There is small amount of pleural liquid between the parietal pleura and the visceral pleura. The pressure of pleural liquid (Pliq) is the pressure producing absorption of liquid from the pleural space. Pliq is more subatmospheric than the pressure exerted by lung recoil (Pel(t)). Therefore, the visceral pleural surface comes into contact with the parietal pleural surface by a certain force, the pleural contact pressure (Pcont). Thus, pleural surface pressure (Ppl)=Pliq+Pcont, and in quasi state, intrapulmonary pressure=Pliq+Pcont+Pel(1). (Pliq, Pcont, and Pel (1) are not overall pressures but local pressures). The main factors responsible for this Ppl gradient include gravity, mismatching of shapes of the chest wall and lung, and others. The relationships among the factors of Ppl are more easily understandable by considering Pcont.
Studies have been performed and debates exist concerning what about pleural liquid. However, Pliq has not been reported as an equation relating multiple factors. We have assumed the pleural space to be a small box and have applied the Starling equations for filtration and reabsorption to it. From these two equations, a simultaneous equation was solved to obtain box pressure, ie., Pliq. Using this equations we can estimate the influence of certain factors on Pliq

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Application of multivariate analysis in the clinical medicine has been widespread rapidly with the progress and prevalence of computers. The discriminant analysis, above all, has been found in many cases because it is proper method of decision to diagnose and treat. In 1967, I applied the discriminant analysis by computer to diagnose liver diseases and it was, in this case, superior to diagnosis by physicians. Since 1990, we have applied the discriminant analysis in treadmill diagnosis and concluded the utility in prospective study. The discriminant analysis suggested that the treadmill diagnosis should be used easily, accurately and universally when heart rate and ST-T change are measured automatically. Simultaneously, we researched references to objectivise the treadmill diagnosis and found a lot of reports and various aspects of the discriminant analysis. The applications of the discriminant analysis have possibility of diagnosing various diseases and could be applied to predict the treatment effects. The discriminant analysis should be expected to wider and newer clinically in the future

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Current methodologies for detecting and identifying Mycoplasma pneumoniae are time consuming and difficult. PCR was shown to be most valuable in detection and identification of such cases. Nevertheless, false-negative PCR results are rather common due to inhibitors of the PCR reaction in the clinical specimen, while false-positive results may occur due to contamination of the reagents with target DNA. To overcome these problems, we designed two nested pairs of oligonucleotide primers which anneal to DNA sequences coding for conserved regions of the 16 SrRNA.
The nested PCR reacted with all of the strains of Mycoplasma pneumoniae, and gave no amplification product with any of the closely related mycoplasmas tested, showing its high specificity. Thus the PCR-based method for the detection of Mycoplasma pneumoniae was shown to be useful in clinical diagnosis

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We analyzed the molecular weight and protease activity of kiwi fruit proteins reacting to IgE antibody presented in sera from 9 patients with kiwi fruit allergy. The 30 KD protein that can bind to IgE antibody was detected using immunoblot analysis in sera from all the patients. This protein was precipitated by ammonium sulfate and was fractionated using gel filtration chromatography. The fractionated protein was found to reduce the molecular size of α casein when incubated together at 37°C. The degradation of α casein molecules was time course-dependent. These results suggest that kiwi fruit 30 KD protein possesses a proteolytic activity. Since actinidin, a kiwi fruit protein, is often used as a softening agent of meat, we should be cautious not only to the ingestion as food but also to these “hidden allergens” such as the kiwi fruit protein

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We investigated whether morphological features can be observed on magnetic resonance imaging (MRI) in early Alzheimer's disease (AD). We classified AD patients into two groups according to mildly (n=12) or moderately (n=12) impairment, and we compared MRI head scans of these patients with scans of normal controls (n=14) with respect to volume of the temporal horn of the lateral ventricles and volume of the hippocampus.
Mildly-impaired patients showed a significantly larger volume of the temporal horn of the lateral ventricles than normal controls, but there was no difference between these groups in volume of the hippocampus. Moderately-impaired patients showed a significantly smaller hippocampal volume than mildly-impaired patients, but there was no difference between them in the volume of the temporal horn of the lateral ventricles. Moderately-impaired patients showed a significantly larger temporal horn of the lateral ventricles and smaller hippocampal volume than normal controls. Thus, we suggest that measurements of the volume of the temporal horn of the lateral ventricles is a useful adjunct diagnostic tool in the routine diagnosis of early AD

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We performed a surveillance of MRSA-infections and-carriers who were admitted to the Center of Critical Care Medicine (CCM). Nine hundred ninety six patients were admitted to our CCM since September '96 to March'98 and were checked for MRSA in their nasal cavity or bronchial secretions at the time of admission and discharge.
The annual cases with MRSA-positive at admission were 27 (2.7%). Thirty one patients changed to MRSA-infection during admission. Bacteriological studies of 15 cases, each of the two strains of 3 periods were similar to the type of coagulase and MIC. MRSA-carriers already had been hospitalized prior to admission to our CCM. MRSA-infected patients were seriously ill and had been treated with antibiotics for long time. We avoided nasokomical infection by isolation of patients and sterilization of beds. Those patients who have been transfered from other wards and patients with infections pulmonary diseases would be better to treat as MRSA-positive patients with high risks.
ICU patients who have heed transferred from other units inside of the hospital or from respiratory unit of other hospital should be treated as suspects of MRSA positive patients

