Search

The circuit parameters involving stray load loss and harmonic torques of high-speed induction motors fed by inverters are determined by both finite-element method and experiments, respectively. In the finite-element method, the parameters are directly determined from the electromagnetic field distribution of the motors under load conditions. On the other hand, in the experiment, the parameters are determined from no-load, locked rotor, and load tests. The characteristics calculated by the proposed circuits are compared with those of the measurement in order to confirm the validity and usefulness of the proposed circuit. It is clarified that the accuracy of the calculated characteristics is significantly improved by the proposed circuit as compared to the conventional circuit, particularly under high-speed conditions.

This paper presents a system architecture for synthetic/natural hybrid coding toward future visual services. Scene-description capability, terminal architecture, and network architecture are discussed by taking account of the standardization activities: MPEG, VRML, ITU-T, and IETF. A consistent strategy to integrate scene-description capability and streaming technologies is demonstrated. Experimental results are also shown, in which synthetic/natural integration is successfully carried out.

Chalcogenide glasses containing Cu and Ag were investigated using a scanning tunneling microscope (STM). Cu–As–Se and Ag–As–Se glasses exhibited different phenomena. When voltages applied to STM tips were low (|V|≤1 V), tunneling spectra in Ag–As–Se changed with scan speed of the tip voltages, while such a feature was not observed in Cu–As–Se. At high voltages (|V|≥3 V), geometrical surface modifications appeared in both glasses, but the shapes were different. In Ag–As–Se hills or holes were created, and in Cu–As–Se deformations were induced under negative tip voltages. Origins of these observations are discussed.

Seventy-five cirrhotic patients with hyperammonemia in the past or at the time of the study were randomly divided into two groups (treated with lactulose or nontreated) in 14 hospitals in Japan. Thirty-six cirrhotic patients were diagnosed as having subclinical hepatic encephalopathy (SHE), and 39 were diagnosed as non-SHE. SHE was diagnosed when the results of all three of the quantitative psychometric tests used (number connection test, and symbol digit and block design tests of the Wechsler adult intelligence scale [revised]) were abnormal as compared with age-matched normal values. The mean number of abnormal psychometric test results and the prevalence of SHE were used for a quantitative evaluation of the efficacy of the lactulose treatment. Twenty-two of the SHE patients were treated with lactulose (45 mL/d) for 8 weeks, and the other 14 SHE patients did not receive lactulose. In the SHE patients administered lactulose, the results of the quantitative psychometric evaluation were significantly improved at 4 and 8 weeks after the beginning of the lactulose administration. The SHE had disappeared in 10 (50%) of the 20 treated patients at week 8, but it persisted in 11 (85%) of the untreated 13 patients. We concluded that lactulose treatment in cirrhotic patients with SHE is effective with respect to psychometric tests.

Photoconductive and photovoltaic responses in glassy Ag–As–S ion‐conducting semiconductors have been studied. The ac conductivity of the glass increases with illumination, while the increase is ascribed to enhanced ionic conduction caused by temperature rise and to interfacial photoeffects. Bulk photocurrent is not detected. By contrast, photovoltages appear in Ag–As–S samples having sandwich and floating electrodes. The photovoltaic characteristics are discussed in terms of classical electrodynamics assuming interaction between electronic carriers and Ag+ ions.

Physical properties of Ag2S‐As2S3 glassy alloys have been studied as a function of the Ag atomic concentration x. With an increase in x, the optical‐absorption edge exhibits a red shift, while the steepness of the Urbach tail changes little. In the glasses with x≥15, the electrical conductivity is governed by Ag+ ionic conduction. The ionic conductivity exponentially increases with x, and in contrast the hole conductivity hardly changes with x; however, the activation energies for the ionic and the hole conductivity are nearly the same at about 0.4 eV for compositions with 15 ≤x≤35. These observations are discussed on the basis of atomic and electronic structures in Ag2S‐As2S3 glasses.

