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The purpose of this study was to evaluate the mesh repair for an incarcerated groin hernia. A total of 110 patients who underwent emergency surgery for incarcerated hernias were retrospectively analyzed using a multivariate analysis. The postoperative complications were associated with bowel resection, odds ratio (OR) 2.984, and 95 % confidence interval (CI) 1.273 to 6.994. The risk factors for bowel resection were femoral hernia, (OR 5.621, 95 % CI 2.243 to 14.082), and late hospitalization (24 h

The ternary compound EuPtP exhibits two valence transitions at T 1 = 235 K and T 2 = 190 K. In order to examine a field-induced valence transition of Eu, we synthesized EuPtP1−x As x compounds with 0.05 ≤ x ≤ 0.5 and studied the magnetic and valence behavior. The substitution of As for P increases the lattice volume linearly and decreases both valence transition temperatures, T 1 and T 2, in contrast to the behavior under external pressures. The magnetization process in a pulsed magnetic field revealed that EuPtP0.5As0.5 exhibits an onset of metamagnetic transition above 50 T with a large hysteresis, which evidences a first-order field-induced valence transition. The analysis of the magnetization curves of x = 0.5 at various temperatures has demonstrated that the field-induced transition is essentially the same as the transition induced by temperature at T 1.

The hexagonal layered compound, EuPtP, exhibits two valence transitions, at T1 = 235 K and T2 = 190 K, and an antiferromagnetic order at TN = 8.6 K. We have examined the effects of magnetic field and pressure, and the specific heat. Analysis of the high-field experiments confirms that half of Eu are in a divalent state at the lowest temperature, and that the number of Eu2 + increases discontinuously at T2 and T1 with increasing temperature. The magnetic entropy reaches ~ 22 J K − 1 mol − 1 at room temperature, which is larger than that expected for J = 7/2 of Eu2 + (17.3 J K − 1 mol − 1). This is in good agreement with the magnetic entropy deduced from the interconfigurational fluctuation model, which explains the valence transition in Eu(Pd1 − xPtx)2Si2. The application of pressure shifts T1 and T2 higher and suppresses the intermediate phase (β phase, T2 < T < T1), whereas it does not change the properties of the low-temperature phase (γ phase, T < T2) and the TN.

The effects of diazepam on the EEG were studied by means of EEG topographic mapping, using recordings with four different references. Subjects were ten healthy, right-handed, male volunteers aged 21-25 years. Double-blind crossover trials with a single oral dose of 10 mg diazepam and placebo controls were conducted in random sequence at intervals of one week. Four referential derivations--ipsilateral earlobe (A1A2), average reference (AV), source derivation (SD), and balanced noncephalic electrode (BNE)--were used. One-minute vigilance-controlled EEGs before drug administration and two hours after drug administration were analyzed using Fourier transformation; absolute power and relative power were calculated for four frequency bands. Diazepam caused a widespread increase of beta-frequency relative power, and a widespread decrease of theta-frequency absolute power when A1A2 and SD were taken as references. From the comparison of different reference electrodes we conclude that the selection of the reference and of spectral parameters (absolute power or relative power) play an important role in pharmaco-EEG studies.

A superconducting current limiter comprising a noninductively wound AC superconducting coil (trigger coil) connected in parallel with a limiting coil was developed. A model electric power system for the application of this type of superconducting current limiter was created, 400 V/100 A class model superconducting current limiters were fabricated, and various current limiting tests were performed with respect to short-circuit currents and phases varied over a wide range. The results demonstrate that the proposed current limiter possesses performance characteristics fully adequate for application to the model system. A 6.6 kV/1500 A class superconducting trigger coil was developed, with a scale permitting, in principle, validation tests of applicability to actual power systems. This coil was demonstrated to be capable of limiting short-circuit currents by a factor of 1/30, and was subjected to detailed evaluation of current-limiting characteristics. >

