In the past the wards of the chronic diseases of the children in National Sanatoriums were occupied by the patients with chronic renal diseases and bronchial asthma. Recently, inpatients with bronchial asthma have been markedly decreased by the medical progress. The children with obesity and school refusal are increased. It is a big social problem. In order to meet the social demand, National Sanatoriums have to reform the equipments and put the right staffs to the right place.

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We investigated usefulness of corneal sensitivity as a quantitative index of sensory neuropathy in diabetic patients. Subjects were 167 patients with NIDDM. Their age ranged from 28 to 65 years old. Corneas exmined showed no erosive lesions which could affect corneal sensitivity. Corneal sensitivity was measured with a Cochet & Bonnet aesthesiometer with a nylon filament 0.12 mm in diameter. The length of the filament was decreased by 10 mm until a patient could perceive the exact number of the filament's attachments to the cornea. Estimation was carried out in 3 portions of the cornea and we perfomed this study by using the mean value for a total of 6 portions in both eyes.
Statistical analysis was made to corroborate correlation between corneal sensitivity and other indices of diabetic complications including subjective symptoms of sensory neuropathy, coefficient of variation of R-R intervals in electrocardiograms, urinary excretion rate of microalbumin and retinal status. Corneal sensitivity was significantly correlated with these parameters, respectively. When comparison was made between patients with decreased corneal sensitivity and age-and sex-matched groups with normal corneal sensitivity, motor and sensory nerve conduction velocities were found to be significantly decreased in the former.
These data suggest that measurement of corneal sensitivity offers a simple and quantitative test of sensory neuropathy in diabetic patients.

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Patients with neurological disease on long-term enteral nutrition underwent evaluation of the clinical effects of enteral nutrition and autonomic nerve functions.
Patients who were fed with a liquid enteral formula (FIBREN-YH), the major in-gredients of which were fermented milk and honey, were tested for blood biochemical parameters, blood pressure, and coefficient of variation in the electrocardiographic R-R interval.
Each patient who was fed FIBREN-YH showed a good nutritional status and maintained good results on analytic testing of blood biochemical parameters. Diarrhea and decubitus ulcer were rarely observed. Blood pressure exhibited a slight tendency to decrease, and the coefficient of variation in the electrocardiographic R-R interval exhibited a gradual increase.
In patients under long-term bed rest or on long-term enteral nutrition, autonomic nervous system complications frequently occur. However, our findings suggest that autonomic nervous system, compications in neurological patients may be preventable to some extent by appropriate enteral nutrition, and that the coefficient of variation in the electrocardiographic R-R interval is useful in evaluating autonomic nerve function.

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The subjects studied were 148 patients who complained of postmenopausal bleeding. The thickness of endometrium (diameter of tumor) was measured by transvaginal ultrasonography and the sensitivity for detecting endometrial cancer was calculated. The sensitivity for detecting endometrial cancer according the thickness of endometrium was also assessed. Forty-two endometrial cancer patients underwent the preoperative measurement of the thickness of endomtrium and the relation between the thickness of endometrium and the infiltration into the muscular tunics was studied.
Endometrial cancer was detected in 13 of 148 cases and the sensitivity was 8.8%. The sensitivities according to the thickness of endometrium were as follows; 0-5 mm (1.4%), 6-10 mm (2.5%), 11-15 mm (18.8%), 16-20 mm (25.0%), 21-5 mm (75.0%), over 26mm (50%). The sensitivity was significantly improved with increase in the thickness of endometrium.
Of 16 patients suffering from endometrial cancer with the endometrium of less than 20 mm in thickness, 15 (93.8%) showed endometrial localization and infiltration with 0-1/3.
These results suggest that the measurement of the thickness of endometrium by transvaginal urtrasonography provided the index for the detection of endometrial cancer and that this measurement method serves as a useful technique to make an early diagnosis of endometrial cancer.

