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Although standing plantar perception training (SPPT) may improve standing postural stability, the underlying neural mechanisms remain unclear. The authors investigated the relationship between regional cortical responses to SPPT using a balance pad and training outcomes in 32 older participants (mean ± SD:72.2 ± 6.0, range:60–87). Regional cortical activity was measured in the bilateral supplementary motor area, primary sensorimotor area, and parietal association area using near-infrared spectroscopy. Postural sway changes were compared before and after SPPT. Changes in two-point plantar discrimination and regional cortical activity during SPPT, associated with standing postural stability improvements, were examined using multiple regression and indicated improved standing postural stability after SPPT (p

BACKGROUND While accumulating evidence suggests a relation between the severity of alcohol dependence and the risk of its recurrence, the impact of dependence severity on the course of the disorder has not been carefully evaluated. The present study examined the impact of several severity indices of alcohol dependence on the drinking course after inpatient treatment. METHODS This prospective study was conducted over a 12-month period following alcohol treatment at a specialized hospital. A total of 712 consecutively admitted alcohol-dependent patients were targeted for enrollment at the time of their hospitalization, with 637 patients registered and followed. The characteristics and severity of the subjects were assessed using multiple methods at admission, with their course after discharge followed continuously using mailed questionnaires that queried them regarding their drinking behavior. RESULTS Greater severity of dependence, assessed using the number of ICD-10 diagnostic criteria met, was associated with a lower rate of abstinence during the study period (p = 0.035). The rate of abstinence also decreased significantly as the baseline blood gamma-glutamyl transferase value and Alcohol Dependence Scale (ADS) score increased (p = 0.031 and p = 0.0002, respectively). In multivariate Cox proportional hazards analyses, the group with the most severe ADS scores had a significantly greater risk of relapse to drinking than the group with the least severe scores (HR = 2.67, p = 0.001). Dependence severity also associated with the drinking pattern; participants in both the controlled drinking group and the abstinence group had lower ADS scores at admission and a later age at first drinking (p = 0.001 and p

Background Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is often caused by Helicobacter pylori and has a good prognosis. Rarely, patients with MALT lymphoma may have gastric cancer and have a poor prognosis. Case presentation We herein report a case in which surgical treatment was achieved for a 72-year-old male patient with gastric and duodenal MALT lymphoma coexisting multiple gastric cancers. He underwent upper endoscopy for epigastric discomfort, which revealed mucosal erosion on the posterior wall of the middle body of the stomach, an elevated lesion on the duodenal bulb, and a raised tumor on the antrum of the stomach. He was diagnosed with gastric and duodenal MALT lymphoma with early gastric cancer. One month after H. pylori eradication, a second upper endoscopy revealed no improvement in the gastric or duodenal mucosa, and areas of strong redness with a shallow recess just below the cardia of the stomach. As a result, a diagnosis of gastric and duodenal MALT lymphoma with two gastric cancers was made. Total gastrectomy with proximal duodenum resection using intraoperative upper endoscopy and regional lymph node dissection was performed. Pathologically, gastric and duodenal MALT lymphoma and three gastric cancers were detected. Since one of them was an advanced cancer, he started taking S-1 after his general condition improved. Conclusion For early detection of gastric and duodenal MALT lymphoma or gastric cancer, appropriate upper endoscopy and a biopsy are important. It is necessary to select a suitable treatment, such as H. pylori eradication, endoscopic treatment, surgery, chemotherapy, and irradiation, according to the disease state.

Background Pseudosarcomatous myofibroblastic proliferation is a rare proliferative lesion of the submucosal stroma characterized by myofibroblast proliferation and inflammatory cell infiltration, and is mainly reported in the urinary system. Case presentation We report a 65-year-old male who was referred to our emergency room with right-side iliac fossa pain. The pain gradually worsened for approximately 2 months, and rebound tenderness was positive. Blood examination showed severe inflammatory findings, and enhanced computed tomography revealed a heterogeneous contrast-enhancing mass lesion measured to be 55 × 50 mm in size at the lower right abdomen. Based on these results, the patient was diagnosed with appendicitis with an abdominal abscess. As the inflammation was severe, we drained the abscess before performing surgery. Approximately 1 month after the abscess diminished, interval appendectomy was performed. Macroscopic findings of the resected specimen showed a perforated diverticulum of the appendix and a small adjacent nodule measured to be 14 mm in size. Histopathological examination with hematoxylin and eosin staining revealed that the nodule consisted of fibroblast proliferation and inflammatory cell infiltration. Furthermore, immunohistochemical examination showed positive for smooth muscle actin and desmin and negative for S-100, c-kit, and anaplastic lymphoma kinase. Based on these histopathological results, we diagnosed the nodule as an unusual case of a pseudosarcomatous myofibroblastic proliferation associated with perforation of the diverticulum of the appendix. Conclusion Herein, we report a rare case of a pseudosarcomatous myofibroblastic proliferation that occurred in the appendix with diverticulitis.

Bright light (BL) therapy is clinically utilized for treatment of sleep–wake disorders through the manipulation of circadian oscillation. It is also extended to depressive disorders including seasonal affective disorder through emotional regulation. Recently, it has been suggested that BL facilitates memory encoding and consolidation via another psychophysiological mechanism of perceptual information processing in the brain. In particular, BL can help to alleviate stress associated with processing of fear memories. In this study, we explored a potential application of BL for treatment of stress-induced and fear circuitry disorders in patients receiving exposure-based cognitive behavioral therapy (CBT). Fourteen patients with panic disorder (PD) or posttraumatic stress disorder (PTSD) were enrolled in a single-blind, randomized control trial to assess BL exposure (8000-lux, 30 min, 9 times, 2 weeks apart) compared to sham light (SL) exposure (800-lux, the same duration and frequency), while patients were concurrently receiving exposure-based CBT. The State Trait Anxiety Index (STAI) and the self-rating version of Montgomery–Asberg Depression Rating Scale (MADRS-S) assessed anxiety-related severity scores before and after therapy. After dropouts, 10 participants remained. STAI and MADRS-S scores showed a significantly greater reduction in the BL group than in the SL group. BL may be an effective augmentative therapy when used with exposure-based CBT for PD and PTSD patients. Future trials with larger sample sizes that are adequately statistically powered are required to confirm these preliminary findings.

Background:Cognitive behavioral therapy for insomnia (CBT-I) is a first-line therapy for insomnia disorders. We assessed changes in discrepancies between subjective and objective sleep measures and correlations between discrepancy changes and clinical insomnia severity for CBT-I in patients with primary insomnia METHODS: Fifty-two outpatients (mean age, 60.3 years; 26 women) with primary insomnia were treated by individual CBT-I (50 min, maximum six sessions, once every 1-2 weeks). One week before and after CBT-I, patients recorded a sleep log and wore an actigraphy device. Subjective and objective time in bed (TIB), total sleep time (TST), sleep-onset latency (SOL), wake time after sleep onset (WASO), and sleep efficiency (SE) were evaluated by averaging 1-week records. Relative values of sleep discrepancy in TIB, TST, SOL, WASO, and SE were calculated for estimating effects of CBT-I. The therapeutic effects were also evaluated using psychological scales before and after CBT-I., Results:Subjective and objective discrepancies in sleep measures decreased by 36, 25, and 37 min in TST, SOL, and WASO, respectively, and 7% in SE (all P < 0.001) after CBT-I. Seven patients transitioned from underestimating SE before CBT-I to overestimating SE after CBT-I. Although CBT-I improved relative values of discrepancy in WASO and SE, alongside ISI, the improvement in insomnia severity only correlated with SOL discrepancy., Conclusions:CBT-I may reduce the discrepancy between subjective and objective sleep measures in patients with primary insomnia. However, a greater therapeutic effect of CBT-I was observed in reducing the ISI, which was slightly influenced by improvements in sleep discrepancies.

