MR findings of avulsive cortical irregularity of the distal femur

Avulsive cortical irregularity, a benign condition occurring only among children and adolescents, has been known to simulate malignancy not only radiologically but also microscopically. Therefore, in addition to plain radiographs, further studies including by magnetic resonance (MR) imaging may occasionally be required. MR images of seven cases of avulsive cortical irregularity of the femur were reviewed. In all cases, the lesion appeared hypointense on T1-weighted images and hyperintense on T2-weighted images, with a dark rim on both sequences at or near the sites of the bony attachment of the medial head of the gastrocnemius muscle. In all cases, bilateral involvement was demonstrated by plain radiography, computed tomography, and/or MR imaging. The authors suggest that avulsive cortical irregularity involves both femora much more frequently than has been reported previously.

Analysis of a Hind III site polymorphism in the type II collagen gene: it's location and frequencies in the Japanese population

Hind III restriction fragment length polymorphism (RFLP) in the cartilage-specific type II collagen gene was studied in a sample of 135 persons randomly selected from the Japanese population. Localization of the Hind III site was determined by the dideoxy method. Based on this sequence, a pair of primers was designed and a polymerase chain reaction (PCR) was carried out. The Hind III allele had a frequency of 0.52 in the Japanese. The genotype digested by Hind III, (++) genotype was present with a frequency of 16.9%, (+-) was present in 70.0% and (--) was present in 13.1%, showing a lower rate of the (--) genotype in the Japanese compared to the Finnish. The difference was statistically significant, tested by chi 2 analysis (p < 0.0001). The present study is the first to report a race-dependent variance in Hind III RFLP on the type II collagen gene.

Gamma Knife thalamotomy for the treatment of functional disorders

Gamma Knife thalamotomy was performed with a 4-mm collimator in 2 cases with thalamic pain following a stroke and in 1 case of Parkinson's disease with tremor. In both cases with pain the maximum dose of 130 Gy was focused at the mediocaudal region of the previous thalamic lesion. In the case with tremor in Parkinson's disease, the maximum dose was 150 Gy. Longer follow-up is now proceeding, but the short-term results are encouraging. Based on data obtained from selective thalamotomy with depth microrecording, Gamma Knife thalamotomy could be a safe and effective technique for the treatment of these functional disorders.

Autoradiographic demonstration of lansoprazole uptake sites in rat antrum and colon

To investigate possible effects of lansoprazole other than its acid suppression through the parietal cell, uptake sites for lansoprazole were studied by autoradiography in rat antral and colon mucosa. Autoradiography was performed using two different methods, i.e., routine fixation and in vitro autoradiography on cryostat sections. Our results showed that the uptake sites for lansoprazole in the gastric antrum were located in the interstitial cells, including unmyelinated nerve fibers, whereas those in the colon mucosa corresponded to epithelial cells and some of the interstitial cells. With electron microscopy, the uptake sites for lansoprazole in the colon epithelial cells were seen exclusively near the apical plasma membrane. On the basis of these findings, lansoprazole may have effects on autonomic nerve and colon epithelial function as well as on acid secretion.

Peripheral B lymphocyte repertoire to mitochondrial antigen in primary biliary cirrhosis--positive correlation between the disease activity and the frequency of circulating B lymphocytes specific for pyruvate dehydrogenase complex

B lymphocytes committed to the production of IgG antibodies (Abs) to mitochondrial antigen such as pyruvate dehydrogenase complex(PDC) were quantitated in the peripheral blood of patients with primary biliary cirrhosis(PBC) using Epstein-Barr virus as a polyclonal activator of human B lymphocytes. B lymphocytes committed to the production of IgG Abs to PDC were found in high frequency in patients with PBC(0.54 +/- 0.16%, mean value +/- SE, of total IgG-producing B lymphocytes) in contrast to type C chronic hepatitis and healthy subjects in which they were less than 0.01%. The frequency of these B lymphocytes specific for PDC increased in parallel to the progression of the Scheuer's stage from I to II (stage I: 0.35 +/- 0.23%, stage II: 1.04 +/- 0.32%), but decreased with further progression to stage IV (stage III: 0.39 +/- 0.21%, stage IV: 0.07 +/- 0.06%). In addition, B lymphocytes specific for PDC decreased in the peripheral blood during the administration of cyclosporin A; this was accompanied by an improvement of lymphocyte infiltration severity in the liver. These data indicate that B lymphocytes specific for PDC are present in the peripheral blood of patients with PBC and their frequency reflects the degree of the lymphocyte infiltration in the liver.

