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The efficacy and safety of degarelix, a luteinizing hormone-releasing hormone(LH-RH)antagonist, in patients with prostate cancer(PCa)were evaluated in a phase II, open-label, multicenter clinical trial. In this trial, a total of 13 patients were accrued at the Yamagata Prefectural Central Hospital from 2007 to 2008. The median age was 80 years(range, 65-85 years), and clinical stages were T1c, T2, T3, and T4 in 1, 4, 6, and 2 patients, respectively. Nodal(N)status was N0 in 9 patients and N1 in 4 patients. Distant metastases were absent(M0)in 12 patients and present(M1b)in 1 patient. The median prostate- specific antigen(PSA)level was 29.1 ng/mL(range, 6.3-427 ng/mL). All but one patient, who died of an unrelated cause, received a monthly dose(80 or 160mg)of degarelix for 12 months and were followed-up for 3 years. The PSA level declined in all patients. One patient died of an unrelated cause during the phase II trial. After completion of the phase II trial, 5 patients were treated with combined and rogen blockade(CAB)(leuprolide plus anti-androgen therapy), 2 patients were treated with single-agent leuprolide, 2 patients received single-agent bicalutamide, and 1 patient was followed-up without additional treatment. Radical prostatectomy was performed in 2 patients. Among the 5 patients treated with CAB, 2 died of metastatic cancer. CAB was effective in suppressing PSA levels in 3 patients. In 1 patient with T3aN1M1b PCa, colon cancer with lung metastases was detected during the follow-up period. Treatment with chemotherapy for colon cancer was effective in suppressing PSA levels for 12 months. In 1 patient with cT3aN1M0 PCa, the PSA level declined to <0.02 ng/mL, and a reduction in size of the prostate gland and metastatic lymph nodes was observed. This effect persisted for 3.5 years after the completion of the 12-month degarelix regimen, and no additional treatment was required.

To clarify the efficacy and indication of hepatectomy in gastric cancer metastasis to the liver, we studied 26 liver metastases patients undergoing hepatectomy. The cumulative 5-year survival rations were 25.3%. A survival analysis showed that prognoses of patients n(-) or T2 group were statistically better than other group. Three patients underwent a repeat liver resection from gastric metastasis and survived for about thirty months. There was an example using chemotherapy which made a liver tumor removal operation possible to the patient who had multiple liver metastases. In conclusion, liver resection is a beneficial option and multimodal therapy including a repeat liver resection and systemic chemotherapy, may be important for improving the prognosis of patients with liver metastases from gastric cancer.

An 85-year-old man had a 2 vessel coronary disease. Preoperative echogram showed the lateral femoral circumflex artery (LFCA) had enough diameter and length. We performed coronary artery bypass grafting (OPCAB) with the left internal thoracic artery (LITA) and LFCA. Postoperative coronary angiogram showed that the LFCA bypass graft was patent and supplied sufficient blood to the anastomosed vessel.

A male patient with severe aplastic anemia was admitted for bone marrow transplantation. While waiting for a donor, high doses of methylprednisolone, anabolic steroid and granulocyte colony stimulating factor were given without response. Deferoxamine was administered for prophylaxis of hemochromatosis because of high level of ferritin. Acute right lower abdominal pain and pyrexia developed. A diagnosis of acute appendicitis was made and appendectomy was performed. The histopathological examination of the resected appendix revealed necrotizing hemorrhagic appendicitis with numerous hyphae of Mucorales. Though anti-fungal agent (amphotericin B) administration was continued, he subsequently developed ileo-cecal abscess and eventually died due to myoglobinuric nephropathy caused by extensive necrosis of the iliopsoas muscle. Autopsy revealed dissemination of hyphae of Mucorales in lungs, kidneys, large vessels and muscle of the bilateral lower limbs. Systemic vascular invasion and embolization of fungal hyphae were also observed. However, culture of exudate sampled from ileocecum yielded no Mucorales. It was emphasized that antemortem diagnosis and effective anti-fungal treatments are essential for the management of intestinal mucormycosis. The relation ship between mucormyocosis and deferoxamine was also discussed.

The patient, a 36-year-old male, was admitted with massive hemoptysis. He had two gunshot wounds in the right lateral abdomen and supraclavicular fossa. His chest X-ray showed right tension hemothorax. Emergency thoracotomy and laparotomy were performed. Massive bleeding from the right pulmonary artery (A4+5), lacerations in the diaphragm and injuries of the liver were found. We performed right middle lobectomy, S3 segmentectomy and plication of the diaphragm and liver. He was discharged uneventfully.