Background Pneumoperitoneum commonly occurs as a result of a viscus perforation and usually presents with peritoneal signs requiring emergent laparotomy. Spontaneous pneumoperitoneum is a rare condition characterized by intraperitoneal gas with no clear etiology. Case presentation We herein report a case in which conservative treatment was achieved for an 83-year-old male patient with spontaneous pneumoperitoneum that probably occurred due to duodenal diverticulosis. He had stable vital signs and slight epigastric discomfort without any other signs of peritonitis. A chest radiograph and computed tomography showed that a large amount of free gas extended into the upper abdominal cavity. Esophagogastroduodenoscopy showed duodenal diverticulosis but no perforation of the upper gastrointestinal tract. He was diagnosed with spontaneous pneumoperitoneum, and conservative treatment was selected. His medical course was uneventful, and pneumoperitoneum disappeared after 6 months. Conclusion In the management of spontaneous pneumoperitoneum, recognition of this rare condition and an accurate diagnosis based on symptoms and clinical imaging might contribute to reducing the performance of unnecessary laparotomy. However, in uncertain cases with peritoneal signs, spontaneous pneumoperitoneum is difficult to differentiate from free air resulting from gastrointestinal perforation and emergency exploratory laparotomy should be considered for these patients.

Highlights • This is the first report of ileo-ileal fistula onset after strangulated ileus without intestinal resection. • Furthermore, this fistula caused severe malnutrition duo to chronic inflammation and ulcer formation. • After resecting the ileo-ileal fistula, the nutrition status was resolved immediately without any medications. • When preserving the intestines in strangulated ileus, these fistulas should be considered. • Since malnutrition in the elderly is a serious problem, it should be treated promptly., Introduction Entero-enteric fistulas are rare complications that occur in patients with inflammatory bowel disease and other intestinal diseases. In this report, we present an ileo-ileal fistula accompanied by severe malnutrition caused by strangulated ileus surgery while preserving the ischemic ileum in a very elderly patient. Case presentation A 90-year-old woman underwent emergency surgery without bowel resection for strangulated ileus in another hospital. Minor abdominal pain and slight fever persisted after surgery. She lost weight, losing approximately 10 kg within half a year. She gradually became difficult to move due to dyspnea upon exertion and generalized edema and visited at our hospital. Pleural effusions, ascites and severe malnutrition were observed. An elastic hard mass with mild tenderness was palpated in her abdomen. Computed tomography showed a loop-like ileum and ileo-ileal fistula with adjacent fat stranding. We performed a partial small bowel resection. The resected specimen demonstrated an ileo-ileal fistula and circumferential ulceration in the loop-like adhesion. After the operation, the nutrition status was resolved immediately without any medications. Discussion In cases of strangulated ileus, there are no deterministic criteria for evaluating intestinal blood flow. This is the first report of ileo-ileal fistula onset after surgery for strangulated ileus without intestinal resection. Furthermore, this fistula caused severe malnutrition duo to chronic inflammation, ulcer formation, and the blind-loop syndrome. Conclusions When preserving the intestinal tract in the operation of strangulated ileus, the occurrence of entero-enteric fistulas should be considered. Since malnutrition in the elderly is a serious problem, it should be treated promptly.

Music is commonly used to modify mood and has attracted attention as a potential therapeutic intervention. Despite the well-recognized effects of music on mood, changes in affective perception due to music remain majorly unknown. Here, we examined if the perception of aversive stimuli could be altered by mood-changing background music. Using subjective scoring data from 17 healthy volunteers, we assessed the effect of relaxing background music (RelaxBGM), busy background music (BusyBGM), or no background music (NoBGM) conditions on response to aversive white noise stimulation. Interestingly, affective response to the white noise was selectively alleviated, and white noise-related P3 component amplitude was reduced in BusyBGM. However, affective responses as well as P3 amplitude to reference pure tone stimuli were similar regardless of background music conditions. Interestingly, heart rate (HR) increased in BusyBGM, whereas no increase in HR was found in similar distress, NoBGM condition. These findings suggest that increase in HR, which happens during BusyBGM exposure, can be a reflecting feature of music that ameliorates the affective response to aversive stimuli, possibly through selective reduction in neurophysiological responses.

Background In recent years, enteral nutrition has become relatively easy to perform through the penetration of percutaneous endoscopic gastrostomy (PEG). However, there have been reports of complications, such as mispuncture of other organs at the time of performing PEG. Previously, we had constructed a gastrostomy under the laparotomy for difficult PEG cases, and 2 years ago, we introduced laparoscopically assisted PEG. This study aimed to clarify the feasibility and safety of LAPEG for elderly people over 65 years old. Methods We evaluated the perioperative outcomes in 7 elderly patients who underwent LAPEG during these 2 years. In these subjects, the safety of LAPEG was evaluated retrospectively based on the surgical outcomes, perioperative complications, and postoperative course using the clinical archives. Results The subjects' mean age was 81.1 ± 8.03 years. LAPEG was successful in all 7 patients. The median operation time was 38 minutes (range, 31-71 minutes). Intraoperative and postoperative early or late complications from LAPEG were not observed in our cases. Enteral nutrition was commenced 2 days after PEG placement in all cases without complications. Conclusion We summarized the LAPEG cases performed at our institution for the elderly, and have reported its feasibility and safety. The strongest advantage of LAPEG was that it allowed placement of the PEG without any complication under direct observation of the intraperitoneal cavity to confirm the safety of each organ.

Crohn's disease (CD) is associated with an increased risk of developing colorectal cancer. In particular, cases in which long-term survival is achieved by patients with local recurrence of CD-associated rectal cancer are rare. We report a case in which curative resection was achieved for a 47-year-old man with long-standing CD and locally recurrent rectal cancer. In this case, the patient obtained a long-term survival without recurrence after surgical resection with adjuvant chemotherapy and immunosuppressive therapy. In the management of inflammatory bowel disease patients with cancer, the management of both cancer and inflammatory bowel disease treatment is important for the long-term prognosis.

