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Brain calcification can be either physiological or pathological. Pathological calcification occurs due to a wide spectrum of causes, including congenital disorders, infections, endocrine/metabolic diseases, cerebrovascular diseases, and neoplasms. The patient's age, localization of the calcification, and association with other imaging findings are useful for the correct diagnosis. Dural arteriovenous fistulas with cortical venous reflux should be included in the differential diagnosis of subcortical calcification via CT. MRA should be conducted subsequently. We recently reported the clinical and imaging characteristics of calcified brain metastases in 20 patients. Hemorrhage, necrosis, or degeneration were detected within the lesions in six patients. Both T1WI and T2WI showed a hyperintense mass surrounded by a hypointense rim in one patient. Hemorrhagic brain metastases can mimic cerebral cavernous malformations. Cancer metastasis should be considered as a differential diagnosis when calcified or hemorrhagic masses are detected in middle-aged and elderly patients. We recommend conducting MRI with Gd enhancement.

We report a rare case of cavitary lung metastasis of rectal cancer, diagnosed initially as septic pulmonary embolism. A 55- year-old woman underwent emergency Hartmann's operation for perforation of the rectal cancer with multiple liver metastases. A 2 cm-sized thin-walled cavitary lesion was seen in the left upperlobe of the lung by CT, and septic pulmonary embolism was suspected. She recoverd from sepsis after intensive care treatment. Pathological diagnosis is adenocarcinoma (tub2), T3N1M1, Stage Ⅳ, she underwent chemotherapy. Serum CEA level was high preoperatively but gradually decreased to normal 4 months after the operation. Multiple liver metastases showed calcification, and the lung lesions remained unchanged on CT. She continued chemotherapy while changing the anticancer drug due to side effects. One year and 5 months after operation, lung CT showed thickened wall and spicula around the cavitary lesion. Serum CEA level was normal, SLX and NSE slightly increased and serum aspergillus antigen was positive. Bronchial lavage cytology was Class Ⅰ and scrape cytology was Class Ⅲ in bronchoscopy. Lung metastasis, primary lung cancer or aspergilloma were suspected and we performed partial lung resection. The pathological diagnosis was rectal cancer lung metastasis.

A 48-year-old female discovered a mass in her left axilla. A thorough examination resulted in a diagnosis of left invasive lobular carcinoma(ILC)of the accessory mammary gland with wide ductal spread. Considering the wide ductal spread, massive resection of the left axilla mass, left lymph node dissection, and a latissimus dorsi musculocutaneous flap procedure were performed. However, histological analysis revealed ILC measuring 80×50 mm with lymph node metastases(5/23)and extensive cancer spread, resulting in a positive surgical margin. It is important to recognize the characteristics of ILC, axillary accessory breast cancer, and the axilla in a treatment strategy.

During medical equipment and hospital information system implementation in small- and medium-sized hospitals, the system introduction often advances after system selection by the management. However, in reality, the requirements of the systems between the management and staff layers were different. Therefore, the system did not often satisfy staff demands, resulting in increased dissatisfaction of the staff for the system. It was important to consider the staff's opinion at the selection of the system manufacturer, vendor, and system to resolve their dissatisfaction for a system. In this study, we let the staff decrease these dissatisfactions in selecting a system manufacturer, vendor, and a system at the system implementation. Therefore, we consider a more useful system implementation method through the staff's motivation building by the questionnaire result analysis. The questionnaire was carried out after each event in relation to system implementation. The enforcement of event for system implementation was useful for the staff's motivation building, because we can consider the staff's opinion with staff understanding. During system implementation, it was important and/or necessary for building the staff's motivation for the success of the system implementation and to utilize it after the implementation.

