Serum iron level was measured in a total of 285 female workers in addition to routine laboratory examinations when they underwent an annual medical examination in fall. Of these, serum iron level was subnormal (60γ/dl) in more than 15% of the workers.
Unfortunately, total iron binding capacity and serum ferritin were not measured. The number of cases of iron deficiency will increase if these tests are added.
In this study the relationship between serum iron and the hematologic findings in apparently healthy female workers was evaluated.
As expected, their RBC counts were within normal limits. A loose correlation was found between serum iron and MCV or MCH. A more close correlation was found between serum iron and Hb or Ht. There were many cases whose serum iron levels were low, but with no hematologic abnormalities. Most of these cases of iron deficiency were asymptomatic. And I suppose the two main causes of iron deficiency are the blood loss of menstruation and inappropriate diet.
I would like to emphasize the importance of measurement of serum ferritin level in addition to the common examination and improvement of dietary life in these female workers.

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In dealing with pelvic masses, it is of great importance to determine which organs are involved and to estimate their shape and properties from the prognostic and the therapeutic points. In this article, the authors discuss the key points in the ultrasonic diagnosis of gynecological diseases.
In the diagnosis of uterine tumors, uterine myomas appear as nodular structures having a uniform echo of low brightness. However, in cases of degenerative uterine myomas, the image in the nodes is one of a spiral and a cystic structure, while uterine myomas associated with pregnancy present an image of a striking increase in the size of the nodes and changes in their relative position. In cases of endometrial hyperplasia, the sonographic image shows a regular layered structure of the endometrium, while an irregular mass structure is seen in the case of carcinoma of the corpus uteri. In addition, uterine sarcoma presents a uterine image of multiple nodular swellings. In cases of carcinoma of the uterine cervix, sonography can give us informations about the degree and the extent of infiltration and metastases in the surrounding tissues. In the diagnosis of ovarian tumors, sonography makes it possible to distinguish between cystic and solid tumors, and in cases of solid-type tumors, based on the analysis of the contour and the internal structure, it is even possible to predict with some degree of accuracy whether they are benign or malignant. In cases of non-tumorous ovarian swellings, ovarian cysts appear as unilocular cysts, while ovarian hyperstimulation syndrome appears as multilocular cysts. Ovarian tumors, on the other hand, are characterized by an image of a clear cystic swelling with a sharp contour in cases of ovarian cystadenomas, and an image of an unclear, mixed tumor with an irregular contour in cases of dermoid cysts. As to the diagnosis of endometriosis, ovarian endometriosis is detected as cystic swellings with a fine granular appearance, while endometriosis of the corpus uteri is recognized as a punctiform mass structure in the muscle layer with small cysts and a high degree of brightness. In cases of severe pelvic inflammatory diseases, the sonographic image is one of a cyst or a mass having a granular echo. With regard to ovarian bleeding, care must be taken to distinguish it from the image of a Douglas' cul-de-sac retention of fluid and also the image of an intrapelviccystic swelling. Moreover, hematomas present an image of a fine, granular mass, while foreign bodies show up as a mass structure with uniform brightness and shape.
In consideration of the above points, it can be said that sonography is the most reliable technique for morphological diagnosis of gynecological diseases since it provides excellent objective imaging of the soft tissues of living bodies. However, there are inherent limits to the ability to determine the tissue origin of tumors, and it is necessary to keep in mind that a final diagnosis must be made on the basis of histopathological studies.

