Because the cell membrane is an important regulator of cell function, its morphological changes are important markers of cell apoptosis. These changes can differ for each cell type, and depend on the treatment conditions, including the drug, doses, and treatment time. To quantify morphological changes, HeLa and Ishikawa cells were investigated with atomic force microscopy. Both cells were treated with cisplatin (1 mM) for 24 hours. The viability and proliferation of the cells were analyzed with methylthiazol tetrazolium method. The proliferation rates of both cells treated with cisplatin decreased more than 50%. The morphological changes induced by cisplatin were dependent on the cell type, and the results were determined quantitatively. The surface of HeLa cells became rougher with cisplatin treatment, whereas cisplatin-treated Ishikawa cells were smoother than untreated cells. In both cases, cell height was decreased with cisplatin treatment. These results suggest that atomic force microscopy can be used to analyze anticancer drug activity in cancer cells.

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Background: Misdiagnosis and inadequate treatment of lumbar foraminal stenosis (LFS) are the most common causes of failed back surgery. Although several surgical procedures have been reported, the optimal surgical treatment remains controversial.
Aim: We describe our method of microsurgical medial fenestration using an ultrasonic bone curette (Sonopet, Stryker Corp., Kalamazoo, MI, USA) to treat patients with LFS and report our early results.
Patients and Methods: We followed up 26 patients who had undergone microsurgical medial fenestration at least 1 year earlier. The patients were 15 men and 11 women with a mean age at surgery of 59.5 years; the mean follow-up period was 30.6 months. The affected nerve root was at L4 in 1 patient and at L5 in 25. Evaluation of our clinical results was based on the Japanese Orthopedic Association score.
Results: There were no intraoperative surgery-related complications. After surgery, 1 patient had recurrence of L5 radiculopathy associated with iatrogenic spondylolysis. He was successfully treated with resection of the inferior articular process without fusion surgery; there was loss of disc height without obvious instability at the corresponding level. The Japanese Orthopedic Association scores showed significant improvement at 1 month after surgery and at final follow-up (p<0.001). No patient had spinal instability or malalignment postoperatively.
Conclusions: Microsurgical medial fenestration using Sonopet, a less-invasive surgical technique that does not result in spinal instability or malalignment, yielded excellent clinical outcomes.

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Background/Aims: Because of the notion that pancreatic and duodenal homeobox 1 (PdX-1)-positive cells are pancreatic stem cells that contribute to the differentiation and proliferation of exocrine cells, we examined PdX-1-associated changes in the morphology of rat pancreatic acinar cells that occur between the late fetal and early neonatal periods.
Methods: Light and electron microscopy and PdX-1 and MIB-5 immunohistochemistry were used to examine pancreatic tissues obtained from fetal rats 22 days postconception (dpc), from newborn rats 48 and 72 hours after natural birth, and from rats 7 days after natural birth.
Results: At 22 dpc, the cytoplasm of the acinar cells was large and eosinophilic due to accumulation of dense and numerous zymogen granules. Zymogen granules, rough endoplasmic reticulum, and other organelles were distributed throughout the cytoplasm. At 48 hours, i.e., just after feeding, the cytoplasm appeared smaller, less eosinophilic, and vacuolated. Electron microscopic examination showed cleaved nuclei and fewer zymogen granules. Expression of both PdX-1 and MIB-5 was increased at 48 hours. At 72 hours, acinar cell cytoplasm was decreased in size. At 7 days, the acinar cells were larger, biphasic distribution of zymogen granules was seen on the eosinophilic apical side, and rough endoplasmic reticulum and other ergastoplasms were seen on the basophilic basal side, typical of mature pancreatic acinar cells. Expression of PdX-1 and MIB-5 was markedly decreased in acinar cells.
Conclusion: Our findings indicate dynamic PdX-1-associated morphologic change from fetal to mature pancreatic acinar cells between 48 and 72 hours after birth.

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Background: We investigated the seroprevalence of human brucellosis and risk factors in a village in Eastern Anatolia, Turkey, where a brucellosis outbreak among cattle had recently occurred.
Patients and Methods: All 501 inhabitants enrolled were screened with the Rose Bengal Test and were asked to fill out a questionnaire to determine the signs and symptoms of brucellosis and the risk factors. Patients' laboratory findings and clinical responses were also evaluated.
Results: The Rose Bengal Test was positive in 44 persons. In comparison of age groups, fever (20.2%), arthralgia (19.2%) and weight loss (8.4%) were frequently seen in children (p<0.05). Hepatomegaly (17.9%) was also prevalent in the age group of 0 to 14 years (p<0.05). The consumption of dairy products, a family history of brucellosis, and raising livestock were significantly related to seropositivity (p<0.05). Rifampicin plus doxycyline was the most common regimen administered in these cases (54.5%) and also had the highest relapse rate (p<0.05).
Conclusion: Brucellosis remains an important public-health problem in the rural areas of Turkey. Appropriate public health measures and education must be pursued to eradicate human brucellosis.

