Clinical and histopathological findings were analyzed in 39 cases of hypersensitivity pneumonitis (HP). There were 21 cases of a pneumonitis referred to as “summer-type” in Japan, and 5 cases induced by isocyanate and other organic solvent, 2 cases of an air humidifier lung, one case in a pigeon breeder, one case induced by antioxidants and the cause in the other cases was unknown. The results of transbronchial lung biopsy and pulmonary function tests showed yielded typical findings. The lymphocyte count in bronchoalveolar lavage fluid (BALF) was 20% higher than normal in 25 of the 28 cases examined, and the higher counts predominanted in summer-type and isocyanate-induced HP. The CD4/CD8 ratio in BALF was significantly lower in the isocyanate-induced HP than in summer-type HP. These findings indicate that isocyanate itself has a continuous and direct effect on suppressor-type T lymphocytes.

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To determine the instantaneous effects of intermittent road traffic noise on sleep, five male students were exposed to the sound of passing trucks with peak levels of 55, 60 and 65 dB (A) about 20 times per night, and sleep polygraphy was recorded. The results were evaluated by an automatic analysing system using a microcomputer with supplemental visual reading based on the criteria of the EEG atlas of Rechtschaffen and Kales.
The following changes per epoch of each sleep parameter were significant compared with those of the control : an increase and a subsequent decrease in alpha waves, a decrease in delta waves, a decreased number of spindles, and an increase in integral electric potential of electromyogram (EMG), when the noise occurred during sleep stage 2, whereas a significant change was detected only in the increase in alpha waves when the noise occurred during REM stage.
In sleep stage 2, peak sound levels of the noise showed a dose-response relationship with the integral of EMG, with the percentage of shallowed stages from sleep stage 2, and with the frequency of body movement as determined visually by sleep polygraphy.
The duration of the effects of the noise was between 1 and 2 minutes. The threshold of noise to induce these changes was less than 55 dB (A) for most of the sleep parameters, and the threshold of noise to induce the decrease in delta waves was between 55 and 60 dB (A).

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Histamine H₂ receptor antagonist (H₂-RA) and H⁺/K⁺ ATPase inhibitor (PPI) were used in treating chronic peptic ulcers and acute gastric mucosal lesions. Recently, in treating peptic ulcers, long-term administration of these drugs developed the pyloric gland gastrin cell hyperplasia and also increased the serum gastrin concentration, etc.Therefore, in order to verify the occurrence of these problems after administration of the drugs, the author has focused on studying the relationship between the serum gastrin concentration and histological changes in the antral mucosa. In this study, male Wistar rats weighing 180-200g were used and the following were assessed : 1) changes of G-cell counts in the pyloric gland 2) gastric acid secretion and 3) changes in the status of gastrin secretion following long-term administration of H₂-RA and PPI given for 4 or 8 weeks were evaluated. After 4 weeks administration of these drugs, gastrin cell proliferation was seen in the rats. In the groups given triple doses of these drugs, hypergastrinemia was obtained at the same time. On the other hand, when administration of the drugs was stopped for the same period, gastrin cell proliferation and hypergastrinemia were disappeared. It can therefore be concluded that there is the potential for recovery when administration of these drugs is stopped for a period equal to that of their administration. In treating peptic ulcers it is emphasized to remember that the changes in the gastric : mucosa and gastric acid secretion are reversible.

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The nasal polyp, a bulging lesion in the nasal cavity, is a frequently reported disease in the rhinopharyngeal field. The author attempts to elucidate the detailed structures of nasal polyp epithelium and the ciliary vesicles detected in some epithelial cells with electron microscopy.
1. The nasal polyp was mainly covered with a pseudostratified ciliated epithelium as those of normal air tract epithelium, and in places with the stratified squamous or columnar epithelium. The pseudostratified ciliated epithelium gradually shifted to the stratified squamous epithelium through the stratified columnar epithelium.
2. The ciliary vesicle was detected in a cell as a round or oval intracytoplasmic cavity provided with many ciliary apparatuses and microvilli. The ciliary vesicles were restrictedly appeared in the pseudostratified ciliated epithelium. On the ciliary vesicle formation in the cells, findings come to the conclusion as follows : (1) Initially duplicated centrioles and associated many tortuous or tubular smooth-surfaced endoplasmic reticula appear and assemble in perinuclear region in some basally located cells. (2) Some of these vesicles migrate and locate at one end of respective centrioles as dome-like or curved vesicular structures. (3) Thereafter ciliary axis extends toward the curved vesicles which are designated as apical vesicles. (4), Some apical vesicles develop a tendency to join each other and to grow into a larger ciliary vesicle. (5) In rare cases, some large ciliary vesicles are protruded as dome-like bulging in the apicalcytoplasm and open into the lumen like those of emiocytotic procedures. This may be indicated a special type of ciliated cell formation in this epithelium. The author concluded that the ciliary vesicles arise from an erroneous process of ciliogcncsis in presumably ciliated cells due to some abnormal ciliogenetic processes including inflammations.

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Dystrophin-associated glycoproteins (DAGs) have recently been classified into two groups by biochemical methods. One group, referred to as dystroglycan complex, is composed of 156DAG and 43DAG, while the other group, sarcoglycan complex, is composed of 50DAG, A3b, and 35 DAG. Each one protein belonging to these complexes was used as a marker for a tissue distribution study. 43DAG was present in all of the tissues examined, whereas 50DAG was present only in skeletal and cardiac muscles. In the muscles of Duchenne muscular dystrophy patients, which lack dystrophin, immunohistochemical staining using anti-DAGs antibodies revealed that 43DAG was well preserved, but that 50DAG, A3b, and 35DAG were greatly reduced. In the muscles of severe childhood autosomal recessive muscular dystrophy patients, in which dystrophin is present, almost all sarcoglycan complex was lost, although 43DAG was present like in control muscle. These findings suggest that dystroglycan and sarcoglycan complexes may play functionally different roles and that muscle degeneration and necrosis may be related to great reduction of sarcoglycan complex.

