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A 53-year-old woman visited the hospital of this study complaining of constipation. Colonoscopy revealed a circumferential tumor with severe stenosis, and a computed tomography scan showed neoplastic lesions in the rectum and right breast area. Histology was poorly differentiated adenocarcinoma, requiring differentiation between type 4 and metastatic rectal cancer. Additional immunohistochemical tests were performed and a rectal metastasis of breast cancer diagnosis was made. Hormonal therapy was effective and the tumor volume was significantly reduced. Rectal metastasis of breast cancer is said to be rare. However, in the case of patients diagnosed with breast cancer or with a history of breast cancer, considering the possibility of gastrointestinal metastasis using histopathological examination is important.

The patient was a 90-year-old male. For early gastric cancer on the posterior wall of the upper gastric body, which is not indicated for endoscope treatment, chemotherapy with arterial infusion was carried out at other facilities at the request of the patient and his family. Thereafter, he suffered a relapse during follow-up, for which our hospital carried out endoscopic submucosal dissection(ESD). The outcome was a resection without cure. Taking into consideration his age and the fact that the scoring system for early gastric cancer with excised lesions without cure by ESD indicated a medium risk, we carried out no additional treatment but did conduct a follow-up. There has been no recurrence for 15 months following surgery. ESD does not provide evidence with regard to recurrence after other treatments. This patient had a scar following arterial infusion chemotherapy and a local injection solution was not infused into the submucosa right under the lesion. Although the treatment of exfoliation was difficult due to fibrosis of the submucosa, en-bloc resection was possible without any complications.

We present the case of a 59-year-old male with chronic hepatitis C. An ischemic low-signal intensity nodule was detected on hepatocyte-phase images at S8 obtained by gadolinium-ethoxybenzyl-diethylene-triaminepentaacetic acid (Gd-EOB-DTPA) -enhanced magnetic resonance imaging (MRI). The nodule remained unchanged in size but showed a high-intensity signal on hepatocyte phase images. Subsequently, the nodule increased in size, and dynamic computed tomography revealed hyperemic changes, suggestive of hepatocellular carcinoma. Hepatectomy was performed, and histopathological examination of the resected specimen revealed a bile-producing, moderately differentiated, hepatocellular carcinoma. Cell membrane expression of OATP1B3 was detected in the cancerous area, which was more densely stained than the noncancerous areas. We followed the clinical course of the patient, who gradually developed a green hepatoma, which presented as an ischemic low-signal intensity nodule that was detectable only on hepatocyte-phase images obtained by Gd-EOB-DTPA-enhanced MRI. We observed a gradual increase in size, hyperemic changes, and a shift to a high-intensity signal on the hepatocyte-phase images.

An 84-year-old woman with hepatitis C virus-related cirrhosis, hepatocellular carcinoma and atrial fibrillation, who presented with hematemesis, was initially treated with endoscopic variceal ligation (EVL) for an esophageal varix hemorrhage. However, computed tomography (CT) upon admission had revealed portal vein thrombosis, despite having received warfarin for existing atrial fibrillation. We subsequently initiated a 2-week treatment with danaparoid;warfarin being discontinued in order to reduce the risk of re-hemorrhage. A follow-up CT after treatment revealed complete reduction of the portal vein thrombosis. This is the first successful report of danaparoid use in the treatment of portal vein thrombosis that developed in a patient who had received warfarin.

Background: Maternal health is affected by infant's sleep problems like night awakening or bedtime difficulties. Previous studies indicated that infant's sleep problems are affected by particular parenting behaviour (hereinafter referred to as parenting). However, the relation between maternal sleep and infant's sleep has been unclear and there is only limited information on the interaction between parenting, infant's sleep, maternal sleep, and maternal health. The purpose of this study was: 1. to examine the relationship between infant's sleep problems and maternal sleep and health; and 2. to investigate comprehensive relations of four parameters; maternal sleep, maternal health, infant's sleep, and parenting., Methods: The subjects were 194 mothers who attended health checkup for 4month old infants. The questionnaire consisted of 3 components: 1) infant's and mother's sleep habits and sleep problems; 2) maternal health; 3) parenting. There were 15 items for parenting, divided into desirable and undesirable behavior. Subjects were classified into Problem Group (n = 40) or Control Group (n = 142) according to the infants' sleep problems. Maternal sleep, maternal health, parenting were compared between two groups. In addition, we examined relationships among the four parameters using path analysis., Results: Over 60% of mothers experienced some sleep problems and about 30% were suspected of being at high risk of insomnia. The most common mother's sleep problem was "poor sleep quality". Over 80% of mothers had some health problems, that most frequently observed being "Shoulder stiffness". Desirable parenting like "Feed fully and checking the diaper before bedtime" was observed in 80% of mothers, while undesirable parenting like "Feeding or checking a diaper immediately" was seen in 71% of mothers. Maternal sleep problems, maternal health problems, and undesirable parenting were more frequent in the Problem Group than the Control Group. As a result of path analysis, the following relations were found: undesirable parenting affected infant's sleep problems, infant's sleep problems influenced maternal sleep, and mother's sleep influenced maternal health., Conclusions: Thirty percent of mothers were suspected of having sleep disorder and more than half practiced undesirable parenting. Undesirable parenting affected infant's sleep problems which in turn directly affected mothers' sleep and indirectly affected mother's health.

