In epidemiologic studies, many serum samples obtained from a large population have to be processed for measurement of fat-soluble vitamins. Quantification results by a high performance liquid chromatography (HPLC) should be stable in both intra-and inter-run, and a quality control may be performed by a X-R control chart. The present study shows that serum retinol, α-tocopherol, α-carotene, β-carotene, and lycopene could be measured simultaneously, by 1) use of photodiode-array (POD) detector, 2) selection of some optimal analytical conditions (e.g. column, mobile phase, column temperature), 3) applying 2 internal standards, and 4) monitoring by a X-R control chart. The present procedure yielded relatively low coefficients of variations (CVs) compared to some reported figures. However, determination of CVs only does not ensure the accuracy and precision of an assay system, and application of a X-R control chart may be necessary for a good quality control of measurement, such as serum fat-soluble vitamins.

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Thoracoscopic lung biopsy is becoming the procedure of first choice for the diagnosis of many localized and diffuse lung diseases. We have performed thoracoscopic lung biopsy for 17 patients with diffuse infiltrative lung disease, in Kurume University Hospital. There were 13 females and 4 males with a mean age of 48 years (range: 19-71 years). Thoracoscopic surgical biopsy was performed in the right lung in 12 and in the left lung in 5. Adequate lung tissue from each case was obtained for pathological examination. The mean surgical biopsy time was 49 min (range: 25-72 min) and bleeding was negligible. The mean duration for chest tube drainage was 2.6 days. No postoperative complication such as prolonged air leakage occurred. A specific diagnosis from the biopsy was achieved in 13 (76.4%) of the 17 cases. In only 6 (35.2%) of the 17 cases, the pathological diagnosis was the same as that from the thoracoscopic biopsy. In these 6 cases, the same diagnosis was obtained only in those with idiopathic interstitial pneumonitis or diffuse panbronchitis. Thoracoscopic lung biopsy was safe and useful for diagnosis for diffuse infiltrative lung disease.

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Plasma β-phenylethylamine (PEA) levels were determined in 27 patients with Parkinson's disease (PD) in order to evaluate its relation with the severity or clinical course of PD. The plasma PEA concentrations in PD patients were significantly lower (mean±SD, 862±554 pg/ml) than those in the control group (1765±790 pg/ml) (p <0.0001). The concentrations of PEA in plasma did not correlate with Hoen and Yahr stage. However, in serial measurements of the PEA of 5 patients in the progressive group of the clinical course of PD, the plasma PEA levels revealed a downward trend after one or two years. On the other hand, in 3 patients of non-progressive group, the plasma PEA remained at the same level. This study suggests that plasma PEA level might reflect nigrostriatal degeneration in patients with PD.

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It is well known that asymptomatic viral shedding is one of the forms of reactivation of herpes simplex virus type-1 (HSV-1). Although there have been some long-term investigations of viral shedding into tears and saliva in healthy subjects in the U.S.A, there have previously been no investigation study in Japan. Racial differences in the incidence of reactivation of HSV-1 have been pointed out, and it has been considered that reactivation is found less often among Japanese people than among Westerners. In the present study, we selected 10 healthy adults (7 males and 3 females) to isolate HSV-1 from tears and saliva 3 times a week over 6 months, and the results were compared with the results of other studies conducted in the U.S.A. It was found that the virus was isolated in 5 (3 males and 2 females) of 10 subjects and of the 5 subjects, the virus was isolated from saliva in 4 and from tears in 1. The number of specimens was 1, 742 for tears and 871 for saliva with isolation of 1 and 4, respectively. The duration of shedding was only 1 day in all of the 5 subjects in whom the virus was isolated. The isolation frequency was significantly lower among Japanese people than among American people when our results were compared with the results of studies conducted in the U.S.A. It was clear that the reactivation rate was lower for Japanese people in terms of asymptomatic shedding.

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An educational trial to encourage sufficient calcium (Ca) intake was conducted on women college students who entered the college for dietitian either in 1993 or in 1994. The trial's effectiveness was assessed by a prospective cohort study. Two hundred and fifteen 18- or 19-yearold students were assigned into two cohorts, i.e., a control cohort (CC) and an educated cohort (EC). Both groups received 3 surveys, i.e., at baseline, 1 week after, and 1 year after the Ca education, which was given only to the EC at baseline to encourage sufficient Ca intake. The amount of Ca taken by the CC did not significantly change in the 3 surveys. The EC took a significantly larger amount of Ca 1 week after and maintained relatively larger amount of Ca 1 year after the Ca education. These results suggest some effectiveness of Ca education on the women college students.

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This study investigated whether or not P300 components are influenced by emotional affect such as sadness and pleasure in twenty healthy subjects and whether or not the P300 effects of facial affect stimuli are influenced by auditory and visual stimulus modalities. Written informed consent was taken from each subject before the study. Each subject was asked to stare at a simple picture of a facial expression (crying or smiling faces) during the auditory and visual oddball tasks. P300 amplitude and area were significantly larger when viewing a crying face (sadness) than a smiling face (pleasure) under both conditions with auditory and visual stimulus. P300 latency was significantly longer while viewing sadness than while viewing pleasure only with auditory stimuli. Reaction time was not changed by facial stimuli. Amplitude and area of P300 were significantly larger in women than men in their modalities, but the effects of facial affect on P300 amplitude and area in women were similar to those in men. These results suggest that amplitude and area of P300 with both modalities recorded while viewing sadness may induce larger attentional resource than pleasure. Gender was a less potent influence of facial expression on P300 parameters. The influence of facial emotion may be important to investigate the recognition processes of subjects.

