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A female patient aged 77 years had refractory watery diarrhea caused by a vasoactive intestinal peptide production tumor. She had impaired consciousness. After presenting to our hospital, we administered opium tincture, after which the diarrhea ceased. Intravenous feeding was able to be stopped along with the potassium load and the infusion of octreotide, and loperamide. The antidiarrheal effects continued after opium tincture was stopped, and the patient was discharged home. These results reveal that opium tincture can be efficacious in treating end-stage refractory diarrhea.

Home care and at-home-based palliative care for cancer patients are being improved bythrough a basic law on cancer control and subsequent institutional reforms in 2007. However, in the revision of the medical treatment fee in 2018, it is a big feature that the facilitystandard for the waiting days and the home return rate was built in the palliative care ward. The number of inpatients in our palliative care department was 3,835 in the 5 years from 2013 to 2018. It consists of 2,414 in general wards and 1,421 in the palliative care ward, regarding the home return rate, the total was 27.5%, but there were 891 from the general ward and 163 from the palliative care ward. In the future, the role of palliative care wards is expected to change, shorting the number of waiting days, and providing a much greater degree of flexibilityin the wayof promoting home care. The important thing is to establish a system to be able to choose the place of recuperation quickly depending on the patient, familysituation, and their hope. Hence, we aim to strengthen the home-visit system by emphasizing the continuityof medical treatment while maintaining the relationship of mutual trust among the local cooperative clinics.

We offer inpatient support for end-stage cancer patients, not only in palliative care units, but also in general medical and long-term care units. We also provide outpatient palliative care and offer emergent backup for the regional home care clinics. From January 2014 to December 2016, 1,832 patients were hospitalized, and among them, 983 patients visited our hospital on an emergency basis. Among the urgent hospitalized patients, 378 patients returned home after adequate palliative care. But 605 patients had to stay admitted in the hospital until their time of death. Ninety-one patients died within 48 hours after urgent hospitalization. Of these 91 patients, 70% came to our hospital because of increasing dyspnea and decreased level of consciousness additionally, 36 of 91 patients had received treatment by home care clinic doctors, and 50% of them had hoped for at-home death. The patients' preference of treatment facility tends to vary depending on their general condition. Hence, we have to offer appropriate facilities for palliative care. Building good relationships between hospitals and regional home care clinics and creating a system for patients to choose the appropriate time and place for treatment with a smooth transition from their home to the hospital during their end-of-life period is important in this process.

We hypothesized that a large number of circulating tumor cells(CTCs)may be isolated from samples obtained by using the leukapheresis procedures that are utilized to collect peripheral blood mononuclear cells for dendritic cell vaccine therapy. We utilized the CellSearch System to determine the number of CTCs in samples obtained by using leukapheresis in 7 patients with colorectal cancer, 5 patients with breast cancer, and 3 patients with gastric cancer. In all patients, a large number of CTCs were isolated. The mean number of CTCs per tumor was 17.1(range 10-34)in colorectal cancer, 10.0(range 2-27)in breast cancer, and 24.0(range 2-42)in gastric cancer. We succeeded in culturing the isolated CTCs from 7 patients with colorectal cancer, 5 patients with breast cancer, and 3 patients with gastric cancer. In conclusion, compared to conventional methods, a large number of CTCs can be obtained by using leukapheresis procedures. The molecular analyses of the CTCs isolated by using this method should be promising in the development of personalized cancer treatments.

The Palliative Care Unit at Heiwa Hospital has 16 beds, and offers inpatient support in general wards, as well as back-up beds in emergencies in collaboration with local home care support clinics. For two years from January 2012 to December 2013, there were 1,213 cases where patients were seen for initial outpatient visits at the Department of Palliative Care. At the time of the initial visit, visiting medical care had been introduced for 25% of the cases. Although 59% of the patients who visited our department are hospitalized, 20% of inpatients have been hospitalized at the request of their home care physician. The availability of back-upbeds offers patients and their families, as well as related medical institutions, a sense of security, and enables home care to continue. The significance of back-upbeds will become even more important in the future.

In 2007, we began using neoadjuvant chemotherapy for the treatment of Stage IV gastric cancer and then performing R0/1 surgery in patients in whom chemotherapy was effective. Here, we evaluate the use of this therapeutic strategy combining chemotherapy and surgery for the treatment of Stage IV gastric cancer. The subjects of our investigation were 46 patients with Stage IV gastric cancer treated from 2007 through 2012. We divided these patients into the NAC group (19 patients), in whom we performed R0/1 surgery after chemotherapy, and the Cx group (27 patients), who continued chemotherapy. We also included 79 patients with Stage IV gastric cancer treated from 2001 to 2006, divided into the OPE group (36 patients), in whom we performed R0/1 surgery without neoadjuvant chemotherapy, and the NC group (43 patients), in whom we performed R2 surgery. We plotted the survival curves of these 4 groups. The chemotherapy protocols used were S-1+cisplatin( CDDP) and S-1+docetaxel( DOC). The disease control rate of these chemotherapies was 72%, and R0/1 surgery was performed in 53.8% of patients with liver metastasis, 62.5% of those with paraaortic lymph node (PALN) metastasis, 29.4% of those with peritoneal metastasis, 100% of patients with T4N2 disease, and 0% of patients with distant metastasis. The 2-year survival rates of the NAC, OPE, Cx, and NC groups were 69%, 55%, 0%, and 20%, respectively. The 5-year survival rates of the NAC, OPE, Cx, and NC groups were 35%, 30%, 0%, and 5%, respectively.

