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In clinical diagnostic imaging of Alzheimer's disease (AD), MRI and nuclear medicine studies such as cerebral blood flow SPECT are positioned as biomarkers expressing pathological conditions. With understanding its usefulness and limitations, it is important to conduct appropriate application and to utilize the correct evaluation of the result in clinical practice. Although FDG-PET and amyloid PET are still not covered for dementia by health insurance, they are extremely useful for differential diagnosis as well as early diagnosis of AD. As image biomarkers, they may have complementary implications. In addition, tau PET under development not only realizes more accurate evaluation of AD but also is expected to be applied in dementia other than AD. In the future, image biomarkers are indispensable for patient selection (early diagnosis) in mild cognitive impairment (MCI) or earlier stages and for judging the therapeutic effect of interventions in cases when early intervention for AD.

A 49-year-old female was initially diagnosed with acute myeloid leukemia (AML) M4 with a CD45＋CD13＋CD33＋CD34-HLA-DR＋ immunophenotype. She underwent allogeneic bone marrow transplantation, but the disease recurred. The bone marrow was infiltrated with 87.0% blasts negative for myeloperoxidase (MPO) staining. Immunophenotyping by flow cytometry identified the presence of a CD45-negative blast population. These blasts exhibited a CD13＋CD33＋CD19-CD10-CD34-HLA-DR- immunophenotype. The lack of CD45 expression is often observed in B-cell acute lymphoblastic leukemia, whereas CD45-negative AML is extremely rare; only one older male with AML-M0 has been reported. In the present case, the CD45-negative blasts had an MPO-CD13＋CD33＋ phenotype, which is similar to AML-M0.

The serum Helicobacter pylori titers are good markers for population-based H. pylori screening and treatment programs because the tests used to estimate these titers are noninvasive, inexpensive, and convenient. However, the reference range of 3-10U/mL, which is used as a standard in commercially available serum H. pylori antibody kit E plate Eiken H. pylori antibody II, is regarded as a gray-zone cutoff value to indicate H. pylori infection status. We aimed to clarify the gray-zone cutoff values of H. pylori infection status with new serum H. pylori antibody kits using latex immunoassay. We enrolled 256 patients who underwent endoscopic examination and H. pylori tests at the Inui Clinic of Internal Medicine or IMS Ota Central General Hospital between January 2013 and December 2015. Serum H. pylori titers were measured using Type L Wako H. pylori antibody J (Wako-LIA), H. pylori-latex Seiken (Denka-LIA), and LZ test Eiken H. pylori antibody (Eiken-LZ). In patients with a positive diagnosis of H. pylori infection, the positive diagnostic values (sensitivity, specificity, and positive predictive value) using Wako-LIA, Denka-LIA, and Eiken-LZ were (94.6%, 86.0%, and 79.1%), (95.7%, 90.2%, and 84.6%), and (85.9%, 92.1%, and 85.9%), respectively;in patients with a negative diagnosis of H. pylori infection, the diagnostic values (sensitivity, specificity, and negative predictive value) using Wako-LIA, Denka-LIA, and Eiken-LZ were (96.9%, 83.5%, and 85.6%), (96.9%, 78.7%, and 82.2%) and (95.3%, 67.7%, and 75.0%), respectively. In this study, the gray-zone cutoff value indicating H. pylori infection status was between 4.0 and 8.7U/mL for Wako-LIA, between 10.0 and 15.2U/mL for Denka-LIA, and between 5.6 and 10.0U/mL for Eiken-LZ. Therefore, we propose that lower titers of the positive antibody are important to diagnose H. pylori infection using Wako-LIA and Denka-LIA. However, when using Eiken-LZ, high titers of the negative antibody should be considered diagnostically important.

We estimated the costs and the benefits of a shift strategy of gastric cancer risk screening (ABC stratification) with H. pylori eradication, and H. pylori test and treatment program in young people, comparing with the current barium gastrograph. The combination of serum pepsinogen, assessing atrophic gastritis status, and H. pylori antibody testing allows for ABC risk stratification. The ABC risk screening could greatly reduce screening and treating cost of gastric cancer. The H. pylori test and treatment program could be the most effective primary prevention of not only gastric cancer but H. pylori-related disease, thereby reducing national cost of cancer and healthcare expenditure. The Japanese Government should take the initiative to implement this strategy as soon as possible.

