The nature of depression in Parkinson disease was discussed with reference to the literature including our cases.
1) The incidence of depression in Parkinson disease was 30-90%.
2) Based on the incidence, clinical findings and results of psychological testing, the depression that is observed in Parkinson disease is not merely induced from endogenous depression or complications of the disease.
3) Depression preceded Parkinson disease in 25% of the patients with Parkinson disease, suggesting that depression in Parkinson disease is not a psychogenic response to chronic long-term care or somatic symptoms.
4) Organic depression is attributed to abnormalities in the organic base (dopamine system originating from the left frontal region including the cortex and subcortical region and from the ventrotegmental area).
5) Depression in Parkinson disease was a result of multiple factors, and its expression (clinical findings) varied according to subtype (endogenous depression, psychogenic depression and organic depression).

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The relationship between silent myocardial ischemia (SMI) and heart rate was studied in 69 patients with stable angina pectoris (AP) and 52 old myocardial infarction (OMI), using 24-hour Holter ECG monitoring. Heart rate increased more than 10beat/min at the beginning of ST depression in AP with positive exercise test, while AP with negative exercise test and OMI showed no relationship between SMI and heart rate. Moreover, in AP with positive exercise test, two third of SMI occurred during daytime, while SMI in other patient groups tended to appear at night. The results suggest that mechanisms to cause SMI might be different in AP with positive exercise test from other groups.

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Immunnological parameters were examined in 12 patients with chronic intractable pulmonary tubercurosis. CD4/CD8 ratio was high in 4 of 12 patients and low in one patient. Serum IgG, IgA and IgM levels were elevated in 11, 10 and 2 patients respectively. PPD and PHA skin reactions were negative in only one patient respectively. Lymphocyte blastgenesis response to Con A was enhanced in one patient, and also, the response to PHA was enhanced in 2 patients and suppressed in one patient. IL-2 production to Con A was increased in 4 patients. IFN-α production of patients with chronic intractable pulmonary tubercurosis was significantly lower than that of healthy subjects. IFN-γ production of the patients was lower than that of healthy subjects. Patients in high serum CRP level were tend to hava low IFN-α production. These data suggest that lymphocyte function such as IFN-α production may play an important role in pathogenesis of chronic intractable pulmonary tubercurosis.

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We have examined superoxide generation from peripheral leukocytes of asthmatic patients and control subjects by flow cytometry. After loading with DCFH-DA, a fluorescent probe for superoxide generation, the blood was stimulated with suboptimal concentration of phorbol myristate acetate (PMA, 20ng/ml) at 37°C for 5, 10, or 15 minutes and the fluorescence intensity of the cells was measured by flow cytometry. When assessed by two parameters, 1) fluorescence intensity of the cells in the absence of fluorescent probe was used as a cut-off value and the difference between the positive cells with PMA stimulation and those without stimulation was defined as Δ PCN, and 2) the difference in mean fluorescence intensity (Δ MFI) between the cells with PMA stimulation and those without stimulation, superoxide generation was significantly decreased in an asthmatic group with attack and in a group receiving steroid therapy. Those findings could be partially explained by the observations that these groups showed an increased fluorescence intensity of granulocytes in the absence of PMA stimulation. These results show that spontaneous superoxide generation without PMA stimulation was already increased in granulocytes from asthmatic patients with attack and steroid therapy, suggesting that the method presented in this paper may be valuable means to evaluate conditions of superoxide generation in asthmatic patients.

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Outbreaks of paralytic poliomyelitis (polio) recurred in China since 1988. From 1990, a team of JICA consultants joined Shandong Provincial Epidemic Prevention Station to initiate cooperation for polio eradication. Polio surveillance system needs to be sensitive enough to detect as many acute flaccid paralysis (AFP) patients as possible. Diagnosis of AFP, and skills for differentiating between polio and non-polio AFP were not satisfactory on physicians in rural areas. To assist these physicians, therefore, a simple clinical scoring system was devised to aid the differential procedure between polio and non-polio AFP. The score card was tested and analyzed in 172 AFP patierts reported in Shandong Province in 1993. From the results, the scoring system for differentiating between polio and non-polio AFP was useful in rural areas. A new scoring system developped on the data would give more reliable results.

