Activity of angiotensin converting enzyme (ACE) is most prominent in pulmonary circulation under physiological condition. It has been confirmed that serum ACE activity is significantly elevated in active sarcoidosis patients, and that the measurement of serum ACE activity is useful in following the clinical course of the disease. The elevated serum ACE activities have been also reported in patients with active tuberculosis, leprosy, silicosis and schistosoma infection. All of these form granulomatous lesions. These pulmonary diseases except for sarcoidosis show only slight elevation of serum ACE levels. From the result of many reports, it may be concluded that the elevation of serum ACE activity is highly specific, less sensitive for the disease activity of sarcoidosis.
On the contrary, low ACE activity is reported in patients with far advanced tuberculosis, chronic obstructive lung disease, spontaneous pneumothorax, pneumonia, lung cancer and ARDS. These diseases are considered to be related to decreased vascular bed space. Though low ACE activities have no meaning for the diagnostic tool, several fihdings suggest that monitoring serum ACE might prove useful as an indicator of endothelial cell integrity.

View full abstract

Clinical study of HCV related hepatocellular carcinoma was carried out with reference to the prognosis to assure the hypothesis that the patients with HCV related hepatocellular carcinoma might have better prognosis compared with the prognosis of another hepatocellular carcinoma, especially with HBV related hepatocellular carcinoma. Meanage of the patients with HCV related hepatocellular carcinoma was significantly older than those with HBV related hepatocellular carcinoma at the time when hepatocellular carcinoma was diagnosed. Among the patients classified as Child-pugh B, there was a higher number of patients receiving surgical resection, TAE and TAI in HCV related hepatocellular carcinoma than another hepatocellular carcinoma, although no significant difference was found between the stages of underlying chronic liver diseases assessed by Child-pugh classification independent of causal agent of hepatocellular careinoma. Moreover, the both positive ratio of AFP and PIVKA II was higher in patients with HBV related hepatocellular carcinoma compared with HCV related hepatocellular carcinoma. These findings suggest that the number of patients with HCV related hepatocellular carcinoma receiving surgical resection, TAE and TAI is increased significantly compared with HBV related hepatocellular carcinoma as a result from the reciprocal effects of these factors, so that the patients with HCV related hepatocellular carcinoma might have longer survival.

View full abstract

We reviewed 31 patients with primary carcinoma of upper urinary tract during the past 10 years from 1982 (14 renal pelvic tumor, 14 ureteral tumor and 3 both regions). Nephroureterectomy was performed in 17 cases, nephrectomy in 9 and local resection in 5 of ureteral carcinoma (4 low stage cases and 1 high stage, high-risk case). The pathological depth of tumor was Ta-1 in 10 cases, T2 in 7, T3 in 8 and T4 in 6.: Lymphnode metastasis was seen in 6 cases (T2; 1, T3; 2, T4; 3), distant metastasis in 1 (T3) and vascular invasion in 4 (T3; 2, T4; 2) at or before operation.
Eight of the 31 cases relapsed in the bladder, 3 in the retroperitoneum, 5 in the distantorgans, 1 of the 14 cases treated with nephrectomy or local resection relapsed in the resting ureter and 1 of the 5 cases treated with local resection relapsed in the ipsilateral renal pelvis. Three of the 4 patients with vascular invasion relapsed in the distant organs. The incidence of cancer death was 0% for 10 cases of stage I, 33% for 6 of stage II, 67% for 6 of stage III and 78% for 9of stage IV. All of the 5 cases treated with local resection is alive during the follow-up period of 12-52 months.

View full abstract

To clarify the relationship between nocturnal arrhythmia and desaturation in DMD, we monitored ECG and oxygen saturation simultaneously in Holter electrocardiogram in 20 DMD in patients. Sustained sinus tachycardia (mean HR>100) was diagnosed in 3 subjects and multifocal vetricular premature beats (VPBs) in ten. Total desaturation time (SaO2<90%) over 11 minutes was diagnosed in six and frequency of desaturation per a night over 11 in eleven. Fifteen patients showed daytime hypoventilation, which was diagnosed by arterial blood PCO2 over 45mmHg. We found nosignificant relation among numbers of VPBs, episodes of tachycardia, mean HR and these desaturation parameters.

