We have analyzed statistics of identification and susceptibility for 272 isolated bacteria from December 1 to 3, 1997 and 213 clinical isolates from April 13 to 15, 1998 at Showa University Hospital, and compared the data with clinically isolated bacteria at Showa University Hospital from July 1990 to June 1992. Data from this earlier period were separately analyzed from July 1990 to June 1991 and from July 1991 to June 1992. Staphylococcus aureus and Pseudomonas aeruginosa were isolated in similar numbers in the current periods as in the earlier period. Both residential and environmental bacteria were also frequently isolated during both the early and later periods. Staphylococcus aureus (110 strains) was most frequently isolated in the current periods, with 64% being methicillin-resistantStaphylococcus aureus (MRSA) . The ratio of MRSA was almost same as that observed from 1990 to 1992. Eighty-one strains ofPseudomonas aeruginosawere isolated, with 6% showing extreme drug-resistance against various antimicrobial agents ; the ratio was reduced from 16% in 1991-1992. Multiple drug-resistance of coagulase-negative staphylococci increased. All Streptococcus agalactiae strains were still highly sensitive to beta-lactams. Enterococci were naturally multiple drug-resistant against cephems, aminoglycosides, clindamycin and sulfamethoxasole / trimethoprim. Enterococcus f aecalis showed sensitivity to penicillins, carbapenems and vancomycin to the same degree as in the period from 1990 to 1992, whereas resistance against new-quinolones increased. Vancomycin resistant enterococci (VRE) was not isolated. Enterococcus faecium was more resistant against various antimicrobial agents than Enterococcus faecalis, and had little susceptibility to penicillins, carbapenems, macrolides and new-quinolones. Stenotrophomonas maltophilia had natural resistance against cephems. Escherichia coli was sensitive to almost all the antibiotics. Both Citrobacter freundii and Enterobacter cloacae, which belong to Enterobacteriaceae, showed resistance to first-generation cephems, second-generation cephems and penicillins. Klebsiella pneumoniaes were sensitive to almost all antimicrobial agents other than penicillins for which there is natural resistance. Serratia marcescens was resistant to most first-generation cephems, second-generation cephems and penicillins, whereas the third-generation cephems, carbapenems, aminoglycosides and new-quinolones were effective antibiotics against Serratia marcescens.
We have found extended-spectrum beta-lactamases (ESBLs) producing strains both in Klebsiella pneumoniae and Serratia marcescens. Surveillance of the incidence of drug-resistant bacteria such as MRSA, methicillin-resistant CNS (MRCNS), extreme drug-resistant Pseudomonas aeruginosa, and also VRE is of extreme importance. We hope that this statistical data can be properly utilized in clinical practice.

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An experimental study was conducted on the efficacy of collagen with porous high-density polyethylene (PHDPE) as an artificial extracellular matrix in transplantation of rabbit auricular perichondrium. PHDPE blocks were wrapped with rabbit auricular perichondrium, and the degree of chondrogenesis was estimated histopathologically 2, 4, and 8 weeks after wrapping the blocks. The 36 rabbits used were divided into four groups : I) PHDPE blocks wrapped with a vascularized perichondrium flap ; II) PHDPE blocks infiltrated with type I collagen and wrapped with a vascularized perichondrium flap; III) PHDPE blocks wrapped with a free perichondrium flap; IV) PHDPE blocks infiltrated with type I collagen and wrapped with a free perichondrium flap. Neochondrogenesis was observed in all groups, but the degree of chondrogenesis was greater in Groups I and II than in Groups III and IV. Chondrogenesis was observed slightly earlier in Groups II and TV, and the degree of chondrogenesis was slightly greater than in Groups I and III . The results indicate that PHDPE can be used as an artificial extracellular matrix for neochondrogenesis. However, improvements and further studies, of for example the long-term persistence of chondrocytes and the development of an extracellular matrix in place of collagen, are necessary before PHDPE can be used clinically.

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Massive resection of the small intestine with or without the ileocecal region is sometimes done in gastrointestinal surgery, but its prognosis is not always satisfactory. Insulin-like growth factor-1 (IGF-1) can promote intestinal proliferation which may be beneficial to postoperative conditions after massive resection of the small instestine.
Therefore, we investigated the effects of IGF-1 on postperative conditions after massive resection of the small intestine with or without the ileocecal region in rats.
Six-week-old male Wistar rats were subjected to massive resection of the small intestine with or without the ileocecal region and continuously administered with IGF-1 or saline until the 7th postoperative day. Serum levels of GOT, GPT, total protein and transferrin were measured. Changes in the levels of body weight, water intake, urine volume and food intake were monitored.
Postoperative serum levels of GOT, GPT, total protein and transf errin, and body weight levels after massive resection of the small intestine without the ileocecal region were not significantly different from the preperative levels, and a distinct effect of IGF-1 was not recognized. However, these levels after massive resection of small intestine with the ileocecal region were decreased significantly from the preoperative levels and the decreased levels were significantly improved by the administration of IGF-1.
The results suggest that administration of IGF-1 has a clinical benefit to improve liver dysfuction and nutritional impairment caused by massive resection of the small intestine with the ileocecal region.

