Previously, we found that the antibody titer belonging to the IgM class produced against the bacterial antigen (Lipid A) was elevated in sera from patients with primary biliary cirrhosis (PBC). On the other hand, the targets of the mitochondrial autoantibodies have been identified as being components of the pyruvate dehydrogenase complex (PDH). We tried to produce an experimental animal model for the investigation of the association between hepatic bile duct alteration and bacterial infection. Female C57/BL mice, aged 4 weeks, were used. An emulsion consisting of lipopolysaccharide (LPS) derived from Salmonella minnesota Re595, PDH, and Freund's adjuvant was prepared. This emulsion was subcutaneously injected on the back of the mice. The mice were divided into a control group (n=5), a group given LPS (n=5) alone, those given PDH alone (n=5), and those given a combination of LPS and PDH (n=5). The antigens were administered once a week every week with a maximum duration of administration of 24 weeks. The serum levels of IgM after 24 weeks in the LPS and LPS+PDH groups were 2.5 times higher than those in the control and PDH groups. The light microscopic findings of liver tissue revealed that infiltration of lymphocytes and plasma cells in the portal area, proliferation of the bile duct, and degeneration of the biliary epithelial cells were more prominent in the PDH and LPS+PDH groups than in the other groups. These results indicate that our animal model may be useful in investigating the pathogenesis of PBC.

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We studied retrospectively the clinicopathological features of gastric cancer with duodenal invasion and compared these with those with non-invasion, to investigate the prognostic significance of duodenal invasion. The patients were grouped into two groups of Group A (65 patients) with duodenal invasion and Group B (197 patients) without invasion who underwent gastrectomy for advanced distal gastric carcinoma according to histological findings. In Group A, many were at high age and with symptoms of pyloric stenosis. Group A (91%) had a significantly higher incidence of serosal invasion and infiltration into the pancreas head than did Group B (76%) (p<0.01). In N3 metastasis, there was a significant difference between Group A (60%) and Group B (36%) (p<0.01). The five-year-survival rate inGroup A was 14.0% and in Group B was 43.3% (p<0.001). In cases of duodenal invasion, patients with symptoms of pyloric stenosis demonstrated a poorer prognosis than those without. Those with longer than 20 mm invasion had a significantly higher incidence of N3 metastasis than those with less than 10 mm (p<0.05). hymphangitic type had longer invasive length to duodenum, and N3 metastasis of the lymphangitic type was frequent comparing to localized type (42%) and invasive type (47%) (p<0.001) (95%) (p<0.01). These results showed that duodenal invasion was a significant prognostic factor in cases of distal gastric carcinoma. In the therapeutic strategy for advanced gastric carcinoma with duodenal invasion, it is necessary to perform gastrectomy with regional lymph nodes dissection and with combined resection of adjacent organs.

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Recently isolated strains of methicillin-resistant Staphylococcus aureus (MRSA) have high levels of resistance to the agent and produce .β-lactamase less frequently than methicillin-susceptible strains (MSSA). This phenomenon has been observed in Japan. The majority of MESA strains (26 of 30) isolated in 1992 produced β-lactamase while only 18 of 31 and 25 of 67 MRSA strains, isolated in 1991 and in 1992 respectively, produced the enzyme. We analyzed the .β-lactamase gene (blaZ) in 30 strains each of MRSA and MSSA isolated from our hospital using the polymerase chain reaction. We found that 28 MSSA strains but only 14 MRSA strains possessed the gene. In addition, the present study indicates that many recently isolated MRSA strains, which lacked blaZ gene and were negative for .β-lactamase, consistently produced coagulase of type II (coagulase typing is a marker of epidemiology for Staphylococcus aureus). These .β-lactamase negative, type II coagulase producing and highly methicillin-resistant MRSA strains are considered to have an increased ability to successfully colonize individuals and an increased epidemic potential, probably because of the saving of the energy otherwise expended in .β-lactamase production and of the loss of .βlactamase plasmid coding the mecA gene repressor, resulting in constitutive PBP2' production. These factors may contribute to the wide spread of these strains of MRSA in a nosocomial environment.

