From July 1992 to December 1994, we performed 106 videoassisted thoracoscopic surgeries (VATSs) in 103 cosecutive patients.
Diagnoses of patients treated with VATS were pulmonary mass in 47, hyperhydrosis in 19, pneumothorax in 13, mediastinal mass in 11 and chest wall tumor in 2.
Of the 47 patients with pulmonary mass, 27 had primary lung cancer and 5 had metastatic lung cancer.
The VATS seemed to be useful in patients with advanced lung cancer where we could avoid exploratory throacotomy, and in patients with small-sized peripheral lung cancer where we could decide the localization of the lesions and the treatment.

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In this paper, we analyzed the clinicopathological features and survival rate of 30 elderly patients with breast cancer (66 years≤) who were treated with breast conserving therapy, in order to evaluate the significance of breast conserving therapy for elderly patients with breast cancer.
The results were as follows: 1) Positive rates of lymphnode metastasis, estrogen receptor and progestron receptor were not significantly different between elderly breast cancer and non-elderly breast cancer. 2) Elderly breat cancer treated with conserving therapy had equally good over all and disease-free survival at present as non-elderly breast cancer treated with conserving therapy. 3) Positive rates of extensive intraductal component (EIC) and lymphatic infiltration, risk factors of local recurrence, were not significantly different between elderly breast cancer and non-elderly breast cancer. Multifocal lesions were not detected in elderly breast cancer. 4) Breast-recurrence. free survival rate of elderly breast cancer was low.
Based on these results, we conclude that breast conserving therapy is an important and reasonable choice among treatments for elderly patients with breast cancer.

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Knowledges about transfusion were checked by questionnaire methods for 581 medical staffs (117 doctors, 407 nurses, 23 pharmacists and 34 medical technologists) at Nagoya National Hospital. We received 437 answers (75.2%) and problems on it and ways to prevent virus infection for staffs were studied. Doctors and nurses in ward where blood transfusions were not commonly used understood only half of questions regardless of period on working. In this study, necessity of the education for fresh staffs and re-education for senior staffs in transfusion medicine was confirmed strictly. To prevent virus infection, it is important for all medical staffs to wear gloves in direct exposure to blood.

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We report here two cases of Graves' disease who had anti-thyroidhormone autoantibodies. Case 1 is a 47-year-old woman who had two operations for Graves' disease when she was 20 years old and 30 years old. After the last operation she continued taking Thiamazol for about 18 years. The existence of anti-thyroid hormone autoantibodies was suspected in September 1990, when both serum TSH and FT4 levels were high. Anti-T4 and T3-antibody levels were 62.2% and 27.9% respectively in August 1991. The anti-T4 antibody level rose to 75.3% in November 1992. The anti-T4 antibody level lowered to 45.3% and the anti-T3 antibody became negative in Februaly 1994. Case 2 is a 45-year-old-woman. In November 1992, she was diagnosed as Graves' disease because low TSH and high FT4 levels and high TSH receptor antibody levels were detected. She also had a follicular adenoma in the left lobe of the thyroid gland. While she was treated with Thiamazol, both serum TSH and FT4 levels became high in September 1993, when the anti-T4 antibody level was 56.1%, and the anti-T3 antibody was negative. The anti-T4 antibody level lowered to 21.2% in July 1994. Paradoxical changes were not observed between TSH levels and FT 4 levels measured with equilibrium dialysis.

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The patient was a 79-year-old woman. She was diagnosed as anemia and thrombocytopenia in 1987, aortic insufficiency and congestive heart failure in 1989. In September 1991, she was hospitalized for treatment of acute pyelonephritis, in November of that year, she began to have fever and swelling at the right lower limb, which was diagnosed as deep vein thrombosis by computed tomography and venography. She was treated with urokinase and heparin, followed by oral administration with warfarin, ticlopidine hydro-chloride and aspirin, which were discontinued because of thrombocytopenia and a severe bleeding tendency. At that time, she was diagnosed as myelodysplastic syndrome (refractory anemia). In December 1992, she developed chronic disseminated intravascular coagulation (chronic DIC). In July 1994, she was admitted to our hospital because of thrombocytopenia and aggravation of a bleeding tendency. After admission, she was given camostat mesilate (600mg/day) orally, with which a fall of fibrin/fibrinogen degradation products and a rise of fibrinogen occurred. Afterwards DIC became worse when the medication was stopped and became better when the medication was restarted. It was thus concluded that oral administration with camostat mesilate was effective for treatment of chronic DIC.

