Parathyroid hormone (PTH) and calcitonin (CT) are known to affect not only bone tissue but also dentine tissue. In the mechanism of action of these hormones on bone tissue, involvement of adenylate cyclase-cAMP system has been reported. However, studies of the mechanism of these hormones on dentine tissue remain insufficient. In the present study, using TCA extraction and double antibody RIA, the content of cAMP in dentine pulp tissue was shown to be much higher than that in the serum. Using dental pulp cells obtained from rabbits of 600 g body weight and cultured for 4 days, which abounded in odontoblasts, cAMP levels in the culture media after 30 minutes' contact with hormones were examined. PTH, at 0.01-1.0μM, increased cAMP levels significantly in a concentration-dependent manner. CT and Parotin, on the other hand, did not influence cAMP levels when added separately. However, when PTH (1 μ M) and CT (10μM) were added together, the increase of extracellular cAMP caused by PTH was inhibited by about 50%, indicating a possible interaction of these hormones in the signal transduction in the odontoblasts.

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The aim of this study is to assess the potential utility of gadolinium-enhanced three-dimensional MR angiography (3D MR angiography) for arterial catheterization of hepatic tumor. Thirty-five consecutive patients with suspected abdominal tumors underwent MR angiography with a gadolinium-enhanced 3D fast gradient echo sequence. Visualization of the vascular tree of visceral arteries, and their variations, the apparent length of common hepatic artery (CHA), and the tilt of celiac trunk were prospectively evaluated by 3D MR angiography. The results were compared with those obtained by the conventional angiography. In 27 patients with hepatic tumors, the prospective planning with 3D MR angiography was compared with the actual catheterization. Celiac trunk, CHA, and superior mesenteric artery (SMA) were visualized on 3D MR angiography in all 35 patients. There was a significant linear correlation of the length of CHA and the tilt of SMA as measured by 3D MR angiography and conventional angiography (r=0.75, r=0.64, respectively). The 3D MR angiography provided useful clinical information for planning of arterial catheterization in all 27 patients with hepatic tumors. Thus gadolinium-enhanced 3D MR angiography is considered to be of value for the planning of arterial catheterization of hepatic tumor.

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Thirty-six patients with intermediate-grade non-Hodgkin's lymphoma (NHL), ranging in age from 16 to 69 (median 52) years, were treated with cyclophosphamide, vincristine, prednisolone, bleomycin, doxorubicin, and procarbazine, followed by mitoxantrone, etoposide, vindesine, methotrexate with leucovorine rescue, and prednisolone (COPBLAM/MEVMP). Twenty-five patients (69%) achieved a complete remission (CR). The five-year survival rate and event-free survival rate (EFS) were 56% and 42%, respectively. A high survival rate was obtained in the low and low intermediate groups compared with the high and high intermediate groups (71%vs. 33%) according to the International Index. Major toxicities, which were dominant in the MEVMP regimen, were myelosuppression and stomatitis, but these were tolerable. COPBLAM/MEVMP seems to be an effective regimen for NHL.

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The advantages of laparoscopic cholecystectomy (LC) over open cholecystectomy (OC) seem to be related to the lesser surgical trauma. The objective of our study was to determine whether or not cholecystectomy leads to the release of interleukin (IL) -6 and C-reactive protein (CRP), and to compare the parameters in patients treated with LC and with OC. We compared the levels of IL-6 and CRP in LC patients (n=10) with those in OC patients (n=10). The level of IL-6 in OC was significantly higher than that in LC after operation. The level of CRP in OC was significantly higher than that in LC after operation. There was a correlation between the operation time and CRP level at 36 hours postoperatively in LC. LC is less stressful than OC in terms of the acute phase inflammatory response. Even in laparoscopic surgery, however, prolonged operation seems to increase the surgical stress.

