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A 65-year-old woman presented to the emergency outpatient department with a chief complaint of left hypochondriac pain and a rapidly expanding tumor mass. Abdominal contrast-enhanced computed tomography(CT)revealed a tumor in the transverse colon and an extensive abdominal wall abscess. A colonoscopy further confirmed a tumor in the transverse colon, and the patient was diagnosed with transverse colon cancer, abdominal wall infiltration, and abdominal wall abscess. Abscess drainage was performed, and abscess cavity shrinkage was noted. Infection control progressed favorably. A transverse colectomy was performed, and the abdominal wall of the infiltration site was only partially excised. Postoperative chemotherapy was performed, and the progress was carefully followed up. Increased tumor markers were noted 12 months postoperatively, and abdominal CT revealed a 20-mm tumor in the abdominal wall. With a diagnosis of local recurrence, the abdominal wall tumor was excised. The tumor markers normalized postoperatively and chemotherapy was completed. The patient has survived without relapses for 30 months since excision.

Unresectable advanced gastric cancer is associated with poor prognosis. In a few studies, long-term survival was achieved with conversion surgery in patients who responded to chemotherapy. Here, we have reported a case of unresectable advanced gastric cancer in which curative resection was achieved with conversion surgery. A 70-year-old man who was diagnosed with advanced gastric cancer with multiple liver metastases received S-1/cisplatin therapy(S-1 120 mg/kg of bodyweight[bw]plus cisplatin 90 mg/kg of bw)as primary therapy. Because of the adverse reactions, secondary treatment with irinotecan therapy(CPT-11 200 mg/kg of bw)was initiated, which led to clinical complete response. A local recurrence was observed 44 months later; hence, irinotecan therapy was reinitiated. Although the disease was stable for 30 months, disseminated nodules appeared; thus, immunotherapy(nivolumab 150 mg/kg of bw)was initiated as tertiary treatment for the progressive disease. Although the number of disseminated nodules decreased, frequent blood infusions were necessary for anemia. Distal gastrectomy was planned as palliative surgery. Since no noncurative factors were detected intraoperatively, we considered that curative resection could be achieved with pancreaticoduodenectomy and changed the procedure. The operative time was 6 hours 35 minutes, and there was a blood loss of 312 g. The pathological diagnosis was ypT2- N1M0P0M0, ypStage ⅡA. At 13 months postoperatively, the patient was alive without recurrence.

A 52-year-old man underwent upper gastrointestinal endoscopy screening that identified a submucosal tumor in the gastric fornix, and a solid tumor with a maximum diameter of 35mm was suspected based on abdominal computed tomography. An endoscopic ultrasound-guided fine needle aspiration biopsy showed spindle-shaped cells with KIT, CD34, desmin, and S-100 all testing negative. Based on the diagnosis of a gastrointestinal stromal tumor, subtotal gastrectomy was performed laparoscopically. Postsurgical histopathological testing led to a diagnosis of a primary gastric inflammatory myofibroblastic tumor. The present case has been defined as one involving a tumor part way along the spectrum between benign and malignant, with local recurrence and distal metastasis. Reports indicate that recurrence occurs frequently in cases wherein sufficient margins are not obtained or wherein there is enucleation, and complete surgical resection is recommended. With laparoscopic surgery, because an enlarged field of view can be obtained, and depending on the lesion site, good exposure of the operative field is possible, the authors believe that this approach would be beneficial in terms of local control. Moreover, it has been reported that anaplastic lymphoma kinase(ALK), which is a tyrosine kinase receptor protein, tests positive in approximately 60% of cases. Reports have also indicated that distal metastasis occurs frequently in cases in which ALK tests negative, and watchful waiting of these cases at regular intervals should be carried out to the same extent as of cases involving malignant tumors.

Pectin is used in several foods as an additive and a thickner. But some cases of anaphylaxis have been reported. Most of these are induced by occasional exposures; however, no cases of anaphylaxis after eating a Citrus unshiu, the albedo of which is rich in pectin, have been reported.A 7-year-old girl developed barking cough and pruritus approximately two hours after eating a frozen Citrus unshiu. She had a history of anaphylaxis induced by consuming cashew nuts. Skin testing and basophil activation tests were performed using a commercially available pectin product. Both tests were positive. In an oral food challenge test, she felt abdominal pain and nausea only after eating fruit, along with the albedo, of Citrus unshiu. We concluded that this case was induced by pectin present in the albedo of Citrus unshiu, but not by the fruit itself. We should consider that patients with cashew nut allergies have a possibility of pectin allergies as well, and that pectin in the albedo of Citrus unshiu may induce anaphylaxis.

A 76-year-old male patient was diagnosed with progressive descending colon cancer. Since the patient had severe respiratoryfunction impairment after right pneumonectomy, the anesthesiologydepartment of our hospital determined that general anesthesia induction was too difficult. He was thus started on capecitabine plus oxaliplatin(XELOX)therapy. Three months after starting this treatment, colonoscopyshowed that the site had become scarred, and tissue examination revealed no indication of malignancy. Accordingly, the patient achieved clinical complete response. The patient had no findings of recurrence 1 year and 11 months after the start of chemotherapy. Chemotherapy for unresectable progressive recurrent colorectal cancer is based on the 5-FU anticancer agent, which exerts its antitumor effect byinhibiting DNA synthesis. The antitumor effect is reportedly high when the expression of thymidylate synthase(TS), a target agent, is low. In this patient, TS expression was low based on tissue examination. TS expression maybe an effective useful predictive factor for the efficacyof chemotherapyadministered to patients with unresectable progressive recurrent colorectal cancer.

