Abdominal tumor in the gynecological domain has been treated mainly by laparotomy. A less invasive and more effective therapy capable of dealing with elderly persons, the youth and unmarried women in whom laparatomy poses a problem and cases desirous of bearing a child in which the impact of laparatomy poses a major problem for the postoperative course has been expected. Diagnosis and treatment under an ultrasonic guide as well as diagnosis and surgery under laparoscopy have come to be performed positively as a routine procedure to cope with such a medicare environment in recent years.
Regarding “puncture and drug infusion therapy under ultrasonic guide”, a new therapy for benign ovarian tumors without having a recourse to laparotomy, we explain about it mainly in reference to our 8-years therapeutic experience and discuss its future. Being therapeutically effective and less invasive, this therapy is expected to become more popular and be used more frequently with various improvements made on the aspect of preserving the function in the future.

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Recently, it is reported that nasal-mask intermittent positive pressure ventilation (NIPPY) during sleep is most effective and non-invasive treatment of respiratory failure in patients with Duchenne muscular dystrophy. Although this system is excellent, longterm nasal ventilation causes tissue damages, especially persistent nasal bridge ulceration from a mask. A commercially available nasal plug (Puritan-Bennett Co.) resolves this problem. This nasal plug-IPPV minimized skin pressure and tissue damage, and achieved high effectiveness.

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The purpose of this report was to study the clinical features and the incidence of ischemic cerebrovascular disease (CVD) after cardiac pacemaker (PM) implantation in 60 paced patients. Sixty patients were divided into two groups, non-physiological PM (VVI group: 26 cases) and physiological PM (PP group: 34 cases). Six patients developed CVD, three with cardiogenic embolism, two with lacunar infarction, another one with TIA due to the stenotic ICA lesion, We found a significantly higher incidence of CVD in VVI group compared to PP group (p<0.05), and VVI group had a tendency to increase the incidence of cardiogenic embolism (p<0.1). These two groups were comparable with respect to follow-up period, clinical background and the incidence of new onset of atrial fibrillation (Af) after implantation. Our data indicate that the type of CVD after PM implantation is not only cardiogenic embolism but also the other type of stroke, and that cardiogenic embolism tend to occur more frequently in VVI group compared to PP group. A prospective randomized study appears to be necessary to confirm the relationship between pacing modes and strokes. with a special reference to the type of stroke.

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It is necessary to consider about the effects of the cerebral blood flow (CBF) when the drugs were administered to the patients with cerebral vascular diseases. Cerebaral vasodilator will be expected to increase the cerebral blood flow. Some drugs that participate in an improvement of the cerebral metabolism were also expected to cause indirect increase of the cerebral blood flow. On the other hand, the antihypertensive drugs were desired not to produce adverse effects to the cerebral blood flow when blood pressure was reduced during the course. The present study was performed to evaluate the effects of the drugs administered to the patients with cerebral vascular diseases from a viewpoint of CBF measurement. Regional CBF (rCBF) measurements were obtained using the ¹³³Xe inhalation method. Mean hemispheric rCBF values (mCBF) were calcculated in both the affected and non-affected hemispheres. According to the 9 rCBF values of the affected side at the measurement before drug administration, CBF values were devided to 3 flow levels. Each parts were named as low, middle and high flow region. Nilvadipine has cerebral vasodilating action. When administered orally over 8 weeks, Nilvadipine showed significant increase of the mCBF in the affected hemisphere. An increase of the rCBF is marked at the low flow region. These results are considered to be beneficial as cerebral vasodilatator. The same results were obtained when Bifemerane administered orally. Bifemerane also seemed to have the desirable effects on CBF. Nipradilol (the antihypertensive drug)has no effects on CBF in hypertensive patients with cerebral vascular diseases.

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We comparatively investigated the clinical evaluation of endoscopic variceal ligation (EVL) with 18 cases and endoscopic injection sclerotherapy (EIS) with 58 cases.
Nine cases underwent EVL and another 9 cases required additional EIS besides EVL. The amount of 5% ethanolamine oleate (EO) used was 50.4 ml in individual EIS, and 11.5 ml in a combination of EIS with EVL, and there were 2 cases with chest pain, 1 case with abdominal pain and 3 cases with hemorrhage as side effects. Among these side effects, 2 cases with hemorrhage were caused by unfitted O-ring and 1 case with hemorrhage was caused by vomiting in inserting a sliding tube. There were no cases of fever, liver dysfunction or renal dysfunction.
In conclusion, the amount of EO can be reduced through a combination of EIS with EVL in spite of no shortening of the treatment period. An effective case is enough with only EVL, but a poorly effective case with EVL should require additional EIS. Although side effects of EVL are minimal, it should be careful of hemorrhage.

