Aim and background: Chronic insomnia in elderly patients significantly affects their health and quality of life (QOL). Nocturia also worsens sleep condition. The aim of this study was to evaluate the improvement effects of quazepam, a long-term acting benzodiazepine, on insomnia and nocturia in elderly patients.
Method: Forty-one elderly outpatients (mean age 77.1 ± 5.6 yr) suffering from chronic insomnia while on regular a short- or ultra-short-acting hypnotic treatment were enrolled. We prescribed 7.5-15 mg of quazepam, which was administered regularly by the subjects before bedtime. A questionnaire was used to compared changes in quality of sleep and frequency of nocturia for before treatment and at 2 and 4 weeks after initiation of treatment. QOL was also examined using the 36-item Short Form Health Survey of the Medical Outcomes Study (SF-36).
Results: Thirty-seven subjects (90.2%) completed the study. All subscales of the sleep quality questionnaire improved significantly (p<0.001) after 2 weeks, as did the total scores (p<0.001) after 4 weeks. Frequency of nocturia decreased significantly from 3.6 ± 1.7 times to 1.5 ± 0.8 (p<0.001) and 1.2 ± 1.0 times (p<0.001) after 2 and 4 weeks, respectively. Every SF-36 subscale also showed significant improvement after 4 weeks. The total SF-36 scores of the group showing a decrease in the frequency of nocturia (>/= 2 times) improved significantly compared with that with a frequency of < 2 times (p=0.016).
Conclusion: Quazepam significantly improves sleep, QOL and nocturia in elderly patients that respond poorly to short-acting or ultra-short-acting hypnotics.

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Objective: A survey was conducted to understand the work conditions, daily living habits and occupational stress of nurses and care workers employed by nursing care medical facilities.
Materials and Methods: Self-completion questionnaires were administered to 68 personnel (27 nurses, 41 care workers) aged 38.3 ± 12.5 years.
Results: The percentage of nurses who fell under the `good' lifestyle category was zero, while the percentage of those in the `poor' lifestyle category was 66.7%. In comparison, 12.2% of care workers enjoyed a `good' lifestyle, and 56.1% had a `poor' lifestyle. From among all the respondents, 60.2% fell under the `poor' lifestyle category. There were significant differences between nurses and care workers (p<0.01) for two categories, `stress from the work environment' and `subjective level of his/her work aptitude', which are presumably stress factors. Significant differences were also observed between them (p<0.05) for the following two categories, `subjective level of physical burden' and `job satisfaction'. There was no significant difference between the nurses and the care workers with regard to the raw scores recorded for all the categories under `physical and mental reactions caused by stress'. However, the care workers scored 8.1 ± 2.3 points in the `feeling of fatigue' category, and their scores were evaluated as `slightly high' as per the determination criteria. With regard to the stress-relieving factors, no significant differences were noted between the nurses and care workers in terms of the raw scores recorded for any of the categories. The raw scores recorded for the `support from supervisors' category were 7.3 ± 2.0 and 7.1 ± 1.8 points for the nurses and care workers, respectively. These scores were evaluated as `slightly high' according to the determination criteria of the questionnaire on stress.
Conclusions: On the basis of the results of this study, it was determined that the work hours per day were longer and the duration of breaks was shorter for the nurses than for the care workers. No significant difference was observed in the daily living habits of the nurses and care workers. The raw scores for the factors (questionnaire items) that were presumed to be the causes of stress were significantly higher for the nurses than for the care workers. Support from supervisors was a stress-relieving factor for both the nurses and care workers.

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Objectives: Prevention of obesity is a high priority of health management at workplaces. We conducted a follow-up study of obesity and obesity-related metabolic disorders in Japanese male workers.
Subjects and Methods: Ninety-eight male workers engaged in the operation of a nuclear power plant in Shimane Prefecture, aged 41 ± 8 years in 2006, were subjected to regular health check-ups in 1996 and 2006.
Results: The changes in their body weights and metabolic parameters (blood pressure, AST, ALT, γ-GTP, LDL-cholesterol, HDL-cholesterol, triglycerides, glucose and uric acid) were compared by BMI class and age group. Twenty-three percent of the subjects fell within the 23.0 to 24.9 BMI range, and 23% were over 25.0 BMI. Body weight increased significantly, by 3.6 ± 5.3 kg in all subjects, but there was no significant difference in weight gain over the 10 years by age or BMI group. Weight gain was positively associated with metabolic parameters, such as the values of systolic blood pressure, ALT, triglycerides and uric acid, and negatively associated with the value of HDL-C.
Conclusions: Japanese male workers, regardless of age and BMI at baseline, experienced an increase of body weight and obesity-related metabolic disorders. Therefore, health professionals in the workplace should consider educating workers about stress-coping methods to reduce job stress, promote a health-supportive environment, such as healthy menus in employee cafeterias and fitness clubs, and be cognizant of high-risk factors in the individual employee.

