Methods: Patients with degenerative lumbar diseases, whose MRIs detected BME, were enrolled. On a T2-weighted fat-saturated MRI, BME appeared as a high-intensity region adjacent to the vertebral endplate. We calculated the contrast ratios (CRs) of BME and normal bone marrow using the signal intensities of BME, normal bone marrow, and the spinal cord. On computed tomography, we calculated Hounsfield unit (HU) values in the same area as BME, the sclerotic endplate, and normal bone marrow to assess bone density. Results: There were 16 men and 14 women, with an average age of 73.5 years. The mean CRs of BME and normal bone marrow were −0.015±0.056 and −0.407±0.023, respectively. BME’s CR was significantly higher than that of normal bone marrow (p<0.01). The HU values in the same area as BME, the sclerotic endplate, and normal bone marrow were 251.9±24.6, 828.3±35.6, and 98.1±9.3, respectively; these values were significantly different from each other (p<0.01). Conclusions The CR on MRI is a useful quantitative assessment tool for BME in patients with degenerative lumbar diseases.

No abstract available.
Retrospective Studies ; Risk Factors ; Vertebroplasty

STUDY DESIGN: Retrospective case-control study. PURPOSE: To evaluate the primary outcomes and radiographic results of percutaneous vertebroplasty (PVP) in patients with singlelevel osteoporotic vertebral fracture (OVF) with intravertebral cleft (IVC) to identify the risk factors for cement loosening after PVP. OVERVIEW OF LITERATURE: PVP is a widely accepted method for managing painful OVF; however, cement loosening occasionally occurs with poor outcomes. METHODS: This retrospective study involved 195 patients treated with PVP for single-level OVF with IVC. Six months thereafter, the primary outcomes were evaluated using the Visual Analog Scale (VAS) for back pain and the modified Oswestry Disability Index. Computed tomography was conducted to detect cement loosening. Possible risk factors, such as age, sex, wedging angle, intravertebral instability, Parkinson’s disease, spinous process fracture, ankylosing spinal hyperostosis, split vertebrae, and adjacent intervertebral vacuum, were assessed. RESULTS: Forty-nine patients (25%) experienced cement loosening 6 months after PVP. The mean VAS scores were significantly higher in patients with cement loosening than in those without (50 vs. 26 mm, respectively; p < 0.01). Cement loosening was closely associated with intravertebral instability (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.04–1.40; p =0.015), Parkinson’s disease (OR, 54.31; 95% CI, 4.47–659.53; p =0.002), spinous process fracture (OR, 7.11; 95% CI, 1.65–30.60; p =0.009), and split vertebrae (OR, 11.59; 95% CI, 1.64–82.02; p =0.014). CONCLUSIONS: Patients with cement loosening experienced worse back pain than those without cement loosening. The important risk factors that influenced cement loosening after PVP were high intravertebral instability, Parkinson’s disease, spinous process fracture, and split vertebrae.
Back Pain ; Case-Control Studies ; Humans ; Hyperostosis ; Methods ; Retrospective Studies ; Risk Factors ; Spine ; Vacuum ; Vertebroplasty ; Visual Analog Scale

　The education program in all medical schools in Japan has been studied and analyzed every 2 years since 1974 by the curriculum committee of the Association of Japan Medical Colleges. Based on the most recent analysis in 2015, the marked innovation of medical education, such as an integrated curriculum, active learning, and clinical clerkship, was recognized.

Background: There has been debate over the indications for percutaneous endoscopic gastrostomy (PEG) in recent years in Japan. In addition, the level of satisfaction of patients and patient’s family after PEG remains unclear. The aim of this study was to investigate the current status of PEG and the level of satisfaction of patients and patients’ families after PEG in Japan.
Methods: We reviewed the existing data of all patients who underwent PEG tube insertion at Yuri Kumiai General Hospital (Akita, Japan) between February 2000 and December 2010. We examined the following points: underlying diseases requiring PEG, levels of consciousness, and performance status. We also sent a questionnaire to the patients and patient’s families to ask about their satisfaction with and thoughts about PEG.
Results: The data of 545 patients who underwent PEG were reviewed. There were 295 men and 250 women, with a mean age of 77.2 ± 11.4 years. PEG was indicated most frequently for cerebrovascular disorders (48.2%, 239/545). There were 515 (94.4%, 515/545) patients showing consciousness disturbance and 444 (81.5%, 444/545) bedridden patients. The questionnaire was answered by one patient himself and 316 patients’ families. When asked, “Was performing PEG a good decision?”, 57.5% (182/316) of the patients’ families answered yes. Meanwhile, when patients’ family members were asked if they would wish to undergo PEG if they were in the same condition as the patient, 28.4% (90/316) answered yes, whereas 55.3% (175/316) answered no.
Conclusions: Few patients were able to make their own decision about PEG tube placement because of consciousness disturbance. As a result, many family members of the patients did not want to experience PEG for themselves. Future studies should be performed to clarify the quality of life and ethical aspects associated with PEG.

