Search

Various efforts have been made in recent years to deal with the uneven distribution of medical doctors in Japan, but very few studies have paid attention to the influence of local education level. In this study, we investigated the relationship between regional education levels and the uneven distribution of doctors. We conducted a multiple linear regression analysis, setting the number of doctors per 100 thousand population per Health Care Region (HCR) as the outcome variable, and the number of high schools whose deviation value is 60 or more, the number of clinics per 100 thousand population, the number of beds per 100 thousand people, the population aging rate, the rate of treatment (outpatient), the density of population and the existence of medical schools as the explanatory variables. As a result, we found that a HCR with a high school with a deviation value of 60 or more had a significantly higher number of physicians per 100 thousand population (P<0.05), and that two or more such high schools intensified the tendency. Similar results were obtained when using only national and public high schools, and when using the rate, rather than the number, of high schools whose deviation value is 60 or more. It is suggested that, especially in rural areas where the lack of the medical doctors is a critical issue, raising the local education level can be an effective measure to relieve the uneven distribution of doctors.

This is an additional report of a case which Kinsui, et al. reported in 2000. A primary testicular tumor metastasized to the para-aortic lymph node in 6 years after the first high orichietectomy. In this case, we performed retroperitoneal lymph node dissection. After 4 months, the levels of 5-hydroxy indole acetic acid (5-HIAA), serotonin, urinary 5-HIAA were normalized without recurrence. This indicates testicular carcinoid needs long-term follow up.

We herein report a 16-year-old boy who presented with fever and generalized convulsion. His symptoms progressively worsened, and electroencephalography (EEG) showed status with bi-frontal focus. One month after the initial presentation, examination of the cerebrospinal fluid showed pleocytosis, an increase in the IgG index and a positive oligoclonal IgG band. Brain MRI suggested slightly high signal intensity in the cerebral gray matter on FLAIR images. We considered that the patient had autoimmune meningoencephalitis, and therefore treated him with methyl-predonisolone pulse therapy, which substantially improved both his clinical condition and EEG findings. Before the therapy, the IgM and IgG auto-antibodies against glutamate receptor (GluR) epsilon 2 and delta 2 were positive, however they became negative after the therapy. In conclusion, some cases of meningoencephalitis with auto-antibodies against GluR may show an electrical status, mild brain MRI findings, and a good response to methylprednisolone pulse therapy. These clinical features were quite different from those observed for cases of Rasmussen's encephalitis.

We herein report the findings of a 2-year-6-month-old boy, who had been experiencing monocular pendular nystagmus, strabismus, and episodic eye deviation nystagmus, intractable dystonia and apneic attack which all began when he was 2 days of age. He underwent a complete blood count test, blood chemistry test, analysis of amino acids in the blood and urine, analysis of pyruvate/lactate in blood and cerebrospinal fluid, head computed tomography and magnetic resonance imaging and no abnormal results were identified. His attacks were resistant to multiple antiepileptic and dopaminergic drugs. He showed transient left and/or right hemiplegia after nystagmus, dystonia and/or apneic attacks at 8-months of age with retardation in intelligence. We diagnosed him to have alternating hemiplegia of childhood (AHC). We were unsure how to deal with his attacks after he was discharged from the hospital, however, resuscitation with the ambu bag by his mother at home and the intravenous infusion of diazepam or thiamylal at the hospital together was proven to be an effective method for treating his severe apneic attacks. The effect of diazepam and amantadine on these attacks was transient, however, the administration of flunarizine with amantadine resulted in an improvement in his attacks. We therefore consider the administration of flunarizine to be essential for the effective treatment of AHC in this case.

In Japan, antipsychotic polypharmacy with high doses for schizophrenia has been traditionally used. However, antipsychotic polyphamacy with high doses provide disadvantages for patient. Recent PET studies show that dopamine D2 occupancy with antipsychotics is important for the treatment of schizophrenia. First, antipsychotics become effective only at which their D2 occupancy exceeds 65%. Second, antipsychotics with D2 occupancy below 90% rarely causes occupancy exceeds 65%. Second, antipsychotics with D2 occupancy below 90% rarely causes extrapyramidal side effect. These results suggest that monopharmacy which uses a single antipsychotic agent with appropriate dose is recommended for schizophrenia treatment.

