The authers reviewed the clinical application of genetic markers as; 1) cancer diagnosis (early detection of cancer, differential diagnosis between benign and malignant lesions), 2) speculation of the prognosis of cancer patient and prediction of chemosensitibity, and 3) determination of high risk people for cancer. It is no doubt that genetic markers is highly useful and going to be available in routine examinations for cancer patients. However, since genetic examination sometimes creates ethical problems, medical doctors should take care of its application and obtain an informed consent.

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Heart rate and blood pressure response to multi-staged exercise were studied in 22 patients with vasospastic angina (VSA) using a bicyle ergometer. Forty two effort angina (EAP) with stenosis more than 75% in diameter in one or two major coronary branches and 65 age-matched normal adults were analyzed as controls. Heart rate and systolic blood pressure increased in parallel with an increase in the exercise level. The response of heart rate was essentially similar in the 3 groups, while blood pressure response was different among 3 groups. When the increase in systolic blood pressure was normalized with changes in heart rate (ΔsBP/ΔHR), the response of systolic blood pressure in VSA was different from other groups; blood pressure elevasion was increased in association with an advance of the exercise level in VSA, while in EAP ΔsBP/ΔHR was almost constant regardless of exercise increment, and ΔsBP/ΔHR of normal group rathe decreased according with an advance of exercise level. Thus, blood pressure response to exercise was greater in VSA than other two groups, suggesting the increased sensitivity of peripheral arteries to α-adrenergic stimulation.

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We investigated the effect of α-interferon (α IFN) therapy on lipid metabolism in patients with chronic hepatits C. Serum values of triglyceride, total cholesterol, HDL-, LDL- and VLDL-cholesterol were estimated before the start, the end and 6 months later, of α IFN therapy. At the end of α IFN therapy, serum values of triglyceride and VLDL cholesterol were increased significantly compared with those values before the start of α IFN therapy. In contrast, serum values of total cholesterol, HDL-and LDL-cholesterol were decreased significantly compared with those values before α IFN therapy. However, 6 months after the end of α IFN therapy, these values in serum were returned to the values before the start of α IFN therapy, suggesting that the effect of α IFN therapy on lipid metabolism might be reversible, when α IFN was administerd for less than 6 months. The changes in serum lipids by α IFN were not different between responders and nonresponders to α IFN therapy. As increase of triglyceride and decrease of HDL-colesterol which were obserued in our satients are well-known risk factors for coronary artery disease, α IFN therapy should be administerd carefully in patients with chronic hepatitis C having risk factors for coronary artery disease.

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Twenty-three in-patients with chronic respiratory failure due to Duchenne muscular dystrophy stayed at home periodically, using nasal intermittent positive pressure ventilation (NIPPV). One of them started home mechanical ventilation 1 year prior to this study As one of medical supporting systems to maintain home mechanical ventilation, we developed monitoring system using pulse oximetry. In this system, host computer at our hospital can communicate patient's computer automatically once daily and on emergency with telephone line to see patients'overnight SpO₂ measured at home. At hospital, we can check the adequacy of ventilation in patient's overnight recording of SpO₂ on NIPPV every morning. According to further decline in pulmonary function, over-night SpO₂ data may indicate the need for ventilator re-settings to manage appropriate nocturnal NIPPV. Instead of visiting hospital regularly, patients can visit hospital only when we reguerted. If no one at patients'home aware the alarm due to acute SpO₂ drop while sleeping, we can recognize the alarm and help emergency at hospital.
We believe that the SpO₂ monitoring system is useful for appropriate management of home mechanical ventilation to postpone tracheostomy or to prevent death.

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Two hundred and twelve patients with cardioesophageal varices were treated in Iwakuni National Hospital from January 1972 to December 1991. These patients were analyzed according to the treatment (operation, endoscopic injection sclerotherapy; EIS, EIS and operation). EIS cases have increased in the 1980s. Nowadays, about 90% of patients were treated with this method. Surgical treatment was chosen to the patients of cardial varices or secondary hypersplenism due to idiopathic portal hypertension. Prognosis was best in the patients with EIS and operation (p<0.05). There was no significant difference in prognosis between the patients with operation and those with EIS. However, prognosis of EIS was better in Child C or emergent patients. In patients with operation, liver failure was a main cause of death. On the other hand, in patients with EIS, rebleeding from varices was a main cause of death especially in the late period.
From these observations, combination of operation and EIS is the most useful therapy to get a long survival time. However, transection of esophagus is difficult because of its fibrous change after EIS. We devised a new method to solve this problem. In our method, transection was carried out in the lower portion two to three centimeters below the esophagogastric junction with EEA-31® (US Auto Suture, Norwalk, Connecticut, USA) instead of the lower esophagus with EEA-25® or EEA-28®. Nonsurgical intervention for cardial varices and hypersplenism is remained to be established.

