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A 53-year-old woman was referred to our hospital because of upper abdominal pain and expansion of the pancreatic main duct. Enhanced computed tomography revealed expansion of the main pancreatic duct from the head to the tail; in addition, a 30 mm cystic tumor was observed in the pancreatic head and a 56 mm tumor was observed in the ventral side of the pancreatic body. Endoscopy revealed fistula formation in the duodenum of the Vater papilla on the oral side. The patient was diagnosed with an intraductal papillary mucinous carcinoma(IPMC). In addition, PET-CT revealed accumulation of FDG in the ventral side of the pancreatic body, and a disseminated nodule in the omental bursa was suspected. We administered 6 courses of gemcitabine plus nab-paclitaxel therapy, after which, the tumor in the ventral side of the pancreatic body disappeared. We then performed sub-stomach-preserving pancreatoduodenectomy. The results of abdominal cavity washing cytology were negative, and there were no disseminated nodules in the omental bursa. Therefore, we could perform R0 excision.

This case was a 62-year-old female. She underwent radical surgery for advanced gallbladder cancer 2 years ago after preoperative chemotherapy consisting of GEM/5-FU and CDDP (GFP). Two years after surgical treatment, multiple lung metastases and lymph node metastases appeared, and therefore, GFP chemotherapy was introduced. Rapid emesis occurred at two-cycle medication the first day, and was continued for several days. It was difficult to control the emesis by standard antienemic therapy. We therefore used aprepitant, a new medicine for antiemetic therapy. It had an excellent effect, and chemotherapy for this patient is still being continued.

Small-for-size (SFS) graft syndrome is an important problem after living-donor liver transplantation in adults. Hemodynamic change is thought to be the main cause of graft injury. Excessive portal flow is associated with hepatic sinusoidal injury, and reduction of portal flow improves postoperative liver function. Increased venous outflow due to hepatic venoplasty or reconstruction of the middle hepatic vein decrease the risk of graft congestion. However, the intragraft acute-phase response remains unclear. Recent studies have revealed that downregulation of heat shock protein (HSP) may account for SFS graft injury, and induction of HSP may prevent SFS syndrome. On the other hand, derangement in the regulation of liver regeneration is recognized as another important factor. Further investigation of the regulatory mechanisms of liver regeneration in SFS grafts may suggest a strategy for the prevention and treatment of SFS syndrome. Successful transplantation of marginal-size liver grafts would improve outcome for recipients and increase the margin of safety for living donors.

The conditions of one step RT-PCR method for detection of virus RNA in field-collected mosquitoes, and preservation period of infected mosquitoes for one step RT-PCR were examined. We compared several virus RNA extraction methods with artificially contaminated mosquito pools with dengue virus (DV), Japanese encephalitis virus (JEV), and yellow fever virus (YFV) with a known amount of plaque forming unit (PFU) to establish the condition of one step RT-PCR. In this study, most effective RNA extraction method was ISOGEN-LS extraction combined with supernatant of centrifuged mosquito homogenates. Detection limit of one step RT-PCR using flavivirus universal primer in ten mosquitoes/tube (pool) was 10 PFU of DV, JEV and YFV, 1 PFU of each viruses using species-specific primer respectively, in one hundred mosquitoes/tube, 100 PFU/tube using universal primer pairs, 10 PFU/tube using species-specific primer pairs respectively. Dengue virus infected single mosquito was mixed with 99 un-infected mosquitoes, and tested by one step RT-PCR. We could detect single infected mosquito in pools containing 99 un-infected mosquitoes. Aedes aegypti and Aedes albopictus were inoculated intrathoracically with a mouse-adapted strain of dengue-1 virus and were kept up to 30 days at different temperature. Then examined by one step RT-PCR to determine the appropriate mosquito handling method and the condition of transportation. Positive result was obtained up to 30 days after the mosquito died naturally. These results suggested that we could detect flavivirus RNA tested not only from live mosquitoes but also dead mosquitoes as well, and could apply one step RT-PCR as a rapid, specific, and highly sensitive tool for flavivirus surveillance.

