Although no accurate statistics are available, there seems to be about 300, 000 bedridden elderly patients, presenting with a serious problem on the nation's health and medical economy. Osteoporosis is the second largest cause for the bedridden state, especially through its major complications such as hip fracture. Effective prevention and treament of osteoporosis therefore is the first step in the prevention of the bedridden state. Screening of the population with dual energy X-ray absorptiometry and ultrasonometry is quite important in detecting early osteoporosis. Sufficient calcium intake and adequate exercise increases peak bone mass and slows down the postmenopausal and senile bone loss. For the treatment of established osteoporosis, calcium, estrogen, calcitonin, active forms of vitamin D and ipriflavone are available. Combined use of these drugs will assure satis-factory therapeutic response in most of the patients with osteoporosis at any stage of the disease.

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It is diffucult to make differential diagnosis between idiopathic interstial pneumonia (IIP) and hypersensitive pneumonitis (HP) by X-ray CT and ordinary pulmonary function test. Both are fibrotic lung diseases, however prognosis of these two diseases are different. The purpose of this study was to make differentiation between IIP and HP by regional pulmonary function test using Positron emission tomography and N-13 gas. We studied 6 cases of IIP and 4 of HP. We measured regional alveolar volume and specific ventilation (V/V), in supine position, by ¹³N inhalation method.
We found low alveolar volume in dorsal lung on both diseases, however V/V showed 1.78±0.6/min, inventral lung, 2.10±0.38/min. in dorsal lung on IIP and 0.85±0.31/min. in ventral lung, 0.83±0.57/min. in dorsal lung HP. So in HP, low alveolar volume in dorsal lung was associated with lowV/V. In HP the pulmonary function test demonstrated obstructive as well as restrictive pattern. It was suspected that this obstructive disturbance in HP was due to granulomatous changes. It was also suspected that granulomatous changes recovered earlier than fibrotic changes, because obstructive disturbance improved earlier than restrictive disturbance.

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Between 1978 and 1990, 34 patients (24 male and 10 female) underwent thoracotomy for the treatment of pulmonary aspergillosis. During this period, 622 patients were diagnosed as pulmonary aspergillosis in our hospital, so that the incidence of resection was 5.5%. In two of the 34 patients, lung cancer was suspected and in 24 patients hemoptysis or bloody sputum were the chief complaints. Fungus ball was observed in the preoperetive chest X-ray films in 31 Patients (86%). Twenty-four patients had a history of pulmonary tuberculosis and aspergillosis was thought to be its sequellae. In 12 patients, the durationl between the onset of pulmonary tuberculosis and pulmonary aspergillosis was less than 5 years, but in 5 patients it was over 15 years. Twenty-two patients underwent lobectomy, 8 pneumonectomy and 2 segmentectomy. Postoperative thoracoplasty was perfomed in 22 patients because of poor residual lung expansion.
The operation lasted more than 5 hours in 9 and the blood loss was more than 2000ml in 18 patients. In 3 patients the index (FEV1/predicted VC) was less than 40% preoperatively but there were 15 patients whose index became less than 40% postoperatively. The postoperative complications were observed in 20 patients, of which bronchopleural fistula in 7 patients was most serious.
Based on these experiences we believe that pulmonary resection is an effective procedure for the control of massive hemoptysis and persistent hemosputum, but the selection of the patients should be made carefully because of serious complications such as excessive bleeding during surgery, formations of bronchopleural fistula, empyema and postoperative respiratory failure. Development of effective antifungal drugs and new surgical procedure in place of resection is expected.

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Every neonate and infant with unexplained neurological deterioration, respiratory distress, failure to thrive, metabolic acidosis, hypoglycemia, liver dysfunction should be suspected of having an inherited error of intermediary metabolism. Since a number of these diseases respond well to treatment, rapid diagnosis and treatment are mandatory.
Adequate prenatal diagnosis and genetic counselling are necessary in case of fatal diseases. Clinical and laboratory results over 20-year period are presented.

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Prostate specific antigen (PA), gamma seminoprotein (γ-Sm) and prostatic acid phosphatase (PAP) have been evaluated in 98 patients with prostatic cancer, 189 with benign prostatic hyperplasia, 7 with acute prostatitis and 32 with other urological diseases.
Normal upper value, or 2 SD of 197 healthy males was 2.8ng/ml for PA. However, because of the prevalence of false positive with this value, the cut-off value for PA was set at 7.4ng/ml, for γ-Sm 4ng/ml and for PAP 1ng/ml. The mean values of PA, γ-Sm and PAP were significantly high in the prostatic cancer. Of the 23 patients with untreated prostatic cancer, 82.6%, 60.8% and 56.5%, respectively, were detectable using a single assay. serum PA levels in 23 patients with untreated prostatic cancer were higher in advanced stages and in poorly differenciated adenocarcinoma. This study shows that PA is more reliable than γ-Sm and PAP indetecting and staging of the prostatic cancer.