We have been practicing palliative care for terminal cancer patients at outpatient sections, patient wards, by home care, and by visiting nursing stations for the last 4 years. After the establishment of our palliative care unit in June 2011, it became difficult for us to provide sufficient home care support by ourselves, because of the increasing number of the patients and their widespread locations. It is therefore necessary to cooperate with regional medical clinics in order to support the patients who need home care even after their condition deteriorates. To determine the extent to which the home care-supporting clinics perform palliative care, we used an original questionnaire. Twenty-five clinics agreed to the publication of their names as our cooperating clinics. The number of patients who received palliative care at home from home care clinics after visiting our hospital increased from 8% to 14%, and the rate of patients who died at home also increased from 10% to 13%. Information about cooperating with home care clinics is very important and the improvement of palliative care skills necessary for home care doctors to continue their support for End-Of-Life cancer patients. Furthermore, the hospital should offer a strict and timely backup when the condition of patients treated at home suddenly deteriorates.

An important step to promote fragment-based drug design (FBDD) is to find high-quality fragment molecules. Therefore the design of the fragment library is the most crucial stage. In our fragment library, the main considerations are ligand efficiency (LE), diversity, and solubility with drug-like properties. We especially considered LE to raise hit probability in screening. We estimated LE of the fragment molecule based on known LE values of the active compounds. We also developed a docking program suitable for screening fragments rather than drug compounds. Furthermore, we explored fragment-linking program, which links together fragments that bind to adjacent sites on a target protein so as to promote FBDD in silico.

Objectives: We investigated a clinical features and outcomes of prostate cancer detected in Tone Central Hospital., Materials and Methods: We investigated clinical features of 532 patients with pathologically confirmed prostate cancer detected in our hospital between 1987 and 2006. Furthermore, we compared survival rates of screen detected prostate cancer (SC group) with those of non-screen detected prostate cancer (NSC group) for 362 cases diagnosed with prostate cancer after 1999. 362 cases consist of 223 patients in SC group and 139 patients in NSC group., Results: Since 1987, the annual number of newly diagnosed patients has gradually increased and we recognized stage migration, a tendency toward an annual decrease in the incidence of stages A and D and an increase in that of stage B. The stage distributions of SC group (223 cases) and NSC group (139 cases), respectively, were 0.4% (1/223) and 9.4% (13/139) in stage A (p = 0.0011), 71.3% (159/223) and 31.7% (44/139) in stage B (p < 0.0001), 24.2% (54/223) and 23.7% (33/139) in stage C (p = 0.9182), and 4.0% (9/223) and 34.6% (46/223) in stage D (p < 0.0001). The 3, 5 and 7-year overall survival rates, respectively, were 95.6%, 92.7% and 84.1% in SC group, and 83.2%, 74.3% and 60.8% in NSC group (p < 0.0001). Furthermore, the 3, 5 and 7-year cause-specific survival rates, respectively, were 98.8%, 97.3% and 95.9% in SC group, and 90.2%, 87.7% and 79.4% in NSC group (p < 0.0001)., Conclusions: Clinical stage distribution has been changed between 1987 and 2006. Furthermore, overall and cause specific survival rates were better in screen detected prostate cancer than non-screen detected prostate cancer, because of increases in earlier stage of prostate cancer in SC group.

Objectives: To identify the relationship of risk factors for atherosclerosis with venous thromboembolism (VTE) and the utility of transthoracic echocardiography in acute pulmonary thromboembolism (APTE)., Methods: In 75 patients with VTE (VTE group), 101 patients with suspected VTE (N group), and 50 control subjects (control group), the frequency of atherosclerosis risk factors such as hyperlipidemia, obesity, hypertension, smoking, and diabetes mellitus and the number of risk factors were evaluated. Transthoracic echocardiographic findings such as tricuspid regurgitation, right ventricular dilation, pulmonary hypertension, and right ventricular dysfunction were evaluated in 15 patients with APTE (APTE group) and 38 patients in the N group (NC group)., Results: The incidence of hyperlipidemia in the VTE group was statistically higher than that in the control group (odds ratio 2.16, 95% confidence interval 1.43-3.08). Additionally, the incidence of obesity was higher in the VTE and N groups than in the control group (odds ratio was 2.76, 95% confidence interval 1.67-4.37). Risk factors other than obesity and hyperlipidemia and the number of risk factors were not significant. The incidence of tricuspid regurgitation, right ventricular dilation, and pulmonary hypertension in APTE was statistically greater than that in NC group. Right ventricular dilation and right ventricular dilation + tricuspid regurgitation are reliable findings in echocardiography. However, even combining with tricuspid regurgitation, right ventricular dilation is insufficient to identify or screen patients with APTE., Conclusions: Hyperlipidemia and obesity may be risk factors for VTE. However, obese patients can manifest similar findings to VTE. Although transthoracic echocardiograpghy is not recommended as a diagnostic or screening test in APTE, it should be used as an ancillary test.

