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A 70-year-old woman with severe respiratory distress was admitted to our hospital by ambulance. Chest X-ray revealed marked elevation of left diaphragm and invagination of megacolon. Colectomy was performed to improve the respiratory distress, but continuous mechanical ventilation was necessary after operation due to hypoxia and hypercapnea. Therefore, plication of diaphragm was additionally performed. With 10 rows of nonabsorbable sutures, 6 to 8 pleats were formed. The following day of operation, she was successfully relieved from the ventilator.

A 57 year-old woman was admitted to our hospital because of large hepatocellular carcinoma (HCC). Laboratory data showed hypercholesterolemia, thrombocytosis and hypoglycemia. Based on several examinations and the clinical course, we diagnosed HCC with paraneoplastic syndrome. It is rare that 3 paraneoplastic phenomena occur in a patient with HCC. In particular, paraneoplastic thrombocytosis is very rare in paraneoplastic syndrome associated with HCC.

To shorten the TBI process, we developed a new device for making the three-dimensional (3D) compensating filter that improves dose distribution. The dose distributions in the phantom and manufacturing time were compared between the new device and the previous one. Clinical evaluations included dose distribution in patients and the clinical rate of interstitial pneumonitis (IP). Our 3D compensating filter is made of polystyrene resin and gypsum. The filter was made after performing two procedures as follows. Patient data were measured by CT, and the 3D dose-distribution data and 3D compensating-filter data were obtained from the CT data by the 3D radiation planning system. We were able to produce the new 3D compensating filter within about 4 hours, including all procedures. The average dose distribution to each site when the 3D compensating filter was used was 92.7% to the head, 102.1% to the thorax, 106.4% to the pelvis, 90.2% to the knee, and 93.8% to the ankle joint, when the scheduled dose was taken as 100%. Dose distribution was improved. IP occurred in 6 of 32 patients (18.8%). There was no significant difference between the TBI and non-TBI groups in the frequency of IP (p = 0.27).

We devised 3D-compensating filters to improve dose distribution during total body irradiation (TBI). This study investigated the effect of these 3D-compensating filters and related complications in patients who had undergone bone marrow transplantation (BMT) followed by TBI. The 3D-compensating filters were fabricated by CT measurement of body thickness. The effectiveness of the 3D-compensating filters in producing a homogeneous dose distribution was checked by a thermoluminescent dosimeter (TLD) and semiconductor detectors in all patients. At the pelvis, the dose was measured simultaneously with an ionization chamber. The average dose distribution to each site when the 3D-compensating filter was used was 93% to the head, 97% to the neck, 99% to the thorax, and 98% to the pelvis in TLD when the scheduled dose was taken as 100%. There was no significant difference between the TBI and non-TBI groups with regard to the frequency of lung toxicity. Clinical interstitial pneumonitis occurred in 22.7% of the patients, interstitial pneumonitis with CMV in 13.6%, and idiopathic pneumonitis in 6.1% without any virus infection. Only one patient was regarded as having radiation-induced pneumonitis. 3D-compensating filters can be conveniently produced within a short time following CT measurement, and they seem to be safe and useful for dose flattening during TBI.

A self-administered questionnaire study of 333 workers (male 253, female 80) in a manufacturing company was carried out one month after informing the workers of the results of their medical checkups in 1993. The questionnaire included several items such as recalled abnormal findings of health examination and ways of overcoming the abnormal findings, recalled results of their medical checkups in 1992, self-confidence in their recollection of the results, and the usefulness of medical checkups. The following were investigated: the relationship between actual as well as recalled results of medical checkups in 1992 and the recollection of them after one year, the effects of examinations after medical checkups in 1992 on their recollection of the checkup results after one year, the effects of actual as well as recalled 1992 checkup results on the recollection of the results one month after informing the workers of the results of their medical checkups in 1993, assurance of correct recollection of the results, the relationship between the usefulness of medical checkups, explanation of abnormal findings and the percentage of correct answers to the results of medical checkups in 1993 one month after informing the workers of their results. It was found that the percentage of correct answers to the results after one year was significantly lower than that after one month in 1992. The rate decreased with the increase in the number of abnormal items in medical checkups. Moreover, the rate also decreased when the results were abnormal. Further examinations in addition to the medical checkups influenced their recollection somewhat after one year. The results that the workers still remembered in 1992 had a stronger effect on their recalling the results one month after informing them in 1993 than the actual results in 1992. The workers' confidence in their recollection of the results was untrustworthy in the same way as their recollection of the results, and they were not able to maintain the recollection of the correct results, although many of the workers realized the usefulness of the medical checkups. Our results suggest that explanation of abnormal medical findings in 1993 was effective because the percentage of partial concordance between actual and recalled results was much higher in the workers who received the explanation than in the workers who did not receive it.