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We evaluated progression in the functional disability of extremities in 20 patients with myotonic dystrophy for 10 years. Tentative functional classification were made for eight stages for locomotion ability, four stages for standing-up ability, and four stages for skillfulness of hands (N=16), respectively. The mean stage valuses in locomotion ability test were 2.7±1.7 (M±SD) at the first assessment and 5.7±2.1 at the last, in standing-up ability 2.0±1.1 at the first and 3.3±1.1 at the last, and in skillfulness of hands 1.4±0.8 at the first and 1.9±1.1 at the last assessment. The statistical analysis showed significant decline of the stages in each functional category by Wilcoxon's test (p=0.000 in each category). The progressions of disability of locomotion and standing-up were observed in most cases, and 40-45% of worsening causes were bone f ructure and poor general condition. Eleven out of 16 cases showed no progression of skillfulness of hands stage. In following-up of those patients with myotonic dystrophy, prevention of bone f ructure and complications, and preservation of upper extremity functions are necessary for their QOL

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It might be difficult to make a precise diagnosis if the initial symptom is far from the primary lesion. We report a 61-year-old male with a primary lung cancer whose initial complaint was abdominal pain. He was admitted to our hospital because of loss of body weight and left abdominal pain. His laboratory data on admission showed abnormal high value of CEA. There was no abnormal lesions detected in routine chest X-ray. Abdominal CT scan and echogram showed a tumor of 5.0×6.5cm in the left adrenal gland, which could suggest metastatic tumor . Several tests were done for detecting primary lesion. Whole body Ga scintigram revealed abnormal accumulation in the upper part of left lung, Lung CT scan confirmed an abnormal tumor of 3.5×4.0cm in the upper part of left lung, which was compatible with the finding of Ga scintigram. The pathologic finding obtained through transbronchial lung biopsy (TBLB) was squamous cell carcinoma. This left adrenal tumor was resected and diagnosed as metastasis of the pulmonary squamous cell carcinoma in adrenal grand. After operation of the adrenal tumor, resection of upper part of left lung including thoracectomy and left pulmonary artery was done.
Previous studies showed that most primary origin of metastatic adrenal tumor was primary lung cancer. In our case, several radiologists could not detect any abnormal lesions in routine chest X-ray on admission. In case with the metastatic adrenal tumor, further examination in lung should be carried out, even if no abnormal findings in routine chest X-ray

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A 70-year-old women with ovarian cancer, admitted to National Hakodate Hospital, complaining unconsciousness, nausea and lower abdominal fullness. Severe hyponatremia (104mEq/l) probably due to ascites was observed and corrected slowly with sodium supplementation and water restriction. After the recovery of neurologic symptoms, she received epidural anesthesia for open laparotomy. No remarkable neurologic and cardiovascular changes were found during the surgery. Appropriate sodium supplementation, fluid management and the choice of anesthetics are important for perioperative management of severe hyponatremic patient

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We report a case of primary hyperparathyroidism, in which changes in bone mineral density after adenomectomy were examined by dual energy X-ray absorptiometry. The subject is male and currently 22 years old. He suffered fractures of the radial and ulnar diaphyses during a basketball game in physical education class at the age of 18 in July 1991. In September 1991, he suffered a fracture of the surgical neck of the left humerus in a near collision with an automobile while he was riding a motorcycle. The subject first visited our clinic because of general malaise and pain in his fingers and forearms around July 1992. He was admitted to our hospital because hypercalcemia and elevation of serum parathyroid hormone (PTH) level were found. In addition to hypercalcemia, hypophosp-hatemia, elevation of alkaline phosphatase concentration, high serum levels of PTH-intact, elevation of the urinary of c-AMP excretion, and depression of the renal tubular reabsorption rate of phos-phate were found. A parathyroid adenoma about 10mm in diameter was recognized on the posterior surface of the right lobe of the thyroid gland. In the corresponding region, a hot area was observed by²⁰¹Tl-^99mTcO₄-subtraction scintigraphy. These findings led us to the diagnosis of right parathyroid adenoma, and adenomectomy was perf omed. The tumor was a benign solitary adenoma. After the excision of the tumor, the serum concentrations of calcium and PTH normalized rapidly and the symptoms such as general malaise and pain in the upper extremities disappeared. During the follow-up period of about two and a half years, the serum concentrations of calcium and PTH have remained within the normal range. The bone mineral density in the lumbar vertebrae has increased, but has not yet reached a normal value. This indicates that a long time is required for the normalization of bone mineral density after adenomectomy

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