Deficiencies of trace metals (copper and zinc) are generally considered not to be a clinical problem, because these trace metals are widely distributed in the foods.
Recently, however, not a few cases of deficiencies of these trace metals in man during intravenous hyperalimentation have been reported. Thus, it has become important to have knowledge of these trace metals in clinical practice. The author reviews basic biochemistry, mechanisms and symptoms of deficiencies of these trace metals.

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The authors have evaluated the clinical application of peripheral blood stem cell transplantation (PBSCT) in the treatment of refractory childhood cancer as an alternative to bone marrow transplantation from May in 1991, We have collected circulating mononuclear cells from the children with various types of cancer during the period of platelet and leukocyte recovery after chemotherapy by leukapheresis utilizing a continuous flow blood cell separator (CS 3000, Fenwall, Lab., IL). Those cells were fractionated on discontinuous gradients of Percoll for enrichment of hematopoietic stem cells, were frozen in a programmed freezer at a cooling rate of -1°C/min, and subsequently were stored at -80°. Progenitor assays were carried out by in vitro methylcellulose colony assay. Peripheral blood stem cells were collected by a total of 17 leukaphereses in those 13 children. We report the results of the 17 progenitor assays and discuss the clinical application of PBSCT,

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The change in the treatment modality was analysed on the consecutive 68 patients with the urinary stone in the middle and lower part of the ureter, from 1983 to 1991. The frequency of open surgery decreased markedly in these years. In 1986, all six stones in the lower ureter were treated with transurethral lithotripsy. The use of extracorporeal shock wave lithotripsy was gradually extended to this area and almost all of the stone cases were treated by this method in 1991.

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The mini-mental state test (MMS) and the Hasegawa dementia scale (HDS) were performed on 23 stroke patients undergoing rehabilitation (16 male and 7 female, mean age 56.7 years) in order to examine the reliability of the two simple tests by the test-retest method and the correlation between the MMS and HDS. The WAIS-R was also performed on 20 of the 23 stroke patients to examine the correlation with the MMS and HDS. In addition, we compared the scores of the first and second MMS by question item in order to investigate the degree of consistency and discussed the several points in testing MMS. High reliability was obtained for both the MMS and HDS (r=0.836, r=0.830) and high correlation was observed between the first MMS and HDS (r=0741) and between the second MMS and HDS (r=0.724). While both the MMS and HDS were correlated with the WAIS-R total IQ (r=0.754, r=0.655), verbal IQ (r=0505, r=0.503) and performance IQ (r=0.581, r=0.467), the MMS exhibited a higher correlation with the WAIS-R total IQ and performance IQ than did the HDS. Low consistency was observed with regard to calculation and recall (39% and 43%) between the first and second MMS.

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We report a case of gastric cancer who showed remarkably high serum AFP level. A 56-year-old female complained of severe abdominal pain and consulted her local doctor. Radiologic examinations disclosed a mass lesion in the antrum of the stomach (Borrmann 3 type).
She was admitted to the department of internal medicine, Kure National Hospital in December 1990. Gastroendoscopy also showed the mass lesion in the antrum of the stomach. Histologic study of the biopsied specimen disclosed tubular adenocarcinoma, moderately differentiated type of gastric origin (Group f). Computerized tomography and ultrasonography showed multiple filling low density area in the liver.
The tissues of the tumor obtained at biopsy were prepared for paraffin section and the tumor cells were stained histochemically by labelled Streptavidin Biotin. AFP was demonstrated in the cytoplasm of the tumor cells. The serum AFP level was 490×10⁴ng/ml and AFP subf raction of this showed the type of hepatocellular carcinoma.
The cases of gastric cancer with such high serum AFP level have not been reported. From the observation of AFP subfraction, it is suggested that the gastric cells may perform retrogetic expression and the function may advance remarkably.

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A case of rectal mucosal prolapse syndrome is reported. The patient was a 45-yearold male who was admitted to our hospital complaning of left lower abdominal pain. Colonoscopy revealed a small elevated lesion with shallow ulceration and one mucosal convergency like bridging fold in the lateral wall of lower rectum. The lesion was confirmed as group 1 by biopsy and we could not have a definitive diagnosis. Barium enema showed a small polypoid lesion, measuring about 10mm in size, with shallow depression at the same site. It was thought that the diagnosis of rectal mucosal prolapse syndrome was most likely. We performed transsphincteric resection of the lesion because conservative treatment by normalizing bowel habit was unsatisfactory and it was not completely ruled out that the lesion might be a kind of submucosal tumor. Histopathological examination demonstrated fibromuscular obliteration of the lamina propriae which was a diagnostic feature of rectal mucosal prolapse syndrome. Postoperative condition of the patient has been very good.
We wish to emphasize that transsphincteric resection of the rectal lesion for rectal mucosal prolapse syndrome is useful and effective for not only correct diagnosis but also radical treatment based on its cause.

