With respect to the natural history of the abdominal aortic aneurysm (AAA), mortality from the rupture is high unless the patients die from some other diseases. Therfore, the radical operation by the replacement with artificial vascular graft is indicated in all patients with AAA, regardless of the age. Operative result of the non-ruptured cases is expectantly well, but in the ruptured cases it is extremely poor especially in the cases associated with shock. The long-term prognosis of the patients with radical operation is almost the same as a common span of the general population. So, radical operation before the rupture should be recommended to the patients with AAA.
Arteriosclerotic obstructive disease of the lower extremities has heen treated as an illness of the aged. Nowadays, medical and/or surgical treatment for this disease have made considerable progress during the last decade. Therefore, we have to manage carefully the patients with intermittent claudication and/or leg ulcer.
The recent progress of the artificial vascular grafts, especilly for the small diameters is also mentioned.

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We studied the central motor conduction in 10 patients with X-linked recessive bulbospinal neuronopathy (XBSN) using the technique of percutaneous electrical stimulation of the brain and the spinal roots. The central motor conduction time from the motor cortex to the cervical segment of the spinal cord (C-CMCT) was estimated by subtracting the latency of the action potentials of the thenar muscle after cervical stimulation from the latency of the action potentials of the same muscle after cortical stimulation. The latencies of the action potentials of the anterior tibial muscle after cortical stimulation and after lumbar stimulation were also measured, and the difference between the two latencies was taken as the central motor conduction time from the cortex to the lumbar segment of the spinal cord (L-CMCT).
The results were compared with those in 13 normal control subjects.
Mean C-CMCT was 5.05ms and mean L-CMCT was 12.9ms in the normal controls. Neither C-CMCT nor L-CMCT was prolonged in this illness. The results reflected the morphological finding of the intact corticospinal pathway in XBSN. Besides, it became clear that severe degeneration of the anterior horn cells did not influence the CMCT. The technique must be useful for diagnosis of XBSN in which family history is not well known.

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W carried out a multi-facility cross-sectional study on post-stroke depression. Subjects were 636 cases with stroke (278 cerebral thrombosis, 48 cerebral embolism, 120 unclear cerebral infarction, 191 cerebral hemorrhage and 2 combined cerebral infarction and hemorrhage). To compare with stroke patients, depression in 40 hypertensive patients and 290 inpatients for other diseases were studied. The Zung's self rating depression scale (SDS) was used, and a score (SDS) of more than 50 was judged to be a depressive state and later subjected to a comparative study of the average scores (SDS). Post-stroke depression was observed in 46.4% of all stroke patients and had a higher frequency in women but no relation to age. Stroke patients were significantly more depressed with bilateral hemisphere lesions than with other lesions, and were relatively more depressed in cerebral hemorrhage than in cerebral infarction. The severity of depression was the most in those patients who were between 4 months and 2 years post-stroke, and significantly correlated with the degree of impairment in activities of daily living. When compared with other diseases, it was found that depression was more marked in stroke patients than in hypertensive patients, but less marked than in patients hospitalized for other severe diseases. Post-stroke depression is especially marked during the rehabilitation period and is therefore thought to be an important inhibitory factor against returning to home and society.

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We carried out a multi-facility cross-sectional study on sleep disturbances after stroke. Subjects were 598 cases with stroke (265 cerebral thrombosis, 44 cerebral embolism, 108 unclear cerebral infarction, 179 cerebral hemorrhage and 2 combined cerebral infarction and hemorrhage). To compare with stroke patients, sleep disturbances in 33 hypertensive patients and 300 inpatients for other diseases were studied. As the method, we used our own sleep evaluation table and a questionnaire. Insomnia was observed in 20 to 50% of all stroke patients, the frequency being high in women and becoming more pronounced with advancing age. The lesion location was not correlated with the severity of insomnia, but disturbance of falling asleep was most severe in patients with bilateral hemisphere lesions. There was no difference with respect to the site of the infarcted vessel or bleeding. The severity of insomnia was the most in patients within 3 months post-stroke, and correlated with the degree of impairment in activities of daily living. When compared with other diseases, stroke patients showed more frequent disturbance to falling asleep and intermittent awakening than hypertensive patients. However comparison with patients hospitalized for other severe diseases, insomnia was rather less marked in stroke patients than in those with respiratory diseases, cardiovascular diseases and other severe diseases.