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The objective of this retrospective study is to evaluate the palliative effect of high dose-rate endobronchial brachytherapy using Co-60 remote after-loading system (⁶⁰Co-HDR) for patient with malignant airway tumors. Ten patients with symptomatic malignant airway obstruction were treated with ⁶⁰Co-HDR. All patients were treated for palliative intent. The fraction size of 5 Gy to 7.5 Gy to the total of 6 Gy to 22.5 Gy for reference point, 1cm outside from the linear source path, were delivered with one week interval. Prior external beam radiotherapy was performed in 6, YAG laser in 4, systemic chemotherapy in 3. There were no fatal complications which seemed to be related to this approach. Significant symptomatic relief were obtained in all (5/5) for hemoptysis, 22% (2/9) for cough. Of the 8 patients who could be evaluated for local tumor responses of ⁶⁰Co-HDR by bronchoscopy, CR was obtained in 2 and PR in 5. Another 2 patients who had extrabronchial tumor attained PR determined by CT. This results indicated that ⁶⁰Co-HDR could safely provide good palliation for patients with endobronchial malignant tumor.

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We report a case of esophageal tuberculosis complicated with silicotuberculosis. The patient was an 81-year-old man who had a history of silicotuberculosis at 61 years of age. He complained of cough, sputum and sore throat. Under the diagnosis of reactivation of silicotuberculosis by sputum examination, he was referred to our sanatorium. Chest X-ray showed diffuse small nodular shadows in the bilateral lung fields, large shadows in the bilateral upper lung fields, swelling and calcification of the mediastinal lymph nodes. Upper gastrointestinal roentgenogram showed an irregular-shaped ulceration in the middle portion of the esophagus. Endoscopic examination revealed a deep ulcer at 30cm from the incisors, the base of which was covered with smoky-black coats and surrounded with granulotic mucosal margin. Histological examination revealed non-caseating epithelioid cell granuloma. Acid-fast bacilli were confirmed by Ziehl-Neelsen's stain. The culture of the biopsied specimen revealed tubercle bacilli. Chest CT scanning at the level of sixth thoracic vertebrae showed a mediastinal lymph node involving the esophagus.
It was considered that the ulcer was resulted from the perforation of a casenous gland into the esophagus, which belonged to tuberculous mediastinal lymphadenitis due to silicotuberculosis.

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I have learned how to care for patients infected with human immunodeficiency virus (HIV) and patients with acquired immunodeficiency syndrome (AIDS) in the United States funded by the Japanese Ministry of Health and Welfare. I studied in the Medical College of Wisconsin. I reported the Wisconsin HIV/AIDS surveillance, universal precautions, hospice for patients with AIDS, and tuberculosis in HIV infection in this paper. Especially, universal precautions are important to care for the patients. Universal precautions are based on the assumption that all patients may carry HIV and HBV. Health care workers therefore should avoid contact with blood and body secretions and use a combination of gloves, gowns, masks, and protective eye wear to shield themselves. The patients infected with HIV are not segregated because of utilizing universal precautions and are cared for in the same way as the other patients. We should establish “universal precautions” as soon as possible and take care of all patients equally.

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The availability of DNA-derived human growth hormone has opened a new frontier in the treatment of growth hormone deficiency. Mass sreenings for cretinism and congenital adrenal hyperplasia have proved to be major factors in the diagnosis and successful treatment outcome.
New drugs, such as nasal desmopressin for central diabetes insipidus, LH-RH analogue for precocious puberty and human insulin for diabetes mellitus have been widely used.

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A patient with Crow-Fukase syndrome or multiple myeloma shows monoclonal gammopathy. We detected IgA (λ)-monoclonal gammopathy in daughter with Crow-Fukase syndrome and in father with multiple myeloma.Case 1 was a 44-year-old foster-daughter, She was diagnosed as having Crow-Fukase syndrome as evidenced by monoclonal gammopathy, pigmentation, neuropathy, hepato-splenomegaly, pleural effusion, ascites and pericardial effusion in 1992. Case 2 was a 74-year-old foster-father. Abnormal plasma cells (35%) in bone marrow, and abnormal lesions by bone scintigram and bone Xray were demonstrated in 1993. He was diagnosed as having multiple myeloma. Her and his monoclonal gammaglobulins were obtained from both of these two cases IgA (λ).
As simultaneous onset and the same pattern of monoclonal gammopathy in these patients, some environmental factor may be the trigger of both diseases.

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Intracerebral tension pneumocephalus is a rare disorder. Only five cases of them have been reported since 1985.
We report two cases of intracerebral tension pneumocephalus with traumatic rhinorrhea. In the first case, intracerebral tension pneumocephalus was induced by lumbar puncture performed two months after trauma. In the second case, intracerebral tension pneumocephalus was observed on computed tomography two months after trauma without surgical intervation. In the second case, rhinorrhea continued after the surgical repair of dural tear. Subdural tension pneumocephalus was induced by lumbar puncture to evaluate continuous rhinorrhea. Both cases had intracerebral tension pneumocephalus where traumatic brain contusion was observed on the initial computed tomography.
Two handred and flinty-one cases of pneumocephalus have been reported since 1985. In those cases, 50 cases were diagnosed as tension pneumocephalus. Eighty percent cases of tension pneumocephalus was observed after proceders such as the not surgical or operation.
We suggest that intracerebral tension pneumocephalus may be induced by surgical intervation, especially for the cases with brain contusion and liquorrhea.