View full abstract

A comparative study was performed on the effects of three antibiotics, arbekacin (ABK), minocycline (MINO) and vancomycin (VCM) for the clinically isolated 104 strains of MRSA.
1) The serum levels of ABK and MINO were low, while that of VCM was almost equal to those of cephems.
The cumulative rate in urinary excretion in first 6 hours of MINO was low in comparison with those of ABK and VCM.
2) Sensitivity test showed an excellent activity of ABK, MINO and VCM for the 104 strains of MRSA.
3) Torelance (resistant rate) of the 104 strains to ABK was 2.9%, that of MINO was 31.7%, and that of VCM was 0%.

View full abstract

We evaluated the polyethylene glycol-dextran sulfate-MgCl₂ method (A) incomparison with phosphotungstate-MgCl₂ method (B), heparin-CaCl₂, NiCl₂ method (C) and polyethylene glycol method (D) for the quantification of high-density lipoprotein (HDL)-cholesterol.
Methods were compared for precision, effectiveness of lipoprotein sedimentation. Within run precision of method A as indicated by CV ranged from 0.9 to 1.1%. Between day CVs were 3.7% and 3.4% for 33.8mg/dl and 89.5mg/dl, respectively. The supernatants obtained with method A, B, C, and D for normal sera were proved to be devoid of β- and pre-β-lipoproteins as judged by agarose electrophoresis with lipid and cholesterol stain. As for the hyperlipidemic and/or jaundiced sera, containing slow-α-fraction, method D failed to precipitate this abnormal lipoprotein and gave higher values of HDL-cholesterol compared with method A, in that abnormal lipoproteins are precipitated completely. No interference by bilirubin, hemoglobin or turbidity was observed for method A. Values obtained with precipitation technique and those with agarose electrophoresis and enzymatic color development for cholesterol correlated well. This precipitation technique, polyethylene glycoldextran sulfate-MgCl₂ method, is appropriate for routine clinical laboratory use in the assay of HDL-cholesterol in various pathological status of lipoprotein metabolism.

View full abstract

In an attempt to establish the reasonable method of washing and sterilizing the bulk of the toothbrushes inseverely handicapped in-patients, several maneuvers were compared.
Anaerobic bacteria were effectively and satisfactorily reduced by immersing brushes in 0.5% glutaraldehyde and rinsing with tap water, or by washing brushes thoroughly for 30 minutes with 70°C running water, while unacceptable number of bacteria remained attached to the brushes when brushes were washed with tap water for 30 minutes, immersed in 0.1% sodium hypochlorite, ordryed by a high-temperature (85°C) dryer. Similar results were obtained when brushes were in tentionally contaminated with some pathogens. Sterilization by applying microwaves for 5 minutes to either wet brushes or dry ones in a microwave oven was also satisfactory.
Because of potential toxicity of remaining glutaraldehyde and easiness and convenience of the method, washing with hot water is considered the choice of method.

View full abstract

Present status of control measures against nosocomial infection in nationwide national hospitals was investigated together with the previously reported study on the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) through questionnaires which were sent out to a total of 250 national hospitals. The following informations were obtained from the filled questionnaires received from 182 hospitals (83 national hospitals and 99 national sanitarium hospitals).
(1) Infection control committees were setup in the 78 national hospitals (94%) and 73 sanitarium hospitals (73%).
(2) Of the 149 hospitals (144 with MRSA-positive patients and 5 without MRSA patients) 112 hospitals (74%) discussed on control measures against MRSA in the infection control committees. Such discussions were made among the medical staff across the wards or in the hospital management meetings in less than 59 hospitals (40%).
(3) Educational programs on the infection control measures to medical staff were conducted in 106 hospiitals (58%) of the total 182. But the lectures were not given regularly in 91 hospitals (86%) of the total 106. Education on proper use of antimicrobial drugs was also given irregularly in 66 hospitals (36%) of the total 182.
(4) Examination for MRSA in the upper respiratory region of the medical staffs was surveyed in 58 hospitals (32%) of the 182, and MRSA carriers among medical staffs were reported from 28 hospitals. The rates of MRSA detection were ranged from 0.5 to 25%.
(5) Bacteriological surveillance of the hospital environments was carried out by surface swab sampling in 68 hospitals (37%) and by air sampling in 50 hospitals (28%) of the total 182. MRSA was detected from swab samples in 30 hospitals (44%) out of the 68, and MRSA was detected from air samples in 15 hospitals (30%) out of 50. The microbiological survey, and disinfection of the hospital personnel and environment appear to be not satisfactory.

