Measles is a most popular and epidemic viral infection of children. At Miyakonojo, in the Miyazaki Prefecture, a marked epidemic of measles have been continuing since 1984. Most of the patients were infants aged from 6 months to 2 years old. Some of them suffered from measles pneumonitis with severe A-a block in ABB. The patients of measles pneumonitis developed severe dyspnea, tachypnea, inspiratory-retraction, and cyanosis, etc.
A remarkable hilar shadow (butterfly-shaped) on the chest X-ray film was common, and some cases showed pneumomediastinum and pneumothorax.
We consider the factors of this epidemic of measles pneumonitis as follows:
(1) regional and environmental factor, (2) antipyretics (iatrogenic factor), (3) infants (age and immunological factors), and (4) viral factor.

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Three children died of measles pneumonitis in Miyakonojo. Their clinical course worsened abruptly and severely. Various methods of treatment were tried for measles pneumonitis.
In this paper we report four cases of measles pneumonitis. They underwent various treatments and took various courses.
Case 1: The patient deteriorated rapidly and died of severe A-a block. No active therapy could not be given since this was the first case of severe measles pneumonitis.
Case 2: The patient was a female child and pulmonary fibrosis was a complication that caused continued dyspnea (inspiratory-retraction, tachypnea, cyanosis) for a long time.
Case 3: In this case the pulse therapy was tried with the combined use of γ-globulin and diuretics. The patient's condition improved rapidly.
Case 4: Use of mother's fresh blood which contained high titer of anti-measles antibody cured the baby dramatically.
We conclude that the therapy of measles pneumonitis should be as in the following.
(1) Antipyretics
Extreme care must be required in using antipyretics when the patient suffers from measles. Careless use of antipyretics may provoke the patient's pneumonitis.
(2) Drip infusion
Rapid infusion must be avoided. Overhydration will induce severe pneumonitis, because the patients with measles are often associated with SIADH.
(3) Pulse therapy
Pulse therapy is effective for measles pneumonitis. And then it is important to make the patient's hydration a rather dry side.
(4) Anti -measles antibody
Fresh blood containing the high-titer of anti-measles antibody is very effective for measles pneumonitis.

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Herpetic whitlow, an infection of the fingers after contact with herpes simplex virus has been increasing and has become one of the common viral infections among hospital personnels. When hospital workers treat the patients with labial or oral herpes simplex without the rubber gloves, herpes virus is liable to be transmitted to the site of previous trivial trauma. Primary eruption is vesicular and painful, usually persisting for three to four weeks. In order to prevent such viral infection, hospital personnels should use the rubber gloves during treatment of patients with viral diseases and dump the needles contaminated with virus immediately without recapping to avoid the risk of needle-sticks.

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Eighteen patients with gastrointestinal symptoms with an elevated urinary amylase in the wards of severely handicapped children from February to March in 1987 was studied. Their ages ranged from 10 to 45 years, with a mean of 27.
These symptoms included nausea, loss of appetite, diarrhea and abdominal distension. Urinary amylase increased in all cases and serum amylase in 5 cases. The clinical course was mild in all cases. These results suggested that they were considered to be a mild form of pancreatitis. Viral study was not available for the etiology.
Urinary amylase became normalized within one week except 5 cases with a persistent elevation of urine amylase activity without symptoms.
Severely handicapped children often show gastrointestinal symptoms. These observations suggest that pancreatitis may be one of the most important causes in handicapped children with gastrointestinal symptoms.

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In patients with bone and joint tuberculosis (T. b.) with no response to rifampicin (RFP), we performed therapeutic drug monitoring using the determination of serum RFP concentrations. However, some patients could not obtain therapeutic efficacy in spite of the sufficient therapeutic concentration of RFP in serum. It was demonstrated that, using serum RFP concentration, it was not accurate to speculate the RFP concentrations in the T. b. tissues including bone, granulation tissues, and pus: Accordingly, in order to know the RFP concentrations of the T. b. tissues, we directly measured RFP concentrations of the T. b. tissues which were obtained at surgical operations. As the results, the parallel relationship between serum RFP concentrations and the RFP concentrations of the T. b. tissues could not be obtained. This finding led us to make the appropriate guideline for the therapeutic efficacy of RFP in patients with bone and joint T. b.
We studied other method for the improvement of therapeutic efficacy of RFP in the T. b. patients. Medication guide has been done in order to improve the compliance for RFP. In our medication guide, we informed the serum RFP concentrations to the patients, and we called it feedback. The patients were encouraged by this feedback; they became cooperative during their treatment; it was useful to shorten both the treament and admission periods for the patients. It was also expected that this feedback may prevent relapse of T. b.

