At present, medical wastes become an object of public concern, and standard of management are established by law.
We investigated the waste standard of desinfectants at the hospital. Hospital drainage is regulated by the water pollution control laws. However, drainage of kitchens, wash rooms and bathrooms at the hospital (>300 beds) is controlled by the law, waste water of wards is managed as general drainage.
Since examining the characteristic of the disinfectants detected in this study, it was clarified that the disinfectants in waste water did not interfere with the bioactivation of activated sluge.

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Fifty-one cases of resected Borrmann type 4 gastric cancer were evaluated. Of the 51 patients, ages ranged from 36 to 87 years with the mean of 62.7 years, the male/female ratio was 1.22:1. The cases with the tumor locating through whole stomach (AMC) accounted for 51%, the tumor size greater than 10cm in diameter was found in 53% of the cases. Peritoneal dissemination was found in 31% of the patients at operation, and 98% of the cases had obvious serosal involvement (S2, S3). Histopathologically, poorly differentiated adenocarcinoma accounted for 61%, followed by 29%, 6% and 4% for signetring cell carcinoma, moderately differentiated adenocarcinoma, and mucinous carcinoma, respectively. The types of stroma of the tumor were scirrhous in 78%, intermediate in 20%, and medullary in 2% of the cases. The depth of cancerous invasion was beyond ss-γ in 98%, the histopathological staging were stage 3 in 37% and stage 4 in 63% of the cases. Total gastrectomy was performed in 86%, followed by subtotal gastrectomy in 4% and distal partial gastrectomy in 10%, however, curative procedures were done in only 37% of the cases. The 2-year-survival rate was 16% in patients who had undergone curative resection, with no patients survived 5 or more years.

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Endoscopic injection sclerotherapy (EIS) was performed in 58 patients with esophagocardiac varices. The results and problems were examined.
Theunderlying diseases were liver cirrhosis in 48 patients, hepatocellular carcinoma in 9 patients and IPH in 1 patient. The EIS performance stage were emergent stage in 3 patients, elective stage in 11 patients and prophylactic stage in 44 patients. In the case of liver cirrhosis, the varices healing rate was 58% and relapse rate was 47%. The results were assessed in relation to the liver reserve capacity and indicated that the varices healing rate tended to increase and the relapse rate tended to decrease when the liver reserve capacity was higher.
Because 78% of the relapses were observed within 6 months of treatment, it is necessary to monitor the clinical course of varices every 3-6 months after therapy and perform supplementary therapy promptly after relapse is recognized,
Hemorrhage was prevented even in patients who had hepatocellular carcinoma. But EIS was not completely effective in patients with tumorous thrombi in the portal vein because many of these patients had severe varices.

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A single pass ventricular lead with a dual chamber electrode system (atrial bipolar sensing electrodes displaced along the lead axis 11 and 12 cm from distal tip) was implanted in 28 patients (11 men, 17 women; aged 48 to 90 years, mean 76.8; height 130 to 172cm, mean 152.5; weight 27 to 75Kg, mean 47.2) for symptomatic high degree AV block and normal sinus node function from December 1989 to August 1992. Lead insertion and pacemaker implantation was almost the same as the VVI system. P wave amplitude was 1.9±1.1mV at implant. Post-operative complications included a pneumothorax and a pocket hematoma. Two late deaths occurred as a result of myocardial infarction and renal failure. One patient also failed to function in the VDD mode six months post-operatively because the atrial sensing electrodes were relocated itself from the right atrium to the right ventricle due to the decrease in the heart size. Another patient had frequent atrial arrthymias several months post-operatively. The remaining 24 patients had no significant troubles while in the VDD mode. Activity levels improved (from NYHA functional class 3.0±0.7 to 1.3±0.3) significantly (p<0.01) and their preopeative CTR (59.1±7.3%) significantly (p<0.01) decreased to 52.8±7.4%. Under the conventional VVI technique, the single-lead VDD system can achieve physiological pacing; therefore this system must be acknowledged as the advantageous therapeutic choice for selected patients.

