We studied the effect of different doses of oxygen on walking in 14 patients with chronic respiratory failure. Setting up 4 stages for oxygen dose while subjects were walking, we compared each stage by measuring the SpO₂, the pulse rate and the ability to continue walking along the corridor. The standard, “the minimum dose of oxygen by which the SpO₂ maintains the stationary state for not less than 3 minutes and maintains not less than 90% SpO₂”, was considered adequate for the dose of oxygen on walking, because the rise in the pulse rate on walking was significantly lower than the previous stage and equal to the next stage. Increasing the dose of oxygen during walking was effective in raising the SpO₂ value, suppressing the rise in the pulse rate with walking, improving subjective symptoms and extending the walk.

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We cultured the bronchial savage of the resected lung in 26 lung cancer patients, and compared these results to the pre- and postoperative informations. The following results were obtained. 1) Bacterial cultures from the bronchial lavage of the resected lungs were positive for the isolation in 3/26 (11.5%) of lung cancers. 2) Cultures from the bronchial lavage of the resected lungs did reflect sputum specimens in 2 of 3 (66.7%) cases. 3) Clinical and pathological informations such as cigarette smoking, obstructive pneumonia, use of antibiotics, histological types of lung cancer and pT factor of lung cancer did not support the presence of the bacteria in the bronchial lavage of the resected lung.
Bacterial culture from the bronchial lavage of the resected lung seems to be useful for the selection of proper postoperative antibiotics.

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We investigated oxygen concentration before and during transport in neonates with congenital heart disease (CHD) to improve the preoperative management of such patients. Sixty-four neonates with CHD were transported by car to our hospital from January 1989 to October 1993. Oxygen concentration during transport as compared with before transport increased in 13 cases, decreased in 21 cases, and was unchanged in 30 cases. The mean concentration in patients with ductus arteriosus-dependent CHD (n=37) was decreased, while that in patients with high pulmonary flow (n=20) was unchanged. In contrast, the mean concentration in patients with low pulmonary flow (n=7) was increased. The management of neonates with CHD in our hospital is reasonable, because excessive oxygen supply has an adverse effect on neonatal CHD.

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Umbilical artery blood gas analysis (UABGA) were performed on 210 cases of newborn infants at Kure National Hospital. The following results were obtained. 1) There was no significant relationship between the age of mother, birth weight, the method of delivery and umbilical artery blood gas (UABG). 2) Umbilical arterial pH (UApH) was high in the groups at weeks <37 of gestational age. 3) When the subjects were divided into two groups based on the time required for the second stage of labor, one group of less than 20 minutes and the other group of longer than 20 minutes, the UApH in the latter group was significantly lower than the former group. 4) The cases with meconium staining of the amniotic fluid tended to show acidosis. 5) There were no significant differences between the UABG of the cases with Apgar score ≤7 and that of those with Apgar score ≥8, and no correlation between Apgar score and UABG was found. The above results suggest that in order to evaluate the status of newborn infants and to manage the care of the preterm fetus, not only the use of Apgar score but also UABGA was important.

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The frequencies of the annual main cadiovascular procedures performed in each hospital must be a index of the grade showing hospital activities. The proper frequencies are, as well, basal condition to maintain highly trained medical and surgical skills. Annual case number of 80 for PTCA for a medical and 80 for CPB for a surgical team are minimal demands.
This investigation revealed that disordered overflooding of hospitals for cardiovascular specialities resulted in deterioration of clinical qualities. The deterioration were exposed in dissatisfaction of facilities, equipments, man-powers and consequently cardiac-special achievements in almost all hospitals but universities.
Proper arrangement of hospitals in regard to the regional population is essential to secure proper case numbers. One cardiovascular hospital is thought to be suitable for one million of regional population. This could be induced only after political guide.
The interventional medical procedures, such as PTCA, should be restricted in the hospitals which have both medical and surgical team. Each medical and surgical team are expected to have two specialists and two trainee-specialists at least. Immediate increase in number of nurse-specialists in ICU, found to be less than half compared to standard in this series, has principal importance of high-grade practice.

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A 42-year-old man was admitted because of sudden onset of dyspnea. After admission, he gradually developed circulatory failure and dyspnea became worse. A tentative diagnosis of pulmonary embolism was made. Results of laboratory tests including ECG, chest roentgenogram and blood gas analyses also supported the diagnosis. We, therefore, instituted the thrombolytic therapy with a recombinant tissue plasminogen activator and heparin. After the treatment, the patient's symptom markedly improved and he quickly recovered from shock. During the therapy, we performed digital subtraction angiography of pulmonary arteries and pulmonary perfusion scintigraphy. Both of them revealed the obstruction of the left pulmonary artery. Thus, the diagnosis of massive pulmonary embolism was confirmed. One month later when the patient was discharged after he became free of any symptoms, we performed catheterization of the pulmonary artery, which revealed persistent occlusion of the left pulmonary artery. The results indicated that improvement in his symptoms was accomplished by thrombolysis of small arterial embolism. The diagnostic usefulness of digital subtraction angiography and therapeutic efficacy of thrombolytic therapy in pulmonary embolism are discussed.