Technology fusion between motor design and control can produce new applications. This paper introduces a saliency-based sensorless drive of adequate designed IPM motor for a specific application in a robot vehicle. The motor is designed considering both configuration so as to fit to the application and the electromagnetic feature to be better adapted to saliency-based sensorless control. The speed and position synchronous control for each wheel-motor in entire speed ranges including zero speed is realized by a single motion controller and drive-amps for individual motors. Finally, two types of robot vehicle, one being a two-wheel deferential drive and the other being an omni direction drive, are developed to transport objects and human. The paper mainly focuses on the concept of motor design and its control. Some analysis and test data are shown in this paper.

Electronic structures of Ag–As–Se glasses, which possess ion-hole mixed conduction, have been studied using a scanning tunneling microscope operating in tunneling-spectroscopy modes. The tunneling spectra show marked dependence on the scan speed of tip voltage. This scan-speed dependence appears to be caused by Ag+-ion migration which is induced by electric fields generated by tips.

Atomic structures of Ag2Te in the low‐ and high‐temperature phases have been studied using a scanning tunneling microscope in air and an x‐ray diffraction system. In the low‐temperature phase having a monoclinic lattice, (001) and (010) atomic images are obtained. In the superionic high‐temperature phase, which is stable at temperatures above 145 °C, (100) surfaces of the Te cubic lattice are observed. In both phases, surface atomic reconstructions are not detected.

A new hybrid position/force control scheme over a position control scheme is proposed. The control scheme modifies the position command for force control against the constraint surface of the environment and is very easily designed and implemented. The merits of the control scheme are that it can cope with a change of constraint conditions and a small position inaccuracy of the environment. A constraint surface position observer is also proposed to reduce disturbances on the controlled force. >

To clarify the relationship between open heart surgery and gallstone formation.Fifty-one patients without gallstones (Group A) underwent cardiac surgery using a heart-lung machine and were followed for 24 months by ultrasonography. Blood tests of hemolysis markers were examined before, immediately after, and 3, 6, and 12 months after surgery. And 52 healthy candidates without gallstone (Group B) also were followed for 24 months.The cumulative gallstone incidence in Group A was 15.7% at 3 months after surgery, 23.9% at 6 months, and 30.4% at and beyond 12 months and was significantly higher than that of Group B (p0.01). The stones showed a high dense pattern, indicative of pigment stones, in eight of the 10 patients assessed by CT. With respect to the type of surgery, latent hemolysis was seen only in patients who underwent mechanical valve replacement. However, there were no significant differences in the gallstone incidence between the patients who underwent mechanical valve replacement and those who underwent another cardiac surgery. The values of hemoglobin, haptoglobin, and lactate dehydrogenase showed abnormal values immediately after surgery, regardless of mechanical valve replacement or another cardiac surgery.The use of a heart-lung machine, which produces hemolysis, appears to have a close relation to gallstone formation after open cardiac surgery.

A 49-year old man was admitted in November 1989, because of anemia, abnormal shadowing on chest X ray and hyperproteinemia. Biclonal gammopathy (IgG kappa + IgA kappa) was shown in serum, and Bence Jones protein in urine. The bone marrow examination showed an increased number of abnormal plasma cells (15.7%) and no evidence of lymphoma, A diagnosis of multiple myeloma (MM) was made. In April 1990, while the patient was treated with the modified M2 regiman, swelling of the right cervical lymph node was observed. Lymph node biopsy revealed that he had non-Hodgkin's Lymphoma (:NHL, diffuse, mixed, B cell type). He was retreated with the CHOP regimen for both disease, but died of respiratory failure in October. 1991. To establish the clonal origin of this case of concominant MM and B-cell NHL, the immunoglobulin gene rearrangements in his lymph node and bone marrow were analyzed. Southern blot analysis with the JH probe and Ck probe showed one common band and one different band in the two samples. Our data suggest that two B-cell malignancies may have arisen from a single B-cell progenitor.

We studied 710 patients with hepatocellular carcinoma(HCC) who underwent non-surgical treatment. Multivariate analysis demonstrated that four factors, the number of tumors, tumor size, portal vein tumor thrombus and the severity of liver dysfunction (Child's classification) before treatment were found to be significant for the prognosis of patients and that severity of liver dysfunction was the most significant factor. of 179 patients with small HCC who underwent percutaneous ethanol injection (PEI), the severity of liver dysfunction was the most significant factor contributing to the prognosis. The prognosis of HCC is influenced by many factors. We conclude that early detection of tumors followed by early therapy is the most important.