View full abstract

Obstructive arterial diseases were treated by means of the combination therapy with endoarterectomy, endoscopic observation and laser angioplasty. Operation method was as follows; The first, endoarterectomy was done from the distal end of the obstructive area. And the next, the condition of the vessel wall was observed by the angioscope, and residual obstructive tissue was removed with laser irradiatiation. The vessel wall after operation was observed again, and closed. Eight cases with arteriosclerosis obliterans were treated with this method. Angiographical findings and ankle pressure index of the whole cases were excellently improved after operation. In addition to the therapy, arteries of the limbs which were under the state of gangrene were investigated after amputation. As the result, the obstructive tissues were segmental and it was suggested that the limb could be salvaged, if the segmental obstructions were released.
We believe that this method is useful for the treatment of obstructive peripheral arterial diseases.

View full abstract

An 83-year-old female with liver cirrhosis was admitted to our hospital because of high fever. Miliary tuberculosis was highly suspected and antituberculous drugs were administered. Fever continued and diffuse miliary shadows appeared on a chest X-ray film and slowly progressed. A transbronchial lung biopsy and prescalenenode biopsy were performed but they were not diagnostic. She was complicated by hepatic dysfunction, which was considered drug-induced type, and antituberculous drugs were discontinued. Then acute respiratory failure occurred twice and steroid therapy was effective.
Consequently 6 months after admission she died from bleeding tendency. Autopsy revealed miliary tuberculosis and diffuse lung fibrosis. Premortem diagnosis was difficult in this case.

View full abstract

A 40-year-old male visited our hospital because of an abnormal shadow on chest roentgenogram of a health examination. On the basis of enhanced chest CT scan findings, the mass lesion was suspected to be a pulmonary arteriovenous fistula. The patient was hospitalized and underwent surgical treatment. Cardiac catheterization revealed normal pulmonary arterial pressure. Pulmonary angiogram revealed a single arteriovenous fistula, which was composed of a single feeding artery and a draining vein (A⁸ and V⁸). Left lower lobectomy was performed. The post operative course has been uneventful without hypoxemia for one year.

View full abstract

A case of type IIc early carcinoma of the rectum is reported. The patient was 75-year-old male admitted to our hospital for total colonoscopy as a minute examination of mass survey using occult blood tests for feces.
Colonoscopy revealed a small shallow depression with fold convergency in the upper rectum and the lesion was confirmed as group 5 by biopsy. Barium enema showed only a swollen fold at the same site. Then, anterior resection with R₂ curettage was performed. The operative specimen demonstrated a superficial depression, measuring 5×5mm in size, with fold convergency, which was morphologically comparable to type IIc early gastric Cancer.
Histopathological examination demonstrated well to moderately differentiated adenocarcinoma limited to tunica mucosa without associated lesion of adenoma. And there was no lymphnode metastasis or vascular in vasion. It was considered that this lesion might possibly be a de novo cancer. Up to present, types of early colorectal cancer have been elevated ones in most cases, but now reports of superficially-depressed types have been increasing gradually.
Therefore, we wish to emphasize that efforts must be made to detect not only elevated lesions but also superficially-depressed ones at the early stage of colorectal cancer. These efforts will lead to more satisfactory results in treating patients with colorectal carcinoma.

View full abstract

Two cases of chronic schizophrenic inpatients with hyponatremia are presented. They had shown some episodes of impaired consciousness and generalized convulsions. A hyponatremia of the one case was induced by water intoxication due to compulsive water drinking, while that of the other by ileus due to postoperative intestinal adhesion and/or antipsychotic drugs.
The low serum levels of sodium and osmolarities were common findings in both of the cases. The differential diagnoses between the two cases were as follows; 1) The specific gravities and osmolarities of urine were consistently decreased in the water-in-toxicated case but not in the one with ileus, 2) the polyuria occurred continuously in the former, but temporarily in the latter, and 3) the body weight showed definite diurnal variations in the former, while a gradual decline in the latter.
The authors emphasized that the differential diagnosis on the clinical conditions related to water intoxication was practically important, touching upon the other pathogeneses of impaired consciousness and generalized convulsion in chronic psychiatric patients.

View full abstract

A 21-year-old female experienced are markable swelling on the sub-mental region of the floor of themouth. The growth was surgically excised, and the diagnosis of epide rmoid cyst was confirmed by histopathological investigation. The use of both CT scan and echography in diagnosing this disorder enabled prediction of the nature of the lesion by its internal structure and its contour.

View full abstract