The cytokine network is activated in the pathogenetic mechanisms of septic diseases. We measured serum concentrations of interleukin (IL) -8, a leukocyte-mediated cytokine, in 152 patients with culture-proven or suspected septicemia and 25 control subjects. The IL-8 concentrations in patients who were diagnosed as septicemia were significantly higher than those in controls. IL-8 concentrations in septic patients with negative blood cultures were also significantly higher than in controls. In addition, serum IL-8 concentrations were assayed prospectively in 3 patients undergoing chemotherapy for acute myelogenous leukemia. Increased IL-8 concentrations preceded onset of fever and elevation of C-reactive protein by 1 day. Finally, to investigate modulation of cytokine release in vitro, U937 human monocytic leukemia cells were stimulated with phorbol 12-myristate 13-acetate (PMA), lipopolysaccharide (LPS), or lipoteichoic acid (LTA). IL-8 mRNA expression was detected by reverse transcription-polymerase chain reaction 30min after PMA or LPS exposure, and IL-8 was secreted into culture media 3 hr after PMA, LPS, and LTA stimulation. These data suggest that IL-8 is a useful early indicator of bacterial infection.

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Prevalence of osteoporosis in senile and postmenopausal women was investigated using an MD method for affected women who consulted the outpatient clinic of this institution. The prevalence of osteoporosis of those patients diagnosed with an MD severity higher than grade I were 20.6%, 51.6%, 48.6%, and 60.6% for women in this 50s, 60s, 70s, and 80s, respectively, demonstrating that the incidences were particularly high for women over 60 years of age. Thirty-nine of these patients diagnosed as involutional osteoporosis were treated with alfacalcidol and calcitonin. There was a significant improvement in the MD Index (GS/D) value obtained 12 to 18 months after initiation of the therapy.

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Purpose : To review a clinical trial of intestinal trasplantation (ITx) under tarolimus and prednisone immunosuppression, initiated in June 1990, in patients with irreversible intestinal failure and who were dependent on total parenteral nutrition (TPN).
Methods : Sixty-four patients (30 girls, 31 boys) with a median age of 3.5years (range, 0.5 to 18years) received 68 intestinal transplants that included isolated small bowel (SB) (n=19), liver SB (LSB) (n=39), and multivisceral (MV) (n=10) allografts. Indication for Itx included : volvulus (n=18), gastroshisis (n=16), intestinal atresia (n=8), necrotizing enterocolitis (n=7), chronic intestinal psuedo-obstruction (n=6), Hirschiprung's disease (n=4), microvillous inclusion disease (n=3), multiple polyposis (n=1), and trauma (n=1).
Results : Mean cold ischemic time was 7.8 (range 2.8-14) hr. The ICU and hospital stay of patients received MV were longer than those for SB and LSB. Currently 36 patients are alive. The 1, 3 and 5year patient and graft survival of 1, 3, and 5 year were 72%, 53%, 53% and 67%, 59%, 59%, respectivery. Operative complication occurred in 44% (29 grafts). A combination of associated complications included intraabdominal abscess (n=12), bleeding (n=9), intestinal leak (n=6), intestinal perfpratopm (n=4), dehiscence with evisceration (n=4), biliary leaks (n=4), bile duct stenosis (n=1), chylorus ascites (n=4), hepatic arterial thrombosis (n=3), and portal vein stenosis (n=1). The program reopened with a new strategy of avoiding predictably difficult patientsm, CMV seropositive donors, and inclusion of graft colon after a moratorium in 1994. the rates on graft loss and complication were reduced from 27.8% to 15.6%, and 63.9% to 21.8%, respectively.
Conclusions : Intestinal transplantation is a valid therapeutic option for patients with intestinal failure suffering complications of TPN. The complex clinical course before and after transplantation of these patients is reflected in a higher complication rate as well as patient and graft loss.

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The purpose of this retrospective study was to analyze the site and rate of lymph nodes metastases originating from thoracic esophageal carcinoma and also to confirm the optimal extension of lymph node dissection in the treatment of thoracic esophageal carcinoma. A total of 70 patients were included in this study. The rate of lymph node metastases was 61% with no difference in the location of tumors. The rates of lymph node metastases in the tumor depth of muscularis mucosae (mm) and submucosa (sm) were 17% and 60%, respectively. Tumors with mm₃ (massive invasion) depth had lymph node metastases of 29%, however, in cases of mm_1-2 (slightly or moderate invasion), no lymph node metastases occurred. The deeper the tumor invaded, the higher and wider was the occurrence of lymph node metastases. The rates of lymph node metastases in the cervical, thoracic, and abdominal nodes were 14%, 37%, and 43%, respectively. Lymph node metastases jumped to the cervical region without upper mediastinal node metastases even if the tumor was located in the lower esophagus or the depth of tumor was mm3. In the thoracic nodes, the rates of metastases to the paraesophageal, the paratracheal (which includes the region of the right and left recurrent laryngeal nerve), and the bifurcation nodes were a maximum of 21%, 17%, and 10%, respectively. In the abdominal nodes, the rate of metastases to the right cardiac nodes was the highest. Among patients who underwent radical lymph node dissection, lymph node metastasis was seen in the paraaortic nodes but not surrounding the splenic artery or in the splenic hilar nodes. Patients who underwent three-field lymph node dissection had relatively better survival compared to those with two-field lymph node dissection. The cumulative survival rate was 52.8% after 5 years. Based on this study, the optimal extension of lymph node dissection is as follows : when a tumor has invaded to the mm3, standard three-field dissection should be performed, including the cervical and thoracic paratracheal, the deep cervical, and the supraclavicular nodes. When a tumor has invaded layer deeper than mp, a three-field dissection including the bifurcation, the pulmonal hilar, the paratracheal (including left thoracobronchial and Botallo nodes) and the intraabdominal paraaortic nodes sparing the pancreas and spleen, should be performed.

