We investigated whether endothelial dysfunction might contribute to the exaggerated vasoconstriction induced by administration of norepinephrine (NE) in the early stage of one-kidney, one clip renal hypertension in rats (1K1C). We also studied the endothelium and the role of angiotensin II type 1 receptor in this phenomenon. Male Wistar rats were sacrificed 48 hours after the creation of renal artery stenosis or a sham operation, and ring preparations of the thoracic aorta were obtained. The dose dependent isometric contraction and relaxation of aortic strips produced by NE and acetylcholine (ACh), respectively, were studied in baths filled with Krebs-Ringer solution. The aorta of 1K1C rats showed significantly (p <0.05) exaggerated contraction to NE and impaired dilatation to ACh, compared with those controls. The contractile responses to NE were augmented by rubbing the endothelium and by treatment with N^G-monomethyl L-arginine acetate or methylene blue more in the controls than in the 1K1C rats ; however, the augmentation in rings from contraction was more prominent than those from 1K1C, and the difference between two groups was not significant. In the second experiment, rats were given 0.05% captopril, 0.02% MK954 or 0.02% nicardipine in the drinking water for one day before and for 48 hours after the creation of renal artery stenosis. The increased contractile responses to NE in the aorta of 1K1C rats were normalized by treatment with either captopril or MK954 but not nicardipine. These findings suggest that endothelial dysfunction may contribute to the exaggerated NE-induced vasoconstriction observed in the 1K1C rats. Blocking of the renin-angiotensin system, especially, the specific blocking of angiotensin II type 1 receptor may protect endothelial function.

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The role of the neurohypophysial peptide hormone arginine vasopressin (AVP), which is thought to be involved in intracerebral antinociceptive mechanism of pituitary neuroadenolysis (NALP), was examined in non restrained adult male Japanese monkeys. The effect of intraventricular administration of AVP on somatosensory evoked potentials (SSEPs) elicited by stimulation of the median nerve and on the total urine output over a 2 hr period were measured.
The results were compared with those obtained by using fentanyl and U-50, 488H. AVP, fentanyl and U-50, 488H only prolonged the late-component latencies of SSEPs, and did not alter short-component latencies. Opioid antagonists, such as naloxone and MR-2266BS, had no effect. AVP reduced the urine output.
D (CH₂) ₅, Tyr (Me) -AVP (AAVP), a potent V₁ vasopressin receptor selective antagonist abolished this AVP-evoked response, but opioid antagonists such as naloxone and MR-2266BS had no effect. The present results support our conclusions that the analgesic effect of AVP on the development of antinociception in monkey is the result of its direct or indirect physiological role in non-opioid pain inhibitory systems via V₁ receptors.

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We investigated of PSA in 57 patients who underwent the prostate biopsy in our hospital during 1994. Serum PSA level were determined with a Markit-M kit. Sensitivity and specificity for prostate cancer at the current standard value of PSA of 3.6 ng/ml (with our PSA kit) were 74.2% and 61.5%, respectively. There were six cases of prostate cancer with PSA values in the 1.5-3.6 ng/ml ceange 6, and 5 of these cases were stage B. Judging from these results, it seems quite necessary to perform prostate biopsy or intense management even if the PSA value is 1. 5-3.6 ng/ml.

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A total of 407 patients who were hospitalized in the Division of Rehabilitation, Kusatsu Branch Hospital of the Gunma University Hospital between 1986 and 1995 was analyzed with respect to age, month, place of residence, disease, complication, day of hospital treatment, outcome, introducer, person taking care of the patient, and members of family. Of the 407 patients, 255 (62.7%) were more than 65 years of age and around 45% were residents of Kusatsu. Among all diseases, cerebral diseases had the highest frequency (34.6%). Furthermore, 26 patients (64.4%) had a complication. The person taking care of the patient was wife (31.7%), son's or brother's wife (21.6%), and daughter (19.2%). Most of them were female (82.5%). Moreover, 208 patients (51.1%) had lived alone or with their spouse and 41 patients (10.1%) had no person to take care of them. Seven patients (1.7%) died during the period of rehabilitation course. However, the events were not considered to be caused by the rehabilitation. Whereas many patients came to our hospital from afar with the expectation of rehabilitation with hot-spring water, it was difficult to follow them up, to contact their family, and to make an environmental arrangement.

