Postcomparison of [(18) F]-fluorodeoxyglucose uptake in the brain after short-term bright light exposure and no intervention.

OBJECTIVE: Bright light therapy is widely used as the treatment of choice for seasonal affective disorder. Nonetheless, our understanding of the mechanisms of bright light is limited and it is important to investigate the mechanisms. The purpose of this study is to examine the hypothesis that bright light exposure may increase [(18) F]-fluorodeoxyglucose (FDG) uptake in olfactory bulb and/or hippocampus which may be associated neurogenesis in the human brain. METHOD: A randomized controlled trial comparing 5-day bright light exposure + environmental light (bright light exposure group) with environmental light alone (no intervention group) was performed for 55 participants in a university hospital. The uptake of [(18) F]FDG in olfactory bulb and hippocampus using FDG positron emission tomography was compared between two groups. RESULTS: There was a significant increase of uptake in both right and left olfactory bulb for bright light exposure group vs. no intervention group. After adjustment of log-transformed illuminance, there remained a significant increase of uptake in the right olfactory bulb. CONCLUSION: The present findings suggest a possibility that 5-day bright light exposure may increase [(18) F]FDG in the right olfactory bulb of the human brain, suggesting a possibility of neurogenesis. Further studies are warranted to directly confirm this possibility.

A Predictive Model of Plasma Lamotrigine Levels.

Introduction: Lamotrigine is one of several mood stabilizers and its effects for the treatment and prevention of depressive episodes, particularly in bipolar disorder, are generally accepted. Although the findings about a therapeutic window of lamotrigine are yet to be determined, it seems important to obtain information on individual pharmacokinetic peculiarities. This study was conducted to formulate the predictive model of plasma lamotrigine levels. Methods: Using the data of 47 patients whose lamotrigine levels, liver function, and renal function were measured, predictive models of lamotrigine levels were formulated by stepwise multiple regression analyses. The predictive power of the models was compared using another dataset of 25 patients. Results: Two models were created using stepwise multiple regression. The first model was: plasma lamotrigine level (µg/mL)=2.308+0.019×lamotrigine dose (mg/day). The second model was: plasma lamotrigine level (µg/mL)=0.08+0.024×lamotrigine dose (mg/day)+4.088×valproate combination (no=0, yes=1). The predictive power of the second model was better than that of the first model. Discussion: The present study proposes a prompt and relatively accurate equation to predict lamotrigine levels.

A young woman with visual hallucinations, delusions of persecution and a history of performing arson with possible three-generation Fahr disease.

OBJECTIVE: Fahr disease (FD) is a rare neurological and psychiatric disorder. The disease is classified by intracranial calcification of the basal ganglia with the globus pallidus region being particularly affected. We examined a young woman with visual hallucinations, delusions of persecution and a history of performing arson with possible third-generation FD. METHOD: Case report of third-generation FD. RESULTS: A 23-year-old woman was arrested for two arsons: i) The patient exhibited progressive psychotic symptoms, including visual hallucinations, delusion of injury, irritability, lability of mood, mental retardation and visual disorders and ii) Computed tomography (CT) imaging demonstrated bilateral calcifications of the basal ganglia (globus pallidus) in the patient, her mother and her grandmother. CONCLUSION: We found a family with a three-generation history of FD who exhibited calcification in the brain and mental retardation. Compared to her mother, the patient described here displayed anticipation of disease onset.

Doctor-shopping patients and users of alternative medicine among Japanese primary care patients.

To describe the clinical characteristics of patients with doctor-shopping behavior (doctor-shopping patients) and users of alternative medicine among Japanese primary care patients, 1088 patients from the general medicine outpatient clinic of a medical school hospital answered an original questionnaire and 30-item General Health Questionnaire (GHQ). A random sample of patients was questioned in accordance with the Diagnostic Interview Schedule modified for use in Japan (DIS-JM). Twenty-three percent of these patients met our criteria for doctor-shopping patients, and 7.9% had used alternative medicine. Multivariate analysis showed no significant difference between the two groups of patients with regard to sex, age, residence, occupation, education, or marital status. The most striking characteristics of doctor-shopping patients were chronicity of illness (p < 0.005), inability to understand doctors' explanations (p < 0.005), disbelief of the doctor's diagnosis and treatment (p < 0.005), and high GHQ scores (p < 0.05). The major factor for alternative medicine users was high expectations of medical school hospitals (p < 0.01). DIS-JM interviews showed that doctor-shopping patients had a high lifetime prevalence of mental disorders. The lifetime prevalence of DSM-III somatization disorders was significantly higher in the two study groups. These results suggest that the risk factors for doctor shopping are strongly associated with chronic conditions and the doctor-patient relationship. Also, users of alternative medicine had high expectations of medical school hospitals as the symbol of modern medicine. Therefore, we emphasize the importance of accurate explanations and maintenance of good doctor-patient relationships by physicians providing care. We also suggest that when obtaining the patient's medical history, doctors ask how many prior visits the patient has made to medical facilities with the same complaint, and how many times the patient has used alternative medicine.

