Guidelines of Endotracheal Intubation for Pediatric Patients The methods of estimating appropriate size and depth of an endotracheal tube for pediatric anesthesia were investigated prospectively. 600 patients were enrolled in this study. 200 of them were under one year of age (infant group), and the other 400 were between one and seven years old (child group). The tube of the appropriate size was decided as having some leakage at 25 cm H_2O and no leakage at 5cm H_2O of inspiratory pressure. The distance to the tracheal bifurcation from the lips was measured by endobronchial intubation. Then 90 % of this distance was denned as the appropriate depth. 16 factors about the body profile were measured in every patient and their correlations with the appropriate tube size and with the distance to the tracheal bifurcation were surveyed. We found the palm length is particularly useful for estimating the appropriate intubation depth in the child group. Finally we introduced some practical guidelines for estimating the appropriate size and the appropriate depth of intubation in pediatric patients. Their application is quite easy and reliable to the daily clinical practice.

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The purposes of the present study were to develop a new technique for predicting maximal aerobic power (VO_2max) using the standing-up exercise and to examine its validity and reproducibility. Eighteen healthy young subjects (9 males and 9 females) performed the test twice within a week and their oxygen uptake (VO_2), heart rate (HR), and rating of perceived exertion were measured during the test. VO_2max was derived by extrapolation from VO_2 and HR during this submaximal exercise stress test. The reproducibility of the measured values and the predicted VO_2max was fairly confirmed. There was a significant correlation between the predicted VO_2max in the present study and the actual VO_2max measured in a bicycle ergometer test. The VO_2max predicted from three measured values (below 50% of actual VO_2max) was found to provide precision equal to that from four measured values during submaximal exercises. It was concluded that this method of predicting VO_2max is valid, accurate, and clinically applicable.

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The present study was undertaken to investigate the effects of growth hormone (GH) on follicular growth, oocyte maturation, ovulation, and production of insulin-like growth factor-I (IGF-I) in the in vitro perfused rabbit ovaries. Ovulation did not occur in any ovaries perfused with GH at a concentration of 1, 10, 100 or 200ng/ml, but the addition of GH to the perfusate increased the follicle diameter in a dosedependent manner. Exposure to GH significantly stimulated the resumption of meiosis, as compared with the contralateral control ovaries. Although the concentration of progesterone in the perfusate did not differ significantly between GH-treated and control ovaries, GH stimulated estradiol production in a dose-dependent manner. The mean number of ovulations per ovary and the ovulatory efficiency were significantly reduced in ovaries perfused with 5 IU of hCG, compared with those in ovaries perfused with 50 IU of hCG. The addition of 1OOng/ml of GH to the perfusate significantly increased the ovulatory efficiency and follicle diameter in the 5 IU of hCG-treated ovaries. Exposure to GH significantly stimulated the resumption of meiosis in the follicular oocytes compared with that in ovaries perfused with medium alone. Furthermore, GH significantly stimulated the resumption of meiosis in ovulated ova and follicular oocytes in ovaries treated with 5 IU of hCG. Changes in the tissue concentration of IGF-I in ovaries perfused with 1OOng/ml of GH paralleled those triggered by exposure to 50 IU of hCG. When the effect of GH on the tissue concentration of IGF-I was determined at 4h, GH stimulated the tissue concentration of IGF-I in perfused rabbit ovaries in a dose-dependent manner. The percent increase in follicle diameter in ovaries treated with GH was significantly correlated with the intraovarian IGF-I content. Thus, exposure to GH stimulated follicular growth, oocyte maturation, and production of IGF-I in the in vitro perfused rabbit ovaries, which indicates that the ovary is in fact a site of GH reception and action. Additionally, GH enhanced the effects of gonadotropins, acting synergistically to promote the ovulatory process.

