With the increase of elderly population, the number of demented elderly is increasging rapidly in Japan. It is necessary to consider social measures for the demented elderly under such conditions. Extensive epidemiological studies were started since around 1980 mainly by municipal governments.
Based on reliable survey results so far obtained, the prevalence rate of the demented elderly was sought. As of 1985, the ratio of demented elderly staying at home accounted for 4.6% of those aged 65 or above (4.4% for men and 5.1% for women), When the persons in hospitals and institutions were included, the ratio was 6.3% (5.8 for men, 6.7% for women). These results have been published by the Ministry of Welfare and Health. This paper also discusses the methodology used in the epidemiological surveys on the demented elderly in Japan, the prevalence rates broken down by sex and age groups, the causative diseases, and the future estimate for the demented elderly.

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Outbreak of MRSA infection in relation to the use of antibiotics was studied over four six-month periods from January 1990 to December 1991. Antibiotics classifications were: Penicillin; first and second-generation cephem; third-generation cephem; fourth-generation cephem; other-β lactams; aminoglycoside; others. When compared with the first period, the total amount of antibiotics in each period decreased to 67% in the second, 68% in the third and 59% in the fourth, which paralleled the decrease in new MRSA infection cases in each period, from 38 in the first to 20 in the second, 21 in the third and 13 in the fourth. The decrease of the third-generation cephem to 20% in the fourth period from the first was particularly noticeable. The fourth-generation cephem also decreased remarkably in the second period, but increased in the third and fourth periods. The amount of antibiotics in the “others” group remained constant, resulting in their proportionate increase in the total amount used from 22% in the first period to 35% in the fourth. Of the 34 cases of MRSA infection in the third and fourth periods, 11 were suspected to have been brought in from outside. It appears that inter-institutional communication for patients changing hospitals is a vital subject that has yet to be discussed in preventing MRSA infection in hospitals.

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We typed HLA-DRB1, B3, B4, B5, DQA1, and DQB1 allele specificities by the PCR-SSO method in 200 hemodialysed patients who had done or were in a waiting list for kidney transplantaion in Sakura National Hospital. An antigen frequency of DR2 (DRB1*1501) was significantly low (p<0.05) and that of DR4 (DRB1*0405) was high (p<0.01) in HD group when they were compared with those of 235 healthy controls. A strong linkage disequilibrium between DR and DQ alleles was observed but none of special DR-DQ combinations in the HD group was noticed. A total of 44 estimated haplotypes was found in two groups.
We calculated HLA-DRB1 (HLA-D) matching ratios between HD patients and controls for DR specificities that are used for recipient selection. The ratios were 100% for DR1, DR7, DR9, and DR10, 90% for DR13, approximately 50% for DR2, DR8, and DR12, 41% for DR4, and 22%, the worst, for DR14.

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Seventy-four cases of cadaveric renal transplant recipients were evaluated about the occurrence of acute tubular necrosis (ATN) which is the one of the postoperative complications of renal transplantation. Machine perfusion method was used with several cold preservation solution (Collins, UW or CMH solution) at the removal of the renal grafts from 60 donors. Drip infusion method with Collins solution was used in fourteen donors. ATN developed in 11 and primary nonf unction kidnyes in three out of 14 recipients whose graft were perfused by drip infusion method. The renal function was immediately recovered after transplant operation in the 11, ATN developed in 42 and primary nonfunction kidneys in 7 out of the recipients whose grafts were perfused by machine method.
In 11 recipients who did not suffer from ATN, warm ischemic time was less than 25 minutes. The recovery of serum creatinine after renal transplantation seemed to be good in the recipients who were not or less required to have hemodialysis after transplantation due to the ATN. The actuarial survival rate of renal grafts without occurrence of ATN was significantly better than the rate of renal grafts with occurrence of ATN. In conclusion, in order to improve the graft survival rate it is necessary to prevent the occurrence of ATN and to increase the viability of the renal grafts by using new cold preservation solution.

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Taurine concentrations in plasma, lymphocytes and granurocytes of Duchenne type muscle dystrophy patients were measured and compared with those of healthy controls. The concentrations in both lymphocytes and granulocytes of the patients were significantly lower than those of controls, though there was no difference in concentrations in plasma between patients and controls.