Objectives: Recent advances in medical and surgical treatment have led to the survival of increasing numbers of adults with congenital heart disease (CHD). However, the social status of these patients remains unknown. This survey investigated the social prospects for adults with CHD, and the limiting factors for social independence., Methods: A written questionnaire on patient characteristics, education, employability, marital status and insurability was designed to define the characteristics of social independence in adults with CHD. Randomly selected adults with CHD were enrolled: 13 patients with cyanotic unrepaired CHD (4 males, 9 females, mean age: 29.8 +/- 10 years, range: 18-56 years) and 102 patients with other CHDs (48 males, 54 females, mean age: 29.5 +/- 10 years, range: 18-74 years)., Results: University of California at Los Angeles functional class I-II was found in 94% of patients, medication in 46%, and hospitalization in 51%. Compared with the data from Japanese general population, study patients had a lower ratio of high school graduates (86% vs 94%), life insurability (51% vs 71%), marital status (31% vs 32%) and employability (82% vs 80%). Patients with unrepaired cyanotic CHD had significantly lower ratio than those with other CHDs (marital status 15%, p = 0.19; employability 40%, p = 0.0003; high school graduates 69%, p = 0.06; life insurability 18%, p = 0.02, respectively)., Conclusions: Factors affecting social independence in adults with CHD were severity of disease, continuing medication, lower level of education, lower self-esteem, and unknown natural history of CHD. To improve social independence in these patients, further development of medical and surgical therapy and more detailed knowledge of the patients, caretakers and society in this field are needed.

Duchenne/Becker muscular dystrophy (DMD/BMD) are the most common inherited muscular diseases caused by mutations in the dystrophin gene. The identification of novel dystrophins in the brain has recently implicated its absence or malfunction etiologically in mental retardation (MR). We therefore examined the relationship between molecular abnormalities and clinical phenotypes. Deletions of the dystrophin gene were analyzed in a total of 137 DMD/BMD patients (DMD 94, BMD 43) to determine central nervous system (CNS) symptoms. The mental capacity was assessed and patients with IQs below 70 were defined as mentally retarded. Thirty-nine percent of DMD boys and 12% of BMD patients were classified as mentally retarded. Eight DMD and 2 BMD patients were diagnosed as having autism. Forty-four percent of DMD and 79% of BMD patients had deletions in the dystrophin gene. All the DMD/BMD patients with deletions upstream of the 5' end of the gene were mentally normal. All of DMD/BMD patients with MR and/or autism had deletions containing the 3' end, although some patients with similar deletions were mentally normal. Our data suggest that Dp140, Dp71 and/or Dp116, the C-terminal translational products of dystrophin, may be related to MR and/or autism in DMD/BMD. However, there was an exception in our series. Three of eight sibling pairs in our cases had different phenotypes, although they had the same mutations in the dystrophin gene. Thus the CNS phenotypes were not determined by the mutations of dystrophin gene alone, and the interaction of dystrophin with other nuclear genes may play important roles.

A 74-year-old man was admitted to our hospital because of a fever of 38.2 degrees C and drowsiness. Two months before admission, he was admitted to another hospital with the diagnosis of Alzheimer's disease. One week before admission, he had a fever which was judged to be due to pyelonephritis. Because imipenem cilastatin and minocycline were not effective in relieving symptoms, he was transferred to our hospital. Methicillin-resistant Staphylococcus aureus (MRSA) was cultured from the blood, and vancomycin was started on the 5th hospital day. Because of the persistent fever and signs of inflammation, Gallium-scintigraphy was performed, showing abnormal accumulation in the left fronto-parietal region of the brain and the sacral region. Enhanced brain CT revealed a crescentic low density area and a fine, intense line of enhancement in the left fronto-parietal region. An emergency drainage of abscess was performed via single left fronto-parietal burr hole. A slightly yellowish, bloody, purulent fluid was obtained. The subdural space was irrigated with saline containing antibiotics and a drain was inserted. MRSA was cultured from the obtained fluid. The fever gradually subsided and drowsiness disappeared. He had had decubitus ulcer, stage I on the surface, in the sacral region, which later turned out to have unexpectedly deep undermining lesion reaching to periosteum. MRSA was cultured from this decubitus lesion. MRSA which entered into blood stream from the decubitus site might have been implanted in the subdural hematoma. Thus, subdural abscess should be kept in mind as an active differential diagnosis in elderly patients with fever and drowsiness.