Appropriate information security measures are very important for today's highly computerized hospitals to maintain the trust from patients. If once the personal information leakage of medical information was occurred, the hospital could lose their trust that has built for long time so far. It is important for hospitals to know the impact of the leakage accident previously advance to decide the investment for information security. The purpose of this study is to evaluate the impact of medical information leakage. The comforting fee for the patient's mental damage as the willingness to accept (WTA) was estimated, when the information leak occurred from a hospital using the contingent valuation method (CVM). Questionnaire survey was conducted using an internet survey service in Japan. We asked for 300 citizens about the use of personal information communication equipment and information security measures and their awareness for the information leakage. In addition, we presented a hypothetical scenario regarding information leakage of own medical information, asked the WTA as the comforting fee by the one choice of acceptance or rejection for the presented fee. In 300 responses, 190 were could be used for WTA estimation. WTA as the comforting fee when the information leakage of medical care information occurred, was estimated 570,541 yen in total. The result was similar with the value estimated by the damage compensation payment estimation model.

A 73-year-old male presented with melena and severe anemia. An esophagogastroduodenoscopy(EGD)and colonoscopy( CS)revealed no source of hemorrhage. Multiple small intestinal tumors were observed on abdominal ultrasound(US). CT also showed mesenteric lymph node metastases and multiple lung and liver metastases. Since active bleeding was suspected, we performed an emergency surgery. The small intestine including 2 tumors and 2 mesenteric lymph node metastases were resected. On histopathological examination, choriocarcinoma was diagnosed. The blood hCG level was remarkably elevated. The primary lesion could not be detected. Chemotherapy containing cisplatin(CDDP)and irinotecan(CPT-11)was initiated; although the blood hCG level was temporally lowered, the patient died of liver failure 8 months after the surgery.

Acquired hemophilia A is a rare disease in which autoantibodies to factor VIII are present. It is often manifested as a sudden onset of a critical bleeding episode, and its incidence is reported to be 1.48 cases per million persons per year. We report herein on a case of acquired hemophilia A associated with a submucosal hematoma of the oral floor, pharynx, and larynx. A 78-year-old male presented with fresh bleeding from his mouth, associated with hematoma of the oral floor, pharynx, and larynx. Laboratory test showed that the activated partial thromboplastin time was prolonged, and the platelet count and prothrombin time were normal. Coagulation tests revealed decreased factor VIII levels, and the presence of factor VIII inhibitor. A diagnosis of acquired hemophilia A was made, and immunotherapy with corticosteroids was initiated. After treatment, the bleeding tendency was controlled. On hospital day 29, the symptoms disappeared. Although acquired hemophilia A is a rare coagulopathic condition, it should be considered as one of the differential diagnoses in a case of sudden onset of severe hemorrhagic tendency of unknown origin.

The aim of this study is to analyze the maldistribution and the trends in the geographic distribution of radiological resources in secondary medical areas of Hokkaido. The distribution was measured by combining the Gini coefficient (GC), which is an indicator of inequality of distribution, and the Herfindahl-Hirschman index (HHI), which is mainly used to assess market concentration. Data concerning the distribution of radiological resources, such as CT, MRI, radiotherapy facilities (RTF), radiological technologists (RT), and medical doctors were obtained from official publications. CT was more equally distributed, and RTF was more inequality than other radiological resources in 2014. Radiological resources excluded CT were higher degree of concentration than population distribution, and it showed that they were located relatively more intensively in urban areas than in rural areas. During the period 1999-2014, the GC for CT, MRI, RTF, and RT decreased, while the HHI increased. These trends indicated increased equality of distribution of CT, MRI, RTF, and RT and the concentration in urban areas. This study suggested that GC and HHI could be powerful indicators for allocation planning of medical resources with further analysis of the maldistribution of medical resources.

Background: Reduced postoperative pain is considered one of the benefits of laparoscopic inguinal hernia repair (LHR). We investigated the need for intravenous flurbiprofen axetil (FA) before emergence from anesthesia in patients who had undergone LHR., Methods: Forty adult patients who were prepared for LHR were randomly divided into the FA group (FA 1 mg x kg(-1) administered at the end of surgery, n = 20) and the control group (no FA administration, n = 20). Postoperative pain was evaluated by the Prince Henry Pain Score (PHPS) as well as by the frequency of on-demand use of nonsteroidal antiinflammatory drugs (NSAIDs)., Results: The PHPS on arrival at the ward was significantly lower in the FA group than the control group. Additionally, none of the patients of the FA group required NSAIDs in the first two hours of postoperative period, compared with 6 patients (30%) of the control group. However, at 4 hours postoperatively, none of the patients of both groups suffered pain at rest and the PHPS was similar in the two groups., Conclusions: Although postoperative pain after LHR is mild and disappears rapidly, FA administration before emergence from anesthesia is necessary for management of pain during the immediate postoperative period.