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We clinically examined 56 patients with metastatic liver cancer who received hepatic arterial infusion chemotherapy via a reservoir at the Department of Surgery, Public Fujioka General Hospital between January 1989 and March 1999. There were 28 males and 28 females. Patient ages ranged from 40 to 83 years, with a mean of 64.1 years. Primary cancers consisted of colorectal cancer in 34 patients, gastric cancer in 8 patients, gallbladder cancer in 4 patients, breast cancer in 4 patients, leiomyosarcoma in 2 patients, pancreatic cancer in 1 patient, bile duct cancer in 1 patient, ampullary carcinoma in 1 patient and ovarian cancer in 1 patient. Thirty-one patients had simultaneous lesions, while 25 patients had metachronal lesions. A catheter was inserted under laparotomy in 25 patients. A catheter was percutaneously inserted through the femoral artery in 31 patients. Agents included 5-fluorouracil (5-FU), epirubicin hydrochloride (EPI) and mitomycin-C (MMC). There were no serious complications.
In 42 patients who received hepatic arterial infusion chemotherapy excluding patients who underwent surgery for metastatic liver cancer and patients who died of other diseases, the mean survival was 421.1 days. When response was evaluated, complete response (CR) was achieved in 3 patients, partial response (PR) in 12 patients, no change (NC) in 11 patients and progressive disease (PD) in 16 patients. The response rate was 35.7%. One-year, 2-year and 3-year cumulative survival rates were 59%, 23% and 8%, respectively. These percentages in the hepatic arterial infusion chemotherapy group were higher than cumulative survival rates in the systemic chemotherapy group and the untreated group. Therefore, hepatic arterial infusion chemotherapy may prolong survival.

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Traditional methods for treating adult groin hernia are accompanied by postoperative pain and the risk of recurrence for laceration due to sutures of the fascia. Tension-free hernioplasty techniques have been recently proposed. Laparoscopic hernioplasty is ideal for the tension-free method, but it requires special laparoscopic techniques and items. In addition, high cost and general anesthesia are overloaded to patients. We treated 24 patients using mesh-plug hernioplasty, a new tension-free method from June 1997 to June 1999. In this method, a plug constructed by a polypropylene mesh (Marlex®) is inserted into the fascial defect and the posterior wall of the inguinal canal is covered with an onlay patch under epidural or spinal anesthesia. Comfort, rapid rehabilitation, lower cost, and diminished complications are the benefits of the mesh-plug procedure. Mesh-plug hernioplasty is available for ambulatory surgery, and will be recommended for ordinary surgery of groin hernias.

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The urinary incontinence in radical prostatectomy partly arises from the damage to the external urethral sphincter during the operation. The present study demonstrated that, as a means of preventing the damage to the sphincter, the prostate shape and the external urethral sphincter could be preoperatively identified using magnetic resonance (MR) imaging. Five necropsy specimens were examined. MR images were obtained in the sagittal plane, and the specimens were then cut and macroscopically examined. Two prostate shapes, croissant and doughnut, were easily identified by both methods. In the four croissant-shaped prostates, the external urethral sphincter was very well developed at the anterior surface of the prostate gland, and the membranous urethra was long. On the other hand, in the doughnut-shaped prostate it developed anteriorly and posteriorly, and the membranous urethra was short. Knowledge as to the prostate shape and the urethral sphincter acquired by MR imaging can help the surgeon to preserve the external urethral sphincter during prostatectomy

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The purpose of this study is to identify the changing role of public health nurses working for public health centers, and their challenges after implementation of the Community Health Act. A questionnaire was mailed to chief public health nurses at 493 prefectural health centers, and replies were received from 347 centers (response rate of 70.4%). The results of this survey were as follows ;
1) Changes in organization and job descriptions improved the specialization and consistency of their activities. Comprehensive understanding of the community by each public health nurse, on the other hand, has become more difficult to attain.
2) In health-related activities, the challenges are provision of specialty services, investigational research for better understanding of community needs, and improvement of home care services.
3) Support services to cities and towns should be take the form of collection, maintenance analysis, and supply of information and provision of advice for program evaluation, rather than through direct support activities.
The challenges for the future are :
1) comprehensive understanding and support of the cities and towns and
2) reinforcement of program evaluation and investigational researches.