To evaluate the therapeutic effect of percutaneous ethanol injection (PEI) on small hepatocellular carcinoma (HCC) with computed tomography (CT).Sixty-seven patients with histologically proved HCC 3 cm or less in diameter underwent PEI. The patients were regularly followed up with sonography and contrast material-enhanced CT for more than 1 year (range, 12-96 months). The CT findings were evaluated for three tumor types distinguished on the basis of their appearance relative to that of the surrounding liver parenchyma: type 1 = hyperattenuating at the early phase (n = 39), type 2 = iso- or hypoattenuating at the early phase and hypoattenuating at the late phase (n = 18), and type 3 = isoattenuating (not detected) at both the early and late phases (n = 10).After PEI, a necrotic area of HCC and the surrounding liver parenchyma was characterized as hypoattenuating at both early and late phases of contrast-enhanced CT, regardless of the type. When an HCC appeared to be completely necrotic within 3 months after PEI, this status was retained until the latest observation in all but three cases.Contrast-enhanced CT can correctly depict PEI-induced necrosis in HCC and is reliable for evaluating the therapeutic effect of PEI.

Endoscopic injection sclerotherapy (EIS) combined with percutaneous transhepatic obliteration was performed in 63 cirrhotic patients with esophageal varices. In all patients, esophageal varices were completely disappeared after EIS. To investigate risk factors for recurrence of esophageal varices after EIS, hemodynamic changes in the portal system before and after EIS were studied by portal vein catheterization and ultrasonography. In patients in whom portal pressure rose after EIS, recurrence of varices was observed in high incidence (p0.05). Furthermore, variceal recurrence appeared frequently in patients with progressive splenomegaly after EIS (p0.05). During post-EIS course, new appearance or increase in size of non-variceal portosystemic collaterals was detected by ultrasonography in 22% of the patients. In these patients, variceal recurrence rate was low (p = 0.09). In patients with shunts around the splenic hilum, variceal recurrence rate was lower compared with the patients with paraumbilical vein (p0.05). Prognostic factors for variceal recurrence were analysed using multiple regression model. It was suggested that the absence of non-variceal portosystemic collaterals was the most risky factor. In conclusion, observation of portal hemodynamics is considered to be useful for the long-term management of patients with esophageal varices treated with EIS.

Seventy-one patients with untreated hepatocellular carcinoma (111 tumors) were studied angiographically to investigate the pathological features of multiple carcinoma. The 111 tumors comprised 23 lesions resected from 14 patients and 88 lesions measuring 3 cm or less in diameter detected in 57 patients who did not undergo resection. Hemodynamically, major lesions exhibited an increase in frequency of tumor angiogenesis and intensity of tumor stain with an increase in diameter. Analysis of angiographic features of tumors measuring 2 cm or less in diameter revealed a greater vascularity in intrahepatic metastatic foci than in primary foci, demonstrating a difference between them. When multiple tumors were classified into the isolated, concentric or disseminated type in terms of the pattern of their distribution, their angiographic findings suggested that min or lesions of the concentric or disseminated type might represent local metastases spread from the primary focus, and that those of the isolated type might represent multicentric occurrence in the liver.

The clinicopathological characteristics of the diffuse gastric mucosal redness were studied in 235 patients with liver cirrhosis. Moreover, in 96 patients in whom percutaneous transhepatic portal catheterization was carried out, the relationship was studied between gastric mucosal lesions and portal hemodynamic aspect with reference to portal vein pressure and extrahepatic collaterals. Extrahepatic collaterals were divided into three groups, which related either of cephalad, caudal and peri-abdominal as the most prevalent extrahepatic collateral on portographic findings. The frequency of the diffuse gastric mucosal redness was increased with the elevation of portal vein pressure, and it was seen more frequently in patients with cephalad collaterals than in caudal. However, the diffuse gastric mucosal redness was seen less frequently in patients with cephalad collateral accompanied with the development of renal shunts. Multiple logistic model analysis showed significant correlation between the diffuse gastric mucosal redness and the development of cephalad collaterals. These results suggest that the gastric mucosal circulation in liver cirrhosis is strongly affected by the development of portosystemic collaterals in portal hypertension.

