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This study investigated whether an artificial membrane lung of nonmicroporous polyolefin hollow fibers bonded with heparin could prolong venoarterial extracorporeal lung assist (ECLA) with low dose systemic heparin in goats. We compared heparin bonded circuits (Carmeda Bioactive Surface, "HB" group, n = 5) with non heparin bonded circuits ("NHB" group, n = 5) in venoarterial ECLA (V-A ECLA) for 7 days. Activated coagulation time (ACT) was maintained at approximately 130 sec by systemic infusion of small doses of heparin in the HB group, and at 200-230 sec in the NHB group. Thrombus formation was assessed by visual examination of the circuit, and possible cerebral embolization of thrombi was observed from behavioral abnormalities of the animals. The mean heparin dose given during ECLA was 20.4 +/- 3.6 U/kg per hr in HB, and 50.9 +/- 14.2 U/kg per hr in NHB, significantly less in HB than NHB (p < 0.01). Blood gas changes across the oxygenator, bypass flow rate, platelet aggregation activity, platelet counts, fibrin monomer (FM) test, and antithrombin-III (AT-III) activity did not differ between the two groups. In HB, thrombi were fewer and no abnormal neurologic symptoms were observed during ECLA. Numerous thrombi were observed in all oxygenators with NHB. One NHB goat developed convulsions and cerebral hemorrhage on the 6th day of ECLA. Nonmicroporous polyolefin hollow fibers can be bonded with heparin. An artificial membrane lung constructed of these fibers showed good anticoagulation by decreased thrombus formation with a small dose of infused heparin.

Case 1 was a 51-year-old Japanese woman. She presented with an asymptomatic brown macule located on the right axilla of 2 months' duration. The smooth macule was 2 cm in diameter with a sharp demarcation (Fig. 1A). Case 2 was a 62-year-old Japanese man. He presented with asymptomatic, symmetric, gray-brown macules located on the groin, axillae, and popliteal region of 6 months' duration. The smooth macules were several millimeters to centimeters in diameter and sharply demarcated (Fig. 1B). Oral or nail lesions, previous inflammatory processes in affected areas, and internal malignancies were absent. A causal relationship with drugs, recent sun exposure, or trauma could not be identified. Findings for work-up, including blood cell count, fasting blood sugar levels, liver function, serum electrolyte levels, serum electrophoresis, urinalysis, antinuclear antibodies, and serological examinations for human hepatitis viruses and syphilis, were within normal limits or negative. The lesions gradually disappeared without medication within 6 months. Biopsy specimens showed a lymphocytic infiltrate with basal vacuolar changes and prominent melanin incontinence in the upper dermis (Fig. 2A). The band-like lymphocytic infiltrate was moderate in Case 1 and mild in Case 2. Immunohistochemistry showed infiltrative CD8(+) T lymphocytes with keratinocytic damage, indicating cytotoxic injury of the keratinocytes (Fig. 2B). Both the epidermis and the upper dermis contained CD1a(+) cells (Fig. 2C). The keratinocytes focally and weakly expressed HLA-DR (Fig. 2D). These findings were identical in samples from both patients.

To save priming time and perform more rapid initiation of emergency cardiopulmonary bypass for acute cardiopulmonary failure, an extracorporeal circuit with a hollow-fiber oxygenator (EL-2000 for pediatric use; Kurary Co. Ltd., Osaka, Japan) was preprimed, and the gas-exchange function was evaluated after 1 year of storage. EL-2000 has a dense polyolefin membrane with a surface area of 0.3 m2. When the bypass flow rates were 250, 500, 1,000, and 1,500 ml/min with 100% oxygen at the same flow rate as the bypass blood flow (namely, V/Q = 1) to the oxygenator, oxygen transport rates of the stored oxygenator were 19.6 +/- 0.3, 38.3 +/- 0.41, 64.4 +/- 0.9, and 76.4 +/- 2.7 ml/min (n = 5, mean +/- SD), respectively. PCO2 differences between pre- and postoxygenator blood (delta PCO2) were 18.6 +/- 1.4, 12.0 +/- 1.6, and 4.4 +/- 1.2 mm Hg at V/Q = 1 and the same bypass blood flow rates, respectively, excluding 1,500 ml/min, the data for which were excluded because of preparatory failure. PCO2 removal indices (defined as the ratio of delta PCO2 to PCO2 in preoxygenator blood) were 0.45 +/- 0.03, 0.29 +/- 0.12, and 0.10 +/- 0.03, respectively. Though the evaluation was done using only a single oxygenator, we feel strongly that the gas-exchange function of the preprimed dense-membrane hollow fiber oxygenator will be preserved even after 1 year of storage.

宮崎県高千穂町土呂久地区における慢性砒素中毒症公害認定患者144名について, 15年以上にわたつて行われてきた検診結果に基づき, 皮膚症状を中心に分析, 検討した。1)男女比は71対73であるが, すでに55名(男32名, 女23名)が死亡している。2)色素沈着·脱失, 掌蹠の角化症, 躯幹部角化症の併発は144名中81名にみられ, これらの症状は加令とともに高度になる傾向を示した。3)表皮内癌の併発は144名中45名(31.3%)にみられた。4)皮膚浸潤癌は基底細胞癌1例のみであつた。5)死亡患者55名の死因は心疾患21名, 悪性新生物18名, 脳血管障害7名, その他9名であつた。6)悪性新生物による死亡患者18名の内訳は肺癌10名, 尿路癌2名, 乳癌, 癌性胸膜炎, 喉頭癌, 脈管肉腫, 悪性リンパ腫, 盲腸癌各1名であつた。

昭和58年から昭和62年の5年間に宮崎県下で5例の紅斑熱リケッチア症を経験した。初診時診断はつつが虫病であつたが, 血清学的検索で本症と確定診断した。症例は43才女子(発症昭和58年10月), 72才男子(昭和60年6月), 68才男子(昭和61年4月), 51才女子(昭和62年5月), 73才女子(昭和62年8月)で, 感染地域は山野3例, 河川1例, 不明1例であつた。潜伏期間は5日1例, 10日2例, 不明2例で, 全例とも高熱, 頭痛, 倦怠感, 食思不振などの全身症状を訴えた。全例に刺し口, 全身性紅斑があり, 3例には出血を認めた。肝脾腫, 全身性リンパ節腫大はなかつたが, 2例には所属リンパ節腫大がみられた。急性期の検査成績では全例赤沈亢進, CRP陽性, 好中球の核左方移動, 軽度肝障害, 正常範囲内での血小板減少を示した。リンパ球減少は2例にみられ, そのうち1例では異型リンパ球(1%)を認めた。治療としてミノサイクリン投与が著効した。本症の新型つつが虫病との鑑別点としては, 1)春から秋にかけて発生し, 2)潜伏期は比較的短いこと, 3)出血を伴う紅斑や4)急性期に白血球増多傾向がみられること, また5)全身性リンパ節腫大がないことなどが考えられた。

Squamous cell carcinoma developed on the erythematous right cheek of a 79-year-old woman where she had used corticosteroid ointments for 20 years. This condition, also known as rubeosis steroidica, might have predisposed the patient to squamous cell carcinoma, although the possibility of its being a coincidental association cannot be excluded.