Clinical epidemiology is the science which can answer many questions in clinical medicine. Clinical epidemiology can quantitatively evaluate many problems and try to optimize medical technology. Among several ways of clinical research, case-control study, cohort study, and randomized controlled trial can test hypothesis with their own strength and weakness. The problems in these research are bias, confounding, and chance which we can manage with several ingenious methods. Randomized controlled trial which has the strongest power to suggest cause-effect relationship has many issues when we interpret or design randomized controlled trial. When we plan to research in clinical medicine, epidemiologist should be engaged early at design-phase of the study.

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To clarify the incidence and clinical characteristics of catheter-related sepsis, 252 cases who received total parenteral nutrition (TPN) from 1985 to 1991 were studied. The incidence of catheter-related sepsis was 35/252, 13.9%, it was higher in malignant (15.8%) versus benign diseases (7.1%), but was not correlated to the duration of TPN. The types of fever before the catheter removed were: remittent 77.1%, continued and intermittent fever 11.4%, respectively. Leukocyte counts ranged from 2000 to 23500/mm³, leukocytosis (>8000/mm³) was found in only 45.7% of the patients. Positive bacterial culture from the removed catheter tip was 13 (59.1%) out of the 22 patients carried out, 84.6% of the pathogen was Candida. It became completely of ebrile within 3 days after the removal of the catheter in 74.3% of the patients, and all patients returned to normal body temperature within 16 days. From the above results, we suggest that if unknown fever, especially a remittent fever was found in patients receiving TPN, despite of normal leukocyte counts or negative bacterial culture, the intravenous catheter should be removed immediately without any hesitation in order to rule out a catheter-related sepsis.

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Variability of minimum heart rates per minute in high school students were studied. There were 50 subjects selected from the ECG screening tests, and all of these tracings were within normal limits. In these subjects ECGs of 24 hours from 9 to next 8 o'clock were recorded and minimum heart rates per minute were calculated. Minimum heart rates per minute ranged from 45 to 80. The heart rate was lowest in the midnight, especially from 2 to 5 o'clock. These results suggest that, minimum heart rates per minute were affected by the circadian rhythm.

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In traditional Chinese medicine, “Bakuhan-seki”, which are igneous rocks composed mainly of silicic anhydride belonging to the quartz-porphyry family, have been used for centuries for the treatment of swelling and skin diseases.
We studied whether they can affect the symptoms and histopathology of the skin in lacquer-induced contact dermatitis in guinea pigs.
The backs of eight 6-week old female Hartley guinea pigs were clipped and 0.5ml of a 0.1% lacquer (japan) solution was applied 10 times a day using even pressure to produce contact dermatitis. The left half of the backs were left untreated, while the right halves were treated with “Bakuhan-seki” in water or white petrolatum.
Redness, edema and erosion were seen on the 3rd day in both untreated areas and areas treated with “Bakuhan-seki” or white petrolatum, but changes were least in areas treated with “Bakuhan-seki”.
Histologically, epidermal thickening and hyperkeratosis, as well as perivascular inflammatory small round cell infiltration, were commonly seen, but epidermal thickening and inflammatory small round cell infiltration were least marked in areas treated with “Bakuhan-seki”. These findings suggest that “Bakuhan-seki” have anti-inflammatory effects and are effective in improving dermatitis.

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Circadian variation in the concentration of serum theophylline and theophylline metabolites from two sustained-release theophylline preparations, Slo-bid (200mg capsules) and Theolong (200mg tablets) were compared at steady state following dosing at 12 hour intervals using a cross-over method. Patiets in this study were 10 asthmatic children ranging in age from 6 to 10 years.
Mean times of maximum serum concentration (T_max) for the preparations were longer at night than during the day. In the case of Slo-bid, however, the peak-trough difference was significantly narrower over the entire time period. While there were no significant differences in the AUCs of Slo-bid and Theolong, AUCs for night-time administration were significantly lower than those occuring during the day. The serum concentrations of theophylline metabolites were below 1.0μg/ml in all cases and were too low to improve the condition of patients with asthma.

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This is a final report of the three-year-studies. Our findings suggest that the production of anti-HLA antibody to husband HLA antigen and anti-idiotypic antibody to autologous T cell receptors of pregnant women has important implications in the mechanism regulating maternal-fetal immunological responses involved in the maintenance of pregnancy. Our results of studies by DNA typing were inconsistent with the conventional theories in that unexplained recurrent spontaneous abortors were limited to specific DR antigen carriers and that the rate of DR antigen coincidence between pregnant women and their spouses was higher than in normal couples. Futhermore, a statistic survey of patients with maternal-fetal infection was carried out, along with a study to characterize the fetal and placental traits from pregnant women with SLE. In the research area of newborns studies were conducted to obtain information concerning basocyte function, relationship between intestinal flora and incubator contamination, clinical significance of IL-1β levels of maternal and cord blood, and function of basocytes obtained by culturing cord blood by a new method.

