A review on occupational health service and activities in Yugoslavia is presented. Information on relevant legislation, organization of occupational health and worker's health care, financing, practices of occupational health units, education concerning graduate and postgraduate studies and continuous education in this field are given. Workers' morbidity pattern is also briefly discussed as well as research activities. Concluding remarks include observations on foreseeable needs and developmental orientation in occupational health in the country.

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The effect of methylcobalamin on the accommodative function of subjects with deteriorated accommodation by induced experimental visual work was studied by measuring small fluctuations of accommodation. The deterioration of small fluctuations of accommodation were difficult to find after visual work in the group receiving methylcobalamin. However, a significant difference of small fluctuations of accommodation was recognized in the non-administered group and in the placebo group (P<0.05), and that change was higher in the non-adminstered group than in the placebo group. Although, the placebo effect of methylcobalamin was undeniable, it was objectively confirmed that methylcobalamin produced a good effect on deteriorated accommodation induced by the visual work.

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The state of vergent eye movement is reported before and after the experimental work. The work performed by 26 subjects was a name search task on a visual display terminal (VDT). Convergence and divergence eye movements were recorded objectively using an accommodo-polyrecorder, and as a sensor of eye movement, elictro-oculogram (EOG) was applied. These eye movements were elicited by watching each target, a far fixation target and a near fixation target, which alternated from far to near every five seconds on the accommodo-polyrecorder. Measurements by this method were conducted at two points in time: (1) before beginning the VDT work and (2) after completing the work. The convergence time was unchanged before and after the work load. The divergence time, however, was prolonged after the work load, which was highly significant (P<0.001). In this study, it is shown that the vergent eye movement, convergent and divergent eye movement, is influenced by VDT work.

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The single-stranded (SS) DNA-dependent ATP hydrolysis at pH 7.5 and 6.2 and the double-stranded (DS) DNA-dependent ATP hydrolysis at pH 6.2 by recA protein (no reaction was detectable at pH 7.5) were found to be inhibited competitively by ribose-modified analogs of ATP, 3'-0-anthraniloyl-ATP (Ant-ATP) and 3'-0-( N-methylanthraniloyl)-ATP (Mant-ATP). The Ki values for Ant-ATP and Mant-ATP in SS DNA-dependent hydrolysis were about 8 and 5μM at pH 7.5 and 12 and 10μM at pH 6.2. For the DS DNA-dependent hydrolysis, the Ki values for Ant-ATP and Mant-ATP were about 7 and 6μM. All these Ki values were much smaller than those of ADP which is also a competitive inhibitor for the ATPase activity of the recA protein. Ant-ATP and Mant-ATP caused a reduction in the Hill coefficients for ATP in SS DNA-dependent ATP hydrolysis at pH 7.5 and DS DNA-dependent hydrolysis. These observations showed that the ATP analogs which have a bulky substituent in the ribose moiety of ATP had strong hydrophobic interactions with the ATP binding site on the recA protein and also contributed to the cooperative effect of ATP.

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The effects and indications of barbiturate therapy for brain protection, and prevention and reduction of the intracranial hypertension were investigated using an ultrashort acting barbiturate, thiamylal, in sixteen cases with intracranial lesions. Final outcome of the treatment revealed 8 good recoveries which were actively administered thiamylal during operation or immediately after. On the other hand, four cases, whose intracranial pressures (ICPs) of over 40 mmHg could not be controlled suffered brain death. Barbiturate therapy was not effective for brain protection of primary damaged lesions. It is concluded that barbiturate therapy may provide a satisfactory reduction of the intracranial hypertension in cases during the early postoperative stage or of under 40 mmHg initial ICP.

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In 47 cases with intracranial lesions, auditory brainstem responses (ABRs) were studied. From a detailed analysis of these data, the following results were concluded: 1) In some cases, the intramedullary and extramedullary pontine tumor could be differentiated by ABR, 2) A very small cerebello-pontine angle tumor was detected by ABR, 3) ABR monitering was useful to evaluate brainstem function during the surgical operation, and 4) ABRs were clinically very useful methods for predicting the outcome of a severe head injury and diagnosis of brain death. These results indicate that ABRs contribute to functional diagnosis of various diseases of the central nervous system.