To monitor the development of specific and cross-reactive antibody response in twenty Japanese volunteers after vaccination with live yellow fever vaccine. Serum samples were collected on various days after vaccination and examined for hemagglutination inhibition (HI) antibodies against yellow fever virus (YFV), Japanese encephalitis virus (JEV) and dengue virus (DV), neutralizing antibodies against YFV and JEV, and IgM antibodies against YFV. None of the volunteers had been previously immunized with this vaccine. Fifteen of 20 had pre-vaccinated with JEV 7 to 40 years before. Ten of the 20 had neutralizing antibodies against JEV before immunization. None of the 20 had detectable antibodies against YFV or DV before vaccination. On day 10th after the vaccination, neutralizing antibodies to YFV were detected in 6 of 19 volunteers and IgM antibodies against YFV were detected in 7 of 19. On day 14th, HI, neutralizing, and IgM antibodies against YFV were detected in all the tested sera. Neutralizing antibodies against JEV were developed in 2 volunteers and HI antibodies against JEV were increased in 3 of 6 volunteers respectively. On day 29th, cross-reactive HI antibodies for JEV and DV were detected in all the tested sera. The results indicate that YF vaccine induces YFV-specific antibodies in all the tested volunteers and that it also induces HI antibodies cross-reactive for JEV and DV. The YF vaccine has a strong immunogenicity because it is a live vaccine, and induces antibody against YFV predominantly. The international certificate of yellow fever vaccination becomes valid 10 days after vaccination. On day 14th after vaccination, we detected neutralizing antibodies against YFV from all tested volunteers, however, only 6 of 19 volunteers had detectable neutralizing antibody on the 10th day after vaccination. Therefore, the vaccine may not be perfectly effective on day 10th after the vaccination.

With the purpose of studying the involvement of physicians to zoonosis, investigation on the consciousness was performed by disseminating a questionnaire to members of Medical Associations of Kobe City (2,584 members) and Fukuoka City (1,814 members). From the members in Kobe, 1,165 replies were collected (answer ratio: 45.1%) and 774 replies from the members in Fukuoka (answer ratio: 42.7%). About 70-80% of all physicians answering the questionnaire stated that they had examined the patients with infectious diseases at a ratio of less than 10% to a total of patients examined. Among them, 70% of the doctors had asked the patients as to whether or not the patients were keeping pet animals or had traveled overseas recently when infectious diseases was suspected. There were 738 doctors (38.1%) (1,355 cases), who had suspected or made definitive diagnosis on 15 diseases of zoonosis as stipulated in the new Infectious Disease Control Law for the recent 5 years. In all, 365 doctors (18.9%) examined the patients who were suspected to have had an infection from pet animals. The causative animals primarily included dogs, cats, and birds such as parakeet, while monkeys, tortoises, etc. were found in several cases. About one half of the physicians felt that the cases of infectious diseases and zoonosis would increase in the future. In the entry of free opinions relating to the effective measures for the prevention of zoonosis, 712 physicians (39.8%) entered 1,050 proposals. The details of these proposals were: 444 proposals on "administrative measures". 244 on the need of "education" to citizens, and 201 on the importance of "medical management". About 80% of the physicians replied that they would cooperate for the secondary investigation. It appears that the physicians place much expectation on adequate measures against zoonosis. Namely, they expect much on the establishment of a reliable network, i.e. the network of administrative authorities--physicians--veterinarians--pet animal suppliers--pet animal keepers.

The reports on the patients with rheumatoid arthritis (RA) complicated with the myeloperoxidase specific-antineutrophil cytoplasmic antibody (MPO-ANCA) associated glomerulonephritis, whose clinical feature is rapidly progressive glomerulonephritis (RPGN), have been rare. We here report three cases of RPGN with MPO-ANCA in RA patients. Case 1. A 44-year-old woman with RA for 25 years was admitted because of RPGN. The level of MPO-ANCA was markedly high (293 EU) and the histological examination of the kidney showed diffuse crescentic glomerulonephritis. In spite of the intensive immunosuppressive therapy, her renal function did not recover and she underwent hemodialysis (HD). Case 2. A 58-year-old man with RA for 5 years was admitted due to RPGN (MPO-ANCA ; 147 EU, Ccr ; 16 ml/min) with the nephrotic syndrome and fever. The treatment with the immunosuppressive agents and the plasma exchange was partially effective to stop the rapid progression of the disease, but a few months later, his renal function worsened (Ccr 7 ml/min). A recent histological examination of the kidney failed to establish the CrGN because of endstage kidney. Case 3. A 56-year-old woman with RA for the past 10 years was admitted because of RPGN (MPO-ANCA ; 652EU). Intensive therapy could not be performed because of an active duodenal ulcer and markedly impaired renal function (Ccr ; 6 ml/min), and soon she underwent HD. Renal biopsy was not done. These three cases suggest that RPGN can occur in part of RA patients with MPO-ANCA.

