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SummaryWhat is known and objective Patients with schizophrenia are most commonly treated with antipsychotic medications, often with the addition of anxiolytics. This study used an oral moisture meter to evaluate xerostomia in patients with schizophrenia taking typical and atypical antipsychotics, anxiolytics and non-psychotropic medications. Methods Patients diagnosed with schizophrenia according to ICD-10 criteria in the Department of Psychiatry, Kitasato University East, and affiliated hospitals were studied. All patients were on psychotropic medications. Patients with diseases associated with xerostomia, such as Sjogren's syndrome I, were excluded. Results and discussion A total of 127 patients were enrolled. Mean oral moisture was 27·81 ± 2·27% (normal, ≥30·0%). A significant association was observed between objective oral moisture and the subjective sense of dry mouth. Multivariate analysis revealed a negative correlation between the number of antipsychotics and, especially, anxiolytics, and the degree of oral moisture. Drug dosages themselves were not significantly correlated with dry mouth. These findings suggest that objective oral moisture measurements show decreased moisture in patients on these medications and that the degree of moisture shows a greater negative correlation with the number, as opposed to the dosages, of psychotropic drugs administered. What is new and conclusions When patients with schizophrenia visit a dental clinic, it is important for the dentist to accurately assess the degree of oral moisture and to determine the medications being taken. Based on these findings of the association of polypharmacy with xerostomia, dentists are encouraged to inform the psychiatrist of the need to actively manage patients’ xerostomia.

The solar energy can mainly be divided into two categories: the solar radiation and the solar wind. The former maximizes at the equator, generating various disturbances over a wide height range and causing vertical coupling processes of the atmosphere between the troposphere and middle and upper atmospheres by upward propagating atmospheric waves. The energy and material flows that occur in all height regions of the equatorial atmosphere are named as “Equatorial Fountain.” These processes from the bottom also cause various space weather effects, such as satellite communication and Global Navigation Satellite System positioning. While, the electromagnetic energy and high-energy plasma particles in the solar wind converge into the polar region through geomagnetic fields. These energy/particle inflow results in auroral Joule heating and ion drag of the atmosphere particularly during geomagnetic storms and substorms. The ion outflow from the polar ionosphere controls ambient plasma constituents in the magnetosphere and may cause long-term variation of the atmosphere. We propose to clarify these overall coupling processes in the solar-terrestrial system from the bottom and from above through high-resolution observations at key latitudes in the equator and in the polar region. We will establish a large radar with active phased array antenna, called the Equatorial Middle and Upper atmosphere radar, in west Sumatra, Indonesia. We will participate in construction of the EISCAT_3D radar in northern Scandinavia. These radars will enhance the existing international radar network. We will also develop a global observation network of compact radio and optical remote sensing equipment from the equator to polar region.

18th EISCAT symposiumSession E3: Ionoshere/thermosphere/mesosphereMay 27 (Sat), NIPR Auditorium

The aim of this study was to compare the multidimensional properties among subtypes of painful temporomandibular disorders (TMD): myofascial pain (group I), disc displacement (group II), arthralgia (group IIIa) and osteoarthritis (group IIIb). A total of 511 patients answered a battery of questionnaires, which included questions relating to intensity and duration of pain, the Japanese version of the McGill Pain Questionnaire, limitation of daily functions, the Hospital Anxiety and Depression Scale, the Eysenck Personality Questionnaire short-form and 34 items of behavioural contributing factors. Group IIIb showed significantly the highest age in all subtypes. Those in group I had higher depression scores than those in group II (P = 0.005). Group IIIa had a lower women's ratio than in group II (P = 0.001) and the patients showed a shorter pain duration than those in groups I (P = 0.000) and II (P = 0.001). Group IIIa patients also showed lower visual analogue scale (VAS) ratings for pain descriptors 'heavy' (P = 0.002) and 'tiring' (P = 0.004) than those of group I, and 'dull' (P = 0.005), 'heavy' (P = 0.001) and 'tiring' (P = 0.005) than those of group II. Group IIIa showed lower ratios of contributing factors of 'an awareness of grinding/clenching during sleep' (P = 0.000) and 'an awareness of clenching sensation when waking up at night' (P = 0.002) than those of group I, and also showed a higher ratio of 'a liking for a hard food' (P = 0.000) and lower ratio of 'talking for a long time on the telephone' (P = 0.001) than those of group II. In conclusion, although several properties were different between subtypes, the majority of them were similar in the four subtypes of TMD.

