Infective endocarditis is a serious infection occurring on the endothelial surfaces of the heart, especially at the valves. Oral commensal bacteria are the important etiologic agents in this disease. Common dental procedures, even non-surgical dental procedures, can often cause bacteremia of oral commensals. Periodontally diseased patients are at risk from bacteremia even after brushing the teeth. Bacteremia itself rarely affect healthy people but they can result in mortal infective endocarditis in those who have a predisposed risk for this disease, such as those with heart valve diseases, pacemaker implantation, etc. Infective endocarditis is thus established when all the 3 conditions are present simultaneously, i. e., 1) a predisposing impairments in the heart, 2) the introduction of bacteria into the bloodstream, and 3) the virulence of bacteria. Antibiotics have to be adequately used to prevent this infection, however, their frequent uses generates drug-resistant mutant bacteria, which is a serious social problem. The development of novel alternative drugs to be used instead of the current antibiotics is thus highly desired. We are now using several types of combinatorial peptide libraries to search for small size molecular mimetics that can interfere with the adhesion of bacteria to the target organ. The use of such peptides is expected to lead to the development of compounds for a novel preventive drug which does not kill bacteria, thus making it safer and less likely to generate drug-resistant mutants. J. Med. Invest. 53: 189-198, August, 2006

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The movement of a subject is a major problem in MRI experiments and diagnosis. At first, this review introduces a new technology named the “Propeller Technique” which can improve the motion artifact by changing the data sampling method in the K trajectory. Our experience of a case who underwent measurement by Propeller technique is reported and the effect of this technique is explained.
One of the recent hot topics is the appearance of the clinical 3T MR instrument, with its characteristic differences from that at 1.5T. The advantage of 3T is that it facilitates the evaluation of functional and metabolic information using MR spectroscopy (MRS) and functional MRI. The application of proton MRS in clinical cases is shown and the standard method to use proton MRS in a clinical setting is demonstrated. Furthermore, the new techniques, which can measure important metabolites in small amount such as neurotransmitters, was developed using a high signal to noise ratio and frequency resolution, which are advantages of 3T. J. Med. Invest. 53: 199-203, August, 2006

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Objective: To study daily intake of calcium, phosphorus and vitamin D, to determine the biochemical findings of rickets and the effect of sunlight exposure and vitamin D supplemention in school girls with hypovitaminosis D.
Methods: A cross-sectional study was conducted on school girls aged 11-15 years selected randomly from various areas of Tehran, Iran. Dietary information and amount of sunlight exposure were estimated by a 7 day recalling method using self-reported questionnaire. Hypovitaminosis D defined as low serum 25-hydroxyvitamin D concentration with two or more others abnormal biochemical findings. Girls with hypovitaminoses D were randomly divided into two groups. The faces and hands of girls in group 1 were exposed to sunlight for one hour per day for twenty days, while those in group 2 were administered vitamin D capsules, 50,000 IU per day for the same period.
Results: four-hundred fourteen girls evaluated, mean daily calcium intake, sunlight exposure and vitamin D acquirement were 360 mg, 10 minutes and 119 IU, respectively. Mean serum 25-hydroxyvitamin D concentration was 30 ng/ml among all girls whereas in 15 (3.63%) of 414 girls was 7.8 ng/ml. Abnormal biochemical findings in these girls included hypocalcemia (n=4), hypophosphatemia (n=5), raised serum alkaline phosphatase (n=13), and parathyroid hormone (n=15). After intervention, mean serum 25-hydroxyvitamin D concentration in sunlight exposure (n=8) and vitamin D (n=7) supplementation increased to 14.4±4 ng/ml and 23±4 ng/ml respectively. There was a significant difference between the two groups (p<0.05).
Conclusion: Vitamin D deficiency developed in rapid growth period of girls without clear clinical rickets in sunny temperate climate city in Iran which vitamin D supplemention improved biochemical findings better than sunlight exposure. J. Med. Invest. 53: 204-208, August, 2006