SummaryIncreases in psychosocial stress and disruption of the biological clock due to irregular sleep-wake schedules as well as an increase in the elderly population have resulted in an increase in sleep disorders, most notably insomnia. In order to manage insomnia, correction of a poor sleep environment is of primary importance. We now have many good GABA A receptor agonists such as benzodiazepines and cyclopyrrolones (zopiclone) for use as hypnotics, but to achieve improvements in nocturnal sleep and restoration of daytime functions, short- or ultra-short acting hypnotics are recommended. Zopiclone has been reported to show weaker effects on sleep architecture than other benzodiazepines and does not exacerbate mild or moderate sleep apnea syndrome. Some patients are therapeutic-dose dependent on hypnotics or anxiolytics without showing detectable side effects. It may be possible for some insomniacs, particularly forelderly people, to use the minimum necessary dose of hypnotics to achieve good sleep and live a happy life from the standpoint of good quality of life.

A chip size package (CSP) and fine pitch ball grid array (FBGA) are increasing by becoming the focal point of attention in semiconductor field. A reel-to-reel consecutive manufacturing process has been developed by the authors for a tape-based substrate consisting of multi conductive wiring layers (minimum four layers) with ball grid array connections. This substrate, compared to those presently in use, is (a) thin (150/spl sim/200um for four layers) and low weight; (b) applicable to many pin counts; (c) makes possible fine conductive wiring and insulating layers with high accuracy in layer thickness and (d) facilitates the control of characteristic impedance. Interlayer connection technology is key to multi-conductive wiring layer structures, which may have effect primarily on substrate reliability. In the present study, a copper deposited plating process was used in conjunction with UV-laser drilling so as to produce very small via-holes in diameter 40-50um as interlayer connections. The reliability of interconnections was confirmed for via-holes with diameter 40-50um under the condition of 1000cycle thermal shocks of -65C/+150C a gaseous phase. Filled via-hole formation without interior voids was found to take place in the plating process. Minute stacked via-hole formation was noted to provide a substrate with high density pin counts. The substrate structure was designed with consideration electromagnetic transmission characteristics by computer simulation. The present substrate meets recent requirements for GHz order signal transmission.

Researchers from 5 Japanese universities have developed a plant growth facility (Space Plant Box) for seed to seed experiments under microgravity. The breadboard model of the Space Plant Box was fabricated by assembling subsystems developed for microgravity. The subsystems include air conditioning and water recycle system, air circulation system, water and nutrient delivery system, lighting system and plant monitoring system. The air conditioning and water recycle system is simply composed of a single heat exchanger, two fans and hydrophilic fibrous strings. The strings allow water movement from the cooler fin in the Cooling Box to root supporting materials in the Plant Growth Chamber driven by water potential deficit. Relative humidity in the Plant Growth Chamber can be changed over a wide range by controlling the ratio of latent heat exchange to sensible heat exchange on the cooling fin of the heat exchanger. The transpiration rate was successfully measured by circulating air inside the Plant Growth Chamber only. Most water was recycled and a small amount of water needed to be added from the outside. The simple, air conditioning and water recycle system for the Space Plant Box showed good performance through a barley (Hordeum vulgare L.) growth experiment.

Chemotherapy has been shown to induce apoptosis in esophageal cancer. However, no windows of opportunity exist to selectively kill tumor cells without killing host cells. Due to the concern that tumor-infiltrating lymphocytes may be killed by chemotherapy, we examined the significance of the effect of treatment on the density of tumor-infiltrating lymphocytes and apoptosis in the tumor itself and in the tumor-infiltrating lymphocytes.In 93 patients with esophageal cancer including 50 with neoadjuvant chemotherapy, esophagectomy specimens were examined for density of tumor-infiltrating lymphocytes and for apoptosis in both tumor cells and tumor-infiltrating lymphocytes.Apoptotic index was increased by neoadjuvant chemotherapy only in tumor-infiltrating lymphocytes, apoptotic index wasor = 4 only in chemotherapy patients. The density of tumor infiltrating lymphocytes was a significant positive prognostic factor in chemotherapy and non-chemotherapy groups, and the high apoptotic index in tumor-infiltrating lymphocytes was an independent negative prognostic factor in the chemotherapy group.Apoptosis in tumor-infiltrating lymphocytes was induced by chemotherapy in some patients in association with a poor prognosis. Unexpectedly, chemotherapy did not increase apoptosis in tumor cells. Both findings suggest a need for improved regimes and individualized treatment.