Differences in survival based on the type of follow-up for the detection of hepatocellular carcinoma: an analysis of 547 patients.

The aim of this study was to identify any significant variables in the prognosis of 547 cases with hepatocellular carcinoma (HCC), and simultaneously confirm the survival among the different surveillance modalities for the initial detection of HCC in a closely followed-up group (regular periodic follow-up with monthly alpha-fetoprotein (AFP) and ultrasonography at least every 4 months), a not closely followed-up group (neither performed with AFP nor ultrasonography regularly) and an incidental group (incidentally discovered due to related symptoms). Five hundred and forty-seven consecutive patients with HCC diagnosed at the Internal Medicine Department of Saga Prefectural Hospital Koseikan from January 1989 to December 1998 were retrospectively analyzed. The 1-, 3- and 5-year survivals in all 547 cases were 69.7, 42.4 and 26.9%, respectively. The 1-, 3- and 5-year survivals in the cases found to have solitary HCC measuring 2 cm or less in diameter at the time of diagnosis were 97.3, 76.2 and 52.3%, respectively. Forty-seven point one percent of the closely followed-up group, which was the high-risk group were found to have solitary HCC measuring 2 cm or less in diameter (48 out of the 102 followed-up cases), while only 18.5 and 11.8% were found in the not closely followed-up group (46 out of 248 cases) and the incidental group (22 out of 186 cases), respectively. The 5-year survival in the closely followed-up, the not closely followed-up and the incidental groups were 42.9, 26.1 and 15.3%, respectively. The significant factors obtained in the closely followed-up group compared to those from the not closely followed-up group included AFP, tumor size, tumor number and portal thrombosis. These findings indicate the importance of a close follow-up for high-risk groups in order to identify HCC at an early stage, and thereby have a positive influence on survival.

Colour Doppler ultrasound for the evaluation of bowel wall thickening.

We performed colour Doppler ultrasound to evaluate bowel wall thickening and to determine the effectiveness of this modality. 42 patients (aged 8-83 years old, mean age 43.5 years) with bowel disease underwent both grey scale and colour Doppler ultrasound examinations. The diagnoses were classified into three categories: inflammation, vasculitis or ischaemia. The bowel wall thickness, wall echotexture and location of the involved portion were all recorded by grey scale ultrasound, while the presence of an intramural colour Doppler flow and arterial signal was evaluated by colour Doppler ultrasound. The colour Doppler flow was graded as "absent", "mild", or "abundant", and the resistive index was also calculated. Bowel wall thickening was observed in the bowel diseases demonstrating inflammation, vasculitis and ischaemia. Patients with ischaemia were significantly older than those with inflammation. The difference in bowel wall thickness was not significant among the disease categories. Differences in bowel wall echotexture, colour Doppler flow, arterial signal and resistive index among the disease categories were significant. The absence of a colour Doppler flow and of an arterial signal suggested ischaemia, while in younger patients, an abundant colour Doppler flow and a stratified echotexture suggested inflammation. The mean resistive index in the ischemic group was significantly higher than that in the inflammatory group. In conclusion, both grey scale and colour Doppler ultrasound are considered to provide useful information for evaluating and differentiating bowel wall thickening in various bowel diseases.

The value of colour Doppler ultrasonography for small bowel involvement of adult Henoch-Schönlein purpura.

Three patients presented with a non-thrombocytopenic purpuric rash on their upper and lower limbs, abdominal pain, diarrhoea, and arthralgia. Grey scale ultrasound showed abnormally thickened walls of the small bowel. Colour Doppler showed blood flow signals in the diseased bowel wall in all patients. Subsequent barium and endoscopic studies showed oedematous bowel loops with petechial lesions. Biopsy from the purpuric rash of the skin demonstrated vasculitis of subdermal small vessels. The clinical diagnosis of Henoch-Schönlein purpura was made in each case. This paper describes the efficacy of grey scale and colour Doppler ultrasonography in the assessment of the small bowel involvement of Henoch-Schönlein purpura.