In order to clarify the effects of walking under various psychosocial and occupational conditions on psychophysiological health, we examined the relationship between the number of steps walked in several situations, such as on all weekdays, at work, and over the weekend, and the results of medical checkups, psychological tests, Breslow's 7 health practices, and other attitudes toward walking as well as health by using a pedometer in a certain manufacturing company. Most of the workers estimated their usual number of steps walked as being less than actual levels on both weekdays and holidays. Generally, the increased number of steps walked was significantly correlated with increased HDL-cholesterol levels, and decreased Triglyceride levels. Contrary to such physical effects, there were more variations with respect to the relationship between walking and psychological health. Moreover, the development of a walking habit at work resulted in some factors becoming worse, such as relaxation, trait anxiety, and serum AST levels when compared to those on all weekdays and over the weekend. In conclusion, it is necessary to consider several situations in which workers usually walk and we must also practice counseling and education for health promotion, to promote walking for health care in the workplace.

To investigate the usefulness of a periodic medical checkup at the workplace from the standpoint of remembering the results, a survey was performed by a self-rating questionnaire on 424 industrial workers in a certain manufacturing company. The questionnaire included several items, such as their recalled abnormal medical findings and follow-up toward them, Breslow's 7 health practices, Goldberg's 12 selected items from the Japanese version of the General Health Questionnaire, and other original health related items. The study was conducted a month after the workers received their results. A total of 391 (290 males and 101 females) or 92.2% responded to the questionnaire. Several factors, such as age, gender, the type of occupation, and perceived health status were significantly correlated to the recalled results of medical checkups, but, only age and the way of observing the results were in accordance with the actual results. Only forty-nine percent of the responders correctly remembered their results. Age and perceived health status were significantly correlated to the exact recollection of the results. In particular, those who had poor perceived health status tended to have a wrong understanding of their medical results. Furthermore, there were those with the highest averaged GHQ scores who responded as having some abnormal findings even though no abnormalities were discovered in the medical checkups. On the other hand, there were those with the lowest averaged GHQ scores who answered that they had no abnormal findings even though some abnormalities were revealed in the medical checkups. The frequency of correct follow-up of the results was lower than the exact recalling of the results. In addition, those who made a mistake in the follow-up were inclined to have an optimistic view. Therefore, comprehensive health care for precise recalling of the results of medical checkups should be required to improve abnormal findings or maintain a good health status.

1. In order to understand the differences in pH optima and reaction rates of RNase A towards low molecular weight substrates and polymer substrates, the subsite structure of bovine pancreatic RNase A was studied. The kinetic studies of various sizes of oligouridylic acids showed that the size of the subsite is three nucleotides long. The kinetic studies on the inhibition of pUp, X-ray crystallographies of RNase A-ApC and pTp complexes, 31P-NMR studies on the binding of RNase A-pAp, and pTp showed the presence of P0, P2 and B3 sites. The location of the P0 site was assigned to be Lys66 by X-ray crystallography of the RNase A-pTp complex. The location of the P2 and/or P3/B3 site was determined by studying the enzymatic activities of several S-peptide analogs in which N-Leu was substituted for Lys7 and/or Lys1 coupled with S-protein toward various chain lengths of oligouridylic acids. The experiment suggested that P2 is Lys7 and P3/B3 is Lys1. 2. Several new pyrimidine base specific RNases were isolated and their primary structures were determined. They were two non-secretory RNases, a bovine liver alkaline RNase, a bovine brain RNase, and a bullfrog liver RNase. The bovine brain RNase has extra 16 amino acids at the C-terminus with O-glycosylated Ser. The bullfrog liver RNase was an extremely heat-stable RNase so far known. 3. Two new RNases belonging to RNase T1 family were isolated and their primary structures were elucidated. They were RNases isolated from Aspergillus saitoi and a mushroom (hiratake). The former RNase has a similar structure to RNase T1, but it was a base non-specific and guanylic acid preferential enzyme. From the results of X-crystallographic studies of this RNase, we suggested that the mechanism of RNase T1 RNase is essentialy a general acid-base catalysis between His40 and Glu58. 4. We isolated several fungal, plant and animal base non-specific acid RNases with a molecular mass about 24 kDa or more, and elucidated their primary structures. These RNases contain two sequences containing common 7-8 amino acid residues in common which include most of the amino acid residues important for the catalysis. Therefore, we proposed to designate these RNases as RNase T2 family RNase. On the basis of chemical modifications, kinetic studies and protein engineering studies of RNase Rh from Rhizopus niveus and RNase M from A. saitoi, we assigned that the catalytic site of RNase Rh consists of His46, His104, His109, Glu105, and Lys108. In the mechanism we proposed for RNase Rh, His46 and His109 work as a general acid and base catalysts. His104 was a phosphate binding site, and Glu105 and Lys108 might work to polarize a P=O bond of the substrate or stabilize the pentacovalent intermediate. However, in the reverse reaction of the transfer reaction step and the hydrolysis step of RNase Rh, His109 and His46 work as an acid and base catalyst, respectively. The X-ray crystallographic studies of RNase Rh, an RNase Rh-2'-AMP or d(ApC)complex, and the protein engineering studies of several mutant enzymes assigned the components of the major base recognition site (B1 site) and the minor base recognition site (B2 sites) of RNase Rh. The enzymatic studies of several mutant enzymes indicated that (i) Asp51 is very crucial for adenine base recognition, and the replacement of Asp51 by other amino acid, such as Thr, Ser, Glu, Asn makes RNase Rh more guanylic acid preferential, (ii) the replacement of Trp49 by Phe, and Tyr57 by Trp make the enzyme more pyrimidine and purine bases preferential, respectively. These trials are the first example of marked artificial change in the base specificity of RNases.

