Background and Aims : Histamine type 2 receptor antagonists are usually used in postoperative patients. Among these drugs, cimetidine has been reported especially to have advantages in immune function. In this study, we evaluated the effect of cimetidine in patients who had undergone operative treatment for gastric cancer by comparing with the effect of famotidine.
Materials and Methods : A total of 41 patients undergoing a distal gastrectomy with D2 lymph node dissection for gastric cancer were included in this study. Patients were divided into two groups : the cimetidine-treated group (C group, n=21) in which cimetidine was continuously administered at a dose of 800 mg/day from starting the onset of general anesthesia until 14 days after the operation, and the famotidine-treated group (F group, n = 20) in which famotidine was administered at a dose of 40mg/day in the same procedure. NK cell activity, CD3, CD4, CD8, and CD4/CD8 ratio were evaluated.
Results : In the F group, NK cell activity and CD3 levels on the first postoperative day were significantly lower compared with each preoperative level. On the other hand, in the C group, there was no significant difference between preoperative levels and postoperative levels in all of parameters.
Conclusion : It is suggested that cimetidine gives an inhibitory action for early postoperative immunodeficiency in patients with gastric cancer compared with famotidine.

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Background and Aims : Complete surgical resection of glioma is difficult due to its characteristic infiltrative proliferation. However, as the extent of resection directly affects the prognosis of the disease, we evaluated a fluorescent technique using 5-aminolevulinic acid (ALA), an intrinsic precursor of Hem, for accurate intraoperative distinction of tumor cells from normal brain tissues.
Methods : We performed intraoperative fluorescent tumor detection after administration of ALA using ALA-induced protoporphyrin IX (PpIX) as a guide in 11 patients who were preoperatively suspected to have glioma, starting in November, 2001. The extent of removal of the tumor was evaluated using contrast-enhanced MRI, and the localization ALA-induced PpIX in the resected tissues was analyzed histopathologically.
Results : Tumor tissues could be identified in 9 of the 11 patients, including subcortical areas invaded by the tumor, and the findings were useful in their resection. ALA-induced PpIX was localized in the cytoplasm of tumor cells, with no uptake being noted in normal tissue.
Conclusions : Intraoperative fluorescent tumor detection using 5-ALA was useful for increasing tumor resection, and can be performed as a useful diagnostic tool for resection of brain tumors.

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Background and Aims : A diagnostic feature of chronic myelogenous leukemia (CML) is the presence of BCR/ABL fusion genes. There are two types BCR/ABL transcripts : CML-and acute lymphoblastic leukemia (ALL) -types. ALL-type BCR/ABL transcript is detectable in approximately 50% of CML patients, and its abundance is generally less than that of CML-type BCR/ABL. However, the exact stoichiometry has not been established. In this report, we sought to quantify these two types of BCR/ ABL transcripts in patients with CML in chronic phase (CP) by highly sensitive quantitative PCR methods. Methods : We examined two types of the BCR/ABL transcripts in seven patients with CML in chronic phase using reverse transcription and real-time quantitative polymerase chain reaction (RQ-PCR). The BCR/ABL expression was normalized to the expression of GAPDH. Results : In 5 out of 7 patients, ALL-type BCR/ABL could be detected. The ratio of CML-type BCR/ABL to GAPDH ranged from 4.94 × 10^-3 to 81.8 × 10^-3, and that of ALL-type to GAPDH ranged from 0.15 × 10^-3 to 0.85 × 10^-3. Thus, ALL-type transcript levels ranged from 1.3 to 54.3% of the CML-type levels. Conclusions : In CML patients, expression of ALL-type BCR/ABL was 1 to 2 orders of magnitude lower than expression of CML-type BCR/ABL..

