Sixty-four episodes of septicemia in 50 patients with hematological malignancy documented from January 1978 to December 1986 in the National Cancer Center Hospital were analyzed on the basis of their pathogens and therapeutic effects.
The group which had been on antibiotic therapy at the onset of septicemia (antibiotics (+)) was compared with another group which had not yet received antibiotic therapy at that time (antibiotics (-)).
1) Seventy-one strains of bacilli were isolated from the total number of 64 cases, including 7 cases diagnosed as infections caused by two organisms. In 31 strains of the antibiotics(+) group, Ps. aeruginosa, Enterococcus and Enterobacter cloacae were identified in 45%, 13% and 10% of the cases, respectively. On the other hand, in 40 strains of the antibiotics(-) group, Kl. pneumoniae, Ps. aeruginosa and E. coil were identified in 30%, 13% and 10% of the cases, respectively.
2) Twenty-two percent of the cases of the antibiotics(+) group and the 77% of the antibiotics (-) group were responded to treatment, and the difference between the two groups was significant (p<0.001). However, there was no significant difference in the therapeutic efficacy between these two groups in granulocyte count and duration of leucocytopenia (<500/cmm) before the diagnosis of septicemia or the primary disease.
3) No significant difference was observed between the antibiotics(+) and antibiotics(-) groups in the therapeutic efficacy of combination therapy among aminoglycosides, broad penicillins and cephems. Of the various combinations in the antibiotics(-) group, the
drug efficacy was compared by the administration schedule between t. i. d. and b. i. d.. The former dosage schedule was higher than that of the latter in the rate of efficacy, but no significant difference was observed between them.

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The long-latency event-related potential (P300) has been shown to reflect endogenous information process especially related to the cognitive function in the human brain. The purpose of this report was to assess the global mental function in normal subjects and the patients with vascular dementia. In this paper we described a standard method for the recording of auditory P300 and N100 components and the assessment of the global mental function using a parameter of the P300-N100 latency difference.
Defined P300 and N100 components were recorded in all 35 normal subjects with the age from 18 to 82 years old and 24 patients with vascular dementia (ages ranging from 34 to 88 years old). The P300 latency gradually increased proportionally with the increase of the age. The regression line was represented by the equation: Y=1.42X+285 and the correlation coefficient was 0.76. The N100 latency was relatively constant with the value
70—130 msec. The latency difference between the P300 and N100 component was strongly related to the age of the subjects.
The P300 latency was significantly prolonged in the patients with dementia when compared to the normal subjects (p<0.01). The P300 latency was more prominently prolonged in the patients with severe dementia evaluated by the neuropsychological tests including WAIS when compared to the patients with mild dementia.
With using a simple mental task of the discrimination of the two different tones, we successfully described the mental function of the patients with dementia. The P300 measurement technique was a very useful and reliable tool for the evaluation of the global mental function on both the electrophysiological and clinical practice as well.

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We measured serum and urine myoglobin (Mb) in children with various stages of chronic renal diseases. Furthermore, we investigated the correlation between Mb andbeta 2-microglobulin (β₂-M), blood urea nitrogen (BUN) or creatinine (Cr) and the following results were obtained.
1) Serum Mb in normal children was 24.6±15.0 ng/ml. In patients with nephrotic syndrome or membranous proliferative glomerulonephritis and with normal renal function, serum Mb was within normal limits. In 2 patients with chronic glomerulonephritis and with disturbed renal function, serum Mb level was significantly high.
In IgA nephropathy, other persistent glomerulonephritis and Henoch-Schönlein purpura nephritis, serum Mb was within normal limits and in 1 case of de Toni-Debre-Fanconi syndrome with slightly disturbed renal function, serum Mb level was high.
2) Correlation coefficients of serum Mb with β₂-M, BUN and Cr were 0.904, 0.777 and 0.859 respectively.
3) Urine Mb level was high in some cases with steroid-resistant nephrotic syndrome or Fanconi syndrome, but in the other cases it was normal.
It seemed that serum Mb was a good indicator to detect an early change of progressing renal glomerular damage and urine Mb level was useful to estimate the function of renal tubules.
Measurement of Mb was easier than that of β₂-M, so it is a useful marker to estimate the progression of renal diseases in childhood.