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Fine morphology of the corneal endothelium was examined by light microscopy, and scanning and transmission electron microscopy using chick embryos on day 5 to 18 of incubation. By light microscopy, the corneal endothelium from 5-day-old embryo was composed of asymmetrical cells of various size with a large number of cellular processes. From embryonic day 6 to day 8, it consisted of 1-2 layers of the cells, but the intercellular space was incomplete. On embryonic day 9, it became a single layered structure of uniform thickness, resembling the postnatal form in appearance. Microvilli were seen on the posterior surface from embryonic day 6 till day 12 under the scanning and transmission electron microscope. From embryonic day 7 henceforth, the cilium was visible in the center of each cell. The microvilli were uniform and had internal fibrous laminar structure, while the cilium had composite axial structure similar to those of the human embryonic corneal endothelium. Both the cilium and microvilli were found before the onset of excretion of the aqueous humor. The microvilli, in addition to absorption, are regarded to be responsible for increasing the surface area for intercellular metabolism. It is suggested that the cilium, which basically has motor function, eliminates the impurities from the anterior chamber before the onset of aqueous humor circulation, and later assists the aqueous humor circulation.

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Among healthy adult subjects, we measured Probe-Reaction Time (Probe-RT) and Physiological Cost Index (PCI) during treadmill walking at different walking speed and cadence. Experiment I. The speed of prefer gait on the floor was measured in 13 healthy adult males with a mean age of 28.3 years (SD=7.38), and their Probe-RT during treadmill walking at 2, 3, 4, 5, and 6 km/hr. was recorded. The speed during treadmill walking at which the Probe-RT became the shortest was nearly the same as the speed of prefer gait. Experiment II. Seven healthy adult males with a mean age of 20 years (SD=1.0) performed treadmill walking at 2 , 3 , 4 , 5 , and 6 km/hr. and their PCI and Probe-RT were measured. The speed at which PCI became the smallest was found close to that at which the Probe-RT was the shortest, further coinciding with the optimal speed. Experiment III. The subjects were 7 healthy adult males with a mean age of 20.1 years (SD=1.07). During treadmill walking of the optimal speed (5 km/hr.), PCI and the Probe-RT were measured at the cadences of 80, 100, 120, 140, and 160 steps/min. It was clarified that the cadence at which PCI became the smallest agreed well with that at which the Probe-RT was the shortest. These results indicate that energy consumption became the smallest at the specific combination of cadence and step length at each speed. It was also elucidated that Probe-RT exerted a role in the evaluation of not only walk proficiency but also locomotion efficiency. The present findings suggest the validity of Probe-RT for the evaluation of gait and locomotion efficiency of the disabled with gait disorder.

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It is well known that human neutrophil elastase (HNE) has the great influence on the tissue injury when the inflammation happens. We studied about the plasma HNE on the patients with inflammatorybowel disease and found the significantly higher plasma levels in the patients with the both Crohn's disease and ulcerative colitis. Furthermore we found the significant tight correlation with the HNE plasma levels and disease activity on the both diseases. From these results, we tried the antiprotease (Ulinastatin) therapy combined with steroid hormone by intraarterial injection to the patients with inflammatory bowel diseases. We got the great response rate (81 %), so we can suspect this therapy cound be th hopeful one.

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The rat lens capsule contains the weakly digitalissensitive isozyme of Na^+, K^+-ATPase (α1 form) and the highly digitalis-sensitive isozyme (α2, α3 form). The highly digitalis-sensitive isozyme was about 60 % of the total Na^+, K^+-ATPase in adult rat lens, which is comparable to that of cerebrum. In contrast, the enzyme in the neonatal rat lens was mainly the weakly digitalis-sensitive isozyme. Along with the development of the lens, the highly digitalis-sensitive form of the Na^+, K^+-ATPase expressed postnatally around the period of the lid separation.

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The maturities of human oocytes were evaluated by the observations of cumuli oophori and coronae radiatae. A total of 1649 oocytes from 273 cycles of in vitro fertilization treatments were classified as overmature (O), mature (M), transitional (T), immature (I) and abnormal (A) according to the morphology of the corona radiata. The rates of both fertilization (%F) and embryonic development (%D) per oocyte were the highest in the group of M (77.6%, 57.0%, respectively), decreased significantly with decreasing maturity of oocytes (T : 57.5 %, 31.8 % ; I : 22.3%, 12.2%, respectively), and were the lowest in the abnormal group of A (18.9%, 10.8%, respectively). Decreases in %F and %D were also observed in the overmature group of O (58.0%, 31.2%, respectively). There wre significant differences in %F and %D between oocytes with and without a first polar body (%F : 69.6% vs 61.9%, %D : 49.0 % vs 34.4%, respectively). Mature oocytes classified according to the morphology of the corona radiata had significantly higher %F and %D than those according to the morphology of the cumulus oophorus, suggesting that the morphology of the corona radiata was more reliable to select mature oocytes than that of the cumulus oophorus. Significantly higher %F and %D were obtained when immature oocytes were matured in vitro for 18-24 hours (65%, 47%, respectively) than for 2-6 hours (44%, 22%, respectively).