Percutaneous ethanol injection (PEI) was performed on 183 tumors in 147 patients with small hepatocellular carcinoma (HCC), of no larger than 3 cm in size and less than three in number, during 9 years and 4 months between August 1983 and December 1992. The 1-, 3- and 5-year survival rates of all 147 patients calculated by the Kaplan-Meier method were 96.3%, 62.5% and 40.7% respectively. Multivariate analysis (Cox's proportional hazard model) demonstrated that the most significant factor contributing to the prognosis of the patients was the severity of liver dysfunction (clinical stage) before treatment. Recurrence was seen in different areas of the liver from the original lesion in 26.9% in one year and 61.5% in three years. Multivariate analysis demonstrated that the most significant factor contributing to the recurrence was the number of tumors before treatment. Regrowth of the original tumor occurred in two patients (1.4%). There was no serious complication due to PEI. To evaluate the therapeutic effect of PEI, contrast-enhanced CT with intravenous bolus injection was considered to be indispensable. We conclude that PEI can be indicated in most patients with small HCC and is also effective.

The effect of ursodeoxycholic acid on liver function tests and on bile acid metabolism was investigated in a multi-center randomized controlled dose study for chronic hepatitis C. Twenty, 18 and 19 patients were administered 150, 600 and 900 mg/day, respectively of ursodeoxycholic acid every day for 16 wk. Serum liver parameters and bile acid composition in the treatment groups were compared with 17 control patients. A similarly significant decrease of serum alanine aminotransferase and serum gamma-glutamyltransferase was observed in patients administered 600 and 900 mg of ursodeoxycholic acid. Serum bile acid composition was determined by high-performance liquid chromatography. At entry, the relative proportions of major bile acids were similar to those observed in normal individuals. Maximal concentrations of total ursodeoxycholic acid were 0.30 mumol/L, 5.59 mumol/L, 21.42 mumol/L and 14.73 mumol/L in the control, 150, 600 and 900 mg/day groups, respectively. The fraction of the total ursodeoxycholic acid increased in a dose-dependent manner, and it was significantly higher than in controls (p0.001). The hydrophobicity index of bile acids was calculated by the method of Heuman, and its correlation with serum parameter levels was analyzed. In the 600 and 900 mg/day dose groups, serum alanine aminotransferase decreased in the cases in which hydrophobicity index significantly decreased during treatment. The same correlation was observed between the hydrophobicity index and serum gamma = glutamyltransferase in these two groups. There was no correlation between these parameters in the control and 150-mg groups. There was no correlation between reduction rate of serum alanine aminotransferase and initial liver histology.(ABSTRACT TRUNCATED AT 250 WORDS)

We performed periodical examinations by ultrasonography (US) and serum alpha-fetoprotein in 272 patients with liver cirrhosis (male, 167; female, 105) over long follow-up periods (1985. 1-1992.9). The average period was 1934 days, and we prospectively studied the early detection of hepatocellular carcinoma (HCC). HCC was detected in 78 patients during the periods, with the average cumulative incidence rate being per year 7%. Tumor size at detection was 15mm or less in diameter in 37.2% HCC patients and 30mm or less in 89.7%. In spite of frequent ultrasonic examinations, it was difficult to detect small sized HCCs in blind spots of US or in the liver with the rough parenchymal echo pattern. Predictive factors important for development of HCC were analyzed using Cox's proportional hazards model. It showed that significant factors were serum AFP level, liver parenchymal echo pattern and small mass lesions (ultrasonic appearance) of the liver.