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Since the advent of the real time B-mode scanner, ultrasonic diagnosis has become indispensable in the field of obstetrics for fetal diagnosis on the basis of observation of the fetal movement. In this paper, the authors discuss the key points of ultrasonic diagnosis and the findings which require caution when this technique is employed for the diagnosis of the diseases frequently seen in the obstetric clinic.
In the early diagnosis of a normal pregnancy, the key points are the detection of the gestational sac and its gradual enlargement with the passage of time, and detection of the fetal heart movement and fetal movement. For the diagnosis of abortion and determination of the prognosis, the key points are detection of the growth, shape and position of the gestational sac, and the chorionic findings. Diagnosis of multiple pregnancies can be achieved during the 5th to 6th weeks of gestation on the basis of the number of gestational sacs, while after the 7th week of gestation the number of fetal (embryonic) heart movements can be employed, and once the fetus is sufficiently developed for the body parts to be distinguished, the number of fetal heads can be counted. However, care must be taken to distinguish such fetal sac appearances as double decidual sacs, uterus bicornis, and blighted twins. For the diagnosis of the fetal appendages, the early placenta can be distinguished by its partial projection into the amniotic cavity, while the developed placenta can be recognized as a mass structure in which a fine granular echo is covered by a fibrous echo. Hydatidiform moles, especially early hydatidiform moles and atypical hydatidiform moles, can be distinguished as a small cyst structure which occupies a deformed amniotic cavity and as an amorphous structure which also contains retained fluid. For the diagnosis of abnormalities of the site of placental attachment, evidence can be gained from the positional relationship between the inferior margin of the placenta and the upper edge of the cervical canal, and at the same time it is necessary to distinguish hypertrophic decidua and local thickening of the myometrium since these events can resemble a placenta previa. In addition, caution is required concerning the suitability of application of the bladder-filling method. The diagnosis of premature detachment of a normal-position placenta can be made on the basis of the presence of a retroplacental hematoma. Ectopic pregnancies can be identified with a high rate of accuracy on the basis of findings of a gravid uterus, even while an intrauterine pregnancy is ruled out, findings of extrauterine attachment of conceptus or a gravid swelling, and findings of a Douglas' cul-de-sac gravid mass or fluid retention.
In consideration of the above points, it is clear that sonography has become one of the most important diagnostic aids in obstetrics for the successful management of the perinatal period. Thus, it is suggested that it is necessary for physicians to achieve a thorough understanding of the obstetrical significance of the various findings provided by this technique during the course of pregnancy.

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The cases of abnormal volume of amniotic fluid experienced in our hospital were evaluated together with their neonatal diseases. Since it is thus clear that there is a distinct relationship between fetal anomalies and abnormalities in the volume of amniotic fluid, it is urgently required to approach positively toward prenatal diagnosis of congenital anomaly. In particular, it is expected that definition and prenatal diagnosis of oligoamnions be clarified as early as possible.

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Chromosome analysis using the G-banding method was performed on cultured lymphocytes in 100 married couples with history of spontaneous abortions more than 2 times. The results of this survey showed that 8 wives and 2 husbands of ten couples (10%) had congenital chromosome abnormalities; a balanced type of reciprocal translocation between two chromosomes, or a centric fusion type of translocation between two acrocentrics. As the incidence of translocation carriers of these types in newborn population in Japan was estimated at 0.146%, it was revealed from the present study that translocation carriers were markedly concentrated in couples with spontaneous abortions 54.8 times in wife's and 13.7 times in husband's population than the general population. As a practically meaningful suggestion, the correlation of chromosome abnormalities with the prior reproductive history of couples has been established from the analysis of the published data.

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Sister chromatid exchange (SCE) implies a symmetrical exchange at one site between two chromatids of a chromosome. SCE is considered to be an indication of DNA damage and repair, and examination of SCE is widely used as a sensitive method for evaluating the mutagenicity of various chemical agents. We analyzed SCE in lymphocytes of forty-five brain-damaged children and ten healthy controls in order to assess whether antiepileptic drugs (AEDs) induce SCEs.
Twenty-three epileptic patients were treated with phenytoin (PHT), phenobarbital (PB) and other AEDs. Twenty-two non-epileptic patients were not given AEDs. 0.5ml of heparinized blood was added to 5 ml of RPMI-1640 medium supplemented with 20% fetal bovine serum and 296 phytohemagglutinin-M. Forty-eight hours after initiation of culture, bromodeoxyuridine (BrdU) was added at a concentration of 0.04μ/ml and the cultures were further incubated for twenty-four hours including final two-hour treatment with colcemid. Lymphocytes from five patients and three controls were also cultured in medium containing various concentrations of PHT or PB. The preparations were stained by BrdU-alkaline-Giemsa method. SCE was counted in 20 cells from each subject.
The frequency of SCE/cell was 5.52±1.29 (mean±SD) in epileptics, 5.52±1.75 in non-epileptics and 3.98±0.48 in controls. SCEs in both epileptics and non-epileptics were signifi-cantly higher than those in controls by t-tets. But there was no significant difference between epileptics and non-epileptics. In vitro studies showed, however, an increase of SCE with elevating levels of either PHT or PB in all subjects.
Although our results showed no clear evidence that AEDs by themselves induced SCEs in brain-damaged patients, an increased SCE frequency due to AED treatment in vitro might suggest their possible mutagenicity.