Background and Objectives: Recently, Japanese infant's bedtime has become late and it is reported that this might have a bad influence on infant's growth. The purpose of the present study was to investigate the actual situation and interrelationships between night waking and other sleep problems in Japanese 4-month -old infant., Methods: The subjects were 194 mothers and infants who participated in health checkups at four months after delivery in Fukuoka City. The questionnaire consisted of 3 components: 1) infant's and mother's sleep practices and sleep problems; 2) coping behavior for infant's sleep; 3) perceptions of child-care and maternal health. Their responses were linked to health checkup's results. The subjects were divided into two groups; Waking Group (n = 111) who was wakening one or more times from 0-6 a.m. and Sleeping Group (n = 83) who was sleeping throughout the night. The proportion of Waking Group was constituted 57.2% in all infants. Infant's growth, sleep, and sleep problems were compared between two groups., Results: The mean infant's bedtime was 10:28 p.m., and the proportion of infants reported to go to bed at 10 p.m. or later was 69.4%. The proportion of infants with irregular bedtimes was 16.5%. Twenty-eight point six percent of infants had sleep problems like difficulty settling, severe night waking and were suspected to be high risk of sleep disorders. Infants in the Waking Group were found to have more numbers of sleep problems than in the Sleeping Group. The proportion with difficulty settling was higher in the Waking Group. Additionally, the proportion with irregular bedtimes was higher in the Waking Group. However, infant's height and weight did not significantly differ between two groups., Conclusions: Late bedtime and high proportion of night waking in 4-month-old infants were found to be characteristic in Fukuoka city. There is a possibility that night waking reflects delayed development of circadian rhythms.

Recently much attention has been paid to the circulatory disturbance and peripheral vascular damage in patients with sepsis and septic shock. We intended to elucidate the interaction between nitric oxide (NO) and endothelin (ET)-1 under various pathological conditions by measuring the concentrations of NO3-, the principal metabolite of NO and immunoreactive ET-1. In cases with good prognosis after the septic shock, ET-1 was significantly higher as compared with these in sepsis without shock. In lethal cases with septic shock, these parameters were abnormally high as compared with the survived case. These levels elevated as the degree of severity progressed. When patients recovered from the septic shock, plasma ET-1 levels rapidly decreased. These results may mean that the level of the concentration of ET-1 plays a key role for prevention of the multiple organ failure even after the recovery from septic shock. The elevated level of NO3- during the initial several days in septic shock will mean that NO is acting to prevent platelet aggregation and to keep blood flow by dilating the arteries during septic shock. On the contrary, it may also be suggested that the elevated level of NO3- and ET-1 leads to the dysfunction of vascular endothelial cells and the apoptosis.

We experienced complete remission in a patient with postoperative abdominal lymph node recurrence of intrathoracic esophageal cancer after treatment with radiation (60Co: 30 Gy) and split CF therapy (CDDP: 20 mg/day + 5-FU: 1 g/day for 5 days). Since then, this patient has remained in complete remission for 43 months with intermittent split CF therapy one or two times a year.

A magnetic resonance imaging (MRI) examination has reportedly produced psychological distress such as discomfort, anxiety and fear in a certain number of patients. In an attempt to prevent such distress during an MRI, the authors took the following psychological measures: 1) improved psychological support for patients by MRI technicians; 2) providing sufficient information to patients about the imager and the nature of the examination; 3) reassurance of the safety, with the patient free to terminate the examination at any time; 4) environmental modification to induce relaxation, including recorded music, paintings and live plants in the examination room. We then evaluated the effectiveness of these combined psychological support factors for all MRI patients. A questionnaire on psychological distress experienced during an MRI was filled out by 143 patients (mean age, 49.4 years) and 105 patients (mean age, 48.4 years) prior to and after our psychological measures, respectively, after MRI test in Saiseikai Nakatsu hospital, and comparisons made between these two groups (chi 2 test, p < 0.05). The number of patients experiencing psychological distress during an MRI was significantly decreased (50.5%) after the measures were implemented as compared to the number (64.3%) beforehand. In particular, female, 60 or older patients and patients examined for the first time showed significant decreases in experiencing psychological distress after the measures were implemented. The number of patients who reported distress, tended to decrease. Patients who developed certain symptoms, such as palpitation, also tended to decrease. Patients who reported the "long examination time" as a distress factor and those who developed palpitation during the examination significantly decreased. Our results indicate that these combined psychological measures are efficacious in reducing psychological distress during an MRI, mainly by curtailing the patient's subjective sense of examination time. In addition to an MRI examination, our psychological measures should be applied to other medical examinations which tend to generate undue psychological distress.