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The purpose of this study is to identify the changing role of public health nurses working for cities and towns, and their challenges after implementation of the Community Health Act. A questionnaire survey was conducted among chief public health nurses in 3, 189 cities and towns (excluding designated cities, kernel cities, and ordinance-designated cities), with replies from 2, 208 cities (response rate of 69.
2%). The results of the survey were as follows :
1) Restructuring was performed in 950 cities and towns (43%), including merger of public health and social welfare services, deployment of public health nurses in the social welfare department, and establishment of a care insurance section.
2) The core activities are planned to be health promotion, development and support of citizens' organizations, and home care services.
3) Requests for public health centers in supporting cities and towns include adjustment of services across broader geographical areas and support of difficult cases.
The future challenges are : 1) increased collaboration with social welfare and other services, 2) restructuring and efficiency improvement of current programs, taking care insurance and other municipal plans into consideration and 3) program evaluation and investigational research.

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A 33-year-old woman, a native of Thailand who was employed as a bar girl, complained of high fever, cough and dyspnea and was admitted to our hospital on 26 February 1999. In the course of hopitalization, infection by human immunodeficiency virus 1 was evidenced by a cell immunity study. Laboratory results and clinical symptoms strongly suggested Pneumocystis carinii pneumonia, and then sulfomethoxazole / trimethoprim (Baktar) and adjunctively corticosteroids were used. Clinical symptoms and chest X-P findings had improved by 23 March 1999, and the patient was discharged on 29 March.

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The first case of living-related liver transplantation (LRLT) in Gunma Prefecture was successfully performed. The recipient was a 16-year-old man with Type II citrullinemia in a stable condition who had recovered from fulminant hyperammonemia and encephalopathy and was being well-managed with protein restriction and phenylacetate administration. His father was finally selected as the donor because he was ABO/HLA compatible, negative for lymphocyte crossmatch, and genetically proven heterozygote, and an optimal graft-to-recipient weight ratio (GRWR ; 0.95%) was estimated with a low rate of hepatic resection (29%) for extended left hepatic lobe graft. The extended left lobe graft with the middle hepatic vein was uneventfully obtained from the donor without hepatic vascular occlusion. The actual graft weight was 370 g and GRWR was 0.86%. After taking out the recipient's whole liver and constructing a temporary portosystemic shunt between the right portal branch and the suprarenal inferior vena cava, the graft was transplanted using the piggyback method. The hepatic artery was reconstructed using a microsurgical technique. Cold and warm ischemic times were 82 and 41 minutes, respectively. The donor was discharged 10 days after surgery, and resumed his job. The recipient was discharged 50 days after transplantation, and is doing well.

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We performed a living-related liver transplantation (LRLT) using a graft from the heterozygote father. Serum amino acid concentration was normalized within a day after transplantation without protein restriction and medication, and amino acid injection was started three days after transplantation. LRLT is still the major form of liver transplantation because of the scarcity of a cadaver donor pool in Japan. LRLT using a graft from a heterozygote donor might be a permissible treatment for Type II citrullinemia. Long-term observation may be necessary to reach a definite conclusion possible. We also discuss postoperative management of the patient.

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Ductal carcinoma in situ (DCIS) of the breast has become a relatively common disease in women, while it remains a rare disease in men. We described a case of DCIS in a 67-year-old man. The patient had have a painless, defined, elastically firm and even tumor without skin retraction at his left retroareolar region. After excisional biopsy, he underwent mastectomy with dissection of axillary lymph nodes. All lymph nodes sampled were negative. The patient is free of disease without adjuvant-therapy at present.

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