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Although standard treatment for autoimmune hepatitis (AIH) comprises prednisolone (PSL) and azathioprine (AZA), some patients are intolerant to or do not respond to PSL and/or AZA. The clinical practice guidelines of AIH in Europe and North America recommend mycophenolate mofetil (MMF) as second-line treatment in these patients. We administered MMF as second-line therapy to 7 patients with AIH (male/female 1/6, age range 27-79 years) who were intolerant to or failed to respond to standard treatment. At the commencement of MMF, the median ALT value was 84U/L (28-254U/L), and the PSL dose was 15.0mg/day (0-45mg/day). In terms of adverse effects of PSL, diabetes mellitus was observed in 4 patients (insulin injection in 2) and femoral head necrolysis in 2. Adverse effects of AZA were present in 2, and 5 patients were not treated with AZA. At 24 weeks of MMF treatment, the median ALT and daily PSL dose were decreased to 16U/L (6-41U/L) and 7.0mg, respectively. Blood sugar control improved, and insulin injection was discontinued in both the patients. While intractable diarrhea developed in 1 patient with cirrhosis, no adverse effect was observed in other 6 patients. In conclusion, MMF appeared effective and safe in at least non-cirrhotic patients with AIH who were intolerant or failed to respond to standard treatment with PSL and AZA in Japanese clinical practice.

We have provided home treatment mainly for cancer patients since June 1995 and had 7 such patients until March 1996. Among them two patients died not at home but in the hospital, although the patients and their family understood that the patients were in the terminal stage of illness. It home was thought to be difficult that they accept death at their homes. From the standpoint of physical and mental conditions, social status and actual medical care, the factors to promote death at home were examined. The two cases mentioned above and their families wished to have treatment at home. The reasons why we decided to discontinue medical care at their homes were twofold: 1) the difficulty of palliating patients' symptoms and anxiety; and 2) the uneasiness of the family in caring for patients at home. Therefore sufficient palliation of symptoms and "death education" for patients and families are required to encourage death at home.

The proliferative activity of carcinoma cells is generally considered to relate to the degree of the malignancy of carcinoma tissues. In this study, the proliferative activity at the tumor-stromal border was studied in 17 cases of oral squamous cell carcinoma (OSCC) and in 30 cases of colorectal adenocarcinoma (CAC) by means of proliferating cell nuclear antigen (PCNA) immunostaining, to evaluate the correlation between proliferative activity and tissue differentiation or invasive mode at the tumor-stromal border. No statistical difference was detected between the PCNA labelling index (PI) and the tissue differentiation of both OSCC and CAC. A significant difference was demonstrated between PI and invasive mode in OSCC, suggesting that the invasive mode at the tumor-stromal border relate to the degree of the malignancy of carcinoma tissues. However, no significance was found between PI and invasive mode of CAC. In addition, no difference of PI was demonstrated between tissue differentiation or invasive mode, and vascular invasion or lymph node metastasis. Therefore, it seems likely that the invasive mode at the tumor-stromal border in CAC also has no significance in deciding the degree of the malignancy of carcinoma tissues.

To establish domiciliary treatment for cancer patients, following conditions must be settled. They are eligibility from clinical science, intentions of patients and their family, social and economical aspects, compatibility with medical service laws in Japan, and so on. Eligibility from clinical science should be the first matter to be settled among them. From the view of clinical science, medical care practices must be carried on in a correct manner even in patients' homes. In this study we focused on suitability from clinical science and examined possibility of domiciliary treatment for 111 inpatients in our hospital on April 6 th 1994. When the possibility was respectively judged by two nurses in our domiciliary cancer treatment committee, a difference appeared in the numbers of the candidates for domiciliary treatment. Finally the committee decided that 37 inpatients could receive medical care practices in their homes. The analysis of the reason in difference by two nurses made us recognize that the process of the selection of cancer treatment must be properly constructed for the well-qualified domiciliary treatment.