We examined the effects of benzodiazepine (BZD) hypnotics and zopiclone (ZPC), a nonbenzodiazepine hypnotic, on sleep and psychiatric symptoms in schizophrenia, as well as the clinical correlates of these variables. Seven male schizophrenic patients chronically taking neuroleptics together with BZD were studied. We replaced BZD with ZPC and performed polysomnography (PSG) and Brief Psychiatric Rating Scale (BRPS) scoring before and after an 8-week ZPC treatment. The replacement of BZD with ZPC increased the mean amplitude of high-amplitude low-frequency delta waves on the frontal derivation recognized by period-amplitude analysis, and it decreased the BPRS negative-symptom score. Under the BZD treatment, the negative-symptom score correlated inversely with the mean amplitude of high-amplitude low-frequency delta waves. This correlation was weak and not significant under the ZPC treatment. Therefore, delta waves during sleep have a close correlation to negative symptoms in schizophrenia, and such a correlation could be influenced by hypnotics. Although these are preliminary findings, it was suggested that, compared with BZD, ZPC might be a beneficial hypnotic in regard to both sleep and negative symptoms of chronic schizophrenic patients.

Diazepam is a representative drug of benzodiazepines. The subjects were 9 right-handed healthy male volunteers 21 25 years of age. Double blind crossover trials with placebo control were conducted in a random sequence at an interval of 1 week. Diazepam 10 mg and placebo were administered as single oral doses. Three-minute EEGs were recorded with subjects' eyes opened before and 2 h after drug administration. One-minute out of the 3-minute EEGs was analyzed with FFT, and the absolute amplitude power (microV) was calculated. These results were subjected to Student's t-test (double difference) and displayed with topographic maps (t statistic significance probability mapping). Diazepam decreased the delta absolute amplitude power over left-parietal dominance, theta absolute amplitude power diffusely and alpha absolute amplitude power over parietal region dominance. It also increased the beta absolute amplitude power over left-antero-temporal region dominance. The EEG profiles taken with subjects' eyes open were different from those of diazepam with eyes-closed vigilance controlled concerning the degree of decrease of delta and beta activities and region of the effect on alpha activity.

EEG effects of zopiclone (7.5 mg), a cyclopyrrolone derivative with hypnotic action, were compared with effects of diazepam (10 mg). Multichannel EEG recordings, double-blind crossover trials with placebo, and oral single doses were used in healthy volunteers. Vigilance-controlled EEG before and after zopiclone (and placebo), and before and after diazepam (and placebo) were analyzed into FFT power spectra. Effects were assessed as placebo-referred pre-post-medication power differences in four frequency bands. Overall statistics showed significant (P0.007) global differences between medication effects in the delta frequency band (0.5-3.5 Hz). After zopiclone, fronto-central delta increased bilaterally, whereas after diazepam delta decreased over centro-parietal to right temporo-occipital regions. These spatially different brain electric effects show that different neuronal populations must have become active in response to zopiclone and diazepam.