We examined whether gargling with black tea prevents influenza infection. Tests were carried out during a five month period (October 1992 to March 1993). The control group that followed their normal daily routine, whereas the test group that gargled with 0.5 w/v% black tea extract twice daily (at 8 a.m. and 5 p.m.). Influenza viruses were isolated from influenza patients and an antigen analysis was carried out. As a result, two strains of influenza A viruses (H3N2) and ten strains of B virus were detected. An HI test was done using paired sera of the control group and the test group. The HI titers raised a four fold or greater in 48.8% (61/125) in the control group and 35.1% (35/134) in the test group. There was a significant difference (p < 0.05) between the control and test groups. These results indicate that black tea extract is effective as a prophylactic agent against influenza infection.

We previously reported that tea catechin shows bactericidal activity against various bacteria including methicillin resistant Staphylococcus aureus (MRSA) and that bactericidal catechin damages the lipid bilayer of bacterial cell membranes. Here we describe that oxacillin (MPIPC) shows antibacterial activity against MRSA in the presence of catechin below MIC. Twenty clinical isolates of MRSA were examined by a cup method. In the absence of catechin, MPIPC even at a concentration of 40 micrograms/ml did not show antibacterial activity against all isolates of MRSA. However, when catechin below MIC (25-100 micrograms/ml) was mixed with the agar medium, MPIPC (5-12.5 micrograms/ml) showed antibacterial activity against all MRSA isolates. By counting the numbers of viable bacteria in a broth culture, only MPIPC (5 micrograms/ml) or catechin (100 micrograms/ml) showed similar growth curves to the control. But addition of both MPIPC and catechin reduced the number of viable bacteria to 1/100-1/10000 after 24 hours of cultures. Besides MPIPC, in the presence of catechin below MIC methicillin (12.5 micrograms/ml), aminobenzylpenicillin (32 micrograms/ml), tetracycline (2.5 micrograms/ml), and chloramphenicol (12.5 micrograms/ml) showed antibacterial activities against multiple drug resistant MRSA to antibiotics mentioned above. These findings suggest a possible use of catechin in the treatment of MRSA infection.

Two infants with congenital aortic valve stenosis underwent successful aortic root replacement with pulmonary autograft. One of the patients was 9 months and weighted 4.2 kg, and the other was 10 weeks weighing 4.6 kg. The former had undergone balloon valvotomy with a resultant severe aortic regurgitation. Operative method was basically similar to that taught by Ross. In terms of the right ventricular outflow reconstruction, however, left atrial appendage was utilized as the posterior wall while equine pericardial monocusp patch formed the anterior wall in the former patient. In the latter, morphology of the left atrial appendage was not suitable for the same kind of reconstruction, and nonvalved equine pericardial tube was used. Both of the patients eventually gained satisfactory circulatory condition. Advantages of aortic root replacement with pulmonary autograft are good competence without residual stenosis, avoidance of anticoagulation, and the high potential of future growth. So this operation is especially indicated for neonates and infants with left ventricular outflow obstruction.

The significance of six sextant ultrasound guided biopsies of the prostate (SS-biopsy) was evaluated in a total of 114 patients. The presence of prostate cancer was suspected (Pca) in 59 subjects through mass screening (MS) for Pca and in 47 patients in out-patient clinics (OPC). The recurrence (REC) was suspected in 3 patients diagnosed previously as Pca. All of them had elevated PSA, abnormal digital rectal examination (DRE) and/or abnormal transrectal ultrasonography (TRUS). All of these tests in 5 patients with benign prostate hypertrophy (BPH) were normal. Moreover, in 34 patients among them, oriented biopsies were performed to the area where Pca was suspected by DRE and or TRUS. Twelve Pca patients were detected in MS group (20.3%), 17 Pcas in OPC group (36.2%) and 3 Pcas in REC group (100%). No Pca patients were detected in BPH group. In 12 Pca patients with T1 or T2, only one Pca patient (8.3%) had over 3 Pca samples among the samples obtained by SS-biopsy. In 20 patients with T3 or T4, 13 patients (65%) had over 3 Pca samples. There was significant relationship between T category and Pca sample numbers among 6 samples obtained by SS-biopsy (p < 0.01). Ten of 12 Pca patients in MS group (83.3%) and 8 of 17 patients in OPC group (47.1%) had less 3 Pca samples. Pca was detected in 9 of 34 patients examined by the oriented biopsy. However al of these Pca were detected by SS-biopsy. It may be not necessary to examine Pca suspected patients by the oriented biopsy if they were examined by this SS-biopsy.(ABSTRACT TRUNCATED AT 250 WORDS)

Seventeen lung cancer patients over 80 years of age were treated surgically at Kanazawa University Hospital from 1973 to 1991. The operative procedures were lobectomy (six patients), segmentectomy (seven patients), partial resection (three patients) and exploratory thoracotomy (one patient). Absolutely curative resection was done in two patients, relatively curative resection in two, relatively non-curative resection in ten, absolutely non-curative resection in two. The three-year survival rate after operation for all seventeen patients was 60.2%. Postoperative complication developed in eleven patients (64.7%). Patients who had lobectomy with mediastinal lymph node dissection had a high incidence of postoperative complications. In recent years, pulmonary resections have been performed in patients over 80 years of age who have been managed with pulmonary rehabilitation, resulting in better course. It is concluded that the limited resections produce good prognosis in patients over 80 years of age with lung cancer.

