MR imaging is still an evolving technique for the diagnosis of joint cartilage lesions. Early morphologic changes in the degenerative cartilage are not reliably diagnosed even with use of tailored MR imaging techniques. The detection of the biochemical changes of cartilage or high-resolution MRI will serve as an important tool for the early diagnosis of cartilage degeneration in near future. Further prospective studies are needed to establish the role of MR imaging in clinical use.

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Breast cancer has emerged as the most frequent malignant neoplasm among Japanese women in recent years, raising awareness in society of the issue of breast cancer, including good screening and therapies. In fact, the establishment of breast cancer screening program with mammography in the United States and Western Europe has contributed to improve the diagnosis of breast cancer at early stage, and proper management, including various options of evidence-based treatment has not only reduced mortality but also enhanced patients' quality of life. However, the mortality rate due to breast cancer in Japan has continued to increase, and the number of patients is also increasing rapidly. It is therefore very urgent to develop a good system of breast care in all medical facilities as well as the provision of a national scheme in Japan. In this report, we review the situations of breast surgery at Nagasaki University Hospital from 1975 to 2004 and current management practices for breast disease, and evaluate the possibility of establishing a better system for breast care at our hospital, which could then act as a core medical institute in Nagasaki.

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The effects of early feeding for postoperative ileus remain unclear. We evaluated whether the early feeding is safe and feasible in Japanese patients after open bowel resection, and whether early feeding can enhance the resolution of postoperative ileus. An early feeding protocol was applied to 23 patients (Group 1). As a control, we reviewed the charts of 25 consecutive patients who were operated on just before the protocol and whose diet was started by traditional methods (Group 2). Daily examination and interviews of patients were performed. The majority of the patients in Group 1 (87.0%) tolerated the early feeding. There were no major complications or mortality that was related to early postoperative feeding. There was a significant difference between Group 1 and Group 2 in the distributions of the time to passage of flatus (median—2 vs. 3 days, p=0.002), the time of the first bowel movement (median—3 vs. 5 days, p=0.001), and the length of postoperative hospital stay (median—15 vs. 22 days, p<0.0001). There was no significant difference in the frequency of postoperative complications between the groups (p=0.44). Early postoperative feeding protocol is safe and feasible for patients who are required colorectal surgery. Early feeding may promote the early resolution of postoperative ileus.

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We compared the diagnostic accuracy of multidetector-row computed tomography (MDCT) with multiplanar reconstruction (MPR) images to non-contrast magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) (MRI/MRCP) for evaluating obstructive jaundice. MDCT and MRI/MRCP images from 53 patients with suspected obstructive jaundice were interpreted by two radiologists. These readers evaluated the images to determine level of obstruction, to differentiate between benign and malignant lesions, and to state the first-choice diagnosis with degree of confidence. We analyzed the obstruction levels in 50 patients excluding 3 patients who did not undergo direct cholangiography (DC). Both MDCT and MRI/MRCP showed almost perfect agreement with DC in two readers (statistic weighted kappa≥0.80) in the determination of obstruction level. The mean area under the receiver operating characteristic curve for differentiating benign from malignant lesions was significantly (p=0.02) larger in MDCT (0.98) than in MRI/MRCP (0.86). We analyzed the first-choice diagnoses for 39 patients excluding 14 patients without final diagnosis confirmed. Readers had, out of 78 interpretations, a high confidence level in their first-choice diagnoses for 44 (56%) and 23 (29%) interpretations using MDCT and MRI/MRCP, respectively. In the interpretations made with high confidence level, 98% (43/44) and 91% (21/23) were correct for MDCT and MRI/MRCP, respectively. In conclusion, MDCT with MPR images is as accurate as MRI/MRCP for evaluating the biliary duct obstruction level, and has high diagnostic accuracy in evaluating the cause of jaundice. MDCT can provide sufficient information on the level of biliary obstruction and cause of obstructive jaundice.

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We assessed the ability of procedural learning and gestalt cognition in patients with schizophrenia by push-button task and tree-drawing test, respectively. The study subjects were 30 patients with schizophrenia and 35 healthy individuals. The patients fulfilled the diagnostic criteria specified in the International Classification of Diseases, Tenth Revision and healthy individuals were all employees of private psychiatric institutions. We used a scale for measuring work ability and classified the patients into two groups of the same size on the basis of the measurements, and called them high-autonomy group and low-autonomy group. In the push-button task, we used an apparatus with 18 buttons whose lighting was controlled by computer, and the lighting order was determined to make the path of lighting form two types of gestalt. Complete push of 18 buttons defined a trial, and we assessed the ability of procedural learning by reduction in reaction time with trial. In the tree-drawing test, we classified the drawing into 3 types, i.e., positive, negative and normal, on the basis of the gestalt of the tree drawn. In each of the two types of gestalt and their combination, the reaction time at respective trials significantly (p<0.0001) decreased in the order of low-autonomy group, high-autonomy group and healthy group, and the reaction time in the respective 3 groups significantly (p<0.0001) decreased with repetition of trials. However, no significant difference was observed among 3 groups in the degree of decrease with trial (p>0.14). The frequency of positive drawing was highest in low-autonomy group and monotonically decreased in high-autonomy group and healthy group, while the reverse order held in the frequency of normal drawing, and the frequency of negative drawing was highest in high-autonomy group. The correlation between the group and the tree-drawing type was significant (p<0.0001). The present study suggests the usefulness of push-button task and tree-drawing test for assessing recovery process in schizophrenia.

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We treated three patients with Fournier's gangrene, in whom a male aged 75 years and a female aged 65 years were cured while a female aged 78 years died. None of them had a history of anorectal or urogenital disease. Debridement and colostomy were performed for all patients. After debridement, two patients were given imipenem cilastatin sodium and clindamycin phosphate, while the remaining one was given only imipenem cilastatin sodium. The patient who died had necessitated a continuous dopamine injection for stabilizing the blood pressure. The infectious disease was progressive, despite the extensive debridement. In Fournier's gangrene with the involvement of deep fascia, particular attention should be paid for the development of sepsis.

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A 50-year-old man experienced tumor recurrence with invasion into the skull base. Preoperative neuroimaging showed partial destruction of the body of the mandible and the anterior and middle cranial bases. Further, there was tumor involvement of the left internal carotid artery. Preoperative embolization of the left internal carotid artery and an extensive resection of the tumor were successfully performed. Even though salivary gland tumors are rarely treated by neurosurgeons, a multidisciplinary approach allowed effective treatment of this tumor. The optimal therapeutic strategy for this rare type of intracranial invasion is described.

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