Antiproteinuric effect of a thromboxane receptor antagonist, S-1452, on rat diabetic nephropathy and murine lupus nephritis

To shed light on the role of thromboxane A2 (TXA2) in renal injury, we evaluated the effects of S-1452, a TXA2 receptor antagonist, on rats with streptozotocin (STZ)-induced diabetic nephropathy and murine lupus nephritis. In STZ diabetes rats (n = 6), urinary protein excretion significantly increased from 8 weeks and was about 5 times as much as that in normal rats at 10 weeks after induction of diabetes. In S-1452-treated rats (n = 6), increase in urinary protein was rarely observed and was significantly inhibited at 8 and 10 weeks after induction of diabetes. In (NZB x NZW)F1 mice, no proteinuria was detected in vehicle controls (n = 20) and S-1452-treated mice (n = 20) from 0 to 8 weeks after initiation of S-1452 treatment. Proteinuria was observed in 3, 7 and 8 mice in the control group, and 0, 2 and 5 mice in the S-1452 group at 12, 16 and 20 weeks after initiation of S-1452 treatment, respectively. Proteinuria developed more slowly in S-1452-treated mice than in vehicle controls. In conclusion, TXA2 receptor antagonist, S-1452, suppresses the progression of renal injury.

Endogenous substrate for energy metabolism and ultrastructural correlates in spermatozoa of the sea urchin Diadema setosum

Energy metabolism in spermatozoa of the sea urchin Diadema setosum of the order Diadematoida was examined. The spermatozoa contained not only several kinds of phospholipids and cholesterol, but also triglyceride (TG). Glycogen and glucose were present at extremely low levels. Following dilution of dry sperm and incubation in seawater, the TG content decreased rapidly. Other lipids, however, remained at constant levels, except for a slight increase in the level of free fatty acid. High lipase activity was demonstrated in the spermatozoa. 14C-labeled fatty acid was oxidized to 14CO2. Ultrastructural study also showed that lipid globules were present at the bottom of the midpiece. After incubation in seawater, morphological changes in the lipid globules were observed and some vacuoles appeared. Thus, the results obtained strongly suggest that D. setosum spermatozoa obtain energy through oxidation of fatty acid from TG stored in the lipid globules at the midpieces.

Establishment of a rabbit short-term dry eye model

The dry eye syndrome is a chronic disease which can become a serious threat to useful vision. However, there is only a limited understanding regarding effective treatment or prevention of this disease. Establishing an effective mode of treatment requires the use of a satisfactory animal dry eye model. Ideally, such a model should rapidly determine the effectiveness of agents that inhibit the damaging effects of this syndrome. This paper presents a short-term dry eye model using rabbits, which combines mechanical prevention of blinking and methylene blue staining. This model is not intended to be a precise representation of the dry eye syndrome, since this disorder has recently become recognized to involve a primary pathological process of the corneal and conjunctival epithelium. However, by using this model, clinical signs of dry eye can be observed after a few hours in the form of acute desiccation. Corneal damage can easily be evaluated both qualitatively by methylene blue staining scores, and quantitatively by chronic assay. Visually observed corneal epithelial thinning was confirmed by scanning electron microscopy (SEM) to be due to loss of epithelial integrity. Using a 3% chondroitin sulfate solution, an already proven effective agent for dry eye, this model effectively demonstrated an 80% inhibition in the development of methylene blue positive lesion after a period of only 2 hours. This short term dry eye model is valuable in primarily screening the efficacy of potential therapeutic agents in the prevention and treatment of dry eye.

