Background: We examined whether dobutamine-stress QT dispersion (QTd) and heart-rate corrected QT dispersion (QTcd) are useful for detecting subclinical anthracycline cardiotoxicity.
Methods: The subjects were10 control subjects and 37 patients divided into 4 groups according to cumulative anthracycline dose: non-anthracycline group (group N), 7 patients; low anthracycline cumulative dose group (group L), 8 patients (<200 mg/m²); medium anthracycline cumulative dose group (group M), 16 patients (200 to <400 mg/m²); and high cumulative group (group H), 6 patients (≥400 mg/m²). Standard 12-lead electrocardiograms were recorded. QTd and QTcd were measured and calculated at rest and after administration of dobutamine at 5 or 30 μg/kg/min. We also estimated cardiac function and cardiac reserve function at rest and after administration of dobutamine at a dose of 5 or 30 μg/kg/min.
Results: At rest, QTd and QTcd were significantly greater in groups M and H. After administration of dobutamine at 30 μg/kg/min, QTd and QTcd were significantly greater in groups L, M, and H. There was good correlation between QTd and the cumulative anthracycline dose; the correlation formula was y=0.051x + 42.2 (r=0.81, p<0.001). The cumulative anthracycline dose of 152.9 mg/m², calculated from the correlation formula, was the cut-off for detection of electrophysiological cardiac abnormalities. Cardiac performance data at rest and dobutamine stress by echocardiography and pulsed Doppler echocardiography are less sensitive for detecting cardiac abnormalities than are QTd and QTcd.
Conclusions: Dobutamine-stress QTd and QTcd are useful for detecting anthracycline cardiotoxicity and subclinical cardiac abnormality at low cumulative anthracycline doses. We must be aware of the possibility of subclinical myocardial abnormalities in patients with a cumulative anthracycline dose of ≥150 mg/m².

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Background: Couinaud's segmentation is widely used for clinical segmentation of the liver. Recently, a new method of liver segmentation was described by Ryu. In this method, the right posterior sector in Couinaud's segmentation is regarded as 1 segment, and the right anterior sector is subdivided into the antero-ventral segment (AVS) and the antero-dorsal segment (ADS), which are demarcated by the anterior fissure vein (AFV). We used data from multi-detector row computed tomography (MDCT) to identify the portal and hepatic veins that are used as anatomical landmarks in both Couinaud's segmentation and Ryu's segmentation.
Methods: We analyzed data from 100 patients who had no space occupying lesions of the liver and had undergone abdominal CT examination from June through September 2008. MDCT was used to obtain contrast-enhanced helical scans of the whole liver during the portal venous phase. Using thin-slice data, we attempted to identify the portal and hepatic veins, in particular the anterior fissure vein (AFV), the antero-ventral portal vein (AVPV), and the antero-dorsal portal vein (ADPV), all of which are used in Ryu's segmentation.
Results: In all cases, we were able to identify the hepatic segments of Couinaud's segmentation. However, in several cases, we were unable to identify the segments used in Ryu's segmentation. The AFV flowed into the intermediate hepatic vein (IHV) in 88% of cases and into the right hepatic vein (RHV) in 12%. Among the former, the AFV flowed into the proximal IHV in 53% of cases. Although the AFV could be identified in these cases, it was difficult to determine the border between the AVS and the ADS.
Conclusions: Our findings indicate that the use of MDCT data to identify hepatic anatomy was more difficult in Ryu's segmentation than in Couinaud's segmentation, because the AFV could not be easily identified in the former. Indeed, even when the AFV could be identified, its use as a landmark was often questionable.

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Aim: To determine the value of the extensor digitorum reflex in neurologic examination.
Methods: The extensor digitorum, biceps, and brachioradialis reflexes were elicited in 65 patients with hemiplegia and upper-limb paralysis and in a control group of 120 apparently healthy people. Reflexes were elicited by both conventional means and a new method for the extensor digitorum reflex. The sensitivity and specificity of the extensor digitorum reflex were compared with that of the conventional biceps and brachioradialis reflexes to evaluate the value of the extensor digitorum reflex for neurologic examination.
Results: The sensitivity of the extensor digitorum, biceps, and nrachioradialis reflexes were 93.65%, 90.48%, and 90.48%, respectively. The specificity of the extensor digitorum, biceps, and brachioradialis reflexes were 95.83%, 94.17%, and 93.33%, respectively. The diagnostic efficacies of the extensor digitorum, biceps, and brachioradialis reflexes were 95.08%, 92.90%, and 91.26%, respectively. There were no significant differences (p>0.05) in sensitivity, specificity, or accuracy among the extensor digitorum, biceps or brachioradialis reflexes in neurologic examination.
Conclusions: The extensor digitorum reflex is a sensitive and useful deep tendon reflex and is suitable for widespread use in neurological examination.

