Hansen's disease is a chronic infectious disease and the strength of the infection of Mycobacterium leprae to human is rather very weak.
Since 1907, the total number of leprosy patients in Japan (30, 359 cases at that time) has been continuously decreasing until now and moreover its decreasing tendency will be continued to the future.
On the other hand the total number of the leprosy patients in the world is still estimated over 10, 000, 000 at present.
In 1990 there are about 7, 300 cases registered and about 6, 500 cases in the whole 13 leprosaria in our country. Most of them (96%) were BI (bacillar index) negative and new registered cases were only 15.
Recently, chemotherapeutic effects have been showed during a relatively short period (2 years in multibacillary patients and 6 months in paucibacillary patients) by use of multidrug therapy combined with rifampicin, B663 (clofajimine) and DDS (dapsone), which are recommended by WHO.
However, rifampicin-resistant cases are reported recently. And as the secondary illness after chemotherapy ocular and peripheral nerve involvements with blindness and sensory loss and motor palsy are still remaining. So the fundamental research is further needed for the sake of the settlement in these regards.

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Recently, sleep apnea syndrome in patients with Duchenne muscular dystrophy (DMD) has been reported.
In this report, we introduced capnographoximeter in order to monitor CO₂ non-invasively as well as sat. O₂ during sleep.
Overnight monitoring on 10 patients with DMD showed repeated oxygen desaturation and CO₂ elevation. Furthermore, we could directly demonstrate effectiveness of night ventiration using CR (chest respirator) or NIPPY (nose intermittent positive airway pressure) for hypoxemia and hypercapnia during sleep.
Therefore, sleep monitoring by capnographoximeter is important not only to diagnose sleep apnea syndrome but also to improve the management of nocturnal dyspnea in patients with DMD.

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Glutamate dehydrogenase (GDH) activity and its isozy e (heat-labile GDH and heatstable GDH) activities were measured in lymphocytes from 17 patients with Parkinson's disease (PD) and 23 normal age-matched control subjects (NC).
Total GDH activity decreased significantly (NC: 74.1±17.1mU/mg protein, PD: 48.7±13.8mU/mg protein, P<0.001) in patients with PD. As compared with NC, the decrease was also observed in its isozyme fractions (heat-labile GDH NC: 56.8±14.1 vs PD: 35.5±12.9mU/mg protein, p<0.001, heat-labile GDH NC: 17.3±6.6 vs PD: 13.1±5.5mU/mg protein, p<0.05) . These data indicate that the decrease in total GDH activity is due to the decrease in heat-stable GDH rather than in heat-labile GDH inactivated at 48°C for 60 minutes. In addition, there exists a substantial overlap of the values of either total, heat-stable or heat-labile GDH activities between control subjects and PD.
In PD, sex difference of GDH activity was not observed. There was no relationship between GDH activity and aging, clinical course or severity. L-dopa therapy does not seem to affect lymphocyte GDH activity. These results suggest that the decrease in lymphocyte GDH activity is not directly associated with neuronal death in PD but may partially reflect some disturbance of glutamate metabolism in CNS.

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Clinico-pathological features and stool occult blood findings were investigated in 141 patients with colorectal polyps and 137 patients with colorectal cancer treated at National Nara Hospital. Patients with polyps were on average 5 years younger than colorectal cancer patients. 83.7% of colorectal polyps were adenomatous polyps, and focal malignancy was observed in 8 patients with these polyps. Of patients having colorectal polyps, 37.7% had visited the hospital because of he complaint of melena . and 29.0% to undergo colorectal examination.
Chief complaints of colorectal cancer patients were melena, abdominal pain and stool irregularity.
Stool was positive for occult blood in 50.6% of colorectal polyp patients, 80.8% of colorectal cancer patients, and 60.0% of early cancer patients. In cancer patients, positiveness of stool occult blood was related to the location, size, depth, and stage of and macroscopic findings of the cancer. But, there was no relationship between occult blood and the histological pattern of cancer.

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The prevention of HBV vertical transmission by the combined use of HBIG and HB vaccine were performed since 1980. Since 1986, the standard method of Ministry of Health and Welfare, Japan has been adopted. We followed up 69 infants from HBe Ag carrier women over two years, and the following results were obtained.
1) Of the 69 infants, 2 cases (2.9%) developed the carrier state. One case was infected in uterus, and the other was a non-responder, and fell into carrier state in 16 months.
2) Of the 67 infants, 62 cases (92.5%) became persistent HBsAb-positive by three vaccine injections.
3) Of the 67 infants after following one year, 63 cases (94.0%) maintained higher PHA-titer- of HBsAb than 2⁴.