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Apoptosis can be described as programmed cell death. Apoptosis regulates cell turnover and is involved in various pathological conditions. The characteristic features of apoptosis are shrinkage of the cell body, chromatin condensation, and nucleic acid fragmentation. During apoptosis, double-stranded DNA is broken down into single-stranded DNA (ssDNA) by proteases. Acoustic trauma is commonly encountered in otorhinolaryngology clinics. Intense noise can cause inner ear damage, such as hearing disturbance, tinnitus, ear fullness, and decreased speech discrimination. In this study, we used immunohistochemical and electrophysiological methods to examine the fragmentation of DNA in the cochleas of guinea pigs that had been exposed to intense noise. Twenty-four guinea pigs weighing 250 to 350 g were used. The animals were divided into 4 groups: (I) a control group (n=6), (II) a group that was exposed to noise for 2 hours (n=6), (III) a group that was exposed to noise for 5 hours (n=6), and (IV) a group that was exposed to noise for 20 hours. The stimulus was a pure tone delivered at a frequency of 2 kHz. The sound pressure level was 120 dBSPL. No threshold shifts were apparent in group I. Group II showed a significant elevation of the hearing threshold (ANOVA, p<0.05^*). The ABR threshold level was also significantly elevated immediately after the acoustic stimulation in groups III and IV (ANOVA, p<0.01^**). In groups I, II, and IV, the lateral wall of the ear did not show immunoreactivity to ssDNA but did in group III. No immunoreactivity was apparent in the organ of Corti in group I or II. However, the supporting cells and outer hair cells in groups III and IV showed reactions for ssDNA. The fine structure of the organ of Corti had been destroyed in group IV. The lateral wall showed immunoreactivity for ssDNA only in group III, whereas the organ of Corti showed reactions for ssDNA in groups III and IV. Our study suggests that apoptotic changes occur in patients that suffer acoustic trauma. Once the apoptotic pathway has started, it is irreversible. Thus, early diagnosis and treatment are necessary. Earplugs should also be worn at rock concerts.

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Introduction: Renal replacement therapy was established in Japan approximately 40 years ago, and a blood purification unit was established in our hospital 31 years ago. With an eye toward the future, we reviewed and analyzed the practice of blood purification therapy in our hospital to date.
Methods: Patients were selected from 3 decades when therapy was performed: from October 1979 through December 1989, from January 1990 through December 1999, and from January 2000 through December 2010.
Results: The total number of patients was 1,115. The numbers of patients with stage 5D/T chronic kidney disease, with acute kidney injury, and undergoing therapeutic apheresis has increased with each decade. Diabetic nephropathy, chronic glomerulonephritis, and nephrosclerosis are the most frequent primary causes of stage 5D/T chronic kidney disease. The percentage of patients with diabetic nephropathy at our hospital has increased markedly and has recently been more than 50% and has exceeded the national average. The trends observed in our study for mean age at the start of dialysis therapy were similar to national trends. Peritoneal dialysis was started in 1999, and the percent of patients undergoing peritoneal dialysis greatly exceeded the national average. Various pathophysiologies were found to be associated with acute kidney injury and therapeutic apheresis.
Conclusion: The number of patients requiring renal replacement therapy continues to increase with the development of the hospital, especially in the Department of Nephrology. Progress in blood purification therapies is remarkable as well. To successfully address these challenges, we must strive for continued self-assessment.

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The aim of this study was to determine the factors associated with intrapartum asphyxia in singleton deliveries beyond 37 weeks' gestation. We reviewed the obstetric records of Japanese singleton deliveries after 37 weeks' gestation managed at Japanese Red Cross Katsushika Maternity Hospital from 2005 through 2010. Forty-nine cases were diagnosed as intrapartum asphyxia on the basis of an Apgar score <4 at 5 minutes or umbilical arterial pH <7.0 or both. Cases with umbilical arterial pH ≥7.1 and 1-minute Apgar score ≥7 were examined as controls (n=10,484). Logistic multivariate regression analysis showed that intrapartum asphyxia was independently associated with cases of trial of labor after cesarean delivery (adjusted odds ratio, 3.24; 95% confidence intervals, 1.0-11; p=0.04). Our findings may be encouraging for the counseling of patients regarding a possible attempt at trial of labor after cesarean delivery.

