The early case detection followed by WHO/MDT is the most important in leprosy control program not only for the destruction of linkage of infection but also the prevention of disability in leprosy. PIME leprosy program has been carrying out active case detection for leprosy since 1986 in Khulna, the third biggest metropolitan city in Bangladesh.
The relation between several detection modes and their associated disability grading was analyzed in order to see the contribution of each detection mode to disability grading.
The disability grading of new registered patients from 1995 to 1997, 1, 115 cases in total was analyzed according to its detection mode.
Voluntary reporting patients from “out of control area” had both high disability grading of G=2 (38.0%)and high MB rate (39.3%). On the other hand voluntary reporting paticnts in control area had less disability grading of G=2 (12.2%)and less MB rate (25.3%). The number of patients referred by local doctors was still small and had both high disability grading of G=2 (27.0%)and high MB rate (51.4%). Children detected under school surveillance did not have any marked disability of G=2 (0%)and were almost PB patients (88.6%). (Prevalence rate of school surveillance was low.) Patients detected under general surveillance had low disability grading of G=2 (2.6%). The disability grading (G=2) of voluntary patients from control area (12.2%) was three times as much as that of patients from general surveillance (2.6%). Lastly patients of family contacts who were aware of the first symptoms had relatively less disability grading (5.9%).
The small number of patients referred by local doctors (3.3% of total number) with high disability grading meant that there would be still great need of information programs on leprosy for local medical professions to think about leprosy. The high disability grading of patients from “out of control area” meant that the more effective leprosy control program should be done in “out of control area”.

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Two received long-term hemodialysis to manage chronic renal failure resulting from treatment of their cystinuria. Both had progressive renal failure caused by D-penicillamine treatment after surgery for urolithiasis. These are the first reported cases involving . The 34-year-old sister had received dialysis since April 1975 and her 26-year-old sister had been on dialysis since October 1977. There has been little variation in the treatment of chronic renal failure whether caused by cystinuria or by other diseases. However, we treated these with cystinuria, along with other patients, by differential diet management. The balance of plasma amino acids improved remarkably after 3.5 years of treatment and both are now undergoing excellent dialysis. The diet restricts methionine and crystine to 2.5 g/day.

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Pituitary adenomas frequently invade the cavernous sinus. The standard transsphenoidal approach does not provide satisfactory visualization of the cavernous sinus structures. The transcranial approach has no advantages, and increases the operative trauma and complications. The oblique transsphenoethmoidal approach, a modified standard transsphenoidal approach, was used to treat 19 patients with pituitary adenomas invading the cavernous sinus. Complete tumor removal was achieved in 15 patients and subtotal removal in 4 patients. The patients tolerated this modified transsphenoethmoidal approach well and the postoperative results were satisfactory. Although the number of patients was too small to allow any statistical analysis, the results, compared with other series, are encouraging.

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Spontaneous osteonecrosis of the knee was described as a distinct entity in 1968 (Ahlbäck et al) . The etiology of this lesion remains unknown, although micro-trauma and vascular insufficiency have been suggested as causes.
Typically the patient is a female in the sixth and seventh decade, sudden onset is characteristic, and the lesion occurs mainly on the medial femoral condyle. Radiographs show a subchondral radiolucency on the weight-bearing area with subsequent flattening, collapse and sclerosis.
We report on idiopathic osteonecrosis of the femoral condyle occurring in two .

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Vasospastic angina was observed in two . The 52-year-old younger sister presented with rest angina at midnight and in the early morning. The coronary arteriogram showed no significant organic stenosis. Vasospasm to the left anterior descending and right coronary arteries was induced by the intracoronary administration of acetylcholine. The 57-year-old elder sister complained of rest and effort angina. Her coronary arteriogram was also normal. Vasospasm to the left circumflex and right coronary arteries was provoked by acetylcholine. In both cases, human leukocyte antigen DQw3 was negative. In the present cases, genetic factors may partly contribute to the mechanism of vasospastic angina. (Jpn Heart J 36: 669-673, 1995)

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父親の過失によって水銀暴露をうけ義母は死亡したが, 幸いにも急性中毒症状は現われなかった14才と11才の姉妹について, 暴露より9カ月後に入院させ精査した. 全身状態は良好で理学的所見なく, 神経学的・運動機能検査で視野狭窄・聴力障害・知覚障害などの異常を認めず, また末梢血, 血液生化学, 腎・肝機能検査でも異常は認めなかった. しかし全血中総水銀量はすでに有意の高値を示さなかったが, まだ尿中, 頭髪中, 臓器（腎）などの水銀値は高く, なお体内にかなりの水銀量が残存していることがうかがわれ, 今後しばらく観察が必要と思われた.

