Up to now, there have been few studies on the mortality patterns in China. The objective of the study is to investigate the mortality pattern in the recent years in Tianjin, China, and to provide useful data and scientific evidence for decision making to prevent diseases in the various districts of Tianjin and its surrounding counties. Using the 1995 mortality data provided by the Department of Health, Tianjin, China, the mortality rates of Tianjin population were calculated by causes-of-death based on the International Classification of Diseases, 9th Revision (ICD-9). The mortality rates were compared with those of the urban areas of China and of Japan. In addition, SMRs for all causes and the three leading causes of death (Heart diseases, Cerebrovascular diseases, and Malignant neoplasms) in Tianjin were calculated by the districts and counties to examine the geographic differences of mortality. The total number of death was 48,983 in Tianjin. 30,592 deaths(62.5%) were attributed to the three leading causes of death, heart diseases (23.2%) had become the first cause of death in Tianjin. The age-specific mortality rates of heart diseases were higher in Tianjin than in the urban areas of China and Japan for both male and female. Especially, the rates of the people aged 45 years and older were much remarkable. Meanwhile, a lower mortality rates from malignant neoplasms were found for both sexes in Tianjin compared with the two regions mentioned above. The wide variation of SMRs from all causes of death and the three leading causes of death amongst regions within Tianjin were clearly observed. The study described the age-specific mortality rates of the three leading causes of death, and pointed out a higher rates from heart diseases in Tianjin relative to the Urban areas of China and Japan. The geographic differences of mortality from all causes and the three leading causes of death were cleared at first in Tianjin.

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Purpose: Among the epididymal abnormalities observed at a relatively high rate in patients with undescended testis, we focused on the state of adhesion between the testis and the epididymis and evaluated the clinical significance of this condition. We devised a new classification based on the location of the abnormal adhesions and attempted to assess abnormal adhesion on the basis of this new classification method.
Subjects and methods: The subjects of the study were patients with a total of 264 undescended testis and 352 testes. The items investigated included morphologiocal observation of the undescended site and the site of adhesion of the epididymis, age at operation, postoperative volume of testis, and seminal findings in patients who consented to a follow-up observation after puberty (n=29). The new classification for abnormal adhesion employed 5 grades based on our hypothesis that the severity of adhesion would be likely to in crease with the departure of the caput epididymidis.
Results: Abnormal adhesion of the epididymis was observed in 53.7% of the testes. The higher the undescended site, the higher the incidence of abnormal adhesion was found to be. There was a significant correlation between the grade of retention and the grade of abnormal adhesion by the new classification. A comparison of the postoperative testis volume with the grade of retention showed a significantly lower value for the high-grade group. A tendency was also observed for the group with severe abnormal adhesion to show a lower value for the postoperative testis volume. When the undescended site was scored and compared with the seminal findings, a high score was seen in the group with a poor sperm concentration.
Conclusions: The high incidence of abnormal epididymal adhesion in patients with a high grade of retention and the close correction between the grade of retention and the grade of abnormal adhesion suggested the clinical importance of abnormal epididymal adhesion in patients with undescended testes. Furthermore, the existence of a correlation between the grade of abnormal adhesion and the postoperative volume of the testis is considered to be an important finding with significant implications for future investigations of issues relating to abnormal epididymal adhesion and fertility.

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 Interferon (IFN) has been widely used as an useful antiviral agent for HCV-related chronic hepatitis patients to block the development to cirrhosis which often complicates hepatocellular carcinoma (HCC). However, its efficacy for cirrhotic patients is still equivocal. In 63 patients with HCV-related cirrhotic patients, the effect of IFN therapy on the occurrence of HCC was evaluated. The patients were allocated into IFN-therapy group and control group according to patients’ will. IFN-α or IFN-β was basically administered for 6 months or 6 weeks at various doses. There was no difference in demographic and clinical features between both groups. HCC occurred in 6 of 39 patients (15%) in the IFN-therapy group during the observation period (IFN group; 44.0±5.3 months, Control group; 42.4±5.0 months) but in 9 of 24 patients (38%) in the control group (p<0.05). The survival rate was also significantly improved in the IFN-therapy group. There were 7 of the 39 IFN-therapy group patients who showed sustained normal levels of serum GPT activity and no detectable HCV-RNA, but none of the control group patients (p<0.05). In these patients of the IFN-therapy group, serum albumin levels and platelet and WBC counts were significantly higher at the end of the observation period than before the IFN therapy, but such increases were not seen in the IFN-therapy group patients who did not show normalization in serum GPT activity and HCV-RNA. Cox’s multi-variate regression analysis revealed that alcohol intake, serum HCV-RNA levels and IFN therapy were significant factors related to the HCC occurrence in both groups. There were two patients who developed complications associated with the IFN therapy, but completely reversed after its discontinuation. In conclusion, IFN therapy may be an advisable candidate for HCV-related cirrhotic patients whose serum HCV-RNA levels were rather low to block the occurrence of HCC.

