In order to promote appropriate procedures in blood transfusion therapy, we surveyed blood transfusions performed in 1998 at Showa University Hospital. All of the homologous blood transfusions and the use of either blood or blood components prepared by the Japan Red Cross were found to be performed adequately. However, three major problems were found to exist: 0.98% of the blood components collected were found unusable due to improper handling ; blood for transfusion was collected unnecessarily from family members ; and transfusions using blood not treated with 15 Gy γ-irradiation were performed in 2.6% of the total cases. The usage of the red cell M·A·P (mannitol, adenin, phosphate: MAP) was found to be similar between the medical department and the surgical department. However, fresh frozen plasma (FFP) was primarily used by the surgical department, while platelet concentrate (PC) was mainly used by the medical department. Overestimation by physicians in the amount of MAP needed resulted in a large quantity of unused blood which was returned to the Division of Blood Transfusion. Therefore, guidelines need to be established to eliminate the waste of unused FFP and PC. Autologous blood transfusions were performed in many departments and were found to be effective in diminishing the need for homologous blood transfusions. The rate of operations that used autologous blood transfusions alone to the total number of operations that used blood transfusions was 23%. An increase in the number of autologous blood transfusions should be promoted in that more operations and procedures can be considered suitable for autologous blood transfusions. Blood transfusion reactions were reported in 0.5% of the total cases. None of the transfusion reactions were found to be severe. The cause of transfusion reactions was not identified from the blood components or from the patient status. To survey and measure the incidence of infection by transfusion of contaminated blood, an examination for the presence of syphilis, hepatitis B, hepatitis C, HIV and HTLV-1 is recommended 2 to 6 months after the blood transfusion. Although we, the Division of Blood Transfusion, provided a written notice recommending a blood examination to both the physician and the patient, the rate of compliance was only 37%. To date, no infection has been reported after a blood transfusion. It is our hope that this summary will be helpful in the establishment of more effective blood transfusion programs.

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The extraction of the articular cartilage settlement of the knee was done for the purpose of the research of joint disease. The concentrations of hyaluronic acid in the joint cartilage, chondroitin sulfuric acid, and keratan sulfuric acid were determined. The condition of the articular cartilage was classified in six stages, And the concentration of the joint marker and the condition of the articular cartilage was compared. Next, a joint marker of the articular cartilage and a joint marker in the joint fluid were compared. Correlation was seen in OA and ON in the condition of the articular cartilage and the component of the articular cartilage. However, clear correlation was not seen with RA. It considered that there was a difference in destruction of Proteoglican due to the disease. As for OA and ON, the fructification of the cartilage was the same as the joint fluid. However, there was a difference in C-4S with RA. As for the articular cartilage of RA as well, the concentration of C-4S decreases with destruction of the articular cartilage. However, the concentration of C-4S rises by chronic synovitis in the joint fluid.

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174 patients with Helicobacter pylori (Hp) positive peptic ulcers from 1996 (Jan. 1) to 1999 (May 31) were treated with a low dose proton pump inhibiter (PPI) with clarithromycin (CAM), and with metronidazole (MNZ: 1-week treated group and 2-week treated group) or amoxicillin (AMOX: 2-week treated group) . In this study, effective rates of three low-dose treated groups were 87.3% in MNZ: 1-week group, 88.5% in MNZ: 2-week group and 95.5% in AMOX group respectively. Total effective rate of this study was 90.8%. Side effects were recognized in 23%, but all the symptoms were slight. In conclusion, we consider that low-dose therapies for peptic ulcers were effective for antibacterial treatment of Hp infection.