In order to investigate the relationship between health practices, various psychosocial factors, and mental health, a survey was conducted by means of a self-rating questionnaire on 424 industrial workers. The questionnaire included items concerning Goldberg's 12 selected items from the Japanese version of the General Health Questionnaire, the Type A scale used in the Framingham study, Breslow's 7 health practices, and other original psychosocial, health practicing items. A total of 391 or 92.2% responded to the questionnaire. Among them, 354 (266 males and 88 females) complete responders to the GHQ were analysed for the present study. As a result, several factors such as decrease in age, perceived present illness, worsening of perceived health status, increase in anxiety concerning health, exacerbation of alcohol and smoking related behaviour, decrease in physical exercise, reduction of Breslow's 7 health practices, perceived stress and difficulty in dealing with stress, increase in stress content, negative and malfunctional coping strategies, and decrease in relaxation were, according to the GHQ scores, related to negative mental health. Furthermore, Type A scores were significantly correlated to GHQ scores, the number of stress factors, and Breslow's 7 health practices in males, but they were weak or had no correlation in females. It is considered that favorable health practices and attitudes towards health might help to maintain positive mental health, but further analysis is needed to determine their causal relationships because of the cross-sectional design of the present study.

A 12-week training period including exercise and diet was undertaken to determine the effects of a newly developed health program on the physical and phychological parameters in 24 obese employees of a certain company. The association between a number of somatic parameters and psychological variables, including the attitude toward better health, and the level of mental health (General Health Questionnaire) were analysed before, immediately or 1 year after the program. After the program, significant overall improvements were found in several physical parameters. Those who had higher initial levels of attitudes toward better health showed greater exercising/dieting achievements during the program. Furthermore, these considerable health-related attitudes seemed to be concerned with higher HDL levels preceding the program, and minor improvements in diastolic blood pressure due to the program. The GHQ scores tended to increase in proportion to decreased exercising/ dieting achievements during the program and undesirable lifestyle that ignored any form of exercising.

Although the "Total Health Promotion Plan (THP)" drawn up by the Labor Ministry includes a self-administered stress checklist (THP-SC) as a health measurement, THP-SC has not been utilized in the way that it had been planned. Hence, we studied the usefulness of this list by comparing it with the General Health Questionnaire (GHQ). We made a questionnaire that included both THP-SC and the 60-item GHQ, and collected answers from 261 white-collar workers (male, average age 43.7). The GHQ was evaluated using the Goldberg's method. When analyzing THP-SC, the number of answers indicating stress was counted, and the respondents were divided into two groups based on the cut-off points of 75 percentile or 90 percentile. In the 60-item GHQ, 48 respondents out of 243 with valid answers had a higher score than the cut-off point, and in the 12-item GHQ, 77 out of 256 had a higher score. The average number of THP-SC was 5.67 +/- 3.19. Concerning the relationship with GHQ, many items of the 'A' section of THP-SC were significant. The comparison also suggested that four or more items checked in 'A' section or seven or more items checked in the whole list would mean that a respondent may be under stress.