We report a patient with concealed sick sinus syndrome who developed intraoperative bradycardia and asystole. An 81-year-old man was scheduled to undergo total gastrectomy under general and epidural anesthesia. There was no history of syncope, and preoperative 12-lead ECG showed normal sinus rhythm. Anesthesia was induced with propofol and remifentanil, maintained with sevoflurane, remifentanil and thoracic epidural infusion of lidocaine, fentanyl and levobupivacaine. Bradycardia was detected on ECG 110 minutes after the start of surgery. Intravenous atropine (0.5 mg, repeated up to a total dose of 1.5 mg) was ineffective in restoring a normal heart rhythm. Ten minutes later, the ECG changed to asystole lasting for about 15 seconds. Regular chest compression and intravenous administration of dopamine (5 microg x kg(-1) x min(-1)) resulted in successful recovery of sinus rhythm. Postoperative ECG showed sinus rhythm. The final diagnosis by a cardiologist was concealed sick sinus syndrome. Many anesthetic agents have some effects on the cardiac conduction system. Remifentanil may have played a role in the development of asystole in this patient. The existence of concealed sick sinus syndrome should be kept in mind even in patients who show no clinical abnormalities on preoperative assessment.

The (pro)renin receptor was first identified as a 350-amino acid protein with a single transmembrane domain. This receptor binds to prorenin to mediate its dual functions: activation of ERK1/2 independently from angiotensin II generation and induction of full enzymatic activity to initiate angiotensin II-dependent effects. (Pro) renin receptor has recently been shown to undergo intracellular processing, such that it exists in three different molecular forms. These include the full-length (pro)renin receptor, truncated amino-terminal soluble fragment, and carboxy-terminal fragment containing an accessory protein of the vacuolar-type H(+)-ATPase. Their exact distributions and existing molecular forms remain to be determined.

This study aimed to contribute to the management of a healthcare organization by providing management information using time-series analysis of business data accumulated in the hospital information system, which has not been utilized thus far. In this study, we examined the performance of the prediction method using the auto-regressive integrated moving-average (ARIMA) model, using the business data obtained at the Radiology Department. We made the model using the data used for analysis, which was the number of radiological examinations in the past 9 years, and we predicted the number of radiological examinations in the last 1 year. Then, we compared the actual value with the forecast value. We were able to establish that the performance prediction method was simple and cost-effective by using free software. In addition, we were able to build the simple model by pre-processing the removal of trend components using the data. The difference between predicted values and actual values was 10%; however, it was more important to understand the chronological change rather than the individual time-series values. Furthermore, our method was highly versatile and adaptable compared to the general time-series data. Therefore, different healthcare organizations can use our method for the analysis and forecasting of their business data.

A study of S-1 chemotherapy treatment of patients with head and neck cancer was conducted in 26 patients with residual or recurrent tumors after the initial treatment, i. e., chemoradiotherapy, radiotherapy and operation. The treatment courses consisted of oral administration of S-1 at a dose of 80 to 120 mg/day depending on the body surface area, for 14 consecutive days followed by a 7-day rest period. The response rate in all patients was 34.6%(9/26). In patients with recurrent tumors, the response rate was 11.1% (1/9). Patients with residual tumors after the initial treatment had a response rate of 47.0% (8/17). The median survival time was 490 days. Moreover, we studied the maintenance of QOL (quality of life) in 15 cases whose deaths were caused by their tumors. The maintenance duration of QOL was 162 to 1,742 days (median 330 days). The mean QOL maintenance rate, i. e., the average period of extended life with stable disease compared to the period from the eternity time of S -1 treatment until patient death, was 81.1% (36.4-98.7%). S-1 is a safe anticancer drug with fewer side-effects than other chemotherapies. S-1 did not cause any serious adverse events in the patients enrolled in this study. Therefore, S-1 appears to be useful for the treatment of patients with head and neck cancer, and it is particularly useful for improving the QOL of patients.

