Follow up arthroscopy was performed on 92 patients who had undergone anterior cruciate ligament (ACL) reconstruction with patellar tendon augmented by woven polyester. The interval between surgery and arthroscopy ranged from 6 to 26 months, with a mean of 13.1 months. The patients were classified into 4 grades according to the arthroscopical findings as follows: grade I, ligamentous tissue ruptured or not observed; gradeII, loose and thin ligamentous tissue observed; gradeIII, thick and taut ligamentous tissue observed, but some ligamentous strands exposed from the synovial tissue; grade IV, thick and taut ligamentous tissue with a synovial tissue observed, as in normal ACL. Based on the arthroscopical findings, 4 of the 92 patients were rated as grade I, 11 as grade II, 24 as grade III, and 53 as grade IV. Correlation between the arthroscopical and functional test results indicated that the mean injured-to-uninjured differences of KT-1000 measurements were significantly smaller in the grade IV group than in the grade I and grade II groups (p<0.05 ). These results suggest that postoperative anterior knee laxity correlate significantly with arthroscopical results, and is a useful parameter for evaluating ACL reconstruction. (J Nippon Med Sch 1997; 64: 512-517)

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To determine whether urinary albumin to creatinine ratio (Albumin index) and urinary N-acetyl-β-D-glucosaminidase (NAG) to creatinine ratio (NAG index) in random spot urine samples can be sued to predict the early stage of diabetic nephropathy in the elderly non-insulin dependent diabetic patients, we measured these concentrations in 150 nondiabetics, 61 diabetics without retinopathy and 56 diabetics with retinopathy. All patients with Albustix-positive urine were excluded. Subjects divided into two groups according to whether they were <60 years (adult group) or ≥60 years old (old group). Multiple regression analysis was used to investigate the relationship between NAG index or Albumin index (dependent variable) and independent variables (age, systolic blood pressure, duration of diabetes, HbA1c) in diabetic patients. Diabetic patients with retinopathy showed the highest mean Albumin index, followed by diabetic patients without retinopathy and then nondiabetic patients both in adult group and in old group (p<0.001, p<0.001, respectively). Diabetic patients with retinopathy showed the highest mean NAG index, followed by diabetic patients without retinopathy and then nondiabetic patients both in adult group and in old group (p<0.001, p<0.001, respectively). Albumin index positively correlated with systolic blood pressure, duration of diabetes and HbA, c (r=0.18, r=0.35, r=0.18, respectively). NAG index positively correlated with age, duration of diabetes and HbA, c (r=0.18, r=0.25, r=0.29, respectively). These results suggest that both NAG index and Albumin index in random spot urine samples may serve as early functional indicators of diabetic nephropathy in elderly diabetics. (J Nippon Med Sch 1997; 64: 518-525)

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Macroscopic and immunohistochemical observations were made to clarify the innervation of normal pancreatic tissues, and the clinicopathological and electron-microscopic findings of 33 cases of pancreatic cancer were obtained. The results showed that the innervation of both the head and the body of the pancreas mainly consisted of nerve fibers separated from the right celiac neuroganglion and the right half of the superior mesenteric arterial plexus. The pancreas was full of nerve fibers ending at acinar lobules, among which the adrenergic nerves commonly control the walls of blood vessels. Pancreatic cancer tends to be accompanied by invasion and metastasis along intra-or extra-pancreatic nerves, and we found that the positive rates for invasion and metastasis were 73.33% and 60.00%, respectively.
The follow-up study revealed that the nerve-invasion group had worse prognosis than the non-invasion group (P<0.05). The approaches of the invasions of the nerves were as follows: (1) through the vessels of the perineurium; (2) through the perineurium; and (3) through the synaptic membrane of nerve endings. The invasion were a continuous process, often resulting in the destruction or even the disappearance of the normal structure of the nerve fibers.
The above results suggest that there are plentiful vegetative nerves inside or outside the pancreas and that pancreatic cancers have a tendency of invading and metastasizing along or around nerves. (J Nippon Med Sch 1997; 64: 526-531)

