Abstract
Objective : To investigate the causes of fever of inpatients hospitalized in the Department of General Practice at Jichi Medical University Hospital.
Methods : We reviewed all medical records of the patients hospitalized in the Department of General Practice at this hospital between April 2003 and March 2004. Patients were selected as the “febrile group” by following criteria, 1) body temperature exceeded 37.5°C on admission, 2) fever and fever of unknown origin (FUO) were included in the clinical problems, and the causes of fever were described.
Results : A total of 464 patients were hospitalized and 221 patients (47.6%) were categorized as the “febrile group”. The most common cause of fever was infection (67.4%), followed by malignant disease (4.1%), collagen disease (3.2%), miscellaneous diseases (10.4%). 26 patients were classified as fever of unknown origin (FUO). Among FUO patients, collagen disease was the most common cause (34.6%), and undiagnosed cases was 26.9% that was similar to past reports. Although the rates of malignant disease and collagen disease were about sixteen percent in each generation from thirties to fifties as the cause of fever, only one patient met the criteria of classical FUO.
Conclusions : The most common cause of fever was infection. Systematic survey including hospitalization is needed early in case an outpatient doesn't cure fever unexpectedly. Noninfectious inflammatory diseases emerge as an important category of the causative disease of FUO.

The purpose of this study was to examine reduced nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity, - a generated superoxide - of neutrophils in human peripheral blood after maximal exercise. Ten healthy male college students (20.2 ± 0.4 yr, 170.5 ± 1.3 cm, 62.8 ± 1.9 kg) participated after giving written informed consent. They performed an incremental exercise to volitional exhaustion using a bicycle ergometer. Peripheral blood was collected before exercise (Pre), just after exercise (Post) and 1-hour after exercise (Post-1h). Phorbol 12-myristate 13-acetate (PMA)-stimulated and opsonaized zymosan (OZ)-stimulated superoxide-generating activity of neutrophils was measured by the cytochrome c reduction assay. NADPH oxidase activity was measured by a cell-free system. NADPH oxidase activity significantly decreased in Post-1h compared with Pre and Post. A similar tendency was seen in PMA-stimulated activity, but not in OZ-stimulated activity. A strong positive relationship between NADPH oxidase activity and PMA-stimulated activity was found in Pre and this relationship attenuated after exercise. NADPH oxidase activity was not related to OZ-stimulated activity at any time points. We concluded that NADPH oxidase activity decreased after exhaustive maximal exercise in human peripheral neutrophils, and suggest that PMA-stimulated activity, relatively - speaking, reflects NADPH oxidase activity; but OZ-stimulated activity is independent of NADPH oxidase activity.

Objective To investigate the characteristics and prognosis of acute and chronic pancreatic pseudocysts and to identify the predictive factors of interventional treatment of pancreatic pseudocysts. Methods From January 1995 to December 2004, 36 patients with pancreatic pseudocysts at Nippon Medical School were studied retrospectively. Group 1 included 9 patients with acute pancreatitis associated pseudocysts which resolved spontaneously. Group 2 included 9 patients with acute pancreatitis associated pseudocysts and symptoms persisted or with complications which requiring interventional treatment. Group 3 included 9 patients with chronic pancreatitis associated pseudocysts which resolved spontaneously. Group 4 included 9 patients with chronic pancreatitis associated pseudocysts with symptoms persisted or with complications which requiring interventional treatment. Results Among the 36 patients, there were 13 women and 23 men. The etiology of pancreatitis due to alcohol was 18(50.0%) cases, biliary tract disease 8(22.2%)cases, others 10(27.8%) cases. The average duration of follow up was (24. 2 ± 18.5) months. The majority of pseudocysts (32/36, 88.9%) were not communicated with the main pancreatic duct;the number and location of the 4 groups of pseudocysts were not significantly different;the biggest diameter of pancreatic pseudocysts in group 3 was the smallest, all below 4 cm, which was significantly less than those in other 3 groups (P < 0.05) ;the majority of volume of pancreatic pseudocysts in group 1 and 3 was not increased, while it was increased in group 2 and 4.