To investigate the pharmacological effects of zopiclone in the central nervous system, we monitored event-related potentials (ERPs, N100 and P300), the reaction time and the scores for subjective mental and emotional state (by using the Polarity Profile Questionnaire, PPQ) on 10 healthy right-handed male volunteers between 21 and 32 years old. Subjects were randomly allocated to receive a single oral administration of zopiclone 7.5 mg or placebo at the first-session, and the drug was crossed over at the second session 1 week later. ERPs, the reaction time and the psychometric scores were monitored at pre-drug, and 1, 3 and 5 hours after drug administration. In the zopiclone group, the reaction time was prolonged significantly at 1 hour after drug administration, the amplitudes of the ERPs significantly decreased at 1 and 3 hours after, and the PPQ scores showed significant changes. Maximum effects on the psychometric scores appeared later than those on ERPs and reaction time. Zopiclone decreased the arousal level and sensory sensitivity, and induced sedation through changes in subjective mental and emotional states.

Zopiclone is a cyclopyrrolone derivative which possesses hypnotic activity. This drug is known to increase the slow sleep stage compared to benzodiazepines in polysomnography. The subjects were 10 right-handed healthy male volunteers aged 21-23 years. Double-blind crossover trials with placebo control were conducted in a random sequence at intervals of 1 week. Zopiclone 7.5 mg and placebo were administered as single oral doses. Three-minute vigilance controlled EEGs at before and at 1, 3, and 5 h after drug administration, and the response times were recorded. One minute out of the 3-minute EEGs was analyzed with FFT and the power spectrum was obtained. Then the absolute amplitude power (microV) was calculated. These results were subjected to Student's t-test (double difference) and displayed with topographic maps (t statistic significance probability mapping). Zopiclone prolonged the latency of the response time, and increased the amount of delta absolute amplitude power over the right central region, beta 1 absolute amplitude power over the left central region and beta 2 absolute amplitude power over the right central area along with decreased alpha absolute amplitude power over the occipital region and theta power over the left frontal pole area after 1 h, when the peak pharmacological effect was expected. The EEG profiles of zopiclone were different from that of diazepam reported previously concerning the increase in delta activity.

Introduction It is not determined whether the continuous use of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (EGFR-TKI) is reasonable for patients with activating EGFR mutations who have progressed with the drug. Methods We retrospectively analyzed the data from 2002 to 2010 of consecutive patients who had advanced non-small-cell lung cancer (NSCLC) harboring activating EGFR mutations, and showed radiological disease progression after EGFR-TKI treatment as the first-line or second-line setting. We classified them into two groups: continuous EGFR-TKI and switching to chemotherapy, and comparedthe clinical outcome. Multivariate analysis for survival was carried out including age, gender, ECOG performance status (PS: 0-1/ 2-4), brain metastasis, EGFR mutations (deletions in exon 19 versus L858R), continuous EGFR-TKI (yes/no), initiation of EGFR-TKI (1st versus 2nd). Results A total of 551 NSCLC patients were screened for EGFR mutations in the period, and 210 patients had EGFR mutations. To explore the use of EGFR-TKI beyond progressive disease (PD), 46 patients were selected and analyzed. There were 9 males and 37 females, and median age was 65 years (42–86 years). Among them, 23 patients had deletions in exon 19, and 23 had a point mutation of L858R in exon 21. Twenty-five patients were continuing EGFR-TKI beyond PD. Twenty-one patients were switched to cytotoxic chemotherapy alone. The median overall survival (OS) was 60.8 months in the patients continuing EGFR-TKI, and 23.9 months in the patients receiving chemotherapy, presenting a significant difference between the two groups (P = 0.0081). Cox analysis showed that continuous EGFR-TKI after PD (HR 0.28, 95% CI: 0.10–0.76, P = 0.01) was associated with improved survival. Conclusion Continuous use of EGFR-TKI beyond PD may prolong OS compared with switching to cytotoxic chemotherapy in patients with activating EGFR mutations. A prospective study will be needed to confirm our results.