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Background & Aims : A new DNA polymerase activity (temporally designated-C) isolated from a rapidly growing apical tissue of cauliflower (Brassica oleracea var. botrytis) inflorescence has been characterized and compared with cauliflower DNA polymerases, -A and-B, and with DNA polymerases α, β and γ from mouse myeloma.
Methods : Enzyme activity was determined in vitro by measuring the incorporation of [³H] dTMP into the DNA polymer under a variety of conditions (inhibitor : NEM, ddTTP, template-primer utilities and so on).
Results : DNA polymerase-C from cauliflower had distinct elution pattern discriminated from these of polymerase-A and-B. Poly (rA) (dT) 10 was utilized as template effectively for polymerase-C, but no significant utilization of polymerase-A was observed. Polymerase-C was sensitive to NEM and was resistant to ddTTP.
Conclusions : These results strongly indicate that DNA polymerase-C from cauliflower is to be a new enzyme for DNA synthesis in cauliflower.

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Background and Aims : While HDL cholesterol in Gunma Prefecture was shown in 1992 to be lower than the national average, another report in 1998 showed much less difference. We clarified the cause of the discrepancy between these reports.
Materials and Methods : We studied HDL cholesterol and the prevalence of hypo-HDL cholesterolemia in Gunma Prefecture from 1993 to 2001 based on mass screening data by the Gunma Health Foundation, and trends in average HDL cholesterol from 1990 to 2000 in Japan investigated by The National Nutrition Survey in Japan.
Results : Lower HDL cholesterol in Gunma Prefecture in 1993 increased reaching the national average in 2001. HDL cholesterol also increased nationwide from 1990 to 2000. This is thought due to decreased carbohydrate intake.

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Background & Aims : We retrospectively examined the incidence of duodenal ulcers (DU) among children in Gunma prefecture over the past two decades, from 1980 to 1999, by data from Gunma University Hospital and its subsidiary hospitals, in order to test the hypothesis that the incidence of DU among children in Japan is decreasing.
Method : By our own experience and by the interview to doctors in 23 major hospitals in Gunma prefecture. In addition, to study trends in the prevalence of anti-Helicobacter pylori (HP) infection, we measured anti-HP Ig-G antibody in the serum from children who come to the Department of Pediatrics, Gunma University Hospital during the same period with a complaint because of low body height for a growth hormone secretion stimulating test.
Result : We identified 48 children with DU in 1980-1989 and 16 children in 1990-1999. The prevalence of HP antibody showed a declining trend from the 1980s to the 1990s, but there was not a statistically significant difference.
Conclusions : The incidence of DU among children in Gunma prefecture is declining recently. Further study is needed to determine whether this is due to the decline in HP infection or not.

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Background and Objectives : Shojusen is known to possess potent antioxidant activity. Reactive oxygen species are closely associated with senescence and many life-related diseases such as diabetes mellitus, cancer and arteriosclerosis. Shojusen was tested for its potential to suppress the promotion induced by ferric nitrilotriacetate (FNT).
Methods : The activity of ornithine decarboxylase (ODC) in the liver and kidney was assayed at 12 hr after ip injection of FNT. At the same time, serum enzymes, lipid peroxides and other markers were assayed to assess the magnitude of oxidative stress induced by FNT.
Results : FNT increased the ODC activity of the liver and kidney, while Shojusen suppressed the increased ODC activity to normal. Shojusen alone had no effect. FNT-induced increases in serum enzymes, lipid peroxides, urinary 8-hydroxy-deoxyguanosine and other markers were also suppressed to normal levels following Shojusen treatment.
Conclusions : The ODC activity reflects the tumor promoter activity. FNT generates hydroxyl radicals in vivo and induces oxidative stress. Antioxidants present in Shojusen may attenuate injuries of the liver and kidney induced by oxidative stress.