Effect of granulocyte colony-stimulating factor (G-CSF) on chemotherapy-induced oral mucositis

In this study, the ability of granulocyte colony-stimulating factor (G-CSF) to treat or prevent chemotherapy-induced oral mucositis in patients with advanced breast cancer was evaluated. A total of 14 patients who received intraarterial (i.a.) adriamycin (ADM) preoperatively were divided into two groups according to whether or not G-CSF was given. Thus, group A (n = 7) was given G-CSF and group B (n = 7) was not. G-CSF therapy reduced both the incidence and duration of ADM-induced oral mucositis, and a positive correlation was also seen between the incidence of mucositis and ADM-induced leukopenia (< 2,000/mm3). Group A was further divided into two subgroups according to whether G-CSF was given after or before the leukopenia had dropped below 2,000/mm3: group A-1 (n = 3) and group A-2 (n = 4), respectively. ADM-induced mucositis was observed in two of the three patients in group A-1, but in none of the four patients in group A-2. These results strongly support the idea that G-CSF can effectively treat and prevent ADM-induced oral mucositis.

Ocular movement during reading in patients with congenital nystagmus

When a healthy person reads sentences arranged horizontally, the eye movement pattern is a series of regular saccades and rest periods. However, eye movements while patients with oculomotor disturbances are reading remain to be defined. In this study, 4 patients with congenital nystagmus (CN) were studied. Coordinated movements of eye and head are also studied by a new apparatus with terrestrial magnetism sensor. While subjects were reading, an eye movement pattern was superimposed by the CN waveform and showed few rest periods. Eye velocity of less than 4 degrees/s was noted in almost every cycle of the eye movements while the patients with CN were reading. When they were requested to read sentences and simultaneously rotate their head naturally, the head movements had the effect of cancelling the eye instability. This finding may be interpreted as a kind of "eye-head coordination".

Lansoprazole inhibits oxygen-derived free radical production from neutrophils activated by Helicobacter pylori

We studied the influence of lansoprazole on Helicobacter pylori-elicited neutrophil activation, including the oxidative burst and infiltration of gastric mucosa, and confirmed whether radiolabeled lansoprazole is actually detected in gastric neutrophils. The oxidative burst of purified human neutrophils was measured by luminol-dependent chemiluminescence (ChL). [3H]Lansoprazole uptake sites in human gastric mucosa were observed by autoradiography. The magnitude of neutrophil infiltration of gastric mucosa was assessed by tissue myeloperoxidase (MPO) content. ChL assay indicated that oxygen-derived free radical production was increased twofold by adding H. pylori water extract, which was significantly inhibited by lansoprazole (10(-4) M). Gastric biopsy samples were obtained endoscopically from patients with H. pylori-positive gastritis. Autoradiographic examination revealed that the [3H]lansoprazole binding site was present in the cytoplasmic granules of infiltrated neutrophils. Tissue MPO content was significantly decreased after treatment with lansoprazole. These data suggest that lansoprazole binds directly to neutrophils, subsequently inhibiting neutrophil accumulation and release of toxic metabolites.

A peptide-based human T cell leukemia virus type I vaccine containing T and B cell epitopes that induces high titers of neutralizing antibodies

We have recently identified the principal linear neutralizing B cell epitopes of human T cell leukemia virus type I (HTLV-I) on the envelope protein gp46, amino acids (aa) 187-199, by using a number of human mAbs. We therefore propose that this region would be a good candidate for a peptide-based HTLV-I vaccine. To develop a peptide-based vaccine that can induce a high titer of neutralizing Abs against HTLV-I, we first synthesized peptides of various lengths containing aa187-199. Because the addition of gp46 aa181-186 or aa200-210 to either the N-terminus or C-terminus of SP187-199 did not alter the antigenicity of the principal neutralizing determinant, we prepared two peptide-based vaccines, MAP181-203 and MAP181-210, by conjugating SP181-203 and SP181-210 with a branched polylysine oligomer. In rabbits, X4 to X8 and X8 to X64 titers of the neutralizing Abs were induced by immunization with MAP181-203 and MAP181-210, respectively. Furthermore, high titers of neutralizing Abs (X40 to X320) were elicited in five different strains of rats by immunization with MAP181-210. We also identified the major T cell epitope on gp46 aa194-210 in various strains of rats immunized with MAP181-210. Furthermore, the peripheral T lymphocytes obtained from the majority of HTLV-I-infected patients including HTLV-I-associated myelopathy/tropical spastic paraparesis, adult T cell leukemia/lymphoma, and healthy carriers, proliferated in response to the peptides containing aa194-210. These results indicated that MAP181-210 contains a T cell helper epitope on aa194-210 not only in rats and rabbits, but also in humans with various HLA haplotypes. It is therefore possible that MAP181-210 could become one of the candidates for a peptide-based HTLV-I vaccine for human use.

