Clinical evaluation of combined endoscopic variceal ligation and sclerotherapy of gastric varices in liver cirrhosis.

BACKGROUND AND STUDY AIMS: Endoscopic injection sclerotherapy (EIS) using cyanoacrylate and balloon-occluded retrograde transvenous obliteration (B-RTO) are the main procedures used to treat gastric varices. However, neither technique is free of problems. EIS for gastric varices may cause embolism in other organs; B-RTO requires a gastrorenal shunt and may aggravate esophageal varices. We have developed a combined form of endoscopic therapy involving band ligation and sclerotherapy which is an effective and safe procedure for treating gastric varices. PATIENTS AND METHODS: Fifty-six patients with gastric varices and liver cirrhosis were treated at Almeida Memorial Hospital from June 1997 to May 2002 using the combined procedure. Each gastric varix was tightly ligated with O-rings, and 1 % polidocanol was injected into the submucosa around the ligated varix. If necessary, additional sclerotherapy was carried out after the initial treatment. RESULTS: The rate of hemostasis for variceal bleeding was 100 %, and no critical complications were noted. Complete disappearance of the gastric varices was observed endoscopically in all cases. Computed tomography showed that collateral vessels outside the gastric wall were not occluded by the treatment. Endoscopic follow-up examinations were carried out, and gastric varices recurred in seven patients (12.5 %). Only two of the patients (3.6 %) had a small amount of oozing bleeding. Additional endoscopic variceal ligation (EVL) and/or EIS were performed in these seven cases, and none of the patients died as a result of a bleeding gastric varix. CONCLUSIONS: The combined procedure was easily performed immediately after endoscopic examination, and required no special apparatus. It was found to be a safe and effective method of treating gastric varices.

Efficacy of triple therapy comprising rabeprazole, amoxicillin and metronidazole for second-line Helicobacter pylori eradication in Japan, and the influence of metronidazole resistance.

BACKGROUND: The widespread use of eradication therapy for Helicobacter pylori in Japan has led to an increase in antibiotic-resistant strains and the problem of re-treatment in cases of eradication failure. AIM: To perform drug sensitivity testing for metronidazole in 92 H. pylori-positive patients who had failed eradication treatment with first-line triple therapy, consisting of a proton pump inhibitor, amoxicillin and clarithromycin, and were administered metronidazole-containing second-line therapy. METHODS: Second-line eradication therapy, consisting of rabeprazole (20 mg b.d.), amoxicillin (750 mg b.d.) and metronidazole (250 mg b.d.), was administered for 1 week and the eradication rates and influence of metronidazole resistance were determined. RESULTS: The eradication rates for rabeprazole-amoxicillin-metronidazole were 88% (81/92) using intention-to-treat analysis and 91% (81/89) using per protocol analysis. The eradication rates were 97% (61/63) for metronidazole-sensitive strains and 82% (18/22) for metronidazole-resistant strains. CONCLUSIONS: As second-line H. pylori eradication treatment in Japan, rabeprazole-amoxicillin-metronidazole triple therapy is effective, even with metronidazole-resistant strains.

Eradication rates of clarithromycin-resistant Helicobacter pylori using either rabeprazole or lansoprazole plus amoxicillin and clarithromycin.

BACKGROUND: The resistance of Helicobacter pylori to clarithromycin has become one of the primary reasons for eradication failure. AIM: To compare the eradication rates of triple therapy using amoxicillin (A), clarithromycin (C) and rabeprazole (R) or lansoprazole (L) against clarithromycin-sensitive and clarithromycin-resistant strains. METHODS: Two hundred and ninety-five patients were randomly divided into four groups and treated for 1 week: 147 cases were treated with RAC, i.e. 49 cases with R20C400 (10 mg R + 750 mg A + 200 mg C, twice daily), 48 cases with R40C400 (20 mg R + 750 mg A + 200 mg C, twice daily) and 50 cases with R40C800 (20 mg R + 750 mg A + 400 mg C, twice daily); 148 cases with treated with LAC (30 mg L + 750 mg A + 200 mg C, twice daily). RESULTS: According to intention-to-treat and per protocol analyses, the eradication rates were 88% and 91% with RAC and 78% and 81% with LAC; the eradication rates with R20C400, R40C400 and R40C800 were 94%, 81% and 86%, respectively, in the intention-to-treat analysis. In addition, the eradication rates for clarithromycin-sensitive strains with RAC and LAC were 98% and 89%, respectively, and for clarithromycin-resistant strains with RAC and LAC were 8.1% and 0%, respectively. CONCLUSIONS: The eradication rate was significantly higher with RAC than LAC. The eradication rate for clarithromycin-resistant strains was low in both groups, and an improved eradication rate could not be achieved by changing the dose of clarithromycin or proton pump inhibitor.