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BACKGROUND: The influence of the mode of dialysis on prognosis in patients with renal disease is controversial. This is at least in part because of heterogeneity of patient populations, who may be receiving either continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis (HD). In the absence of randomized trials, epidemiological investigations present the best method for studying the problem.
METHODS: In order to determine the influence of the mode of dialysis on prognosis and on the cardiovascular system, erythropoiesis, and calcium metabolism, 36 patients having CAPD and 36 patients undergoing HD were selected for study. Patients were matched based on age, sex, and etiology of renal disease. A 5-year follow-up study was conducted.
RESULTS: Among CAPD patients there was 1 death due to severe infection, 1 from myocardial infarction, and 3 from congestive heart failure. In this group the average age were 58±3 years. Among HD patients there were 8 deaths due to congestive heart failure, 1 from cerebrovascular accidents, and 2 due to severe, infection. In this group the average age was 63±3 years. Six CAPD patients were transferred to HD, because of recurrent peritonitis or elevation of serum creatinine. Patients on CAPD had lower blood pressures, and patients on HD had lower total cholesterol levels. Other parameters were not significantly different between two groups, including the doses of erythropoietin and calcium supplements administered.
CONCLUSIONS: This study provides evidence that clinical outcomes in renal failure may depend to some extent upon the mode of dialysis. The results suggest that levels of blood pressure and serum total cholesterol should be taken into account when treating patients with either CAPD or HD, since both blood pressure and total cholesterol levels are likely to be important in contributing to mortality and morbidity in these patients.

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 To evaluate the long-term outcome of patients with anti-myeloperioxidase (MPO) anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, the impact of addition of an intravenous pulse cyclophosphamide therapy to a daily oral corticoid therapy was assessed in 20 patients for 5 years. No patient diagnosed with Wegener's granulomatosis was included in this study. Ten patients received corticosteroid treatment alone (OCS group) and 10 patients were treated with corticosteroid and cyclophosphamide in combination (CYC group). Four patients in CYC group, survived their renal function without dialysis. Three of 6 patients that required dialysis therapy, died of gastric ulcer, thrombocytopenia probably due to cyclophosphamide, and cardiac failure. Two of 10 patients in OCS group did not need dialysis therapy. Five (50%) of these patients died and 3 (30%) received dialysis therapy. Three patients died of pulmonary hemorrhage, one died of colon cancer, and one died of cardiac failure. At the diagnosis, no significant differences in the levels of serum creatinine and MPO-ANCA titer, sex ratio and ages were observed between two groups. However, the retrospective analysis revealed that 1) the patients who survived for 5 years without dialysis therapy irrespectively of two types of therapy were all women, 2) the levels of MPO-ANCA at 3 months after the initiation of treatment were significantly higher (p＜0.05) in patients treated with corticosteroids alone than those with combination therapy, and that 3) the scores of renal histopathology (glomerular sclerosis and interstitial fibrosis) were significantly higher in patients who failed to survive than those who succeeded to survive without dialysis therapy. From these results, it is suggested that the combination therapy with corticosteroids and cyclophosphamide might be effective for improvement of life and renal survival of patients with MPO-ANCA associated vasculitis. Moreover, the values of MPO-ANCA should be evaluated after the start of the therapy.

