Review was made on the transmisson-mode of HCV with some recent pertinent litratures.
Incidence of posttransfusion hepatitis drastically reduced after introduction of anti HCV screening to donating blood in 1989-1992. However, many problems concerning the transmission-mode of HCV remained unresolved. Attention has been drawn to contaminated syringe (widely used in the past), dialysis, i. o. drug-users, needlestick accidents, acupuncture, tattoo and especially intrafamilial transmission. In endemic areas where a large outbreak of NANB-hepatitis recorded in the past, high positive rate of anti-HCV was demonstrated in the general population, and available evidence strongly suggests that contaminated syringe played a dominant roll in spreading of HCV.
Further works are in progress to clarify the roll of sexual, and vertical transmission route of HCV.

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We studied the efficacy of interferon (IFN) retreatment in fourty patients with HCV positive chronic liver diseases who had no benifical response to the prior IFN treatment. Eight patients (20%) had complete response, four patients (10%) had patial response and twenty-eight patients had no response.
The factors related to complete response were as follows; (1) normalization of aminotransf erase levels during initial IFN therapy, (2) low HCV-RNA titers (less than 10⁵ copies/ml), (3) HCV genotype III or IV and (4) total amount of IFN, more than 400 mega units at retreatment followed by less than 400 mega units at initial treatment.

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In this study, we analyzed complications in the cases of slowly progressive muscular wasting diseases in the matured age. The subjects were 34 myotonic dystrophy (MyD), 26 limb-girdle muscular dystrophy (LG), 7 Becker muscular dystrophy (BMD), 10 fascioscapulohumeral muscular dystrophy (FSH), 4 distal myopathy (Dist) and 4 spinal muscular atrophy (SMA). All cases were in ages higher than 40 year-old.
High incidences of cataract and diabetes mellitus were observed in MyD. Malignant neoplasm occurred in three cases, but had no disease specificity. Vertebral osteoporosis and deformity were prominent in thoses cases of LG, BMD and FSH. LG and BMD also showed remarkable osteoporosis in both pelvic and ankle bones. In MyD, osteoporosis was observed more remarkably in ankle bone, whereas less remarkably in proxymal bones such as vertebrae and pelvis. In ECG study, the ischemic changes, myocardial damages and conduction blocks were observed in 23, 24 and 25% of all cases, respectively. The conduction block in MyD was the prominent incidence of 47%. Two cases had trace of cerebrovascular accident in the brain CT, and lacunar infarction was noted in 8 out of 56 cases. In MyD, the diffuse low density area in the white matter was seen in 24%, and moderate or severe brain atrophy in 76%. MyD also showed low IQ which had no significant correlations with age, duration of illness and the degree of brain atrophy.
In these cases with progressive muscular wasting, the complications are classified as the secondary changes of muscular wasting such as osteoporosis, smooth muscle disorder, cardiac muscle involvement which may be followed by cerebral embolism, and common symptoms with aging. MyD had complicated clinical features which was modified by the progelia and endocrinological and metabolic disorders.

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We evaluated the quality of life in renal transplant patients with poor functioning graft. Sixty-eight cases with functioning grafts and 44 patients on re-hemodialysis after graft rejection were assessed by medical questionnaires. Seventy-three subjects of total 112 (65.2%) were responded by mail to the survey concerning their quality of life. The responses were that they were totally satisfied with their life.
Furthermore, in the 36 cases receiving re-hemodialysis after graft rejection, the influences of hypertension, hyperlipidemia, hyperuricemia, and diabetes mellitus were studied on the duration with poor graft function. The graft survival time from the point whose serum creatinine was increased beyond 3.0mg/dl put on re-hemodialysis, was relatively shortened when they have those complications. It seems to be nescessary for the renal transplant patients to avoid such complications to achieve longer graft survival and enjoy higher quality of life, even for the patients with poor functioning graft.

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We studied US findings of the cob-rectal cancer in the abdominal screening without any procedure, and compared it with Ba-enema findings in the patients with cob-rectal cancers. We could detect 29 cancers out of 45 patients by the US examinations (64.4%). The cancers in the rectum or the sigmoid colon were comparatively difficult to be detected. The size of the cob-rectal cancers measured both in US examination and Ba-enema was similar in diameter. Even the small cancers as 2cm in diameter could be detected. The circulatory cob-rectal cancer in US examination shows the thick, irregular and immobile hypoechoic wall with the dilatation of the cob-rectal wall, retention of the juice, gas and the peristalsis in the oral side, whereas with the normal colo-rectal wall and cavity in the anal side. The non-circular cob-rectal cancer of Borrmann-2 or 3 type shows the hypoechoic tumor with the hyperechoic area in the ulcer of the cancer. We conclude that the cob-rectal cancer can be detected with the careful scanning of the intestinal wall and hyperechoic cavity in usual routine US examination without any procedure.