We compared the biomechanical characteristics of bipolar and unipolar hemiarthroplasty on the proximal migration of the outer head by determining the von Mises stress distribution and acetabular (outer head) displacement with clinical assessment of hemiarthroplasty in 75 patients. This analysis used the two-dimensional finite element method, which incorporated boundary friction layers on both the inner and outer bearings of the prosthesis. Acetabular reaming increased stress within the pelvic bone and migration of the outer head. A combination of the acetabular reaming and bone transplantation increased the stress within the pelvic bone and grafted bone, and caused outer head migration. These findings were supported by clinical results. Although the bipolar endoprosthesis was biomechanically superior to the unipolar endoprosthesis, migration of the outer head still occurred. The bipolar endoprosthesis appeared to be indicated in cases of a femoral neck fracture or of avascular necrosis in the femoral head, but its use in cases of osteoarthritis in the hip required caution.

In order to design cementless femoral prostheses for the femoral canal of Japanese patients with secondary osteoarthritis of the hip joint, we analyzed the anatomical features of the hip joint in 85 hips of 55 patients with osteoarthritic hip and 90 hips of 60 subjects with normal hip in three-dimensional CT images. We found that 9 different stem designs varying in width and proximal radius were required to accommodate the hips with secondary osteoarthritis. In normal hips, the anatomical features of the proximal femoral canal to the femoral length was directly proportional. Thus, the values for the proximal radius, the position of the isthmus, off-set value and width of the stem for femoral neck fracture and aseptic necrosis of the femoral head should increase with the stem size, but the ratios of the increase were found different. The mean taper angle from the lower end to the lesser trochanter to the upper end of the isthmus was 3.8 degrees regardless of femoral length.

To develop stem design achieving primary fixation of stems and effective load transfer to the femur, we studied stress analysis of stems in cementless total hip arthroplasty by two-dimensional finite element method using boundary friction layer in stem-bone interface. The results of analyses of stem-bone interface stresses and von Mises stresses at the cortical bones indicated that ideal stem design features would be as follows: 1) Sufficient length, with the distal end extending beyond the isthmus region. 2) Maximum possible width, to contact the cortical bones in the isthmus region. 3) No collars but a lateral shoulder at the proximal portion. 4) A distal tip, to contact the cortical bones at the distal portion.

We reported a rare case of non-Hodgkin's lymphoma of iliac bone which developed peripheral blood involvement associated with hypercalcemia. 42-year-old man was admitted to Fukui Medical School Hospital because of right iliac bone pain. An X-ray film of the pelvis disclosed the osteolytic change of right iliac bone. A CT scan of the pelvis showed soft tissue density tumors involved bilateral iliac bone. He had no superficial lymphadenopathy or organomegaly. Examination of peripheral blood and bone marrow did not show any abnormalities. Monoclonal immunoglobulin was not detected in serum. Examination of biopsied specimens from iliac bone tumor showed infiltration of round cells. Immunocytochemical analysis showed only MT-1 positive. He was treated with combination chemotherapy of vindesine, cyclophosphamide, prednisolone and pirarubicin followed by radiation therapy. But, there was no significant response. Following radiation therapy, he developed coma. Serum calcium was 9.8 mEq/l. The pathologic immature cells were found in peripheral blood. The bone marrow aspirates showed 63% pathologic cells. These cells expressed CD19, CD20, HLA-DR antigens. He was diagnosed as having leukemic non-Hodgkin's lymphoma, B-cell type, and was treated with combination chemotherapy. But he died of systemic fungal infection.

A new apatite-collagen complex was prepared in calcium beta-glycerophosphate solutions at pH 8.50. For this preparation, reconstituted type I collagen was cross-linked with phosvitin in the presence of alkaline phosphatase by use of a cross-linking agent of dimethyl suberimidate. After two weeks of immersion in daily-renewed solution of calcium beta-glycerophosphate, the complex contained apatite approximately two times the modified collagen in weight. When viewed in a scanning electron microscope, needle-like crystals precipitated densely on the collagen fibrils. However, in some portion of the complex, dot-like precipitate was observed as well. X-ray diffraction and IR analyses of the complex suggested that the apatite precipitated on the collagen fibrils was very similar to bone mineral in two aspects, crystallinity and carbonate content.

