The Waste Disposal and Public Cleansing Law (hereinafter referred to as “Waste Disposal Law”), that was revised in October 1991 and came into force on the 4th of July, 1992, has specified the infectious waste discharged from medical institutions (hospital, clinic, clinical laboratory, medical facilities for animals, and research institutions for medicine, dentistry, pharmacy, and veterinary medicine) as the special management waste. The Ministry of Health and Welfare has prepared the “Infectious Waste Disposal Mannual according to the Waste Disposal Law” with respect to the regulations on infectious waste according to the Waste Disposal Law.

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Fifty-one patients with hepatocellular carcinoma were examined for esophageal varices by endoscopy. Then, the endoscopic findings were classified into 4 stages based on the score of F and the RC factors. Twenty-five cases (49%) had an F score of 2 or more or were positive for RC, and had potentially hemorrhagic esophageal varices. Hemorrhage was detected in seven out of these 25 patients, i. e., 14% of the total. The severity of endoscopic findings was correlated with that of the hepatic cancer and the clinical condition of the patient. However, no relationship was observed in a few cases. Among the patients who presented concomitant pylethrombosis, marked varices were found in 73% of the cases and hemorrhage was seen in 60% of them. Thirteen cases were treated with endoscopic injection sclerotherapy (EIS), which proved remarkably effective in 31%, moderately effective in 46%, and ineffective in 23%. All the patients who responded well to EIS were in the stage I or less of hepatic cancer. The patients with concomitant pylethrombosis and portal tumor were highly hemorrhagic, and many of them refused EIS treatment.

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Of 124 autopsied cases of lung cancer with numbers of asbestos bodies in 5g wet weight of 10% formaldehyde-fixed lung tissue, incidence of undifferentiated carcinoma including small cell carcinoma and large cell carcinoma increased in male cases in Kure, Hiroshima, while in female cases that of squamous cell carcinoma was extremely small (3.2% among the total female cases of lung cancer), and numbers of adenocarcinoma and small cell carcinoma were as much as of 74% and 16% of female cases, respectively. Among the 42 cases of high asbestos exposure (more than 151 asbestos bodies in 5g lung tissues), cases with lung cancer were 23, 54.8%, in number and twice as much as those of hepatocellular carcinoma or controls.
In the group of lung cancer exposed to high asbestos, cases with squamous cell carcinoma were only 3, 13.6%, in number, however, cases with undifferentiated carcinoma excluded half of highly exposed cases with lung cancer.
These results suggest that in the past Kure area, where one of the biggest naval shipyard is located in Japan, might have been exposed to high asbestos environment, not only because of more than 65% cases with lung cancer among highly exposed group, but also because of 40% of cases with hepatocellular carcinoma or controls among exposed group.

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Obviously granulocyte stimulating factor (G-CSF) is an indispensable drug for doseintesified chemotherapy in gynecological malignancies.
However, G-CSF is also an expensive drug and from the viewpoint of cost-benefit, it is necessary to make a standard that indicates minimal administration with high efficacy. Hematotoxicity was investigated in 289 courses undergoing chemotherapy (the earlier series) and based on the analyzed results, a reasonable standard was proposed. Upon this standard, hematotoxicity was examined in the following 85 courses (the latest series).
In conclusion, administration rate of G-CSF and antibiotics were reduced to the half in the latest series, compared with those of the earlier series.

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One hundred sixty-six patients with diabetes mellitus were examined on their depressive state using self-rating depression scale (SDS). Thirty-six percent of patients were recognized as in a state of depression since their SDS points were over and equal to 40. SDS points were not affected by sex, age, duration of disease, body mass index, blood sugar control, blood pressure and treatment modalities. Diabetic complications such as retinopathy, nephropathy and neuropathy were more frequent among patients with SDS points more than 40. Retinopathy predominated among patients with SDS points more than 40 twice as many as among patients with SDS points less than 40. Diabetic patients who had a number of complications showed higher SDS points. Bifemelane that was supposed to improve brain metabolism was administered to 19 patients with SDS points more than 40 and other 18 patients were followed without bifemelane. Then SDS tests were repeated 3 months later and compared with previous ones and between groups. Although both groups showed improvement in SDS, it should be taken into account that the group treated with bifemelane had more complications than the group without the drug. Bifemelane definitely lowered SDS in patients with up to 2 complications compared to those without bifemelane. The results suggest that drugs improving brain metabolism can be helpful to depressive state associated with diabetes mellitus.

