Background: In 2010, approximately 300,000 patients with end-stage renal disease received chronic dialysis therapy. Chronic dialysis patients are at high risk for infection because the process of hemodialysis requires vascular access for prolonged periods. The burden of infection-related mortality among patients with end-stage renal disease is best illustrated by the findings of the Japanese Society for Dialysis Therapy, which reported that the annual mortality rate due to infection was the secondly highest cause of death. Increased susceptibility to infection: In an environment where multiple patients receive dialysis concurrently, repeated opportunities exist for person-to-person transmission of infectious agents, directly or indirectly via contaminated devices, equipment and supplies, environmental surfaces, or the hands of personnel. Furthermore, dialysis patients are immunosuppressed, which increases their susceptibility to infection. Infection control procedures in dialysis setting: It has been reported that infection control procedures using the standard precautions are not adequate for general health-care settings. Therefore, the recommendations by the Center of Disease Control and Prevention and the manual of hemodialysis procedures by the Japanese Society for Dialysis Therapy are widely used and are expected to reduce the infectious disease. Noteworthy infection in dialysis setting: Viral hepatitis, tuberculosis and antimicrobial-resistant bacterial infection are infectious diseases that are of particular importance. The blood access infection among hemodialysis patients and peritonitis among peritoneal dialysis patients are also frequent and life-threatening infections. Appropriate infection control will reduce the infectious disease mortality and improve the prognosis of the dialysis population.

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Valproic acid-induced Fanconi syndrome in severely disabled, developmentally retarded, and non-ambulatory epileptic children has gradually become more widespread. Although the mechanism is unclear, renal involvement has been suspected. We investigated the effect of antiepileptic drugs and ambulatory state on renal tubular function in epileptic patients. We studied 77 patients who were treated at the Department of Pediatrics and Child Health, Nihon University Itabashi Hospital. The patients were divided into three groups according to antiepileptic drug administration and ambulatory state: severely disabled patients taking mainly valproic acid (9 cases), ambulatory patients taking valproic acid monotherapy (34 patients), and ambulatory patients taking carbamazepine monotherapy (34 patients). Laboratory analysis of renal tubular function showed that β₂-microglobulin levels were increased significantly in severely disabled patients. In addition, α₁-microgulobulin levels were increased significantly in ambulatory patients receiving carbamazepine monotherapy but not valproic acid. These results suggest that carbamazepine affects renal tubular function to a greater extent than valproic acid in ambulatory non-handicapped patients with epilepsy. We propose the importance of monitoring urinary α₁-microgulobulin and β₂-microglobulin levels in epileptic children for the early detection of subclinical renal tubular dysfunction.

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Purpose: We conducted a clinicopathologic investigation of surgical site infection (SSI) after stoma closure and discuss methods for its prevention. Patients and methods: In 23 patients who underwent stoma closure at our hospital, we examined the relationship between the risk of SSI after stoma closure and various clinical factors (stoma type, interval from ostomy, operation time, intraoperative blood loss, anastomosis method, wound drainage, perioperative blood transfusion, etc.). Result: In all, 6 cases developed SSI; of these, 5 (21.7%) had incisional SSI. There were no significant differences in the clinical factors between the groups with and without SSI. There were no SSIs in the group that did not require blood transfusion or the ileostomy group, and the infection rate was low in the wound drainage group. Conclusion: Efficient wound drainage may contribute to SSI.

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Congenital fistula disease in the abdominal wall is often a residual disease and intestinal yolk urachal remnant, which is well known to be associated with umbilical cord. We report a rare case of congenital prepubic sinus. The patient was a 6-month-old boy. Both exudation of pus and bloody material were observed from the midline fistula of the abdominal skin. The opening of the fistula was 6 cm below the midline to the navel. After contrast medium from the hole toward the pubic bone to the skin, then changed a direction to head (umbilical) like L character type. Excision of the fistula was carried out under the diagnosis of congenital prepubic fistula. The fistula penetrated the white line, with the head bent 90 degrees to the side in front of the peritoneum, and led to a blind end at the front of the umbilicus. We failed to detect any connection with the urachus, urinary bladder, umbilical, or gastrointestinal tract. The fistula was removed with the median umbilical ligament. Histopathological findings in the lumen from the opening was covered in smooth muscle and transitional epithelium, and led to the blind end. Three years later, we have not observed recurrence of the disease.

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A mass was found in the abdominal cavity of a 71-year old man during a routine upper gastro intestinal endoscopy. CT scans showed a well-enhanced, solid mass, 3.5 cm in diameter, in the abdominal cavity. On the other hand, magnetic resonance imaging scans showed low intensity on both T1 and T2-weighted imaging. We considered the potential for a stromal tumor and removed the tumor during resection of the omentum with a margin of approximately 5 cm. The tumor was definitively diagnosed as a benign solitary fibrous tumor by histopathological examination and immunohistochemical staining. Although solitary fibrous tumors are generally benign, we must carefully observe such patients after operation because of the potential for recurrence.