A 47-year-old man with a 15-year history of bipolar disorder treated with anti-depressants, lithium carbonate or neuroleptics was admitted because of marked difficulty in gait and speech. At the age 45, he was unable to walk without bilateral assists and became a wheel-chair state. There was no family history and his mother, father and younger sister were neurologically free. General physical examinations revealed no abnormalities. Neurologically, he was moderately demented (mini mental state examination: 18/30) and showed bilateral horizontal gaze nystagmus, parkinsonism, cerebellar ataxia, dysarthria and moderate spastic paraparesis. No involuntary movements were noted. Wet blood smear showed acanthocytes, while blood chemistries revealed no abnormalities including levels of serum creatine kinase, hepatic enzymes and blood beta-lipoprotein. Kell antigen expressions of the red blood cells were within normal limit. Western blot analysis with anti-chorein antibody detected normal chorein expression levels of the red blood cells. Cranial MRI showed severe symmetric atrophy of the frontotemporal lobes, caudate nuclei, putamen, and brainstem. Also, MRI-gradient echo showed symmetric iron accumulation in the medial portion of the globus pallidus without surrounding high intensity areas, so called "eye-of-the-tiger sign". Genetic analyses revealed no mutations in the PANK2 and PLA2G6 genes. Therefore, he was diagnosed as idiopathic neurodegeneration with brain iron accumulation (NBIA). These findings suggest that NBIA is heterogeneous and other additional genes remain to be found.

Background: [corrected] The transdermal fentanyl patch (Durote patch) is an opioid preparation requiring replacement once in three days, which is occasionally prescribed to replace morphine preparations. The conversion ratio from morphine to fentanyl has been claimed to be 100:1 or 150:1, but there may exist individual variations., Methods: We retrospectively evaluated the analgesic effects and adverse effects of fentanyl patch in 24 cases among 22 patients (11 men and 11 women)., Results: There were some reasons for switching; the major one was for home-care. In most cases rotation was completed in a few days and the side effects disappearance or were reduced, but 4 cases of them showed severe diarrhea or exhibited exacerbation of the pain, and had to go back to morphine. There were a wide variations of conversion ratio with a mean of 96.6., Conclusions: The fentanyl patch is a useful agent to control severe cancer pain because of excellent analgesic effect, less adverse effects and more convenience as well as itsundesirable characteristics when transition of patients to home-care is considered or oral administration should be avoided. Above all it offers a great possibility to improve cancer patient's quality of life.

Deep neck infection (DNI) remains an emergent and life-threatening otolaryngologic disease. We examined 69 patients, 52 men and 17 women, with DNI, who were treated in our hospital between January 1995 and December 2004. The mean age of the patients with DNI was 50.0 years and the peak incidence was in the sixth decade. Twenty patients suffered from diabetes mellitus (DM). The primary DNI lesion was found in the tonsils in 34 cases, the oral cavity in 16 cases, and the pharynx in 12 cases, respectivelys. Among the 69 patients with DNI, the infection remained in the suprahyoid region in 31 cases, but it extended to the infrahyoid region in 33 cases and to the mediastinum in 5 cases. The titer of C-reacting protein (CRP) and the duration of admission were considered as parameters of the severity of DNI. CRP was significantly higher in elderly patients, in patients with DM, and in patients whose infection extended to the infrahyoid region and to the mediastinum, however, significant difference was not found between men and women, or among the types of primary DNI lesions. Moreover, the duration of admission was significantly longer in elderly patients, in patients with DM, and in patients with infrahyoid and mediastinal DNI, whereas no significant differences were found between men and women or among the types of primary lesions. Therefore, age, DM, and the extension of DNI are considered to be important factors which determining the severity of DNI.

