Cardiac involvement is one of the major complications of Kawasaki disease (mucocutaneous lymph node syndrome). Although the frequent association of coronary artery lesions in this disease is well known, other cardiac abnormalities such as myocarditis, arrhythmia and mitral insufficiency are not uncommon. In order to evaluate the usefulness of vectorcardiography in the diagnosis of cardiac involvement in this disease, quantitative analysis of serial Frank lead vectorcardiograms was performed in 100 patients.
The outstanding vectorcardiographic findings in the early acute phase of the disease were (1) anterior displacement of the T loop, (2) decreased magnitude of the maximum QRS and T vectors and (3) decrease in the spatial length/width ratio (L/w ratio) of the T loop. Although the PR interval was usually prolonged in the third and the fourth weeks, this was not seen in cases with coronary aneurysm. The L/W ratio was smallest in the first week of the illness and the largest in the third week. The vectorcardiographic changes were more marked in cases with high erythrocyte sedimentation rates or long febrile periods and in those complicated with coronary aneurysm.
The above findings suggest that vectorcardiography is of considerable value in detecting cardiac involvement in Kawasaki disease.

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Eleven patients with primary aldosteronism (PA) and 7 patients with essential hypertension were hospitalized, and blood samples were collected every 4 hours for measurement of plasma aldosterone concentration (PAC), plasma renin activity (PRA) and plasma cortisol concentration. A total of 6 mg of dexamethasone was administered for 2 days and blood samples were drawn. In 6 cases of primary aldosteronism, spironolactone was administered for more than 3 months, and the examination was repeated. The hormonal circadian rhythms were analyzed by the Cosinor method.
PAC in PA was high in mesor (420.2 ± 127.7pg/ml) with a significant rhythm (p <0.05); the acrophase was 6 : 15 (clock time). Dexamethasone slightly decreased the mesor, while PAC circadian rhythm was observed. PRA was suppressed in patients with PA, and had a significant circadian rhythm only before dexamethasone administration.
PAC in essential hypertension showed a significant circadian rhythm (p <0.05); the acrophase was 5 : 44 (clock time). The rhythm was also observed after dexamethasone administration. No circadian rhythm of PRA was observed in essential hypertension.
Following long term spironolactone treatment, PAC in PA was observed to still be high and showed an apparent circadian rhythm identical to that observed before spironolactone treatment. ACTH suppression with dexamethasone caused a forward shift in the acrophase (p <0.05). Spironolactone treatment increased PRA but its circadian rhythm was not observed.
These results suggest that the renin-angiotensin-aldosterone system play no role in regulation of the circadian rhythm of PAC in PA with long term spironolactone treatment. ACTH seemed to participate in phase shifts of the circadian rhythm of PAC.

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A longitudinal incision was made in the avascular portion of the medial menisci of 23 dogs. In one knee a flap of synovium was sutured into the wound, and in the other, the wound was sutured as a control.
In the group of menisci in which a synovial pedicle flap was used, 21 out of 23 healed, and the longitudinal lesion was repaired with fibrovascular tissue at 6 weeks. In the controls, no healing occurred.
The healing of meniscal lesion occurred with the vascularized synovial pedicle flap and the neovascularization from the parameniscal area.
The maximum tensile strength of a 1 mm wide flap of meniscus using a synovial pedicle flap at 6 weeks was 250g (Crosshead speed : 0.1mm/sec).

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The usefulness of angiotensin converting enzyme (ACE) inhibitor in the treatment of congestive heart failure is well known. In order to study the effect of ACE inhibitor on compensatory cardiac hypertrophy and failure, captopril, a potent ACE inhibitor, was administered to experimental myocardial infarction (MI) rats.
The systolic blood pressure was significantly lowered and the left ventricular end-diastolic pressure was lowered in captopril-treated MI rats. Both the left and right ventricular weight/body weight ratios were significantly greater in non-treated MI rats than in controls and captopril-treated MI rats, while there were no significant differences between the latter two groups.
Percent V3 myosin heavy chain was increased in non-treated MI rats, but this increase was obviously suppressed by administration of captopril for 4 weeks. β-MHC mRNA expression determined by northern blotting analysis was also distinctly lower in 1 week treated rats than in non-treated MI rats. The plasma atrial natriuretic peptide (ANP) concentration andγ-rANP mRNA expression were significantly lower in captopril-treated MI rats than in non-treated MI rats.
Thus, captopril induced regression of cardiac hypertrophy, reversed the cardiac MHC profile and improved hemodynamic alterations in experimental MI rats. The present results further suggest that not only afterload reduction but also preload reduction may be responsible for the beneficial effects of captopril in cardiac hypertrophy and failure.