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A total of 257 breast cancer patients of the T1 stage (including 69 BCT cases), who underwent operationsons in the 2nd Department of Surgery, Showa University between 1990 and 1996, were examined their clinico-pathological factors for the prognosis at the operation.
Out of 69 BCT performed cases, 5 recurrences (7.2%) were experienced. There were 3 cases of bone metastasis, 3 cases of remnant breast and one lung metastasis. All 5 recurrent patients are still living. The 5 cases whitch experienced recurrence within three years were not influenced by NTD (nipple-tumor distance) .
It seemed that the retrospective clinico-pathological data showed that Surgical margin, Lymph node metastasis, Lymphatic invasion and Venous invasion might be important factors of recurrence after BCT.
Post-operative investigation of the BCT patients indicated that 3 patients out of 4 who had re-operations felt regret and strong anxiety because of the recurrence.

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The preventive effects of Sasa senanensis Rehder extract by alkaline hydrolysis on degranulation from rat peritoneal exudate cells (PECs) were examined.
Calcium-ionophore A23187 as the degranulation stimulus in a 1 mM Ca²⁺ buffer solution showed a dose-dependent increase in histamine release from rat PECs, while there was no significant histamine release in the Ca²⁺ free buffer solution. Preincubation with Fe-SE (Fe substituted for the Mg of chlorophyll) or Cu-SE (Cu substituted for the Mg of chlorophyll) for 5 min suppressed calcium-ionophore A23187-induced histamine release in a concentrationdependent manner. A23187 evoked a quick increase in cytoplasmic free calcium ( [Ca²⁺] i) levels in the presence of extracellular calcium. Preincubation with each SE showed the suppressive effect on calcium influx increases induced by A23187. Sodium cromoglycate as the prototypical antiallergic compound prevented the histamine release and the increase in [Ca²⁺] i levels induced by A23187.
These results indicate that the preventive effects of both SE extracts against degranulation from rat PECs are due to the inhibition of the [Ca²⁺] i level increase, suggesting they may be useful as effective anti-allergic agents.

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Twenty-four patients with Crohn's disease who underwent resectional surgery at Showa University Hospital and other allied hospitals, over a recent 21-year period were analyzed to evaluate the surgical results and postoperative courses. The average onset age was 34 years old and the ailing time from the onset to the operation was 3 years. Eleven patients (45.8%) had ileocolonic disease and three of them underwent surgery because of enterovesical fistula. Another three patients had bowel stricture. Eight patients (33.3%) had ileal disease and four of them were operated on for bowel stricture. Postoperative recurrence occurred in ten patients (41.6%) ; seven of those patients were indicated for reoperation. Five of the seven reoperated patients had ileocolonic disease and intestinal stricture, and this was the reason for their reoperations. The cumulative reoperation rates were 21% at 5 years and 29% at 10 years after the initial operation. The risk of reoperation tended to increase in proportion, as the onset age began younger. The follow up periods ranged from 6 months to 21 years (average 9.1 years) ; two patients died. It is important to determine proper operative indication and appropriate operative procedures and also to improve surgical therapy combined with dietry controls and chemotherapy.

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A 24-year-old male visited our hospital complaining of consciousness disturbance. His conscious level was E₁V₁M₄ on the Glasgow Coma Scale (GCS) . His pupils were 2.5 mm on the right and 5.5 mm on the left side, respectively. A head CT scan revealed a subarachnoid hemorrhage (SAH) with a hematoma (5×3×3 cm) . DSA demonstrated a giant aneurysm of the left middle cerebral artery. The size of the aneurysm was 30×28mm in diameter. After DSA and CT exams, the left pupil declined to midriasis. Within 5 hours after admission, we decided to perform a direct operation. As expected, the brain was very hard and we started a STA-MCA bypass before clipping. During the operation, various methods for brain protection were employed. We conducted neck clipping and external decompression. At that time, the pre-operative enhanced CT was instructive because the aneurysmal wall was not uniform. Hyperbaric oxygen (HBO) therapy was performed 7 times the day after the operation. Postoperative DSA revealed complete neck clipping, but the M2-M3 portion of the MCA could not be detected. A postoperative CT also showed the low-density area of the MCA. Fortunately, the patient recovered from severe SAH and was transferred to the rehabilitation center. One year after first falling ill, the patient's level was E₄V₅M₆ on GCS and he could walk with cane. Repeated DSA revealed that the passage of the M2-M3 portion of the MCA was relatively good. This was a rare case of ruptured giant aneurysm in a juvenile patient.

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We studied a case of Morgagni hernia. An 84-year-old woman admitted to the hospital because of dyspnea. An anteroposterior radiogram of the chest showed bowel gas on the diaphragum in the right lung field. An operation was performed by the abdominal approach. The herniated small intestine, transverse colon and a part of omentum were easily returned to the abdomen. The hernia sac was not resected and the hernia was closed. The post-operative course was satisfactory and the patient was discharged 20 days after surgery.

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