The susceptibility pattern of methicillin-resistant Staphylococcus aureus (MRSA) following the 1991 use of vancomycin (VCM) and arbekacin (ABK) . The isolation rate of MRSA in S. aureus was about 50 %, roughly the same as that after 1990. The ratio of MRSA in S. aureus isolated from outpatients was 15-35 % each month and that from inpatients was 50-80 % each month. The antibiotic susceptibility pattern from August to September 1993 and from May to June 1994 were compared. Most isolated MRSA was resistant to most β-lactams and ofloxacin. The ratio of resistance against imipenem and flomoxef was consistently increased. Susceptibility remained for minocycline (75 %) and VCM (100 %) . For ABK, 20 % of MRSA (41 strains) showed a minimum inhibitory concentration of over 4 μg/ml in the period from August to September 1993, suggesting a tendency toward resistance. However, the isolating frequency of ABK-resistant MRSA decreased to 5 % in the period from May to June 1994. Analysis of the coagulase type showed that type II was 82.5 % during the period from August to September 1993 and 94 % from May to June 1994, indicating accumulation of type II. Analysis of the enterotoxin type showed that C-type was 83.3 % from August to September 1993 and 75 % from May to June 1994. ABK-resistant strains were frequently isolated from MRSA showing coagulase II of VII and enterotoxin C.

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To prevent nosocomial infection, countermeasures against the origin and route of in-fection have been implemented. To control the origin of infection, the patient may be isolated or the contaminated item may be burned or disinfected. To control the route of infection, protective wear or hand-washing practices should be encouraged. In this report, we compared the anti-bacterial effect of new protective wear made of antiseptic fiber with that of conventional protective wear. W e examined contamination in wear used in the clinic. Specimens were collected by stamping both sides of wear. The specimens were then cultured, the numbers of colonies were counted, and the Gram-stained cultures were analyzed microscopically. Bacterial colonies were isolated from the outside of the antiseptic wear immediately after clinical care in all cases, and the degree of contamination was depended on the type of clinical care (i.e., more contamination in complex or prolonged care) . After 6 hours, the number of colonies was markedly decreased. Bacterial colonies were isolated from the inside of the wear immediately after the care, and all bacterial colonies were observed within 6 hours. The control experiment showed that the antibacterial effect of clinically isolated Methicillin-resistant Staphylococcus aureus (MRSA) was evident in the new antiseptic wear. It is concluded that the new antiseptic wear is of practical use for the prevention of nosocomial infection.

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Topical cooling of the heart is an effective method of protection for the myocardium during ischemia, but it has some disadvantages. The disadvantages include phrenic nerve injury, uneven supply of the cardioplegic solution due to coronary spasm and damage to the epicardium. In order to avoid these cooling-related disorders, mild topical cooling was applied and the heart was immersed in FC 43 emulsion of perfluorochemicals (PFC) which has an excellent oxygen transport activity, in attempt to supply oxygen to meet the increasing demand for oxygen of the myocardium. The hemodynamic recovery was studied in 4 groups of isolated rat hearts, during ischemia for 60 minutes (group A) and 90 minutes (group B) at 30°C after cardioplegic arrest, two groups (A1 and B1) were not immersed in FC 43; the other two groups (A2 and B2) were immersed in FC 43. As a result, there are no significant differences in the hemodynamic recovery between group A2 and group A1. The 5 hearts in group B1 were unable to resume the beat after reperfusion. In contrast, all hearts of group B2 resumed the beat; the cardiac function was restored by more than 70%, and the results were significantly better (p<0.001) than in group B1. These results suggest the possibility that oxygen was supplied to the myocardium by immersion of the hearts in perfluorochemicals there by meeting the demand for oxygen of the myocardium in the state of ischemia and hypoxia with the aid of mild topical hypothermia.

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The aim of this study was to classify the histologic grades of atypia of colorectal villous tumors by hematoxylin and eosin staining, and to investigate the clinical characteristics and proliferative activity of epithelial cells by staining proliferating-cell nuclear antigen (PCNA) with an anti-PCNA monoclonal antibody among the classified groups. Thirty-five colorectal villous tumors obtained by endoscopic biopsy or mucosal resection from 32 patients were studied. The histologic grades of atypia of colorectal villous tumors were classified as moderate atypia (MO group), severe atypia (SE group), or cancer (CA group) . The size of colorectal villous tumors tended to increase with greater degree of atypia. There were significant differences in size between the MO group and the SE and CA groups. The number of PCNA-positive cells (PCNA value) in the SE group (31.6±6.6 %) was significantly higher than in the MO group (25.5±4.4 %), but no difference was found between the SE group and the CA group (noncancerous lesion, 33.5±6.9 %) . The results suggest that it is necessary to carefully treat both colorectal villous tumors in the SE group and colorectal cancers.

