A 59-year-old man was admitted with sudden onset of back pain and abdominal discomfort. There was no history of pancreatitis, abdominal injury, or abdominal surgery. Enhanced abdominal computed tomography (CT) showed retroperitoneal hematoma behind the head of the pancreas, and emergency angiography demonstrated retroperitoneal bleeding due to rupture of a superior pancreaticoduodenal artery aneurysm. Embolization was tried unsuccessfully, because of difficulty in selective cannulation of the vessel feeding the aneurysm. Emergency laparotomy was performed. We inserted a finger behind the pancreas via the lateral side of the duodenum by Kocher's maneuver, then ligated the ruptured portion of the superior pancreaticoduodenal artery. We did not reconstruct the artery because blood supply to the peripheral tissue was good. The patient's postoperative course was uneventful, and he was discharged from the hospital in good condition 1 month after surgery. CT proved to be useful in revealing the voluminous retroperitoneal hematoma, and angiography proved to be necessary for the definitive diagnosis of pancreaticoduodenal artery aneurysm.

Sleep disorders are risk factors for hypertension. This adverse effect is especially affected in women. Nevertheless, the impact of sleep habits on the cardiovascular response remains unclear in young women. This study aimed to determine whether sleep habits could affect blood pressure regulation at rest and during exercise in young women. Twenty-two young women participated in this study. The Pittsburgh Sleep Quality Index (PSQI), resting blood pressure (BP), and BP response to the 2-minute isometric handgrip exercise, which consists of 25% maximum force production using left hand, were measured. Beat-by-beat arterial BP changes during exercise was measured using the Finapres™ device, and it was averaged every 30 sec before and during exercise; BP reactivity was evaluated by the delta change from rest to exercise. The PSQI score was 5.2 ± 2.2. The resting systolic and diastolic BPs were 105 ± 7 mmHg and 62 ± 7 mmHg, respectively. BP reactivity to the exercise were Δ 4 ± 7 mmHg, Δ 4 ± 7 mmHg, Δ 6 ± 7 mmHg, and Δ 7 ± 9 mmHg, for each 30-sec interval. Poorer sleepers (PSQI > 4.5) showed a tendency toward lower resting systolic BP compared with better sleepers (PSQI < 4.5) (p = 0.069). Systolic BP reactivity to the last 30 sec of exercise was correlated with the PSQI score (r = 0.484, p = 0.022). In conclusion, sleep quality may affect the cardiovascular regulation at rest and during exercise in young women.

The aim of the present study was to measure the amount of nerve growth factor (NGF) present in saliva, and investigate the relationship with aging, gender, and number of retained teeth. The subjects were 93 healthy volunteers (35 males and 58 females) aged 18-87 years. Stimulated saliva was collected during gum chewing, and saliva secretion per minute and NGF concentration per unit volume were measured by enzyme-linked immunosorbent assay. We found that NGF in saliva was measurable in all subjects. The mean NGF concentration in saliva was 55.70 ± 38.27 pg/ml, and no relationship was found between NGF concentration and aging, gender, and the number of retained teeth. The mean NGF amount in saliva was 84.38 ± 71.06 pg/min. The NGF amount in saliva decreased with age, especially for the group aged 70 years and older. It was higher in male than female subjects, and was significantly higher in the group without tooth loss compared to the edentulous group. In addition, regarding the relationship between the saliva flow rate per minute and NGF amount in saliva, the latter increased significantly with a rise in the former. These results indicate that the NGF amount in saliva is influenced by aging, masticatory function, and saliva amount. It is speculated that human salivary glands play an important role in the synthesis and expression of NGF.

1) To become physicians who care for patients as human beings, medical students must know about child welfare. A serious problem in the fields of medicine and welfare is child abuse. Collaboration is needed to support children and families, but many challenges exist.
2) The goal of our Multidisciplinary Team Workshop, which started in 2006 and targets students in a wide range of fields, is to educate future practitioners about the necessity of multidisciplinary collaboration.
3) More than 80% of the participating students felt the workshop was useful, and the participation of medical students increased the significance of the workshop for students from other disciplines.