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This research investigates the current care of hospitalized, chronically mentally ill persons to determine to what extent current hospitalization supports Nirje’s principles of normalization. We propose that care-providers try to incorporate rehabilitation programs that help the patients acquire the pattern and rhythm of living necessary for them to live in the community in their daily hospital life rather than to fit the patients into hospital rules or schedule. Therefore, care-providers must look back on their own views of the humanity, disabled people, and support and may have to change them if necessary. It is important that care-providers do not give up having psychiatric patients not give up restoration of normal social living. To develop such individual attempts into rewarding activities, it is necessary to set goals in the hospital and to let an interdisciplinary team work to achieve them. Moreover, the situation is expected to change if efficient care management is implemented to support psychiatric patients in the community. High-quality care to realize independent living of patients in the community including collection and distribution of information, management of symptoms, assistance for self-care, and psychological education is provided at hospitals that maintain the idea of, and strong belief in, providing high-quality care for returning patients to the community. The findings of this study will provide insights into how to design better hospitalization and/or community care for the mentally ill. J. Med. Invest. 53: 209-217, August, 2006

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UCP-1 is suggested to have important roles for thermogenesis and energy expenditure. To elucidate whether the A-3826G polymorphism that is located in the 5’ flanking region of the UCP-1 gene has roles in healthy young people, the polymorphism was genotyped among 251 young Japanese men whose mean age is 22.7 years old. We analyzed relationship between the A-3826G polymorphism and body mass index (BMI) or six biochemical parameters, serum concentration of total cholesterol (TC), high density lipoprotein (HDL) cholesterol, triglyceride (TG), asparatate aminotransferase (AST), alanine aminotransferase (ALT), fasting plasma glucose. The genotype frequencies were observed at the frequencies of 24.3% for AA, 48.2% for AG and 27.5% for GG, respectively. When BMI and the biochemical parameters were compared by ANOVA among individuals with each genotype, the statistical difference was observed only for BMI (P=0.016). Bonferroni’s test demonstrated that the men with the AG genotype have higher BMI than those with the AA genotype (22.4±2.8 vs. 21.4±2.2) (P=0.04). The individuals with the AG genotype also showed trend to have higher BMI than those with the GG, although the difference was not statistically apparent (22.4±2.8 vs. 21.5±2.3) (P=0.07). Our results indicated that the young healthy Japanese men with the AG heterozygote showed higher BMI than those with other genotypes. J. Med. Invest. 53: 218-222, August, 2006

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Diabetics with end-stage renal disease (ESRD) exhibit abnormal life span of erythrocytes, and thus, HbAlc is not necessarily a good indicator for blood glucose control. The present study was conducted to reaffirm this point and determine whether glycated albumin (GA) can be used instead of HbAlc.
The following three groups of patients with diabetes served as subjects: 49 predialysis patients with ESRD (predialysis group), 37 patients with ESRD on dialysis (dialysis group), and 40 patients without nephropathy (non-dialysis group). The profile set mean blood glucose was calculated by measuring blood glucose levels seven times a day. The relationship of profile set mean blood glucose with HbAlc and GA levels was then investigated.
Corrected HbAlc levels were calculated by applying the profile set mean blood glucose of each ESRD patient to the regression formula for the HbAlc of non-dialysis patients. The actual and corrected HbAlc levels for the predialysis patients were 5.4±1.1 and 7.9±1.1%, respectively, while those for the dialysis patients were 5.6±1.0 and 7.5±0.9%, respectively (p<0.0001). The changes in GA levels in relation to the blood glucose control in the dialysis patients matched those in non-dialysis patients.
HbAlc levels for diabetics with ESRD were lower than indicated by their blood glucose control. When assessing blood glucose control based solely on HbAlc, erroneous results may be obtained. In such cases, GA may be used instead of HbAlc. J. Med. Invest. 53: 223-228, August, 2006