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We studied long-term prognosis of duodenal ulcer (DU) retrospectively. Fifty five (15.9%) out of 345 patients with active DU were endoscopically followed-up for more than 10 years, they were classified into 3 groups; 35 patients (63.6%) with DU alone (D), 10 patients (18.2%) with gastric ulcer (GU) after scarring of DU (Ds+G) and 10 patients (18.2%) with DU plus GU concurrently or alternately (D+G). After 10 years, two patients underwent gastrectomy for GU bleeding and gastric cancer respectively, and 3 patients died of an unrelated disease. The ocurrence of GU was more frequent, though not significantly, in older smokers. DU recurred more often in smoking, younger, male, and hypotensive patients with erosive gastritis, apparent bulb deformity, maintenance therapy and the history of bleeding from ulcer. In all, none of them was a significant factor, while smoking and male had a significant relationship with DU recurrence in the group D. In the group D+G, the recurrence rate of DU was higher than that in the group D. In some, DU did not reccur without any maintenance therapy and, in some, it could not prevent recurrence of DU. Criteria should be established for the indication of maintenance therapy.

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29 cases of de novo acute leukemia which were treated for the first remission induction between Jan. of 1990 and Sep. of 1995 were analysed with regard to the response of therapy and prognosis. Complete remission (CR) was obtained in 22 of 29 patients (86.2%). CR rate was 18 of 21 AML cases (85.7%), 7 of 8 ALL cases (87.5%) and 10 of 13 patients aged over 65 years old (76.9%), 15 of 16 patient aged under 65 y. o. (93.7%), respectively. 5-year survival rate in total cases was 30.7%. 5-year disease free survival rate was 33.9% in all CR cases (32.4% in AML, 62.5% in ALL, 17.9% in patients over 65 y. o., 46.4% in patients under 65 y. o., and 49.5% of patients who achieved CR by the first induction course, 28.5% of patients who needed 2 or 3 induction courses for CR, respectively). Though the acute leukemia has become a curable disease, the result for aged patients seemed to be not satisfactory.

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The main purpose of pediatric practitioners in the national medical institutes is to cultivate the human resource in the future. We pediatricians are achieving it to keep healthy physical and mental development of children who will contribute to the society of senior people in the future Japan. However, decreased number of children with low delivery rate, diminished number of admission of pediatric patients who are favored by advanced medical service which is resulted in the change of severity of disease, and the present system of health insurance attribute the pediatric medicine to the strict situation, that is slashing or mingling of the pediatric wards and practitioners. Moreover, the substantial facilities of private and public hospitals in the local autonomies are bringing dialogues in the way of pediatric medical service in the national facilities forward. This symposium was held to improve the present situation and to innovate the future prospect in the pediatric field of national hospitals which exert to promote the political medicine and play an important role in the field of clinical research and regional medical service. The present situations or problems in the national hospitals and health insurance system, the regionalization of medical service and the future of pediatric medical service were vigorously discussed.
These problems are not easy to simplify to conclude, however, it is important to argue and to progress the practicable plans which reflect on the pediatric medical service in the national hospital aiming at the 21th century.

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We report a patient, a 17-year-old woman, with hepatitis B virus (HBV) membranous glomerulonephritis. She was consulted to the hospital because of leg edema. Her mother was a HBV carrier. The patient was found to be a HBV carrier at 5 years old and had proteinuria since 10 years old. Urinalysis revealed 4+ proteinuria. Her serum albumin was 2.9g/dl and total cholesterol level was 336 mg/dl. Thus, we suspected of nephrotic syndrome. Both HBe antigen and HBe antibody were positive, however liver function test was normal. A percutaneous kidney biopsy was performed. Histological findings of the biopsy specimen was membranous glomerulonephritis by light microscopy. Immunohistochemical study disclosed diffuse granular deposition of HBe antigen and IgG. Electron dense deposit were found within the basement membrane by electron microscopy. These results indicated the diagnosis of HBV membranous glomerulonephritis. After interferon therapy, HBe antigen became negative and urinary protein was decreased immediately. The second renal biopsy was performed 6 months later. Studies of frozen sections for immunohistochemistry revealed disappearance of HBe antigen.