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Although most neonates born to mothers with Basedow's disease do not have thyroid dysfunction, some have transient hyperthyroidism or transient hypothyroidism as a result of transplacental passage of materials such as anti-TSH receptor antibody (TRAb), thyroid-stimulating antibody (TSAb), and antithyroid drugs.
We report the thyroid function of ten neonates born to mothers with Basedow's disease. Two cases in them presented severe transient neonatal thyrotoxicosis. Suppressed TSH levels and low thyroxine levels persisted for several weeks. The TSH response to TRH administration was blunted, indicating that the hypothyroidism was pituitary origin. These cases had certain characteristics, in common onset of maternal Basedow's disease during pregnancy, suppressed TSH levels, extremely elevated TRAb levels, low birth weight and transient neonatal thyrotoxicosis. One of the two infants had a growth disorder and another had a mild neurodevelopmental defect.
The results of these evaluations suggested that appropriate management of pregnancy in Basedow's disease could prevent impairment of neonatal thyroid function and that careful observation of the neonates would be required.

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Although aspirin therapy or high-dose γ-globulin therapy may be effective in the acute stage of Kawasaki disease, there was a 12.8% incidence of coronary lesions in nationwide survey. We treated 269 patients in the acute stage with aspirin alone (group A, n=43), prednisolone plus aspirin (group B, n=157), high-dose γ-globulin plus aspirin (group C, n=24), and combination therapy consisting of aspirin, prednisolone and high-dose γ-globulin (group D, n=45) within 9 days of onset at Gunma Children's Medical Center and retrospectively reviewed the effects of the combination therapy in acute stage of Kawasaki disease. The incidence of coronary lesions greater than 4.0 mm was 9.3% in group A, 8.3% in group B, 16.7% in group C, and 2.2% in group D. The relatively small sample size in this study does not allow a more definitive statement, but combination therapy appears to be more effective for coronary lesions.

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A 61-year-old male who experienced anterior chest pain while playing golf was referred to our hospital for acute myocardial infarction caused by occlusion of the left main trunk (LMT) and stenosis of the right coronary artery (RCA). The left main trunk was recanalized by percutaneous transluminal coronary recanalization (PTCR). As 90% stenosis of the trunk still remained, emergency coronary artery bypass grafting (CABG) of the left anterior descending artery (LAD), the diagonal branch (Dl) and the right coronary artery was performed using saphenous vein grafts (SVGS). The was no chest pain was observed postoperatively, and patency of all grafts was confirmed by postoperative angiography.

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Three cases of Diphyllobothriasis, which is caused by one of the commonest parasites transmitted by the fish in Japan, have recently been encounters. In all three cases, chief complaints were abdominal pain and diarrhea. The patients discovered a chain of tapeworm proglottids discharged spontaneously on their anus and brought them for identification. The first case was in a 25-years-old man. After admission, he used a laxative, and two strobila, one 140cm long with a scolex, and the other 180cm long without a scolex. The second case was in a 59-years-old woman. After admission, she was treated with Gastrografin (100ml) by gastrointestinal tract, and expelled a strobila without a scolex, 880cm. The third patient was treated only with praziquantel. Ultimately, praziquantel was administered orally to all three patients. We confirmed the absence of tapeworm eggs in the patients' stools two months later.

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A case of mucinous carcinoma of the skin is reported. A 68-year-old Japanese male had a tumor measuring 6 × 6 mm on the right wing of his nose. The tumor was reddish-brown in color and had a smooth surface and firm consistency. Histologically, the tumor grew subcutaneously as a well-circumscribed nodule composed of both myxomatous and solid tumor areas. In the myxomatous area, the tumor cells were cuboidal and formed large mucin-filled cystic spaces. In a small portion of the solid area, the tumor cells were large and had clear cytoplasm, the histological findings similar to those of clear cell hidradenoma. Immunohistochemically, the tumor cells were positive for carcinoembryonic antigen and S-100 protein. The unique histology of this skin appendage tumor is discussed.

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Decompression prior to a primary resection is desirable for the treatment of obstructive left colorectal cancer. The long intestinal tube method is inadequate to decompress the digestive tract. In our institute, a combined method using a decompression tube and a long intestinal tube has been adopted. A percutaneous transhepatic cholangioscopy (PTCS) tube is used as the decompression tube. This tube is useful for this method because of its appropriate degree of rigidity, and is inserted into an obstructive lesion through a guide wire during colonoscopy. A small PTCS tube is gradually exchanged for a large PTCS tube. Colon preparation with saline solution is performed using both tubes prior to surgery.
This method was selected in three patients with rectal cancer and one with sigmoid colon cancer.
Successful results were obtained in all patients. Our method is effective for preoperative management of patients with severe obstructive colorectal cancer.

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Obturator hernia that is successfully diagnosed preoperatively has been increasingly reported with a recent progression of imaging techniques. We describe a case of the disease in which computed tomography (CT) was very useful to make the definite diagnosis preoperatively.
An 83-year-old woman was admitted to the hospital because of nausea and vomiting. Obturator hernia was suspected by a gastrografin study using an ileus tube. The final diagnosis of obturator hernia was made by CT, which demonstrated a water density mass located between the internal and external obturator muscle. Emergency laparotomy was performed with enterectomy. The operative outcome was satisfactory.

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