Fifty cases of spontaneous pneumothorax treated in our hospital between 1988 and 1993 were reviewed. Forty-three cases were males and 7 cases were females. Treatments were broken down into rest cure for 11 cases and chest tube drainage for 39 cases. Of the chest tube drainage therapy cases, 30 could attained complete remission, but the remaining 9 cases required thoracotomy. In either case, the recurrence rates after the first pneumothorax and second attacks were 39% and 36%, respectively.
Stature and roentgenologically determined lung sizes were also examined in 34 male patients with spontaneous pneumothorax in comparison with those of 30 healthy men, who were age-matched control subjects. Among the significant findings was that the patients were much taller than the controls. The lungs were also significantly elevated in the patients compared with those of the controls. These results indicate that the patients liable to spontaneous pneumothorax are tall with their lungs housed high in the thorax compared to the ordinary people.

Prognostic facfors were examined in 71 patients receiving home oxygen therapy under the direction of our hospital between 1984 and 1994. In 25 patients who had undergone right catheterization, relationships between pulmonary hemodynamics and prognosis were also discussed. Mean pulmonary arterial pressure (P_PA) were correlated negatively with PaO₂. This indicated that hypoxic pulmonary vasoconstriction was the major cause of pulmonary hypertention in these patients. Pulmonary hypertention was revealed in 80% of the patients with P_PA ≥20 Torr and in 52% of the patients with P_PA ≥25 Torr. Acute hemodynamic effects of low-flow oxygen administration were investigated in 17 patients. PPA decreased significantly from 25.5 Torr to 23.5 Torr after oxygen administration and pulmonary arteriolar resistance (PAR) decreased from 243 dynes ·ses ·cm^-5 to 225 dynes·sec·cm^-5, but this change was not significant.
In patients with pulmonary fibrosis and sequelae of tuberculosis, the survival rates were lower than that of the patients with pulmonary emphysema. The median survival time (MST) for patients with cor pulmonale was significantly lower than that for those without cor pulmonale. When background factors were compared between the group with % home stay≥90% and % home stay<90%, there were no significant differences in observation periods, arterial blood gases and spirometry. The factors influencing % home stay were considered to be an important subject in addition to improving the survival rate.

Y-graft replacement was successfully performed in a patient aged 93 years with ruptured infrarenal abdominal aortic aneurysm. The patient was in shock on arrival and underwent an emergency operation with the administration of cathecholamines. The ruptured infrarenal abdominal aortic aneurysm with a large hematoma, which was located in the area of the left common iliac artery, was 10cm in the maximum diameter. The bilateral common iliac arteries were strongly calcified and occluded. The distal end of the graft was anastomosed to the external iliac artery. The patient's postoperative course was uneventful.

We reported nine cases of metastatic skin carcinoma experienced at the Department of Dermatology, Obihiro Kosei Hospital during the period from April 1991 to March 1993. Lung was the most common primary lesion (four out of nine cases), followed by uterus (two) and stomach, breast, and kidney (one each). The clinical features of the metastases were classified into nodular (five cases), inflammatory (one case) and sclerotic (three cases) types. Peculiar zoster-like inflammation was seen in metastatic gastric cancer. Pathologically, adenocarcinoma was more common than squamous cell carcinoma. The average interval between the diagnosis of the primary cancers and the development of the skin metastases was about 30±25 months. The average life span after the detection of the skin metastases was 6.8±5.6 months. Poor prognosis of skin metastasis was thus reconfirmed.

OBJECTIVETo clarify the seasonal differences of the trace element excretion in sweat, the trace element concentration in sweat and their loss during exercise were compared between summer and winter.

METHODSSweat samples were collected from ten healthy adult males. Bicycle ergometer exercise was conducted by each subject at a heart rate of 140 beats/min for 1 hour, in summer and in winter. Sweat was collected by the arm bag method.

RESULTSConcentrations of major (Na, K, Ca, and Mg) and trace elements (Zn, Cu, Fe, Ni, Mn, and Cr) in sweat tended to be lower in summer than in winter, and significantly lower concentrations of Mg (p<0.01), Na, Cu, and Mn (p<0.05) were found in summer. The sweat volume in summer (0.90 L) was 1.7-fold larger than that in winter (0.52 L) (p<0.01). The amount of loss of each element to sweat calculated from the concentrations in sweat and sweat volume showed no significant difference between summer and winter.

CONCLUSIONSIt is suggested that there was no significant difference in the amount of loss of trace elements in sweat due to exercise between summer and winter.

BACKGROUND/AIMS: Autoimmune pancreatitis (AIP) is frequently associated with diabetes mellitus (DM). This study evaluated the effect of steroid therapy on the course of DM in AIP. METHODS: Glucose tolerance was examined in 69 patients with AIP. DM onset was classified as either a simultaneous onset with AIP or an exacerbation of pre-existing DM. Based on the changes in the HbA1c levels and insulin dose, the responses of DM to steroids were classified as improved, no change, or worsened. RESULTS: Thirty (46%) patients were diagnosed as having DM (simultaneous onset, n=17; pre-existing, n=13). Three months after starting the steroid treatment, the DM improved in 13 (54%) of 24 DM patients. The DM improved in 55%, had no change in 36%, and worsened in 9% of the 11 simultaneous onset DM patients, and it improved in 54%, had no change in 31%, and worsened in 15% of the 13 pre-existing DM patients. At approximately 3 years after starting the steroid treatment, the DM improved in 10 (63%) of 16 patients. The pancreatic exocrine function improved in parallel with the changes in the DM in seven patients. CONCLUSIONS: Because approximately 60% of DM associated with AIP is responsive to steroids in the short- and long-terms, marked DM associated with AIP appears to be an indication for steroid therapy.
Diabetes Mellitus ; Glucose ; Humans ; Insulin ; Pancreatitis ; Steroids

Objective: The purposes of this trial were to demonstrate the feasibility and effectiveness of the hybrid of intracavitary and interstitial brachytherapy (HBT) for locally advanced cervical cancer patients in the phase I/II prospective clinical trial. Methods: Patients with FIGO stage IB2-IVA uterine cervical cancer pretreatment width of which was ≥5 cm measured by magnetic resonance imaging were eligible for this clinical trial. The protocol therapy included 30–30.6 Gy in 15–17 fractions of whole pelvic radiotherapy concurrent with weekly CDDP, followed by 24 Gy in 4 fractions of HBT and pelvic radiotherapy with a central shield up to 50–50.4 Gy in 25–28 fractions. The primary endpoint of phase II part was 2-year pelvic progression-free survival (PPFS) rate higher than historical control of 64%. Results: Between October 2015 and October 2019, 73 patients were enrolled in the initial registration and 52 patients proceeded to the secondary registration. With the median follow-up period of 37.3 months (range, 13.9–52.9 months), the 2- PPFS was 80.7% (90% confidence interval [CI]=69.7%–88%). Because the lower range of 90% CI of 2-year PPFS was 69.7%, which was higher than the historical control ICBT data of 64%, therefore, the primary endpoint of this study was met. Conclusion The effectiveness of HBT were demonstrated by a prospective clinical study. Because the dose goal determined in the protocol was lower than 85 Gy, there is room in improvement for local control. A higher dose might have been needed for tumors with poor responses.