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This paper presents a case of colonic tuberculosis with verified tubercle bacilli by colonoscopic biopsy. The patient was a 59-year-old man who had a history of pulmonary tuberculosis at 34 years of age. He complained of cough, sputum and loss of weight. Under the diagnosis of pulmonary tuberculosis by chest X-ray and sputum examination, he was referred to our sanatorium. Tubercle bacilli were detected by sputum and stool examination. Double contrast colonography revealed some barium flecks from cecum to transverse colon. Colonoscopy revealed ulcerations with granulotic mucosal margin at five regions. Colonoscopic biopsy showed epithelioid cell granuloma without caseous necrosis. Acid-fast bacilli were confirmed by Ziehl-Neelsen's stain. He was diagnosed as secondary colonic tuberculosis. But smear and culture examination of the biopsy specimens were all negative. It was considered to be the effect of chemotherapy that had been already started.

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Sixteen patients treated for bronchial asthma were diagnosed as active tuberculosis. The following clinical characteristics were demonstrated. Clinical signs and radiogaraphic features of pulmonary tuberculosis were atypical especially in the steroid-therapy group and because of this tendency the diagnosis of tuberculosis were delayed. As a general, anti-tuberculous chemotherapy was effective in both the steroid-therapy group and non-steroid-therapy group. But asthmatic control became more difficult due to the associated tuberculosis in some cases. Careful clinical observations as well as regular sputum examinations and roentgenograms seemed to be more appropriate than prophylactic therapy with INH for high risk patients on steroid. High-dosed BDI requires far more studies for susceptibility to tuberculosis.

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A 62-year-old man visited our hospital, complaining of low grade fever, general fatigue and upper back pain. He had Raynaud's phenomenon in winter for several years. Although serum creatine kinase was markedly elevated, physical examination did not show any abnormal findings as to neuromuscular system. After admission, proximal dominant muscle atrophy appeared and progressed rapidly. Diagnosis of polymyositis was made on the findings of muscular biosy. Since myoglobinuria and renal insufficiency were detected, pulse methylprednisolone therapy was carried out at intervals of 3-4 weeks. The therapy produced, a transient improvement of symptoms and a decline in the creatine kinase level. However, muscular atrophy spread to respiratory muscles in the end. He died of respiratory failure, six months after his admission.
The effect of pulse methylprednisolone therapy on polymyositis has been reported recently. In our case, this treatment was effective but could not suppress the progression of clinical symptoms completely.

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A 3-year-old Japanese boy was treated as Kaposi varicelliform eruption (KVE) during a course of atopic dermatitis, but he recurred KVE immediately after improvement instead of treatment by acyclovir injection. The level of CF antibody of herpes simplex (HS) virus did not increase after recurrence.
Out of forty-five HS patients in our clinic 74.3% of the cases disclosed positive CF antibody of HSV. Subtype 1 of HSV was detected on the face in 80% of the cases, and subtype 2 on the genitalia in 73.3%.

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A case undergoing implantation of autogenous bone and hydroxyapatite for the bone defect produced after curettage of infantile solitary bone cyst is reported.
The patient was a 13-year-old boy. On 14 October 1990, he suffered from a fracture of his right femur when he was playing soccer. By an X-ray examination, he was diagnosed as a pathological fracture caused by bone tumor, and its curretage and osteosyndesis were carried out in another hospital. Pathological diagnosis of that tumor was solitary bone cyst.
Since then, he was observed periodically in our hospital. But gradually, the size of the tumor shadow on the X-ray photograph became enlarged. And so we performed the re-operation on 29 July 1991. After removal of a bone plate, we performed curettage of the bone tumor again and implanted the autogenous bone and hydroxyapatite into the bone defect. On the X ray photograph on October 1992 (1 year 2 months after the second operation), induced cancellous bone was observed around the hydroxyapatite.
At present, he has no clinical symptoms and is enjoying much sports activities aggressively.
Hydroxyapatite seems to be very useful for supplement of the bone defect, particularly in infantile cases.

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