Background & Aims : SHPS-1 is a transmembrane protein that binds the protein tyrosine phosphatases SHP-1 and SHP-2 through its cytoplasmic region. It is highly expressed on the surface of CD11c⁺ dendritic cells (DCs) and macrophages. We have recently shown that priming of CD4⁺ T cells by DCs is markedly impaired in mice that express a mutant form of SHPS-1 lacking most of the cytoplasmic region. We have now evaluated further the functions of CD4⁺ T cells derived from SHPS-1 mutant mice. Methods : The expression of cell surface molecules on CD4⁺ T cells was examined by flow cytometry. The proliferation of CD4⁺ T cells was measured by [³H] thymidine incorporation. Cytokine production by CD4⁺ T cells was measured by ELISA. Results : SHPS-1 is expressed at low level on CD4⁺ T cells of wild-type mice. The T cell receptor (TCR)-stimulated proliferation of CD4⁺ T cells from SHPS-1 mutant mice was markedly decreased, whereas the TCR-stimulated production of IL-2 and IFN-γ by these cells was markedly increased, compared with those apparent with wild-type cells. Differentiation of CD4⁺ T cells from SHPS-1 mutant mice into Th1 cells was also impaired. Conclusions : Present results suggest that SHPS-1 is essential for proper regulation of CD4⁺ T cell functions.

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Background : Focused assessment with sonography for trauma (FAST) is useful for detecting hemoperitoneum (HE) in trauma patients in the emergency room (ER), but, patients' condition cannot be evaluated adequately by FAST alone. CT is useful for the diagnosis of multiple trauma, but has certain drawbacks. We evaluated the utility of mutidetector computed tomography (MDCT) as the initial tool for proper diagnosis and treatment planning of multiple trauma patients. Method : We retrospectively analyzed 128 cases treated in ER of Gunma University Hospital between April 1, 2005 and December 31, 2006, and they were hospital patients were hospitalized with blunt multiple trauma. We analyzed the sensitivity, specificity, and accuracy of FAST, compiled MDCT finding, lifesaving treatment, and outcome. Result : Eight patients were FAST positive, and 7 of the 8 were scanned by MDCT. There were 120 patients were FAST negative patients, 23 of the 120 were MDCT-negative, despite visceral injury, however 9 of the 120 had visceral injury by MDCT findings. Damage control surgery without MDCT was performed in one case, but the patient died after surgery. Six of the patients in the HE-positive group had really HE. One of the 6 died while a waiting surgery, transcatheter arterial embolization (TAE) was performed in three patients, and one person out of the 3 died. The course of the remaining 2 patients was monitored, and they are alive. A patient in the HE-negative group with bladder rupture required surgery. There were 120 patients in the FAST-negative group. One of the 6 patients in the HE-positive subgroup died while a waiting surgery. One patient required chest and pericardial drainage. TAE was performed in 2 patients, and the remaining 6 were monitored and are alive. There were 23 FAST-negative patients patients who had visceral injury. Five of them required chest drainage, one received TAE, 17 were monitored, and all of the 23 are alive. There were 14 cases of pelvic fracture alone, and all of them were FAST-negative. One patient required surgery for open femoral fracture, TAE was performed in three, 10 monitored, all 14 are alive. Only one patient developed shock during MDCT. The others underwent scanning safely. Conclusion : MDCT is a better tool for the diagnosis of blunt multiple trauma of the trunk than CT, because the scanning time is shorter.

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Background : In our previous study, we investigated the effect of gargling with various gargles in reducing oral bacteria and Candida. In this paper, we investigated the oral bacteria and Candida decreasing effect of toothbrushing, toothpaste and gargling with 3 % povidone-iodine after toothbrushing. Methods : Fifteen health volunteers were applied to the following examination. We compared three processes. 1) only toothbrushing 2) toothbrushing with toothpaste 3) Gargling with 3 % povidone-iodine after toothbrushing. Saliva was harvested as specimen before and after oral care methods, and cultured. The number of bacteria and Candida colonies detected were compared. Results : Oral bacteria were detected in all specimens before oral care methods, and decreased in 73.3∼84.0% of specimens after oral care methods. Candida were detected in 23.1∼33.3% of specimens before oral care methods, and decreased in 33.3∼60.0% of specimens after oral care methods. Conclusions : Gargling with 3 % povidone-iodine after toothbrushing was the most effective in decreasing oral bacteria and Candida.

