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Objectives: In order for activities preventing cognitive decline in the elderly and burdens of the caregiver to be effective and efficient, it is important to assess cognitive impairment and the behavioral and psychological symptoms of dementia (BPSD) in community-dwelling elderly people with cognitive impairment. The purpose of this study was to investigate differences in BPSD between assessment at home and assessment at an adult day-care facility, and to assess the relationship, between BPSD and caregiver burden in disabled elderly people with and without mild cognitive impairment (MCI) or dementia., Methods: We studied 594 participants with activity limitations out of a target population of 917 community-dwelling elderly persons utilizing adult day-care service. Dementia and MCI were determined using a clinical history of dementia, the Clinical Dementia Rating scale, and/or the Mini-Mental State Examination (MMSE); 116 were diagnosed with dementia, 103 as having MCI, and 243 as cognitively normal controls (CN). BPSD were assessed at home and at the adult day-care facility with the Neuropsychiatric Inventory (NPI) and the Dementia Behavior Disturbance Scale (DBD). Activities of daily living (ADL) were evaluated using the Barthel index, and caregiver burden was assessed using the short version of the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI_8)., Results: People diagnosed with dementia were found to be significantly more impaired on the DBD, MMSE, BI, and J-ZBI_8, than CN or those with MCI. Those with MCI also showed significantly more impairments relative to CN. The scores on the NPI and DBD assessed at home were higher than that assessed at the adult day-care facility in each group. The differences of NPI and DBD scores between home assessment and assessment at the adult day-care facility were greater for people with dementia than for people with MCI or CN. Multiple regression analysis revealed that the best explanatory variables for J-ZBI_8 are home assessments of NPI and DBD, the MMSE for people with dementia, home assessment of DBD and MCI, and home assessment of NPI and BI for CN. Both NPI and DBD were not associated with the J-ZBI_8 when assessed at the adult day-care facility regardless of level of cognitive impairment., Conclusion: The scores of the BPSD and caregiver burden worsened with increasing severity of cognitive impairment, and the BPSD was more apparent when assessed at home compared to at the adult day-care facility. These findings suggest that the assessment of BPSD at home is important in determining MCI or dementia and to estimate caregiver burden in community-dwelling elderly people with basic ADL limitations.

Radio-frequency ablation (RFA) has been successfully applied for local control of metastatic tumor. The aim of this study was to assess the effectiveness and safety of RFA to post-chemotherapeutic metastatic germ cell tumors (GCTs). As combined modality therapy, RFA was performed to 42 tumors in 19 patients of GCTs at our institution between November 2000 and December 2008. RFA was performed for 10 liver metastatic tumors (in 6 cases), 32 lung metastatic tumors (in 13 cases), and median age was 36 years old (range 20-53) and the median tumor size was 12 mm (range 2-40). We used Cool-tip RF system (straight electrode needle of the internal cooling type, Radionics, Palm Coast, USA) for RFA with ultrasound or CT fluorosent guidance under intravenous or local anesthesia. The therapeutic effect was assessed by the contrast-enhanced CT or MRI. When contrast enhancement was remained in the tumor, the treatment was repeated. The 28 evaluable lesions followed were with median 25 months in the term of the surveillance, and 9 tumors were treated by an additional session of RFA repeatedly. complete response (CR) was achieved in 12 out of 12 tumors (100%) with tumor maker normalization. On the other hand, 12 out of 16 tumors (75%) without marker normalization showed CR. All of the 24 tumors with tumor diameter of 30 mm or less achieved CR, and the tumor greater than 30 mm achieved no CR. Major complications included pneumothorax (n=9) and hemato-thoraxes (n=2), but no complications in surrounding organs. The chest drainage tube was required in 4 cases (36%). RFA might be an alternative therapeutic option of combined modality therapy as salvage therapy for post-chemotherapeutic metastatic germ cell tumors.