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Urinary metabolites of rats exposed to ethylene oxide (EO) were analyzed by gas chromatography-mass spectrometry (GC/MS). Male Wister rats (220－240 g) were exposed to EO for 6 hours. The urine was collected during 18 hours after the exposure and extracted with ethyl acetate. For the water-soluble metabolites, ethanol was added to the urine, centrifuged and the supernatant fraction was evaporated to dryness. The residue of the extract was methylated with diazomethane and trimethylsilylated with bis (trimethylsilyl) trifluoroacetamide. Ethylene glycol, 2-hydroxymercapturic acid, 2-methylthioethanol and 2-mercaptoethanol were identified as the metabolites of EO. These results suggest that the inhaled EO was hydrolyzed to ethylene glycol, and conjugated with glutathion to form the mercapturic acid and methylthio metabolite.

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The response of a mouse's foot to heat was studied. Transplanted syngeneic tumor, C3H mouse mammary carcinoma, was treated with irradiation and hyperthermia in a waterbath. The tumor did not disappear in any of the mice treated with radiotherapy with a dose of 20 Gy alone, but disappearance of the tumor was observed in 11 of 15 and 6 of 8 of the mice treated with combined therapy of irradiation and hyperthermia. There was a significant difference between these two groups. Synergistic effect was confirmed (P< 0.001, P< 0.005). Hyperthermia using Thermotron RF-8 was performed on 19 patients (5 bladder cancers, 3 uterine cancers, 3 rectal cancers, 4 soft tissue tumors, 2 oral cancers, 1 biliary tract cancer, 1 renal cancer) between April, 1986 and December, 1986. They were irradiated with a daily dose of 1.5-2.0 Gy, 5 times a week and hyperthermia was performed within 30 minutes after each irradiation once or twice a week. Intratumoral temperature was kept at 43℃-45℃. Temperature over 41℃ was maintained in most patients. Clinical response was assessed by tumor regression rates. Partial response a (PRa), defined as 80% or more regression in tumor volume, was obtained in 1 bladder cancer patient and PRb, defined as 50% to less than 80% regression, was obtained in another 5 patients. Side effects were observed in all patients including mild skin burn, nausea and diarrhea. Rectovaginal fistula developed in 1 patient. Combined radiotherapy and hyperthermia seems to be useful in advanced cancer patients.

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It is said that prolactin (PRL) is correlated with fetal lung maturation during late pregnancy. However, there are few reports about PRL during early pregnancy and the period of periimplantation. Recently, transient hyperprolactinemia at the preovulatory phase or after follicle aspiration for in vitro fertilization has been reported. Nonetheless, the effect of high PRL on the folliculogenesis and the early embryogenesis is still controversial. Moreover, some researchers reported that human fetal umbilical cord sera was good for the development of ova fertilized in vitro. Therefore, we studied the effect of graded concentrations of PRL (10, 30. 100 ng/ml) on the development of embryos fertilized in vivo or in vitro using ddY mice. We concluded that higher PRL levels caused a smaller number of developed embryos, in statistical significance, into blastocysts and hatched blastocysts. In general, embryos fertilized in vivo developed better than those fertilized in vitro.

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Presented here is the case of a 69-year-old woman with pancreatic cancer. Efforts were made to discover the origin of the cancer but without success. Tumor nodules were scarcely observed in the pancreas macroscopically at autopsy, while histological examination of the pancreas revealed the presence of a well-differentiated adenocarcinoma (duct cell carcinoma). The invasion to the wall of the intrahepatic bile duct was also observed microscopically.