A 17-year-old man with fracture of the mandible underwent open fixation under general anesthesia. He was an athlete of the rugby suffering the fracture in a match. His preoperative physical examinations were normal except for I degrees atrioventricular block on electrocardiogram (ECG). During anesthesia, atrioventricular dissociation and frequent premature ventricular contractions were induced by the stimulation of nasotracheal intubation and the administration of atropine for the reversal of muscle relaxation. We thought the cause of the arrhythmia is the athlete's heart which may be vagotonic and may induce vagal reflex or fatal arrhythmia. This case demonstrates that it is necessary to pay attention to chronotropic action associated with the intubation of nasopharynx, the handling of laryngoscope and the usage of drugs for the anesthetic management of the athlete.

Seventeen patients with clinical stage I lung cancer were given irradiation therapy with heavy ion radioactive rays at 73.1 +/- 11.2 GyE. Lung injury due to irradiation was evaluated by measuring routing parameters of pulmonary function. No statistically significant changes in these parameters were observed after irradiation, even in patients followed up for a period of 1 year. Chest X-ray examinations, including CT scan images, disclosed the development of nonsegmental consolidations in the irradiated areas, changing into minor fibrosis 1 year later. We concluded that heavy ion particle irradiation has minimal impact on pulmonary function, and is of therapeutic valve to elderly patients and patients with complications.

To evaluate the long-term effects of pulmonary rehabilitation on physiological outcome, 12 patients with pulmonary emphysema were enrolled in an inpatient pulmonary rehabilitation program for 6 weeks. After discharge from the hospital, they were followed up for 1 year. The pulmonary rehabilitation program consisted of breathing retraining, thoracic mobilization, exercise training, and patient education. Although the subjects did not participate in outpatient maintenance group sessions after their discharge, they continued breathing retraining and exercise training at home. Their vital capacity improved significantly, and was sustained over the course of the year; other pulmonary functions, however, did not change significantly. Maximum exercise load increased 31% after the rehabilitation program; although it was 18% higher than baseline at follow-up one year later, that was not a significant change. The follow-up data on exercise traming had generally deteriorated 1 year after the rehabilitation program. The change in maximum exercise load from baseline before and after the inpatient pulmonary rehabilitation program correlated closely with the change in maximum exercise load thereafter to follow-up one year later (R = 0.62). We conclude that it is pessible to estimate long-term change in exercise capacity on the basis of short-term changes achieved during inpatient pulmonary rehabilitation. It may be necessary to develop maintenance programs of some kind to help pulmonary emphysema patients retain the benefits of pulmonary rehabilitation over the longer term.

We studied factors contributing to an increase of DLco (steady state) from rest to exercise in 10 healthy men. DLco(ss), Dm, and Vc were measured under three different conditions, rest, constant load exercise (50 watts), and hyperventilation (equal to the tidal volume and respiratory rate of exercise). DLco(ss) increased significantly during exercise and hyperventilation compared with at rest. DLco(ss) also increased significantly during exercise, compared with hyperventilation. During constant load exercise (50 watts) increased Dm and Vc, caused by increased ventilation, together with increased of Vc caused by increased of pulmonary blood flow resulted in an increase in DLco(ss).

We sought to clarify the factors associated with exercise capacity in patients with pulmonary emphysema. Exercise capacities of 20 men with pulmonary emphysema were evaluated by bicycle ergometery, and the results were used to divide the subjects into two groups: high exercise capacity (n = 10) and low exercise capacity (n = 10). Pulmonary-function tests were done, emphysema scores were computed from CT scans, breathing pattern was recorded during submaximal exercise (up to 20 watts), and index of rapid shallow breathing was computed. Neither FEV1 nor airway resistance differed between the two groups, and patients with lower exercise capacity tended to have lower tidal volumes and higher values of the index of rapid shallow breathing during submaximal exercise. Functional residual capacity measured by body plethysmography and emphysema scores were inversely associated with exercise capacity. We speculate that among patients with pulmonary emphysema and a given degree of airway obstruction, a high functional residual capacity causes breathing during submaxinal exercise to be rapid and shallow, and that this rapid and shallow breathing makes ventilation inefficient, increases the work of breathing, and limits exercise capacity.