From January 1993 to June 1998, 319 cases were histopathologically diagnosed as prostatic cancer. In 7 of the 319 cases (2.2%) transurethral resection of the prostate (TUR-P) had been performed and a diagnosis of benign prostatic hyperplasia had been made with the resected specimens. The interval between TUR-P and the diagnosis of prostatic cancer ranged from 22 months to 15 years. All the cases showed an elevation of the prostate specific antigen (PSA) value (6.4-399 ng/ml, Tandem-R: RIA) at the time of cancer diagnosis. In 2 cases, PSA was measured in cancer screening. The clinical stage was stage B1 in 2 cases, stage B2 in 2 and D2 in 3. Only one case had been regularly followed-up after TUR-P, in which cancer was diagnosed by needle biopsy 22 months after TUR-P, because of the sustained high PSA values. Since most of such patients have an advanced stage of prostate cancer, it is of importance to have periodical follow-up examinations after TUR-P. The measurement of PSA appears the most reliable means in this way.

The present investigation was conducted to examine the effects of intra-arterial chemotherapy (IAC) for patients with invasive bladder cancer. A total of 37 patients were treated with IAC at Nara Medical University and its affiliated hospitals between January, 1993 and August, 1997. There were 27 patients in the poor risk group. The remaining 10 patients underwent anti-tumor IAC. Thirty of the 37 patients received chemotherapeutic agents via a reservoir, and the remaining 7 patients received a one-shot injection of agents followed by transcatheter arterial embolization (TAE). In the reservoir group, there were 18 patients who received IAC in combination with radiation therapy. As a result, reduction of tumor size was noted in 53%, and the 3-year cause-specific survival rate was 54% in all cases. There was a significant difference in the 3-year survival rate between the radiation-treated group and the group without radiation. The adverse events included anemia, leukopenia, thrombocytopenia and gastrointestinal symptoms, but none of them were severe. The results of the present study indicate that IAC is useful in the treatment of invasive bladder cancer for poor risk patients.

We describe prevalences of prolonged activated partial thromboplastin time(APTT) and lupus anticoagulant(LAC) in autoimmune thyroid disease(AITD). Prolonged APTTs were observed in 33(6.2%) blood samples out of 532 AITD cases(327 Graves' diseases and 205 Hashimoto's thyroiditis), but in only 8(2.0%) samples out of 396 non AITD cases(213 thyroid tumors, 14 subacute thyroiditis and 169 normal thyroids). The samples with prolonged APTT showed no abnormality in coagulation factors(factor VIII, IX, XI, XII, von Willebrand factor(vWF), prekallikrein, or high molecular weight kininogen) or factor VIII, IX inhibitor. Among samples with prolonged APTT, LAC evaluated by platelet neutralization procedure(PNP) was positive in 17(51.5%) samples of AITD, and in 2(25.0%) samples of non AITD. In prolonged APTT cases, the frequency of fetal loss in patients with AITD was higher than non AITD patients. But no significant difference was obtained between thyroid autoimmune antibody and the frequency of fatal loss. These indicate unknown biological association of between AITD and LAC.

We investigated the change of optic nerve head blood flow (ONHBF) and choroidal blood flow (CBF) in response to noradrenaline (NA) intravenously administered in anesthetized cats. NA (0.03, 0.1, 0.3 micrograms/kg/min) was injected 5 minutes continuously via the femoral vein. The relative blood flow and systemic blood pressure were continuously measured before and after NA administration with fundus camera-based laser Doppler flowmetry. Systemic blood pressure increased by 6%, 42% and 48% according to the dose. The changes in ONHBF after NA administration were -1.4 +/- 3.5% (mean +/- standard deviation) with 0.03 micrograms/kg/min, 2.4 +/- 6.9% with 0.1 micrograms/kg/min, -2.2 +/- 4.4% with 0.3 micrograms/kg/min, respectively. It did not change significantly despite doses of NA. CBF did not change significantly with 0.03 micrograms/kg/min. CBF increased significantly by 62.7 +/- 65.4% with 0.1 micrograms/kg/min, and 80.4 +/- 73.1% with 0.3 micrograms/kg/min. These results suggest that ONHBF is autoregulated despite the change of perfusion pressure by NA administration. This response is different from that of CBF.