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Sagamihara National Hospital is approved as one of the rheumatoid arthritis (RA) facilities by the Ministry of Health and Welfare. We performed anesthetic managements for 1300 operations from 1974 to 1991, which were mainly done for bone/joint surgeries and pain relief of RA. Operation of RA in the department of orthopedic surgery have increased year by year, and especially total hip replacement (THR) and total knee replacement (TKR) were indicated, reflecting the development of artificial joint replacements. General anesthesia with endotracheal intubation was employed formerly in the operation of patients with RA, but recently we believe that continuous epidural anesthesia was an appropriate and useful method for the various beneficial reasons. We also suggest that mental care is needed for the patients with RA, considering the clinical features of, RA.

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As inquiries concerning medical and pharmaceutical information business become more sophisticated, the ability to exchange questions and answers in written format is becoming essential.
As part of the efforts to construct the “Medical and pharmaceutical Information Network among National Medical Institutions through FAX”, a facsimile was installed in the Medical and Pharmaceutical Information Management Office in our Pharmaceutical Department, in July 1990. With this installation, it became possible to exchange medical and pharmaceutical information through written documents. The medical and pharmaceutical information retrieval system reported in this paper uses personal computers, along with a card-based database management system. This combination enables the proper storage, management, and indexing of medical and pharmaceutical documents, and thus increases the information collection capacity of the system.

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We experienced 2 cases of leukemia expressing Philadelphia chromosome (Ph¹) and major breakpoint cluster region (M-BCR) rearrangement.
[Case 1] A 71-year-old woman was admitted because of chest pain and thrombophlebitis of the left leg. Hematological data on admission revealed as follows: WBC 19, 100/μl with 27% lymphoblasts expressing CD 10 and CD 19, Hb 12.3g/dl, Pit 11.4×10⁴/μl. Bone marrow aspiration showed hypercellular picture and 72.0% of the cells were lymphoblasts. Ph¹ and M-BCR rearrangement were both detected. After remission induction chemotherapy (1-DVP), complete remission was obtained, and then, Ph¹ and M-BCR rearrangement were both disappeared, this case was thought to be Ph¹ (+) acute lymphocytic leukemia (ALL).
[Case 2] A 55-year-old man was admitted because of fever and right hypochondralgia. Hematological data on admission revealed as follows: WBC 127, 500/μl with 23% blasts, Hb 16.1g/dl, Pit 12.5×10⁴/μl. Bone marrow aspiration showed hypercellular picture and 64.4% of the cells were blasts expressing both lymphoid and myeloid markers. After remission induction chemotherapy (VP), hematological remission was obtained, but then, Ph¹ and M-BCR rearrangement were both remained. This case was thought to be blast crisis phase of chronic myelogenous leukemia (CML).
These two cases suggest that consolidation chemotherapy for Ph¹ (+), M-BCR rearrangement (+) leukemia must be decided based on the clinical and cytogenetical course.

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A 27-year-old multipara pregnant woman complained of ophthalmalgia and disturbance of visual acuity at 23 gestational weeks. Laboratry and ophthalmological examinations revealed hemolytic anemia with severe red blood cell fragmentation, DIC and bilateral exudative retinal detachment caused by DIC. Ultrasonography showed bilateral ovarian solid masses. Gastrofiberscopy and biopsy revealed signet ring cell gastric cancer of Borrmann type 4. Anti-DIC therapy and adnexectomy was performed. Histological findings of the resected ovarian mass were compatible with Krukenberg tumor. The patient died probably with cerebrovasucular damage due to hematological disturbances 7 days after the onset of ophthalmic symptoms.
In patients with microangiopathic hemolytic anemia, even if during pregnancy, we shoud keep in minds of gastric cancer.

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A 16-year-old male “Jehovah's Witness” underwent a patch closure for atrial septal defect (ASD). He and his family insisted on having an operation for his ASD without blood transfusion. The patient, his parents and surgeons had a discussion so we decided to do the operation without blood transfusion. The operation using cardiopulmonary bypass took about four hours under high dose fentanyle anesthesia without blood transfusion. We also used Cell-Saver® to reduce blood loss.
We often worry about “Jehovah's Witness” for their rejection of blood transfusion for their commandment. But we have to consider how we should take care of “Jehovah's Witness” and to respect their will at the same time.