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We started the long-term admission therapy for childhood patients with bronchial asthma in 1969. During the 24 years, 926 childhood patients with bronchial asthma were admitted. They consisted of 605 males and 321 females. In 1969, 16 childhood patients with bronchial asthma were admitted and after that the number of in-patients with childhood asthma has been gradually increasing.
The average period of hospital treatment for the 16 childhood patients admitted in 1969, was 616 days and increased after that. It was 1273 days for the patients of 1975, then gradually decreased and reached 323 days in 1987. The days of hospital treatment of asthmatic-childhood patients admitted from 1988 to 1992, became shorter than before.
In 1987, we began to do the environmental improvement in the house where the patients lived. Our environmental improvement was to eliminatee allergens, such as mites and fungi, from the house. Majorty of the patients, admitted to our hospital were very severe before admission. These severe cases became almost free from attacks of asthma, once they were hospitalized if they were discharged from the hospital to the house free of allergen, as mentioned above, they could keep the same life in the house as hospital life. The environmental improvement accomplished in the patient house has shorten the days of hospital treatment for the asthmatic patients.

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Two hundred and twenty-seven sputum specimens were subjected to the detection of mycobacteria by MB check system (Roche Ltd.) and Ogawa-tween egg culture method. The number of positive specimens and their period (days) for colony growth with Mb check, Ogawa-tween egg method and centrifugation-Ogawa-tween egg method were as follows: 130 and 19.5 days, 86 and 31 days and 89 and 31.2 days respectively.
The detection rate of smear-positive and culture-negative specimens (SPCN) with these 3 different methods (total 92 smear-positive specimens used) were as follows: 13%, 23%, and 22% respectively.
These results indicate that MB check system can be used as the rapid and efficient detection method of mycobacteria in sputum which may further contribute to the more accurate identification of mycobacteria in conjunction with the DNA probe and DDH method.

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We studied thirty-five inpatients presenting a language disturbance following a left putaminal hemorrhage. These patients were submitted to the Standard Language Test of Aphasia (SLTA) on admission and discharge. The results were analyzed and compared with our former report of thalamic aphasia. Writing (0-4), speech (0-3) and comprehension (0-3) were analyzed separately as factor scores, and these three scores were summed individually as a total score (0-10). On admission, language disturbances were mainly severe and twenty patients scored 0 or 1 on the total scores. Writing disturbance was worst and speech was worse than comprehension, therefore, as the same result as our report of thalamic aphasia. On discharge, all the cases except four cases improved. We conclude that improvement of comprehension is best and improvement of speech is better than writing, while improvement of comprehension and speech are equal in thalamic aphasia in our former report.

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Chick embryo raised by long-term culture with calcium-deficient diet outside the eggshell (SL) is known to develop dyslipidemia. In order to elucidate the relationship between calcium and lipid metabolism, we compared the cholesterol bio-synthetic function between SL and normal (NL) embryos. Plavastatin-sodium (PVNa), a potent inhibitor of HMG-CoA reductase, is characteristic of regulating the mechanism of cholesterol bio-synthesis. Although plasma calcium level was lower in SL embryo, tissue calcium content was not significantly different. Cholesterol content in liver was higher in SL. Cholesterol bio-synthesis in liver was dramatically suppressed in NL administered PVNa, but not in SL. These results suggest that the calcium homeostatic change in the chick embryo may affect cholesterol bio-synthesis.

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Eight patients with small T2 brast cancers were treated by a combination of quadrantectomy and radiotherapy. Mean follow-up was 21 months. There were no locoregional relapse and distant metastasis. Focality rate in stage 11 showed 75.0% in quadrantectomy specimen and 45.4% in stage I. The mean number of focality in remaining breast tissue was seven foci in stage if and four foci in stage I. Papillary carcinoma seemed to have multifocality. It was difficult to conclude from small number of cases. But to improve QOL of breast cancer patients, T2 breast cancer may be treated by quadrantectomy and radiotherapy, because of multifocality and a much higher frequency of local recurrence compared with T1 breast cancer.

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Operation for aneurysm of the distal aortic arch can not be performed without aortic cross-clamp at the proximal portion of the left subclavian artery and might require different technique from the operation of the ordinary descending thoracic aortic aneurysm, because of the technique of protection of the cerebrovascular system, of the selection of the suitable aproach to the aneurysm and of the special handling of the nerves in order not to be injured.
From April 1989 to September 1992, 6 patients underwent operations. All of them were true aneurysms, male patients were 4, and average age was 68 years. The operation was supported by the assist devices and techniques as follows; (1) slight hyopothermic anesthesia, (2) one-lung ventilation, (3) centrifugal pump, heparin-coated tubes and cannulas, and (4) autotransfusion of patient's blood.
The artificial prosthesis was implanted at the site of aneurysm under aortic crossclamp supported by the methods including surface cooling anesthesia, left thoracotomy, colapsed one-lung and left heart bypass with administration of small dosage of heparin.
The following results were obtained: The average of aortic-cross clamp time was 100 min. Mean esophageal temperature was 32.9°C, average of ACT was 446 sec (heparin 2.0mg/kg), and 204 sec (0.5mg/kg) respectively. Average blood loss was 1, 074ml and blood transfusion volume was 1, 383ml. Three cases underwent operations without blood transfusion. All the patients were discharged after uneventful courses. We believe that this technique is useful for the treatment of distal arch aneurysm.

