Age-specific incidence and mortality rates of hemopoietic disorders in Japan show a remarkable increase in the elderly. This increased risk of hemopoietic disorders with advancing aging proceeds in parallel with the same trend of age-associated high mortality diseases such as cancer, apoplexy and cardiovascular diseases. A rapid increase of hemopoietic disorders in the elderly urges us to establish a new therapeutic strategy in considering geriatric assessment and QOL of the patients.
Recent advances of molecular biology on normal aging and hematopoiesis are also reviewed and the possible important interactions of normal aging upon the development of hemopoietic disorders are discussed.

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The incidence of ulcerative colitis tends to rise in many regions, but some researchers, if not many, describe the disease as being unchanged or on the decline. Interest has focused on regions of low prevalence such as Japan and the Mediterranean countries. Many investigators reported that more deaths generally occur in the first disease year and that a higher mortality is reported in patients with a broader range of lesions. Occurrence of the disease in the early years of life is associated with the development of malignant tumors with a higher incidence being noted in the total colitis type. Surveillance of such individuals is warranted because they could be at high risk for carcinoma of the colon.
Familial occurrence is importantly noted because the etiology is involved with the inheritance of an endogenous predisposition. According to an established theory, a high prevalence of the disease is noted among the first degree relatives of the probands. Relations of the disease to environmental factors are studied in many parts of the world to elucidate relations with dietary habits, smoking, and the like, but no satisfactory results have been obtained as yet.

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Attacks of myocardial ischemia without any symptoms are termed as silent myocardial ischemia (SMI). We studied the incidence of attacks and arrhythmias in 87 patients of SMI demonstrated on 24-hour electrocardiographic (Holter) monitoring. SMI patients were demonstrated in 3 groups by Cohn's report: type I; those totally asymptomatic (9 cases), type II; those after myocardial infarction (9 cases) and type III; those with angina pectoris (65 cases). The frequencies of SMI events on 24-hour Holter monitoring were as follows; one, from 2 to 4 and more than 5 times were 25 (30%), 46 (55%) and 12 cases (15%), respectively. The episodes of SMI occurred predominantly during the daytime hours; from 6:00am to 0:00pm and from 0:00pm to 6:00pm were 40% and 30%, respectively. At event time of SMI (44 events) sinus tachycardia, ventricular premature contractions (VPCs) and atrial fibrillation were found in 21 (48%), 4 (9%) and 1 event (2%), respectively. Incidences of VPCs for 24 hours of type I, II and III were 100, 78 and 69%, respectively and the greater part of VPCs was more than Lown's grade 3. Sixty-seven patients of SMI (7 for type I, 8 for type II and 52 for type III) were followed up for from 1.1 to 3.3 years (mean 2.4 years). Eleven (16.4%) died and of those patients, five (7.5%) were cardiac death (2 for type II and 3 for type III) . Four (6%) developed myocardial infarction (1 for type II and 3 for type III). Thus, patients with SMI had high incidences of arrhythmias and cardiac events.

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Sclerotherapy for varicosis in the lower limbs, with features including an inconspicuous operative wound and the possibility of outpatient treatment, is widely used in Japan.
In the year since such therapy was introduced in our hospital in July 1991, a total of 100 patients with varicosis have been treated. The sclerosing agent in this therapy was 3% polydocanol, which is dispensed in our hospital; it was administered by injection at a dose of 2-7ml each time in up to four locations per limbs. The average number of treatments was 1.87 times. Cures were achieved with one or two treatments in 75% and in three or less in 90% of the patients.
The type of varicosis was the saphenous type in 56.0%, segmental type in 34.5%, reticulum type in 6.5% and web in 3.0%. This was the treatment of first choice for saphenous type that was not considered suitable for sclerotherapy. Ligation of the saphenous vein trunk by small incision was performed under local anesthesia in 63.2% of the saphenous type.
The symptoms of varicosis disappeared in all cases after sclerotherapy. Minor complications such as pigmentation and drug-related skin rash were found, but there were no serious side effects such as pulmonary infarction or deep vein thrombosis. And the results were judged as being good.

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A 28-year-old man underwent gastrectomy (Billroth I procedure) for duodenal ulcer 9 years before. Thereafter he occasionally experienced vomiting. The glucose level at vomiting was as low as 43mg/dl and was reversed by ingestion of sugar. A 75g oral glucose tolerance test (OGTT) revealed a glucose level of 37mg/dl at 180min, with a peak immunoreactive insulin (IRI) level of as high as 1428.0μU/ml at 90min, leading to a diagnosis of reactive hypoglycemia. Frequent small meals and the use of the calcium antagonist nilvadipine, 8mg/day, abolished nausea and vomiting. On day 7 of the treatment a 75g OGTT was performed. The lowest glucose level was 43mg/dl at 150min but the peak IRI level was only 503.0μU/ml at 30min. Subsequently because of headache, the drug regimen was changed to dilitiazem hydrochloride, 90mg/day. On day 11 after the initiation of the treatment a 75g OGTT showed the lowest glucose level of 76mg/dl at 240min, with a peak IRI level of as low as 148.7μU/ml at 90min. The patient is now on treatment with dilitiazem hydrochloride and is doing well. We consider that calcium antagonists are effective for the treatment of reactive hypoglycemia developing following gastrectomy.