Background: As a complementary medicine we have evaluated the efficacy of Benihuuki green tea, which contains methylated form of tea catechin reported stronger anti-allergic activities than ordinary catechin, on Japanese Cedar Pollinosis (JCP) in comparison with Yabukita green tea, contains ordinary catechin. This study was carried out during the pollination season, Feb.–April, in 2005.
Method: Four hundred eighty six patients with JCP, visiting 12 otorhinolaryngology clinics in Fukuoka prefecture were divided into A and B groups and subjected to quasi-single blind clinical trials. Under ordinary conditions, A-group patients took Benihuuki green tea and B-group took Yabukita green tea every day from February 1^st to the end of Japanese cedar and Cupressaceae pollination season. We compared nose and eye symptom scores, medication scores and disturbance of quality of life (QOL).
Result: There were no differences observed between the two groups with respect to their symptom scores and the disturbance of QOL. However, decreasing trend of the medication scores was observed in A-group (p < 0.1).
Conclusion: It has been suggested that Benihuuki green tea is a possible candidate as a complementary medicine for JCP during the pollination season.

The purpose of this study was to determine the effects of well-rounded exercise program (WREP) on cardiorespiratory fitness, muscular strength, flexibility, body composition, and serum lipid concentration in a group of older outpatients. WREP was composed of programmed aerobic/ anaerobic accommodating circuit exercise (PACE) and flexibility exercises. Twenty-two volunteers (69.6±3.2 yr) were used as subjects. All participants engaged in a supervised exercise program (50 min/day and 3 days/week) for 12 weeks. After 12 weeks of training, there was a significant increase in VO₂ corresponding to lactate threshold (13.4%) but peak V0₂ did not change. There were significant increases for knee extension (17.1%) and flexion (12.3%), chest pull (10.9%), low back flexion (26.6%), and shoulder press (14.6%) after training. Side stepping agility (13%), trunk flexion (129%) and trunk extension (19%) were also significantly improved. There were significant decreases in percent of body fat (-8.3%), total cholesterol (-7.1%) and low-density lipoprotein cholesterol (-9.7%) . Blood pressure also decreased in SBP (-lOmmHg) and DBP (- 5 mmHg) . The decline in SBP was significant in thirteen hypertensive patients (-14 mmHg) compared to non-hypertensive patients (- 5 mmHg) . These results indicate that WREP elicits significant improvement of overall fitness in older outpatients.

A 72-year-old man who suddenly felt an excessive thirst and developed pollakisuria and high fever on Sept. 29, 2001. A general practitioner initially diagnosed him as having urinary tract infection on the same day. Vomiting and unconscionsnes occurred on Oct. 3. He was brought to our hospital by ambulance. Laboratory data on admission showed plasma glucose of 1110 mg/dl, blood pH of 7.167 and HCO3- of 7.6mmol/L, and positive urinary ketone bodies, compatible with diabetic ketoacidosis. Serum amylase was elevated, but he had no symptoms of acute pancreatitis. Insulin therapy was started immediately and hyperglyvemia was improved. He has never had diabetes mellitus and his HbA1c was normal (5.3%). His urinary C-peptide was very low (2.4 μg/day) and diabetes-related autoantibodies including anti-GAD, IA-2 antibodies and ICA were negative. So his case was diagnosed as fulminant type 1 diabetes mellitus. Fulminant type 1 diabetes, which has been brought to light by Dr Imagawa’s group, is characterized by near-nomal HbA1c despite diabetic ketoacidosis, rapid loss of insulin secretion and absence of diabetes-related autoantibodies.Great care is needed to recognize the patients with fulminant type 1 diabetes among the elderly with symptoms of urinary tract infection. Here, we reported the case of an aged man who developed aypical fulminant type 1 diabetes.
Diabetes Mellitus, Insulin-Dependent ; Diabetes Mellitus ; symptoms <1> ; Type 1 ; Urinary tract infection

An 11-year-old boy, who underwent a Rastelli operation using a 14mm artificial graft and left pulmonary artery (PA) plasty with an autologous pericardium patch 7 years previously, had severe recurrent left pulmonary stenosis. Reoperation was performed including right ventricular outflow tract reconstruction and left PA plasty. The PA at the most stenotic site was only 2mm in diameter; it was enlarged to 10mm by good exposure and an incision on the pulmonary intima. A bovine pericardium patch with a handmade ePTFE valve was sutured onto the autologous tissue not onto the pulmonary intima to avoid restenosis and in expectation of the growth of the pulmonary orifice. On postoperative 3-D CT, the left pulmonary artery was patent and 9mm in diameter. Pulmonary scintigraphy showed an improvement in the left pulmonary perfusion. This sutureless technique was useful in this case of severe pulmonary stenosis.

Bone mineral density (BMD) at the distal one-third of the radius bone was measured by the dual energy X-ray absorptiometry (DEXA) method and cytoplasmic free calcium concentration ([Ca²⁺] _i) of urinary granulocytes was by flow cytometry. Enrolled in this investigation were healthy aged people (male: n=34, female: n=36, mean 74.4 yrs) in a rural area of southern Nagano prefecture. We used acetoxymethyl ester of fluo-3 (fluo-3AM) to measure [Ca²⁺]_i, in human urinary granulocytes. BMD of the male population (0.67g/cm²) was higher than that of the female population (0.47g/cm²).[Ca²⁺] _i, of urinary granulocytesin the female population (78.7nM) was higher than in the male population (48.2nM).[Ca²⁺] _i, in urinary granulocytes of the aged population was 63.5±51.2nM (mean±SD). These values were within the values of healthy adult peripheral blood cells, suggesting that these granulocytes were functional like blood cells. These data indicated that [Ca²⁺] i, of urinary granulocytes increased when BMD decreased, suggesting that the measurement of [Ca²⁺] _i, would give us a clue for the understanding of the pathophysiological mechanism of osteoporosis in the aged.