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We tried to determine exercise tolerance by comparing urine levels of creatinine, albumin, beta 2-microglobulin (β₂-M), IgG and transferrin (Tf) for the first 1 hour and second 1 hour after treadmill exercise test in children with chronic renal glomerular diseases.
Furthermore, we measured serum and urine myoglobulin (Mb) before and after physical education at school and the following results were obtained.
1) Urine IgG was not detected and the other urine parameters were not so varied before and after treadmill exercise in patients with steroid-sensitive nephrotic syndrome.
2) In 5 out of 8 cases with nephritic nephrosis or persistent glomerulonephritis, urine IgG was detected and urine IgG/Tf ratio of these cases tended to elevate after exercise.
3) As to the level of urine β₂-M, a marked tendency was not observed but in 1 case with IgG excretion after exercise, urine β₂-M was markedly increased.
4) As to the level of serum and urine Mb before and after physical education, we observed a marked increase in urine Mb in 1 case with slightly disturbed renal function.
In cases with increased level of urine IgG/Tf ratio or increased urine Mb concentration, mild or moderate degree of exercise was considered to be appropriate.

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There were 3 outbreaks of VZ infection among the children with chronic diseases in the wards for 6 years (1979-1985), and we injected VZ live vaccine to the patients for preventing the infection. Twenty-one boys and 5 girls underwent vaccination with subcutaneous injection to an upper arm. Those patients who had a past history of VZ infection, positive intra-cutaneous reaction, or positive antibody titer of VZ were excepted from the present study. We obtained the following results by injection of VZ vaccine.
1) The preventive effect of VZ vaccine on the VZ infection was excellent and there were no side effects.
2) In only one case, the original disease took a bad turn (a relapse).
3) Elevation of VZ antibody titer (or positive intradermal reaction) was obtained in all cases who were examined and it seemed that all patients gained enough immunity to prevent VZ infection.
It seems that it is necessary to inject VZ vaccine positively in the children wards of chronic diseases to prevent the VZ infection.

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Microdensitometric analysis of radiograms of the second metacarpal bone and related biochemical parameters were investigated in one hundred and four severely handicapped children and adults. These patients were classified according to the degree of limited mobility (group 1, bedridden; group 2, capable of rolling; group 3, capable of crawling; group 4, capable of walking). The metacarpal index (MCI), the cortical bone density (ΔGSmax), the medullary bone density (ΔGSmin) and the bone density per unit length (ΣGS/D) were decreased, especially in group 1.
Serum 25-hydroxy vitamin D₃ and 1α, 25-dihydroxy vitamin D₃ were the lower levels of normal range in these patients. Serum calcium, inorganic phosphorus, alkaline phosphatase and parathyroid hormone were normal.
The admistration of 1α-hydroxy vitamin D₃ improved the bone density, but MCI was not significantly increased. Exercise may be necessary to increase the width of cortical bone.
It is concluded that limited physiological activity results in bone fragility and the prevention of deterioration of mobility may be important in these handicapped patients.

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The medical training for the feeding in the most cases of severely handicapped children is very difficult. For improving the training, the body size and the basal metabolic volume (BM) of severely handicapped children were measured and the measuring methods were discussed.
A total of 66 severely handicapped children were examined. They were divided into 4 groups by the motor function. The classification of the groups and the number of the children in each group were as in the following; group I was walking (12), group II was creeping (9), group III was sitting up in bed (11), group IV was lying (34). As a result, the average age, height, weight and Kaup index of them were 17 years old, 132cm, 25kg and 14, respectively. These average values were accounted for 83, 52 and 71% of each standard value. Especially, in group N, there were many very thin children. The average BM was 755kcal/day, and it was very low, 56.6% of the BM of healthy children (1350kcal/day).
Accordingly, the severely handicapped children whose physical constitutions were quite different from healthy children were examined, and the method of measuring BM was theoretical and practical when discussing the measurement of BM by kcal/m²/hr. Eighty-five percent of the standard measurement, which was calculated from the measurement of BM by kcal/m²/hr of the healthy children based on each sex and age, was considered as the BM of the severely handicapped children.