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One hundred and forty-eight patients with recurrent breast cancer were treated in our hospital during the 15 years from January 1967 to December 1981. Eighteen patients had a long disease-free interval (more than 5 years).
In this paper, we analyzed the clinical features and treatment of these patients.
The following results were obtained; (1) The clinical stage of the primary lesions of these patients was relatively early and most cases were node-free.
(2) All of the five patients demonstrated positive ER.
(3) Common sites of recurrences were local skin or bone.
(4) Post-relapse survival (PRS) period was considerably prolonged.
Considering the above results, we conclude that surgery and endocrine therapy are the treatments of choice for local skin and osseous metastases, respectively.

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In immunochemotherapy for hepatocellular carcinoma, it is important to suppress the concurrence of necrosis in the non-cancerous region of the liver after administration of TAE (Lipiodol+ADM 10mg+Sponzel) as well as to recognize the tumor cells as heteroantigens. Thus, we examined the antitumor effects of OK-432 by injecting it into the hepatic artery simultaneously with TAE.
In five patients with primary hepatoma, TAE plus OK-432 10 KE were injected via the hepatic artery (group IA) and their immunobiochemical and histological data were compared with those of five controls receiving TAE only.
In the group IA, prominent leukocytosis and lymphopenia were observed immediately after the injection, but a statistically significant increase in both leukocyte and lymphocyte counts was observed at and two weeks after treatment, as compared with the controls. As to lymphocyte subsets, the group IA showed decreased OKT4 and OKT4/8, while the controls showed rather increased OKT4/8. Histologically, the group IA was characterized by cumulative infiltration of lymphocytes to the regions surrounding the tumor cells and degenerative destruction of the involved tumor cells. And we report the resected case after immunochemoembolization which is diagnosed as advanced hepatocellular carcinoma complicated by tumor thrombi of portal and hepatic vein.

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We examined partial pressure of CO₂ in expired gas (P_ETCO₂) by PCO₂ monitor and arterial PCO₂ (PaCO₂) simultaneously in 98 patients with Duchenne muscular dystrophy. Relationship between P_ETCO₂ and PaCO₂ was linear within and around normal value. But when value of PaCO₂ was abnormally high, lineality between two values was broken. We could predict value of PaCO₂ from P_ETCO₂ by the equation;
PaCO₂=1.45×P_ETCO₂-17.3 (r=0.91).
Examination of P_ETCO₂ was painless and studies could be repeated easily. We conclude that P_ETCO₂ examination is highly useful for the management of patients with Duchenne muscular dystrophy, because respiratory failure is the main cause of death in this disease.

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Cigarette smoking is not only one of the most important risk factors for coronary artery disease, but also anginal attacks often occur during smoking. Coronary vasoconstriction is considered to be one of the mechanisms which cause anginal episodes.
Thirty patients with angina pectoris, 27 men and 3 women, were investigated. Group I comprised 22 patients with rest angina and group II consisted of 8 patients with effort angina.
Five minutes after smoking one cigarette, a first study of ²⁰¹T1 myocardial SPECT was performed. Consecutively, after sublingual administration of isosorbide dinitrate, a second SPECT was done.
Most cases improved and it was recognized as positive when changes of localized perfusion defects were observed between both SPECTs. In the group I, 19 out of 22 patients (86%) were positive, but in the group II, 2 out of 8 (25%) were positive. The differences were statistically significant. (p<0.05)
By the examination of coronary angiography in 20 patients, the result of myocardial scintigraphy using cigarette smoking and isosorbide dinitrate seemed inversely proportional to the severity of narrowing of the coronary artery. In addition, background factors including risk factors were also compared for both groups. Because the result of this myocardial scintigraphy was positive in the rest angina group and in the group with minimal coronary arteriographic abnormalities, it suggests that myocardial scintigraphy using cigarette smoking and isosorbide dinitrate is useful as a non-invasive auxiliary diagnostic method to detect coronary spasm or coronary vasoconstriction-prone angina pectoris including silent myocardial ischemia.