Hepatocellular carcinoma (HCC) is considered to develop either on a background of preneoplastic lesions as multistep carcinogenesis or on a liver without such a lesion as de novo. The latter course can be assumed by our clinical experience of imaging diagnosis and by follow up studies of alpha fetoprotein (AFP) producing HCCs. Although serial checkup of AFP is important, serological or genetic approach is little use for early detection of HCC. At present, imaging diagnosis especially ultrasound is the best modality for detecting early developing HCC. The most reliable way for the final diagnosis of the detected mass is done by aspiration histology using a 21G needle with ultrasound guidance. Recent new imaging modalities such as contrast enhanced ultrasound using CO2 microbubbles or CTAP are not so reliable as aspiration histology, especially in tumors less than 15 mm in diameter.

Ultrasound is now widely used in the diagnosis of liver diseases. Applications of ultrasound in the diagnosis of liver cirrhosis are reviewed in this paper. Characteristic findings of liver cirrhosis in ultrasound are nodular liver surface, round edge, and hypoechoic nodules in liver parenchyma which represent regenerative nodules of cirrhotic liver. Detection of hypoechoic nodule more than 10 mm is important in the early diagnosis of hepatocellular carcinoma. Detection of splenomegaly, ascites, and portosystemic collaterals is possible by ultrasound. Evaluation of portosystemic collaterals is beneficial in the management of esophagogastric varices and portosystemic encephalopathy. Ultrasound is useful in the non-invasive diagnosis and long-term management of cirrhotic patients.

Since December 1989, the Japan Red Cross Blood Bureau has screened blood donors for hepatitis C virus antibody on the basis of enzyme-linked immunosorbent assay and high titers of antibody to HBc antigen. To elucidate the effectiveness of the new screening tests in preventing posttransfusion hepatitis, the incidence of posttransfusion hepatitis after the introduction of the new tests (December 1989 to December 1990) was compared with the incidence before their introduction (January 1982 to December 1988). The incidence of posttransfusion hepatitis was 9.8% (219 of 2240), with a mean transfusion volume of 10.2 units, before the screening and 3.7% (12 of 326), with a mean transfusion volume of 14.7 units, after the introduction of the new tests. Statistical analysis revealed a significant decrease of incidence of posttransfusion non-A, non-B hepatitis after the introduction of the new tests (X2 = 10.9, p0.01). Posttransfusion hepatitis B occurred in 3 of 2,240 recipients (0.13%) before the introduction of HBc antibody testing. No cases of posttransfusion B viral hepatitis developed after the introduction of the new tests. Hepatitis C virus antibody status was investigated in 7 of 12 posttransfusion hepatitis patients who contracted the disease after the new screening tests were initiated. Hepatitis C virus antibody seroconversion occurred in three of the seven cases (43%), as detected on first- and second-generation hepatitis C virus antibody assays and reverse-transcription polymerase chain reaction.

Endoscopic papillotomy (EPT) has become a popular form of treatment in managing common bile duct stones. But it may fail in difficult cases such as large stones of over 20 mm, confluence stones, and impacted stones. Over the past 5 years, our success rate in clearing the bile duct by conventional endoscopic techniques (mechanical lithotripsy) was about 90 per cent. Recently, we have performed electrohydraulic lithotripsy or laser lithotripsy with peroral cholangioscopy in these difficult cases. Complete clearance of the duct was obtained in all 23 patients who underwent peroral cholangioscopic lithotripsy. No complication occurred. In conclusion, peroral endoscopic treatment of common bile duct stones should be safe and effective.

Pancreatic adenocarcinomas are known to have a high incidence of K-ras gene mutations. Differential diagnosis of pancreatic cancer and chronic pancreatitis sometimes presents a clinical dilemma. We recently developed a highly sensitive and specific polymerase chain reaction capable of detecting 3-30 copies of mutant K-ras genes harboring codon 12 single base changes in the presence of 300,000 normal copies. Mutant ras genes were detected in DNA purified from pancreatic juice from all 6 cases of pancreatic adenocarcinoma and 1 case of intraductal papillary neoplasms of the pancreas. In 2 of 6 other cases with pancreatic adenocarcinoma, circulating metastatic cells were detected in DNA purified from peripheral blood. Activated ras genes were not found in pancreatic juice of three control cases (chronic pancreatitis and choledocholithiasis) or in the peripheral blood of two patients with insulinomas. Notable conclusions of this study are that there can be significant levels of shed tumor cells in peripheral blood and an even higher number in pancreatic juice. In addition, two different K-ras mutations were found in some patients.

