Intestinal parasitic infections in Bekasi district,West Java,Indonesia and a comparison of the infection rates determined by different techniques for fecal examination

This study was undertaken to determine the current status of intestinal parasitic infections among schoolchildren in West Java, Indonesia, and to compare the infection rates obtained by three different methods of fecal examination. A total of 285 fecal samples were collected from 131 males and 154 females at a junior high school. Samples were brought to the Department of Parasitology, Faculty of Medicine, University of Indonesia, and were examined for parasites by the Kato-Katz thick smear method (K-K). The residual samples were suspended in more than five volumes of 2% potassium dichromate solution and brought to the Department of Parasitology, Kobe University School of Medicine, Japan, where they were examined for parasites by the Army Medical School method (AMS III) and by the Sucrose Centrifugal Flotation method (SFL). The K-K revealed a total of two helminths with a prevalence of 10% (29/285). In contrast, nine species of parasites, 31% (89/285) positive, were obtained by AMS III, while 10 species, 22% (62/285) were found by SFL. Overall, 12 species of parasites were detected by the three methods: four species of nematoda (Trichuris trichiura, Ascaris lumbricoides, hookworm, and Enterobius vermicularis); five species of protozoa (Giardia intestinalis, Entamoeba histolytica-like cyst, E. coli, Cyclospora sp, Blastocystis hominis); two unidentified species of nematode eggs; and one unidentified species of mite egg.     

Development of a tree model that allows simple estimation of the required care level using the items of the basic investigation of long-term care insurance

In long-term care insurance, the required care level of the disabled elderly is calculated from the results of the basic investigation. However, this calculation involves complex mathematical processes, and the estimation of the required care level at small facilities is difficult. We, therefore, developed a tree model that allows simple estimation of the required care level from the state of noticeable disabilities in daily activities. The model was prepared separately for dementia and physical disabilities. From the patients being cared for at Higashiyama Geriatric Hospital for the Elderly who had undergone primary rating, a total of 240 individuals consisting of 20 each in each of the 6 required care levels for both dementia and physical disabilities were selected, and the results of their primary rating were reviewed. "Putting on and taking off a jacket" and "care after urination", in which the required care levels increase relatively consistently as the investigation items progressed from those for "independent" to those for "totally assisted", were selected as the first selection items in dementia and physical disability models respectively. In a dementia model, the state of "putting on and taking off a jacket" and "care after urination" were matched for various required care levels as follows: "Independent"-->assistance needed, "observation needed" and "independent" in "standing up"-->required care level 1, "observation needed" and "not independent" in "standing up"-->required care level 2, "partly assisted"-->required care level 3, "totally assisted" and "not totally assisted" in "eating"-->required care level 4, and "totally assisted" and "totally assisted" in "eating"-->required care level 5. In a physical disability model, the state of "care after urination" was matched for various required care levels as follows: "Independent" and "independent" in "walking"-->assistance needed, "independent" and "not independent" in "walking"-->required care level 1, "direct or indirect assistance"-->required care level 2, "totally assisted" and "independent" or "observation needed" in "eating"-->required care level 3, "totally assisted" and "partly assisted" in "eating"-->required care level 4, "totally assisted" and "totally assisted" in "eating"-->required care level 5. The accuracy rate, i.e. the frequency of complete matching between the estimation of the required care level using this tree and that of the primary rating, was 71.1% in those with dementia and 66.7% in those with physical disabilities. The near accuracy rate, i.e. the frequency of matching between the two estimations within one rank higher or lower was 98.3% in those with dementia and 99.2% in those with physical disabilities. From these results, this tree model is considered to be useful for clinical rating.     

