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We examined plasma biomarkers as predictive factors for advanced hepatocellular carcinoma(ad-HCC)patients treated with sorafenib. We analyzed a-fetoprotein(AFP), AFP-L3, des-g-carboxy prothrombin(DCP), neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR), and vascular endothelial growth factor(VEGF)before sorafenib therapy, and changes in AFP-L3, NLR, PLR, and VEGF 1 month after sorafenib therapy in 16 patients. High AFP-L3(hazard ratio: 1.058, 95%CI: 1.019-1.098, p=0.003)and high NLR(hazard ratio: 1.475, 95%CI: 1.045-2.082, p=0.027)were significantly associated with poor prognosis in ad-HCC patients treated with sorafenib. There were no significant differences in changes in AFP-L3, NLR, PLR, and VEGF 1 month after sorafenib therapy. We suggest that AFP-L3 and NLR levels before sorafenib therapy in patients with ad-HCC are an important predictive factor for the therapeutic effect of sorafenib and patient survival.

We aimed to determine the usefulness of arrival time parametric imaging (AtPI) using contrast-enhanced ultrasonography (CEUS)with Sonazoid in the evaluation of early response to sorafenib for hepatocellular carcinoma (HCC). Thirteen ad- vanced HCC patients with low a / -fetoprotein (AFP) level (≤35 ng/mL) who received sorafenib for at least 4 weeks were enrolled in this study. CEUS was performed before and after treatment (2 weeks), and the images of the target lesion in the arterial phase were analyzed by AtPI. In the color mapping images obtained by AtPI, the mean arrival time of the contrast agent in the target lesion from the starting point (mean time: MT) was calculated. In each patient, differences between MT before and MT 2 weeks after treatment were compared. MT (+) and MT(-) groups were designated as such if the difference was 0 or greater(blood flow velocity of the lesion was reduced)and less than 0 sec(blood flow velocity of the lesion was increased), respectively. The overall survival was evaluated between the 2 groups. In the MT (+) group (7 patients) and MT (-) group (6 patients), the median survival times were 307 and 208 days, respectively, which was statistically significant. We suggest AtPI is useful for evaluating early response to sorafenib in advanced HCC patients with low AFP level.

We compared the benefits of sorafenib with that of hepatic arterial infusion chemotherapy (HAIC) for advanced hepatocellular carcinoma (ad-HCC) refractory to transcatheter arterial chemoembolization (TACE). We evaluated the patient characteristics, the median survival time (MST), and the prognostic factors in 17 patients in the sorafenib group and in 26 patients in the HAIC group. No significant difference was observed in the patient characteristics between the groups. The MST in the sorafenib group and HAIC group was 483 days and 284 days, respectively. A significantly longer survival time was noted in the sorafenib group (p=0.033). The prognostic factors were sorafenib therapy in all 43 patients(hazard ratio: 3.32 [95% CI: 1.36-8.10], p=0.008) and the longer treatment period of sorafenib in the sorafenib group(hazard ratio: 0.99 [95% CI: 0.984- 0.999], p=0.009). When compared with HAIC, sorafenib showed favorable treatment results in patients with ad-HCC refractory to TACE.

Our purpose is to develop a QA/QC (quality assurance/quality control) web system using a server-side script language such as HTML (HyperText Markup Language) and PHP (Hypertext Preprocessor), which can be useful as a tool to share information about QA/QC in radiotherapy. The system proposed in this study can be easily built in one's own institute, because HTML can be easily handled. There are two desired functions in a QA/QC web system: (i) To review the results of QA/QC for a radiotherapy machine, manuals, and reports necessary for routinely performing radiotherapy through this system. By disclosing the results, transparency can be maintained, (ii) To reveal a protocol for QA/QC in one's own institute using pictures and movies relating to QA/QC for simplicity's sake, which can also be used as an educational tool for junior radiation technologists and medical physicists. By using this system, not only administrators, but also all staff involved in radiotherapy, can obtain information about the conditions and accuracy of treatment machines through the QA/QC web system.