Percutaneous ethanol injection (PEI) was applied to 162 lesions in 133 patients with hepatocellular carcinomas (HCC) 3 cm or less in diameter (small HCC) between Aug. 1983 and Apr. 1992. Histological findings in resected specimen for which PEI had previously been performed before surgery showed that PEI could completely necrotize an HCC of 32 mm in diameter. The antitumoral effect by PEI could correctly be evaluated by enhanced CT. The 1-, 3-, 5- and 7-year survival rates after PEI calculated by the Kaplan-Meier method were 95.9%, 60.5%, 36.9% and 21.7%, respectively. The survival rate of post-PEI patients with I or II grade in clinical stage was better than that of those with III. Recurrence occurred in hepatic areas different from the original lesion in 27.8% in one year and 63.6% in three years after PEI, rates quite similar to those of recurrence after surgical resection for HCCs of 3 cm or less in diameter. For such recurrence, PEI alone was then repeated in half of the 76 patients. Complications caused by PEI were not serious and did not necessitate intensive care. Because of its anti-tumor therapeutic effect and minimal damage to the liver, PEI might be considered a viable alternative to surgery for most patients with small HCC.

We evaluated the usefulness of percutaneous biopsy under sonographic control and histological examination in the early diagnosis of hepatocellular carcinoma (HCC) in comparison with CT and angiography. 121 patients in whom hepatic nodules 3cm or smaller in size were found by ultrasound as suspected HCC underwent percutaneous biopsy, CT and angiography. 118 patients were finally diagnosed as HCC. Correct diagnosis of HCC was obtained by each modality in relation to tumor size as follows: 87.3% by histological examination, 55.1% by CT, 52.5% by angiography. However, the diagnostic capability of these modalities for HCC 1.5cm or smaller in size was as follows: 88.5% by histological examination, 34.6% by CT, and 23.1% by angiography. Cytology using a biopsy specimen was performed in 26 patients and it showed a positivity of 61.5%. In conclusion, for a definitive diagnosis of small HCC 1.5cm or less in size, the current imaging modalities have some limitations. On the other hand, percutaneous biopsy and histological examination are the most reliable and indispensable for making a definite diagnosis of small HCC.

To elucidate genetic susceptibility to alcoholic liver injury (ALD), polymerase chain reaction (PCR) method assay was developed to detect point mutations in each gene and gene frequency in various liver diseases was studied. It was shown previously that ALDH2(1) gene was more frequently found in patients with ALD (confirmed in this study), probably because they are able to consume too much alcohol (non-flushing type). This study revealed that, in addition to this ALDH heterogeneity, ADH heterogeneity may correlate with the severity of alcoholic liver injury, especially in those was low ADH activity and tend to have severe damage.

The diagnostic value of angiography for small hepatocellular carcinoma was evaluated in comparison with histology, contrast-enhanced computed tomography, and ultrasonography. A total of 120 patients with small hepatocellular carcinoma (less than 3 cm in size) were examined. The definitive detection rate for primary tumors less than 2 cm in size was 44.9% by angiography, while it was 68.6% for primary tumors between 2 cm and 3 cm in size. When the primary tumor was less than 2 cm in size and without tumor vessels on angiography, it tended to be of Edmondson's grade 1 and to show fatty change. When the primary tumor was less than 2 cm in size and without tumor stain while non-cancerous parenchyma showed irregular stain, it tended to be of Edmondson's grade 1 and normotrabecular type. Angiography was found to be of particular value in detecting satellite tumors with a nodular parenchymal echo pattern in non-cancerous areas, because ultrasonography often fails to differentiate these satellite tumors from non-affected parenchyma.