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Seventy-three cases presently older than 18 years old (mean 22 years old) who had been long-stay patients with chronic renal disease concurrently attending school for the handicapped (mean for 5 years and 8 months) were investigated through questionaires. At the time of investigation, 57 (78.1%) patients were still under treatment and 4 (5.3%) had no occupation. One third had been absent from school for more than 6 months and/or remarkably behind in studies on their admission and another one third could insufficiently improve their abilities during hospitalized life. After leaving hospital, the history of renal disease and the one of school for the handicapped were disadvantageous to 50 (70.4%) and 34 (47.2%) patients respectively. The friendship was chosen as the greatest advantage (58.9%) in the hospitalized life, whereas the lack of social experiences as the greatest disadvantage (56.2%). The lack of social experiences, the restriction of exercises and adverse effects of drugs etc. were pointed to have strongly influenced on their characters and way of thinking. On the other hand, the progress in treatment and diagnosis, lightening the medical expenses in adulthood, shortening the period of hospital treatment and explanation of the disease were requested to the medical treatment of renal disease.

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We investigated hepato-pancreatic dysfunction in 17 patients diagnosed with alcoholism according to the diagnostic criteria therefor.
With regard to the alcoholism, the following results were obtained. 1) Alcoholic abstinence led to improved hepatic function. However, improvement of pancreatic function was not observed as a result of abstinence. 2) Pancreatic function disorders were observed in 14 (82%) of the 17 patients. Those with PFD values less than 59% accounted for 64%, diabetes was observed in 35% of the cases showing a degree of dysfunction classified as great.
Correlation between degree of pancreatic dysfunction and alcohol intake and drinking history was investigated. There were no statistically significant differences between patients with a daily alcohol intake of greater than and less than 900ml (Nihonshu). There were also no significant differences between patients with a drinking history of greater than or less than 20 years. Furthermore, there was no correlation with whether there existed symptoms such as gastric pain, diarrea and diabetes.

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Esophageal stripping had been a palliative procedure originally and sufficient intra-mediastinal lymph nodes dissection had not been technically possible. However, we continued to apply this procedure to operations for intrathoracic esophageal cancer. The main problem was insufficient lymph nodes dissection due to hypotension and arrhythmia during manipulation of the tissue near the heart. When the diaphragm was incised from esophageal hiatus to sternum and fibromuscular tissues between pericardium and diaphragm was fully dissected, intra-operative hypotension did not occur even if the heart was pressed by retracter. Moreover, esophageal hiatus was widened up to 20cm in length by means of lateral traction of the hiatus by heavy thread.
This provided a good view of deep mediastinal cavity by additional use of lighting devices, and intramediastinal lymph nodes dissection up to tracheal bifurcation could be done using special equipments such as long scissors, hemostats and so on. These techniques and devices made it technically feasible for middle intra-thoracic esophageal cancer to dissect intra-mediastinal lymph nodes up to 5cm. higher than the lesion and to extract the intra-thoracic esophagus invertedly without thoracotomy.
Twenty-eight patients with intra-thoracic esophageal cancer underwent the esophageal stripping. The average age of the patients was 71 years old, male to female ratio was 5.3:1, the advanced cancers spreading over two segments were 10 cases (35%), and operative mortality rate was 14.2% (4/28). These results showed that this modified technique was applicable and safe for the middle thoracic esophageal cancer in the elderly who were usually considered as high risk patients.

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A clinical study was made of 26 cases of breast cancer which turned out to be malignant during the course of follow-up for benign tumors or no dominant masses in spite of the subjective symptom of known masses.
During the follow-up period, 13 of 18 patients with growth of the mass visited hospital for reexamination. The age of the patients ranged from 30 to 55 at the time of diagnosis. Twenty-six follow-up cases were compared with 262 cases of breast cancer diagnosed by the first examination. Family history of breast cancer and special type of invasive carcinoma in histologic findings were present more frequently in the follow-up cases. About half of the follow-up cases were diagnosed by needle aspiration cytology. The suffering time over 7 months or more affected on the stage, but it did not affect on the prognosis at the average period of 5 years after the operation. Therefore, we conclude that needle aspiration cytology is one of the useful examination for the decision of follow-up case. The patient who has a feeling of mass should be examined within 6 months as a high risk group. It is emphasized that patient must be checked again when the mass changes its size or hardness.