This study investigated the image quality using controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) to shorten the imaging time in dynamic abdominal examinations. Comparisons with the conventional generalized autocalibrating partially parallel acquisitions (GRAPPA) method were made by changing the sampling shift in CAIPIRINHA using a 3.0 T MRI. The measurements included the visual evaluation of five stages, the signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) in phantom experiments. The visual evaluation (five stages) and SNR were determined using a nickel sulfate bottle phantom attached to the MRI device. Each evaluation was performed on the middle slice of the 3D image. The SNR was compared with the mean region of interest value calculated from five locations within the phantom. The CNR was determined using custommade phantoms that mimic the T1 and T2 values of the liver and spleen. In the results, at reduction factor (Rf) = 6 and 8, the SNR per unit imaging time was reduced with GRAPPA, while there was no decrease in SNR and CNR with CAIPIRINHA. By performing imaging using an appropriate sampling shift, it is possible to acquire an equivalent GRAPPA in a short period of time using CAIPIRINHA.

A 71-year-old man was diagnosed with a gastric tumor approximately 50mm in diameter on computed tomography (CT). In January 2000, he underwent a proximal gastrectomy. Pathological examination showed 5 mitoses per 50 high-power fields, while immunohistochemical analysis showed positive staining for KIT. Accordingly, the tumor was diagnosed as an intermediate- risk malignant gastrointestinal stromal tumor (GIST) for which the patient was followed. In January 2002, an abdominal CT scan revealed multiple hepatic tumors and a lower abdominal tumor, and the patient was diagnosed with liver metastases and peritoneal disseminations from GIST. After informed consent was provided, chemotherapy with 400 mg/day imatinib was initiated. The patient demonstrated a partial response 2 months after treatment. At 12 years 8 months after the diagnosis of liver metastasis and peritoneal disseminations, the patient shows no sign of recurrence.

We report a 68-year-old, American Society of Anesthesiologists Class I (ASA I), female patient scheduled for malignant uterine adnexal tumor surgery and revascularization for ovarian cancer. An epidural catheter was inserted at T12-L1 for 5 cm. Anesthesia was induced with remifentanil (0.25 microg x kg(-1) x min(-1)), sevoflurane (5%) and rocuronium (30 mg). Anesthesia was satisfactorily maintained after intubation with sevoflurane (1.5%) and remifentanil (0.2 microg x kg(-1) x min(-1)). We extubated the patient because spontaneous breathing and consciousness were observed. We intubated the patient immediately for apnea that occurred after extubation. The patient made an uneventful recovery after naloxone administration. In pharmacokinetic simulation, on the assumption that epidural administrated fentanyl was carried to blood content promptly, effect concentration to cause respiratory depression was not reached. Postoperative apnea was rationalized as follows; tardy respiratory depression with the epidural administration, and unexpected dosage of the residual fentanyl in the catheter.

Vocal cord synechia causes respiratory disturbance and severe pneumonia. A 63-year-old woman with recurrent laryngeal nerve paralysis caused by translaryngeal intubation after resection of acoustic tumor and by thyroid surgery in her history and progressive dyspnea, had received vocal cord synechiotomy under general anesthesia. Preoperative endoscopic examination revealed edematous larynx, immobility of left unilateral vocal fold, insufficient mobility of right vocal fold, left arytenoid cartilage dislocation and a posterior glottic adhesion. Anesthesia was induced by propofol administration, and a muscle relaxant was administered following confirmation of effective face mask ventilation. Trachea was cannulated immediately after incision of the scar under indirect video laryngoscopy. Vocal cord synechiotomy was completed without any respiratory complication. The case indicated that recurrent laryngeal nerve paralysis has a potential for vocal cord synechia and difficulty of tracheal intubation, and visibility of the surgical field among anesthesiologists and surgeons by indirect video laryngoscopy for vocal cord synechiotomy contributes to establish prompt surgical manipulation and tracheal intubation as to vocal cord synechiotomy.

Aim: Although anemia is common among the elderly, available data for anemia among them are limited in Japan. The aim of the present study was to compare the prevalence of anemia among elderly groups, and evaluate factors attributable to anemia., Methods: We enrolled 284 elderly residents in 2 long-term health care facilities, and 1,019 people aged 65 and over who visited outpatient clinics for medical checkups in 1 hospital all located in urban areas in Hiroshima. Hematological data from the 2004 National Nutrition Survey in Japan were cited for comparison., Results: Based on the WHO criteria for anemia, more than half of the residents in both health care facilities were anemic, regardless of gender. However, the prevalence of anemia among elderly people visiting outpatient clinics at hospital was only about 6% for both genders. Analysis of underlying diseases among residents of the health care facility did not reveal any association between a particular disease and anemia. Total serum protein values were significantly lower in the elderly in health care facilities than in those of the elderly of the outpatient clinics, and they showed weak statistical correlations with anemic state in the former group. Finally, the elderly in outpatient clinics showed significantly lower prevalence of anemia compared to the elderly in the National Nutrition Survey in Japan, partly due to selection bias., Conclusions: The prevalence of anemia in the elderly covered a broad spectrum depending on the group examined. Anemia in the elderly was an indicator of comorbidity.

