Pulmonary hypertension is a serious complication in patients with bronchopulmonary dysplasia. The author studied the effect of tolazoline and 100% oxygen on pulmonary hemodynamics in 12 infants including 11 who were oxygen-dependent with bronchopulmonary dysplasia and pulmonary hypertension. Cardiac catheterizations were performed on all cases, at 4 months to 4 years of age. Mean pulmonary arterial pressure and pulmonary vascular resistance were measured (1) before and after tolazoline injection (1 mg/kg, into the main pulmonary artery), then after a 30-minute stabilization period, (2) before and after a 5-minute 100% oxygen inhalation period. In room air, the arterial O₂ saturation values were 87 ± 6 %, the mean pulmonary artery pressure values were 39 ± 4 mmHg, the pulmonary vascular resistance values were 7.7 ± 1.2 Wood units·m². After tolazoline injection and the 5-minute 100% oxygen inhalation, the mean pulmonary artery pressure decreased significantly (p<0.01). The percent decrease in mean pulmonary artery pressure after inhaling 100% oxygen for 5 minutes was greater than that after tolazoline injection (p<0.05). There were no correlations between the percent decrease in mean pulmonary artery pressure after the 100% oxygen inhalation and that following tolazoline injection. The percent decrease in mean pulmonary artery pressure after 100% oxygen inhalation was inversely related to the arterial oxygen saturation in room air (r=0.68, p<0.05), while that after tolazoline injection was not.

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To evaluate coronary artery involvement and hemodynamics in patients with a history of Kawasaki disease, the disappearance time of contrast medium (run-off time) was quantified using X-ray densitometry. The run-off time of the morphologically normal coronary artery was thought to serve as an indicator of coronary flow velocity, and it correlated with the dilatation ratio of coronary artery diameter in response to dipyridamole loading. These results suggest that impairment of the coronary artery intima resulting from Kawasaki disease influences coronary flow, even in cases with morphologically normal coronary areries. The run-off time of coronary arteries with maximal diameters of more than 4.0 mm was significantly (p<0.01) greater than that of non-dilated coronary arteries, and that of giant coronary aneurysm that progressed to obstruction was more than 500%. The run-off time of coronary lesions of each grade improved significantly after dipyridamole loading (p<0.01).

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In a recent experiment, we found a new cytolytic action of stored human milk that was exerted on Molt-4 and Raji cells, human leukocytes, red blood cells, and mononuclear cells found in human milk. This action was observed in about 90% of the human milk samples we examined, even those kept frozen at -20°C for 48h. Cytolysis was not seen in stored human milk heated at 56°C for 30 min or in milk treated with eserine. It was also noted that enhanced hemolysis was seen in those samples to which bile salts had been added. This suggests that the cytolytic action was induced by the action of lipoprotein lipase (LPL) and bile-salt-stimulated lipase (BSSL), both of which are found in human skims in cream (fat globules).
Both fractions obtained from Pseudomonas aerginosa LPL and human milk, at the same retention time on HPLC, had hemolytic factor-producing activity. Furthermore, silica gel thin-layer chromatography revealed that the hemolytic action was due to oleic acid produced by hydrolysis of cream by LPL and BSSL during the storage period.
We also observed that human serum albumin inhibited the hemolytic action of oleic acid contained in stored human milk.

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Urinary excretions of guanidinoacetic acid (GAA), β₂-microglobulin (β₂MG), and N-acetyl -β-D-glucosaminidase (NAG) are putative parameters of proximal tubular functions. In this study, I investigated the effect of age on these parameters in newborn infants. Urinary samples (N = 97) from 25 fullterm infants and 6 preterm infants without serious complications were studied. Urinary concentrations of GAA, β₂MG, and NAG activity, as well as creatinine (Cr), were measured in each sample. The ratio of urinary GAA to Cr (U-GAA/Cr ; mg/g) in the neonates ranged from 4.6 to 440.0 mg/g (mean±SD, 111.76±78.90 mg/g). U-GAA/Cr in healthy adults was 67.1±32.1 mg/g. U-GAA/Cr had a positive correlation with postnatal age (r =0.33, p<0.001) and with postconceptional age (r =0.43, p<0.001).
In contrast, the ratios of urinary β₂MG to Cr (U-β₂MG/Cr ; mg/g) and U-NAG/Cr (U/g) had negative correlations with postconceptional age, but not with postnatal age. U-GAA/Cr correlated with neither U-β₂MG/Cr nor with U-NAG/Cr.
We speculate that U-GAA/Cr might reflect proximal tubular function, in a manner different from that of urinary β₂MG and urinary NAG activity.