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A forty-three years old healty housewife gave an enema to herself for constipation. Then an abnormal tumor prolapse was found out of the anal verge, so she came to our hospital to take medical advice. The digital repair was able to do.
According to the endoscopical finding at transverse colon, a giant polyp like Yamada's type II was pointed out at a distance of 60 centimeters from the anal verge, and invagination was diagnosed. For the reccurence of bowel obstruction, pertial colectomy at transverse colon was performed. Histological finding of the resected polyp was lipoma.
We conclude that anal incarceration might happen by the combination with migrating colon and invagination.

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Many reports have been presented on the treatment of spontaneous carotid cavernous fistula (SCCF). However, treatment of SCCF is controversially. We reported three cases of SCCF. The first case was a 57-year-old female. Right carotid angiography demonstrated low flow CCF and Type B on classification by Barrow. SCCF disappeared by Matas manuever only. The second case was a 62-year-old woman. Bilateral carotid angiography showed low flow CCF and Type D by Barrow. CCF disappeared by Matas manuever, embolization and ligation of left external carotid artery. The third case was a 66-year-old woman. Bilateral carotid angiography revealed high flow CCF and Type D reported by Barrow. Treatments were Matas manuever and transvenous embolization. Embolization was performed by using platinum microcoils through internal jugular vein, inferior petrous vein to cavernous sinus. In summary, we believe that the first step of SCCF treatment is Matas manuever in 2-4 weeks and if unsuccessfully, tranvenous embolization is performed. With improvement of technology in minicatheters and embolic materials, transvenous embolization should be considered as one of the most effective, safest method for SCCF.

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The authors reported a child case of acute lymphocytic leukemia considerably suspected to be complicated with pulmonary profound mycosis in the first induction therapy. The patient was a 3-year-old boy, who showed a fever and a cough in the first induction therapy. Chest radiograph and computed tomography sections revealed pulmonary aspergillosis. Neither medication nor surgical operation was done. Although complete remission was achieved, the amount of the agents in consolidation therapy was reduced to 80% as a prevention against severe neutropenia. The complete remission has been sustained and computed tomography sections after 10 months demonstrated a remarkable disappearance of the pulmonary lesion. We have been discussing an application of peripheral blood stem cell transplantation.

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Perinatal group B streptococcal (GBS) infection has been recognized as one of the most common causes of neonatal infectious morbidity and mortality. GBS are found in 10 to 15% of pregnant women. Vertical transmission of GBS to neonates occurs in 70 to 80% of culture-positive women, but only 1 to 2% of their infants develop early-onset disease. We report two cases of early-onset neonatal GBS infection. The first case is the rapidly progressing septic type with severe meningitis. The second one is the amniotic infection type, and the baby was transported to our hospital with severe dyspnea and massive lung bleeding secondary to DIC. Both mothers were found to be asymptomatic carriers of GBS. Recently the American Academy of Pediatrics has recommended that all pregnant women should be screened for vaginal and rectal carriage of GBS with a culture at 26-28 weeks of gestation. Culture-positive women with any of several risk factors should receive the chemoprophylaxis to prevent neonatal sepsis.

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We reported a premature infant with hydrocephalus induced by choroid plexus papilloma (CPP). The infant was diagnosed as hydrocephalus by use of prenatal ultrasound sonographic examination at the 31 st week of gestation. Cesarean section was performed at the 32 nd week of pregnancy. Immediately after birth, Neonate Reservoir (NR) was inserted in the subscalp space. The management of hydrocephalus was maintained by puncture of NR. Brain CT scan and MRI demonstrated a marked ventricular dilatation with a cystic tumor stain in the trigonum of the right lateral ventricle. NR was safe and recommendable for the management of neonatal hydrocephalus. Total removal of the tumor was performed at 7 months after increase of body weight. The tumor was found in the base of right trigonum to be elastic hard, having less clear demarcation and covered with a cyst wall. The incidence of CPP with cysts is reported very rarely in literature. The large cyst might have developed from fusion of microcysts and the continuous secretion of the tumor into the microcyst. We discussed about surgical management of premature infant hydrocephalus with CPP and pathogenesis of CPP with microcysts.

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As a part of blood transfusion service, we reviewed the platelet transfusion from 1982 to 1994 in National Hirosaki Hospital. An annual usage of platelet product increased with wide fluctuation over 50 times more than 12 years ago. In 1994, amount of 1594 units of platelet product were trans-fused for 31 cases 130 times totally, about three fourth of those were used in the department of medicine. According to indication, platelet products were used 112 times (86.2%) for the replacement during chemotherapy, 16 times for DIC, and twice for operation. Eight cases out of 31 received equivocal platelet transfusion on the point of dying. These results suggested that we blood transfusion service should achieve the standard of platelet transfusion more precisely.

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