We retrospectively reviewed the discrepancy in Gleason score between needle biopsy and radical prostatectomy specimens. Specimens from 153 patients who underwent radical retropubic prostatectomy at Gifu University Hospital and 9 community-based institutions between January 2001 and December 2005, were studied. Gleason score was determined by the general pathologist at each institution. The coincidence rate of Gleason score between biopsy and prostatectomy specimens was 49.7%. In contrast, 37.4% of biopsy specimens were undergraded. In biopsy specimens given a Gleason score of 5 or less, the Gleason score was coincident or undergraded compared with prostatectomy specimens. In biopsy specimens given a Gleason score of 6, the coincidence rate was 39.6%. In 56% in biopsy specimens of cancers with a Gleason score of 6 the Gleason score was undergraded compared with the prostatectomy specimen. In this group, extra-prostatic extention was found significantly more often than in other groups (p = 0.04). In patients, who underwent extended biopsy, or had a more positive biopsy core (> or = 25%), the coincidence rate was significantly greater (p = 0.03). We should be aware of the limitations of Gleason scores based on biopsy specimens, and give treatment opinions careful consideration.

We report a case of gastric cancer with ascites treated with chemotherapy. The patient is a 67-year-old male. Combination chemotherapy of S-1 and CDDP was given as the first-line treatment. However, the symptoms did not improve with that regimen, so we decided to change the chemotherapy to paclitaxel as second-line treatment. After 4 cycles, CT scan revealed decreasing ascites and endoscopy a reduction of the primary tumor. The patient has maintained a condition of decreasing ascites with improvement of QOL for 8 months. This regimen is considered effective treatment for unresectable gastric cancer.

How much should be done for better managements of the perioperative thromboprophylaxis? In Japan, the guideline for prevention of venous thromboembolism (VTE) was established for the first time in February, 2004. Our academic medical center formed a committee for prevention of thrombosis for all departments using operating rooms in October, 2002 and began to make the database of symptomatic pulmonary thromboembolism (PTE). From the end of September, 2003, we asked the surgeons to indicate the PTE risk grades when ordering surgical operations. The prevention team of VTE prepared VTE risk tables and recommended prevention methods for perioperative period. If surgeons did not choose prevention methods, the team took the consultation. Also, we made a manual how to make emergency calls and a flow chart for the diagnosis and therapy cooperating with cardiologists and anesthesiologists. We founded another meeting of Kinki Clinical Thrombosis Research Association for the study and education. We assessed the incidence of symptomatic PTE every year. The incidences of symptomatic PTE were 14 of 4101 (0.34%) in the first year, 2 of 3796 (0.053%) in the second year; 2 of 4002 cases (0.049%) in the third year under general anesthesia, respectively. Cases of fatal PTE were 2 (0.34%), 1 (0.049%) and 0 (0%), respectively. The multidisciplinary thromboprophylaxis effort that we had adopted was very important to prevent aggravation of VTE.

Previous studies have revealed that mothers of children with attention-deficit/hyperactivity disorder (AD/HD) have an authoritarian parenting style. However, the psychological process of developing an authoritarian parenting style has yet to be clearly defined. To clarify this psychological process, the present study examined the hypothesis that the characteristic behaviors of children with AD/HD initially increase the mothers' parenting stress, which influences their parenting style. Thirty-six mothers of children with AD/HD (children's mean age: 8.1 years) and the same number of controls (children's mean age: 8.4 years) participated in the present study. The mothers' parenting stress was assessed using the Japanese Parenting Stress Index. Parenting styles were assessed using the TK-style scale for evaluating the relationships between parents and children. The results indicated that the mothers of children with AD/HD had significantly higher scores than controls for all parenting stress items and negative parenting style variables (dissatisfaction, reproach, strictness, interference, inconsistency and disagreement of 10 attitudes). Stepwise multiple regression analysis revealed that the characteristic behaviors of children with AD/HD were associated with the degree of attachment in mothers, which was related to the strict and reproachful parenting style in the AD/HD group. These results suggest that mothers of children with AD/HD are likely to have a strict and reproachful parenting style as a result of a lack of attachment with the child.

A 45-year-old woman underwent left radical nephrectomy in April 2002. Pathological diagnosis was a renal cell carcinoma, clear cell subtype, pT3a, v(-), NO. One year later, abdominal ultrasound revealed a left ovarian tumor which had an enlargement tendency. A laparoscopic bilateral salpingooophorectomy was performed. Immunohistochemical analysis confirmed the diagnosis of metastatic ovarian renal cell carcinoma. This is the 20th case in the literature.

Four and half years have passed since Mt. Oyama in Miyake Island erupted. Ambient sulfur dioxide (SO2) is still above the environmental air standard in parts of the island, even though emission of the volcanic gas has diminished. Reconstruction of life-support infrastructure in the island and safety measures started in July 2002, and a short-term trial stay project for former residents was completed in April 2003 for the total rehabilitation of the island. We conducted health examinations, and questionnaires on clinical symptoms among the reconstruction workers in January 2003, as well as questionnaires on respiratory symptoms among former residents who joined the trial stay, in late fall of 2003. The peak expiratory flow rate and symptoms of the workers and the symptoms of the short-term residents were not correlated to SO2 concentrations. In addition, we investigated the medical histories of outpatients at Miyake-mura National Insurance Center Clinic. We could not recognize any cases directly connected with higher ambient SO2 concentration in the area of the island, but there was a male worker, in his thirties, who suffered an initial attack of bronchial asthma, which required intensive care and treatment. As a general rule, all the workers and the residents are asked to wear gas masks for SO2 when its concentration is above 2.0 ppm and to stay in the house with desulfuration facilities as a precautionary measure at night. The residents are now well informed about the risks of volcanic gas and preventive measures for adverse health effects. We could not evaluate correlations between SO2 exposure indices and health effects sufficiently due to the limitation of the field study, but this study presents useful pieces of information as a risk communication for reconstruction workers and former inhabitants to the island.

