Radical changes were made last year in the educational program of liberal arts at Juntendo University School of Medicine. The number of required courses was decreased, and students were given more freedom to choose electives. A survey at the end of the first semester evaluating the reforms showed great satisfaction on both sides: students were highly motivated to study, and the teachers were ready to answer their needs.

We studied the effect of bath products consisting of sodium bicarbonate and sodium sulfate on living subjects when these products are used with herbal ginseng extract as a trial for a new bath product; changes in dynamic circulation were used as indicators.
Experiments were conducted from December 1990 to February 1991 on 20 subjects consisting of healthy male adults (35.6±8.9 years).
Two types of bath products were used. One consists of sodium bicarbonate and sodium sulfate and the other was the combination of the former with ginseng extracted by alcohol. Twenty five grams of each product was dissolved in 200 liters of water.
As indicators of dynamic circulation, skin surface temperature on thorax, abdomen, dorsal side of hand and dorsum of foot, volume of blood flow in leg skin (on tibia), deep body temperature in frontal region and right calf, electrocardiograph, blood pressure, and the volume of the pulsewave in the right index finger and big toe were measured. After the experiment, each subject's opinion was gathered through a questionnaire.
The experiment was performed in an air conditioned room (26°C and 50% humidity) with bathing at 41°C for 10 minutes. The value of each indicator was measured before bathing and 15, 30, 45, and 60min after bathing.
Although no significant differences in measured values were found between the two kinds of bathing, we observed faster decrease in skin temperature and faster lowering of blood flow rate in the ginseng bath group as compared with the control group. We also noted a decreased difference in pulsewave height between upper and lower extremities after bathing in the ginseng bath group, but not in the control group. This response was observed solely in the ginseng bath group because a significant increase in pulsewave height occurred in the big toe while no increase is observed in the fingers in contrast to the control group.
Faster decrease in blood flow rate in the skin and increase in pulsewave height caused by the exposure to the same temperature imply increased heat conducting distance and interruption of heat transfer from deep areas to the skin. We therefore conclude that ginseng bathing is effective in keeping the body warm. The results of inquiries after bathing indicated that many subjects felt that ginseng bathing tended to warm their bodies.
As a result of using ginseng extracted by alcohol with bath products consisting of sodium bicarbonate and sodium sulfate, differences in peripheral vessel resistance between extremities tended to decrease after bathing. We consider that this is due to the improved general circulation throughout the whole body.

Hereditary spherocytosis (HS) is a condition characterized by jaundice, hepato-splenomegaly tumors, and the presence of spherocytes. It accounts for about 70% of the reported cases of congenital hemolytic anemia in Japan. Many researchers state that this pathologic condition primarily arises from an abnormality of the red blood cell membrane. We have encountered a familiy, all the members (23-year-old daughter, 20-year-old son, 53-year-old-father, and 46-year-old-mother) of which had their cases diagnosed as HS by peripheral blood examination and electron microscopy. Excluding the farher, the peripheral blood examination also revealed anemia in the other family members. Moreover, the common HLA was found in all the members of these two families including the one on the mother's side, but human parvovirus B19 was not detected at all. We are providing the socalledprophylactic visiting care for the two families, while giving them information about HS which is arelatively easily-misunderstood hereditary disease. We did not find any report about married coupleswith hereditary spherocythosis. In this paper, we report our findings so far obtained through visiting care with some bibliographic discussion on HS.

Telomerase has been reported to increase its activity in more than 80% of human pulmonary cancer tissue samples, thus potentially contributing to cancer diagnosis. This led us to try the measurement of telomerase activity in bronchoalveolar lavage fluid in cases clinically suspected to be primary pulmonary cancer. Methodologically, the measurement was made by means of TRAP (telometric repeat amplification protocol) assay, a high-sensitivity assay system using the technique known as polymerase chain reaction (PCR). The resultsshowed that telomerase activity in all the 6 cases, diagnosed as primary lung cancer histologically, was positive. On the other hand, on cytologic examination, 4 out of these 6 cases were positive, and the remaining 2 cases (squamous cell carcinoma and adenocarcinoma) were negative. Histologic examination revealed that of these 4 cases, 2 and 2 were pulmonary cancers and pulmonary tuberculoses, respectively. The above results suggested that examination of telomerase activity in bronchoalveolar lavage fluid may be useful for cancer diagnosis clinically.

During the one-year period from April 1992 through March 1993, we measured 25, 498 blood samples by the use of a sequential multichannel autoanalyzer, which our hospital installed in August 1991. Of the total, 4, 707 samples were thoroughly examined under the microscope. They included those from the patients for which physicians indicated laboratory testing, those samples whose white cell counts were less than 3, 000/μlor more than 10, 000/μl, the cases in which the amount of hemoglobin was less than 10.0g/dl, and the samples which defied blood typing. The result was that three cases of myelodysplastic syndrome were detected, although the autoanalyzer failed to find any abnormalities in these three cases.
Laboratory technicians in hospital are so busy that they hardly have time enough for thoroughgoing examination of hemogram. Nevertheless, the recent experience has brought home to us the importance of a microscopic scrutiny, into hemogram and its application to diagnosis.

