We report two cases of farm chemical poisoning which were treated successfully. Two elderly men separately swallowed down paraquat/diquat solutions in an attempt to kill themselves, and resultantly developed pulmonary fibrosis. After steroid therapy, clinical symptoms desappeared, although a slight degree of abnormality remained on chest X-rays. Case 1: a 57-year-old man; the amount of ingestion, 100 ml; hospitalized 2 hours after ingestion; shock, (-); urinary PQ reactoin, (2); serum PQ level, 1.14 ug/ml; pulmonary injury at first examinatoin, (-); pulmonary manifestation of symptoms, at day 3 after hospitalization; minimum Pao₂, 67.6 mmHg. Case 2: a 65-year-old man; the amount of ingestion, one gulp; hospitalized 27 minutes after ingestion ; shock, (-); urinary PQ reactoin, (3+); serum PQ level, 6.6ug/mg; pulmonary injury at first examination, (-); pulmonary manifestation of symptoms, at day 5 after hospitalization; minimum Pao₂, 58.3mmHg. For treatment, gastrointestinal lavage, forced diuresis and direct hemoperfusion were performed in both cases. Steroid pulse therapy was followed by repeated oral administration of large doses of steroid.
Hepatic and renal disorders were transient. Pao₂ was normal when the patients were discharged. The primary reasons we could save their lives are probably that the amount of PQ ingestion was relatively small, hemodialysis was performed repeatedly at early stages, and that large amounts of steroid were used immediately after the onset of pulmonary fibrosis.

We studied 494 patients with lung cancer who had been treated in our hospital from January 1985 through December 1994. Of the total number of cases, 20.4% were stage I; 4.5%, stage II; 12.1%, stage IIIA; 23.8%, stage IIIB; and 34.3%, stage IV. The 5-year-survival rate of patients with non-small cell lung cancer (NSCLC) was 61.0% in stage I, 43.4% in stage II, 21.2% in stage IIIA, 0% in stage IIIB and 0.9% in stage IV. The 3-year-survival rate and median survival time (MST) of patients with small cell lung cancer was 10.3% and 13.7 months in limited disease, and 0% and 4.8 months in extensive disease.
By histologic type, the 5-year-survival rate of patients with NSCLC was 19.7% in squamous cell carcinoma, 19.5% in adenocarcinoma and 5.3% in large cell carcinoma. The 5-year-survival rate of patients who were discovered by health screening was 39.4%; by subjective symptoms, 9.8%; and during the observation of other diseases, 14.7%. The 5-year-survival rate and MST of the patients with NSCLC treated in the Department of Internal Medicine of our hospital (stage III or IV) from 1985 through 1989, and from 1990 through 1994, were 1.9% and 7.4 months in the former period, and 3.7% and 9.9 months in the latter. Approximately 75% of the cases of lung cancer treated in our hospital were stage III or IV disease, and prognosis was very poor. Therefore, prevention and detection in the early stage of lung cancer are important.

A 48-year-old man was readmitted to the hospital because of severe intraventricular conduction defects (QRS duration was 0.30 sec). The patient had been given pilsicainide hydrochloride (150 mg/day) prior to the hospitalization. The blood tests revealed that the concentration of pilsicainide was 3.30 μg/ml, which was several times higher than the average value in patients given in a dosage of 150 mg per day. Five months before the second admission, impaired left ventricular (LV) myocardial function and paroxymal atrial fibrillation were observed in the patient. His illness was diagnosed as myotonic dystrophy as the patient presented with skeletal muscle atrophy, premature frontal baldness, hatchet face, cataract, and testicular atrophy. The trial of remedication with pilsicainide in the same dosage for seven days did not produce the toxic effects as seen previously. Both load-dependent LV dysfunction in myotonic muscular dystrophy and moderately impaired renal function in the patient probably underlay the state of intoxication.

We examined the clinical features, 12-leads ECG, Holter ECG, monitor ECG, and electrophysiologic study (EPS) in nine consecutive paroxysmal atrioventricular block (PAVB) patients treated in our hospital between 1995 and 2000. In some of them, parasympathetic nerve stimulating maneuvers, drug administration and head-up tilt test (HUT) were performed as provocative tests. EPS documented that the sites of AV block were within the His-Purkinje system (H-PSB) in five patients, proximal to the His bundle potential (AHB) in three patients. In the remaining one patient, the His bundle potential was not recorded. The main features of the patients with H-PSB were as follows: 1) often wide QRS complex with or without axis deviation; 2) variable degrees of AV conduction disturbance in a short period; 3) sinus tachycardia, and normal length and constant PQ intervals in a daytime being apt to precede PAVB; 4) rather long ventricular asystoles leading to abrupt syncope; 5) easy induction of the block by intravenousadministration of atropine. In the other hand, the features of the patients with AHB included: 1) narrow QRS; 2) progressively increasing or decreasing in PQ intervals preceding PAVB; 3) ventricular asystole lasting about 3 to 10 seconds; 4) the failure to induce PAVB by any probale provocative tests.
Although we treated all the patients with permanent pacemakers, there might have been other management method for AHB patients who had about 3-second ventricular asystole.