Cobalamin-deficient P388D1 mouse leukemic cells were created by propagation in a cyanocobalamin-free medium in which the original fetal bovine serum was replaced by bovine serum albumin. These cobalamin-deficient cells gradually ceased to multiply when the medium contained 5-methyltetrahydrofolate. The growth of cells that had been cultured with this coenzyme was recovered following the addition of cyanocobalamin (CNCbl), at concentrations above 37 pM. In contrast to the effect of CNCbl, cobinamide, and cobalamin analogues prepared from hydroxy cobalamin by reaction with ascorbic acid, did not have a growth-inducing effect on these cells, nor did these analogues inhibit CNCbl-dependent growth. Transcobalamin II-cobalamin complex had a remarkably stimulating effect on cell growth. The growth inducing effect became apparent with a cobalamin concentration of only 0.37 pM. This was about 1/100th the level of free cobalamin required for cell growth. However, no growth-inducing effect was seen at an R protein-bound cobalamin concentration of 37 pM, indicating that once cobalamin has been bound to R protein, it loses its growth-promoting effect on these cells in culture.

Sweet's syndrome (acute febrile neutrophilic dermatosis) is an unusual condition characterized by fever, polymorphonuclear neutrophil leukocytosis of the blood, thick painful plaques on the face, neck and limbs, and a dense dermal infiltrate of mature neutrophils seen histologically. Recently, this disease has also been reported in association with various malignant neoplasms and chronic inflammatory disorders. In the literature, seven cases of Sweet's syndrome associated with collagen diseases have been reported, but no cases with mixed connective tissue disease (MCTD). The first case of Sweet's syndrome associated with MCTD was herein described and discussed. A 49-year-old man was admitted to our hospital with the complaints of high fever and painful erythema on his face, neck and limbs. Six months ago, MCTD was suspected, with the presence of limited cutaneous sclerosis of the hands, Raynaud's phenomenon, polyarthralgia, an elevation of CPK value and a positive anti-RNP antibody. Just before hospitalization, he suffered a prodromal infection of the upper respiratory tract for two weeks. He was diagnosed as Sweet's syndrome by the clinical and histological features. He began receiving corticosteroid therapy (prednisolone 60 mg/day), and within a week he showed dramatic improvement in the above symptoms.

We describe a woman with systemic lupus erythematosus presenting with nephropathy after the complete resection of a thymoma and the adjacent thymic gland. The woman showed no symptoms of autoimmune disorders or nephropathy at operation. One year later, however, she noticed arthralgia, and laboratory examination showed mild proteinuria, leukopenia, a high level of serum antinuclear antibody (1:1280), anti-dsDNA antibody, and a low level of complement. Renal biopsy showed focal necrotizing glomerular lesions, suggestive of lupus involvement. The pathogenesis of lupus erythematosus in our case is briefly discussed in relation to preceding thymoma and its resection.

Sonograms of 282 cases of hepatocellular carcinoma (HCC) less than 5 cm in size were examined. Among these, 73 cases of resected or biopsied HCCs were compared in terms of their pathologic findings and sonograms. Low echoic pattern was the more common among smaller HCCs, and low echoic periphery pattern tended to prevail with increasing size. The pathologic factors of fatty change and clear cell formation are responsible for elevating the echo level. Among HCCs less than 2 cm, the low echoic group is more differentiated than the iso-echoic group by Edmondson's classification. "Lateral acoustic shadow", "nodule in nodule", and "septum" are characteristic findings in HCC by sonography, and they correspond to the pathologic findings. However, "posterior echo enhancement" was not seen to be specific for HCC, as it was also observed with similarly frequency in hemangiomas.

To examine the effects and optimal dose of danazol on idiopathic thrombocytopenic purpura (ITP), we administered a low-medium dose to 14 patients with this disease. A low-medium dose of danazol was effective in maintaining the platelet count at a high level, even after the dose of prednisolone was reduced. A low-medium dose of danazol without other therapy was effective in 3 of 6 patients even after they had been refractory to other treatment. A low dose of danazol was also effective in some patients for whom the other regimes were not indicated. It is concluded that a low-medium dose of danazol instead of a high dose is worth trying in ITP when the patient has become refractory to other therapeutic approaches or when these are not indicated.

