Clinical and laboratory guidelines for assessment and management of patients presenting with chronic fatigue syndrome (CFS) were described. Relevant international consensus diagnostic criteria and research literature on the epidemiology, pathophysiology, concurrent medical and psychological disturbance and clinical management of CFS were presented. Medical and psychiatric morbidity should be carefully assesed and actively treated, while unnecessary laboratory investigations and extravagant treatment regimens should be avoided. No single infective agent has been demonstated as the cause of CFS, and immunolopathological hypotheses remain speculative. The etiologial role of psychological factors is debated. Effective clinical management requires a multidisciplinary approach, with consideration of the medical, psychological and social factors influencing recovery.

View full abstract

We applied the mutation analysis of argininosuccinate synthetase (ASS) gene for the molecular diagnosis of 6 citrullinemic patients. They include two patients with a variant type of neonatal citrullinemia, two with adult onset type II citrullinemia, and two with transient citrullinemia during infantile period. Two frequent mutations (IVS-6^-2 and R 304 W), which comprise about 70% of variant alleles among Japanese citrullinemic patients, were investigated by PCR-RFLP and cycle sequencing method. No patient was found to have either of these two mutations causing classical citrullinemia (type I and III ), indicating the presence of the different genetic backgrounds. It is also suggested that the biochemical defects of type II and transient citrullinemia could not be caused by the mutations within the ASS gene. Therefore, DNA diagnostic method to detect the representative ASS mutations is applicable to distinguish classical citrullinemia among various clinical phenotypes of neonatal citrullinemia. It also can be performed in a routine service laboratory with clear-cut results within a short period of time.

View full abstract

Nine src family members are known to date: c-src, c-yes, c-lck, c-fyn, c-hck, c-lyn, c-blk, c-fgr and c-yrk. They encode proteins of molecular weights of 55 to 62 kilodaltons, which are non-receptor type, membrane associated and protein tyrosine kinases. For the related Src kinases, a close correlation exists between elevated tyrosine kinase activity and cell transformation. However, the involvement of pp 60^c-src in human hepatocellular carcinoma remains obscure. In this study, we analyzed the amount of pp 60^c-src at protein and/or kinase activity levels in tumorous and adjacent nontumorous portions of hepatocellular carcinoma from the same patient. The kinase activity of pp 60^c-src was significantly elevated in the tumorous tissue, than in the nonmtumorous cirrhotic portions. These results suggest that activation of the protooncogene product pp 60^c-src may play an important role in the malignant transformation of hepatocytes in human liver.

View full abstract

Since the incidence of HIV carrier has recently increased, obstetricians have a possibility to examine pregnant womem with a infection of HIV. We report the obstetric course of 4 cases in our hospital and the perinatal infection and the marital infection.
CD 4 level was lower in all 4 cases. Case I (31 y. Japanese, 0-P): termination of pregnancy in first trimester. Case II (25 y. Foreigner, 1-P): termination of pregnancy in second trimester. Case III (22 y. Foreigner, 0-P) and Case IV (23 y. Foreigner, 1-P): delivery with cesarean section in third trimester. In summary, (1) Termination of the pregnancy may be indicated because of the prevention of the perinatal infection (Case I and II ). (2) The delivery with caesarean section is recommended to prevent the vaginal infection and the bottle feeding is better owing to the prevention of the infection via a mother's milk (Case III and IV) . (3) AZT should be carefully treated becauseof the uncertainly of its side effect for a mother and a fetus (Case III and IV) . (4) There were no infection from wife to husband in the Case II and IV. Therefore, We hope that the mechanism should be clarified in future.