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The ploidy of bone marrow megakaryocytes was investigated in 6 patients with ITP, 7 with MDS, 6 with CML, 4 with ET, and 8 hematologically normal patients. Megakaryocytes in Giemsastained bone marrow smears were classified morphologically into three maturation stages. Thereafter the amount of DNA in the nuclei of individual megakaryocytes whose maturation stages were already identified was measured by microscopic cytofluorometry in the same marrow smears restained by the Feulgen reaction. The results obtained are as follows : The mean percentage of megakaryocytes in stages I and II was significantly higher in patients with ITP, while that in patients with MDS was lower. The percentage of the megakaryocytes with 8 C or less ploidy tended to be higher in MDS (50.57% ± 13.62) and ITP (40.33% ± 10.19) as compared with that of hematologically normal patients (34.26% ±8.80). In patients with ITP, the proportion of cells in stages I and II (7.66% ± 0.82) was highest among the various patient groups with an increased number of cells with ploidy of 8 C or less. On the other hand, in patients with MDS, the microcytofluorometric study revealed an increased number of megakaryocytes in the low ploidy class despite the lowest number of megakaryocytes in stages I and II. In patients with CML and ET, there was no significant difference in morphological proportion and ploidy distribution from the normal group. The clinical significance of these results was discussed.

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Between August 1989 and June 1991, 171 patients underwent cardiac surgery at Maebashi prefectural hospital.
Autologous blood donation and recombinant human erythropoietin (EPO) administration were utilized to reduce homologous blood transfusion.
Autologous blood donation was carried out in 130 patients, and the volume was 662±241 ml (mean±SD). EPO was administered to 96 patients. The increase in hemoglobin level achieved by EPO therapy in these patients was from 12.5±1.7 g/dl to 13.6±1.2 preoperatively, despite 586±331 ml autologous blood donations.
Of the 171 patients, 33 received homologous blood, and 138 (80.7%) underwent surgery without homologous blood transfusion. There were 22 patients who were unable to donate autologous blood or in whom EPO could not be administered. The other 130 (87.2%) patients of 149 were followed without homologous blood transfusion.
We believe that transfusion requirements during cardiac surgery can be further decreased by the use of EPO.

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To study metabolic bone disorders after gastrectomy, a questionnaire, QCT and DIP examination were undertaken. The results are as follows :
1 Over 50% of postgastrectomy cases had complaints attributable to metabolic bone disorder.
2. The incidence of cases in when the amount of bone calcium carbonate was under the level of age-matched controls (± 2 SD) was high at 35.0% of the postgastrectomy group.It was 6.5% in the other postoperative group by the QCT examination.
3. By the DIP examination, the incidence of the above-mentioned cases was also high at 50. 0% of the postgastrectomy cases.
4. Rapid turnover protein can be useful as a serum screening marker of metabolic bone disorder.
5. From the viewpoints of time-economy, cost containment and avoiding radiation hazards, QCT examination should be performed in cases who are below normal range by DIP examination.

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Many citizens are beginning to take care of their health and therefore need trained sports medicine doctors. The levels of VO₂ max were significantly greater in males than in females (P <0.01). Heart rate with exercise declined to lower rates along with an increase in age and this difference was significant (P <0.01). However, there was no significant sex-related difference in heart rate. Pressure-rate product was greater in youth, from age 18 to 39. Vital capacity and FEV_1.0 were greater in males and then declined to lower values along with an increase in age. Percentages of abnormal lab data ranged from 8 % to 17%.

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The present pilot study was designed to analyze the efficacy and toxicity of the association of natural α-interferon (nIFN), melphalan, and prednisolone in untreated patients with multiple myeloma. Nine patients were treated with conventional melphalan-prednisolone therapy. Another 15 patients were treated with the combination therapy of nIFN, melphalan and prednisolone. We concluded that treatment with nIFN is beneficial because of the good response rate and improvement in the synthesis of serum immunoglobulins. However, adverse reactions to nIFN were sever when the patients were treated with daily intramuscular injection of 6 × 10⁶U/body of nIFN. Thus, we have started a randomized study which includes daily intramuscular injection of 3 × 10⁶U/body of nIFN.

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Thirteen patients with nephroblastoma, including one with unfavorable histology and one mesoblastic nephroma, were treated at Gunma University Hospital and Gunma Children's Hospital Medical Center between 1971 and December 1988. The ages of the patients, 6 boys and 7 girls, ranged from 3 months to 11 years (median 2 years). The stages were I in 4 patients, II in 2, III in 5, and IV and V in one patient each. Nephrectomy was done in 12 patients and rupture with tumor spillage was experienced in 3. Chemotherapy consisted of actinomycin D and vincristine before 1987. Radiation (16-40. 5Gy) was given in 11 patients. After 1987, postoperative therapy was performed according to the NWTS-2 regimen. At the time of evaluation, January 1992, 11 out of 13 patients survived without any evidence of disease. Complications of treatment included scoliosis of the spine, atrophy of the chest and abdominal wall and postoperative intestinal obstruction after nephrectomy. Recent advances in the understanding and management of nephroblastoma are discussed.