A 60-year-old man with liver cirrhosis caused by hepatitis C, who was receiving warfarin anticoagulation following acute myocardial infarction, was diagnosed with advanced hepatocellular carcinoma and multiple lung metastases, and began treatment with sorafenib 200 mg daily. From the treatment's start to 14 and 63 days later, sorafenib was increased to 400 mg and 600 mg, respectively. After increasing the quantity to 600 mg, he had an increase in PT-INR values and experienced a lower-extremity hemorrhage. For the patient with liver cirrhosis, who is receiving warfarin, PT-INR values might be elevated during the early period of sorafenib treatment dosage as for the increase in quantity. Therefore, when increasing dosage, a frequent measurement of PT-INR and a careful follow-up for PT-INR is necessary.

Two years of palliative home care for advanced and recurrent breast cancer of six patients was performed since January 2007. The reasons to provide palliative home care include an administration of skin infiltrative tumor, pain, home oxygen therapy (HOT), and chemotherapy. Most important part of home palliative care is to prepare any physical and psychosocial problems among any types of occupation.

A 46-year-old woman was diagnosed with complaints of bilateral breast tumor with massive ascites retention. The patient was examined as scirrhous carcinoma by lacteal gland inspection and dysplastic cell by ascites cytotechnology. We diagnosed her case to be bilateral breast cancer with peritonitis carcinomatosa, lymph node metastases and bony metastases. In addition to that, gastric metastasis was diagnosed by the result of widespread irregular gastric mucosa, which was inspected through upper gastrointestinal endoscope. The patient was treated with S-1 and paclitaxel and has achieved a remarkable response. The patient's tumor, gastric metastasis, and ascites were disappeared almost completely.

A 62-year-old man was admitted to our hospital complaining of sore throat and epigastralgia. Laboratory tests revealed leukocytosis and an elevated CRP level. CT showed a low density area in the right hypopharynx, wall thickening of the esophageal and gastric wall with an intramural low density area. Phlegmonous esophagogastritis associated with hypopharyngeal abscess was diagnosed. The infection was extension and his condition was serious because of his accompanying poorly controlled diabetes. He was successfully treated by antibiotics and drainage of the hypopharyngeal abscess. CT was useful for early diagnosis, confirmation of the extent of inflammation and follow-up.

IFNalpha is important for the defense against viral infection. By using a sensitive radioimmunoassay, we previously established the existence of endogenous IFNalpha in human. Serum IFNalpha, i.e., endogenous IFNalpha gradually increases with age, reaching the highest peak at young adults and then gradually declining with aging. We also found that serum IFNalpha levels were significantly low in the patients with Sjögren's syndrome. Subsequent treatment with a small dose 450 IU/day of orally administered IFNalpha significantly improved saliva secretion and the pathology of salivary glands of the patients as well. Since natural killer (NK) cell activity has been reported to be significantly decreased in the patients likely because of the decrease of IFNalpha, we may assume that correction of endogenous levels of IFNalpha by administering small amounts of IFNalpha will improve the vicious cycle in the pathology of the patients with Sjögren's syndrome.

Purpose: To examine the correlation of the presence of meibomian gland dysfunction(MGD) with the incidence of superficial punctate keratopathy (SPK) after penetrating keratoplasty., Subjects & Methods: We studied 151 eyes of 141 patients that underwent penetrating keratoplasty. SPK and the presence of MGD were evaluated by slit-lamp examination. Tear function was evaluated by Schirmer test., Results: Among 151 eyes investigated, 78 eyes had neither MGD nor hypolacrimation. The number of eyes with MGD only, with hypolacrimation only, or with both MGD and hypolacrimation was 34, 23, and 16. The presence of SPK after penetrating keratoplasty was correlated with the presence of MGD 1 month or 6 months post-surgery, but no correlation was observed with the presence of hypolacrimation. There was no interaction between the presence of MGD and hypolacrimation and the incidence of SPK., Conclusion: This study suggested that the active treatment of MGD is important in the post-surgery management of SPK.