Liver abscess formation has been recently concerned after hepatic arterial embolization using porous gelatin particles( Gelpart)(GP), and inhomogeneous particles size or fragmentation of GP may partly contribute to this complication. The purpose of this study was to investigate the size distribution and incidence of fragments of GP before and after microcatheter passage. 1 mm- and 2 mm-GP were injected into three microcatheters with different inner-diameters by three interventional radiologists. The particles were stained with methylene blue dye, and the longer- and shorter-particle diameters were measured by a digital microscope. The particles less than 300 microm and 600 microm in longer- diameter was defined as fragment for 1 mm- and 2 mm-GP, respectively. Diameter of GP showed a wide bimodal distribution by fragments and non-fragment particles. The change of mean particle diameter ranged within 10%, and the ratio of shorter- to longer-particle diameter remained similarly at 0.75. The incidence of fragments was approximately 10% and 5% before microcatheter passage and increased by one-two times and two-five times after microcatheter passage for 1 mm- and 2 mm-GP, respectively. In conclusion, GP were ununiform in particle size distribution and contained fragments. GP did not change in shape significantly after microcatheter passage, however, 2 mm-GP was more prone to fragmentation than 1 mm-GP.

Objective: The present study aimed to investigate a simple education program that is effective for sleep improvement among medical students who will be medical doctors in the future. The education program applied in the present study was developed for sleep improvement based on behavioral science and changes in knowledge and sleeping habits were observed., Methods: Subjects were 6th-year medical students of 2002 and 2003. Students of 2002 attended a program including a 90-minute lecture and a 2-week practice learning session, and students of 2003 attended only the lecture. In the lecture, behavior therapy for chronic insomnia was explained using a booklet. In the practice learning session, students set a target behavior for improvement and conducted self-monitoring of their sleep and the targeted behavior. Changes in knowledge about sleep, attitude toward the therapy, sleep, and sleep-related habits were observed and compared between the 2 groups of subjects immediately and 2-weeks after the lecture., Results: It was found that after both programs subjects had more knowledge about sleep than before. In the program including practice learning session, subjects' attitude for managing patients changed from before the lecture to after the lecture, and after the practice learning session. It was found that more than half of the students thought that they could provide sleep guidance based on the behavior therapy. Regarding the subjects' sleep, significant improvements were observed for "having nightmares upon falling asleep," "sleepiness during daytime," "sense of getting a sound sleep," and "mood upon waking up." Regarding sleep-related habits, significant improvements were observed for "taking a nap," "dozing off," and "eating breakfast." On the other hand, only the lecture subjects improved irregularity of bedtime and sleeping time. Although an increase in knowledge and improvement of sleep were observed among students who attended only the lecture, a further increase in knowledge and improvement of sleeping habits were observed among students who also attended the practice learning session., Conclusion: The results described herein suggest developing and providing a simple and convenient education program for sleep improvement was effective for increasing students' knowledge about sleep, developing improved coping methods regarding sleep, and improving sleep. It is also suggested that behavioral scientific instructive methods, including practice learning, are effective for medical education.

Two cases of group infections with the group A rotavirus (ARV) occurred among adult residents at welfare facilities. Case 1 occurred at a care facility for the elderly between March and April of 2000, where 14 patients aged 68 to 93 (average: 85) of 93 residents developed cardinal symptoms of diarrhea, vomiting and fever. ARV was found in 7 stool samples and their G-serotype was G2. Case 2 occurred at a facility for the disabled in April 2006, where 15 patients aged 28 to 64 (average: 48) of 51 residents developed cardinal symptoms of diarrhea, vomiting and fever. ARV was found in 11 stool samples and their G-serotype was G1. The ARV route of infection was not specified in either case. Since G2 was identified among sporadic diarrheas in the general public during the 1999/2000 season when Case 1 occurred, and similarly for G1 during the 2005/2006 season for Case 2, there may be an associations between group-infection cases among adults and sporadic diarrhea in the general public. Of the three types of antigen detection kit and RT-PCR used to detect ARV for this study, RT-PCR showed the highest detection. RT-PCR was considered to be the most effective in detecting the virus for group infection cases.