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 The purpose of this study is to retrospectively analyze the clinical characteristics in patients with diabetes mellitus that were introduced to dialysis therapy. First, we reviewed 120 cases of end-stage renal failure due to diabetic nephropathy that were introduced to dialysis therapy in 1996 and 1997. Presenting features were as follows: men, 62.5%; mean age at introduction, 57±1 years; and mean serum creatinine level, 7.3±0.2 mg/dl. To find any clinical characteristics in the population, we divided patients to 3 groups according to age-younger (below 40 years old:12 patients), senior (more than 65 years: 32 patients) and middle: 76 patients-. In younger age group, average aged of 36±1 years old had lower serum creatinine levels (6.1±0.4 mg/dl) (p<0.05) and greater cardio-thoracic ratio (61.1±1.3 %) (p<0.05) obtained from the chest x-ray film than other two groups. There were no significant differences between the middle aged (59±1 years old) and the senior aged group (72±1 years old) in the levels of serum creatinine and cardio-thoracic ratio. To further analyze the clinical characteristics in the rest of groups, the other 113 patients in 1998 and 1999 who were matched with middle age group in the former study, were retrospectively analyzed. The average was 61±2 years old, and men 54%(62/113). The %changes in body weight were as follows: 9.5±2.8% (p<0.05) from teens to 20s and 19.2±3.2% (p<0.05) from teens to 30s in men. Compared to these changes, the %changes in body weight in women were as follows: 9.6±2.1% (p<0.05) from teens to 30s and 18.6±2.4% (p<0.05) from teens to 40s. The ages of the start of dialysis therapy were 54±2 years old in men and 59±3 years old in women and there was a significant difference (p<0.05). In summary, it is suggested that young patients with diabetic nephropathy received dialysis therapy because of hypervolemic symptoms compared to elder patients, and the renal deterioration progressed more rapidly in male than in female diabetic nephropathy as other renal diseases. From these data, in clinical practice these differences should be borne in mind.

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 Acute renal failure requiring hemodialysis therapy after coronary artery bypass surgery occurs in 1 to 5% of patients, however, the optimal timing for initiation of hemodialysis therapy still remains undetermined. To assess when continuous hemodialysis therapy is begun, we studied the comparative survival between 14 patients who started to receive continuous hemodialysis therapy with the timing of decrease of urine volume less than 30 ml/hr and other 14 patients who waited to begin dialysis therapy until the level of urine volume of less than 20 ml/hr during 14 days. Between two groups, there were no significant differences in age, sex ratio, the score of APACHE (Acute Physiologic and Chronic Health Evaluation) II, and the levels of serum creatinine at the start of continuous hemodialysis therapy (2.9±0.2 vs 3.1±0.2 mg/dl) as well as the levels of serum creatinine at admission. Overall mortality of those patients was 50%. Twelve of fourteen patients who received continuous hemodialysis therapy with the timing of decrease of urine volume less than 30 ml/hour. In contrast, only 2 of 14 patients in the other group survived. There was a significant difference of p<0.01 between two groups. The initiation of treatment for acute renal failure following after coronary artery bypass surgery would be determined by the decrease of urine volume but not the levels of serum creatinine. The early start of continuous hemodialysis therapy might be preferable for improvement of survival of the patients suffered from acute renal failure following coronary artery bypass surgery.

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Background: The advantages of using noninvasive techniques of bilirubin measurement are the avoidance of pain and of local infection as well as real-time results. Recently the accurate measurement of total serum bilirubin by transcutaneous bilirubin using a reflectance spectrophotometer, the BiliCheck^TM, has been introduced in a heterogeneous newborn population. But there is limited data on the use of BiliCheck^TM on Oriental babies including Japanese newborn infants.
Methods: A total of 240 transcutaneous bilirubin measurements were taken from the three body sites (forehead, chest, and left or right upper arm) of 52 Japanese neonates and compared with simultaneous total serum bilirubin measurements determined by the direct spectrophotometric method. Of 240 occasions, 206 measurements were taken before starting phototherapy and 34 were during phototherapy. A phototherapy eye-patch was placed over the measurement site on the forehead prior to the start of phototherapy.
Results:As a preliminary study, total serum bilirubin concentrations measured by the direct spectrophotometric method and by the bilirubin oxidase method were compared. There was a good correlation between the values obtained by these 2 methods (r=0.980, y=1.05 x＋0.176, p <0.0001). The precision of the device was expressed as a mean coefficient of variation of less than 5% and operator difference was small as coefficient of variation below 5%. Before phototherapy, the correlations between the transcutaneous bilirubin measurements by the BiliCheck^TM and total serum bilirubin by the direct spectrophorometric method were high; r=0.925 on forehead, 0.848 on chest and 0.822 on upper arm, respectively. However, the correlation became less during phototherapy (on forehead r=0.803, p<0.001).
Conclusion: These data indicate that accurate measurements of total serum bilirubin by transcutaneous bilirubinometry with BiliCheck^TM are applicable in Japanese infants. But the use of the device for infants who receive phototherapy needs further study.

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