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Patients with amyotrophic lateral sclerosis (ALS) often suffer from salivation problems such as drooling and dry mouth. We examined resting salivation rate cross-sectionally in 66 advanced ALS patients with tracheostomy invasive ventilation using a cotton roll method, and investigated clinical factors associated with salivation rate. Resting salivation rate in the patients was well preserved (median value 0.6 g/min), and was significantly more increased in patients with impairment of jaw movement (P = 0.007) or mouth opening (P = 0.003) than in patients with less impairment, and in patients with the mouth being constantly open ≥ 10 mm in rostrocaudal length than in patients with < 10 mm. These data indicate that salivation rate was increased with progression of dysfunction of voluntary jaw movement. Appropriate oral care is required in advanced ALS patients to maintain their oral hygiene and to avoid penetration of saliva into the airway.

Objectives: We aimed to clarify the relationships of the different stages of behavior change in dietary habits followed by the mothers of school-age children with the actual breakfast intake of these children and the health-associated behavior of the family., Methods: We carried out a questionnaire-based survey of 1949 children at 18 elementary schools and of 881 families with children attending seven elementary schools in Kagoshima prefecture. We were supplied with information about children's breakfast intake and content on the day they took the survey and information about mothers' breakfast intake and the stage of behavior change in dietary habits to which they belonged, for which five stages were defined using the stage-of-change model., Results: The collection rates were 83.3% and 83.1% among children and mothers respectively. Of the children, 83.1% ate breakfast every day, while 15.1% were not in the habit of having breakfast. Furthermore, 98.6% children had eaten breakfast on the day of the survey, but 15.1% had eaten only staple foods such as rice or bread; only 34.0% children combined staple foods, a main dish, and vegetables/fruits in their breakfast. Regarding dietary stage, 28.1% of the mothers belonged to the "maintenance" stage; 24.0%, the "action" stage; 6.9%, the "preparation" stage; 9.8%, the "contemplation" stage; and 5.7%, the "precontemplation" stage. Mothers belonging to the first two stages constituted the "action group," because they were already taking care of their dietary habits, and mothers belonging to the latter three stages constituted the "no-action group", because they were not taking care of their dietary habits. The mothers who could provide no answers to the question constituted the "no-answer group" (25.5%). A comparison of the three groups revealed that mothers belonging to the no-answer group had more children who went without breakfast than the action group (P = 0.000). The children of mothers belonging to the no-action group (P = 0.003) and the no-answer group (P = 0.036) were not in general eating vegetables/fruits in their breakfast, in contrast with the action group. Furthermore, in the case of families with mothers belonging to the no-action and no-answer groups, the families did not often talk about diet, and the incidence of smokers among the fathers was high., Conclusion: In this study, the breakfast habits of children and the health behavior of families differed by stage of dietary behavior change to which the mother belonged.

Patients with metastatic spinal tumor are the largest in number among the patients with bone tumor. It causes a severe bone pain, pathological fracture and spinal cord compression. Thus it harshly hampers patient's quality of life. We report 3 patients with lung cancer whose initial manifestation was metastatic spinal tumor. We treated the 3 patients with palliative radiotherapy and medication. Although the severe pain has improved on a numerical rating scale(NRS), but performance status(PS)and activity of daily living(ADL)of the 3 patients got worse because the disease was progressed and complicated. Generally, PS of cancer patients found by bone matastasis is low. However, it is difficult to take an effective treatment, which leads to ADL improvement. There are many choices for treating metastatic bone tumors including pain control, bisphosphonate administration, radiation therapy, strontium radiotherapy, bone cement, palliative surgery and orthotics. In addition, a development of molecular target drugs, such as Denosmab, is expected as future modality of palliative care. In conclusion, we should detect a bone metastasis in the patient with lung cancer as early as possible, and select an appropriate treatment in collaboration with each specialist for achieving the ADL and PS improvement.

