The superficial cervical artery (SCA) is a superficial branch of the transverse cervical artery. The SCA supplies the upper part of the trapezius muscle. Since 1986, we have harvested SCA flaps for the reconstruction of neck scar contractures and intractable ulcers of the parietal region. We developed the SCA flap for use as a skin flap in 1990, and in 1993 we succeeded in harvesting it as a free flap. We first employed the flap with a musculocutaneous pedicle, but later we developed the flap as a muscle pedicled flap and a vascular pedicled flap. Moreover, we have successfully employed the flap as a "Super-thin flap," and as microvascular augmented flaps for harvesting extremely large flaps safely. In the 1980s and early 1990s the concept of "perforator flaps" was unknown, but the SCA is now considered to be a perforator. Thus, we can call the flap the SCA perforator (SCAP) flap. The SCAP flap has a wide rotation arc and low donor-site morbidity, and our clinical studies clearly show that it is useful for reconstruction.

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Objective: Diffuse alveolar damage (DAD) is a pathological pattern of acute respiratory distress syndrome that can be a direct cause of death in many diseases. The process of fibrosis and myofibroblasts (MFS) in DAD were investigated. Methods: Lung tissues obtained at autopsy from 23 cases of DAD were studied with light microscopy and the light microscopic immunoperoxidase method. Results: Four cases of exudative stage DAD and 18 cases of organizing stage DAD were detected. All cases showed hyaline membranes and α smooth muscle actin-positive MFS. MFS were located in the alveolar walls in the exudative stage. MFS were observed in the intra-alveolar spaces in all 18 cases of the organizing stage. Fifteen of 18 cases showed Mib-1- positive proliferating MFS in the alveolar spaces. Eleven of 18 cases of the organizing stage showed proliferation of MFS in the alveolar walls themselves, in addition to that in the intra-alveolar spaces. Discussion: In previous reports, intra-alveolar fibrosis composed of MFS or fibroblasts or both was essential in lung fibrosis. In this study, we found that (1) in the early stage of DAD, MFS appear in the alveolar walls, (2) in organizing DAD, intra-alveolar fibroses were formed as in the previous reports, (3) in addition, fibroses were formed in the alveolar walls themselves in 11 of 18 cases of organizing DAD.

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A 20-year-old man with right scrotal pain underwent surgery under a diagnosis of acute scrotum. The right testis and spermatic cord were normal, but there was a remarkably reddish and swollen nodule with a pedicle at the head of the right epididymis. Based on pathological findings, this case was diagnosed as torsion of the epididymal appendix.

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There have been few studies of kidney volume. Therefore, we performed a study of mean kidney volume and its correlations with sex, lateral asymmetry, kidney length, width, thickness and weight in 103 kidneys excised from 54 cadavers used for practical training in the department of anatomy of this university. Mean kidney volume was 131.0±97.4 ml (103 kidneys) and was greater in males than in females (p<0.05) but showed no lateral asymmetry. A strong correlation was only observed for mean kidney volume with weight (r=0.919), but no other correlations were observed. Next, the correlation between kidney-volume and cross-sectional area was investigated by measuring cross-sectional area after 59 kidneys having a macroscopically favorable appearance from 30 cadavers were sectioned frontally along the major axis. A strong correlation (r=0.769) was observed between cross-sectional area (mean: 45.82±9.84 cm²) and mean kidney volume (133.47±52.33 ml). These findings suggest that approximate values for kidney volume and weight can be obtained from kidney measurements using X-rays imaging and can, in turn, be applied clinically.

