Fullerenes (represented by buckminsterfullerene, C₆₀) are a new kind of organic compound with a cage-like structure. A great deal of attention has been focused on their unique properties. From the viewpoint of drug discovery, fullerenes could be novel lead compounds for drug discovery. However, fullerenes are poorly soluble in aqueous media. Incorporation of water-soluble groups into the fullerene core enables investigation of its biological activities. Certain fullerene derivatives show inhibitory activity against human immunodeficiency virus reverse transcriptase. Hepatitis C virus RNA polymerase is also inhibited by fullerene derivatives. Therefore, fullerene derivatives are candidate antiviral agents. In addition, fullerene derivatives exhibit antiproliferative activity by inducing apoptosis related to the generation of reactive oxygen species. Fullerene derivatives also have the potential to be anticancer drugs.

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Purpose: This study was aimed to determine the effect of maximum voided volume (MVV) on the efficacy of desmopressin, which is commonly used to treat primary monosymptomatic nocturnal enuresis (PMNE) in children and adolescents.
Materials and Methods: Bladder capacity was measured with different methods in 52 patients with PMNE, and the effect of bladder capacity on desmopressin therapy was investigated.
Results: Patients with PMNE in whom MVV was 70% or less of estimated bladder capacity were found to be unresponsive to desmopressin therapy.
Conclusion: The MVV can be measured before desmopressin therapy in patients with PMNE as a marker to predict treatment success. Our results suggest that desmopressin should not be used in patients with low MVV.

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Background: It has been suggested that mechanical bowel preparation (MBP) has no benefit in terms of anastomotic healing, infection rate, or improvement in the postoperative course in patients undergoing elective colorectal surgery, and that it should be abandoned. However, the effect of MBP on postoperative gastrointestinal motility has been assessed subjectively. In this randomized trial, we objectively assessed the effect of MBP on postoperative gastrointestinal motility and mobility in elective colonic resection.
Method: In total, 79 patients scheduled to undergo elective colonic resection for cancer were randomized to MBP or no-MBP groups prior to surgery. All patients ingested radiopaque markers before surgery to evaluate postoperative gastrointestinal motility, objectively evaluated by the transition of the markers at postoperative days (PODs) 1, 3, 5 and 7. The groups were then further subdivided into open and laparoscopic-assisted colectomy (LAC) groups and evaluated in terms of gastrointestinal motility and postoperative mobility.
Results: There was no significant difference between the no-MBP and MBP groups in terms of perioperative and postoperative course. In the LAC subgroup, there was no significant difference between the no-MBP and MBP groups in terms of marker transition. However, in the open subgroup, there was a significant difference between the groups in terms of the residual ratio of markers in the small intestine at POD 3 (no-MBP 35.3% vs. MBP 69.2%; p=0.041), excretion rate of markers at POD 5 (no-MBP 49.7% vs. MBP 8.8%; p=0.005), and residual ratio in the small intestine at POD 7 (no-MBP 3.1% vs. MBP 28.8%; p=0.028). Additionally, the excretion rate in the no-MBP group was significantly higher than in the MBP group at POD 7 (74.1% vs. 33.8%; p=0.007).
Conclusions: Our data provide additional evidence to support the abandonment of MBP in elective open colonic surgery.

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The purpose of this study was to clarify clinical and radiographic features of bone changes associated with soft-tissue tumors of the hand. We reviewed clinical records and radiographs of 115 patients who had undergone operations for soft-tissue tumors or tumorous conditions of the hand. Bone changes were detected in the radiographs of 21 of the 115 patients. Giant cell tumor of tendon sheath was the most common histological type to be associated with bone changes. The most vulnerable part of the hand was the palmar side of the phalanx from the distal shaft to the head. Most of the bone changes were erosion with clear margins. The erosions tended to extend deeper into the bone with limited widening. "Steep deep" erosions were found in 5 patients; these erosions did not require reconstruction after surgical curettage, and tumors did not recur.

