In order to study differences between event-related potentials generated during counting and button-pressing tasks, the auditory event-related potentials from 103 patients (62 males, 41 females) aged 43-90 years with chronic cerebrovascular diseases were recorded. All patients were evaluated for severity of cognitive deterioration with Hasegawa's Dementia Score (HDS) examination, and 44 also underwent Wechsler Adult Intelligence Scale (WAIS) examination.
The target stimulus was a pure tone with a frequency of 2, 000 Hz delivered binaurally at 75 dB in 20 % of trials, and the non-target stimulus was a pure tone with a frequency of 1, 000 Hz delivered at 75 dB in 80 % of trials. On the counting task, the patient was instructed to keep a mental record of the number of target tones, and on the button-pressing task, to press the button switch as quickly and precisely as possible whenever he recognized the target tone. Responses were recorded from Cz and Pz electrode placements on the scalp (International 10 : 20 system) referred to linked mastoids. Waveforms were averaged on-line by a signal processor (7 T17 or 7 T18), which also controlled the stimulus presentation and artifact rejection.
The button-pressing task was easier to perform than the counting task, and the P300 waveforms were clearer in the former than in the latter. The P300 latency of the button-pressing task was shorter than that of the counting task.
The P300 latency of both tasks was found to be negatively correlated with HDS, and the button-pressing task showed higher correlation than the counting task.
On the button-pressing task, the P300 latency was found to be negatively correlated with Total IQ, Verbal IQ, Performance IQ and many subtest scores, while on the counting task it showed negative correlation with Performance IQ and only a few subtest scores. Most negative correlations between the P300 latency and subtest scores were greater on the button-pressing task than on the counting task, indicating that the former is a better measure of cognitive function than the latter.
Of the subtests, Object Assembly, Digit Symbol, Block Design and Picture Completion scores showed highly negative correlations with the P300 latency. We therefore presume that the P300 component strongly reflects constructional ability in cognitive function.
HDS and Performance IQ showed significant negative correlations with the P300 latency of both tasks. Analysis of covariance for their regression lines showed significant differences.
In the counting task, the N100 latency was negatively correlated with the score of one subtest, namely, Vocabulary. However, the N200 and P200 latencies did not correlate significantly with WAIS IQs or subtest scores on either the counting task or the button-pressing task.

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The fine structural changes in membrane systems of cardiac muscle cells in the setting of chronic doxorubicin (DXR) cardiotoxicity were studied by thin section electron microscopy (TSM), the freeze-fracture method and scanning electron microscopy (SEM) using the osmium-dimethyl sulfoxide-osmium (O-D-O) method. Male albino rabbits were treated intravenously with a dose of 2.5 mg/kg of DXR once a week for 5-10 weeks. Five weeks after the initial treatment with DXR, partial dilatation of the sarcoplasmic reticulum (SR) was observed by TSM and SEM. From 8 to 10 weeks after the DXR treatment, marked dilatation of the SR, characteristic of “DXR cardiomyopathy”, was observed by TSM, while three dimensional SR structures showing extensive spherical ballooning could be seen clearly in bold relief using the O-D-O method. From 5 to 10 weeks after the DXR treatment, the density of the intramembranous particles of the SR and the sarcolemma were decreased in the degenerated cardiac muscle cells. These changes may be responsible for the dysfunction of membrane systems of cardiac muscle cells seen in “DXR cardiomyopathy”.

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In experimental membranous glomerulonephritis (Mb-GN) mediated by homologous renal tubular epithelial antigen (Tub-Ag) -antibody complexes in rats, peculiar features were observed in comparison with heterologous immune-complex nephritis. Specifically, typical membranous type nephritis developed in rats with a persistently high level of autologous antibody and comparatively long periods were necessary for the development of renal lesions after the appearance of circulating antibody. To investigate this phenomenon in detail, the effect of combining of pertussis vaccine (PV) with Tub-Ag on experimental glomerulonephritis and the avidity of the autologous antibody to Tub-Ag were studied.
An experimental Mb-GN was induced in Wistar strain rats with a single injection of homologous Tub-Ag which had been extracted from the kidney by pronase digestion. Some rats were injected with PV in combination with Tub-Ag. Avidities of the auto-antibody to Tub-Ag from nephritic rats and of the antibody to a heterologous antigen, bovine serum albumin (BSA), were estimated by the method of Farr with a slight modification.
Serum level of antibody to Tub-Ag were higher in rats which had been given PV than in control rats. More severe morphological changes and a shorter incubation period were observed in the rats with high levels of antibody, indicating that the persistence of a high level of auto-antibody to Tub-Ag is important for progression of the renal lesion. Avidity of the auto-antibody to Tub-Ag from nephritic rats was markedly lower than that of the antibody to BSA.
These results may explain some aspects of the peculiar profiles which were observed in this experimental Mb-GN mediated by homologous Tub-Ag.

