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Leptin is a hormone which is predominantly secreted by adipose tissue. Recent studies have shown that leptin increases arterial blood pressure. Although data from available animal studies clearly indicate an association between leptin and hypertension, results of human studies have been less definitive. We conducted a case-control study to examine the association between serum leptin levels and hypertension in 111 hypertensive subjects and 222 male controls, using conditional logistic regression analyses. Mean serum leptin levels were found to be marginally higher in the case subjects than in the control subjects (3.3 ng/ml versus 3.0 ng/ml), however, conditional logistic regression analysis revealed that subjects in the highest quartile had a significantly increased risk of hypertension compared with those in the lowest quartile, even after adjusting for drinking status and diabetes mellitus (adjusted OR, 2.11;95% CI, 1.01-4.39). Our findings suggest that leptin plays an important role in the development of hypertension.

We discuss the concept of social capital, which has received much attention recently. Social capital is important for the following 2 key reasons:(1) a highly democratic polity and a strong economic performance that attaches great importance to the public good can be achieved on the basis of high social capital;and (2) social capital can effect health status in the human population, and widening of income inequality harms human health through the erosion of social capital. In addition, there are 3 political implications of social capital for Japanese society:(1) social capital has implications for the political decision of whether Japanese society should adopt a “medium burden for medium welfare” or a “low burden for small welfare” model together with the concept of social overhead capital;(2) reciprocity, which is one of the primary components of social capital, is similar to the philosophy underlying the health care system of Japan;(3) Japanese society needs to change from a society that emphasizes the relationships between its members to a society that is open to outsiders and has sufficient opportunities.

A very rare case of echinococcus cysts of the heart and brain in a 27ﾝyear-old man who worked as a butcher, lived on a farm, and had a dog before disease onset. The initial manifestation of hydatid disease was anaphylactic shock, the etiology of which remained unknown on initial hospitalization. On rehospitalization, the diagnosis of cardiac hydatidosis was made and the patient underwent surgery. Two years later, reoperation was required for hydatid cyst of the brain and cardiac cyst recurrence. There was no other organ involvement from the disease onset, which is rarely reported. Based on this case, we suggest that echocardiography be performed as a standard method in the diagnosis of anaphylactic reaction of obscure etiology in the areas endemic for hydatidosis, even in the absence of symptoms indicative of cardiac involvement. This especially applies to individuals with occupational or epidemiological exposure to the infection.

Autoimmune hepatitis (AIH) is a chronic and progressive disease characterized by histological interface hepatitis, hypergammaglobulinemia, and circulating autoantibodies. Multiple factors, including molecular mimicry, a genetic background including major histocompatibility complex class II, and defective function of regulatory T-cells, are involved in the pathogenesis. The diagnosis is made based on the scoring system of the International Autoimmune Hepatitis Group, the sensitivity and specificity of which are90%, respectively. AIH is classified into 3 sub-types based on the profiles of circulating autoantibodies: anti-nuclear antibody and/or smooth muscle antibody-positive (type 1), anti-liver-kidney microsomal antibody-positive (type 2), and anti-soluble liver antigen/liver-pancreas antigen antibody- positive (type 3). Recently, however, the number of atypical cases lacking the usual features has increased-for example, patients with acute-onset or fulminant-type AIH, autoantibody-negative patients, male patients, and patients with bile duct injury-and thus the clinical features of AIH have been diversified. AIH is responsive to immunosuppressive treatment in most cases; however, relapse occurs in more than 80% of patients within 1 year after immunosuppressive treatment withdrawal. The 10-year survival rate and the 10-year hepatocellular carcinoma-free rate are90%, respectively, indicating that some patients reach liver failure or develop hepatocellular carcinoma. To improve the prognosis of these patients, persistent normalization of transaminase is required.

The contribution of age groups and causes of death to the sex difference in life expectancy (SDLE) at birth in Japan and Scotland was estimated for the period 1965-1990. The purpose was to determine the particular age groups and causes of death responsible for the opposite trend of SDLE in the two countries. SDLE has been widening and narrowing in Japan and Scotland, respectively. The availability of complete and reliable data for these two developed countries facilitated the study. A method of decomposing the total SDLE into age and cause of death components was employed. About 40-60% contribution to SDLE was observed for ages after 65 years. Marked increase in the contribution of the 75+ age group and marked decrease in the contribution of ages 45-64 for Japan and Scotland, respectively, had a major effect on the widening and narrowing of SDLE in the two countries, respectively. The contribution of diseases of the circulatory system was the maximum until 1980 in Japan (< or = 1.8 years or 33.6%; cerebrovascular disease alone < or = 23.4%) and until 1990 in Scotland (< or = 3.1 years or 47.0%; ischemic heart disease alone < or = 42.0%). In Japan, the contribution of malignancy had a marked increased from 0.7 year (12.3%) to 2.0 years (32.6%), particularly for the trachea, bronchus and lung, while there was only a small increase in Scotland from 1.0 year (16.6%) to 1.2 years (19.8%) with an increase in the negative contribution of female breast malignancy. In Japan, the contribution of diseases of the respiratory system increased considerably from 0.5 year (8.5%) to 1.1 years (18.1%) while it decreased in Scotland from 1.0 year (16.5%) to 0.6 year (10.7%). About 60-75% of SDLE is due to the above three groups of causes of death. Malignancy and diseases of the respiratory system had a persistently increased contribution in Japan with resultant widening of SDLE by 0.9 year. Diseases of the circulatory system have always had a high contribution. On the contrary, in Scotland the contribution of diseases of the circulatory system and malignancy was practically unchanged and diseases of the respiratory system had a decrease with a consequent narrowing of SDLE by 0.4 year. Further epidemiological study is necessary to detect and analyze in detail the internal gradients (environmental and genetic-biological) of major contributor diseases to SDLE in Japan and Scotland.

The incidence of hepatitis A (HA), hepatitis B (HB), and non-A, non-B hepatitis (NANBH) was 27%, 30% and 43% among 73 patients with sporadic hepatitis. Epidemiological data (geographical distribution, seasonal variation, age, sex, and occupation) were not distinguishing of the type of hepatitis. Neither intrafamilial infection nor previous contact with viral hepatitis patients could be demonstrated in the NANBH cases. Fever and jaundice were less frequent in NANBH than in HA. Maximum levels of SGPT, serum bilirubin, ZTT, and gamma-globulin were significantly lower in NANBH than in HA and HB. Ten of 29 NANBH patients (35%) presented abnormal SGPT activities for more than 6 months, and four (14%) more than 12 months. In the ten patients with prolonged courses, jaundice was more frequent and maximum levels of SGPT were higher than in patients with transient courses. Histopathologic findings were not markedly different from those of HA and HB. Bile duct damage, fatty deposition, and giant multi-nucleated cells were recognized in 6, 12, and 2 NANBH patients, respectively. There were no characteristic ultrastructural changes in NANBH.