A 24-year-old man presented with abdominal distension, diarrhea, and nausea. Blood tests showed eosinophilia (WBC 14400/microl, Eos 36%) and slight hypoproteinemia (TP 6.4 mg/dl, Alb 3.7 mg/dl). Ultrasonography and computed tomography revealed massive ascites (WBC 11500/microl, Eos 95%, protein 4.7 g/dl) and wall thickening of the small intestine. Endoscopic and histological examinations showed mucosal redness and edema with eosinophilic infiltration throughout the digestive tracts. Fecal alpha1- antitrypsin clearance was increased (44.6 ml/day). A diagnosis of eosinophilic gastroenteritis with ascites and protein-losing gastroenteropathy was made, and was classified as mixed type of both predominant subserosal and mucosal disease. Prednisolone therapy improved all the symptoms and findings. Measurements of serum levels of several cytokines and chemokines showed that interleukin-5 and soluble interleukin-2 receptor, but not eotaxin, were possible indicators of the disease activity. It should be kept in mind that eosinophilic gastroenteritis is one of the causes of ascites.

A 48-year-old woman with iron deficiency anemia (Hb 8.1 g/dl) and Helicobacter pylori (H. pylori)-associated enlarged fold gastritis underwent successful H. pylori eradication. Hemoglobin, serum iron concentrations, and other indices of iron deficiency anemia reached almost normal levels 10 to 16 months after the first eradication treatment. Iron absorption tests and measurements of basal acid output were performed before and after eradication therapy. Iron absorption almost doubled within 3.5 months, whereas basal acid output was nothing but it increased after 15 months. Therefore, it was suggested that the increase in iron absorption was possibly involved in improvement of iron deficiency anemia after H. pylori eradication therapy. Furthermore, it was also suggested that mechanisms other than increase in acid secretion might be involved in increase in iron absorption.

A 73-year-old woman was diagnosed as having tuberculosis of ileocecum by colonoscopy and started on medication. A month later, she admitted for ileus. Colonoscopy showed improvement of tuberculosis of ileocecum. An ileus tube was inserted on the same day, and ileus was improved once. But after removing the tube, she had ileus again. Computed tomography just after re-inserting an ileus tube with Amidotrizoic acid showed 3 stenoses of ileum. A partial resection of the small intestine was performed. Mycobacterium tuberculosis with PCR was positive. A postoperative course was uneventful and no recurrence has occurred up to now. During treatment of tuberculosis, ileus caused by intestinal tuberculosis may occur. It must be considered to examine the small intestine before beginning to treat tuberculosis of ileocecum or colon.

A 73-year-old woman without a history of allergic diseases visited our hospital complaining of sore throat and nocturnal cough. Blood tests showed marked eosinophilia (18000/mm(3);WBC 21900/mm(3), Eos 82.0%) with normal serum levels of C-reactive protein, non-specific and various allergen-specific IgE. Stool tests for protozoa or helminthic ova were negative. Chest X-ray films showed no pulmonary abnormalities. Endoscopic and histological examinations revealed reflux esophagitis (grade C according to the Los Angeles Classification System) with hiatal hernia with inflammatory infiltrates including eosinophils within the esophageal mucosa. A computed tomography showed the thickening of the esophageal wall. An administration of lansoprazole improved reflux esophagitis and also eosinophilia, and an alteration to famotidine caused heartburn with an increase in eosinophils. A re-alteration to omeprazole relieved the symptom and decreased eosinophils. It was shown that gastroesophageal reflux disease was one of the possible causes of eosinophilia.

In the management of hepatocellular carcinoma (HCC), a tumor thrombus occurrence between the hepatic vein and right ventricle is life threatening. We studied the effectiveness of radiation therapy to the venous thrombosis between the inferior vena cava and right ventricle. CASE 1: A 66-year-old man who suffered from no hepatic viral infection had hepatectomy of the huge HCC (over 20 cm) and recurrence at the post dperated liver and lung. After transarterial embolization, he suffered from dispnea and was found with tumor thrombus from the left hepatic vein to right atrium. Radiation therapy to the tumor thrombus was done and dispnea disappeared. He died by pneumonia at 5 months after the radiation. CASE 2: A 74-year-old woman who had hepatecomy and RFA for multiple HCC. For the recurrence of HCC, TAE and RFA were performed. After the tumor thrombus in the inferior vena cava, mammarian cancer was found and radiation therapy was performed. She died after 4 months from lung edema, but no growth of tumor thrombus was found. CASE 3: A 79-year-old man who had TAE, hepatectomy, RFA and MCT for multiple hepatoma. After these treatments, tumor thrombus at the right ventricle was found. Although he suffered from portal tumor thrombosis, lung metastases, bone metastases and colon cancer after the radiation therapy, he is still alive at the 19 month of treatments. Radiation therapy is safe and effective for venous tumor thrombosis of HCC.