View full abstract

There are very few reports of a direct association between leprosy and HTLV-1 infection, though clinical leprosy has long been associated with a defect in cell mediated immunity. We studied leprosy patients to see whether an association between leprosy and HTLV-1 infection, and compared leprosy with hepatitis B (HBV) and hepatitis C (HCV) virus infection.
Samples from leprosy patients (395) were collected from 1993 to 1994 at National Leprosarium Kuryu Rakusenen, Gunma prefecture in Japan. There were 216 male and 179 female cases. They wereover 47 years old and mean of their age is 71. Controls (9602) were blood doners over 50 years old at Gunma prefecture. There were 6554 male and 3048 female cases.
All sera (leprosy and controls) were screened for HTLV-1 by enzyme immunoassay. All sera positive or doubtful by at least one of the two techniques were studied by immunofluorescence assay and by Western blot. Antigens and antibodies to HBs were screened with sandwich immunoassay and detected by IMX ETA. Antibodies to HCV were detected by passive hemagglutination assay.
Statistical analyses were conducted with χ² test.
The prevalence of HTLV-1 antibodies in leprous patients (8.4%) is significantly higher than in controls (0.62%) at Gunma prefecture. The seroprevalence of lepromatous leprosy (L form) is double of tuberculoid leprosy (T form): 9.3% and 4.1%.
HBs antigen positive patients are all L form (3 males, 2 females).
The HBs antibodies prevalence in leprous patients (22.5%) is significantly higher than in controls (4.64%). However the seroprevalence of L form (20.8%) is significantly lower than T form (31.8%).
The HCV antibodies prevalence with leprosy (32.0%) is significantly higher than that with blood doners (1.97%).
The significant difference is not found on the prevalence rates between L form (33.2%) and T form (27.3%).
There is suggested that easily infective against HTLV-1 in leprosy as similar to HBV and HCV. It is suspected that patients with leprosy may be associated with a defect in cell mediated immunity by HTLV-1, HBV and HCV as same as Mycobacterium leprae.

View full abstract

Serum drug concentration were measured by the HPLC method in 2 cases of acute intoxication.
Case 1: 63 years old female was admitted with coma about 17 hours after ingestion of an estimated dose of 3000 mg levomepromazine. After admission the patient had a cardiac arrest and serum levomepromazine level was 2018 ng/ml. After successful resuscitation, direct hemoperfusion (DHP) was tried on. Though after DHP serum drug level was 35 ng/ml, clinical condition did not change.
Case 2: 58 years old female was admitted with coma about 8 hours after ingestion of an estimated dose of 1000 mg thioridazine. Serum thioridazine level was 1895 ng/ml in admission. After 35 hours and 60 hours serum drug level was 428 ng/ml and 427 ng/ml. The elimination curve was similar to that of 2 compartment model.

View full abstract

The annual cases with MRSA were increased from 69 cases in 1986 to 190 cases in 1988 and then gradually decresed to 98 cases in 1994, but after that, they are icreased again to more than 150 cases. MRSA were detected most often from sputum and 57% of it was detected by sputum and urine.
In our hospital, only several antibiotics such as VCM, ABK and Sulfamethoxazole + Trimethoprim were sensitive to MRSA in 1994.
About 20 % of the patients with MRSA were in intensive care unit (ICU). The patients infected with MRSA were increased annually and about 67 % of the patients have mooved to another ward keeping with MRSA. Bacteria in ICU were detected often at the place of entrance, nurse station and from sheets of the patients and the hands of the nurses. It would be important to clean up ward and sterilize the hands of medical stuffs because there are many immuno-compromized hosts and sometimes the patients with artificial treatments such as mechanical ventilation in ICU.

View full abstract

An unusual case of pancreatic body cancer with only massive hematemesis and melena was reported. The 69-year-old male complaining his first hematemesis without other symptoms admitted to our hospital in emergency. Gastrof iberscopy and UGI series showed a profound ulcerating tumor locating at the posterior wall of the upper gastric body, with a biopsy suggesting poorly differentiated adenocarcinoma. Gastric cancer was also suspected on CT scan. Laparotomy was performed under a diagnosis of gastric cancer, but it was considered non-resectable because of wide retroperitoneal and intestinal spread. After the surgery, massive hematmesis and melena continued, the patient died of uncontrollable GI bleeding. On autopsy a tumor measuring 12±10cm was found mainly at the pancreatic body and tail with penetration into gastric wall, duodenum and transverse colon. Histopathologically it showed adenosquamous carcinoma of pancreatic origin.

View full abstract

We report a case of MALT-lymphoma of the rectum in 48-year-old man with special reference to retrospective discussion on four times biopsies. Previous three times biopsies showed background RLH without evidence of monoclonality. At the fourth conventional biopsy, infiltration of mediumsized lymphoma cell (LC) into interfollicular region was found and led to a diagnosis of malignant lymphoma (ML) . Histopathological examination of the resected tumor revealed a MALT-lymphoma (sm, ly(+), n(+))in RLH.
Thirty months observation after operation pointed out no symptome of recurrence. By retrospective studies on biopsies, the first and third biopsy were taken from RLH region. The second biopsy was also taken from RLH and another part suspicious of ML, but a diagnosis of ML was not done because a monoclonality was not demonstrated. By the fourth conventional biopsy in a good state of preservation, ML with RLH was diagnosed finally.
Conventional biopsy method was not adequate for diagnosis of GI-tract lymphoma because of artificial effect. Endoscopic strip biopsy or a partial resection of the lesion may make a diagnosis of ML of the GI-tract easy.

View full abstract