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A case of hypophosphatemia caused by antacid complicated with acute respiratory failure due to alveolar hypoventilation is reported. A 75-year-old man was admitted to our hospital because of dyspnea which began several hours before. On admission, cyanosis and hypopnea were noted, however, no abnormalities except hypopnea were found on physical examination. Chest X-ray film was normal and blood gas analysis revealed marked hypoxemia and hypercapnea and acidosis. Endotracheal intubation was performed and mechanical ventilation was started. He had been followed at a practitioner's out patient clinic because of chronic gastritis. Dried aluminum hydroxide gel and magnesium hydroxide were given over a year. Laboratory examination on admission showed hypophosphatemia and hypophosphaturia. Intravenous administration of dibasic potassium phosphate was started and then, serum phosphate became normal on the 2nd day after admission. In accordance with the increase in serum phosphate, hypopnea improved and mechanical ventilation was discontinued on the 2nd day. Hypophosphatemia in the present case was considered to be due to phosphate depletion due to antacid and might be responsible for the development of acute respiratory failure through respiratory muscle weakness.

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The perinatal histories and magnetic resonance imaging (MRI) of 16 children with idiopathic growth hormone deficiency (complete type) were assessed in order to define the relationship between perinatal insult and the development of growth hormone deficiency.
The pregnancies in growth hormone deficiency were complicated by a significantly higher incidence of breech delivery and asphysia. MRI findings demonstrated that 12 of 16 patients with idiopathic growth hormone deficiency have an ectopic neurohypophysis and absence of the infundibulum.
We believe that the growth hormone deficiency in these patients is related to the insult to the pituitary stalk.

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An epidemiological survey study on obesity and blood pressure of 545 elementary school children and 596 junior high school students in Osafune town from 1989 to 1992 was carried out and effects of nutritional patterns and of blood pressure of children's parents were also investigated.
Body mass indices of these children were as high as that of sex-age matched Japanese children, Children with body mass index of 20% greater than Japanese mean level were found in 6.3% of elementary school children and 5.4% of junior high school students.
There were 4 children (0.4%) with systolic blood pressure of greater than 140mmHg and one of them with diastolic blood pressure of greater than 90mmHg, All of the 4 children, who were junior high school students, were diagnosed as the infantile hypertension.
Blood pressures, especially systolic ones, were positively correlated to body mass in dices in children, but not to blood pressures of children's parents, nutritional patterns and salt concentration of a morning fasting urine.
These data suggest that the effect of excessive body weight on blood pressure in children is greater than those of domestic circumstances and genetics.

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Experience of extracorporeal shock wave lithotripsy (ESWL) using the MPL 9000 lithotriptor at the Department of Urology of Osaka National Hospital is reported. The MPL 9000 lithotriptor are characterized by having both ultrasound and fluoroscopic imaging for accurate stone localization and real-time treatment monitoring.
Between May 12 and December 31, 1992, 58 patients underwent 126 treatments for 65 stones, which were located in the renal calyx and/or renal pelvis including 3 cases of staghorn calculus (37 cases), pelvicoureteral juncture (PUJ) (2 cases), upper ureter (15 cases), middle ureter (3 cases), lower ureter (1 case), bladder (2 cases) and others (4 cases). Out of the 65 stones in 58 patients, 58 stones in 52 patients and 38 stones in 36 patients were available with follow-up≥one-month and≥three-month, respectively. The overall stone-free rate one-month and three-month after the last ESWL treatment were 48.3% and 68.4%, respectively. The operative auxiliary procedures after ESWL were required in 2 patients, one was transurethral ureterolithotripsy (TUL) for the patient with left lower ureteral stone and the other was percutaneous nrphrolithotripsy (PNL) for the patient with left staghorn calculus. Although we experienced five cases in 4 patients (8.6%) of perirenal hematoma, all of them required no blood transfusion.
We believe that our experience of ESWL with the MPL 9000 lithotriptor demonstrated an almost favorable result.

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