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Mass screening for the simultaneous detection of both breast and thyroid cancer was conducted in Gunma Prefecture from April 1980 to March 1991. The total number of subjects was 314, 120 at the first screening by physical examination alone. There were 27, 329 women (8.7% of all subjects) who were referred for a second examination. The rate of attendance at the second examination was 95.8%. Breast cancer was detected in 240 women (detection rate ; 0.08%) and thyroid cancer in 288 (0.09%). The detection rate of breast cancer was approximately twice as high at the initial screening (0.11%) as at the subsequent periodic screening (0.06%), and higher in examinees aged 40 years or more. The coverage rate for examinees in the population aged 30 years or more was 14.6% in 1990. As the number of women screened increased from year to year, the repeat examinees occupied a greater percentage than those undergoing initial examination. Patients with breast cancer detected by mass screening showed an earlier stage and more favorable prognosis as compared with those of our outpatients. The 10-year survival rate was 90.4% in patients detected by mass screening and 72.3% in outpatients, a statistically significant difference (P<0.01). This screening program is effective for detecting breast cancer in an early and more curable stage and for reducing the mortality rate from breast cancer. In order to conduct the mass screening system with high quality and effective management, it is important to train physicians in screening techniques, and to educate women in the practice of breast self-examination. Furthermore, mammography in addition to a physical examination is necessary for the first screening.

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The prevalence and incidence of insulin-dependent diabetes mellitus (IDDM) in children under 18 years of age in Gunma were studied using information obtained from questionnaires sent to hospitals in Gunma prefecture.
The number of IDDM patients was 80 (31 boys and 49 girls) in March of 1991. The prevalence and incidence of IDDM were 1.65/10, 000 and 1.71/100, 000, respectively. The incidence was very similar to those found in other areas of Japan. However, the prevalence was slightly higher. Thirty percent of IDDM patients were identified at school physical check-ups, because of glucosuria and 58.3% of these patients had already shown diabetic symptoms such as polyuria and polydypsia.

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Since the magnetic resonance imaging system was introduced in our hospital, we have had about one hundred patients who admitted with lumbar pain, sensory deficit or motor deficit. In this report, we analyzed those patients' complaints and their associated MRI findings. It was shown that about half of these patients, whose complaints were only lumbar pain, were not admitted. Lumbar disc herniation was found in 58 cases (54%). A peak incidence occurred in the 6 th decade in female cases but no peak was demonstrable in males. It was noteworthy that 2 of the males in their 2nd decade had evidence of lumbar disc herniation on MRI. This suggests that young patients are susceptible to lumbar disc herniation and therefore should be evaluated by the MRI system.

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A case of myelopathy due to the calcification of the yellow ligament was reported. A 66-year-old Japanese female was admitted complaining of gait disturbance, numbness and clumsiness in both hands. Neurological examination revealed muscle weakness and hypesthesia of both upper extremities and hands. CT scan of the spine demonstrated an oval calcified mass at the C4/5 and multiple calcified nodules at the C5/6 vertebral level, projecting into the spinal canal. MRI demonstrated a low signal mass in both T₁ and T₂ imaging. After laminectomy of C4, C5, and C6, neurological symptoms almost completely disappeared. If an early diagnosis is obtained and decompressive surgery is performed promptly, good results can be expected.

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A 27-year-old professional painter with a history of toluene abuse was admitted to the hospital because of tetraparesis. Laboratory examinations revealed hyperchloremic metabolic acidosis with normal anion gap, hypopotassemia, elevation of serum CK and functional disturbance in the distal tubules. Increased urinary excretion in the hippuric acid indicated exposure to toluene in this patient.

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We reported a case of sarcoidosis manifesting with diffuse small nodular lesions in the spleen on CT and MRI. These lesions showed low signal intensity on T2 weighted MRI. Following intravenous contrast material administration, CT and Ti weighted MRI demonstrated them as poorly enhanced lesions in the spleen. In a case of diffuse small nodular lesions, differentials include microabscesses, malignant lymphoma, and Gamma-Gandy nodules. Because these may show findings similar to this case, accurate differential diagnosis is essential.

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We present two patients with spinal cord tumors that caused scalloping of the vertebral bodies.
One patient had multiple cystic tumors in the thoraco-lumbosacral region associated with von Recklinghausen's disease, and the other had multiple tumors in the thoracolumbar region.
Both patients showed dural ectasia, probably due to chronic intraspinal hypertension.
According to Hadley, scalloping is visualized as erosion of the posterior surfaces of the vertebral bodies on conventional lateral X-ray films.
In case one, scalloping of the vertebral bodies was combined with erosion of the articular processes and laminae with no evidence of discal destruction, and dural ectasia was also noted at the disc space level.

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