Thirty-one patients (18-67y [mean 52.4y] ; 26 males, 5 females) with pancreatic stone (s) were successfully treated by extracorporeal shock wave lithotripsy (ESWL) between 1990 and 2000. Causes of chronic pancreatitis were alcohol (27), idiopathy (3), and pancreas divisum (1) . Thirteen patients had a single stone, 8 patients from 2 to 5 stones, and 10 patients had more than 5 diffuse stones. One to 14 (average 3.2) lithotripsy sessions were performed and 600 to 24, 565 injections (average 5386) were administered. In 29 of 31 cases (93%) treatment was effective. Complete clearance from the main pancreatic duct was achieved in 19 cases (61%) and partial clearance in 10 (32%) . ESWL achieved complete clearance in 14 of the 20 cases (70%) without endoscopic pancreatic-sphincterotomy (EPST) . Therefore, EPST may not always be necessary. After ESWL, symptoms related to pancreatic stones disappeared in 25 of 27 patients (93%) . The PFD test showed improvement in pancreatic exocrine function in 10 of 13 cases (77%) ; all 10 cases had more than 2 pancreatic stones (p<0.01, Student's t-test) . The 75 g-glucose tolerance test indicated improved endocrine function in only 1 of 11 patients. The major complication of ESWL, resolved by conservative treatment, was subcapsular liver hematoma in one patient. All patients had a minor complication, subcutaneous hematoma in the pathway of shock-waves. Of 25 cases followed from 168 to 3126 days, recurrence was noted in 5 cases (20%) (Kaplan-Meier) . Suspected reasons were continuous drinking and stricture of the main pancreatic duct (MPD) . We conclude that ESWL for pancreatic stones is useful, effective as a repeatable procedure and clinically safe.

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We investigated the relationship between thyroid function and the response to antidepressant drugs in patients experiencing a depressive episode by a logistic regression analysis in order to identify independent predictors of the outcome. The study sample consisted of 46 patients between the ages of 18 and 84 years with a definite diagnosis of a depressive episode of a major depressive disorder or bipolar disorder (Diagnostic and Statistical Manual for Mental Disorder, IVed.) . We administered pharmacotherapy with antidepressant drugs to the patients for 12 weeks. At the commencement of pharmacotherapy (week 0), and 12 weeks thereafter (week 12), the levels of thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) in the serum were measured and a test using the 17-item Hamilton Rating Scale for Depression (HRSD-17) was performed. The patients were divided into two groups: the good-outcome group (25 patients) based on at least 50% improvement in the HRSD-17 score as defined as responders and the poor-outcome group (21 patients) (<50%) as nonresponders. A logistic regression analysis revealed that the serum FT4 level at week 0 significantly correlated with the treatment outcome (odds ratio 43.4 ; 95% confidence interval 1.33 to 1413.26; p=0.03) . In both the responders and nonresponders, there were significant reductions in the FT4 level between week 0 and week 12. In responders, the degree of decrease in the serum FT4 levels from week 0 to week 12 was significantly greater than that in the nonresponders (df=44, F=0.39, p=0.007) . These results suggest that the serum FT4 level before treatment is a prognostic factor for antidepressant treatment and that it decreases as depression improves.

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We investigated the difference in Activities of Daily Living (ADL) which was evaluated separately by the patient's family and by medical staff for aged people who were admitted to a facility of health care services for the elderly. One hundred eighty-eight subjects, 85 men and 103 women (mean age 82.8 years), were studied. On admission 7 values of ADL, feeding, toileting, dressing, grooming, bathing, locomotion and communication, were evaluated by the subject's family after admission the subject were evaluated again by the medical staff, which consisted of physicians, nurses, physical therapist, and others. Subsecguently both ADL reaults were compared. The effect of whether a patient was admitted directly from his home or transferred from another hospital on ADL evaluation was also studied. a study of the effect on ADL evaluated according to the underlying morbidity, fracture, stroke, and others, was conducted as well. Evaluation for ADL was assigned to three levels: Total Independence (TI), Partial Independence (PI), and Total Dependence (TD) ADL evaluated by the family was compared with that by medical staff using an χ² test, and the coincidence rate was analysed.
The coincidence rate of the ADL evaluated by the family and by medical staff was 47.6%. ADL Discrepancy was observed in bathing and dressing. For the coincidence rate, no difference was observed between those who were admitted directly from them homes and those who were transferred from other hospitals. The coincidence rate for fracture and anotter morbidity group was significantly lower than that of the stroke group (p<0.05) .
The overall coincidence rate was less than 50% the reason for this discrepancy in bathing, which requires a great deal of assistance, and dressing, which requires less assistance, is most likely attributed to the difference in manpower and equripnant for the former and time consumed for the later. In addition, the reason that the discrepancy was significant in the ADL for bathing, which needs a lot of assistance, appears to be that hemiplegia due to a stroke is more likely to impress a family as being a severe disability compared to a fracture and aging, The difference of ADL evaluation between the family and medical staff suggests a gap regarding the significance of ADL and a gap between care and assistance for the disabled. A physician should carefully consider care and welfare service which the patient receives, after having compared his own evaluation for the patient's ADL with that of the family.

