Gastric intramucosal bleeding in portal hypertensive gastropathy was investigated in terms of gastric mucosal microcirculation, coagulation-fibrinolysis factors, and local fibrinolysis in patients with liver cirrhosis. The gastric mucosa was examined by endoscopy, and the patients were classified into two groups with or without bleeding. Gastric mucosal blood flow was measured simultaneously with coagulation-fibrinolysis factors or local fibrinolysis in both groups. As gastric mucosal blood flow, the gastric mucosal blood volume (IHb) and the oxygenated hemoglobin concentration (ISO₂) were determined by the organ reflection spectrum method. Coagulation-fibrinolysis factors were measured in the blood. For evaluation of local fibrinolysis, gastric biopsy specimens were placed on a standard fibrin plate, and the fibrinolysis area was measured. Compared with the non-bleeding group, the bleeding group showed increased IHb and decreased ISO₂ (p<0.05), suggesting marked congestion of blood flow. Gastric intramucosal bleeding was frequently observed in patients with marked congestion of blood flow and markedly abnormal values of coagulation-fibrinolysis factors. Gastric local fibrinolysis was also significantly enhanced in the bleeding group (p<0.05). In addition, local fibrinolysis was correlated positively with the gastric mucosal blood volume (r=0.68, p<0.05) and negatively with the oxygenated hemoglobin concentration (r=-0.58, p< 0.05). These results suggest the following mechanism of gastric mucosal bleeding in liver cirrhosis and portal hypertension. Congestion of gastric mucosal blood flow is present in liver cirrhosis and portal hypertension. An increase in the microvascular pressure and hypoxia cause release of tissue plasminogen activators from gastric mucosal cells and vascular endothelial cells. As a result, gastric local fibrinolysis is enhanced, causing gastric mucosal bleeding.

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It has recently been shown that nicotine administration reduces antral motor function. The aim of this study was to test whether cisapride administration can improve nicotine-evoked antral hypomotility in humans. Eight healthy smoking volunteers were selected for the study. After an overnight fast, manometric recordings and electrogastrographic recordings were performed before and after the ingestion of a mixed solid meal. The measurements (manometric and electrogastrographic protocols) were carried out on two separate days. In each protocol, the measurements were made under three different conditions on three separate days; a placebo day, a nicotine day [nicotine patch (14mg/day)], and a nicotine plus cisapride day (the nicotine patch and 5mg cisapride) in a crossover randomized design. The number of antral phase III complexes, antral phase III motility indexes (the sum of the highest of all antral phasic contractions >10 mmHg in 10min), and postprandial antral motility indexes (the sum of the highest of all antral phasic contractions >10mmHg for the duration of 30min) were significantly lower on the nicotine day than on the placebo day (P<0.01, P<0.05, and P<0.01). However, the values obtained on the nicotine plus cisapride day were significantly higher in comparison with those obtained on the nicotine day (P<0.05, P<0.05, and P<0.01) and were similar to those obtained on the placebo day (P=0.92, P=0.79, and P=0.36). The frequency stability index (maximal signal amplitude for a given 2-minute recording segment occurring at a frequency of ≥2 cycle/min and .≤4 cycle/min) was similar on the placebo day, the nicotine day, and the nicotine plus cisapride day in both the fasting (P=0.69) and postprandial periods (P=0.22). These results indicate that (a) transdermal nicotine administration reduces antral gastric motor function without modification of slow wave rhythmicity and (b) cisapride administration improves nicotine-evoked antral hypomotility.

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Previous studies have reported some significant participation by gastric alcohol dehydrogenase (ADH) in alcohol metabolism, similar to that by hepatic ADH. However, the localization of this ADH in the stomach is not yet determined and there has been no study on the localization of ADH in the stomach of alcoholics before and after abstinence from alcohol. The aim of the present study was to reveal any changes between before and after abstinence from alcohol in the immunohistochemical localization of ADH using biopsy specimens from the gastric mucosa. Twenty male alcoholics (aged 47.8±7.4 yrs) gave signed informed consent for this investigation. Esophago-gastro-duodenoscopy (EGD) and gastric corpus biopsy were performed just before abstinence and at one month later. ADH in the biopsy specimens was immunohistochemically examined with an anti-ADH antibody, using confocal laser scanning microscopy. The fluorescence intensity for ADH was compared for each pair of specimens before and after abstinence from alcohol using an image analyzer. Age, total alcohol consumption, degree of gastritis, and the liver function tests of all patients were also analyzed. The strongly immuno-positive cells for ADH in the gastric mucosa were identified as parietal cells. The fluorescence intensity for ADH was significantly higher in those specimens obtained after abstinence than in those before abstinence (p<0.005). The immunoreactibility for ADH in the cells assessed by confocal laser scanning microscopy was greatly improved after abstinence of alcohol, suggesting recovered alcohol metabolism in the gastric mucosa after abstinence from alcohol. The present study, demonstrating the cellular ADH localization in the gastric mucosa before and after abstinence from alcohol, may contribute to clarifying gastric alcohol metabolism in alcoholics.