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Leukotriene B_4 (LTB_4) and Tumor Necrosis Factor α (TNFα) are believed to be associated with the causes and morbid states of inflammatory bowel disease. I poured LTB_4 and TNF α into large intestines of rabbits bred with a normal diet and examined these intestines histologically. Next I poured TNF α into large intestines of rabbits bred with a linoleic-acid-rich diet and similarly examined those intestines. I made continuous measurements of the lymphoid follicle counts, which are considered to be the first lesions of Crohn's disease and compared the results in the large intestinal slice samples of both groups. As a result of these examinations, I found that histological features of large intestines bred with a normal diet and intracolonically administered TNF α after LTB_4 enema, and also those of rabbits bred with a linoleic-acid-rich diet and intracolonically administered TNF α, simulated the changes of first mucosal lesion in ulcerative colitis. The large intestinal lymphoid follicle numbers of the control group bred with a linoleic-acid-rich diet (6.50±2.59) were well within the range of statistical difference when compared with that of the control group bred with a normal diet (1.83±1.47, P<0.01), and that of TNF α enema group that had bred with a linoleic-acid-rich diet were the greatest numbers (12.17±2.93, P<0.05).

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The usefulness of neoadjuvant chemotherapy of antitumor agent HCFU was evaluated in ten patients with colonic cancer using, as indices, TSIR and effects on tissues. There were significant differences in TSIR between parts of oral or anal to the incision and normal mucous membrane. As for effects on tissues, specimens from five patients were found in grade 0 and those from other five in grade IIA. The TSIR of patients whose tissues showed negative effects was 37.0±6.68 %, while the TSIR of patients with positive effects was 58.3±24.35 % which was significantly higher than the former. The mean dose of the antitumor agent administered to patients with negative effects was 5.7±0.36g, while that to patients with positive effects was 11.0±4.74g which was significantly larger than the former. Although there were no correlations between TSIR and tissue effects, it was considered that the antitumor agent could be expected to be clinically effective in patients whose TSIR were higher than 50 %, as the TSIR of patients with positive tissue effects were 58.3%. However, details must be studied on problems such as conditions in analyses, correlations between TSIR and tissue effects, evaluation of tissue effects, and correlations between preoperative antitumor treatments and postoperative outcomes. Furthermore, accumulation of cases with clinically effective TSIR and long-term follow up of patients are needed.

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A 61-year-old man was admitted to the adjacent hospital suffering from hypotention and shock following accidental hit his abdomen by iron pipe. CT of the abdomen revealed infrarenal origin of huge aneurysm of the abdominal aorta suspecting rupture caused by blunt trauma to the abdomen. He was then transferred to our emergency room where he required cardio-pulmonary resuscitation. He was rush to brought to the operating room. Exploration of the aorta in the cavity as well as extending into retroperitoneal space. The aneurysm was replaced with Y-graft. Postoperative course was uneventful. In brief review of the Japan literatures, there had been no case reported previously as rupture of pre-existing abdominhl aneurysm caused by blunt trauma as we experienced.

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A 65-year-old Japanese female was admitted to our hospital because of an abdominal tumor. A hen-egg sized tumor was palpable in the epigastrium. Laboratory data showed no abnormalities. Ultrasonography of the abdomen revealed hypoechoic mass adjoining pancreatic head and gall bladder, which was recognized as low density areas on CT. Ga scintigram showed abnormal uptake in the same portion. Laparoscopy disclosed a tumor that had smooth surface under the lig. teres hepatis. Under Iaparoscopic biopsy was performed. Histological study of the biopsied specimen revealed non-Hodgkin lymphoma. Tumorectomy was performed. The tumor was 5 cm in diameter and had a thin capsule. Histological study revealed non-Hodgkin, malignant lymphoma, diffuse, large cell type, B cell type. Laparoscopic biopsy was useful to diagnose intraabdominal malignant lymphoma.

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