Cadaver kidney procurement system was established by the Ministry of Health and Welfare in 1987 to promote cadaver kidney sharing through a computer network.
Japanese islands were devided into 8 blocks, i. e., Hokkaido, Tohoku, Kanto-Shinetsu, Tokai-Hokuriku, Kinki, Chugoku, Shikoku and Kyushu. Each block has one to four regional kidney procurement hospitals (sub-center) and was online through the host computer in Sakura National Kidney C enter. Transplantation hospitals in each block will be linked to the sub-center hospitals by computer system in the near future.
The kidney procurement computer networks have provided recipient candidates registration, authorized anti-HLA serum tray and donor-recipient matching support.
From 1983 to 1986, 7, 635 recipient candidates were listed and 6, 935 recipient candidates were typed HLA-A, B, C, DR by authorized HLA-tray. The donor-recipient matching by the computer system was supported 226 times, with an average of 56 each year.
In Japan, the yearly new treated cases of end-stage renal diseases (ESRD) were about 7, 000 and the total number of patients with chronic hemodialysis were 75, 000 at the end of 1986. On the other hand, the outcome of cadaver kidney transplantation is nearly as same as living-related donor, the graft survival was 70% at the fourth year after the application of new immunosuppressive agent, cyclosporine. But, the number of cadaver kidney transplantation remained small, about 150 cases a year.
The problems of promoting cadaver kidney transplantation are complex and numerous, but, the most encouraging factor is that staffs and people will have a right understanding of brain death and needs of kidney transplantation.
The Ministry of Health and Welfare set up the Kidney Transplantation Promoting Month from 1986 for the purpose of screening kidney diseases and educating the people to bring the donor-card.
We now have to recognize the treatment of ESRD from the view point of the national policy.

View full abstract

The dynamic function of the lymphatic system in the upper limb was examined by ^99mTc-HSA and the changes in lymph flows before and after surgery of breast cancer were examined. There were various types of lymphatic drainage system even in the normal cases, and these were classified into type I (subtypes a, b, c, and d) and type II (subtypes a, b, c, d, e, and f).
Type j decreased and type 11 increased after surgery of breast cancer. Postoperative edema was hardly observed in type j . When comparison was made between modified mastectomy and standard (extended) mastectomy, edema developed more frequently in the latter, and cases more than 3 years after operation showed a stronger tendency to have edema. Postoperative edema was hardly observed in cases where a lymph flow around the cephalic vein was observed before or after surgery.
Even in the normal cases, some showed stagnation of lymphatic flow around the subclavian region, and the diagnosis of metastasized lymph node by this method of examination was difficult.
Although saving life is the first thing to consider in the treatment of cancer, complete removal of the axillary lymph nodes in cases of early breast cancer is controversial.
Particularly, when removal of the adipose tissue on the cranial side of the subclavian artery and vein, around the cephalic vein and near the venous angle is performed, due care must be exercised, since this may cause postoperative edema.

View full abstract

The dynamic function of the lymphatic system in the upper limb was examined by ^99mTc-HSA and the changes in lymph flows before and after surgery of breast cancer were examined. There were various types of lymphatic drainage system even in the normal cases, and these were classified into type j (subtypes a, b, c, and d) and type Jf (subtypes a, b, c, d, e, and f).
Type I decreased and type II increased after surgery of breast cancer. Postoperative edema was hardly observed in type I. When comparison was made between modified mastectomy and standard (extended) mastectomy, edema developed more frequently in the latter, and cases more than 3 years after operation showed a stronger tendency to have edema. Postoperative edema was hardly observed in cases where a lymph flow around the cephalic vein was observed before or after surgery.
Even in the normal cases, some showed stagnation of lymphatic flow around the subclavian region, and the diagnosis of metastasized lymph node by this method of examination was difficult.
Although saving life is the first thing to consider in the treatment of cancer, complete removal of the axillary lymph nodes in cases of early breast cancer is controversial.
Particularly, when removal of the adipose tissue on the cranial side of the subclavian artery and vein, around the cephalic vein and near the venous angle is performed, due care must be exercised, since this may cause postoperative edema.

View full abstract

Recently, the breast reconstruction has become necessary, with increasing postoperative survival rate in the early stage of breast cancer. This report details our operative technique of the immediate breast reconstruction utilizing the transverse rectus abdominis myocutaneous flap.
The advantages of this method include an inconspicuous donor site scar, complete reconstrucion of a breast without mammary implant and the convenience of operating on patients lying supine on the operation table. Abdominoplasty is an additional benefit in the middle-aged women.
The disadvantages of this procedure include a lower abdominal weakness and an insufficiency of vascular supply at the contralateral flap tip. Abdominal wall herniation diminished using MARLEX MESH at the area without posterior rectus sheeth. Furthermore, we tried to deepithelize distal portion of the flap when it was fixed at the skin and chest wall.
The method of the transverse rectus abdominis myocutaneous flap is one of the useful procedures of the breast reconstruction.