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Although the patent ductus venosus is congenital, the symptoms due to hyperammonemia vary, possibly depending on the shunt ratio and individual tolerance to ammonia. We have experienced two adult patients with large caliber patent ductus venosus and compensated liver cirrhosis. In one case, the ductus venosus simply communicated to the portal vein, but in the other case there were multiple short communicating vessels between the ductus venosus and left portal vein. Both cases were successfully treated by the transvenous embolization with steel coils and ethanolamine oleate, which has an expansive nature.

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Carcinosarcoma of the bladder is a rare malignancy characterized by an intimate admixture of malignant epithelial elements (carcinoma) and malignant soft tissue elements (sarcoma). Patients with carcinosarcoma usually present with high-stage malignancy. Cystectomy or transurethral resection of the bladder tumor (TUR-Bt) is the preferred treatment, often followed by radiation therapy, but the prognosis is very poor^1-7). To our knowledge, almost 80 cases have been reported in Japan, usually as case reports or small series^{6, 7)}. In almost all cases, the chief complaint was gross hematuria. We herein report a case of carcinosarcoma of the urinary bladder in a patient whose chief complaint was abdominal pain. His pain worsened, and the occurrence of hydronephrosis indicated that extremely rapid tumor growth may have occurred. No evidence of recurrence was noted 30 months after the performance of cystectomy.

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The purpose of this article is to describe our initial experience using laparoscopy to perform surgery for endometrial cancer. The patient was 59 years old with 2 para and was diagnosed as having a clinical endometrial adenocarcinoma in FIGO Stage Ia or Ib. Hysterectomy, bilateral salpingo-oophorectomy and lymph node sampling were performed using a laparoscopic procedure. We analyzed the problems and advantages of the procedure in this case.

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Uterine leiomyoma is a common benign tumor. This report concerns a rare case of laparoscopic resection of a unilateral, ovarian leiomyoma requiring seven hours of surgery. A 66-year-old woman (para 2) was referred to Kochi Health Sciences Center because of a pelvic tumor. Transvaginal ultrasonographic examination revealed a pelvic tumor suspected of being a uterine leiomyoma in the cul-de-sac. Total laparoscopic hysterectomy and bilateral salpingo-oophorectomy was performed. A morcellator was used to reduce the volume of the leiomyoma. The uterus and right adnexa were removed via the vagina. When the left ovarian leiomyoma was diminished, it was also removed via the vagina.

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Eosinophilic cystitis is a rare form of allergic cystitis. We reported a case of eosinophilic cystitis coexisting with superficial bladder cancer, which seemed to be invasive bladder cancer on imaging. We performed total cystectomy in this case. When invasive bladder cancer is diagnosed by imaging, coexistence of eosinophilic cystitis with superficial bladder cancer should be considered if biopsy does not show invasive bladder cancer.

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We report a case of adenocarcinoma detected in the right pleural effusion of a 75-year-old woman. Investigations failed to reveal the site of the primary lesion, and the case was treated as primary unknown cancer. The pleural effusion disappeared after chemotherapy; however, as there was serious bone marrow suppression, the clinical course was observed at an outpatient clinic without chemotherapy. A search for the primary lesion was repeated, but it was not found. One year after first admission, a chest X-ray showed left pleural effusion. Adenocarcinoma was detected in the effusion and a tumor mass obtained from the pleural cavity. Ovarian cancer was diagnosed based on the histological, serological and MRI findings. Thus, this was a rare case of ovarian cancer in which the diagnosis was confirmed by repeated evaluation and in which the initial diagnosis had been primary unknown cancer with malignant pleural effusion only.

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Lithium, prescribed for bipolar disorder, is known to induce thyroid dysfunction, most commonly hypothyroidism. Thyrotoxicosis due to lithium-induced painless thyroiditis is a rare complication. We have previously reported that the serum concentration of immunosuppressive acidic protein (IAP), an α1-acid glycoprotein, increased during the acute phase of subacute thyroiditis, but was within the normal range in patients with painless thyroiditis. In the present case, a 31-year-old woman, receiving long-term lithium therapy for bipolar disorder, had a recurrent episode of painless thyroiditis, and her serum IAP was increased. The pathogenic mechanism for lithium-associated painless thyroiditis may differ from that of autoimmune conditions.

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