In hyperkeratotic type tinea pedis, a sufficient curative effect is generally not obtained with topical antimycotic agents alone, because the main symptom is plantar keratosis. Oral antifungal drugs, such as itraconazole and terbinafine, are useful for treating hyperkeratotic tinea pedis in patients who can orally ingest drugs. In patients who do not respond to oral antifungal agents, we recommend the combination of an oral antifungal agent (such as itraconazole or terbinafine) and a topical antifungal agent, although problems may be encountered in obtaining reimbursement under the Japanese health insurance system. If oral administration is impossible, various topical application methods, such as concurrent use of urea ointments and the use of occlusive dressing technique, can be tried. In any case, it is important to continue treatment without losing hope. Combination therapy with oral and topical antimycotics is considered the most effective treatment. I generalized including domestic and foreign reports, and I pointed out problems, mainly regarding the cure for disease in consideration of the pharmacokinetics in the stratum corneum. In the future, we hope to see the development of more oral and topical antifungal agents that have fewer systemic adverse effects (in particular, hepatic disorders), have interactions with other drugs, and are transferred to the skin at higher concentrations. Treatment regimens (including dosage and treatment period) for existing drugs will also have to be reviewed in multicentre clinical trials.

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Aim: Community Consultation Center was established in 2007 as a core facility of a project entitled "Community Support Network for Citizens with Mild Cognitive Impairment and Dementia" subsidized by the Ministry of Education, Culture, Sports, Science and Technology. This study reports the activity within the facility and users' outcome.
Methods: At the facility, users consulted their memory problem, and a screening tool with a touch-panel type computer (TP) was used to check their memory loss. Dementia was suspected when the TP score was 12 or less points, and clinical psychotherapist implemented Mini-Mental state examination. All the results were summarized in reports, and we prompted users to see their primary doctors, or nearby medical institutes that we offered. In this study, we asked these medical institutes of their outcome. Informed consent was obtained from all users.
Results: A total of 2,802 people visited the Center, and 1,565 people registered (male/female=519/1,046; mean age, 74 years). 561 people used the center twice or more. Among 1,354 who had TP, 722 users got a score under 12 (46.1%). A total of 409 responses from medical institutes were collected. The data revealed that Mild cognitive impairment (MCI) was 11.2%, Alzheimer's disease was 37.1%, and vascular dementia was 8.00%.
Conclusion: These results indicate that approximately half of the users of the Center was suspected dementia, and a prevalence of both MCI and dementia reached to about 60%. This Center has proven to be useful for early detection and diagnosis.

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A 54-year-old male with a chief complaint of dysphagia was admitted to our hospital. Upper gastrointestinal endoscopy and esophagogram revealed a submucosal tumor in the cervico-thoracic esophagus, and pathological examination of the biopsy specimens revealed a squamous cell carcinoma. Computed tomography of the neck and chest showed cT4N0M0, cStage III. The patient received neoadjuvant chemotherapy (NAC) with cisplatin and 5-FU. Follow-up examinations after NAC evaluated a stable disease. The patient underwent larynx-preserving thoracoscopic esophagectomy. Reconstruction was done using a gastric tube through the retrosternal route and free jejunum graft with micro-vascular anastomosis. The postoperative course was uneventful and the patient had been able to eat most foods without aspiration. We herein describe the importance of team management for a cervico-thoracic esophageal cancer.

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Drug metabolism involves chemical reactions modifying pharmaceutical substances. Lipophilic chemical compounds are converted to hydrophilic compounds by enzymes related to drug metabolism. Some drugs are activated after drug metabolism; on the other hand, some xenobiotic compounds become toxic through these enzymes. Cytochrome P450 is an enzyme that plays a major role in drug metabolism. Metabolites produced by cytochrome P450 from one drug are predictable from the viewpoint of chemical reactivity. Novel metabolites from nonylphenol and bisphenol A are discovered considering the ipso-position metabolic reaction of cytochrome P450.

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