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We investigated the usefulness of serum CA 125 levels in the diagnosis and therapeutic monitoring of endometriosis. In patients with a chief complaint of menstrual pain, the serum CA 125 levels decreased rapidly after the initiation of danazol or buserelin therapy and relief of pain was obtained. The decrease in CA 125 levels correlated closely with the clinical course. In patients with a chief complaint of infertility, the serum CA 125 levels decreased rapidly after the initiation of therapy but pregnancy occurred in only one patient. The decrease in CA 125 levels did not correlate with the clinical course. The serum CA 125 level and the stage of endometriosis according to the Revised American Fertilty Society (Re-AFS) classification were not correlated. In Patient 1 who had stage III endometriosis accordina to the Re-AFS classification, the serum CA 125 level decreased rapidly after initiation of buserelin therapy, but the serum CA 125 level did not correlate well with the objective improvement or the change in the epdometriosis score. In Patient 2 who had ac hocolatecyst, there was a significant correlation between tumor size measured by US and the decreasein CA 125 level. It was concluded that measurement of serum CA 125 levels is useful for the diagnosis and therapeutic monitoring in most but not all patients with endometriosis.

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Recently, morphine suppository is clinically evaluated for the relief of severe pain in patients with cancer and other diseases with prolonged severe pain instead of oral preparation or injection. Several reports have demonstrated that rapid and subsequent prolonged analgesic effects could be obtained by using morphine suppository with alginic acid. In this paper, the clinical evaluation of analgesia and the application of this suppository to the outpatients were studied by the use of the sustained release morphine suppository.
The mean relief time of pain with suppository containing morphine hydrochloride 15 mgalone (M suppository) was 7 hours (2 patients), as opposed to the mean relief time of 13.3 hours (10 patients) with the sustained release morphine suppository containing alginic acid (MA suppository). A marked difference between the analgesic time of M (6hours) and MA (12 hours) suppository was found on the alternate method of the suppositories in cancer patients.
No significant changes in blood pressure and respiratory rate were observed in all patients, and mild nausea were noted in some patients. Furthermore, good pain control was obtained by using the MA suppository in outpatients. The MA suppository seems effective in clinical use for the relief of severe pain.

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Measurement of serum GOT/GPT ratios in 101 patients with hepatocellular carcinoma (HCC) and in 202 healthy subjects revealed lower ratios (p<0.01) in the HCC prior to radical surgery compared with the healthy control. Serum GOT/GPT ratios in patients with HCC showed no relationship with the tumor-size.
Serum GOT/GPT ratios were serially determined in a case of chronic hepatitis. The ratio remained unchanged at the onset of HCC.
A significant increase in serum GOT/GPT ratio was observed in the patients with HCC at the terminal stage.
Our study suggests that measurement of serum GOT/GPT ratio may be of no clinical value for observation of the onset of HCC in patients with chronic liver diseases.

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We evaluated the medical care of infants and children at the University Teaching Hospital (UTH), Lusaka, Zambia in comparison with that in the Department of Pediatrics, National Tsu Hospital (NTH), Mie, Japan. UTH had 17, 606 in patients under 15y. o. in 1987, and NTH had 902 in patients during 1989 and 1990. The under-5-y. o. in patients' rate at UTH was 86.1%, significantly higher than that of TNH (67.1%) (p<0.01). In classification of diseases, UTH showed the following: infectious disease 53.4%, non-infectious disease 13.3%, accidents 15.8% and malnutrition 17.5%, whereas NTH showed infectious disease 63.2%, non-infectious disease 32.9% and accidents 3.9%. As for mortality, 16.8% of inpatients (2, 954 cases) died in the ward at UTH, and only 0.3% of inpatients in the ward at TNH. The causes of death in the ward at UTH were the following: malnutrition 39.4% (1, 163 cases), diarrhea 16.0% (473 cases) and lower respiratory tract infection 13.7% (406 cases). We concluded that developing countries showed a great difference in actual medical care state as compared with that in Japan, and that it needed extensive cooperation in the field of education in public health, education at school, production of food and industry to accomplish an improvement in the medical care system.

