Forced oscillation technique (FOT) has been recognized as a method to measure lung function. Recently, a new FOT machine, MostGraph (Chest Co., Ltd., Tokyo, Japan), has been developed. As FOT only requires the subject to breathe normally, it will be particularly useful for children for whom cooperation is difficult. Coherence values reflect the reproducibility of a typically normal breath. A coherence value of 0.7 was regularly used for MostGraph measurement. As no previous report to date has shown a coherence value of 0.7 to be a valid value, we evaluated whether a coherence value of 0.7 is suitable for children. We evaluated 131 school children and measured lung function by using MostGraph. We compared MostGraph parameters (R5, R20, R5-R20, X5, Fres, and ALX) between three different coherence values (0.7, 0.8, 0.9). We evaluated ninety-five healthy children (mean age: 7.6 ± 1.4 years old), and excluded children with complications. MostGraph parameters showed no significant difference between three values in all respiratory phases. A coherence value of 0.7 was appropriate to measure the lung function of children by using MostGraph.

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Gastric emptying time of carbohydrate drinks (CDs) has been few reported in Japan. The aim of this study was to evaluate gastric emptying time of CDs measured by ultrasonography in healthy adult Japanese volunteers. Four healthy adult volunteers (2 male, 2 female) were studied. Each volunteer was provided 3 drinks on 3 separate occasions. Volunteers ingested 400ml of water, 6.2% CD (Pocari Sweat^®), and 12.5% CD (Pocari Sweat^® to which glucose was added) in the morning (6.00 am). Gastric emptying time was measured separately for the 3 drinks using ultrasonography. All tests were performed by a single medical doctor (M.W). Volunteers were able to ingest all three study drinks without any discomfort. Residual gastric volumes returned to baseline in 45min after drinking water, 60min after 6.2% CD, and 90 min after 12.5% CD in all volunteers. Conclusion: Ingestion of 12.5% CD within 2 h prior to induction of anesthesia may be considered to be safe in the Japanese population.

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In pregnant women the inferior vena cava is compressed due to uterine volume increase. As a result, it is said that a decrease in body temperature, so called “Hie”, is likely too cool and blood circulation in the pelvis is deteriorated. “Hie” of pregnant women is said to be the reason for various abnormalities such as premature birth or weak labor. However, the relationship between preterm labor and “Hie” has not been clarified. Therefore, the present study was undertaken to investigate the relationship of first birth preterm labor pregnant women and “Hie”. The first experiment was conducted using a questionnaire survey of “Hie” in preterm labor pregnant women and normal pregnancy women. As a result, a significant difference was observed between the preterm labor pregnant women and normal pregnancy women. In the preterm labor pregnant women it was revealed that they often felt the “Hie”. In the second part of the study, the body temperature of preterm labor pregnant women and normal pregnancy women was measured. As a result, a significant difference was observed in the axillary temperature between the two groups. In summary, it is inferred that there is an association with preterm labor pregnant women and the “Hie”, and thus it is considered necessary to consider a means to prevent “Hie” in preterm labor pregnant women.

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Historically, an increased resting heart rate (HR) in patients with coronary artery disease has been reported to be associated with a prognosis factor. However, it is unclear if an increased HR at discharge is associated with the prognosis of ST elevated myocardial infarction (STEMI) in the coronary intervention era. We enrolled 386 consecutive patients with STEMI within 24 hr of symptom onset between June 2001 and February 2013. They were divided into groups with a heart rate of 70 bpm or greater (173 patients) versus less than 70 bpm (213 patients). We assessed the rates of major adverse cardiac and cerebrovascular event (MACCE*) between two groups. In addition to the overall analysis we also performed the same analyses separately for patients with LAD, RCA, and LCX lesion. The HR＞70 group had a significantly higher incidence of MACCE than the HR＜70 group (p＝0.002). Although there was a significant difference between the two groups in LAD (p＝0.017), there were no differences in RCA and LCX (p＝0.150, 0.923). Although multivariate analysis demonstrated that HR＜70 was one of independent predictors of MACCE in LAD lesion, HR＜70 was not an independent predictor of MACCE in all patients. The present study suggested that in patients with STEMI, elevated heart rate at discharge could be an independent prognosis factor, especially in patients with LAD lesion.

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Dental anesthesia with the intravenous (IV) administration of midazolam (MDZ) has been widely used because of the ease of administration and long-standing clinical experience. However, no detailed reports have investigated the optimal dose necessary to obtain sufficient sedative effects of dental treatment and to avoid the side effects of excessive sedation, such as respiratory depression. This clinical study was conducted to determine the optimal dose of IV MDZ necessary to achieve adequate oral anesthetic effects. We attempted to define the reference index in order to evaluate the most effective clinical anesthetic method in the oral clinical field. The present study was conducted in 10 healthy men. IV MDZ (0.01mg/kg BW) was administered as the first dose. Then, MDZ (0.01mg/kg BW) was administered incrementally until a side effect was elicited or until the accumulated MDZ dose reached 0.1mg/kg BW. For each administration point, oral function, sedative effect, and safety were evaluated. MDZ dose accumulation of over 0.04mg/kg BW reduced the mouth-opening capacity and vomiting reflex. MDZ dose accumulation of over 0.05mg/kg BW reduced the quantity of salivation. Using the VAS level, a peak in the sedative effect occurred at 0.06mg/kg BW. Using the auditory evoked potentials monitor, the epoch showed that optimal sedation increased at 0.03–0.06mg/kg BW. These results suggested that an MDZ dose of 0.06mg/kg BW was suitable for sedation in dental treatment. The results of this investigation can be applied in clinics as an effective index of intravenous sedation.