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Two cases with partial anomalous pulmonary venous drainage into the high segment of superior vena cava were operated upon.
Superior vena cava (SVC) were devided at the distal site of entry of the anomalous veins. Distal end of the SVC were connected to the right atrial (RA) appendage or a pedicle conduit of RA appendage, RA free wall and pericardium. The anomalous pulmonary veins were connected to the left atrium via SVC, atrial internal conduit and atrial septal defect.
Follow-up MRI was useful for the evaluation of the operation and this technique was effective for the disease.

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A case of hyperosmolar nonketotic diabetic coma (HKNC) associatedd with rhabdomyolysis and increased serum levels of pancreatic enzymes and CA19-9 is reported. A 52-year-old man was admitted to our hospital because of consciousness disturbance. Thirst, polyuria, body weight loss appeared about 3 months before, and symptom of flu began a week before and then consciousness disturbance developed and the patient visited our hospital. On admission, mild consciousness disturbance (somnolence) and marked hyperglycemia, hyperosmolality were noted, however, urine ketone was negative and acidosis was not present. Creatine phosphokinase (CPK), myoglobin were markedly increased and mild elevations of blood urea nitrogen and creatinine were found. Moreover, increased levels of pancreatic enzymes (amylase, lipase, trypsin and elastase I) and increased serum level of CA19-9 were found without elevation of other tumor markers. A large amount of fluid and continuous intravenous insulin administration were started, with improvement of his hyperglycemia and consciousness disturbance in about 12 hours. CPK, myoglobin, various pancreatic enzymes and CA19-9 became normal within a month after admission. Serum levels of C-peptide and urinary excretion of C-peptide were found to be normal. Glycemic control of the patient was excellent with oral hypoglycemic agent when he was dicharged. Although elevations of various pancreatic enzymes were known to be associated during diabetic ketoacidosis, this is the first report showing the association of HKNC and elevated pancreatic enzymes and CA19-9.

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The patient was a 27-year-old woman with frequent bronchial asthma attack. Since March 1989, egg white-like sputum had increased in volume up to about 300ml per day, she was suspected of having bronchorrhea and admitted to our hospital. On the chest roentogenogram, there were no abnormal findings in peripheral areas of lung. In spite of dosing of β-agonist for the purpose of remission of attack of bronchial asthma, the symptoms became worse.
On analytic examination conducted on sputum, the level of albumin was found as high as 1.26mg/ml, and, consequently bronchorrhea due to increased leak of plasma components into the bronchial lumen was suspected. The patient was then treated with betamethasone, starting from a dose of 2mg per day and at 7 days of treatment sputum volume decreased to about 8ml per day and albumin level to 0.08mg/dl with remission of sympto ms.

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The demographic data and the pharmacological treatment of the severely mentally retarded inpatients (adolescents or young adults) were reinvestigated in 1991, while the past survey was done in 1981. The mean age of the patients was 16.3 years old in 1981, and 24.7 years old in the present study. Accordingly, the duration of hospital stay has been prolonged from 50 to 120 months in these years.
Forty-eight patients (67.6%) were given antipsychotic drugs, among which levomepromazine was the most common, and followed by propericiazine. These drugs were used to control the hyperactivity and heightened aggressiveness. In the meantime, less independent patients who needed more daily care were given lesser amounts of drugs.
The antiepileptics (phenobarbital, valproate and so on) were prescribed to fifty-five patients (77.5%). No apparent correlation was found between the use of antiepileptics and the degree of behavioral aberrations. Thirteen cases were remarkably refractory to the antiepileptics, and eventually one to four kinds of drugs were supplemented.

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We studied beneficial and adverse effects of angiotensin-converting enzyme (ACE) inhibitor in patients with severe congestive heart failure associated with Duchenne muscular dystrophy (DMD).
Two patients with DMD who were considered to be In NYHA functional class IV despite digitalis and diuretic therapy were given captopril or enalapril. The addition of ACE inhibitor to digitalis and diuretic therapy improved NYHA functional class, CTR, levels of atrial natriuretic poly-peptide, ejection fraction, and left atrial dimension in these two patients. As adverse effects by ACE inhibitor, renal dysfunction, reduction in hemoglobin concentration, and severe hypotension were particularly recognized in one patient.
Thus, it is suggested that appropriate dose of ACE inhibitor should be administered in patients with severe heart failure associated with DMD under careful monitoring for adverse effects.

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