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Background A phase III clinical trial of pirfenidone in patients with idiopathic pulmonary fibrosis (IPF) in Japan has revealed that pirfenidone attenuated the decline in vital capacity (VC) and improved progression-free survival (PFS). We conducted an extended analysis of the pirfenidone trial to investigate its efficacy with respect to IPF severity in the trial population. Methods Patients in the phase III trial were stratified by baseline pulmonary functions including %VC predicted, %diffusion capacity for carbon monoxide predicted, and oxygen saturation by pulse oximetry on exertion and were categorized into mild, moderate, and severe groups of functional impairment. The efficacy of pirfenidone for VC and PFS over 52 weeks was compared among the three sub-populations. Results Of 264 patients, 102 (39%), 90 (34%), and 72 patients (27%) were classified as having mild, moderate, and severe grades of functional impairment, respectively. This classification was associated with arterial oxygen partial pressure at rest and degree of dyspnea at baseline. While pirfenidone attenuated VC decline at all grades of severity, covariance analysis revealed pirfenidone to have better efficacy in the sub-population with mild-grade IPF. Mixed model repeated measures analysis confirmed that pirfenidone markedly attenuated VC decline in patients with mild-grade IPF compared to its effects in patients with moderate or severe IPF. Pirfenidone also improved PFS markedly in patients with mild-grade IPF. Conclusion This extended analysis suggested that pirfenidone exerted better therapeutic effects in patients with milder IPF. Further analysis with a larger population is needed to confirm these results.

Integrated pest management strategies were adopted to combat the coffee berry borer (CBB) after its arrival in Hawaii in 2010. A decision tree framework is used to model the CBB integrated pest management recommendations, for potential use by growers and to assist in developing and evaluating management strategies and policies. The model focuses on pesticide spraying (spray/no spray) as the most significant pest management decision within each period over the entire crop season. The main result from the analysis suggests the most important parameter to maximize net benefit is to ensure a low initial infestation level. A second result looks at the impact of a subsidy for the cost of pesticides and shows a typical farmer receives a positive net benefit of $947.17. Sensitivity analysis of parameters checks the robustness of the model and further confirms the importance of a low initial infestation level vis-a-vis any level of subsidy. The use of a decision tree is shown to be an effective method for understanding integrated pest management strategies and solutions.

G eant 4 is a toolkit for simulating the passage of particles through matter. It includes a complete range of functionality including tracking, geometry, physics models and hits. The physics processes offered cover a comprehensive range, including electromagnetic, hadronic and optical processes, a large set of long-lived particles, materials and elements, over a wide energy range starting, in some cases, from 250 eV and extending in others to the TeV energy range. It has been designed and constructed to expose the physics models utilised, to handle complex geometries, and to enable its easy adaptation for optimal use in different sets of applications. The toolkit is the result of a worldwide collaboration of physicists and software engineers. It has been created exploiting software engineering and object-oriented technology and implemented in the C++ programming language. It has been used in applications in particle physics, nuclear physics, accelerator design, space engineering and medical physics.

This paper proposes a real-time testing method for multilevel signal interfaces. It utilizes multilevel drivers that can modulate both the voltage and timing of an output signal, and multilevel comparators based on a dynamic threshold concept. The authors also consider the impact on test cost of the proposed system and compares that cost with a conventional binary test system.

