During 3 decades with my work in National Hospital, a great progress took place especially in the fields of echography, renal physiology, histological and genetic diagnosis.
This report reviewed some of these fields focused on epidemiology, etiological role of genetic renal diseases, corticosteroid treatment of idiopathic nephrotic syndrome and so on with base of our clinical interests.

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The development of the surgical technique and the perioperative management provided the wide indication of the operation and the safety procedures. Especially, the progress of antimicrobial agents contributed to the surgical treatment and prevention of the perioperative infection.
On the other hand, the agents abuse caused the appearance of the multiple antibiotics resistant pathogen. It is impossible to control all perioperative infection by the antimicrobial agents, it should be used to prevent the infection of operative field and the wounds. We should consider the target organ, the degree of the contamination and the kind of pathogen to choose the effective antimicrobial agents and determine the therapeutic period.

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We examined the changes of hyalurate, P III P and IV collagen 7 S for 33.0±12.6 months after start of IFN therapy to investigate the effect of interferon-α (IFN-α) therapy on the markers of hepatic fibrosis in 62 patients with chronic hepatitis C virus infection showing laparoscopic findings of a speckled or nodular liver. One or more of these markers were decreased after IFN-α therapy, irrespective of response of alanine aminotransferase (ALT) activity and HCV-RNA in serum to IFN-α therapy, although most remarkable decrease were found in patients with sustained HCV-RNA negative after IFN-α therapy. Hepatocellular carcinoma developed in 8 patients during follow-up. Serum HCV-RNA in these patients had become positive again after IFN-α therapy or sustained positive from start of IFN-α therapy. Therefore, independently of improvement of the markers of hepatic fibrosis, these findings suggested that sustained HCV-RNA negative in serum after IFN-α therapy to lower the occurrence of hepatocellular carcinoma in patients with laparoscopic findings of speckled or nodular liver indicating a precancerous lesion as regenerative nodules.

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We have investigated limiting factor of exercise in 21 patients with pulmonary emphysema. Each patients were performed a symptome-limited maximal exercise test. During exercise, expiratory and inspiratory gas were collected for measurement of VO₂, VE. Also heart rate, SPO₂, O₂-Pulse were measured. In order to determine limiting facter of exercise of patients with pulmonary emphysema, we have compared with data which we have gotten by performing a limited maximal excercise test in 15 patients with idiopathic interstitial pneumonia. We have used parameter such as VO₂ max, VE max, O₂-Pulse max, as well as differentiation between obtained maxinal exersice and rest (ΔVO₂, ΔVE, ΔO₂-Pulse) for analyse to limiting factor of excercise in patients with pulmonary emphysema. The results were followed. There were no signif ical differentiation in ΔO₂ max and ΔVO₂ between 2 groups. Also no significal differentiation were found in VE max and ΔVE between 2 groups. We have found low value of O₂-Pulse max ΔO₂-Pulse value in patients with pulmonary emphysema comparing to patients with idiopathic interstitial pneumonia, in spite of these Beta were not significant. Conclusion was that cardiac factor such as O₂-Pulse have possibility of limiting factor of exercise in patients with pulmonary emphysema.

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The effectiveness of methotrexate (MTX) in treatment of rheumatoid arthritis (RA) was evaluated in 26 cases with ages 22 to 78 years, and MTX levels were studied following a 2.5mg oral administration in both serum and synovial fluid.
Clinical results showed that marked improvement was found in 2 cases, moderate improvement in 13 cases, minimal improvement in 4 cases, no change in 7 cases, and none of the patients showed clinical worsening.
Two hours after MTX administration, serum MTX levels peaked, higher than those of synovial fluid. Twelve hours following MTX administration, both serum and synovial levels of MTX were not detectable. These results suggest that MTX will not remain in the joint for a long time. Thus, it is suggested that immunologic effect of MTX may be less when it is used as an anti-rheumatic drug.

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Seven patients (total 19 cases) with sputum retention due to bronchopulmonary infection were treated with a pernasal intratracheal suction. The catheter with slightly bent tip was more easy for intratracheal catheter insertion. All patients have recoverd consequently. Additional procedures were necessary in three cases. In two of the three cases, minitracheotomy were performed subsequently. One of the two was cured. In the other one, due to repeated neck overextension the canula had came off. and usual tracheotomy was performed. The last case had developed to pyopneumothorax and pleural drainage was done.
Pernasal intratracheal suction, which can be done by not only docter but also nurse, is useful in many cases as a first step. Minitracheotomy is also less invasive than usual tracheotomy.

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A case of granular cell tumor of the breast which is a relatively rare entity is reported.
A 32-year-old woman was admitted to the hospital bacause of a recently enlarging tumor of the right breast which was noticed about one year before admission. Physical examination revealed a 2×2cm, solitary, hard nodule with skin retraction in the upper lateral quadrant. Regional lymph node was not palpable.
Echographic diagnosis should be a breast cancer. Aspiration biopsy cytology resulted in class I. Since a malignancy could not be ruled out, a biopsy of the lump of the breast was performed.
On microscopic examination there were large tumor cells with abundant cytoplasm and intracytoplasmic granules which were positive for amylase resistant PAS stain. Atypism and mitosis were not seen. Immuno-histochemical stain showed positive for S-100 protein and neuron specific enolase. Histological diagnosis was benign granular cell tumor of the breast. There has been no recurrence for 12 years after the operation. Granular cell tumor of the breast are rare, and benign tumor in the most cases, but there are few malignant cases as positive distant metastasis in the literature.

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A couple consisting of a 29-year-old pregnant woman and a 35-year-old man consulted our clinic to receive prenatal diagnosis. The woman was 6 weeks pregnant. The couple had two daughters. The first daughter was five years old and clinically normal. The second daughter had shown multiple malformations and died two days after birth. Chromosome abnormalities had not been detected at that time. Chromosome analysis of amniotic cells revealed that the fetus was female with a balanced reciprocal translocation, t(4;5)(p15.1;p14.2). Then, we analyzed the chromosomes of the couple and detected that the husband had the same t(4;5) translocation, while the wife had a normal karyotype. Although we informed the couple that offspring with a balanced rearrangement transmitted from one parent are usually clinically normal, the couple decided to abort the pregnancy. On reexamination of the chromosomes of the second daughter, she was diagnosed as having an unbalanced karyotype derived from her father heterozygous for a t(4;5) reciprocal translocation. In prenatal diagnosis for a couple especially those who have previously experienced a pregnancy and birth of an infant with congenital abnormalities, we need to carefully analyze chromosomes of both the fetus and the couple.

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