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A clinical and statistical analysis was done with regard to the external dental fistula treated for 11 years in the Department of Dentistry and Oral Surgery, Nagoya National Hospital and some findings were obtained.
Twenty-one cases were treated during approximately 11 years from April 1978 to December 1988 in our department and accounted for 0.15% of the total outpatients.
With respect to the age of the patients, 5 cases were in the twenties, which accounted for 23.8% of the total cases, 4 cases in the sixties.
With respect to the disease classification of the causal teeth, 11 patients had radicular periodontitis, accounting for 47.80 of the total cases, 3 had radicular cyst (13.0%), and other 3 had wisdom teeth (13.0%).
With respect to the treatment in our department, 6 patients underwent the extraction of tooth with obliteration of the fistula, 4 underwent the extraction of tooth only, and other 4 underwent the root canal treatment. The cases of surgical treatment accounted for 81.0%.

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This case was a male neonate presented with bleeding from upper gastrointestinal (UGI) tract. Hemorrhage was improved by the treatment of thrombin followed by milk-feeding, though plasma transfusion was not effective for the improvement in his general condition and hemorrhage.
There is surprisingly little experience to the use of thrombin in the treatment of UGI tract hemorrhage in neonatal period. Significance of the thrombin therapy and milk feeding on patients with UGI tract hemorrhage is emphasized.

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We performed percutaneous endoscopic gastrostomy (PEG) in 10 patients who were unable to swallow because of neurological disease. Period of PEG ranged from a half month to 13 months, with a mean of 4.2 months. Parenteral nutrition at home by PEG were able in 2 cases. Complications of gastric ulcer around stopper in 2 cases and subcutaneous abscess in 4 cases were observed.
This method is simple and safe, and is useful for the patients with poor operative risk.

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We rcently began a clinical trial in which minimal dose of bucladesine were administered for four to thirteen days to a patient with advanced heart failure.
Tolerance to dobutamine was obviated by using bucladesine concomitantly. The patient was a 62-year-old man who was admitted for congestive heart failure (CHF). After discharge he developed recurrent CHF during subsequent four years. He was treated with daily metildigoxin (0.1mg), triamterene (50mg), furosemide (100mg), and captopril (37.5mg). The CHF was refractory to these medications and he was hospitalized again. Administration of dopamine or dobutamine was started. With this therapy he gained diuresis and weight reduction. These two drugs were repeatedly administered four times. Although tolerance to dopamine or dobutamine developed, yet bucladesine (4γ/kg/min) was effective when added to this regimen. Seven days after the cessation of this combined administration, rapid daily weight gain with decreased urine output appeared. Nine days after initiation of combined treatment with dobutamine and dopamine, the patient noted dyspnea on effort. So we resumed a concomitant use of bucladesine and dobutamine. After five days of administration of these two drugs, symptoms of CHF resolved. Thereafter he received them four times intermittently. The administration of the two drugs was discontinued on each occasion when his body weight returned to the control level. Several short-term studies on bucladesine have reported that it has a salutary effect on patients with CHF assessed by hemodynamic parameters. Since bucladesine was reported to have not only hemodynamic but also direct diuretic effect, congestive heart tailure was evaluated by changes in urine volume and in body weight when we used bucladesine for longer periods.

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We assessed the efficacy of oral sulfamethoxazole-trimethoprim (ST) in the prevention of bacterial infection in four severely handicapped children, who were admitted to the Suzuka Byoin National Sanatorium. The frequency and duration of the febrile episodes were decreased by the administration of ST (62.5mg/kg body weight) for 6-12 months judging from the decrease of the markers of infection. These data suggested that the prophylactic treatment with ST might be one of the beneficial treatments to improve the quality of life in severely handicapped children.