Gastrointestinal diseases and halitosis: association of gastric Helicobacter pylori infection.

The relationship between gastrointestinal conditions and halitosis is discussed. Few reports have suggested that gastrointestinal diseases may cause halitosis. H. pylori infection, which causes gastric ulcers, is considered as a possible cause for halitosis. Intensity of malodour of mouth air was found to be higher in H. pylori-positive patients than in negative patients. The levels of hydrogen sulphide and dimethyl sulphide in mouth air were also significantly higher in the positive patients than in the negative patients (P<0.05). When odour strength in exhaled breath was compared between the two groups, no significant difference was found. Hence, H. pylori infection might not cause a systemic condition producing breath odour. Although there were no significant differences in periodontal parameters or tongue coating between the positive and negative groups, H. pylori may be a frequent contributor to the production of malodour even though its role had not been suspected before. Further study would be necessary to clarify the reason for the increase of volatile sulphur compounds (VSCs) level in H. pylori infection.

[The relationships between the prevalence of asthmatic symptoms and environmental factors].

The relationships between the prevalence of asthmatic symptoms and environmental factors were evaluated using a modified version of the Japanese ATS-DLD children's questionnaire. The questionnaire was distributed to 13,306 students in 3 areas of Yokohama City; in 1986 (4705), 1988 (4440), and 1991 (4161). The results indicate: 1. The prevalence of asthmatic symptoms among boys increased slightly from 1986 (9.2%) to 1991 (9.6%), but no increase was observed that among girls (5.7%). The overall prevalence among boys was 1.7 times higher than that among girls. 2. On the whole, the air pollution level was Tsurumi-ku > Naka-ku > Midori-ku. But the prevalence of asthmatic symptoms among boys was Naka-ku > Tsurumi-ku > Midori-ku in 1986, 1988 and 1991. The prevalence among girls was the same result in 1986, but in 1988 and 1991, it was Tsurumi-ku > Naka-ku > Midori-ku. 3. In the longitudinal study of the same group, the prevalence of asthmatic symptoms among boys decreased between 5th and 6th grade. In contrast, remission of asthma increased between 5th and 6th grade. And the prevalence of asthmatic symptoms among girls decreased between 3rd and 6th grade. In contrast, remission of asthma increased between 3rd and 6th grade. 4. Children who had a personal or family history of allergic diseases, allergic disposition, respiratory diseases before 2 years old, wheezing or difficulty in breathing, or allergies against foods or medicines, showed a statistically significant Odds ratio (p < 0.01) for asthmatic symptoms.

[The association between emergency clinic visits for asthmatic attacks and fluctuating environmental factors].

The number of nocturnal visits of asthmatic attack patients to the emergency room of Yokohama Medical Association's Clinic from January 1990 to December 1991 was compared to daily levels of air pollution (NO, NO2, SO2 and SPM) and weather (temperature and relative humidity) variables measured in Yokohama City. Trend-cycle components (Trend) that control for the weekly effects, other irregular variance for asthmatic attack incidence and environmental parameter measurements were estimated from the original data series using the method of Akaike and Ishiguro (1980). The rate of increase for each environmental parameter was then calculated from its trend-cycle components. We classified the data into four stages on the basis of rising and falling temperature and humidity. For each stage of temperature and humidity, fluctuation we estimated correlations between the number of asthmatic attack visits and original data series measurements, estimated trend-cycle components, and calculated rates of increase for each of the air pollutants. The daily number of asthmatic attack visits was negatively correlated to the daily mean values of all air pollutants, but positively correlated to the daily mean temperature and relative humidity. The trend-cycle components of the air pollutants were also negatively correlated to the frequencies of asthmatic attacks (p < 0.01 for all pollutants except NO2). In contrast, the number of asthmatic attack visits were in general positively correlated with increasing levels of pollutants. Furthermore, when both temperature and relative humidity decreased, significant correlations (r > 0.31, p < 0.001) between the number of asthmatic attacks and increased rates of all air pollutants were observed (r: NO2 > NO > SO2 > SPM).