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We performed an epidemiological study to clarify the infection routes of Helicobacter pylori (HP) in residents of a certain district. We sampled 10% of adult residents comprising 7, 389 males and females in a certain geographical area for our study by random sampling. Among them, the blood was drawn from 325 subjects who agreed to undergo health checks, and Helicobacter pylori antibody (anti-HPIgG) and an antibody against hepatitis A virus (anti-HAV) were measured. In addition, we conducted a questionnaire survey on all of the 325 subjects and mainly investigated the relation between the life-style and the rate of anti-HPIgG carriers. In this geographical area, the positive rate for anti-HPIgG in the subjects in their twenties was 67% (10/15), and it increased with age. The positive rate for anti-HAV in the subjects in their twenties was 17% (2/12). When we investigated the positive rate for HP antibody in 114 subjects of 57 families. The positive rate in parents whose children (20-39 years old) were also positive for anti-HPIgG was significantly higher than that whose children were negative for anti-HPIgG (p<0.03). There was no significant relation between other life-style factors surveyed and the positive rate for anti-HPIgG. The rate of positive anti-HPIgG carriers in this geographical area was higher in the subjects in their twenties comparing to average Japanese infection rate, suggesting that this area was highly infected by HP. Infection within the family was thought to be a factor of the higher rate of HP infection in younger generations.

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Purpose of this study was to survey subjective health problems occurring among Japanese nursing students. Data collected with the self-administered Cornell Medical Index Health Questionnaire Japanese version (JCMI) from 102 Japanese first year nursing students were analyzed. The total CMI score (section A-R) ranged from 2-108 with an average of 23.1 (SD=15.9). The mean CMI for physical (section A-L) and psychological health complains (section M-R) were 15.7 (SD=11.8) and 7.3 (SD=6.1), respectively. Two-way analysis of variances with multiple comparison of means revealed significant relationships between age and psychological health complaintsand both physical and overall health complaints. The older nursing students reported more physical and overall health complaints than the youngest. The nursing students who reported more complaints about psychological health also reported significantly more physical and overall health complaints . A comparison of Fukamachi's and Brodman's criteria for classification of neurotic traits is discussed. Findings from this study support the hypothesis that psychological health is somewhat reacted to physical health.

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In order to test for the presence of primary infections by multiple herpes simplex virus-1 (HSV-1) strains and the simultaneous reactivation of multiple strains in latent HSV-1 infections, viral clones isolated from 12 viral strains shed into saliva of malignant patients without herpetic lesions and from 10 viral strains obtained from the herpetic focus were analyzed by DNA cleavage patterns. In asymptomatically shed viral strains, only 1 of 12 strains (8.7%) had different clones. In infectious viral strains, all clones of 10 viral strains showed the same cleavage patterns in each strain. These results suggest the existence of simultaneous reactivation in multiple latent HSV-1 infections.

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Langerhans cells are important in the human immune system as a part of the dendrtic cell system. This study was carried out to demonstrate the presence of Langerhans cells and their distribution in normal human larynx and hypopharynx, by light (S-100 polyclonal antibody) and transmission electron microscopy. The results are summarized as follows: 1) Langerhans cells with cytoplasmic granules (Langerhans granules or Birbeck's granules) were situated in the suprabasal region of the squamous epithelium in the larynx and the hypopharynx. 2) They distributed in the membranous portion of the vocal folds, epiglottis, aryepiglottic folds, arytenoid regions and interarytenoid notch of the larynx. The cells surrounded the vestibule and glottis of the larynx. 3) They distributed in the postcricoid area, piriform sinus and posterior pharyngeal wall of the hypopharynx. The cells were situated above the entrance of esophagus. 4) The cells were suggested to be a factor of immune response at the entrance of trachea and esophagus.

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Using retrospective studies, we have investigated the possibility of obtaining characteristic findings of inflammatory pseudotumor of the liver by magnetic resonance (MR) imaging. We examined 8 patients (involving 8 masses) who had been histologically diagnosed as having an inflammatory pseudotumor in the liver. The histological studies were performed on an excised specimen of 1 mass, and on aspiration needle biopsy specimens and the clinical courses of the other 7 masses. T1 weighted images (T1WI) and T2 weighted images (T2WI) were obtained on MR imaging. MR imagings were analyzed for visualized patterns, patterns of internal structure and patterns of contrast enhancement on dynamic MR imaging. The 8 masses were visualized as hypointense on T1WI and hyperintense on T2WI by MR imaging. Dynamic MR imaging revealed that 1 mass was markedly enhanced peripherally while another mass was homogeneously enhanced, and that enhancement was most marked immediately after injection of contrast medium and then gradually disappeared. Vessels were observed in 4 masses (the portal vein in 2 masses, the hepatic vein i 1 mass, and portal and hepatic veins in 1 mass), and these vessels were clearly visualized on T 1 WI. The MR imaging findings from the early stage of an inflammatory pseudotumor showed a pattern similar to that of hepatic tumors with rich blood flow. The portal vein or hepatic vein was found in the tumor in half the patients, suggesting that this characteristic was useful for diagnosis of an inflammatory pseudotumor in the liver.