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For the effective use of blood, it is advantageous to introduce “Maximum Surgical Blood Order Schedule (MSBOS) ”and “Type and Screen (T & S)”. Unfortunately, we have not introduced these devices in. our institution, because we have not yet obtained cooperation from comedical staffs who are not well familiar with the devices. To overcome this situation, we tried to use blood effectively according to the “blood selection criterion”, when we prepared blood for blood transfusion during operations. We first used the blood that had longer effective period, when the ratio of transfusion requirements for a surgical operation was ranging from 0 to 30%. When the ratio was ranging from 61 to 100%, we first used the one that had shorter effective period. When the ratio was ranging from 31 to 60%, we took the following method; when the ratio of crossmatched blood to transfusion (C/T) was equal or greater than 2.1, we first used the blood that had longer effective period. When the ratio was ranging from 1.0 to 2.0, we first used the one that had shorter effective period. As a result, the ratio of blood that was returned to the Blood Center or unable to useb decreased from 3.78% in 1983 to 0.90% in 1992. We conclude that the “blood selection criterion” is advantageous for the institutions that have not introduced MSBOS or T & S, or for the blood administration without the Blood Transfusion Center.

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The Gamma nail was designed to treat intertrochanteric and subtrochanteric fractures. We report the results of 21 patients treated by the device, whose mean age was 79 years old. The mean duration of the operation was 51 minutes and the operative blood loss was 87 ml. The clinical result was excellent and good in 86% and showed satisfactory fracture union. Operative complications were none, but two postoperative complications developed, which included one varus displacement and one superior cutting out of the femoral head.
The Gamma nail transmits weight closer to the calcar than does the dynamic hip screw and it has greater mechanical strength, so that the early weight-bearing can be achieved in porotic bone. A closed operative technique reduces operative invasion and blood loss.
To minimize complicatons, proper placement of the lag screw and special care of the weight-bearing in very porotic bone are important.

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Longitudinally beads-shaped hot area visualized in serial three or more ribs in bone scintigram was investigated retrospectively to determine its characteristic appearance and mechanism in reference to clinical course, past history and so on. Of 1531 consecutive cases studied by bone scintigraphy, a total of fourteen cases, consisting of 7 male and 7 female (mean age of 65 years) and of 7 cancer, 2 multiple myeloma and 5 benign disease, had the beads-shaped hot areas (incidence of approximately 1%). Bone scintigraphy was performed with ^99mTc-MDP and a rotatory gamma-camera equipped with a lowenergy high-resolution collimator. The hot areas were found in the 3rd to the 10th ribs at the anterolateral or other sites along the insertions of the thoracic muscles. In a typical case, 6 lines of the hot areas were noticed bilaterally and 8 ribs per line were involved. In all of the 6 cases followed up by reimagings during 3 months to 3 years, the hot areas became faint or invisible. All of the 7 cases capable of hearing the past history have had a thoracic contusion or other traumatic accident. And, the hot area is thought to be due to costal fracture in conclusion. However, costal metastases may be incident to the hot area particularly in multiple myeloma. Therefore it is not always able to differentiate nonpathological from pathological costal fractures.

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Serum concentrations of the benzodiazepine drugs were measured by the HPLC method in acute intoxicated cases between January and December 1993. Analysis was made on a total of 45 cases and 45 kinds of the drugs with 103 substances were demonstrated. The HPLC could detect 64 substances related to 20 kinds of the benzodiazepine drugs, but no major tranquilizer or antideperessant drugs were detected.

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The drug history administration is quite important for the efficient managements of pharmaceutical counseling which has been adopted since 1988 in a new national insurance payment system as the inpatient pharmaceutical dispensing service.
In October 1992, we started the efficient computer system for the administration of drug history by connecting computer systems between medical account section and department of pharmacy and in addition by inputting additional information such as allergy history and adverse reaction from counseling, medical records, conference and other sources.
This system has efficiently worked and helped the inpatient pharmaceutical counseling, while some points remain to be improved.
Hereafter, the importance of drug history administration will further augment to facilitate more safe and effective use of drugs in geriatrics.

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We examined histamine release test by using whole peripheral blood taken from children with food allergy. Whole blood samples were challenged with antigen obtained from RAST standards, and histamine in the supernatants was measured by anti-histamine antibodies with RIA. The methods were simple and useful for a diagnosis of allergen as has been reported (Mita et al., Arerugii 40(12): 1477, 1991.) In the present study, we examined 42 blood samples from children with food allergy by challenging 349 allergens, and compared either one of histamine release, skin test, or IgE RAST with food elimination-provocation test. Histamine release test was more closely related to food provocation test than IgE RAST and skin test when samples were taken from children over 3 years of age. A substantial number of cases seemed to be required for obtaining significant results.

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We investigated side effects of recombinant interferon α-2b (IFNα-2b) in 30 patients with chronic active hepatitis C. After starting of IFN therapy, the leukocyte counts and the platelet counts fell significantly. On the other hand erythrocyte counts tended to rise transiently, but they reduced after 2 weeks of therapy. Other side effects included fever in 967%, which subsided in spite of continuation of therapy, headache and heaviness in the head in 90.0%, anorexia in 83.3%, general fatigue in 76.70, sore throat in 43.3%, eruption in 33.3% and visual disturbance in 30.0%. IFN therapy was discontinued in 2 patients because of depression. The incidence of these side effects was higher than that appeared in the pamphlet of IFNα-2b and that has been conventionally considered.

