Since the report of Duke in which an allergic etiology was considered to be the cause of Meniere's disease, the hypothesis that a certain type of Meniere's disease is generated through immuno-pathological mechanisms has been advocated for 70 years. During this period, another entity of immune-mediated inner ear disorders, i. e., autoimmune inner ear disease was introduced. Fundamental immunological phenomena of the inner ear have been rapidly elucidated since 1980. The endolymphatic sac is the only site which contains immuno-competent cells within the inner ear. The inner ear is capable of mounting active immune responses when appropriately stimulated and the endolymphatic sac plays an integral function for inner ear immune response. Acutally, many reports have been published that link immunity and Meniere's disease with a variety of proposed immune-related etiologies from autoimmunity to non-autoimmunity. It is suggested that immune injury to the endolymphatic sac plays an important role in the pathogenesis of Meniere's disease. These functional and morphological circumstances strongly suggest that an immunological etiology of Meniere's disease is not theoretically unfounded.

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In order to evaluate the usefulness of the mitotic index (MI) and the Ki-67 nuclear antigen labeling index (Ki67LI) in pre-treatment biopsy specimens as predictors of response to chemotherapy for uterine cervical carcinomas, twelve patients with squamous cell carcinoma who received neoadjuvant chemotherapy before radical surgery were investigated. The MI and computer-quantitated Ki67LI were determined using H&E; and immunostained slides of biopsy specimens collected before chemotherapy. Tumor size was measured three-dimensionally by MR imaging, and assessed before and after chemotherapy. We compared the values of MI and Ki67LI with changes in tumor size and the following results were obtained.
1) The percentage reduction in tumor size ranged from 0 to 98%. The MI ranged from 0.5 to 15, and Ki67LI ranged from 0.01 to 50.1%. 2) A significant positive correlation was observed between response to chemotherapy assessed on MR image and MI [Spearman's correlation coefficient (r) =0.66, n=12, p=0.027], and between response to chemotherapy and Ki67LI (r=0.72, n=12, p=0.017). 3) A significant correlation was observed between MI and computer-assessed Ki67 LI [Pearson's correlation coefficient (r) =0.80, n=12, p=0.002]. Therefore, pre-chemotherapy MI and Ki67LI were both good predictors of response to platinum-based chemotherapy. Because MI is technically more convenient and economically less expensive than computer-quantitated Ki67LI, MI remains a simple and reliable predictor from the clinical point of view.

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Placental abruption is a serious cause of fetal mortality. We retrospectively reviewed 24 patients with placental abruption who underwent cesarean section to evaluate ultrasonographic images with reference to the clinical findings and fetal and maternal prognosis. Fourteen of these patients presenting with placental edge separation and persistent hematoma showed a significantly smaller area of abruption, a smaller amount of intraoperative bleeding, a smaller incidence of disseminated intravascular coagulation, and a higher Apgar score as compared to the 10 patients with a thickened placenta. The patients with thickened placenta tended to have a typical clinical presentation, whereas those with plancental edge separation and hematoma appeared to have an atypical and mild clinical manifestation. It was concluded that ultrasonography is useful in the diagnosis of mild and atypical placental abruption.

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The p73, a homologue of the p53 tumor suppressor protein, has a pro-apoptotic activity which is induced by the c-Abl, a protein tyrosine kinase appearing in the nucleus and cytoplasm of proliferating cells. However, the role of p73 and c-Abl in ovarian cancer is not well-defined. We investigated immunohistochemical expressions of p73 and c-Abl in 64 ovarian carcinomas, 13 borderline and 14 benign ovarian tumors to elucidate their clinicopathological relevances. Of the malignant, borderline, and benign ovarian tumors, respectively, 33 (51%), 10 (77%) and 13 (93%) had negative or low p73 expression, 31 (48%), 3 (23%) and 1 (7%) had high p73 expression, 23 (36%), 5 (38%) and 10 (71%) had negative or low c-Abl expression, and 41 (64%), 8 (61%) and 4 (29%) had high c-Abl expression. A high p73 or c-Abl expression was significantly associated with ovarian carcinomas as compared to benign tumors (p=0.003 and p=0.03 respectively). In addition, a significant correlation was found between the high p73 expression and disease stage (p=0.04) and patient's survival (p=0.02). No correlation was found with c-Abl expression. These results reveal an association of p73 overexpression with advanced ovarian carcinomas which may suggest the p73 overexpression as an indicator of poor prognosis.