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Aims : We investigated the effects of intravenous administration of olprinone hydrochloride (Olprinone), a phosphodiesterase III inhibitor, early after open-heart surgery.
Materials & Methods : Thirteen adult patients undergoing cardiac surgery with a postoperative pulmo-nary capillary pressure of greater than 10mmHg were administered Olprinone intravenously at 0.3μ g/kg/ min. Hemodynamics and the plasma concentration of Olprinone were monitored throughout this study.
Results : Heart rates tended to increase immediately after administration and peaked significantly highly after 120 minutes. Systemic blood pressure tended to decrease, but, pulmonary arterial pressure remained unchanged. Cardiac output tended to increase slightly 120 minutes after administration, while pulmonary capillary wedged pressure and central venous pressure decreased significantly. The systemic vascular resistance index tended to decrease, but the pulmonary vascular resistance index remained unchanged. Although the left ventricle stroke work index tended to decrease, the right ventricle stroke work index remained unchanged. The pH and base excess increased significantly after administration. Mixed venous oxygen saturation tended to increase. The plasma concentration of Olprinone increased to effective plasma levels 60 minutes after administration, and reached twice levels of 60 minutes, 240 minutes after administration.
Conclusions : Early after open-heart surgery, intravenous infusion of Olprinone reduced both preload and afterload, and improved cardiac performance. The administration of Olprinone is effective for patients with congestive heart failure, but high-dose administration should be considered carefully for patients with hypovolemia because of potential excessive hypotension.

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Background : The so-called “rush parturition” or “parturient women with no prenatal care” were studied.
Methods : Of 2473 cases of delivery during a period of 5 years and 9 months from January, 1997 to September, 2002, 25 cases (1.01%) of parturient women with no prenatal care were studied.
Results : They consisted mainly of women aged 20-30 years with 7 cases in their 20s and 15 cases in their 30s, their mean age being 31.4 years. The proportion of multipara was overwhelmingly high. By nationality, there were 19 Japanese (76%) and 6 foreigners (24%). Transvaginal delivery was found frequently. They followed a very quick course of delivery, with the time from admission to delivery being within 10 minutes in 4 cases (16%), within 1 hour in 11 cases (44%) and precipitation delivery in 3 cases (12%). Gestosis, infections, complications in neonates (low birth weight, polydactyly, Down syndrome, stillbirth) were confirmed at a high percentage and unpaid delivery expenses were noted in 40% of them.
Conclusions : These results suggest that no prenatal care were very dangerous and risk factor for delivery. As the social background, “rush parturition” have been observed in patients with monetary problem.

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Background and Aims : We have simplified the method of cardiopulmonary bypass (CPB) from moderate hypothermia with ice slush topical cooling to normothermia without ice slush. In this study, we evaluated the hemostatic benefit of normothermic CPB.
Patients and Methods : Forty-three patients who had undergone standard coronary artery bypass grafting or single valve replacement until April 1998 to January 2001 were investigated. The hypothermia and normothermia group included 22 and 21 patients, respectively.
Results : Bleeding control time from the end of CPB to the end of surgery was significantly (p<0.01) shorter in the normothermia group than in the hypothermia group (102±17 versus 131±31 minutes). Total bleeding during surgery was significantly (p<0.01) less in the normothermia group than in the hypothermia group (328±149 versus 613±387ml). Postoperative 12-hour bleeding was less in the normothermia group (183±75 versus 248±110ml ; p <0.05). The platelet count immediately after surgery remained higher in the normothermia group than in the hypothermia group (12.8±5.3 versus 8.7±3.0× 104/mm3; p<0.01).
Conclusions : Normothermic CPB effectively shortened bleeding control time after CPB, significantly reducing intraoperative and postoperative bleeding, probably due to platelet preservation.