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The case was a 73-year-old woman with severe generalized erythroderma that was unresponsive to the corticosteroid therapy. Physical examinations revealed gastric cancer of Borrmann type I (group V adenocarcinoma). After the removal of the tumor, the skin conditions began to improve two weeks later and high titers of SCC-related antigen, serum LDH and peripheral eosinophiles became within normal limits. There have been few female cases of erythroderma associated with internal malignancy.

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With the development of ultrasound and other diagnostic techniques, chance discovery of kidney cancer has increased but many are cases in which the cancer has metastasized. We report 5 recently encountered cases of kidney cancer diagnosed from bone metastase with a brief discussion. The patients were all males ranging in age from 44 to 70 years. Metastatic focis were located in the right stibia, 6th and 7th thoracic vertebrae, right pelvis, 2nd lumbar vertebra, and multiple metastases originating in the right pelvis, respectively. Initially, the pain presented in a locus corresponding to the focus. Two cases with metastasis to the spine had paralysis of the lower half of their body. Three cases underwent nephrectomy and one underwent subtotal cordotomy. Two cases were irradiated for the metastatic foci. As to the treatment, interferon was used in 4 cases, MVB in 2 and UFT in 3. Morphine hydrochloride was used in 3 cases for pain. Four patients died over 2 to 38 months (mean: 5.7 months) following the initiation of the treatment. Only one case survived the cancer for 18 months. Chemotherapy and irradiation were considered effective for alleviation of pain.

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There are few patients with bone and joint tuberculosis now in Japan. Therefore, patients who appear to be cases of doctor's delay are increasing.
Recently, we could diagnose a patient as lumbar spinal tuberculosis at a relatively early stage by computed tomography (CT). We also had experiences of treating two other patients with lung tuberculosis, before they were correctly diagnosed as spinal tuberculosis.
The former was a 44 year old man. During his admission due to tuberculous pleuritis, his low back pain increased. We could recognize the abscess at the intervertebral disc level between L4 and L5 by CT under the condition of imaging soft tissue.
One patient of the latter, a 72 year old man was operated on the diagnosis of spinal osteomyelitis between T7 and T8. After then, he suffered from tuberculous pleuritis and he was subsequently diagnosed as spinal tuberculosis.
Another patient of the latter, a 53 year old woman had high fever while under treatment for lumbar disc herniation. She was diagnosed as miliary tuberculosis and then was correctly diagnosed as spinal tuberculosis.
We can protect against cases of doctor's delay for bone and joint tuberculosis diagnosis, if we take enough care about the patient's history, X-ray and CT results. We should not forget that patients can become seriously ill if a misdiagnosis is made.
CT under the condition of imaging soft tissue is one method that we should try to ensure correct diagnosis.

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We have improved a device, an outer retractor holder fornierly reported by us, in order to install it more easily and to make more cheaply.
The device is comprised of a retractor grasper, which is an improvement of a commercial vise plier, with a spring and a rod. The top of the rod has a steel wire and a optimal portion of the rod is fixed to the operating table with a ball joint block. The grasper grasps an ordinary retractor through the sterile draping outside the surgical field. Then the spring of the grasper is connected easily with the steel wire in a original manner. The strength of the retractor's traction can be adjusted in a step-like manner after any part of the springs are thus engaged.
The device is available for use at any time without disinfection. Whenever an operator himself is needed for removing the retractor temporarily or for adjusting the depth during an operation, this can be readily done as a result of using sprinsg. The selected site, direction, and height of this device can be easily changed by adjusting or shifting the rod and the ball joint block. One or two devices are used depending upon the surgical sites.

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Squamous cell carcinoma of the uterine cervix is one of the most intensively studied cancers in the human malignant tumors and as its cytological features are well established, it is possible to diagnose the early stage of the lesions. However, it is difficult to detect the early stage of the lesion of cervical adenocarcinoma because there are not sufficient data about the relationship between its cytological and histopathological findings. In this report, we present two cases of adenocarcinoma in situ of the uterine cervix detected preoperatively, discuss the cytological fndings, and analyze the DNA content of their tumor cells. In cytological smears of these cases, we recognized pseudostratified, palisade-like or feathering aggregation of the tumor cells, cytoplasmic vacuolation, increased nuclear/cytoplasmic (N/C) ratio, abnormal nuclear arrangement and prominent nucleoli, which seem to provide the useful cytological landmarks in the diagnosis of the early lesions of cervical adenocarcinomas. Moreover, in both of these cases, DNA aneuploidy was revealed.

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Clinical examination was conducted on the thirteen cases of papilloma which developed in the oral cavity and were diagnosed histopathologically during the past fifteen years. Among the benign tumor cases, 9.8% were papillomas. There was no sexual difference, and the largest number of cases was found in those patients in their thirties. About half of the cases ranged from 11 to 20 mm in size. There was a tendency to a larger size for those with a longer time span before visiting the hospital. The site of development was most often found on the tongue or the palate. No relationship with stimulation was found. The majority of the initial symptoms was painless tumor formation. As for the duration of the time between the initial development and the patient presentation to the physician, 76.9% were within three years or less. The morphology was mostly polypoid. As for the treatment, total extraction was conducted. At present, no recurrence has been recognized.

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