Transcatheter arterial chemoembolization therapy combined with percutaneous ethanol injection for unresectable large hepatocellular carcinoma: an evaluation of the local therapeutic effect and survival rate.

BACKGROUND/AIMS: This study was undertaken to evaluate the effectiveness of combination therapy with transcatheter arterial chemoembolization followed by percutaneous ethanol injection in patients with unresectable large hepatocellular carcinoma by comparing the use of this combined regimen with transcatheter arterial chemoembolization alone. METHODOLOGY: Six hundred and thirty-one consecutive patients with hepatocellular carcinoma lesions observed from Jan 1989 to Dec 1999 (11 years) at the Internal Medicine Department, Saga Prefectural Hospital Koseikan were retrospectively enrolled in the study. The series included 120 patients with large unresectable hepatocellular carcinoma lesions, the largest of which were greater than 3 cm in largest dimension. Fifty-two patients underwent a single transcatheter arterial chemoembolization followed by percutaneous ethanol injection, which were compared with 68 patients treated by transcatheter arterial chemoembolization alone. Both groups of patients with hepatocellular carcinoma did not differ regarding the base-line characteristics. The overall survival rates and recurrence ratio of initially treated lesions were compared in both groups. RESULTS: On overall survival rates by the Kaplan-Meier method, three- and five-year survival in the transcatheter arterial chemoembolization and percutaneous ethanol injection group (59.0%, 32.1%) proved to be significantly longer than those in the transcatheter arterial chemoembolization group (27.1%, 17.0%). In addition, during the follow-up local recurrence in the combination group (23.1%) was significantly lower than that in the transcatheter arterial chemoembolization group (50.0%). CONCLUSIONS: The combined treatment with transcatheter arterial chemoembolization and percutaneous ethanol injection proved to be more effective and safer. Furthermore, a lower incidence of local recurrence was observed than transcatheter arterial chemoembolization alone which resulted in an increased survival of the patients associated with unresectable large hepatocellular carcinoma lesions.

Cerebral infarction in a young adult associated with protein C deficiency. A case report.

Protein C deficiency is a cause of thromboembolic disease. Venous thrombosis is the most common clinical manifestation. Arterial thrombosis is unusual and involvement of the intracranial arteries is especially rare. Herein the authors describe a case of cerebral [correction of cerebellar] infarction associated with protein C deficiency and review the relevant medical literature. A thirty-year-old man was hospitalized because of dysarthria, right limb ataxia, and a gait disturbance. Cranial computed tomography disclosed an infarction in the right cerebellar hemisphere and brachium pontis. Three months earlier the patient had had a transient ischemic attack with truncal ataxia and gait disturbances. On admission, the protein C antigen was 57% and protein C activity was 45%. Investigation of family members revealed protein C deficiency in an uncle. Literature review of stroke cases associated with protein C deficiency revealed that most had had a previous vascular event and/or a positive family history or had used oral contraceptives chronically. Protein C deficiency should be considered in young stroke patients with a positive family history of vaso-occlusive disease, previous ischemic events, or chronic oral contraceptive use.

Comparison of systemic and renal hemodynamics measured by Doppler ultrasonography in canine experimental hypovolemia.

The aim of this study was to examine renal hemodynamics at the hypovolemic and recovery phases in two different hypovolemic shock models using Doppler ultrasonography, and to compare this with systemic hemodynamics. In experiment 1, the hypovolemic phase was induced in 6 mongrel dogs by removing arterial blood at 30 ml/kg for 60 min. In the recovery phase, this blood was reinfused at 30 ml/kg over 60 min. In experiment 2, hypovolemia was induced in 12 beagle dogs by rapid blood removal until blood pressure decreased to 40 mmHg and was maintained at this pressure for 30 min. Six of the dogs were then infused with 20 ml/kg hydroxyethyl starch over 5 min, and the other 6 were infused with 60 ml/kg lactated Ringer's solution also over 5 min. Parameters for systemic and renal hemodynamics were measured by using a polygraph and the Doppler method, respectively. The decrease of diastolic blood flow, resulted in an increase of vessel resistance, and was detected in the hypovolemic kidney by the Doppler method. The rapid and large volume infusion of resuscitation fluids was effective for the recovery of both systemic circulation and renal blood flow, however this induced an increase of kidney vessel resistance, a result of the autoregulation mechanism of the kidney. The changes in these parameters at the main renal artery and interlobar artery were similar.