Radiochromic film (RC-film) is of great interest as a film-type dosimeter for radiation oncology applications. We present a two-dimensional image-based evaluation of the measurement accuracy of a commercial RC-film product (Gafchromic MD-55-2 film, ISP TECHNOLOGIES, Inc.) by using a commercial Laser Densitometer (Model 1710, Computerized Medical Systems, Inc.) as an optical density imaging system. The coefficient of variation of the density (pixel-value) in one sample was approximately 3% to 11% at 3 Gy or less, and 3% or less at 4 to 60 Gy. Although the coefficient of variation between three samples at the same dose was about 14% at 1 Gy, it decreased as the dose increased, reaching several percent. In 1 to 6 Gy samples, geometric imaging artifacts [interference (moire) patterns] were observed, and it was found that scan-sampling pitch influenced the accuracy of measurement of the density of the sample. To improve the accuracy of density measurement, sufficient knowledge about characteristic features of the density measuring system is essential.

The notion that difficulty in behavioral inhibition is the essential impairment of attention-deficit/hyperactivity disorder (AD/HD) has been prevailing. In this study, we assessed impulsive behaviors with regard to emotion, rule, and inattentiveness, by developing an impulsiveness scale and applying it for 103 parents of a boy with AD/HD. Exploratory factor analysis (EFA) of 18 items identified four primary factors: labeled emotion expression, social rule, rule in conversation, and inattentiveness. A covariance structural analysis was performed to extract response bias from latent constructs, and the fitness of the model was examined. In the finally adopted model on impulsive behaviors, the four factors extracted in EFA was explained by two independent second-order latent variables: labeled general impulsivity and cognitive impairment. Cognitive impairment significantly influenced on inattentiveness only, while general impulsivity on all the four factors. Furthermore, the scores of primary four factors were compared between two groups of a normal class group (n = 20) and three AD/HD subtypes:combined type (n = 37), predominantly hyperactive-impulsive type (n = 14), and predominantly inattentive type (n = 18). The results suggest differences in impulsive behaviors among the AD/HD subtypes.

Domestic violence (DV) implies violence against women by intimate male partners. DV is a serious health issue for women, as well as a violation of human rights. It is a challenge to develop effective public health interventions, as they have to take into account complicated social and psychological background factors. In this paper we present an overview of various interventions in Japan and elsewhere in the world up to now, and propose a strategy for developing effective public health interventions. Governments and NGOs have been involved in various interventions to eliminate DV, e.g., establishing legal frameworks, providing emergency shelters for abused women, and educating male abusers. Health sector interventions include: systematic DV education to health professionals in Europe and the United States; and development of DV victim support networks, in which health facilities play core roles, in Asia and Latin America. The major expected roles of health professionals are identification and treatment of abused women, and prevention of recurrent violence. However, achievement of those goals is insufficient, because of the lack of systematic education, different views on DV between health professionals and abused women, misunderstanding of background factors, and lack of coordination between relevant agencies. The health sector, including clinical and public health services, is expected to play important roles in identifying and supporting abused women in Japan. A possible strategy is to integrate DV interventions into existing maternal and child health service systems. All the front-line health professionals should be provided with systematic training and practical manuals to treat abused women. Further research and evaluation of past interventions are needed to develop effective interventions.

The chimeric anti-CD20 monoclonal antibody rituximab was recently approved for the treatment of malignant B cell lymphoma. We report the case of a 49 year-old female with advanced mantle cell lymphoma (MCL), who successfully underwent auto-peripheral blood stem cell transplant (auto-PBSCT) in combination with in vivo purging of tumor cells using rituximab. Systemic swelling was detected in her lymph nodes, and she was histologically diagnosed with MCL. From bone marrow involvement and 28% of lymphoma cells in her peripheral blood, she was identified as stage IV of MCL. She achieved a partial response (PR) after three cycles of standard chemotherapy (ProMACE-CytaBOM) followed by 1 course of rituximab at 375 mg/m2 per week for four weeks. Prior to treatment with rituximab, IgH/bcl-1 translocation in her peripheral blood was found to be positive in 0.5% of 199 cells. After administration of rituximab, this fell to 0% in her peripheral blood and bone marrow. Stem cells were mobilized with cyclophosphamide at 2,000 mg/m2 for 2 days, followed by granulocyte colony-stimulating factor (G-CSF). On one day prior to harvest, rituximab was infused at 375 mg/m2 for in vivo purging of tumor cells. The IgH/bcl-1 translocation in the peripheral blood stem cell harvest (PBSCH) product was found to be 0%. Subsequently, a pretreatment regimen of CBDCA at 350 mg/m2 x 4, ETP at 500 mg/m2 x 3, MCNU at 200 mg/m2 x 1, and CPA at 2,000 mg/m2 x 2 was adopted to condition the transplant, followed by auto-PBSCT. After the transplant, the patient achieved an uncertain complete response (CRu). The present case suggests in vivo purging with rituximab is effective, and that this method may have a role as a first-line therapy in MCL patients who respond poorly to standard treatment.

A 74-year-old man who had undergone artificial pneumothorax therapy for pulmonary tuberculosis 40 years earlier was admitted because of blurred vision, headache, and numbness of the lower limbs in October 1997. He presented with anemia and leukocytopenia with monoclonal gammopathy of IgM (kappa). His bone marrow was diffusely infiltrated with small lymphocytes, plasmacytoid lymphocytes, and plasma cells expressing IgM, kappa surface immunoglobulin. On the basis of these findings, primary macroglobulinemia (PMG) was diagnosed. CT scan of the chest demonstrated pleural effusion of the right lung encapsulated in a thickened pleura, and pseudochylothorax was diagnosed from a specimen of chyliform fluid which contained numerous cholesterol crystals and was positive for Mycobacterium tuberculosis (MT) on PCR assay. The patient's condition was also complicated by chronic renal failure due to IgA nephropathy, which may have been a consequence of the tuberculosis, possibly due to an abnormal IgA-mediated immune response to MT. The patient gradually developed pure red cell aplasia during the course, probably due to an autoimmune mechanism. Later in the course, immunoglobulin gene analysis of the malignant cells of PMG showed that they were derived from antigenically selected cells. In the context of antigenic stimulation, the role of MT antigen in the pathogenesis of PMG was of interest in this patient.