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Two cases of paraduodenal hernia are reported. One case was a 35-year-old male who complained of abdominal pain and diarrhea. Leucocytosis was noted. When the emergency operation was done as acute abdomen, we observed that a portion of jejunum of 50cm long was herniated into the retroperitoneal space, just to the right side of the inferior mesentric artery and the sac was situated in the left upper abdomen. This case was diagnosed as paraduodenal hernia at this time. Another case was a 77-year-old male who complained of epigastralgia, upper abdominal distension, and vomiting. The paraduodenal hernia was suspected by means of CT scan just before the operation. On laparotomy, we observed that a small portion of jejunum of 25cm long was herniated into the right upper side of the retroperitoneal space, just to the left side of the superior mesentric artery.
There have been 81 cases of paraduodenal hernia reported in Japan from 1902 to 1991. Major symptoms of paraduodenal hernia were abdominal pain (63 cases: 80.8%), vomiting (53 cases: 67.9%), and abdominal mass (14 cases: 17.9%). Seventeen cases (21.0%) were resected intestine due to ischemic change. Only 9 cases (11.1%) were diagnosed as paraduodenal hernia correctly before laparotomy. The most cases were misdiagnosed as ileus or appendicitis and so on. Recently the number of cases diagnosed preoperatively as pareduodenal hernia are increased by means of CT scan. Preoperative CT scan is useful for diagnosis of paraduodenal hernia.

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The patient, a 41-year-old woman, developed acute portal vein thrombosis during the first trimester of pregnancy. She was admitted with severe epigastralgia and melena. An abdominal computed tomography revealed a thickened small intesinal wall and ascites. A superior mesenteric angiography revealed an occlusion of the portal vein involving the superior mesenteric vein and the development of pen-portal collateral circulation. The patient was found to be pregnant through an ultrasonography, and this was confirmed by an obstetrician. Though a definite relationship between thrombus formation and the pregnancy was unclear, the increased coagulability was considered undesirable, and an artificial abortion was performed.
Warfarin administration was subsequently continued successfully. The patient was not compatible with the criteria used for the diagnosis of extrahepatic portal vein occlusion in Japan because of the absence of portal hypertension. The patient's portal hypertension development will be monitored monthly from this time.

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A 35-year-old male was admitted to our hospital because of abnormal liver function tests at a medical examination on May 14, 1992. There was nothing relevant in his past medical history, and an episode of cold occurred towards the end of April that year. Laboratory data on admission showed a slight elevation of the serum bilirubin and transaminase levels and abnormal elevation of the levels of ductal enzymes. Viral markers and autoantibodies were negative. Ultrasonography revealed heterogenous pattern with hyperechoic lesion in the liver and the atrophic area was markedly enhanced in contrastenhanced CT. Peritoneoscopy revealed wide plate-shaped depressions and potato-shaped elevations. Histological findings showed confluent necrosis around the central vein and round cell infiltration in the lobules. We report a case of scar liver diagnosed with peritoneoscopy in the absence of subjective complaints.

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In this paper, we present a case of malignant fibrous histiocytoma (MFH) successfully treated with combination of hyperthermia, chemotherapy and radiotherapy. A 43-yearold female with MFH was referred to this hospital for its treatment. After admission, the following three treatment modalities were used concomitantly. 1) Radiotherapy: Dose of 61.4 Gy was delivered by conventional fractionation. 2) Hyperthermia: Radiofrequency hyperthermia was administered for 40-50 minutes once a week for 4 times. 3) Chemotherapy: Adraamycin was administered by continuous infusion at a dose of 12mg/sqm/day for five consecutive days and this was repeated twice. Tumor response was good and complete remission seemed to be obtained with acceptable acute toxicities.

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A 51-year-old man was referred to our department because of left scrotal swelling and pain. His symptom was induced by severe varicocele on the left side. A laparoscopic ligation of internal spermatic vein was performed successfully under general anesthesia.
The procedure is regarded as a useful approach to symptomatic varicocele.

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We studied the died inpatients from January 1977 to December 1991. Among 3364 discharged patients in this period, the number reached a total of 103 (3%). Neurologic patients amounted to 74 and psychiatric patients, 29. Regarding the direct causes of death, infection (22.3%) and cerebro-vascular disease (21.4%) were followed by suicide as well as neoplasm (10.7%). There were 5 male and 6 female suicides, 3 of them were schizophrenic, 5 of them, neurotic and the remaining 3 were diagnosed as depression. Six cases committed suicide within the site of hospital. Six cases took the method of hanging and others died from fall, intoxication and so on. Prodromal signs, such as attempts, were recognized in 7, but no causes were revealed in 4 cases. Seven cases committed suicide within 41 days after their admission. We conclude that much attention has to be paid if a patient develops suicidal prodromal signs, including attempts, soon after his admission.

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