The hemodynamics of the intrahepatic portal vein in 35 healthy subjects and 74 patients with liver cirrhosis was studied by measuring blood flow velocity with pulsed Doppler ultrasound technique. The flow velocity of portal vein decreased from the portal trunk to the first branches and to the second branches in the right and left lobes. Especially, an abrupt decrease of the flow velocity in the umbilical part of the left portal vein was characteristic of hemodynamics in the intrahepatic portal vein. The flow velocity in the third branches decreased more than that of the second branch in the right portal vein, but did not exist in the left. And the velocity was almost equal in all the subsegments. Blood clots of the left portal vein in 25 of 36 lesions were found in 31 patients with intrahepatic portal vein thrombus. This characteristic hemodynamics of the left portal vein was thought to be the main cause for the formation of blood clots. In the group with liver cirrhosis, the flow velocity was lower than in healthy subjects in the portal trunk, bilateral first branches and right second branches, but did not exist in the left second branch and bilateral third branches. No interrelationship between the intrahepatic portal flow velocity and the severity of liver cirrhosis and portal hypertension was observed.

Hepatocellular carcinoma epidemiology has undergone great changes in Japan. Life span, new diagnostic procedures and viral infections obtained through intravenous injections have contributed to these changes. The aetiological aspects and clinical features of HCC should be reappraised to account for the current use of techniques such as US and CT in the early diagnosis of HCC. In Japan most HCC seem to be HBV and/or HCV associated whereas small HCC seem to be HCV-associated more so than large HCC. The usual clinical symptoms and signs are somewhat useless and of limited value while the newer techniques permit an early clinical diagnosis of small HCC. This diagnostic advancement has also permitted a remarkable progression in HCC therapy.

Duplex Doppler sonography (ultrasonic equipment: Toshiba SSA-270A) were performed in the patients with various renal disease (male 44, female 32) admitted to our hospital between June 1990 and August 1991. Interlobar arterial blood flow velocity was measured at the side of renal pyramid through a longitudinal scan. Both the maximum blood flow velocity (Vmax) and the minimum blood flow velocity (Vmin) were measured quantitatively and resistive index (RI: defined as (Vmax-Vmin)/Vmax) were calculated. Vmax and Vmin correlated well with the creatinine clearance (Ccr) (r = 0.56, r = 0.66 respectively), whereas RI, by which we can detect Doppler waveform changes, correlated weak with Ccr (r = 0.39). We found twenty-nine patients (40%) with an elevated RI (greater than or equal to 0.70). They had severe renal dysfunction and active pathologic findings in the tubulo-interstitial or vascular compartment of the kidney. Doppler examination of renal blood flow velocity was valuable not only to estimate renal function but also to assess pathophysiology of renal disease.

We carried out ultrasound guided direct-puncture bile aspiration (DPBA) in 58 patients with acute cholecystitis. Symptoms and laboratory findings of acute cholecystitis were rapidly improved after DPBA. NO serious complications were seen during and after the DPBA procedure. It was concluded that DPBA is practical and safe treatment of acute cholecystitis. Furthermore long follow up study revealed that this therapeutic method would be useful and reliable for elder patients and patients with systemic complication.

Hepatocellular carcinoma (HCC) arises in patients with chronic liver diseases, particularly liver cirrhosis.

Pharmacokinetics of theophylline were determined in patients with liver cirrhosis and idiopathic portal hypertension with reference to estimated hepatic blood flow assessed by indocyanine green (ICG). Decreased plasma clearance of theophylline was noted in patients with liver cirrhosis and the clearance was significantly lower in Child C group than in Child A, B groups (17.5 +/- 3.4 ml/Kg/hr vs 27.6 +/- 8.7, p less than 0.05). Theophylline has been classified as a drug with a low hepatic extraction ratio and it has been believed that changes in hepatic blood flow have little effect on its clearance. The results of present study indicate that theophylline clearance is basically not related to ICG clearance but to theophylline extraction ratio, supporting the common belief. However, it is noteworthy that the clearance was related to decreased hepatic blood flow rather than extraction ratio in a cirrhotic patient with huge extrahepatic shunt, suggesting that hepatic clearance of this drug could be affected by hepatic blood flow under some circumstances.