The number of cases of prostate carcinoma (PCA) is steadily inceasing in Japan. The clinical application of a reliable tumor marker, prostate specific antigen (PSA) for the diagnosis, as well as the increasing elderly population in Japan may account for this increase. The subjects were patients at the Nara Medical University and its affiliated hospitals; 1) 687 cases without PCA were evaluated for age-specific PSA and the incidence of abnormal PSA following urological manipulations, 2) 135 cases with histological proven BPH by transurethral resection of prostate (TUR-P) were examined for PSA density (PSAD) and positive PSA rate in BPH, 3) 135 cases receiving a needle biopsy with suspicion of PCA were examined for the efficacy of PSA and PSAD and other parameters, and 4) 459 PCA cases treated between 1988 and 1994, were examined for specific PSA and PSAD values by stage and degree of cell differentiation. The PSA assay used in this study was MARKIT-M PA (normal range < or = 3.6 ng/ml). The PSA was decreased gradually with age in non-PCA patients, and abnormal PSA was found in 5.5% of these patients following manipulations. The average PSA was 2.95 +/- 2.03 ng/ml in 130 BPH patients (mean age: 71.1 +/- 7.0 years old. and average prostate volume: 32.9 +/- 16.1 ml). And abnormal PSA level (more than 3.61 ng/ml) was found in 22.3%. The mean PSAD was 0.1.0 +/- 0.06, and PSAD was below 0.15 in 86.1% of these BPH cases. Among the 135 cases receiving a needle biopsy, 33 cases had PSA values between 3.61 and 10.0 ng/ml. Of these cases, PCA was found in 18.5% of the 27 cases with a PSAD below 1.5, and in 33.3% of the 6 cases with a PSAD over 1.5. PSA and PSAD were proportionally increased with stage, and a significant difference in the PSA value was observed between stage B1 and B2, and stage C and D (P < 0.05). However, PSA and PSAD values were not significantly correlated with the cell differentiation in PCA stage A2-C. In total, PSA was 18.1 ng/ml in well, 23.9 ng/ml in moderately and 35.9 ng/ml in poorly differentiated type PCA. The positive rate of PSA was 22.3, 65.4 and 83.5%, that of prostate acid phosphatase (PAP) was 10.0, 17.8 and 45.8%, and that of GSM was 25.0, 14.7 and 68.4%, in BPH, stage A PCA and stage BPCA, respectively. In conclusion, PSA is the most reliable tool in the diagnosis of localized PCA. However, the differential diagnosis of BPH and localized PCA is difficult when the PSA value is between 3.61 and 10.0 ng/ml, and accurate staging of localized PCA is difficult with PSA or PSAD alone. At present, it is necessary to use all possible tools for the early detection of localized PCA, and to perform the needle biopsy in all PCA-suspicious cases.

A 40-year-old male was admitted to the hospital with acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia (PCP). Two months before admission the patient had a high fever, general fatigue and mild epigastic tenderness. On admission, physical examination revealed numerous small tumors on the head, gingiva, neck, nasal ala, anterior forehead, anterior thoracic, bilateral sole and bilateral lower limbs. At that time, the CD4 cell count was 130/microliters. Upper GI endoscopy was performed because of sever epigastralgia and hematemesis. The gastric mucosa was diffusely nodular and erythematous with bleeding. This biopsy showed Kaposi's sarcoma, and the same findings were obtained from the duodenum, rectum and skin, AIDS with related cutaneous and gastrointestinal KS and PCP was diagnosed. We performed a combination of chemotherapy and Interferon-alpha therapy, and the KS almost completely disappeared within 3 months.