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Objectives: The influence of mastication and swallowing on gastric motor function was evaluated by electrogastrography (EGG) and abdominal ultrasonography.
Methods: The subjects were 30 elderly patients with tubal feeding without mastication and swallowing (T group) and 30 elderly controls who processed food by mastication and swallowing (C group). Gastric motor function was percutaneously examined before and after the ingestion of 250 ml of a liquid diet using an electrogastrograph (NIPRO EGG, A&D, Tokyo, Japan). The cross-sectional area of the gastric antrum was measured at 1 and 30 min after the start of ingestion of the liquid diet by external ultrasonography of the abdomen, and the gastric excretion function was evaluated. Furthermore, the spectral analysis of heart rate variability was performed using Holter electrocardiograms before and after ingestion. The low frequency power (LF power, 0.04-0.15 Hz), high frequency power (HF power, 0.15-0.40 Hz), and the LF/HF ratio were determined.
Results: The peak amplitude at 3 cycles per minute (cpm) was significantly increased after ingestion in the C and T groups (p<0.05), and the ratio of increase was significantly lower in the T group (p<0.05). The mean amplitude for the brady-gastria and tachy-gastria was significantly higher in the T group than in the C group (p<0.05). The gastric excretion function, as evaluated by external ultrasonography of the abdomen, was significantly lower in the T group than in the C group (p<0.05). An analysis of heart rate variability demonstrated that the HF power, a parameter of parasympathetic activity, after ingestion was significantly higher in the C group than in the T group (p<0.05). No changes in LF power or LF/HF ratio, parameters of sympathetic activity, were induced by ingestion in either the C or T groups. Conclusions: The parasympathetic nerve dominantly controls gastric motor function, but autonomic nervous activity is reduced in patients who are unable to masticate and swallow food, resulting in adverse effects on gastric motor function and excretion function. Mastication and swallowing not only prepare food for passage from the oral cavity to the esophagus but are also important in terms of subsequent events that occur in stomach. It has been proposed that autonomic nervous activity might be involved in mastication and swallowing. J. Med. Invest. 53: 229-237, August, 2006

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Transforming growth factor-β (TGF-β) family members regulate a variety of cellular functions and play important roles in cell differentiation. Activin receptor-like kinase 7 (ALK7), a receptor for TGF-β family members, was initially cloned from rats as an orphan receptor and has been recently shown to be a type I receptor for nodal, activin B and activin AB. ALK7 is expressed not only in neurons, but also in insulin-producing islet β cells and white and brown adipose tissues; however, the specific functions of ALK7 in these tissues are not known. In order to test whether ALK7 is involved in adipocyte differentiation, we analyzed its expression during adipocyte differentiation. ALK7 expression was detected in the late phase of adipocyte differentiation by reverse transcriptase-polymerase chain reaction (RT-PCR), Western blotting and immunofluorescence staining in 3T3-L1 cells. We also detected the expression of ALK7 by RT-PCR in stromal vascular fraction (SVF) cells. These results indicated that ALK7 is a novel marker specifically expressed during the late phase of adipocyte differentiation. Furthermore, our results suggest the possible involvement of nodal or activin B in adipocyte differentiation. J. Med. Invest. 53: 238-245, August, 2006

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Human guanase is known as a specific enzyme in the liver, kidney, and brain. However, its functional significance remains poorly understood. In addition, interestingly, a different organ distribution between humans and rats was suggested. Here, we performed immunohistochemical staining with anti-human nedasin (neuronal and endocrine discs large/SAP102 associated protein), whose sequence was identical to that of guanase, antibody and histochemical staining for guanase in normal tissues of rat and human liver, kidney, and small intestine, and compared the results. Guanase activity was observed uniformly in the rat hepatocytes, biliary epithelium and vascular endothelium cells, while it was localized to the hepatocytes and biliary epithelium in the human liver. When the histochemical staining for guanase and the immunohistochemical staining for nedasin were compared, the stained regions were different in the rat liver but were almost consistent in all human tissues. Totally consistent staining results were also obtained between rats and humans in the other organization except the liver. Based upon the research reports to date, the experiments on guanase and nedasin in rat organs performed in this study are considered to have important implications in the investigation of their physiological significance. J. Med. Invest. 53: 246-254, August, 2006

