The long-term outcome of 327 patients with cerebrovascular disease (CVD) admitted to the Department of Neurology, National Sendai Hospital, during the period from 1979 to 1989 was analyzed. The follow-up rate was 99.70, and the mean follow-up period was 60.5 months (one to 150 months). The activities of daily living (ADL) grade with CVD at discharge was 34% of patients with CVD for the excellent group, 32% for the good group, 14% for the fair group, 10% for the poor group and 9% for the dead group. The ADL grade at follow-up was 30%, 21%, 13%, 8% and 28%, respectively, for the five groups. The ADL grade worsened significantly with age at both discharge and follow-up. The survival curve depended on the age at onset of CVD. The older the age at onset and the poorer the ADL grade at discharge, the shorter the mean survival period. In the poor group for ADL at discharge, the mean survival period was 75.3 months for patients under age 60 at onset, 61.8 months for patients aged 60 to 74 years at onset and 22.7 months for patients aged 75 or older at onset. The cause of death was the CVD itself in 66% of the CVD patients, Recurrent attacks were rather frequent in the first two years after the onset of CVD. The mean annual recurrence rate, was calculated to be 4.2% for the 12-year follow-up period.

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A study was conducted to investigate the concentrations of neurotransmitters and their metabolites in cerebrospinal fluid (CSF), and to correlate these with neurological findings in patients with cerebral ischemia. It was considered that the findings might be useful for the development of new treatment for acute or chronic-stage cerebral ischemia.
Method: lumbar puncture was performed on 14 patients treated at the National Hiroshima Hospital between 1990 and 1991. Levels of neurotransmitters were measured in the CSF samples obtained.
Results :1) The levels of dopamine, homovanillic acid (HVA), 5-hydroxyindoleacetic acid, cyclic AMP and cyclic GMP in CSF were increased significantly in the acute stage of cortical territory infarction. It was considered that a depressed rate of dopamine metabolism with an increased level of HVA was indicative of a poor prognosis. 2) It was suggested that changes in the level of alanine showed a significant positive correlation with changes in the level of glycine in CSF, that the levels of glutamate in CSF were increased significantly in cases of perforator territory infarction, and that increases in these level were related to the appearance of dementia in the chronic stage of cerebral infarction.

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We have been conducting a lung cancer screening since 1986 to the inhabitants of almost all towns and cities of Kumamoto prefecture in Kyushu, Japan. In 1988, we found a high prevalence (41.5%) of cases with pleural plaque among the inhabitants of Matsubase town where our hospital is located. In this town, three asbestos mines and four factories were operating between 1883 and 1970. Asbestos ore was found to be an anthophyllite by analytical electron microscopy. Most cases were considered to be exposed environmentally, rather than occupationally. The age-adjusted rate and standardized mortality ratio of lung cancer were not higher than those in other cities and towns in Kumamoto prefecture. No case of malignant mesothelioma in this town has been confirmed during the past fifteen years, but further follow-up of these subjects are needed.

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We investigated 49 children with ventricular tachycardia (VT) without structural heart disease. There was no significant difference in heart rate during VT between sustained and non-sustained VT. In the group with significant symptoms, sustained type was more frequently seen than non-sustained type (p<0.003). The site of origin of VT was as follows, right ventricle in 65% and left ventricle in 35%. In the group with significant symptoms, VT originated more often in the left ventricle than in the right ventricle (p<0.002). Catheter ablation and cryosurgical ablation were very effective for cases with no good response to any antiarrhythmic drugs. Four of 49 cases (8.2%) had died suddenly. Three of them had syncopal episodes, and during the treadmill testing, polymorphic or bidirectional VT was provocated. These findings suggested that the prognosis of the patient with exercise-induced, multifocal, polymorphic and bidirectional VT was poor. In cases with no satisfactory response to medical therapy, catheter ablation and cryosurgical ablation should be considered.