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Percutaneous epiduroscopy is a minimally invasive technique for the examination of the epidural space and which allows the diagnosis and the treatment of chronic back pain and radiculopathy. In the present study, epiduroscopy was operated on 16 patients with the aim of comparing the lumbar epidural space of the patients with chronic and complicated low back pain that are refractory to conventional pain managements. In 11 patients, we identified inflammatory coloring around the diseased nerve root. In 6 patients, hard connective tissue adhesion was apparently observed. Two of them have had spinal surgery in their histories. All sixteen patients experienced significant pain reduction after epiduroscopy. The duration of the effect was 2-8 weeks. Epiduroscopy is considered to be effective for the patients with chronic low back pain that is resistant to medication or nerve blocks.

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Background & Purposes : Passive static stretching plays an important role in maintenance of healthy musculoskeletal systems. To establish a possibly ideal protocol for the exercise management, duration and frequency of the stretching of the exercise were examined in combination with thermo therapy. Subjects and Methods : In 22 healthy undergraduate students statistic stretching was performed five times for repeated 10 seconds (5×10 group) in half, and once for 50 seconds (1×50 group) in others. In both groups the same exercise was done in combination with thermo therapy one week later. The straight leg raising (SLR) angle and the stretching strength calculated from Hand-held dynamometer were evaluated before and, immediately and 10 minutes after stretching. Results : SLR angle and the stretching strength were augmented immediately after stretching significantly in subjects receiving the exercise in 5×10 group but not in 50×1 group. Thermo therapy did not enhance the efficacy of the stretching. There was significant correlation between the augmented rate of SLR angle and that of stretching strength in 10×5 group. Consideration : To improve the SLR angle statistic stretching five times for repeated 10 minutes may be recommended better than once for 50 minutes, and the effect might be due to neurophysiological factors.

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Aims : The treatment of oral malignant tumors cause not only disorders of essential functions such as swallowing, articulation and respiration, but aesthetic disorder of face showing personal identity. Therefore, more stable and qualitative treatment is demanded for oral malignant tumors. The aim of the present study is to analyze the treatment of oral malignant tumors. Subjects and Methods : A clinico-statistical investigation was carried out with 46 oral malignant tumor patients in the Department of Oral and Maxillofacial Surgery, Gunma University Hospital between January 2001 and December 2003. Results : The most common age group of the patients was 60-69, which accounted for 39.1% of all patients, and the frequency of senior patients aged 50-79 accounted for 82.5%. The primary tumors in tongue (16 ; 34.7%) and in maxillary and mandibular gingiva (22 ; 47.7%) were most common. Forty patients (86.9%) were diagnosed squamous cell carcinoma (SCC) pathologically. In the staging of the patients with SCC, stageIIcases (17 ; 42.5%) were most frequency. The treatment strategy for oral SCC consisted of surgery mainly, and of adjuvant radio/chemo therapy. The 5-year cumulative survival rate for oral SCC was 71.0% in all cases, 80.0% in stageI, 85.0% in stageII, 57.0% in stageIIIand 33.0% in stageIV. Conclusions : Because of the tendency for the oral malignant tumors to increase in senior patients, it is thought to be important for the treatment strategy to consider the general condition and complication of the patients.

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Objective : The purpose of this study was to clarify the self-care characteristics of pregnant women with no access to a medical institution. Methods : Nine mothers who lived on remote Okinawan islands and had given birth within the past year were interviewed about self-care during pregnancy by a semi-structured method, and the results were analyzed. Results : The subjects were conscious of their health and had been able to manage it themselves. "Obtained information from every source by myself, and thought and acted by myself to prevent problems and to maintain a normal pregnancy" : was the reply they selected to describe their self-care during pregnancy. Conclusions : Four supports were suggested by the results of the analysis to improve the self-care ability of pregnant women : promoting women's conscious interest in their body and ability to judge their physical condition themselves, providing an evaluation of their self-care from a professional viewpoint ; helping them to be able to get cooperations of their husbands : and providing individual and concrete information.