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The patient was a male aged 46 who visited our hospital with a chief complaint of bilateral intrascrotal tumor. Induration and tenderness were observed in the bilateral epididymides, and no effect was seen by pharmacotherapy at all. Leucocyte count showed an abnormal increase as 31, 300 in the peripheral blood, and proliferation of lymphocyte associated with dyskaryosis was observed. HTLV-1 antibody in peripheral blood was 256 times as much, and 900 of the surface markers of lymphocyte was seen to be of T-cell origin, from which acute adult T cell leukemia (ATL) was diagnosed. Many infiltrations due to T cell-type lymphoid leukemic cell were observed in the left testicle extracted with the purpose of examination. In the physical findings, no swelling of the lymph node was observed and only hepatic swelling was seen by CT test. It was a rare ATL case with the bilateral intrascrotal region as the site of initial lesion.

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Parkinson's disease (PD) is a degenerative disease of the basal ganglia. Patients with PD treated with levodopa had been reported to show positive Coombs tests 20 years ago. Immunological abnormalities including the occurrence of autoantibodies against 5-100 protein, neuron-specific enolase, axonal neurofilaments or sympathetic ganglia, reduced mitogen responses and diminished number of CD 4 positive cells have been observed. PD patients tend to be more tolerant to common cold or cancer.
In this study, we examined lymphocyte subsets, natural killer (NK) activity and anti-body-dependent cellular cytotoxicity (ADCC) in four patients with juvenile parkinsonism treated with levodopa for 10 years. The percentage of Leu 7 or Leu 11 positive cells were normal but HLA-DR positive cells increased slightly. Two patients showed decreased NK activity and all four patients showed reduced ADCC activity that might be dependent to levodopa therapy.
The effector cells of ADCC against Raji cell or Chang liver cell, K cells might be heterogenous since there is no correlation between ADCC activity against Raji cell and Chang liver cell. Reduced cytotoxicity in PD patients suggest that there will be the other reasons showing the tolerance against common cold or cancer.

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A case of diabetes insipidus, which developed after aneurysmal rupture, is reported. A 55-year-old male patient complaining of severe headache was referred to our hospital. Brain CT examination revealed subarachnoid hemorrhage and angiograms showed an anterior communicating artery aneurysm. On the following day, the aneurysm was surgically occluded using a microsurgical anterior interhemispheric approach. Aneurysmal occlusion was performed uneventfully. The patient had shown mild polyuria after admission (3800-5200ml/day), which improved on the 4th day. The neurological state of the patient had been normal for three days after admission, but his state of consciousness level deteriorated progressively thereafter and he became apallic on the 6th day. At this point serum electrolyte examination revealed hypernatremia (182mEq/L) and severe dehydration (356mOsm/kg), while urinary osmolarity was 284mOsm/kg. We therefore diagnosed the patient as having diabetes insipidus and began to administer DDAVP nasally. After the treatment, electrolyte disturbances and dehydration began to Emeliorate and were normalized by the 6th day of DDAVP treatment. His neurological state began to improve three weeks later. He was alert and presented no palsy two months later, though he complained of mild amnesia. Diabetes insipidus had disappeared by that time.
This was a rare case in that diabetes insipidus appeared in the early stage after subarachnoid hemorrhage. We believe that diabetes insipidus started several hours after the subarachnoid hemorrhage attack, in light of the fact that polyuria (5200ml/day) and mild hypernatremia (150mEq/L) were present on the day of admission.

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An adult case who had been suffering from chronic cerebral infarction with right anterior and middle cerebral artery occlusion is reported. Encephalo-duro-arterio-synangiosis (EDAS), an indirect EC-IC anastomosis, was performed on the patient, resulting in a good revascularization of the brain. The case was a normotensive patient who had no history of meningitis, hypertension or diabetes mellitus. Since no adequate cortical branches were opacif ied by cerebral arteriogram, the EDAS operation was selected. Arteriogram obtained 3 months and 7 months postoperatively, demonstrated a gradual cerebral revascularization with dilated STA. Though it is generally thought that vascularization is insufficient in adults, EDAS as an indirect EC-IC anastomosis, may be indicated in cases where an adequate recipient artery is not available like in this patient.

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