The reports on the patients with rheumatoid arthritis (RA) complicated with the myeloperoxidase specific-antineutrophil cytoplasmic antibody (MPO-ANCA) associated glomerulonephritis, whose clinical feature is rapidly progressive glomerulonephritis (RPGN), have been rare. We here report three cases of RPGN with MPO-ANCA in RA patients. Case 1. A 44-year-old woman with RA for 25 years was admitted because of RPGN. The level of MPO-ANCA was markedly high (293 EU) and the histological examination of the kidney showed diffuse crescentic glomerulonephritis. In spite of the intensive immunosuppressive therapy, her renal function did not recover and she underwent hemodialysis (HD). Case 2. A 58-year-old man with RA for 5 years was admitted due to RPGN (MPO-ANCA ; 147 EU, Ccr ; 16 ml/min) with the nephrotic syndrome and fever. The treatment with the immunosuppressive agents and the plasma exchange was partially effective to stop the rapid progression of the disease, but a few months later, his renal function worsened (Ccr 7 ml/min). A recent histological examination of the kidney failed to establish the CrGN because of endstage kidney. Case 3. A 56-year-old woman with RA for the past 10 years was admitted because of RPGN (MPO-ANCA ; 652EU). Intensive therapy could not be performed because of an active duodenal ulcer and markedly impaired renal function (Ccr ; 6 ml/min), and soon she underwent HD. Renal biopsy was not done. These three cases suggest that RPGN can occur in part of RA patients with MPO-ANCA.

Before 1983, S. hadar was seldom isolated from man, animals, food or the environment in Japan: only one strain having been isolated from man and one from the environment. In subsequent years there has been a progressive increase in the number of isolations. S. hadar is now one of the commonest serotypes isolated from cases of sporadic diarrhea in Shizuoka Prefecture (Table 1). However, the epidemiology of S. hadar is not clearly understood. Reports on the clinical features of S. hadar gastroenteritis are also scarce. We examined the clinical symptoms of 15 cases of S. hadar gastroenteritis. S. hadar was encountered in patients of all ages. Infants and young children below 10 years of age constituted 47% of all cases. Seventy per cent of young children below 10 years of age experienced fever of more than 39 degrees C. This incidence was significantly higher than that of general Salmonella gastroenteritis observed in our previous study, in which fever of more than 38 degrees C was noted in 61% of the children. We found one case of presumptive person-to-person spread. No other household contacts of index patients suffered from diarrhea during the same period. Systematic examination for Salmonella contamination was performed for poultry farms, broiler chickens, broiler processing plants and meat on the market. 259 Salmonella strains were isolated from 1197 samples. S. hadar accounted for 37.1% (96) of all isolations (259). A drug resistance test was performed for 51 strains of the diarrhea cases and 67 strains of the environment. The pattern of the distribution of MICs of 9 drugs was similar in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

A systematic examination was performed for environmental food contamination by Salmonella in poultry farms, broiler chickens, broiler processing plants and meat on the market. Salmonella was isolated from 219 of 1197 samples and the serotypes showed a wide distribution. (Table 1-1). S. hadar accounted for 37.1% (96) of all isolations (259). The contamination rate of broiler chickens on arrival at broiler processing plants is relatively low. However, in the broiler processing plants, containers, processing machinery, cooling water and slaughters were highly contaminated by Salmonella, S. hadar being the most prominent serotype in the plants. 64% of chicken meat on the market was contaminated by Salmonella, S. hadar being the second most prominent serotype. 11% of the pork and none of the beef or horseflesh was contaminated by Salmonella. These results indicate that poultry is the main source of S. hadar infection in humans. However, no S. hadar was isolated from cultures of 119 samples of feed for chickens from each delivery (Table 1-1). Thus, as the main source of infection by S. hadar of broiler chickens, an association with the feed seems to be ruled out. S. hadar was isolated at three of 18 poultry farms within Shizuoka Prefecture. Follow-up studies were performed at the three poultry farms which revealed that in two of them, Salmonella was completely eradicated on completion of disinfection. In the other one farm, which is still being disinfected, various strains of Salmonella including S. hadar still survived. We conclude that the main cause of the problem is the magnification of contamination of Salmonella-free material during the process at the broiler processing plants.(ABSTRACT TRUNCATED AT 250 WORDS)