Between November, 1987 and May, 1990, definitive operation was performed in 7 infants for tetralogy of Fallot with absent pulmonary valve. Preoperative respiratory failure was serious in 5 patients and semi-emergency operation was done. Surgical procedure consisted of closure of ventricular septal defect, reconstruction of right ventricular outflow tract using heterograft valved pericardial roll and plication of aneurysmally dilated pulmonary artery with or without pulmonary artery suspension in 5 infants with severe respiratory distress and heart failure, operated on 26 days to 5 months of age. In the other two less symptomatic infants, operated on at 13 months of age, reconstruction of right ventricular outflow tract was performed by transannular bovine pericardial patch with monocusp. There were no operative death and six infants are doing well 6 months to 3 years postoperatively, but one patient died of prolonged respiratory infection and respiratory failure one year after operation. Postoperative pulmonary arteriogram revealed a 42 to 61 (mean 54) percent reduction in right and left pulmonary artery size in 3 patients who underwent extensive plication of pulmonary artery. We suggest that definitive plication with or without suspension of pulmonary artery, together with closure of ventricular septal defect and reconstruction of right ventricular outflow tract is supposed to eliminate air way obstruction.

A 41-year-old male patient was admitted to Maebashi Red Cross Hospital with a complaint of a left flank mass. Left renal tumor and contralateral adrenal mass were revealed by ultrasonography, computed tomography and magnetic resonance imaging. Endocrinological examinations were unremarkable. Left nephrectomy and right adrenalectomy were performed simultaneously. Histological findings of the left renal tumor confirmed clear cell carcinoma, and those of the right adrenal tumor revealed myelolipoma with mature adipose tissue and hematopoietic elements.

Clinical characteristics of BPH were investigated in the relationship among prostate volume estimated by transrectal sonography, symptoms by questionnaire, residual urine volume, and voiding force evaluated by uroflowmetry. There was no apparent relationship among them, which might be caused by the poor reproducibility of residual urine volume, the difficult enumeration of the symptoms, contamination of other diseases of which voiding disorder is correlated with aging and other unknown factors. Under such a situation, this disease should be treated as a BPH syndrome. Moreover we propose that BPH syndrome should be classified into three types; type 1: symptomatic BPH without enlarged prostate, type 2: asymptomatic BPH with enlarged prostate and type 3: symptomatic BPH with enlarged prostate.

Cardiac performance in 54 patients with total anomalous pulmonary venous connection was investigated by cardiac catheterization before and after surgery. 51 patients underwent intracardiac repair, and 17 of them died during or immediately after operation. According to the preoperative study, the left ventricular ejection fraction (LVEF) of surviving patients was significantly higher than that of patients who died, and the pulmonary arterial mean pressure of surviving patients was significantly lower than that of patients who died. However, there was no significant difference between the left ventricular end-diastolic volume (LVEDV), right ventricular ejection fraction (RVEF), and right ventricular end-diastolic volume (RVEDV) in surviving patients and those who died. Post-operative catheterization studies showed significant increases of LVEF and LVEDV compared to pre-operative figures. RVEF and RVEDV and pulmonary arterial mean pressure decreased significantly after surgery. It was concluded that preoperative cardiac performance of surviving patients was better than that of those who died, and post-operative cardiac performance of surviving patients was basically normal.

Total repair for truncus arteriosus using an external conduit was performed in 12 patients from 1978 through 1989. Six cases were infants (mean age: 3.4 months) and 6 were children (mean age; 1 years 9 months). Two cases had Collet-Edwards type II truncus and the other 10 cases had type I truncus. One of the infants was associated with an interruption of the aorta and another had a severe regurgitation of the truncal valve (TrV). For external conduits, we used a non-valved conduit in one infant, a composite valved conduit of Dacron containing a heterograft valve in 4 children and a valved pericardial roll made of an autologous or porcine pericardium in 5 infants and 2 children. One infant with a severe regurgitation of the TrV needed valve replacement along with enlargement of the annulus of the TrV. One infant who had replacement of the TrV died early postoperatively. Another infant died 10 months after total repair due to an infection of an external conduit. Cardiac catheterization was performed in all 10 survivors. The mean value for the systolic pulmonary/systemic pressure ratio decreased from 0.98 +/- 0.09 preoperatively to 0.36 +/- 0.09 postoperatively. Replacement of an external conduit was performed due to a conduit stenosis in 2 children and 1 infant, 10 years and 2 months, 7 years and 9 months, and 1 year and 8 months after the total repair, respectively. In one of these 2 children, replacement of the aortic valve was performed due to a severe aortic regurgitation. We conclude that our results of total repair for truncus arteriosus were satisfactory. However, it remains to be solved how to manage an infant with truncus arteriosus associated with a severe regurgitation of the TrV.

