Three hundred inpatients with intractable epilepsies are classifed according to the international classification. Most intractable epilepsies and epileptic syndromes are temporal lobe epilepsies, frontal lobe epilepsies of localization-related epilepsies, Lennox-Gastaut syndrome of cryptogenic or sympto-matic generalized epilepsies and syndromes, symptomatic generalized epilepsies with nonspecificetiology of symptomatic generalized epilepsies, and severe myoclonic epilepsy in infancy of epilepsies and syndromes undetermined as to whether they are focal or generalized. Factors making epilepsies in-tractable are as follows: 1) severe seizure propensity showing drug-therapy resistance, 2) underlying organic brain damages, 3) existence of factors making drug-therapy difficult like psychotic symp-toms, idiosyncrasy for drug, lack of familiar and social supports, self-induced seizure, 4) mis-diagnosis and -treatment. In Lennox-Gastaut syndrome, widely extending epileptogenesis from cortico-thalamic circuit to midbrain and lower brain stem is supposed to be related to pathop hysiological mechanisms regarding intractability by the results of long-term follow-up studies. In temporal lobe epilepsies the formation of abnormal epileptogenic networks involving hippocampus is supposed to be related to the intractability by the neuropathology of surgically resected specimens in temporal lobe epilepsies. As to the treatment, drug therapy in patients with intractable epilepsies should be reevalutaed and then epilepsy surgery should be considered if there are indications for surgery. Lastly I would like to stress the need of comprehensive care system by multidisciplinary team.

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Among the tests in which T. pallidum is used as antigen, T. pallidum hemagglutination (TPHA) test and fluorescent treponemal antibody-absorption (FTA-ABS) are most commonly used for clinical serodiagnosis.
These tests need a complicated pretreatment of the sera (semi-quantitative method) as well as requiring special techniques, thus increasing the reaction time and affecting intra-and interassay precision studies unfavorable.
To overcome these problems, we evaluated latex agglutination test for T. Pallidum (TPLA) with Behring Nephelometer Analyzar (BNA).
The linearity of the TPLA ranged from 40 to 560 titer units (T. U.). Intra-and interassay pre-cision studies showed high reproducibility. Protentially interfering substances, such as bilirubin, hemoglobin and rheumatoid factor, did not affect the result.
There was a significant correlation between TPLA and TPHA (n=67, γ=0.85, p<0.001). The agreement between TPLA and TPHA for positive sera was 91%. Result of intra-and interassay, correlation with TPHA and the short reaction time (12 min compared to 2 hr for TPHA ) make TPLA a useful candidate for screening of serum treponemal antibody.

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We evaluated the effect of aspirin and ticlopidine on the level of plasma von Willebrand factor (vWF), a marker of vascular endothelial damage, in patients with cerebral thrombosis. Plasma vWF was measured by ristocetin cofactor assay in the controls and the patients with cerebral thrombosis before and after oral administration of a daily 81 mg of aspirin or a daily 200 mg of ticlopidine for 4 weeks. The levels of plasma vWF were elevated in the pre-treated patients with cerebral thrombosis as compared with the controls. The vWF activities decresed in the patients after treated with daily 81 mg of aspirin or daily 200 mg of ticlopidine for 4 weeks. These results suggest that these antiplatelet drugs can prevent the vascular endothelial damage in the patients with cerebral thrombosis.

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For early diagnosis of biliary atresia, revaluation of serum direct bilirubin was reported. Direct bilirubin level of neonatal jaundice and biliary atresia suspected in the neonatal period was measured. There was significant difference between two groups. The border line of serum direct bilirubin level was estimated 1 mg/dl. During observation period of jaundice, however, decrease of direct bilirubin does not necessarily mean negative factor of diagnosis of biliary atresia.

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At the end of 1994, 143, 709 patients were beeing dialysed and 9801 kidney transplants were performed in Japan. In addition to patients with glomerulonephritis and nephrotic syndrome, those with diabetic nephropathy and nephrosclerosis are increasing. Therefore, the number of dialysed pa-tients is expected to increase year by year. On the other hand, kideny tranplants can not be expected to increase because of cadaveric kidney tranplant is not so popular these days.
National Hospitals play an important role in the field of renal disease as the center hospital in each area in our country. For example, they manage the patients with various renal diseases to preserve their renal function, induce dialysis (hemodialysis and contenuous amburatory peritoneal dialysis) for the patients with end stage renal disease and make effort to reduce the complications of patients with long term dialysis. They also perform the kidney transplants. But according to the questionarie survey on the medical treatment system of renal disease to the national hospitals, manpower and dialysis units are not sufficient as the center hospitals in the area and they expect the support from the goverment. And to promote the treatment of renal failure in the National Hospitals, it is also expected to establish the new network system which can provide new in-fomations and the advanced technology to medical staffs who engaged in renal devisions.

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A 42 year - old man with oppressive feeling of epigastrium, nausea, vomitting consulted a physician's office. His electrocardiogram (ECG) revealed ventricular tachycardia, and was received a cardioversion. Since he was admitted to our hospital for close examination of his heart.
On addmission, his ECG showed sinus rhythm and a chest X-ray film revealed normal cardiac silhouette (CTR 48.2%). His laboratory data revealed normal. Echocardiogram showed an enlarged right ventricle (RV) and detected an intraventricular septum of RV near the apex. Right ventriculography showed hypokinesis and the chest CT, MRI showed the abnormal septum. The his-tology of the biopsied right endmyocardium showed the fibrosis and involvement of the fat tissue. The diagnosis of arrhythmogenic right ventricular dysplasia (ARVD) was made based on the clini-cal and pathological findings.

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Meningomyelocele should be surgically closed within 24-48 hours after birth to prevent infection and preserve neural function. Primary wound healing can be attained in most small thoracolumbar and lumbosacral meningomyelocele defects with wide undermining of the wound edges and direct closure of the wound. However, the closure of moderate to large defects presents a challenging problem. Advancement flaps, bipedicle flaps, transposition flaps, rotation flaps, and Limberg flaps have been utilized successfully in achieving closure of large meningomyelocele defect. In the present paper, we have utilized Limberg and transposition flap methods in two thoracolumbar and lumbosacral meningomyelocele patients that could not be repaired by direct primary closure. As good results with no complications have been achieved, these local flap repair methods for cases of meningomyelocele with moderate to large defects can be recommended.

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Three cases of chronic traumatic thoracic aneurysms were reported. Time intervals between thoracic trauma and operation varied from 5 months to 23 years. All aneurysms were located in the descending thoracic aorta. Surgical corrections were accomplished with no mortality and morbidity. Evidence of chronic traumatic thoracic aorta injury may not be revealed clinically for many years. This diagnosis should be considered in dealing with patients who have a history of severe thoracic trauma, no matter how remote.

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