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This report describes a case of 63-year-old female with sideroblastic anemia. At first she was diagnosed as aplastic anemia because of pancytopenia. Three and a half years later, histochemical examination of the bone marrow revealed ringed sideroblasts on the sideroblastogram. Chromosome analysis revealed abnormal pattern of 47 XX+8 in 34 cells of 35 bone marrow cells analyzed. These results strongly suggest involvement of preleukemic phase. She died of candidiasis after 6 months. Autopsy revealed, however, no leukemic findings in the bone marrow.

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A 52-year-old man was admitted because of his cardiac enlargement. He had been found his gait disturbance and insufficient extension of the elbow since childhood and was pointed out of the cardiac enlargement when he was 40 years of age. Physical examinations revealed bradycardia of 45 per minute, scapuloperoneal-type muscle weakness and atrophy, limitation of neck antiflexion and contracture of the right elbow. The marked enlargement of the CTR of 71% on a chest X-ray film and idioventricular rhythm on ECG were found. The cardiac catheterization showed permanent atrial standstill instead of normal cardiac pressure, cardiac index and LV ejection fraction with increased LV enddiastolic volume. In both electromusculography and muscle biopsy the neurogenic origin of the muscle abnormality was suggested. Thus, a diagnosis of Emery-Dreifuss Muscular Atrophy was made. Waters et al. reported the detailed hemodynamic studies of the disease in 1975, and our case corresponded to this disease.

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Von Recklinghausen's disease (neurofibromatosis) is a hereditary, autosomal dominant disease, characterized by cutaneous neurofibromas, accompanied by cafe-au-lait spots. The possible hazards of anesthesia are related to the widespread organ involvement and to other pathological changes. We examined retrospectively 36 patients in which anesthesia was performed 45 times (from 1967 to 1983).
Complications included severe kyphoscoliosis, renal artery dysplasia with hypertension, and laryngeal stenosis. No evident pheochromocytoma was found. Halothane was used 31 times. Enflurane, neuroleptic anesthesia, penthrane, ether, or epidural anesthesia was used for the rest of the cases. Anesthetic method did not seem to influence the outcome as long as measures were taken against the complications.
It is said that the anesthesiologists must prepare for an emergency when they deal with von Recklinghausen's disease, and that the most dangerous complication is a pheochromocytoma. Thus, a careful management is mandatory especially for hypertensive patients with von Recklinghausen's disease.

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The Moyamoya Disease is a cerebrovascular anomaly of unknown cause, first discovered in Japan about 1955.
Since only few cases have been reported so far about the complication of this disease during pregnancy, its management during pregnancy and delivery has not been well established.
The present case was a 28-year-old woman with gravida 1, para 0, and the patient was hospitalized in the 35th week of prengancy due to toxemia.
On the 17th day of hospitalization, the patient developed a severe headache while sleeping at night, and immediately lost consciousness completely.
A CT scan revealed bilateral intraventricular hemorrhage, and a hematoma was surgically removed, and subsequently a 2700g baby girl was delivered by Cesarean section with the Apgar score of 7 points.
Afterwards, the patient fell into a vegetable, comatose state, and 11 months later, intracranial hemorrhage occurred again, and at that time the diagnosis of Moyamoya disease was made by the carotid angiography.
The patient died on the next day.

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Diabetes insipidus is seldom associated with pregnancy.
A 27-year-old woman (gravida; 1, para; 1) developed diabetes insipidus at the third trimester of previous pregnancy and it disappeared 30 days postpartum. During the last pregnancy she had repeatedly diabetes insipidus and it also disappeared immediately after delivery.
Although various theories have been proposed to account for the effect of pregnancy on the development of diabetes insipidus, it is suggested that development of diabetes insipidus in the present case may result from increased vasopressinase activity during pregnancy.

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[in Japanese]

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