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We compared examination data collected from institutionalized asthmatic children at admission and just prior to discharge from hosipital. We examined patient profiles, medication, lung function, bronchial hypersensitivity, and exercise ability.
At the time of discharge, medication was reduced or discontinued. Values for pulmonary function, bronchial hypersensitivity and exercise ability were improved.
We wish to stress the importance of teaching allergen avoidance and physical training. Also we strnogly recommend institutional therapy for severe asthmatic patients.

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We experienced a case of chronic pancreatitis who developed osteomalacia due to malabsorption of Ca²⁺ and vitamin D₃ eight years after a pancreaticoduodenectomy (PD). At the age of 46, a PD was performed because of high suspect of carcinoma of the head of the pancreas. The patient had repeated admissions for diabetes mellitus and malnu-tritional problems after the operation. This time the patient complained of decreased muscle power, arthralgia of the hip, knees and foot joints. An examination at the Depart-ment of Bone and Soft Tissue revealed osteomalasia. As serum vitamin D₃ was low, we administered activated vitamin D₃ (2 μg/day), hyperalimentation containing vitamins, and digestive enzyme preparations. His symptoms disappeared within two weeks. The above mentioned course suggests a shortage of vitamin D₃ in this case.

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A 73 year-old woman was admitted to the Department of Internal Medicine of our hospital with the chief complaints of fever, general fatigue, weight loss and right knee joint pain. Initially, systemic infectious disease, malignant tumor and diffuse connective tissue disease were suspected. Thorough examination, however, revealed no evidence of these conditions. Joint fluid examination, performed just before discharge, showed a markedly increased polymorphonuclear cell count (8747/mm³) and the presence of Staphylococcus hominis.
Eventually, the patient was diagnosed as having infectious arthritis caused by Staphy-lococcus hominis, which has not been reported previously as a pathogenic organism in infectious arthritis. The systemic symptoms seen in this patient were considered to be related to infectious arthritis.
Infectious arthritis should be kept in mind, particularly among internists, for the differential diagnosis of patients with systemic symptoms such as fever and fatigue.

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We reported a family of familial hyperphosphatasemia due to increased alkali phosphatase(ALP, EC. 3. 1. 3. 1.) isoenzyme 3 and 5.
The patient was 31-years-old male who was admitted to our hospital by hyperphosphatasemia in 1992. Although ALP 3 was dominant, all bone examination was normal. It was found that his mother, sister and brother also had hyperphosphatasemia in December 1994. His mother had diabetes mellitus and the pattern of her ALP isoenzyme was same as normal person, however, that of his sister and brother revealed high levels of ALP 3 and ALP 5 similar to the patient. their sera treated by neuraminidase showed a neuraminidase resistant band. Therefore, familial hyperphosphatasemia of this family may consist of intestinal ALP and intestinal variant ALP.
Although the increasing ALP 3 of most cases are bone origin, possibility of intestinal variant ALP should be considered.

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The neonatal ambulance transport in Mie prefecture and the neonatal intensive care in the Tsu National Hospital were clinically reviewed. Instead of the real time function, of neonatal emergencies in day and night time or the increment of maternal transport, more rapid transportation system feasible to treat infants born in rural area with well-trained nursing in the first period of life which decide their prognosis, or the assignment of substantial neonatal intensive care units which lack in Mie prefecture confronts us now. Meanwhile neonatal mortality rate is improving in our hospital, however, it is supposed that the infants with poor prognosis were given birth with serious condition and developed severe circulatory and renal disturbances. It is necessary to consolidate the system of timely-maternal transport of high risk pregnancy to the obstetric facilities where effective and professional intensive care in neonates is available. Premature and mature infants with intact survival under the courtesy of perinatal medical support system are human resource in the future and those who engaged.in neonatal emergency treatments are guarantors to keep the quality of life in infants and their mothers.

