The association of thrombocytopenia with insulin-dependent diabetes mellitus (IDDM) has rarely been reported. We observed thrombocytopenia in four out of the ten diabetic children newly diagnosed within the past five years. Thrombocytopenia in these patients was not so severe clinically as to cause bleeding and thus did not draw attention of the endocrinologists. It was postulated that immune mechanisms are involved in the pathogenesis of thrombocytopenia on the basis of elevated levels of platelet-associated IgG (PAIgG) in three of the three patients on whom it was measured. Our observation suggests that mild thrombocytopenia may be a rather frequent association with IDDM. A prospective study is required in order to determine the incidence of thrombocytopenia and to clarify the significance of PAIgG in relation to other immunological abnormalities observed in IDDM.
Introduction : Nakazato village is located in the far-southwest region of Gunma prefecture. It takes at least one hour to go to the nearest general hospital. Author's clinic does not have a CT scanning device. Until that time, every patient went to far hospitals by oneself, when CT scan was necessary for further examination. This study adverted to the usefulness of Mobile CT in a rural clinic. Patients and Methods : Between June 1995 and October 1997, 20 patients needed CT scanning because of further examination. The mean age was 72 years old, and the ratio of male to female was 9 to 11. Results : Seven patients had surgical treatment for cancer, and we had suspected recurrence of primary cancer. Four patients needed CT scanning in following various diseases. Nine patients had an abnormal shadow on chest roentgenogram. The disease was detected in 8 patients (40 %) out of 20 patients. Of 7 postoperative cancer patients, 2 had primary cancer recurrence, each of which was lung cancer and breast cancer. Of the remaining 9, 6 patients had a disease, which was chronic bronchitis in 2 patients, and bronchoectasia, emphysema, lung abscess and pleuritis in 1 each. Conclusion : Using the mobile CT makes it easy for patients to take further examination. We deliberate that this device is useful and recommends for rural clinics or hospitals, which do not have a CT scanning device.
The author interviewed and observed 14 patients in the neurosurgery ward to elucidate characteristics and factors related to preoperative anxiety of craniotomy patients and obtained the following results : (1) Six common preoperative anxiety of craniotomy patients are : fear of change and collapse of personality, fear of physical disability due to complications, fear of lost or altered role in the society, fear of change in body image caused by tonsure, fear of postoperative death, fear of ambiguity and something unknown. (2) These fears are related to their past experience of operations, subjective symptoms, sufferings, triggers of their decision to have operation, expectation from the surgery, awareness of expected complications as well as their understanding of neurology.
Aspergillosis is an uncommon complication of pulmonary carcinoma. A 60-year-old female was performed right lower lobectomy because of adenocarcinoma with pseudocavities. The diagnosis was bronchiolo-alveolar adenocarcinoma, and there was aspergilloma in one of the cysts in the tumor. Cavitation or cystic change in bronchiolo-alveolar adenocarcinoma is rare because of nondestructive growth pattern with an adequate blood supply in this histologic type. Additionally, bronchiolo-alveolar adenocarcinoma associated with pulmonary aspergilloma is rare.
A 22-year-old nulligravida was evaluated at a hospital for persistent vaginal bleeding and malodorous discharge. She was considered to have a foreign body in her vagina, apparently penetrating the uterine cervix with perforation into the peritoneal cavity. By history the object had been present for 6 years. She was transferred to our university hospital for surgical removal. On computed tomography and magnetic resonance imaging, the object was cylindrical and was located in the vaginal vault without evidence of perforation. With both modalities it appeared lucent relative to surrounding tissues. Removal required limited dissection of the vaginal wall, and the object proved to be a plastic container cap. No vesico-vaginal fistula or other complication was present. Precise early diagnosis was difficult in this case, but details of the chief complaint offered valuable clues and imaging was informative.
During the court journey in 1826, Nagasakiya was the usual inn where the Dutch stayed in Edo. While Siebold was there, a lot of people including the governor of Nagasaki, feudal lords, and imperial doctors visited him alternately. Siebold obtained diverse information from them, and this became the cause of the Siebold Incident later in 1828. In this study, we opened the important materials which could overthrow the established story of the von Siebold Incident. The first one is the letter which Siebold sent to Mamiya on February 25, 1828. So far, the von Siebold Incident has been considered to begin with Mamiya's notice to the government, which stated that Mamiya had received via Takahashi Sakuzaemon a letter from Siebold, a total stranger to him. The second material is the warrant issued by the government against Siebold, who violated the law by writing a letter to Mamiya. Concerning how the government dealt with this case, there still remain many questions. For example, the government did not check the relationship between Siebold and Takahashi at all, even though they knew that it was Takahashi who had given the letter of Siebold to Mamiya. It may be because Mogami had already been under investigation that he could escape the accusation of the government. In any event, the whole story related to the letter and the warrant seems to signal the existence of another intent of the government, something beyond the ban of communication with foreigners.