Background Gefitinib is an effective agent for use in treating patients suffering from non-small cell lung cancer (NSCLC) with activating epidermal growth factor receptor (EGFR) mutations. However, no optimal strategies have been established for treating these patients after gefitinib fails. Here, we conducted a retrospective study to assess the survival benefit of continued gefitinib treatment in these cases. Patients and methods We analyzed gefitinib responders with activating EGFR mutations who developed progressive disease (PD) during the course of therapy. Prognostic variables were analyzed using a Cox proportional-hazards model. Results Among the 146 patients retrospectively reviewed, exon-19 deletion mutations and L858R point mutations were detected in 78 and 68 patients, respectively. Median survival time after PD confirmation was 14.9 months (95% confidence interval [CI]: 7.9-21.9), and the median duration of continued gefitinib therapy beyond PD was 3.4 months. Statistical analysis showed that good performance status (0-1) (hazard ratio [HR]: 0.7), progression of previously evaluated lesion (HR: 0.6), and at least 3 months of continued treatment (HR: 0.4) were independent prognostic factors. Conclusion Continuation of gefitinib beyond PD is an effective optional treatment in EGFR-mutated patients. Disclosure All authors have declared no conflicts of interest.

The effects of administering total parenteral nutrition (TPN) supplemented with the dipeptide of L-alanyl-L-glutamine (Ala-Gln) on gut structure, barrier function, and protein metabolism were investigated in septic rats. Sepsis was induced by the continuous intraperitoneal administration of endotoxin via a miniosmotic pump. Twenty-three rats were divided into two groups and fed parenterally for 5 days. The Ala-Gln group (n = 11) received a conventional TPN solution supplemented with 2% Ala-Gln, whereas the control group (n = 12) received conventional TPN solution alone. One rat in each group died of endotoxemia. The groups showed similar nitrogen balance, urinary excretion of 3-methylhistidine, and plasma concentration of endotoxin in the portal vein. The groups showed similar incidence of bacterial translocation from the gut to the mesenteric lymph nodes. The intestinal mucosal weight and villous height were significantly greater in the Ala-Gln group than in the control group. Pathological derangement of the mucosal structure was more marked in the control group than in the Ala-Gln group. These results suggest that TPN supplemented with Ala-Gln preserves the gut structure without decreasing the nitrogen balance under septic conditions.

The purpose of this study was to assess cervical lymph node (C-LN) metastases and to examine whether the site of the C-LN metastasis impacts on survival of the patient with thoracic esophageal cancer.Transthoracic esophagectomy and three-field dissection (mediastinal, abdominal, and C-LN) followed by esophageal reconstruction were performed on 68 patients with squamous cell carcinoma of the thoracic esophagus who were seen at our institution from 1983 to 1990.C-LN metastasis was seen in 20 (29.4%) patients, and the survival curve of the 20 patients with positive C-LN metastasis was not significantly different from that of the 48 patients without positive C-LN metastasis. The survival curve of patients (n = 7) with positive node limited to recurrent laryngeal nerve chain node (RLN group) was significantly better than that of patients (n = 13) with positive internal jugular nodes including supraclavicular nodes (IJN group) (p = 0.010; generalized Wilcoxon). This was because there were more patients in the IJN group (84.6%) than in the RLN group (28.6%) (p = 0.022) who had five or more positive nodes in the three fields.The results suggest that RLN should not be defined as M1 but as N1 in thoracic esophageal cancer.

We present a case of long-term trihexyphenidyl (THP) abuse in which memory and cognitive impairments were observed 23 years after the commencement of medication. This case showed a dramatic improvement after withdrawal of THP. Clinical course during admission was followed with psychometric testing and laboratory examinations. The fact that the patient showed no evidence of lowered alertness during the clinical course raises the possibility that THP can primarily induce impairment of memory and cognitive functions. This is supported by the findings on the resting EEG of the patient. This case emphasizes the need to exercise caution in prescribing high doses of anticholinergic agents for long periods, particularly in elderly patients with underlying brain pathology.

The authors have developed and tested a 6.6 kV/1.5 kA-class fault current limiter based upon the S-N transition of a non-inductive trigger coil. This transition is extremely rapid (of microsecond order), hence, the quenching mechanism cannot be explained in terms of conventional thermal conduction. The analysis of this rapid quenching mechanism is important with respect to the development of a reliable fault limiter. Therefore, computer simulation studies have been conducted using a combination of both heat transfer and circuit equations, and taking the flux flow state into consideration. The results demonstrated that the heat transfer coefficient in the first stage of quenching is about 10 times as high as the conventional values.