We have observed lattice vibrations of MgCl 2 thin films for the first time by surface enhanced Raman scattering induced by a silver underlayer. Two Raman active bands of the MgCl 2 crystal, E g and A 1g , were observed at ∼160 and 240 cm −1 . The band width of A 1g mode was about 20 cm −1 . The Raman spectra indicate that the lattice structure of the evaporated MgCl 2 film is well ordered like that of a polycrystal. We have also measured Raman intensity of A 1g mode, varying the film thickness from 0.6 to 7 nm. This film thickness dependence indicates that the Raman enhancement occurs within a very short distance from the substrate.

We have obtained the Raman spectrum of crystalline α-TiCl 3 using a highly sensitive Raman spectrometer and applying great care in the sample preparation. The result was different from the one obtained by previous workers [I. Kanesaka, M. Yonezawa, K. Kawai, T. Miyatake, M. Kakugo, Spectrochim. Acta. 42A (1986) 1415]. Assignments of the observed Raman bands were made by a normal mode analysis of the lattice vibrations.

We have obtained the Raman spectrum of ball-milled α-TiCl 3 . We found six bands in the Raman spectrum. Five of them were assigned to the same bands as those observed in crystalline α-TiCl 3 . A new band appeared at 224 cm −1 for ball-milled α-TiCl 3 , probably due to the breakdown of the crystal symmetry.

The use of persons who become alcoholic despite having a well-defined negative risk for alcoholism (inactive aldehyde dehydrogenase-2 or ALDH2) is advantageous in genetic research because of this population's reduced heterogeneity and possible genetic factors conferring susceptibility to alcohol dependence. This investigation of central serotonin neurotransmission, specifically the serotonin 1B (5HT1B) receptor gene and its role in both regulating alcohol consumption and developing alcohol dependence revealed overrepresentation of the C allele of the 861GC polymorphism of 5HT1B in alcoholics with inactive ALDH2, compared with its frequency in nonalcoholic controls. No significant differences in 5HT1B genotype and allele distributions were observed between alcoholics with active ALDH2 and controls, however. Taken together with recent observations, these results suggest that genetic variability of the 5HT1B receptor is involved in the development of some type of alcohol dependence.

Each country has its own gambling culture; various types of gambling are found in Japan. Multitudes of people have the opportunity to come into contact with gambling (including gaming) in Japan. In the past, understanding of the risks of gambling, along with treatment and the necessity of recovery support, has been poor in Japan. However, the number of supporters interested in this issue has been increasing over the past 20 years. In 1989, Gamblers Anonymous (GA) held its first meeting in Yokohama, Japan. Since then, the number of GA groups within Japan has seen a tendency to increase. Rehabilitation facilities dealing with gambling-related problems engage in various initiatives to address addiction and recovery. Medical institutions have also been accumulating achievements by providing multi-disciplinarily support for those suffering from gambling-related issues. We report information on Japanese GA; Gam-Anon; and rehabilitation facilities, counseling rooms, administrative agencies, medical institutions, debt support facilities, and judicial organizations that deal with gambling-related issues. We hope to obtain information that will be beneficial for future support by clarifying the state of Japan and exchanging information with countries overseas.

To identify predictors for anxiety and depression in orofacial outpatients and to investigate the patients' compliance rate in taking a series of psychologic tests.Three thousand six hundred sixty-six patients completed a battery of questionnaires. These consisted of items inquiring about sex, age, past history of disease, presence of pain, the Hospital Anxiety and Depression Scale (HADS), the Eysenck Personality Questionnaire Short Form (S-EPQ), a Japanese dental version of the McGill Pain Questionnaire (JDMPQ), a visual analog scale (VAS) of pain, pain duration, and diagnosis. After univariate analyses had determined those variables with significant differences between an over-probable group (OPG, HADS scoresor = 8) and an absent group (AG, HADS scores8), we estimated the odds ratios of these variables for OPG as independent variables, and every variable was adjusted between the independent variables by multiple logistic regression models.For anxiety, 3 variables were independently related to the OPG and considered to be meaningful: age 30 or older, neuroticism score on the S-EPQ, and selection of the JDMPQ pain expression term "sickening." For depression, 4 variables were independently related to the OPG and considered to be meaningful: age 30 or older, neuroticism and extroversion scores on the S-EPQ, and selection of the JDMPQ pain expression term "sickening." The compliance rate for the tests was under half of the patients (3,666 of 7,542 patients).Although the predictability for anxiety or depression by some baseline parameters is considered to be low, age, personality traits, and choice of certain pain expression terms are useful predictors of anxiety or depression. The improvement of the compliance rate for psychologic screening will be a future challenge for Japanese clinics managing orofacial patients.