Though various clinical conditions of aspergillosis can occur, depending essentially on the host’s immunological status, the focus of research in North American and European countries has mainly been on invasive pulmonary aspergillosis in immunocompromised patients. There are, however, also many problems to overcome in chronic forms of aspergillosis. One of those problems is that there are no codified treatment guidelines for chronic pulmonary aspergillosis (CPA). Especially in Japan, this issue is more serious, because there are more cases with CPA due to the many aged people with past history of tuberculosis. Several clinical cases and case series have reported the usefulness of the various antifungal agents that are available. The new triazole, voriconazole, in particular, seems to be effective in the treatment of CPA. The aim of the present study is to evaluate the efficacy and safety of voriconazole in the treatment of CPA in non-immunocompromised patients. We conducted a prospective, open-label, non-comparative, multicenter study over a 2-year period. For inclusion in the study, patients with confirmed or probable CPA were recruited in 11 hospitals of the National Hospital Organization in Japan. Clinical, radiological, serological, and mycological data were collected at baseline and 12 weeks after treatment or at the end of treatment. Among 77 patients enrolled in the study, 71 patients (mean age 65.9 years, 56 males and 15 females) were eligible for the study. All of the eligible patients presented with underlying lung diseases, including sequelae of tuberculosis (n = 35), non-tuberculous mycobacterial lung disease (n = 8), chronic obstructive pulmonary disease (COPD) (n = 8), interstitial pneumonia (n = 7), cystic lung disease (n = 4), pneumothorax (n = 3), bronchial cancer (n = 1), and others (n = 5). Voriconazole was indicated in 48 cases (68 %) as the first-line treatment for CPA and 23 patients previously received other antifungal therapies. Based on a composite of clinical, radiologic, serological, and mycologic criteria, good response was seen in 43 patients (60.6 %), no response was observed in 19 patients (26.8 %), and 4 cases (5.6 %) got worse. Five patients (7.0 %) were unassessable for efficacy. The common adverse events were visual disturbances (17 patients, 23.9 %), abnormal liver function test results (12 patients, 16.9 %), adverse psychological effects (3 patients, 4.2 %), and others (10 patients, 14.0 %). Treatment with voriconazole had to be stopped in 2 cases (2.8 %) because of serious adverse events (abnormal liver function test results). There was no association between adverse effects and trough voriconazole levels in serum. In Japan, voriconazole provides effective therapy of CPA in non-immunocompromised patients with an acceptable level of toxicity.

The emissions from the power line communication (PLC) system should be investigated for the influence to the electromagnetic environment. The method of moment (MOM) has been studied to estimate the emitted electric field. However, the MOM is difficult to treat the dielectric material of the cable. This paper proposes the method of creating the wire grid model considering the dielectric material of the power line cable. The radius of the wire was determined from the per unit length inductance of the cable. The admittance is inserted between wires to present the effect of the dielectric material, and the value is determined from the admittance calculated by using the FEM based on the two-dimension model. The other admittance was inserted between each wire and ground and the value was also determined from the FEM results. The appliances were presented by T-type network based on the measurement results. The common mode input impedance and radiated magnetic field were measured and compared with the calculated one, and the evaluation indicated that the well agreement was obtained. A simple model of the indoor power line system was constructed and the radiated magnetic field was calculated. The evaluation was indicated that the calculation results almost agreed with the measured one. These results mean that the wire grid model is effective to estimate the radiated electromagnetic field from PLC system.

We have succeeded in observing a pico-second current pulse accompanying a single flux quantum (SFQ) using a high- T c superconducting (HTS) sampler. The sampler circuit used in this study, an on-chip sampler, has two pulsers connected to each other at the comparator in one chip. The waveform of an SFQ current pulse from one pulser is measured by using another SFQ pulse from the other pulser as a sampling pulse. We observed a waveform exhibiting two peaks with 5.8 and 1.6 ps widths. Based on these values, we estimated the sampling-pulse width as 2.8 ps, suggesting the potential bandwidth for the HTS sampler of 125 GHz. This value coincides well with the bandwidth expected from the critical current-normal resistance ( I c R n ) product of the Josephson junctions of 1 mV.

We are developing waveform measurement systems using a high- superconducting (HTS) sampler. As one of the methods for introducing high-frequency signals into the sampler chip, we are testing optical input systems. A uni-traveling-carrier photodiode (UTC-PD), which has potential bandwidth of over 300 GHz, is used in the systems for converting optical signals to electrical ones in front of the sampler circuit. Our preliminary experiments revealed high enough sensitivity even at temperatures as low as below 40 K for the UTC-PD that is to be cooled with the sampler chip. In the present study, we test two types of modules. One packages the UTC-PD separately from the sampler chip, and the other integrates both of them. In the former type, the optical and sampler modules are connected using V-connectors. The modules are cooled with a cryocooler to the operating temperature of the sampler circuit, which is around 40 K. Signals to be measured are input into the UTC-PD with a 1.55-mum carrier wave. We have succeeded in observing sinusoidal waveforms of up to 20 GHz using both types of modules.