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A 28-year-old woman was admitted to our hospital with complaints of mucosanguinous stool and low grade fever. She was diagnosed as a typical chronic continuous type of ulcerative colitis by the findings of barium enema and colonoscopy. Since she had an allergy to sulfasalazine, prednisolone was chosen. She became pregnant during an active stage while being treated with 20 mg of prednisolone a day. Prednisolone was withdrawn to avoid the side-effects of the medicine on the fetal outcome. This resulted in her symptoms becoming far worse and the oral ingestion being discontinued. Total parenteral nutrition (TPN) was required under careful nutritional management. The TPN consisted of glucose, electrolytes, amino acids, vitamins, trace elements and intravenous lipid preparation. Her total energy intake was 2320 kcal a day. Vitamins were administered to her on the bases of the guideline of the American medical association Rapid turnover proteins, transferrin, vitamins, trace elements and amino acids in addition to routine laboratory tests were measured to estimate her nutritional condition. The data showed that biotin was 10 times lower than the expected value and that other factors were within normal limits. This is the first case in Japan where a woman suffering from an active ulcerative colitis was treated with TPN and delivered of a healthy baby. We concluded that TPN under careful control was useful in the nutritional management and therapy of the pregnant patient who suffered from severe colitis. We believe that the amount of biotin's supplementation should be increased in this type of case because it was 10 times lower than the normal value, although the deficiency symptoms did not develop.

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An autopsy case of a 75-year-old female with lymphoid interstitial pneumonia with monoclonal gammopathy of lgA κ type is reported. The patient was admitted to UOEH Hospital suffering from a cough, sputum and fever. After examining a specimen of transbronchial lung biopsy and chest X ray films, Iymphoid interstitial pneumonia was suspected. Serum immunological examination showed monoclonal lgA κ type hypergammaglobulinemia. Marked clinical and radiological improvement was attained after prednisolone administration. After 16 months, however, the patient deteriorated and expired on January 21, 1986. On postmortem examination, a number of plasma cells as well as lymphoid cells were seen to have infiltrated in the thickened interalveolar septa and the parenchyme of the lymph nodes throughout the whole body. The architecture of lymph nodes remained preserved, while the cortex as well as the medulla was almost completely replaced by plasma cells and lymphoplasmacytoid cells. Immunohistochemical examination demonstrated the presence of lgA κ in the plasma cells and some of the lymphoplasmacytoid cells in both lymph nodes and lungs. These findings suggest that the proliferating plasma cells and lymphoplasmacytoid cells were in neoplastic or preneoplastic states and support the hypothesis that lymphoid interstitial pneumonia may be an expression of the systemic lymphoproliferative disorders in the lung.

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We report two cases of severe acute pancreatitis; a 53-year-old man (Case 1) and a 60-year-old woman (Case 2). Case 1 was classified as "severe" according to the Ranson's criteria and he died of MOF on the 21st hospital day. Case 2 was classified as "moderate", but a large pancreatic abscess was observed by CT scan. She died of this abscess complicated with duodenal perforation on the 33rd hospital day. CT findings showed that this case was not "moderate" but "severe". Therefore, we believe that the findings of CT scan are an important factor for assessment of the severity of acute pancreatitis.

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Because a large percentage of childhood obesity may persist into adulthood and cause a hotbed of so-called seijin-byoh (adult diseases), its treatment should also be considered from the viewpoint of seijin-byoh prophylaxis. Most obese children, however, are awkward in their movements, in spite of binge eating or bulimia, and unable to carry out any severe exercise-diet therapy. For such subjects, we have designed a new practicable procedure, and obtained excellent results for the last five years. The main principle of our procedure is that the control of caloric intake is relaxed as much as possible after due consideration of a child's growth in height: no restriction for mild, 10-15% of the requirement for moderate, and 20-25% for severe obese children, respectively. The ratio of protein/energy is established at a higher level than usual, while that of fat/energy at a lower level. For exercise, walking is the most easy and important exercise and the proper speeds for individuals are converted from the same amount of movement determined at the 1st increase point of serum lactate values, where the proportion of movement-energy originating from body fat reaches the highest percentage at about 75%. Our new procedure is supported also by the fact that the reduction in body weight combines with the improvement in measurement values of fatty metabolites without any change in values of proteins.