A 16-year-old Chinese girl was found to have abnormalities on chest roentgenography at a school health checkup in 2004, and she visited our outpatient clinic for the first time on July 2. Based on the imaging, there were multiple nodules ranging in size up to 5cm in the longest dimension, with regularly shaped clear margins, in both lungs. We considered lung metastases of a malignant neoplasm as the most likely diagnosis and performed a systemic workup but failed to make a clinical diagnosis. We therefore performed an open lung biopsy on November 8. Microscopically, the tumors consisted of a mixture of areas with a papillary pattern, a solid pattern and a sclerosing pattern. Component tumor cells were of two types: epithelial-like cells that covered the surface of the papillary structures and round or polygonal cells that showed a solid pattern of growth underneath. Immunohistochemical examinations revealed that these tumor cells were positive for an alveolar epithelium marker. From these results, we made a diagnosis of sclerosing hemangioma. Here we report a rare case of multiple sclerosing hemangiomas together with a review of the literature.

An 89-year-old woman with essential thrombocythemia and chronic respiratory failure was admitted for treatment of hemoptysis. She stopped taking aspirin and was given tranexamic acid. Though her hemoptysis improved, respiratory failure suddenly worsened. As a result of various examinations and laboratory findings, acute exacerbation of chronic pulmonary thromboembolism was diagnosed. Though there was the risk of recurrence of hemoptysis, she started taking aspirin again. Her respiratory failure improved but hemoptysis did not reappear. Thrombosis and hemorrhage are common complications of essential thrombocythemia, however, pulmonary thromboembolism is a rare complication. There is a possibility that the exacerbation of this case was caused by tranexamic acid as well as rest and cessation of aspirin. If a patient with essential thrombocythemia bleeds, we should be careful when using tranexamic acid.

A 49-year-old woman with primary Sjögren's syndrome a few years previously was admitted to our hospital complaining of tongue and skin eruptions, swelling of the face and neck and for examination of liver injury and hypereosinophilia. A blood test revealed leukocytosis with eosinophilia, mild liver injury, polyclonal hypergammaglobulinemia, and positive results for anti-nuclear antibody, anti-SS-A antibody and anti-SS-B antibody. Chest CT scan showed multiple nodular opacities with cavities in peripheral regions of both lungs. Biopsy specimens from the right lower lobe obtained by video-assisted thoracoscopy revealed marked infiltration of plasma cells and lymphocytes in alveolar lumina, lymph follicles with germinal centers in other areas of the pulmonary parenchyma, and lymphocytes infiltrate in alveolar wall adjacent bronchi and bronchioles. The histological diagnosis was pulmonary involvement of multicentric Castleman's disease. This was a rare case of Sjögren's syndrome accompanied by pathological findings of multicentric Castleman' s disease showed multiple nodular opacities in chest CT scans.

"Case 1" A 56-year-old woman who suffered from postoperative recurrent non-small cell lung cancer received gefitinib therapy. Approximately 7 months after the therapy was begun, although the intrathoracic disease responded to the treatment, she developed meningeal carcinomatosis and died of rapidly progressive central nervous system disease. "Case 2" A 46-year-old man with stage IV non-small cell lung cancer started gefitinib therapy after chemotherapy. The pulmonary lesions markedly improved responding to gefitinib therapy, however, approximately 6 months after the therapy was begun, multiple brain metastasis and meningeal carcinomatosis were detected. Approximately 4 months after the diagnosis of meningeal carcinomatosis, he died of disease progression and disturbance of consciousness. It has been reported that the central nervous system is a frequent metastatic site of non-small cell lung cancer in patients treated with gefitinib. We report two cases of meningeal carcinomatosis that occurred during the period in which their intrathoracic disease was responding to gefitinib therapy. We should consider the possibility of metastatic central nervous system disease, even in patients in whom gefitinib therapy is apparently successful.

