Background: In April 2009, a novel influenza A (H1N1) pdm virus was identified in Mexico, and spread quickly around the world. We treated 5 patients with influenza-associated encephalopathy due to this virus. We investigated the clinical characteristics, treatments and outcomes. Methods: We studied patients with influenza-associated encephalopathy due to influenza A (H1N1) pdm that presented at the department of pediatrics at Nihon University Itabashi hospital between September 2009 and February 2010. Result: The 5 patients (1 boy, 4 girls), ranged in age from 6 years to 11 years, with an average age of 7 years and 11 months. In all patients, brain CT showed diffuse cerebral edema, and electro-encephalogram revealed diffuse high voltage slow waves in all leads. They were all treated with oseltamivir, and methyl-prednisolone pulse therapy in accordance with the guidelines for influenza-associated encephalopathy in Japan. Three patients recovered without any sequelae; however, the remaining two had residual neurological sequelae. These two patients presented with severe disturbance of consciousne, and their central nervous system symptoms appeared within 12 hours after the onset of fever. One patient had periventricular leukomalasia and symptomatic epilepsy by perinatal brain hypoxia, and the other patient had one complex febrile and two febrile seizure. Conclusion: This study showed that patients with influenza-associated encephalopathy due to novel influenza A (H1N1) pdm infection were all older than the average age of patients with seasonal influenza. Underlying neurological disease or past history may be associated with poor prognosis. Thus, further detailed studies are required.

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Objective: We report the annual operation statistics of the department of Surgery at the Nihon University School of Medicine for 2009. Materials and Methods: We investigated the type and number of the operations in the Divisions of Digestive Surgery, Cardiovascular Respiratory and General Surgery, and Pediatric Breast and Endocrine Surgery at Itabashi Hospital and Nerima Hikarigaoka Hospital of the Nihon University School of Medicine, and Surugadai Nihon University Hospital between January and December 2009. Results: Hepato-biliary operations were increased. There was no decrease in the number of operations in the other divisions. Conclusion: Despite the decrease in the number of surgeons the number of operations increased in one division. Department of Surgery at the Nihon University School of Medicine can expect future deveropment.

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To establish a prognostic evaluation system and treatment strategy for lung cancer metastases to the bones, we evaluated the prognosis-related factors and the effects of the zoledronic acid hydrate on bone metastases in 93 patients. Consequently, in this retrospective study of 30 patients, the performance status (PS), paralysis, and total scores of the scoring system for the preoperative evaluation of metastatic spine tumor prognosis (Tokuhashi score) significantly affected the survival periods. In the prospective study of 63 patients, there were significant differences between the PS and visual analogue scale (VAS) within a 6-month period. Only PS significantly affected the prognosis in Cox regression analyses. There was less than 10/100 VAS after treatment in 64.7% of patients after administration of zoledronic acid hydrate.

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A 56-year-old man was admitted to the hospital with episodes of shortness of breath and chest pain on effort immediately after standing. Physical examination revealed a systolic murmur at the left sternal border in the fourth intercostal space. Transthoracic cross-sectional echocardiography showed a sigmoid-shaped septum protruding markedly into the left ventricle. Treadmill exercise testing revealed no ischemic ST-T changes. Dobutamine stress echocardiography (DSE) resulted in left ventricular outflow tract obstruction (LVOTO) accompanying the chest symptoms. Latent LVOTO occurs rarely in cases of sigmoid-shaped septum, which are considered normal during the aging process. We conclude that we should pay attention to latent LVOTO among the causes of unexplained chest pain in patients with sigmoid-shaped septum, and that DSE is necessary to make the diagnosis of latent LVOTO.

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A 37-year-old man was transferred to another hospital complaining of disturbance of consciousness accompanied by convulsions. Neurological examination revealed no abnormalities. Chest CT scan showed a mediastinal tumor and he was referred to our hospital. Since this is considered the most invasive thymoma, operation was performed. The tumor was excised extensively according to the standard surgical removal of thymoma. The tumor had adhered firmly to the confluence of the brachiocephalic veins, and required angioplasty. The intraoperative pathological diagnosis was difficult, permanent pathologic diagnosis was hyaline-vascular type (HV type) Castleman′s disease (CD). CD of the HV type with symptoms is rare.

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Injury of the superior vena cava after central venous catheterization is an uncommon but potentially lethal complication. When chemotherapy and radiotherapy are being performed simultaneously, complication risk will be increased. Here, we present a case of 56-year-old man with locally advanced esophageal carcinoma who was complicated by catheterization-induced injury of the superior vena cava during concurrent chemoradiotherapy. As far as we know, this is the first report of catheterization-induced injury of the superior vena cava that concurrent chemoradiotherapy was substantially associated with. Due to the vulnerability of vascular wall, caution should be paid when central venous catheterization during concurrent chemoradiotherapy.

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A 70-year-old man with portal hypertension, likely due to extrahepatic portal vein occlusion, was followed up by a family doctor. Esophagogastric varices were diagnosed by endoscopic examination and he was referred to our hospital for treatment of the varices. Although the esophageal varices decreased in volume after repeated courses of endoscopic injection sclerotherapy, massive hematemesis occurred from ruptured gastric varices. Endoscopic hemostasis was resistant for the gastric varices located in the cardia and fornix of the stomach. The dilated left gastric vein was primarily responsible for gastric varices. Percutaneous transhepatic transcatheter variceal embolization via the portal vein was considered to be difficult because of the marked tortuosity and stenosis of the portal trunk with cavernous transformation. The transileocolic obliteration (TIO) method was selected and conducted. After the procedures, a marked hemostatic effect was achieved. TIO is an effective and useful treatment for hemostasis of gastric varices, especially in patients with marked abnormalities of the portal trunk.

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