In 14 patients with chronic pulmonary emphysema, the relations between changes in psychological status associated with pulmonary rehabilitation and exercise tolerance were studied with the Cornell Medical Index and the Yatabe-Guiford Personality Inventory. Although the scores on the latter did not change, the cardio-respiratory score on the Cornell Medical Index improved significantly (p < 0.05). The only index of exercise tolerance that improved significantly was the distance walked in 10 minutes (p < 0.05). The changes in the scores of "Lack of Objectivity" and "Rhathymia" correlated negatively with the change in the distance walked in 10 minutes (R = -0.80, p < 0.01; R = -0.81, p < 0.01). The change in psychological status that accompanied pulmonary rehabilitation has been related to the improvement in the distance walked in 10 minutes.

To evaluate the effects of pulmonary rehabilitation on pulmonary function, 15 patients with chronic pulmonary emphysema underwent pulmonary rehabilitation for six weeks as inpatients. Pulmonary rehabilitation consisted of relaxation techniques, breathing retraining, thoracic massage, physical exercise, and walking. In 8 of the 15 patients vital capacity increased by more than 200 ml (over 10%), and in 7 of the 15 patients the load of maximal exercise increased by more than 5 watts (over 10%). Increases in vital capacity were not associated with increases in maximal exercise load. The percent change in vital capacity associated with pulmonary rehabilitation correlated significantly with the percent change in tidal volume and the percent change in expiratory minute ventilation at the maximal load. The percent change in tidal volume at the maximal load correlated significantly with the percent change in maximum oxygen uptake. We attribute the increase in vital capacity to an improvement in thoracic cage movement. These findings suggest that pulmonary rehabilitation can increase vital capacity in some patients with chronic pulmonary emphysema, and that such an increase is not directly connected to increases in exercise capacity.

A 69-year-old woman was admitted to our hospital because of slight fever, general fatigue, joint pain and proximal muscle weakness. Severe elevation of serum enzyme levels of CPK, transaminase and aldolase was noted. The chest roentgengram showed diffuse reticular and nodular infiltrates. Histological examination of the transbronchial lung biopsy specimens revealed alveolitis and organizing pneumonia. Daily administration of 80 mg predonisolone was effective for both lung findings and myositis.

The patients referred from our hospital at the Department of Oral Surgery, University of Tokyo, during the two years from January 1990 to December 1991 were analyzed statistically. The results were as follows: 1. Our subjects were 1,152 patients (24.2% of first-time patients), 540 males and 612 females. 2. Concerning age distribution, the majority was in their forties, fifties and sixties. 3. More patients were from internal medicine, ENT clinic, plastic surgery and cardiothoracic surgery. 4. On the number of patients categorized by disease at other departments, the largest number was cardiovascular disease. 5. On the number of patients categorized by disease at our department, the majority were dental diseases (dental caries, marginal periodontitis and missing teeth).

Forty patients who had transitional cell carcinoma of the bladder with positive pelvic lymph node metastasis, treated at Chiba University Hospital between April 1975 and March 1991 were investigated to evaluate the significance of pelvic lymph node dissection. The frequency of the patients with positive lymph node was 9.1% in all patients with transitional cell carcinoma of the urinary bladder, 4.0% in the clinical T1, 3.4% in T2, 35.7% in T3a, 32.1% in T3b, 46.2% in T4, and none in Tis and Ta. Of the 40 patients, 16 underwent cystectomy pelvic lymph node dissection, 19 had biopsy of suspicious lymph nodes which turned out to be positive for metastasis, and 5 were defined by computed tomography. Pelvic lymph node dissection was performed at the common iliac, presacral, external iliac, internal iliac, and obturator nodes. In the 16 patients who underwent cystectomy with pelvic lymph node dissection, the frequency of metastasis in each nodal group was 38% in common iliac, 31% in external iliac and obturator, and 25% in presacral and internal iliac. Out of the 16 patients, eight had regional lymphatic metastasis, three had only extra regional lymph node metastasis, and five had both regional and extra regional metastasis. Three of nine patients who had single positive node had common iliac or presacral positive node without regional lymph node metastasis.