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We report a case of transcatheter arterial embolization for the management of massive bleeding due to hepatic artery aneurysm which ruptured into the gallbladder.
The patient was a 77-year-old female who was admitted to our hospital complaining of massive hematemesis, jaundice and epigastralgia. At first, bleeding from duodenal mucosal lesion caused by direct invasion of the gallbladder cancer was suspected. But, abdominal contrast CT revealed a round-shaped high density area of about 3 cm in diameter which was enhanced to the extent of the vascular system in the gallbladder. And, celiac angiography demonstrated extravasation and pooling of contrast medium from an anterior branch of the right hepatic artery.
The diagnosis of right hepatic artery aneurysm which ruptured into the gallbladder was made. Following transcatheter arterial embolization by use of Spongel failed to stop bleeding completely. Two days after the first embolization, transcatheter arterial embolization using steel coils was performed successfully, with the coils positioned one at the bifurcation of right and left hepatic artery and the other at the bifurcation of gastroduodenal artery. This angiographic technique brought about not only rapid hemostasis but only good long-term prognosis.
We wish to emphasize that transcatheter arterial embolization provides an effective and safe alternative to surgery for the control of massive bleeding from ruptured hepatic artery aneurysm besides defining the bleeding point.

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We report a case of allergic bronchopulmonary aspergillosis (ABPA). He had a history of bronchial asthma for about forty years, and he had been treated at other hospital with a diagnosis of pneumonia for one year. When he was referred to our hospital in July 1987, his chest roentogenogram showed infiltration in the right middle and lower lung fields. Bronchoscopy showed edematous stenosis of the middle lobe bronchus. Clinically, he was diagnosed as pulmonary tuberculosis with bronchial asthma, so he was treated with antituberculous drugs. After four months, his chest roentogenographic findings improved. After antituberculous drugs therapy, in April 1988, his chest roentogenogram showed consolidation in the right upper lung field. Bronchoscopy showed edematous stenosis of the upper bronchus, and after antibacterial drugs therapy, his condition improved. In October 1990, when he complained of cough and sputum, his chest roentogenogram showed infiltration in the right middle lung field, and his data showed eosinophilia and high IgE. Aspergillus fumigatus was detected from bronchial lavage. The diagnosis of ABPA was made, but we thought it was difficult to diagnose this case as ABPA only on roentogenographic findings.

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A 71-year-old woman with diabetes mellitus (DM) was admitted to our hospital on December 15, 1989 because of vomiting and disturbances of consciousness. On admission, her consciousness was drowsy. Urine glucose was 4+; urine ketone bodies, negative; plasma glucose, 2870mg/dl; serum osmolality, 375mOsm/kg·H₂O. Her electrocardiogram was compatible with the findings of subendocardial myocardial infarction (posteroinferior infarction). She was diagnosed as hyperosmolar hyperglycemic nonketotic diabetic coma (HNC) associated with subendocardial myocardial infarction. She was treated with saline (1300ml/12hrs.) with soluble insulin (98units/12hrs.). DM was controlled by oral administration of 500mg of tolbutamide. She was discharged on March 12, 1990.
Three patients with HNC complicating myocardial infarction have been reported since 1965, when a first patient with HNC was reported in Japan. Prognoses of the three cases were poor. The reasons why prognosis of the present patient was better than those of the three reported cases are discussed.

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We report a case of a neonate with Klinefelter's syndrome complicated by congenital heart disease. A male infant born at 40 weeks of gestation and weighing 3100g was referred to our hospital because of cyanosis and a heart murmur. On physical examination, the infant showed several minor anomalies including low-set ears, micrognathia, a webbed neck, wide-spaced nipples, accessory tissue on the left thumb, and left congenital club foot. Chromosome analysis revealed a 47, XXY karyotype. Echocardiogram and cineangiogram revealed a pulmonary atresia with intact ventricular septum, a patent ductus arteriosus, and an atrial septal defect. Twenty-nine days postpartum the infant underwent left Blalock-Taussig's procedure with an uneventful recovery. To our knowledge, there have been only a few reports of surgery for Klinefelter's syndrome complicated by congenital heart disease, especially in neonates.

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A 75-year-old female was admitted to our hospital because of fever and general fatigue. On admission, laboratory data showed mild anemia (RBC 308×10⁴, Hb 10.0g/dl), and elevations of LDH (1080IU/ml) and CRP (13.4mg/dl). Several antidiotics were not effective. Malignant lymphoma was suspected, but no suggestive findings were found. When thrombocytopenia, anemia, and psychogenic and neurogenic disorders were observed, thrombotic thrombocytopenic purpura (TTP) was diagnosed. Though plasmapheresis was given, anemia was rapidly progressive. Autopsy disclosed that there were much of malignant cells in the capillary of all organs. They made mass structure out of the vessels. Immunohistologic studies showed that LCA and L26 were positive, UCLH1 and Factor VIII were negative. The diagnosis of angiotropic B-cell lymphoma was made.