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In Gunma University Hospital, a total hospital information system termed GUNMAS (Gunma University Network for Medical-Hospital-Informating Archiving System) has been gradually developed. We are devising an operation system as a part of GUNMAS. The operation system is divided into three systems; preoperative, intraoperative, and postoperative. In February 1990, a preoperative system called operation ordering was started. In December 1990, an intraoperative system was started. We describe outlines and problems of this operation system.
The operation system consists of an Office Processor, N6500 (NEC), and 13 terminals, N5200 (NEC). The preoperative system, operation ordering, contains an application for surgical operation and anesthesia, a regulation at the operation center, and a printout of preoperative lists. The intraoperative system is designed to input intraoperative information by surgeons, operation nurses, and anesthesiologists. The postoperative system is for utilization of these data.
A lot of information is needed for surgery and anesthesia. We utilized the information in other systems of GUNMAS. We emphasize that the operation system presents information from many hospital systems of GUNMAS.

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During the 14-year period from 1975 to 1988, 134 patients with upper gastric cancer underwent total gastrectomy and proximal gastrectomy. 102 (76.1 per cent) of them were curative resection. The surgical procedures in these cases consisted of 59 total gastrectomies and 43 proximal gastrectomies. In the present study, the surgical results were retrospectively examined in terms of the two surgical procedure.
The 5-year survival rate for total gastrectomy was 60%, higher than the 48% rate for proximal gastrectomy. The survival rates of stage I and II for the total gastrectomy compared favorably to those of proximal gastrectomy. End results tended to be better in patients who underwent total gastrectomy. The 5-year survival rate of patients with stage III who underwent total gastrectomy was 48%, higher than the rate of 21% for the proximal gastrectomy. There was a significant difference between the two groups in stage III.
The results of the present study indicate that total gastrectomy should be performed in most cases of upper advanced gastric cancer.

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Zinc is one of the essential elements in the living body, and it is used for RNA synthesis. We have studied how rabbit dentine calcification is affected by zinc acetate, and zinc concentrations in the liver, cortex renis, submandibular gland and dental pulp. Details are as follows.
1) When we injected zinc acetate into a rabbit, we could see a brown line which represented zinc ferricyanide or zinc sulfate. We found it to be zinc by means of electro-micro-analysis. The minimum zinc volume was 1 mg/kg, which made the accumulation line. With up to a 30 mg/kg volume we did not see any effect on calcification. The accumulated volume corresponded to the administered volume.
2) Compared with zinc of the chelating type, the ionic type of zinc accumulated more in dentine.
3) We assumed that zinc was moved in the blood vessels as a binding substance with serum protein and then accumulated in dentine. Zinc took at least 20 or 30 minutes to accumulate in dentine after intravenous injection.
4) Zinc concentrations were significantly increased in dentine pulp.

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We have pointed out the increased incidence of onset of cerebral infarction in the morning hours and that the abrupt increase in blood viscosity early in the morning is one of the possible factors directly related to the timing of such occurrences. On the other hand, since it is known that blood pressure shows a diurnal pattern similar to that of blood viscosity, its change may be also involved in the initiation of cerebrovascular diseases. Thus, we examined, using a portable sphygmomanometer, circadian variation of blood pressure, and the effect of captopril retard on it, in 6 patients (4 males and 2 females) with mild hypertension with special interest in its early morning change. As a result, in all cases, an increase in blood pressure a couple of hours before awaking early in the morning was observed. Administration of captopril retard just before going to bed, tended to mitigate the increase in blood pressure early in the morning in 5 cases. In one case, however, excessive fall of blood pressure during the night made for a rather abrupt increase in blood pressure early in the morning. From these findings, it is suggested that while administration of antihypertensive drugs just before going to bed is recommended for the prevention of cerebrovascular diseases, its timing must be carefully decided for each patient because the circadian change in blood pressure varies from patient to patient.