To assess the effects of H2O on the fracture stress of sintered hydroxyapatite (HAP) ceramics prepared by procedures similar to those used for HAP coated on the metal substrate, four-point bending tests were carried out at 0.5 mm/min either in air (20 C, R.H. 73%) or in distilled water (37 degrees C). Then, strength data obtained were analyzed using two-parameter weibull statistics. In each condition, the bending strength data gave a good fit to single-mode weibull distribution. Weibull analysis of the data gave weibull parameter m = 7.8, sigma 0 = 26.2 MPa in air and m = 8.1, sigma 0 = 18.5 MPa in distilled water, which were calculated assuming a surface flaw model. The mean value of bending strength was 27.3 MPa in air and 18.2 MPa in distilled water. These results indicated that a corrosive environment such as H2O affects fracture stress when measured at a constant stress rate. This effect is considered to be caused by slow crack growth of cracks, occurring at a loading level lower than those at which specimens will fail. Using the weibull distribution function estimated in this study, the effects of both dimension of specimen and stress distribution in the specimen on the mean fracture stress have been predicted.

Lifetime and survival probability of brittle materials under given conditions of stress distribution, environment and component size can be predicted using an SPT (Strenght-Probability-Time) diagram. The SPT diagram for sintered hydroxyapatite (HAP) coated on the metal substrate via the fused glass was drawn and the safe working stress in 37 degrees C distilled water was estimated. The dynamic fatigue test carried out in 37 degrees C distilled water gave the fatigue parameter n = 19 for sintered HAP. This parameter is constant except that it depends on material and environment, and the greater the value of n, the greater the resistance to fatigue failure. For sintered HAP, therefore, the resistance to fatigue failure under this wet condition is low. To draw the SPT diagram, anchor points were taken from the fracture stress and time-to-failure data measured at 1 mm/min. The SPT diagram obtained suggested that a lifetime of 20 years with survival probability of 99.9% required the safe working stress of less than 3.2 MPa. The effects of accuracy of fatigue parameter on the uncertainty in SPT diagram were estimated.

To evaluate the usefulness of single photon emission computed tomography (SPECT) with technetium-99m-pyrophosphate (99mTc-PYP) for estimating infarct size, we compared SPECT data with maximum creatine phosphokinase values. Background threshold was established in a series of phantom experiments. When a 40% cut-off was applied, the SPECT data most closely approximated actual phantom volumes. Therefore, the 40% cut-off level was used in the present study. In 10 patients with acute myocardial infarction, planar 99mTc-PYP myocardial scintigraphy and SPECT using a rotating gamma camera were performed two days after the initial myocardial infarction episode. The maximum creatine phosphokinase value (CPKmax) was also measured repeatedly following the episode. When the infarct size measured by SPECT using transaxial images and calculated by the pixel counts, it correlated very closely with CPKmax (r = 0.94). Most studies so far have reported that the CPKmax level reflects infarct size. We conclude that the infarct size as measured by 99mTc-PYP SPECT closely approximates the actual infarct size, and that this method is useful to determine the severity of infarcts clinically. Among the 10 patients in this series, three of five with infarcts greater than 60 ml died of pump failure. Therefore, we may be able to predict prognosis after accumulating more such cases and improving the methodology.

Thirty-one patients with head and neck cancer were administered pretreatment induction chemotherapy (so-called neo-adjuvant chemotherapy) consisting of a UFT and ADM combination. The chemotherapy consisted of ADM (0.5 mg/kg b.w.) once a week up to 3 times, and UFT (600 mg/day) every day for 20 days. Overall response rate was 37.9% (11/31), and 1 CR and 10 PR were obtained. After definitive treatment, the primary control rate was 80.6% (25/31). Sixteen primary lesions in the 31 patients were classified according to Shimosato's grading system into 1 grade IV, 5 grade III and 10 grade II b a-I. Lymph-node metastases in 5 cases were also classified. The grading of lymph-node metastases was lower than that of the primary lesions.

In order to detect the interstitial pulmonary disease of rheumatoid arthritis (RA), we studied 91 patients with RA and compared the appearances of high resolution CT with those of plain chest X-ray film. We found 43 cases of interstitial pneumonitis on CT. We classified the CT and X-ray appearances as 4 groups (0-3) based on the degrees of pulmonary lesions. The both classifications accorded only in 46 cases (51%). In 46 cases who were not detected any changes by plain X-ray film, 17 were detected interstitial changes by CT. As to the early interstitial changes, the detectability of CT was superior to that of plain X-ray film.