The effects of 40 mg of indeloxazine hydrochloride, a cerebral metabolic enhancer, on sleep were investigated in 6 healthy male students. Polygraphic recordings were made for 8 consecutive nights on each subject. An inert placebo was given on the first 3 nights and on the 7th and 8th nights, and 40 mg of indeloxazine was administered on the 4th, 5th and 6th nights. Drug and placebo were administered orally at 21:30 h, and the recording of polysomnograms started at 22:00 h and ended at 8:00 h the next morning. The polysomnograms were evaluated by computerized automatic analysis using the interval histogram method. Indeloxazine prolonged both sleep latency and REM latency, and increased stage 1 sleep, but decreased stages 3, 4 and REM sleep. A significant increase of REM sleep was observed on the 7th and 8th recovery nights. No obvious changes were shown in the subjective assessments after administration of the drug. These results suggest that the effects of indeloxazine on sleep are similar to those of the tricyclic antidepressants. Furthermore, polysomnographic examinations might be useful in evaluating the pharmacological properties of cerebral metabolic enhancers.

Intraoperative spinal cord monitorings using evoked spinal cord potentials (ESCP) have been performed in 19 patients with spinal cord tumors, including five intramedullary tumors and two arteriovenous malformations (AVM) since 1984. There were 10 men and 9 women between the ages of 22 and 73 years, with an average of 49 years. ESCP resulting from median or tibial and peroneal nerve and/or spinal cord stimulation were used for monitoring according to the spinal level of tumors.

The authors describe an autopsy case of glioblastoma occurred after 38 years received lobotomy. The patient was a 72 year-old male, who received lobotomy at 34 year old against schizophrenia. CT scan taken at 72 year old showed irregular low density areas without mass effect in the bilateral frontal white matter adjacent to the anterior horn. After 4 months, the signs of intracranial hypertension were observed and his consciousness was disturbed abruptly. CT scan revealed ring enhancement with marked mass effect in the left frontal lobe. A biopsy specimen from the tumor showed a picture of anaplastic astrocytoma. Family rejected the remission maintenance treatment. The patient died 3 months later the onset. At autopsy, a large tumor occupied in the left frontal lobe was recognized. The tumor demarcated poorly from the cerebral tissue and invaded into the left anterior cingulate gyrus and the corpus callosum. Histologically, tumor cells composed of fibrillary, gemistocytic and multinucleated astrocytes. GFAP, NSE and vimentin were found in large cells. Histological diagnosis was glioblastoma. It was suggested that the tumor occurred from the region around a cyst of prefrontal lobotomy in the left frontal lobe. In the right frontal lobe, a large cyst in size of 30-18 mm was present in the centrum semiovale. The wall of cyst was composed of layer of glial scar tissue. The origin of the cyst was discussed.

A multi-institutional study comparing the antimanic effect of carbamazepine (CBZ) and lithium carbonate (Li) was performed using a double-blind group comparison design in a series of 105 patients with bipolar disorders. CBZ and Li were given for four weeks using a fixed-flexible method at an equipotent dose ratio of 1:1, starting from an initial dosage of 400 mg with a maximum dosage of 1200 mg. The final global improvement rate, based on the number of cases showing moderate to marked amelioration of manic symptoms, was 62% in the CBZ group and 59% in the Li group, with no significant difference being found between the two groups. Incidence of cutaneous side-effects was significantly higher in the CBZ group. The mean daily dosage and serum level of CBZ in the fourth week were 674 +/- 239 mg and 7.3 +/- 2.4 micrograms/ml respectively; these were within the therapeutic range. The daily dose and serum level of Li, however, were 710 +/- 239 mg and 0.46 +/- 0.22 mEq/l, and the Li level seemed to be too low to compare its therapeutic effect with that of CBZ. Prior to the present study, approximately 80% of the patients in both groups had been receiving antipsychotic medication, equivalent to 8.0 mg of haloperidol on average, without favorable response. This medication was maintained unchanged during treatment. While the shortcomings of the present study limit the interpretation of the data, it may be suggested that the usefulness of CBZ as a drug for the treatment of manic states is comparable to that of Li.