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Study Group for Chest Disease by National Sanatorium in Kinki Region Out of 2833 patients with pulmonary mycobacteriosis admitted to 11 sanatorium hospitals in the Kinki district during the two years of 1988 and 1989, 141 cases (5.0%) were associated with neoplastic disease. Of these patients there were 113 male cases and the meanage was 69.3 years old. Gastric cancer was most frequently seen (in 50 cases) and pulmonry tumor in 39 cases.
There were 10 cases of colorectal cancer and 10 of hepatic tumor. The prognosis of the pulmonry tumor group was poor and we thought that this was because of the difficult diagnosis. In the gastric cancer group, the mean age was older than the pulmonary group, but prognosis was better.

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We performed percutaneous transluminal coronary angioplasty to the stenosis in the proximal portion of the left descending artery using percutaneous cardiopulmonary support (CP supported PTCA) in a 72-year-old male with a history of high lateral myocardial infarction. An arterial cannula (17 F) was inserted by puncturing the left femoral artery to the common iliac artery. Avenous cannula (21 F) was positioned at the right atrioinferior venacaval junction using similar technique. An infant membrane oxygenator was connected and pumped with a centrifugal pump (80ml) at a flow rate of 2.0l/min. We dilated the stenosis from 99% to 25% with a 3.0mm Stack perfusion catheter. Changes in the blood pressure were less than 10mmHg throughout the operation. There was no vascular complications. We think that CP supported PTCA is a usefull method to perform PTCA in a poor risk patient.

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Lymphangioma occurring in the large intestine is a rare benign tumor. We have recently encountered a case of lymphangioma of the ascending colon. The patient was a 42-year-old male who was admitted to our hospital for the treatment of cholecystolithiasis.
Colonoscopic examination, performed incidentally, revealed about 20mm in size, semilimpid globular submucosal tumor with “cushion sign” in the ascending colon.
Barium enema examination demonstrated a sharply marginated round defect with increased radiolucency in the same site.
These findings were suggestive for colonic lymphangioma.
Initially, polypectomy under endoscopic control was thought to be feasible, however, surgical resection was adopted because he was expecting laparotomy for cholecystolithiasis, Histopathologically, the colonic lesion was diagnosed as cystic lymphangioma. In this paper, we have discussed efficiency and usefulness of total colonoscopy on diagnosis and treatment of colorectal lymphangioma.

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A case of malignant mixed mesodermal tumor (MMMT) of the uterine corpus in a 64-year-old woman is reported, Hermenarche was at the age of 16, she was a case of gravida III and para IV, and her menopause occurred at the age of 52. she was seen for genital bleeding and genital discharge. Gynecological cytology and biopsy revealed immature adenocarcinoma cells. Laparotomy demonstrated the tumor originating from the uterine corpus, disseminating to the bladder and peritoneum. The uterus and both adnexa were resected. The white and soft tumor located in the fundus uteri was diagnosed as MMMT including adenocarcinoma, chondrosarcoma, leiomyosarcoma and rhabdomyosarcoma. Post operative anticancer chemotherapy was performed.
she died of ileus caused by disseminating peritoneal metastasis 6 months after the operation. Autopsy findings showed that all abdominal organs were adhered by tumor metastasis. Histologically, the tumor consisted mainly of sarcomatous component based on mucinous stroma. This finding may indicate that poor prognosis is affected by sarcomatous component of the tumor.

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We experienced a case of amylase-producing ovarian cancer. We found high values of amlase in the blood, ascites and in the tumor of the ovarium, and it was verified by observing the release of amylase from incubated tumor cells which were found in the ascites. A 83-year-old woman complained of loss of appetite, abdominal distension and constipation for two weeks. A mass was recognized in the right lower abdominal region. She was introduced and hospitalized at our hospital. Tumor markers such as serum CEA and CA 125 were 5.7ng/ml and 2300U/ml, respectively. CT and US showed a large tumor of about 10 cm in diameter in the right ovarium accompanied by the ascites. Cytological examination of the ascites showed Class V (abenocarcinoma). Amylase was released from the incubated tumor cells of the ascites. Amylase levels of the serum and ascites were 2390 and 3317IU/l, respectively. Both of them were significantly high, especially in salivary (S)-type amylase. General condition of the patient became worse rapidly and passed away on the 22nd day after admission. The result of the autopsy showed a tumor in the right ovarium and a marked S-type amylase activity was found in extraction fluid of the tumor.

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There is a tendency to limit the operative scars as small as possible nowadays and to reduce patient's physical and psychological pain. We analysed 13 patients; 3 managed by minil aparotomy, and 10 by laparoscopic cholecystectomy (LSC). The length of skin incision in minilaparotomy was longer according to the obesity index. There was no significant difference between the two methods in operative time. The patients were offered less pain, faster recovery, and improved cosmetic results by the seprocedures, especially by LSC. Complication occurred in one case of LSC. To avoidserious comprications, it is most important to decide the indication properly with imaging diagnosis, and to convert to open cholecystetomy early in difficult cases.

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