Background & Aims : To assess the effectiveness of CT during arteriography (CTA) in superselective transarterial chemoembolization (TACE) for invasive bladder cancer, and to report preliminary results of superselective TACE. Methods : Angiography was performed in 20 patients with invasive bladder cancer, using a combined CT-Angiography system. Of the 20 tumors, 19 were T3, one was T2. The vesical arteries were selected using a 3F microcatheter, and perfusion was confirmed using CTA. TACE was performed after administrating 40 to 100 mg of cisplatin, with and without gelatin sponge particles. The effects of TACE were assessed by surgery or a combination of cystoscopy and CT in 15 cases. Results : The vesical arteries were successfully selected in 18 of 20 patients. In 16 small tumors, the tumor stain was clearly depicted on CTA. In two large tumors, the vascular supply was identified as involving multiple arteries. One case showed complete remission, six showed partial remission, and eight showed no change. Complications included mild local pain around the perineum during TACE, and transient nausea in some patients. Conclusion : CTA may be useful in superselective TACE for invasive bladder cancer, and may contribute to effective treatment of bladder tumors.

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Background and Aims : The present scanning electron microscope study showed the transformation of muscle capillary from the continuous capillary lacking fenestrae to the fenestrated capillary after the bilateral hindlimb casting.
Methods : Five adult Wistar strain rats were killed after the bilateral hindlimb casting for two weeks. Capillary endothelial cells in the tibialis anterior muscle of hindlimb casting rats were studied by scanning electron microscopy, thin-section electron microscopy, and light microscopy.
Results : Muscle fiber atrophy and enlargement of the endomysium were conspicuous in the casting rats. Muscle capillaries resided in the enlarged connective tissues. In the scanning electron microscopy, the diameter of caveolae in the casting rats was larger than those seen in the control rats, and the number of caveolae in the casting rats was greater than those seen in the control rats. Fenestrae were found only in the capillary endothelial cells of casting rats and calibrated at 76.6±28.7nm in diameter. In thin-section electron microscopy, fenestrae appeared as small gaps in the attenuated portions of the endothelial cells.
Conclusions : Fenestrated capillaries in the tibialis anterior muscle appear in corresponded to the increased permeability in the endothelial cells of the casting rats.

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[Purpose] In this report, the clinical features and surgical treatment highlighting areas of concern in treatment of inflammatory abdominal aortic aneurysm (IAAA) are discussed together with a review of literature. [Patients and Methods] Among 287 patients undergoing repair for abdominal aortic aneurysm (AAA) between 1992 and 2003, IAAA was observed in six (2.1%). All six patients were male, and the mean age at the time of surgery was 66 ± 8 years, ranging from 52 to 72. Four patients (67%) had been previously treated for hypertension, and no genitourinary dysfunction occurred in any patients. Two patients (33%) complained of lumbago prior to surgery. The preoperative diagnosis of IAAA was made in only two patients (33%) because the mantle sign and other typical appearances of IAAA were identified in only these patients. [Results] Five patients underwent elective surgery and there was one case of urgent surgery. There was massive adhesion in five patients developed between the aneurysm and the mesentery and/or intestine. Postoperative ileus due to duodenal stenosis occurred in one patient. [Conclusion] The preoperative diagnosis of IAAA is sometimes difficult, and the operation for IAAA should be modified to avoid excessive dissection.

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Purpose : The purpose of this study was to investigate the postoperative course of patients with skeletal mandibular prognathism. We examined the change of masticatory efficiency and the relationship between masticatory efficiency and relapse.
Patients and methods : A total of 21 patients underwent orthognathic surgery and were examined with masticatory efficiency tests pre and post operative. We evaluated the masticatory efficiency by means of measurement of absorbance using ATP particle and evaluated the ability of the biting off test using incisor teeth in 17 patients. And we analyzed the degree of relapse using cephalometry.
Results : All preoperative masticatory efficiency of the patients were lower than in healthy people, and there was no patient who had a higher masticatory efficiency than healthy people till one year after surgery. Improvements of masticatory efficiencies one year after surgery were recognized in 16 patients. Results of Biting off test using incisor teeth for all the patients got to the maximum level at the time of one year after surgery. As for the relationship between both masticatory efficiencies and relapse of SNB, overbite and overjet, correlations were recognized between poor masticatory efficiency and relapse of overbite. 5 in 6 patients who recognized malocclusion revealed poor masticatory efficiencies after surgery.
Conclusions : Disturbance of improvement of masticatory efficiency after surgery seemed to be caused by malocclusion in molars and decreasing of overbite by reason of relapse.