We studied the effects of exercise on muscle mitochondria, and lipid and glycogen content in non-alcoholic steatohepatitis (NASH) model rats. Male Sprague-Dawley rats were randomly separated into 3 groups: the control group was fed standard chow; the NASH group was fed a methionine-choline-deficient high-fat diet (MCD); the NASH-exercise group was fed the MCD and exercised three times a week. Exercise training consisted of continuous running for thirty minutes at a 13 m/min, 6° slope on a motor-driven rodent treadmill for 6 weeks. Mitochondria content in NASH group decreased in the both fiber types compared with those of the control group. As compared between the NASH and NASH-exercise groups, however, exercise not only promoted significant improvements in liver fibrosis and cirrhosis and triglyceride (TG) content but also increased mitochondria content in type I muscle fiber in particular. These data suggest that exercise improved hepatic steatosis in NASH model rats and can prevent the progression of NASH.

Delirium is a common and serious psychiatric syndrome caused by an underlying medical condition. It is associated with significant mortality and increased healthcare resource utilization. There are few biological markers of delirium, perhaps related to the etiologic heterogeneity of the syndrome. Functional near-infrared spectroscopy (fNIRS) is an optical topography system to measure changes in the concentration of oxygenated hemoglobin ([oxy-Hb]) in the cerebral cortex. We examined whether altered cortical brain activity in delirious patients with end stage liver disease (ESLD) is detected by fNIRS. We found that the [oxy-Hb] change during the verbal fluency task (VFT) was reduced in patients with ESLD compared with healthy controls (HC) in the prefrontal and bi-temporal regions. The [oxy-Hb] change during the sustained attention task (SAT) was elevated in patients with ESLD compared to HC in the prefrontal and left temporal regions. Notably, [oxy-Hb] change in the left dorsolateral prefrontal cortex during SAT showed a positive correlation with the severity of delirium. Our results suggest that [oxy-Hb] change in the prefrontal cortex during the sustained attention task measured with fNIRS might serve as a biological marker associated with delirium in ESLD patients.

症例は74歳，女性．平成10年9月にスクリーニングで施行した上部消化管内視鏡検査で胃体中部大彎に広範囲の腺腫を指摘された．癌病変の併存も考慮し平成11年4月に診断的EMRを施行したが病理組織は胃腺腫であった．その後は1年に一回程度の内視鏡検査にてフォローしたが，平成17年5月まで生検はいずれもGroup IIIであった．平成19年1月，胆嚢炎で入院時に内視鏡検査を施行したところ腫瘍は著明に増大しており，生検でもPapillary adenocarcinomaであったため胃全摘術，リンパ節郭清，胆嚢摘出術を施行した．胃病変は肉眼的には明らかな隆起を有する1型腫瘍であるにもかかわらず，病理組織診断では深達度Mで脈管侵襲やリンパ節転移は認めなかった．近年，胃腺腫の癌化危険因子について様々な知見が得られている．悪性度の高い腺腫については，積極的に内視鏡的切除を試みる必要があると思われた．

塩酸セベラマーを内服中の透析患者に発生した結腸穿孔を2例経験したため報告する．症例1は70歳代，女性．透析歴8年．2004年3月に腹痛，嘔吐のため当院に救急搬送された．CTで腸管穿孔と診断し，緊急開腹術を行った．下行結腸に穿孔と硬便の突出を認め，結腸部分切除，人工肛門造設術を施行した．術後に敗血症，DIC，小腸皮膚瘻を合併したが，集学的治療で改善し，軽快退院した．症例2は50歳代，女性．透析歴10年．2006年12月，入院中に腹痛，嘔吐が出現し，CTでS状結腸穿孔と診断し緊急開腹術を行った．大腸全体に硬便が貯留し，S状結腸に穿孔と便塊の突出を認め，S状結腸部分切除，人工肛門造設術を施行した．翌日より維持透析を再開し，経過良好で軽快退院した．塩酸セベラマーは透析患者の心血管系疾患予防の有用性から使用頻度が増加しているが，極度の便秘により腸管穿孔や腸閉塞を引き起こす可能性が示唆されている．死亡例も報告されているため，投薬には十分な注意が必要である．

We examined the effects of low-dose oral risperidone (RIS) on nocturnal sleep in healthy participants. This study was performed in a placebo-controlled manner in 10 healthy male volunteers (mean age, 23.6 years), with administration of 0.5 mg of RIS oral solution or a placebo in the morning or evening for 2 consecutive days. Each night, polysomnography (PSG) was performed, and PSG data during non-rapid-eye movement (REM) sleep were processed by power spectral analysis. An evening administration of 0.5 mg RIS significantly increased total sleep time, sleep efficiency and sleep stage 3, and significantly decreased total waking time and waking after sleep onset (P < 0.05). A morning administration of 0.5 mg RIS significantly increased sleep stage 3 (P < 0.05). According to power spectral analysis, the evening administration of RIS significantly increased the theta power (P < 0.05) and decreased the beta power (P < 0.05) during non-REM sleep. The administration of 0.5 mg oral RIS increases sleep stage 3 and increases total sleep time following evening administration.

Aim: The recruitment patterns of the intrafusal and extrafusal fibres in the soleus (SOL) and extensor digitorum longus (EDL) muscles of rats were investigated during brief-intensity exercise by assaying their glycogen content histochemically. Methods: Six adult male rats were assigned to each of four groups that ran up a 6° incline on a motor-driven treadmill, at 40 m min−1 for either 0.5, 1, 2, or 4 min. Six adult male rats in the control group did not run. Extrafusal and intrafusal fibres were classified by myosin ATPase staining. Optical densities for glycogen content were evaluated in serial periodic acid Schiff (PAS) stained-sections from the B and C regions of intrafusal fibres. Results: The glycogen content of type IIA fibres in the SOL and EDL muscles decreased significantly in the early phase of exercise whereas the glycogen content of type I fibres in these muscles decreased later than that of type IIA fibres. The glycogen content of bag2 fibres decreased after 1 min of exercise in the SOL muscle and after 2 min of exercise in the EDL muscle. On the other hand, the glycogen content of bag1 and chain fibres decreased significantly after 2 min in the SOL muscle but not in the EDL muscle. Conclusion: The results suggest that during brief-intensity exercise, as the glycogen content of type IIA fibres is reduced earlier than that of type I fibres, bag2 fibres are most important early in this type of exercise.

魚骨による虫垂穿孔の1例を経験したので報告する.症例は43歳,男性.下腹部痛を主訴に来院した.腹部所見と腹部CT検査所見から糞石を伴う急性虫垂炎と術前診断し,手術を施行した.開腹すると虫垂体部に魚骨様異物による穿孔を認めた.虫垂穿孔部以外の炎症は軽度であり,順行性虫垂切除術を行った.元素分析とその形態から異物は魚骨であると判明した.病理学的検査で虫垂穿孔部以外の粘膜は炎症を認めないことから穿孔性虫垂炎ではなく,魚骨による虫垂穿孔と診断した.魚骨による虫垂穿孔は稀であり,本例は病理学的に虫垂穿孔であることを確認できた興味深い症例であると思われた.