Sharing of the IL-2 receptor gamma chain with the functional IL-9 receptor complex

The third subunit, the so-called common gamma (gamma c) chain, of the IL-2 receptor is shared among the receptors for IL-2, IL-4, IL-7 and IL-15, and dysfunction of the gamma c chain is thought to cause X-linked severe combined immunodeficiency (XSCID) ascribed to impairment of early T cell development. However, cytokines linked to XSCID are as yet unidentified. A mAb specific for the gamma c chain, TUGm2, profoundly inhibited cell proliferation in response to IL-9. Another mAb, TUGm3, immunoprecipitated [125I]IL-9 cross-linked with either the IL-9 receptor or the gamma c chain. These results demonstrate that the gamma c chain is included in the functional receptor complex for IL-9, which was initially characterized as a T cell growth factor and is essential for IL-9-dependent growth signal transduction.

A peptide-based human T cell leukemia virus type I vaccine containing T and B cell epitopes that induces high titers of neutralizing antibodies

We have recently identified the principal linear neutralizing B cell epitopes of human T cell leukemia virus type I (HTLV-I) on the envelope protein gp46, amino acids (aa) 187-199, by using a number of human mAbs. We therefore propose that this region would be a good candidate for a peptide-based HTLV-I vaccine. To develop a peptide-based vaccine that can induce a high titer of neutralizing Abs against HTLV-I, we first synthesized peptides of various lengths containing aa187-199. Because the addition of gp46 aa181-186 or aa200-210 to either the N-terminus or C-terminus of SP187-199 did not alter the antigenicity of the principal neutralizing determinant, we prepared two peptide-based vaccines, MAP181-203 and MAP181-210, by conjugating SP181-203 and SP181-210 with a branched polylysine oligomer. In rabbits, X4 to X8 and X8 to X64 titers of the neutralizing Abs were induced by immunization with MAP181-203 and MAP181-210, respectively. Furthermore, high titers of neutralizing Abs (X40 to X320) were elicited in five different strains of rats by immunization with MAP181-210. We also identified the major T cell epitope on gp46 aa194-210 in various strains of rats immunized with MAP181-210. Furthermore, the peripheral T lymphocytes obtained from the majority of HTLV-I-infected patients including HTLV-I-associated myelopathy/tropical spastic paraparesis, adult T cell leukemia/lymphoma, and healthy carriers, proliferated in response to the peptides containing aa194-210. These results indicated that MAP181-210 contains a T cell helper epitope on aa194-210 not only in rats and rabbits, but also in humans with various HLA haplotypes. It is therefore possible that MAP181-210 could become one of the candidates for a peptide-based HTLV-I vaccine for human use.

[Current status and problems of home care for patients with terminal cancer from the viewpoint of local clinics]

On the basis of investigations of 15 patients from our clinic with terminal cancer who were treated by home hospice care, and questionnaires filled out by their caretakers, we examined the current status and problems of the home hospice care system with respect to four phases, namely, the period of preparation for home care (hospitalization period), stable period, terminal period, and the period immediately before death. [Preparation period] The following problems occurred in this phase: introduction of pain management and nutrition management was insufficient; there were only a few cases in which the patient chose home care of his or her own will; and sufficient instructions were not given to caretakers on discharge from the hospital, with respect to medical treatment at home. [Stable period] In two of the four cases in which patients complained of severe pain, the pain was not alleviated because pain management was provided only at the outpatient clinics of the hospital, and collaboration between hospitals and our clinic was insufficient. [Terminal period] Two patients could not be admitted to the hospital upon sudden exacerbation of the condition, suggesting the need to establish a system in which large hospitals can cope with sudden exacerbation of their condition of patients with terminal cancer treated at home. [Period immediately before death] Of the 14 patients who died, 7 died at home and 7 died in the hospital or during transport to the hospital. Three subjects died within a few days after admission. Two of the subjects who died in the hospital or during transport had hoped to stay home until the last moment. Further improvement of the system is necessary in order to meet the needs of terminal cancer patients who wish to die at home. On the basis of the cases taken care of at our clinic, we examined the home care system according classification into three types; hospital-outpatient clinic type; hospital-home care type; and clinic-home care type. An ideal system for the treatment of patients with terminal cancer who hope to stay at home until the last possible moment seems to be the clinic-home care type in which a primary care team that is able to dispatch physicians and nurses, and an around-the-clock support system, are supported by outside organizations and specialists.