This report reviews drug consultations at patients' home and collaboration of pharmacists with medical teams over 4 years. The participation of pharmacists is necessary for home care service, because of their pharmaceutical expertise and the demands from the medical team and patients at home.

A 32-year-old woman who 1 year earlier underwent a right mastectomy for stage II breast cancer with the histology of invasive ductal carcinoma (scirrhus type) was admitted due to recurrent, metastatic breast cancer in January 1997. She presented multiple metastatic lesions in the skin, lymph nodes, bone, lungs, liver, and spleen, and her bone marrow was replaced almost entirely by tumor cells. The patient was sequentially treated with 5 courses of cyclophosphamide (CPA) and adriamycin (ADM) (CA); 2 courses of CPA, ADM, and 5-fluorouracil; 5 caurses of docetaxel hydrate; and 1 course of CA. After recovery of the normal bone marrow by standard-dose chemotherapies, peripheral blood stem cells (PBSC) were then collected after mobilization with G-CSF. The number of breast cancer cells in bone marrow and PBSC samples was determined by immunocytochemical staining with an anti-cytokeratin monoclonal antibody. The number of tumor cells in PBSC sample was within the level for non-metastatic breast cancer. Complete remission was obtained with high-dose chemotherapy consisting of CPA and Thio-TEPA, and supported by autologous PBSC transplantation.

An 88-year-old Japanese woman with splenomegaly, but without lymphadenopathy, was admitted because of epigastric distress. Laboratory data disclosed an RBC of 310 x 10(4)/microliter, Hb of 10.1 g/dl, Ht of 30.6%, Plt count of 9.8 x 10(4)/microliter, and WBC of 4,470/microliter with 38% abnormal lymphocytes. Peripheral blood films revealed lymphocytes with thin, short cytoplasmic villi, condensed nuclear chromatin, and small nucleoli. The lymphocytes stained negative for tartrate-resistant acid phosphatase. Also, immunophenotyping was positive for expression of the cell surface markers CD19, CD20, IgG, kappa and HLA-DR, but not for CD5, CD10, CD11c, CD23, CD25, CD38, or CD103 antigens. Chromosomal analysis of peripheral blood cells disclosed the 46, XX, del(7), (q32) aberration. A splenectomy was performed simultaneously with partial colon resection because of a mucinous carcinoma found in the transverse colon. Histologic examination of resected spleen tissues revealed a distinctive pattern of white pulp infiltration by lymphoma cells. The histologic findings and clinical data were consistent with the features of splenic lymphoma with circulating villous lymphocytes. Our patient exhibited a relatively benign clinical course, and was being followed on an outpatient basis with no additional therapy.

A 34-year-old male with a history of chickenpox developed primary abdominal non-Hodgkin's lymphoma (diagnosed in August 1995). Treatment with cyclophosphamide, doxorubicin, vincristine, and prednisolone achieved a partial remission. In July 1996, the disease recurred, and the patient received chemotherapy with carboplatine, etoposide, mitoxantrone, and prednisolone, but no response was noted. Involvement of the central nervous system and meninges was diagnosed on September 12, 1997. Blast cells were detected in the peripheral blood on September 26. Based on these findings, he was diagnosed as having leukemia. On September 27, painless vesicles developed on the left gluteal region. On October 13, the patient was hospitalized because the vesicles had spread over his entire body. Pathologic examination of the roofs of the blisters showed masses of inclusion bodies. Based on this, a diagnosis of varicella-zoster infection was made. Treatment with acyclovir (750 mg/day) for seven days failed to form crusts. New vesicles developed after the drug was discontinued, but crusts formed after acyclovir therapy was resumed. He died of interstitial pneumonia on December 21. Autopsy could not be performed. Histopathologic examination of pulmonary tissue obtained by necropsy did not reveal the presence of inclusion bodies characteristic of herpes simplex or varicella-zoster infection. Varicella-zoster virus (VZV) antigen was negative by an immunochemical staining method using monoclonal antibodies against VZV. Continuous long-term administration of acyclovir has been reported to be effective for non-Hodgkin's lymphoma complicated by recurrent intractable herpes zoster.

Many neurosurgeons prefer to use intraoperative computed tomographic (CT) scanning, when possible, to check whether there is residual lesion or unexpected bleeding. We report a practical intraoperative CT imaging system using a high-speed CT scanner installed in the operating room along with a digitally controlled neurosurgical operating table. We designed a rail-track system to mobilize the CT gantry. The gantry is fixed onto a motorized carrier that can be moved smoothly on a rail-track embedded in the floor and with a maximum reach of 2.85 m from the room's wall to the operating table. The longitudinal motion of the operating table is easily adjusted by a foot switch from manual control to automatic control directly from the CT scanner's computer like an ordinary CT scanner bed in increments of 2, 5 or 10 mm during CT scanning. Either a carbon-made radiolucent head frame or carbon-made head plate is used as a headrest. Using this CT scanner system, pre- and intraoperative CT scannings were performed on 46 patients with brain tumors, cervical lesions or other intracranial lesions. We could operate on the patient with enough working space between the mobile CT gantry and the operating table for microneurosurgery. We could obtain intraoperative CT imaging of a patient on the operating table while the surgical wound remained open, the surgical drapes kept in place, and the surgical position unchanged, saving time in intraoperative CT scanning and preparation for further surgery when needed. This intraoperative CT imaging system installed in the operating room should be useful for neurosurgery.