Hepatic arterial embolization (HAE) has been widely performed for unresectable hepatocellular carcinoma (HCC) in a selective manner using a microcatheter. Gelatin sponge is exclusively used as an embolic agent, though it has not yet been approved for an arterial blockade. Recently, new porous gelatin particles (GP) have been approved and are clinically available. In this study, passage of GP through microcatheters was investigated, as it is an important requirement for a new agent. Both 1-mm and 2-mm GP were injected through each of six current 2.0 Fr-2.7 Fr microcatheters by five board-certified interventional radiologists. In general, use of a 2.5 mL lock syringe was associated with higher subjective resistance score (5-10/10), longer injection time (20-30 sec), and lower injection pressure (1.0-2.5 MPa) with difficulty. When it was impossible to inject GP with a 2.5-mL lock syringe,injection was retested with a 1 mL lock syringe resulting in lower resistance score (1-6), shorter injection time (6-10 sec), and higher injection pressure (1.5-2.5 MPa) regardless of particle size. Thus,it is recommended to use a 1 mL lock syringe for injection of GP through a microcatheter. After passing through a 2.0 Fr microcatheter, 2 mm particles showed no significant deformation or fragmentation under observation by stereomicroscopy.

We briefly examined detection kit using the EIA method for Norwalk virus, and compared the results of the tests using the EIA method with those using RT-PCR method. In reproducibility, an amount of variation was observed in data obtained from positive controls and in lower values. The sensitivity obtained from the EIA method was about 300 times lower than that obtained from the RT-PCR method. Results accordance ratio between EIA method and RT-PCR method was 70%. This results discrepancy was presumably caused by a difference of sensitivity and specificity between these two methods. In conclusion, this detection kit using the EIA method is easily manually operated so that this kit can be considered as an effective and simple detection tool for Norwalk virus.

The efficacy of non-pharmacological intervention for chronic insomnia has been proven by several meta-analytic reviews, an NIH report, an American Academy of Sleep Medicine review, and numerous clinical trials. Behavior therapy for chronic insomnia consists of relaxation, stimulus control, sleep restriction, cognitive restructuring and sleep hygiene education, which has produced reliable and durable changes in total sleep time, sleep onset latency, number and duration of awakening. These studies also showed that the post-treatment effect of behavior therapy is equal to that of hypnotic therapy, and that these effects were maintained for 6 months on follow-up assessment. Elderly insomniac patients would gain considerable benefit from behavioral treatments because there are no adverse physical effects as there are from pharmacological therapy. The authors present the basic theory, techniques of behavior therapy for insomnia, and the results of two important key meta-analytic reviews. Any behavioral approach such as convenient education, self-care enhancement by bibliotherapy, and individual face-to-face counseling, seem to be fruitful not only for American but also Japanese insomnia patients. Nonetheless, there are no currently actual intervention studies using behavior therapy in Japan. We have discussed the methodology of intervention study and published a behavioral self-help manual for people with sleep problems. Development of a behavioral approach to chronic insomnia seemed to be very beneficial and a useful contribution to mental health services.

We developed a guide wire with multiple markers for use during implantation of the port-catheter system for intraarterial infusion chemotherapy. With the markers on this guide wire, the distance from the common hepatic artery to the right gastroepiploic artery can be precisely measured. From this measurement, it is possible to determine the distance from the side hole to the catheter tip; unneeded catheter can be cut off with surgical scissors. In all eight cases in which this guide wire was used, we implanted the port-catheter system in the ideal position.