An angiogenic factor, platelet-derived endothelial cell growth factor/thymidine phosphorylase (PD-ECGF/TP), stimulates the chemotaxis of endothelial cells and confers resistance to apoptosis induced by hypoxia. 2-Deoxy-D-ribose, a degradation product of thymidine generated by TP enzymatic activity, partially prevented hypoxia-induced apoptosis. TP was expressed at higher levels in tumor tissuses compared to the adjacent non-neoplastic tissues in a variety of human carcinomas. High expression of TP is associated with an unfavorable prognosis. To investigate the effect of TP on cisplatin-induced apoptosis, human leukemia Jurkat cells were transfected wild-type or mutant (L148R) TP cDNA. TP inhibits a number of steps in the cisplatin-induced apoptotic pathway, activation of caspase 3, 9 and mitochondrial cytochrome c release. These findings suggest a mechanism by which TP confers the resistance to apoptosis by cisplatin. Moreover, mutant TP that has no enzymatic activity also suppressed cisplatin-induced apoptosis. These findings indicate that TP has cytoprotective functions against cytotoxic agents which are independent of its enzymatic activity.

We treated a patient with a postoperative local recurrence of gallbladder cancer who showed a long-term response to low-dose 5-fluorouracil (5-FU) and cisplatin (CDDP) therapy. A 60-year-old woman was diagnosed with advanced gallbladder cancer, for which she underwent an extended cholecystectomy, bile duct resection and a partial resection of the duodenum in March 2000. The pathological diagnosis was well differentiated tubular adenocarcinoma of si, ly1, v1, hinf2, binf2, n0. Eight months later, she presented with cholangitis and obstructive jaundice due to a local recurrence of the gallbladder cancer and her serum CA19-9 level had increased to 1,991.6 U/ml. The biliary obstruction was treated by PTCD and a subsequent self-expanding metallic stent. In addition, she was also placed on combined chemotherapy with low-dose 5-FU and CDDP. Her serum CA19-9 level thereafter gradually decreased, so that after eight months it was within the normal range, and the recurrent tumor at the hepatic hilus was also observed to have decreased in size on the CT scan. As of this writing she has undergone eight courses of low-dose 5-FU and CDDP therapy over about a year and has been able to maintain a good quality of life without any severe adverse effects.

A study was conducted examine whether the asymmetric confusability effect was generalized to an array of face photographs, and furthermore to investigate how the impression of faces affected the recognition of addition and deletion of the faces. In a preliminary investigation, 27 subjects rated the impression of 83 face photographs, and the photographs to be used in the present study were chosen on the basis of the impression scores. In the study, 40 subjects saw 14 photographs consisted of three or four faces and took a recognition test of unchanged photographs and changed photographs with a specific face added or deleted. The data showed that (a) the addition superiority was not found in the recognition of changes in face arrays; (b) the impression of faces differentially affected the recognition of addition and deletion changes in face arrays. These results suggest that the mechanism underlying the recognition of the deletion of a face may be different from that of addition.

A 72-year-old woman was admitted because of anorexia and dyspnea. She was given a diagnosis of pulmonary hemorrhage and renal failure. Despite treatment with high-dose steroid and hemodialysis, the patient died of disseminated intravascular coagulation on the 9th hospital day. Autopsy revealed intra-alveolar hemorrhage, crescentic glomerulonephritis, and systemic vasculitis with fibrinoid necrosis. A direct immunofluorescence study demonstrated linear deposition of IgG along the glomerular basement membrane (GBM). Both anti-GBM antibody and anti-neutrophil cytoplasmic antibody with perinuclear pattern (P-ANCA) were detected in the patient's serum by enzyme immunoassay. Goodpasture's syndrome with P-ANCA was diagnosed. There has been some controversy as to whether vasculitis occurs in patients with Goodpasture's syndrome. This was a rare example of well-documented Goodpasture's syndrome with P-ANCA and systemic vasculitis, the exact etiologic relationships among which remain to be clarified.

