Background and Objective : Depressed affect is thought to be influenced not only by workplace stress but also by various socio-environmental conditions. The relationships between depressed affect and such factors are expected to differ by gender. Subjects and Methods : We applied the KCS to the 649 workers. A total of 595 (91.7%) replied, and among them a total of 574 (96.5%) completed the questionnaire. By performing a factor analysis, we compared the factor structures of males and females. Results : In the exploratory factor analysis, five factors were estimated with a significant eigenvalue of at least 1 in both males and females.12 items asking depressive affect showed high factor loadings on the first factor of males (depressive affect), while these items were mostly explained by two distinct factors of females, the first factor (emptiness) and the second factor (personal devaluation). And only in males, the item relating to stress at their workplace had a somewhat high factor loading on the depressive affect factor. Conclusion : There is a relationship between depressive affect and stress at their workplace only in males. Only in females depressive affect is explained by two types of depressive mood, with emptiness and with personal devaluation.

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Purpose : We studied the effect of exercise for improving oral function in elderly users of day-care centers. This is the baseline study. Methods : Subjects were 34 users of day-care centers (average age : 79.7 (±8.9) years old). They were able to brush their teeth by themselves. We interviewed them about activities of daily living (ADL) and general oral health assessment index (GOHAI) score. We also examined teeth number, dentures, and oral function. Result : Their average number of teeth were 10.85 (±9.8). Their total scores of ADL and GOHAI were almost normal. Items rated low GOHAI score were difficulty of chewing and difficulty of eating. Oral function was related to ADL and GOHAI. Conclusion : It is important for elderly to enjoy eating food safely, talking with friends, and building the smooth human relationships. Exercise to improve oral function seems necessary.

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Background and Objectives : Community and occupational health collaboration recommended in Japan's national health promotion policy remains well below expectations and appropriate methodologies have yet to be specified. We attempted to identify techniques used by public health nurses responsible for community health to promote occupational health collaboration. Subjects and Methods : Semi-constitutive interviews were conducted with 11 public health nurses experienced in collaboration between community and occupational health activities. Activities in the process were extracted and analyzed qualitatively and recursively. Results : Techniques used were identified in six processes : (1) initiating collaboration between community and occupational health activities, (2) creating systems needed for collaboration, (3) developing trusting relationships within occupational fields, (4) ascertaining prevailing business site and personnel status, (5) developing collaborative projects, and (6) evaluating and refining collaborative projects. Conclusion : It was confirmed that public health nurses facilitated collaboration with industrial health programs by interlinking the six processes above.

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We report 41 cases of Mondor's disease, a relatively rare benign condition caused by thrombophlebitis of the subcutaneous vein around the breast, in the last 46 months. Of the 41, only 1 was a man. Their ages ranged from 26 to 73 years (mean : 43.5). Foci were in the anterior chest wall between the epigastrium and axilla, and all had ipsilateral disease (right : left=14 : 27). Etiology was unknown in 35, postoperative breast cancer in 4, and 1 each of postoperative breast biopsy and lactating breast. Subjective symptoms of Mondor's disease include painful subcutaneous cords or grooves in the skin that disappear spontaneously without treatment one or two months after onset. Medical examination and treatment of this disease requires a good knowledge of its manifestations to distinguish it from other breast diseases.

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Background : Dermatofibrosarcoma protuberans (DFSP) is an uncommon infiltrative tumor of the dermis and subcutaneous tissue. Recent cytogenetic studies have demonstrated a chromosomal translocation of the collagen type I alpha 1 (COL1A1) gene on chromosome 17 to the platelet-derived growth factor B-chain (PDGFB) gene on chromosome 22. Various exons of the COL1A1 gene have been reported to be involved in the fusion with exon 2 of the PDGFB gene. Method : The COL1A1-PDGFB fusion transcript was detected by reverse transcriptase-polymerase chain reaction (RT-PCR) using frozen tissue from 4 DFSP patients. Nucleotide sequence analyses were carried out using the PCR products to identify the breakpoints. Results : COL1A1-PDGFB fusion transcripts were detected in all tumor specimens. Sequence analyses revealed that the end of exon 25, 45, 32, or 11 in the COL1A1 gene was fused with the start of exon 2 in the PDGFB gene. Conclusion : Detection of this aberrant fusion transcript can be useful as a diagnostic method for DFSP.

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A 34-year-old woman who was 41 weeks pregnant showed thrombocytopenia (4.0×10⁴/μl). According to results showing an increased number of megakaryocytes in the bone marrow and a high titer of PAIgG, a diagnosis of idiopathic thrombocytopenic purpura (ITP) was made in August 2005. Thereafter, she was treated with prednisone for 23 months, but a complete remission of ITP was not achieved. She was referred to our hospital for splenectomy in July 2007. She was treated with warfarin on developing a pulmonary embolism due to deep vein thrombosis. Her platelet count was 3.9×10⁴/μl, and she showed mild tachycardia, hand tremor, and struma. Free T4 was 5.17 ng/dl, TSH<0.005μIU/ml, and TSH receptor antibody was positive (18.2%). A diagnosis of Basedow's disease associated with ITP was made. She was started on thiamazole therapy. Two months after treatment with thiamazole, the platelet count increased to the normal range even with a decreasing dose of prednisone. She was splenectomized in December 2007 because of her insistence on the operation. After the operation, the platelet count increased further maintaining a level of 25-30×10⁴/μl. We suggest that there is a common immunological imbalance between ITP and Basedow's disease, because of the improvement of ITP by anti-thyroid therapy.

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A 31-year-old woman seen in an emergency for acute 3-hour abdominal pain presented with diffuse abdominal distention and slight peritoneal signs. An architect by professions, she had no history of abdominal problems or unique dietary habits. Abdominal computed tomography (CT) indicated a dilated intestinal tracts and marked ascites. Based on a diagnosis of suspected strangulated ileus, we conducted emergency operation, finding the ileum rotated 180^° clockwise. We found no adhesions or anatomical abnormalities, making a definitive diagnosis of primary small bowel volvulus. We resected the necrotic ileum and performed end-to-end anastomosis. The postoperative course was uneventful, and she was discharged on postoperative day 17.
Retrospective CT analysis showed radial distribution of mesentery, but no "whirl sign", characteristic of small bowel volvulus, possibly because rotation as slight as 180 degrees did not produce the sign in this patient.

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A 72-year-old male diabetic patient was admitted due to autoimmune hemolytic anemia (AIHA). We started 1mg/kg weight of prednisolone daily and multiple daily insulin infusion for hyperglycemia. Gall bladder cancer and early stage gastric cancer were then diagnosed. We removed the gall bladder and the spleen for treatment of AIHA without prednisolone for better control of diabetes mellitus. Five weeks later, endoscopic gastromucosal resection (EMR) was performed for gastric cancer. The patient suffered from fever and respiratory failure after 4 days. Chest computed tomography showed consolidation, bronchial wall thickening and a ground glass appearance in bilateral lungs. Although the sputum and blood culture were negative, β-D-glucan and mannan antigen increased. Neutrophilia (87%) was shown. The WBC count had not increased (7300/μl) compared with the CRP elevation (21.8mg/dl). Therefore, we diagnosed overwhelming postsplenectomy infection syndrome followed by atypical pathogen infection. We used ciprofloxacin and fosfluconazol, respirator at low tidal volume ventilation, sivelestat sodium hydrate and methylprednisolone for respiratory failure and regular insulin aiming for a blood glucose range of from 80 to 140mg/dl. The patient subsequently recovered.

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