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Backgrounds & Aims : In daily practice, we have sometimes encountered patients with both Oketsu syndrome and livid telangiectasis on the colon mucosa detected by colonoscopy. The object of this study was to examine the relationship between livid telangiectasis on the colon mucosa and abdominal Kampo diagnosis. Methods : We enrolled consecutive 30 patients with various diseases who underwent total colonoscopy in our department. Clinical characteristics including age, sex, colon adenoma, hemorrhoids and livid telangiectasis on the colon mucosa were examined in each patient. After colonoscopy, abdominal Kampo diagnosis was determined in each patient based on medical records. Results : About half of telangiectasis-negative patients did not have the symptom of “resistance or tenderness on pressure of the para-umbilical region”, whereas all telangiectasis-positive patients had this symptom (p = 0.017). Colon polyps were observed more frequently in telangiectasis-positive patients than in telangiectasis-negative patients (p = 0.029). Conclusions : Livid telangiectasis on the colon mucosa may be related to “resistance or tenderness on pressure of the para-umbilical region” and Oketsu syndrome. Understanding of telangiectasis of the colon mucosa and Oketsu syndrome may contribute to the care of people's health. (173 words)

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Aim : We studied the relationship between Gunma University Hospital and clinics in diabetic treatment.
Methods : We analyzed the result of a questionnaires given to 27 clinic doctors who participated in our first seminar.
Results : The clinic doctors were almost satisfied with the relationship between Gunma University Hospital and their clinics, but requested quicker, and more detailed responses from Gunma University Hospital. They wanted to transfer their diabetic patients to Gunma University Hospital in any step of diabetic treatment. According to the transfer of the patients from Gunma University Hospital, some clinic doctors needed the information about the patient in advance.
Conclusions : Further questionnaires are necessary to establish a good relationship between Gunma University Hospital and clinics, since clinic doctors responding to this questionnaire, may mostly be many diabetic specialists.

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Aims and Methods : To clarify the difference of liver disease in Egypt and Japan, we analyzed fifty-seven patients with liver disease in Alexandria Armed Forces Hospital and compared with Japanese patients. All the patients were native Egyptian and already seen by another doctors in Egypt then introduced to us to obtain the second opinion. Results : Fifty-seven including 45 male and 12 female patients came to see us in the outpatient department of Alexandria Armed Forces Hospital. Mean age was 48.9 in male and 40.4 in female. Thirty-seven (82.2%) of male and 10 (83.3%) in female had anti-HCV. Fifteen of 45 male (33.3%) and 2 of 12 (16.7%) female had positive anti-Schistosomiasis antibody. All 17 patients having anti-Schistosomiasis had anti-HCV antibody including 10 Liver cirrhosis, 6 chronic hepatitis and one hepatocellular carcinoma. Mean age of patients of liver cirrhosis with co-infection with Schistosoma and HCV was 51.4 years old which is younger than those with Japan (62.5 years old, personal data). Ten anti-HCV-Ab negative patients included one Gilbert syndrome, 2 patients with autoimmune hepatitis, 3 with HBV carrier in which one patient recovered from hepatitis A and the other had fascioliasis co-infection, 2 of hepatitis A and one of each patient with liver cirrhosis and obstructive jaundice. Conclusion : Many Egyptian patients with liver disease were infected with both HCV and Schistosomiasis. Co-infection or previous infection of schistosomiasis could be a factor of progression of hepatitis C but the progression to hepatocellular carcinoma in the same situation was controversial.

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Background : The Japanese Society for Pediatric Asthma proposed a scoring system for the intensity of treatment in its guidelines for bronchial asthma published in 1998. To characterize the scoring system, we analyzed what factors had an effect on the treatment point in asthma patients, and whether the scoring system was useful for evaluation of asthma severity. Methods : We enrolled 125 children (77 boys and 48 girls, mean age± S.D. : 7.6 ± 3.4 years old) with bronchial asthma who visited our asthma clinic throughout a year (1999). We calculated the treatment points by reviewing the diary in which symptoms and treatments in each subject were recorded by his/her parents through a year. Results : Either age, gender, or type of asthma had no significant effect on either the maximum (p = 0.89) or the minimum (p = 0.15) values of the treatment point with in the study year. The component of the treatment points depended on the asthma severity. The greatest component of the maximum treatment point was the use of oral theophylline in patients with mild and moderate asthma-severity (35.7% and 26.0% of total point, respectively) whereas intravenous theophylline in patients with severe asthma. Significant determinants of maximum treatment point were the asthma severity in the preceding year (1998), that in the study year (1999) and minimum treatment point. Conclusions : Proper use of the treatment point might help physicians to provide better medical treatment in each patient.