[Falling accidents among metropolitan elderly resulting in emergency ambulance transfer].

The aim of this study was to examine the frequency and number of falling accidents in the the elderly population and to investigate the characteristics of the accidents. The investigation was performed in 58 Tokyo metropolitan townships for a one-year period from September 1st, 1997, and the 517 cases, in which persons were over 65 years old, fell down were studied (136 men, 381 women). The yearly accident frequency for 1,000 elderly over 65 population was 4.13 cases for men and 7.88 cases for women, being 1.9 times higher in women. Also the number of accidents in each township was significantly correlated to the population of the elderly over 65 (men r = 0.674, women r = 0.846, p < 0.001). The analysis by age showed the percentage of accidents in single-family housing among the oldest-old population was significantly higher than the young-old population (p < 0.05) for both men and women. According to logistic regression analysis results, injured body part and the form of dwelling house were significantly correlated as risk factors of fracture (p < 0.05). The odds ratio of injured body part was 7.559 (95% CI 4.926-11.598), and that of the form of dwelling house was 1.660 (95% CI 1.067-2.584), showing that injury of limbs and the accidents in single-family housing would increase risk of fracture. Promoting preventative measures for falling accidents in single-family housing appears important in the prevention of falling accidents among the metropolitan elderly.

[Selection of antibiotics and planning of eradication for H. pylori infection].

There is general agreement that H. pylori should be eradicated in patients with peptic ulcers. But the optimal therapeutical regimen to be used still remains a matter for many investigations. An increase in the prevalence of antibiotic-resistant H. pylori strains has been reported recently. The recommended drugs for the eradication in Japan are clarithromycin (CAM) and amoxicillin (AMPC) because metronidazole (MNZ) is anti-parasites drug in Japan. A total of 392 H. pylori strains in the last twelve years were tested for sensitivity to CAM, MNZ, and AMPC. The Primary resistance of H. pylori to CAM, MNZ, and AMPC were found in 10.2%, 26.5%, and 0.3% strains, respectively. The resistant strains to CAM were gradually increasing in the last few years. The eradication therapies which do not increase antibiotics resistant strains after eradication failure were reported. The recommendation for eradication in patients with peptic ulcer disease includes those with bleeding ulcers. The pretreatment with proton pump inhibitors (PPI) does not influence the success of PPI-based triple therapy in eradicating H. pylori.

Three cases of acute methyl bromide poisoning in a seedling farm family.

We encountered three patients (Patient I: 39-year-old man, Patient II: 34-year-old woman, and Patient III: 5-year-old girl) with acute methyl bromide poisoning, which had occurred as a result of exposure to the gas that leaked from methyl bromide cans stored in a warehouse of a seedling farm. Since all three patients exhibited almost the same initial symptoms, i.e., severe vomiting, tonic convulsions and clouding of consciousness, botulism was suspected at first. However, subsequent inquiry revealed that 27 cans of methyl bromide had been stored in the building that the patients lived in, and that the cans had been damaged a few days before the onset of the patients' illness by a thrashing machine that was being moved by them to another location. Inspection revealed that all the cans of methyl bromide had passed the expiry date and were corroded. Even though none of the cans had been used, three cans with a capacity of 750 g were found to be empty. Plasma bromide ion concentrations were determined to be high (72.9 microg/ml, 67.8 microg/ml and 91.5 microg/ml; normal level, < 5 microg/ml), and acute methyl bromide poisoning was diagnosed 8 days after admission of the patients to the hospital. Hemodialysis (peritoneal lavage in the case of the child) was performed immediately, after which the plasma bromide ion concentrations returned to normal and the general condition of the patients gradually improved.

[Changes in the prevalence of asthma-like symptoms and risk factors in school children in Yokohama from 1986 to 1991].

We conducted a questionnaire survey of first graders from six elementary schools in three areas of Yokohama annually from 1986 to 1991 (about 700 children each year) to investigate the changes in prevalence of asthma-like symptoms and association with potential risk factors. The prevalence rate of asthma-like symptoms increased from 7.6% to 11.0% in boys and from 6.5% to 8.8% in girls from 1986 to 1991. The ratio of affected boys was consistently higher than that in girls, but there were no significant regional differences. We found statistically significant odds ratios for the effect of a previous history of allergies, respiratory disease before age two, wheezing or difficulty in breath before age two and cough without respiratory tract infections on the prevalence of asthma-like symptoms.