We reviewed cerebral angiograms studied between May 1985 and December 1992 focusing on unruptured incidental intracranial aneurysms. In a total of 605 cases of cerebral angiograms except for patients with SAH, 43 patients (7.1%) were found to have unruptured aneurysms. In the 72 patients with headache, 11 patients (15.3%) were found to have unruptured aneurysms. This high frequency of unruptured aneurysms in headache patients is significant as a factor showing that headache may be due to unruptured aneurysms. The result of this observation is that as a screening study for headache patients, cerebral angiography may be required in spite of the invasive and high-risk method. But we think that MR angiography is, at present, a useful screening study only for detecting cerebral aneurysms with a diameter of over 5mm, and which are considered to need an operation.

Co-existence of three M-components in the serum or urine is rare. A case of non-Hodgkin's lymphoma was associated with three M-components. A 64-year-old woman was referred to our hospital because of M-proteinemia in June, 1989. On admission, serum electrophoresis on cellulose acetate membrane disclosed a triple M-peak. Immunoelectrophoresis showed M-bows for anti-IgG, anti-IgA, anti-IgM and anti-kappa simultaneously. In the urine, kappa type only Bence Jones protein was found. Scanning computed tomography revealed bulky masses in the lower abdomen, and the tumor masses were removed and diagnosed as non-Hodgkin's lymphoma. Immunohistochemical staining with antibodies to each immunoglobulins revealed the cells producing single M-component of each isotype of immunoglobulins. Although surgical removal of tumor caused a marked decrease in M-component especially IgA kappa, consistent presence of plasmacytoid lymphocyte was observed in peripheral blood. Combination therapy with melphalan and procarbazine resulted in disappearance of IgG kappa and IgA kappa from the serum. In January 1990, she achieved partial remission and was discharged. The patient has remained in remission for 16 months.

Six patients had nine kidneys with lymphoma. Five patients (83%) had non-Hodgkin lymphoma, and three (50%) bilaterally. There were multiple nodules in four kidneys (44%). The lesions were changeful in the course. Gallium scintigraphy showed abnormal uptakes. Magnetic resonance imaging was examined in one case. The lesions were hypovascular in the angiographies. Inflammation is one of the different diagnosis.

We describe a patient with CML who developed hypercalcemia in his course of blast crisis. A 25-years-old man was diagnosed as CML with priapism in April 1985, and controlled with BHAC-DVP, VMP, busulfan therapy. In December 1987, he readmitted to our hospital with abdominal pain. Investigations at that time showed: white blood cell count 11600/microliters (blast cells 9%); hemoglobin 8.4 g/microliters; platelets 19.0 X 10(4)/microliters; serum calcium 13.2 mg/dl; BUN 44 mg/dl; creatinine 2.7 mg/dl. Treatment with predonine, 6-MP and vincristine was begun. But serum calcium level rose gradually up to 16.5 mg/dl. So we tried middle dose Ara-c therapy, serum calcium decreased to 6.8 mg/dl. At once he was in a chronic phase, but he relapsed and died of heart failure. Necropsy showed extensive leukemic blast-cell infiltration of the bone marrow, liver, spleen, lung, and kidney. The cause of hypercalcemia in our case was suspected of local osteolytic hypercalcemia, because multiple bone destruction was found.

Thin (2mm) section contiguous computed tomographic (CT) scans were obtained through the bronchi of the right upper lobe and the left upper division in 30 patients. All segmental bronchi were identified. The right subsegmental bronchi were identified in 100%, and the left subsegmental bronchi in 97%. The type of the orifice of the right bronchus was trifurcated (53%), the extension of B1 was apicoanterior (50%), and the size of B2b was equal to B3a (63%). The extension of the left B3 was subapicoanterior (38%), and the size of B1+2c was equal to B3a (62%).

Thin (2 mm) section contiguous computed tomographic (CT) scans were obtained through the bronchi of the right middle lobe, the left lingular division, and the lower lobes in 24 patients. All segmental bronchi were identified except subsuperior and medial basilar segmental bronchi. Subsegmental bronchi of the left inferior lingula were seen in only 17%, but other subsegmental bronchi in greater than 75%. Variations in branching patterns were discussed.

It is well known that the permeability of the blood brain barrier and blood cerebrospinal fluid barrier changes more or less in various diseases of the central nervous system. At present, thee is no clinically available index which reflects the alteration of the permeability of the blood brain barrier and blood cerebrospinal fluid barrier. The brain scintiraphy is an examination which detects a breakdown in the blood brain barrier, its clinical usefullness is limited only in a localized and extremely pathological proces of the brain. In this report, a cerebrospinala fluid isotope measurement comined with the brain scintigraphy was presented as a clinical examination for blood brain barrier function. Thirty minutes prior to brain scintigraphy, potassium perchlorate (4 mg/kg) was given orally to reduce the accumulation of 99mTc04-in the choroid plexus and to minimize iradiation for tr other organs. Spinal tap was performed two hours after injection of 99mTc04- according to Haines's method...