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Sentinel lymph node (SLN) biopsy was performed in 72 women with primary breast cancer. During the SLN biopsy, blue dye was used in 18 patients (blue dye; B group), and methylene blue associated with radioactive tracer was used with rhenium colloid in 12 patients (R group) and with phytate in 42 patients (F group). The identification rate of SLNs was 83.3% in the B group, 91.7% in the R group, and 92.9% in the F group. The frequency of SLNs was higher in the B group than in the R or the F group. Back up lymph node dissection was performed in all cases following the identification of SLNs. The rate of accurate identification was 93.3% in the B group, 90.9% in the R group, and 92.3% in the F group. In conclusion, the identification rate was lower in the B group than in the R or the F group, suggesting that methylene blue associated with radioactive tracer using rhenium colloid or phytate may improve the reliability of SLN biopsy.

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Aims : The hemodynamic and metabolic effects of hypertonic saline (HTS) infusion were studied in normovolemic dogs. Methods : Seven adult mongrel dogs, weighing 10 to 15kg, were used in this study. Under general anesthesia, the pericardium was opened via a right thoracotomy. High-dosage of HTS (10% NaCl, 5ml/kg) was infused intravenously within a five minute period. Results : Systemic blood pressure significantly increased from 110± 10mmHg to 125 ± 10mmHg. Central venous pressure and left atrial pressure also significantly increased (4.6 ± 1.7 → 9.3±1.9mmHg, 3.5 ± 1.4 → 5.7 ± 2.4mmHg, respectively). Cardiac output increased significantly from 2.0±0.2L/min to 3.0±0.2L/min 10 minutes after HTS infusion. Arterial blood gas analysis revealed that pH, base excess and HCO3^- had decreased significantly 10 minutes after HTS infusion. Hemoglobin and hematocrit levels significantly decreased after HTS infusion. Although O₂ content decreased significantly, the myocardial O₂ extraction rate did not change. Serum sodium and chloride values increased significantly and sustained those levels until 60 minutes after HTS infusion. Conclusions : In conclusion, HTS infusion remains a simple and valuable clinical procedure to use in restoring adequate hemodynamic conditions after hypovolemic shock.

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Background and Aims : Percutaneous radiofrequency ablation for hepatocellular carcinoma is a safety and effective treatment. However, when the tumor is located just under the top of the diaphragm, visualization of the tumor may be difficult with an extracorporeal conventional ultrasonographic examination. In this report, the efficacy of thoracoscopic radiofrequency ablation (TRFA) for hepatocellular carcinoma located just under the top of diaphragma has been evaluated in patients.
Patients and Methods : Five patients underwent thoracoscopic radiofrequency ablation therapy seven times. A thoracoscopic approach with two ports of 12mm in size for a scope and for intraoperative ultrasound, allowed us to obtain additional information regarding liver tumors and a complete treatment for liver lesions. An Lita RFA system (RITA) was applied and a Lita 500PA needle was used.
Results : Five patients were positive for HCV and had liver cirrhosis. The average tumor size was 2.4cm with ranging from 2.0 to 3.0cm. The average session was 3.3 (3 to 6) times. The average procedure time was 180 (90280) min for TRFA, and the average blood loss was 18 (050) ml. No severe complications occurred. Dynamic computed tomograms one week after TRFA demonstrated complete necrosis in all patients. The patients were followed up for 733 months (average 21 months). One patient died of cerebral infarction without hepatocellular carcinoma, and the other are well now without disease.
Conclusions : Thoracoscopic radiofrequency ablation is a safe and effective technique for hepatocellular carcinoma located just under the top of diaphragm.

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Backgrounds & Aims : In recent years, there has been increased interest in complementary and alternative medicine (CAM) among the general population. For this study we examined the effect of the “self-care course” in which CAM is emphasized. Methods : Five courses were held over a period of three months at the Yoshioka Health Center in Gunma, Japan. The self-care program we used was based on Dr. Weil' s “8 weeks optimum health” and was redesigned for simplicity for our study. The average number of participants per course was 37.6. The participants were required to evaluate their own achievement rate by the visual analogue scale (VAS). Before and after results were compared by using questionnaires (POMS, GHQ30). Results : A decrease was observed on VAS on the item titled “Projects”. With POMS we noted meaningful statistical improvements in the item of depression-dejection and confusion, and also noted were meaningful statistical improvements of the GHQ30 total score. Conclusions : This study about CAM inspire new effective methodology in the field of community health.