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Many studies have been performed on the mimetic muscle and the facial nerve of adult humans. However, the morphological features of the mimetic muscle and the facial nerve in fetuses have not been elucidated. The aim of this study was to examine the mimetic muscle and the facial nerve in fetuses and to elucidate the features of the mimetic muscle and the facial nerve in newborns and infants. In this study 8 sides of 5 cadavers aged 23 to 36 weeks of gestation were investigated. Concerning the differentiation of the mimetic muscle, although the muscles, inserted around palpebral fissures and oral fissures, differentiated well, the muscles inserted around the nose and eyebrows differentiated poorly. Concerning the development of the facial nerve in each mimetic muscle, although the zygomatic, buccal, mandibular and cervical branches developed well, the temporal branch developed poorly. Therefore, the differentiation of the mimetic muscle and the development of the facial nerve correlate to each other ; the mimetic muscle and the facial nerve around palpebral fissures and oral fissures develop better than around the nose and the eyebrow.

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There are certain methods to treat craniomaxillof acial bone defects. If one does not want to use autogenous bone, hydroxyapatite (HAP) might be an alternative bone substitute. Although it has the advantage of no donor area morbidity, a sinking phenomenon has been found to occur ; its degree differs from site to site. In the present study, we investigated the effect of the site of the onlay graft and differences in its porosity on the sinking phenomenon. The experiment was performed by inserting HAP blocks having 30% and 50% porosity under the periosteum at three sites: the frontal bone, the zygoma, and the mandible, of mature male New Zealand White (NZW) rabbits. Three NZW rabbits were allocated to a sham group, and 16 rabbits were sacrificed 8 weeks after grafting. Villanueva's bone stain was used to histologically examine the interface between the HAP and the recipient bone for autogenous bone substitution and migration, identified by the presence of a mixture of osteoblasts and osteoclasts. The order of severity of the sinking phenomenon according to site was: mandible >zygomatic bone >frontal bone, and according to porosity: 50%>30% ; and clear differences from the sham groups were shown. Based on the above findings, the results of the experiment showed that selecting porosity after considering the strength of the implant and the site to be grafted is an important factor when applying HAP clinically. When comparing the present experiment's results with Yamada et al's study results, it can be concluded that the degree of sinking is lesser in mature rabbits than immature rabbits.

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With the aim of elucidating factors relevant to the outcome, a 6-year follow-up study of panic disorder (PD) was performed. We studied one hundred patients with the Diagnostic and Statistical Manual for Mental Disorder, III-revised defined PD (37 men and 63 women, 39.5±13.6 years) as subjects who first visited the outpatient clinic of Showa University Hospital from September to December 1993 and participated in the 1-year follow-up study undertaken between October and December 1994. The present study was undertaken from April to May 2000. Written informed consent was obtained from those who were still undergoing treatment as outpatients. Furthermore, to those who discontinued their treatment, the aim of this study was explained by mail, thereafter, investigation was performed through a direct phone call for those whose informed consent was obtained. Factors such as frequency of panic attacks, severity of agoraphobic avoidance and anticipatory anxiety, drug compliance level, state of treatment and psychosocial stress level for the recent 3 months were subjected to analysis. A total of 57 cases, 6 undergoing treatment as outpatients and 51 corresponding through phone calls, participated in this study. Thirty-six cases (63.2%) suffered from more than one panic attack or limited symptom attacks, 38 (66.7%) experienced a certain degree of agoraphobic avoidance and 42 (73.7%) experienced anticipatory anxiety for the recent 3 months. Twenty-four cases (42.1%) were referred to psychiatric outpatient clinics, including our institute, 14 (24.6%) were treated by nonpsychiatrists, and out of the total, 41 cases (71.9%) were treated with drugs. These patients who experienced panic attacks or a moderate level of agoraphobic avoid ance/anticipatory anxiety were categorized as the poor outcome subgroup. Out of the 57 subjects, 25 (43.9%, 95%C.I.: 31.0-56.8%) were classified into the poor outcome subgroup. Logistic regression analysis using good/poor outcome as a dependent variable and sex, marital status, duration of illness, initial level of symptoms, characteristics rated by EPQ as independent variables, revealed that the poor outcome was predicted by marital status (not married), a strong sensation of shortness of breath or smothering and a mild sensation of palpitations, pounding heart, or accelerated heart rate.