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Alstrom syndrome is a rare disorder characterized by early obesity, loss of central vision, diabetes mellitus, hearing loss and short stature. Previous studies, have reported no information regarding oral findings. This article describes oral findings in two cases of Alstrom syndrome. In both cases, gingivitis was present and also light yellowbrown discolored enamel bands were observed on the anterior teeth. This staining may have resulted from discoloration of the preexisting slight band-like enamel hypoplasia. The gingiva was examined histologically by light and transmission electron microscopy. Irregular thickness of the basal lamina and delamination of the myelin sheath were detected by transmission electron microscopy. There is no information about pathological odontogenesis in Alstrom syndrome in previous reports. Oral present findings may contribute further information about the clinical manifestations of Alstrom syndrome. (J. Oral Sci. 43, 221-224, 2001)

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It has been found that female progeny with the early feathering (EF) phenotype rarely emerge in late feathering (LF) strains of chickens. However, few detailed studies on the incidence of reversion have been reported. The present study was conducted to examine the incidence of reversion across three generations (G7-G9) in an LF line of the Nagoya breed and to investigate the characteristics of DNA structures of the revertant EF females. A total of five EF revertant females were observed (G7: 3 out of 376, G8: 1 out of 383, G9: 1 out of 411), and the incidences observed in G7, G8, and G9 were 0.80, 0.26, and 0.24%, respectively. Results of two PCR and one RFLP-PCR analyses indicated that there were two types of EF revertants in the Nagoya breed (3 birds were Type I and 2 birds were Type II), and that the reversion to the EF phenotype might be accompanied by the loss of either an OR (occupied repeat) or a UR-K region (unoccupied repeat on the K locus), which were homologous DNA regions produced by insertion of an avian endogenous virus gene (ev21) and duplication. Moreover, phenotypes of full-sib and half-sib of the EF revertants confirmed that the sires of the EF revertants have never harbored excision of either OR or UR-K at the ev21-K complex locus on one of two Z chromosomes, suggesting that the reversion event occurred in spermatogenesis.

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Single mothers have many social handicaps on daily living. They are highly likely to use social services than two parent families. Our survey was carried out through Big Brothers/Big of Greater St. Louis and Big Brothers/Big of Southwestern Illinois. Big Brothers/Big are organization which offer their services to one parent families, mainly to single mothers families. This article reports findings that indicate hesitation to make use social services on the part of poor single mothers. They also don't have enough information of private social services. Sliding scale system has little influence to those low income groups's motivation of using services. Moderate income groups have little confidence in public services, have more confidence in private services and self help group.

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At the beginning of 1904, James Joyce wrote off in one day an autobiographical story-essay, 'A Portrait of the Artist,' and entered into his literary career as a creative writer. This was rejected by the editor of Dana, which occasioned him to write an extended draft of the portrait, Stephen Hero. In the latter half of that year, he wrote for the Irish Homestead three short-stories which were later to be incorporated in revised form in Dubliners. 'The

,' the first of the three for the Homestead, had been rewritten and revised at least three times during the next twelve months before the final Dubliners version took on the shape. It is imperative and vitally important to examine the remarkable differences between the first Homestead version and the final version, for they will reveal how Joyce started his career as an artist and how he came to maturity as a writer in so short a time. We may not be sure what made him develop so rapidly, but the question is not why but how he developed his art. As his letter shows, Joyce had from the start a definite programme "to betray the soul of that hemiplegia or paralysis which many consider a city" through a series of stories in Dubliners. This theory may seem naturalistic at first, but the process of revisions of 'The ' was the process to add symbolic details to the simple naturalistic story narrated directly by an innocent boy-narrator. It is symbolic, not 'vivisective' as the hero of Stephen Hero would have us believe. The boy in the final version is not an observer but is more involved in the incident than the boy in the first version. Joyce selected the incident of the priest's death to bring about the unique effect of the paralysed soul of the city, and not vice versa. He anticipated that the effect would decide the whole tone of the stories that would come after it. Indeed, there is no difference of the sequences of the story between the two versions: both are consisted of four consecutive parts. It will be almost enough, however, to compare the 'introductory' parts of the drafts to know the difference of the depth and breadth between them. The opening passages of the first draft are completely rewritten and re-organized in many drastic and also in many subtle and complicated ways: the incident itself, vaguely hinted at in the Homestead version, is clearly defined in the Dubliners version-the word "paralysis" is given a vivid imaginative function with its full implication of social as well as religious hemiplegia of the city. In the first draft, the incident, the narrator's relation to it, and the disease of the dying and demented priest, though implicitly narrated, are never allusive nor suggestive of anything, while in the final draft, it is the whole implication of the death of the priest and its relation to the involved boy that matters. The boy's relation to the outer world, apparently cut off through an open hostility to the grown-ups, is barely maintained by a closer relationship with the corrupted priest as an allegorical incarnation of the "maleficent and sinful being." This renewed attraction-repulsion relationship makes it necessary to add an entirely new paragraph to the final draft, where the ordinary relation between the priest and the boy is significantly reversed: the priest desires to confess something and the boy smiles feebly as if to absolve the simoniac of his sin. This paragraph reminds us of the passages in the Portrait where the young Stephen with his enfeebled mind sees in the darkened bedroom "pale strange faces" of the dead. But in spite of many similarities, the essential difference is clear: the young Stephen is not yet aware of the fact that the sinner can recede into some pleasant region; even a small transgression of his fellow students can rouse in him a faint sickness of awe,