Allogeneic hematopoietic stem cell transplantation (allo-SCT) recipients are prone to infections. The incidences of mycobacterial infections after allo-SCT in several case series vary from less than 0.1-5.5%. However, no study has been published on tuberculosis following unrelated cord blood transplantation (UCBT). We retrospectively reviewed medical records of 113 adult patients with a median age of 54 years who underwent reduced-intensity UCBT (RI-UCBT) at Toranomon Hospital from March 2002 to May 2004. Mycobacterium tuberculosis infections were diagnosed in three patients (2.7%), of these two patients developed primary infection and one patient developed reactivation of latent tuberculosis. The interval between RI-UCBT and the diagnosis of tuberculosis was 34, 41 and 61 days. All the patients had disseminated disease at diagnosis. Histological examination showed the lack of granuloma in caseous necrosis. Combination antituberculous treatments showed limited efficacy, and two patients died immediately after diagnosis. M. tuberculosis caused life-threatening illness, rapidly progressing in RI-UCBT recipients. The lack of granuloma in caseous necrosis suggests the impaired T-cell function in early post transplant phase of RI-UCBT. We should consider M. tuberculosis in the differential diagnoses of fever of unknown source after RI-UCBT.

OBJECTIVE To determine the risk factors, such as socio-economic background, quality of antenatal care and availability of family planning, responsible for high maternal mortality in Surabaya, Indonesia. METHODS The study used a case-control design. Descriptive, bivariate and multivariate analyses were carried out, comparing 59 maternal deaths and 177 women survivors in the referral hospital, from 1996 to 1999. RESULTS The risk factors for maternal mortality were: living outside of Surabaya [odds ratio (OR) = 11.7, 95% confidence interval (CI) = 5.0-29.2], unemployment (OR = 4.4, 95% CI = 1.7-13.8), unavailability of toilet facilities (OR = 2.9, 95% CI = 1.0-7.7)

To evaluate the diagnostic value of a halo on computed tomography (CT) in the diagnosis of invasive pulmonary aspergillosis (IPA), we retrospectively reviewed chest CT scans and autopsy reports for patients who had been admitted to our hospitals for the treatment of hematological malignancy. Pulmonary complications were suspected in all patients and chest CT scans were taken within a month of death. We examined the association between autopsy and CT findings in 48 patients who were diagnosed as IPA (n = 17), candidosis (n = 4), zygomycosis (n = 2), infiltration of hematological malignancy (n = 12), bacterial pneumonia (n = 6), cytomegalovirus pneumonia (n = 2), pulmonary hemorrhage (n = 2), or pulmonary congestion (n = 1). Patients with IPA showed a variety of CT findings, including halo (n = 13), nodules (n = 14), granular shadows (n = 3), masses (n = 6), consolidations (n = 9), wedge-shaped consolidations (n = 1), and cavitation (n = 2). In contrast, 0, 11 and two of the 31 patients without IPA showed halo, nodules and masses, respectively. These signs were more frequently observed in IPA patients than in non-IPA patients. The CT halo, especially, seemed to be specific for IPA in hospitalized neutropenic patients with hematological malignancies who developed antibiotic-resistant fever. For CT findings other than these three signs, there were no significant differences between IPA- and non-IPA patients.

We have developed a data-acquisition (DAQ) system, whereby a CAMAC system is controlled using a graphical user interface (GUI) on a Windows NT TM system. This system has enabled easy DAQ operation with a sufficient data-acquisition performance, through the use of a CAMAC auxiliary crate controller. This system is now in practical use for measurements of ( e, e ′ X ) reactions at LNS.

Introduction of a magnetic spectrometer for the analysis of nuclear reaction products can open a new dimension in structure studies as well as reaction studies through the capability of achieving high-resolution and low-background measurements. Ion-optical matching methods to achieve better energy (momentum) resolutions than those inherent to the incident beam causing the reaction are described for a magnetic spectrometer using beams from an accelerator. They are the lateral dispersion matching, focus matching and also the kinematic correction. In addition the angular dispersion matching should be performed if better resolution of the scattering angle is important. These conditions are described in the first order approximation of ion optics. The diagnostic methods to realize the conditions of lateral dispersion matching and angular dispersion matching condition are briefly presented. The method described here can be applied for a good resolution spectroscopy of a reaction using a beam from ion source or a secondary beam with a larger energy spread.

A survey was carried out into white line disease in 1781 Thoroughbred racehorses kept in stables at the Japan Racing Association (JRA) Miho Training Center (MTC) September-October 1996. The survey was conducted while horses were being shod by farriers. The horses that still exhibited damaged white lines after regular trimming were diagnosed as having white line disease. The factors recorded were age, sex, number of diseased horses, number of diseased hooves, number of lesions by region over the bearing border of the hoof and the classified length of such lesions. The percentage of total diseased horses was 11.5% (204 animals), with incidence increasing significantly with age (Por =0.01). Occurrence was independent of sex (P0.05) was more frequent in the fore- than in the hindhoof and developed more frequently at the toe than at any other region of the forehoof-bearing border. Most lesions ranged from 20 to 30 mm in length.

