Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system. Recent studies in experimental allergic encephalomyelitis and acquired knowledge in fundamental immunology using molecular biological techniques suggest that the inactivation of T cells by anti-disease specific T cell receptor will be a specific therapy for MS. Here, I'll present the recent advances in the diagnosis and treatment of MS.

View full abstract

Forty-two death cases of tuberculosis (120 of 350 inpatients with tuberculosis) happened in our hospital during the 5-year period from 1984 through 1989. The age of the time of death was over 70 years old in 66.7 per cent of the total death cases. Twenty-three cases (54.8%) received initial chemtoherapy and 8 cases (19.0%) received repeat-chemo-therapy.
Four cases (9.5%) were persisters. Seven cases with sequelae of tuberculosis (16.7%) received no chemotherapy. Eight cases (19.4%) had positive M. tb. in sputum and 5 cases (11.9%) had positive atypical mycobacterium in terminal stage.
As to their cause of death, death from respiratory failure occurred in 12 cases (28.6%), death from pneumonia occurred in 7 cases (16.7%), death from cancer occurred in 9 cases (21.4%) and death from tuberculosis occurred in 3 cases (7.1%). Death of respiratory failure and hemoptysis from tuberculosis and tuberculosis death were 30.9 per cent of total death cases.
Poor prognostic factors were found in respiratoy failure (33.3% of total cases), airway infection (16.7%) bedridden patients (14.3%) and low nutrients (23.8%).

View full abstract

Seventeen consecutive episodes of blood culture-positive infection in 14 patients were evaluated out of 401 children with acute lymphocytic leukemia (ALL) between January 1919 and December 1988 in the Department of Pediatrics, Sapporo National Hospital.
The most frequent organism causing septicemia were Klebsiclla pneuntoniae and Staphylococcus epidermidis. Most cases of septicemia occurred during induction therapy or in relapse. All septicemia developed when the absolute neutrophil count was less than 500/mm³. The incidence of septicemia decreased with increasing levels of granulocytes. No children with granulocyte count greater than 1000/mm³ died in connection with septicemia. All the episodes occurring at the neutrophil count under 100/mm³ were fatal. Polymicrobic septicemia occurred 2 times and multiple episodes 5 times and high mortality rate were seen in these cases.
The prompt use of broad-spectrum antibiotics may be considered when granulocyto-penic patients with ALL become febrile.

View full abstract

Peptic ulcer, gastrointestinal perforation, and amyloidosis associated with collagen disease were studied. Prospectively, peptic ulcer was found in 30 (22.3%) of 134 cases of rheumatoid arthritis (RA), and three (3.3%) of 90 cases of other collagen diseases. Peptic ulcer associated with RA was found much more in the stomach (86.7%) rather than in the duodenum (6.7%). 63.6% of gastric ulcer in RA was located in the antral region. 45.2% of peptic ulcer in RA was painless and incidentally found out. Periodic screening of peptic ulcer was recommended in RA patients. Two cases of intestinal perforation in patients with systemic lupus erythematosus (SUE) and mixed connective tissue disease (MCTD) were reported. In both cases, emergent operation revealed the multiple ulcer perforation in the small intestine. It was noticed that symptoms of peritonitis due to gastrointestinal perforation was somewhat masked in the patient with corticosteroid-treated collagen disease, and there was no obvious relationship between clinical or serological course and intestinal perforation. Nine cases of secondary amyloidosis associated with RA were described. Biopsy of the stomach was useful to diagnose amyloidosis (positive proportion for amyloid: 86%). Persistent diarrhea and gastrointestinal bleeding were hardly treatable, so that gastrointestinal amyloidosis was considered to be one of the life-threatening factor in the patients with amyloidosis associated with RA. In addition, randomized study of biopsy of the gastric antral region was performed in the outpatients with RA. Biopsy specimens positive for amyloid was found in one of 27 cases (4%).

View full abstract

The author reports and discusses the ocular complications and management of lepromatous patients in National Leprosarium “Tohoku Shinsei-en”. Ages of 327 patients ranged from 38 to 93 (mean: 66.3). Three hundred and five patients out of these 327 (93%) had ocular complications such as cataract (50.8%), Iagophthalmos (41.3%), ectropion (35.7%), trichiasis (27.8%), corneal opacification (20.3%), posterior synechia of iris (20.0%), keratic precipitate (19.6%), phthisis bulbi (19.1%), corneal degeneration (17.1%), extreme miosis (13.1%), entropion (12.8%), aphakia(12.5%) and so on.
Fifty-one cataract operations were performed. In 69% of these cases postoperative visual acuities were better 3 years after surgery than after 3 months in patients with lagophthalmos and in 84% of the patients without lagophthalmos. It revealed that lagophthalmos did not affect the visual preservation after cataract surgery.
Lagophthalmos is one of the most serious ocular complications that attributes to the corneal opacification and leads to visual disturbance.

