A change in influenza treatment strategy is ongoing in Japan focusing on differential diagnosis of influenza infection based on influenza-like symptoms in clinics, although rapid diagnosis based on classical flu symptoms was not practical.
We studied conventional diagnostic and therapeutic measures for treating influenza and new rapid diagnosis and medication.
Subjects were 25 people admitted to our hospital studied retrospectively, and differentiated by paired-serum antibody titer or virus isolation. To determine the validity of the clinical diagnosis at the first visit of patients, we checked 36 patients undergoing rapid diagnostic tests.
The accuracy of ordinary clinical diagnosis of influenza was at least 35%. We found that the paired serum antibody was indispensable in serological diagnosis, and if both HI and CF antibodies are tested at the same time, the second should be tested 2 weeks later. We found that the test of both HI and CF antibodies detected an unknown type of Influenza A virus variant in 1 case. The sensitivity of Directigen FluA in rapid diagnostic tests was 71% and specificity 100%. Severe respiratory complications such as asthma-like stridor (28%) and pneumonia (32%) were found in 44% of 25 cases.

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A newly-devised method to measure the volume of the oral cavity was presented and both the reproducibility and objectivity of the method were studied.
Method : The tip of a 60 ml syringe filled with water is inserted into the mouth of a test subject. Water is pumped into the mouth slowly and the maximum volume of water is recorded. The volume is measured both when the mandible is in the position of central occlusion and also in the relaxed position. This procedure is repeated six times and the measurements are averaged. The average is regarded as the volume of the mouth. The volume of the oral cavity of ten test subjects was measured with this method. The volume of the oral cavity of six patients who had had various operations in the field of oral and maxillofacial surgery was also measured with this method both before and after the operations.
Results : 1) The volume of the oral cavity when the mandible was in the position of central occlusion was thought to be more reproducible than that in the mandible relaxed position.
2) The volume of the oral cavity has a particularly close correlation with body height and total head height.
3) The difference in the volume of the oral cavity before and after surgery seemed to coincide with the results of the operation carried out.
From these results, our new method is considered fully objective and reliable.

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Microwave coagulation therapy (MCT) and radiofrequency ablation (RFA) have become common therapy for liver tumors. Few reports of histological examination have used experimental model. We studied changes in liver tissue after MCT or RFA using dogs or pigs. Normal liver tissue of an anesthetized dog or pig was coagulated by MCT (Azwell Co.), RFA (Boston Scientific Japan Co.), or RFA (RITA Medical System, Inc.). In the experiment using dog livers immediately after and 5 days after operation, these apparatuses differed in coagulating the liver parenchyma macroscopically. No difference among them histologically, however, i.e., immediately after operation, hemorrhage was observed and, 5 days later, granulomatous change was observed at the marginal zone of the coagulated area. In the experiment using pig livers, RFA showed hemorrhaging immediately and 6 hours after operation and granuloma 1 week after operation at the margin of the ablated area histologically. No histological difference was seen in the ablated area based on ablation time. Both MCT and RFA showed good coagulation in liver tissue.

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Shojusen is a preparation including 3 Chinese herbs ; extracts of Sasa krinennsis, Pinus densiflora, and Panax ginseng. Peritoneal macrophages prepared from normal mouse were stimulated in vitro with Shojusen or its components, and the effect of the stimulation on the cytokine production of macrophages was studied. Shojusen augmented in vitro production of macrophage chemotactic factor, interleukin-1α (IL-1α), and tumor necrosis factor-α (TNF-α) of macrophages. Similar enhancement was found by stimulation with the extract from Sasa krinennsis alone but not with the extract of P.ginseng. Lipopolysaccharide prepared from Escherichia coli also enhanced the in vitro cytokine production of macrophages, indicating that the augmentation kinetics of Shojusen and Sasa extract may differ from that of LPS.

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A total of 64 patients who participated in community-based rehabiliation presented by the Kusatsu Branch Hospital between 1988 and 1999 was analyzed for age, disease, exercise duration, person taking care of the patient, family members, and outcome. Of the 64, 45 took part in ambulatory rehabilitation (group exercise) at the Kusatsu Health Center and 19 received home and/or visiting rehabilitation. Ambulatory rehabilitation was held 5 times a month and was used by 6.1 patients per day on average. Those aged 70 to 79 took part the most. Cerebral disease had the highest frequency (38%). Most persons taking care of the patient were female (81%) and many patients (57.8%) lived alone or with a spouse. Although the most frequently observed outcome was no change, only a few patient discontinued. Visiting rehabilitation was conducted once a month and used by 2.5 patients per day on average. The most frequently observed outcome was discontinuation by hospitalization or death. One of the factors most predisposing to bedridden was lack of motivation. Ambulatory rehabilitation can give patients a chance to participate in the community and provide strong motivation for joy in life. Since very few companies offering services under the care insurance system carry their business to rural areas, rural administrative organizations must cope with disabled persons by old welfare works. Rehabilitation planned by a hospital that respects self-reliance may be more important than long-term care insurance system that inclines to respect care.

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Hepatic encephalopathy was worsened by intestinal hemorrhage in a 63 year-old man with HCV-positive liver cirrhosis. Prolonged administration of branched chain amino acid enriched solution for hepatic encephalopathy induced metabolic hyperchloremic acidosis in the patient accompanied by deep coma and tachypnea. Enriched chloride ion in the solution was assumed to cause acidosis. In addition to hyperammonemia and hypoglycemia, metabolic acidosis with hyperchloremia appeared to be a potential complication in using amino acid solution for hepatic encephalopathy. Just after the patient was diagnosed as hyperchloremic metabolic acidosis, the infusion of amino acid solution was immediately stopped. Acidosis was successfully treated by sodium bicarbonate and consciousness disturbance was ameliorated. Abnormality of laboratory data and clinical symptoms was reversible by conservative therapy.
It is important to avoid excessive administration of amino acid solution, although hepatic encephalopathy is hardly controlled by other supportive therapies.

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