Current status of radiation therapy--evidence-based medicine (EBM) of radiation therapy. Current management of patients with esophageal cancer

The best management for small mucosal esophageal cancer is generally endoscopic mucosal resection. However, for submucosal cancer and extensive mucosal cancer, either radical surgery or radiation seems to be an equally efficacious option. Radiation therapy concurrent with chemotherapy is more effective than radiation therapy alone for patients with unresectable esophageal cancer. The key drugs are cisplatin and 5-fluorouracil. However, for patients with poor performance status or for aged patients, radiation therapy alone is still a choice of treatment. Surgery has generally been indicated for patients with resectable esophageal cancer. However, outcomes of concurrent chemoradiation therapy may be comparable with those of surgery. Therefore, a prospective randomized study should be performed to determine the best management for patients with resectable esophageal cancer. The usefulness of intra-cavitary irradiation for esophageal cancer has not been clarified. A prospective randomized trial with a large number of patients is necessary to determine the effectiveness of intra-cavitary irradiation. The best management for patients with loco-regionally recurrent esophageal cancer after surgery has not been determined. Intensive therapy should be considered if the site of recurrence is limited and the time interval from surgery to recurrence is long. Chemotherapy is essential in the management of patients with small cell esophageal cancer. However, the best local therapy has not been determined.     

Current status of nuclear medicine clinical application of FDG-PET for cancer diagnosis. Head and neck cancer

Accurate detection of head and neck cancer is crucial in patients' quality of life. The head and neck area consists of many complicated anatomical structures. Conventional imaging procedures such as CT and MRI provide much detailed information, but accurate estimation of the spread of cancer is still limited. Positron emission tomography (PET) using 2-deoxy-2-[18F]fluoro-D-glucose (FDG) is clinically useful in detecting head and neck cancer, providing accurate estimates of head and neck primary cancer especially in cases that are equivocal on CT and/or MRI. FDG-PET is able to show metastatic lymph nodes that may appear normal on CT and/or MRI. Further, whole body FDG-PET makes it possible to detect distant metastases. The clinical usefulness of FDG-PET in head and neck cancer is discussed in this review.     

Spontaneous regression of malignant lymphoma of the lumbar spine

Spontaneous regression of diffuse B-cell type lymphoma of the lumbar vertebra is reported. A 61-year-old woman experienced spontaneous disappearance of a large psoas mass associated with an infiltrating process of the lumbar vertebrae. The biopsy of the residual change after spontaneous regression revealed reactive foamy histiocytes and small lymphocytes with no atypia. The lesion recurred 7 months later with no systemic treatment in the interim, when the diagnosis of lymphoma was finally made. Spontaneous regression may be related to potentiation of the host immune response, which affects tumor growth.     

A case of gastric duplication evaluated by gastric emptying scintigraphy

Gastric duplications are relatively rare, and communication with the gastric lumen is extremely rare. A 67-year-old man was referred to our hospital because of recurrence of epigastric pain and fullness. An upper gastrointestinal contrast study revealed a double compartment stomach, with gastric duplication starting at the esophagogastric junction outside the greater curvature. Computed tomography of the stomach with gastrografin as contrast demonstrated complete communication of the gastric duplication and primary stomach. The patient was diagnosed with complete gastric duplication. Gastric emptying scintigraphy with Tc-99m diethyltriamine pentaacetic acid was performed. Test meal entered the primary stomach and duplication cyst simultaneously, and radioactivity in the primary stomach decreased linearly and gastric emptying was not delayed. In the duplication cyst, about 70% of the food that entered the cyst once was immediately evacuated from it, but the remaining 30% remained in the cyst for a long time. Gastric emptying of the primary stomach was not affected by formation of the duplication cyst.     

Preclinical studies on [11C]MPDX for mapping adenosine A1 receptors by positron emission tomography

In previous in vivo studies with mice, rats and cats, we have demonstrated that [11C]MPDX ([1-methyl-11C]8-dicyclopropylmethyl-1-methyl-3-propylxanthine) is a potential radioligand for mapping adenosine A1 receptors of the brain by positron emission tomography (PET). In the present study, we performed a preclinical study. The radiation absorbed-dose by [11C]MPDX in humans estimated from the tissue distribution in mice was low enough for clinical use, and the acute toxicity and mutagenicity of MPDX were not found. The monkey brain was clearly visualized by PET with [11C]MPDX. We have concluded that [11C]MPDX is suitable for mapping adenosine A1 receptors in the human brain by PET.