【背景】近年胃の発癌因子としてHelicobacter pylori (以下H. pylori) の感染が広く認知されてきたが, 感染者のうち胃癌に進展するのは僅かな例である.【目的, 方法】H.pylori感染胃癌例の個体差を明らかにするため年齢, 性別, 胃癌の分化度, ABO式血液型について検討を行った.【対象】1996～2000年に診断が確定している胃癌例113例, 胃・十二指腸良性疾患18例を対象とした.【結果】男性の H.pylori陽性は分化型が, 陰性例は低分化型が多く, 女性ではその逆の傾向がみられた.H. pylori陽性胃癌, 胃十二指腸良性疾患例では血液型比率は日本人における比率とほぼ同様であったが, H. pylori陰性胃癌ではA型が減少しAB, O型が増加する傾向がみられた.【考察】H. pylori感染と胃発癌における決定的な相関を有する因子は認められなかったが, 男女差, 血液型で一定の傾向が認められた.予防医学的見地からも胃発癌性の個体差の解明が必要と考えられた.

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Background & Aims : Phospholipase D (PLD) hydrolyzes phosphatidylcholine and produces lipid second messengers including phosphatidic acid (PA) and diacylglycerol (DG). Although cellular PLD has recently been recognized as an important signal-transmitting enzyme, the roles of PLD in pathophysiological conditions are largely unknown. The aim of this study is to elucidate the roles of PLD in the production of reactive oxygen metabolites in experimental rat colitis.
Methods : Colitis was induced in rats by oral administration of dextran sulfate sodium. Luminol amplified chemiluminescences of the colonic mucosa and polymorphonuclear leukocytes were both measured.
Results and Conclusions : Oleate-dependent PLD was activated in the colitic mucosa. Chemiluminescence and myeloperoxidase activity of the colitic mucosa were significantly higher than those of the control normal mucosa. Preincubation of the mucosa in vitro with PLD, PA, or DG significantly enhanced chemiluminescence of the colitic, but not of normal mucosa. On the other hand, administration of glycerol, which inhibits the production of PA and DG by PLD, significantly decreased chemiluminescence induced by exogenous PLD. In rat polymorphonuclear leukocytes suspension, the addition of PLD, PA, or DG significantly increased chemiluminescence and propranolol significantly decreased the chemiluminescence induced by both PA and DG. These results suggest that PLD in neutrophils may be relevant to the production of reactive oxygen metabolites in experimental rat colitis.

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Background & Aims : Myosin II is a typical motor protein and is classified either as non-regulated myosin, for example, skeletal muscle myosin, or as myosin regulated by phosphorylation or Ca-binding. Myosin II from Physarum polycephalum is a Ca-binding myosin. Although expression of myosin II as a recombinant protein is essential for the analysis of its structure, function and regulation, it is not easy. Successful examples are smooth muscle myosin II and Dictyostelium myosin II, both of which are regulated by phosphorylation. Myosin II regulated by Ca-binding has not yet been obtained. Here, I report the expression of heavy meromyosin (HMM), i.e., the motor domain of Physarum myosin II.
Method : I used baculovirus expression system. Sf9 cells were infected with the virus constructs.
Results and Conclusions : The recombinant HMM showed basal Mg²⁺-ATPase activity, which was activated by actin to a similar extent to native myosin purified from Physarum. Ca-binding activity of HMM was also comparable to that of the native myosin. In vitro motility assay showed that motor activity of HMM was sensitive to Ca²⁺. The present study is the first report of expression of the motor domain of a myosin II that is regulated by Ca-binding.