We have obtained the Raman spectra of TiCl n (n= 2, 3, and 4). Assignments of the observed Raman bands were made by a normal mode analysis. The force constants were determined from the observed Raman band frequencies. We have found that the Ti-Cl stretching force constant increases as the oxidation number of the Ti species increases.

Depression is well known as one of the psychiatric complications of interferon (IFN) therapy in patients with chronic active hepatitis C. We compared the psychiatric status during interferon therapy between patients with renal cell cancer (RCC) and those with chronic active hepatitis C.The psychiatric status of 40 patients with renal cell cancer, 36 who were subjected to radical nephrectomy and 4 who were not because of the presence of distant metastasis and other complicated underlying diseases, was assessed by psychiatrists before and at 2, 4, 12 and 24 weeks after the start of IFN therapy according to the major depressive episode diagnostic criteria listed in the DSM-III-R and the Hamilton Depression Scale (HDS). The mental aspect was measured using the Eysenk Personality Questionnaire (EPQ) before IFN therapy, and the results were compared with those obtained in 85 hepatitis C patients evaluated according to the same protocol for psychiatric assessment.Eight of the 40 patients were diagnosed as having depression before IFN therapy and 5 of them became even more depressed 2 weeks after the start of IFN therapy. Nine patients were found to be depressed after the start of IFN therapy, 7 of them were diagnosed before 4 weeks of therapy. All the patients needed treatment for depression: discontinuation of IFN therapy in 4, decrement of the IFN dose in 8, and psychiatric drug medication in 13. The patients who suffered from depression had significantly higher scores in neuroticism (EPQ) before IFN therapy than those who did not become depressed. There was no difference in age, sex or cancer stage between the two groups. The occurrence of depression in RCC patients was the same as that observed in hepatitis C patients receiving IFN therapy. But in RCC patients the depressive state was diagnosed earlier and was more severe than that observed in hepatitis C patients.Urologists should be aware of the psychiatric symptoms of RCC patients under IFN therapy just as in hepatitis patients. The depression in RCC patients was considered to be related to the cancerous disease itself which may explain its higher degree of severity, as compared to hepatitis C patients.

The effects of functional training on physical Activities of Daily Living (ADL) based on the Health and Medical Service Law for the Elderly have been controversial. The aim of the present study was to explore its characteristics and influence with a large sample.669 participants and 1,110 non-participants in functional training were recruited from 54 cities and villages in 1998. The effects of functional training on physical ADL were evaluated by comparing the baseline ADL and 1-year follow-up ADL in the "index of Activities of Daily Living for bedridden elderly (1993)".1. The change in physical ADL in participants was significantly better than that in non-participants after adjusting for age. 2. Significant effects of functional training were observed in both sexes, in all three age groups, and in ranks J, A and B. 3. There was no significant difference between the sexes in terms of the influence of functional training. Functional training was more effective in the younger group, in stroke subjects, and individuals suffering from any disease within one year prior to the baseline. 4. A total of 16.4% of the participants demonstrated increased physical ADL, while 7.2% of the participants also had increased mobility.Functional training has a significant positive effect on increase of physical ADL. Functional training based on the Health and Medical Service Law for the Elderly is an effective program especially for homebound and/or frail people who are at risk of becoming bedridden. Further longitudinal studies are now needed to improve functional training for increasing ADL and QOL.

This paper investigated the trend in prescription patterns in the treatment of psychiatric inpatients using a database of our 1993 survey as well as reports of surveys conducted by Ito et al. in 1973 and 1979. To make the database of our survey comparable with surveys in 1973 and 1979, we extracted and analyzed 1,164 cases which met the criteria of Ito's survey, requiring that patients were diagnosed as having schizophrenia and were hospitalized for two years or longer. The results were as follows: 1) The most common number of different drugs per patient increased from 4 in 1973 and 1979 to 8 in 1993. That of psychotropics increased from 2 to 5. That of neuroleptics increased from 2 to 3. 2) The most commonly prescribed neuroleptics were haloperidol followed by levomepromazine and chlorpromazine. While the top three neuroleptics had not changed, the mean daily dose of haloperidol rose from 8.4 mg in 1979 to 15.3 mg in 1993.

