The effect of oral administration of viable Lactobacillus casei strain Shirota (LcS) on prevention of azoxymethane (AOM) -induced intestinal tumors in the rat was investigated. Thirty rats each received a weekly subcutaneous injection of AOM at a dose of 7.4mg/kg body weight for 10 weeks. Twenty-five weeks after the start of the carcinogen treatment, all rats were sacrificed, and the total intestine and the mesenteric lymph nodes (MLN) were removed. The incidence of tumors and lymphocyte surface markers derived from the MLN were investigated. The incidence of colon cancer was significantly lower in the rats which had consumed the LcS diet compared to the controls. The number of lymphocytes and CD8-positive lymphocytes was significantly higher in the rats given the LcS diet. LcS may therefore effectively inhibit chemically-induced colon carcinogenesis in the rat. CD8-positive T lymphocytes may play a key role in this protective effect against colon carcinogenesis.

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The prognosis of ovarian clear cell adenocarcinoma remains poor, even in the early stages. Thus, great efforts are being made to improve the treatment modalities of this disease, with chemotherapy in particular being in a period of dynamic development. To date, no universal criteria of histological grade or effective prognostic factors have been established for ovarian clear cell adenocarcinoma. The purpose of the present study was to investigate the prognostic significance of histological architectural subtype, immunohistochemical staining with CA125 and proliferation factors in ovarian clear cell adenocarcinoma tissues. Tumors obtained from 24 patients with ovarian clear cell adenocarcinoma (Stage I-IV) were examined for architectural subtype and immunohistochemical expression of CA125, PCNA, Ki-67, and topoisomerase II. Architectural subtype was classified into three types (papillary, solid, and tubulocystic/glandular) . The expression of CA125, PCNA, Ki-67, and topoisomerase II were compared with clinical features of the study population and overall survival. Survival curves were constructed according to the Kaplan-Meier method. The PCNA, Ki-67 and topoisomerase II labeling indices in the tumors were 44.3±14.7%, 14.0±5.0% and 13.9±7.7% (mean±S.D.), respectively. Strong expression of CA125 was observed in 41.7% of the tumors. This expression was not associated with FIGO stage or architectural subtype. Patients with papillary type carcinoma had a lower probability of survival than those with the solid type. Patients with strong expression of CA125 demonstrated a higher probability of survival than those with weak expression. These results suggest that low immunohistochemical expression of CA125 and papillary subtype in ovarian clear cell adenocarcinoma are associated with a poor prognosis.

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The etiology of idiopathic carpal tunnel syndrome remains poorly understood. This study investigated the relationship between idiopathic carpal tunnel syndrome and transverse carpal tunnel ligament histology, especially clinical severity of this disease and immunohistochemistry of the ligament. Ligament biopsy specimens were obtained from eleven wrists during operation for carpal tunnel release, and one control specimen was obtained. After staining of different slices from each specimen with HE and antibodies to collagen types I to VI, each slice was classified into 3 grades based on pathology, where grade 1 was the least and 3 the greatest pathological progression. Out of eight specimens from mild carpal tunnel syndrome patients, 4 were grade H-1, and the other 4 were grade H-2 based on HE staining. Out of 4 specimens from moderate to severe carpal tunnel syndrome patients, 1 was grade H-2 and the other 3 were grade H-3 with HE. Grades for anti-type I collagen were C-1 in 6 out of 8 mild CTS patients, whereas the grades were C-2 or C-3 in 3 out of 4 moderate to severe patients. Grades for anti-type III collagen were C-1 in 4 out of 4 mild patients whereas the grades were C-2 or C-3 in all 4 moderate to severe. The sum of type I and type III grades were 2 in control patients, 2-3 in the mild CTS patients, 4 in the moderate patients and 6 in the severe patients.
There was a correlation between the severity of this disease and the degree of transverse ligament pathology stained with HE, anti-type I and III collagen antibodies. These suggest that disturbance of the maturation of collagen fibers in the transverse carpal ligament is an important factor in idiopathic carpal tunnel syndrome.