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This report deals with a case of sigmoid colon cancer which recurred locally as a cyst 1 year after surgery together with pulmonary infarction. The cyst was resected after a filter was placed in the inferior vena cava to prevent further pulmonary infarction. The patient, a 63-year-old woman, underwent sigmoid colon resection for the sigmoid colon cancer in December 1989. In December 1990, an elastic tumor with a size of an infant's head was found in the lower right abdomen and she was admitted to our hospital. Pulmonary infarction occurred the morning after abdominal angiography was performed. Pulmonary perfusion scintigraphy showed infarction in the right middle lobe, and venography revealed thrombi in the right external iliac vein compressed by a mass. The intrapelvic tumor was removed after a Greenfield inferior vena caval filter was placed immediately below the renal veins to prevent possible embolism in association with surgery. At laparotomy, a cystic tumor was resected. This was a moderately differentiated adenocarcinoma, which was histologically diagnosed as a local recurrence of the sigmoid colon cancer. She died with distant metastasis in the liver after 22 months, but without recurrence of pulmonary infarction.

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We report a case of chronic type of superior mesenteric artery occlusion with abdominal angina demonstrating interesting clinical course and etiology. The patient was a 72 year old woman. She was admitted to our hospital for the examination of abdominal pain in May 1993. Postprandial abdominal pain continued for 1 to several hours after meals without melena or diarrhea. She had abdominal bruits. Usual laboratory findings were normal including the negative test of blood stool. Fiberscope of upper GI tract and barium study of small and large intestine were normal, however, enhanced CT and abdominal angiography showed the occlusion and stenosis of superior mesenteric artery. And then, we diagnosed abdominal angina induced by superior mesenteric artery occlusion. As her abdominal pain was decreased by medicines, she could discharge. The etiology of her arterial occlusion may be due to anti-phospholipid antibody syndrome because she had anti-cardiolipin antibody.

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The patient, 25-year-old man, has been suffering from persistent liver disorders since 1991. On Aug. 5, 1992, after having heavy drinking to cerebrate his birthday, jaundice, ascites, impairment in liver function and disturbances in his consciousness developed. Two months later, he was admitted to our hospital complaining of abdominal fullness and edema in lower extremities. On admission, prothrombin time was 61% and ICG retention rate was 60%. The diagnosis of fulminant hepatic failure: acute-on-chronic type (Sherlock) was made.
Upon laparoscopy, his liver had an appearance of “Kartoffel Leber”. Computed tomography (CT) of the liver revealed atrophy of the liver with an irregular surface. Several nodules with relatively high density were present and low density area was increased. Total liver volume, sum of the liver area in serial tomograms, was decreased to 1056cm³ (normal: 1493±230cm³), and volumes of low density area and high density area were 471cm³ (45%) and 585cm³ (55%), respectively. The liver function showed improvement in parallel with the restoration of the liver volume, a decrease in low density area and an increase in relatively high density area.

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The authors report a 3-month-old female diagnosed as nesidioblastosis. She had a continuous refractory hypoglycemia in the presence of hyperinsulinism soon after birth. Subtotal pancreatectomy (95%) was carried out as the initial operative procedure, however, a second operation of near-total pancreatectomy (99%) was required because of continued hypoglycemia. Microscopic examination of the first surgical specimen showed diffuse nesidioblastosis without B-cell hypertrophy and that of the second surgical specimen showed diffuse nesidioblastosis with B-cell hypertrophy. We discuss the differential diagnoses (nesidioblastosis, islet cell hyperplasia, endocrine cell dysplasia, focal or diffuse adenomatosis, adenoma), the extent of pancreatectomy and the difference of pathological findings between the first and second surgical specimen.

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Trimahutine maleate is a gastroenteric motor modulator which improves abnormal peristaltic movements through the direct effect on the smooth muscle cells. We examined a case of senile depression with dysarthria due to trimebutine maleate. The patient was a 67-year-old female. At the age of 65, she became depressive state without any causes and some nontricyclic antidepressants gave her no relief from the depression and induced side effects (drowsiness, dry mouth and dysarthria), When she was 66 years old, she was given trimebutine maleate (100mg) for her irritable colon syndrome. After several hours of the administration, she suffered from dysarthria and finger tremor. Quitting trimebutine maleate stopped the symptoms a few days later. The cranial CT findings before the occurrence of dysarthria showed cavum septi pellucidi, cavum Vergae, calcifications in bilateral basal gangilas and mild atrophy of cerebral cortices and the findings after the occurrence had no change. Cerebral hemorrhage and infarction were ruled out by her CT findings and the other drugs were unlikely to cause the dysarthria. Therefore, trimebutine maleate might induce the dysarthria which seemes to be the breakdown of the balance between dopaminergic and cholinergic systems in the brain. Moreover, it is speculated that her dispositional frailty of the central nervous system and the cerebral organic changes by cavum septi pellucidi, the calcifications and aging underlay the apperance of the dysarthria.

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A case of endogeneous Klebsiella pneumoniae endophthalmitis spreading from prostatitis was reported. Bacterial endophthlmitis from urinary tract infection is relative rare. However, we may have to pay attention to bacterial and candidal endophthalmitis, and to prevent the unfortunate episode of such infection by suitable treatments.

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Superoxide dismutase (SOD), an enzyme which decomposes active oxygen responsible for tissue damage in the body, was orally administered to a child with a history of severe atopic dermatitis since infancy.
This patient had been admitted 7 times, had undergone various therapies but had shown no remarkable improvement. Skin erputions improved markedly after oral ad-ministration of SOD, and the patient had been under obserbstion on an ambulatory basis with no admission thereafter. This case is described here with some discussions.

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