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Objective: While the Rome III classification seems logical, some aspects need further evaluation. The aim of this study was to evaluate the clinical characteristics of Japanese dyspeptic patients and to determine whether this classification could be applied to them., Material and Methods: A total of 364 consecutive patients with a mean age of 54.5 years who had chronic symptoms occurring at least several times per week that could be attributed to the upper gastrointestinal tract were recruited. All of them underwent blood tests, ultrasonography, and endoscopy, which revealed no organic, systemic, or metabolic diseases. They also answered a questionnaire about their symptoms., Results: The subjects were divided into a postprandial distress symptom (PDS) group, epigastric pain symptom (EPS) group, and chronic idiopathic nausea symptom group. There was considerable overlap among these groups (109/198, 55.1%), and patients with non-erosive reflux disease accounted for 52.0% (103/198) of all subjects. The Rome III classification could not be applied to 62.7% of the PDS group and 61.3% of the EPS group because the onset of symptoms occurred less than 6 months before diagnosis (4.6 +/- 0.4 months for PDS and 4.6 +/- 0.5 months for EPS)., Conclusions: The current Rome III criteria for functional dyspepsia dose not adequately identify a large proportion of Japanese dyspeptic patients, primarily due to earlier presentation for medical evaluation. Therefore, the 6-month period after onset of dyspeptic symptoms should be shortened at least in the Japanese population experiencing dyspeptic symptoms.

Ectopic thyroid tissue is an uncommon congenital aberration that is seldom present at two different sites simultaneously. The patient was a 32-year-old woman with dual ectopic thyroid accompanied by positive antithyroid antibodies. The simultaneous occurrence of dual ectopic thyroid and positive antithyroid antibodies has been documented in only two cases: the case discussed here and one previous case. The cervical ectopic thyroid was followed up by ultrasound, which showed an increase in the size of the lesion and an internal echo texture that became slightly heterogeneous after the patient had her second child. We speculated that these changes resulted from the changes in hormone demand brought on by pregnancy and parturition.

A 41-year-old woman noticed a mass on the inside of her right thigh in April 2003. Ultrasound examination revealed a mass measuring 18 mm × 10 mm × 10 mm in the subcutaneous fatty tissues. Its boundary was relatively clear, with rough edges. The interior of the lesion was hyperechoic and contained an irregular hypoechoic area in its center; a color Doppler sonographic examination detected no blood flow signals. Incision biopsy examination seemed warranted. Pathologically, the specimen showed a proliferation of fibroblast-like spindle-shaped cells but no atypical cells. Immunologic staining revealed that sections were positive to vimentin; negative to CD34, CD68, α-smooth muscle actin (α-SMA), and S-100 protein; and mildly positive to HHF35. These results led to a diagnosis of nodular fascitis. Nodular fascitis is not common, and few studies have described its sonographic characteristics. We therefore used ultrasound to follow up the patient and found that the lesion was markedly smaller 3 months after the first examination, at which time it was hardly discernible as a mass. Here we compare the ultrasound and pathologic findings, and report the results of a bibliographic study.

Objectives: To investigate the efficacies of two different triple-therapy regimens (standard versus low doses), and the influence of cytochrome P450 enzyme (CYP) genetic polymorphism on these efficacies, in Japanese patients undergoing Helicobacter pylori eradication treatment., Methods: All patients received 1 week of triple therapy. Patients in group A (low-dose regimen) received omeprazole 40 mg/day + amoxicillin 1500 mg/day + clarithromycin 800 mg/day; patients in group B (standard-dose regimen) received omeprazole 40 mg/day + amoxicillin 2000 mg/day + clarithromycin 1000 mg/day., Results: A total of 225 patients (113 in group A and 112 in group B) were randomised to one of the two triple-therapy regimens. The eradication rates were 78.8% (89/113 patients; 95% CI 70.1, 85.9) in group A and 83.0% (93/112 patients; 95% CI 74.8, 89.5) in group B. Genetic polymorphism of CYP2C19, a major metabolic enzyme of omeprazole, did not affect eradication rates, while susceptibility to clarithromycin greatly affected the success of eradication. The cumulative ulcer relapse rate at 24 weeks after endoscopically documented ulcer healing (30 weeks after completion of the drug regimen) was 8.3% for group A and 12.5% for group B (log rank test: p = 0.6248). However, comparison of the cumulative relapse rate of 6.7% in patients after successful H. pylori eradication with the relapse rate of 27.3% in those who failed H. pylori eradication revealed a significant difference in the remission-time curve (log rank test: p = 0.0047). This finding suggested the existence of a relationship between H. pylori eradication failure and ulcer relapse. Both drug regimens were well tolerated. Endoscopically proven reflux esophagitis developed in about 10% of patients after eradication, but was not clinically significant., Conclusions: One week of triple therapy with a low-dose regimen provides adequate H. pylori eradication in Japanese patients. CYP genetic polymorphism is of minimal clinical significance with both triple-therapy regimens.