The effects of sodium-4-[2-(2,3-dimethyl-4-[1-(4-isobutylphenyl) ethoxy]benzolamino)phenoxy]butyrate (ONO-3805), newly developed as a non-steroidal 5 alpha-reductase inhibitor, on rat accessory sex organs was compared with chlormadinone acetate (CMA) and non-steroidal antiandrogen, flutamide (FLU). ONO-3805 demonstrated excellent antiandrogenic activity which was similar to that of CMA in reducing the accessory sex organ weight. Moreover this agent did not show any significant effects on the serum testosterone level, but CMA and FLU changed it significantly. We previously reported the androgenic activity of antiandrogen (CMA, FLU, AA560, cyproterone acetate, medroxy progesterone, estrogen), but ONO-3805 is free of androgenic activity.

It is well known that some adrenal androgens are converted into testosterone and dihydrotestosterone which are more powerful androgens than the adrenal androgens. However, most of the experiments to investigate the antiprostatic agents have been done on rats which secrete only a marginal amount of adrenal androgen. A study was performed to investigate the effects of antiprostatic agents on the action of the adrenals in rats. Non-sterodidal antiandrogens flutamide and 1-chloro-2-hydroxy-2-methyl-N-(3,4,5-trichlorophenyl)propanamide (AA560), steroidal anti-androgens, chlormadinone acetate (CMA) and 17 alpha-acetoxy-6-chloro-2-oxapregna-4,6-diene-3,20-dione (TZP-4238) and 5 alpha-reductase inhibitor, sodium (-)-4[2-[2,3-dimethyl-4-[1-(4-isobutylphenyl)ethoxy]benzolamino ] phenoxy]butyrate (ONO-3805) and N-(2-methyl-2-propyl)-3-oxo-4-aza-5 alpha-androst-l-ene-17 beta-carboxamide (MK-906) were tested in rats treated with dehydroepiandrosterone sulfate (DHEA-S) and androstenendione (A). In the noncastrated rats not treated with DHEA-S and A, all of these agents decreased the accessory organ weights in a dose dependent manner. In the rats treated with LHRH agonist and DHEA-S and A, all agents (3.3 mg/day) showed similar effects in intact rats. However nonsteroidal antiandrogens and TZP-4238 were stronger than the others. It was not clear whether this effect was mediated through the suppression of adrenal androgen action or the inhibition of physiological increase in testosterone caused by an LHRH agonist. The effects of Flu, ONO-3805, CMA and TZP-4238 on the accessory sex organs were investigated in castrated rats receiving DHEA-S and A.(ABSTRACT TRUNCATED AT 250 WORDS)

Information about voiding disturbance was obtained from 34,140 elderly males in Gunma Aged Club Association (Q group) through a questionnaire and from 8,129 males by prostate mass screening for prostate disease (MS group) as to: (1) the characteristics of the subjects examined by the mass screening, (2) the relationship between the voiding disturbance and aging and (3) the frequency of voiding disturbance in the normal elderly males. In MS group, the percentage of young subjects, especially less than 60 years old, who complained voiding disturbance was higher than the expected percentage on the assumption that it increases with aging. The percentage of voiding disturbance in these young subjects was also higher than that of males in the same decade in Q group. In their past and present history, the percentage of benign prostatic hypertrophy (BPH) in these young subjects was higher than the expected percentage on the assumption that the incidence of BPH increases with aging. Judging from these results, it was estimated that they were not satisfied with the medical care by which they were treated or were being treated, and they received this mass screening to obtain consultation for their complains. Loss of the force was related with the prostate size estimated by digital rectal examination but not with aging. However, nocturia was well related with aging but not with the prostate size. Hesitancy, strain and dribbling were not apparently related with either the prostate size or aging. It was demonstrated that frequency of nocturia was 0 to 1 in less than 60 years old normal males, 0 to 2 in 60 to 79 years old ones and 0 to 3 in over 80 years old ones. The other symptoms studied in each decade were also analyzed and discussed.

It was reported that a new steroidal anti-androgen, TZP4238 (17 alpha-acetoxy-6-chloro-2-oxapregna-4,6-diene-3,20-dione), was 10 times stronger than chlormadinone acetate (CMA) as the in vivo anti-androgenic potential. To confirm this result, the effect of TZP4238 and CMA on ventral prostates of intact rats, or castrated ones treated by testosterone, was investigated. Our experiments demonstrated that TZP4238 was 3-5 times stronger than CMA. The effects of this compound on the androgen-receptor complex formation in the human and rat prostates were investigated and compared to the other anti-androgen and related compounds. An aliquot of cytosol or KCl extract from rat or human prostate was incubated with [3H]R1881 in the presence of various tested compounds. By means of dextran coated charcoal assay and sucrose density gradient centrifugation analysis, TZP4238 and TZP4239 showed a stronger inhibitory effect than other compounds except dihydrotestosterone. Judging from all these results, it was estimated that TZP4238 was 2-3 times stronger than CMA. The Scatchard plot analysis revealed that the inhibitory effect of TZP4238 was a competitive type. Between CMA and TZP4238, the difference of in vivo anti-androgenic potential was not identical with that of the inhibitory effect on the androgen-receptor complex formation.