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Background and Aims : Recently, it was reported that metabolic syndrome (MS) is related to the large intestinal neoplasm. Therefore, we studied the relationship between MS and the colonic neoplasm using our original scoring system, i.e., the Gastrointestinal Metabolic Syndrome Score (GIMS). Patients and Methods : The participants were medical examinees who underwent total colonoscopy (CS) from January to December 2006. Regarding body mass index, blood pressure, triglyceride, high density lipoprotein cholesterol and fasting blood sugar results in each case, we referred to the criteria of MS and scored them from 0-2 (0 : normal range, 1 : aberration minor, 2 : aberration). We added up the values to calculate the GIMS. We defined neoplastic lesions as adenoma or adenocarcinoma. When we found a neoplastic lesion in CS, we examined the case using the GIMS. Results : The average of GIMS in the neoplastic cases was significantly higher than that of the non-neoplastic cases (p<0.05). Considering the higher rate in the efficiency and in the therapeutic patients, we decided that the positive standard was two or more scores in GIMS. Conclusions : GIMS is easily calculated and can be used to support diagnosis of large intestinal neoplasm in the future.

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[Objective] This study was aimed to compare the characteristics of fatigue between cancer patients during the treatment/chronic phase and patients who were initially diagnosed with conditions other than cancer. These included patients who presented at the Department of General Medicine, patients without a history of cancer or in whom cancer was not suspected. [Subjects and Methods] Valid replies to a questionnaire obtained from 283 and 353 patients with and without cancer, respectively, were compared using a t-test. Fever, nausea, diarrhea, sleep disorder, pain and dyspnea were assessed in addition to fatigue, which was assessed using the CFS. [Results] Fatigue significantly differed from the presence of the other symptoms among the cancer patients, whereas only fever and sleep disorder significantly differed among the non-cancer patients. Among the latter, fatigue obviously hindered routine activities regardless of other symptoms, yet only 4.8% described fatigue as the chief complaint. [Conclusion] Fatigue experienced by the cancer patients reflected the degree of control over the other symptoms. That the severity of fatigue is high in non-cancer patients should always be taken under consideration, even if they do not describe fatigue as the chief complaint.

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[Purpose] The purpose of this study was to analyze original papers published between 2002 and 2006 on self-management in patients at home undergoing cancer chemotherapy, and clarify the research problems. [Methods] A search was carried out using "Japana Centra Revuo Medicina" with "chemotherapy", "outpatient treatment", and "self-management" as key words, and the design, methods, and contents of research were analyzed. [Results] There were 35 papers, and the research design was factor analysis research in 60%, and the type was qualitative research in 60%. The content of research was clarification of the influences of adverse effects of chemotherapy on patients' body/psychology/mind and society and coping phenomena in 45.7%, and the clarification of intervention effects to promote self-management in 25.7%. There were only a few studies on families or at a high evidence level. [Conclusion] Causal hypothesis testing studies at a high evidence level, focusing on psychological/educational interventions and family/social support, are necessary.

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Based on the results of previous studies, a "workshop for support in decision-making" was organized in trial, and those items that are considered important in nurses' support of ALS patients in decision making were explored. Descriptive and qualitative analysis was conducted on data obtained from questionnaires. Consequently, this study found two areas related to the support of patients in making decisions. The "supports by individuals" included the followings : the assessment skills (determining timing and extensive assessment concerning life activities in general and including families and intra-family relationships) and approach/psychological support techniques (active listening, communication, empathy, understanding of the patient). For "support by the community", organization of a sub-support system (supportive attitude of those offering help and playing the central role), and teamwork (information sharing within the team, cooperation and role assignment) was recognized. These findings indicated that to help patients in their decision-making process, the usual support system for home care patients should be a dual structure reinforced by a sub-support system to help the supporters who play the central role ; and such a structure should lead to improving supports by individuals, such as objective establishment of a direction in support and collection of diverse information for assessment.

