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.

抄録全体を表示

女性外来受診者について, MD法を施行し, 骨病変 (骨減少) の発生頻度を調査した.骨病変の発生頻度 (MD骨減少度1度以上) は50歳代20.6%に対し, 60歳代51.6%, 70歳代48.6%, 80歳代60.0%と60歳代以降で顕著であった.このうち, 退行期骨粗霧症と診断された患者39名にアルファカルシドールとカルシトニンの薬剤を投与した.12～18ヶ月後MD指標値 (ΣGS/D) の有意な改善が見られた.

抄録全体を表示

トーマススターツル移植施設における免疫抑制剤タクロリムスを使用した1990年から1998年までの小児小腸移植64例68回の手術手技と成績について報告する.小腸不全の内訳は腸捻転 (n=18), 腹壁破裂 (n=16), 腸閉鎖 (n=8), 壊死性腸炎 (n=7), 腸管偽閉塞症 (n=6), ヒルシュプルング病 (n=4), microvillous inclusion disease (n=3), ポリポーシス (n=1) および外傷 (n=1) であった.術式は小腸単独移植 (n=19), 肝小腸複合 (n=39) および多臓器移植 (n=10) であった.冷阻血時間は2.8-14.8hrで, 平均7.8hrであった.ICU滞在日数と入院期間は多臓器移植で長かった.現在まで35グラフトが生存しており, 1, 3と5年の患者とグラフトの生存率は各々72%, 53%, 53%および67%, 59%, 59%であった.手術合併症は29グラフト (44%) に発生し, 腹腔内膿瘍, 腹腔内出血が多く, 腸管縫合不全, 腸穿孔, 乳縻腹水, 胆汁痩などが見られた.1994年までの手術合併症の頻度は64%で患者およびグラフト喪失は27.8%に達しており, プログラムを一旦停止し症例分析が行われた.その結果を踏まえた1995年以降, 合併症の頻度は21.8%と減少し, 患者およびグラフト喪失は15.6%に低下した.
移植前の長期にわたる経静脈栄養 (TPN) 下の敗血症, bacterial translocationやovergrowthによる長期, 高頻度の抗菌薬の使用と移植後の免疫抑制状態のため, 手術合併症の多くは重篤な感染症の引き金になり, さらにグラフト喪失の原因となった.肝小腸移植と多臓器移植のレシーピエントは長期のTPNに耐用できずに肝硬変や肝不全に陥っている上に, 手術範囲や侵襲が過大となり, さらに免疫抑制に感染が加わり術後管理が困難であった.

抄録全体を表示

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.

抄録全体を表示

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.

抄録全体を表示

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.

抄録全体を表示

症例は31歳, 女性.長期間放置の後に平成9年6月, 高血糖状態にて入院.単純性糖尿病性網膜症を伴っていたが, 神経障害は明らかではなかった.入院後, 一日尿中C-ペプチド排泄の減少も認められ, インスリン療法が導入された.約2ケ月間に空腹時血糖を403mg/dlより156mg/dlにまで徐々に改善された.経過中, 自覚的にも血糖検査上からも明らかな低血糖状態は認められなかったが, 8月中旬より意識障害が出現, 脳MRI検査にて両後頭葉から側頭葉にかけて皮質下に広範囲な高信号領域を認め, 低血糖性昏睡類似の変化と考えられた.その後若干の意識状態の改善が一時的に認められるも脳MRI検査上同様の所見の継続が認められるとともに更なる意識障害の進行を認め, 敗血症にて死亡した.高血糖状態からの血糖コントロール中に意識障害の出現を認め, 脳MRI検査上低血糖性昏睡類似の不可逆性脳障害を呈した糖尿病症例を報告した.

抄録全体を表示

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.

抄録全体を表示

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.

抄録全体を表示