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In order to determine the clinical value of apolipoprotein A₁ (Apo A₁) as a marker of fibrosis of the liver, serum Apo A₁ concentration was measured in 47 patients with chronic liver disease proven by liver biopsy, of whom 10 was chronic inactive hepatitis, 27 was chronic active hepatitis and 10 was liver cirrhosis. Mean concentration of serum Apo A₁ was lower in liver cirrhosis than in chronic inactive and active hepatitis. Serum Apo A₁ concentration correlated with serum concentration of P III P and IV collagen 7S, known widely as a marker of fibrosis of the liver. However, the correlation between serum Apo A₁ concentration and biochemical parameters was different from those of serum concentration of P III P and IV collagen 7S as shown in our previous study. Serum Apo A₁ concentration showed a trend of negative correlation with serum aminotransferase activity and fibrosis of HAI scoring. These findings suggest that serum Apo A₁ reflects not only ongoing fibrosis but also completed fibrosis of the liver and serum Apo A₁ concentration is a useful marker for diagnosis of fibrosis of the liver.

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Cytogenetic studies on the chorionic villus from spontaneous abortions of 5-1 week pregnancies were carried out to investigate the correlation between chromosome anomalies and spontaneous abortion. The method to be used as prenatal diagnosis was discussed. Chromosomes were prepared in long term culture and then were analysed by Q and G banding method. The frequency of chromosome anomalies detected totaled 55.7% (34 of 61 cases) investigated. The types of anomaly were classified as autosomal trisomies in 19 of these abnormal cases (55.9%), as polyploidy in 6 cases (17.6%), as structural anomalies in 5 (14.7%) and as monosomy X in the remaining 4 (11.8%). Diagnostic errors arising from examination of long term cultures of villus were found mostly due to maternal cell contamination. To overcome this problem, Y-body analysis, in situ harvesting and histological study were carried out. Y-body analysis and in situ harvesting were found useful for minimizing diagnostic errors. However, histological criteria were found insufficient for chromosomally abnormal diagnosis.

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Plasma concentration of lidocaine and α₁-acid glycoprotein (AAG) in 10 patients with acute myocardial infarction were analyzed by FPIA (fluoresence polarization immunoassay) and SRID (single radial immunodiffusion) method during lidocaine infusion continuously. Concentrations of lidocaine and AAG tended to rise in all, leading to failure of lidocaine clearance and binding of the drug in plasma. The lidocaine clearance data were analyzed by Fisher's t-test and the significance of the difference was found 3-h (0.553ml/hr/kg) between 48-h (0.356ml/hr/kg) at the 0.1 significance level. AAG concentration was correlated with lidocaine concentration at the 0.796 coefficient of correlation. The rate of rising AAG concentration in 5 patients with heart failure were greater than others, so there was significance difference between these two modes of slopes in regression equation at the 0.05 significance level by t-test analysis. If lidocaine clearance depended on the duration of infusion and AAG, a Bayesian estimation program was defined by the rule: Cp=D/(α·weight-β·AAG-γ·t). In this individual analysis, establishment of lidocaine infusion dosage was based on average rules: D=Cp·(0.439 wt-0184 T-0.0294 AAG) in cases of heart failure, D=Cp·(0.935 wt-0.445 T-0214 AAG) in cases of others (non-heart failure).

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This paper presents an autopsy case of lupoid hepatitis with intrahepatic portosystemic shunt. The patient was an 85-year-old woman without a history of blood transfusion or trauma. She was diagnosed as having an autoimmune hepatitis 5 years before, but steroid therapy was not administrated. On suspicion of liver cirrhosis, she was admitted for further examination. Anti-nuclear antibody, anti-DNA antibody and LE cell phenomenon were all positive. Abdominal ultrasonography revealed multicystic lesion in the left lobe. An afferent vessel from the left branch of portal vein, an efferent vessel into the left hepatic vein were confirmed. Blood flow within the lesion was also confirmed by pulsed Doppler flowmetry. On the basis of these findings, intrahepatic portosystemic shunt was diagnosed. Autopsy disclosed the presence of muscle layer and elastic fiber layer at the site of the shunt. Endothelial cells were also confirmed. Surrounding vessels had no evidence of thrombus or scar formation, but macronodular cirrhosis due to lupoid hepatitis was found in the hepatic parenchyma. By histopathological evaluation of the shunt, the condition was considered as congenital. But from the clinical course, the likelihood of this being an acquired change could not be denied.

