Apoptosis represents an important mode of cell death induced by chemotherapeutic drugs. It is plausible that apoptosis may also play an important role in alopecia caused by anticancer drugs. C57 BL/6 mice were induced to enter into anagen by hair shaft depilation and a single intraperitoneal injection of cyclophosphamide (150 mg/kg) was given. Skin specimens were taken from the backs of mice at day 9, 10, 11, 12 and 13 postdepilation (p.d.). Specimens were stained with TUNEL method, and DNA was isolated from the plucked hair follicles and was electrophoresed. Many TUNEL-positive cells were observed in hair bulbs in the cyclophosphamide group at days 10-13. At day 13 p.d., most follicles were damaged and extensive hair loss was observed. Fragmented DNA, but not so distinct, were observed in a DNA ladder pattern corresponding to the in situ results. This study suggests that anticancer drugs can induce apoptosis-related damage to the hair follicles in mice. Control mice when treated with saline also showed apoptosis when they spontaneously entered into catagen, but they never showed hair loss. Consequently, hair loss induced by anticancer drugs may result from a wave of induced apoptotic death.

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Cyclin D1 and E have been found to be deregulated and overexpressed in various types of cancers. In order to study the cell cycle regulatory mechanisms in gastric cancer, we have analyzed the protein expression of cyclin D1 and cyclin E in 76 tumor specimens from patients with primary gastric cancer, using immunohistochemistry. Overexpression of cyclin D1 was observed in 38 cases (50.0%). Overexpression of cyclin E was observed in 40 cases (52.6%). There was no significant difference between the expression of cyclin D1 and any clinicopathological factor. Cyclin E overexpression was correlated with a high incidence of lymph node metastasis, a low incidence of T1, and with Stage I. There was no significant difference in survival curves between cyclin D1 (+) and cyclin D1 (-). The survival curves of cyclin E (-) were significantly higher than those of cyclin E (+). These results suggested that in gastric carcinoma, cyclin E overexpression was useful as a prognostic indicator, but cyclin D1 was not.

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One hundred eighty-six clinical isolates of Haemophilus influenzae (H. influenzae) collected from January 1996 through December 1997 from 182 pediatric patients and 16 isolates from blood or cerebrospinal fluid (CSF) of 13 patients with bacteremia and purulent meningitis collected during the last ten years were examined for in vitro susceptibilities to 23 antibiotic agents, including 3 penicillins, 9 cephalosporins, 4 carbapenems and others, as well as for their encapsulated types and β-lactamase production. Ceftriaxone (a third generation cephalosporin) had the highest activity against the strains in this study (minimal inhibitory concentration, MIC₉₀ of 0.025 μg/ml) and cefditoren (a new oral cephalosporin) was the most active oral antimicrobial agent (MIC₉₀ of 0.05μg/ml). Meropenem had a much higher activity against H. influenzae (MIC₉₀ of 0.2 μg/ml) than the other carbapenems (imipenem, MIC₉₀ of 1.56μg/ml, panipenem, MIC₉₀ of 1.56 μg/ml, and biapenem, MIC₉₀ of 3.13μg/ml). Regarding the serotyping of the encapsulated strains, 172 strains (85.1%) were nontypeable and 30 (14.9%) were serotyped (24 strains of type b, 4 strains of type e, one each of type a and c). Fifteen of the strains isolated from blood and CSF were type b and one was nontypeable. Sixteen of 202 strains (7.9%) produced β-lactamase and all of them produced both penicillinase and cephalosporinase. The production of β-lactamase in this study was lower than that reported in previous studies [1-3]. In this study, some strains were found against which the MICs of carbapenems were very high (highest MIC of imipenem was 12.5μg/ml, of panipenem was 6.25μg/ml and of biapenem was 25μ/ml). Therefore, we assayed the binding affinities of imipenem for each of penicillin-binding proteins (PBPs) about one of these resistant strains. In resistant strains, inhibitory concentrations (IC₅₀) of imipenem for PBP4 and 5 were much higher than those in susceptible strains. Thus, the results demonstrate the decrease of the affinity of imipenem for PBP4 and 5. lt seems, therefore, that the major factor in the resistance to imipenem of H. influenzae was the low affinity of PBP4 and 5 for the drug.