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We performed functional oral reconstruction using implant superstructures in a patient who underwent reconstructive surgery with a rectus abdominis flap, and evaluated the stomatognathic functions. First, particulate cancellous bone and marrow with titanium mesh were used for mandibular reconstruction. Implant placement was performed in the mandible at 6 months after the bone graft. Second-stage implant surgery and vestibuloplasty using Platine mucosa were performed 6 months after the first implant surgery, and final implant superstructures were installed. At the 33-month follow-up, there was no bone resorption around the implant, or peri-implantitis and the implant was stable. Masticatory function markedly improved after these treatments. Prior to the implant surgery, with the use of a palatal augmentation prosthesis, the speech articulation test and conversation intelligibility test revealed improvement in speech functions. However, these functions were reduced slightly after the final implant superstructures were screwed. The stomatognathic dysfunction after ablation of oral cancer is diverse. Therefore, it is important for the improvement of QOL that evaluation of oral dysfunction, combined with oral rehabilitation and selection of the surgical technique based on a prosthetic treatment plan be performed.

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We report the case of a patient with pineal parenchymal tumor of intermediate differentiation, in which neoadjuvant chemotherapy and CyberKnife radiotherapy were performed to improve the degree of surgical resection for tumor reduction and to prevent postoperative meningeal dissemination. During an evaluation for headaches, a pineal tumor and hydrocephalus were incidentally identified in this 22-year-old man. The diagnosis was made by neuroendoscopic third-ventricle fenestration and biopsy. For neoadjuvant therapy, chemotherapy (IFO 1700mg, CDDP 38mg, and etoposide 110mg) was administered for 5 days. This was followed 1 month later by 5 fraction stereotactic CyberKnife radiotherapy. Tumor reduction was observed 1 month after the CyberKnife radiotherapy. Craniotomy and tumor resection were performed, achieving complete macroscopic resection. Intraoperative findings showed no changes due to radiotherapy, such as arachnoid thickening or adhesions between the tumor and surrounding normal tissue. After neoadjuvant therapy, the histopathological findings showed cytoplasmic vacuolization, irregular unevenness of nuclei, and some nucleoplasm and nucleolus membrane leakage. Currently, as of 5 years postoperatively, no findings suspicious of local recurrence or meningeal dissemination have been identified. Neoadjuvant chemotherapy and CyberKnife radiotherapy is an effective mean of treatment for pineal parenchymal tumor of intermediate differentiation.

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A 42-year-old man had a low-grade fever, malaise and muscle pain for over 4 months. On admission, he presented with right cervical lymphadenopathy. He was diagnosed with brucellosis based on the B.canis agglutination test and PCR. Two masses (12mm and 8mm) were found at the 6th segment of his liver; they appeared to be hepatocellular carcinoma based upon imaging tests. He underwent subsegmental liver resection. In the pathological results, the masses were identified as focal nodular hyperplasia. Brucellosis is a rare infection with only 30 cases reported to date in Japan. B.canis infection is a zoonotic disease of which dogs are usually the natural hosts. It causes non-specific symptoms, such as fever, joint pain, and lymph node swelling. This patient was difficult to diagnose due to the lack of any prior history of contact with dogs.

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We report two cases complicated with lower limb compartment syndrome after surgery for rectal tumor in the lithotomy position. Case 1: A 61-year-old man underwent laparoscopic low anterior resection for the rectal cancer. The position used was the crushed stone position and the lower limbs were fixed using the boot type of fixture, with the intraoperative head low, and the right side low［MS1］. Operative time was 6 hours and 25 minutes. From the first postoperative day, the patient suffered spontaneous pain and swelling of the left lower leg, with numbness of the posterior tibial nerve, saphenous nerve area, and weakness of ankle-plantar flexors. Contrast CT showed swelling and a low-density area of the left medial muscle in the lower limbs. Serum CK was ＞10,888IU/L, compartment pressure was ＞22mmHg. We diagnosed this as compartment syndrome, which was confined to the superficial ［MS2］ area of the back side of the left lower leg, and performed fasciotomy on the same day. After surgery he was discharged without sequelae. Case 2: A 60-year-old man underwent abdominoperineal resection for rectal GIST. The fixed posture and lower extremity position was the same as in Case 1. Operative time was 4 hours and 50 minutes. The patient had spontaneous pain and swelling of the left thigh to lower leg immediately after the surgery. At 5 hours postoperatively the lower leg swelling was exacerbated, serum CK was 30,462IU/L, and compartment pressure was ＞60mmHg. We diagnosed this as a left lower leg compartment syndrome. He underwent fasciotomy on the same day. After surgery the left lower leg was nimble ［MS4］without sequelae. Rectal surgery is often performed in the lithotomy position. Therefore, it is necessary to carefully consider the possibility of the onset of lower limb compartment syndrome resulting from the lower leg pressure. Upon onset, this is a complication that may leave severe dysfunction, and thus the lithotomy position should be fixed with sufficient care. When it develops, it is necessary to take early appropriate action. From these clinical experiences in our operating room, we have introduced a new standard at the time of lithotomy position surgery; similar complications have not been observed after its introduction. We also include those details.

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