Pallidotomy has recently regained acceptance as an effective treatment for Parkinson's disease. From our 50 cases of unilateral pallidotomy and 10 cases of staged bilateral pallidotomy, details and indications of the procedure is described. The unilateral pallidotomy is quite effective for L-dopa induced dyskinesia, which usually completely disappears soon after the operation. The effect is long-lasting. When on-off phenomenon exists, unilateral pallidotomy improves off-stage rigidity or akinesia. Symptoms during on-stage are not changed. Indications of pallidotomy is that(1) L-dopa induced dyskinesia, and(2) on-off phenomenon. Bilateral pallidotomy, even by staged one, causes severe drooling, or speech disturbance(the volume of the voice decreases and the articulation worsens), and is not recommended. Vim thalamotomy is, on the other hand, the established treatment for tremor of Parkinson's disease or of essential tremor. The effect is long-lasting. Rigidity or akinesia is not expected to be improved so much.

The reverse transcription-polymerase chain reaction (RT-PCR) gene assay, as well as electron microscopic examination, is commonly used to detect Norwalk-like viruses (NLVs). Types and number of primer pairs used are considered to be of critical importance for efficiency of the RT-PCR detection. This study was performed to determine primer pairs useful for the detection of NLVs. NLVs genes were detected by RT-PCR in 48 cases in Yamanashi Prefecture between December 1997 and March 2000. The probe type of the gene was G2P-C in 21, G2P-B in 10, G2P-A in 6, G1P-A in 3, G1P-B in 2, and a mixture of G2P-A and G2P-B in 6. The NLVs genes of G2P-C and G2P-B were estimated to have undergone mutation in the polymerase region and poorly specific to the primer pair 35/36, a combination that has been used most commonly for the RT-PCR assay in Japan. The primer pair G2R1/F1 that amplifies the capsid (CAP) region of NLVs genes can detect all NLVs genes of the Genogroup2. The combination of this primer pair with another primer pair G1R1/F1, which like G2R1/F1, amplifies the CAP region, makes discrimination between NLVs of different groups possible. Consequently, this combination, may be the most useful for the NLVs detection by RT-PCR.

We developed a multiple side-holed sheath introducer that can also be used as a catheter for aortography before selective arteriography of the pelvic organs or lower extremities, as an alternative to straight or pig-tail catheters, which were formerly used for aortography. Aortography using the multiple side holed sheath introducer provided good detection of arteries in 100% of 10 cases, without any complications or difficulties. Thus, the present sheath introducer can replace straight or pig-tail catheters, resulting in the more economical use of one catheter prior to selective arteriography.

In order to clarify the factors which affect bone metabolism at a young age, we investigated the relationships among the change of biochemical markers of bone turnover, the height velocity (HV) and puberty onset in healthy Japanese children. One hundred and twelve children (61 boys and 51 girls) were recruited at the fourth grade level in the elementary school (9 years old) and followed for 6 years. Serum bone specific alkaline phosphatase (B-ALP), serum tartrate-resistant acid phosphatase (TR-ACP), urine hydroxyproline (Hyp) and urine calcium (Ca) were measured as the biochemical markers of bone turnover. Bone mineral density of calcaneus was also measured by ultrasound method at the first grade (12 years old) and the third grade (14 years old) of junior high school. Heights and weights of all subjects were measured every April and the HV were calculated between each year. Puberty onset was defined as the time when pubic hair appeared in boys and as the time when menarche started in girls by self-administered questionnaire. All the biochemical markers of bone metabolism except for urine Ca had a significant positive relationship with HV. The values of the markers were highest of the time when the HV was maximum. In girls, the values of the biochemical markers remained high before menarche and then decreased significantly within three years after menarche, suggesting that bone turnover changed rapidly from high turnover type to low turnover type after menarche. On the other hand, in boys, high turnover type remained for a few years after puberty onset. Bone mineral density of calcaneus by ultrasound method increased significantly in boys between the two years in junior high school, but the increase was unclear except for broadband ultrasound attenuation (BUA) in girls in the same period.

