Pulmonary nuclear medicine dates back to Knipping and West in the late 1950's but practically starts with the successful production of ¹³¹I-MAA by GV Taplin in 1963. Not only is the diagnosis of pulmonary embolism greatly facilitated by using ¹³¹I-MAA but also studies of regional lung function have made rapid progress. Radioactive gas and aerosol inhalation have been used to study ventilation distribution in the lungs. Using nuclear medicine technology regional hypoxic vasoconstriction was found to play a great role in regulating regional perfusion distribution in the lungs. Ventilation and perfusion mismatch and match indicate organic lung diseases and pulmonary vascular diseases, respectively. Aerosol deposition patterns in the lungs are helpful in the differential diagnosis of chronic obstructive lung disease (COPD). Technegas is an ultrafine aerosol which is probably more useful for ventilation studies than conventional aerosols produced by either a jet or an ultrasonic nebulizer. Besides respiratory lung function pulmonary nuclear medicine techniques have made it possible to study nonrespiratory lung function. One is mucociliary clearance mechanisms. They can be studied by using a nonabsorbable aerosol like ^99mTc-albumin. Dynamic mucociliary clearance function can be visualized in vivo by radioaerosol inhalation lung cine-scintigraphy. Four abnormal mucociliary transport patterns were discernible in COPD. An objective evaluation of a drug effect on mucociliary transport is feasible. Detailed quantitative analysis of mucociliary clearance is also possible by computer techniques. Pulmonary epithelial permeability is studied following inhalation of ^99mTc-DTPA aerosol. Inhaled ^99mTc-DTPA disappears from the lungs more rapidly in smokers and patients with interstitial lung diseases. Nuclear medicine has great potential to elucidate other functions of the lung which are still not defined yet by the present knowledge of lung function.

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We continued high-dose intravenous immunoglobulin treatment (IVIg) in 3 patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and in 7 patients with multiple sclerosis (MS) for several years. The clinical condition of all patients with CIDP and 3 patients with MS improved after IVIg.
After we discontinued IVIg in 2 patients with MS, these patients deteriorated. When we started treatment as soon as deterioration became apparent, the patients had a beneficial responce to IVIg. We conclude that some of the patients, it will be benefited by contining this treatment for a long period.

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Recentry, we use fiberscope to intubate for difficult airway patient as routine work. From January 1993 to May 1994, we experienced 76 cases of fiberoptic intubation. These cases occupied 3.8% of general anesthesia during same time. Among fiberoptic intubation cases, emergency operation ones such as cervical myelopaty, cervical injury, facial bone fracture occupied 15%. The procedure was successful in 71 cases, but was not in 5 cases. These 5 unsuccessful cases consisted of 3 for inadequate vision due to bleeding in oral cavity and 2 for technical failure.
Fiberoptic intubation is a very useful technique for difficult airway. However this technique is difficult to master. Therefore, to oprate fiberscope skillfully especially for case of emergency, we must be familiar to fiberoptic intubation.

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We performed 29 fuluoroscopically guided baloon dilatation procedures in 12 patients with upper gastrointestinal strictures. Except for esophago-tracheal-fistula which occurred in one patient with baloon dilatation for esophageal stricture after radiation therapy, no other complications were observed. This procedure is safe and effective for the treatment of upper gastrointestinal stricture. Therefore we thought these manners were available and safe IVR (Interventional Radiology) procedures in upper gastrointestinal tract stricture.

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With a view of studying for residential treatment of school refusal in national sanatorium hospital, 263 in-patients were classified into school refusal with excessive adaptive attitude (type I), with passive and negative attitude (type II), with immaturity of impulse control (type III), and with impossibility of classification (type IV).
There were no differences of therapy among these types.
As to the course after discharge, the patients of type I went on to high school more than those of other types. The patients who went on to a part-time high school were found in type II, III and IV more than in type I. The patients at home after discharge were found at about 15% of each type.
The percentage of patients who were able to conduct their community lives well after discharge was 78% in type I or 75% in type II. As compared with these, the percentage of patients who were able to conduct their community lives well after discharge was 65% in type III or 55% in type IV. Consequently, the prognoses of patients in typelU or typeN were slightly worse.
The problem behaviors of type I or II patients in hospital were found in only 23 cases (33%) or 46 cases (38%), but those of type III patients in hospital were found in 35 cases (70%).
These results concluded that the patients of school refusal with excessive adaptive attitude (type I), or with passive and negative attitude (type II) were adapted for residential treatment in national sanatorium hospital.