Although concern about the prescription pattern of psychotropics is growing, there have been very few surveys in Japan. In this survey conducted in 1993, prescription data, patient characteristics, etc. were collected for 2,395 inpatients from 18 psychiatric hospitals. Their mean age was 48.4 (S.D. = 13.6). Of these patients, 1,818 (75.9%) were diagnosed with schizophrenia, 115 (4.8%) with mood disorder, and 102 (4.3%) with mental retardation. The results were as follows. 1) They were prescribed an average of 10.1 different drugs: of these, 5.6 were various psychotropics (2.6 neuroleptics, 1.2 antiparkinsonian drugs, 1.0 hypnotics). 2) The mean daily dose of antipsychotics was 1,082 mg of chlorpromazine equivalent. 3) The most commonly prescribed neuroleptic was haloperidol (53.2% of the total patients) followed by levomepromazine (48.7%), chlorpromazine (24.8%), bromperidol (18.7%), and zotepine (18.3%).

The number of patients treated with interferon (IFN) has increased markedly in Japan since 1992, when the Health and Welfare Ministry approved the use of IFN for treating chronic active hepatitis C. It is important to identify and treat depression, which is one of the psychiatric complications of IFN therapy and often leads to discontinuation of the therapy, in patients with chronic hepatitis C. In this study we prospectively investigated the incidence of depression during IFN therapy in patients with chronic active hepatitis C. The psychiatric status of 85 patients (53 men, 32 women; mean age 49.1 years) with chronic active hepatitis C who began receiving IFN at Showa University Hospital was assessed before and 2, 4, 12 and 24 weeks after the start of IFN therapy, using the major depressive episode diagnostic criteria listed in the DSM-III-R and the Hamilton Depression Scale HDS). All of the patients provided informed consent prior to participation in this study. IFN therapy was discontinued in 5 cases (5.9%) because of physical side effects and in 4 cases (4.7%) because of depression. Two, 11, 14, 25 and 16 patients were diagnosed as having major depressive episodes before and 2, 4, 12 and 24 weeks after the start of IFN therapy, respectively. The number of patients who were asymptomatic before the start of IFN therapy but were diagnosed as having a major depressive episode at least once during IFN therapy was 31 (31/83 = 37.3%). The mean HDS scores at 2, 4, 12 and 24 weeks (5.4, 6.0, 8.8 and 6.6) were significantly higher than that before the start of IFN therapy (3.0). The patients whose first diagnosed major depressive episodes occurred more than 4 weeks after the start of IFN therapy tended to be more severely depressed than those in whom it occurred less than 4 weeks after the start of IFN therapy. Compared to the 47 patients who completed 24 weeks of IFN therapy without experiencing depression, the 31 patients who were diagnosed as experiencing major depressive episodes during IFN therapy had significantly higher neuroticism scores determined using the Eysenck Personality Questionnaire, showed a more severely depressed mood and experienced more severe sleep disturbances before the start of IFN therapy. The latter group of patients also tended to have comorbid chronic physical disorders such as hypertension or diabetes mellitus and the histories of mental disorders before the IFN therapy; however these differences were not statistically significant. There were no differences between the two groups in patient age or sex, the severity of hepatitis before the IFN therapy, the type of IFN used in the therapy or the efficacy of IFN in the treatment of the hepatitis C. Our results indicate that the decision as to whether to treat chronic active hepatitis C with IFN should be made carefully and that early intervention and careful monitoring of depression are required during IFN therapy in the treatment of chronic active hepatitis C.