We compared cardiac output values obtained by the following 3 methods: 1. Iced bolus injectate method, using the injectate temperature actually measured for computation [bolus cardiac output with flow-through temperature probe: BCO (p)]. 2. Continuous cardiac output measurement, using Vigilance system (continuous cardiac output: CCO). 3. Iced bolus injectate method, assuming injectate temperature to be 0 degrees C (bolus cardiac output without flow-through temperature probe: BCO). Only the subject receiving cardiovascular surgeries using cardiopulmonary bypass (CPB), and requiring a thermodilution catheter for hemodynamic monitoring during anesthesia were selected for the study. The total cases consisted of 15 patients (10 males), in which 60 measurement were made. Following the anesthetic induction with fentanyl, midazolam, vecuronium bromide, and intubation, a Baxter Swan-Ganz CCO thermodilution catheter was inserted through the right internal jugular vein. Compared to BCO(p), CCO showed excellent precision and bias; (r2 = 0.935, P < 0.0001, bias = -0.19 l.min-1, SD = 0.36 l.min-1). Although BCO correlated well with BCO(p), the bias was much greater (r2 = 0.919, P < 0.0001, bias = -1.25 l.min-1, SD = 0.45 l.min-1) than BCO(p). In conclusion, the values obtained by BCO(p) and CCO methods were very accurate. On the other hand, a considerable overestimation was found with BCO since the compensation for actual injectate temperature was not performed

Intraoperative transesophagial echocardiography (TEE) was performed in a 27-year-old man who underwent direct suture for atrial septal defect (ASD) under general anesthesia. Myocardial ischemia occurred about five minutes after weaning from cardiopulmonary bypass, and at that time TEE showed that anteroseptal wall, lateral septal wall and lateral wall are severely hypokinetic and another wall is diffusely hypokinetic in the left ventricle after detecting air bubbles in the left ventricle by TEE. The changes in TEE preceded the ST elevation in the ECG. Bolus infusion of isosorbide dinitrate and continuous infusion of nitroglycerin showed no effects on these changes. Ten minutes after the onset of myocardial ischemia, these changes were alleviated. TEE enabled us to detect air bubbles and evaluates myocardial ischemia before the appearance of ST changes in ECG.

It has been reported that several genes may be good indicators for determining biological behavior, including the prognosis, of colorectal cancers. We have summarized these reported genes, such as tumor suppressor gene, oncogenes, metastasis suppressor gene, adhesion molecules, growth factors, proteinases, and others, including microsatellite instability. Some of the genes such as p53, DCC, c-met, or matrix metalloproteinase are considered to be reliable for determining biological aggressiveness. We introduced several interesting genes which we are focusing using cDNA subtraction library analysis. We hope that these genes are well combined for best analysis of the biological behavior of colorectal cancers and use for practical clinical analysis. In addition, we hope that novel important genes indicative for prognosis will be found.

Intraoperative transesophageal echocardiography (TEE) was performed on a 62-year-old man who underwent abdominal aortic replacement for abdominal aortic aneurysm under general anesthesia combined with epidural anesthesia. Coronary artery spasm occurred after unexpected massive hemorrhage, and TEE showed hypokinesis in the posterior-inferior left ventricular wall. The changes in TEE preceded the ST elevation in the ECG. Bolus infusion of isosorbide dinitrate and continuous infusion of nitroglycerin alleviated these changes. TEE enabled us to detect and evaluate coronary spasm before the appearance of ST changes in ECG.

We report a case of pneumonitis due to Rikkunshi-to. A 79-year-old woman was admitted to our hospital because of interstitial pneumonia. She complained of dry cough and dyspnea on exertion. Fine crepitations were heard on physical examination. The chest X-ray film revealed diffuse reticulonodular shadows in both lung fields. Under the suspicion of drug-induced pneumonitis, all drugs were stopped and she was given prednisolone. Consequently her complaints, laboratory data and chest X-ray findings markedly improved. Microscopic examination of transbronchial lung biopsy specimens showed interstitial pneumonia. The results of lymphocyte stimulation test and lymphocyte migration inhibition test were positive for Rikkunshi-to. Based on these findings, we diagnosed this case as pneumonitis due to Rikkunshi-to. To our knowledge, there has been no previous case of pulmonary hypersensitivity due to Rikkunshi-to reported in the world.

We report a case of early gastric cancer with Virchow's node metastasis. The patient underwent partial gastrectomy and postoperative immunochemotherapy using MMC, 5'-DFUR and PSK, which reduced the Virchow's node. Three years after surgery, we found metastases to the left subclavicular and axillary nodes other than the Virchow's node. Then UFT was administered orally at 600 mg/day, and the metastatic nodes diminished, then vanished. The patient is alive nearly five years after surgery.