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A 50-year-old man in Kitakyushu City visited a hospital for evaluation of an opacity in a routine chest X-ray film. After examinations by bronchoscopy and chest roentgenography, a clear coin lesion was found in the middle lobe of the right lung and was suspected to be a lung cancer. A right thoracotomy was performed to remove it. The lesion (10.6×9.8 mm) was a well-defined ellipsoid granuloma due to a foreign body with a central zone of necrosis surrounded entirely by a fibrous wall. In a cross section of the dissected granuloma two degenerated worm-like structures were revealed. The sections of the worm (216-240×296 μm at the greatest diameter) had at least a 3-layered cuticle and prominent internal longitudinal cuticular ridges but no external cuticular ridges. The lateral chords were as high as the muscle layer which consisted of abundant somatic muscle (more than 30 muscle cells/quadrant). Judging from these morphological characteristics, the pulmonary granulomatosis was diagnosed to be due to an immature dog heartworm, Dirofilaria immitis. This identification was further supported by results from immunological methods. The present case is the 56th human case of dirofilariasis (the 39th as a pulmonary case only) in Japan.

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Since the first reported case of human dirofilariasis in 1964, a total of 56 cases have been recorded from Japan, including 39 pulmonary and 16 extra-pulmonary cases. The difference in case number between pulmonary and extre-pulmonary sites is statistically highly significant (P≒0.001). Distribution of the lesion in pulmonary dirofilariasis is mainly concentrated in the right lung (P<0.001). The rapid increase of human dirofilariasis within the last 5 years indicates that this disease is one of the important anthropozoonoses.

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Over the past six years we have practised the examination of standard allergen patch test for patients with allergic contact dermatitis or other contact skin diseases and report the data in this paper. Three hundred and ninty-four patients, who complained of itching and skin legion due to contact with chemical agents were exmined. Following the widespread use of the patch test procedure, we used eighteen standard allergenic agents and about eighty percent of these patients showed positive reaction. Furthermore, over fifty percent of the patients manifested positive reaction to the plural allergenic agents. The highest percentage of positive reaction was found in the 30 - 40 years old patients. Of the series of allergenic agents, urushiol caused the highest positive reaction. Among other agents, metal group, e.g., cobalt chloride, and formalin were also high. Many positive patients to paraphcnylendiamine (PPD) were engaged in the occupations associated with PPD. This evidence indicates that the materials that are frequently treated at the place of work or homelife play a major role in the pathogenesis contact skin diseases.

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A statistical study was conducted of 31 penetrating keratoplastics performances over the past 6 years from January 1980 to December 1985, and the factors necessary to achieve successful penetrating keratoplasty are discussed on the basis of the results of the study. The patients were followed up for more than one year after operation. The graft transparency, visual acuity and incidence of corneal rejection were evaluated at one year after operation and the combined surgery with penetrating keratoplasty was also evaluated, The results obtained were as follows: 1) The distinctive feature of the cases with visual acuity of more than 1.0 were that the recipients were younger than 40 years of age and the donors were also less than 50 years at the time of the operation. 2) The patients with vascularized cornea showed a higher incidence of rejection and a lower successful ratio rate than did the avascular corneal patients. The above results indicate that the factors necessary to achieve a successful penetrating keratoplasty are young recipients, young donors and no vascularization of recipient cornea.

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During the past ten years bioethics has gradually become an important subject for discussion in Japan. However these discussions are quite different from those in the United States where bioethics has been a major field of study for some time. The purpose of this paper is to show the differences between the Japanese and American ideas regarding bioethics by studying the social environment in the United States. When compared to Japan, there is a great difference in this environment and the American views on ethics. Japanese studying bioethical problems should study them by first comparing the points of differences stated in this paper and then applying their conclusions to the bioethical problems here in Japan.

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