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Background & Aims : CXC chemokine receptor 3 (CXCR3) appears to serve as a useful marker for the identification of circulating type 1 T helper cells (Th1), whereas CC chemokine receptor 4 (CCR4) is a useful marker for circulating Th2 cells. Suplatast tosilate (IPD) is a Th2 cytokine inhibitor that decreases IgE antibody levels through specific inhibition of interleukin-4 (IL-4) and IL-5 production by T cells. We examined the effects of IPD on CXCR3-or CCR4-positive cells among CD4 and CD45RO double-positive T cells (CD4-positive memory T cells) in patients with asthma. Methods : We analyzed the T cell subsets of 10 patients with stable mild asthma before and after 4 weeks of treatment with IPD (300mg/day) in a prospective single-arm study. Results : The number of CXCR3-positive and CCR4-positive memory T cells was measured by flow cytometry. There was no significant increase of CXCR3-positive T cells in the asthma patients, but the patients showed a decrease of CCR4-positive T cells and an increase in the ratio of CXCR3-positive to CCR4-positive T cells. Conclusions : These findings indicate that IPD therapy altered the balance between CXCR3-and CCR4-positive cells in patients with asthma.

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Background & Aims : Human Toll-like receptor 1 (TLR1) is a receptor which mediated immune response to microbial lipoproteins, associates with TLR2 and recognizes the native mycobacterial lipoprotein along with TLR2. Methods : We examined the regulation of TLR1 surface expression in human peripheral blood monocytes and B cells by interferon-γ (IFN-γ) and interleukin-4 (IL-4). Results : IFN-γ up-regulated TLR1 surface expression on human peripheral blood monocytes and B cells. By contrast, IL-4 down-regulated TLR1 surface expression on human peripheral blood monocytes, but up-regulated TLR1 surface expression on human peripheral B cells. Conclusions : These results indicate that Th 1 cytokine IFN-γ enhances receptors involved in the response to native mycobacterial lipoprotein and that activation of cellular immunity may enhance defense against mycobacterium through both monocytes and B cells, whereas Th2 cytokine IL-4 modulates the receptor response to native mycobacterial lipoprotein and that activation of humoral immunity may enhance defense against mycobacterium through B cells, but not monocytes.

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A 27-year-old woman underwent endoscopic partial thyroidectomy for a thyroid tumor under consideration of cosmetic effects. The tumor was 2.7cm in size with normal thyroid function. Following informed consent, an endoscopic partial thyroidectomy was successfully performed. The tumor was white-yellowish, 2.7cm in size, and partially included cystic lesions. No malignancy was histopathologically observed, and a diagnosis of adenomatous goiter was obtained. After surgery, there was no scar on the neck and the patient was satisfied with the cosmetic result.

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We report a case of peritoneal abscess due to colon penetration by a fish bone, which was preoperatively diagnosed by CT.
An 88-year-old woman referred for an abdominal tumor with dull upper abdominal pain was found in abdominal CT to have a tumor in the right upper abdomen. Gastrointestinal and colon endoscopy showed no abnormality. Following the administration of antibiotics for a right knee injury, abdominal pain improved and the abdominal tumor shrank. Follow-up abdominal CT confirmed tumor shrinkage and the presence of a calcified linear foreign body. The patient was followed up and soon after discharge, the abdominal tumor greu and abdominal pain recurred. Resection of the tumor and transverse colon showed a fish bone to be present in the abscess.

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