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In hepatic disorders, abnormal plasma amino acid profiles are observed. In this study, we examined whether soy protein isolate (SPI) improved plasma methionine concentration in the model animals. Portacaval shunt (PCS) increased alanine aminotransferase (ALT) activity and methionine concentration in blood of rats fed a 40% casein diet supplemented with 0.6% methionine (casein-M diet). A 40% SPI diet supplemented with 1.28% methionine (SPI-M diet), which contained the same amount of methionine as that in 40% casein-M diet, normalized plasma ALT activity and methionine level in PCS rats.These effects of a SPI diet may be due to its amino acid composition, since an amino acid mixture diet mimicking a 40% SPI-M diet was also effective to hypermethioninemia of PCS rats. To find key enzymes for the beneficial effect of soy protein, we examined effects of a 40% SPI-M or casein-M diet on the activities of three methionine-metabolizing enzymes in liver of PCS rats. A SPI-M diet stimulated only the activity of cystathionine γ-lyase, compared with a casein-M diet. A SPI diet has a preventive effect on hypermethioninemia, at least in part, by stimulating cystathionine γ-lyase activity in liver and may be used for nutritional management of liver disorders with hypermethioninemia. J. Med. Invest. 53: 255-263, August, 2006

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Guanase is known as an enzyme released from the liver. Recently, cloning and sequencing of the guanase gene were reported. In addition, almost simultaneously, it was reported that an unknown protein that binds to neuronal and endocrine lethal(1)-discs large (NE-dlg), one of the membrane-associated guanylate kinase homologues (MAGUK) family proteins involved in synaptic connection between neurons, was cloned and named nedasin (NE-dlg associated protein), whose sequence was almost identical to that of guanase. We immunostained fresh frozen sections of surgically removed human liver, kidney, and small intestine with anti-nedasin antibody, and simultaneously performed histochemical staining for guanase for comparison. Histochemically, guanase activity was observed in the cytoplasm of hepatocytes and biliary epithelium on the liver, in the mucosal epithelium on the small intestine, and in the proximal tubule on the kidney. Immunohistochemically, a brown discoloration due to DAB oxidation was seen in the cytoplasm of hepatocytes and biliary epithelium on the liver, in the proximal tubule but in the distal tubule a little on the kidney, in the mucosal epithelium on the small intestine. The stained region of the liver and the small intestine were different from that of the kidney. The different staining properties dependent on the organs were considered to be due to different isozymes. The physiological significance of guanase may vary with the isozymes, further studies are considered necessary. J. Med. Invest. 53: 264-270, August, 2006

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We have previously shown that human immunodeficiency virus type 2 (HIV-2) without functional vpx and vpr genes is severely defective for viral growth in lymphocytic cells, and suggested that the virions produced in the absence of Vpx and Vpr are critically damaged. To examine the nature of replication-defect for the vpx/vpr double mutant, we quantitatively and morphologically studied the virions produced in cells transfected or infected with wild type clone, single (vpx and vpr mutants) or the double mutant. While no significant difference in virion production was found for various virus clones in transfected cells, a major growth retardation in infected cells was readily observed for the vpx and vpx/vpr mutants. In particular, no viral growth was detected for the double mutant. By contrast to the very distinct growth characteristics of the three mutant clones, no appreciable difference in virion morphology was noted. These results indicated that Vpx and Vpr of HIV-2 may cooperatively contribute to virion infectivity without affecting virion morphogenesis. J. Med. Invest. 53: 271-276, August, 2006