View full abstract

Serum tumor markers (CEA, CA19-9, SCC, NSE) were measured in 64 patients with lung cancer and 34 patients with pulmonary tuberculosis. The serum CEA levels tended to be higher in adenocarcinoma, SCC in squamous cell carcinoma, NSE in small cell carcinoma, whereas CA19-9 levels were increased with the advancement of clinical stages. In pulmonary tuberculosis, serum levels of these tumor markers were within normal limits or slightly elevated in most cases except 3 cases with very high levels in SCC and NSE. These cases should be examined more completely and followed for a longer time. In lung cancer, measurement of CEA, CA19-9, SCC, and NSE is considered to be useful in the diagnosis and classification of histological types.

View full abstract

We studied on the extent of cancer invasion of biliary tract using intraoperative ultrasonography in 23 patients, including 6 gall bladder cancer, and 17 bile duct cancer (3 nodular type, 9 nodular invasive type, and 5 invasive type based on the General Rules on Cancer of Billiary Tract of Japanese Society). The ultrasound apparatus used in this study was Aloka SSD 256, 330 (5MHz and 7.5MHz) with immersion and direct contact methods. These ultrasonograms gave us the cancer invasion as irregular high echo zone extending the primary lesion, especially remarkable in the horizontal spreading aspect of bile duct wall. This procedure enabled us to have a more correct diagnosis of the extent of cancer invasion than the intraoperative cholangiography, so that this was not only very useful, but aslo necessary in the curative operation. Additionally to make sure, we did same trial on 10 cases of the Borrmann type 4 stomach cancer, supposedly showing the same scirrhous invasion in the pathology. The findings of these cases showed that such high echo area was identified with thick fibrous layer of the invasive cancer of biliary tract. We conclude that intraoperative ultrasonography give us a more correct diagnosis of the extent of bile duct cancer invasion than the intraoperative cholangiography and other methods, and that this procedure is not only very useful, but also necessary in the curative operation.

View full abstract

Accurate determination of the extent of neoplasm is essential for the proper surgical management of rectal cancer. Fifty-two patients with rectal cancer were examined by computed tomography (CT), in order to determine the direct invasion of rectal carcinoma and local lymphnode metastasis, between January 1984 and December 1980. Diagnostic accuracy rate for the direct invasion was 100% in the rectosigmoid and upper rectum, 76% in the lower rectum and 81% in the whole cases. CT identified local lymphnodes and accuracy was 69% in the rectal carcinoma.
CT is useful for the preoperative determination of the direct invasion of the rectal carcinoma.

View full abstract

A computer software, by which diabetic patients were instructed to change their insulin dosage, was developed using an expert-system-construction-support software, “SOGEN”, which was the only Japanese software available for personal computers at that time when we started this study. This application software was made in order to give instructions for the regimen of insulin therapy in which long-acting insulin, for example Lente or NPH insulin, was used once a day, but short-acting insulin could be used twice a day if necessary. Output of this application was quite similar to that of a physician. Thus, this could be used for the education of diabetics when they learned the self-injection of insulin guided by the self-measurement of blood glucose. Because “SOGEN” supported only production-type knowledge, the number of the rules in this software was too many. Thus, the whole view of the system could not be easily obtained. However, because each rule was written in easy Japanese, not in a sophsticated language for the computering, the content of the computer software could be understandable for any clinician without knowing the computering. This point was supposed to be important because the previous applications contained so-called “black box” in their software, and that was an obstacle to a wide acceptance of this kind of approach for the patient education.

View full abstract

An application software aimed for the education of diabetic patients, was made on a trial basis using TDK TUTOR SYSTEM TM. The end-product was executed in microcomputers PC 9801. The attitude of patients became more active when they used the application software, than when they were guided by printed materials. This kind of application software is considered to be useful in clinical situations, despite that has some limitations as it can be used only for the patients with attended physicians.