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Monoclonal antibodies (mAbs), which have replaced polyclonal anti-human hemoglobin antibodies for the clinical detection of blood in feces, were investigated. Ten mAbs were successfully cloned and their characteristics, including cross-reactions with other animal hemoglobins, are reported in the present paper. Of the combinations of any 2 of 10 mAbs, 12 showed a precipitin reaction with human hemoglobin. With the strongest combination, a standard curve for determining human hemoglobin by enzyme-linked immunosorbent assay was obtained. Good results were also obtained on alatex agglutination assay.

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On the basis of the three patients with epilepsy who showed repeated, stereotypic psychotic episodes after a series of seizures, the factors and the mechanisms of the development of the psychotic episodes in each epileptic patient are discussed. Each of the three patients had a temporal lobe seizure focus and experienced temporal lobe partial seizures and secondarily generalized seizures. The dominant symptom of each patient's psychotic episode were hallucinations in patient 1, mania in patient 2, and paranoia in patient 3. We interpreted the mechanism of the development of the psychotic episode on the basis of two factors: (1) the patient's life history, and (2) a series of seizures as stimuli. Psychologic vulnerability was progressively formed in each patient's life history Through these processes a“critical episode”was established as the basis for the development of the psychotic episodes. The reduction of consciousness levels by the series of seizures and the transient temporo limbic dysfunction due to excessive paroxysmal discharges were believed to act as stimuli for the psychotic episodes on the critical stage. It was thought that by this mechanism, each stereotypic and repeated psychotic episode was developed. Furthermore the interval in each case between the onset of clinical seizures and manifestation of a psychotic episode corresponded to the time required for the establishment of the critical stage. In discussing these patients, we placed particular emphasis on the patient's life history for the development of the psychotic episodes. It is believedthat this viewpoint is significant not only psychopathologically for the psychotic episodes in epileptic patients but also therapeutically.

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To perform cancer pain control effectively on a large scale, as in an university hospital, the“Cancer Pain Control Manual”was created at Showa University Hospital and has been in use since April 1989. Early treatment methods, according to the“Cancer Pain Control Manual”were approved in almost all cases. However several areas of treatment must be improved to meet the requirement of various patients. Therefore, to improve the quality of life of patients, the following three new methods were evaluated and adopted : (1) preparation of sublingual buprenorphine, (2) preparation of 4 % morphine injection solution, and (3) use of eptaLocine. The value of sublingual buprenorphine for outpatients and for patients who are not able to take oral medications was indicated. The 4 % morphine injection solution was useful to administer a large dose of morphine to patients. Eptazocine was useful to suppress the side effects of opioid analgesics. As a result of this evaluation, the“Cancer Pain Control Manual”has been substantially improved in all aspects.

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Serum creatine kinase (CK) and CK isoenzymes were measured in several cerebrovascular conditions (subarachinoid hemorrhage [SAH], intracerebral hemorrhage [ICH], and cerebral infarction [CI] ), brain tumor, and head injury. The differences in serum total CK activities between SAH and ICH were large. In 4 of 20 cases of SAH and 3 of 9 cases of ICH, serum total CK values were higher than the reference value. Serum CK isoenzyme levels (non-CK-M activity and CK-MB protein) were also high; 8 cases of SAH (40 %), they were higher than the reference value. The CK-BB isoenzyme was detected by electrophoresis in 3 cases of SAH. On the other hand, in ICH, values of serum CK isoenzymes were almost the same levels as the reference value. Serum total CK activity and CK isoenzymes varied within the reference values; in no case were the levels higher than the reference values. Serial changes of serum CK and CK isoenzymes were observed after surgery for SAH ; total CK activity increased 0.5 day after surgery, and reached a maximum of 1500 to 2500IU/l between 1 and 1.5 days after surgery. The CK activity decreased to the reference value 6 to 7 days after surgery. The change in CK isoenzymes levels were similar. CK-BB was detected by electrophoresis in some cases, but its appearance was not dependent on the complexity of the operation.