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A case of pancytopenia that developed during the course of mumps in a patient with idiopathic portal hypertension is reported. A 30-year-old woman visited our hospital because of 38-39°C fever that had lasted over 10 days. Laboratory examinations revealed pancytopenia (white blood cell: 1400/mm³, red blood cell: 314×10⁴/mm³, hemoglobin: 9.5g/dl, platelet: 7.7×10⁴/mm³), and she was admitted for further evaluation and treatment. Mild anemia and enlarged liver were noted on physical examination. Bone marrow aspiration showed that erythroid, myeloid and megakaryocytic bone marrow cells were normal or slightly hyperplastic, suggesting that the pancytopenia in this patient was caused by increased peripheral destruction rather than decreased production in bone marrow. Enlarged liver and spleen were found on CT of the abdomen. On the 3rd day after admission, enlargement in her right parotid gland and submandibular gland developed, and she complained of pain in these glands. Laboratory examination showed increased serum levels of amylase, 70% of which was found by isoenzyme examination to come from the parotid gland. Furthermore, antibodies to mumps virus were significantly elevated, and IgM antibody to mumps virus was detected by enzyme-linked immunosorbent assay. Four weeks after admission, her blood cell counts increased to WBC: 3500/mm³, RBC: 357×10⁴/mm³, hemoglobin: 10.8g/dl, platelet: 17×10⁴/mm³. Antigens and antibodies to various hepatitis viruses were all negative, and indocianine green retention test was normal. Abdominal angiographic examination did not show obstruction in her portal or hepatic veins. These results suggested that the pancytopenia was caused by increased peripheral destruction of blood cells by mumps virus in this patient with idiopathic portal hypertension.

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We report a case of pancreatic fistula associated with traumatic injury in a patient with relapsing pancreatitis with pancreatolithiasis.
A 37-year-old man was suffered from stab wounds in the chest and abdomen, involved pancreas and adjacent organs. After the laparotomy, a pancreatic fistula communicating with main pancreatic duct, derived from pancreatic injury with abscess formation developed. Since the persistent fistula seemed related to poor exertion of pancreatic juice through the main pancreatic duct and high intraductal pressure due to the ductal stones, we employed extracorporeal shock wave lithotripsy (ESWL) as a minimalinvasive therapy for pancreatolithiasis. ESWL was successfully applied to fragment the pancreatic duct stones without any complication.
Consequently, the fistula closed and pancreatic exocrine function also recovered.

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Purple urine bag syndrome is reported to occur in aged bedridden patients, especially women who have indicanuria and persistent urinary tract infection. We report two patients, a male and a female, who were aged bedridden and had persistent urinary tract infection. However, indican in the urine was only slightly positive in one and negative in the other. Although it is considered that some species of bacteria and indican in urine participate in the occurrence of this syndrome, a conclusion could not be obtained in this study since the sample was very small.

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A 47-year-old woman who was suffered from tuberous sclerosis with a wide variety of radiologic manifestations was reported. Plain CT scans showed renal angiomyolipoma, multiple calcified subependymal nodules along the latelal ventricles, and pulmonary lymphangiomyomatosis. Bone radiograph showed multiple sclerotic changes. We think the role of radiological examinations is important for the diagnosis of tuberous sclerosis.

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We studied the allergenicty of non-steroidal antiinflammatory drugs (NSAIDs) in delayed-type hypersensitivity (DTH) by leukocyte migration test (LMT) in order to determine the causative drug in a patient displaying hypersensitivity to NSAIDs, An LMT was preformed using an indirect agarose-plate method. The concentration of tested antigen drugs were their therapeutic concentration level. Lymphocytes collected from the peripheral blood of patient were adjusted to a cell count of 1.25×10⁶ cells/ml and incubated with the tested drugs at 37°C for three days in CO₂-incubator. The supernatant was isolated, and the migration test was performed as follows. Granulocytes collected from healthy humans were adjusted to a density 2.5×10⁵ cells/μl, suspended in the supernatant fluid which had been isolated as described above, and migrated on an agarose plate for 48 hours. Migration index (M. I.) values were calculated from the area of the field of migration. The leukocyte migration activatory factor (LMAF) was detected in tested 5 cases NSAID sensitive patients. On other hand leukocyte migration inhibitory factor (LMIF) was not detected. Our findings indicate that tiaramid hydrochloride and diclofenac Na induce LMAF production by lymphocytes and thereby induce their NSAID drug hypersensitivity. Also these findings indicate that LMT is valuable in detecting the causative drugs in NSAIDs hypersensitive patient, and DTH playss a major role in the pathogenesis of this hypersensitivity.

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