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Foot orthoses are commonly used in patients with rheumatoid arthritis (RA) to support the foot and relieve pain, however little is known about the biomechanical effects of in-shoe foot orthoses in reducing or redistributing high pressures and loading forces. The purpose of this study was to compare the foot pressures and loading forces during gait in rheumatoid arthritic patients and healthy subjects, and evaluate the biomechanical effects of the foot orthoses in the RA patients. Twelve female RA patients with foot pain in walking, all Steinbrocker class II, and 8 healthy women without foot pain were matched for age. Foot pressures and loading forces with and without orthoses were measured using the F-Scan program. The pressure distributions and loading forces were standardized by the body weight and compared, and the effects of the foot orthoses were evaluated. The foot orthoses of RA patients provided higher pressure reduction than those of the control group (3.00±0.38g/cm²/BW and 3.29±0.29g/cm²/BW respectively, p<0.001). Similar redistribution of plantar pressures and loading forces were found between two groups but the RA patients had a greater change at the stance phase of gait (p<0.0001). The foot orthosis produces greater pressure and loading force relief and redistribution in RA patients than in normal subjects.

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We conducted a one-year comparative study of 25 patients with corticosteroid-induced osteoporosis associated with diffuse connective tissue disease. The patients were randomly divided into 2 groups: group A (9 patients), monotherapy with active vitamin D3 (V.D3); and group B (16 patients), combination therapy with V.D3 and etidronate. Four markers were employed: as an bonegenic marker, serum alkaline phosphatase (ALP); as a bone resorption marker, urinary deoxypyridinoline (DPD); as a bone salt minerals assay level, young adult mean (YAM); and bonefracture ratio. Results showed that: ALP decreased in both groups with no significant difference between groups; DPD increased significantly from baseline (p<0.05) in group A, but it decreased significantly from baseline (p<0.05) in group B, but again without a significant difference between groups; YAM resulted in no significant improvement in group A, but a significant improvement from baseline (p<0.01) was shown in group B, with a significant difference between groups (p<0.05); and a new spinal compression fracture ratio was extremely lower in group A than in group B. The findings indicated cyclical/intermittent etidronate therapy is effective in preventing corticosteroid-induced osteoporosis.

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We report a case of delayed cerebrospinal fluid (CSF) pseudocyst following shunt malfunction in a 20-year-old patient with myelomeningocele. Magnetic resonance (MR) images and a radioimmunoassay shunt-gram detected the CSF fistula at the old scar of the myelomeningocele repaired 20 years before. Since the revision of the shunt system failed to keep the pseudocyst, the lesion was successfully directly repaired. Treatment of the delayed CSF pseudocyst following shunt malfunction thus requires a radical operation of the lesion.

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We present a patient with duodenal papillary carcinoma who repeatedly developed acute pancreatitis preoperatively. The patient was a 65-year-old male. In February 1997, the patient consulted a local hospital due to vomiting, high fever, and jaundice. With the diagnosis of obstructive jaundice, percutaneous transhepatic biliary drainage (PTBD) was performed, revealing a distal bile duct obstruction. Because duodenal papillary carcinoma was diagnosed based on endoscopic findings, the patient was admitted to Kurume University Hospital. Hypotonic duodenography (HDG) disclosed a protruding lesion with an irregular surface in the descending part of the duodenum, resulting in a diagnosis of positive duodenal invasion (du₁). Because computed tomography (CT) demonstrated a protruding lesion on the medial side of the second portion of the duodenum, positive pancreatic invasion (paric₂) was diagnosed. On March 18 and April 22, sudden abdominal pain, leukocytosis, and an increase in serum amylase were noted. CT revealed that the pancreas was diffusely enlarged, showing an ill-defined boundary between the pancreas and adipose tissue and fluid collection. On CT, the lesion was evaluated as Grade 3 and moderate. For treatment, pancreatic enzyme inhibitors and antibiotics were intravenously injected. Peritoneal perfusion was concomitantly performed during the second treatment. Because symptoms remitted thereafter, a pylorus preserving pancreatoduodenectomy (PpPD) was carried out. The postoperative histologic examination revealed negative pancreatic invasion. Concerning the etiology of acute pancreatitis, not pancreatic invasion, but impaction of the liberated tumor mass in the common canal was considered responsible for the repeated pancreatitis because the tumor showed a cauliflower-like shape.