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Donath-Landsteiner antibody (D-L antibody) is seen usually in children complicated with some special forms of infections. We have reported here an adult case of polymyositis with D-L antibody.
The patient was 46 year-old male. He admitted our hospital for the examination of weight loss and muscle weakness in November, 1993. He had muscle atrophy with the elevation of serumenzymes of muscle origin. He was diagnosed asp olymyositis based on the finding of muscle biopsy. After admission, He had transient hemolysis. Coombs' test, hemagglutinin, minorred blood cell (RBC) antibodies and Ham's test were negative. Osmotic resistance test of RBC was normal. However, Donath-Landsteiner antibody was positive.
This case is interesting because of the complication of polymyositis and D-L antibody. Moreover, adult case with D-L antibody like our case is rare.

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We studied by questionnaire th present status of support for home care patients with progressive muscular dystrophy (PMD) in 26 national sanatoria and National Center for Psychiatry and Neurology that have special PMD wards. The present status study included the support from June 1, 1993 through May 31, 1994 and was evaluated on June 1, 1994. The questionnaire was collected from all 27 institutions.
Home care PMD patients were supported as outpatients in 24 institutions (89%), in day-care unit in 11 (41%) and by home visit in 10 (37%). Five institutions made home visits to home care patients under respirator control. Emergency admissions were seen in 24 institutions. Frequent requests of support from home care patients wer eperiodic medical checkup, way of rehabilitation, consultation of heredity and procedure for notebook of physical handicap and medical certiticate of pension. The future attitude of support for home care patients was positive in 13 institutions and negative in 14.

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Activity of daily life (ADL: dressing and undressing, bathing, excretion and eating), sleeping conditon and presence of decubitus ulcers among demented old patients were investigated. Subjects were 2341 demented patients of 167 national medical institutes. There were all older than the age of 65. They were devided into two group: demented patients (673) and immobilized delnented patients (1668). On the whole, as the degree of dementia was more severe, ADL function dropped considerably. But the function for eating seemed to be well maintained even in the most severely demented patients. When compairing patients within the same degree of dementia, ADL function was lower in immobilized patients. Many demented patients developed sleep disorders. For severely or very severely demented patients, many mobile patients showed insomnia or reversal of night and day while the immobilized patients showed somnolence. In spite of efforts of medical staff, number of patients with decubitus ulcers increased as the degree of dementia proceeded. This tendency was noticeable in immobilized patients.

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We sometimes encounter difficulties in differentiating tuberculous peritonitis from other inflammatory disorders or ascites due to carcinomatous peritonitis. Acid-fast bacilli are rarely detected in ascites. We reported a case of tuberculous peritonitis accompanied with female genital tuberculosis in which acid-fast bacilli were detected in ascites.
The patient was a 23-years-old single woman who had been admitted to the hospital on September 1, 1994, because acid-fast bacilli were detected in ascites by a direct smear in other hospital. She had a lower abdominal distention and a spike fever of 39-40°C. Her serum CA125 level was 870U/ml. Computed tomography showed marked ascites in Douglas pouch. However acid-fast bacilli were not detected in her sputa in spite of the abnormal shadow in the right lung on chest X-ray. Menstrual blood culture for acid-fast bacilli was positive after admission. After treatment by anti-tuberculous drugs of INH, EB, EVM, ascites and serum CA125 level were decreased.

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A 34-year-old women with miliary tuberculosis and lymphadenitis of right supraclavicular lymphnode is reported. Initially chest x-ray film showed only swelling of the left hilar lymphnode. But gradually, milliary shadow and right mediastinal lymphnode swelling has appeared on chest x-ray film. We performed incision and drainage of supra-clavicular lymphnode abcess, and administerd SM, INH, REP, PZA. At first, swelling of right mediastinal lymphnode has improved, followed by improvement of themiliary shadow. From this clinical course, we considered that M. tuberculosis has continuously disseminated from the lymphnodes of prirnary complex.

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The Transfusion Committee of National Hirosaki Hospital conducted a questionnaire survey about understanding of blood transfusion to all the staff and the student nurse of our hospital.
1. Of all 314 valid answers, 165 cases (53%) replied that they knew risks accompanied with blood transfusion. According to occupation, the nursing staffs showed the highest understanding rate (88%), and the physicians and co-medical staffs showed 78% and 70% respectively. The understanding rate of student nurses increased according as they were promoted yearly.
2. In case of blood transfusion, “autologus blood”, “banking blood” and “blood of relatives” were selected equally. The others (2%) replied to refuse blood transfusion.
This questionnaire survey reconfirmed importance of further informations of the transfusion cornrnittee for all the staffs in our hospital.