A case of 65-year-old man of aorto-caval fistula induced by ruptured abdominal aortic aneurysm is reported. The symptoms were hematuria and chest pain, and an emergent operation was performed. In the operation, Fogarty's balloon occlusion catheter was used to reduce bleeding from inferior vena cava, and to prevent pulmonary embolism. The fistula was 3cm in size, and abdominal aorta was replaced with a low porosity polyester Y-graft. The symptoms of pulmonary congestion and hematuria were improved after operation. The balloon occlusion catheter was effective for reducing bleeding from IVC, and prevention from pulmonary embolism after operation.

A 73-year-old man was admitted to the hospital on March 31, 2000 because of nonsustained ventricular tachycardia (VT). In 1983, he was diagnosed as having apical hypertrophic cardiomyopathy (APH). Electrocardiograms showed high amplitude of R waves and giant negative T waves (GNT), and left ventriculography (LVG) revealed spade like configuration. He stopped medication without leave six months after the diagnosis. The latest ECG showed a decrease in amplitude of R waves, no signs of GNT, ST elevation in precordial leads, and an increase in QRS duration. LVG demonstrated midventricular obstruction, apical aneurysm, and the intraventricular pressure gradient in systolic phase was 56 mm Hg. No stenotic lesion was observed in coronary arteriography. Early diastolic paradoxic flow from the apical chamber toward the outflow of the left ventricle was detected by pulsed Doppler echocardiography. VT was successfully treated with beta-blocker and amiodarone, but he needed hospital treatment again one month later because of congestive heart failure. During the follow-up of APH, the decrease in amplitude of R waves and disappeasance of GNT, ST elevation, and the increase in QRS duration in electrocardiograms, and the detection of early diastolic paradoxic flow by echocardiography could be the predictors of developing apical aneurysm and/or left ventricular dysfunction.

Background: We evaluated decreases in glycosylated hemoglobin (HbA1c) achieved by reducing carbohydrate from various sources in type 2 diabetes mellitus patients. Methods: We followed up 138 male and 107 female outpatients on a moderate low-carbohydrate diet without diabetic medication for 6 months. Changes in carbohydrate sources (Δcarbohydrate) were assessed from 3-day dietary records at baseline and 6 months, and associations with changes in HbA1c (ΔHbA1c) were examined with Spearman’s correlation coefficients (rs) and multiple regression analysis. Results: ΔHbA1c was –1.5%±1.6% in men and –0.9%±1.3% in women, while Δtotal carbohydrate was –115.3±103.7 g/day in men and –63.6±71.1 g/day in women. Positive associations with ΔHbA1c were found for Δtotal carbohydrate (rs =0.584), Δcarbohydrate from soft drinks (0.368), confectionery (0.361), rice (0.325), bread (0.221), Chinese soup noodles (0.199) in men, and Δtotal carbohydrate (0.547) and Δcarbohydrate from rice (0.376) and confectionery (0.195) in women. Reducing carbohydrate sources by 50 g achieved decreases in HbA1c of 0.43% for total carbohydrate, 1.33% for soft drinks, 0.88% for confectionery, 0.63% for bread, 0.82% for Chinese soup noodles and 0.34% for rice in men and 0.45% for total carbohydrate, 0.67% for confectionery and 0.34% for rice in women, although mean reductions in carbohydrate from these sources were much smaller than that from rice. Conclusion Decreases in HbA1c achieved by reducing carbohydrate from soft drinks, confectionery, bread and Chinese soup noodles were 2- to 4-fold greater than that for rice. Our results will enable patients to decrease HbA1c efficiently (UMIN000009866).

We evaluated decreases in glycosylated hemoglobin (HbA1c) achieved by reducing carbohydrate from various sources in type 2 diabetes mellitus patients.

We evaluated decreases in glycosylated hemoglobin (HbA1c) achieved by reducing carbohydrate from various sources in type 2 diabetes mellitus patients.