Interleukin-6 and interleukin-8 levels in serum and synovial fluid of patients with osteoarthritis.

Concentrations of interleukin (IL)-6 and IL-8 in serum and synovial fluid obtained from patients with osteoarthritis (OA) of the knee were determined by the chemiluminescence-ELISA (CL-ELISA) method, the sensitivity of which is 100-1,000 times greater than that of the conventional ELISA method. The results were compared with those obtained from patients with rheumatoid arthritis (RA) and from healthy subjects. The mean IL-6 and IL-8 levels in synovial fluid indicated higher concentrations in RA than in OA. The IL-6 and IL-8 levels in serum were significantly higher in RA and OA relative to controls. Among OA patients in whom remarkable improvement was noted in hydrarthrosis, the synovial fluid IL-6 and IL-8 levels at the initial examination were relatively higher, and were markedly decreased after treatment with sodium hyaluronate (NaHA). Among those in whom no improvement was noted in hydrarthrosis, the synovial fluid IL-6 and IL-8 levels at the time of initial examination were relatively lower, and hydrarthrosis was not significantly improved even after treatment with NaHA. In addition, there was a tendency for the synovial fluid IL-6 and IL-8 levels to decrease as HA levels increased. Evaluation of X-ray findings revealed that the IL-6 levels in synovial fluid at the initial examination in low-grade cases tended to be significantly higher than in high-grade cases. In low-grade cases, as determined by X-ray findings, there was a significant decrease in IL-6 levels in synovial fluid after treatment with NaHA.

The health care system for female workers and its current status in Japan.

In this paper we describe female workers' health care, the women's and maternal protection system within the Japanese legal system, the current status of female workers in Japan, and problems regarding methods of advancing health care and the women's or maternal protection system. Motherhood is respected in the workplace in Japan, and in order to provide an environment in which women can work and still bear and rear children with a sense of security, laws concerning maternal protection of female workers, and revisions in terms of the system have been made, and a new system has been in effect since the fiscal year of 1998. Nevertheless, gender discrimination against women and the disparagement of women, rooted in gender role stereotypes concerning the division of labor, remain firmly planted in the social environment and in long-established custom.

A preliminary evaluation of intra- and interindividual variations of hOGG1 messenger RNA levels in peripheral blood cells as determined by a real-time polymerase chain reaction technique.

The hOGG1 (8-oxoguanine-DNA glycosylase) gene may contribute to further understanding of the relation between oxidative DNA damage and carcinogenesis. A real-time PCR technique was used to determine mRNA levels in peripheral blood cells to assess the possibility of using hOGG1 mRNA as a biomarker in epidemiological studies. To evaluate the intra- and interindividual variation of hOGG1 mRNA levels in peripheral blood cells, we measured them in five healthy nonsmokers three times over a 1-year period. The beta-actin mRNA level in each subject was set equal to 100, and the levels of hOGG1 mRNA were found to range from 1.6-17.6. The intraindividual variation range was 1.8-6.4. Although the difference in the mRNA levels between the sampling dates was not significant (P = 0.73), a significant difference in mRNA levels was found between the subjects (P < 0.01). The subjects seemed to fall into groups according to their individual levels. This preliminary study may provide initial information on the hOGG1 mRNA level of peripheral blood cells as a biomarker in epidemiological studies on oxygen radicals, oxygen radical-related agents, and cancer.

Effects of acute and chronic cigarette smoking on the expression of endothelin-1 mRNA of the cardiovascular tissues in rats.

Although smoking has been suggested to be involved in the development of cardiovascular diseases, details of the mechanism still need to be revealed. We investigated the effects of cigarette smoking on the tissue mRNA expression of endothelin-1 (ET-1). Male Wistar rats of 4 weeks of age were exposed to smoke from six cigarettes for 30 min (acute exposure) and six cigarettes for 30 min/day, 5 days a week for 6 months (chronic exposure). Half of the rats exposed to 6 months smoking were kept in clean-air conditions for a further 3 months to clear the effects. Tissue expression of ET-1 mRNA in the kidney, aorta, heart and lung was determined by reverse transcriptase polymerase chain reaction (RT-PCR) followed by Southern blot analysis. There was no significant difference in body and organ weight of the heart and kidney between the control and smoking group in either the acute or chronic experiment. In the acute-exposure experiment, expression of ET-1 mRNA was increased in the heart and lung, while that in the kidney and aorta was unchanged. In the chronic-exposure experiment, however, there was no significant difference in the expression of ET-1 mRNA in all the tissues between the smoking and control groups. These results suggest that cigarette smoking could cause cardiovascular and pulmonary diseases by modulating ET-1 mRNA expression in the tissues.