In hypertensive patients with left ventricular hypertrophy (LVH), the influence of exercise on the regional variations in ventricular repolarization is not well understood. The present study compared dispersions of QT and QT apex (QTD and QTaD), which are indices of regional variations in ventricular repolarization, between hypertensive patients with echocardiographic evidence of LVH and those without LVH. Seventy essential hypertensive patients underwent a modified Bruce protocol exercise test, and QTD and QTaD were measured at rest and at peak exercise level. All subjects had undergone coronary angiography and did not have coronary artery disease. None of them showed ST-segment depression during or after exercise. There were 20 patients with LVH and 50 patients without LVH. The QTD and QTaD at rest were not different between the patients with LVH and those without LVH (56+/-32 vs 57+/-28 ms, 52+/-20 vs 49+/-23 ms). At peak exercise level, QTaD was significantly decreased compared with the baseline in hypertensive patients without LVH (49+/-23 to 42+/-16ms, p<0.05), whereas in patients with LVH QTaD increased (52+/-20 to 67+/-17ms, p<0.05). QTaD at peak exercise level was positively correlated with the left ventricular mass index (r=0.357, p=0.0024). These data were unchanged after correction for heart rate using Bazett's equation. In conclusion, QTaD increased after exercise in hypertensive patients with LVH. Inhomogeneity of repolarization is induced by exercise stress in hypertensives with LVH.

The poor sensitivity and the poor predictive value of ST-segment depression have limited the usefulness of the exercise electrocardiogram (ECG) in the diagnosis and evaluation of coronary artery disease (CAD). The QT dispersion (QTD), recorded as the difference between maximal and minimal QT intervals on a 12-lead exercise ECG, is sensitive to myocardial ischemia and may improve the accuracy of exercise testing in patients with CAD who do not show an ST-segment depression. Exercise ECGs were analyzed in 50 subjects who had undergone coronary angiography for clinical indications. None of them showed an ST-segment depression during or after exercise: There were 25 patients with significant coronary artery stenosis and 25 without significant stenosis. The QTD measured before, immediately after, and 1 min after exercise was similar in the 2 groups. The QTD at 3 and 5 min after exercise was significantly greater in patients with CAD than in the controls, and the most marked difference in QTD was observed at 3 min after exercise. A QTD at 3 min after exercise of >60 ms had a sensitivity of 80% and specificity of 88% regarding the diagnosis of CAD. When a deltaQTD (post-exercise QTD minus QTD at rest) at 3 min after exercise of >0 ms was added to a QTD of >60 ms as a condition for positivity, the specificity increased to 96%. QTD measured at 3 min after exercise increases the accuracy of exercise testing in patients with CAD who do not show an ST-segment depression.

Regional cerebral blood flow and amino acid concentration in the cerebrospinal fluid were studied in 12 cases of vascular dementia, 12 cases of Alzheimer's disease, 12 cases of chronic alcoholism, and 12 age-matched healthy controls. In vascular dementia, blood flows were decreased in the cerebral cortex, frontal white matter, thalamus, caudate nucleus, and putamen and alpha-aminobutyric acid and glutamic acid concentrations were increased in the cerebrospinal fluid. In Alzheimer's disease, blood flows were decreased in the frontal cortex, parietal cortex, temporal cortex, and frontal white matter and alanine concentration was increased in the cerebrospinal fluid. In chronic alcoholism, blood flows were decreased in the cerebral cortex, thalamus, and putamen and urea, alanine, and glycine concentrations were increased in the cerebrospinal fluid.

A new device, FemoStop, in which the compression bag is replaced with a translucent one made of polyethylene for easy inspection, was used in 74 patients (76 examinations) who underwent angiography, including the setting of indwelling catheters in 10 patients, to obtain an easy and reliable maneuver for arresting hemorrhage at the puncture site. No failure in arrest of hemorrhage was recognized, and complications such as hematoma and re-bleeding were nonexistent. The doctor's time required for the arrest of hemorrhage was less than 5 minutes. On the other hand, in a beginner using the conventional manual compression method in 74 patients (74 examinations), the rate of failing to arrest hemorrhage was 5/74 cases, small hematoma was seen in three cases, re-bleeding occurred in one, and the time required for arrest was about 20 minutes. In conclusion, FemoStop was clinically useful for beginners.