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CT characteristics of spontaneous rupture of HCC (n=13) were reviewed retrospectively, and the value of emergency CT studies in this disease was evaluated. Especially, tumor protrusion ratio (TPR) and ascitic CT numbers were measured to for comparison with the data for unruptured HCCs and ordinary (e.g. non-hemorrhagic) ascites (n=13). As a result, except for diffuse type HCCs, the TPR was significantly higher than for the unruptured HCCs. Nine cases had intraperitoneal HDAs, and the laterality of the HDAs corresponded with that of the ruptured tumors in 8 cases. Also, the ascitic CT numbers apart from the HDA were still higher than the ordinary ascites. Therefore, a high TPR, RDAs adjacent to the tumor, and elevated ascitic CT numbers are important CT manifestations indicating HCC rupture. Diffuse HCCs, however, require careful clinical evaluation. (J Nippon Med Sch 1997; 64: 532-537)

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In this study, a new Questionnaire, "Care Note", was developed for palliative cancer care and it was validated in relation to the level of satisfaction in their daily lives felt by patients during supportive care. Care Note and EORTC QLQ-C 30 were administered to 97 patients with various forms of malignant disease (mean age 61, M/F 73/24). They filled in a Care Note questionnaire twice a week, on average they completed 6.77 questionnaires (a total of 657 questionnaires). The average time to answer was 5.49 minutes, and patients compliance was good. Evaluation indices in the first examination (n=97) were shown as: content validity, test-retest reliability, item-scale correlation revealed discriminant validity and convergent validity with internal consistency, using Cronbach in the range alpha =0.695-0.814, were proved. Concurrent validity with EORTC QLQ-C 30 was satisfied.
A multiple regression analysis showed that social well-being (p<0.0001) and global quality of life (p=0.0001) were explanatory valuables for expressing satisfaction in relation to daily life. (J Nippon Med Sch 1997; 64: 538-545)

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Closed-chest transcatheter electrical ablation (catheter ablation) has been applied to various supraventricular and ventricular tachyarrhythmias as a radical therapeutic technique since its introduction in 1982. Currently, it has become a first line therapy for supraventricular tachyarrhythmias except atrial fibrillation and uncommon types of atrial flutter. We first carried out the ablation procedure in 1991 for the treatment of ventricular tachycarida. Up to February 1997, a total of 187 patiens underwent catheter ablation in our institution. The aims of this study are to demonstrate our results of catheter ablation in the early 5 years and to show the usefulness of this new curative method. Successful results were obtained in 168 of 187 patients (overall final success rate: 89.8%). The success rates of each category of tachyarrhythmias were 100/105 patients (95%) with WPW syndrome, 41/46 (89%) with atrioventricular nodal reentrant tachycardia, 7/10 (70%) with atrial flutter, 4/4 (100%) with atrial tachycardia, 2/2 (100%) with medically refractory atrial fibrillation, 13/15 (85%) with idiopathic ventricular tachycardia and 3/7 (43%) with sustained ventricular tachycardia associated with structural heart disease, respectively. Complications that required invasive treatments were observed in 3 patients (2 hemopericardium and 1 complete atrioventricular block). Our results indicate that catheter ablation is highly effective in most categories of tachyarrhythmias and can be applied safely without lethal complications. (J Nippon Med Sch 1997; 64: 546-565)

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A 50 yearold man developed ascending necrotizing myelitis without any associated disease. After admission due to gait distrubance, the symptoms progressed rapidly and quickly. Neurological disturbance had progressed to an incomplete paraplesia below C 4 level; incontinence and drowsiness developed. Herpes Simplex viral myelitis was suspected through virological tests, which showed higher specific HSV antibody values of HSV-1 IgG of 640-fold in serum. Myelin basic protein (MBP) in the cerebrospinal fluid (CSF) registered 24.3 ng/ml. When he was treated with Acyclovir for 17 days, his general and neurological status improved significantly. Virological examinations showed 50-fold HSV-1 IgG in serum, and MBP in the CSF was 3.3 ng/ml. The MBP measurement and virolgical tests of the CSF and serum prove extremely important in diagnosing an ascending myelitis of unknown cause. (J Nippon Med Sch 1997; 64: 566-568)

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