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The authors try to identify the relationship between side effects and gustatory change of the cancer patients who received chemotherapy. The subjects are 110 patients with hematological/ hematopoietic tumor who gave informed consent to participate in this study. The survey includes gustatory change and other side effects. The following results were obtained :
1. Side effects were observed in 97.3% of the subjects. The most popular of these was epilation, followed by nausea and fever.
2. Among these side effects, fever, stomatitis, numbness of extremities, diarrhea, anal pain, palpitation and oral and lingual numbness are related to gustatory change during and after therapy.
3. More patients with stomatitis experienced change in saltiness during therapy than those without.
4. More patients with numbness of extremities experienced change in saltiness, sourness, bitterness during therapy and saltiness and sweetness after therapy than those without.
Careful observation of the side effects will help us perform more predictable assessment and intervention on dysgeusia.

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Childbirth Stage is an important and transitional stage of developmental crisis for women. There are, however, few studies on the development of motherhood at childbirth stage and on self-evaluation of childbirth experience. In this study, special attention is paid on the discrepancy between ideal and actual experience to study the relationship between self-evaluation of childbirth experience and motherhood awareness development. The relationship between satisfaction in the conditions mothers believe important at childhood and motherhood awareness were studied to find the following results : (1) The higher the satisfaction in four factors of childbirth self-evaluation (“good delivery”, “safe and easy delivery”, “trust in obstetrics staff” and “motherhood awareness”), the higher the self-evaluation and self-esteem scores, (2) discrepancy between the conditions mothers believe important at childbirth and satisfaction affects self-esteem scores and (3) Whether satisfaction is achieved in the conditions they believe important in the items of self-evaluation scale at childbirth determines rise in self-esteem of mothers and affects motherhood awareness development.

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A 31-year-old woman was admitted to hospital because of hyperglycemia in June 1997.
She had simple diabetic retinopathy. Conventional insulin therapy started since urinary C-peptide secretion was remarkably decreased (19μg/day). Intermediate type inslin dose was gradually increased from 8U (once a day) to 44U (twice a day) for 2 months. Fasting plasma glucose decreased from 403 mg/dl to 156 mg/dl. During this period, there were no hypoglycemia symptoms and no hypoglycemia was detected in the laboratory findings. In the middle of August, she experienced disturbance in her consciousness which worsened daily. Magnetic Resonance Imaging (MRI), revealed higt density areas along the gyrus in bilateral temporal, parietal and occipital lobes of the brain. This MRI finding is quite similar to that observed in patients with hypoglycemic coma. Her consciousness level further deteriorated, she fell into a coma, and finally died from septic shock.

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A 34-year-old Thai male was referred to our hospital for the treatment of Pneumocystis carinii pneumonia associated with acquired immunodeficiency syndrome (AIDS). Dyspnea and hypoxia were severe on admission, so combined therapy of prednisolone and sulfamethoxazone-trimethoprim was chosen for carinii pneumonia. Although anti-retrovirus therapy was not performed because the patient refused, anti-carinii pneumonia treatment was effective. Opportunistic infection in patients with AIDS has markedly declined in the past 2 years, but examination of infectious disease is needed in clinical fields of human immunodeficiency virus infection.

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After many years of research work, we have discovered that Philipp Franz von Siebold was given a commitment by the Dutch King and the government to survey the Japanese nation. Siebold was in return asked to present to the King all the materials he had collected, except what he had acquired for private reasons. With the collection expanded, it is very likely that Siebold came to feel the necessity to record what he had collected and which ones he would present to the King. The list here can be one of such records. In the meantime, the word “summary” in the title implies a possibility of a comprehensive list prepared separately. Otherwise, Siebold may have tried to make a temporary list only for submitting to the officials. It has been revealed in the previous issues that Siebold exploited his personal connections with the Japanese, in order to collect the materials concerning Japan for his study. The list introduced here brings to light a part of the materials he possessed, which involve Japan as well as the countries surrounding Japan, such as Ryukyu (Okinawa), Ezo (Hokkaido) and the Korean Peninsula.

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