[in Japanese]

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Cervical and endometrial cancer of the uterus, and ovarian cancer are three major malignant diseases in gynecology in Japan, these Diagnosis and therapy are almost established. In uterine cervical cancer, radiation therapy and surgery of these diseases are two main treat-ment methods, and both treatment results are almost the same. And radiation therapy is also used as postoperative treatment to patients with high risk factors.
In endometrial cancer, surgery is main therapy. Radiation therapy is undergone only to medically inoperable Cases Preoperative radiation is widely carried out in Europe and America, but almost none in Japan. Postoperative irradation is adapted to the cases with high risk factors. But recent advance of chemotherapy changes the importance of radiation therapy in such patients.
I review the literatures of radiation therapy of uterine cervical cancer and of endometrial cancer.

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Intraoperative radiation therapy (IORT) + postoperative external beam radiation therapy (ERT) with chemotherapy and ERT alone with chemotherapy have been performed in our hospital for unresectable, especially locally advanced, pancreatic cancer. We compared the former method with the latter. Chemotherapy was performed together with radiation, using 5-FU, CDDP, and MMC. IORT+ERT was successful in only half of the treated patients, while ERT alone was successful in almost all of the patients. As a result, the doses of radiation were often shorter in patients treated by the former method compared to the latter method. Both methods, when completed for locally advanced pancreatic cancer (stage Wa), produced good effects on tumor markers, tumor size and pain. Furthermore, the latter method was better than the former in improving the survival time and quality of life (QOL). Therefore, ERT is a practical and useful method for patients with locally advanced pancreatic cancer.

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Four (two male, two female) cases of chronic subdural hematoma (CSH) found in demented patients were reported. Out of the two male cases, one had been chronically a heavy drinker, the other had suffered from head trauma several months before. As for two female cases, one had been found to have subdural fluid colleciton ahead of CSH, the other had once suffered from CSH. Clinical signs seen in these patients of CSH were disturbance of consciousness, or mono-and hemiparesis, or incontinence. Most of their family members had misunderstood these signs of CSH as an aggrava-tion of dementia. In the clinical assesment of patients with dementia, we have to be more careful not to miss those clinical signs, even though the patients can not tell us any symptoms. And we should practice examination of imagings of head (CT scan or MRI) as early as possible, when the presence of CSH in suspected.

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Neonatal mass screening for inborn errors of metabolic disease started in 1977. A screening program of congenital hypothyroidism started in 1979, and screening of congenital adrenal hyperplasia started in 1989. About 460, 000 neonates born in Okayama prefecture were screened. 4 cases were diagnosed as classical PKU (phenylketonuria), 1 case of BH4 (Tetrahydrobiopterin) deficiency, and 5 cases as HPA (Hyperphenylalaninemia). 2 cases of MSUD (Maple syrup urine disease) were found No cases of homocystinuria nor classical galactosemia were screened. About 410, 000 neonates were screened for congenital hypothyroidism and 96 neonates (72 in our hospital) were confirmed and well treated. The frequency was 1/4, 000. About 180, 000 neonates were screened for congenital adrenal hyperplasia and 14 (11 in our hospital) cases were confirmed. The frequency was 1/13, 000. Long-term intellectual milestone in these patients demonstrated good results.

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Pediatricians in general hospitals must play a major part in the support system of child rearing during the perinatal period. We sent out questionnaires to 430 mothers who gave birth at Kanazawa National Hospital and at two obstetric facilities in Ishikawa Prefecture, to identify their concerns about newborns and their expectations of our medical services.
The main reason for selecting our hospital for giving birth was the availability of maternal and newborn care in times of sudden, acute incidents during the perinatal period. Many mothers expressed more concerns about babycare after giving birth than while pregnant. After dismissal from the hospital most mothers were uneasy about their new responsibilities (in addition to some physical discomfort) and required personal child rearing advice.
Pediatricians in general hospitals must therefore provide and support for mothers with their child rearing during the first month after giving birth. Such support should contribute to the sound growth of children.

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The prevention of embolism is important in cases with defibrillation of atrial fibrillation. In chronic atrial fibrillation, there is some protocol for preventing the occurrence of embolisms, but no precise protocol in transient atrial fibrillation. A woman with transient atrial fibrillation was admitted to our hospital. She had the history of acute myocardial infarction, diabetes mellitus, hypertension and hyperlipidemia. Disopyramide phosphate (45 mg) was administrated intravenously and the rhythm was converted to sinus rhythm. After defibrillation, ST elevation on electrocardiography and the increase of the enzyme conserning with myocardium. In this patient, disopyramide phosphate was administrated later, but no electrocardiographic change were revealed. Coronary angiography revealed three vessel disease but not spastic. So, coronary embolism was strongly suspected. Some reports were seen about the electrocardiographic changes following the use of anti-arrhythmic agents, but the mechanism of those changes were due to conduction disturbance. Our case seems to be rare case with coronary embolism after pharmacological defibrillation of transient atrial fibrillation.

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We examined 68 patients (12. 4% new patients) between July and September 1996. The number of males was not significantly different compared to the number of females. The incidence of tinea was the highest in patients with dermatophytosis, especially tinea pedes(47.3%). The cultured spe-cies of tinea mainly showed Trichophyton rubrum and T, mentagrophytes (75%). In 1994 and 1995, we examined 64 patients with herpes simplex, 20 males and 44 females. They showed 2 high peaks of age distribution, at 20-30 years and 50-60 years of age. In cases of herpes zoster, the number of female patients was higher than male patients. The highest region distribution occurred on the trigeminal lesion. Complications of malignant tumors occurred in 6.2% (8 patients).

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A 35 years old male with a history of schizophrenia developed neuroleptic malignant syndrome (NLM) by use of sulpiride and failed to respond to dantrolene or bromcriptine. The patient stayed in ICU for 32 days and was given supportive care such as mechanical ventilation, use of sedatives and muscle relaxants, and strict management of body temperature. He responded to the therapy and was discharaged in a good condition after 323 days of hospitalization. He has been followed for 4 years to this date and doing well only with use of etizolam as an outpatient.
It may be suggested from this case that NLM can be successf my managed with conservative and supportive care until the inducting agents are metabolized and excreted from body if it failes to respond to initial medication therapy.

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A case of gestational transient hyperthyroidism treated with an antithyroid drug is reported. A 27-year old gravida I para I woman in the 11th week of gestation was admitted to our hospital because of severe emesis due to pregnancy. On admission, her serum levels of free triiodothyronine (FT₃) and free thyroxine (FT₄) were both high and her thyroid stimulating hormone (TSH) was below the detection limit of the assay. Anti-TSH receptor antibody and autoantibodies to thyroid were both negative. Despite intravenous fluid therapy, her emesis did not improve and she lost 4 kg after admission. In the 13th week of gestation, her serum FT₃ and FT₄ increased to 18.0 pg/ml and 6. 8 ng/dl, respectively, and administration of thiamazole was started. Serum levels of FT₃ and FT₄ decreased 3 weeks after treatment, and the dose of thiamazole was reduced and then finally discontinued in the 22nd week of gestation because her FT 3, FT 4 and TSH levels normalized. She delivered a girl weighing 3164 g in the 41st week of gestation.

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