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Ultrasonography is a useful emergency room technique for detection of abdominal hemorrhage in trauma patients. In the JATEC course (Japan Advanced Trauma Evaluation and Care course), FAST (Focused Assessment of Sonography for Trauma) is advocated to determine the presence of a fluid pool, especially hemorrhage, in the pericardial, thoracic, and abdominal cavities. Most clinicians are initially likely to regard fluid as hemorrhage from the abdominal organs, but the fluid may also be derived from blood, ascites, urine, or other fluids. We report a 39-year-old man who suffered a bruise to his lower abdomen in a traffic accident. He underwent ultrasonography, and an echo free space was found in his Morison's pouch. Intraabdominal hemorrhage was suspected, but a CT scan did not show any multiple organ injury, but the bladder was ruptured. The fluid in the abdominal cavity was urine derived from this bladder rupture. The cause of FAST positivity, except for hemorrhage, is thought to be a blind spot for clinicians ; however, causes other than hemorrhage need to be considered, especially in patients with trauma to the lower abdominal region.

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Herniation through an abnormal hiatus in the broad ligament of the uterus, in which there is an abnormal hiatus in the broad ligament of the uterus and the intestinal tract is incarcerated, accounts for from 1.27% to 3.8% of all internal hernias.
Case 1 : A 51-year-old female who underwent an appendectomy at the age of 14. She was treated with I.V. fluids at a nearby clinic after complaining of upper abdominal pain and nausea. On the third day, she was referred to our hospital for further examination. Although her abdominal area was swollen and tenderness was observed throughout the abdominal part, there was no rebound tenderness or muscular guarding. An expansion of the small intestine was observed using a CT and US but there were no ascites. Blood tests revealed a severe inflammatory reaction and dehydration. Upon insertion of an ileus tube, ileus tube imaging was performed on the fourth day. Because a complete obstruction of the small intestine was found in the right pelvis, the patient was determined to be a candidate for surgery and a laparotomy was thus performed. A hiatus measuring approximately 1.5cm in size was observed in the right broad ligament of the uterus where the ileum was invaginated by approximately 20cm and it had also necrotized. The small intestine was resected and the site of the hiatus was directly obstructed. On the 15th day after the operation, the patient was released from the hospital.
Case 2 : A 53-year-old female with no history of a laparotomy. She felt discomfort in her abdominal area and had not felt well since the same morning. Because the symptoms did not improve, she visited our hospital in the evening. Although swelling was found throughout the entire abdomen, there was no spontaneous pain, tenderness, or nausea. A CT scan revealed an expansion of the small intestine and mild ascites. Progress was monitored conservatively but the patient repeatedly vomited. An additional CT was thus performed on the second day, which revealed an exacerbation of the swelling in the small intestine and increased ascites, thus resulting in emergency surgery. A hiatus of approximately 2cm was observed in the left broad ligament of the uterus where the ileum was invaginated by approximately 5cm. Manual repositioning was performed and the small intestine was not resected. On the ninth day after the operation, the patient was released from our hospital.

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We report a case of gastric outlet obstraction due to non-steroidal anti-inflammatory drugs-induced ulcer with difficulties in differentiation from gastric cancer. A 49-year-old female had been administrated diclofenac sodium to treat rheumatoid arthritis for eleven years. She underwent upper gastrointestinal endoscopy because of epigastralgia and inappetence. The endoscopic examination revealed a large and irregular-shaped ulceration and severe pyloric stenosis. We suspected it to be gastric cancer. However, histlogical examination of biopsy samples did not reveal malignant cells. Because pyloric stenosis became worse, the patient underwent distal gastrectomy. The pathological diagnosis was gastric outlet obstraction due to nonmalignant active ulcer. Recently a surgical operation is rarely selected because the antiulcer drug, H.pylori eradication or the endoscopic treatment are very effective for the gastric ulcer. However, the surgical operation is necessary for the outlet obstraction due to gastric ulcer that is difficult in differentiation from gastric cancer.

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