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This study deals with meniscal regeneration after partial meniscectomy in the avascular portion of the canine menisci. The materials consisted of 58 knees (2 each from twenty-nine dogs). The avascular inner edge of the middle segment of the medial menisci was excised, and an immobilization was carried out on one knee by penetrating Steinmann pins into the femur and tibia. A Charnley external fixation device was attached and a distraction force was applied (non-weight bearing group). The opposite knees were exempted from any immobilization or weight bearing restrictions (control group). The menisci were morphologically studied at 1, 2, 3, 4, 6, 8, 12 weeks and 13 months after surgery. Macroscopic evaluation revealed that 27 of the 29 menisci (93%) in the non-weight bearing group and 21 of the 29 menisci (72%) in the control group demonstrated meniscal regeneration. Microscopically, regenerated tissues during one to three weeks after the operation were populated by fibroblasts. Electron-microscopic observation showed their transformation into fibrocartilage cells at 13 months. The study indicated that meniscal regeneration was more favorable under the non-weight bearing status limitations during the early term after meniscectomy, and that metaplasia could occur in the avascular portion of the meniscus.

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The establishment of the Japan Marrow Donor Program (JMDP) was followed by transplantation of unrelated marrow to treat leukemia and aplastic anemia, As of September 1994, 200 patients had received marrow grafts from unrelated donors, 55, 700 donors and 2, 329 patients had been registered in the JMDP, and HLA-matched donors had been found for 60% of the patients. Graft-versus-host disease (GVHD) is a major cause of transplant-related complications after unrelated BMT. In order to reduce mortality from GVHD, patients should receive marrow grafts from the best donors, with maximum HLA-matching with unrelated donors. In an effort to increase the number of HLA-typed volunteers, the Gunma Marrow Donor Bank was established in July 1994 to support the JMDP.

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A 76-year-old man came to Tone Central Hospital complaining of bilateral thigh pain and gait disturbance. X-ray films revealed extensive osteoblastic and osteolytic changes. He was admitted to our hospital and the results of various examinations resulted in a diagnosis of rectal involvement by prostate carcinoma with multiple bone metastases. Hormonal therapy (LH-RH analogue) was then started, rectal bleeding developed after 6 months. Although radiation therapy stopped the bleeding, the patient died of disseminated intravascular coagulation syndrome.

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Postoperative benign biliary stricture was successfully treated with a new type of biliary stent (Strecker expandable stent). A 70-year-old woman was transferred to our hospital because of cholangitis symptoms. She had a history of cholecystectomy for cholecystolithiasis at 45 years of age and endoscopic sphincterectomy for choledocholithiasis at 63 years of age. Endoscopic retrograde cholangiograms revealed a stricture of the common hepatic duct about 3 cm in length. Percutaneous transhepatic biliary drainage (PTBD) was performed and biopsy specimens obtained under percutaneous transhepatic cholangioscopy (PTCS) showed benign histology. We introduced a Strecker expandable metallic stent into the biliary stricture via the PTBD route under X-ray fluoroscopy. Neither migration nor occlusion of the stent were observed 38 months after its insertion. This stent is useful for the treatment of postoperative benign biliary stricture.

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A 37-year-old female with complaints of lower abdominal pain and nausea was admitted to our hospital. An emergency operation was performed after a diagnosis of acute appendicitis was made. At laparotomy, a whitish, appendiceal tumor was found invading the cecum, and ileocecal resection was performed. The microscopic diagnosis of the tumor was mucinous cystadenocarcinoma of the appendix infiltrating the cecum. At a second look operation three days after the first operation, peritoneal calcinosis was found in the Douglas cavity but no regional lymph node metastasis was detected. Right hemicolectomy with lymph node dissection was then performed.
Preoperative diagnosis of primary carcinoma of the appendix is difficult. Thus, intraoperative rapid histological diagnosis by frozen block is necessary, in addition to preoperative examinations, including echography and CT scans.

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A 44-year-old woman developed inflammatory carcinoma of the left breast with swelling and redness 25 years after injection-type augmentation mammaplasty. After neoadjuvant chemotherapy and radiation, extended radical mastectomy was performed. Histologically, the tumor was scirrhous carcinoma with severe lymphatic invasion and lymph node metastases. The opposite breast and axillary nodes revealed metastatic carcinoma of the left breast. Despite radiation, chemotherapy and hormonal therapy, the patient developed widespread metastatic disease and died one year after initial treatment. Forty-eight cases of breast cancer after augmentation mammaplasty has been reported in the Japanese literatures. These cases presented often advanced disease, because of a delay and difficulty of diagnosis. It is important to make an early diagnosis and treatment for these patients.

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A 11-month-old girl was noted to have hepatomegaly, and abdominal echography, CT scan and MRI revealed a huge tumor in the medial segment of the left lobe, located close to the hepatic hilum and involving the anterior segment of the right lobe. It was made clear that tumor resection was impossible at the exploratory laparotomy. We started the chemotherapy using THP-Adriamycin and Cis-platinum according to J·PLT-91B2 protocol. After four courses of chemotherapy, the tumor had regressed markedly and was resected with medial segmentectomy at second look operation. Postoperatively, the patient was treated with two courses of chemotherapy. The serum level of AFP is not within normal limits, but she is doing well without any evidence of disease 6 months after hepatectomy.

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