To investigate effects of asbestos on the process of cancer development, the capacity of asbestos which increases cellular uptake of external carcinogens was tested for asbestos-mediated viral RNA transfection in cultured cells. For the transfection, crocidolite, amosite, anthophyllite and chrysotile were placed onto Vero-E6 cells with poliovirus RNA inoculum, respectively. All asbestos samples mediated viral RNA transfection compared with the background including only viral RNA. The transfection was much greater with combined exposure to asbestos and kaolin than with exposure to asbestos alone.

The enhancement pattern of hepatic metastases from colorectal cancer on CT arteriography (CTA) was evaluated in 79 cases with 405 lesions. Sixty-two percent of overall lesions irrespective of size showed ring-like enhancement, and 33% of lesions less than 1 cm in diameter showed homogeneous enhancement. In pathological examination of 59 resected lesions, the enhancement pattern on CTA had a good correlation with the extent of tumor cellularity, necrosis or fibrosis in the lesions. And in 8.5% of resected lesions, the extent of enhancement on CTA was larger than that of perfusion defect on CT arterial portography, which was almost equal to the size in the resected specimen. In such lesions, the enhancement on CTA might include enhancement of normal hepatic parenchyma around the lesion.

Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy. Appropriate diagnosis and therapy contribute to obtaining good results. We performed carpal tunnel release in 61 patients including 8 cases with chronic renal failure. They included 18 males and 43 females. Age distribution was from 28 to 76 years of age among the males, and from 29 to 82 years of age among the female patients. Bilateral operations were performed in 13 cases (male 5, female 8). Operations were carried out with local anesthesia in all cases except one. The skin incision was about 5 cm on the palmar skin. Hypertrophy of the transverse carpal ligament was found in all cases, with a thickness of 4 mm on the average. Usually, the ligament was as hard as gum in consistency. There were also hypertrophy of the subcutaneous connective tissue and palmar aponeurosis or aberrant muscle in some cases. In CTS following long-term hemodialysis for chronic renal failure, the ligament was very hard and appeared to be partly calcified. All patients improved clinically after the operation. We should understand the characteristic clinical symptoms and signs of CTS. Clinical worsening was prominent at night and/or early in the morning. Definite diagnosis was performed by electrophysiological means. Operative indications are 1) cases whose daily activities are disturbed due to severe symptoms with progressive aggravation, 2) cases with muscle weakness in the distribution of the median nerve, 3) cases with thenar atrophy, 4) cases which, electrophysiologically, are suspected of demyelination of the median nerve. As there were many unpredictable anomalies and variations among the lesions, correct decompression of the median nerve under direct vision is necessary during surgery.

Beginning in 1972, a survey of respiratory symptoms and allergic skin tests in school children from an agricultural area in the Hokuriku region has been continuing. A higher prevalence of respiratory symptoms in school children with positive house dust skin test has been previously reported. In order to elucidate the relationship between results of a house dust skin test during childhood and manifestation of respiratory symptoms thereafter, an examination of respiratory symptoms was conducted in 1991, of the portion of the 5,334 subjects who participated in the earlier survey during childhood, who still live in the same town after leaving junior high school. The results are as follows: 1) During childhood (school-age), prevalence of respiratory symptoms (subacute cough, wheezing when having a cold, wheezing attack) was higher in the positive skin test group (612 subjects) compared to the negative group (856 subjects). There were no significant differences between the two groups in the prevalence of respiratory symptoms (subacute phlegm, wheezing when not having a cold). 2) In young adulthood, prevalence of respiratory symptoms (subacute cough, subacute phlegm) was higher in the negative skin test group compared to the positive group. There were no significant differences between the two groups in the prevalence of respiratory symptoms (wheezing when not having a cold, wheezing attack). The prevalence of wheezing when having a cold was higher in the positive group compared to the negative group. 3) The paradoxical results in young adulthood was due to a marked decline in the prevalence ratio of the high positive rate skin test group (184 subjects) to the negative skin test group. This suggested a decline in contribution of serum IgE to manifestation of respiratory symptoms in young adulthood compared to childhood, with the result that the positive skin test group had a higher prevalence of respiratory symptoms during childhood, but lower in young adulthood.