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An immunochemiluminometric assay has been developed for the measurement of thyroid stimulating hormone (TSH) by use of Chemilumi Analyzer (Kyowa Medex). A study was performed to evaluate the feasibility of this system.
Linearity was confirmed up to 205μU/ml. Within-run and between-day precision of the method as indicated by C. V. ranged from 2.5 to 6.6% and 2.3 to 11.6%, respectively. Recoveries of TSH from serum were from 96.9 to 107.2%. For TSH, no interference by bilirubin, hemoglobin, turbidity and ascorbic acid was observed. Excellent correlation between TSH measurements on immunoradiometric assay was observed.
In the normal subjects the concentration of serum TSH ranged from 0.45 to 2.20μU/ml.

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In this report, we describe quantitative analysis of the intermediates of tricarboxylic acid cycle by stable isotope dilution method and discuss some basic problems on the preparation. For clinical applications, we investigated the differential diagnosis for lactic acidemias caused by inherited disorders, acute hypoxia, severe liver dysfunction and diabetic ketoacidosis. The analytical recovery and accuracy of these acids were superior to the conventional method. The urinary levels of lactic acid, succinic acid, fumaric acid and citric acid in normal subjects were 46.2±16.6μg/mg Creatinine, 12.7±7.9μg/mg Creatinine, 8.7±7.9μg/mg Creatinine and 800±348μg/mg Creatinine, respectively. In lactic acidemias with similar profiles, we suggest that the lactic acid/citric acid ratio and the quantitative values of these acids are good indices for the defects of its metabolic enzymes or the dysfunction of this cycle.

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Rapid aging of the population has led to a dramatic increase in elderly patients seeking treatment at medical institutions. Degeneration in organ function and loss of reserve capacity are not simply physiological corollaries of aging. These conditions are frequently exacerbated by other pathological changes. When administering drugs to the elderly, it is vital to consider not just the pharmacokinetic aspects but also the pharmacodynamicsabsorption and distribution throughout the body, metabolism and excretion. It has been said that when prescribing drugs for the elderly, as opposed to younger patients, not only must we exercise greater caution in determining drug choice and amount, metabolic dynamics and side effects, but we must also give detailed guidance about the proper use, so patients understand the necessity and consequences of the drug in terms of overall treatment. Patients can thus receive a minimum dosage and take it faithfully as directed.
Some characteristics of elderly patients: (1) They are more liable to develop high serum drug concentrations because of excretory limitations imposed by the slowdown in metabolic function, especially in the kidneys and liver. (2) Decline in serum albumin levels aggravates any rise in free serum drug content. (3) Patients often receive treatment for a number of ailments at several unrelated hospitals, meaning they may be taking many types of medication at once. (4) Because many ailments in the elderly are chronic, drug treatment continues over extended periods, creating a higher risk for side effects. (5) Difficulty in making the patients understand often leads to poor compliance.
Various approaches to these problems are now being studied. In view of recent trends, we have invited presentations on a wide range of topics related to medication use in elderly patients.

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An autopsy case of Binswanger disease with putaminal and thalamic hemorrhage was reported. A 77-year-old woman who had a history of hypertension showed dementia, hemiparesis, parkinsonism, and convulsions associated with periodic activity on EEG. CT-scan demonstrated cerebral atrophy with ventricular dilatation and periventricular lucency (PVL) in addition to low density areas in the bilateral putamen. Pathologically, a marked general atherosclerosis was observed. In the cerebrum, diffuse myelin pallor and severe loss of axons in the deep white matter, despite of sparing of U-fibers. There were multiple small infarctions and severe arteriosclerosis of small arteries or of arterioles in the cerebral white matter, basal ganglia, thalamus, and pontine basis. In addition, the lesions of hypertensive cerebral hemorrhage were found in the bilateral putamen and left thalamus. We discussed the occurrence of hypertensive hemorrhage in Binswanger disease and the relationships between the dementia found in this case and the white matter lesion.

