BACKGROUND: Elderly population in Japan was 14.5% of whole population in 1997, it is estimated 27.4% in 2025 and 32.3% in 2050. Average life span in 1995 was 76.8yrs for men, 82.5yrs for women Now Japan can be called by a society of advanced age, so there can be so many economic and welfare problems to be resolved. METHODS: Increasing of the advanced aged and the life span is calling for Japan to take a fundamental countermeasures for aging welfare policy. RESULTS: Aging welfare policy is changed from poor relief and selective one to general and universal one. For example, delivery system of welfare service is changed from one-way service supply system by administration to service utilization system by person with needs. CONCLUSION: The objects for service is focused not only at low income peoples, but also at all members of nation regardless of incomes. And medical health service is also focused not only at treatment of disease before, but also at councelling and care for improvement of health.
Aged ; Aging* ; Female ; Health Services ; Humans ; Japan* ; Male

The authors have experienced a case of neurofibromatosis with pulsating exephthlmos of the left eye of a 15 year old Korean boy. Skull P-A showed wider left orbital cavity and absence of greater and lesser wings of the left aphenoid bone. Pathologic examination was performed with biopsy which was taken fro upper lid of the left eye and conformed neurofibromatosis. The literatures relating to this disease were briafly reviewed.
Adolescent ; Biopsy ; Exophthalmos* ; Humans ; Male ; Neurofibromatoses* ; Orbit ; Skull

The mechanism of vasodilation induced by fentanyl was investigated using isolated rat thoracic aortic rings. Rings were contracted with norepinephrine(10(-7) M, NE) and potassium chloride(40 mM, KC1) with and without endothelium Fentanyl (10(-9)-10(-5) M) produced dose-dependent relaxation and had no significant effect from endothelium(intact and denuded rings, test with 3X10(-4) M LNAME, N-nitro-L-arginine methyl ester). Pretreatment of indomethacin(2.5X10(-3) M, inhibitor of cyclooxygenase) failed to influence of cumulative dose-response curves. RD(50)(50% relaxation dose) and KC1/NE ratio as potency difference of fentanyl, verapamil(10(-8)-10(-5) M, Ca2+ channel blocker), nitroglycerin(10(-10)-10(-5) M, activator of guanylate cyclase) were not similar. Fentanyl and control(distilled water) were not demonstrated any different contraction produced by incremental addition of Ca2+ to aortic rings exposed to Ca2+ free, K+ -depolarized(100 mM KCl) solution(extracellular Ca2+ influx). But fentanyl had effect on intracellular Ca2+ release elicited by caffeine(20 mM) and NE(10(-7) M) indicated by dose-dependent inhibition of contraction in Ca2+ free solution. We conclude that, in rat aorta, fentanyl-induced relaxation is endothelium-independent but mediated by inhibition of alpha-adrenoceptors operated intracellular Ca2+ release (inhibition of contraction by NE) and caffeine-induced Ca2+ release from store.
Animals ; Aorta* ; Endothelium ; Fentanyl* ; Muscle, Smooth* ; Potassium ; Rats* ; Relaxation* ; Vasodilation

BACKGROUND: The mechanisms of pulmonary hypertension(PHT) are usually quite different in acquired disorders of the left side of the heart from those of congenital heart disease. Accordingly, this study was designed to compare pulmonary hemodynamics immediately after cardiopulmonary bypass(CPB) in patients with undergoing repair of atrial(ASD) or ventricular septal defect(VSD) and mitral valve replacement(MVR). METHODS: 49 patients with PHT defined as a resting systolic pulmonary arterial pressure(SPAP) greater than 35 mmHg were studied and were divided preoperatively into two groups; repair of ASD or VSD(Group I, n=18) and MVR(Group II, n=31). Measurements were made after sternotomy and prior to initiation of CPB and upon stabilization following discontinuation of CPB. RESULTS: In group I, SPAP, DPAP and MPAP decreased by 44%, 22% and 35% respectively and pulmonary vascular resistance index(PVRI) decreased by 47% after CPB. In group II, SPAP, DPAP and MPAP revealed 25%, 32% and 29% reduction respectively and PVRI decrease by 39% after CPB. SPAP decreased more significantly after CPB in group I(44% vs 25%, p<0.05). CI increased significantly in group II while decreased in group I. Intraoperative inotropes and vasodilators were used more in group II than in group I(24/31 vs 6/18). CONCLUSIONS: The successful replacement of the valve and patch repair of defect may reduce both PAP and PVRI moderately in patients with PHT.
Heart ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular* ; Hemodynamics* ; Humans ; Hypertension, Pulmonary* ; Mitral Valve* ; Sternotomy ; Vascular Resistance ; Vasodilator Agents

Candida species inhabit the skin and mucous membranes of healthy individuals with low virulence, and osteomyelitis due to candida is very rare. However, the incidence of invasive candidal infection caused by intravenous drug use, broad-spectrum antibiotics, and indwelling central venous catheter is increasing. A 73-year old man visited the outpatient clinic complaining of right shoulder pain that radiated to the right acromioclavicular joint. He had undergone multiple injection procedures followed by nonsteroidal anti-inflammatory drug therapy for several weeks. The ultrasonographic findings showed a heterogeneous mass around the right acromioclavicular joint, while the right shoulder MRI and the overall findings of the body bone scan were suggestive of osteomyelitis. Pathologic findings of ultrasonographically guided joint aspiration fluid showed acute and chronic nonspecific inflammation, while the tissue culture and staining revealed Candida parapsilosis.
Acromioclavicular Joint ; Ambulatory Care Facilities ; Anti-Bacterial Agents ; Arthritis, Infectious ; Candida ; Central Venous Catheters ; Incidence ; Inflammation ; Joints ; Mucous Membrane ; Osteomyelitis ; Shoulder ; Shoulder Joint ; Shoulder Pain ; Skin