Aspergillus osteomyelitis in a child who has p67-phox-deficient chronic granulomatous disease.

Here we describe Aspergillus osteomyelitis of the tibia in a 9-year-old boy who has an autosomal recessive form of chronic granulomatous disease (CGD). The patient showed a p67-phagocyte oxidase (phox) deficiency, which is rare type of CGD in Japan. The initial treatment which consisted of surgical debridement and antibiotic therapy with amphotericin B (AMPH), did not control the infection. Aspergillus fumigatus (A. fumigatus) pure isolated from drainage fluid and necrotic bone tissue demonstrated less susceptible to antifungal agents, including AMPH, fluconazole and flucytosine. Recombinant interferon gamma was then administrated, and it was effective in controlling the course of severe invasive aspergillosis. This report indicates the use of interferon gamma might be helpful in control for Aspergillus osteomyelitis of the tibia in a child with CGD demonstrated p67-phox deficiency refractory to conventional therapy with AMPH.

[Electrophysiological atlas of human thalamus and adjacent structures.--Microcomputer assisted mapping of neurophysiological data and its application to stereotaxic surgery].

During stereotaxic surgery anatomical structures and their extent on trajectories were identified by neural noise (field potential) obtained by semi-microelectrode technique. Locations of anatomical structures (the white mater, caudate nucleus, thalamus, subthalamic field and nuclei in the subthalamic field) were fed into microcomputer (NEC PC-8001) as 3 dimensional correlates and stored in minifloppy disc system (NEC PC-8031). Data with satisfactory recordings from 48 trajectories from 30 patients (18 parkinsonism, 5 central pain, 7 others) entered this study. Microcomputer was so programmed that locations of the trajectories and electrophysiologically identified anatomical structures at that location in various coronal, sagittal and horizontal planes were displayed. Accumulation of this display from various groups of patients automatically created electrophysiological atlas. For comparison of thus created electrophysiological atlas with anatomical atlas display was made on various sections of the Schaltenbrand and Bailey's Atlas which were also stored in the mimifloppy disc system. Electrophysiological topography of the thalamus and adjacent structures was reasonably similar to anatomical topography with minor, but significant individual variations. In most cases the ventral border of the thalamus was located in the close vicinity of CA-CP line, however, in some cases the thalamus was located deep into the subthalamic field. This was thought to be due to the difficulty in identifying the ventral border of the thalamus by this technique and in such occasions other neurophysiological method for identifying the ventral border of the thalamus, i.e., thalamocortical evoked potential and other stimulation technique, were necessary. Medial aspect of the V. im. nucleus emitted neural noise of different characteristics which in current program was recognized as the subthalamic field. This implies that the medial and lateral aspects of the V. im. nucleus are cytoarchitecturally different and that it is possible to differentiate the medial and lateral aspects of the V. im. nucleus by this technique. The lateral thalamic border, i.e., thalamocapsular border, also showed relatively wide range of individual variations. When various parameters including age, sex, diagnosis and width of the 3rd ventricles were examined for possible cause of these variations, a tendency was noted that the thalamocapsular border was medially placed when the width of the 3rd ventricle was small. In this system it is possible to display sequentially electrophysiologically identified structures along any trajectory. This display method, which was called "tract study," was very usefull for comprehensive understanding of location of trajectory in relation to individually varying anatomical structures...

[Neurogenic pulmonary edema following severe head injury--case report (author's transl)].