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The purpose of this study was to compare the endocrine effects of hypotension induced by halothane and isoflurane. Eighteen mongrel dogs were anesthetized with pentobarbital intravenously.
The dogs were randomly divided into two groups: the halothan group (n=8) received 0.9% halothan in oxygen, and the isoflurane group (n = 8) received 1.3% isoflurane in oxygen. The inspired concentrations of halothan and isoflurane were increased until mean arterial pressure decreased to 60mmHg, which was maintained for 60 minutes. Hemodynamic date and blood samples for determination of norepinephrin (NE), epinephrine (E), plasma renin activity (PRA), and aldosterone (ALD) levels were collected before, during, and after hypotension. Dogs in the halothan group demonstrated no change in NE during induced hypotension. In the isoflurane group, NE tended to decrease throughout the observation period. In the halothane group, E decreased continiously during induced hypotension but slightly increased thereafter. In the isoflurane group, E decreased to 53% to 59% of control values during observation. The PRA level of the halothane group increased to twice the control value during induced hypotension, then returned towards control values after induced hypotension. On the other hand, PRA tended to increase slightly during induced hypotension in the isoflurane group. In the halothan group, ALD showed a significant increased compared with control values during induced hypotension, whereas ALD of the isoflurane group tended to increase.
Result of the present study suggest that the suppression of sympathetic nervous activity in halothane and isoflurane induced hypotension are associated increases in the concentration of each anesthetic, but that resposes in the renin-angiotensin-aldosterone system in halothane-in-duced hypotension are greater than those in isoflurane-induced hypotension.

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We report two cases mis-swallowed dentures which were not sopntaneously excreted of even though the denture reached the large intestine. Typically mis-swallowed dentures or other foods of viscosity, such as rice cakes are spontaneously excreted within about 4 weeks after passing through the stomach in adults, and rarely necessiate removal by endoscopic or surgical therapy. In the present, 2 cases who were diagnosed by a local medical doctor immediately after the mis-swallowing, the denture reached the large intestine, as recoginzed by plain abdominal roentgenography and was not finally excreted: in 1 case it was endoscopically excreted, and in the other case it was surgically removed due to bridge-induced perforative peritonitis. To progress the observation and therapeutic approach for cases of mis-swallowed denture, the degree of advancement should be frequently confimed by roentgenography, and development of perforation is considered when stagnation or deviation of denture in the intesrinal tube are found at the site and abdominal pain and signs of peritoneal irritation develope. Therefore, abdominal findings of evidence of the signs of peritoneal irritation should be carefully examined. The definite diagnosis can be obtained by a free-air pattern on plain abdominal roentgenogram. When denture reaches the large intestine in advance, endoscopy should be carried out because perforation occurs more often in the large intestine than in the small intestine, and the removal of the denture is considered as a therapy to prevent perforation from occuring. For endoscopic removal, the denture should be transanally removed after confirmation of non-insertion of the tip of both bridges into the mucous membrane of the intestinal tube and by inducing the denture into sliding tube by using a wire. When the tip of the bridge is not confirmable by endoscopy or resistance in the traction of wire grasped denture occurs, the removal procedurt should be replaced by surgery due to the risk of inserting the bridge into mucous membrane of the intestinal tube. When closure of the perforative region due to the surgery is not performed for a long-term period, the perforative region should be spread to the direction of the intestina axis, and suture-closure to the transversal axis should be performed by wound-lip excision after removing the denture. In long-term progressed, cases. anastomotic closure should be carried out by excision of the tubular intestinal tube including the perforative regions.

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An operated case of uterine lipoma is reported. A 66-year-old woman was admitted to our hospital because an uterine tumor was found during a routine physical checkup. A low density tumor was revealed in the uterine corpus by abdominal CT, and also a hyper echoich tumor was revealed by abdominal ultrasonography. From these findings, uterine lipoma was suspected, and surgical resection was undertaken. A yellowsh tumor mass, measuring 6.5 × 6 × 6 cm, was revealed in the uterine corpus; it appeared as a typical lipomatous lesion. She is healthy now, and the reccurence of the tumor is not observed. Uterine lipoma is a very unusual tumor; 6 cases had been reported up to 1994. The histogenesis is still uncertain, however tumorous growth of misplaced embryonic fat cells is considered to be the most probable theory.

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We report two cases of amoebic colitis. The first case was in a 45-year-old Japanese man with chief cimplaints of diarrhea and bloody stool. The patient had no history of oversea travel. A barium enema study and colonoscopy revealed multiple areas of erosion and mucosal edema in the rectum and the sigmoid colon. In paticular, several varioliform shadows were recognized in the transverse colon on barium enema study. Each elevated lesion had small barium flecks in its center. These findings suggested amoebic colitis. A high antibody titer was revealed by serologic testing (indirect hemagglutination test) . After treatment with metronidazole the symptoms and the examination findings improved. The second case was in a 39-year-old Japanese man who complained of bloody diarrhea and weight loss. The patient had no history of oversea travel. A barium enema study revealed diffuse barium flecks with some spicule formation in the rectum. On colonoscopy, multiple aphthoid ulcers and areas of hemorrhagic erosion were observed through out the rectum. These findings suggested ulcerative colitis. However, treatment with salazosulfapyridine failed to improve the symptoms. Amoebic colitis was considered as part of the differential diagnosis. Serologic testing (indirect hemagglutination test) for amoebiasis was highly positive. Salazosulfapyridine was replaced by metronidazole, and the symptoms and the examination findings improved.

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