[in Japanese]

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We detected prostate-specific antigen (PSA) mRNA in the peripheral blood of patients with prostate cancer using reverse transcription and a polymerase chain reaction (RT-PCR), and evaluated the usefulness of this detection method to search for metastasis of prostate cancer. Peripheral blood from 40 patients with prostate cancer, 22 patients with benign prostate hyperplasia (BPH), and 7 females were analyzed for PSA mRNA using RT-PCR. In one stage A prostate cancer patient PSA mRNA was not detected (RT-PCR negative) (0 %) . Among the 14 stage B prostate cancer patients, PSA mRNA was detected in one (7.1%) (RT-PCR positive) . All of the 10 stage C prostate cancer patients were RT-PCR negative (0 %) while 13 out of 15 state D prostate cancer patients (86.7%) were RT-PCR positive. One of the 22 BPH (4.5%) patients was RT-PCR positive and the 7 females were RT-PCR negative. RT-PCR for PSA mRNA identified 13 of 15 patients with metastatic bone disease (86.7% sensitivity) and it was negative for 24 of 25 patients with no metastasis (96% specificity) . The usefulness of RT-PCR for PSA mRNA as the modality in searching for metastasis was supported from this follow-up study.

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A new check method for laboratory test was developed. This method was aim at the accuracy guarantee and cut of useless re-test. Either separately by single-item check, inter-item check, and previous-results check, or by all three check systems simultaneously. The checking criteria for the single-item check was set by making a histogram based on the results of approximately 20, 000 tests. Each x± 3 SD of the results were cut to determine the check range for each test. In contrast, the check rate of the single-item method was less than 1 % in all tests, and its average check rate was 0.28%. The checking criteria for the inter-item check was established from the results of items whose correlation of coefficient were more than 0.500 with more than 1, 000 tests. Instead of utilizing regression equations, the check zone for each combination of tests was set by reducing the periphery of each tests results zone by 1 %. The average check rate for the present inter-item check was 0.65%. The checking criteria for the previous-results check was established by taking into account the number of days that bad elapsed since the previous test. A 40-grade cross-sectional histogram was prepared based on the frequency from the previous test. The upper and lower limits of each cross-sectional histogram were then set at 99% from the medium. The check zone was determined by connecting those limits. The average check rate of the present method was 2.68%. Although the combination check rate of the conventional method was above 20%, the present method gave just 3.1% of check rate, indicating reduce the labor and fee of re-testing.

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We measured specific IgE antibodies (CAP-RAST) to Japanese cedar, Cryptomeria japonica, orchard grass, ragweed, mites and house dust 2, in order to elucidate the distribution of specific IgE antibodies to common aeroallergens in young male subjects in their 20s. The specific IgE antibody positive to Japanese cedar was present in 36.4% of the subjects ; that to mites, 33.1% ; and that to house dust 2, 35.5%. Regarding the relationship between self-reported allergic diseases and the specific IgE antibody, levels of specific IgE antibodies to Cryptomeria japonica, mites and house dust 2 were significantly higher in subjects with allergic diseases compared to those without. Levels of specific IgE to Japanese cedar, Cryptomeria japonica and mites were significantly higher in subjects with pollinosis compared to those without. These results indicate that Cryptomeria japonica, mites and house dust 2 influence allergic diseases, and Japanese cedar, Cryptomeria japonica and mites have an effect on pollinosis. We also confirmed the existence of subjects who were specific IgE-positive and symptom free, and subjects who were specific IgE-negative with symptoms.

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The number of muscle fibers per 1 mm² of unit area was obtained by scanning 100 points distributed evenly on a cross-sectional surface of the thyroarytenoid muscles including the vocal muscle ; the mean number of 25 subjects (14 males and 11 females) was 639.8±48.6. As for frequencies of muscle fiber types which are classified according to contraction functions, the mean frequency of red muscle fibers (Type I ) involved in sustaining tonic contraction and postural maintenance was the highest, 43.7%, followed by 28.8% for intermediate muscle fibers (Type III) which has a sarcoplasm between Types I and II (white muscle fibers involved in fast and twitch movements) and 27.6% for Type II, in that order. There was no statistically significant difference between Types II and III . The frequencies of Type I, II and III were not different between the three age groups (60, 70, 80 and above) and sex difference. A comparison of the thyroarytenoid muscle with the anterior tibial muscle of the leg as well show that the frequency of Type I was high. These results showed that the thyroarytenoid muscles including the vocal muscle, which is involved in phonation in humans, show a marked trend toward Type I.