We reviewed 497 patients with male urethritis diagnosed between January, 1986 and March, 1989 at the Asama General Hospital. The incidence of gonococcal urethritis (GU) was 47.7%, and that of non-gonococcal urethritis (NGU) 52.3%. There was no difference in the age distribution between GU and NGU. Prostitutes were the most common source of the infection in both GU and NGU. Incubation periods were longer in NGU than in GU, statistically. Urethral discharge was the most common symptom. Purulent urethral discharge was seen more commonly than serous urethral discharge in GU. On the contrary, serous urethral discharge was more common in NGU. Penicillin-resistant gonococcus comprised 29.4% and mixed infection of the C. trachomatis existed 25.6% in GU. C. trachomatis was detected in 71.8% in NGU. In GU, new quinolones and penicillins were administered frequently. The effective rates 1 week after the administration were 80.6% and 83.3%, respectively. In NGU, new quinolones and minocycline were administered frequently. The effective rates were 70.4% and 85.3%, respectively. Ofloxacin (OFLX) showed the highest effective rate to NGU among the four new quinolones. The relapse rate for the two-week administration group was lower than that for the one-week-administration group, but the difference was not statistically significant.

The cardiac performance was evaluated in patients who had received arterial switch operation (AS-op) for transposition of the great arteries (TGA) in their infancy with special attention to postoperative supravalvular pulmonary stenosis (SVPS). AS-op was performed in 36 infants; 13 with simple TGA and 23 with TGA accompanied with ventricular septal defect. Nine patients had undergone pulmonary arterial banding with systemico-pulmonary shunt. The mean age at surgery was 7 months. Postoperative catheterization was performed on average of 15 months after surgery. The end-diastolic volume (EDV) and ejection fraction (EF) of the left and right ventricles (LV, RV) were calculated from biplane cineangiograms. LVEDV and RVEDV were normalized and expressed as % of normals. SVPS was defined as peak systolic pressure gradient of 50 mmHg or higher between the RV and the pulmonary artery (PA). The mean LVEDV, RVEDV, LVEF and RVEF values were all within the normal range. Inverse correlation was observed between the peak systolic RV-PA pressure gradient and RVEF (n = 29, r = -0.84, p less than 0.001). SVPS after AS-op was observed in 8 patients (22%). Stenosis was observed at the site of anastomosis of the artery. In these cases, the diameter of the PA at the stenotic site decreased to 52% of the preoperative values. Branch stenosis of the PA was observed in 3 patients who had undergone surgery during the neonatal period. Generally, the results after AS-op were satisfactory in terms of cardiac performance. Postoperative SVPS was observed in 8 patients (22%) with decreased RVEF. Careful observations of the growth of PA after AS-op are mandatory.

Multivariable analysis (quantification method I and II) was used to investigate the relationship between survival rates and prognostic factors. The items studied were age, stage, pathological differentiation, gait disturbance, acid phosphatase and erythrocyte sedimentation rate (ESR). The data were available for 353 patients for all items. The significance of each item was evaluated in all patients-group, subgroup stratified by their cause of death, and subgroup stratified by their stage. The significance of age and gait disturbance which represent the general condition was proven in all patients, non-cancer death group and stage ABC group. In the cancer death group, stage D group was the most significant as prognostic factor. ESR was the most significant in the stage D group and the significance was gradually increased with the observation time.

To investigate the androgenic activity of steroidal and nonsteroidal anti-androgens, the effect of several compounds on some parameters as an androgenic activity was measured in the ventral prostate (VP) and seminal vesicle gland (SV) of castrated male rats. Ornithine decarboxylase (ODC) activity, arginase activity, androgen receptor (AR) in cytosol and nucleus, histological examination and weight of accessory sex organs were used as parameters for androgenic activity. The ventral prostate weight was increased by the administration of not only steroidal anti-androgen, medroxyprogesterone (MPA), chlormadinone acetate (CMA) and cyproterone acetate (CPA), but also estradiol-17 beta(E2) and nonsteroidal anti-androgen, AA 560. However flutamide (Flu) failed to increase VP weight. In SV, the tendency to increase weight by the administration of these compounds was also observed. However, it was not obvious as in VP. It was proven by the measurement of the parameters that all tested compounds except Flu had an androgenic activity. It seems that the androgenic activity was caused by a different mechanism because the parameter response to the administrated compounds was not identical.