In this study we investigated the one-year outcome of panic disorder. The subjects were 169 panic disorder patients (69 males, 100 females; mean age 36.5 years), who attended the outpatient clinic of the Department of Psychiatry, Showa University Hospital, from September to December 1993. The outcome study was performed from October to December 1994. Patients who were being treated at Showa University Hospital during the outcome study were interviewed in person, and those who were not were interviewed by telephone. The one-year outcome of 100 patients (32 interviewed in person and 68 interviewed by telephone; 37 males, 63 females; mean age 39.5 years) was assessed. That of the remaining 69 patients was not assessed because they did not provide informed consent or had moved during the last year. The patients who were assessed (N = 100) were older and exhibited less severe phobic avoidance on their first visit to the clinic than those who were not assessed (N = 69). The frequency of panic attacks, and the severity of phobic avoidance and anticipatory anxiety decreased significantly between the time of the patients' first visit to the clinic and the time of the outcome study. Panic attacks, phobic avoidance and anticipatory anxiety disappeared in 27.0%, 32.9% and 13.6% and decreased in frequency or severity in 61.8%, 62.0% and 61.4% of the cases, respectively. Seventy-three patients felt that the severity of their panic disorder symptoms decreased between the time of the outcome study and the time of their first visit to the clinic, 20 felt that it had not changed and 7 felt that it had increased worse. The phobic avoidance and anticipatory anxiety at the time of the patients' first visit to the clinic were more severe, and the Global Assessment of Functioning Scale score was lower in the case of the former group of patients than in that of the latter two groups.

This supplement describes the development and structure of the Comprehensive Assessment List of Affective Disorders (COALA) system, which was recently developed for a collaborative follow-up study of a broad spectrum of affective disorders in Japan and which consists of a series of semistructured interviews for affective and related disorders. The COALA distinguishes itself from the extant semistructured interviews by being able to provide polydiagnostic, comprehensive and serial assessments. It is polydiagnostic because it derives diagnoses according to 29 historical and modern diagnostic systems through computer algorithms. It is comprehensive because it not only depicts the symptoms profile and rates their severity according to various endogenicity indices and severity rating scales but also measures, in the psychosocial domain, the life events and their characteristics. In addition, it has sections for past illnesses and family history. It is serial because the system includes follow-up semistructured interviews that can be administered monthly and that monitor changes in the psychopathological and psychosocial features. The theoretical underpinnings of the COALA system, especially its polydiagnostic approach to a broad spectrum of affective disorders and its treatment of psychosocial factors, are discussed in view of recent proposals for the future nosological research. The findings of the interrater reliability study (n = 107) are also presented, with satisfactory to excellent results for almost all of the psychopathological and psychosocial variables, all of the composite severity ratings and most of the polydiagnostic evaluations.

The blood levels of soluble CD8 (sCD8) and soluble CD4 (sCD4) were measured in patients with various liver diseases, and their significance was studied. The levels of sCD8 were significantly higher in patients with chronic active hepatitis (CAH), autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), acute hepatitis (AH), fulminant hepatitis (FH) and liver cirrhosis (LC) as compared with the normal controls (NC), and correlated positively with those of GPT (r = 0.67, p0.001). In addition, a comparison of the exacerbation of CAH with remission showed that the sCD8 levels were significantly higher in the former. On the other hand, there was no significant rise in the level of sCD4 in patients with any liver disease, except FH, no definite relationship between sCD4 and sGPT, and no consistant tendency in sCD4 levels between exacerbation and remission. The reason for an insignificant elevation of the sCD4 level is the fact that in hepatitis the CD8-positive cells, which are cytotoxic T cells, are directly involved in hepatocyte damage; therefore the CD8-positive cells are predominantly activated, while the activity of the CD4-positive cells is considered to be lower. Instead of determining the number of CD4-positive cells and CD8-positive cells in the mononuclear cells of peripheral blood, serum sCD4 and sCD8 levels can be measured simply and inexpensively. Thus, these levels may be useful immune markers.

Six patients with chronic respiratory failure associated with hypercapnia were treated with nasal intermittent positive pressure ventilation (NIPPV) at home. NIPPV was delivered via a custom molded nasal interface described by McDermott. The patients consisted of one patient with kyphoscoliosis, three with Tb-sequela, one with COPD, and one with neuromuscular disease. Each patient had been treated with oxygen therapy until assisted ventilation was initiated because of CO2 retention. NIPPV was administered using a volume cycled flow generator set to deliver a minute volume such that PaCO2 was maintained between 35 and 45 Torr on NIPPV trial performed during wakefulness under the condition of no leakage from the mask. Supplementary oxygen was added so that oxygen saturation was maintained above 90 percent during more than 95% of nighttime NIPPV. Arterial blood gas tensions during daytime spontaneous breathing showed an improvement (PaCO2 68.3 +/- 7.2 Torr, PaO2 70.4 +/- 15.5 Torr, SaO2 91.6 +/- 4.3% before treatment; PaCO2 55.8 +/- 4.7 Torr, PaO2 87.5 +/- 16.5 Torr, SaO2 95.5 +/- 1.7% on treatment, mean +/- SD). The duration of NIPPV at home ranged from 2 to 24 months (11.7 +/- 6.8), and there was no hospitalization due to exacerbation during this period. In conclusion, NIPPV via a custom molded mask is simple, noninvasive, and suitable for the provision of long-term and domiciliary assisted ventilation.