An atypical case of hereditary motor and sensory neuropathy (HMSN) type 2 with cerebellar ataxia, hand tremor and bilateral recurrent nerve palsy was described. The patient was a 57-year-old man who complained of dyspnea, stridor , hoarseness during exercise and snored heavily during sleep since he was 20 years old. These symptoms and signs were slowly progressive. He had difficulty in breathing even at resting state when he was 54 years old and since then, he noticed muscle wasting of his hands and feet. Neurological examinations on admission revealed pes cavus, scoliosis, distal muscular atrophy in his four extremities, especially severe in bilateral lower limbs. Deep tendon reflexes were diffusely depressed. The fiberscopic examination demonstrated the limitation of bilateral vocal cord abduction and his tongue was slightly atrophic. Fine postural tremor was found in bilateral hands. Mild limb and truncal ataxias were also noted. Blood pCO2 level was elevated to 66% although FEV1.0% and vital capacity were within normal limits. Peripheral nerve conduction velocities were almost normal, though distal terminal latencies were slightly prolonged and amplitudes of evoked potentials were markedly decreased. The sural nerve biopsy studies revealed the chronic axonal or neuronal degeneration of both large and small myelinated fibers. From the clinical, electrophysiologic and histopathologic findings, the diagnosis of HMSN type 2 with bilateral recurrent nerve palsy and other atypical neurological findings was made. It is practically important to evaluate the presence or absence of vocal cord paralysis in the patients with HMSN from clinical viewpoints.

We encountered two cases of patients who showed vocal cord dysfunction and bronchial asthma. By using an ++astograph , we found that bronchial responsiveness of these ailments differed. In the case of vocal cord dysfunction, bronchial responsiveness to methacholine indicated a false high level by adduction of the vocal cord. Therefore other evaluations including pulmonary function and bronchoscopy were required to distinguish it from bronchial asthma. On the other hand, in the case of bronchial asthma, bronchial responsiveness to methacholine was mild, but life threatening asthmatic attack occurred after inhalation of methacholine. Psychological factors were not neglected in considering both of these cases. Therefore we must consider these results and psychological factors when evaluating bronchial responsiveness.

A 19-year-old psychologically disturbed female was admitted to our hospital because of intractable dyspnea and wheezing for twenty two months. She had been diagnosed as having asthma and had received several medications including steroids before admission to our hospital. According to our clinical observations, she was considered not to have asthma because neither FEV1.0 nor PaO2 was decreased during the periods of wheezing and FEV1.0 was not changed by inhalation of bronchodilators, although she had a family history of allergy and false bronchial hyperreactivity by asthograph. On physical examination, diffuse wheezing was heard mainly over the larynx during inspiration at the times of dyspnea. There was flattening of the inspiratory flow-volume loop during wheezing. Bronchoscopy performed during an attack confirmed that wheezing was due to adduction of the vocal cords throughout the respiratory cycle. Therefore, this case was diagnosed as vocal cord dysfunction. Her symptom was considered to be a form of conversion reaction derived from her unhappy past history. Following psychosomatic therapy, all of her medications became unnecessary. She understood the mind-body relationship of her condition, and learned to achieve self-control.

We investigated the quality of life (QOL) in 72 patients with bronchial asthma who are under our gradational psychosomatic treatment (GPT) by means of an 11-item questionnaire. The results were summarized as follows: 1) Ninety-two percent of the subjects showed a good understanding of mind-body relations and modified their stressful adaptive patterns. 2) Asthmatic symptoms improved in 86 percent of the subjects. Other symptoms also improved in 72 percent of the subjects. 3) In 81 percent of the subjects, their daily life improved. Furthermore 96 percent of the subjects obtained some advantages through GPT. 4) There were various improvements in psychological states, personal relations and life style in most of the subjects. 5) The attitudes of their families toward the patients improved in 46 percent of the subjects, however 71 percent of the families developed a better understanding of the cause of asthma from the psychosomatic point of view. 6) Most of the subjects with moderate or severe symptoms were considered to have reduced the grade of severity of their symptoms from the doctor's standpoint.

Twenty-one patients with active acromegaly and two patients with pituitary gigantism were treated with the long-acting somatostatin analogue octreotide (100-600 micrograms/day, sc, two or three times daily or 300-1500 micrograms daily by intermittent sc infusion) for 9-63 months. There was rapid clinical improvement. The fasting plasma GH levels were significantly suppressed (less than 50% of the values before treatment) in 17 patients and were normalized (less than 5 ng/ml) in 6 patients (27.3%). Plasma IGF-I levels were lowered by 50% and were normalized in 7 out of 18 cases. The effect of octreotide on pituitary tumor size was evaluated in 13 patients. In 4 cases, the shrinkage of the pituitary tumor was detected by computed tomographic scans and/or magnetic resonance imaging studies. The drug was generally well tolerated. However, there were probably newly formed gallstones in two patients during the therapy. Our study suggests that octreotide is an effective and relatively safe new approach for treating active acromegaly and gigantism.