The performance of n–γ pulse-shape discrimination for a liquid scintillation detector has been investigated for γ-ray count rates up to 50 kcps. A method in which the ratio of the total to partial charge in the anode pulse is directly measured has shown much improved quality of the pulse-shape discrimination when pile-up events are rejected; it can discriminate neutron events of 50 cps from γ-ray events of 29 kcps. The method with simple pile-up rejection has the advantage that only general purpose electronics are required.

This study was undertaken to assess the capabilities of intrauterine ultrasonography performed while inflating the endometrial cavity with fluid and magnetic resonance imaging as a means to assess the depth of myometrial invasion by endometrial cancer preoperatively. Twenty women with endometrial disorders underwent preoperative intrauterine ultrasonography and magnetic resonance imaging. We introduced the probe and hysteroscope simultaneously into the uterine cavity and observed both the uterine cavity surface and cross-sectional uterine muscle. We classified the depth of myometrial invasion as none, superficial (less than half of the myometrium), or deep (more than half of the myometrium). The accuracy of magnetic resonance imaging and intrauterine ultrasonography in assessing the depth of myometrial invasion was 85%. In two cases, intrauterine sonography was able to demonstrate superficial myometrial invasion that could not be diagnosed by magnetic resonance imaging. In contrast, intrauterine ultrasonography was unable to diagnose myometrial invasion in two cases in which magnetic resonance imaging could diagnose it. Intrauterine sonography may be useful for estimation of myometrial invasion of endometrial cancer.

In 1978, the first case of hepatitis E was identified as non-A, non-B hepatitis. Hepatitis E virus (HEV) infection is believed to be one of the common causes of enterically transmitted acute hepatitis in developing countries and is rare in developed countries, except in patients with a history of travel. However, an increasing number of chronic HEV infection cases have recently been reported in developed countries. In these countries, immunosuppressed patients with HEV infection, such as organ transplant recipients, human immunodeficiency virus (HIV)-infected patients or patients with haematological malignancies, could develop chronic hepatitis E (CHE) infection. Approximately 60% of HEV infections in immunocompromised patients after solid organ transplantation evolve to CHE without antiviral treatment. Clinical manifestations of CHE are often nonspecific symptoms. Many patients with CHE infection are asymptomatic, but some have jaundice, fatigue, abdominal pain, fever and asthenia. Several extrahepatic manifestations have also been reported. Although chronic HEV infection can result in progressive severe liver failure and cirrhosis, diagnosis is often controversial because of the lack of specific diagnostic criteria. Many CHE cases are diagnosed by HEV RNA-positive serum or stool for >6 months. Immunosuppressive drugs, interferon-alpha and ribavirin have been used for treatment. Diagnostic reverse-transcription polymerase chain reaction is useful for estimating treatment efficacy. Preventive measures for HEV infection have been discussed, while systematic guidelines have not yet been reported.

Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease without proven effective therapy. A multicentre, double-blind, placebo-controlled, randomised phase III clinical trial was conducted in Japanese patients with well-defined IPF to determine the efficacy and safety of pirfenidone, a novel antifibrotic oral agent, over 52 weeks. Of 275 patients randomised (high-dose, 1,800 mg x day(-1); low-dose, 1,200 mg x day(-1); or placebo groups in the ratio 2:1:2), 267 patients were evaluated for the efficacy of pirfenidone. Prior to unblinding, the primary end-point was revised; the change in vital capacity (VC) was assessed at week 52. Secondary end-points included the progression-free survival (PFS) time. Significant differences were observed in VC decline (primary end-point) between the placebo group (-0.16 L) and the high-dose group (-0.09 L) (p = 0.0416); differences between the two groups (p = 0.0280) were also observed in the PFS (the secondary end-point). Although photosensitivity, a well-established side-effect of pirfenidone, was the major adverse event in this study, it was mild in severity in most of the patients. Pirfenidone was relatively well tolerated in patients with IPF. Treatment with pirfenidone may decrease the rate of decline in VC and may increase the PFS time over 52 weeks. Additional studies are needed to confirm these findings.