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In order to explore the role of the blood cellular element in the development of reperfusion injury, the author examined whether neutrophil depletion or pretreatment with aspirin modifies infarct size and vascular resistance in the subendocardial portion of the ischemic area during reperfusion. The proximal circumflex coronary artery was occluded for 120 minutes, followed by 6 hours of reperfusion with whole blood (control group, n=7), with blood depleted of neutrophils by a neutrophil adsorption column (neutropenic group, n=7), or pretreated with aspirin (aspirin group, n=6). Severe circulatory neutropenia persisted throughout the 2-hour reperfusion period in the neutropenic group. Circumflex vascular resistance was significantly increased from the onset of reperfusion in both the control and aspirin groups. This increase in vascular resistance was prevented in the neutropenic group. Infarct size was significantly smaller in the neutropenic group than in the control group (30±5% vs. 53±8% of the risk avea, p<0.05). In the aspirin group, infarct size was 61±8 % of the risk area, a value not significantly different from that of the control group. Light and electron microscopic studies of the ischemic zone demonstrated a relative preservation of the endothelial structure of the microvasculature in the neutropenic group. In contrast, severe endothelial lesions and microvascular obstruction by neutrophils were observed in both the control and aspirin groups. These findings show that microvascular damage plays an important role in the pathogenesis of reperfusion injury and that neutrophils are important mediators of this microvascular damage.

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In the case of benign prostatic hypertrophy (BPH), operative treatment presents many problems and drug therapy is still important. We have examined the effects of a new steroidal antiandrogen (TZP4238, 17α-acetoxy-6-chloro-2-oxapregna-4, 6-diene-3, 20-dione) and a nonsteroidal 5α-reductase inhibitor (ONO3805, sodium- (-) -4- [2- {2, 3-dimethyl-4- [1- (4-isobutylphenyl) ethoxy] benzoylamino} phenoxy] butyrate), which are effective in reducing prostate weight, using Wistar rats. We also examined the clinical effects of these compounds in patients with BPH. Under endogenous androgen conditions, we assessed the effects of some antiandrogens on reduced accessory sex organ weight. As a result, it was suggested that progestin drugs (TZP4238 etc.) produced this effect at low doses and that the effect lasted for more than six weeks. Under exogenous androgen conditions, that is, without central nervous system action on the prostate, the effect of ONO3805 was almost equal to that of chlormadinone acetate (CMA). Furthermore, we examined TZP4238 and other drugs in terms of on the action of androgen-receptor complex formation in the cytosol and nuclear extracts. TZP4238 showed a competitive inhibitory action, in contrast to ONO3805. On the other hand, only ONO3805 had a 5α-reductase inhibitory action. Among tested compounds neither TZP4238 nor ONO3805 significantly changed blood testosterone concentrations in the rat. Clinical results are as follows : progestin drugs (TZP4238 and CMA) were more effective than others tested in reducing prostate volume and improving voiding disturbance and residual urine volume but produced frequent loss of libido. On the other hand, the 5α-reductase inhibitor was associated with no loss of libido. To maintain the patient's quality of life, it is hoped that a drug based on 5α-reductase inhibition, which has few side effects, will be developed.

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During the-15-year period from April, 1977 to March, 1992, 84 patients with esophageal cancer were treated. Thirteen patients (15.5%) including 11 males and two females were superficial esophageal cancer. The mean age was 65.1 years, with a range of 54 to 75 years. The location of lesions was the middle intra-thoracic esophagus in 10 patients, the lower intra-thoracic esophagus in two, and the abdominal esophagus in one. The invasion to the intraepithelium (ep) was observed in four patients, to the muscularis mucosa (mm) in two, and to thesubmucosa (sm) in seven. No lymphnode metastasis was seen in ep and mm cancer with good prognosis. The rate of lymphnode metastasis was increased in sm cancer, suggesting that sm cancer shouldbe treated with extended surgical pro-cedures according as the treatment for advanced cancer.

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What is the vital history of bone grafts following anterior cervical decompression and fusion? Three of our own patients were studied using MRI to answer this question. One month after the bone graft, high signals were seen in T₁ weighted images (T₁WI), while low signals were found in GFE (one MRI sequence). These findings were considered to indicate degeneration and regression of the bone graft, and the grafts were assumed to be fragile. After 3 months, both T₁ WI and GFE showed low signals, suggesting that ossification and corticalization were complete. Therefore, it is considered necessary to wear a cervical collar with good fixation for one month postoperatively to avoid inadvertent burden and excessive movement of the cervical vertebrae.