No abstract available.
Choledochal Cyst*

OBJECTIVES: Multiple lung cancers and/or precancerous lesions can be developed because many bronchi are exposed to carcinogens simultaneously according to the concept of 'Field Cancerization'. We had performed a careful bronchoscopic examination and analysed the patients of double bronchial lesions who received the separate pathologic evaluation. METHODS: We studied 21 patients of double bronchial lesions among 1855 patients of bronchoscopic examination from April 1990 to December 1993 in Korea Cancer Center Hospital. We classified the patients into three groups(double malignancies of different histology, double malignancies of same histology, and combination of malignant and benign lesions) and analysed the histologic type, location, radiologic findings, and clinical parameters. RESULTS: Among 21 patients, six patients had double malignancies of different histology, eight had double malignancies of same histology, and seven had combination of malignant and benign lesions. Out of 14 double malignant cases, 11 cases are considered as synchronous multiple primary lung cancers. Combination of squamous cell carcinomas was found in 5 cases, combination of small cell carcinoma and squamous cell carcinoma was found in 4 cases. Combination of adenocarcinoma and squamous cell carcinoma and combination of squamous cell carcinoma and poorly differentiated carcinoma were found in 1 case respectively. All patients of synchronous multiple primary lung cancers were male and had long smoking history(average 40 pack years). Among 21 cases of double bronchial lesions, only one lesion could be detected by prebronchoscopic radiologic examination including chest CT in 15 cases. CONCLUSIONS: The presence of double bronchial lesions including multiple primary lung cancers and the limitation of radiologic examination to detect early bronchial lesions encourage us to examine the whole bronchi carefully and to perform pathologic evaluations.
Adenocarcinoma ; Bronchi ; Bronchoscopy ; Carcinogens ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Humans ; Korea ; Lung Neoplasms ; Male ; Smoke ; Smoking ; Tomography, X-Ray Computed

Taxol, an anticancer drug, blocks cell division by stabilizing microtubules. However, taxol has distinct cell-cycle-independent effects. For example, taxol and bacterial LPS induce strikingly similar responses in murine microglial cells. Here, we report that taxol, like LPS, provides a ""second"" signal for murine microglial cell activation to induce tumoricidal activity. Tumoricidal activity determined by MTT assay appeared that taxol or LPS alone weakly activated microglial cells to kill P815 mastocytoma cells, whereas combinations of taxol or LPS with IFN-r synergized to activate macrophages to lyse tumor cells in a dose dependent manner. Secretion of nitric oxide (NO) correlated with tumor cell killing, and the activated microglial cells failed to kill tumor cell targets in the presence of N'-monomethyl-L-arginine (N'MMA), a competitive inhibitor of NO synthase (NOS). Treatment of the cells with anti-TNF-a neutralizing antibodies clearly blocked taxol plus IFN-r induced tumoricidal activity as well as NO production. Collectively, the data illustrate the potential for taxol to activate microglial cell mediated-antitumor mechanisms in addition to its better characterized role as an anti-mitotic agent.
Antibodies, Neutralizing ; Cell Division ; Homicide ; Macrophages ; Mastocytoma ; Microglia ; Microtubules ; Nitric Oxide Synthase ; Nitric Oxide* ; Paclitaxel*

No abstract available.
Animals ; Fibronectins* ; Macrophages* ; Mycobacterium bovis* ; Nitric Oxide Synthase* ; Nitric Oxide* ; Rats* ; Urinary Bladder*

BACKGROUND: Continuous positive airway pressure (CPAP) during spontaneous breathing has contributed greatly to the management of the neonatal respiratory distress syndrome and adult respiratory failure associated with acute lung disease. CPAP systems may be grouped into two general categories, demand flow CPAP system and continuous flow CPAP system. The purpose of this study was to evalute the respiratory effects of continuous flow CPAP system compared with demand flow CPAP system. METHODS: Cardiorespiratory values were measured in twelve respiratory failure patients on demand flow CPAP system and continuous flow CPAP system made by authors. CPAP level and FIO2 were maintained at the same level for both modalities. RESULTS: Changing from demand flow CPAP to continuous flow CPAP was associated with significant decrease in tidal volume(demand flow CPAP 450+/-153.0 ml, continuous flow CPAP 338+/-73.8 ml), airway pressure fluctuation(demand flow CPAP 6.4+/-1.2 cmH2O, continuous flow CPAP 2.4+/-0.7 cmH2O) and improvement in arterial oxygen partial pressure (demand flow CPAP 90.0+/-20.9 mmHg, continuous flow CPAP 105.9+/-24.6 mmHg). There were no significant changes in other cardiorespiratory values, such as arterial blood pressure, heart rate and respiratory rate. CONCLUSIONS: These results suggest that continuous flow CPAP system may be a beneficial modality in the management of respiratory failure patients compared to demand flow CPAP system.
Adult ; Arterial Pressure ; Continuous Positive Airway Pressure ; Heart Rate ; Humans ; Lung Diseases ; Oxygen ; Partial Pressure ; Respiration ; Respiratory Distress Syndrome, Newborn ; Respiratory Insufficiency ; Respiratory Rate