We have developed a way to directly connect the test head of LSI tester and a faster way to measure the logic state using an electron beam tester. By connecting directly to the test head of LSI tester, we could drive the LSI at over 40 MHz. This also allows us to change the device under test in five minutes. The faster measurement technique of logic state measurement is called Multistroboscopic sampling. It is about 70 times faster than conventional stroboscopic waveform measurement at 1024 patterns and 1 MHz clock rate.

SummaryTwo children, a sister and a younger brother, were measured with regard to stature, head and neck height, iliospinal height, and trunk length, every morning and evening for one year. They were 7·5 years old and 6·6 years old, respectively, on the first day of the investigation. In both children, stature and trunk length, but not the other dimensions, were longer in the morning and shorter in the evening. Almost all the year's statural elongation was due to lower limb elongation, but there was a sharp upward turn in April–May which resulted from an increase in trunk length. The head and neck height curves were flat throughout the year.

We present a 10-bit 1-MS/s successive approximation analog-to-digital converter core including a charge redistribution digital-to-analog converter and a comparator. A new linearity calibration technique enables use of a nearly minimum capacitor limited by kT/C noise. The ADC core without digital blocks has been fabricated in a 0.18-mum CMOS process and consumes 110muW at 1.8 V power supply. With the calibration it achieves 9.0-dB improvement of SNDR and 23.3dB improvement of SFDR. The measured SNDR and SFDR are 51.1 dB and 69.8 dB respectively.

IVC(inter-vehicle communication) is one of the most important research topics in ITS (intelligent transport systems). In the IVC scheme using DS/CDMA (direct sequence/code division multiple access), allocation of PN codes is a major problem to be solved. In this paper, a good PN code allocation scheme for the DS/CDMA IVC system that allocates each PN code to the position on the road is examined by computer simulation. Five kinds of the PN code allocation maps are compared under several conditions.

The cleaved facet of a packaged laser diode in operation was scanned by a near-field optical microscope. This " true" near-field emission profile showed several sub-peaks even though the emission was described as single-mode operation by the manufacturer. Possible correspondence existed in the observation in " conventional" near-field emission profile, when the lens focus of monitor video microscope was adjusted just inside the laser diode cavity. This intentionally " under-focused" image showed several sub-peaks that should correspond to the lateral field distribution inside the laser diode cavity. Since the optical probe was estimated to detect the optical near-field around 100nm apart from the tip (when the probe and the ambient refractive index were n= 1.5 and n= 1.0, respectively) or nearer to the tip (when the refractive index was n= 3, as in the GaAs), it may detect the optical field inside the laser diode cavity when the probe was at the vicinity of the end facet of the cavity. Another possibility was an optical coupling between the optical probe and the laser diode cavity, which might modify the original field distribution inside the laser diode cavity. In both cases the present observation suggests us that a near-field probe works as a novel tool to manipulate cavity EM field. We have further compared the emission profile with the " active region" that was identified by the near-field photo-induced current measurement.

Recently, the remarkable advance on mobile terminal technologies has enabled us to develop full-scaled navigation systems for pedestrians. In most systems developed so far, researches have been focused on visualization effect on maps to users to guide pedestrians to their destination smoothly. The authors present a context-adaptable pedestrian navigation system, which provides users with the preferable route, considering the conditions of each area and the objectives of users. A graph-based approach is employed utilizing metadata to represent logical space built over the real space, and a scoring scheme is provided by partitioning target region to its edges, which enables to expand target region. The usability of this system in many environments is examined by numerical simulations. The authors also discuss the possibilities of the system in practical settings in an open area, temporarily built-up sites.

We describe two patients who developed respiratory syncytial virus (RSV) pneumonia after BMT. One died of RSV pneumonia after three courses of steroid pulse therapy. Surprisingly, RSV antigen was identified in the bronchoalveolar lavage fluid (BALF) obtained post mortem. Steroid pulse therapy might have suppressed anti-RSV immunity, leading to persistent RSV infection for more than 1 month. The other patient received donor lymphocyte infusions (DLI) for relapsed plasma cell leukemia, while having active RSV pneumonia. His respiratory condition improved after DLI, and RSV antigen disappeared in BALF and nasal swabs. DLI might be effective in cases of life-threatening RSV pneumonia.