We report a case of dermatomyositis (DM) in a 15-year-old female with toxoplasmosis after ingestion of raw bovine liver. Facial erythema and cervical lymphadenopathy preceded myalgia and muscle weakness of the extremities. The diagnostic criteria of DM was fulfilled because of symmetrical and proximal dominant muscle weakness, elevation of myogenic enzyme (CPK, GOT, LDH, myoglobin, aldorase), myogenic pattern of electromyogram, skeletal muscle biopsy showing interstitial myositis with mild destruction of muscle fiber, and facial erythema. Immunological findings showed IgG anti-toxoplasma antibody to be 1340 IU/ml and IgM to be 7.0 (Cut off index 0.7), suggesting acute toxoplasmosis. Treatment with prednisolone for DM and acetylspiramycin for toxoplasmosis was successful. Toxoplasmosis should be considered as a possibility in patients with myositis.

The relationship between personality types and the symptoms of emesis gravidarum in pregnant women was analyzed by means of the Cattel personality test (revised by Nishizono) performed in early and mid pregnancy. Personality types were classified into five from cyclothymia A to schizothymia E. As for emesis, the patients were also classified into three groups, severe (35), mild (41) and none (19), according to the severity and duration of the symptoms. As a result, there was no significant difference between the types and the symptoms, but significant differences were seen in interpersonal attitudes, especially in sociality and dominative propensity, which were constituents of the personality type. The results of the analysis suggested that the patients who revealed disunification tended to express strong emesis as a somatic language. These results therefore indicate the necessity for counseling about personality without simply explaining it as their predisposing constitution, when we encounter strongly emetic pregnant women.

Between October 1990 and June 1993, 112 patients underwent fine needle aspiration cytology and core needle biopsy of the prostate under transrectal ultrasonographic guidance. They were suspected of having prostatic cancer from the prostatic antigen level, digital rectal examination and/or transrectal ultrasonography. Twenty seven of the 112 cases (24%) were diagnosed with prostatic cancer. Their cytological diagnoses showed 22 class IV or V, 2 class III, and 3 class I or II. Efficiency, false negative rate and false positive rate were 86%, 11% and 0% in fine needle aspiration cytology. We could obtain sufficient samples for fine needle aspiration cytology in all cases. No severe complication was observed. However, we missed 3 patients, in fine needle aspiration cytology, who were strongly suspected of having prostatic cancer, and reexamination or additional core needle biopsy would have been necessary on 15 of the 112 patients (13%) who showed false negative or class III cytological results, if we had screened prostatic cancer only by fine needle aspiration cytology. In conclusion, fine needle aspiration cytology may not be as useful as core needle biopsy to screen prostatic cancer.

We examined the hemodynamic and neurohumoral effects of carperitide in dogs with low-output heart failure (LHF) produced by volume expansion, ligation of the left anterior descending coronary artery and methoxamine infusion. Carperitide (0.1 approximately 1 micrograms/kg/min, i.v. infusion for 30 min) decreased pulmonary arterial pressure, right atrial pressure and systemic vascular resistance and increased cardiac output. These pharmacological activities were equivalent to those of nitroglycerin (NG, 3 micrograms/kg/min). Although most of the animals did not excrete urine after induction of LHF, carperitide, unlike NG, increased urine volume. The plasma level of cyclic GMP was elevated about three times by induction of LHF and further increased after treatment with carperitide (1 microgram/kg/min). Carperitide had no effects on plasma renin activity, plasma aldosterone concentration and plasma noradrenaline. These results taken together indicate that carperitide reduces both preload and afterload in association with an increase in cyclic GMP production and improves the untoward hemodynamic alterations in LHF dogs.

A new immunochromatography assay (Dainascreen Ausab Dainabot) has been recently introduced for the detection of the presence of antibody to HBsAg. To evaluate the feasibility of using the Dainascreen Ausab, we carried out comparison tests with this method and PHA. In the test of 439 sera from HB vaccinees, inhabitants in Iki Island, Nagasaki Pref., patients with autoimmune diseases and with acute hepatitis B, 154 (31.2%) were positive by Dainascreen Ausab, 145 (29.4%) were positive by PHA and 145 (29.4%) were positive by both Dainascreen Ausab and PHA. Nine (1.8%) were positive by only Dainascreen and there were none positive by only PHA. A good correlation was observed between the titer of the antibody by this method and IMx. The anti-HBs assay by this method was able to be completed within 15 minutes and the procedure was very simple. The results indicate that the sensitivity of Dainascreen is superior to PHA and that it is easy to use.

