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Gallbladder carcinoma producing alpha-fetoprotein(AFP)is rare.We report a case of AFP producing carcinoma of the gallbladder with huge metastatic hepatic tumor.A 81-year-old female with a hepatitis B virus(HBV)had a fever and right hypochondralgia.Abdominal CT showed an enlarged gallbladder with gallbladder stones, a huge tumor in the right lobe of liver, and swelling paraaortic lymph nodes.Acute cholecystitis was treated by percutaneous transhepatic gallbladder drainage (PTGBD).The hepatic tumor was diagnosed as hepatocellular carcinoma for HBV carrier and the high level of AFP and PIVKA- II .We performed right lobectomy, cholecystectomy and the resection of paraaortic lymph nodes.In the resected gallbladder, the papillary tumor was detected.Histopathological diagnosis was moderately to poorly differentiated adenocarcinoma of the gallbladder.The liver tumor and paraaortic lymph nodes were metastases of the gallbladder carcinoma.The both of gallbladder and liver tumor immunohistochemically stained positive to AFP.It was difficult to diagnose the hepatic tumor because of HBV carrier, the high level of AFP and the unnoticed gallbladder tumor.Gallbladder carcinoma with the high level of AFP might have relation to liver metastases.

Objective: The purpose of this study was to describe workplace bullying experienced by professional caregivers at welfare facilities for the elderly in Japan and to confirm its effects on stress reactions., Methods: A cross-sectional survey was carried out using self-administered questionnaires in 2009 of all the employees working in rural area of facilities for long-term care. Among the 1,233 respondents who filled out all questionnaires concerning stress reactions the Japanese version of the Negative Acts Questionnaire (NAQ) (response rate: 63.9%), we analyzed 897 professional caregivers. We measured stress reactions by using the stress reaction scores of the Brief Job Stress Questionnaire (29 items) and workplace bullying and harassment by using NAQ. We used the unpaired t-test and analysis of covariance (ANCOVA) to compare crude and adjusted average stress reactions with groups classified on the basis of each subscale of the NAQ or all of them., Results: About 40% of both men and women suffered from "malicious gossip" and over 60% of both men and women experienced "someone withholding necessary information so that their work gets complicated". Among women, scores of the lack of vigor and fatigue were significantly higher in caregivers targeted by person-related bullying than those not targeted (p<0.05). Scores of depression were significantly higher in caregivers targeted by work-related bullying than those not targeted (p<0.05). Scores of anxiety were significantly higher among caregivers targeted by sexual harassment than those not targeted (p<0.05). Among men, scores of the lack of vigor were significantly lower in caregivers targeted by work-related bullying than those not targeted (p<0.05)., Conclusions: Among women, workplace bullying or harassment could may aggravate effects on psychological stress responses. While among men, work-related bullying was positively associated with vigor.

A 71-year-old man was admitted with a swelling of the left scrotum where Galium scintigraphy was positive. He had a history of malignant lymphoma of the right testis and had undergone an orchitectomy, with adjuvant CHOP (cyclophosphamide, doxorubicin, vincristine, predonisolone) chemotherapy and radiotherapy to the post-orchitectomy site and opposite testis. An open biopsy of his scrotum and left testis revealed relapse of the malignant lymphoma in the left scrotal skin.

"The Checklist for Evaluation of Mental Health Activities at the Workplace" was developed for workplace staff evaluating mental health activities in their own workplace. The validity and reliability of the checklist were examined and criteria for evaluation were developed for workplace/organization/companies with 50 or more employees in Japan. The checklist initially included 33 items covering seven major domains of occupational mental health, with a four-point response option, based on the Japanese Guideline for Worker Mental Health in the Workplace and a relevant literature review. A questionnaire was send to 60 members of the Occupational Mental Health Committee (OMHC) of the Japan Society for Occupational Health to ask their opinions on the checklist and on the minimum requirement for each item on the checklist; 30 (50%) responded. A random sample of 1,335 workplaces from a contractor list of workplaces for worker compensation insurance and a questionnaire was send to the personnel department to fill in the checklist; 412 (31.5%) responded and data from 335 of them with 50 or more employees were analyzed. Some OMHC members felt that one of the items (concerning the Total Health Promotion program) should be dropped; thus the checklist was revised to include 32 items, still covering the seven domains. Based on the workplace survey data, most domain scales showed internal consistency reliability at an acceptable level; explanatory factor analysis yielded a four-factor structure that was well concordant with the hypnotized seven-domain structure. Three levels of adequacy of mental health activities were set for each domain scale: "red" (inadequate), "yellow" (minimal), and "green" (adequate). One third of occupational health professionals from 49 workplaces rated the evaluation result based on the checklist as concordant with their view; 95% of them said the checklist would be useful in promoting occupational mental health activities. The study indicated that the checklist had reliability (based on internal consistency reliability) and content- and construct-validity (based on expert opinions, a factor-structure concordant with empirical data, and evaluation by workplace staff). The checklist seems useful in promoting occupational mental health activities.