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The Protocol for treatment of central nervous system injury was evaluated with consideration given to the goal of preserving neuronal integrity as well as future functional restoration. A case involving injury to the spinal cord is presented. There was associated cervical spinal canal stenosis and the patient was treated with high-dose methylprednisolone as well as an expansive laminoplasty. This was performed in an effort to prevent secondary spinal cord damage during the acute and subacute stages.
Functinal electrical stimulation (FES) was performed for the neurologic (motor) deficits of the right upper extremity, in the chronic stage. Following methylprednisolone therapy, the severe tetraparesis showed significant recovery with subsequent further improvement being achieved after the laminoplasty. Persistent motor deficits of the hand were restored by utilizing FES, after 5 weeks of exercises. It was concluded that the results of these procedures were very encouraging. Further trials should be performed. Both basic science and clinical studies will be required to further efforts in achieving effective functional restoration following injury to the brain and/or spinal cord.

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To evaluate the clinical significance of anti-GOR testing at a regular check-up, we examined 188 serial stored sera from 55 patients with abnormal liver function, who visited our hospital for a regular check-up. Twelve sera from 5 cases were positive for anti-Gor. Of the 5 cases, 2 were positive for both anti-GOR and anth-C100-3, but another 2 were negative for anti-C100-3. The remaining case soon became negative for anti-GOR. The serum level of ALT was high at the first regular check-up in two cases with anti-GOR. In the other 3 cases with anti-GOR, the corresponding level was within normal limits at the first regular check-up, but was increased at the second check-up and thereafter. Anti-GOR was detected even when the results of liver function tests were normal and when anti-C100-3 was negative.
Thus, anti-GOR seems to be more useful than anti-C100-3 as a marker of hepatitis C virus (HCV). We speculate that anti-GOR and HCV-related antibody testing at regular check-ups would reveal the prevalence of silent HCV carriers, the period and mode of their virus acquisition and the mechanism of progression from the silent carrier state to clinically symptomatic hepatitis.

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Out of 27 operated patients with thymoma, 19 had invasive thymoma of the Stage II, III on IV according to Masaoka's classifications. Total resection of the thymus and adjacent tissues was performed in 25 patients and subtotal resection or bypass operation in two. Nineteen patients with invasive thymoma underwent postoperative radiation therapy. All patients who underwent total resection of thymoma are still alive to date, supporting the necessity of total resection in achieving a good prognosis in the surgical treatment of thymoma. Chemotherapy and additional inradiation are necessary for patients in whom total resection of the thymoma is impossible due to pleural dissemination or extensive invasion to the great vessels.

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From 1975 to 1991, 450 patients with early gastric cancer were operated on in our hospital. Three hundred and seven patients were diagnosed by mass screening (mass screening (MS) group) and 143 visited medical institutes for abdominal symptoms (outpatient (OP) group). We compared clinicopathological features between the MS and OP groups. Both groups were similar in the age distribution, male-female ratio, locations of gastric lesions and macroscopic types. Microscopically, lesions in the MS group were less infiltrative in depth, width, lymphatic and venous permeation and lymph node metastasis than those of the OP group. Therefore, mass screening contributes to identifing earlier phases of gastric cancer, permitting limited surgery and thereby preserving quality of life.

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Twelve patients with left atrial myxoma, including a patient with brain tumor were successfully operated on. Eleven patients had a past history of embolism. The maximal diameter of tumors was mostly over 5cm, supporting the necessity to diagmosing left atrial myxoma in the early stage.
Temporary arrhythmia occurred in five patients postoperatively, but there were no recurrences. In patiants with lobular-formed myxoma, the frequency of embolism was high, suggesting the necessity of early surgical intervention.

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We examined the utility of direct percutaneous transluminal coronary angioplasty-direct PTCA-in patients with acute myocardial infarction. The subjects were 124 patients with acute myocardial infarction, hospitalized in our facility, who underwent direct PTCA (mean age : 63. 2 years old). Primary success was achieved in 91.1%, and the residual coronary luminal narrowing at sites of dilatation was 35.6±23.3%. Causes of failed PTCA were : inability to pass the guide wire through the target lesion in 5 patients, inability to advance the dilatation catheter in 2, insufficient dilatation in 2, coronary dissection in 1, and difficulty in advancing the guiding catheter into a tortuous aorta in 1. Acute coronary occlusion was found in 6 patients as an early complication related to direct PTCA, but was successfully treated in 5 patients by repeat PTCA. The in-hospital mortality rate was low : 5 patients with cardiac death (mortality rate : 4.0%), of which 4 showed cardiogenic shock. Two weeks after occurrence, coronary angiography and left ventriculography could be performed in 105 of 113 patients who had undergone successful direct PTCA. The patency rate of the infarct-related artery was 93.3%, and the ejection fraction from the left ventricle was 56.1±13.1%. It was concluded that direct PTCA was a useful means of acute myocardial infarction.