The effect of bathing with artificial sodium sulfate on changes in the systolic blood pressure and the level of atrial natriuretic polypeptide (ANP) in plasma or atrium of normotensive male rats was studied. The following results were obtained:
1) As a result of bathing for 20 minutes at a temperature of 37°C, the systolic blood pressure lowered and the plasma ANP level decreased. The blood pressure lowered most clearly after artificial sodium sulfate bathing at a prescribed concentration (p<0.5), while the plasma ANP level decreased significantly after plain water bathing (p<0.01).
2) The atrial ANP level showed no significant change. Presumably the reason was that the quantity of atrial ANP was so large that it was not affected by fluctuations in the peripheral ANP level.
3) The temperature and duration of bathing, the concentration of bath salts, and other factors might also influence the plasma ANP level.
These results suggest that the artificial sodium sulfate bathing lowers the blood pressure by preventing heat radiation from the skin and by delicate regulatory mechanisms on ANP secretion.

The effects of bathing with artificial sodium sulfate on the systolic blood pressure and the level of atrial natriuretic peptide (ANP) in plasma and or in atrium of spontaneously hypertensive rats (SHR) were studied. The following results were obtained:
1) As a result of bathing for 20 minutes at a temperature of 37°C, the systolic blood pressure lowered and the plasma ANP level increased. The blood pressure lowered with increasing concentration of sodium sulfate (p<0.01).
2) The plasma ANP level in a standing position for 20 minutes decreased than in a normal position.
3) The plasma ANP level in SHR was higher and increased more clearly by bathing, compared to the previous results in normotensive rats (WKA). The blood pressure lowered far more in SHR than in WKA.
4) The atrial ANP level was not significantly influenced by bathing nor by changing the posture.
These results indicate that the artificial sodium sulfate bathing has more potent hypotensive effect than plain water bathing probably due to prevent heat radiation, and affects the blood pressure and the plasma ANP more significantly in SHR than in WKA. In addition, the effects of mild bathing to cardiovascular and neurohumoral systems may modulate directly or indirectly the ANP secretion.

Change of digital blood flow during sodium sulfate bathing was studied using laser Doppler flowmeter. The 10 subjects were divided into two groups; group A and group B. In group A, digital bloood flow was measured in the following order; in the air→plain water→air→sodium sulfate bathing→air, while in group B, in the air→sodium sulfate bathing→air→plain water→air. The temperature of the water was kept at 40°C using thermostat. The 10g of sodium sulfate was dissolved in the 10L of water. In group A, the digital blood flow was 60.2±16.7 in the plain water and 70.6±35.0 in the sodium sulfate water, while in group B, 30.4±12.7 in the sodium sulfate water and 7.36±10.06 in the plain water (P<0.05).
Above results suggest an increase in digital blood flow in the sodium sulfate bathing, although there were great differences by individual and by the order of immersion.

Comparative studies were made mainly on malignant cases of cholelithiasis in 111 patients with gallstones detected in our regular chekup (group A) during the five-year period from 1985 to 1989 and 67 patients who had gallstones surgically removed together with malignancies (group B) during the same period.
The group A patients representing 4.2% of the total 2, 637 examinees were suspected to suffer from biliary obstruction and malignant tumors involving the digestive system. However, further examination found only one case of biliary tract cancer.
The group B patients account for 20.9% of the total 321 surgery cases. In 37 (55.2%) of the 67 patients, 45 legions were malignant-mostly cancer in the digestive organs. Cancer of the lower portion of the digestive tract was found in 11 patients (29.7%) of the 37. The occult blood test at hospitalization revealed that 8 patients (28.6%) in 28 were positive, and 9 were not clear. Follow-up examination showed the rate of false-positive reaction to blood test stood at 14.3%.
From the foregoing results, to detect cancer of the large intestine at an early stage in the regular medical checkup sponsored by the agricultural cooperative, the occult blood test using the stool of examines alone is not enough. It is high time to introduce endoscopic examinationinto the screening program. In view of the fact that most of the gallstone cases detected at the regular checkup were symptomless, careful followup examinations are deemed necessary with the possibleonset of gallbladder cancer and presence of malignancies in mind.

We report a patient with gingival metastasis of lung cancer in whom the use of sedatives was successfully avoided by employing holistic care approaches. A 64-year-old man had been receiving chemotherapy with the diagnosis of advanced lung cancer. Eighteen months later, a rapidly growing gingival metastasis was observed. Arterial embolization was performed, but it failed to control the bleeding. No active treatment was performed, and he was subsequently transferred to our hospital. He desired death, with markedly pessimistic views, and wished to undergo deep and continuous palliative sedation (DCPS) due to severe total pain (particularly psychological and spiritual) from the beginning. However, he died peacefully before receiving DCPS. We present a literature review of gingival metastasis from lung cancer, as well as our assessment and palliative care for the total pain of this patient.