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　　This study aimed at clarifying sibling's views and their issues concerning their brothers and

with autistic disorders, the characteristics of their developmental features at each stage, and their recognition, and response to difficulties, in order to acquire the key to home-based supports for siblings. 43 siblings who had brothers and with autistic disorders were interviewed. As a result, as for sibling's views of their brothers and , “The way they are” based on their actions or character, and “their personality” were shown. As for sibling's matters concerning their brothers and , “the consciousness of others” such as others' looks and concern, “direct damage” such as physical attacks on them and breakage of personal belongings, “difficulties in coping” and “consideration” for their brothers and were shown. Moreover, it was suggested that as for developmental features, the school-age was a significant term during which the sibling's view of their brothers and changed. From the above, as home-based support, it is necessary to tell siblings suitable information about the actions and the characteristics of their brothers and , to pay attention to their trifling problems from an early stage, and to show them the methods to solve the problems they face.

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Embodying modernity and nationality was a self-improvement task for fin de siècle Siamese monarchs. In post-1932 Siam, kingly bodies no longer wielded the semantic and social potency necessary to inhabit the whole of a nation. Siam required a corporeal reassignment to signify a new era. This study examines previously neglected propaganda materials the Phibunsongkhram regime produced in 1941 to recruit women for nation building, specifically, the texts supplementing Cultural Mandate 10 addressed to the “Thai

.” I argue that with the Thai texts, the regime relocated modernization and nation building from male royal bodies onto the bodies of women. Moreover, these texts specified gendered roles in nation building and inserted nationalism into the private lives of women by framing nation-building tasks as analogous to self-improvement and the biological and emotional experiences of a mother. Vestimentary nation building prescribed by Mandate 10 turned popular magazines into patriotic battlegrounds where all Thai were gatekeepers and enforcement came in the form of photo spreads, advertisements, and beauty pageants. By weaving nation building into fashion and the private lives of women, the Phibunsongkhram regime made the (self-)policing of women’s bodies—formerly restricted to elite women—not only essential but also fashionable and patriotic for all Thai .

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To assess the familial aggregation of uterine myomas in Japanese women with myomas, one hundred forty four women requiring surgery for myomas and 288 age-matched healthy controls were studied in Hokkaido, Japan. The incidence of positive first-degree family history of myomas among women aged 45-54 years with myomas was greater than that among controls (31.5% versus 15.2%, respectively, p < 0.01). Analyses categorized by the status of parity and familiality among subjects showed that the risk for myomas was the greatest in women who had both fewer births (parity = 0 or 1 ) and the positive family history of myomas as compared with those who had both more births (parity 2) and the negative familiality of myomas (odds ratio = 5.8, 05% confidence interval = 2.3 --14 8). The results of this study suggest that Japanese middle-aged women with myomas have the familial predisposition of uterine myomas. Furthermore, nulliparous women with the familial aggregation of myomas may be at increased risk of the disease. J Epidemiol, 2002 ; 12 : 240-253

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Two pediatric cases of Microsporum canis infection that occurred in a cat breeder family and the isolation of dermatophytes from their 166 breeding cats are reported. The patients were a 16-month-old girl and her 26-month-old sister who both had tinea capitis. Their family consisted of six members: the , their great-grandmother, grandmother, grandfather, and mother. Except for the two , the family had no history of skin lesions. The grandmother had been a cat breeder for 20 years. We tested the cats using the hairbrush technique, and 56 of the 158 cats (35%) tested were positive for M. canis. In particular, cultures performed from 4 cats developed M. canis colonies that grew densely from all spikes on the hairbrush. On the basis of observations of the cultures, cutaneous infection was suspected when five or more colonies grew on a single plate medium (9 cats), whereas growth of fewer colonies was thought to suggest saprophytic colonization on cat hair. M. canis is known to be highly transmittable among cats, but 65% of the cats investigated remained negative. It was thus considered possible to prevent further spread of infection by practicing basic infection control and improving the environment.

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