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Aspiration of foreign bodies into the tracheobronchial tree is much commoner in children than in adults, but often occur in adult with underlying disease. We report two cases of bronchial foreign body aspirations in adult with neurogical disorder. In case I with acute subdural hernatoma, foreign object was a false tooth and in case II with supranucleal palsy, was a chicken. Both foreign bodies were impacted in the trunchus intermedius and were removed with curette, snear loop and basket forceps through bronchofiberscopy. Therefore, we adovocate that in the patient with neurogical disorders, the physician should take care of aspiration and in order to remove foreign bodiese immediately, a set of various forceps should be prepared.

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During the past one year' we have performed carrier and prenatal diagnoses of Duchenne and Becker muscular dystrophy (DMD and BMD) in eighteen familial cases at risk carrying DMD/BMD in the neurornuscular clinic of the National Sanatorium Yakumo Hospital between October 1992 and October 1993. We employed polymerase chain reaction (PCR) for intragenic restriction fragment length polymorphisms (PCR-RFLPs), which were observed in the pERT 87 locus of the DMD gene. Fetal sex was determined by specific ampification of Y chromosome (DYZ1). Seventeen carriers and noncarriers were comfirmed by the DNA method, although one family with BMD did not show informative polymorphysms. If dinucleotide repeat polymorphisms of 5' and 3' end of the DMD gene are employed, almost all cases at risk for DMD/BMD are expected to be diagnosed for the Carrier state. Prenatal diagnosis was successfully done in two fetuses. One was normal male and the other one was female.

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The patient, a seventy-six year old woman, was admitted to our hospital on March 16, 1995. She had undergone laparotomy for the retroflexio of the uterus fifty years ago. She experienced severe abdominal pain followed by abdominal distension at 15 o'clock on the day of admission. A scout film of the abdomer showed distended loops of small bowel. Laparotomy was performed from 20 o'clock on the same day, which revealed small bowel volvulus of about 60cm length starting from a point 70c proxmial to the ileumend. Twist of the bowel and its mesentery was 180-degree to ward he clockwise direction. The twisted portion of the intestine was not resected, and only the twist was released.

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A forty-eight year old felnale with chronic lumbago caused by giant polycystic kidney had performed renal paracentesis treated with minocycline chrolide and 95% ethanol·Abdominal computed tomography was examined three and six months after paracentesis of the cyst. The giant polycystic kidney was found to be reduced in volume. Because reninactivity in the fluid nosl inside the renalcyst was kept at the low level, and the renal function was kept at the moderate level for the long time, we suspect that the renin activity in the renalcyst fluid could be one of the markers fo rhypertension and for the onset of chronic renal failure.

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Intrahepatic portosystemic venous shunt is a rare disease and can be the cause of hepatic encephalopathy. We reported here radiological findings of five cases. Abdominal ultrasonography showed lobulated or tubular anechoic structures communicating with hepaticveins (or IVC) and portalveins. Enhanced CT scans showed high density areas which communicated with hepaticveins (or IVC) and portalveins, and densities of these areas were identical to that of the vascular structure. Color doppler sonography and MRI were also useful imaging modalities.

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We sent a questionnaire and a booklet designed to be handed to patients by pharmacists after oral explanation on morphine to 577 pharmacy departments of hospitals with over 100 beds in Japan. The purpose was to explore opinion about the content and utilization of the booklet. We analyzed the answers of questionnaires completed by 365 institutions by March, 1994. The recovery rate was 63.3%.
The answers were as follows; (1) 88.8% supported the usefulness of this booklet for patients. (2) 54.7% answered that institutions should pay money for the booklet and distribute to patients for free. In contrast, only 8.2% answered that patients themselves should pay money for it. (3) 62.7% answered that pharrnacists were the most appropriate medical staffs to hand out the booklet, and 37.5% answered that physicians were the best. (4) 66.6% answered that both patients and family were suitable subjects to receive the booklet. In contrast, 10.9% answered that only the family were appropriate. (5) 55.0% answered that the best time to deliver the booklet was when morphine was prescribed for the first time. On the other hand, 36.7% answered that the best time was when physicians judged it to be so.
Thus, the results of the investigation suggest that the usefulness of the booklet is supported by 88.8% of institutions. However, there are various opinions among the institutions about the booklet's utilization, such as recipients or the time of supply.

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We investigated the detection of Helicobacter pylori (HP) with biopsied materials from gastric body and vestibulum pyloris of 352 patients with stomach diseases. Using culture method HP was positive in gastric ulcers (77.5%), doudenal ulcers (62.9%) and gastritis (43.7%). HP was detected more frequently, from gastric body than ventibulum pyloris in each of these diseases. Culture method was more sensitive and more specific than other methods. However, urease test was the quicker method.
Therefore, the culture method supplemented by urease test was thought to be most effective for detecting HP.

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