Morphological changes in rat lung after long-term exposure to diesel emissions.

Wistar rats were exposed for 24 mo to diesel emissions containing a low (0.2 ppm, 0.21 mg/m(3)), medium (1.04 ppm, 1.18 mg/m(3)), or high (2.96 ppm, 3.05 mg/m(3)) concentration of NO(2) and particles, or diesel emissions containing a medium (1.12 ppm, 0.01 mg/m(3)) concentration of NO(2) without particles. At 6-mo intervals during the exposure period, rats were autopsied, and their lungs were prepared for light- and electron-microscopic examination. Morphological evaluations included examination for hyperplasia of airway goblet cells, shift in the types of glycoprotein of intracellular mucus granules in goblet cells, infiltration of inflammatory cells in the airways, enlargement of the cross-sectional area of an alveolus as a parameter of air space enlargement, and development of alveolar holes, which is considered to be an early hallmark of alveolar destruction. The number of goblet cells with acid-form mucus granules increased with the exposure concentration and time; however, goblet cells did not show any hyperplastic changes. Furthermore, inflammatory cells such as alveolar macrophages, mast cells, plasma cells, neutrophils, and lymphocytes infiltrated the airways and the alveoli, and showed some cell-to-cell contact. Although no significant enlargement of the air space of the lungs was seen in any exposure group, the number of alveolar holes was significantly higher in the high-concentration group in comparison with the control group at each exposure time, and also increased in other exposure groups, even in the low-concentration group at certain exposure times. Morphological changes in the lungs were mild even in the animals exposed to the highest levels of diesel emissions for 24 mo. Elimination of particles from diesel emissions led to reduced morphological changes such as a decreased shift in the types of glycoprotein of mucus granules in goblet cells, decreased infiltration of inflammatory cells in the lungs, and reduced anthracosis.

[The public health significance of the measurement of cytokines in serum].

As variable functions of cytokines have been proved in recent years, cytokine levels in biological fluids such as serum, plasma, and synovial fluid of patients with every kind of disease have been enthusiastically measured. As a result, many studies have shown an increase or decrease in the production of cytokines or abnormal cytokine levels in biological fluids. However, the relationship between the abnormal levels of cytokines and the intensity of the clinical symptoms or the prognosis remains unclear. The significance for the measurement of cytokines depends on whether it should be valid for detecting a preclinical status such as AST or ALT used for health checks or for disease screening such as some tumor markers. The purpose of this study is to know whether or not some cytokine levels in serum could be biomarkers for preventive purposes. Serum cytokine levels (IL-4, 6, 8, 12, and IFN-gamma) were measured in three different types of cohorts (nursery school infants, manufacturing workers and middle and old aged women) with chemiluminescence ELISA. The results showed no differences with atopic status in infants, pulmonary fibrosis in workers or with the decrease in bone stiffness, these results are mainly due to a great inter-individual variability of serum cytokine levels. This study concludes that serum cytokine levels are inappropriate as biomarkers for preventive purposes. However, a further detailed evaluation in healthy people with high serum cytokine levels may be necessary.

Time-dependent effects of stressor application on metastasis of tumor cells in the lung and its regulation by an immunomodulator in mice.

The effects of the timing of stressor application on transplanted tumor cells and its possible regulation by an immunomodulator was investigated. Male C57 BL/6N mice were subjected to rotational stressor for 7 days relative to tumor cell inoculation: stressor after inoculation of Lewis lung cancer cells, stressor during inoculation and stressor before inoculation. Stressor application and tumor cell inoculation induced transient decreases in body weight, particularly in mice stressed after inoculation. The mice exposed to the stressor during inoculation or before inoculation showed significant increases in the number of metastatic foci relative to control mice. Early administration of an immunomodulator, PSK, significantly attenuated the increase of metastatic foci in stressed mice. The weights of thymus gland and spleen at 14 days after inoculation were similar in the three stressor groups and the control group. Application of the stressor reduced NK cell activity of the normal mice as well as tumor bearing mice. The lowest pre-inoculation NK cell activity was observed in mice stressed for 7 days beginning on the day of inoculation. The NK cell activity decreased in the tumor bearing mice which were stressed at the time of tumor inoculation. Decreased NK cell activity was reversed at day 14 after tumor inoculation. The mice exposed to the stressor after inoculation showed lowest level of NK cell activity relative to mice exposed to the stressor before or during inoculation. The treatment of mice with PSK reduced these changes significantly. The present results suggest that the rotational stress reduces splenic NK cell activity, which may influence the magnitude of tumor metastasis, depending on the time of tumor cell injection. Further, administration of an immunomodulator may counteract the reduction of the NK cell activity.