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As society ages, the composition of the diseases that occur within it changes accordingly. With that in mind, we examined the characteristics and trends in the recent inpatients and compared these recent inpatients with those of a previous report to identify the changes that accompany the aging of society. Subjects were 1, 534 cases (men 56.9%, female 43.1%, average age 47.1 years) who were hospitalized at Kurume University Hospital for treatment during the 5-year period from January 1st, 1994 through December 31st, 1998. The ratio of inpatients over 65 years old was about 1.8 times higher than in the previous study, showing a clear trend toward an increased overall age of inpatients. As for the types of disease observed, the most common malignancies were epithelial tumor, followed by other benign tumors, as well as 76 cases which included diseases resembling tumor (epulis and exostosis etc.). A majority of the patients (55.6%) were directed to the Hospital by their dentist, a finding similar to that of the previous report. As for geographical distribution, 93.3% of the inpatients lived within 40 km of the center of Kurume City where our oral surgery is located, an increase of about 10% from the last report. In other words, our results showed a reduction in the sphere of treatment distribution.

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Changes in the aspects of primary infection of herpes simplex virus type 1 in the maxillofacial region have been observed due to the increase in the number of adult cases. To elucidate the possibility of serologic diagnosis in primary infectious patients and the influence of virucide on antibody production, we evaluated changes in serum antibodies (neutralizing antibody, lgM, and lgG antibody) in pair serum in 35 primary infectious patients using a micro-plate method and ELISA. At the first examination, 31 (89%) of 35 patients did not have neutralizing antibodies, and 23 of the 31 patients showed significant increases of neutralizing antibody titer more than four times at the second examination. Three of the 4 patients that had neutralizing antibodies showed significant increases at the second examination; therefore, 26 (74.3%) of the 35 patients could be diagnosed as having primary infection only by neutralizing antibodies. Regarding 9 patients who did not show significant increases in neutralizing antibodies, 5 of the 9 patients showed increases in lgG antibody titer more than two times at the second examination, and at the first examination, lgM antibody titer in 3 of the remaining 4 patients was more than 0.2 that is the cut-off value; therefore, it was possible to diagnose the 8 patients as having primary infection. We evaluated the influence of the use of virucide, gender, age, period between onset and the first examination, and period between onset and the second blood collection on antibody production; however, there were no differences observed except that significant increases in antibody were observed in 4 children aged below 10 years, although they used virucide. These results revealed that it was not possible to serologically diagnose whether there was primary or recurrent infection only by neutralizing antibody titer.

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Pleomorphic adenoma is the best-recognized tumor among those of salivary gland origin that also has the highest incidence. However, it is not uncommon for it to become malignant, and it has been noted that the frequency of malignancy increases as a result of the tumor persisting without being treated following the onset of adenoma. Carcinomatous components demonstrate various histological appearances, and in particular, there have been sporadic reports of carcinosarcoma in which malignant findings are not only observed in epithelial components, but in mesenchymal components as well. We conducted a histopathological study on cases of malignanttransformed pleomorphic adenoma, namely so-called malignant mixed tumor observed in our department. The subject cases consisted of a total of 19 cases registered in the diagnostic files of our department and included 12 males and 7 females. Age ranged from 46 to 87 (average 67.7) years old. The sites of occurrence consisted of the parotid gland in 17 cases, and palatal and buccal minor salivary glands in one case each. Histological types consisted of 7 cases of adenocarcinoma not otherwise specified, 3 cases of squamous cell carcinoma, 3 cases of salivary duct carcinoma, and one case each of polymorphous low-grade adenocarcinoma and epithelial-myoepithelial carcinoma, while the remaining were 2 cases of sarcomatoid carcinoma and 2 carcinosarcoma. We described herein their histological characteristics, discussed diagnostic problems in various instants in which each phenotype on this setting, and reviewed the literature, especially as to carcinosarcoma in contrast with those derived from other organs.

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We have experienced a case of advanced gastric cancer with liver metastasis effectively treated by intra-hepatic arterial infusion of 5-fluorouracil (5-FU), mitomycin C (MMC) and peroral administration of 5-FU. The patient was a 48-year-old male diagnosed as having advanced gastric cancer with multiple liver metastasis in the bilateral lobes of the liver. This patient was treated by intra-hepatic arterial infusion of 5-FU (250 mg/2days × 8 doses), MMC (20 mg × 1 dose, 6 mg/2 weeks × 6 doses) and Peroral administration of 5-FU (200 mg/day). At 14 weeks later, a CT revealed that the metastatic liver tumors had disappeared. However, at 7 months after the therapy, the patient eventually died of liver and brain metastasis. These results suggested that intra-hepatic arterial infusion of 5-FU and MMC was an effective therapy for metastatic tumors in the liver, but we need to perform intra-hepatic arterial infusion using a new prolonged regimen to treat the liver metastasis.

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We have experienced a case of the stomach with hypergastrinemia and type A gastritis with multiple carcinoids in a 37-year-old woman. An upper gastrointestinal series revealed multiple minute polyps in the upper body of the stomach. All polyps were diagnosed as carcinoid using endoscopic biopsies. She had neither symptom or signs of typical carcinoid disease. The serum gastrin level was as high as 725 pg/ml. Total gastrectomy was performed, and the diagnosis of multiple gastric carcinoids (sm, no) with type A gastritis was histologically confirmed. After the operation, the serum gastrin level returned to normal, and the patient has been doing well and is disease-free to date at 7 years after the operation. This case suggested that multiple gastric carcinoid lesions may be precipitated by chronic atrophic gastritis accompanying hypergastrinemia. In the treatment of multiple gastric carcinoids with type A gastritis, total gastrectomy with lymph node dissection should be standard operative procedure, in order to resect the fundic gland area completely which could be the origin of carcinoids and endocrine cell micronest.

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