A 63-year-old man visited our hospital complaining of brown urine. A physical examination showed jaundice of the skin and conjunctiva bulbar. Blood tests showed elevated serum levels of bilirubin and hepatobiliary enzymes. A type 2-like mass lesion was found near the papilla of Vater during the endoscopic retrograde cholangiopancreatography and was histologically proven to be a well-differentiated adenocarcinoma. A diagnosis of obstructive jaundice due to primary duodenal cancer arising near the papilla of Vater was made. After the jaundice was decreased by endoscopic biliary stenting, a pancreatoduodenectomy was performed. A histopathological examination of the resected specimen concerning the location and manner of invasion of cancer cells revealed that the cancer arose from the duodenal mucosa near the papilla of Vater.

To study a role of intracellular Ca2+ on protection effects in animals against intoxication, that is, autoprotection. When carbon tetrachloride (CCl4) of 0.2 ml/kg was i.p. administered daily to male Donryu rats, the serum alanine aminotransferase (ALT) activity rose to a maximal level one day later, and then decreased to the control level within three days. Thus, the animals were not received any intoxication effect of CCl4 due to second, third and fourth administrations. Thus, animals have a sensitive and non-sensitive periods against intoxication of CCl4. In non-sense period, the animals were protective against the poison. Such protection is an autoprotection. To study a role of intracellular Ca2+ on CCl4-induced autoprotection, we measured the intracellular Ca2+ in hepatocytes isolated from rats after daily CCl4 i.p. administration. Then, the peaks of the intracellular Ca2+ centered on three days and twelve hours after the first CCl4 administration from the first to fourth administration. These results show that the peak of the intracellular Ca2+ is perfectly corresponding with the trough of the serum ALT; that is, the protective period in animals against intoxication. Therefore, this result means that intracellular Ca2+ can mediate biodefense signal caused by CCl4 intoxication.

Apolipoprotein B (apo B) synthesis in fatty liver was described in this review. Apo B synthesis has not been intensively studied in fatty liver. Recently, we demonstrated that hepatic apo B mRNA level increased in two experimental models of fatty liver. Davidson et al. reported that apo B mRNA editing was enhanced in fatty liver induced by refeeding after fasting. However, further investigation is needed to clarify whether alteration in apo B gene regulation participates in development of fatty liver.

A 61-year-old male was referred to our hospital for evaluation of right upper arm pain. He was diagnosed as having primary hepatocellular carcinoma with bone metastasis by his high titer (111,683 ng/ml) of serum alpha-fetoprotein, computed tomography and abdominal angiography, and so UFT therapy, 400 mg daily, was instituted. After 2 months of this therapy, the titer of serum alpha-fetoprotein gradually decreased. Seven months later, the titer was 3,997 ng/ml and reduction of the hepatic tumor size was shown by computed tomography and ultrasonography. Furthermore, the right upper arm pain diminished and X-ray examination revealed remarkable improvement. During chemotherapy, there was no severe side effect apart from mild anemia and the patient is presently still alive. This case suggests the efficacy of UFT for the treatment of primary hepatocellular carcinoma.

In order to evaluate relationship between circulating androgens levels and development of ovarian hyperstimulation syndrome (OHS) in anovulatory patients treated sequentially with hMG and hCG, serum concentrations of androstenedione (A), testosterone (T) as well as estradiol (Ed) were measured serially in a total of 17 anovulatory patients including 9 who did not develop OHS and 8 who developed mild or moderate OHS. Increase of Ed levels during the period of hMG treatment varied remarkably in individual patients with OHS ranging from 7.2 to 190.1 times as much the pretreatment value. On the other hand, increase of A levels during the hMG treatment was recorded in the range from 2.0 to 3.2 times as much the pretreatment value in 4 patients with mild OHS, and from 1.5 to 5.9 in 4 patients with moderate OHS. However, the ratio of A increase remained within 1.4 times in patients without OHS. A transient increase of circulating T was observed in 2 days after commencement of hCG treatment, ranging between 1.4 and 3.2 times in patients without OHS, between 1.8 and 2.4 times in patients with mild OHS and between 3.8 and 6.8 times in patients with moderate OHS. It is concluded that serial measurements of A and T during the course of hMG and hCG treatments respectively appear to be an additional index other than Ed to predict development of OHS.