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Recently arthroscopic Bankart suture repair has been performed for the traumatic anterior instability of the shoulder. We investigated the use of MR arthrography in the diagnosis of anterior instability of the shoulder. The purpose of this study was to compare MR arthrography findings of an anterior inferior glenohumeral ligament-labrum complex with arthroscopic findings. 50 shoulders with traumatic initial anterior dislocation and 50 shoulders with recurrent anterior dislocation and 10 shoulders of a control group without complaints were evaluated. Spin echo T1-weighted images in the transaxial plane and oblique coronal plane were obtained after injecting 20ml of Gd-DTPA diluted with saline (1: 100) . Bankart lesion was evaluated by MR arthrography accordin to Hirose's classification (Type Na, Nb, la, lb, 2, 3) . There was a difference in the type of Bankart lesion between traumatic initial anterior dislocation and recurrent anterior dislocation. In the thickness of the anterior inferior glenohumeral ligament (AIGHL), there was a significant correlation between traumatic initial anterior dislocation and recurrent anterior dislocation (p<0.01) although the types of Bankart lesion were not related to the number of dislocation. Secondly, MR arthrography findings were compared with the Arthroscopic findings in 97 shoulders of 97 patients with recurrent shoulder dislocation. Arthroscopic findings were classified according to Kurokawa's classification (Type 1, 2n, 2a, 3n, 3a, 4a) . MR arthrography findings of the Bankart lesion significantly correlated with the arthroscopic findings (p<0.01) . MR arthrography clearly visualized AIGHL and was helpful in determining operative indications.

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Recently some reports on pedicle screwing as one fixation technique in the cervical vertebra have been presented. However, pedicle screws in the cervical spine have not been used widely because the cervical pedicle is thin in comparison with the thoracic or lumbar spine and is adjacent to the spinal cord, nerve roots, and vertebral arteries, which make the surgical procedures complex. In the case of the lumber vertebra which has a thick pedicle, even if there is some dispersion in the screw insertion point or direction, the screw can be inserted into the pedicle without much problem. However, in the case of the cervical spine, it is assumed that the insertion point, direction and the diameter of the screw may be limited. The purpose of this study was to evaluate the morphometry of the pedicle including the vertebral body and to establish an appropriate insertion point, direction, diameter, and length of the screw in order to perform safe and rigid pedicle screwing. Ten cervical specimens from C3 to C7 (50 cervical vertebrae, 100 pedicles) were evaluated with manual measurements. Using the original method that determines the anatomical intramedullary axis of the pedicle, mean inclination of axis, mean outer pedicle height, width, mean inner pedicle height, width and mean thickness of the pedicle cortex were measured. The distance from the entry point superior to the inferior margin of the inferior articular process of the same vertebra and medial to the lateral margin of the lateral mass of the same vertebra were measured. The pedicle axis inclination was also measured. The thinnest pedicle cortex was always the lateral cortex in all-level vertebrae. It was considered that the appropriate diameter of the cervical pedicle screw was 3.0-3.5 mm at C3, C4, C5, 3.5-4.5 mm at C6, 4.0-5.0 mm at C7.

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The purpose of this study was to define the changes in serum calcium (Ca), inorganic phosphorus (P), total and bone-type alkaline phosphatase (ALP), osteocalcin (OC) and calcitonin (CT) after osteotomy, and to know the bone metabolic properties during the early period of bone healing. The subjects were 11 cases (1 male and 10 female, 16-61 years, mean age: 39.6 years) who underwent osteotomy of the hip joint. Samples of venous blood were taken before and on days 3, 7, 14, 21 and 28 after the operation. Ca, P and total ALP activity were measured by the recommended methods, and bone-type ALP (B-ALP) activity was measured by electrophoresis. OC was measured by radioimmunoassay and CT was measured by a newly developed chemiluminescent immunoassay. Ca concentration decreased, reaching the lowest value by day 3 and returned to the pre-operative value by day 14. P concentration decreased, reaching the lowest value by day 3 and increased significantly by day 21. B-ALP activity fell by day 7 and started to increase to day 21. OC concentration significantly decreased by day 3 and then increased throughout the period. In contrast, CT concentration rose during the first 3 days and decreased week by week. According to the rise of B-ALP, osteoblast activity can be accelerated on about day 7 after osteotomy. The changes of OC and CT reflected the bone resorption and formation at the fracture site. Further investigations are required to determine the clinical significance of biochemical markers to estimate the prognosis of healing after bone fracture.