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Although Crohn’s disease is associated with various digestive symptoms, there have been few reports on gastric motility. In this study, we conducted a study of gastric motility in Crohn’s disease using 20 healthy subjects (N group) and 15 patients with Crohn’s disease (C group) by electrogastrography (EGG) using a Nipro electrogastrograph. An EGG was recorded for 30 minutes in a fasting state and after ingestion of 300 ml of a liquid meal. As an index of gastric emptying, the rate of change in the cross-sectional area of the gastric antrum was measured 1 and 15 minutes after ingestion of the liquid meal by external ultrasonography. In an EGG frequency analysis, waveforms with a peak of 3 cycles/minute (cpm) were noted in the N group, and the peak amplitude increased significantly after the ingestion of food. In the C group, division of the normal-gastria component was noted after the ingestion of food in 5 patients (33.3%). In a comparison of the peak amplitudes of fasting brady-gastria, normal-gastria, and tachy-gastria between the N and C groups, the peak amplitude was significantly increased in normal-gastria in the N group, and in brady-gastria and tachy-gastria in the C group. In a comparison of the rates of food ingestion-induced changes in the peak amplitudes for brady-gastria, normal-gastria, and tachy-gastria between the N and C groups, the peak amplitudes were significantly increased in normal-gastria in the N group, but not in the C group. In the case of gastric emptying investigated by external ultrasonography, the rate of food ingestion-induced change in the cross-sectional antrum area was significantly lower in the C group (50.5±9.2%) than in the N group (65.0±8.5%). For gastrointestinal motility, a 3 cpm normal-gastria represents efficient gastric motility. In the C group, the peak amplitudes of brady-gastria and tachy-gastria were significantly increased, but were low in normal-gastria in the fasting EGG, postprandial division of the normal-gastria component was noted, and the rate of food ingestion-induced increase in the normal-gastria peak amplitude was significantly lower than that in the N group, suggesting that patients with Crohn’s disease have a functional abnormality in, not only the small and large intestine, but also the stomach. J. Med. Invest. 53: 277-284, August, 2006

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The aim of this study is to evaluate whether the technetium-99m sestamibi (^99mTc-MIBI) single photon emission computed tomography (SPECT) characteristics of pituitary adenomas might be correlated with cavernous sinus invasion, proliferative potential or the multidrug-resistance (MDR-1) gene product P-glycoprotein (Pgp) expression in pituitary adenomas. Fifteen patients with pituitary adenomas, including 10 nonfunctioning adenomas, two prolactinomas, two GH producing adenomas, and one ACTH producing adenomas was investigated for this study. SPECT images with ^99mTc-MIBI were acquired 15 minutes (early) and 3 hours (delayed) after injection. The tumor-to-normal brain ratio was calculated both early (ER) and delayed (DR) images. Retention index (RI) was calculated using the following formula: (DR-ER)/ER×100%. The pituitary adenomas specimens were examined by immunohistochemistry using anti-Pgp and MIB-1 monoclonal antibodies.
^99mTc-MIBI SPECT findings were not related to MIB-1 labeling index or cavernous sinus invasion. ^99mTc-MIBI SPECT RI (-38.55±20.77) of the Pgp-positive group was significantly lower than that (-15.78±19.40) of Pgp-negative group (p=0.0494). No siginificant difference was observed in the ER and DR of ^99mTc-MIBI SPECT between Pgp-positive and negative groups.
Our study suggests that although ^99mTc-MIBI SPECT is not useful to evaluate the proliferative potential or cavernous sinus invasion of pituitary adenomas. ^99mTc-MIBI SPECT could predict anti-cancer drug resistance related to the expression of Pgp in pituitary adenomas. J. Med. Invest. 53: 285-291, August, 2006