A data system which enables utilization of individual patient data by public health nurses, physicians and home helpers, is required both for the continuous and comprehensive monitoring of the various needs of the aged receiving care services at home in the local district and for facilitating welfare services. Therefore, an experimental and comprehensive system for public health, medical services and welfare was put into practice for district public health services for the aging society. The results of this trial system shows that this system is useful indeed for the welfare services, though it also has several problems.

We report MRI (magnetic resonance imaging) findings of 31 cases with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysm. Among these cases, 25 were studied within 72 hours after onset of SAH. A resistive type MRI scanner operating at a field of 0.2 Tesla was used in obtaining inversion recovery (IR) and saturation recovery (SR) images. IR 1500/43/400 (T1 weighted image, T1W), SR 1000/60 (SR image) and SR 2000/100 (T2 weighted image, T2W) were chosen for analysis. The SR image was usually adopted and coronal and/or sagittal images were added when there was enough time for examination. Slice thickness was 10 mm and slice interval was 15 mm. The scan was not necessarily aimed at the visualization of aneurysm itself. 1) In the acute phase of SAH, subarachnoid spaces near the ruptured aneurysm were appeared as isointensity areas on T1W and as high intensity areas on SR image. In the subacute phase, they were depicted as high intensity areas on both T1W and SR images, and as high intensity areas on T2W. 2) Intraventricular hemorrhage was visualized as a niveau-like high intensity area, especially, within the posterior horns on the SR images. 3) SR and T2W images were suitable for detection of aneurysm itself. In a resistive-type scanner, small aneurysms were not easily visualized due to the lack of high resolution. However, 29% of aneuysms, which were not giant, could be visualized on MRI. 4) Identification of intracerebral hemorrhage and cerebral ischemia from various causes was easy on both T1W and T2W images.(ABSTRACT TRUNCATED AT 250 WORDS)

To establish a more reasonable therapeutic guide line for large and/or invasive pituitary adenomas, 257 cases of pituitary adenoma were analyzed. Among 83 cases with slight or moderate suprasellar extension (Wilson's Grade II-A & B) in the pre-CT era, 57 patients were alive at the time of follow-up (mean follow-up period: 12.7 years). Death of unspecified causes other than cancer, myocardial infarction, etc. were reported in nine patients. Among 60 cases of Grade II-A & B in the post-CT era, 59 patients were alive (mean follow-up: 3.4 years). Comparing these groups, cases with huge suprasellar extension (Grade C) had much worse prognosis. Only two patients were alive among 14 cases of Group C in the pre-CT era. Seven cases of death with unspecified causes were reported. In the 13 cases of Group C in the post-CT era, 12 patients were alive but at least four of them were severely handicapped. In 10 cases with sphenoid invasion (Grade IV) in the pre-CT era, only two were alive. In the group of Grade IV in the post-CT era, one patient died and three patients were operated repeatedly. Severe complications of irradiation therapy occurred in seven patients (mean interval: 6.6 years) among 120 cases of irradiated pituitary adenomas in every category. Among six cases with histological malignancy, three were operated repeatedly; among the latter group, two patients died and the third showed intracranial metastases. The present data indicate that large and/or invasive pituitary adenomas have a pessimistic prognosis, although adenomas with mild or moderate simple suprasellar extension have fairly good prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

It is well known that the risks in patients subjected to repeated transsphenoidal surgery are higher than in patients without prior therapy. The authors report their experience of repeated transsphenoidal surgery in 18 pituitary adenoma cases, 7 as the second step of two staged operation, 7 for recurrent adenomas and 4 for the postoperative CSF rhinorrhea. Technical points in re-opening and closure of the transsphenoidal route are presented. A huge adenoma with suprasellar extension may be successfully removed by two staged operation. Some adenomas become less hemorrhagic at the second operation. Recurrent adenomas are also safely operated when the goal of the surgery is limited to the decompression of the optic nerve with sparing the pituitary function. CSF rhinorrhea is easily controlled by packing the sella turcica and the sphenoid sinus with one piece of fat for each compartment.