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Blood pressure control in preeclampsia is inevitable for both maternal and fetal wellbeing. The uteroplacental insufficiency is considered as one of the causes of preeclampsia and intrauterine growth retardation (IUGR), so that we have to keep in mind not to decrease uteroplacental blood flow when using anti-hypertensive drugs.
For hypertensive pregnant women, hydralazine and alphamethyldopa have widely been used. Alpha-blockades, beta-blockades or Ca⁺⁺-antagonists have recently been used as antihypertensive drugs in preelampsia. In the same manner, labetalol hydrochloride which is alpha- and beta-blockade, has become the first choice for the same purpose, for it reduces peripheral blood vessel resistance without decreasing cardiac output which may improve uteroplacental insufficiency.
From 1985 to 1987 we investigated the effects of labetalol on maternal blood pressure and on babies' condition, by giving it to 9 pregnant women who became severe preeclampsia on the 2nd to the 3rd trimester. Labetalol was started by 150mg/day or 200mg/day orally and doubled every 3 or 4 days, until systolic blood pressure was controlled between 130 to 160mmHg and diastolic blood pressure between 90 to 110mmHg. Six out of the nine cases required labetalol of more than 600mg/day, in one case the maximum dose was 1000mg/day.
The mean gestosis index was 4.11 on admission, and decreased significantly to 3.44 after the drug administration. Proteinuria and edema also improved. All the babies were alive, five of which were small for dates (SFD). No adverse effects were recognized in both mother and newborn, except for 2 babies who developed transient tachypnea.
We conclude that labetalol hydrochloride can be the first choice of the drug in controlling blood pressure of preeclamptic patients without side effects.

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CT-guided stereotactic operation was performed in 55 patients with hypertensive intracerebral hematoma. Location of the hematoma was putamen in 28 cases, thalamus in 14 cases, subcortical area in 9 cases, cerebellum in 3 cases and pons in one case. Ages ranged from 36 to 85 years (mean 59.5). The mean timing of the surgery after bleeding was 4.2 days. The estimated volume of the hematoma on CT was 8ml to 57ml in putaminal, 9ml to 40ml in thalamic, 18ml to 77ml in subcortical, 17ml to 26ml in cerebellar and 5ml in pontine hemorrhage. Aspiration rate at surgery was 60.4% in putaminal, 37.9% in thalamic, 41.7% in subcortical, 45.2% in cerebellar and 30% in pontine hemorrhage. In addition, we evaluated ADL at 6 months postoperatively in patients with putaminal and thalamic hemorrhage. It is concluded that stereotactic operation is advisable in those cases with 10 to 50ml hematoma volumes in putamen or thalamus. On the other hand, in cases with over 50ml volume, hematoma should be evacuated by craniotomy.

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Among children with nephrotic syndrome admitted to Mie Byoin National Sanatorium between 1982 and 1984, 32 cases were diagnosed at first biopsy as minimal-change nephrotic syndrome, and 13 of these 32 cases demonstrated positive IgM by immunofluorescence studies. These cases consisted of 11 steroid-sensitive (84%), 1 steroid-dependent (8%) and 1 steroidresistant (8% cases). At second biopsy, the steroid-resistant patient was diagnosed as having FGS, and remission was not achieved. However, all of the rest of the patients achieved remission. Although the IgM-positive group showed massive proteinuria, no cases were complicated by hematuria or high blood pressure. A comparative study between IgM-positive and IgM-negative cases with regard to clinical findings, response to treatment and prognosis revealed no significant difference. Therefore, patients with IgM-positive minimalchange nephrotic syndrome could be handled in the same way as IgM-negative patients, and only those resistant to therapy would seem to require a follow-up renal study.