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There have been few case reports of ventricular septal perforation through a left ventricular aneurysm. A 56-year-old male patient was diagnosed with left ventricular aneurysm and ventricular septal perforation located in the posterior wall of the left ventricle 2 weeks after the onset of AMI, and he underwent end ventricular exclusion with single PTFE patch and Teflon felt. The postoperative course was uneventful and the patient was transferred for cardiac rehabilitation 15 days after the operation. This procedure was considered appropriate and reasonable.

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We report our experience with a case of breast spindle cell carcinoma that grew rapidly during preoperative chemotherapy. The patient was a 44 year old female, with the chief complaint of palpation of a right breast lump; a tumor about 5 X 3 cm in size. The patient underwent a medical check-up to provide an additional workup. Mammography and breast ultrasonography showed a characteristic lesion with a partially obscured border and nonuniform interior in the right breast area C. It was to be diagnosed as invasive ductal breast cancer after needle biopsy was performed. After observation of a side effect during preoperative chemotherapy, it was canceled. A rapid increase was observed during the course of approximately 1 month after withdrawal. Pectoralis muscle preservation mastectomy and axillary lymphectomy and skin grafting were performed. The histopathological diagnosis was spindle cell carcinoma.

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Acute focal bacterial nephritis (AFBN) is a localized bacterial infection of the kidney. Patients present with an inflammatory mass without frank abscess formation, and may represent a relatively early stage renal abscess. We report 4 cases of AFBN with neurological symptoms, including meningeal irritation, unconsciousness and seizure. Each of the 4 patients had hyperleukocytosis and elevated levels of C-reactive protein. Two patients had neck stiffness. However, cerebrospinal fluid findings from all 4 patients were normal. Initial urinalysis showed leukocyturia in patient 1, whereas no abnormalities were observed in the other patients. Patients 1 and 3 exhibited unconsciousness and mild brain edema, as observed on cranial computed tomography (CT). Abdominal enhanced CT was indispensable for the diagnosis of AFBN in these patients. Hence, we recommend that enhanced CT should be performed for patients with fever of unknown origin.

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A 72-year-old man with chronic renal failure who was undergoing hemodialysis was admitted to our hospital because of anemia. Gastrointestinal fiberscopy showed a type 2 tumor in the middle part of the greater curvature of the stomach, and histopathological analysis of the tumor biopsy revealed adenocarcinoma. Distal gastrectomy was performed with lymph node dissection. On the basis of the histopathological examination, the tumor was an adenocarcinoma with lymphoid stroma (por2) and EBV was detected in tumor cells with in situ hybridization for EBV-encoding small RNAs. Therefore, the tumor was diagnosed as EBV-associated gastric carcinoma. The present case demonstrated that EBV-associated with gastric carcinoma might develop because of depression of cellular immunity in chronic renal failure.

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Polypoidal choroidal vasculopathy (PCV) is characterized by a branching vascular network with polypoidal lesions under the retinal pigment epithelium (RPE). It is classified as a specific form of exudative age-related macular degeneration in Japan. However, several issues regarding the pathogenesis clinical findings and treatment of PCV remain unsolved, and these were investigated by the authors. 1. Indocyanine green angiographic findings: There were two different patterns on indocyanine green angiograms. With the first pattern, both feeder and draining vessels were visible and network vessels showed characteristic findings of choroidal neovascularization (CNV). Points of focal dilatation on marginal vessels comprised polypoidal lesions. With the second pattern, neither feeder nor draining vessels were visible and there were few network vessels. The points of deformation of network vessels appeared to be polypoidal lesions. The former patterr represents deformation of CNV, i.e. polypoidal CNV; the latter is thought to result from abnormalities of choroidal vessels, i.e. PCV in the narrow sense. 2. Pathological findings of PCV in the narrow sense: Histopathological characteristics of PCV in the narrow sense, which had been removed by vitrectomy, were dilatation and hyalinization of vessels, massive exudative changes in blood plasma, basement membrane-like deposits and scant granulomatous tissue. These vessels were located beneath Bruch′s membrane. The findings indicate that PCV in the narrow sense arises from hyalinized arteriolosclerosis of choroidal vessels. 3. Optical coherence tomographic findings: A break was found in the high reflective line which corresponds to Bruch′s membrane. Low reflective tissue was observed at the break corresponding to a feeder vessel. The high reflective line which corresponded to the retinal pigment epithelium was uneven, and highly elevated portions of the RPE corresponded to thick network vessels and polypoidal lesions. Feeder vessels are thought to invade via Bruch′s membrane to form network vessels and polypoidal lesions at the termini of the network vessels, both of which push the RPE upward. Therefore, polypoidal CNV is thought to represent deformation of CNV under the RPE. In PCV in the narrow sense, an irregular thickened line with highly reflective substances adhering to the lower portion of it, curved downward corresponding to the site at which the network vessel filling began. A dimple in the RPE was observed which paralleled the curve of the line. The RPE was pushed upward, corresponding to network vessels. Judging from the results of histopathological studies, abnormally dilated vessels may be pushed up above the atrophic choriocapillaris secondary to an increase in intravascular pressure due to the presence of several dilated vessels and by massive exudation from these network vessels within the choroid. The dimple in the RPE might be attributable to intra-choroidal pressure being decreased at the point at which network vessel filling began.

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