Interleukin-2 (IL-2) production by human B-cell line

A human B-cell line (Hairy-BM) constitutively secreting interleukin-2 (IL-2) was established from tumor tissue resected surgically from a patient with breast cancer. Hairy-BM was found to be 100% CD20+, 98% surface immunoglobulin (sIg) G+, 98% sIg kappa chain+, 100% HLA-DR+, 94% IL-2 receptor (IL-2R alpha), 98% IL-2R beta, and devoid of T-cell, monocyte, and natural killer cell surface antigens. The B-cell origin of Hairy-BM was also confirmed by clonally rearranged Ig heavy- and Ig light-chain genes. The growth of Hairy-BM expressing IL-2R was promoted by recombinant IL-2 (rIL-2) and anti-CD25 antibody significantly blocked the growth enhancement. IL-2 secretion from Hairy-BM was confirmed by radioimmunoassay. By using a sensitive polymerase chain reaction technique, we demonstrated that Hairy-BM expressed IL-2 mRNA, IL-2R alpha mRNA, and IL-2R beta mRNA. These findings indicate that certain B-cells not only produce, but also respond to IL-2 in an autocrine fashion with increased proliferation.

Multidrug-resistance gene (mdr1) expression in human tumor xenografts

We examined the expression of human multidrug resistance gene (MDR1); 13 of 34 xenografts showed various MDR1 gene transcript levels by reverse transcriptase-polymerase chain reaction. MDR1 was detected in 3 of 10 lung, 5 of 8 gastric, 3 of 3 colon and 2 of 3 pancreatic cancers, but not in 4 breast cancers, or 6 gliomas. We evaluated drug-sensitivity of xenografts in vivo; 28 of 34 xenografts showed drug resistance to vincristine and/or doxorubicin, whereas 13 of 28 drug-resistant xenografts expressed MDR1. The expression of MDR1 may explain the intrinsic drug resistance in certain xenografts.

Attenuated endothelium-dependent peripheral vasodilation and clinical characteristics in patients with chronic heart failure

Impairment of endothelium-dependent vasodilation has recently been reported in the peripheral vascular bed in patients with chronic heart failure. However, the clinical implications of this type of vascular dysfunction have yet to be elucidated. We have determined the degree of impairment of endothelium-dependent vasodilation as evaluated by acetylcholine-induced changes in forearm blood flow and compared this to various clinical parameters in 23 patients with chronic heart failure. Cumulative changes in forearm blood flow induced by acetylcholine (3.0 and 4.5 micrograms/min/dl tissue volume) were significantly lower in patients with chronic heart failure than in normal controls (10.1 +/- 8.0 ml/min/100 ml vs 20.4 +/- 11.7 ml/min/100 ml tissue volume; p < 0.01). In patients with heart failure, no significant relation was found between acetylcholine-induced changes in forearm blood flow and age, sex, duration of symptoms, duration of hospital stay, or resting hemodynamic parameters, although a significant positive correlation was observed with peak oxygen uptake (r = 0.53, p < 0.05) and ventilatory threshold (r = 0.42, p < 0.05). These observations suggest that the impairment of endothelium-dependent peripheral vasodilation may be one of the factors contributing to exercise intolerance in patients with chronic heart failure, probably resulting from its limiting effect on nutritive skeletal muscle blood flow during exercise.