We examined the idea that, when the Zöllner figure in one eye and the principal lines in the figure in the other eye were presented, the perceived depth is due to "phenomenal" disparity. The phenomenal disparity is defined as apparent displacement between two illusory "oblique" principal lines in one eye and two "parallel" principal lines in the other. Observes were asked whether depth was seen or not at upper or lower part of the two perceived lines and, if seen, which line was closer. Seventeen observers showed that only 9% of their responses was consistent with the idea, although they reported depths for disparity stimuli. This suggests that the dichoptic presentation of such figures should not be considered as that requires the processing of binocular disparity.

We studied the protective effect of sustained-release theophylline granules on early or late response in exercise-induced asthma (EIA) in 16 patients ranging in age from 7 to 18 years. A standardized exercise test was examined 2 hours after administration of theophylline granules on one day and after no medication on another day. On both days, the lung functions and the serum theophylline and cortisol concentrations of the patients were examined before exercise and over a period of 8 hours after exercise. On days without medication, early response was seen in 16 patients and late response in 6. On days with medication, the theophylline granules inhibited early response in 13 of the 16 patients and late response in 5 of the 6 patients. This suggests that theophylline preparation is a useful drug for inhibiting the dual responses of EIA.

A case of recurrent small cell carcinoma of the lung, accompanied by intraperitoneal metastasis, was orally treated with etoposide (50 mg/day) for 3 consecutive weeks. Subjective symptoms such as abdominal pain began to improve one week after the start of treatment. After three weeks of treatment, these symptoms disappeared completely, and CT findings also improved. The serum NSE level, which was as high as 89.5 ng/ml before treatment, fell to 8.7 ng/ml after 3 weeks of treatment. The patient is now being followed at the outpatient clinic of our hospital. As adverse reactions to the drug, alopecia and leukopenia were observed. The leukopenia appeared in the third week of treatment, but the white blood cell count returned to normal soon after the drug was discontinued.

To assess the reliability of the exercise ECG in detecting silent ischemia, ECG results were compared with those of stress-redistribution thallium-201 single-photon emission computed tomography (SPECT) in 116 patients with prior myocardial infarction and in 20 normal subjects used as a control. The LV was divided into 20 segmental images, which were scored blindly on a 5-point scale. The redistribution score was defined as thallium defect score of exercise subtracted by that of redistribution image and was used as a measure of amount of ischemic but viable myocardium. The upper limit of normal redistribution score (= 4.32) was defined as mean +2 standard deviations derived from 20 normal subjects. Of 116 patients, 47 had the redistribution score above the normal range. Twenty-five (53%) of the 47 patients showed positive ECG response. Fourteen (20%) of the 69 patients, who had the normal redistribution score, showed positive ECG response. Thus, the ECG response had a sensitivity of 53% and a specificity of 80% in detecting transient ischemia. Furthermore, the 116 patients were subdivided into 4 groups according to the presence or absence of chest pain and ECG change during exercise. Fourteen patients showed both chest pain and ECG change and all these patients had the redistribution score above the normal range. Twenty-five patients showed ECG change without chest pain and 11 (44%) of the 25 patients had the abnormal redistribution. Three (43%) of 7 patients who showed chest pain without ECG change had the abnormal redistribution score. Of 70 patients who had neither chest pain nor ECG change, 19 (27%) had the redistribution score above the normal range. Thus, limitations exist in detecting silent ischemia by ECG in patients with a prior myocardial infarction, because the ECG response to the exercise test may have a low degree of sensitivity and a high degree of false positive and false negative results in detecting silent ischemia.