A case of severe head injury associated with fulminant pulmonary edema considered as neurogenic which developed within short time after the injury was presented. A five-year-old boy who had no previous history of cardiopulmonary disease was struck on his right frontal region by car accident at 15.30 PM on July 5 of 1979. Immediately after the impact he lost his consciousness and subsequently transferred to a local hospital where bilateral dilated pupil and flaccid paralysis of the limbs were noted. On transmission of the patient to Omuta City Hospital 30 minutes after the injury, massive foamy fluid was discharged from the tracheal tube. On admission, he was comatous, with bilateral dilated and fixed pupils and flaccid paralysis of the limbs. There was no retinal bleeding. He showed ataxic respiration with severe stridor and massive discharge of foamy fluid pinkish in colour from the trachea characteristic in pulmonary edema was significant. Chest x-ray film demonstrated perihilar densities suggesting pulmonary edema. CT scan showed extremely small ventricle on both sides without manifestations of intracranial hematomas or cerebral contusion. With an intensive medical treatments including corticosteroids, alkalizing agents and alpha-blocker were administered under controlled respiration, the discharge of edema fluid was gradually decreased and the findings on blood gases were also improved. However neurological signs were aggravated and he died 8 hours after the injury. Central venous pressure was maintained at the level between 8 to 10 cm. From these clinical findings the pulmonary edema was concluded as neurogenic. Direct or indirect injury to the hypothalamic efferent pathway at the level of lower brain stem seemed to be important as the cause of neurogenic pulmonary edema in this case. The possible pathophysiology of neurogenic pulmonary edema associated with brain stem injury and intracranial hypertension was discussed with other related literature.

[Relationship between referral and patient characteristics].

In order to evaluate the relationship between referral and patient characteristics, 594 new patients utilizing Saga Medical School general clinic were studied using a questionnaire and chart review. Results obtained are as follows: 1) Fifty-eight patients (10%) came for follow-up of mass screening tests, 174 patients (29%) were self-referral, the remaining 362 patients (61%) were under previous care by other physicians. Only 64 patients (11%) had a referral letter. 2) Those patients who were not advised to visit our clinic by non-medical personnel, patients who were seriously ill, elderly patients, residents in distant area, and those with medical problems tended to have a referral letter. 3) Of the 64 patients having referral letters, 15 (23%) took the initiative in asking their previous doctor to write a referral letter. Patients who were highly educated had a greater tendency to request referral letters. 4) The reasons cited by the patients without a referral letter included "Did not think of the necessity" (22%), "Wanted to confirm diagnosis" (22%), "Did not want to make the doctor lose face" (16%), "No improvement in symptoms" (14%) These results indicate that education of patients and the general public, and establishing good physician-patient communication and trust are necessary for increasing the use of referral letter.

[Information value of clinical signs and stat tests as indicators of female outpatient urinary tract infection].

This study was designed to evaluate signs and stat tests as an indicator of lower urinary tract infection in female subjects with urogenital complaints at an out-patient clinic. Of various symptoms including hematuria, pollakiuria, dysuria, urinary retention, and micturition pain, pain during micturition was present in 48% of 25 patients with urinary tract infections and in 4% of 27 patients without urinary tract infections, and was the sign with the highest positive predictive value. Comparison and discrimination of the infection and non-infection groups using a single laboratory valuable yielded significant F-statistics for urinary leukocyte esterase (14.5) and leukocyte count in urinary sediment (31.1), and revealed large Mahalanobis' distances for the same variables. Multivariate analysis using a discriminant function of categorical data (Hayashi's Suryoka type 2) revealed that combining occult blood with leukocyte esterase in the urine or combining red cell count with leukocyte count in sediment did not yield substantially smaller misclassification error than did leukocyte esterase alone or leukocyte count alone. It was concluded that neither urinary occult blood nor red cell count in sediment contribute substantially to the prediction of urinary tract infection. For the purpose of detecting urinary tract infection among outpatients, a receiver-operating characteristic analysis demonstrated that the optimal cut-off point in sediment was 3 or more leukocytes per microscopic high power field (x 400). Urinary leukocyte esterase was found to have limitations for use in screening, because its optimal decision level is equivalent to trace esterase reading on the dipstick test.

[Diagnosis of IIIrd ventricular cyst with "amipaque (metrizamide) CT ventriculography (author's transl)].

The patient is a 17-year-old female. She was suffering from dwarfism, irregular menstruation and obesity. Out of the dwarfism, there were no other neurological abnormalities. The serious clinical examinations were performed, and the cerebral angiography and the CT scan demonstrated the findings of the obstructive hydrocephalus. Namely, enlarged IIIrd ventricle and small IVth ventricle were observed with routine CT scan. Because these findings on CT scan, we thought the hydrocephalus was based on the aqueductal stenosis. The vertebral angiography showed stretched posterior medial choroidal arteries and compressed the basilar tip posteriorly and inferiorly. Moreover, the carotid-angiography demonstrated the following findings, unrolling of the anterior cerebral arteries laterally stretched bilateral lenticulostriate arteries laterally shifted sylvian groups of the middle cerebral arteries, and stretched bilateral internal cerebral veins. Judging from that angiographic findings and CT scan, we thought there would be cystic tumor in the IIIrd ventricle. However, we suspected the IIIrd ventricular tumor, we were not able to differentiated it from the enlarged IIIrd ventricle itself exactly. Because, it's density in CT scan was equaled with that the cerebrospinal fluid. According to above facts, we performed "Amipaque CT ventriculography through the ventricular catheter after V-P shunt. By "the Ampiqque CT ventriculography" we found exactly there was large cystic tumor in the IIIrd ventricle. Their manifestation and some differential diagnosis were discused.