N-nitroso compounds in two nitrosated food products in southwest Korea

Gastric cancer is the commonest malignant neoplasm in Southwest Korea. The possibility of carcinogenic dietary factors led to the investigation of exposure to N-nitroso compound precursors among residents of the City of Chonju and of two outlying rural townships in North Cholla Province. Two traditional and widely consumed home-prepared food products, salted pickled cabbage (kimchi) and salted seafood sauce (chut-kal) were analysed (a) for nitrite, nitrate, total secondary amines and pH in these food products prior to nitrite incubation and (b) for volatile nitrosamines and total N-nitroso compounds before and after incubation with nitrite in simulated human stomach conditions. Nitrate levels were significantly higher in kimchi (median 1550 mg/kg) than in chut-kal (median 140 mg/kg) (P < 0.001). Secondary amine levels in non-nitrosated samples of kimchi (median 5.5 mg/kg) were significantly lower than secondary amine levels in non-nitrosated chut-kal (median 56 mg/kg) (P = < 0.001). Analyses of nitrite-incubated kimchi revealed high levels of total N-nitroso compounds (median 1173 micrograms/kg); the increase with nitrosation was significant (P = 0.001). The concentration of N-nitroso compounds in nitrite-incubated kimchi was significantly greater than that found in nitrite-incubated chut-kal (P = 0.015). The combination of high levels of nitrate in the kimchi, the demonstration of high levels of total N-nitroso compounds in this food after nitrosation, and the volume of kimchi consumed in the traditional diet suggest that salted pickled cabbage may play a role in gastric carcinogenesis in Southwest Korea.

[Home chemotherapy for peritoneal carcinomatosis]

Nineteen patients diagnosed with peritoneal carcinomatosis were treated by in-home chemotherapy over a period of four years from August, 1990 to July, 1994. Primary diagnoses of the four male and 15 female patients included 12 cases gastric cancer (four males, eight females), five cases of ovarian cancer, one case (female) of appendicular cancer, and one case (female) of breast cancer. In addition to oral administration of UFT-E and 5'-DFUR, chemotherapy included weekly intravenous injection of a massive dose of 5-FU (1,000 mg/m2), subselective intraaortic infusion and intraperitoneal infusion using a reservoir. These methods were used individually and in combination. The drugs used included 5-FU, CBDCA, CPA, THP, and EPIR. Subselective intraaortic infusion was performed by low dose continuous infusion using the Baxter infusor multiday type. Six gastric cancer patients lived normally for over one year, while four died in less than a year. All ovarian and appendicular cancer patients were CR, the breast cancer patient was PR. Ten patients continued working at their jobs while receiving at home chemotherapy treatments. Diuretics were used to alleviats ascites. Although there were no side effects on digestive organs, 5-FU and CBDCA were mixed with 100 mg hydrocortisone in the infusor to improve cachexia, and promote appetite and activity. Bone marrow suppression was very slight at these dosages, and weekly checkups were adequate. The at-home rate (number of days at home/entire period since onset) of all patients was 78%.

[Magnetic resonance imaging (MRI) of bone marrow necrosis]

Magnetic resonance (MR) of bone marrow was studied in two cases of acute leukemia which showed bone marrow necrosis. Case 1:A 24-year-old female was admitted because of sternum pain and bleeding tendency. She was diagnosed AML based on the peripheral blood picture. Bone marrow biopsy revealed the presence of bone marrow necrosis. T1 weighted imaging of MR showed low signal intensity in all vertebral marrow. Fatty marrow was demonstrated after achieving complete remission and the MR imaging of bone marrow changed to show high intensity, suggesting fat deposition. Case 2: A 19-year-old female suffered from chest pain and lumbago, and was diagnosed as ALL. DIC and bone marrow necrosis were confirmed during chemotherapy for remission induction. T1 weighted imaging showed the mosaic pattern of low and high signal intensity. She achieved complete remission and bone marrow clot revealed the presence of fatty marrow. Most areas of low signal intensity of T1 weighted imaging changed to those of high signal intensity. These observations suggest that necrotized bone marrow seemed to change to fatty marrow along with achieving remission. MR imaging study of bone marrow is useful for evaluating hematopoiesis in hematologic disorders.

