Autoantibodies to IL-1 alpha in sera from rapidly progressive idiopathic pulmonary fibrosis.

To clarify the clinical significance of autoantibodies to interleukin-1 alpha (IL-1 alpha autoantibodies) in rapidly progressive idiopathic pulmonary fibrosis (IPF), we measured the level of IL-1 alpha autoantibodies in serum of 11 patients on the first hospital day, when patients were admitted due to severe symptoms, and on the 21st hospital day. IL-1 alpha autoantibodies in serum were measured using radioimmunoassay, and the limitation of this assay for IL-1 alpha autoantibodies was 5 ng/ml. These antibodies were detected in 5 of 11 patients on the first hospital day. On the 21st hospital day, these antibodies were detected in all patients, and its level was increased compared with that on the first hospital day. IL-1 alpha autoantibodies that appeared in patients corresponded to that of IgG. The half life of exogenous autoantibodies was investigated following administration of autoantibody rich plasma obtained from healthy blood donors to 6 control patients (CP) and 6 progressive IPF patients. These autoantibody levels in their serum were less than 5 ng/ml before administration. Serum was obtained at the indicated time after administration of IL-1 alpha autoantibodies and the level of these autoantibodies in serum was measured, then the half life was calculated. Half life of exogenous IL-1 alpha autoantibodies in progressive IPF patients was significantly shorter than that in CP (71.3 +/- 31.8 hr vs 352.0 +/- 98.3 hr, p < 0.01). These findings suggested that IL-1 alpha autoantibodies were generated in response to the inflammatory process of rapidly progressive IPF and may act as a regulatory factor for IL-1 alpha.

[Cooperative medical care by physicians of general hospitals and psychiatrists of an alcoholism treatment unit in Mie Prefecture].

Clinical practice of psychiatric liaison with physicians is the first step for an early treatment of alcohol dependence. Screening patients with alcohol dependence in general hospitals, carrying out intervention, and referring them to psychiatric specialists are running smoothly by the cooperation of member of the Mie Association for the Study of Alcohol-related Diseases. This association is being conducted by managers constituted of doctors, nurses, and medical social workers and the meeting is held every 6 months at district general hospitals to achieve three objectives; 1) evoking a sense of responsibility for alcoholic patients in the mind of general hospital staffs, 2) developing a network for psychiatric liaison with physicians to care patients of their alcohol dependence, and 3) keeping up activities of the association. We have already held the regular meeting 12 times, and prepared pamphlets for screening alcohol misuse and for early intervention. A course for learning skills of early intervention in this summer won the favor of participants. Through case conference of alcoholism and full accounts of the experiences given by recovered patients or their families, meeting attendants know patients' distress, families' sorrow, and their delight brought by the recovery, and are motivated to assist patients with alcohol dependence. Thus, "Spirit to Spirit" is a keyword to develop a network of the cooperative medical care for supporting patients with alcohol dependence. Referral of alcoholic patients to psychiatrists and/or psychiatric liaison therapy is promoted by a reliable, faithful, and face to face relationship between physicians and psychiatrists. Physicians' learning the skill for early intervention in alcohol dependence is followed by an increase in referral of patients to psychiatrists, and which suggests the importance of providing teaching and training of medical care for alcohol dependence to medical staffs including doctors of emergency care units, orthopedics, obstetrics, and dentistry. Therefore, systematic tools for screening alcohol dependence in general practice, and for referring patients to psychiatrics after brief intervention are needed to be prepared under the leadership of a learned society. Popularizing the skill of brief intervention in general medical practice is also indispensable for advising alcoholic patients about changing their drinking pattern or abstinence.

[The prevention and measures to complication of video-assisted thoracoscopic surgery for lung cancer patients].

Video-assisted thoracoscopic surgery (VATS) for patient with lung cancer is seemed to be more genetic in future. It is because of small wound, little ache and short hospitalization. However, dissection of lymph-nodes is necessary since it is lung cancer. Because the thoracoscopic lobectomy is performed in the limited space, troubles those we cannot predict can happen. So surgical techniques of to prevent troubles are important. And this is the first step to avoid postoperative complication. It is necessary that to grasps a state of the patient and not to leave perioperative troubles.

CCU network as primary care of acute myocardial infarction.

The early pre-hospital care of patients with acute myocardial infarction (AMI) is critical because of high mortality during acute phase of AMI. A CCU network has been established by the Metropolitan Tokyo CCU Communication Society and the help of the Ambulance Units through the Control Room of the Tokyo Fire Department, performing ECG telephone line transmission and telephone consultation. Out of 1439 patients admitted by means of CCU network during the 8-month period (Jan. 1982-Aug. 1982), 505 (30.3 percent) had AMI as a final cardiac diagnosis. Many patients were admitted directly to the CCU by ambulance from the place where the patient was located, with the shortest overall time of 7 hours 25 minutes. Fifty-three percent of patients with AMI were admitted within 6 hours after the onset of symptoms. The mean patients' decision time was 9 hours 48 minutes, which comprised one half of the overall period as well as physician delay of 6 hours 36 minutes on the average. Thus, community oriented educational programs to more fully inform the population and individual hospital evaluations to hospitalize patients with chest discomfort are needed in order to shorten the decision time and physician delay expediting the care of these patients.

Combination of epidural morphine and fentanyl for postoperative analgesia.

The rapid onset of epidural fentanyl could be used to cover the latency period of epidural morphine, thus potentiating analgesia during anesthesia regression after short-acting local anesthetics and possibly extending morphine analgesia for longer duration. The object of this study is to determine whether there are clinical advantages or disadvantages of combining epidural morphine and epidural fentanyl for postoperative analgesia. Patients scheduled for gynecologic procedures were assigned to two groups (n = 54 for each): Group 1 receiving 4 mg epidural morphine, and Group 2 receiving 4 mg epidural morphine and 100 micrograms fentanyl 30 minutes before the estimated completion of the surgery using lidocaine epidural anesthesia. Comparisons were made with regard to: (1) times before the first supplemental analgesic for incisional pain, (2) numbers of supplemental analgesic during the first 48 hours postoperatively, and (3) adverse effects. The two groups were comparable. The number of patients requiring supplemental analgesics between the fourth and 17th hours was significantly greater in Group 1 (n = 10, compared to n = 0 for Group 2; p less than 0.05). The mean time before the first supplemental analgesic was significantly longer in Group 2 (p less than 0.05). The number of supplemental analgesics during the first 48 hours was significantly less in Group 2 (p less than 0.01). No significant difference was found regarding adverse side effects. The results obtained confirm the potential desirability of combining epidural morphine and epidural fentanyl for postoperative analgesia.