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The development of new and useful pharmaceutical drugs is essential in order to improve the quality of drug therapeutics. Clinical trials play a central role in drug development. Over time, the clinical trial infrastructure has improved and is now integrating the contribution of clinical research coordinators (CRC). Nevertheless, the attitude of doctors towards clinical trials still favors conventional/historical methodologies. In the present study, we explored the view of doctors towards clinical trials for drug development, in order to improve communication among participants, sponsors, and investigators.
A questionnaire was designed for this pilot study. The questionnaire included general attitudes, difficult points, the benefit of doctors in participating as investigators, special attention requirements, and the expected role of CRC in clinical trials for drug approval. In addition, the appropriate use of the outpatient clinic was examined. The questionnaire was provided to doctors in each department of Tokushima University Hospital in 2000 and 2004. Because of the small number of subjects included in this pilot study, no statistical analysis is presented.
A total of 89 (81%) and 62 (56%) doctors among 110 responded to the survey in 2000 and 2004, respectively. Inquiries about the familiarity of the physicians with clinical trials for drug approval revealed that 84% in 2000 and 66% in 2004 were aware of such trials. The attitude towards participating as investigators in the clinical trials was favorable, with a response of 66% in 2000 and 58% in 2004. Patients’ refusal and the informed consent process were considered difficult areas by many doctors. Expected roles of CRC included activities based on the nurse’s specialty. Although many doctors agreed to take care of the study participants separately from the clinical practice, they lacked the time to do so.
In spite of the doctors’ workload reduction by introduction of the CRC concept, their views regarding clinical trials for drug approval remain conventional. Further refinement in the support process by CRC should be considered in our hospital, and the views of the doctors should be investigated in a larger study, in order to promote clinical trials for drug approval in Japan. J. Med. Invest. 53: 292-296, August, 2006

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Dental pulp cells have a capacity to differentiate into mineralization-inducing cells. To clarify the molecular mechanism, we established an in vitro mineralization-inducing system by rat clonal dental pulp cell line, RPC-C2A, and tried to purify a mineralization-inducing factor in conditioned medium (CM) from preosteoblastic MC3T3-E1 cells. The active factor was impermeable to an ultrafiltrating membrane, and sedimented by ultracentrifugation. The sedimented factor was found as a needle-like structure about 1.3 µm in average length as observed by transmission electron microscopy. The factor contained type I collagen, suggesting not a matrix vesicle, but a soluble matrix. The mineralization-inducing activity was also detected in CM from primary culture of rat calvaria (RC) cells. These results suggested that the soluble matrices from osteoblastic cells serve, at least in part, as differentiation-inducing agents. J. Med. Invest. 53: 297-302, August, 2006

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Purpose: The respiratory quotient (RQ) is useful for evaluating glucose and lipid metabolism in vivo. We previously reported that the RQ value, even after fasting, was high in diabetics being treated with sulphonylurea (SU), which might explain the accumulation of fat, leading to weight gain in such individuals. In the present study, we measured the RQ in type II diabetic patients who were being treated with a rapid-onset/short-duration insulinotropic agent, nateglinide, and compared it with those being treated with SU. Methods: A glucose tolerance test was performed in 20 patients with type II diabetes mellitus treated with nateglinide and in 14 patients treated with SU, and the RQ was simultaneously measured. Results: The RQ values in the patients treated with nateglinide, were similar to those in healthy adults, but was lower than in those treated with SU. No weight gain was observed in patients treated with nateglinide. Conclusion: A significant weight gain was reported in subjects treated with SU, accompanied by an increase in RQ. However, weight gain was less frequent in diabetics treated with nateglinide. J. Med. Invest. 53: 303-309, August, 2006