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Purpose : This study aims at identifying childbirth experience and change in meanings during early puerperal period of one month to develop intervention to improve mental health of mothers after childbirth.
Subjects and Method : The subjects were two mothers of their first babies. Semi constitutive interviews were conducted twice, at an early puerperal period and between discharge and one-month postpartum, asking “what is your childbirth experience?” The interviews were tape-recorded and transcribed to explore their experiences, change in meanings and importance of retrospective review.
Result : Two mothers showed changes in their mental state through describing their childbirth experience. During the first interview, they described the facts and verbalized their feelings. The second interview, on the other hand, showed that they made more self assertive statements, reflecting their efforts in exploring meaning in their experiences.
Conclusion : Presence of a listener supports mothers in finding meaning in their childbirth experience. It was indicated that the way a listener listened to the mothers is important.

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Background & Aims : To clarify possible prognostic factors contributing to shoulder girdle disorders. Methods : Subjects were 122 pitchers registered with the Gunma High School Baseball Association who underwent medical check. Results : The range of internal rotation of the shoulder joint was significantly reduced on the pitching side, while that of external rotation was extended. Twenty-eight pitchers (23.0%) reported shoulder pain. Factors significantly related to pain included maximum pitching ball-speed, tenderness at the coracoid process, impingement signs, and superior labrum both anterior and posterior (SLAP) lesion signs, but not shoulder instability. There were no significant radiological alterations related to pain. Conclusions : These results suggest that impingement syndrome and SLAP lesion may play an important role in the induction of shoulder pain, and physical therapy and careful follow-up are needed for high school pitchers with these signs.

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Background & Aims : Lipopolysaccharide-induced colonic dysmotility using an in vivo rat model was examined in this study. Methods : Six days prior to the experiment, force transducers were sutured to the proximal colons of the rats. On the day of the experiment, while monitoring colonic contractions, lipopolysaccharide (LPS) (1mg/kg) was given intravenously. Results : LPS injections induced abnormal high amplitude colonic contractions within 15 to 30 min in all the rats tested. After the period of these abnormal waves, motility gradually decreased. These high amplitude contractions were partly suppressed by atropine, a nonspecific cholinergic receptor antagonist. Conclusions : These results indicate that LPS induces a transient increase in colonic motility followed by suppression in conscious rats. This increase might be mediated by cholinergic receptors.

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A seventeen-year-old boy was referred to our hospital, complaining of continuous pain of his left wrist joint. Plain roentgenogram showed an osteolytic lesion at the distal end of the radius. An operation in which the tumor was curetted was performed suspecting giant cell tumor. Pathological diagnosis was of a giant cell tumor. One month after the operation, radiological findings showed local recurrence with an expanded lysis. Wide resection of this tumor followed by a vascularized fibular graft was performed. Six months after the second operation, soft part swelling suggesting local recurrence was again prominent. Upper arm amputation was performed because of the bad local condition. The pathological diagnosis of these operative specimens was of giant cell tumor similar to that of the initial specimen. Multiple metastases appeared eight months after the third operation. In spite of intensive treatment, the patient died of respiratory failure. Autopsy revealed that pathological features from metastatic specimens were similar to those of osteosarcoma, not giant cell tumor. When we encounter patients presenting with a giant cell tumor, especially when they are younger than the age at which such lesions usually occur, we should bear in mind the possibility of an osteosarcoma and perform intensive chemotherapy and surgery.

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A 77-year-old was admitted to the emergency center for abdominal pain. As the patient complained of cerebral infarction aftereffects and sensory deafness, he could not express his condition sufficiently and abdominal pain was gradually alleviated. Thus the patient was directly admitted to the Department of Gastrointestinal Medicine. However abdominal pain recurred, and abdominal Echo graphy and CT showed signs of a ruptured abdominal aortic aneurysm with a great hematoma in the retroperitoneum. Y-shaped artificial graft replacement was successful. The postoperative course was uneventful and he was discharged on postoperative day 35. We report this case because operative timing was delayed because the patient could not express his symptoms due to aftereffects of a cerebral infarction.

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A 72-year-old woman with liver cirrhosis and hepatocellular carcinoma admitted for hematemesis due to ruptured gastric varices did not undergo balloon-occluded retrograde transvenous obliteration because varices were not visualized by angiography. Percutaneous transhepatic obliteration was contraindicated due to ascites. Shunt-occluded endoscopic injection sclerotherapy (SO-EIS) was done for gastric varices under occlusion of the gastro-renal shunt using a balloon catheter. Varices were completely eradicated. SO-EIS is thus a safe, effective treatment for gastric varices.

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