In order to ascertain and evaluate mothers' perceptions of the sexual development and behavior of their children with autism, we conducted a questionnaire survey on participants in meetings held in Nagasaki. From among 172 persons who consented to participate in the survey and responded to the self-administered questionnaire, we selected 71 mothers of sons with autism (aged 6 years or over) as the study subjects. The questionnaire included items on children's sexual behaviors, the appearance of secondary sexual characters/sexual development, the mothers' perceptions of the children's sexual development and behavior, and assessments of their own child and persons with autism in general with respect to masturbation, romantic relationships, and marriage. According to the severity of the children's autism, subjects were classified into severe and non-severe groups and the above-mentioned items were compared between the two groups. No significant difference was observed between the two groups in terms of the age at first appearance of secondary sex characters; however, the age at which interest in the opposite sex was first shown was significantly earlier in the non-severe group (p = 0.031). Among 58 children aged 120 months or over, 29 (50.0%) were masturbating and the proportion of such children was significantly larger in the severe group (p = 0.014). Regarding problem sexual behavior, no significant difference was observed in the frequency of worried mothers between the two groups (p = 0.80), while “talking about sex in public” was more frequent in the non-severe group (p = 0.018). Approximately 80% of the mothers in both groups had positive views about masturbation both for their own child and for persons with autism in general; however, the proportion of mothers showing positive views about romantic relationships or marriage was significantly smaller in the severe group (p < 0.0001). The present study demonstrated that mothers' perceptions of sexual development and behavior in their children with autism vary according to the disease severity. This finding indicates the necessity for healthcare professionals to actively concern themselves with the mothers.

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‹Background› Recently, the incidences of pulmonary embolism (PE) and/or deep vein thrombosis (DVT) after orthopedic operation increased in Japan. However the effective prevention methods have not been established yet. To make the effective prevention of PE and/or DVT after total hip arthroplasty (THA), we investigated the time-dependent changes of serum thrombin-antithrombin III complex (TAT) and D-dimer levels after THA. ‹Subjects & Methods› We measured changes of serum TAT, and D-dimer levels (before, on day 1, day 5, week 2 and week 4 after operation). Twenty-six women (mean age 64.5 years old), who had undergone THA for osteoarthritis of the hip joint were enrolled and divided into two groups at random. One group had been intravenously injected with 1,000 units of heparin during THA (IH Group, 14 patients), and the other group had not been injected (NH Group, 12 patients). ‹Results› No patients showed clinical PE and/or, DVT. The levels of TAT and D-dimer in IH group significantly reduced compared with these in NH group on the fifth and first postoperative day, respectively (p < 0.05). There were no severe complications clinically. ‹Conclusion› Our data suggests that intravenous heparin injection during THA might be a potentially effective and safe strategy for prophylaxis of PE after THA.

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Introduction: A retrospective study was performed to investigate the relationship between the severity of liver cirrhosis and the outcome of cardiac surgery. Methods and Results: Twenty-one patients with liver cirrhosis underwent cardiac surgery in our institution. According to the Child-Pugh classification, 13 patients were in class A, 7 in class B, and 1 in class C. Coronary artery bypass grafting was performed in 7 patients, surgery for valvular disease in 10 and other procedures in 4. Major postoperative complications occurred in 8%, 29%, and 100% for Child-Pugh class A, B, and C, respectively. Preoperative hemoglobin level was significantly lower in the patients with postoperative complications. None of 4 patients underwent coronary revascularization using off-pump procedure or mini-pump system experienced major complication. The operative mortality was 0%, 14%, and 0% for Child-Pugh class A, B, and C, respectively. Conclusions: Although the overall mortality rate in patients with liver cirrhosis was acceptable in our study, the incidence of severe complications, such as prolonged ventilation, mediastinitis and irreversible hepatic insufficiency was problematic in Child-Pugh class B and class C patients. Application of less invasive cardiac surgery, such as mini-pump system or off-pump procedure will improve the operative outcome in such patient group.

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The aim of this study was to assess the therapeutic efficacy and long-term outcome of percutaneous and surgical treatment in patients with postoperative biliary stricture. The subjects consisted of 19 patients with postoperative benign biliary stricture secondary to bile duct injury or fibrosis at the bilioenterostomy. All of the patients were initially managed by percutaneous transhepatic biliary drainage. Five patients failed to achieve internalization across the stricture and then underwent a wide hilar hepaticojejunostomy. An additional 4 patients required surgery because of a complex injury involving the right hepatic artery in one and the occurrence of so-called “blind-loop syndrome&rdquo in 3. Hepatobiliary scintigraphy clearly demonstrated a functional obstacle in the bile flow in these patients. Percutaneous management with an internal/external catheter placement was accomplished in 10 patients. A successful outcome was achieved in all patients with a mean follow-up 6.7 (range 2-12) and 5.2 (range 1-12) years for the surgical and percutaneous treatment, respectively. Conclusively, postoperative biliary stricture requires multidisciplinary management. The surgical repair should therefore be carefully considered for cases with tight stricture, a complex injury, or blind-loop syndrome. In order to accurately characterize the biliary flow and to select the optimal treatment, hepatobiliary scintigraphy may thus provide us with helpful information.

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A 78-year-old man was referred to our hospital for gross hematuria. Ultrasonography and magnetic resonance urography revealed tumor in the right lower ureter. Computed tomography revealed right cervical lymph node swelling and pathological diagnosis was diffuse large B-cell lymphoma. Right nephroureterectomy was performed and pathologic examination revealed small cell carcinoma of the ureter with a small urothelial cell carcinoma component. As the patient had concomitant other malignancies, additional systemic chemotherapy was not performed. As of 3 months after operation, postoperative course has been uneventful. Only 11 cases of primary small cell carcinoma of the ureter have been described.

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