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We examined clinical and sonographic findings in 112 patients diagnosed as having hemorrhagic ovarian cyst (HOC) who had clinical and transvaginal sonographic follow up. The patients were classified into group A (n=40) with signs and symptoms of acute abdomen and group B (n=72) with no symptoms or mild abdominal pain, and their ultrasonographic and clinical findings were compared. Significant differences were found in mean age, white blood cell (WBC) count, greatest diameter of the mass, shortest diameter of the mass, and size of cross section of the mass. The internal echograms of HOCs were grouped into 4 types: (1) hyperechoic and hypoechoic solid type; (2) reticular or sponge-like type; (3) mixture type of solid and cystic components; and (4) cystic types. In all image types, septum-like or thread-like echoes were seen. Transvaginal sonography (TVS) of type 1, type 2, and type 3 images showed a clear division into hyperechoic and other areas with the passing of time which was finally changed into a cystic pattern and disappeared. HOCs were found more frequently in nulliparous patients (n=79, 70.5%) than in multiparous (n=33, 29.5%). There were many luteal phase (n=86, 76.8%) in comparison with follicular phase (n=13, 11.6%). Thirteen cases were detected during early gestation (n=13, 11.6%). In group A, severe pain reduced or disappeared within 3 h in 37/40 (92.5%) of the patients. Blood flow inside the masses was analyzed in 14 patients by the color Doppler method and showed no significant change. Taken together, this study elucidated the ultrasonographic and clinical characteristics of HOCs, which provide useful information to differentiate HOCs from organic masses and help to avoid unnecessary laparotomy.

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Three-dimensional transvaginal ultrasound was used to determine the location of early gestational sacs (E-GSs) and, as a result, the physiological implantation sites of human blastocysts. We examined 138 patients who were found by three-dimensional transvaginal ultrasound to have a GS with an inner diameter of 3 to 6 mm (E-GS). The uterine cavity was divided into three parts: upper, middle, and lower regions. The upper region was subdivided into the right, middle, and left areas, and the middle region was subdivided into the right and left areas. Thus, overall 6 areas were designed and the frequency of the E-GS detection in each area was evaluated. Of the 138 patients, 123 (89.1%) had E-GSs detected in the upper region, which was found to be the most frequent region. When the frequency of E-GS detection among the upper three areas was compared, the right and left upper areas had a higher frequency than the middle upper area. As to the miscarriage rate, patients with E-GSs detected in the upper region had a significantly lower rate than those in the middle and lower regions (p<0.05). The endometrium suitable for human blastocyst implantation under physiological conditions is at the uterine fundus, especially near the uterotubal junction.

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Background and objective: From 1920 to 1940, many people were affected by esophageal carcinoma in villages in the mountains of Nara Prefecture in Japan. However, a movement for the improvement of living conditions, especially concerning food, diminished the incidence of cancer of the esophagus. Today Xinjiang in China, esophageal cancer is also one of the main causes of death. Therefore, we analyzed in Xinjiang whether the improvement of dietary habits can reduce mortality of esophageal cancer.
Methods: The mortality of esophageal cancer and related matters obtained from the Japanese Literature and Governmental Information, Xinjiang Medical School Cancer Center Hospital, and the Chinese Literature were analyzed.
Results: The Kazaks have a higher incidence of esophageal cancer and a lower male/female ratio than other ethnic groups and Japanese people. Kazaks eat very hot meals rapidly, and male Kazaks are more likely to drink hard liquors. In Japan, people in regions with high alcohol consumption tend to have increased mortality of esophageal cancer, but regions with high smoking rates show no correlation with esophageal cancer mortality. There were no data relevant to the incidence of esophageal cancer and alcohol consumption or smoking rates in Xinjiang. The male mortality rate in Nara Prefecture was much higher than that in other areas in the 1930s, but it decreased gradually and eventually reached national levels. The female mortality rate in Nara decreased at a sluggish pace, but retained a several-fold incidence rate until the 1980s. In 1995, women in Nara reached the national level at last. The male/female ratio was low in Nara all the time, and alcohol consumption in Nara was low, too.
Conclusion: Recently, it has been indicated that alcohol consumption is strongly related to esophageal cancer. However, women in Xinjiang do not drink strong liquor at all. One of their causes of esophageal cancer is dietary habits, which concerns both genders. Therefore, the incidence of esophageal carcinoma could be reduced by dietary reform in Xinjiang, where women as well as the overall population have a high incidence of esophageal carcinoma.