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Tracheo-innominate artery fistula (TIF) is a serious, life-threatening complication following tracheostomy. We report a fatal TIF in a 15-year-old girl with Pelizaeus-Merzbacher disease. She received a tracheostomy for prolonged translaryngeal intubation due to acute respiratory failure without a trial of noninvasive ventilatory support before intubation. Severe hemorrhage from the TIF occurred 6 months after tracheostomy; immediate resuscitation failed. Antemortem fiberoptic bronchoscopy showed tracheal stenosis accompanied by granulation tissue, and postmortem examination revealed TIF with ulcerative granulation. Preventive intervention is required to avoid catastrophic TIF due to its high mortality rate. Moreover, to avoid prolonged translaryngeal intubation leading to tracheostomy, noninvasive ventilatory support before translaryngeal intubation, if applicable, is beneficial.

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The aims of this study were to compare the perinatal outcomes of successful vacuum extraction (VE) or failed VE and to compare the perinatal outcomes of failed VE followed by forceps delivery (FD) or Cesarean section (CS) from 2000 through 2007. Compared with cases of successful VE, cases of failed VE followed by CS had a significantly higher incidence of neonatal complications, whereas cases of failed VE followed by FD had a significantly higher incidence of maternal injury. Both CS and FD remain important yet distinct treatments for emergency cases of failed VE. Therefore, the decision to use a second instrument (FD) or to proceed to CS should be made in each case on the basis of these differences.

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We present here a case of fore-lying of the umbilical cord. In this case, transvaginal sonography did not reveal the umbilical cord beyond the fetal head before maternal urination; however, 5 minute later, a fore-lying umbilical cord was revealed between the floating fetal head and the uterine cervix after urination. The present case indicates the importance of careful evaluation of preterm premature rupture of the membranes by means of transvaginal ultrasonography in predicting umbilical cord prolapse.

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Primary Sjögren's syndrome (SS) is a rare autoimmune disease, especially in children. Juvenile primary SS with interstitial nephritis is rare in Japan. We report on a 12-year-old girl in whom salivary gland swelling had recurred from the age of 5 years, SS was diagnosed at the age of 10 years, and interstitial nephritis developed at the age of 12 years. The patient presented with a chief complaint of swelling of both parotid glands. The patient had a history of recurrent parotitis from 5 years of age, with episodes recurring 5 to 6 times a year and resolving within 3 days each time. However, at the age of 11 years, the patient had continuous mild swelling of the parotid glands. Examination on admission showed bilateral nontender parotid gland swelling; mild swelling of the lower extremities, xerostomia, and xerophthalmia but no exanthem. Laboratory findings were as follows: serum protein, 10.1 g/dL; immunoglobulin (Ig) G, 3,828 mg/dL; antinuclear antibodies, 1,280-fold; anti-Ro/SS-A antibody, 512-fold; anti-Ro/SS-B antibody, 4-fold; creatinine, 0.45 mg/dL; blood β2-microglobulin, 2.2 mg/L (slightly elevated); and cystatin C, 0.86 mg/L. Urinalysis showed proteinuria and a β2-microglobulin concentration of 11,265 mg/L. Thus, this patient had low molecular weight proteinuria. Schirmer's test showed decreased tear secretion (5 mm), and fluorescein staining showed marked bilateral superficial punctate keratitis. A lip biopsy showed infiltration by small round cells (mild to moderate), interstitial fibrosis, loss of salivary gland parenchyma, and atrophy, with no obvious epimyoepithelial islands, leading to a diagnosis of SS. Light microscopic examination of the renal biopsy specimens showed expansion of mononuclear cell infiltration in the renal interstitium, inflammatory cell infiltration of interstitial areas with edema and mild fibrosis, and tubulitis and mononuclear cell infiltration that included many lymphocytes and plasma cells. There were no pathological findings of glomerulonephritis. Small arteries showed no obvious abnormalities. Immunofluorescent staining showed slight, nonspecific deposition of IgM, but no deposition of IgG, complement 1q, 3, or 4. On the basis of the renal biopsy showing nonspecific chronic interstitial nephritis, renal tubular atrophy, and interstitial enlargement, tubulointerstitial nephritis associated with SS was diagnosed.