View full abstract

For the past nine years, we treated thirty-two distal radial fractures by prompt reduction and percutaneous pinning. Of these, 14 subjects were given follow-up study with physical and radiological examination.
No one developed postoperative lasting pain or pinning-related complications. A less than satisfactory outcome resulted when grip strength was weak and motion(especially supination)of the wrist joint was impaired. Ulnar variant versus grip strength showed negative correlation, and volar angle versus supination came out positively correlated. Therefore among the prognosis-determining factors that were given by radiological measurement, reduction of shortened radius and volar angle were gravely important parameters. On the other hand, early joint motion possibly played a part in making prognosis better.

View full abstract

With regard to the cases which had been operated under the diagnosis of the odontogenic maxillary cyst at the Department of Dentistry and Oral Surgery of the Nagoya National Hospital during the past 11 years, we made the clinico-statistical and the histo-pathological examination and obtained some findings. Herewith we present the results of the findings obtained.
There were 34 cases including 15 cases of the postoperative maxillary cyst and 19 cases of the odontogenic maxillary sinusitis.
With respect to the incidence among different age groups, it was most frequent in subjects from 40 to 49 years old, and they suffered from the postoperative maxillary cyst in 6 case (40.0%) and from the odontogenic maxillary sinusitis in 5 (26.3%).
In view of the odontogenic maxillary sinusitis, on the other hand, the ciliated epithelium was found numerously in the epithelial tissue, and the tendency to the edema and infiltration of the subepithelial tissue was recognized, and the glandular tissue existed at a high rate, comparing to the postoperative maxillary cyst.

View full abstract

We used the noninvasive ¹³³Xenon venous technique to measure 3622 regional cerebral blood flows (rCBFs) in 1955 cases for last about six years. The majority of patients was fifty and sixty decades in age, and their diagnosis was ischemic cerebrovasculer disease. Sixty-four healty, non-hospitalized volunteers(10-76 years)were studied as control value. The age-related curve of rCBF showed a rapid decrease in young age groups and a gradual decrease in older age groups. The curve was well fitted to the hyperbola (X-13.0621) (Y-42.6038) =556.493. The correlation coefficient was 0.93. This finding showed that the declined rCBF related with age was attributed to more than two factors. When cerebro-vascular CO₂ reactivity was tested in the healty control group, the rCBF on average increased to 90.5 ml/100g/min from 70.2ml/100g/min (28.9%) being accompanied with the elevation of P^CO2 of 11.4mmHg in arterial blood gas on average. The CO² reactivity index was 2.75±1.65 on average. On the other hand, following an intravenous injection of Diamox (1g) the rCBF increased to 80.0ml/100g/min from 59.6ml/100g/min (34.2%) on average in the control group.

View full abstract

Using the ¹³³Xenon venous method, we have studied the regional cerebral blood flow (rCBF) in 947 patients with cerebrovascular ischemic disease. In 116 stroke or TIA patients with internal carotid artery occlusion or severe stenosis, their rCBF revealed 48.9ml/100g/min on average in the group of one side occlusion, 46.7ml/100g/min in the group of one side occlusion and the other side severe stenosis and 47.0ml/100g/min in the group of both sides occlusion. These values reduced approximately 12%, 16% and 15% of the rCBF in healthy volunteers of same age, respectively.
In 28 patients with moya moya disease, their rCBF tended to be higher in younger N cases and lower with advantaed age. In the majority of the cases, their rCBF was age-dependent with 20-25ml/100g/min below the curve of age-matched rCBF of healthy volunteers. The reduction of rCBF was observed in 69 (48.3%) of 143 cases clinically, diagnosed as small vessel disease, in 58 (41.4%) of 140 cases with vertebrobasilar insufficiency and in 23 (44.2%) of 52 cases with syncopal attack compared with the rCBF of healthy volunteers.