A monoclonal antibody, MRK16, recognizing specifically an epitope of P-glycoprotein (P-GP) was used to determine the degree of expression of P-GP in kidney and urinary bladder cancers. Immunohistochemistry, immunoelectronmicroscopy, and immunoprecipitation were used for this study. Expression of P-GP was found in 6 of 20 kidney cancers treated without anticancer drugs. Also expression of P-GP was found in 17 of 47 urinary bladder cancers. 11 of 31 in primary cases, 0 of 5 in recurrent cases treated without anticancer drugs, and 6 of 11 in recurrent cases treated with anticancer drugs were positively expressed. These results indicate that a certain proportion of kidney and urinary bladder cancers intrinsically acquired multidrug resistance, and also that prior administration of anticancer drugs may induce P-GP in initially negative tumors. We also succeeded to detect MDR1 mRNA by means of in situ hybridization. From our present data, our methods to detect P-GP and MDR1 mRNA appeared to be very useful from the point of clinical application.

Between 1960 and 1988, 65 patients with grade 1 renal cell carcinoma were nephrectomized in our institutions. To delineate potentially curable cancer, the host and tumor factors influencing the prognosis were analyzed. Factors that had unfavorable effects were the presence of tumor thrombi in renal veins, fever, and elevation of erythrocyte sedimentation rate (ESR), serum alpha 2-globulin and C-reactive protein (CRP). Patients who were under 39-years-old or with pT1-2a tumor had excellent prognosis. The ratio of tumor thrombi, pT, fever, ESR, serum alpha 2-globulin and CRP levels all increased with age. In conclusion, patients with normal levels of fever, ESR, serum alpha 2-globulin, CRP and no tumor thrombi and/or with pT1-2a tumor were considered to be the potentially curable cancer patients.

In vitro synergism of sulbenicillin and dibekacin was investigated with 19 strains of E. coli, 20 strains of Enterobacter and 20 strains of Pseudomonas aeruginosa on agar plates. As the results, sulbenicillin and dibekacin were found to be synergistically bacteriostatic against all these organisms, though the synergistic effects were somewhat less potent against E. coli. The concentrations of dibekacin required for assuming a clear synergism were 0.78 approximately 1.56 mug/ml.

Between January 1987 and July 1988, 151 cases of renal cell carcinoma were nephrectomized at out institutions. Among them 41 cases (27.2%) were diagnosed incidentally. The ratio of incidental carcinoma has been increasing steadily in the past decade. Thirty-four of these cases (82.9%) were detected by ultrasound, 4 by computerized tomography, and three by excretory urography. Twenty-eight of these cases were found serendipitously during examination for other diseases, while others had no symptoms at all. Only 8 of these cases (19.5%) showed microscopic hematuria. The stage and the grade of these incidental carcinoma were significantly lower than those of symptomatic carcinoma (p less than 0.001). The survival rate of the former was better than that of the latter (p less than 0.01), especially in patients with pT1-2b tumors (p less than 0.05) or with tumors smaller than 10 cm in diameter (p less than 0.05).

An asymptomatic 84-year-old man was admitted to our hospital for a further examination of an abnormal shadow in the right lower lung (S9) on chest X-ray film. Sputum and specimens of transbronchial brushing showed cytological characteristics of well differentiated adenocarcinoma. Considering his age, his family did not agree to any surgical operation, irradiation or intensive chemotherapy. Therefore, using PSK: 3.0 g/day, immunotherapy was started on October 26, 1984. However, the abnormal density continued to increase in size and was observed radiographically to infiltrate to the neighboring segment (S6) over the following four months. From March 1985, the tumor regressed gradually and had almost disappeared on chest X-ray films by December 1985. Since then, this remission has been maintained by administration of PSK alone (3.0 g/day).

Majority of Pseudomonas aeruginosa strains were inhibited at 25 approximately 50 microng/ml of carbenicillin. There was no difference in MIC'S determined using either MUELLER-HINTON agar or Heart Infusion agar. All strains which showed one plus or more sensitivity in either of mono- or tri-disc test showed MIC of 100 microng/ml or less. In view of the high serum concentrations obtainable with 20 approximately 30 g per day dose of carbenicillin, the disc sensitivity test for this antibiotic should reasonably be interpreted as sensitive when it is one plus or more. The combination of carbenicillin with gentamicin or dibekacin showed marked synergism in vitro against Pseudomonas aeruginosa.