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It has been known for a long time that athletes may have hematuria and proteinuria after participating in various sports. In the early 1900's, Collier confirmed the presence of protein by testing the urine of a regatta racer after a race, and Barach confirmed blood casts and red blood cells in the urine of marathon runners. Since then, many reports have examined the hematuria ratio in a variety of sports, but to date none have examined mountain climbing. We studied the ratio and change in hematuria in 59 subjects (49 men and 10 women) during mountain climbing on Mt. Kitadake, 3192 m above sea level. The subjects' urine was tested using an occult blood test sheet before climbing, after reaching the summit and after descending the mountain. Hematuria was found in 16 subjects (27%) and proteinuria was found in 23 subjects (39%) . The mechanism of development of hematuria in sport is thought to be due to increased blood flow in the heart, vascular system and lungs, and muscles from accelerated metabolism. Eventually, a urinary flow disorder is caused by ureterial flexion, and extension and compression of renal pedicle blood vessels. We found that increased capillary permeability induced by hypoxia, and autonomic abnormalities caused by renal bloodstream disorders are in addition seen in mountaineering.

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To investigate the role of recombinant human bone morphogenetic protein 2 (rhBMP-2) in the differentiation of osteoblasts and chondrocytes from mesenchymal progenitors, the effects of rhBMP-2 on differentiation of C3H10T1/2 pluripotent cells and MC3T3-E1 osteoblastic cells were examined. When C3H10T1/2 cells were treated with rhBMP-2, they differentiated into osteoblastic cells with alkaline phosphatase (ALP) activity and specific immunoreactivity for type I collagen and osteocalcin, and also chondrocytes immunoreactive with type h collagen appeared. RhBMP-2 also induced production of para thyroid hormone (PTH) -dependent cAMP in C3H10T1/2 cells. When C3H10T1/2 cells were transplanted into the peritoneal cavity of athymic mice using rhBMP-2-containing diffusion chambers, they generated both bone and cartilage in the diffusion chambers. RhBMP-2 also stimulated ALP activity and production of PTH-dependent CAMP and osteocalcin in MC3T3-E1 cells, but did not induce chondrocytes. MC3T3-E1 cells trans-planted in rhBMP-2-containing diffusion chambers formed only bone in the diffusion chambers. These results suggested that rhBMP-2 stimulates differentia-tion of both osteoblasts and chondrocytes, but its effects depend on the stage of differentiation of the target cells.

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Mast cells induced from normal mouse spleen cells by long-term culture showed strong regulatory effects on lymphocytes. These cells affected the kinetics ofin vitroplaque-forming cell (PFC) responses to sheep red blood cells (SRBC) . PFC responses were enhanced in an early phase (2^ndand 3^rdday), but suppressed in a later phase (4^thand 5^thday) . Thymocyte response to Con A, and B cell response to LPS were suppressed by mast cells. Supernatant collected from cultured mast cells enhanced PFC response and thymocyte response to Con A, but B cell response to LPS was suppressed. After Con A stimulation, the mast cell supernatant suppressed the B cell response more strongly. The thymocyte response to Con A was also suppressed. Large doses of the Con A-stimulated mast cell supernatant partially suppressed the PFC response. Up- and down-regulatory factors in the conditioned mast cell supernatant were responsible for the immunoregulatory functions of the mast cells, which was confirmed by chromatography and SDS-PAGE analysis. Further experiments are needed to identify these up- and down-regulatory factors.