View full abstract

We measured the cord serum values of the thyroid-stimulating hormone (TSH), thyroxine (T₄) and triiodothyronine (T₃) in 922 newborns from mothers who had no thyroid disorders. The T₄ and T₃ values increased progressively during the period between the 27th to the 40th week of gestation. However, the TSH values had no correlation with gestational age. There were significant positive correlations between the TSH and T₃ levels (r=0.16, p<0.01) and between the T₄ and T₃ levels (r=0.52, p<0.01), but there was no significant correlation between the TSH and T₄ levels (r=0.07).
The delivery style influenced TSH value. The mean cord serum TSH value in newborns who were vacuum delivered was 16.3±10.0μU/ml (n=30), which was significantly higher than the value measured for normal vaginal delivery which was 9.5±6.0μU/ml (n=622) (p<0.005); the mean cord serum TSH value for abdominal delivery was 6.5±3.1μU/ml (n=79), which was significantly lower than that for normal vaginal delivery (p<0.005). In addition, the TSH levels in high risk newborns were significantly higher than those of no risk newborns. It was suggested that the cord serum TSH levels reflected the delivery stress of newborns.

View full abstract

Many bacterial examination are manual examination that are not suited for complete automation. Their systematization is often difficult with a main computer of the mini computer class used in the entire examination department. Therefore, we developed a bacterial examination system using a very adaptable personal computer and a non-programming language data base software. Necessary information is inputted into the main computer and sent to a personal computer in the bacterial examination room by telecommunication. The subsequent various processings and data accumulation are done by the personal computer. This system has allowed automatic printing of results, monthly re-ports, and work sheets and simplified clerical work such as inquiry about results. In addition to reports on individual examination, information that supports diagnosis at the hospital as a whole such as data on nosocomial infection and bacterial resistance has been rapidly provided to clinical medical care.

View full abstract

We analyzed primary site of cancer, site of metastasis, physical status, causes of pain, indication and doses for morphine administration, medication, quality of daily life, and plasma morphine concentration in 136 patients who received continuous morphine drip for over ten days. The duration of morphine administration was relatively short in patients with dyspnea whereas it was relatively long in patients with pain. There was no correlation between the dose of morphine and survival time. In patients who required an increased dose of morphine a few days before their death, the most frequent complaint was dyspnea and less for abdominal distention, and the least for pain.
There was a dose-dependent increase in plasma morphine concentration in patients without pleural fluid, ascites, and edema (Y=0.89x+ 1.17, r=0.918, p<0.01). However, the plasma morphine concentration in patients with pleural fluid, ascites, and edema was about half of that observed in patients who have normal distribution area. The rapid development of pleural effusion and ascites lowered the blood level of morphine. There-fore, constant observations of the blood level of morphine should be made to see whether it has been maintained.
In the terminal care of cancer patients, at present it is most important for the physician and medical staff to take heed when the patients complain of pain.

View full abstract

Recently, we have found an increased absorption of theophylline in restraint water-immersion stressed rats. We have futher studied the mechanisms involved pharmacologically. First, this stimulatory effect was inhibited by treatment with sodium bicarbo-nate and was related to the degree of stomach damage induced by water-immersion stress inversely. Metochlopramide or sodium picosulfatestimulated the theophylline absorption similar to that by water-immersion stress. These effects were also inhibited by atropine. It was suggested that the stimulatory effect of theophylline absorption was in part caused by the increase of gastro-intestinal movement. Cimetidine has been reported to inhibit the hepatic metabolic enzyme in liver. Indeed, cimetidine pretreatment increased the absorption of theophylline. Pharmacokinetic data have showed that Ka increased by 3 times and Kel decreased by 1/10 compared with control. Rat blood GOT, GPT, ALP and LDH activities were determined in control and stressed rats groups. Among them, LDH activities increased by 6 folds compared with controlrats. This increased LDH actvities have returned to control level by 24 hours after thewater-immersion stress.
In this study, it has showed that the theophylline absorption was increased dominantly by the pretreatment of water-immersion stress. The mechanisms involved in the stimulatory effect would involve some mechanisms such as increased gastro-intestinal movement or decreased hepatic drug metabolism.

View full abstract

The questionnaires were dispatched to the members of the Joint Study Unit on Dia-betes Mellitus in the National Sanatorium in respect to the clinical aspects of the patients with this disease. The replies included 1636 patients, 870 males and 766 females. Eighty-six per cent of the member hospitals operate the outpatient clinics for diabetics. Blood sugar was checked in the fasting state, in random period and/or after meals. HbAic, HbA1 or fructosamine in combination with HbAi c were used to assess the control of blood sugar. Fifty three per cent of the patients were on diet therapy, 33% were on hypoglycemic agents and 14% were on insulin. Seventy eight per cent of males and 850 of females were older than 50 years old. The patients older than 60 years old occupied 53% of male and 63% of female patients, indicating that the aged diabteic patients might be increasing. The increase of aged patients brings up a new problem in the education of patients on diet and excercise because of their decreased mental activities.
Pulmonary tuberculosis as a complication of diabetes mellitus was two to three times higher in male patients than in female patients, suggesting that the endocrine factor might be playing an important role.