The purpose of this study was to construct a scale to measure both the positive and negative aspects of communion and agency, and to examine relationships among subscales. First, 264 undergraduates, both men and women, rated themselves on 40 items, and CAS (Communion-Agency Scale) was constructed, which consisted of four subscales with 6 items each. Second, 472 undergraduates, 303 women and 169 men, completed the scale, and were assigned, according to their scores on positive communion and agency, to one of four gender types: androgynous, masculine, feminine, and undifferentiated. Analyses of variance for negative communion and agency, with gender types (positive communion and agency) as independent variables, were performed. Factor analysis was also performed on the data. Results indicated that higher positive communion was associated with less negative agency, and higher positive agency with less negative communion. We discussed merits of measuring positive as well as negative aspects of communion and agency.

Objective: This study was designed to investigate the possibility of nutrition guidance for patients with rheumatoid arthritis (RA). We studied interrelationship between disease activity and nutrient intake or serum cytokine concentration in patients with RA., Methods: Dietary survey was performed to assess nutrient intake of RA patients. Disease activity parameters, such as weariness index, arthritically index and QOL index were evaluated by self-questionnaire. CRP and serum cytokine concentrations were measured. Interactions between these parameters and nutrient intake were analyzed., Results: In comparison of nutrient intake between patients with RA and healthy controls, RA patients indicated lower ratio of polyunsaturated to saturated fatty acid (P/S) than controls. Preceding with the analysis between disease activity parameter and nutrient intake, RA patients were divided into two groups according to their activities. High weariness group indicated higher lipid intake and energy supplies from fat than low group, suggesting the relationship between disease activity and lipid intake in RA patients. From the comparative study of serum cytokine concentration between patients with RA and healthy controls, RA patients indicated higher concentration of IL-1 beta, IL-6 and IL-8. Serum concentrations of these proinflammatory cytokines correlated significantly with some nutrient intakes., Conclusion: These results imply the relationship between nutrient intake and disease activity in patients with RA. It is important to develop nutrition guidance to improve symptoms for patients with RA.

We performed preoperative intraarterial chemotherapy in twenty cases of uterine cervical adenocarcinoma (stage Ib: 2, II: 15, III: 3) and evaluated the efficacy of this therapy. The dosages used were 75-120 mg of CDDP, 10-20 mg of MMC and 30-60 mg of EPIR. These drugs were administered by intraarterial one-shot infusion twice every three weeks. In five cases, complete response (CR) of the primary lesion was confirmed by histologic examination. There were no cases of CR inpatients with well differentiated adenocarcinoma. Stage reduction was achieved in all cases except three. In all but one case, more than 50% volume reduction was recognized on MR images. These results were not significantly different from those in cases of uterine cervical squamous cell carcinoma in which we performed this therapy. Therefore, we concluded that intraarterial chemotherapy is highly effective and should be carried out as neoadjuvant therapy for advanced uterine cervical adenocarcinoma.

LD78 is a member of a new cytokine superfamily, consisting of at least twelve small proteins, which are involved in inflammation and cell growth. Depending on their primary structure, these cytokines can be divided into two families, one of which contains LD78 and is known as the CC family. The protein and gene structures and the physiological functions of LD78 in comparison with the other CC family members are summarized here. Furthermore, the generation mechanism of the three LD78 genes and their expression are discussed.

The metabolic and functional connection between corneal endothelial cells is thought to depend on the transfer of small molecules via gap junctions, as has been reported for other tissues. Cell-to-cell communication in the corneal endothelium was studied by monitoring the spread of fluorescence following the direct injection of Lucifer Yellow CH into single endothelial cells of the excised rabbit cornea. The image of the endothelial cells was observed during the injection and post-injection periods using specular microscopy and fluorescence microscopy. In the fresh cornea, the dye transferred readily from the injected endothelial cell to its neighbors. In damaged cells, dye transfer was slower or did not occur. After 5 hours of incubation in tissue culture medium 199, the specular microscopic image degraded, lowered cell membrane potential and decreased dye transfer rate were measured. This study showed that in normal corneal endothelial cells there were efficient cell communication channels between neighboring cells, and as the endothelium becomes less viable, cell communication is inhibited.