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Backgrounds & Aims : Most medical schools have acknowledged the importance of medical ethics education. Yet the methodology for such an education has to be established.
Methods : We used an 8-item questionnaire to survey the needs and expectations of medical students with regard to their medical ethics class.
Results : One hundred and nineteen first-year students voluntarily responded to this survey. Students from two different school years gave considerably similar responses. The opinions of many students were as follows : the medical ethics class should be offered, necessary and sufficient hours for such a class would be two or four semester hours, the course should not follow the National Examination for Physicians format, sessions consisting of both lectures and discussions are desirable, and the course should start in the first grade. They felt that a clinical doctor, a philosopher interested in medicine, or a medical professional who has studied philosophy and ethics would be most appropriate as the teacher in charge. The teachers' roles anticipated were to introduce actual ethical problems in a clinical setting, to provide coordinate axes for the opinions and values of each students, and to instigate arguments.
Conclusions : The items that provide the key to a plethora of medical ethics education concerns are 1) the cooperation between clinical doctors and philosophers and ethicists, 2) the introspective discussion oriented class format, and 3) an acceptance and ensuring of divergent perspectives.

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【背景・目的】腎尿路疾患の早期発見を目的に3歳児健診時に検尿を実施する自治体が増加している.尿異常を指摘された児については, 負担のない検査で鑑別診断を行う必要がある.【対象と方法】対象は1995年6月より2001年5月までの6年間に, 3歳児健診で尿異常を指摘されて群馬県立小児医療センター腎臓内科を受診した104例である.血尿単独症例が87例と最多であり, 血尿蛋白尿症例が1例, 蛋白尿単独症例が6例, 白血球尿症例が10例であった.【結果】血尿単独症例の臨床診断は無症候性血尿が78例, 良性家族性血尿が7例, ナットクラッカー現象が1例, 特発性高カルシウム尿症が1例であった.無症候性血尿症例のうち4年以上経過を観察し得た35例中17例で血尿が消失した.血尿蛋白尿症例は紫斑病性腎炎と推定された.蛋白尿単独症例は6例中4例がネフローゼ症候群であり, 尿細管性蛋白尿と矮小腎が各1例であった.白血球尿症例は全例が女児であり, 陰門膣炎が6例, 異常なしが4例であった.【結語】3歳児の無症候性血尿症例の中には加齢に伴なって血尿が消失する例が少なからず存在するため, 過剰な管理は行わずに就学時まで経過観察すべきである.蛋白尿単独症例はネフローゼ症候群か先天性腎尿路疾患の可能性が高いため要注意である.女児の白血球尿は外陰部の炎症によるものが多い.

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Background & Aims : Prokinetics have been used in combination with polyethylene glycol electrolyte lavage solution (PEG-ELS) to reduce the volume of lavage solution and to ensure the preparation. However, prokinetics sometimes accompany troublesome side effects including fatal ones. The aim of this study is to elucidate the usefulness of mosapride citrate, which has fewer side effects, for colonoscopy lavage preparation.
Methods : Eighty-two patients were randomly assigned to receive 2, 000 ml of PEG-ELS with sennoside (control group) or 1, 500 ml of PEG-ELS with sennoside and mosapride citrate (mosapride group). Colonoscopists blinded to group assignment scored the adequacy of colon cleansing. Time to lavage solution ingestion, time and number of motions to the appearance of clear excretion, and side effects were recorded.
Results and Conclusions : The mosapride group had a favorable trend in the overall colon cleansing and a significant superiority in the residual foam over the control group. Side effects had a tendency to be less frequent in the mosapride group. Time to lavage solution ingestion was significantly reduced in the mosapride group. Mosapride citrate coadministered with sennoside and 1500 ml of PEG-ELS is applicable to bowel preparation with favorable colon cleansing and good patient acceptability.

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Background & Aims : To evaluate the effects of cryopreservation and setting an eye on changes in the blood Estradiol (E₂), Progesterone (P₄) levels and thickness of the endometrium before and after the transfer.
Methods : We studies whether these parameters can give us a clue to the mechanism leading to implantation and pregnancy from January 1999 to December 2000, 269 patients underwent 860 thawed embryo transfers.
Results and conclusions : 57 out of 269 cases achieved pregnancy, the pregnant rate being 21.2%. Abortion occurred in 23 cases, the abortion rate being 40.3%. No significant difference was found in mean age, mean number of embryo transfer, total score of embryo transfer in the Veeck's classification and mean score of embryo transfer between the pregnant and non pregnant cases. Pregnant cases tended to have many embryos of high grade transferred. No significant difference was found in blood E₂, P₄ levels and thickness of the endometrium in the pregnant and non pregnant cases.
There was no difference in mean age, mean number of embryo transfer, total score of embryo transfer in the Veeck's classification, mean score of embryo transfer and number of grades between the pregnant continuation cases and abortion cases. The cases of abortion showed a relatively high blood E₂, level compared with the cases of clinically continued pregnancy. No difference in the blood P₄ level and thickness of the endometrium was found between the two. The changes in these parameters can be used a guide in predicting prognosis of the pregnancy.