症例は33歳の男性.腹痛の精査目的で入院となったが,入院後6日目に腹痛の増強のため緊急手術を行った.小腸に6つの腫瘤を認め,うち5つが鶏卵大～手拳大となって腸閉塞をきたし,腫瘤間の腸管は緊満していた.小腸切除を行ったが,手術創,肝,リンパ節などの腫瘍が急速に増大し,術後44日目に死亡した.摘出標本の肉眼形態は,隆起型,潰瘍限局型,びまん浸潤型など多彩な形態を呈した.病理組織所見では,異型度の強い大小不同の紡錘形細胞・円形細胞が粗に配列し,強い脈管浸襲と腫瘍壊死をともなっていた.免疫化学的染色では,ミオグロビンとデスミンが陽性であり,多発性小腸横紋筋肉腫と診断した.横紋筋肉腫は,頭頸部などに好発する軟部組織悪性腫瘍であり,消化管では原発性・転移性ともに極めて稀である.多発性で予後が極めて不良であったことから,本症例は潜在性の原発巣からの多発転移と推測されるが,その病態については不明である.

症例は糖尿病を有する58歳,男性,会陰部の疼痛・腫脹を主訴に入院となった. CTにて会陰部から陰嚢の結合組織内にガスの貯留を認め,切開を行うと膿汁とガスが噴出した.切開後も炎症は下腹部,鼠径部へ拡大し,切開を追加したが消退しなかった.入院20日目にARDSを発症し,患者は呼吸不全となった.下腹部,鼠径部,会陰部の皮膚が壊死に陥り,デブリドマンを繰り返すことにより,大きな皮膚欠損となったがこれにより炎症は消退した.呼吸状態も改善し29日目に人工呼吸器を離脱した. Fournier症候群は会陰部を中心とする壊疽性筋膜炎で,しばしば治療に抵抗し重篤化する.こうした例では壊死組織の積極的な広範囲切除が必要と考えられる.

The synthesized pyrimidine compound MS-818 has neurotrophic effects in several kinds of neuronal cells, but its effect with respect to muscle cells remains unknown. We therefore examined the effects of MS-818 on regeneration for 12 weeks in a wounded area (damaged and gap areas) of cut muscle in adult rats. The right semitendinosus muscles of treated and control groups were severed and sutured at the belly and the left semitendinosus muscles were left intact. MS-818 was administered intraperitoneally to the treated group at a dose of 5 mg/kg once daily. Control rats received an equal volume of physiological saline. A reference group underwent no surgical procedure. MS-818 significantly increased the maximal isometric twitch tension (Tmax) compared to control and reference rats after week 4 (approximately 1.4-fold control value; 0.6-fold reference value). Northern blotting showed that MS-818 enhanced myogenin mRNA expression to about 1.5-fold above the control level at 2, 4, and 7 days after surgery. Immunohistochemical and histochemical studies showed significant enhancement in the treated group since myogenic cells expressed desmin and were positive for neonatal myosin, and the fiber diameters and numbers of premature myofibers and end plates were increased when compared with those in the control group. These results show that MS-818 accelerated the proliferation and differentiation of activated satellite cells and the fusion of myotubes to form immature myofibers. At week 12, Tmax, fiber diameter, and number of end plates in the treatment group recovered 60, 85, and more than 100%, respectively, compared to the reference group. The mechanism of MS-818 effects on the accelerated regeneration of cut muscle is discussed.

症例は84歳,男性.体重減少および下痢を主訴に来院した.入院時検査において貧血・栄養不良を認めた.上部消化管内視鏡検査にて胃体中部大彎側に2型の腫瘤を認め,生検にて低分化型腺癌あるいは扁平上皮癌と診断を得た.注腸では横行結腸と胃体中部大彎側に瘻孔を認めた.横行結腸に穿通した胃癌と診断し,幽門側胃切除術・横行結腸部分切除術および2群のリンパ節郭清を施行した.術後の病理検査では,標本を全割し検索したが,腺癌成分は認めず,扁平上皮癌と診断した. 胃扁平上皮癌は稀な癌であり,その頻度は約0.09%といわれている.われわれの検索した限り,本邦では26例の報告を認めるのみである.また,胃結腸瘻も比較的珍しく,胃扁平上皮癌との合併は今までに報告されておらず極めて稀な症例と思われ,若干の考察を加え報告する.

低ゴナドトロピン性性腺機能低下症と結節性硬化症に大腸癌を合併した1例を経験した.症例は36歳,男性.腹部膨満感を訴え,来院した.入院時現症では腹部の圧痛,膨満を認め,また,顔面の脂腺腫・性器の発育不全を認めた.てんかんを指摘されており,他院で治療を受けていた.諸検査にて,回盲部腫瘤による腸閉塞と診断,当日手術を施行した.開腹所見では,盲腸癌であった.術後2・3日目にてんかん発作を認めた他は経過順調であった.テストステロン補充療法・抗癌剤投与を行ったが,1年6カ月で再発し,死亡した. 結節性硬化症は顔面の皮疹・痙攣発作・知能発育遅延を3主徴とする疾患である.本症例の低ゴナドトロピン性性腺機能低下症は思春期前より低ゴナドトロピン状態が持続し, 2次成長を欠いた類富官体型を呈する例であった.

Aims: This study evaluated the acceptance of controlled drinking (CD) goals among physicians specializing in the treatment of alcohol dependence (AD) in Japan. Methods: A mailed questionnaire survey was sent to physician members of the Japanese Society of Alcohol-Related Problems ( n = 232) who were specialists in the treatment of AD in Japan. The evaluated items included the acceptance of CD goals, the definition of CD, the reasons for accepting or rejecting CD and the patient factors used to make treatment-goal decisions. Results: CD as an interim goal on the way toward abstinence was accepted by about two-thirds of the specialists, while CD as a final goal was accepted by about one-third of specialists. Specialists supported harm-free drinking and a satisfactory quality of life, rather than alcohol consumption limits, as the definition of CD. Of note, a significantly higher percentage of specialists who rejected CD, compared with those who accepted CD, supported the disease model of AD as grounds for their decision. Specialists who accepted CD relied mostly on factors such as the severity of dependence, attitude toward CD and abstinence, and the level of psychological dependence and social stability, when making treatment-goal decisions. Conclusion: CD was accepted as an interim goal by two-thirds and as a final goal by one-third of Japanese physician specialists. Despite differences in drinking cultures and treatment circumstances, great similarities were found between this study and those conducted in Europe and North America with regard to the reasoning of treatment providers and the use of patient characteristics to make treatment-goal decisions.