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Fourteen patients with hepatoblastoma were treated at Gunma University Hospital and Gunma Children's Hospital Medical Center between 1966 and December 1992. The ages of the patients, 13 boys and 1 girl, ranged from 2 months to 10 years (median 1 year). The tumor was stage I in 2 patients, II in 5, IIIA in 2, IIIB in 4, and IV in one patient. The histological type was well differentiated in 6 and poorly differentiated in 4 (unknown in 4). Macroscopically, the tumor was resected in 9 of 11 patients who underwent operation. Intraarterial infusion of adriamycin or mitomycin C was done in 5 patients and embolization of the hepatic artery was also performed in 3. Chemotherapy was used in 11 patients but radiation (16-40Gy) only in 3. At the time of evaluation, January 1993, 7 out of 9 patients whose tumor was resected survived without any evidence of disease. Six patients died of disease between 1 and 8 months after treatment. One patient died of recurrent disease 5 years after treatment. Postoperative complications included portal hypertension with esophageal varices. Hemihypertrophy was observed in 2 patients.

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A case of cervical spine and cord injury with occlusion and stenosis of vertebral arteries is reported.
A 16-year-old girl was transferred to our hospital because of head and neck injuries sustained in a fall from a motorcycle. She had a vertex skin wound and complained of neck pain. She showed severe quadriparesis with complete flaccid plegia on the right and paresis below the C₅level on the left, hyperesthesia of the upper extremities and left hemihypesthesia below the upper thoracic level. Cervical films showed unilateral interfacetal dislocation and fracture of the C₄ vertebral body. CT scan revealed multiple fractures in the body, transverse process and posterior arch at C₄ and C₅, and clock-wise rotation of C₃. Vertebral angiograms showed complete occlusion of the right vertebral artery at the lower portion of C₄ and lateral displacement and narrowing of the left vertebral artery at the C₄ level. She was operated on four days after the trauma. Initially, posterior reduction of the interfacetal dislocation and wire fusion of C₃, C₄ and C₅ was carried out, and then while still under general anesthesia, an anterior approach was used to aclieve decompres and an iliac bone graft was performed. A halo-vest was attached. Postoperatively, neurological deficits gradually improved, and she was able to walk despite the right hemiparesis one month after surgery. Postoperative angiograms showed improvement in the narrowing of the left vertebral artery and recanalization of the right vertebral artery. Acute cervical spinal trauma may be associated with narrowing or occlusion of the vertebral arteries even if symptoms of vertebro-basilar insufficiency are not apparent. It is important to ascertain the state of the vertebral arteries in order to properly treat severe cervical spinal injuries.

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A case of total extirpation of an intra-and extradural and extramedullary neurinoma involving in the left C₁-C₂ is reported. Neurologically, upper cervical cord tumor (particularly extradural lesions) frequently produce a lower corvical cord symptoms in the initial stage. Therefore, a prolonged period before a definite diagnosis can be obtained and the ultimate development of tetraparesis occurs in many cases. At extirpation of the tumor for which intensified magnetic resonance imaging by the use of Gd-DTPA is very useful for diagnosis, it is necessary to perform atraumatic manipulation with microsurgical techniques on the spinal cord. This is based on assessment by magnetic resonance imaging of whether or not preservation of the C₂ spinous process is possible.

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A 47-year-old female underwent coronary artery bypass grafting (CABG) for a 75% stenosis of the left main trunk. At the time of CABG, perioperative myocardial infarction (PMI), probably due to coronary artery spasm, occurred. Intraaortic balloon pumping (IABP) was not effective in maintaining sufficient circulation. We therefore chose to use a left ventricular assist device (LVAD). Cardiac function improved gradually, and the patient was weaned from the assist device 6 days after the installation of LVAD without significant complications. Circulatory support with LVAD is effective in the treatment of patients with refractory heart failure after open-heart surgery.

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The case of a 5-year-old male with ventricular septal defect associated with Downs syndrome. Who severe postoperative intrapulmonary shunt is reported.
Severe hypoxemia occurred immediately after release of the aortic cross-clamp following intracardiac repair. Extracorporeal membranous oxygenation was used for 5 days to treat the hypoxemia, but no improvement was achieved and the patient ultimately died. The existence of congenital pulmonary arteriovenous fistulas, organic changes in the intrapulmonary vascular system, and respiratory syncytial viral infections were speculated to have been a possible etiology of this intrapulmonary shunt.

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