Objective To identify effects of bile acids on pancreatic cancer, The ultrastructure and growth of PANC-1 and MIA PaCa-2 cell lines in crude bile modified medium were studied. Methods The growth of PANC-1 and MIA PaCa-2 cells in RPMI 1640 with or without 1％, 2％ and 4％ of the purified crude bile (containing total bile acids 10.17mmol/L) was assessed for 2, 4, 6, 8d by using MTT assay to determine inhibitory rate. The cell surface and intracellular ultrastructure of PANC-1 cells was investigated by SEM and TEM at 24h and 48h, respectively. Re sults The proliferation of both cell lines in bile treated medium were greatly retarded (P ＜0.001). The inhibitory rate of 1％, 2％ and 4％ bile on Panc-1 cells in 4d were 38％, 60％ and 66％, respectively (P ＜0. 05), on MIA PaCa-2 cells at 4d were 28％, 39％ and 52％, respectively (P ＜0. 05). The cells grown in bile for 48h lost their mi crovilli, their mitochondria and other organelles became vacuolated. Conclusion The bile acids in bile has cytotoxicity on PANC-1 and MIAPACA-2 cells, which may inhibit pancreatic cancer progress in patients clinically.

We report an extremely rare case of primary squamous cell carcinoma of the stomach. A 69-year-old man was admitted to our hospital with a 2-month history of dysphagia and tarry stools. Endoscopic examination revealed a cauliflower-shaped protruding mass along the lesser curvature of the gastric cardia. Biopsy of the lesion revealed squamous cell carcinoma of the stomach. Computed tomography revealed a thickened stomach wall and a mass protruding into the gastric lumen. Total gastrectomy with splenectomy, distal pancreatectomy, and Roux-en-Y reconstruction was performed, together with a lower thoracic esophagectomy via a left thoracotomy. Histopathological examination of the specimen revealed well-differentiated squamous cell carcinoma of the stomach. Postoperative follow-up was uneventful for the first 18 months. However, multiple liver metastases and para-aortic lymph node metastasis developed subsequently. Despite systemic combination chemotherapy, the patient died because of progression of the recurrent tumors. Here, we review the characteristics of 56 cases of gastric squamous cell carcinoma reported in Japan.
Aged ; Biopsy ; Carcinoma, Squamous Cell* ; Cardia ; Deglutition Disorders ; Drug Therapy, Combination ; Esophagectomy ; Follow-Up Studies ; Gastrectomy ; Humans ; Japan* ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Pancreatectomy ; Splenectomy ; Stomach Neoplasms ; Stomach* ; Thoracotomy

BACKGROUND/AIMS: Left-sided diverticulitis is increasing in Japan, and many studies report that left-sided diverticulitis is more likely to be severe. Therefore, it is important to identify the features and risk factors for left-sided diverticulitis. We hypothesized that left-sided diverticulitis in Japan is related to obesity and conducted a study of the features and risk factors for this disorder in Japan. METHODS: Right-sided diverticulitis and left-sided diverticulitis patients (total of 215) were compared with respect to background, particularly obesity-related factors to identify risk factors for diverticulitis. RESULTS: There were 166 (77.2%) right-sided diverticulitis patients and 49 (22.8%) left-sided diverticulitis patients. The proportions of obese patients (body mass index > or =25 kg/m2, p=0.0349), viscerally obese patients (visceral fat area > or =100 cm2, p=0.0019), patients of mean age (p=0.0003), and elderly patients (age > or =65 years, p=0.0177) were significantly higher in the left-sided-diverticulitis group than in the right-sided-diverticulitis group. The proportion of viscerally obese patients was significantly higher in the left-sided-diverticulitis group than in the left-sided-diverticulosis group (p=0.0390). CONCLUSIONS: This study showed that obesity, particularly visceral obesity, was a risk factor for left-sided diverticulitis in Japan.
Aged ; Diverticulitis ; Humans ; Japan ; Obesity ; Obesity, Abdominal ; Retrospective Studies ; Risk Factors

Background: Gitelman syndrome (GS) is an autosomal recessive salt-losing renal tubulopathy resulting from mutations in the thiazide-sensitive Na-Cl cotransporter (NCC) gene. Notably, lack of awareness regarding GS and difficulty with prompt diagnosis are observed in clinical practice, particularly in rural settings.Case presentation: We report a case of a 48-year-old man with GS who presented to a local clinic on a remote island. Occasional laboratory investigations incidentally revealed a reduced serum potassium level of 2.6 mmol/L. A careful medical interview revealed episodes of intermittent paralysis of the lower extremities and muscular weakness for >30 years. Subsequent laboratory investigations revealed hypomagnesemia, hypocalciuria, and hypokalemic metabolic alkalosis. Based on the patient’s history, clinical presentation, and laboratory investigations, we suspected GS. Genetic testing revealed a rare homozygous in-frame 18 base insertion in the NCC gene that might have resulted from the founder effect, consequent to his topographically isolated circumstances.Conclusion: More case studies similar to our study need to be added to the literature to gain a deeper understanding of the functional consequences of this mutation and to establish optimal management strategies for this condition, particularly in rural clinical settings.