeared to increase muscle extensibility and heighten the effect of stretching. However, as the mechanism for improved muscle extensibility due to high-voltage AC electric field exposure was not clear, further study is necessary.

PURPOSE: Atrial natriuretic peptide (ANP) has a variety of pharmacologic effects, including natriuresis, diuresis, vasodilatation, and suppression of the renin-angiotensin system. A recent study showed that ANP infusion improved hypoxemia and pulmonary hypertension in a lung injury model. On the other hand, the pulse contour cardiac output (PiCCO(TM)) system (Pulsion Medical Systems, Munich, Germany) allows monitoring of the intravascular volume status and may be used to guide volume therapy in severe sepsis and critically ill patients. MATERIALS AND METHODS: We treated 10 pulmonary edema patients without heart disease with human ANP (HANP). The patients were divided into two groups: a group with normal Intrathoracic Blood Volume (ITBV) (900-1100 mL/m2) (n = 6), and a group with abnormal ITBV (n = 4), as measured by the PiCCOtrade mark device; the extravascular lung water (EVLW) and pulmonary vascular permeability index (PVPI) in the two groups were compared. RESULTS: The average patient age was 63.9 +/- 14.4 years. The normal ITBV group showed significant improvement of the EVLW (before, 16.7 +/- 2.7 mL/kg; after, 10.5 +/- 3.6 mL/kg; p = 0.0020) and PVPI (before, 3.2 +/- 0.3; after, 2.1 +/- 0.7; p = 0.0214) after the treatment. The abnormal ITBV group showed no significant improvement of either the EVLW (before, 16.3 +/- 8.9 mL/kg; after, 18.8 +/- 9.6 mL/kg; p = 0.8387) or PVPI (before, 2.3 +/- 0.8; after, 2.7 +/- 1.3; p = 0.2782) after the treatment. In both groups, the EVLW and PVPI were strongly correlated with the chest X-ray findings. CONCLUSION: We conclude that HANP supplementation may improve the EVLW and PVPI in pulmonary edema patients without heart disease with a normal ITBV. The PiCCO(TM) system seems to be a useful device for the management of pulmonary edema.
Aged ; Atrial Natriuretic Factor/administration & dosage/*therapeutic use ; Cardiac Output/*drug effects/*physiology ; Female ; Humans ; Injections, Intravenous ; Male ; Middle Aged ; Monitoring, Physiologic/*instrumentation ; Pulmonary Edema/*drug therapy/*physiopathology

Background/Objectives: Since April 2006, smoking cessation treatment has been included in public health insurance coverage, although conditionally. The tobacco control program usually takes 12 weeks or so. When it comes to the form of treatment, most medical care facilities adopt nicotine replacement therapy (NRT) at their outpatient ward. The cessation success rates are considered not so high as before. In stead of treating nicotine-addict outpatients individually, our hospital has been offering a stop-smoking program all its own since 1999. This study was designed to examine the results of our efforts in the last six years retrospectively.Subjects/Methods: Enrolled for this study were 232 patients who had participated in our six-month smoking cessation program between 1999 and 2005. A non-smokingsupport team made up of a physician, pharmacist(s), nurses, dietitian(s) and physical therapist(s) takes care of groups of participating patients, each group consisting of 10 or less. The patients undergo behavior therapy throughout the 6-month period and NRT in the first eight weeks. Under the program, nutrition guidance is offered regularly by dietitians for weight control and physical exercises by physical therapists for relief from the stress due to abstinence from smoking. We took a questionnaire survey of all the subjects and worked out the ratios of those persons who had remained abstinent up to one year after they stopped smoking to the total.Results: The rates of abstinence maintained eight weeks, six months and one year after the start of cessation were 78.4%, 70.3% and 64.7%, respectively. Of those who were still abstinent, 78.0% replied that they found it easy to resist the urge to smoke cigarette thanks to the smoking cessation program.Conclusion: Our six-month participatory tobacco control program was found effective as high cessation rates were maintained.
Cessation of smoking ; seconds ; month ; week ; Smoking

We report a clinical study conducted to investigate the effects of Electric Field Therapy (EFT) generated by HEALTHTRON on the stiffness in the neck and shoulder area. In Japan, most cases of stiffness in the neck and shoulder area are caused by painfully hypertonic muscles due to various causes such as cervical damage, mechanical stress, disordered cutaneous sensation and psychogenic stress. Internal disorders can also be significant causes of the painful stiffness in the neck and shoulder area. Subjects were 62 outpatients with chief complaints of stiffness in the neck and shoulder area. Informed consent was obtained from each subject. The patients with organic and/or pathological changes in the muscloskeletal system, mental disorder, or internal disease were not included in this study according to the exclusion criteria for feasible focus in hypertonic muscles.
The present study consists of two comparisons, 1) standard treatment in our clinic vs. additional HEALTHTRON, by observing the visual analogue scale (VAS) of stiffness in the neck and shoulder area and general condition, lymphocyte percentage in peripheral blood, blood pressure, and 2) HEALTHTRON alone vs. direct-contact electric stimulation (DCES) alone by observing circulatory blood in the trapezium, and the changes of autonomic nervous activity by heart rate variability (HRV). Results of the first research revealed that the stiffness in the neck and shoulder area was improved more quickly by additional HEALTHTRON than by the standard treatment, according to the results of VAS analysis. The general conditions were also improved in the patients treated with the additional HEALTHTRON. The lymphocyte percentage was increased by the addition HEALTHTRON, which suggested that parasympathetic nerve get a predominant position. The average blood pressure in the hypertensive patients in both groups was decreased after the treatment in this investigation, but blood pressure did not change in the patients with hypotension. The second research found that the blood circulation in the trapezium increased in each group treated with HEALTHTRON or DCES; however, the differences between two groups were not statistically significant. No changes in activity of the autonomic regulation were observed in the patients treated with DCES from an analysis of HRV. In contrast, the sympathetic and parasympathetic nervous systems were activated by HEALTHTRON, according to HRV analysis. These results suggest that EFT (HEALTHTRON) are effective for treating stiffness in the neck and shoulder area, and improve the status of the autonomic nervous system.

The present study was performed to investigate the effects of 120 km walking, 40 km a day for 3 successive days on the condition that taking rest and foods freely, upon physical functions for healthy male and female subjects. All measurements were enforced at postabsorptive state early in the morning for the 10 successive days including the days of walking. Blood pressure, heart rate, and body weight were measured every morning. Blood samplings enforced, too. Urine collections were enforced from first day to 7 th day. The results obtained were as follows;
1) There were no changes in heart rate, blood pressure, and body weight, which were measured early in the morning, before and after 120 km walking.
2) Serum GOT and GPT activities had little changes, while serum LDH, α-HBDH, and CK activities increased gradually after walking.
3) Serum CK-MB activities, which indicate myocardial injury, increased after walking, on the contrary CK-MB/CK ratio decreased. It was suggested that effects of 120km walking to myocardium were rather than slight ones.
4) In spite of the same sorce in which serum CK-MB and LDH-1 were resulted, both did'nt exhibit same patterns in serum.
5) Serum lipids decreased gradually after walking.
6) Urinary excretion of creatinine and uric acid increased after 120km walking especially.
7) If it is allowed to take sufficient foods and rest, 120km walking, 40km a day for 3 successive days, would not result in such a physical stress over the following days.