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A patient who was on hemodialysis had acute myocardial infarction. Direct PICA was performed and reperfusion of the stenotic artery was obtained. Serum CPK levels decreased and the patient, had been stable. Several days later, CPK and LDH increased again without significant increase of CPK-MB component. Restenosis was highly suspected and CAG was performed, however no restenosis nor extension were observed. IABP was used but circulatory failure progressed and the patient died eventually. The autopsy showed severe systemic atherosclerosis, hemorrhagic necrosis and cholesterine emboli of the intestine. This shower embolism may be caused by catheter manipulation and IABP use on patient with severe athrosclerosis.

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A case of tuberculous pleuro-peritonitis with massive bilateral pleural effusions is reported. A 20-year-old woman was admitted to our hospital for evaluation and treatment of a fever which had persisted for more than 2 weeks. On admission, she had a remittent fever, with peak as high as 41°C, and increased serum levels of CRP, transaminases, LDH and alkaline phosphatase. Despite intravenous administration of antibiotics, her fever persisted, and left pleural effusion was found by chest X-ray film on the 8th day after admission. The pleural effusion was an exudate, and cytological and bacterial examinations were negative. Ascites was found by abdominal CT scan, and a drainage tube was inserted into the left pleural space because of increased pleural effusion on the 13th hospital day. Then, right massive pleural effusion was noted on the 16th hospital day, and a second drainage tube was inserted into the right pleural space. The diagnosis of tuberculous pleuritis was made by pathological examination of a pleural biopsy specimen which showed an epitheloid granuloma with typical Langhans type giant cells and acid-fast bacilli. Antituberculous therapy was started, and all clinical symptoms and signs improved with this therapy. Cases of tuberculous pleuroperitonitis have been rare. Only 15 cases have been reported in Japan since 1980.

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We experienced a case of primary hyperparathyroidism which presented chief complaint of epigastralgia as a general digestive symptom and hypercalcemic crisis in the course of treatment. In spite of absence of typical bone lesion, or nephrolith, the case presented renal failure in a short period of time. Although abnormal high PTH value was observed, no other endocrine abnormalities were noted. Transfusion and administration of calcitonin made diverse clinical symptoms disappear. Image examination by scintigraphy in addition to ultrasound and computed tomography confirmed an ectopic parathyroid tumor. Radical operation was performed; a giant adenoma having cystoma inside was extirpated.

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Paralytic ileus is a major complication of Duchenne type muscular dystrophy occasienally observed in advanced stage patients. Extreme lordois and emaciation are two important risk factors. Frequent episodes of nausea and vomiting prevent dietary intake and result in further body weight loss. The vicious circle is easily interrupted by intravenous hyperalimentation. Five kg body weight gain may prevent the gastrointestinal symptoms and increase dietary intake.

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We reported a case showing a transcortical sensory aphasia and Gerstmann's syndrome. The case is a right-handed 55-year-old man with no paralysis whatsoever. His head CT scan shows spread infarction, mainly of the left frontal lobe from the subcortical external capsule to the anterior part of the insula.
Previous reports have indicated some cases of transcortical sensory aphasia due to thalamuc, putaminal and left frontal lesions, but there were few cases also presenting with Gerstmann's syndrome.
In our case, it was considered that these symptoms could be presented together due to the frontal lesion. This case shows a fluent type aphasia despite the left frontal lesion. There fore, it supports the opinion that transcortical sensory aphasia can be caused by a left frontal lesion as reported by Hamanaka et al. (1992).

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A case of endobronchial hamartoma with special reference on its biopsy and pathological diagnosis is reported.
A 59-year-old man was referred and admitted to our hospital with complaints of dry cough and dyspnea. X-ray film at admission revealed diffuse reticular shadow in both of the lungs. Gallium scintigram showed diffuse uptake in both sides of the lung. Respiratory function tests disclosed a severe disturbance. RA test was positive. Patient was treated with steroids under a diagnosis of interstitial pneumonia combined with RA. By brochofiberscopy, a polypoid tumor in the bronchus of the right lower lobe was observed. Biopsy was performed twice. At the first time, the specimen was inadequate. At the second time, angiomyxomatous lesion was found. Histological examination of the resected tumor by endoscopical wire polypectomy revealed a chondromatous hamartoma. We retrospectively discussed concerning the biopsy and pathological diagnosis.