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Stem cell transplantation (SCT) is a useful treatment for hematological malignancies, but it is limited to younger patients because of its high treatment-related mortality. Fludarabine (Flu), a novel anticancer agent with potent immunosuppressive activity, used as a conditioning regimen (reduced intensity transplantation; RIST), can decrease treatment-related mortality, as recently reported. However, the best drug combination and the best timing for RIST remain unknown. We herein report the SCT outcomes of 36 patients undergoing Flu treatment at our institution since December 2002 and retrospectively analyze the results. RIST conditioning with Flu was well-tolerated. No severe toxicity related conditioning regimens was observed in our patients, even though there were 10 patients with a history of autologous (n=5) or allogeneic stem cell transplantation (n=5). Hematological engraftment was found in 33 patients. The median times for reconstitution of WBCs, RBCs, and platelets were 16 days, 27.5 days and 34 days, respectively. Stable complete donor chimerism after SCT was present in all patients with WBC engraftment, and no patients experienced late rejection. Thirty-two patients were evaluated for acute graft versus host disease (aGVHD). Nine patients had no aGVHD. The incidence of grade I/II and III/IV aGVHD was 78% and 22%, respectively. Skin lesions were the major sites of involvement. Gut involvement was present in 9 patients. All 4 patients with grade IV GVHD had stage four hepatic GVHD. Twenty-two patients were analyzed for chronic GVHD (cGVHD). Twelve patients had no cGVHD, 6 had limited type and 4 had extended type. The overall survival (OS), relapse rate (RR), and non-relapse mortality (NRM) in all patients over 7 years were found to be 41.7%, 20.1%, and 34.6%, respectively. Induction failures were present in 5 cases of AML and 1 case of NHL. Disease progression was the primary cause of death, which occurred in 12 of 21 patients. Six patients died of grade IV GVHD (n=2) or complicated fungal infection contracted during the GVHD treatment (n=4). One patient died of secondary MSD, which originated from donor hematopoietic cells. Two patients died of cerebral bleeding and cardiac rapture, respectively. We found that the patients' state on SCT was the most important factor in long-term survival. The OS of standard risk and high risk patients with hematological malignancies were 75% and 30.3%. We concluded that stem cell transplantation using a non-myeloablative conditioning regimen with Flu was a useful therapeutic approach for patients with hematological malignancies.

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We describe 2 cases of abdominal wall endometriosis, a condition that usually occurs in surgical scars from previous cesarean sections and presents as a mass with cyclic pain and swelling.
Wide local excision with clear margins seems to be the only effective treatment. However, the mass in our 2 cases changed in size with menstruation, and palpating the masses was sometimes difficult.
Therefore, we administered an oral contraceptive containing a combination of estrogen and progesterone (Planovar^®) preoperatively to each patient so that the endometrial mass could be reliably palpated on the day of operation. The mass was excised cleanly in each case.

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Obstructive sleep apnea syndrome affects 1% to 2% of children. It is caused mainly by upper airway obstruction and manifests as snoring and sleep disturbance. Adenotonsillectomy can improve quality of life because airway obstruction occurs when both tonsils and adenoids are enlarged. We describe an 8-year-old girl with a recurrence of obstructive sleep apnea syndrome caused by hypertrophy of the tubal tonsils 4 years after adenotonsillectomy. The findings from this case highlight the importance of 1) identifying hypertrophy of the residual adenoid and compensatory hypertrophy of the tubal tonsils in patients with obstructive sleep apnea syndrome after adenotonsillectomy and 2) determining the optimal timing of adenotonsillectomy with respect to both the severity of obstructive sleep apnea and compensatory hypertrophy of other lymphoid tissue of Waldeyer's ring, as growth of such tissues is most active during the first several years of life.

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We describe a patient with extrahepatic portal venous obstruction due to a giant hepatic hemangioma associated with Kasabach-Merritt syndrome. A 67-year-old woman presented with upper abdominal distension and appetite loss. The medical history was not relevant to the current disorder. Initial laboratory tests revealed the following: serum platelet count, 9.9 ×10⁴/μL; serum fibrinogen degradation products, 12 μg/mL; prothrombin time, 1.26; and serum fibrinogen, 111 mg/dL. Computed tomography demonstrated homogenous low-density areas, 15 cm in diameter, in the left lobe of the liver. Common hepatic arteriography revealed a hypervascular tumor with pooling of contrast medium in the delayed phase. The portal venous phase of supramesenteric arteriography revealed obstruction and cavernous transformation of the portal vein. We diagnosed extrahepatic portal venous obstruction due to a giant hepatic hemangioma associated with Kasabach-Merritt syndrome. Laparotomy was performed, and the liver was found to be markedly enlarged. After mobilization of the left lobe, left hepatectomy was performed with intermittent clamping. After resection, Doppler ultrasonography revealed recovery of the portal venous flow. The cavernous transformation shrank. Pathologic examination of the surgical specimen confirmed the presence of a giant benign hepatic cavernous hemangioma. The patient was discharged 16 days after operation. Laboratory data and complications improved after 2 months.

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Myoepithelioma is a rare neoplasm that can occur in either the major or minor salivary gland and accounts for less than 1% of salivary gland neoplasms. We report a rare case of a nasal myoepithelioma that originated from the nasal inferior turbinate. The tumor, measuring 50 × 30 × 20 mm, was in the right nasal cavity and had a necrotic surface. We removed the tumor through endonasal endoscopic surgery. The tumor had spindle-shaped cells and was positive for cytokeratin, (AE1/AE3), vimentin, S-100β, and MIB-1 but was negative for CD34, desmin, neuron-specific enolase, and synaptophysin. Slight immunoreactivity for smooth muscle actin was noted in some tumor cells. There has been no evidence of tumor recurrence in the 18 months following surgery.

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The purpose of this study was to examine the association between time of delivery and perinatal outcomes in singleton deliveries at Japanese Red Cross Katsushika Maternity Hospital. We performed a retrospective cohort study of all singleton deliveries at ≥22 weeks' gestation from 2002 through 2009 at our hospital. During the nighttime period (12 midnight to 8 am), although the rate of delivery of high-risk pregnancies was low, the rate of low umbilical artery pH (<7) was higher than that during the daytime periods (8 am to 4 pm) (odds ratio 1.9, 95% confidence interval 1.1-3.4, p=0.02). During the nighttime period, in addition, the rate of low umbilical artery pH in patients with emergent cesarean delivery was significantly higher than that during the daytime period (odds ratio 6.9; 95% confidence interval 2.5-19, p<0.01). In our hospital, the rate of adverse neonatal outcomes associated with cesarean birth was increased at nighttime period.

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