[Transition of branched-chain amino acids and tyrosine ratio (BTR) in the blood of acute hepatitis patients].

The molar ratio of branched-chain amino acids to tyrosine (BTR) correlates well with the Fischer ratio, and can be measured in a short period of time. It is regarded as the method of analysis that will eventually replace the Fischer ratio. But clinical significance of BTR in terms of acute liver disorders has not been examined thoroughly as of yet. In this study, we measured BTR of 34 patients with acute hepatitis, and examined the transition of the acute period of acute hepatitis and its recovery process. Thirty-four patients diagnosed with acute viral hepatitis became subjects of examination (16 patients of A type, 15 patients of B type, 1 patient of C type, 2 patients of non-A, non-B, non-C type). Out of the 34 patients, 11 were in serious stages (HPT under 40%), including 3 in fulminant condition. By using preserved serum obtained during the acute period (within 1 week of the highest transaminase value), recovery period (within 4 weeks), and treatment period (3 months and later), measurements were conducted with Diacolor:BTR (enzymatic analysis, ONO Pharmaceutical Co., Ltd.), and the results were compared with those of 50 healthy subjects (25 men, 25 women). BTR correlated well with the Fischer ratio for chronic hepatic patients, and with albumin (Alb), PT, and ICGR15 as well, proving that it is useful as an indicator of hepatic reserve ability. But BTR has not been thoroughly examined as it relates to acute liver disorders. In this study, BTR fell in the acute period, correlating with the serious period, proving that it is a useful indicator. For acute liver damage, BTR supports conventional indicators (Alb, Ch-E, HGF, etc.) for assessing serious damage. Also, it has been suggested that measuring the passage of BTR could be the indicator of true recovery, including amino acid metabolism for liver disorders.

[Proper use of laboratory tests from a perspective of health insurance administration].

The national medical expenditure increases at a rate of 1 trillion yen a year, and the expenditure for 1992 is estimated to be about 23 trillion yen. One of the most important jobs of the Health Insurance Administration is to control the medical expenditure. Every time the medical fee is amended, laboratory tests are always the target of the cost containment. In the past, the biochemical tests have been separated into the cost for performance of test, and the cost for assessment of the results, the cost of tests for specific diseases has been comprised, or fixed, and the fee of EKG, EEG, Echo etc after the first has been forced to be reduced. These are all administrative policies, but ultimately, they must be selected properly by the physician who requests these tests. In the future, a system should be established which enables the physician to efficiently (cost-efficiently) select the most appropriate test. For this purpose, undergraduates and post-graduates should learn the concepts of clinical epidemiology and clinical economics. These academic disciplines should be incorporated to increase the value of the treatment. Furthermore, the physician should be given economical incentive of proper use of medical resources.

Cost-effectiveness analysis of mass screening for breast cancer in Japan.

The official Japanese recommendation for breast cancer screening is physical examination by a physician, in contrast to US recommendations of mammography. In this analysis of breast cancer screening, the authors used Japanese data in a cost-effectiveness model to compare the following five strategies: (1) no screening (N); (2) physical examination alone (PE); (3) mammography (MG); (4) PE followed by MG if PE findings were abnormal (PE----MG); and (5) PE combined with MG for all screened women (PE + MG). None of these programs would save medical expenditures. The total discounted net costs per patient (in US dollars) were as follows: N, +54; PE, +412; MG, +517; PE----MG, +340; and PE + MG, +731. The number of years of life saved per cohort of 100,000 asymptomatic Japanese women would range from 708 (PE----MG) to 3724 (PG + MG). The additional cost of each strategy (compared with N) per additional year of life would be +49,700 for PE, +40,400 for PE----MG, +14,300 for MG, and +18,000 for PE + MG. The least costly screening option (PE----MG) does not have the lowest cost per additional year of life saved (MG does). MG would be preferable to the current Japanese recommendation of PE alone.

[Amygdaloid kindling in weanling rat and rekindling upon maturization].

To understand the epileptic phenomenon in the immature brain and to investigate whether or not the epileptogenesis acquired in young age is retained after maturation, we carried out the amygdaloid kindling preparation (AM-K) on rat. Ten 3-week-old Wistar rats (3-week-old group) and ten 10-week-old rats (10-week-old group) were stimulated every 2 hours during 09:00-17:00, from five days after operation (Experiment 1). Nine kindled weanling rats (K-group) and ten weanling rats with no stimulation only electrodes implantation (non-K-group) were rekindled upon maturization (Experiment II). Stages of AM-K were classified according to the criteria of Racine. The results obtained were as follows: 1) The 3-week-old group needed significantly fewer stimulations and a shorter AD-durations during early stages (C0-2) of amygdaloid kindling, in comparison with the 10-week-old group. However, there was no significant difference between the two groups as to stimulations and AD-duration during later stages (C3-4) of the kindling. 2) The K-group were rekindled significantly fewer stimulations and a shorter AD-durations than non-K group during early stages. On the other hand, there was not significant difference between the two groups as to stimulation and AD-duration during later stages of the kindling. From the results, the following conclusions were made; The seizure susceptibility of weanling rat's limbic system is high and the epileptogenesis in the limbic system can be maintained even up to adulthood.