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A 69-year-old female underwent left lobectomy for hepatolithiasis in February 1994. She was admitted to the Kurume University Hospital in December 1997 because computed tomography (CT) showed calcification in the porta hepatis. Ultrasonography (US) revealed a hyperechoic area with an acoustic shadow in the right hepatic duct. Dilated intrahepatic bile ducts and a mural lucent area in the right hepatic duct were noted on endoscopic retrograde cholangiography (ERC). Although the above findings suggested a diagnosis of recurrent hepatolithiasis, percutaneous transhepatic biliary drainage (PTBD) for biopsy was performed in order to rule out cancer. Biopsy showed no evidence of malignancy. Under a cholangioscope, a tip of a nylon suture was found to be protruding into the bile duct. Although a gallstone had already slipped off, the surface of the nylon suture was covered with biliary sludge. The protruding tip of the nylon suture was considered to be the nucleus of the stone. The tip was removed under cholangioscopy. Postoperative CT confirmed the absence of calcification in the porta hepatis. There has been no recurrence of hepatolithiasis after surgery. Although the formation of gallstones around the core of nylon sutures is very rare, absorbable sutures should be used during surgery of the bile duct because nonabsorbable sutures can become the nucleus of gallstones.

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Postoperative bilateral chylothorax after cervical surgery has been rarely reported, whereas unilateral chylothorax has been occasionally reported after thoracic surgery. Here, we report a rare case of bilateral pleural effusion that developed after cervical abscess drainage. On the second day after the drainage, the patient felt dyspnea, and bilateral pleural effusion was found on a chest X-ray. The effusion was thought to be chyle and was successfully treated with conservative management. Additionally here, we have suggested that non-traumatic chylothorax was caused by increasing intraluminal pressure occurring inside the thoracic duct after its ligation. Careful follow up of any respiratory symptoms and of chest X-rays is recommended after cervical intervention.

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We have recently encountered two patients with early gastric cancer in the remnant stomach which resulted from gastritis cystica polyposa at the anastomosis site. The remnant stomach, which had been reconstructed with the Billroth II method, contained an elevated sessile lesion at the anastomosis site. One patient was a 73-year-old woman who had undergone gastrectomy for a gastric ulcer at 30 years earlier, cancer type I+IIa of the remnant stomach was diagnosed, and total remnant gastrectomy was performed. The other patient was a 59-year-old man who had undergone gastrectomy for a duodenal ulcer at 31 years earlier, cancer type I+IIa of the remnant stomach was diagnosed, and subtotal remnant gastrectomy was performed. Histological examination in each case showed that moderately differentiated adenocarcinoma had developed from gastritis cystica polyposa. These results suggested that this cancer has a close relationship with gastritis cystica polyposa.

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This report describes two arterial anomaly cases in the celiaco-mesenteric region, which were encountered in two Japanese male cadavers in the dissecting room at Kurume University School of Medicine in 1999. In these cases, the usual celiac trunks were not identified, and the hepato-mesenteric and the gastro-splenic trunks were independently arising from the abdominal aorta. Moreover, in the first case, the common hepatic artery passed ventral side of the portal vein and divided into the hepatic proper and the gastroduodenal arteries. This type of arterial anomaly belongs to the TypeV of Adachi's classification and the TypeIV of Morita's classification. In the second case, the common hepatic artery passed dorsal side of the portal vein and divided into the hepatic proper and the gastroduodenal arteries. This type of arterial anomaly belongs to the TypeVI of Adachi's classification and the TypeIV of Morita's classification.

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