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We report on a 2-month-old boy with a dermoid cyst arising at the anterior fontanelle, with observation during both the open and closed stages of the fontanelle. The etiology of this benign, curable tumor is discussed.

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We report 2 cases of ruptured aneurysms of the posterior inferior cerebellar artery associated with an arteriovenous malformation (AVM). The aneurysm and AVM were simultaneously embolized with n-butyl cyanoacrylate. In one case both the aneurysm and the AVM were totally obliterated; in the other case the AVM was subsequently treated with radiosurgery. In both cases the aneurysms were successfully occluded. The effectiveness and limitations of this treatment are discussed.

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Background: Only 8% to 22% of cases of subarachnoid hemorrhage (SAH) are of nonaneurysmal origin. Among these, perimesencephalic nonaneurysmal SAH is a distinct clinical and radiologic entity with normal angiographic findings and a good prognosis. In contrast, SAH of nonaneurysmal origin occurring along the cortical convexity is rare and poorly understood. We report 2 cases of subarachnoid hemorrhage along the cortical convexity and discuss their possible etiologies.
Methods: In a retrospective analysis of 234 patients with SAH, we identified 2 patients with a typical computed tomographic pattern of convexity SAH that was associated with no known etiology.
Results: In these 2 cases, the source of hemorrhage could not be identified with computed tomography, magnetic resonance imaging, or digital subtraction angiography, although neurovascular outcomes were good. The patients reported such incidents as coughing or exertion immediately before headache developed. These incidents may have caused increased intracranial pressure.
Conclusion: We suggest the possible involvement of a brief increase in intracranial pressure, such as that accompanying coughing or exertion, in the occurrence of SAH along the cortical convexity.

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Lipoma of the finger is rare, and there have been few case reports of lipoma causing bone erosion in the finger. We report on a patient with a long-standing lipoma that caused deep erosion of the distal phalanx of the index finger. A 38-year-old man presented with a painful mass of the left index finger. Anteroposterior radiographic images showed a radiolucent area in slightly distal to the center of the distal phalanx. Magnetic resonance imaging revealed a large soft-tissue mass with high signal intensities and slight irregularity on both T1- and T2-weighted images which suggested lipoma. The patient underwent marginal excision of this tumor and curettage of the bone surface of the erosion. The pain resolved after surgery. The diagnosis of lipoma was confirmed with postoperative histological examination. Lipoma should be included in the differential diagnoses of a finger tumor, even if radiography shows bone erosion.

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On March 11, 2011, an earthquake occurred off the coast of Honshu, Japan. The quake was followed by a powerful tsunami that caused extensive damage to the east coast of the Tohoku and Kanto regions. This disaster destroyed the medical system in place and thus drastically reduced the ability of the healthcare system to handle the large number of casualties. During the initial response to this disaster, we participated in several types of outreach medical relief teams dispatched to the affected area from the day of the earthquake onwards. The ratio of persons injured to persons missing or dead for the 2011 Japan disaster (0.31: 5,994 to 19,371) was much lower than for the Indian Ocean Tsunami of 2004 in Thailand (1.01; 8,457 to 8,393) and for the Great Hanshin-Awaji Earthquake of 1995 in Japan (6.80; 43,792 to 6,437). The different ratios for the different types of disasters indicate that medical relief efforts in response to natural disasters should be tailored to the type of disaster to optimize the effectiveness of the response and prevent further deaths. From a medical viewpoint, unnecessary deaths must be prevented following natural disasters. Doing so requires appropriate information transmission and an understanding of the mission's overall and specific objectives: 1) rapid search and rescue; 2) early care in the field, evacuation centers, and primary clinics; 3) definitive evaluation at disaster base hospitals; and 4) proper evacuation to unaffected areas. We propose a descriptive device that can guide headquarters in dealing with the commonalities of a disaster.

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