Clinicopathological studies were carried out in 35 cases of mucin-producing tumor of the pancreas. In addition, natural history and serial pancreatogram changes were studied in 12 long-term follow-up cases. 83% of the main duct type and branch duct type greater than 4 cm were malignant, whereas hyperplasia cases were found in the branch duct type of 3 cm or less in size without marked dilation of the main duct and excrescent nodules. 33% of carcinoma cases were accompanied by parenchymal invasion and all those cases were of polypoid type of 2.5 cm or more in size. In long-term follow-up cases, all 3 cases of the main duct type showed progression of pancreatograms. In contrast, 8 of 9 cases of the branch duct type remained unchanged. These results suggest that surgical resection is mandatory in the main duct type and that the branch duct type where hyperplasia is highly suspected can be followed up.

Postoperative phosphate dynamics were studied in 30 patients who underwent radical surgery for thoracic esophageal cancer and who were postoperatively nourished by total parenteral nutrition. There was a significant fall in the serum phosphate level on the 2nd and 3rd postoperative days in all patients. Postoperative hypophosphatemia was due to an increase in urinary phosphate excretion which was indicated by the fall in TRP% and TmPO4/GFR. A highly significant positive correlation was observed between the increase in urinary phosphate loss and the enhanced secretion of parathyroid hormone which was possibly triggered by surgical stress, a decrease in the serum level of calcium, the action of phosphate buffer or diuretics. All the patients except for those with postoperative pulmonary complications responded to the drop in serum phosphate by renal conservation of phosphate. A slight decrease in the serum level of phosphate was also found on the 6th postoperative day in most patients who were receiving parenteral hyperalimentation. The second fall in phosphate was due to transcellular shifts of phosphate. It is concluded that patients with postoperative pulmonary complications develop severe hypophosphatemia which should be prevented by replacement therapy with phosphate in the immediate postoperative period.

An adult case of Virus-associated hemophagocytic syndrome (VAHS) was reported and a review of this syndrome in adults in Japan was also made. A 79 year-old woman was referred to our hospital for detailed examination for sustained generalized fatigue lasting for about two weeks. Other clinical manifestations of this patient included fever, generalized lymphadenopathy, hepatosplenomegaly, anemia and mild liver dysfunction. The biopsy of the lymph node revealed hyperplasia of histiocyte with hemophagocytosis. There was also an elevation of IgG antibody against EB virus and the patient was therefore diagnosed to have VAHS. The prednisolone therapy was then initiated and the patient responded to this treatment very well. By the review of the Japanese literatures, seven adult cases of VAHS were found. Based on the descriptions on these cases, the prognosis of this syndrome appeared to be extremely poor which is totally different from VAHS in children. Our case showed a very favourable clinical course following steroid therapy and this suggested that steroid therapy should be considered even at the early stage of this syndrome in adults.

A highly sensitive enzyme immunoassay was developed for the determination of urinary trypsin inhibitor related antigen (UTIRA) in plasma, urine and cancer tissues, and we investigated its significance as a tumor marker in patients with cancer of the digestive organs. Variations in UTIRA in plasma and urine were not associated with the age of the volunteers, but in urine, high average was observed in male volunteers. UTIRA levels in the urine of the patients with esophageal, stomach and colorectal cancer increased as the stage progressed, except in the patients with liver cancer. And those levels in the urine significantly decreased after a curative operation, but did not decrease after a non-curative operation. UTIRA levels in stomach cancer tissues were significantly higher than those in adjacent healthy mucosa, but UTIRA levels were not high in tissues of esophageal, colorectal and primary liver cancers. Therefore, we speculate that the high levels of UTIRA in urine and plasma in patients with cancer of the digestive organs may not be caused by UTIRA released from cancer tissues. The determination of UTIRA may be significant in a broad sense as an index of the cancer stage or recurrence of cancer, particularly of the stomach.

Two years and 10 months after gastrectomy, a 38-year-old man was diagnosed as having carcinomatous peritonitis due to gastric cancer. He was treated by intra-abdominal administration of 100 mg CDDP three times in addition to UFT. After each administration of CDDP, the amount of ascites and the serum value of CEA were decreased. Subjective symptoms, such as epigastric pain or sensation of fullness, were also improved. Although one year and 8 months has passed since the first administration of CDDP, the performance status of the patient remains 0. Nausea or vomiting was noted within 2 days after each administration. However, severe complications, like renal failure or intra-abdominal hemorrhage, were not observed. These findings suggest that repeated intra-abdominal administration of CDDP may be a useful therapy for carcinomatous peritonitis due to gastric cancer.