With the diagnosis of metastatic tumor of the lung suspected, we had a chance to experience a histopathological case of carcinoma of the uterine cervix (adenoid squamous cell carcinoma), which was thought to coexist with carcinoid tumor. In this paper, we report the results of cytological as well as histological examinations of the case.
The patient was as 43-year-old woman. She visited our hospital, complaining about abnormally prolonged uterine bleeding (metrorrhagia). Cytodiagnosis was performed with a Papanicolaou smear. A microscopic examination revealed squamous cell carcinoma occurring together with adenocarcinoma. A similar finding was obtained by cervical biopsy. Thus, the case was diagnosed as adenoid squamous cell carcinoma.
Then the patient underwent radical hysterectomy and lymphadenectomy, followed by chemotherapy. After leaving the hospital, she was put under doctor-monitored observation. About 4 years after the surgery, a chest x-ray examination found abnormal shadows. For inspection, bronchoscopy was performed. Carcinoid of the lung was diagnosed through histopathological as well as electron microscopic examination of specimens taken from bronchial polyps during bronchoscopy. At the same time a cytologic study was conducted. It also revealed neoplasms strongly suspected of caricinoid tumors. Retrospective studies of cytological and histopathological images of the uterine cervix when the patient first visited us found only adenocarcinoma and squamous cell carcinoma, but no signs of carcinoid tumors. However, the immunohistological staining of NSE and chromoganins A, both neuroendocrine markers, showed positive findings in some adenocarcinomatous parts of the tissues of the unterine cervix. Therefore, we considered that the cervical cancer is compounded of adenoid squamous cell carcinomas and tumors having properties of neuroendocrine cells.
From this, we concluded that it is necessary to take into account a differential diagnosis of neuroendocrine tumors including carcinoid of the uterine cervix when less differentiated adenocarcinoma and squamous cell carcinoma are suspected in histological and cytological examinations. Furthermore, we thought it important to make a definite diagnosis after meticulous examinations by immunohistological staining and electron microscopy.

With household digital compact wrist blood pressure monitors, blood pressure was measured in hemiplegic patients who were receiving kinesitherapy.
During the training program routinely worked out by physical therapists, most patients had shown elevated levels of both systolic and diastolic blood pressure. There were some patients whose blood pressure went up so high as to call doctors' attention.
As changes in blood pressure are affected by various factors, we cannot say at once that doing exercise alone adds to blood pressure. Nonetheless, by using a household blood pressure monitor, it would be easy to know the extent to which blood pressure rises in accordance with the amount of exercise, so that it would be possible to make patients and their family aware of the importance of blood pressure readings. We thought it possible to obtain an index of the amount of exercise at home.

Since the discovery of the first strain in 1961 in England, MRSA, the most notorious multidrug-resistant hospital pathogen, has spread all over the world. MRSA repeatedly turned down the challenges by number of chemotherapeutics, the fruits of modern organic chemistry. Now, we are in short of effective therapeutic agents against MRSA prevailing among immuno-compromised patients in the hospital. On top of this, we recently became aware of the rise of diverse clones of MRSA, some of which have increased pathogenic potential compared to the classical hospital-associated MRSA, and the others from veterinary sources. They increased rapidly in the community, and started menacing otherwise healthy individuals by causing unexpected acute infection. This review is intended to provide a whole picture of MRSA based on its genetic makeup as a versatile pathogen and our tenacious colonizer.
Adenosine ; Chemistry, Organic ; Chromatography, Micellar Electrokinetic Capillary ; Clone Cells ; Colon ; England ; Fruit ; Humans ; Methicillin ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Sprains and Strains ; Staphylococcus ; Staphylococcus aureus

Fecal microbiota transplantation (FMT) has been reported as a safe and effective therapy in patients with refractory and recurrent Clostridium difficile infection (CDI). FMT has also been reported as a promising therapy in patients with ulcerative colitis (UC). Both, CDI and UC, are believed to be caused by dysbiosis, such as altered compositions or decreased diversity of the intestinal microbiota. This report describes a patient with UC in remission with a second recurrent episode of CDI, who was treated with FMT. A single FMT performed via colonoscopy completely resolved the patient's diarrhea and eradicated C. difficile bacteriologically without any severe complications. Molecular biological analysis of the patient's fecal microbiota showed that FMT could dramatically change the altered composition of intestinal microbiota and restore its diversity. Despite the restoration of the intestinal microbiota, FMT could not prevent a relapse of UC in this patient. However, it improved the intestinal symptoms of CDI and could prevent further recurrences of CDI.
Clostridium difficile ; Clostridium ; Colitis, Ulcerative ; Colonoscopy ; Diarrhea ; Dysbiosis ; Fecal Microbiota Transplantation ; Gastrointestinal Microbiome ; Humans ; Microbiota ; Recurrence ; Ulcer