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We evaluated clinical and laboratory findings of the high-risk group in organic acidemias. We also evaluated those of the patients with organic acidemias diagnosed by the screening during the last three years. We did this in order to use screening facilities in an efficient way.
Twenty-four patients with 6 different organic acidemias were detected after the analysis of urinary organic acids excretion in 550 patients which constituted the high-risk group. Of the 24 patients, 20 showed acute symptoms such as vomiting, convulsion, and/or consciousness disturbance. Of these, 10 patients were diagnosed as primary lactic acidosis and the other 10 patients had secondary lactic acidosis due to propionic acidemia or methylmalonic acidemia, and so on. Two patients were suffering from glycerol kinase deficiency. The remaining two patients were diagnosed without any clinical symptoms. One had multiple carboxylase deficiency and the other had dicarboxylic aciduria.
The major reasons for screening included psychomotor retardation, convulsions, and muscular hypotonia, but the diagnostic values of those symptoms were low and calculated to be 2.5%, 3.3% and 2.9%, respectively. On the other hand, lactic acidosis, metabolic acidosis, tachypnea, and hyperammonemia were characteristic findings of organic acidemia and the diagnositic values of those findings were calculated to be 48.8%, 38.5%, 35.7% and 28.60, respectively. These results indicate that when patients with suspected organic acidemias are associated with metabolic acidosis and/or lactic acidosis during an acute illness, they may possibly be suffering from some organic acidemias.
From our three-year experience in the screening of organic acidemias, the patient with muscular dystrophy associated with psychomotor retardation are considered to be a highrisk group for glycerol kinase deficiency. Patients with hyperleucinemia detected by a neonatal screening for inborn errors of metabolism may be thought as a high risk-group for multiple carboxylase deficiency. The patients whose siblings died of Reye syndrome-like symptoms should be investigated for dicarboxylic aciduria through a urinary organic acids excretion analysis, even if there are no clinical findings.

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A 65-year-old right-handed female is reported. She showed pure word deafness and auditory sound agnosia due to bilateral temporal lesions of the cerebrovascular accident. Brain CT-scan revealed a low-density area in the left temporal lobe and a high-density area extending the right temporal lobe.
Neuropsychological and audiological examination demonstrated no aphasic symptoms such as paraphasia, naming disturbance, or reading. Her auditory comprehension was severely involved, and she could neither repeat words nor write from dictation. She could not recognize familiar meaningful non-verbal sounds.
Pure tone audiometry was performed on her admission, but she could not answer constantly, although she seemed to be able to hear. And one months after the onset, she had a hearing loss of 30 to 50dB for 500 to 2000Hz, two months after the onset, 20 to 40dB hearing loss on both side. Auditory brain stem responses showed normal on the right and a little prolongation of I-V latency interval on the left. Middle latency responses and slow vertex responses were all normal.
Her disability to recognize meaningful sounds improved gradually, however, some degree of disability was still detected even two months after the onset.
We also discussed the auditory processing of verbal and non-verbal inputs, and explained the mechanism of pure word deafness and auditory agnosia of this case.

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Two cases of toxic megacolon associated with ulcerative colitis were successfully treated by medical therapy, one case was given steroid hormone intravenously and the other case was treated by intraarterial injection of steroid hormone through inferior and superior mesenteric arteries. It was useful to know the disease activities not only by the toxic factors but by the multiple disease activity indices to decide medical treatment or operation.
From 1976 to 1987, fourteen medically treated cases and 16 operative cases were reported in Japanese literatures. Eight cases were successfully treated by intraarterial steroid hormone injection therapy which was one of the most important treatments by our opinion, but one out of three undergoing surgery after intraarterial injection therapy died. So, overall mortality rate of intraarterial injection therapy was 9% The average duration of toxic megacolon was 7.1 days, among medically treated cases.
For these reason a policy will be recommended that; instead of the emergency earlier operation, intensive medical management including intraarterial steroid hormone injection therapy will be done, operative treatment will be undertaken after about seven days if necessary.

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Meconium peritonitis with intraperitoneal hemorrhage was a very rare condition.
A one-day-old girl, weighed 2534g, was referred to our department because of severe abdominal distension and respiratory distress. She was critically ill. The temperature was 37.4°C, pulse rate 173/min. and respiratory rate 42/min. Laboratory tests revealed that white blood cell count was 92, 300, and red blood cell count 228×10⁴. Blood gas analysis showed severe respiratory acidosis. Abdominal paracentesis was done to examine the ascitic fluid, which was greenish brown and contained both squamous cells and red cells. The presence of squamous cells indicated perforation of the intestine because they were present in amniotic fluid, which was swallowed. Under a diagnosis of meconium peritonitis with intraperitoneal hemorrhage, abdominal drainage was carried out under local anesthesia. Her general conditions improved gradually after the drainage of the abdominal cavity. At the 14th day after birth, laparotomy was done under general anesthesia. It revealed adhesive intestines and ileal atresia with partial necrosis. Resection of the ileum and drainage of the abdominal cavity were done. The postoperative course was uneventful. She is well now.