The clinical efficacy of fleroxacin (FLRX), a new fluoroquinolone, for acute uncomplicated cystitis (AUC) in women was assessed. Two regimens, 3-day and 7-day courses of FLRX, 200 mg once a day, were compared. Clinical and bacteriological efficacy were evaluated after the therapy, and recurrence rate was evaluated 1 week and 4 weeks after termination of the therapy. Of 136 registered subjects, 35 in the 3-day group and 47 in the 7-day group were evaluated. According to the criteria of Japanese UTI Committee (3rd edition), the rate of excellent results was significantly higher in the 7-day group (78.9%) than in the 3-day group (48.6%), but the overall clinical efficacy rate was similar being 100% and 97.9%, respectively. Although no recurrence was seen 1 week after the therapy in either group, recurrence was seen in 14.3% and 7.4% of the cases in the 3-day and 7-day groups, respectively, 4 weeks after the therapy. Adverse reactions were observed in 2 and 3 cases in the 3-day and 7-day groups, respectively. Both 3-day and 7-day regimens of FLRX treatment showed good efficacy. Although the 7-day treatment was superior to the 3-day treatment as to high rate of excellent results and low rate of recurrence, the 3-day treatment was concluded to be sufficient for AUC.

A case of pulmonary eosinophilic granuloma that underwent spontaneous remission is presented. A 23-year old man presented with dry cough and fever. Chest X-ray film revealed diffuse reticulo-nodular infiltrates in the middle and upper lung fields. Chest CT and HRCT showed multiple cystic lesions with thick walls and small nodules predominantly in the inner zone. Based on radiographic findings, pulmonary eosinophilic granuloma was suspected. Bronchoalveolar lavage cell data showed lymphocyte and eosinophil alveolitis with no increase of CD 1 lymphocytes. The symptoms and radiographic findings improved markedly within 4 months after the onset of symptoms without treatment and upon cessation of smoking. Chest CT and HRCT showed that the cystic walls were thinner and that the small nodules had decreased. Thoracoscopic lung biopsy revealed granulomatous lesions consisting of CD 1 and S-100 protein positive histiocytes with infiltration of eosinophils and fibrous lesions. Pulmonary eosinophilic granuloma was diagnosed. There has been no recurrence for 1 year.

An international standard of prostate specific antigen (PSA) assays was constructed and prognosis of the patients with prostate cancers showing gray zone PSA was studied. For lower levels of serum PSA (< 50 ng/ml), the conversion formula to that of Tandem-R PSA from other assays was presented. Furthermore, based on the standards of Stanford Reference and Markit-MPA, conversion rates to this international standard from the conventional PSA assays were also obtained. Patients' cancer-specific survival was found to be significantly better in the gray zone group. Further studies to obtain higher specificity such as using free or complex rate in total PSA is necessary.

Zonisamide (1,2-benzisoxazole-3-methanesulfonamide, AD-810) is a broad spectrum antiepileptic drug which has been launched in Japan and South Korea. It lacks the ureide structure included in most of the existing antiepileptic drugs. Zonisamide was synthesized by the sulfonation and the successive amination of 1,2-benzisoxazole-3-acetic acid in a very poor yield. After several efforts to optimize the compound, zonisamide was selected based on the balance of the efficacy and safety. The yield was greatly improved by the development of new synthetic routes. Zonisamide suppressed maximal electroshock seizures in mice, rats, rabbits and dogs. Its therapeutic plasma concentration range between anticonvulsant and neurotoxic effects was much wider than that of the existing antiepileptic drugs. In electroencephalographic studies on animal models of epilepsy, zonisamide, like phenytoin and carbamazepine, restricted the spread or propagation of seizures and, like sodium valproate, it suppressed the epileptogenic focus activity. Zonisamide was effective in several kindling models. In clinical studies, zonisamide exerted the efficacy against partial seizures (simple, complex, secondarily generalized seizures) and some generalized seizures (tonic-clonic, tonic, atypical absence seizures) that were comparable to that of carbamazepine and sodium valproate, respectively. Zonisamide was also effective in monotherapy. The adverse effects related with zonisamide were mainly drowsiness, ataxia, loss of appetite and gastrointestinal symptoms. Serious adverse effects which may be life-threatening have not been reported.

Object: In differential diagnosis of BPH and early stages prostate cancer (PC), PSA-density (PSAD) was evaluated in 63 cases with BPH and 82 cases of PC (stage A: 8, B: 17, C: 17, D: 40)., Methods: Serum PSA values were determined by MARKIT-F PA, and prostate volume was calculated by transabdominal ultrasonography, in which every glands including peripheral zone was visualized in the transverse and sagittal planes, and predicted prostate volume was calculated by three dimension (a x b x c x 0.52). PSAD was determined by serum PSA divided by prostate volume., Results: PSAD values were 0.106 +/- 0.006 (mean +/- SD) in BPH, 0.538 +/- 0.094 in stage A and B of PC, and 2.973 +/- 0.764 in all PC cases. There was a statistical significance (p < 0.005) between BPH and each other groups of PC by student's t-test. In using 0.208 (mean +/- 2 SD of PSAD in BPH group) as a cut-off value, the detection sensitivity was 84% in stage A and B of PC and the specificity was 97% using BPH groups as a control, therefore the efficacy was 93%. In 18 out of 19 cases with BPH having PSA values more than 3.6 ng/ml (false positive group), PSAD values were less than 0.208., Conclusion: PSAD is suggested to be a useful tool for differential diagnosis of BPH and early stages of PC.