In order to establish the physiological values of serum lipids in healthy workers, 1,728 workers aged 35 years and over (1,035 males and 693 females) were examined after the over-night fast. Serum total cholesterol and serum triglycerides were measured by enzyme method. High density lipoprotein-cholesterols were measured by precipitation method (heparin-Mn2+) and beta-lipoprotein also by precipitation method (heparin-Ca2+). Ratios of total cholesterols to HDL-cholesterols and beta-lipoproteins to HDL-cholesterols were calculated. The results obtained are as follows: (1) Frequency distributions of 4 sorts of lipid values and 2 indices fitted approximately to the log-normal distribution. (2) High positive correlation coefficients were found between three lipid measurements, i.e. total cholesterol, triglyceride and beta-lipoprotein, in both men and women. High positive correlation coefficient was found between two ratios, total cholesterol/HDL-cholesterol and beta-lipoprotein/HDL-cholesterol. (3) Geometric means and, 5-95th percentile values in bracket were 184.5 (135-253) mg/dl for total cholesterol in men, 185.4 (139-247) mg/dl for total cholesterol in women, 84.9 (38-188) mg/dl for triglyceride in men, 71.3 (40-126) mg/dl for triglyceride in women, 47.9 (28-81) mg/dl for HDL-cholesterol in men, 51.5 (33-80) mg/dl for HDL-cholesterol in women, 348.3 (211-577) mg/dl for beta-lipoprotein in men, 306.9 (193-489) mg/dl for beta-lipoprotein in women, 3.9 (2.3-6.6) for total cholesterol/HDL-cholesterol in men, 3.6 (2.3-5.7) for total cholesterol/HDL-cholesterol in women, 7.3 (3.6-14.6) for beta-lipoprotein/HDL cholesterol in men, and 6.0 (3.1-11.7) for beta-lipoprotein/HDL-cholesterol in women. (4) Group average values of total cholesterol, triglyceride, beta-lipoprotein, total cholesterol/HDL-cholesterol and beta-lipoprotein/HDL-cholesterol tended to increase with age in women. These differences by age were statistically significant. (5) Mean values of HDL-cholesterol were higher in women than in men in all age groups.