One hundred and eighty three patients with squamous-cell carcinoma of the tongue were treated with electron beam irradiation at the Dept. of Radiology, Nihon University School of Medicine, from 1967 to 1988. We analyzed the therapeutic results of the investigation to find out indications of squamous-cell carcinoma of the tongue to see if it could be treated by intra-oral cone irradiation with electron beam (IOC). The patients were restaged, as follows: stage I, 38 cases: stage II, 64 cases: stage III, 58 cases: stage IV, 23 cases. There were 113 males and 70 females, ranging in age from 18 to 87 years old. IOC was applied for T 1 or smaller T 2 cases. External neck irradiation and IOC were combined for larger T 2, T 3 or T 4 cases. The two-year local-control rates for primary lesions with the present method were 85% for T 1, 73% for T 2, and 58% for T 3. There were no two-year local-control cases for T 4. Clinical feature of the tumor were classified into tumourous type, small ulcerating type, and large ulcerating type. The two-year local-control rates were as follows: 80% for tumorous types, 68% for small ulcerating types and 53% for large ulcerating types. Uneven fractionated irradiation was performed on 144 cases and even fractionated irradiation was performed on 39 cases. The two-year local-control rates were as follows: 68% for uneven fractionated irradiation cases, 61% for even fractionated irradiation. In T 2 and T 3 cases, the two-year local-control rates were as follows: 77%, 63% for uneven fractionated irradiation cases, 56%, 40% for even fractionated irradiation cases. The two-year local-control rates were increased by uneven fractionated irradiation for T 2, T 3 cases (P < 0.05). We analyzed the therapeutic results in details for T 3 cases. T 3 patients were classified into two categories according to tumor size (category 1: long axis X short axis > 1000mm2: category 2: long axis X short axis < or = 1000mm2). The two-year local-control rates were 48% for category 1, and 72% for category 2. T 3 patients were classified into two categories according to clinical feature of the tumor (tumors with ulcers and tumors without ulcers). The two-year local-control rates were 43% with ulcers, and 74% without ulcers. The actuarial five-year survival rates were 92% for stage I, 72% for stage II, 67% for stage III, and 12% for stage IV.(ABSTRACT TRUNCATED AT 400 WORDS)

The efficacy of the response and safety in combination therapy of radiation and furtulon, a derivative of fluoropyrimidine, for malignant tumors were tested on a multi-institutional basis. Patients in this study were given daily 800 mg of oral furtulon and also irradiations. Twenty-three out of 30 evaluable cases showed CR or PR response (response rate was 77%). The response rates of the cases classified into regions of primary sites were 67% of stomach (4/6), 57% of colorectum (4/7), 100% of breast (9/9), 67% of esophagus (4/6), 100% of ovary (1/1) and 100% of lung (1/1). Four out of 36 cases were not given the full scheduled treatments due to grade 3 side effects, consisting of one diarrhea case suspected due to furtulon side effect, 2 impaired general condition cases according to the progression of diseases, and one case showing radiation dermatitis, dysphagia due to radiation mucositis and leukocytopenia. These results show that the combination therapy of radiation and furtulon is an efficacious and safe modality for primary and metastatic tumors.

To get the better therapeutic ratio with low LET radiation therapy alone, the improvement of the physical dose distribution and the mode of dose fractionation are required. Since 1972, uneven fractionation irradiation with electron beam has been used for head and neck tumors. The 2 year control rates for primary tongue cancer T1, T2 and T3 by this method were approximately comparable to that of the small source implantation. In the treatment results for the cervical lymph node metastasis, uneven fractionation technique is superior to conventional one. Furthermore, this results was reviewed by means of multivariate analysis.

The development of prophylactic therapy for acute lymphoblastic leukemia (ALL) in the central nervous system in children has resulted in an improvement of the prognosis and prolongation of patients' lives. On the other hand, late irradiation effects have increased with the improvement of the prognosis. Therefore, there is now an important need to lessen these late effects without deteriorating the prognosis. We have investigated the recurrence rate, the survival rate and the cause of death of ALL patients who were divided into a none prophylactic irradiation group and 15 Gy, 20 Gy and 24 Gy irradiation groups. The results show that the effect of prophylactic irradiation has been more effective in the 20 Gy group than that of the 24 Gy group. Furthermore, brain atrophy and leukoencephalopathy, which were investigated by X-ray CT in long-term survivors of post-prophylactic irradiation without recurrence, have been less in the 20 Gy group than in that of the 24 Gy group. This report presents the result that the most favorable dose for prophylactic irradiation for central nervous system leukemia of ALL in children is 20 Gy by a step-up method.