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Dynamic changes during walking were evaluated in kyphotic patients by measuring load pressure using an F-SCAN, a sensor that facilitates measurement of plantar pressure. The subjects consisted of kyphotic patients demonstrating severe thoracic kyphosis and more than 1 old compression fracture at the transitional zone between the thoracic and lumbar vertebrae. The results of analysis in these patients were compared with those in healthy subjects. As a structural evaluation, plumb-line shift from the central sacral line (P-CSL) in a standing profile was correlated with changes in load pressure. The types of central loci of the plantar pressure were analyzed in these two groups, the total load between heel contact and toe off was evaluated in the respective locus, and the integrates and load duration were also determined in the respective compartments after dividing the plantar region into the following 4 compartments : heel, plantar arch, anterior foot, and toe. kyphotic patients maintain their anteroposterior equilibrium during walking by shifting the centroid in the posterior direction, a P-CSL. Therefore, the F-SCAN demonstrated an increased proportion of weightbearing at the heel. Points of application of the centroid in the planta pedis were almost identical between kyphotic patients and healthy subjects during natural standing. Therefore, it was considered that kyphotic patients maintain their anteroposterior equilibrium by increased integrates at the heel (prolongation of load times at the heel) . That is, the interval between heel contact and plantar contact tended to increase with the degree of anterior P-CSL.

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Periductal fibrosis of the interlobular bile ducts of the liver was examined in 20 cases of biliary atresia (BA) . Spindle-shaped mesenchymal cells, which we regarded as cholangio pericytes, were observed in all cases around interlobular bile ducts, and concentric circular fibrosis with ductal stenosis was seen in the cirrhotic cases. Cholangio pericytes were positive for a smooth muscle actin on immunohistochemistry, which is a marker of activated fat-storing cells. Electron microscopy revealed fat-storing cells, myofbroblasts and fbroblasts in the cholangio pericytes. Fibroblasts were observed in the cases of advanced periductal fibrosis, whereas fat-storing cells and myofibroblasts were seen in the cases with no obvious periductal fibrosis. These pathological findings suggest that periductal fibrosis in BA is mediated by fat-storing cells and activated myofibroblasts. Active periductal fibrosis is considered to be a characteristic intra-hepatic disorder associated with BA.

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We reviewed the results of bipolar hemiarthroplasty performed in 49 hip joints in 42 patients. The mean follow-up period was 122.3 months (range, 65 to 183 months) . The original disease was avascular necrosis (ANF) of the femoral head in 23 joints, osteoarthritis in 14, femoral neck fracture in 10 and ankylosing spondylitis in 2 joints. The revision surgery had to be performed in 7 other joints (14.3%) and severe loosening was found in 7 joints. Out of 27 joints with a normal acetabulum, proximal migration of the prosthesis of over 3 mm was radiologically diagnosed in only 2 hips (7.4%) . In the 22 joints that needed acetabular reaming during the first surgery, proximal migration was seen in as many as 19 joints (86.4%) . The results of the present study suggest that bipolar hemiarthroplasty can be successful in patients who have normal acetabulum, such as early ANF and should not be used for degenerative and displastic acetabulum that need reaming and bone grafting.

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A case of abdominoperineal excision with perineal continent colostomy and continent appendicocecostomy with antegrade enema is presented. The technique and 21-month follow-up are described. For antegrade enema, 1.5 L of tap water was used using an infusion system with a 10 F Foley catheter. This procedure was performed in a sitting position on a regular toilet, and 40 to 80 min were required. The success for 48-hour continence and the patient's comfort justify its use in selected patients.

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We report a novel hMSH2 gene mutation in a HNPCC kindred who developed various malignant tumors other than colorectal cancer through four generations. The clinicopathologic background of this proband was determined, and germline mutations in the hMSH2 gene were determined by single-strand conformation polymorphism (SSCP) analysis and direct DNA sequencing. This 36-year-old woman was diagnosed with multiple synchronous and metachronous early colorectal cancers with endometrial cancer by endoscopic studies, natural history, ultrasound of the abdomen, and endometrial curettings. Colonoscopic examination subsequently revealed synchronous early colonic adenocarcinoma. She underwent endoscopic polypectomy following transabdominal hysterectomy, bilateral salpingo-oophorcctomy, and selective pelvic and para-aortic node excisions. Screening for germline mutations of the hMSH2 gene detected a novel frameshift mutation caused by a one-base (G) deletion in exon 11 of the hMSH2 gene. We report a kindred with HNPCC who developed various malignant tumors other than colorectal cancer through four generations. We detected a novel mutation in this HNPCC proband. These results may help us to identify presymptomatic patients with HNPCC.

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