Borrelia burgdorferi is a pathogenic spirochete which causes Lyme disease mediated by members of the Ixodidae, as discovered in 1982 [1]. Lyme disease is a complex multisystem disorder. Many cases of this disease were found and reported for the first time in Lyme. Connecticut, United States in the latter half of the 1970s [2]. There are reports, particularly from Europe, maintaining that B. burgdorferi, which is the pathogenic spirochete of Lyme disease, is involved in causing Bell’s palsy [3–5]. Cases have also been described in Japan where ECM occurred after a tick bite and the patients were serologially diagnosed as having Lyme disease [6]. It is important therefore to examine the relation between Bell’s palsy and B. burgdorferi in Japan. In the present study, the authors focused on patients residing in or near Toky whose main complaints were associated with facial paralysis.

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Ninety-eight patients with facial paralysis were studied by an indirect enzyme-linked immunosorbent assay (ELISA) employing two types of Borrelia burgdorferi antigen, namely sonic extract and flagellum protein of B. burgdorferi. IgG or IgM antibodies were detected by sonic extract ELISA in 22 (32.4%) of 68 patients with Bell's palsy, and in 2 (10.0%) of 20 patients with varicella-zoster virus infection. This difference was statistically significant (P

Between March 1987 and November 1989 a cross-sectional serological survey was conducted on 884 residents of Paraguay to obtain data on the prevalence of antibodies to human T-cell leukemia virus type I/II (HTLV-I/II). Sera from 8/884 individuals (0.9%) were positive, confirmed by Western blotting and radioimmunoprecipitation (RIPA). This study shows that HTLV-I/II is very rare (or absent) among the general (healthy) population (0/338) and ethnic Japanese (0/227) in Paraguay. However, it can be detected at a rate of 2-3% in prostitutes (4/178) and homosexuals (4/117), suggesting sexual transmission as an important route for spread of HTLV-I/II in Paraguay.

We have realized the world's largest-size 40-in.-diagonal TFT-LCD by seamless panel-connection technology. This technology can easily make a large display degrading affecting the advantages of TFT-LCDs. In this paper, we discuss several techniques for a seamless connection.

Anew drug delivery ~ ~ ocduded arterial infusiam (]aN)AI) ~ devldalM~d a d applied to the t t e l ~ t of t m d i l P n t tunzu~ A double ~ I=t: :-~ catheter is wed at the BOA[ to occlude t . . . .~ , , ,~y the f e e d i q artery of mali_~,unt tumor and to infuse az~ieaacet ~ late the distal artery to tbe ~ I a t e r r u ~ of the ~ blood flow kve~o tba d r u p at high ~ v z t i m ia the u , , ~ r atZacted mr~Rn~ Mzmmrom~ffit of dl~qg cmcezdra f in in flame by simtdst im , t a ~ 1 3 3 re~miM tlmt a ~ level of drug ~ p ~ t aelecti~Jaly in the tuzmr t i m ~ fur a lanlp~r

The PCM tape recorder should perform the traditional function of recording for practical use in studios. Along with electronic editing, tape-cut editing will also play an important role in studio work. Advantages of tape-cut editing are as follows. 1) Editing time can be minimized if splice points are not numerous. 2) Editing can be performed with only one PCM deck without expensive electronic equipment. This paper describes signal processing, block diagram, performance, and experimental data of digital tape-cut editing.

Fifteen patients with malignant spinal metastases underwent fixation of the spine using metallic implants and bone cement. The operation provided considerable relief of pain in all 15 cases and a significant improvement in mobility in 12 cases. These results compared favourably with 77 patients with fatal metastatic cancer of the spine who were treated without spinal surgery. The technique seems to be best indicated for use in patients with breast and thyroid cancer with a relatively prolonged terminal course.

We first used the closed irrigation-suction treatment in 1970.From 1970 until June 1973, 55 patients have been treated by this technic, 46 of 55 were followed for more than five months. Of 46, 41 were successful in that wound healed and no further evidence of drainage or intection occured. We pointed out many problems of this technic and improved the method. To improve the effect of the irrigation, we made a 4 channel method utilizing the double silicon tube, and succeeded in preventing the obstruction of the tube.

Five patients with segmental obstruction of the hepatic inferior vena cava associated with Budd-Chiari syndrome were successfully treated by percutaneous transluminal angioplasty using Gruntzig balloon catheters. Three or four balloons were used simultaneously to achieve sufficient dilatation. Long-term patency was obtained in all 5 cases without serious complications. This procedure may be applicable to other portions of the venous system as well.