From September 1986 through July 1987, all fecal specimens obtained from infants and children who visited the pediatric clinic of the Shizuoka General Hospital with complaints of abdominal pain or diarrhea were examined for thermophilic Campylobacters. Bacteriological and epidemiological studies were performed on household contacts. The mothers of the patients were compared with the mothers of age-matched control subjects. Bacteriological examination of animals in 49 primary schools in Shizuoka city was performed. C. jejuni was isolated from 47 (9.4%) of the 499 feces samples, occupying first place in the bacterial etiology of acute bacterial enteritis. Infants and young children below 10 years of age comprised 81% of the total cases. Fourteen (13%) strains of C. jejuni were isolated in 9 families among 105 household contacts of the index patients. Six symptomatic contacts in two households had eaten the same suspected chicken as the respective index patients. In three families, C. jejuni was isolated from the remainder of the chicken. The serotype of these isolates was identical to that of the isolates from the index cases and the other family members. It was also noted that the same chopping boards were used for the preparation of salads after cleansing with water. In two index cases, the antibody of convalescent serum against C. jejuni isolated from the chicken, as estimated by passive hemagglutination method, ranged from 1:320 to 1:1280. These facts strongly supported the assumption that they had been infected by the chicken. The remaining persons were asymptomatic and the possibility was left that the index cases had been secondarily infected by these carrier persons.(ABSTRACT TRUNCATED AT 250 WORDS)

Fifteen cases of typhoid fever occurred in "HARADA" district Fuji City in Shizuoka Prefecture during the period of 1983 to 1985. Epidemiological and bacteriological investigations were carried out on the samples from a small water supply system, and drains of apartment houses in 1985. Water from a small river in the neighboring water supply system, and faecal specimens from people living in close proximity were investigated. The results obtained were as follows: 1) Salmonella typhi were isolated from 3/3 patients (1 pupil and 2 employees) in 1983, 3/5 patients (3 employees) in 1984, and from 4/7 patients (1 kindergartner, 1 pupil and 2 junior high school boys) in 1985. Phage type of these isolates were the same type "D1". 2) In the bacteriological survey on environment, S. typhi (phage type D1) were isolated from water of the water source of "HARADA" water supply in Fuji City with membrane filter methods, and from the sand source "HARADA" water supply with enrichment culture methods. Also, with an examination that tested 3,670 inhabitants, it was found that a carrier (phage type D1) was living near the "HARADA" water supply. 3) In the three selective media for the isolation of S. typhi, Bismuth sulfite agar (Difco) was the most sensitive, and detected 13 samples (61.9%) out of 21, from water source and sewage.

It is clear that the prognosis of uterine cervical cancer depends on the spread of cancer, especially lymphnodes metastases and parametrial infiltration. The correct diagnosis of parametrial infiltration before treatment is, however, difficult and there are many over- and under-diagnosis. In this paper, we discuss the details of parametrial infiltration based on the radically hysterectomized specimens in Shinshu University Hospital from 1964 to 1978. In these period, 284 cases of uterine cervical cancer were operated by Okabayashi's radical hysterectomy and our postoperative classification were carried out. The results were as follows; 1) The incidence of parametrial infiltration were 16.4 in Stage Ib, 36.6% in Stage IIa, 57.5% in Stage IIb and 35.6% in all cases. 2) When divided the parametrial tissue into three parts, we could find carcinomatous infiltration into uterine part in 77.3% of positive cases, middle part in 16.2% and pelvic part in 16.2%. 3) The agreement between clinical diagnosis and histological findings were 72.2% in all cases. 4) The CPL classification had close relation with parametrial infiltration (C type; 0%, P type; 17.9%, L type; 61.8%). 5) The 5-year survival rate of patients with infiltration showed poor outcome (63.0% in 81 cases), but that with no infiltration had good prognosis (98.4% in 128 cases). In conclusion, parametrial infiltration is very important for treating the uterine cervical cancer patients.