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Measurement of 2nd generation anti-HCV, quantitative detection of HGV-RNA using PCR and clinical application of interferon have brought a rapid progress on diagnosis and treatment of hepatitis C. In this symposium many important problems as follows were discussed by five symposists.
For early diagnosis of acute hepatitis C, anti-core assay is useful, but detection of anti core IgM is difficult as well as of C-100. In differential diagnosis between acute hepatitis and relapse from carrier state, both negative anti-HCV at acute stage and positive at convalescent stage have to be confirmed. Sensitivity of 2nd generation anti-HCV assay is higher than of anti C-100, but some problems on specificity still remained.
For monitoring in interferon therapy, anti C-100 assay is useful, but evaluation of efficacy by HCV-RNA is necessary. In several effective cases with normalization of ALT, HCV-RNA was still detectable. PCR is the most sensitive method for virological diagnosis, on the other hand identical results were not always obtained by comparative examination of the same samples at different laboratories. Clinical efficacy of interferon therapy is not so high as once thought in the early study, but it is possible that decrease of HCV-RNA and ALT can prevent progression of hepatitis. On the problem of needle stick injury among hospital workers, reliable method to prevent hepatitis C is unkuown. Considering of low frequency of hepatitis after needle stick and high efficacy of interferon to acute hepatitis C, interferon can be administrated after falling ill.

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We presented a case of paragonimiasis Miyazakii with numerous symptoms such as pleuritis, infiltration lesion in the lung, subcutaneous nodules and pericarditis. A 26-year-old female was admitted to our hospital due to cough, fever and left lateral chest pain. During the course, subcutaneous nodule appeared in the abdomen and it moved to the chest. Diagnosis was made by serological examination. Administration of prazyquantel for 3 days improved subjective and objective symptoms, however, per. icardial effusion developed on the 4th day of administration, Pericardial effusion was thought to be due to paragonimiasis Miyazakii.
According to some reports, the incidence of pericarditis was less than 2% and the incidence of this disease having subcutaneouse lesion, pleuritis, intrapulmonary lesion and pericarditis was thought to be low. Also we reviewed 9 cases of paragonimiasis with subcutaneos lesions in the recent literature.

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We encountered, synchronous triple cancers developing in the course of liver cirrhosis. A 63-year-old man was referred from another hospital and admitted to our hospital in November 1989 with liver cirrhosis and cholelithiasis. We detected two lesions (13mm and 10mm in size) in the right lobe of the liverby ultrasonography. We examined these two lesions by angiography and US-guided liver biopsy, but no evidence of malignancy was revealed. These two liver lesions subsequently showed no change and in size. He complained of right-sided abdominal pain from August 1990 and was admitted again. Barium enema showed Borrmann type 2 carcinoma in the ascending colon and gastroscopy showed early type 2a carcinoma of the gastric angle. The patient underwent subtotal gastrectomy, right hemicolectomy, and cholecystectomy in October 1990. We detected two lesions in the left lobe of the liver by intraoperative ultrasonography, in addition to the two lesions in the right lobe. We therefore added wedge resection of the left lobe of the liver. Histological examination of the resected liver revealed hepatocellular carcinoma of Edmondson's grade Z and metastatic adenocarcinoma. He was admitted for a third time with left-sided carcinomatous pleurisy in March 1991, and he died in April because of respiratory failure.

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A 32-year-old male with eyelid ptosis, progressive external ophthalmoplegia, mild weakness of the limbs, dementia and EEG abnormality is reported. Muscle biopsy was performed at the biceps muscle. Modified Gomori trichrome staining showed ragged red fibers, and electron micrographs showed accumulation of abnormal mitochondria. Our case belongs neither to typical Kearns-Sayre syndrome nor to chronic progressive external ophthalmoplegia, since it does not have heart block and pigmentary retinopathy but has CNS abnormalities. We regard this case as probable Kearns-Sayre syndrome from recent genetic investigations about mitochondrial encephalomyopathy.

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In three cases of tumor near the transparent septum, we performed surgery using the transcallosal approach.
In consideration of previous reports on the procedure involving the problem of hemorrhagic infarction owing to a damaged parasagittal vein, we evaluated the lesion by means of MRI sagittal section and venous phase of cerebral angiography to select the venous entry zone and operative side. With these preparations, it was possible to resect the tumors in a suffciently wide visual field, while preserving the parasagittal vein during surgery in all three cases. However, it must be noted that there is the possibility of causing subendymal damage in cases of an extra large tumor extending to the body of lateral ventricle, particularly when the tumor is attached to the outside of the body of lateral ventricle.