Streptomyces hygroscopicus subsp. aureolacrimosus SANK 60286 produces a new family of milbemycins, named milbemycins alpha 11, alpha 12 [corrected], alpha 13, alpha 14 and alpha 15, together with other milbemycins. Their structures are 3-methyl-2-butenoyloxy and 3-methylbutyroyloxy derivatives at C-4a of milbemycins A3 and A4, or 3-methyl-2-pentenoyloxy derivative at C-4a of milbemycin A3, respectively. Milbemycin alpha 14, 3-methyl-2-butenoyloxy derivative, especially possesses a potent acaricidal activity.

特別養護老人ホームにおいて, 簡易痴呆検査法としての「時計」の描画の有用性について検討した.対象は全国の済生会関連の特別養護老人ホーム11施設入所者1,015名 (男266名, 女749名) である. 検査方法として, 1時45分を指している時計の描画と, ミニメンタルステートテスト (以下MMSTと略す) を施行し, 両検査結果を比較検討した.比較検討できた症例は834例 (平均年齢81.35歳) であった. 時計の評価は, 外枠の円・文字盤の数字・長針と短針の2本の針, の3つの要素のうち2つ以上できたものを「時計らしく書けている」と分類し, 3つの要素すべてと時計の針の位置まで含めて完全に書けたものを「完全に書けた」と分類した. 4群に分類すると, 各群のMMSTの平均点は, (1)「全く書けなかった」496例が5.9点, (2)「時計らしく書けなかった」144例が16.4点, (3)「時計らしく書けた」170例が21.7点, (4)「完全に書けた」24例が23.5点であった.時計の描画の群を「時計らしく書けている」かどうかで2群に分け ((1)(2)対(3)(4)), MMST 20点以下と21点以上を境界とした場合の鋭敏度・特異度・正診率は0.89, 0.64, 0.84であり, スクリーニング検査として有用であると考えられた.「時計」の描画は高齢者を対象としても外来などで比較的容易に行うことができる検査である. 時計の外枠の円・文字盤の数字・長針と短針の2本の針, の3つの要素のうち2つ以上できるかどうかを基準として,『時計らしく書けている』かどうかを判定すると, 痴呆の有無をスクリーニングできる可能性があり,「時計」の描画は, 簡易痴呆検査法として有用であると考えられた.

Through our retrospective analysis of HTCA and clinical effects as well as fundamental studies, the following results were obtained: In this retrospective study, HTCA for lung cancer showed a predictive accuracy of 71%, a true positive rate of 50% and a true negative rate of 77%. To obtain good predictive accuracy, HTCA should be modified to provide conditions comparable to those in vivo with regard to drug concentration and drug exposure time. More precise analysis of the pharmacokinetics of anticancer agents might yield methodological improvement. A decrease in the chemosensitivity spectrum in vitro was observed after chemotherapy. This might be related to evidence that patients with prior chemotherapy exhibited a poor response rate to chemotherapy. There were no active anticancer agents against specimens with aplating efficiency of more than 0.04%. More extensive prospective trials will be necessary to determine the clinical value of HTCA. HTCA could be a superior assay for detecting the anti-tumor activity of new agents and a useful method for in vitro phase II study.

Rubella accompanied by serum aminotransferase elevations occurred in a 24-yr-old man. Liver biopsy showed ballooning degeneration and focal necrosis of liver cells, clumped Kupffer cells, and infiltration of inflammatory cells, mainly of the mononuclear type. Most mononuclear cells in the liver were CD8-positive and CD16-negative cells (cytotoxic T cells) which were in broad contact with the surface of liver cells. Leu 7 (natural killer) cells were few and sporadic. HLA class I antigens were expressed on liver cell membrane. Although hepatic involvement in adult rubella is not generally recognized, it may have been the cause of this patient's liver injury. Thus, cytotoxic T cells may play a role in liver injury in acute rubella infections in adults.