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On 130 cases of primary breast cancer who received srgery in Showa University Hospital from 1990 to 1992, we investigated the relation of the presence of hormone receptor, MIB-1, p53, c-erbB-2 and prognosis retrospectively. On formalin-fixed paraffin-embedded sections, following antibody, estrogen receptor (ER), progesterone receptor (PR), MIB-l, p53, and c-erbB-2 were used for immnohistochemical staining by the labelled streptavidin biotin method. We investigated the prognostic value with histological subtype, grading, and clinicopathological factors. Immnohistochemically, 68.5% of cases were positive in ER, 53.8% in PR, 39.2% in MIB-1, 50.8% in p53, 66.2% in c-erbB-2, respectively. An increase of MIB-1 positive cells, positive for p53, and c-erbB-2 were correlated with poor prognosis. In particular, MIB-1 increased and p53 positive cases were 69.2% in overall survival of five years ; therefore, this combination was a good indicator to estimate prognosis.

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Shoulder pain is one of most common complaints among baseball pitchers. This study attempts to clearify the pathomechanics of throwing injuries of the shoulder and compare the findings with arthroscopes and motion analyses. An arthroscopic study: Ten injured baseball players were studied. Nine players had Biceps tendon labrum complex lesions (BLC lesion) and seven players had partial thickness rotator cuff tears. Two cases had insufficient AIGHL with Bennett lesions. A biomechanics study: Five baseball player with shoulder pain and six top athlete baseball players as the control were studied. The subjects were filmed pitching from two directions, and the pictures were syncronized with each other. Velocity, angle and angle velocity the of trunk and the upper arm were calculated using APAS (Ariel Performance Analysis System) . The time of maximum velocities of the shoulder, elbow and wrist of the injured players was faster than those of the top athletes, but the intervals of time of maximum velocity between the elbow and the wrist were longer. Comparing stick figures between injured players and top athletes, the upper arm motions of the subjects were larger than those of the top athletes in the acceleration phase. Perhaps these motions induce shoulder stress from the posterior-inferior to anterior-superior on the glenoid according to arthroscopic findings and X-rays. Repeating this stress, the biceps tendon labrum complex is stripped off the glen oid, which induces rotator cuff tears. To prevent the shoulder from disorders and to accelerate the ball smoothly, trunk rotation without shoulder stress is most important in baseball pitc hing.

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It is known that pulsatile secretion of gonadotropin reflects hypothalamic LH-RH secretion. LH pulsatile secretion during the night starts to appear in the prepubertal period. However, little information is available in regard to the LH pulse in patients with amenorrhea in adolescent girls. In the present study, nocturnal LH pulsatile secretion was measured in patients with hypothalamic amenorrhea, and the relationship between LH pulsatile secretion and grade of amenorrhea was determined. Thirty-five patients with hypothalamic amenorrhea were divided into Group I (n=21) and Group II (n=14) by a progestogen test. Group I patients were sub-classified into two groups according to the response to clomiphene citrate (CC) ; CR (n=5) successfully ovulated by CC, and CNR (n=7) did not ovulate. Blood samples were collected from the patients every 20 min. from 20: 00 pm to 6: 00 am. Serum hormone levels were measured by radioimmunoassay and LH pulsatile secretion was compared with normal healty women (n=6) . Informed consent was obtained from all the patients and their parents. 1) Nocturnal mean estradiol levels and LH pulse frequency were significantly lower in Group II than those in Group I. Although nocturnal LH pulsatile secretion in Group I was near normal, Group II was characterized by a significantly low frequency and a similar amplitude compared with Group I. 2) There was no obvious change in estradiol levels while significantly lower basal LH levels and frequency and amplitude of LH pulse was observed in CNR. The LH pulsatile secretion in CNR was similar to that in Group II . From the results obtained above, it is suggested that the CNR patients might have an impaired estrogen feedback mechanism in addition to a disorder of LH pulse generator.