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Background & Aims : Although aortic valve replacement (AVR) is the only effective treatment for patients with aortic stenosis (AS), it is generally recognized that the surgical risk increases with age.
Methods : We examined the outcome of surgical management for AS in patients above 70 years of age in comparison with younger ones to determine whether age was a risk factor.
Results : We obtained relatively good results in 3-and 5-year mortality (17% and 25%) in the elder group which were not significantly different from the younger group (5% and 13%). Perioperative factors were not significantly different between the two group. Elderly patients had significantly smaller body surface areas (BSAs) (1.43 ± 0.15 vs. 1.53 ± 0.16m²) and smaller valves (20.5 ± 1.8 vs. 22.0±2.0mm). The age was significantly correlated with the BSA (correlation coefficient=-0.433, p<0.001) and the valve size (Spearman's σ=-0.414, p<0.005). The valve size was also significantly correlated with the BSA (Spearman's σ=0.612, p< 0.0001).
Conclusions : The risk of AVR in patients with AS was not significantly increased by age and AVR may be performed with good results in both short-and long-term outcomes.

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症例は67歳女性.交通外傷を契機に偶然発見された肝外発育型海綿状血管腫の1例を経験した.腹部CT, MRI, 上部消化管造影で胃の粘膜下腫瘍が疑われたが, 腹部血管造影で肝外発育型の肝血管腫と診断された.広範囲に突出している肝外発育型海綿状血管腫は破裂の危険もあり, 肝外側区部分切除を施行した.腫瘤は5.5×5.0×5.0cm大で重量は50gで, 病理組織学的に肝海綿状血管腫と診断された.肝海綿状血管腫は肝良性腫瘍の中で最も高頻度にみられるが, 肝外発育型は稀である.

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膵のsolid and cystic tumor (以下SCT) の1手術例を経験した.症例は14歳女性.上腹部腫瘤を主訴に近医より紹介され来院した.CTおよびMRで膵体尾部の嚢胞性腫瘍を認めた.腹腔動脈造影では膵体尾部に異常新生血管の増生と濃染する腫瘤が認められた.以上の所見より膵のSCTの術前診断で手術を施行した.腫瘍は膵体部から前下方へ発育し, 8.0×12.0×12.0cm大であり, 膵実質への浸潤はなく腫瘤のみ摘出できた.切除標本割面は厚い線維性被膜を有し比較的柔らかく, 充実性の部分と嚢胞部分が混在していた.病理組織学的にSCTと診断された.

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21世紀の国民病といわれる肝臓病は, ウイルス肝炎, 特にC型肝炎が慢性肝炎, 肝硬変, 肝癌と進展する一連の疾患であることが臨床的に明らかとなり, 肝癌の早期診断, 治療, さらに予防の必要性が高まっている.1999年には肝癌による死亡者は3万3千人を超え, 癌の中では肺癌, 胃癌に次いで3位であり, B型肝炎も含めるとウイルス性肝疾患患者数は3百万人を越えると言われている.今後日本の肝癌は2015年まで上昇を続け, その後減少するが, 欧米はそれに遅れて増加すると予想されており, 内外からの治療, 予防の需要が増加している.我々第一内科肝臓研究グループは慢性肝炎の治療から, 肝硬変, 肝癌の診断と治療さらに肝発癌のメカニズムに迫るべく基礎実験から臨床治験を重ねてきた.その一端をここに報告する.

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