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Nitroprusside (SNP) -trimethaphan (TMP) mixture (1 : 10 ratio) produces potent vasodilatory action to induce hypotension. However, the effects of hypotension induced by various mixture ratios of SNP and TMP on the organ blood flows remain to be elucidated. Twenty-one dogs were anesthetized with 0.87% halothan in oxygen. They were divided into three ; groups : The 1 : 1 ratio group (n=7) received a mixture of SNP (0.02%) and T-MP (0.02%) the 1 : 2.5 ratio group (n=7) received a mixture of SNP (0.02%) and TMP (0.05%) ; the 1 : 5 ratio group (n=7) received a mixture of SNP (0.02%) and TMP (0.1%) . Mean arterial pressure (MAP) was reduced to 60 mmHg by the SNP-TMP solution. The renal, hepatic, pancreatic, and muscle blood flows (RBF, HBF, PBF, and MBF) were measured using the hydrogen clearance method. The MAP and left ventricular dP/ dt max in three groups decreased (p<0.01) during the hypotensive period but in higher ratio groups remained depressed after hypotension was terminated. Heart rate in the 1 : 2.5 ratio group decreased but in other groups remained unchanged during and after hypotension. Cardiac index (CI) in the lower groups decreased (p<0.01) but in the 1 : 5 ratio group tended to decrease during the hypotensive period. Systemic vascular resistance (SVR) in the three groups decreased (p<0.01) during the hypotensive period. The RBF, HBF, and PBF in the three groups remained unchanged throughout observation, but the MBF in the three groups reduced (p<0.01) during the hypotensive period. In conclusion, the results of this study show that hypotension induced by SNP-TMP mixture (1: 1 to 1 : 5 ratio) was due to the reduction in SVR and left ventricular contractivity associated with the decrease in CI, but that the splanchnic organ blood flows were maintained even in the presence of cardiac depression.

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To clarify operation characteristics of various types of one-hand-operated wheelchairs, three experiments were carried out using a standard type wheelchair (type S), 4 types of one-hand-operated wheelchairs, 1 type of double-hand-rim type wheelchair (type W), and 3 types of lever type wheelchairs (types L1, L2, L3) . In experiment 1, the velocity, number of strokes, number of running off the track, relative metabolic rate (RMR), and heart rate during driving at a comfortable pace and the maximum pace were compared. In experiment 2, (1) the time needed to perform 7 driving and operational tasks, number of strokes, and stability on straight runs were evaluated ; in addition, the subjective exercise intensity, regions of fatigue, and difficulty of operation were measured conducted (10 healthy subjects), and (2) the ease of operation by a care-giver was compared among the lever type wheelchairs. In experiment 3, the time of slalom driving and the degree of independence in moving around in the hospital were compared after 1-week practice of wheelchair operation (19 elderly disabled subjects) .
(1) The velocity of driving at a comfortable pace was similar to the velocity of walking by hemiplegic patients in all types of wheelchairs, and the RMR was less than that during “moderate exercise”, but the heart rate immediately after a run at a comfortable pace was higher in types W and L1 than in the other types. (2) The ease of operation in executing driving tasks was best in type S, followed by types L2, L3, L1, and W in this order. In type L1, the efficiency of transmission of force was poor, the velocity was slow, and the number of strokes was high. In type L3, the difficulty of transfer was large, but the transmission of force was good, and the velocity was the highest in runs on slopes. The ease of manipulation by a care-giver was relatively good in type L1, but considerable improvements were needed in all L types. (3) Independent moving in the hospital was considered possible when the time of a one 5 m shuttle slalom run is about 1 minute or less. Independence was often achieved fastest in patients who could drive the type S wheelchair only as slowly as the type W wheelchair when they used type L wheelchairs. Palpitation and pain of the upper limbs were often reported by those who used type L wheelchairs. From these results, type S is considered to be suitable for patients with good residual abilities, and type L for those with poor residual abilities. In particular, type L1 is considered to be appropriate for those with reduced upper limb muscle strength and coordination, type L3 for those who retain considerable upper limb muscle strength and have needs for outdoor operations, and type L2 for patients in an intermediate category. Type W was the least fit, and it, along with type L1, should be applied carefully to patients with cardiac disorders. These indications should be considered in selecting one-hand-operated wheelchairs for individual patients.