Informative usefulness of age, sex and vital signs in the differential diagnosis of disturbed consciousness among 175 emergency outpatients.

Final diagnoses were determined among 175 emergency patients with disturbed consciousness with a Glasgow Coma Scale (GCS) of less than 15 and diagnostic usefulness of basic information was assessed using clinico-epidemiological indices. Subject patients included 98 males and 77 females with average age 53.4 years. Final diagnoses were as follows: intracranial lesions in 69 patients (39.4%), metabolic and systemic diseases in 97 (55.4%), mental diseases in 4 (2.3%), and diseases of unknown origin in 5 (2.9%). Cerebrovascular disorders and epilepsy were most frequent among the intracranial lesions, and poisoning, hypoglycemia, acute alcoholism and hypoxic encephalopathy among the metabolic and systemic diseases. Informative usefulness of age, sex and vital sings in diagnosing cerebrovascular disorders was analyzed with the use of ROC curves, showing that cut-off points of age over 60 years and of systolic blood pressure greater than 160 mmHg were most useful.

Obstructive jaundice due to multiple hepatic abscesses.

A 63-year-old Japanese male with diabetes mellitus developed obstructive jaundice following the onset of multiple hepatic abscesses. Percutaneous transhepatic cholangiography showed intrahepatic bile duct irregularity and dilatations accompanied by a complete obstruction of the right branch of the intrahepatic bile duct. Three kinds of organisms were cultured from the blood and the drained bile. The cholangiographic changes returned to the normal after the liver abscesses subsided following biliary drainage and the administration of intravenous antibiotics.

Deep breathing test (DBT) in predicting white coat hypertension.

We have evaluated the diagnostic value of deep breathing test (DBT) in detecting the patients with white coat hypertension on the outpatient basis. Thirty patients with untreated mild to moderate hypertension underwent 24-hour ambulatory blood pressure monitoring. Those who had a mean 24-hour blood pressure less than 135/80 mmHg were categorized as having white coat hypertension and the remainder were categorized as sustained hypertension. These two groups were compared with regard to the differences of office blood pressures before and after DBT (i.e., deep breathing 5 times for a minute in sitting position). Although the office systolic pressure significantly fell after DBT in both groups (p < 0.001 vs p < 0.05), there was no significant difference (p = 0.27) between the two groups. On the other hand, the office diastolic blood pressure significantly fell in the white coat hypertensives in contrast with no meaningful fall of it in the sustained hypertensives (p < 0.01 vs p = 0.66). At the cutoff level of -3%, -5% and -10% of the differences in office diastolic blood pressure before and after DBT, the sensitivity for the presence of white coat hypertension were 64.7%, 58.8% and 29.4%, respectively, and the specificity were 61.5%, 84.6% and 100%, respectively. These findings demonstrate that the deep breathing test is useful for identifying white coat hypertension in the outpatient clinic.

[Analysis of 293 cases of hepatocellular carcinoma of recent ten years--I. Epidemiology, anamnesis and tumor occupying rate].

Two hundred and ninety-three cases of hepatocellular carcinoma (HCC) admitted to the key hospital of the rural area of western Japan, Saga Prefectural Hospital, during 10 years since 1979 to 1988 were analysed retrospectively. The male to female ratio was 3.7 to 1 and the ratio of HBs-Ag positive to negative was 3.5 to 1. The peak of the age distribution was seventh decade. The incidence increased annually, especially in HBs-Ag negative males. Their past history of blood transfusion was considered as an etiology of HCC in 19 (9.9%). The HCC was diagnosed approximately 10 years earlier in habitual drinkers than non-habitual drinkers of both positive and negative HBs-Ag. The incidence of small tumors is associated with the past history of chronic liver disease, negativity of HBs-Ag, lack of symptoms and old age.