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Various mucosal changes of the digestive tract induced by 75 mg/l MNNG plus 3 g/l Tween-60 dissolved into tap water in Wistar female rats were autoradiographically and histologically studied, and the following results were obtained.
1) The incidence of the tumor in rats administered orally for more than 10 months was 47% in the stomach and 73% in the small intestine.
2) The number of labeled cells (NLC) in 6-week-aged normal rats was 100 in the small intestine, 26.6 in the pyloric gland, 20.6 in the oxyntic gland and 12.6 in the colon. Tumors were frequently found in the small intestine and pyloric gland showing higher NLC by administration of MNNG.
3) Increases of NLC and positive NLC-a were found in the mucosa of the pyloric gland and small intestine 6 months after administration of MNNG, and epithelial tumor, descending adenomatous hyperplasia and sarcoma developed 10 months after administration.
4) Autoradiographically, cells of the proliferative zone in the lower half of mucosae of normal pyloric gland and small intestine were labeled in a regular manner, while labeled cells in the regenerative mucosa induced by administration of MNNG were found near the luminal surface.

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Sera from 533 patients with chronic liver diseases were tested for the presence of antibodies to hepatitis C virus (anti-HCV).
Anti-HCV were found in 69.8% of patients with chronic hepatitis, 63.9% with cirrhosis, and 80.6% with hepatocellular carcinoma. A higher prevalence of antibody was detected in patients with a history of blood transfusion.
In 18.1% of patients with clinically diagnosed alcoholic liver injury, anti-HCV were detected. Only one of 10 patients histologically diagnosed as having alcoholic liver injury was anti-HCV seropositive.
Ant-HCV were detected in 3 of 11 patients with primary biliary cirrhosis, but two had a history of blood transfusion.
Anti-HCV were not detected in patients with autoimmune hepatitis during steroid treatment, nor in patients with fatty liver or asymptomatic hepatitis B virus carriers.

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We treated 18 cases of breast carcinoma associated with pregnancy or lactation. The two most recent cases are presented, and all 18 cases were analyzed. Case 1, a lactating patient diagnosed 4 years after the first symptom, was stage IIIa when diagnosed. Recurrence was observed 7 months after mastectomy and she died 11 months after the operation. Case 2, another lactating patient, was diagnosed 10 months after the first symptom. When the diagnosis was made, bone metastasis was present and the stage of disease was IV. She is now still alive, 20 months after the mastectomy.
Breast carcinomas associated with pregnancy or lactation comprise 1.1% of all patients with breast carcinoma. The average interval from the first symptom to diagnosis was 7.4 months, and 12 of our patients were stage III or IV. Recurrence was observed in 7 patients, and 9 died. The 5 year survival rate is significantly worse than that of all patients with breast carcinoma. But no recurrence was observed in 5 of 6 patients who had no lymph node involvement. The importance of early diagnosis and treatment is confirmed.

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Ten week-old male Wistar rats were used for cross section anatomy of the urogenital tract in the pelvis. The prostate was located in the middle, slightly to the dorsal side, of the pelvic cavity on transverse and longitudinal section. The urinary bladder was positioned at the cranial side of the prostate on longitudinal section and in the middle of the pelvic cavity. The seminal vesicles were located in positions to the right and left of the urinary bladder. Cross section anatomy was estimated to be useful for ultrasound diagnostic procedures of the prostate and urinary bladder.

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The effect of different 2 -drug combinations among β-lactams were examined in vitro against 17 clinical isolates of methicillin-resistant staphylococcus aureus (MRSA) in surgical inpatients.
In 12 combinations of group A (ampicillin, ABPC ; cefazolin, CEZ ; cefotiam, CTM) and group B (imipenem, IPM; flomoxef, FMOX ; cefmetazole, CMZ), and fosfomycin (FOM) and group B, the strong synergistic activity (FIC index≤0.5) was found in 17 strains (100%) among combinations of CTM and FMOX, and CTM and CMZ. In 16 strains (94.1%) among CEZ and CMZ, and in 14 strains (82.4%) among CEZ and FMOX.
The mean FIC index of 17 strains was 0.220 (CTM+CMZ), 0.256 (CTM+IPM), 0.265 (CEZ+CMZ) and 0.291 (CTM+FMOX). They have shown good synergistic activity against MRSA strains. Relationship between mean MICs of each drug and those of effective plasmalevels was investigated and the following results were observed. For all 12 combinations, mean MICs of at least one of two drugs were below the effective plasma levels. Above all, in the combinations of ABPC and CMZ, CEZ and IPM, and CTM and IPM, the mean MICs were markedly decreased.
It can be therefore concluded that these in vitro results suggest the expectation of sufficient clinical effects.