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The purpose of this study was to determine the energy allowance of severely handicapped children. The activity during the daily life of 30 severely handicapped children was examined and the energy expenditure was determined. These children were divided into 4 groups. The classification of the groups and the number of these children were as in the following; group I was walking (9), group II was creeping (7), group III was sitting up in bed (4), group IV was lying (10). Activity index (X) was calculated by the energy expenditure in each group. Since these children were in their developing stage, the weight increment of 134 severely handicapped children for one year was obtained to take the weight increase index (G), and the calculating way for the energy allowance was examined.
The following results were obtained: 1) The time systems of the daily life of these children were different from the motor functions. Children spending their time in a bed for 80 to 90% of a day in group IV should improve their daily activities. 2) Life activity indices of each group were; group I 0.18, group II 0.12, group III 0.08, group IV 0.05. These indices were almost same as the healthy children except group I. 3) Weight increase indices (G) were, 0.08 in children under one year, 0.02 in 2 to 4 years old, 0.01 in 15 to 19 and 0 over 20. Weight increase index (G) was added to life activity index (X). 4) The mean of the energy allowance estimated from our results was 927 kcal/day. The mean of it's ST% was 41.

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Radionuclide hysterosalpingography (RNHSG) was performed to evaluate patency of the fallopian tube in the 16 sterility patients. First, in 3 out of 16 cases, technetium-99m macro-aggregated albumin (MAA) was deposited on the posterior formices of vagina, as described by Iturralde and Venter. But all of the 3 cases did not demonstrate spontaneous migration of Tc-MAA fom the vagina to the uterus and the ovaries. Therefore in the other 13 cases Tc-99m-MAA particles were applied directory onto the internal cervical mucosa through the cervical canal using a syringe with a blunt needle. This method was compared with contrast histerosalpingography (CHSG).
In the evaluation of 26 tubes we found that the accuracy of RNHSG for evaluation of the fallopian tube patency was over 92%. RNHSG could demonstrate functional fallopian tube obstruction in an immobile but anatomically patent tube.
RNHSG is paticulary an attractive method for the evaluation of functional and mechanical tube obstruction in sterility patients.

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The authors evaluated the correlation between aneurysmal intraventricular hemorrhage (IVH) and its clinical course. This series included 187 cases of ruptured cerebral aneurysm in which CT scan was performed within 72 hours after the episode of subarachnoidal hemorrhage (SAH). The cases of IVH were classified as follows, ventricular rupture (VR) and ventricular influx (VI). Furthermore, the degree of IVH was classified into five groups (grade 1: slight to grade 5: cast). Of 187 cases with ruptured cerebral aneurysms, IVH was recognized in 65 cases (35%). VR was demonstrated in 37 cases and VI in 28. Regarding the degree of IVH, grade 1 was 33 cases, grade 2: 3 cases, grade 3: 12 cases, grade 4: 6 cases and grade 5: 11 cases. In 37 individuals with VR, many ruptured cerebral aneurysms were located on anterior cerebral artery complex (32/37). On the other hand, in 28 cases with VI, ruptured aneurysms of anterior cerebral artery complex were only five cases. Overall mortality was 61.5% in IVH group and 24.6-0 in non-IVH group. Of 98 cases in which intracranial surgery was performed within 48 hours after SAH, incidence of poor and dead cases was 41% (9/22) in IVH group and 18% (14/76) in non-IVH group. This was statistically significant (p<0.03). Furthermore, incidence of poor and dead cases was 63% (12/19) in VR group and 17% (13/18) in VI group. The outcome of patients with VR was statistically worse than patients with VI (p<0.01).
Regarding the level of consciousness in 60 cases with IVH in whom intracerebral hematoma with mass effect was not recognized, VR group did worse than VI group at CT examination, but grading of IVH was not related to the degree of consciousness.
Regarding IVH due to ruptured cerebral aneurysms, clinical aggravation in the acute stage was correlated to VR than clot in suprasellar cistern.

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The aim of the present study was to measure and compare the blood loss when total hip replacement was performed under epidural and general anesthesia. Forty-three patients underwent either epidural analgesia with mepivacaine or bupivacaine (E-group, n=22), or general anesthesia with Thalamonal^TM, thiamylal, pancuronium and N₂O/O₂ (G-group, n=21) for total hip replacement. Preoperatively the patients were of equal physical status with similar laboratory values.
The mean arterial blood pressure before induction of anesthesia and during operation and average duration of operation didn't differ significantly. The mean blood loss of the E-group was 708±330g (mean±s. d.) and that of the patients in the G-group was 979±401 g. Patients in the E-group lost significantly less blood at operation than those in the G-group (p<0.05). After operation the mean blood loss of patients in the E-group was also less than that in the G-group (p<0.05). The fall in hemoglobin concentration on the first postoperative day, however, was identical in the two groups. Because arterial blood pressure did not differ significantly between the two groups, it can't be the main reason for decreased bleeding during operation. Controlled ventilation used in general anesthesia in this study, gave a rise in intrathoracic as well as venous pressure. The absence of this mode of ventilation in the epidural group may be the reason for the decreased blood loss as compared to the general anesthesia group. From this series it is evident that the need for blood transfusion in the total hip replacement can be significantly reduced by the use of epidural analgesia.