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We investigated a new separated type of dental appliance (mandibular advancing positioner: MAP) that is mobile and allows free adjustment of mandibular advancement. In 8 adult male patients with sleep apnea syndrome (SAS), the mean apnea index (AI) decreased from 31.1 to 4.2, and the mean apnea hypopnea index (AHI) decreased from 44.2 to 11.7. The distance of mandibular advancement using the Flankfort horizontal plane as a standard ranged in the 8 SAS patients from 1.8 to 5.0mm by lateral cephalograms. A high positive correlation was observed between the distance of mandibular advancement and the rate of improvement in AI (R²=0.878), or the rate of AHI (R²=0.861), showing a higher improvement rate with more marked mandibular advancement.

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Hepatocellular carcinoma (HCC) is usually visualized as high density area in early phase of an incremental dynamic computed tomography (ID-CT). Small HCC nodules less than 2cm in diameter are sometimes, however, showing no contrast enhancement. We examined 26 HCC nodules less than 2cm in diameter by ID-CT. All HCC nodules examined were originally detected by ultrasonography and diagnosed by fine needle biopsy in histology. We studied the sensitivity of ID-CT in detecting HCC nodules and a possible association between a presence or absence of contrast enhancement an the degree of cell differentiation of HCC nodules. Of the 26 HCC nodules, 22 (84.6%) were detected by ID-CT. Of the 22 detected nodules, 7 were depicted as high density area in early phase of ID-CT, and 5 were moderately differentiated HCC and the other 2 were poorly differentiated HCC in histology. Twelve nodules were low density area in early phase of ID-CT, and all of them were well-differentiated HCC. The other 3 nodules, which were isodense in early phase, were depicted as low density area in late phase, and 2 were well-differentiated HCC and other was moderately differentiated HCC. In this study, most of small and welldifferentiated HCC nodules less than 2 cm in diameter showed no contrast enhancement in early phase of ID-CT. Therefore, when ID-CT of intrahepatic nodules less than 2cm shows low density in early phase without contrast enhancement, well-differentiated HCC are most suspected, and further examinations such as magnetic resonance imaging and needle biopsy are needed.

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We have evaluated the efficacy of magnetic resonance (MR) imaging for detecting hepatocellular carcinoma less than 20mm in diameter (sHCC). This study involved 72 cases of sHCC tumors which were also investigated by angiography and histology. These cases were retrospectively examined for correlations between tumor stain (vascularity) on angiography, histological features (fat deposition, clear cells and the grade of differentiation) and the findings on T1 and T2 weighted MR imaging. The sHCC detection rate by MR imaging was 73.6% (53 cases) and by angiography was 59.7% (43 cases). Thirty-five cases were detected both by MR imaging and by angiography. The main MR imaging patterns were hypo to isointense on T1 weighted images (T1WI) and hyperintense on T2 weighted images (T2WI) in 22 cases, and hyperintense on both T1WI and T2WI in 7. In 18 cases which were not demonstrated by tumor staining on angiography, the main MR imaging patterns were hyperintense on T1WI and isointense on T2WI in 14. The histological features included fat deposition in 22 cases, 20 cases of which were hyperintense on T1WI, and 10 of these 20 were hyperintense on both T1WI and T2WI. Fat deposition was marked in 9. According to the grade of differentiation, 23 of the 26 cases with well differentiated HCC tumors were hyperintense on T1WI, and 21 of the 27 cases with moderately to poorly differentiated HCC were hypo to isointense on T1WI and hyperintense on T2WI. sHCC was visualized by MR imaging, reflecting vascularity, fat deposition and the grade of differentiation. In particular, MR imaging is useful for a differential diagnosis between the well differentiated HCC and the moderately to poorly differentiated HCC, and useful for the diagnosis of an early HCC.

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A case with an alpha-fetoprotein (AFP)-producing carcinoma originating from the rectum is described. A 71-year-old male patient, who underwent a rectectomy for rectal carcinoma, developed space occupying lesions in the liver and a remarkable AFP elevation (220, 000ng/ml) in the 6th month postoperatively, and then expired one year later. Histologically, the rectal carcinoma consisted of well-differentiated adenocarcinomas, and contiguous cancerous cells proliferating in either a medullary or trabecular pattern. In the “trabecular” areas, localization of AFP was confirmed immunohistochemically. Results of concanavalin A or lens culinarisd agglutinin affinity chromatography demonstrated that it was between a hepatic type and a yolk sac type, and was considered to be an intestinal type. This could have been an AFP-producing rectal carcinoma, in which the patient experienced liver metastasis at a relatively early postoperative period and died. This shows that AFP-producing rectal carcinomas are highly malignant, biologically, similar to AFP-producing gastric cancers.

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