A case of a HIV infected 61-year-old bisexual male with dilated cardiomyopathy (DCM) is reported. The death was originally recorded as from undetermined causes, but on autopsy, his heart showed left ventricular dilatation macroscopically, variety in size and vacuolation of cardiomyocyte, partial deciduation of cardiac muscle and diffuse perivascular fibrosis microscopically. These findings were compatible with DCM which was compounded by excessive weight loss. The further data indicated that the etiology of DCM in this case was directly related to the HIV infection.

We have used the omental pedicle flap (OPF) method to treat 10 patients with chronic empyema secondary to pulmonary tuberculosis. Since 1987 they included 9 men and one woman ranging from 48 to 70 years in age. Two patients were required re-operation because of residual bronchopleural fistulas, and the additional procedures (muscle plombage and thoracoplasty) performed in order to close residual dead space produced more severe thoracic deformity and pulmonary dysfunction. In our first successful case, complete thoracoplasty combined with the OPF method also produced pulmonary dysfunction. On the other hand, thoracic deformity was avoided in 3 other patients and 4 patients without thoracoplasty showed better pulmonary function postoperatively. A comparison of the re-operated patients with the successful cases highlighted two important points regarding the OPF method. One is the need for firm fixation of the OPF to a fistula. We usually place a muscular pedicle flap over the OPF, and add limited thoracoplasty as necessary. The other important point is the control of infection. Open window thoracostomy before the OPF method is effective in patients with active infection. The OPF method is an effective radical operation for severe empyema even when residual dead space is present, and it can also be applied to patients with poor pulmonary function.

A 60-year-old woman was admitted to our hospital for surgical treatment of the left inguinal hernia. She had suffered from diabetes insipidus for ten years, and hormonal study revealed low plasma level of vasopressin. She has been taking nasally desmopressin acetate 5 micrograms twice a day and urinary output has been well controlled around 1200-1400 ml.day-1. CT-scan showed empty sella without any pituitary tumors. There were no evidences of increased intracranial pressure and neurological deficit. Following nasal instillation of desmopressin acetate 5 micrograms one hour before anesthesia, spinal anesthesia was performed with tetracaine 10 mg. Cephalad sensory block assessed by pinprick spread to T6 within 10 minutes. Systolic blood pressure gradually decreased from 120 to 90 mmHg, although no vasoconstrictors were needed. Arterial blood pressure was stable during the surgery. The operation lasted 80 minutes with 650 ml of fluid replacement, blood loss of 50 g and urinary output of 25 ml. She had no postspinal headache nor neurological deficit after surgery. Empty sella syndrome associated with diabetes insipidus is rare. Low spinal anesthesia can be performed safely whenever there is no evidence of increased intracranial pressure, although care should be taken for perioperative fluid and circulatory management.

A 8-year-old boy was admitted to our hospital with complaint of cough and abnormal shadow on chest X-ray. Bronchoscopy and biopsy revealed a bronchial mucoepidermoid carcinoma, which obstructed right main bronchus. Right upper sleeve lobectomy was performed. The histological examination revealed a low grade malignant mucoepidermoid carcinoma. There were no metastases in the mediastinal lymph nodes. He has been healthy with no evidence of recurrence during 4 years after operation.

A 64-year-old lung cancer patient combined with angina pectoris was admitted to our hospital. Chest roentgenogram showed a coin lesion in the left upper lobe. Broncho-fiberscopic examination proved adenocarcinoma. Coronary angiography revealed 90% stenosis of the left circumflex artery. Percutaneous transluminal coronary angioplasty (PTCA) was done and resulted in success. Eight days after PTCA, left upper lobectomy for lung cancer was undergone. Postoperative course was uneventful. Compared with coronary artery bypass grafting, PTCA was very useful for the patient having malignant disease combined with angina pectoris because of little surgical stress and no delay of operation.