Serum hepatitis C virus RNA level as a predictor of subsequent response to interferon-alpha therapy in Japanese patients with chronic hepatitis C

Serum hepatitis C virus (HCV) RNA level has been shown to be a good predictor of subsequent response to interferon-alpha (IFN) therapy in US patients in whom genotype 1a/1b are both predominant. To determine whether serum HCV RNA level is a predictor of subsequent response to IFN in Japanese patients or not, appropriately collected pre-IFN therapy serum samples from 35 Japanese patients with chronic HCV infection were studied. Serum HCV RNA level and HCV genotype were determined and correlated with the subsequent response to IFN. Response to IFN was defined by serum alanine transaminase level: complete and sustained response (n = 15), complete response followed by relapse (n = 10), and no response (n = 10). Patients with complete and sustained response had lower pre-IFN serum HCV RNA level (median: RT-PCR+, bDNA-) compared to the complete response to relapse group (median: 5.25 x 10(6) genome equivalent/ml [eq/ml], P < 0.001) and the no response group (median: 10.63 x 10(6) eq/ml, P < 0.001). Seven (46.7%) of the complete and sustained response patients had HCV genotype 2a and three patients had a mixture of genotypes 1b and 2a. In contrast, all 10 patients in the complete response to relapse group had genotype 1b whereas 8 of 10 patients in the non-response group had genotype 1b and 2 had genotype 2b. The patients with HCV genotype 2a had lower serum HCV RNA level than those with 1b (P = 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

[An epidemiological study on osteoporosis using ultrasound bone densitometry]

Ultrasonic bone density measurements were performed in a population to study the relationship of bone density to age, body size, fracture, hip and back pain, and their diagnostic value for osteoporosis. In additions other factors related with osteoporosis diagnosed using ultrasonic measurements values were examined. The study subjects were thirty-eight men and sixty-three women who participated in community health examinations in 1993 in Akabane, Aichi prefecture. Indices evaluated for ultrasonic bone density measurement were speed of sound (SOS), broadband ultrasound attenuation (BUA) and stiffness index (SI). 1) In men, means for SOS and SI values declined with age from the forties to the seventies, but BUA was not related to age. In premenopausal women, SOS, BUA and SI were not related to age, but an age related decline was observed in postmenopausal women. 2) BUA was positively related to body weight in men and women, while the relationship with SOS and SI was not as strong. 3) Two postmenopausal women experienced fractures due to osteoporosis, and their SI values were less than 59%. About fifty percent of the subjects had hip and back pain but no clear association of SI to prevalence rate was observed. 4) Osteoporosis was diagnosed using SI values. Cases of osteoporosis were relatively older, had more years since menopause, were lower in height, body weight and thickness of skinfolds, but had higher serum total cholesterol levels others. 5) Further prospective epidemiological studies should be performed to evaluate the validity of this diagnostic criterion using SI values, and to clarify the relationship of lifestyles to ultrasonic bone density measurement and osteoporosis.

[Smoking cessation counseling based on behavioral science: theory and practice]

"Cigarettes and other forms of tobacco are addictive due to nicotine in tobacco smoke." That is the conclusion of a report issued in 1988 by the Surgeon General of the U.S.A. It is the physician's responsibility to treat patients with nicotine dependence just like those with dependence on narcotic drugs or alcohol. Cigarette smoking is "the cause of the single, biggest preventable disease" in Japan, and it is estimated that about 110,000 people die yearly from cigarette smoking. As physicians, we can contribute to society by helping our patients to quit smoking, which will decrease smoking-related illnesses. However, physicians do not now provide adequate guidance, either because of limited time or a lack of educational materials. Prompted by this situation, we developed a step-by-step smoking cessation program for use by physicians and their co-workers in outpatient clinics. The program, called "The Smokebusters Program," is based on the recognition that smokers are at different stages of readiness to change. It has the following components designed to move the patient to the next stage in the process of becoming a non-smoker: an instructor's manual, six self-help guides for patients at various stages, a smoking habit questionnaire, a cessation counseling record for instructors, and stickers for the patient's file to show progress in quitting smoking. This paper begins by describing the need for smoking cessation counseling. Second, theoretical models and effective counseling methods for smoking cessation based on behavioral science and pharmacology are described. Finally, the details of The Smokebusters Program and the procedures for smoking cessation counseling are presented.