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A statistical study on 374 emergency outpatients at National Hospital Tokyo Disaster Medical Center for last 3 years, from 1997, revealed the following results:
1) The most common diseases were ureter stone (27%), cystitis (13%) and benign prostate hypertrophy (9%) .
2) The most common symptom was abdominal/back pain (29%) and urinary retention (14%) .
3) Emergency operations were performed in 16 patients (4.2%), half due to torsion of the testis.

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We experienced a case of pseudomyxoma peritonei with no therapy for 4 years. A 71-year-old man visited our hospital because of appetite loss and a sensation of fullness in the lower abdomen. We found massive ascites by abdominal ultersound. However we could not diagnose the genesis of the symptoms. After this examination, the patient rejected another examination and did not visit our hosipital for 4 years. After 4 years, the patient visited our hosipital because of sensation of tenderness, diarrhea, and pyrexia. After admission, we diagnosed pseudomyxoma peritonei by abdominal ultersound, abdominal magnetic resonance imaging, histopathological of ascites. Pseudomyxoma peritonei has a poor prognosis because no effective therapy has yet been established. We thought this patient was a rare case of pseudomyxoma peritonei with no therapy for 4 years.

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Intoxication caused by inhalation of nitrous gas, although not well-known in Japan, tends to occur in persons engaged in fire-extinguishing welding, plating, etc. We encountered a 64-year old man working in the plating industry for whom a diagnosis of adult respiratory distress syndrome (ARDS) was carried out. The patient inhaled nitrous gas during a plating extraction process after inserting an aluminum rod with nickel plating in a mixed solution of nitrous and sulfuric acid. Subsegumently, severe dyspnea and a compressive feeling in the chest appeared. A near-by general practitioner diagnosed acute pulmonary edema and transferred him to the emergency center of our hospital for intensive care. Treatment consisted of administering a surfactant for an artificial lung to maintain peak inspiratory pressure (PIP) and prevent pulmonary cavity collapse, and to ameliorate atelectasis and methyl prednisolone to prevent the release of various chemical mediators. The patient showed good progress and was discharged to a general ward on day 14. The onset of pulmonary disorder is not uncommon following intoxication caused by nitrous gas inhalation; prevention is especially important for the disease. It is considered crucially important to maintain good working conditions and to arrange a protective system in addition to making the general public aware of the disease.

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A41-year-old man was admitted to our hospital because of wheezing, dyspnea and fever in May 1988. A Chest X-ray and CT on admission revealed infiltration and multiple cavities with fungus balls in the right upper lobe. Bronchogram showed typical central bronchiectasis. The patient's laboratory examination revealed eosinophilia and a high total IgE level. Aspergillus —specific IgE antibody was positive as were serum Aspergillus precipitatins. Immediate skin reactivity against Aspergillus antigen was positive. Radiologic, serologic and immunologic findings led us to diagnosie this case as allergic bronchopulmonary aspergillosis (ABPA) with fungus balls.
Oral predonisone relieved the patient's symptoms, and improved laboratory and radiological findings. As aspergilloma was suspected to exacerbate the symptoms of ABPA, amphotericin B via inhalation, and f luconazole or flucytosine were administered for about two years. Fungus balls were gradually diminished and disappeared after flucytosine was administered. Currently, the patient is fully functional and works of delivering newspapers. Current maintenance predonisone dose is 10mg every other day.

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