Aims : To evaluate the effectiveness of percutaneous vertebroplasty (PVP) in treating refractory pain caused by vertebral compression fracture. Patients and Methods : Seventeen PVPs were performed for 15 vertebral compression fractures in 10 patients with osteoporosis or bone metastasis. Under CT guidance using a unilateral transpedicular approach, the tip of the biopsy needle was placed into the anterior third of the midline of the vertebral body, and bone cement (methylmethacrylate) was carefully injected to fill the vertebral body. The degree of pain after PVP was assessed by comparing it with the pain before PVP, using a 10-degree scoring method. Results : In 15 of 17 PVPs, pain was reduced to 3.2/10 as early as 3 hours after the procedure. Pain reduction was attained in all cases, and the final pain score was 1.9/10 at 3 months after PVP. No serious complications were seen. Conclusion : PVP is safe and relatively easy to perform, and the relief of pain is significant and immediate after the procedure.

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Background and Aims : With the childbirth age becoming high in addition to the low birth rate in recent years, there is a growing perception that a child itself is a variable baby. With this, coupled with the increased safety of cesarean section, indications for cesarean section have been expanded. Previously we closely examined and studied the cases in which vaginal birth after cesarean section (VBAC) resulted in uterine rupture. Methods : Using 226 cases subjected to VBAC as the subjects, a retrospective analysis was made. Results : Uterine rupture (threatening uterine rupture, incomplete uterine rupture) occurred in 20 cases (8.9%) of the 226 cases of VBAC. Conclusion : Considering that medical suits for obstetric accidents are assuming a serious proportion, it is necessary to judge the situation properly and take steps suited to the occasion. In trying VBAC, utmost care is required, and it would be worthwhile to recommend elective cesarean section for the pregnant women who have the history of cesarean section.

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Background : Profiles of patients initially consulting the Department of General Medicine are unknown.
Methods : Using a questionnaire and medical records, we examined “reasons for consultation”, “chief symptoms”, and “referrals to specialized departments” for patients who consulted our department between June and July 2002.
Results : Patients' responses were as follows : “I have some symptoms, but do not know which department I should consult”(71.5%), “I know the nature of my disease and the appropriate department”(13.4%), “I am consulting the Department of General Medicine to request Kampo therapy”(6.4%). Those not knowing which department to consult had various symptoms (headache, abdominal pain, fever, “numbness”, chest pain or discomfort, dizziness, fatigue, etc.), and 35.6% of these were diagnosed and treated by the Department of General Medicine.
Conclusions : Most patients consulting our department for the first time requested referral to a specialized department or requested primary diagnosis and treatment. These patients may have benefited from particular functions of “general medicine”.

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Aims : We evaluated therapeutic outcomes of microwave coagulation therapy (MCT) for hepatocellular carcinoma (HCC).
Materials and Methods : Forty patients including 30 primary and 10 recurrent cases undergoing MCT at our institute between January 1995 and December 2000. In the 10 recurrent cases, hepatectomy, percutaneous ethanol injection therapy (PEIT) and transarterial infusion therapy (TAI) had been performed in 8, 1, and 1, respectively as the first therapeutic procedure. The average tumor size and number of tumors in 40 patients were 2.7cm and 1.6, respectively.
Results : The one-, three- and five-year cumulative survival rates were 84.7%, 45.3% and 32.6%, respectively. Good clinical results were obtained in recurrent cases with hepatectomy, liver damage A, tumors less than 3 cm in size, Stage I, well-differentiated tumors, and a percutaneous. Local recurrence occurred in 4 of 65 nodules and the local recurrent rate was 6.2%. Complications occurred in 21 patients (52.5%) including 5 with high fever above 38.5°C, 1 with ascites, and 1 with hyperbilirubinemia.
Conclusions : MCT appears to be effective in treating HCC tumors less than 3 cm in size.

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We describe a 15-year-old Japanese boy with porokeratosis Mibelli with a unique clinical appearance. Two typical lesions were symmetrically distributed in the preauricular area bilaterally. An immunohistochemical study demonstrated CD1a+ /HLA-DR-cells in the lesion epidermis ; these were considered Langerhans cells with an abnormal phenotype. Since porokeratosis is believed to represent a clonal expansion of mutated epidermal cells, cutaneous mosaicism of keratinocytes may be involved in the development of this disease, in which the loss of HLA-DR antigen in Langerhans cells in the lesion allows the clonal expansion of abnormal keratinocytes. The symmetric distribution of the lesions in our case supports this hypothesis.

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We report a case of idiopathic acquired anhidrosis successfully treated with steroid pulse therapy. A 21-year-old Japanese man noted the lack of sweating except palms, soles, forehead, upper chest, axillae, and external genital region. The affected skin appeared dry without peculiar skin changes. No abnormalities were seen in routine laboratory tests including serum IgE level, autoantibodies, neurological tests, or endocrinologic studies. No sweating was induced by high temperature at 40 degrees for 15 minutes or by intradermal injection of pilocarpine. Histopathological features of the affected skin showed a slight mononuclear infiltrate around the eccrine glands without degeneration of secretary components. Immunohistochemical studies demonstrated CD-4 positive cells dominantly infiltrating around the eccrine glands. After 2 courses of methylprednisolone pulse treatment, sweating was almost completely restored to his entire body.

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The major postoperative complications in rectal surgery are urinary retention and urinary tract infection. Although the pelvic autonomic nerve preserving procedure is performed, urinary dysfunction may still occur. In this article, we report a patient with rectal cancer who developed a postoperative urinary tract infection (UTI). An insufficient estimation of bladder function and frequent periodical bladder catheterizations were considered to be the cause of the UTI. In conclusion, the careful management of urinary tract complications is required in patients undergoing surgery for rectal cancer.

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[in Japanese]

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