View full abstract

Primary myelofibrosis (PMF) is an uncommon haematological disorder characterized by diffuse fibrosis of the bone marrow associated with a progressive anemia. Management of PMF consists mainly of repeated blood transfusions. A 38-year-old man was found to have a pancytopenia and made the diagnosis of PMF. Partial splenic embolization (PSE) produced an improvement of haematological features in this case. Leukocyte and platelet counts remarkably increased, and the transfusion reqirements were reduced after PSE. The role of surgical or non-surgical splenectomy in PMF remains controversial in consideration of the risk of the operation and extramedullary haematopoiesis involving spleen. On the other hand, there have been many cases that the operation provided satisfactory symptomatic improvement and markedly improved the blood picture. PSE is one of the procedures for the treatment of hypersplenism. It should be considered that PSE is the treatment of pancytopenia requiring repeated blood transfusions.

View full abstract

Three patients (42-year-old man; 67-year-old woman; 26-year-old man) with MERRF (myoclonus epilepsy associated with ragged-red fibers) were reported. MERRF as well as hereditary dentatorubral-pallidoluysian atrophy was one of the common diseases among the differential list of progressive myoclonus epilepsy in Japan. The patient 2 developed her initial symptom at the age of 62, whereas the patient 3, a son of patient 2, at the age of 6. The ages and clinical courses of the mother and her son were greatly different. The patient 1 had cataract since the age of 29. Cataract has never been reported in MERRF, but cases of mitochondrial myopathy with cataract were reported by Greene et al, Sengers et al and Yamamoto et al. Therefore, cataract in the patient 1 might be resulted from mitochondrial dysfunction. The patients 1 and 3 had urinary disturbance (urinary retention). Plasma levels of lactate and pyruvate in the patient 1 were normal even after exercise with an ergometer bicycle and were regarded as not necessarily useful for diagnostic means in MERRF. The amplitudes of P²⁵ and N₃₃ in somatosensory evoked potentials in our patients were giant as well as in other cortical myoclonus. Somato-sensory evoked potentials might be useful to differentiate MERRF from other mitochondrial encephalomyopathies.

View full abstract

Six cases (4 men and 2 women) of HAM have been found in Tsushima Island with the population of 48, 500. Their age of onset ranged from 32 to 57. We examined 9, 215 people (19% of total population) for anti-HTLV-I-antibody. The carrier rate was 20.8% of whole subjects. The incidence of HAM among seropositive carriers might be estimated about 1: 1200 and was no significant difference between the sexes. The carrier rate was 5% or less of persons under 20 years of age. It became higher as they grew older and was as high as 50.5% among females in the 9th decade. We should keep in mind the presence of HAM patients in the HTLV-I-epidemic areas.

View full abstract

Among patients who were suspected to have dilated cardiomyopathy (D. C. M.) at first medical examination, some cases eventually are proved to have ischemic cardiomyopathy (I. C. M.) by coronary angiography. We studied whether we can make differentiation between D. C. M, and I. C. M, by comparing various parameters such as age, blood pres-sure, serum cholesterol, fasting plasma glucose, arrhythmia, cardiothoracic ratio and ejection fraction quantitated by M-mode echocardiography obtaind at first medical examination. Age was the only useful indicator for differentiation of the two entities unless CAG was conducted.

View full abstract

This study reports some observations concerning the impaired glucose tolerance (IGT) and the diabetes mellitus (DM) which are frequently associated with Werner's syndrome.
These three patients all exhibited characteristic clinical symptoms and signs of Werner's syndrome since at 20-30 years of age, and they also had siblings with the same disease in their families. Oral glucose tolerance tests(75g O-GTT) showed the IGT pattern in two cases and DM pattern in one case. Plasma IRI levels after the 75g glucose load showed high responses in all three cases. Further more, two cases gave high IRI values already at the fasting state(pre-loading). Then the urinary excretion of C-peptide (CPR) showed also high values.
Although abnormal glucose tolerance were mild in these three cases, but hyperexcretion of urinary CPR, hyperinsulinemia and hyperresponsiveness of IRI after glucose loads were recognized.
Regarding the etiology of glucose intolerance accompanied by hyperinsulinemia, in one case we evaluated that insulin binding capacity in the erythrocytes of the patient was normal: otherwise, the pyruvate dehydrogenase activity in the lymphocytes showed a remarkably low rate.
Concerning the abnormal glucose tolerance associated with Werner's syndrome, it was speculated that this phenomenon reflects partially a defect of post-receptor mechanism.

View full abstract