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Tissue samples were collected from patients with crystal-induced arthritis and were sliced to make sections with ordinary paraffin. Then, analysis of crystals were attempted in the sections using an Electron Probe Micro Analyzer (EPMA), X-ray diffraction (XRD), and μX-ray diffraction (μXRD) . With the EPMA, the distribution condition of the precipitate, identification of the elements, and the contents were analyzed. The XRD identified chemicals contained in the entire tissues. The μXRD focused on the precipitate obtained by the EPMA to identify the chemicals. Consequently, it was possible for the tissue samples to be analyzed for crystal conditions by making the sections with paraffin treatment. The results of the XRD showed no diffraction peak indicating crystal substances. However, the results of the μXRD showed a diffraction peak indicating crystal substances. Use of the EPMA provided an accurate understanding of the crystal distribution at sites where crystal presence was suspected, and to identify the kinds of elements and measurements the contents. Moreover, histopathological specimens at the same sites were made, by which tissular lesions around the crystals could be observed. Conventionally, analyses of crystals were conducted after the crystal body was removed. The analysis using sections with paraffin reveals the difference of elements among individual crystals in a tissue and the difference of structural elements between the surface and the inside of a crystal. This method using blocks with paraffin is able to analyze cases in the past and to compare the cases with histologic pictures in terms of reaction condition of cells around the crystals. Therefore, this analysis proved to be a very useful method for the characterization of crystal-induced arthritis.

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Labyrinthectomy or vestibular neurectomy is usually selected as a surgical treatment for intractable vertigo symptoms associated with inner ear diseases. However, these procedures are highly invasive, and laser techniques to destroy vestibular end organs have been developed as an alternative. This study was undertaken to determine the feasibility of using an argon laser to abolish saccular function. The temporal bones of 20 human cadavers whose ages ranged from 52 to 91 years at the time of death (average: 82.7), stored in 4% formaldehyde solution for 6 to 12 months, were used as the material. Histopathological examination was first performed to identify pigments in the saccular wall that might influence the absorption of argon laser beams ; the pigment was determined to be lipofuscin. The permeability of the argon laser was then evaluated. After the stapes was removed from the temporal bone, one shot irradiation at 1.5 watts for 0.5 seconds was performed perpendicularly to the saccular wall through the oval window. Histological examination revealed that there were multiple small perforations at the target site. These findings suggest that destruction of the saccular macula with an argon laser adversely affects the cochlea in the aged.

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A 78-year-old woman was admitted to our hospital in October 1997 because of numbness of both her hands, defect of precision motion, and gait disturbance. At that time, the JOA Score (Ruling Standard for the Treatment of Cervical Myelopathy of Japan Orthopedics Association) was 7 out of 17. On epidural mass was found posterior to the odontoid, which showed low signal intensity in T1 and T2 weighted sagittal views. In a sagittal view with Gd-DTPA, we did not find contrast enhancement in the mass, and we discouered that the mass was severely compressing the spinal cord. We diagnosed that the myelopathy was caused by the epidural mass. Laminectomy of C1 and C2 and occipito cervical fusion were performed without removing the mass. After surgery, mR imaging showed a reduction in the sige of the mass, and the JOA score was improved from 7 to 11 out of 17. In the case of instability and arthrotic change of the atlanto-axial joint, fibrocartilage dysplasia could be caused by chronic and mechanical stimulation which repeatedly produced the fissure and restoration of the ligament transversum atlantis. The mass was histologically reactive hypertrophy of the ligament transversum atlantis ; therefore we could expect that the mass would be reduced in size by only fixing the atlanto-axial joint.

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We generated questionnaire tables for quality of life (QOL) in patients with Parkinson's diA 62-year-old woman visited our hospital because of bronchial asthma and chronic hepatitis. After she received Stronge Neo-minophagen C (SNMC) intravenously, Wheezing and nasal discharge appeared. Therefore, we examined the challenge test of SNMC. 15 cc of SNMC challenge produced nasal discharge, sneezing and dyspnea with a 21% decline in FEV 1.0. SNMC consists of glycyrrhizin, L-cystein, aminoacetic acid and sodium sulfite. In a glycyrrhizin inhalation test, FEV 1.0 values declined 13.6% and she experienced dyspnea and nasal discharge. We suspect that glycyrrhizin induced the asthma attack.

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