To refine estimates of the burden of alcohol-related oesophageal cancer in Japan.We searched PubMed for published reviews and original studies on alcohol intake, aldehyde dehydrogenase polymorphisms, and risk for oesophageal cancer in Japan, published before 2014. We conducted random-effects meta-analyses, including subgroup analyses by aldehyde dehydrogenase variants. We estimated deaths and loss of disability-adjusted life years (DALYs) from oesophageal cancer using exposure distributions for alcohol based on age, sex and relative risks per unit of exposure.We identified 14 relevant studies. Three cohort studies and four case-control studies had dose-response data. Evidence from cohort studies showed that people who consumed the equivalent of 100 g/day of pure alcohol had an 11.71 fold, (95% confidence interval, CI: 2.67-51.32) risk of oesophageal cancer compared to those who never consumed alcohol. Evidence from case-control studies showed that the increase in risk was 33.11 fold (95% CI: 8.15-134.43) in the population at large. The difference by study design is explained by the 159 fold (95% CI: 27.2-938.2) risk among those with an inactive aldehyde dehydrogenase enzyme variant. Applying these dose-response estimates to the national profile of alcohol intake yielded 5279 oesophageal cancer deaths and 102,988 DALYs lost - almost double the estimates produced by the most recent global burden of disease exercise.Use of global dose-response data results in an underestimate of the burden of disease from oesophageal cancer in Japan. Where possible, national burden of disease studies should use results from the population concerned.Affiner les estimations de la charge du cancer de l'œsophage lié à l'alcool au Japon.Nous avons effectué une recherche bibliographique dans PubMed pour trouver les revues publiées et les études originales sur la consommation d'alcool, les polymorphismes de l'aldéhyde déshydrogénase et le risque de développement d'un cancer de l'œsophage au Japon, publiées avant 2014. Nous avons réalisé des méta-analyses à effet aléatoire, y compris des analyses de sous-groupe par variant de l'aldéhyde déshydrogénase. Nous avons estimé les décès et l'espérance de vie corrigée de l'incapacité (EVCI) dus au cancer de l'œsophage en utilisant les distributions de l'exposition à l'alcool en fonction de l'âge, du sexe et des risques relatifs par unité d'exposition.Nous avons identifié 14 études pertinentes. Trois études de cohortes et quatre études de cas-témoins présentaient des données de dose-réponse. Les données issues des études de cohortes montrent que les personnes ayant consommé l'équivalent de 100 g/jour d'alcool pur avaient un risque 11,71 fois supérieur (intervalle de confiance à 95% [IC]: 2,67–51,32) de développer un cancer de l'œsophage par rapport aux personnes qui n'ont jamais consommé d'alcool. Les données obtenues à partir des études de cas-témoins ont montré que l'augmentation du risque était 33,11 fois supérieure (IC à 95%: 8,15–134,43) par rapport à la population en général. La différence par la conception de l'étude est expliquée par un risque 159 fois supérieur (IC à 95%: 27,2–938,2) parmi les personnes présentant un variant enzymatique inactif de l'aldéhyde déshydrogénase. En appliquant ces estimations de dose-réponse au profil national de consommation d'alcool, nous sommes arrivés à 5279 décès et 102 988 EVCI dus au cancer de l'œsophage – soit presque le double des estimations produites par la plus récente charge globale de la maladie.L'utilisation de données globales de dose-réponse se traduit par une sous-estimation de la charge de morbidité pour le cancer de l'œsophage au Japon. Dans la mesure du possible, la charge nationale des études portant sur les maladies devrait utiliser les résultats obtenus sur la population concernée.Refinar las estimaciones de la carga del cáncer esofágico relacionado con el consumo de alcohol en Japón.Se buscaron revisiones y estudios originales publicados antes de 2014 sobre la ingesta de alcohol, polimorfismos del aldehído deshidrogenasa y el riesgo de cáncer de esófago en Japón en la base de datos PubMed. Se efectuaron metaanálisis de efectos aleatorios, que incluían análisis de subgrupos de variantes del aldehído deshidrogenasa y se estimaron las muertes y la pérdida de años de vida ajustados por discapacidad (AVAD) por cáncer de esófago mediante distribuciones de exposición para el alcohol basadas en la edad, el sexo y los riesgos relativos por unidad de exposición.Se identificaron 14 estudios pertinentes. Tres estudios de cohorte y cuatro estudios de casos y controles contenían datos sobre la respuesta en relación con la dosis. Las pruebas de los estudios de cohorte demostraron que el riesgo de cáncer esofágico de que quienes consumen el equivalente a 100 g/día de alcohol puro era 11,71 veces mayor (intervalo de confianza del 95 % [IC]: 2,67–51,32) en comparación con aquellos que nunca consumieron alcohol. Las pruebas de los estudios de casos y controles demostraron que el riesgo aumentó 33,11 veces (IC del 95 %: 8,15–134,43) en la población en general. La diferencia por el diseño del estudio se explica por el aumento en 159 veces (IC del 95 %: 27,2–938,2) del riesgo entre las personas con una variante inactiva de la enzima aldehído deshidrogenasa. La aplicación de estas estimaciones de la respuesta en relación con la dosis al perfil nacional del consumo de alcohol dio lugar a la notificación de 5279 muertes de cáncer esofágico y 102 988 AVAD perdidos, lo equivale a casi el doble de las estimaciones producidas por la carga mundial más reciente de la actividad de la enfermedad.El uso de datos mundiales sobre la respuesta en relación con la dosis da lugar a una subestimación de la carga de enfermedad de cáncer esofágico en Japón. Siempre que sea posible, los estudios sobre la carga nacional de la enfermedad deben utilizar los resultados de la población afectada.تنقيح تقديرات عبء سرطان المريء ذي الصلة بتعاطي الكحول في اليابان.أجرينا بحثاً في قاعدة بيانات PubMed عن الاستعراضات المنشورة والدراسات الأصلية حول تعاطي الكحول وتعدد أشكال نازعة هيدروجين الألدهيد واختطار سرطان المريء في اليابان، التي تم نشرها قبل عام 2014. وأجرينا تحليلات وصفية للتأثيرات العشوائية، بما في ذلك تحليلات الفئات الفرعية حسب متغيرات نازعة هيدروجين الألدهيد. وقمنا بتقدير حالات الوفاة وفقدان سنوات العمر المصححة باحتساب مدد العجز جراء الإصابة بسرطان المريء باستخدام توزيعات التعرض للكحول استناداً إلى السن والجنس والمخاطر النسبية لكل وحدة تعرض.قمنا بتحديد 14 دراسة ذات صلة. واشتملت ثلاث دراسات أترابية وأربع دراسات لحالات إفرادية مقترنة بحالات ضابطة على بيانات عن علاقة الجرعة بالاستجابة. وأظهرت البيّنات المستمدة من الدراسات الأترابية تعرض الأشخاص الذين تعاطوا ما يعادل 100 غم/يوم من الكحول الصافي إلى خطورة الإصابة بسرطان المريء بمقدار 11.71 مرة (فاصل الثقة 95 %؛ فاصل الثقة: من 2.67 إلى 51.32) مقارنة بالذين لم يتعاطوا الكحول إطلاقاً. وأظهرت البيّنات المستمدة من دراسات الحالات الإفرادية المقترنة بحالات ضابطة أن الزيادة في الخطورة بلغت 33.11 مرة (فاصل الثقة 95 %؛ فاصل الثقة: من 8.15 إلى 134.43) في عامة السكان. ويتضح الفرق حسب تصميم الدراسة في الخطورة التي بلغت 159 مرة (فاصل الثقة 95 %؛ فاصل الثقة: من 27.2 إلى 938.2) بين الأشخاص الذين لديهم متغير غير فعال لإنزيم نازعة هيدروجين الألدهيد. ونتج عن تطبيق هذه التقديرات لعلاقة الجرعة بالاستجابة على المرتسم الوطني لتعاطي الكحول 5279 حالة وفاة بسرطان المريء وفقدان 102988 من سنوات العمر المصححة باحتساب مدد العجز - وهو تقريباً ضعف التقديرات الناتجة عن العبء العالمي الأحدث لممارسة المرض.ينتج عن استخدام بيانات علاقة الجرعة بالاستجابة على الصعيد العالمي التقليل من تقدير عبء المرض الناجم عن سرطان المريء في اليابان. وينبغي أن تستخدم دراسات عبء المرض على الصعيد الوطني النتائج المستمدة من السكان المعنيين حسبما أمكن.得到更精确的日本酒精性食道癌负担估算值。.我们搜索PubMed数据库，查找2014年前发表的关于日本酒精摄入、乙醛脱氢酶多态性以及食道癌风险的综述与原始研究。我们还进行了随机影响综合分析，包括用乙醛脱氧酶变体进行的亚组分析。根据酒精影响类别的年龄、性别及相对风险，我们使用酒精影响分布估算了食道癌死亡率与残疾调整生命年（DALY）的损失。.我们找到了14项相关研究。三项队列研究和四项病例对照研究提供剂量反应的数据。队列研究的证据表明，与从不饮酒的人群相比较，这些每天消耗相当于100克纯酒精的人群患食道癌的风险是前者的11.71倍（95%置信区间，CI：2.67-51.32）。病例对照研究的证据表明，从整体人口方面看，患食道癌的风险增加了33.11倍（95%置信区间，CI：8.15-134.43）。研究设计发现的差异显示，携带不活跃乙醛脱氢酶变体的人患食道癌的风险是159倍（95%，CI：27.2-938.2）。把这些剂量反应数值应用到全国酒精摄入数据中，我们得出食道癌死亡人数是5279人，残疾调整生命年损失是102988年，这些数据几乎是最新全球疾病负担研究数据的两倍。.使用全球剂量反应数据导致对日本食道癌疾病负担的低估。在可能的情况下，全国疾病负担研究应该使用相关人群的研究结果。.Выполнить точную оценку бремени рака пищевода, обусловленного употреблением алкоголя, в Японии.Мы изучили содержащуюся в базе данных PubMed информацию по опубликованным до 2014 г. обзорам и оригинальным исследованиям, касающимся употребления алкоголя, полиморфизмов альдегиддегидрогеназы и риска развития рака пищевода в Японии. Мы провели метаанализ случайных эффектов, включая анализы в подгруппах по вариантам альдегиддегидрогеназы. Мы оценили количество смертей и утраченных лет жизни с поправкой на инвалидность (ГЖПИ) в результате рака пищевода, используя распределение подвергающихся воздействию алкоголя лиц по возрасту, полу и относительному риску на единицу воздействия.Мы выявили 14 исследований, имеющих отношение к вопросу. Для трех исследований в когортах и четырех исследований методом «случай-контроль» были представлены данные о зависимости между дозой и эффектом. Данные когортных исследований свидетельствуют о том, что у лиц, потреблявших алкоголь в дозе, эквивалентной 100 г чистого алкоголя в сутки, риск развития рака пищевода возрастает в 11,71 раз (доверительный интервал, ДИ 95%: 2,67–51,32) по сравнению с лицами, никогда не употреблявшими алкоголь. Данные исследований методом «случай-контроль» свидетельствуют о том, что кратность повышенного риска развития заболевания во всей популяции составляет 33,11 (ДИ 95%: 8,15–134,43). Разница в плане исследования объясняется кратностью риска 159 (ДИ 95%: 27,2–938,2) для лиц с неактивным вариантом фермента альдегиддегидрогеназы. Применение таких оценок данных о зависимости между дозой и эффектом к национальному профилю потребления алкоголя позволило получить 5 279 смертей от рака пищевода и 102 988 утраченных ГЖПИ, что почти в два раза превышает результаты последних международных оценок бремени данной болезни.Использование данных о зависимости между дозой и эффектом, полученных по результатам международных оценок, приводит к недооценке бремени рака пищевода в Японии. В ситуациях, когда это возможно, для исследований по расчету бремени заболевания на уровне страны следует использовать результаты, касающиеся конкретной популяции.