To evaluate the mechanism of gastric adaptive relaxation (GAR), we designed and established the experimental system for the measurement of GAR in isolated stomach from the guinea-pig by modifying the method of Desai. We also investigated the roles of non-adrenergic, non-cholinergic (NANC) nerves and endogenous nitric oxide (NO) in GAR by using this system. The rapid increase in the capacity of isolated stomach was observed over a certain pressure as GAR. GAR was abolished by tetrodotoxin (10(-6) M) in the presence of atropine (3 x 10(-6) M) and guanethidine (5 x 10(-6) M). NG-nitro L-arginine (LNNA) (10(-4) M), a NO synthesis inhibitor, also abolished GAR. L-arginine (10(-3) M), a precursor for NO synthesis, reversed LNNA-induced impairment of GAR. Sodium nitroprusside (10(-6)-10(-4) M), a NO-donor, induced the gastric relaxation. These results suggest that GAR is mediated by NANC nerves, possibly via endogenous NO.

MX2, a new lipophilic morpholino anthracycline, has been reported to have superior chemotherapeutic effects to adriamycin against murine and human tumor cells. In this study the chemotherapeutic effect of MX2 against C6 glioma cells was examined as well as the photocytotoxicity of MX2 and the combination effect of MX2 and photodynamic therapy (PDT) in vitro. Colony formation is inhibited even with only 2 hour treatment with MX2 in a dose-dependent manner. In this colony forming efficiency assay the drug concentration required for 50% inhibition of colony formation for C6 glioma cells was 24.0 +/- 4.5 ng/ml. Mild photocytotoxicity of MX2 against C6 glioma cells was observed at a high concentration (100 ng/ml) of MX2 following exposure to white light but not red light. In combination, MX2 and the photosensitizer haematoporphyrin derivative (HpD) exhibited an additive cytotoxic effect against C6 glioma cells when the cells were treated with MX2 either immediately after red light illumination following incubation with HpD or at an interval of 24 hours before incubation with HpD. We conclude that MX2 may be clinically useful against malignant glioma alone, and in combination with other therapies such as PDT.

Twenty-five consecutive patients with myelodysplastic syndrome (MDS) were followed in the Second Department of Internal Medicine, Miyazaki Medical School from 1984 to 1993. The diagnosis of MDS was morphologically based on the criteria of FAB. At the time of diagnosis, 9 patients had refractory anemia (RA), 1 had RA with ring sideroblasts (RARS), 6 had RA with excess blasts (RAEB), 6 had RAEB in transformation (RAEB-t), and 3 had chronic myelomonocytic leukemia (CMMoL). Prognostic factors involved in survival times and progression to leukemia were analyzed in these patients; FAB classification of MDS, age, sex, peripheral blood cell counts, bone marrow examination, karyotype, numbers of blasts. None of these prognostic factors had a significant effect on the prognosis of MDS patients. Study of the therapeutic effects on MDS patients revealed no significant increase of survival time in treated MDS patients compared to non-treated patients. Further, no significant difference in survival time was found between MDS patients treated with or without anticancer drugs. These results indicated that MDS patients were pathologically and therapeutically heterogeneous.

A 63-year-old man with smoldering adult T-cell leukemia (ATL) which became acute was admitted. During chemotherapy, he experienced epigastric pain and fever due to neutropenia. The combination therapy of antimicrobials and rhG-CSF was ineffective and he died. Autopsy revealed systemic invasion of ATL cells. The stomach findings resembled those of phlegmonous gastritis, a rare form of bacterial gastritis, along with diffuse, mucosal necrosis with hemorrhage. The pathogenesis of necrotizing gastritis remains to be elucidated. The patient had also received histamine H2 antagonist for gastric ulceration, which might have influenced the gastric bacterial flora.

A 76-year-old Japanese male consulted our hospital complaining of dysphagia. He also complained of dyspnea, and a cardiovascular disorder was detected. Otolaryngological examination revealed dysphagia due to pharyngeal tumor. Further examination detected left renal cell carcinoma with multiple pulmonary metastasis, and selective angiography revealed arteriovenous fistula in the primary tumor. After resection of the pharyngeal tumor and left nephrectomy, pharyngeal tumor was pathologically confirmed as metastasis of renal cell carcinoma. Furthermore, after left nephrectomy, the cardiovascular disorder gradually improved. Thus, the cardiovascular disorder was considered to have developed based upon the arteriovenous fistulae. Pharyngeal metastasis of renal cell carcinoma is extremely rare, and the cardiovascular disorder in this case was also an extrarenal manifestation.

The effect of isoflurane on hypoxic pulmonary vasoconstriction (HPV) was examined using the separately ventilated left lower lobe lung model in dogs. When the HPV was induced with anoxic gas ventilation of the left lower lobe, the magnitude of HPV inhibition by isoflurane of 2 MAC was predominant, as assessed by the index of pressure-flow curve which is a novel indicator of pulmonary vascular tone in the left lower lobe. However, isoflurane 2 MAC attenuated the HPV by only 16%, as assessed by indices of the changes in left lower lobe blood flow rate and PaO2. This weak HPV inhibition, as shown by the latter parameters, may result from the net effect of isoflurane-induced HPV inhibition and secondary HPV enhancement due to decreases in cardiac output and pulmonary arterial pressure by isoflurane. However, none of the parameters showed inhibition of HPV when the HPV was induced by collapse of the left lower lobe. This discrepancy in the results may be caused by a lack of isoflurane reaching the hypoxic lobe when the HPV is induced with atelectasis. These results show that potency of HPV inhibition with isoflurane depends on the method of induction or evaluation of HPV, and that inhibition of HPV response with isoflurane at clinical concentrations is negligible in an atelectasis-induced HPV, in which no isoflurane is directly reaching the hypoxic lobe.