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The present study was aimed at elucidating the role of inflammatory cells in the pathogenesis of cryptogenic organizing pneumonia, and the mode of action of erythromycin in inhibiting the progression of the disease . Bronchoalveolar lavage fluid was obtained from 16 patients with cryptogenic organizing pneumonia and 4 control subjects. Neutrophil chemotactic activity was determined in relation to the concentration of two cytokines, interleukin-8 and tumor necrosis factor- a. Eight patients with cryptogenic organizing pneumonia, 4 with bronchoalveolar lavage fluid neutrophilia and 4 without, received low dose oral erythromycin daily (600 mg) for 2 to 3 months. Bronchoalveolar lavage fluid was obtained before and after treatment . In the bronchoalveolar lavage fluid of cryptogenic organizing pneumonia patients with bronchoalveolar lavage fluid neutrophilia, the levels of neutrophil chemotactic activity, interleukin-8, and tumor necrosis factor- a were significantly increased compared with levels measured in control subjects and in cryptogenic organizing pneumonia patients without bronchoalveolar lavage fluid neutrophilia. The level of interleukin-8 correlated with the percent of neutrophils and neutrophil chemotactic activity of bronchoalveolar lavage fluid, while the level of tumor necrosis factor-a did not. Furthermore, the levels of interleukin-8 and neutrophil chemotactic activity in the bronchoalveolar lavage fluid of cryptogenic organizing pneumonia patients with bronchoalveolar lavage fluid neutrophilia were significantly decreased following treatment with erythromycin. In contrast, the level of tumor necrosis factor-a was not affected by treatment with erythromycin. It is possible that cryptogenic organizing pneumonia is caused by neutrophil-mediated inflammation, and that the favorable clinical effect of erythromycin is due to inhibition of neutrophil accumulation in the peripheral airways through a biological activity other than bacteriostasis, e.g., local suppression of interleukin-8 production.

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A 40-year-old female came to our clinic to have an examination of a mass in the left lower abdomen. Histology of the removed tumor revealed granuloma caused by talc. This is a very rare case in Japan.

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Dural arteriovenous fistula (AVF) of the anterior cranial fossa is associated usually with cerebral hemorrhage or subarachnoid hemorrhage, while an association with transient global amnesia has not been reported previously. A case presenting the latter unusual symptom is described and the surgical treatment of AVF is discussed. A 64-year-old woman was hospitalized complaining of transient memory impairment. Magnetic resonance (MR) imaging demonstrated a flow void in the left frontal lobe and temporal pole. Cerebral angiography revealed an AVF in the anterior cranial fossa, which was fed bilaterally by the ethmoidal arteries and by branches of the external carotid arteries. The AVF drained into the superior sagittal sinus and the superficial sylvian vein via large varices. Following transfemoral embolization, surgical treatment was carried out . Postoperative angiography revealed complete obliteration of the anomaly. There were no further episodes of amnesia. In our presented case, there is an association between the presenting symptoms and the AVF. The combination of ischemia and congestion in the frontal and temporal lobes may have caused transient memory impairment. From our surgical experience, the excision of the vascular connection between the dura and the frontal lobe following the coagulation of the dura mater of the anterior part of the base of the skull without extensive excision seems to be recommended.

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We encountered a 62-year-old female with advanced gastric cancer, in whom multiple nodular lesions in the liver, which were depicted as small low density areas, less than 5 mm in diameter, on computed tomography and demonstrated as a heterogenic pattern on ultrasonograms. This patient was suspected to have multiple liver metastases of gastric cancer. She deteriorated gradually and died of respiratory failure due to lung metastasis. At autopsy, these hepatic nodular lesions were biliary hamartomas. Biliary hamartoma is a lesion usually identified microscopically, and there have been only 8 cases including ours, which were depicted on images. Along with a remarkable advance in imagings, it should become more important to differentiate biliary hamartoma from malignant hepatic neoplasms on images.

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Recently, a number of reports have been published on recurrent herpetic infection of the oral mucosa. In most of these cases, the infected tissue is the fixed intraoral mucosa, such as the gingiva or hard palate. Infection of movable mucosa such as the tongue, which is reported in the present paper, has not been reported in detail previously. In each of the two cases reported in the present paper, intraoral lesions were diagnosed as recurrent herpes-glossitis after isolation of the herpes simplex virus (HSV).

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An automatic sleep analysis system using a super minicomputer was developed. The system improved and expanded the data processed by the mini-computer. It had the following features: 1) waveforms were collected and analyzed at a high speed (reproduced at 10 or 20 times the speed of a data recorder) by an off-line procedure to utilize the computer resources more efficiently; 2) all information and the original wave-forms were output to a laser printer because of the lower cost and more efficient arrangement of the data; 3) various wave-form parameters were measured by wave-form analysis; 4) the application program was based on general-purpose language; and 5) wave-form reanalysis and reconstruction of the logic was easily implemented for automatic evaluation of the sleep stages. Automatic analysis of the sleep stages was impossible for 15 of 1484 periods (20 sec per period) with one of the cases analyzed, and 142 of 1484 periods had to be corrected because of erroneous identification.

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