Pheromones are interesting molecules given their ability to evoke changes in the endocrine state and behaviours of animals. In goldfish, a sex pheromone, 17α,20β-dihydroxy-4-pregnen-3-one (17,20β-P), which is released by preovulatory females, is known to trigger the elevation of luteinising hormone (LH) levels, as well as reproductive behaviour in males. Interestingly, when 11-ketotestosterone (11-KT) is implanted into adult female fish, LH levels increase in response to the pheromone at any time of the day, which is normally a male-specific response. However, the neural mechanisms underlying the male-specific information processing of 17,20β-P and its androgen dependence are yet unknown. In the present study, we focused on the preoptic area (POA), which plays important roles in the regulation of reproduction and reproductive behaviours. We mapped activity in the POA evoked by 17,20β-P exposure using the immediate-early gene c-fos. We found that a population of ventral POA neurones close to kisspeptin2 (kiss2) neurones that appear to have important roles in reproduction was activated by 17,20β-P exposure, suggesting that these activated neurones are important for the 17,20β-P response. Next, we investigated the distribution of androgen receptor (ar) in the POA and its relationship with 17,20β-P-responsive and kiss2 neurones. We found that ar is widely expressed in the ventral POA, whereas it is only expressed in approximately 10% of 17,20β-P-activated neurones. On the other hand, it is expressed in almost 90% of the kiss2 neurones. Taken together, it is possible that ar expressing neurones in the ventral POA, most of which were not labelled by c-fos in the present study, may at least partly account for androgen effects on responses to primer pheromones; the ar-positive kiss2 neurones in the ventral POA may be a candidate. These results offer a novel insight into the mechanisms underlying male-specific information processing of 17,20β-P in goldfish.

We have previously reported that exercise training prevents a maturation-induced decrease in insulin sensitivity and suggested that an improvement of insulin sensitivity by exercise training was attributable, in part, to an increase in insulin-sensitive GLUT-4 on the skeletal muscle plasma membrane. In this study, we examined the effects of maturation and exercise training on the gene expression and protein content of the components of post-insulin receptor signal transduction in rat skeletal muscle. Rats aged 3 weeks were sedentary or trained by voluntary running through 4 or 27 weeks of age, and then the rats in both the sedentary and trained groups were killed and the gastrocnemius muscle was immediately removed for analysis of mRNA and protein content. The concentration of mRNA and protein for insulin receptor substrate-1 (IRS-1) in sedentary rats significantly decreased with maturation (49% and 63%, respectively, at age 27 weeks v age 4 weeks), but in trained rats they did not decrease with maturation. Although the level of phosphatidylinositol 3-kinase (PI 3-kinase) mRNA in sedentary rats was not altered with maturation, PI 3-kinase protein in sedentary rats significantly decreased with maturation (73% at 27 weeks v 4 weeks). However, PI 3-kinase protein in trained rats did not decrease with maturation. These results suggest that the prevention of maturation-induced decreases in the protein content of IRS-1 and PI 3-kinase is involved in the mechanisms responsible for the improvement of insulin sensitivity by exercise training, and exercise training may affect transcriptional regulation of the IRS-1 gene and posttranscriptional regulation of PI 3-kinase expression.