A 49-year old male with chronic myelogenous leukemia (CML) and psoriasis was admitted for interferon treatment. He was given 6 MU of human lymphoblastoid interferon (HLBI), a natural alpha-interferon, daily for 1 month followed by 3 MU every other day for 1.5 months and twice a week for 1 month. Because HLBI administration showed no favorable effects on the hematological findings and because of the exacerbated psoriasis of the patient, it was discontinued. Subsequently his psoriasis improved to the initial findings observed at the admission. We reported a case of CML in which psoriasis was exacerbated during interferon therapy.

A 54-year-old woman with leucocytosis and skin lesion was hospitalized and diagnosed as chronic type adult T cell leukemia (ATL) in August 1989. Since her ATL cell count and LDH level increased after hospitalization, oral administration of etoposide was started at a dose of 100 mg/day for seven days. The oral administration of etoposide induced another chronic state of ATL. After 10 months without medication, she was readmitted because of an acute ATL crisis. After daily administration of etoposide at a dose of 50 mg/day, the white blood cell count and serum LDH level decreased to the normal range, and abnormal lymphocytes of peripheral blood disappeared. The low-dose daily administration of etoposide at a dose of 25 approximately 50 mg/day could be maintained over six months. No severe side effects except for alopecia and mild myelosuppression were noted during the treatment. Chronic daily administration of oral etoposide is one candidate for the treatment of ATL in an outpatient clinic.

We investigated the effect of halothane on the hypoxic pulmonary vasoconstriction using in vivo measurement of the pressure-flow curve of the left lower lobe in the dog. With hypoxic ventilation of the left lower lobe, the pressure-flow curve shifted to the right and the slope of the curve became flatter. Although inhalation of 1 MAC halothane by the left lower lobe during hypoxic ventilation had no effect on the pressure-flow curve configuration, inhalation of 3, 5 MAC made the slope steeper. We analyzed these changes by the distensibility model proposed by W. Mitzner et al, and our data support the hypothesis that hypoxic ventilation decreases the small pulmonary vessels of 1-4 orders and also increases the compliance of the orders of vessel where the constriction has occurred, and halothane antagonizes the HPV response by further increasing the compliance of the constricted vessels. The inhibitory effect of halothane on HPV was weaker in in vivo preparation compared with the effect in in vitro preparation. Some humoral factors in the perfusate could contribute to this effect.

A 37-year-old female with hypercalcemia presented with lumbago, nausea and vomiting. Peripheral blood (PB) and bone marrow (BM) smears revealed no lymphoblasts on the first admission. The value of parathyroid hormone related protein (PTHrP) was increased and osteoporosis was found in the lumbar vertebrae. After 5 months, diagnosis of acute lymphocytic leukemia (ALL) was made on the evidence that lymphoblasts were found in PB (1%) and in BM (98%). Treatment with vincristine, daunorubicin, prednisolone and L-asparaginase achieved complete remission (CR) and the serum calcium level returned to the normal range. She has maintained CR, and is currently treated with consolidation therapy by cyclophosphamide and methotrexate. Acute leukemia is known to be rarely accompanied with hypercalcemia. This rare case was accompanied with hypercalcemia in acute leukemia. Hypercalcemia appeared to be attributable to the increased bone absorption by PTHrP derived from tumor cells. This important case will help understanding the etiology of hypercalcemia associated with ALL.

Clinical significance of urinary tract infections (UTI) after kidney transplantation was studied in 57 cases. Of these patients, the UTI occurred in 63% of cases during follow-up after transplantation. Although the bacteriuria were observed more frequently in living-related donor (LD) group at pre-operation, cadaveric donor (CD) group showed significantly higher frequency in bacteriuria and UTI after transplantation. The initial UTI occurred within 4 weeks after transplantation in 86% of cases. The significant risk factors in the occurrence of UTI were presence of bacteriuria in post-operation, CD group, mismatch numbers in HLA, amount of steroid, and ages of donor and recipient. Of the bacteria isolated, about half were pathogens in UTI, which was a 2 times higher risk compared with the time of chronic hemodialysis. Gram negative rods were found to be major pathogen in UTI cases. The effect of UTI on graft survival was not obvious. However, of the patients who have bacteriuria at operation, 52% were found to have bacteriuria due to the same strain during follow-up. Therefore, bacteriological examination of urine at transplantation must be done carefully.

A 39-year-old woman was first admitted to our hospital with increased white cell count on May, 1983. Physical examination showed only mild splenomegaly. Hematological examination revealed leukocytosis (14,600/microliters) with ATL cells (59%). Serum anti-HTLV-I antibody was positive. Examination of HTLV-I provirus in the abnormal T cells revealed the defective type. She was diagnosed as chronic type of ATL based on the clinical features. Cytogenetic study of the ATL cells revealed 47, xx, +4. For 12 months, she was followed without any therapy. WBC reduced to almost normal range and ATL cells decreased to 3 to 6% for 8 months. On May, 1985, she was readmitted to our hospital because of leukocytosis (32,200/microliters), and increased ATL cells (57%). She was diagnosed as crisis of ATL. Investigation of the proviral DNA and chromosome showed the same results as those of the chronic phase, indicating that ATL cells in both the chronic phase and the crisis phase originated from the same clone. She died after 3 months from massive diarrhea. Postmortem examination showed the extensive infiltration of leukemic cell in the small intestine.