View full abstract

A clinic for consultation of cardiovascular diseases was opened in Vmlya Health Center, Ibaraki prefecture. The initial motivation of the project was our interest in taking part in the regional medical care. It was also expected that the opening would call the regional people's attention to the prevention and care of the diseases. From August 1984 to December 1987, 77 subjects were examined in the clinic. Further examinations were applied to 37 of them (48%). They derived from three sources: 1) various mass examinations of the lung cancer and tuberculosis, 2) consultation by general practitioners, and 3) applicants by themselves. In the first group, when specialists of the pulmonary diseases checked on the indirect chest x-ray films, abnormal findings of cardiovascular system were detected in 64 subjects who were advised to visit the clinic. Twenty-eight of them were candidates for further examinations. From the second and the third groups, 13 were examined.
In the clinic, a specialist of cardiovascular diseases examined them. The blood pressure measurement, history taking, percussion and auscultation were performed. The electrocardiograms were recorded at the specialist's judgement. The further examinations were done in Seiranso Byoin National Sanatorium. The results from those examinations were reported to the examinees through the Health Center. A diet regimen was also prescribed if necessary. Among the cardiac abnormalities, each one case of followings were operated: secundum atrial septal defect, coronary arterio-venous fistula and postinfarction angina pectoris. Permanent pacemaker implantations were done in two cases.
Through the progress of the activities of the clinic, cooperation of specialists of both pulmonary and cardiovascular diseases became possible and the x-ray films of mass examinations were used efficiently. The clinic would prospect for binding various factors of the regional medical care system.

View full abstract

Tinea corporis caused by Microsporum cants (M. canis) in humans exposed to cats infected with this dermatophyte is characterized by multiple, small erythematous patches with pronounced inflammatory manifestations. In this paper, a recent case showing as many as 81 skin lesions is presented, with some comments on 8 other cases dealt with the department during the past decade.
The patient was a 58-year-old housewife who developed a total of 81 skin lesions involving the face, trunk and forearms 2 weeks after she began to keep a stray cat having hairless patches in January 1986. The lesions were itchy, scarlet erythematous ones with associated marked signs of inflammation. Culture of scrapings of her affected skin and of diseased hair of the cat resulted in growth of fungi which were identified as M. canis.
Thus far there were 9 cases of tinea corporis caused by M. canis after exposure to cats. In this series, females were remarkably predominant with a male-to-female ratio of 2:7, both of the 2 males being a child. This fact indicates that this superficial dermatophyte infection of the skin occurs more commonly in women and children who are more likely to be exposed to cats than men. Skin lesions ranged in number from 7 to 81, all being small erythematous ones with pronounced signs of inflammation. Seven of these 9 patients were aware of hairless patches of the cats to which they were exposed. The fungus grown on culture of involved cat's hair was identified as M. canis in 4 of 5 patients.

View full abstract

Paraquat, diquat and 1, 1'-diethyl-4, 4'-bipyridyldiylium (internal standard) were analyzed simultaneously by a high-performance liquid chromatography. A Nova-Pak C₁₈ (3.9mm×15cm) column was used with an eluent of 12.5% methanol containing 0.005M 1-heptanesulphonate, 0.05M diethylamine and adjusted to pH 3.0 with orthophospholic acid. Paraquat and diquat were quantitatively detected at the level of 0.1μg/ml. This method was suitable for the analysis of paraquat and diquat in human serum samples following poisoning.
Furthermore, a procedure for the rapid and selective extraction of paraquat and diquat from human serum was modified using Sep-Pak C₁₈ cartridges without deproteinization. Serum or urine (1ml) from patient with 0.5μg of internal standard was adjusted pH to 11-13 with sodium hydroxide or ammonia then passed through Sep-Pak C₁₈ cartridge without deproteinization. Adsorbed herbicides were quantitatively eluted with acidic methanol (5ml) after the removal of interfering materials with water (5ml) and methanol (5ml).
These simple and rapid analytical methods would be useful in clinical laboratories.

View full abstract

During the past 11 years, 33 cases of carcinoma of the esophagus underwent surgical treatment at the department of surgery, Zentsuji National Hospital.
They were 26 males and 7 females, aged from 51 to 82 years (mean age 64.3 years). The chief complaint was the passage disturbance or difficulty in swallowing and the duration of the disease was 1 to 3 months in the majority of the cases. Location of the lesion was middle intrathoracic esophagus (Im) in 19 cases, lower intrathoracic (Ei) in 7 cases, upper (Iu) and abdominal esophagus (Ea) in 3 cases in each one and cervical (Ce) in one case. Radiological and endoscopical findings showed the advanced cancer except 2 cases with early cancer in superficial elevated types (mm ca. and ep ca. in histological findings). The stage classification was Stage I in 2 cases, II in 8 cases, III in 9 cases and N in 14 cases.
About the operative methods, reconstructions were performed with antethoracic route on 13 and retrosternal on 11 cases. The organs for substitution were stomach on 24 cases. The operative deaths were 5 cases. The prognosis of them were very poor and all of them, except 3 cases who still alived over one year, died within 3 years after the operation.
Three cases had the simultaneous primary multiple cancers (ca. of the tongue, stomach and liver). Another one case combined with esophageal varices had very poor prognosis due to rapid bone metastasis.