We studied the effects of exercise training on the activity of the pyruvate dehydrogenase (PDH) complex in rat gastrocnemius muscle (experiment 1) and the response of the complex to glucose and insulin infusion (euglycemic clamp) in trained and sedentary rats (experiment 2). In experiment 1, half of the rats were randomly allocated as sedentary animals and the other half were trained by voluntary running exercise for 8 weeks. The total activity of the PDH complex was not affected by exercise training, and the activity state (proportion of the active form) of the PDH complex was decreased from 15.0%+/-2.4% to 7.5%+/-1.1% by exercise training. The activity of 3-hydroxyacyl-coenzyme A (CoA) dehydrogenase ([3-HADH] an enzyme in beta-oxidation) was significantly higher in trained versus sedentary rats. In experiment 2, sedentary and trained rats were starved for 24 hours before performing the euglycemic clamp. Glucose and insulin infusion was performed by a euglycemic clamp (insulin infusion rate, 6 mU/kg/min) for 90 minutes. The PDH complex was inactivated to less than 1% in both sedentary and trained rats after 24 hours of starvation. The glucose infusion rate (GIR) during the euglycemic clamp was higher in trained versus sedentary rats. The euglycemic clamp resulted in activation of the PDH complex in both sedentary and trained rats, but the response of the PDH complex to the euglycemic clamp was significantly higher in trained rats (5.8%+/-0.5%) than in sedentary rats (2.9%+/-0.5%). These results suggest that exercise training promotes fatty acid oxidation in association with suppression of glucose oxidation in skeletal muscle under resting conditions, but increases the rate of carbohydrate oxidation when glucose flux into muscle cells is stimulated by insulin.

Nuclear respiratory factor 1 (NRF-1) is a regulatory factor of nuclear genes for respiratory subunits and for components of the mitochondrial transcription and replication machinery. This study investigated the effects of an acute bout of aerobic exercise on the postexercise expression of mRNA for NRF-1 and RNA moiety of endonuclease for mitochondrial RNA processing (MRP-RNA) in soleus muscle of 5 days-trained and untrained rats. In the trained group, rats were run on a motor-driven treadmill at a speed of 25 m/min for 90 min/day for 5 days. On the final day, rats were run by the same procedures and were sacrificed at various postexercise time points (0.5, 3, 6, and 24 h). The basal level of cytochrome oxidase activity was increased by the training, which was associated with the increase in the expression of mRNAs for subunit VIc and III of the enzyme. The NRF-1 mRNA expression was transiently increased by approximately 35% at the time point of 6 h after exercise, although the basal level of the expression was not altered by training. A similar transient increase (approximately 50%) in NRF-1 expression by the acute bout of exercise was also observed in untrained rats. In contrast to the NRF-1 expression, the basal level of MRP-RNA abundance was not altered by 5 days training and was not affected by the single exercise bout in either 5 days-trained or untrained rats. These results suggest that the postexercise increase in NRF-1 mRNA expression in rat skeletal muscle may be an early response to endurance exercise for an enhancement of the mitochondrial oxidative capacity.

Effects of aging on the activities of heart pyruvate dehydrogenase complex and pyruvate dehydrogenase kinase were examined using 7, 35 and 60 wk old rats. Aging did not affect the total activity of pyruvate dehydrogenase complex but decreased the activity state (percentage of active form) of the complex in rats under the fed condition (52%, 36% and 26% for 7, 35 and 60 wk old rats, respectively). This decrease in the complex activity with aging was suggested to be associated with an age-related decrease in the blood glucose disposal. Starvation for 24 h decreased the activity state to less than 3% in all of the age groups. The activity of pyruvate dehydrogenase kinase associated with the complex was not related to the alteration in the activity state of the complex; the kinase activity was slightly lower in 60 wk old rats than in the younger rats under the fed condition and activation of the kinase by starvation was greater in the younger rats. The mechanism for the decrease in activity of pyruvate dehydrogenase complex was discussed on the basis of glucose and fatty acid utilization of heart muscle cells.

症例は65歳の男性で, 高血圧にて近医通院加療中AFP高値を指摘され, 精査にて胃幽門前庭部IIc型異癌と肝左葉肝細胞癌の重複癌との診断に至った.開腹したところ, 肝左葉は萎縮していたが肝内には腫瘍は認めず, 直径5cmにも腫大した肝円索を腫瘤状に触知した.このため手術は肝円索腫瘍を含め肝左葉切除術および幽門側胃切除術を施行した.摘出標本を検索したところ肝円索腫瘍は肝とは連続性がなく, 肝円索に迷入した肝組織が癌化した異所性肝細胞癌であると診断した.異所性肝組織は胆嚢, 肝の支持靱帯, 後腹膜, 膵, 脾, 大網, 胸腔内などに存在し, これらも主肝と同様に硬変化, 癌化することがあるとされている.異所性肝細胞癌は非常にまれではあるが, 本邦でこれまでに4例の報告があり, 文献的考察を加えた.

One of the events in the brain is an increasing cerebral blood flow during exercise. The tissue oxygen level may be increased because blood flow correlates with tissue oxygen level. However, it is little known whether the tissue oxygen pressure in hippocampal region (Hip-pO2) will be affected by exercise.The aim of this study is to examine Hip-pO2 levels in the hippocampus and its changes during exercise.We applied improved Clark-type electrodes to measure Hip-pO2 level in the hippocampus of rats that were subjected to three groups, 2h swimming without weights (low intensity, n=6), 2h swimming with a 5 g weight (moderate intensity, n=6), and 2h swimming with a 10 g weight (high intensity, n=6).Exercise affected the Hip-pO2 level, the responses varied with the exercise intensity and duration. Interestingly during and after the Low intensity swimming the Hip-pO2 level showed long lasting enhancement (10-20% above resting level). But the moderate and high intensity swimming increased Hip-pO2 level at the start of the swimming (50%, P0.05 and slightly above resting level, respectively, at 10 min of 2h swimming) and then began to decrease (at 120 min and 10 min of 2h swimming, respectively), and suppressed the Hip-pO2 levels during post exercise resting period (2h) (85-95% of resting level, NS and 60-70% of resting level P0.05, respectively).We propose that exercise-induced hippocampal hyper/hypo oxygen condition may participate in beneficial exercise effects on brain function.