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Nutritional support has advanced and is now widely accepted as a basic component of patient care. However, the inadequate administration of total parenteral nutrition and catheter-related sepsis has become increasingly problematic. One of the earliest nutrition support teams was established in Boston City Hospital in 1973, and similar teams have subsequently been established all over the world, including Japan. A nutrition support team was developed at the Nippon Medical School Hospital in March 2005. The team is composed of certified nutrition support physicians, nurses trained in nutrition support, dieticians, a pharmacist, and other staff members. At first, nutritional screenings for malnourished patients were performed by evaluating serum albumin levels. The percentage of malnourished patients whose serum albumin levels were less than 3.0 g/dl was 31.8% (310 of 974 patients). Enteral nutrition was performed in 3.8% of the admitted patients. Total parenteral nutrition was performed in 6.4% of the admitted patients. Next, the energy intake from food consumption, via both enteral and parenteral nutrition, was evaluated for 3 days from April 29 through May 1, 2005. The mean energy intake of the 155 admitted patients was 1,295 ± 526 kcal/day. Of these patients, 86% ate food and consumed 80 ± 26% of the served meals. Energy from the oral intake of food amounted to 1,362 ± 501 kcal/day, whereas that from enteral nutrition amounted to 945 ± 497 kcal/day and that from parenteral nutrition amounted to 1,003 ± 405 kcal/day. No nutritional support was performed in 4.5% of patients. The results of this study demonstrate that at least 25% of the patients were malnourished and inquired additional nutritional support by the newly developed nutrition support team.

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Rheumatoid arthritis (RA) is an autoimmune disease characterized by the infiltration of various leukocyte subpopulations into both the developing pannus and synovial space. The chronic nature of this disease results in multiple joint inflammation with subsequent destruction of cartilage and joint. The etiologic cause of RA has not been clearly understood, but pro-inflammatory cytokine such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and IL-6 mediated autoimmune responses are considered to play a crucial role in the pathogenesis of RA. The diagnosis of RA is primarily based on clinical grounds. However, not only clinical findings, but also serological and radiological examinations are required for the diagnosis, according to the classification criteria of RA established by American College of Rheumatology. Several clinical trials revealed the existence of "windows of opportunity" since radiological progression of RA is most prominent within the first two years of disease. Therefore, present treatment strategies for RA is use of disease-modifying anti-rheumatic drugs (DMARDs) singly or in combination as early as possible in the disease process, because suppression of disease activity correlates with reduction in radiological joint damage. However, many patients have persistent disease even when treated with DMARDs. There has been an increased understanding of the phenomenon of immune dysregulation in RA during the past several years and it is now possible to treat several autoimmune diseases based on this knowledge. An example is the successful treatment of clinical signs and symptoms and radiographic progression by blocking TNF, which is a key cytokine in the pathogenesis of RA. Therefore, the ultimate goals in managing RA are shifting from the prevention of joint damage, loss of function, and decrease pain to the complete remission clinically and radiologically.

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Many patients require a medical check-up as an outpatient with the chief complaint of low back pain, because the morbidity of low back pain is high. Many cases of acute lumbago resolve spontaneously, but some cases shift to chronic lumbago. Low back pain is classified as somatic pain and radicular pain resulting from the lumbar area, and other pain originating in the abdomen and pelvic viscera. We describe it mainly as low back pain and inter vertebral disc herniation. At the time of diagnosing inter vertebral disc herniation, the straight leg raising test is a very useful physical examination and MRI is the best examination for imaging studies. The therapeutic principle is conservative treatment, because symptoms of inter vertebral disc herniation may improve naturally. Surgical treatment is chosen when severe nerve damage, such as bladder problems or dropfoot, is present and patients are in significant pain.

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A 55-year-old man was admitted to our hospital to evaluate a large pseudocyst. Computed tomography showed a 5-cm pseudocyst filled with contrast medium in the head of the pancreas, and color Doppler ultrasonography revealed high-velocity pulsatile flow inside the cyst. Celiac angiography confirmed bleeding from the superior anterior pancreaticoduodenal artery into the cyst. Pancreaticoduodenectomy was performed. Pathologic examination showed a thick-walled pseudocyst filled with clots. The postoperative course was uneventful. Five years after the operation, the patient remained free from bleeding. Bleeding from pancreatic pseudoaneurysms may cause sudden death in patients with chronic pancreatitis, therefore, this entity should be borne in mind, and prompt treatment is of utmost importance in cases of major bleeding.

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