Two cases of primary empty sella with intractable headache were treated via the transsphenoidal approach. One patient was a fifty-three-year-old female with right upper nasal quadrantanopsia and intractable retrobulbar pain and the other was fourty-six-year-old female with continuous retrobulbar pain with a history of transient right temporal hemianopsia. Both cases were diagnosed by metrizamide CT cisternography. They had normal endocrinological functions. They did not respond to drug therapy and were treated surgically. In each case, the dura mater of the floor of the sella was elevated with lyophilized human dura mater and bone fragments obtained during the procedure. In the former case, significant improvement of visual field defect was not obtained but the retrobulbar pain disappeared completely after the operation. In the latter case which had intractable headache for six months, the symptom disappeared just after the operation. Until now, retroorbital pain has not recurred in both cases for several months. Primary empty sella has been considered to be a benign condition except in some cases with CSF rhinorrhea or with visual disturbance. Headache which is often accompanied to primary empty sella has rarely been treated surgically because it is difficult to know whether the headache is related to the empty sella or not. Another reason may be that there is few available data concerning to the efficacy of surgical treatment. Headache caused by stretching of the dura of the floor of the sella is usually frontal or retrobulbar, continuous, profound and intractable.(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of this study is establish the physiological values of serum colloid reaction and serum enzyme activities representing the liver function. 1,732 industrial workers (1,035 males aged 35-65 yr, and 697 females aged 35-60 yr) were examined by the serum zinc sulfate turbidity test (ZTT) and serum thymol turbidity test (TTT) according to the standard method of "The Japanese society of gastroenterology," serum alkaline phosphatase (ALP) by Kind-King method, serum gamma-glutamyl transpeptidase (gamma-GTP) by the modified Orlowski method, and serum glutamic oxaloacetic transaminase (GOT) and serum glutamic pyruvic transaminase (GPT) by UV method. Then frequency distributions, geometric means, several percentile values of these six laboratory data and correlations among the values were determined. The results are as follows: 1) Frequency distributions of serum ZTT, TTT, ALP, gamma-GTP, GOT, and GPT almost fitted to the log-normal distribution. 2) Geometric means and 0-95th percentile or 5-95th percentile values in bracket were 6.6 (3.7-11.7) Kunkel unit for ZTT in male, 8.2 (5.1-13.0) Kunkel unit for ZTT in female, 0.6 (0-2.8) Kunkel unit for TTT in male, 0.8 (0-2.8) Kunkel unit for TTT in female, 6.6 (4.1-10.4) King-Armstrong unit for ALP in male, 5.5 (3.2-8.9 for 49 year or less, 4.6-10.3 for 50 yr or more) King-Armstrong unit for ALP in female, 15.8 (0-45) mU/ml for gamma-GTP in male, 8.4 (0-17 for 44 yr or less, and 0-20 for 45 yr or more) mU/ml for gamma-GTP in female, 21.4 (0-39) Karmen unit for GOT in male, 20.8 (0-35) Karmen unit for GOT in female, 13.9 (0-29) Karmen unit for GPT in male, and 12.7 (0-32) Karmen unit for GPT in female. 3) Serum ZTT and TTT levels were higher in female than in male. Both ALP and gamma-GTP levels were higher in male than in female, and have become high according to aging in female. Serum level of GPT was higher in male than in female. 4) There were significant positive correlations between serum ZTT and serum TTT levels, and also between serum GOT and serum GPT levels.

A case of cryptococcosis simulating brain tumor was reviewed. A 66-year-old female was admitted to our hospital with chief complaint of vertigo, gait disturbance and dysarthria. These symptoms started about one year before admission and worsened. Vomiting and urinary incontinence appeared. Neurological examination revealed left cerebellar ataxia and dysarthria. In plain CT (computerized tomography) irregular ill-defined low density area was noted in the cerebellar vermis and bilateral cerebellar hemispheres. And slight ventricular dilatation was found. Irregular shape of ring-like enhancement corresponding to capsule and patchy or mottled enhancement inside the tumor were seen. Suboccipital craniectomy was performed and yellowish necrotic tumor with hard capsule was removed. Histological diagnosis was not neoplasm or tuberculoma. Postoperatively liver function progressively worsened. She died due to disseminated intravascular coagulation. Autopsy revealed typical liver cirrhosis without malignant change. 3.0 X 2.5 cm sized, slightly hard, yellowish lesion was found on upper part of cerebellar hemispheres. This had extremely necrotic tissue and a great number of cryptococcus neoformans were found. And other intracranial lesion was not confirmed. Finding of pulmonary cryptococcosis was not gained. Our case is very rare because of solitary cerebellar abscess and absence of meningitic episode or pulmonary cryptococcosis. There are three types of inflammation in cerebral cryptococcosis. The commonest manifestation is the meningitic type, the second mode is granulomatous lesion and the third and the least presentation is intracranial abscess formation. CT reveals various findings according to clinical stage. CT findings are those of meningitis, meningoencephalitis, granuloma and abscess. Cryptococcal granuloma or abscess often simulates brain abscess, glioma and metastatic brain tumor.(ABSTRACT TRUNCATED AT 250 WORDS)