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This paper presents a case of intestinal tuberculosis with jejunal perforation. A 42-year-old man with cerebral infarction was admitted to a hospital. He complained of persistent fever and abdominal pain since hospitalization. Under the diagnosis of pulmonary tuberculosis by chest X-ray and gastic juice examination, the patient was referred to our sanatorium. Sputum and stool examination confirmed the presence of tubercle bacilli. Double contrast colonography revealed annular stricture of the sigmoid colon with granulotic change and deformation with poor stretching from the ileocecal region to splenic flexure. Endoscopy of the sigmoid colon showed circular stricture with granulotic mucosal margin and easy-to-bleed ulceration. In contrast radiography of the small intestine, annular stricture with fold convergence and granulotic change was detected at five regions mainly in the jejunum. On the basis of these findings, intestinal tuberculosis was suspected. Chemotherapy with streptomycin, isoniazid and rifampicin was administered, however, perforation of the digestive tract was found in the second month, and an emergency laparotomy was performed. A perforation was detected in the jejunum at 150cm from the Treitz's ligament. This was managed by partial resection of the small intesine. This was histopathologically found to conform to jejunal perforation due to intestinal tuberculosis.

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A retrospective analysis of surgical treatment of elderly patients, more than 80 years of age, was performed. There were 43 cases of surgical treatment on elderly patients aged over 80 cut of all cases of 258 with surgical treatment, an incidence of 16.7% over the past 2 years (1990-1991). The most common disease was colorectal cancer, which was present in 11 cases (25.6%). On the other hand, 11 cases (55%) were elderly patients more than 80 years old, among the 20 cases of surgery for colorectal cancer. Forty-one cases (95.3%) of these elderly patients were alive without any particular complication, but only two patients died from terminal cancer, or renal failure. From these results, surgical treatment could be performed safely even in elderly patients by an intensive post operative managements, especialy in the view of respiratory function.

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The clinical course, treatment and prognosis of spinal paralysis caused by spinal metastasis of prostatic cancer were studied in 7 patients. Of the 7 patients, 5 had primary disease and 2 were resistant to endocrine therapy. The level of paralysis extended up to the 3rd cervical vertebra in one patient, the 4th thoracic vertebra in 4 and the 5th thoracic vertebra in 2 patients.
Patients with primary disease frequently experienced symptoms which preceded the onset of paralysis by a considerable period of time. The interval between manifestation of the symptoms and their initial visit to the department of urology was generally long, ranging from 2 to 14 months.
Spinal laminectomy and instrumentation was performed in 3 of 5 patients with primary disaese. In 2 of the 3 patients paralysis disappeared, while in the other patient, paralysis did not completely disappear because of insufficient rehabilitation due to advanced age. Hormone therapy was performed in 2 patients, leading to disappearance of the paralysis. Patients with relapse were generally in poorer condition and died before long in spite of traetment.
The above findings indicate that early detection and early treatment are essential in the management of spinal paralysis associated with prostatic cancer. Laminectomy is the treatment of choice, although single use of hormone therapy can produce satisfactory results in some cases. Selection of the most appropriate treatment must be made on the basis of the clinical conditions of individual patients.

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We found 6 cases of calcinosis cutis, which is assumed to be caused by large intravenous dosis of sulpyrine injected against the pain of Hansen disease. There were 2 male and 4 female cases. Their age ranged from 56 to 86. The types of disease were as follows: 5 L-type and 1 T-type.
The periods, in which the longer large dose injection therapy was applied, were mainly distributed from 1954 to 1977; in the case 1, 4, 940 injections were carried out mainly at the lateral sides of both upper arms for last 10 years and we found the calcinosis on the same site.
Table 1 shows the names of pains at that time, the site of calcinosis, serum Ca, P, Al-F, urea nitrogen and anti-PGL antibody ; no titers corresponding to the possible metabolic abnormality were observed in any case.
Besides, the pathoThistological findings by H. E. staining, the differential thermal and gravitational analyses of extirpated calcium component, the identification of crystalline compounds by X-ray diffraction patterns, and the quantification of F, P and Ca by chemical analysis were performed, and thus we here report their results.

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A set of 25-year-old monozygotic twins had clinical evidence of tuberous sclerosis, but they were discordant for clinical symptoms. Its manifestations constitute a triad of adenoma sebaceum, epilepsy and mental retardation, one twin suffered generalized seizures from early life and her mental retardation was severe. The other twin also suffered seizures relatively late in her life and was mentally subnormal.
Modification of tuberous sclerosis gene expression by the effects of environmental factors is suggested.

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