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We reported the usefulness of three dimensional CT angiography (3 DCTA) in cerebrovascular disease. Twenty two of twenty three intracerebral aneurysms were visualized in 3 DCTA. 3 DCTA was especially useful for the evaluation of posteriorprojection anterior communicating arteries and the distinction between a carotidposterior communicating aneurysm and an infundibular dilatation. An anteriorprojection carotid bifurcation aneurysm, which we missed in DSA, was visualized clearly in 3 DCTA. Stenotic cervical carotid artery lesions were well evaluated in 3 DCTA, including ulceration. 3 DCTA was not so useful for evaluation of intracranial artery stenosis. 3 DCTA was useful as a non-invasive method to evaluate cerebrovascular diseases.

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In our sanatorium, aged long-term inpatients with MRSA are prevalent and the wards are contaminated by MRSA. We report here the results of periodic bacterial examination, prevention and removal of MRSA in the wards over a three-year perod. These examinations and countermeasures against MRSA were very laborious and expensive, nevertheless they were largely unsuccessful, contrary to our expectation It is thought that the prevalence of MRSA is due mainly to the presence of many bedridden patients with the microorganism. Therefore it appears that eradication of MRSA in hospital wards is almost impossible as long as these patients remain.

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This is a case report of a patient with liposaroma of the anterior chest wall. Liposarcoma can potentialy evolve in any part of the body, but that of the chest wall has been rare, as malignant tumors of the chest wall are few. We report a case of a liposarcoma of the anterior chest wall where the differential diagnosis from mammary gland tumor was difficult before the operation. A 57-year-old-woman presented to the hospital with a anterior chest wall tumor which was progressive in size. She was admitted for an operation. A tumor of the left anterior chest wall was smooth, soft, and fixed, and the margin was clear. An operation was performed under the diagnosis of either chest wall or mammary gland tumor. Two giant neoplasms with capsules wesl located under the pectoralis major and fixed to the mammary gland. An extirpation was performed. The size of the giant tumors was 24×17×15cm, and the weight 2000g. The pathological finding was a lipoma like type well-defferentiated lipo saroma.

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We report a 61-year-old woman who had a local recurrence of breast cancer 13-years after operation for the primary tumor. In March 1981, the patient underwent modified radical mastectomy for a right breast cancer at the age of 48. The histological findings were t2, n0, and scirrhous carcinoma. In June 1994, the patient was admitted to our hospital because of a chest tumor. A 3×5mm unmovable and elastic hard mass was palpated, and lumpectomy was carried out.
The excised tumor was histologically comprised of scirrhous carcinoma and it was diagnosed as recurrence on the chest wall. Thus, wide local resection was done. The patient is alive with no further recurrence 7 months later.

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We report a relatively rare case of mucinous carcinoma of the breast which showed a local recurrence 15 years after lumpectomy. A 64-year-old female was seen at the hospital because of a elastic derb mass in the right breast. On physical examination, a 1.8×1.6cm well-defined and movable mass with smooth surface was palpated in the B region of the right breast, which was the same place of the previous operative scar. Aspiration biopsy cytology revealed class V. Breast-conserving surgery (quadrantectomy with axillary dissection) was performed. Histological findings were mucinous carcinoma, n0, lyo, v0, f, with extensive intraductal spread. Serial examination of surgical margin in the resected specimen showed marked cancerous lesions. Because of diffuse invasion of mucinous carcinoma, she was underwent total mastectomy.

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The authors reported a case of Down syndrome complicated with idiopathic pulmonary hemosiderosis. The patient was a 9-year-old female. She had three episodes of dyspnea, fever and anemia. Cytological examination of her sputum showed many macrophages with hemosiderin granules. Biopsy of the lung and the kidney was performed to confirm the diagnosis of pulmonary hemosiderosis and to exclude Good-pasture syndrome, collagen diseases with glomerulonephritis. After corticosteroid was started, she showed neither events of pulmonary hemorrhage nor abnormal laboratory findings.

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We studied 78 cases of small intestine mechanical ileus experienced in our department for ten years. In sixty-two cases of simple (obstructive) ileus, forty-three cases were successfully treated without operation and nineteen cases were operated. Patients with longer suction period and greater amount of suction discharge received operation. All sixteen of strangulated ileus were operated; ten cases (mild strangulated) were treated without bowel resection and six cases (severe strangulated) had bowel resection. One case of severe strangulated ileus died of multiple organ failure. All other cases improved after treatment. The WBC count was useful to distinguish severe strangulated ileus from other types of ileus. Mild strangulated ileus was difficult to diagnose. The senile patients with severe strangulated ileus should carefully be treated, because they seldom had typical symptoms.