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The common femoral artery (CFA) of 90 stroke patients was examined by B-mode ultrasonography. Results showed that 50 patients had cerebral infarction (CI) and the others had with cerebral hemorrhage (CH) . The degrees of plaque and stenosis from the ultrasonography were evaluated. The patients were divided into four classes according to the degree ; and the relation with age, sex, post onset time, side of hemiplegia, ankle pressure index (API), risk factors (i.e. hypertension, diabetes, hyperlipidemia), and clinical categories in case of CI were studied. Fourty-seven out of 90 patients (52.2%) showed atherosclerotic lesions. From these 47, 34 (68.0%) were CI patients, compared to 13 (32.5%) CA patients. This showed that the frequency and the degree of atherosclerosis were significantly greater in CI patients than in CA patients (p<0.001) . Although 88.2% of the low API patients (API<1.0) had atherosclerotic lesions and showed a significant correlation (p<0.01), 46.0% of the normal API patients also had atherosclerotic lesions. Whereas atherosclerosis had some relation to age, it showed no significant correlation with sex, post onset time, side of hemiplesia and clinical categories of CI.
In terms of risk factors, hypertension and hyperlipidemia were strongly related to atherosclerotic lesions, but diabetes was not. The correlation between the risk factors and atherosclerosis was significantly higher in CI patients than in CA patients. These results suggest that when CI patients are treated, the possibility of arteriosclerotic obliterans must be kept in mind, and that ultrasonography is effective for the early detection of atherosclerotic lesions of CFA.

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The purpose of this study was to obtain an estimation of the muscular strength of the lower extremities and to develop treatment guidelines from the relationship with the possible standing level, the ratio of isometric knee extension muscular strength/body weight, and the independent moving degree. The subjects were nursing home residents (age: 58.9±17.0), consisting of 74 males (60.2±18.5) and 68 females (57.6±15.5) . An apparent positive correlation was shown between the standing level and isometric knee extension muscular strength (Both legs standing: r=0.67, p<0.01, Single leg standing: r=0.75, p<0.01) . The muscular strength in each of four boxes used in this study (40, 30, 20, and 10 cm in height) was 28.9, 35.3, 44.3, and 51.9% respectively, of the body weight for both legs ; and 62.3, 68.0, 90.2, and 102.7% respectively, for one leg. As for the relationship between the standing level and moving ability, the standing level at both legs at 20 cm is divided by the independent degree into assistance and independent levels. Moreover, the standing level using one leg at 40 cm was necessary to become independent without anxiety. This evaluation is considered to be useful for clinical practice.

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The number of fish allergy patients in Japan is increasing. At Watanabe Kodomo Clinic in Sapporo we have seen 70 cases between 1982 and 1999. While many patients' clinical symptoms indicated the immediate response types of reaction, incidents of non-immediate response types are on the rise.
In nearly all of these cases, patients exhibited positive skin reactions to both food allergens (specifically fish) and to airborne allergens as well.
In every case, the patient was below the age of six months. Most commonly, the fish that elicited reactions were cod, salmon and mackerel. After food provocation tests, patients exhibited a variety of symptoms, including urticaria, itching throat, laryngeal edema and others. Hypersensitivity to fish has been noted as an etiologic factor in a large subset of children with aseptic dermatitis.

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