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Purpose: The acute coronary syndrome is often caused by the rupture of plaques and thrombus formation even without significant stenosis, and patients with soft plaques, but without significant stenosis evidenced by coronary angiography (CAG), often develop an acute coronary syndrome. To address this discrepancy, a qualitative diagnosis of coronary plaques using a 16 slice multidetector-row CT was conducted.
Methods and Results: Volume rendering and cross-sectional MPR images were obtained. Based on the CT values, plaques on the coronary artery wall were classified as lipid-rich soft plaques (CT value<50 HU) and non-soft plaques (>50 HU).
A significant correlation was observed between the percent stenosis determined in cross-sectional MPR images and those determined by CAG (r=+0.92, p<0.01). Diffuse plaques with CT values of less than 50 HU often caused stenosis at level of 75% or less, which were not indicated by percutaneous transluminal coronary angioplasty.
Conclusions: Although diffuse soft plaques with CT values less than 50 HU are not an indication of intervention, a risk of an acute coronary syndrome exists, due to rupture. These soft plaques must be stabilized by treatment even when they do not cause significant stenosis, and MDCT is considered to be useful for their evaluation. J. Med. Invest. 53: 310-316, August, 2006

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A 56-year-old man was admitted to our hospital because of anal bleeding. Colonoscopy and barium enema revealed type 4 tumor in the rectum. Biopsy revealed poorly differentiated adenocarcinoma. Low anterior resection with total mesorectal excision and lymph node dissection was performed. In immunohistochemical staining, chromogranin A and synaptophysin were positive at major lesion, and CEA were focal positive. The resected tumor was diagnosed pathologically as neuroendocrine cell carcinoma. The Ki-67 labeling index (LI) was 87.8%, so proliferative activity and potential malignancy was very high. Multiple metastatic tumors appeared in pelvis and lung eight months after operation. Treatment for neuroendocrine cell carcinoma of the rectum was controversial. Surgical resection and adjuvant chemotherapy might be one of the methods for gastrointestinal neruroendocrine cell carcinoma. J. Med. Invest. 53: 317-320, August, 2006

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A 55-year-old-male patient underwent subtotal esophagectomy for esophageal cancer (pT1b, N0, M0, stage II) in April 2005. The patient received postoperative chemotherapy (docetaxel 40mg/body, 5-fluorouracil 750 mg/body, cisplatin 10mg/body: administered every 4 weeks) for 3 months. Six months postoperatively, routine follow up CT demonstrated multiple metastatic tumors in the bilateral lungs. Under the diagnosis of multiple lung metastases, the patient was hospitalized and received intensive chemotherapy with docetaxel 40mg/week (day1), 5-fluorouracil 500mg/day (days1-5), cisplatin 10mg/day (days1-5). After two weeks administration, the patient eagerly hoped for outpatient treatment. The treatment was changed to outpatient chemotherapy with S-1 100mg/day (continuous administration for 3 weeks followed by rest for 1 week) and cisplatin 20mg/every week. The treatment enabled the patient to keep working. Follow up CT showed disappearance of all tumors two months after TS-1/cisplatin chemotherapy. There were no obvious signs of recurrence 5 months after chemotherapy. The S-1/cisplatin therapy in the outpatient was thought to be one of the effective treatments in maintaining quality of life for the patient. J. Med. Invest. 53: 321-324, August, 2006

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The solitary necrotic nodule of the liver is an uncommon nonmalignant lesion with an uncertain etiology. The lesion was defined as a nodule with a completely necrotic core and fibrous capsule etc. and without a consistency of viable cells. The characteristic features of this benign lesion on the imaging modalities are similar to the metastatic tumor. In this paper we discuss the case of a rapid-growing solitary necrotic nodule of the liver occurring in a patient with chronic renal failure on hemodialysis. The lesion located on the left median lobe of the liver had rapidly enlarged in diameter in the last seven months. Despite some examinations by imaging modalities to confirm the preoperative diagnosis, we were unable to visually confirm. Several histological examinations using a needle biopsy specimen were performed, but the diagnosis was all necrotic tissue. However, we recommended an extended left hepatic lobectomy for this rapid-growing lesion since cholangiocarcinoma with necrosis could be hardly differentiated. Permanent histology revealed that the lesion was solitary necrotic nodule. We consider that permanent histology of the entire lesion is possibly the only accurate method of diagnosis. Since the solitary necrotic nodule does not indicate malignancy, hepatic resection should be performed. J. Med. Invest. 53: 325-329, August, 2006

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