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Although hilar cholangioma is the most common cause of stricture of the hilar bile duct, several diseases can contribute to stenosis. Here, we report on a patient with immunoglobulin (Ig) G4-related sclerosing cholangitis (IgG4-SC) of the hilar bile duct arising from obstructive jaundice. The patient had undergone laparoscopic cholecystectomy for the removal of gallstones. The differential diagnosis for icterus included hilar cholangiocarcinoma, primary sclerosing cholangitis, IgG4 sclerosing cholangitis, ischemic bile duct stenosis, a complication of cholecystitis, amputation neuroma, and iatrogenic stenosis. Numerous examinations were performed, but a definite diagnosis remained elusive. Because cholangiocarcinoma could not be ruled out, we proposed surgical resection. The patient subsequently underwent extended right liver lobectomy and intrahepatic cholangiojejunostomy. Pathological examination revealed numerous inflammatory cell infiltrates resembling IgG4-positive antibody plasma cells in the stromal layer of the stenotic bile duct walls. Hypertrophy of the nerve fiber fascicles was not observed. The serum IgG4 level of the patient was within the normal range. Few reports of IgG4-SC with a normal serum IgG4 level have been published. When this condition presents as it did in the present case, establishing a definite diagnosis can be difficult.

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Solitary fibrous tumor is a rare neoplasm, which was first described as a primary spindle-cell tumor of the pleura, is a type of mesenchymal tumor. Although the majority of these tumors originate in the pleura, they can also derive from extrapleural sites, such as the liver, lung, abdomen, and extremities. We report a rare case of a nasal solitary fibrous tumor that originated from the nasal superior turbinate. The tumor, measuring 45 × 25 × 10 mm, was in the right nasal cavity. We successfully removed the tumor in one piece through endonasal endoscopic surgery. The tumor had spindle-shaped cells within a collagenous stroma and was positive for CD34. There has been no evidence of tumor recurrence in the 14 months following surgery.

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Standard surgical methods for managing true aneurysms of the deep femoral artery have not been established because these aneurysms are rare. An 85-year-old man, who had a ruptured aneurysm of the deep femoral artery, underwent aneurysmectomy and distal reconstruction with a contralateral autologous vein graft. Three-dimensional computed tomography is a valuable diagnostic modality to evaluate synchronous aneurysms and peripheral arterial circulation for treatment planning. Because of their etiology, aneurysms of the deep femoral artery should be treated with revascularization when technically feasible, even if the superficial femoral artery is patent. A contralateral saphenous vein may be the preferred conduit because ipsilateral venous stasis is likely.

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A 58-year-old man was admitted to our hospital because of dyspnea, dysphagia, and back pain. A chest roentgenogram showed bilateral pleural effusion. Bloody fluid was aspirated via thoracocentesis, but no malignancy was detected on cytological examination. Computed tomography revealed a hypodense circular mass approximately 8 cm in diameter with well-defined margins in the posterior mediastinum. Furthermore, T2-weighted magnetic resonance imaging showed the lesion to be a hyperintense mass. Video-assisted thoracoscopic surgery was performed, and the tumor was diagnosed as a mediastinal cystic hemangioma. The bilateral bloody pleural effusion was attributed to the cystic tumor.

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Dedifferentiated liposarcoma of the mesentery is an extremely rare tumor.
A 71-year-old man with a 2-month history of abdominal distention was admitted to our department for evaluation and treatment of an abdominal mass. Computed tomography and magnetic resonance imaging revealed an 11 × 9 cm mass lesion with fat density in the upper right abdominal cavity, displacing the ascending and transverse colon ventrally. Abdominal angiography showed small feeding vessels of the tumor from the ileocolic artery and the middle colic artery. On basis of these findings, liposarcoma arising from the mesocolon ascendens was diagnosed, and complete removal of the tumor and central pancreatectomy (partial resection of the body of the pancreas) were performed. The histopathological diagnosis was dedifferentiated liposarcoma, and the patient is free from recurrence 6 months after surgery. The treatment strategy for abdominal dedifferentiated liposarcoma is surgical resection with a wide surgical margin.

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