Protective effect of OK-432 on peritoneal recurrence was examined in an experimental mouse model with Meth A fibrosarcoma injected into both abdominal wall and intraperitoneal cavity. OK-432 was given through either intratumoral (i.t.), intradermal (i.d.), intraperitoneal (i.p.), or i.p. + i.t. route. A significant antitumor effect against abdominal tumor was observed in mice given i.t. or i.p. + i.t. injection of OK-432. A significant protective effect against peritoneal recurrence and prolonged survival time was obtained in an i.p. + i.t. group, although other treatment groups showed only minimal effect. We conclude that combined i.p. and i.t. administration of OK-432 may prevent peritoneal recurrence and lead to prolongation in clinical patients with advanced GI tract cancer.

A 72-year-old female was admitted because of a palpable hard tumor, 15 X 7 cm in size, in the left lower quadrant of the abdomen. According to a diagnosis of retroperitoneal tumor, laparotomy was performed, revealing a large tumor extending between the descending colon and the pelvic cavity, which could not be separated from the retroperitoneum, uterus, left ovary, urinary bladder or rectum. A number of metastatic nodules were disseminated to the peritoneum and mesenterium. The pathological diagnosis of the nodules was poorly differentiated carcinoma of transitional cell type, origin unknown. After discharge, oral administration of bestrabucil (100-200 mg/day), the benzoate of an estradiol-chlorambucil conjugate, was given to the patient at an outpatient clinic. The tumor ceased to be palpable when the total amount administered reached at 14 g. Ultrasonography and computed tomography demonstrated significant reduction in tumor size. A decrease in the peripheral leukocyte count was observed after every consecutive administration and it took about 2 months to recover to the normal level. No other side effects were observed in this case. Although administration was stopped at a total amount of 16.1 g, reenlargement of the tumor has not been observed for 9 months.

A 62-year-old male, who had worked for 20 years as a farmer and who had been exposed to respirable agricultural chemicals apart from silica, was admitted in April, 1987, because of progressed exertional dyspnea. The chest X-ray film on admission showed irregularly-distributed infiltrative shadows in both lung fields. The chest CT also revealed irregular increase of densities in lung fields. Though the TBLB specimen from right B8 indicated only fibrotic changes, the tissues obtained by open lung biopsy from right S3 and S8 revealed PAS-positive proteinaceous deposits in the alveoli as well as alveolitis or fibrotic change of alveolar septum. Bronchoalveolar lavage fluid (BALF) contained phospholipids composed mainly of lecithin. According to these findings, the case was diagnosed as pulmonary alveolar proteinosis associated with alveolitis and patchy fibrotic changes. It is not completely clear whether fibrotic changes are induced by pulmonary alveolar proteinosis itself or fibrosis and proteinosis result coincidentally from direct response to fibrogenic agents. Inhaled agricultural chemicals may play a role for the pathogenesis of this case, for which further studies are required.

Two hundred forty-four cases of gastric carcinoma were subjected to cytophotometric DNA analysis. DNA distribution patterns were roughly classified into low and high ploidies. The ratio of high ploidy was 55.7% (44/79) in the positive group of lymph node metastasis, which was significantly higher than 31.5% (52/165) in the negative group (P less than 0.01). The incidence of lymph node metastasis increased rapidly in the high ploidy cases with the progression of carcinoma, while it increased slowly in the low ploidy cases. DNA ploidy was well correlated with lymph node metastasis, and the mode of metastasis seemed to be different between the low and high ploidy groups.

The correlation between the growth pattern and peptic ulceration occurring in the cancer lesion was studied in early gastric cancer. Although the superficially spreading type (Super), which grows slowly, showed a high rate of being accompanied by peptic ulceration (74.0%), the deeply penetrating type (Pen), with rapid growth, had a lower such rate (Pen A- expansive type 9.7%; Pen B- infiltrative type 16.1%). Deep ulceration accompanied 32% of the Super cases, 12% of the small mucosal cases and no cases of the Pen type. The Super and small mucosal types located at the intermediate gland area had peptic ulceration more frequently than those at the other areas. The rate of the cases of peptic ulceration of undifferentiated adenocarcinoma was high in the Super and small mucosal types, and that of differentiated adenocarcinoma was 64.0% in the Super and only 33.3% in the small mucosal type. This study clarified that the growth of early gastric cancer was inhibitively influenced by peptic ulceration, which was modified by the localization and histologic type of the carcinoma.