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We reported a case of the torsion of the ovarial dermoid cyst in a child. A 13-year-old girl complained of lower abdominal pain and admitted to our hospital. As the pain became more severe and emergency CT showed a ovarial cystic tumor with calcification, we diagnosed the torsion of the ovarial cyst. An emergency operation was done on July 20th 1994

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We reported a case of foreign body insertion from anus. A 37-year-old man, who inserted a bottle from anus could not pick it out. He was admitted our hospital, and the bottle was removed with spinal anesthesia.

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A 41-year old female was suffering from a left sided breast tumor and dull epigastralgia. She was diagnosed as cancer of the breast and the stomach and operated for two lesions on the same day. Post operative histological diagnosis was the gas-tric cancer and its metastasis to the breast. But she survived with no recurrence for a period of 46 months and its clinical course was very good compared to 21 cases of breast metastasis from gastric cancer reported in Japanese literatures. Finally the diag-nosis was concluded as the double cancer of the stomach and the breast after reconsid-eration of histological findings. The diagnosis of this case was difficult to differentiate between primary cancer and metastatic tumor of the breast.

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A case of breast cancer following breast augmentation is reported. The case was a 47-years-old woman who underwent breast augmentation with silicone injection 22 years ago, and the silicone was removed because of breast deformity 19 years later. She visited our hospital with a complaint of the tumor growth in her right breast and partia mastectomy with axillar lymph nodes sampling was performed. The pathological diagnosis revealed mucinous carcinoma with matastasis to axillary lymph node combined with silicone granuloma.
The incidence of breast cancer after breast augmentation is reported to be similar to that in genaral population. However, the diagnosis in the early stage is very difficult due to the existence of silicone and granulomas. Therfore careful examinations should be recomended in these cases.

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An eighty-three year old female has undergone orthopedic surgical treatment for the infection of the left hip joint causing high fever. After the operation she felt sick with onset of abdominal pain and abdominal fullness. Emergent operation was performed, and we diagnosed that she had the occlusive ileus at the sigmoid colon caused by the intrapelvic abscess following the total hip replacement.
Recently, according to the aging in the population, there has been many patients for orthopedic surgical operation including total hip replacement which had a delete-rious effect into the pelvis.
We suspect that the post-operative complications at hip joint can be one of the causes of ileus.

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124 patients with transitional cell carcinoma of the bladder treated at Sagamihara National Hospital during 13 year period from 1980 to 1993 were analyzed. Because most of grade 1 and grade 2 tumors did not have muscular invasion, patients with grade 1 and grade 2 tumor were treated by transurethral resection. Five-year survival rates were 90.1 per cent for this patient group.
Most of patients with grade 3, stage Ta and T₁ tumor were also treated by transurethral resection. However, 5-year survival rates were 66.7 per cent for this pa-tient group. To improve the survival rates of patients with grade 3, stage Ta and T₁ tumor, total cystectomy was thought to be necessary for the patients with intravesical tumor recurrence. Most of patients with grade 3 and stage T₂, T₃ and T₄ tumor were treated by total cystectomy and chemotherapy were added postoperatively. However, 5-year survival rates were 46.0 per cent for this patient group.

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The author treated a 21-year-old female with a papilloma measuring 10×20 mm occurring on the right palate and a 57-year-old male with a pedunculated papilloma measuring 15×20 mm occurring on the left palate. Histologically, both cases showed dendriform propagation of the squamous epithelium of the tumor stratum, with no evidence of malignancy. Complete surgical excision was performed, and no recurrence has been observed in either case.

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Cases and results of prescription changes as a result of 600-point operations are report Guidance in medication was given to 326 patients totaly of the Internal Ward by the pharmaceutical Division of the National Sanatorium Tsuruga Hospital between November, 1993 and Octoder, 1994. The prescription was changed as a result of pharma-ceutical consultations by physicians with pharmacists or because of pharmaceutical information provided by pharmacists to physicians in 62, or 19%, of these patients.
600-point operations were considered to be useful for supporting physicians in con-ducting drug therapies and, thus, providing individual and flexible medical care. We suggested 600-point operations may be useful for the cost-benefits in drug therapies.

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