The purpose of this study is to find out the most suitable expansion speed in the rapid palatal expansion method in the rat. A total of 96 male rats of Wistar strain were used. The midpalatal suture of the rat was expanded by means of distal displacement of two maxillary incisors. Circular metal wedges of different thickness were inserted between the two incisors. The animals were divided into three groups according to the expansion speeds applied; slow, intermediate and rapid groups, respectively. It took 5 days in the slow group, 3 days in the intermediate, and 1 day in the rapid to achieve 2 mm interval between the two incisors. 1. Although the body weight of the rats was temporarily lost when an interval reached 2 mm, but it turned to gain after 48 hrs in the slow group, 72 hrs in the intermediate, and 96 hrs in the rapid. 2. A cephalography revealed that the width of the midpalatal suture in the control rats was 0.13 mm on the average. On the 6th day of the experiment, the width of the suture increased into 0.26 mm in the slow group, 0.34 mm in the intermediate, and 0.55 mm in the rapid. On the 26th day, however, the width of the suture in the slow and the intermediate group recovered to normal, while the width remained at 0.46 mm in the rapid group. 3. The width of premaxilla increased in the intermediate and rapid group. 4. Histologically, in the slow group, most fibers in the sutural tissue ran along the force line, the osteoid seam was conspicuous, and a few Howship's lacunae were found on the 6th day of the experiment. On the 26th day, the fibers were recumbent, the osteoid seam decreased in width, and Howship's lacunae were not found. It was assumed that the restoration of the expanded suture was almost complete. 5. On the 6th day of the intermediate group, the osteoid seam was conspicuous and some Howship's lacunae were found. The cellular infiltration and the impletion of capillaries were also found in the sutural tissue.(ABSTRACT TRUNCATED AT 400 WORDS)

We reviewed 465 cases of ureteral calculi treated at Jömö Urological Hospital using a Dornier HM3 lithotripter during the period from October 1985 to February 1989. The 336 men and 122 women ranged from 11 to 78 years old with a mean age of 42.2. The stone size ranged from 4 mm to 30 mm with a mean length of 10.6 mm. Complete stone elimination by ESWL was achieved in 431 of the 465 cases (92.7%). The success rate was best for stones in the lower ureter, which was 98.1 per cent (53/54). For upper and mid ureteral calculi it was 92.4 per cent (363/393) and 83.3 per cent (15/18), respectively. ESWL after push up made 100 per cent (30/30) of patients completely free of stones, while ESWL after bypass 93.0 percent (106/114) and ESWL in situ 91.9 per cent (295/321). The rate of residual stone increases in proportion to the age of patients. Minor side effects such as fever and pain were observed. Our results suggest that ESWL currently is the first therapeutic option for the majority of ureteral calculi.

Between March, 1986 and May, 1988, extended direct anastomosis was performed for coarctation of the aorta (CoA) (5 infants) and interruption of the aortic arch (IAA) (3 infants). The aortic arch was hypoplastic in 3 patients. The incision was made in the inferior aspect of the aortic arch proximal to the origin of the carotid or brachiocephalic artery, which was then anastomosed to the descending aorta. Pulmonary artery banding was placed in 4 patients with associated complex cardiac anomalies. Aortic cross-clamp time was 19-54 minutes (mean 41 minutes). Pressure gradient between upper and lower extremity was 0-10 mmHg (mean 4 mmHg). There were no operative deaths and no neurologic complications. The peak flow velocity at the site of aortic reconstruction measured by Doppler echocardiographic study after surgery was 1.2-2.5 m/sec (mean 1.7 m/sec). This procedure has the advantages of leaving the subclavian artery intact and no aortic shelf tissue. And it can be applied in IAA or CoA with hypoplastic aortic arch.

The preoperative evaluation, surgical course, and early follow-up results of 5 infants less than 4 months of age who underwent aortic valvotomy for severe valvular stenosis between 1983 and 1985 were reviewed to determine the early prognosis of these neonates. Two of the 5 patients had been used respiratory support due to severe congestive heart failure and dyspnea. Emergency aortic valvotomy was performed in all during cardio-pulmonary bypass which achieve maximal relief of the stenosis without significant causing aortic insufficiency. There was a single operative death and there was one late death at 2 months after surgery who was regarded to have a extensive endocardial fibroelastosis. The other three patients have had a favorable early prognosis during mean follow-up period of 1.78 (0.4-3.8) years. They had been followed by means of two-dimensional and doppler echocardiography, which inferred that the aortic pressure gradient had been kept under 41 mmHg and which indicated that there were no LV enlargement to prove significant aortic valve insufficiency. These results indicate that early infants with severe valvular stenosis can undergo sufficient valvotomy safely and have a favorable early prognosis.

The effect of cancerous ascites on NK activity was evaluated by a 12-hr exposure method. Erythroleukemia cell line, K 562, was used as the target cells, the effector cells were isolated from 34 healthy volunteers. The final protein concentration of ascites was adjusted to 0.02, 0.2 and 2.0 mg/ml, after centrifugation and membrane filtration. When ascites was added at the start of assay, NK activity was almost completely suppressed by cancerous ascites of 2.0 mg/ml; it was not suppressed by 0.02, 0.2 mg/ml. No suppression was found when cancerous ascites was added 6 hrs after the start of assay. Our results suggest that the lowered NK activity of cancer patients may be attributable to unknown factor (s) released from cancer cells.