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In traditional practice patterns, physicians take care of all clinical decisions, such as diagnosis, treatment, and recovery. In the Nippon Medical School Hospital a clinical pathway for distal gastrectomy patients, recorded as a post-operative care map, was introduced in August 2000. In January 2001 the post-operative management was analyzed and standardization of practice was carried out with printed order sets, such as drugs and infusion solutions. The aim of this study was to evaluate the clinical significance of the clinical pathway for gastrectomy patients by employing standardized postoperative management and printed order sets.
Patients and methods: From January 2001 to December 2001, 87 patients underwent distal (43), total (28), proximal (7) and partial gastrectomy (9) for gastric cancer (stage IA: 47, IB: 9, II: 7, IIIA: 8, IIIB 2, IV: 10) and gastrointestinal stromal tumor (4). These patients were randomly assigned to either the main building or the east building of our hospital. In the main building 38 patients were looked after using traditional practice (control group). In the east building 47 patients were looked after according to the clinical pathway (path group) and 2 patients were excluded from the path group because of neo-adjuvant chemotherapy and severe heart failure. Aspects of the patients' outcomes, including length of stay, the first day of the diet, morbidity, and medical costs, were compared between the path group and the control group. All data were expressed as means±standard deviation. Statistical analyses were made using Student t-test, Mann-Whitney U-test, and χ² test, and the 5%level was chosen for statistical significance.
Results: The length of the hospital stay was 27.1±10.0 and 40.8±26.1 days (p<0.005) and the length of post-operative stay was 18.1±9.5 and 28.2±22.3 days (p<0.01) in the path group and the control group, respectively. The post-operative day when the diet was started for the path and control groups was 6.8±8.9 and 8.2±7.2, respectively; however, the length of the intravenous infusion for the two groups was 11.8±1.1 and 16.5±1.2 days (p<0.01), respectively. There was no statistically significant difference in the morbidity rate between the path group (3/47) and the control group (5/38). The total cost was \1,502,587±41,650 in the path group and \1,932,197±131,030 in the control (p<0.001).
Conclusion: A clinical pathway for gastrectomy patients proved useful to optimize their postoperative care, including medication management and diet education. It is suggested that the implementation of a standardized clinical pathway for gastrectomy patients reduced the length of the hospital stay and the medical costs.

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To investigate the functional role of leptin in human ovulation, we measured serum leptin, LH, FSH and estradiol in 16 young adult women suffering from ovulatory dysfunction with BMI ranging from17.5 to 24.5 (group A). The control subjects included 12 women with regular ovulation and matched age and BMI (group B). We found that serum leptin concentration in group A subjects was significantly lower than that in group B subjects (4.1±0.5 vs. 6.1±0.4 ng/ml, p<0.01). The percent body fat, estradiol, LH and FSH concentrations in groups A and B were not significantly different. These results indicate that anovulatory young adult women have lower leptin concentration than women with regular ovulation, thus suggesting a key role for leptin in regular ovulation or ovulatory dysfunction.

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Forty-nine patients with syphilis were seen from January 1996, to June 2000 at the Dermatological Clinic of Nippon Medical School Hospital. The frequency of syphilis among all outpatients was 0.17%, and the number of male syphilis patients was almost twice that of female syphilis patients.
Many sexual contacts (especially with female prostitutes) were considered to be the source of the infection in a large proportion of the syphilis patients. Chancres were observed in 50% of the 6 patients with primary syphilis. Macular or papular syphilide and psoriasis syphilitica were the most frequently observed symptoms in the patients with secondary syphilis. The Jarisch-Herxheimer reaction was observed in 18.8%. The titer of IgM-TPHA responded well to the therapy, and decreased or even disappeared after treatment. The titer of TPHA did not change markedly upon treatment. A retrospective study of syphilis from 1980 revealed that the incidence of syphilis, especially early infectious syphilis, in patients at our clinic has decreased markedly since 1991.

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In Japan, there are many dialysis patients because of the successful development and wide application of dialysis techniques. Almost all patients require long-term hemodialysis treatment because kidney transplantation is performed rarely. Renal hyperparathyroidism is one of the serious complications for hemodialysis patients. According to the overview of regular dialysis treatment reported by the Japanese Society for Dialysis Therapy, parathyroidectomy is required in 9.2%of patients who remain on hemodialysis more than 10 years and in 33.5%of those who so remain for more than 25 years. In this paper, we will describe the diagnosis, surgical indications, and operative strategy of renal hyperparathyroidism.
The symptoms and biochemical variables were high serum parathyroid hormone (PTH) level, hyperphosphatemia, bone and joints pain, itching, irritability, muscle weakness, severe skeletal deformity, progression of ectopic calcification, and anemia. The clinical indications for performing parathyroidectomy to treat renal hyperparathyroidism in our institute are based on the indications reported by Tominaga et al. These are 1) high serum PTH level, 2) detection of enlarged parathyroid glands, 3) detection of osteitis fibrosa cystica on radiography or detection of high bone turnover by bone metabolic markers or bone scintigram, 4) resistance of symptoms to medical treatment.
The routine operative procedure for renal hyperparathyroidism is total parathyroidectomy with forearm autograft. For autotransplantation, 30 pieces sliced 1×1×3 mm of diffuse hyperplasia are implanted into 30 pockets in the forearm without arteriorvenous (A-V) fistula for hemodialysis. In any surgical procedure for renal hyperparathyroidism, it is crucial to identify all parathyroid glands, including supernumerary glands and ectopic glands.
At the initial operation for renal hyperparathyroidism, the surgeon must remove all parathyroid glands to avoid persistent and recurrent hyperparathyroidism and choose proper and adequate parathyroid tissue for autograft.

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