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Effects of cefuzonam in combination with imipenem (IPM), flomoxef (FMOX), cefmetazole (CMZ), fosfomycin (FOM) and ampicillin (ABPC) on methicillin-resistant S. aureus (MRSA) were studied using 17 strains of clinical isolates. Synergism was observed in 15 strains (88.2%) with CZON-IPM, 11 strains (64.7%) with CZON-FMOX, 13 strains (76.5%) with CZON-CMZ and 10 strains (58.8%) with CZON-FOM. However, the combination of CZON-ABPC did not differ among most strains.
The combination of cefuzonam with other β-lactam antimicrobial agents that have high binding affinity for the penicillin-binding protein (PBP) 4 showed synergism against MRSA.

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A 71-year-old male with double cancer of the stomach was treated surgically by partial gastrectomy with R- 2 lymph node dissection and gastroduodenostomy to restore continuity of the GI tract (Billroth-I resection). Three months after this first operation the patient underwent an extended enterectomy and right hemicolectomy for thrombosis of the SMA. For postoperative nutritional management TPN was administered and, after treatment for short bowel and malabsorption syndromes proved difficult during both postoperative periods, he was switched to and has since been maintained on HPN for 6 years postoperatively.
During these years mechanical complications related to the insertion of subclavian catheters occurred frequently, but the frequency of these episodes was markedly reduced after the nursing staff became familiar with the catheter management and two filters were used in series in the catheter line. Fat emulsions were not administered throughout the period of HPN and, probably because of this, subnormal serum cholesterol levels were noted 6 years postoperatively but there was no overt essential fatty acid deficiency. This suggests the necessity of supplementing HPN with fat emulsions at least by intermittent infusions through a peripheral vein.
An analysis of the serum for amino acid fractions revealed that, among the BCAA, valine was decreased while phenylalanine was increased and, consequently, the Fisher ratio was reduced. This points to the necessity for amino acid supplementation.
Six years postoperatively, anemia and folic acid deficiency were noted, indicating that the need for iron should always be taken into consideration in patients maintained on long-term home hyperalimentation.
The present patient on one occasion developed cutaneous manifestations of trace element deficiencies, and supplementation of the deficient elements resulted in symptomatic improvement He also experienced one episode of cholecystitis during the course of chronic HPN and has since been placed under medical surveillance while receiving UDCA.
The patient also developed severe diarrhea requiring antidiarrheal drug administration postoperatively.
At the present time the symptom has subsided to the point where any such medication is unnecessary.

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A 76-year-old woman was found to have a protruding lesion on the posterior wall of the duodenal bulb by endoscopic examination during health examination. Histological examination of the specimen obtained by biopsy under endoscopic control revealed hyperplastic changes of the epithelial cells of the villi and crypts, in addition papillary proliferation in part.
Thus she was admitted to our hospital for the purpose of total biopsy by endoscopic polypectomy. Endoscopic polypectomy of the lesion was performed. The resected specimen was 12 × 10 × 7 mm in size. Histological examination revealed papillary adenocarcinoma localized to the mucosal layer in a part of the hyperplastic polyp.
From the diagnostic viewpoint, we emphasized the significance of endoscopic polypectomy as whole biopsy.

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A case of spontaneous rectus-sheath hematoma diagnosed by computed tomography and echography is presented. The patient was a 60-year-old female who complained of left lower abdominal pain and mass. An elastic soft tumor with tenderness, 4.5 × 5.0 cm in size, and localized purpura, 1.5 × 1.5 cm in size, were recognized. Computed tomography revealed a well-defined tumor shadow in the rectus abdominis muscle with was well enhanced by contrast medium. In addition, echography displayed a well-defined tumor with heterogeneous intrinsic echos. A diagnosis of spontaneous rectus-sheath hematoma was made and removal of the hematoma was performed. From these results, we consider computed tomography as well as echography to be useful methods of diagnosing rectus-sheath hematoma.

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We report a case of Klinefelter's syndrome associated with insulin dependent diabetes mellitus in a 41-year-old-man with small testes and without pubic hair. His karyotype, 46XY, 47XXY, showed mosaicism on chromosome examination. Fasting plasma glucose was 409 mg/ dl and his diabetes was controlled with 30 IU insulin injection. Both serum and urinary C peptide were very low (1.6 ng/dl and 16 μg/day) and serum C peptide was not elevated by glucagon tolerance. The mechanism of combined Klinefelter's syndrome and diabetes mellitus is not yet known. An autoimmune mechanism might underlie the phenomenon in this patient, because ICSA (islet cell surface antibody) was observed.

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