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A case of IIc+ IIa early carcinoma of the rectum is reported.
The patient was a 65-year-old male admitted to our hospital for total colonoscopy as a minute examination of mass survey using occult blood tests for feces. Colonoscopy revealed a shallow depression with marginal elevation in the upper rectum and the lesion was confirmed as group5 by biopsy. Barium enema showed only a small barium fleck at the same site. Then, low anterior resection with D₂z curettage was performed.
The operative specimen demonstrated a superficial depression, measuring 1.3×1.1cm in size, with marginal elevation, which was morphologically comparable to type IIc+IIa lesion.
Histopathological examination demonstrated well differentiated adenocarcinoma limited to tunica mucosa without associated lesion of adenoma. There was neither lymphnode metastasis nor vascular invasion. It was considered that this lesion is a de novo cancer. Up to present, types of early colorectal cancer have presented with elevated lesions in most cases, but now reports of superficially-depressed types have been increasing gradually.
Therefore, we emphasize that efforts must be made to detect not only elevated lesions but also superfically-depressed ones at the early stage of colorectal cancer. These efforts will lead to more satisfactory results in treating patients with colorectal carcinoma.

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The goal of rehabilitation for patients with spinal cord injury lies in sending them back to normal family or social life. But, it is not an easy task in practice. Due to various problem such as coincidence of complications, like bed sores and uropathy as well as inadequacies in accepting conditions of personal and social enviroments.
Futhermore, in the case of transporting the patients when they are injured; many patients are normally taken to emergency hospitals, where injuries are hardly subjected to accepted conditions. Therefore their hospitalization is often unreasonably prolonged without being given satisfactory rehabilitation. Research was made on the problems of these patients with spinal cord injuries, in going back to normal family life.
1) For patients with spinal cord injuries, going back to normal family life, it is necessary to conduct a duly planned rehabilitation with clear objective to be made at the time occurrence of injury.
2) For going back to normal family or social life is the final objective of rehabilitation; closer cooperation is necessary not only of doctors, PTs and OTs, but also of members of welfare offices in municipalities, home helpers, volunteers, etc.
3) In reforming and rebuilding the houses, it is also important not to easily make compromises, allowing for sufficient provisions to meet the needs of patients.

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The prescription of hypnotics for outpatients of 6 national hospitals in Kantoh-Koh-Sin-Etu area were surveyed between 18th and 23th, October, 1993. The incidence of the prescription of hypnotics was 8.6% (1240 of 14394 cases), who received hypnotics through the pharmacy in each hospital. It was 4.5%, excluding the prescription at department of psychiatry. It was highest in 60s age group. Especially, it appeared that the frequency of hypnotic prescription for old patients was highest at the departments of medicine and surgery. In all departments, the highest incidence of the prescription of hypnotic drug was nitrazepam. The second highest incidence was triazolam, followed by flunitrazepam, and brotizolam. It appeared that long-acting hypnoyics were prescribed frequently in department of psychiatry and shortacting frequently in departments of medicine and surgery.

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While there is a possibility of large-scale disasters occurring anywhere in Japan, the area around our hospital is a key points of traffic and it is highly possible that major traffic accidents occur there. Since the Shigaragi Railway Accident in 1992, we have studied measures to cope with a large-scale disaster, have made arrangements to provide various emergency materials and have worked out with relevant manuals. On the basis of these measures, we carried out a simulation with the disasters at the Shigaragi railway, Osaka Newtram and Nagoya Airport taken as examples. If preparations are made in advance, our hospital alone could possibly cope with even considerably h rge-scale disasters. In large-scale disasters, however, there is a limit as to what a single hospital can do so that nation-wide assistance and co-operation of national hospitals are indispensable. Issues such as giving correct informations on the disaster, integrating two or more agencies, dispatching relief squads, storing materials for emergency and securing vacant beds were suggested. Comprehensive training regarding these issues was thought to be crucial.

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