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Hip in patients with rheumatoid arthritis have protrusio deformity with thin medial acetabular walls. To reinforce the medial wall, the femoral head is fashioned into a solid graft which is anchored against the medial wall as a plug.
A series of eight operations on five patients was done. The clinical and radiographic results were uniformly good at a mean of 33 months postoperatively. All grafts appeared to be united and incorporated, without evidence of resorption, and no complications were encountered in a follow-up period ranging from 12 to 67 months.

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Placental sulfatase deficiency (PSD) is a rare disorder. However, we recently experienced two cases of this disorder. Urinary estriol measurements at routine prenatal checks of 36 gestational weeks were clues to diagnosis of both cases. Urine estriol levels were at extremely low, while serum HPL levels were normal. Fetal ultrasonographic and cardiotocographic findings revealed no abnormalities. DHAS loading test had no alteration to E₃ levels and placental sulfatase activities were remarkably decreased.
Case 1: A 26-year-old woman, gravida I, para I, showed less than 5μg/ml of urine E₃ levels at 36 weeks of gestation on August 18, 1986. She was admitted immediately on the same day and underwent further studies. She was diagnosed as PSD. Induction of labor was carried out on September 17, 1986. A 3170g male infant was delivered vaginally, with Apgar score of 9 and had no superficial abnormalities.
Case 2: A 27-year-old woman, gravida I, Para 0, showed less than 5μg/ml of urine E₃ levels at 36 weeks of gestation on August 26, 1986, and was also admitted immediately on the same day. She was diagnosed as the same disorder. Emergency C-section was required due to premature abruption of placenta at 38 weeks on September 11, 1986. A 2558g male infant was delivered with Apgar score of 9 and had no superficial abnormalities.
This disorder is X-linked, and recessively inherited. It is noticeable that ichthyosis develops on affected males. Babies in our two cases showed a slight degree of ichthyosis and have been followed up by a pediatrician and a dermatologist.

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The patient aged 89 years, suffering from dysuria due to benign prostatic hypertrophy underwent transurethral resection of the prostate under spinal anesthesia. During the operation, hypotension and somnolence and then wet rales developed in the whole area of his chest. Blood gas analysis revealed severe hypoxemia and metabolic acidosis, and the laboratory tests showed pancytopenia and hyponatremia. His chest X-ray film revealed lung edema. It was suspected that he developed water intoxication caused by massive intravascular absorption of irrigating solution.
Oxygen inhalation by face mask was started. Blood pressure recovered as soon as cardiovascular stimulant was injected and blood transfusion was started, and then diuretic, hypertonic sodium solution and dopamine were given by bolus or by drip infusion. The lowest value of serum sodium was 93mEq/l. All of the laboratory data recovered to almost normal level on the first postoperative day, and abnormal findings on his chest X-ray film disappeared on the second postoperative day.
This suggests that prevention, diagnosis and early treatment of water intoxication are important to save the patient's life.

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The patient, 50-year-old woman, was admitted to the hospital because of contusion of her right face. She was mentally retarded from birth and could not speak. One day before admission, she fell down and hit her right face on the ground. On admission, her right face was distended and could not open her right eye and fever developed. On laboratory examinations we found the pyuria and the elevation of the concentration of serum creatine kinase (CK), GOT and LDH. As the diagnosis of urinary tract infection was made and antibiotics was administered, she became afebrile within a few days. Myocardial infarction was ruled out by electrocardiograms. Electrophoretic analysis of CK revealed the extra-band between CK-MM and CK-MB. Thin-layer gel filtration using Sephadex G-200 superfine revealed the presence of high molecular weight form of CK. The high molecular weight form of CK was identified as the CK-linked immunoglobulin (IgA-lamda) by immunological analyses. The concentration of serum CK was down to normal range on the 20th day after admission when she recovered, and we could not detect the CK-linked immunoglobulin at that time.
The CK-linked immunoglobulin was found in the sera of patients with muscle diseases, myocardial infarction, ulcerative colitis and malignancies and so on, but there was only one report that it was found in the serum of a patient with muscle contusion. So, this case was thought to be a very rare case.
The mechanism of the appearance of CK-linked immunoglobulin is still unknown. Someone says that the non-specific reaction of the body is thought to be its mechanism, but others say that the immunological reaction may be involved in its mechanism. As CK-linked immunoglobulin is not detected at all in the sera of patients with myocardial infarction whose concentration of serum CK rises and falls rapidly like this case, we think that the immunological reaction may be involved in its mechanism.

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