Background/Aims: Image-enhanced endoscopy can detect superficial oro-hypopharyngeal squamous cell carcinoma; however, reliable endoscopy of the pharyngeal region is challenging. Endoscopy under general anesthesia during transoral surgery occasionally reveals multiple synchronous lesions that remained undetected on preoperative endoscopy. Therefore, we aimed to determine the lesion detection capability of endoscopy under general anesthesia for superficial oro-hypopharyngeal squamous cell carcinoma. Methods: This retrospective study included 63 patients who underwent transoral surgery for superficial oropharyngeal squamous cell carcinoma between April 2005 and December 2020. The primary endpoint was to compare the lesion detection capabilities of preoperative endoscopy and endoscopy under general anesthesia. Other endpoints included the comparison of clinicopathological findings between lesions detected using preoperative endoscopy and those newly detected using endoscopy under general anesthesia. Results: Fifty-eight patients (85 lesions) were analyzed. The mean number of lesions per patient detected was 1.17 for preoperative endoscopy and 1.47 for endoscopy under general anesthesia. Endoscopy under general anesthesia helped detect more lesions than preoperative endoscopy did (p<0.001). The lesions that were newly detected on endoscopy under general anesthesia were small and characterized by few changes in color and surface ruggedness. Conclusions Endoscopy under general anesthesia for superficial squamous cell carcinoma is helpful for detecting multiple synchronous lesions.

A 69-year-old woman had dysphagia, hoarseness, and asthma-like symptoms such as cough and wheeze. Inhaled corticosteroids and long-acting β₂ stimulants was not effective. Gastrointestinal endoscopy showed compression of the esophagus wall from outside. Enhanced computed tomography (CT) showed thoracic descending aortic aneurysm compressing esophagus and left lower lobe bronchus. Immediately thoracic endovascular aortic repair (TEVAR) was performed. After surgery, significant improvement of hoarseness and asthma-like attack was obtained at the time of 1 month after surgery. This is the first reported case of TEVAR which improved compression symptoms of both esophagus and bronchus due to thoracic aortic aneurysm in Japan.

We collected and analyzed large-scale data concerning the fall of stroke inpatients in convalescent rehabilitation wards. Three hundred seventy-four of 1,107 inpatients experienced one fall or more, and 16 factors associated with falls were clarified by the chi-square test. To extract the significant item from a multifactor, the logistic regression analysis of 16 factors was carried out, and we developed an assessment sheet for the risk degree of first fall prediction in stroke inpatients. We selected eight variables as the items on the assessment sheet : history of previous falls, central paralysis, visual impairment, sensory disturbance, urinary incontinence, use of psychotropic medicines, mode of locomotion, and cognitive impairment. The total score of the assessment sheet was ranged from 0 to 10 and the mean score of fallers (6.4±1.5) among subjects was significantly higher than that of non-fallers (5.1±1.9) (p <0.001). When the subjects were classified into three groups, a significant difference (p<0.001) in the tendency of fall incidence in term of days after admission was found among the three groups on the basis of the Kaplan-Meier survival curve.

The efficacy of Landiolol hydrochloride (Onoact^®) for the treatment of arrhythmia was studied in 10 adult patients who underwent cardiovascular surgery. Onoact was continuously infused at a mean rate of 0.018 mg/kg/min initially and followed by 0.01 mg/kg/min. After the initiation of Onoact infusion, supra-ventricular tachycardia was eliminated in 5 out of 6 patients, and ventricular tachycardia disappeared in all 4 patients. The decrease in systemic blood pressure was not significant. Low-dose continuous infusion of Onoact was safe and effective even in patients just after cardiovascular surgery.

A 60-year-old man was admitted to our hospital due to cerebellum infarction. He had undergone replacement of the aortic valve and ascending aorta because of aortitis syndrome 2 years ago. Electrocardiogram showed complete atrioventricular block. Echocardiography showed aortic annular abscess and vegetation on the prosthetic aortic valve. A pulmonary autograft was transplanted of the aortic root (Ross operation) after complete resection of the infected sites. The postoperative course was uneventful. The ross operation was considered to be a treatment of choice for prosthetic aortic valve endocarditis.