Immunologic and immunohistologic analyses were performed on lymphocytic infiltration in periportal areas of the liver obtained from 105 autopsy cases over 60 years of age and 63 cases under 60 years of age, all cases showing no symptoms of overt liver diseases. Lymphocytic infiltration in the periportal areas began to be found in the livers of young autopsy cases in the 4th decade, with an incidence of more than 60%. The incidence reached 100% in cases of 6th decade and over, accompanied by increased severity. The infiltrating lymphocytes consisted mainly of T cells, (approximately 85%), regardless of sex, age and underlying diseases. In terms of T cell subsets composing the infiltrating lymphocytes, there were 3 types; A:CD4+ cells greater than CD8+ cells. B:CD4+ cells = CD8+ cells. C:CD4+ cells greater than CD8+ cells. Type A was seen in 60/105 cases (57%), type B in 10/105 (9%) and type C in 35/105 (34%). The presence of cases with predominant CD8+ cells appeared to be characteristic of lymphocytic infiltration lesions in the liver, and was different from lesions in other organs. It was suggested that lesion of lymphocytic infiltration in the periportal areas of the liver might be of an autoimmune nature, gradually advancing with age.

The principal means of preventing dental caries in Japan are dietary control and tooth-brushing. However, these measures in public health have not been conducive to a definite reduction of dental caries, while the use of fluorides has led to a remarkable and rapid decrease in caries prevalence. Fluoride mouth-rinsing are usually incorporated into the school-based programs. Many trials were carried out in the elementary schools and a 30-50% reduction in caries increment was reported. To provide greater benefits to the permanent teeth, therefore, it is suggested that fluoride mouth-rinsing should be started earlier in the age. However, fluoride mouth-rinsing is not recommended generally for preschool children who cannot rinse out their mouths well. Among the solutions for mouth-rinsing, there are some different types in the fluoride used, the fluoride content and the frequency of application. The most commonly used fluoride mouth-rinsing solution for daily use is 0.05-0.1% NaF in neutral or weak acid solution. The present study was conducted to confirm the fluoride mouth-rinsing with a lower content of fluoride solution would have an additional cariostatic effect if it is started at the age of four. Participants rinsed with a weak acid (pH 5.0) NaF solution (100 ppm F) for 30 seconds 5 times a week. After all, they were received benefits from fluoride before eruption of the permanent teeth. In the present study, it was demonstrated that the effect of dental caries inhibition was greater than those in the previous study. Especially, many lower first molars were free from dental caries. After 7 years, the caries reduction rates were about 48% in DMFT and 54% in DMFS respectively. So far as 4 first molars, the caries reduction rate was about 41% in DMFT, and this figure was almost the same as all DMFT. It was recommended that the fluoride mouth-rinsing program with a lower fluoride content solution should be started at the age of four.

From 1971 to 1986, massive small intestinal resection was done in twenty-five cases; intestinal atresia 12, intestinal volvulus 9, necrotizing enterocolitis 2, intussusception 1 and gastroschisis 1. Thirteen cases (52%) of them have survived. Of 12 cases with intestinal atresia undergoing small intestinal resection, 7 cases had atresias of multiple type, on the other hand, in intestinal volvulus, 4 of 9 cases without malrotation have had massive small intestinal resection, compared with 5 of 30 cases with malrotation. Many clinical problems have occurred after massive small intestinal resection, especially in cases with short bowel syndrome (shorter than 30 cm in length), but home parenteral nutrition has become one of the key treatments for cases with short bowel syndrome.

One hundred and eighty-two cases of choriocarcinoma were treated in our clinic during the 26 years period from 1957 to 1982. Forty-one patients among them (2.3%) had cerebral metastases. Analysis on the autopsy findings of patients with cerebral metastases of choriocarcinoma proved neurosurgical resectability in most cases. Craniotomy and removal of cerebral metastatic lesion has been adopted since 1972, and a significant difference was noted in the surviving time between surgically treated group and the group without surgery. The risk factors for developing brain metastases were analyzed. Patients whose uterine lesion showed immature type of histopathology (p less than 0.01), patients without uterine lesion (p less than 0.05) and patients with pulmonary metastasis (p less than 0.01) had higher risk of developing cerebral metastasis.