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A case of primary aldosteronism due to bilateral adrenal hyperplasia associated with non-functioning adrenal tumor is reported. A 41-year-old man was admitted to our hospital because of the evaluation of hypertension and hypokalemia. Hypertension was diagnosed 1 year before and he had been followed at a practitioner's outpatient clinic with nifedipine. Hypokalemia was found and he was referred to us for further evaluation. On admission, hypertension, hypokalemia were noted, plasma renin activity (PRA) was low and plasma aldosterone was high. PRA was not stimulated by intravenous furosemide administration and 2-hour standing. Diurnal variation of aldosterone was disappeared, while diurnal variation of cortisol was present. A small right adrenal tumor was found on computerized tomography. Radio-iodinated adosterol was accumulated to bilateral adrenal gland equally on adrenal scintigram. Plasma aldosterone in both right and left adrenal veins were high by selective adrenal vein sampling. Based on these data, diagnosis of primary aldosteronism due to bilateral adrenal hyperplasia and non-functional adrenal tumor was made. Hypertension and hypokalemia were successfully treated with spironolactone.

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A 39-year-old man had been having a history of slowly progressive limb muscular wasting with cardiac arrythmia for three years. He had no past history of allergic diseases or habitual drugs. The neurological examination revealed proxymal dominant muscular weakness and atrophy, decreased deep tendon reflexes, and normal central nervous system functions. Waddling gait and Gowers' sign were observed. There were no muscular tenderness, fasciculation or pseudohypertrophy of the muscles. ECG showed supraventricular tachycardia and complete heart block. A chest X-ray film demonstrated increased CTR of 56% with normal lung field. Eosinophilia (1, 300/cmm), increased IgE, serum levels of CK and myosin light chain 1 were demonstrated by the laboratory studies. EMG showed a myogenic pattern with positive sharp waves and pseudomyotonic discharges. Motor nerve conduction velocity was normal. Muscular CT findings were atrophy of the paravertebral muscles and limb proxymal muscles as well as moth-eaten appearance in the femoral flexor muscles. The microscopic morphological findings of biopsied femoral quadriceps muscle were variation in fiber size, hyaline degenerated fibers, rimmed vacuole fibers, incresed connective tissues, lymphorrhage in the perivascular area in endomysium and infiltration of eosinocytes. Then, diagnosis of eosinophilic myositis was established. Oral administration of prednisolone rapidly lowered serum CK level and eosinophilia, however, muscular wasting lasted much longer than alleviation of these laboratory findings. The serum level of myosin light chain 1, which is a fragment of muscle skeletal protein, decreased in parallel with clinical improvement of muscle symptoms. Eosinophilic myositis is a rare condtion, and association with allergy, paracyte infection and hyper-eoshinophilic syndrome has been reported. But the present case was considered to be different from these conditions because of his past history and clinical symptoms. He was likely to be a clinically important case dominantly affected the striated muscle system, i. e., cardiac and skeletal muscles. And serum myosin light chain 1 level turned out to be a more useful parameter for muscle wasting in myopathy than CK.

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Extreme lateral lumbar disc herniation (ELLDH) occurs intra and/or extraforaminally, and compresses the nerve root that exits at the same level. We experienced a case of L2/3 ELLDH which involved L2 nerve root. It was diagnosed by MRI and a definite diagnosis was done by discography and CT-discography. We treated operatively by the method of osteoplastic hemilaminectomy. At one year after the operation, she is symptom-free and can work again.

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The effect of disodium pamidronate (the disodium salt of 3-amino-l-hydroxy propylidine-1, 1-bis-phosphonate) was examined in four patients (77±12 years; mean±SD) with hypercalcemia due to malignant diseases including bladder carcinoma, cholangiocellular carcinoma, breast cancer and chronic myelogenous leukemia. Before and after singledose intravenous infusion of disodium pamidronate (15-30mg), serum calcium, albumin, phosphate, parathyroid hormone (PTH), urinary calcium and phoshpate were measured. Serum corrected calcium (CCa) levels as well as serum calcium levels decreased significantly from 4 days to 14 days after administration of disodium pamidronate (p<0.05); before (11.7±1.0mg/dl), one day after administration (10.0±1.2), 2 days (10.8±1.3), 4 days (10.3±0.5), 6 days (9.8±0.5), 10 days (9.5±0.6) and 14 days (9.8±0.7). Normal serum CCa levels of each patient was attained in the course of 14 days. Serum phosphate also showed the tendency to the fall after administration. On the other hand, serum intact PTH level (before; 17±13pg/ml) increased, having a peak level (57.2±52.7pg/ml) 6 days after infusion. Urinary calcium/creatinine ratio decreased (p<0.05); before (0.86±0.37), , one day after administration (0.60±0.31), 2 days (0.61±0.36), 4 days (0.40±0.23), 6 days (0.27±0.15), 10 days (0.27±0.15), 10 days (0.30±0.13) and 14 days (0.26±0.28). These results show that disodium pamidronate is useful in the treatment of hypercalcemia of malignancy and the effect of reducing serum calcium level seems to be attributable to the suppression of the bone resorption.

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