Acute biological effects of intratracheally instilled titanium dioxide whiskers compared with nonfibrous titanium dioxide and amosite in rats.

The dimensions of man-made mineral fiber whiskers are similar to those of some kinds of asbestos. Thus these mineral fibers raise the concern for potential health hazard for workers exposed in the occupational environments. This study was designed to define acute biological effects of intratracheally administered titanium dioxide whiskers (TO1) compared with nonfibrous titanium dioxide (TOP) and UICC amosite (Ams), and their relations to acute lung inflammation in rats. The observed geometric mean length (microm) and width (microm) and geometric standard deviation are: TO1(2.1[2.0], 0.14[1. 53]); Ams (4.3[3.3], 0.31[1.9]); and TOP (50 nm, 1-2 microm aggregates). Ten-week-old Wistar-Jcl male rats received a single tracheal injection of test materials at doses between 0.05 and 1.0 mg/rat. Control animals were injected with the same volume of saline. Lung tissue and bronchoalveolar lavage (BAL) fluid were collected from rats on days 1, 3, and 7 after administration. In the group injected with TO1, total protein, cytokine-induced neutrophil chemoattractant (CINC)/growth-regulated gene product (GRO), interleukin (IL) 1beta, and tumor necrosis factor (TNF) alpha increased on day 1. Subsequently, total elastolytic activity and fucose levels in BAL increased by day 3. All parameters, except for fucose in BAL, recovered to the normal levels. Animals in the Ams group showed increased total protein and CINC/GRO and decreased total elastolytic activity in a dose-dependent manner on day 1. The fucose level increased on day 3 in the Ams group. All parameters returned to their control levels on day 7. Animals in the TOP group did not show significant changes any of parameters during the experimental period. Gene expression of TNF-alpha and monocyte chemoattractant protein (MCP) 3 in the lung increased dose-dependently in the animals treated with the three materials. The mRNAs for eotaxin and MIP-1alpha were overexpressed in the lung of animals treated with Ams and TO1, while RANTES mRNA was overexpressed dose-dependently in the lung of animals treated with Ams on day 1. Onset of inflammatory response was more rapid in the Ams group than the TO1 group. Recovery of the fucose level in BAL was slower in the TO1 group than in the Ams group, though we observed similar histopathological changes in the lung of animals with TO1 or Ams. We conclude that whisker-induced acute biological effects in the lung may be related to the shape of the whiskers and not to their chemical composition or surface crystal structure, showing biological effects similar to those of UICC amosite.

A diary form quality of life questionnaire for Japanese patients with lung cancer and summarization techniques for longitudinal assessment.

The aim of this study was to confirm the validity and reliability of a new diary-type quality of life (QOL) self-rating questionnaire tailored for use by Japanese inpatients with lung cancer receiving chemotherapy. Two kinds of summary statistics were tested in QOL analysis. The questionnaire has a four-scale structure; physical, psychological, daily activity and global scales. Fifty-three patients were enrolled to test the reliability and validity. Summary statistics were assessed using indices of the area under the curve (AUC) and the maximum fluctuations of QOL scores (Dif max) in patients receiving cisplatin or carboplatin. The questionnaire had satisfactory reliability and validity. The physical, psychological and global scales scores changed to the worst levels after treatment, continuing for 1 week in the cisplatin group, whereas those of the carboplatin group began to worsen from day 3, but returned to prechemotherapy levels by day 9. The cisplatin group showed significant decrease of QOL compared with the carboplatin group in the AUC of psychological and two global scales, in the Dif max of psychological and linear analogue global scales. These results suggested that this questionnaire reflects differences in the influence of chemotherapy, and that AUC and Dif max may be useful indices for the analysis of QOL as measures to assess multidimensional QOL.