The efficacy of Landiolol hydrochloride (Onoact^®) for the treatment of arrhythmia was studied in 10 adult patients who underwent cardiovascular surgery. Onoact was continuously infused at a mean rate of 0.018 mg/kg/min initially and followed by 0.01 mg/kg/min. After the initiation of Onoact infusion, supra-ventricular tachycardia was eliminated in 5 out of 6 patients, and ventricular tachycardia disappeared in all 4 patients. The decrease in systemic blood pressure was not significant. Low-dose continuous infusion of Onoact was safe and effective even in patients just after cardiovascular surgery.

OBJECTIVEThe purpose of this study was to clarify the relationships among fall risk, physical activity habits, and ADL capability in a community-dwelling Japanese elderly population.

METHODSThe subjects were 1,407 Japanese aged 65 or older (604 males, 803 females). Fall risk was evaluated using the Falling Assessment Chart of Suzuki et al. (2003). Physical activity habits such as the frequency of leaving the house, the use of transportation, the frequency of physical exercise, and interests were evaluated. ADL capability was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence.

RESULTSApproximately 25% of the subjects had a high fall risk (score of 5 or more). Fall risk increased with age and ADL capability decreased with age. The group with a low fall risk (score<5) had a significantly higher ADL capability than the group with a high fall risk (score≥5). From results of two-way ANCOVA (gender×physical activity habits) with age as the covariate, the fall risk of people who regularly go on leaving the house, exercise, and have interests tended to be low. Further more, the relationships between the scores and physical activity habits were examined by two-way ANCOVA with age and ADL capability as the covariates. There were significant differences in the frequency of leaving the house, and elderly persons who leaved regularly the house, had a low fall risk.

CONCLUSIONSThis study showed that fall risk is closely related to ADL capability, and that the frequency of leaving the house is very important for reducing fall risk.

PURPOSEThe present study aimed to determine the problems of the Japanese version of the Center for Epidemiologic Studies Depression (CES-D) scale when applied to Japanese independent community-dwelling elderly focusing on its factor structure.

METHODSThe subjects were 1791 community-dwelling independent elderly aged 60 and over (848 males and 943 females). This study used the Japanese version of the CES-D scale to assess depression in the elderly.

RESULTSFrom the results of an exploratory factor analysis, the four factors of somatic symptoms, depression affect, positive affect and relation with others were interpreted.These factors were the same as those in the previous study, but the items making up each subscale differed. Therefore, the construct validity of each subscale was not necessarily assured. In the confirmatory factor analysis, goodness-offit was high for both the first and second-order factor models. In examining the validity by Akaike's information criterion (AIC), the second-order factor model assuming depression as a higher-order factor among the four factors was a better fit than the first-order factor model. Although the reliability of each subscale was not sufficient, adequate reliability was assured in the total scale.

CONCLUSIONAn assessment of depression using the Japanese version of the CES-D scale should be conducted using the total score, while a re-examination of items making up each subscale is needed.

OBJECTThe purposes of this study were to investigate the actual status in subjective symptoms of fatigue (SSF) and lifestyles of young male students living in two different life spheres of the Tokyo metropolitan area and a rural area, and to find, regional differences in these characteristics and relations between SSF and lifestyles in school life.

METHODSA questionnaire regarding SSF and lifestyle was administered to 412 healthy male students (16-18 yr) attending the two National Colleges of Technology located in the Tokyo metropolitan area (MA) and a local city (LC). Statistical techniques such as a chi-square test and Hayashi's Quantification Theory I analysis were used to examine relations between SSF and lifestyles.

RESULTS AND CONCLUSIONA significant difference was found only in "feeling of physical disintegration,", and the MA group was higher than the LC group. The MA students showed shorter sleeping hours and earlier awaken time compared with LC students. In the relations between SSF and lifestyles, sleeping habit was an important factor significantly relating to SSF in both groups. Paying attention to good sleeping habits is an important countermeasure for preventing SSF in the male students.

A 61-year-old man was found to have an abdominal aortic aneurysm (AAA) during follow-up for ischemic heart disease. On admission, ultrasonograms and computed tomograms revealed a thickened aortic wall surrounded by a soft tissue (so-called mantle). The obstructive right anterior brain artery and stenotic right internal carotid artery were also detected by angiography. Coronary angiography demonstrated multiple stenotic lesions of the coronary arteries. The excised AAA was replaced with an prosthetic graft. The mobilization of the adjacent viscera was kept as little as possible in order to prevent injury to them. We reported a case of “inflammatory” abdominal aneurysm associated with various atherosclerotic lesions.