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Benign osteoblastoma is a rare bone tumor that mainly involves vertebral column and long bones. A 9-year-old female who had had back pain with a rapid progression paraplegia visited our out-patient clinic in May 1990. A preoperative magnetic resonance imaging (MRI) indicated an extradural tumor of thoracic spine.
Immediate laminectomy and resection of extradural lesion was performed, followed by a remarkable improvement of the symptoms. The location of the lesion was extradural and between Th₄ to Th₇ level. The tumor was found to have arised from lamina of Th₅. Gross examination of the lesion showed that it was red brown and soft similar to meningioma, but histological diagnosis of the lesion was benign osteoblastoma. Entire lesion was resected and, so far, one year after surgery, no recurrence has been observed.

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To evaluate the usefulness of steroid pulse therapy fQr treating IgA nephropathy, urinary protein, glomerular filtration rate (GFR), and renal glomerular pathology were compared between before and after two courses of methylprednisolone pulse therapy. It consisted of 1, 000mg of methylprednisolone a day for 3 consecutive days together with oral prednisolone 20mg a day. Twelve patients with progressive IgA nephropathy were included in this study who met the following criteria: i) proteinuria of 1.0g/24 hours or more for at least 3 months and ii) crescent formation in more than 100 of the glomeruli observed.
The daily urinary protein measuredd at 2.5±0.4 (1.0-5.5)g before the purse therapy significantly decreased to 1.5±0.4(0-4.5)g after the therapy (p<0.005). The GFR of 70±10 (31-115) ml/min slightly increased to 78±10 (34-130)ml/min (p<0.05). Renal biopsy carried out before therapy revealed crescents formation in 31±6 (10-57)% of glomeruli observed consisting of cellular crescents in 42±7(10-75)%. After therapy, percentages of glomeruli with crescents did not apparently changed but cellular crescents were not observed in 10 patients and decreased from 73% to 33% in another patient. Urinary protein remained decreased even after 9.5±0.9 (6-16) months in 9 patients but began to increase after 5, 6, and 8 months in 3 patients to the pre-treatment level. These results suggest that the steroid pulse therapy has rapid and reliable effects on progressive IgA nephropathy, and remission for about 6 months can be obtained.

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A 42-year-old man was admitted with upper abdominal pain. IVP showed horseshoe kidney and right non-functioning kidney due to the ureteral stone. Retrograde pyelography (RP) and aortograghy were done. The stone was accumulated at the portion across the iliac artery. Right nephrostomy was performed. The urine volume from the nephrostomy was very little during the observation period of 43 days. A right nephroureterectomy with excision of the bladder cuff was performed. Transitional cell carcinoma of the ureter was revealed. The patient is presently well at However 7 months after surgery.

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W ereport a case of acardius diagnosed by magnetic resonance imaging (MRI). MRI demonstrated morphological features of the acardius and the relation among the acardius, the fetus and the placenta. The soft tissue of the acardius showed high signal intensity on T₂ weighted images, representing edematous changes. MRI could demonstrate not only morphological features but also histological changes of the acardius. MRI is considered a useful modality in the diagnosis of acardius.

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The main symptoms were mammary development and genital bleeding. Mammary development started at 7 months of age and bleeding occurred at 9 months of age.
Blood level of LH was 2.5mIU/ml, FSH<2mIU/ml and E₂ 57.6pg/ml. The LH·RH test response was poor and mass was not detected in USG. Between the initial examination and the first operation, the mammary gland enlargement was not marked, genital bleeding stationary and the bone age at 1 year and 10 months was equivalent to 2 years and 6 months. Stature was +1.0 SD to +3.0 SD, and E₂ 10-281pg/ml. Enlargement of the left ovary was seen in CT scan and USG.
At the time of the first operation at 4 years, a left ovarian cystectomy was performed. The histological diagnosis was a follicular cyst. E2 in the follicular fluid was 39, 800pg/ml.
Genital bleeding appeared after about 6 months, E₂ was 157pg/ml, the LH. RH test response was poor and enlargement of the left ovary was seen in USG. The second operation was left ovarian cystectomy performed at 5 years. The diagnosis showed a lute inized follicular cyst. E₂ in the follicular fluid was 98, 700pg/ml.
This case appeared to be ovarian precocious puberty, but true (idiopathic) precocious puberty could not be ruled out. We hope to observe the course of this patient over a long period in the future.

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