Block of the Ganglion Impar for Treatment of a Patieat with Non-malignant Chronic Perineal Pain

A 62 year-old woman with chronic perineal pain was successfully managed by chemical neurolysis. When she was referred to us, other practitioners had already investigated her. However, the cause of pain was not identified and the pain was refractory to conventional analgesic treatment. She underwent caudal block with 0.25% bupivacaine 5 ml six times to avoid placebo response of the block prior to therapeutic neurolysis. Then, block of the ganglion impar with phenol water under fluoroscopy was performed. Six months later, she still has no pain

Measurement of Platelet-derived Microparticle Levels in the Chronic Phase of Cerebral Infarction Using an Enzyme-linked Immunosorbent Assay

Assessment of platelet function is a critical component of the treatment andsecondary prevention of cerebral infarction, and measurement of platelet-derivedmicroparticle (PDMP) levels using flow cytometry may be a good indicator of plateletfunction. However, the flow cytometric analysis is not feasible in a variety of clinicalsituations. The goal of the present study was to measure PDMP levels using anenzyme-linked immunosorbent assay (ELISA) in chronic cerebral infarction patientsand to determine the utility of PDMP level measurement for the monitoring of theeffect of cilostazol and aspirin.A crossover study was performed using 4-weeks of aspirin (100 mg/day) and4-weeks of cilostazol (200 mg/day) in 18 patients. PDMP levels were also measured in 20volunteers as controls. Experiments demonstrated that PDMP levels were significantlyhigher in chronic cerebral infarction patients (median 8.8 U/ml, interquartile range5.1-14.9 U/ml, n=18) than in controls (median 5.5 U/ml, interquartile range 5.0-8.2 U/ml,n=20) (P=0.047). PDMP levels did not decrease after therapy with either aspirin(median 10.9 U/ml, interquartile range 6.2-17.9 U/ml, n=12) or cilostazol (median 9.2U/ml, interquartile range 6.1-14.3 U/ml, n=12) compared with baseline PDMP levels inthe 12 patients who completed this trial (median 11.4 U/ml, interquartile range 5.2-23.7U/ml, n=12). There were no significant differences in PDMP levels between aspirin andcilostazol (P=0.61). In conclusion, PDMP levels as measured by ELISA were increasedin patients with chronic cerebral infarction regardless of the anti-platelet therapy. Thismethodology may be a useful strategy of assessing platelet function in chronic cerebralinfarction patients

The Effect of Pramipexole on Depressive Symptoms in Parkinson's Disease.

Depression is a common occurrence in patients with Parkinson's disease (PD).Pramipexole is a dopamine agonist that has been used to treat both motor andnon-motor symptoms associated with PD. We conducted a study to elucidate the effectof pramipexole on each of the depressive symptoms as assessed by the Zung Self-RatingDepression Scale (SDS). Twenty patients with PD were treated with pramipexole1.5-3.0 mg daily for 2-3 months. The SDS and the Unified Parkinson Disease RatingScore (UPDRS) were measured in each subject before and after the treatment. Both theSDS and the UPDRS decreased significantly after treatment with pramipexole.Individual assessment of each item in the SDS indicated that 'crying spell','confusion', 'psychomotor retardation', 'emptiness', and 'dissatisfaction' symptomsimproved significantly following treatment, while 'depressed affect', 'decreasedlibido', 'constipation', and 'indecisiveness' symptoms were worse after the treatment.As the symptom of 'indecisiveness' did not respond to treatment, it might be anessential symptom in patients with PD

Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2016 for the Clinical Practice of Hereditary Colorectal Cancer (Translated Version)

Hereditary colorectal cancer accounts for less than 5% of all colorectal cancer cases. Some of the unique characteristics that are commonly encountered in cases of hereditary colorectal cancer include early age at onset, synchronous/metachronous occurrence of the cancer, and association with multiple cancers in other organs, necessitating different management from sporadic colorectal cancer. While the diagnosis of familial adenomatous polyposis might be easy because usually 100 or more adenomas that develop in the colonic mucosa are in this condition, Lynch syndrome, which is the most commonly associated disease with hereditary colorectal cancer, is often missed in daily medical practice because of its relatively poorly defined clinical characteristics. In addition, the disease concept and diagnostic criteria for Lynch syndrome, which was once called hereditary non‐polyposis colorectal cancer, have changed over time with continual research, thereby possibly creating confusion in clinical practice. Under these circumstances, the JSCCR Guideline Committee has developed the "JSCCR Guidelines 2016 for the Clinical Practice of Hereditary Colorectal Cancer (HCRC)," to allow delivery of appropriate medical care in daily practice to patients with familial adenomatous polyposis, Lynch syndrome, or other related diseases. The JSCCR Guidelines 2016 for HCRC were prepared by consensus reached among members of the JSCCR Guideline Committee, based on a careful review of the evidence retrieved from literature searches, and considering the medical health insurance system and actual clinical practice settings in Japan. Herein, we present the English version of the JSCCR Guidelines 2016 for HCRC