Total knee arthroplasty by the I/B total condylar type 1 or Kinematic stabilizer was undertaken on thirteen severely damaged knees of 7 patients with rheumatoid arthritis or osteoarthrosis. The short term results from 4 to 18 months after the operations were satisfactory as following: 1) The total knee score has improved on the average, from 25 points preoperatively to 83 points at follow up time. 2) Significant relief of pain and improvement of walking ability were obtained postoperatively. 3) Preoperative flexion contracture or flexion deformity could be corrected postoperatively, on the average from 27° to 6°. Increase of range of motion was 14 degrees on the average. 4) Valgus/varus instability could be satisfactorily aligned and stabilised. Postoperative femoro-tibial angle was 176° on the average. 5) The complications included a fracture of femoral condyle and transient peroneal nerve palsy.

A multi-institutional double-blind study comparing the therapeutic effect of adjunctive carbamazepine and placebo with standard neuroleptic treatment was performed on 162 patients with DSM-III diagnosis of schizophrenic (n = 127) or schizoaffective disorders (n = 35) who had excited states or aggressive/violent behavior that responded unsatisfactorily to neuroleptic treatment. The patients participated in a 4-week trial of carbamazepine plus neuroleptics (n = 82) or placebo plus neuroleptics (n = 80). The sum of patients with marked and moderate improvement was modestly larger in the carbamazepine group (48 vs. 30%, P less than 0.05). There was no significant difference between the carbamazepine and placebo groups in the changes of total BPRS scores, although the carbamazepine group showed more improvement on the items suspiciousness, uncooperativeness and excitement. The results suggest that carbamazepine, when used in combination with neuroleptics, is a useful drug for the treatment of excited states of patients with schizophrenic and schizoaffective disorders.

Between September, 1981 and August, 1982, the IAP serum levels were measured in 151 patients to evaluate the correlation between these levels and the clinical spectrum. Pre- and postoperative IAP levels were also compared with the hospital course. Abnormally high IAP levels (greater than 450 micrograms/ml) were observed in malignant diseases, especially in patients with cancer of the pancreas, choledochus, gall-bladder, and esophagus. Of 193 patients, 81 revealed abnormal levels; 28 of these (34.6%) died during this study. The average of their survival time was 2.7 months. Nine of 81 patients (11.1%) experienced severe complications, but recovered. On the other hand, 112 patients with normal IAP levels had a relatively good hospital course; 9 (8%) died. None of the 112 patients experienced any complications. These results suggest that the IAP level may be a good tool in predicting clinical features and prognoses.

The ESCAPs (evoked spinal cord action potentials) due to both median nerve and spinal cord stimulation were recorded from the interlaminal yellow ligaments posteriorly or intervertebral discs anteriorly on 12 neurologically normal adults, 50 patients with cervical myelopathy and 10 cats in order to determine the main lesion in the cervical cord electrophysiologically. The abnormal ESCAPs obtained from 50 patients with cervical myelopathy were classified into three groups as follows: Grade 1; slightly abnormal, Grade 2; moderately abnormal and Grade 3; severely abnormal which had the positive wave. In general, there was a tendency that the patients graded higher had lower evaluating score of the Japanese Orthopaedic Association. The spinal level on which the highest grade of ESCAPs was recorded generally corresponded to the level which was clearly diagnosed as the main lesion by neurological and radiological examinations, such as the case of single level disc hernia. Therefore, it has become possible to diagnose the main lesion of cervical myelopathy by recording ESCAPs.