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A 66-year-old female patient was admitted to the hospital in January 1991 complaining of painful anal bleeding and pruritus ani. Plasma levels of tumor markers, such as CEA, CA 19-9, CA 125 were markedly elevated. Both abdominal ultrasonography and CT scanning demonstrated multiple tumors in the liver. Polypectomy and incisional biopsy of erythematous perianal skin lesion were performed. A needle biopsy of the liver tumor was also done under ultrasonographic guidance. Pathological examination of these specimens showed Paget's cells and signet-ring cell carcinoma. The patient was treated with hypertensive cancer chemotherapy by angiotensin-II, with a 28-day interval. Treatment consisted of mitomycin C (MMC, 10mg/body day 1), fluorouracil (5-FU, 250mg/body day 1-5, 10-14) and cis-platin (CDDP, 100mg/body day 10). After the second course, subjective symptoms clearly disappeared and the metastatic lesions of the liver regressed on computed tomograpy. The CEA level in plasma decreased from 5400 to 46.5ng/ml. No severe side effects except for moderate anorexia and nausea were observed. The patient survived for one year after being diagnosed as Paget's disease in association with anorectal cancer and liver metastasis.

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We report a case of acute hemichorea associated with lacunar infarction in the head of caudate nucleus and the genu of internal capsule. The patient was a 61-year-old man who underwent superficial temporal artery and middle cerebral artery (STA-MCA) anastomosis for high degree internal carotid aretry stenosis, and his symptoms continued chronically. The symptoms improved shortly after surgery and disappeared thereafter, and this patient has been asymptomatic for 4 years until now. When test findings were compared between before and after surgery, favorable patency in the anastomotic blood vessels was observed by angiography, and improvement of the cerebral blood flow (CBF) which extensively decreased mainly in the affected cerebral hemisphere were observed by CBF measurement. It is known that acute hemichorea is caused by infarction of the caudate nucleus, etc., and its mechanism is considered to be due to disorder of the accommodation in the excitation and inhibition systems connecting the putamen, caudate nucleus, globus pallidus, thalamus, subthalamic nucleus and cerebral cortex. It was considered that this case was cured because accommodation system of the involuntary movement was controlled by improvement of the CBF due to the vascular anastomosis.

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A 9 month old boy was examined because of his hypotone and macrocephaly.
His CT scan revealed progressive white matter low density predominantly in the frontal region and tentative diagnosis of Alexander disease was made.
EEG showed bifrontal dominant slow wave. We need careful attention to such minimal low density in the white matter on CT examination in the cases of macrocephaly.

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In this study we investigated the pathologic process and the cause of death in 20 patients who were 90 years or older and were hospitalized in our hospital in 1991.
1) Over 90-year-old patients were 4.6% of all patients who were admitted to our hospital for the first time in 1991.
2) Both malignant tumor and respiratory disease were most frequent causative diseases for hospitalization.
3) Causes resulting in death were: malignant tumor; 3 cases, pulmonary infection; 2 cases, suffocation; 1 case.
4) All patients were not obese and tended to be slender. Albumin was within normal range. Cholesterol was low value. Blood pressure was not high.
5) They hope to recover from diseases and leave the hospital. Their families also were ready to accept their discharge from the hospital.
6) The relative proportion of the cases of bedridden condition or dementia were less than those of 70 and 80-year-old patients.

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Seven patients with chronic idiopathic thrombocytopenic purpura resistant to the conventional drug regimen, were treated with a herb medicine Kamikihitou. The Age of the patients ranged from 4 to 19 years old with a median of 9 years old, and there were four boys and three girls. Among six available cases, two cases responded markedly (33.3%). There were no side effects throughout the observation period. In the two cases with a good response, the platelet counts began to increase after 10 to 14 weeks of the drug administration. In one case, platelet counts showed a slight increasing tendency in the 22nd week which might represent the effect of the drug if the treatment had been continued further. In cases in which the value of PAIgG was less than 180, the platelet counts rarely exceeded 2×10⁴/mm³.
Thus, Kamikihitou is recommended to be used for cases of chronic idiopathic thrombocytopenic purpura not controlled by other drugs.

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