The degree of dyspnea when using metered-dose inhalers (MDIs), and the relationship between subjective self assessments and objective peak expiratory flow rates were examined by means of visual analogue scales and mini wright peak flow meters in 16 subjects with asthma. Three subjects who were neurotic in character were found to have a poor perception of the degree of airway obstruction after inhalation compared with objective changes in their condition. Two subjects, one neurotic and one alexithymic, assessed the degree of dyspnea to be worse after inhalation, when objectively there were few changes. However, one neurotic subject perceived an improvement in his condition when, in fact, there was little change. Furthermore, some severe cases used MDIs in the rogressive state of airway obstruction. In conclusion, we must pay attention to patients' characters when determining treatment in order to prevent overuse of MDIs or delays in treatments including the use of MDIs.

We investigated the use of metered-dose beta agonist inhalers (MDIs) by means of 17-item questionnaires from the standpoint of psychosomatic medicine in 56 subjects with bronchial asthma. The results can be summarized as follows: 1) Many asthmatics with neurotic characters used MDIs frequently; Thirteen percent of them suffered adverse effects. The number of times the inhalers were used increased in proportion to the severity and the duration of illness. Fifteen percent of the subjects used MDIs frequently because of anxiety. 2) Fifty percent of the subjects, most of them had neurotic or alexithymic characters, used MDIs without suffering from dyspnea or wheezes; the subjects who used MDIs because of anxiety increased in proportion to the duration of illness. 3) Seventy eight percent of the subjects were anxious about asthmatic attack when they did not carry any MDI; sixty two percent of the subjects, most of them had neurotic or alexithymic characters, actually experienced asthmatic attack. 4) Seventy three percent of the subjects used MDIs secretly; sixty percent of the subjects did not like to inhale in the presence of others. 5) There were some subjects who acted incorrectly on or after asthmatic attack when MDIs were not effective.

We studied 201Tl myocardial scintigraphy and 99mTc-HSA gated blood pool scan to evaluate the influence of growth hormone on myocardial blood flow and hemodynamics in 16 patients with acromegalies. Contraction properties were almost within normal limit, but cardiac output was in high output state, because left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF) and cardiac output were 47.8 +/- 17.1%, 37.3 +/- 14.9%, and 6.4 +/- 1.7 L/min, respectively. Otherwise, 201Tl myocardial images revealed 62.5% no redistributed hypoperfusion, 18.8% redistributed hypoperfusion, 56.3% myocardial hypertrophy and 25.0% left ventricular enlargement. These data suggested the high incidence of acromegalic cardiomyopathy due to primary or secondary growth hormone effect.

A 37-year-old female with refractory asthma taking betamethasone orally (1 mg/d), showed a fever of 38.5 degrees C, productive cough and dyspnea. The chest X-ray demonstrated diffuse infiltration in the left lower lung field. The WBC count was 16,000/mm3 with 6% eosinophils. She was treated with intravenous drip infusion of antibiotics (Cefotiam 2 mg/d and Sisomicin 150 mg/d) for 2 weeks, and her symptoms and the chest X-ray findings improved. However, at the end of the therapy eosinophilia was noticed. Sixteen days after the completion of antibiotic therapy, she again experienced fever, cough and dyspnea. The chest X-ray again demonstrated diffuse infiltrations in the left lower lung field. The total IgE level, histamine and circulating immune complex titers were elevated. The WBC count was 14,700/mm3 with 34% eosinophils. Although a sputum culture yielded no organisms, many eosinophils were observed in the sputum. There were no clinical or laboratory findings compatible with allergic broncho-pulmonary aspergillosis. After the administration of oral prednisolone (40 mg/d), the patient showed rapid improvement with resolution of all symptoms and normalization of the IgE, histamine and circulating immune complex levels. The chest X-ray revealed marked regression of the pulmonary infiltrations. A microscopic examination of a transbronchial biopsy specimen demonstrated moderate eosinophilic infiltrations. It was compatible with the diagnosis of pulmonary infiltration with eosinophilia. Treatment was performed with prednisolone. The result of a lymphocyte stimulation test was positive for Cefotiam. An in vitro test was performed to evaluate the diagnosis of drug allergy in this case.(ABSTRACT TRUNCATED AT 250 WORDS)