View full abstract

A 25-year-old man visited our hospital with a mass in his left testis. He then underwent a radical orchiectomy under the diagnosis of testicular tumor. Pathological diagnosis was choriocarcinoma and embryonal cell carcinoma. Postoperative serum α-fetoprotein and HCG returned rapidly to normal and there were no evidences of metastases by chest X-ray film, IVP, lymphography, US and CT. Based on these findings, diagnosis of stage I non-seminomatous germ cell testicular tumor was made and he was kept under medical treatment, adopting “watch and see policy”. Contrary to our expectation, the disease relapsed as retroperitoneal lymphadenopathy 4 months after the orchiectomy. However, the patient was treated by retroperitoneal lymphnode dissection (RPLND) combined with chemotherapy. At 6 months after RPLND, he is well and has no evidence of the disease.

View full abstract

A case of dermatomyositis associated with giant mitochondria in a liver was presented. A 57-year-old woman was admitted to our hospital because of eruption with itching and weakness of the proximal limb muscles. She had a lilac-coloured (heliotrope) change in the skin over the eyelid, chest, left upper and lower extremities. The results of main laboratory examinations on admission were as follows; elevation of erythrocyte sedimentation rate, high levels of LDH, GOT, GPT, and CPK, positive C-reactive protein, rheumatoid factor and antinuclear antibodies.
Morphologically, muscle biopsy showed infiltration of small round cell in the muscle, and the findings of liver biopsy were residua of acute hepatitis associated with giant mitochondria. These findings of this case highly suggest relationship between giant mitochondria in the liver and auto-immune disease. We reported this case and reviewed some additional literatures.

View full abstract

A 5-month-old, breast-fed mature infant developed eruption in 1987. When he was 3 months old, edematous erythema with slightly elevated margin developed on his face, especially on his bilateral cheek. After that, a rash appeared in the diaper area, finger and toes with diarrhea and alopecia. There was no family history of similar disorders.
A clinical diagnosis of zinc deficiency was made because the patient serum zinc level was low (15μg/dl). The patient was treated with 30mg of oral zinc sulfate daily. The clinical response was dramatic ; the eruption disappeared in one week. We discontinued the therapy of zinc supplementation, but any recurrences of the disease did not occur.
This means that the diagnosis of this patient could be acquired acrodermatitis enteropathica in a breast-fed infant.

View full abstract

A case of insulinoma is reported in which the localization of the tumor was established preoperatively using ultrasonography and angiography. The patient, a 22 year old woman, was admitted to our hospital because of syncopal attack. The blood insulin level was slightly high and both of fasting test and glucagon loading test showed the findings compatible with that of insulinoma. Ultrasonography and angiography revealed the tumor mass in the tail of the pancreas. The patient was treated with a distal pancreatectomy with splenectomy using the artificial pancreas. The histological examination of the pancreas showed insulinoma. The postoperative course was uneventful.

View full abstract

A 67-year-old man was admitted on July 14th 1986 because of general malaise, a low fever, loss of weight and an abnormal shadow on the chest x-ray film. He was diagnosed as pulmonary tuberculosis associated with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Hyponatremia was relieved by administration of antituberculous agents and the restriction of water intake. There have been only a few reports about cases of pulmonary tuberculosis associated with SIADH. The pathogenesis and treatment of this disorder were also discussed.

View full abstract

A rare case of sellar mixed germ cell tumor is reported. A 13-year-old boy suffering from headache, nausea, and vomiting was diagnosed as sellar tumor by CT scanning and MRI. Both serum alpha-fetoprotein (AFP) and serum human chorionic gonadotropin (HCG) levels were markedly elevated. Partial resection of the tumor was performed and it showed histologically the mixed germ cell tumor composed of seminoma, yolk sac tumor, and choriocarcinoma. Both AFP and HCG were demonstrated in the tumor cells by the immunohistochemical method. The levels of serum AFP and HCG decreased after the resection followed by chemotherapy and radiation, and increased prior to the recurrence. Immunohistochemical studies for AFP and HCG can be a tool for diagnosing the primary intracranial germ cell tumor. And serum AFP and serum HCG may represent a specific and sensitive markers for monitoring these germ cell tumor.

View full abstract

A 65 year old female was admitted to the hospital because of headache, nausea and vomiting after a head injury. She developed somnolence 9 days after the injury. Cranial computed tomograpy (CT scan) revealed right occipital hematoma and bilateral subdural effusion. The conservative treatment was done, then neurological signs and symptoms improved gradually. Abnormal behavior and right hemiparesis were seen after 80 days of the injury. The CT scan disclosed left subdural hematoma. Left parietal burr-hole craniotomy and evacuation and irrigation of the hematoma were performed with good recovery. CT scan taken after 102 days of her injury showed right subdural hematoma which disappeared without operation in one year.
Subdural hygroma resulting from a tear of traumatic arachnoid membrane may develop to chronic subdural hematoma. Therefore, careful observation should be required when CT scan shows posttraumatic subdural hygroma.

View full abstract