Background The efficacy of disulfiram in preventing an alcoholic relapse has been controversial. The aim of our study was to assess the efficacy of supervised disulfiram for the treatment of alcohol dependence with a multi-institutional study in Japan. Methods In a single-blinded, randomized placebo-controlled study, we recruited 109 patients diagnosed with alcohol dependence under ICD-10 criteria. The patients were randomly allocated to 4 treatment groups, depending on whether they took disulfiram (200 mg daily) or a placebo or whether they received adjunctive therapy consisting of mailed letters which delineated and emphasized the harmful effect of alcohol and the management of alcohol craving. The proportion of abstinence among the 4 groups at 26 weeks after discharge was the primary outcome measure. The proportion of abstinence was compared with the severity of alcohol dependence and craving. Furthermore, we examined the proportion of abstinence in patients with inactive aldehyde dehydrogenase-2 (ALDH2). Results There were no significant differences among the 4 groups in terms of abstinent patients or study dropouts. The ratio of abstinence was not related to the severity of alcohol dependence or the degree of alcohol craving. Patients with inactive ALDH2 significantly sustained abstinence with the use of disulfiram (p = 0.044). Conclusions Supervised oral disulfiram use followed by intervention via letters seems to be ineffective for increasing abstinence. Further studies are necessary to prove the efficacy of disulfiram for the pharmacological treatment of alcohol dependence. We indicated the effectiveness of disulfiram for the maintenance of abstinence in patients with inactive ALDH2.

Background & Aims We previously reported that intrahepatic cholangiocarcinomas (ICCs) can be divided into three categories according to their gross appearance with possible links to biological behavior. Ki- ras and p53 gene alterations are thought to be involved in early and late phases of carcinogenesis, respectively. This study was performed to investigate the relationship between the gross appearance and genetic alterations of ICC. Methods We examined 21 patients with ICC. Ki- ras point mutations were assessed by polymerase chain reaction/single-strand conformation polymorphism methods followed by direct DNA sequencing. Expressions of p53 protein were immunohistochemically assessed. Results Ki- ras point mutations were found in 10 patients (48%), and expressions of p53 protein were detected in 4 (19%). Applying the gross classification that we previously proposed, Ki- ras mutations were prominent in the periductal extension type (4 of 6; 67%) and the spicula-forming type (6 of 10; 60%). On the other hand, none of the five mass-forming-type tumors harbored Ki- ras mutations. Expressions of p53 protein did not show any clear association with gross appearance. Conclusions Ki- ras gene alterations may be involved in the cholangiocarcinogenesis of periductal extension and spicula-forming but not mass-forming types, suggesting that the underlying processes of development are different.

硬変肝切除中の肝血行動態を観察し, prostaglandin E1 (以下, PGE1と略記) の投与効果を検討した.肝硬変併存肝細胞癌20例を対象とし, 対照群とPGE1群 (0.03μg/kg/min) に分類した.肝切除前後で超音波カラードップラーにより肝血流量を算出し, 平均動脈圧, 心拍数, 動脈血中ケトン体比を測定した.肝切除術, 対照群では門脈血流量が56%に減少したが, PGE1群では肝動脈径の拡張と門脈血流速度の上昇により, 肝動脈, 門脈血流量がそれぞれ39%, 62%増加した.PGE1群においては肝切除前後で動脈圧, 心拍数は保たれ, 動脈血ガス分析は対照群と差異を認めなかった.ケトン対比は対照群では1.6±0.5から0.8±0.2, PGE1群では1.4±0.6から1.0±0.4とPGE1群においてその低下が有意に抑制された (p

Introduction. The efficacy of disulfiram in preventing an alcoholic relapse has been controversial. The aim of our study was to assess the efficacy of supervised disulfiram for the treatment of alcohol dependence with a multi-institutional study in Japan. Methods. In a single-blinded, randomized placebo-controlled study, we recruited 109 patients diagnosed with alcohol dependence under ICD-10 criteria. The patients were randomly allocated to four treatment groups, depending on whether they took disulfiram (200 mg daily) or a placebo or whether they received adjunctive therapy consisting of mailed letters which delineated and emphasized the harmful effect of alcohol and the management of alcohol craving. The proportion of abstinence among the four groups at 26 weeks after discharge was the primary outcome measure. Furthermore, we examined the proportion of abstinence in patients with inactive aldehyde dehydrogenase-2 (ALDH2). Results. There were no significant differences among the four groups in terms of abstinent patients or study drop-outs. Patients with inactive ALDH2 significantly sustained abstinence with the use of disulfiram (P = 0.044). Conclusions. Supervised oral disulfiram use followed by intervention via letters seems to be ineffective for increasing abstinence. We indicated the effectiveness of disulfiram for the maintenance of abstinence in patients with inactive ALDH2.

Since the prevalence of alcohol use disorders is high among cases of drunk driving (DD), it is said that treatment interventions should be directed at preventing DD. The National Police Agency introduced a specialized two-day lecture program including Brief Intervention (BI) for drivers whose licenses had been revoked at four out of 47 prefectures in 2010. Once the driving license was revoked, he/she was compelled to attend a two-day lecture before retaking the driver's license examination. Before the new program was introduced, all of the traffic offenders attended the same lecture regardless of the reason for the revocation of their drivers' licenses. In this presentation, we compare the efficacy between the new and previous programs. In 2010, 10,745 traffic offenders participated in the lecture (681 were in the new program, while 10,064 were in the conventional program). We compared the rate of traffic offences within a year of attending the program between the two groups. The prevalence of arrests for DD and other traffic offenses in the subjects of the new program were 0% and 15.6%, respectively, while the corresponding figures for participants of the conventional program were 0.54% and 20.9%. These results suggest that BI had deterrent effects against repetition of all traffic offenses including DD, and that the treatment program should be adopted to deter DD. Language: en

In this study, initial hepatic metabolic function was evaluated by determining the arterial ketone body ratio (AKBR) and plasma amino acid concentrations in an experimental orthotopic combined hepatopancreatic transplantation (OHPT), and comparing the same values in orthotopic liver transplantation (OLT). In OHPT, AKBR decreased in the anhepatic phase and recovered to the preoperative value just 1 h after reperfusion. On the other hand, in OLT, the recovery of AKBR took 3 h after reperfusion with a significant difference compared to OHPT (P less than 0.05). Plasma amino acid levels, especially alanine and total free plasma amino acids increased in the anhepatic phase and recovered within 1 h of reperfusion in OHPT. However, they did not recover until 3 h after reperfusion in OLT. This rapid recovery of hepatic metabolic function in OHPT should be attributed to the order of reperfusion in which the reconstruction of arterial blood flow precedes that of portal blood flow. This model is useful for assessing the best way by which the grafted liver can for assessing the best way by which the grafted liver can control the timing, order, rate, and volume of blood that should be released.

1989年度1年間に当科で経験した術後急性胆嚢炎症例について検討を行った.同時期の腹部手術症例は380例であり, そのうち8例 (2.1%) に術後胆嚢炎を認め, 全例胃癌手術後 (92例中8例8.7%) であった.術後に発熱, 右季肋部痛を認めるものに対して, 積極的に超音波検査を施行し早期発見につとめた.その結果, 術後8日以内と比較的早期に食事摂取開始後発症した例では, 保存的療法にて治癒せしめることができた.一方, 縫合不全などほかの合併症を伴い術後10日目以降に発症した症例では, 保存的療法に抵抗した.しかし経皮経肝胆嚢ドレナージにて全例開腹手術を施行することなく治癒した.従来重篤で予後不良であるとされていた術後急性胆嚢炎は, 本疾患に対する認識と積極的な超音波検査により, その予後改善が期待される.