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A report on a patient with congenital dilatation of the common bile duct, which was accompanied by carcinoma of the papilla of Vater one and a half years later. In July 1992, at the age of 68, mastopathy of the left breast was diagnosed at the National Kyushu Cancer Center. Further tests showed high levels (116U/ml) of serum tumor marker CA 19-9. The patient was diagnosed to have congenital dilatation of the common bile duct without anomalous arrangement of the pancreaticobiliary ductal system and monitored through the outpatient clinic. In April 1994, the patient was admitted because of high fever (38.9°C) and jaundice. On admission, serum CA 19-9 was 452U/ml, bilirubin 6.3mg/dl, GOT 161IU/L, GPT 91IU/L, ALP 518IU/L, LDH 323IU/L, P-amylase 143I/UL was recorded, all of which were abnormally high. ERCP showed a mass in the lower portiton of the common bile duct which suggested a tumor of the common bile duct or papilla. On May 23rd 1994, a pancreaticoduodenectomy was performed. The post operative diagnosis was carcinoma of the papilla of Vater (adenocarcinoma). After that the CA 19-9 level had fallen to 41U/ml. The high serum CA 19-9 values and follow-up of congenital dilatation of the common bile duct led to the early detection of carcinoma of the papilla of Vater.

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An autpsied case of Binswanger disease with bilateral corticospinal tract (pyramidal tract) degeneration was reported. A 68-year old man who had a history of hypertension and cerebral infarction showed progressive dementia with involvement of affect and volition, pseudobulbar palsy and pyramidal signs. Pathologically, a severe general atherosclerosis was observed. In the cerebrum, especially in the frontal lobes, diffuse myelin pallor and severe loss of axons was found in the deep white matter, despite of sparing of U-fibers. There were multiple small infarctions and severe arteriosclerosis of small arteries or of arterioles in the white matter, basal ganglia, thalamus, internal capsules and pontine basis. In addition, there was a bilateral corticospinal tract degeneration with severe loss of myelin and axons extending from the white matter in the precentral gyri through the posterior limbs of internal capsules to the spinal cords. To our knowledge, there has been no report of Binswanger disease associated with bielateralcorticospinal tract degeneration. Therefore this case was very rare and interesting. We discussed the pathogenesis of the bilateral corticospinal tract degeneration in this case and the relationships between the dementia and the cerebral white matter lesions.

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The present paper deals with the actual condition of 2341 (11.1%) aged patients diagnosed as having dementia out of 20729 aged patients hospitalized at 167 national medical institutes over the country. Out of the 2341 patients with dementia, 673 (3.2%) patients were not immobilized (hereaferreferred to as D group) and 1668 (8.0%) were immobilized (referred to as ID group). The average age of the patients with dementia, duration of their illness, and average hospitalized periods were 78.5 years, 4.9 years and 41.1 months respectively. Sixty-two percent of the demented patients were hospitalized at the department of internal medicine and 15% at the department of psychiatry. The reasons for the hospitalization of these patients were cerebrovascular disease (37%), followed by respiratory disease (14%) and dementia (10%). There were more patients with a past history of cerebrovascular disease in the ID group.Dementia manifested in at least 15% of the patients after hospitalization. There were more patients with more serious dementia in the ID group (p<0.01). In the ID group, the progression of dementia was associated with more serious immobilized condition (p<0.01). Patients with dementia ascribed to cerebrovascular disease were the largest in number. An analysis on these results is included in this study as well.

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A 75-year-old Japanese male with a 7-year history of psoriasis vulgaris was referred to the Department of Dermatology, Kumamoto National Hospital for the development of generalized pustular lesions. His 43-year-old eldest son was also being reated for psoriasis vulgaris and psoriasic erythroderma.
The patient had been treated with the application of corticosteroid ointment and the formation of pustules forced him to apply the ointment more eagerly, leading to an exacerbation. Although resembling pustular pustulosis, his condition was identified to be cutaneous infections by multiple species of fungi and bacteriae including MRSA. Impairment of cutaneous immunity due to corticosteroids was suspected to be responsible for the cutaneous infections. Comprehensive dermatological skill is required to manage such patients on prolonged corticosteroid treatment.

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