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Changes of the activities of six enzymes in serum, GOT, GPT, LDH, GGTP, ALP and LAP, before and after the administration of phenobarbital and phenytoin, 75 mg and 225mg/day, respectively, were studied in six cases. A significant rise in serum GGTP activity was observed in all the cases. However, the mode of elevation was different individually. The highest activity of GGTP was found to be 4.4 times of the activity prior to the administration, Early rise of the activities of serum GPT was observed in 5 out of 6 cases. Those results suggest that phenobarbital and phenytoin may induce GGTP and, furthermore, may change the membrane permeability of the hepatic cell.

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Protein-bound fatty acids obtained after the lipid extraction of Marrinetti and Catteau's method were analyzed by gas-liquid chromatography. The saturation indices of the fatty acids of three patients with chorea-acanthocytosis were low (0.31±0.30, n=3), compared to that of normal controls (0.74±0.25, n=10). Sialic acid contents of the erythrocyte membrane of the patients were lower than that of the controls, while serum sialic acid contents were normal.
These findings also support our previous reports that acanthocytes could be formed by abnormal interaction between proteins and lipids deep inside the erythrocyte membranes in the patients with chorea-acanthocytosis.

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We studied the role of biogenic amines in the genesis of convulsions induced by lidocaine, pentylenetetrazole in mice.
Convulsive dose (CD₅₀) of lidocaine and pentylenetetrazole was 70mg/kg, 55mg/kg, respectively. Lidocaine convulsion was attenuated by pre-treatment with a-methyl-p-tyrosine or 5-hydroxytryptophan or disulfiram, but was augmented by pre-treatment of methamphetamine or p-chlorophenylalanine.
These data suggest that central noradrenergic system is involved in lidocaine convulsion.

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This study group was organized to improve the results of radiotherapy in national hospitals. The period of the study is three years from 1986 to 1989.
Many national hospitals are the centers of local medical facilities, therefore, it is expected that they should play their role to offer the high technical care, inspite of the great unbalanced finance.
This study had been conducted to improve the results of radiotherapy.
The fundamental studies including the dose distribution, time dose factor and proper arrangement of radiotherapeutic equipments, and the clinical studies including applied hyperthermia, sensitizes and chemotherapy were performed respectively. Preliminary results were satisfactory.

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The clinical features of pituitary insufficiency are related to the lack of individual pituitary hormones and their specific target gland secretion. We experienced two cases of hypopituitarism with no definite symptoms but consciousness disturbance by chronic hypoglycemia. One case was 44 year old male and the other was 67 year old female. There were not enough signs and symptoms suggesting hypogonadism and hypothyroidism. The endocrinological examinations were performed because of the documentation of hypoglycemia and the reversibility of the symptoms upon administration of glucose, and a diagnosis of idiopathic hypopituitarism was made.
In reviewing 1058 cases of hypopituitarism in Japan, the symptoms relating to a deficiency of gonadotropin and/or thyrotropin were more common than those of hypoglycemia (only 13.4%).
It was of interest in the present case that there was isolated symptom of ACTH deficiency and that symptoms of other pituitary hormone deficiency were little.

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With the development of antibiotics, the number of cases of actinomycosis of the jaw (lumpy jaw) which show the typical clinical symptoms have been decreasing. We experienced a case of lumpy jaw which developed during the treatment of idiopathic thrombocytopenic purpura.
The case was an 18-year-old male with idiopathic thrombocytopenic purpura, who received steroid hormones and immunosuppressive agents and underwent a therapeutic splenectomy. During the period of reducing the doses of steroid hormones, he developed lockjaw. The lockjaw gradually progressed and the typical signs of lumpy jaw such as brawny indurations, multiple abscesses and sulphur granules in pus were observed. Because the administration of steroid hormones and immunosuppressive agents could not be discontinued, the use of antibiotics which were usually effective had no effects, and the healing of both diseases were delayed. Several antibiotics were tried, and minocycline and ofloxacin were found effective. About seven months later the actinomicosis of the jaw was cured, and subsequently the idiopathic thrombocytopenic purpura was healed. No signs of relapse have been observed.

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