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A 28-year-old female was diagnosed with acute myeloid leukemia (AML) due to t (8;21) (q22;q22.1); RUNX1-RUNX1T1 at 21 weeks of gestation. Because no adverse prognostic genetic mutations were discovered, we decided to continue the pregnancy without chemotherapy for as long as possible. After careful monitoring with blood tests every two weeks, the disease did not progress until full-term, and a cesarean section was performed at 39 weeks of gestation. About two months after delivery, blasts in the peripheral blood increased to 46.5%, and myeloblasts in the bone marrow increased to 21.2%. The patient received idarubicin and cytarabine induction therapy, followed by three cycles of high-dose cytarabine consolidation therapy, and complete remission was maintained. Here we report a rare case who could avoid chemotherapy until full-term labor without progression of AML.

A 76-year-old woman was admitted because of a 25 mm solitary nodule in right S10 on chest computed tomography (CT). 18 fluoro deoxyglucose-positron emission tomography (FDG-PET) indicated accumulation with standardized uptake value( SUV) max 5.2. The serum carcinoembryonic antigen( CEA) and squamous cell carcinoma antigen( SCC) level was elevated. Although the diagnosis was not established by bronchofiberscopy, lung cancer was suspected and the video assisted thoracoscopic surgery (VATS) was carried out. Since no malignant cells were detected by intra-operative pathology, partial resection of the right lower lobe was performed. The postoperative pathological examination revealed features of mixed squamous and glandular papilloma.

An 70-year-old woman was reffered to our hospital to examine for a left lower lobe atelectasis on chest X-ray. Chest computed tomography (CT) showed the mass in middle mediastinum. The video-assisted thoracoscopic surgery( VATS) was performed to establish diagnosis and treat. 50 mm mass was found in the area surrounded by the descending thorasic aorta, esophagus, left atrium, left lower lobe, and mesiastinal pleura, and was regarded as a neurogenic tumor originating from the pulmonary branch of the vagal nerve. The histopathological diagnosis was benign schwannoma. She was dischraged on the seventh postoperative day, without any neurological complications.

We report a resected case of basaloid squamous cell carcinoma (BSC). BSC is a rare type of malignant lung tumor. A 79-year-old woman had a 13 mm tumor in the left upper lobe on chest computed tomography (CT). On fluorodeoxyglucose-position emission tomography (FDG-PET), the tumor showed the accumulation of FDG with an SUVmax of 14.7. A left upper lobectomy with lymph node dissection was performed by video-assisted thoracoscopic surgery. The pathological diagnosis was BSC (pT2aN0M0, stage IB). There was no recurrence following lung cancer resection for 12 months. BSC is generally poor prognosis.

We report a resected case of fetal adenocarcinoma. Fetal adenocarcinoma is a rare type of malignant lung tumor. A 53-year-old man had a 25 mm tumor in the right upper lobe on chest computed tomography. On fluorodeoxyglucose-positron emission tomography( FDG-PET), the tumor showed the accumulation of FDG with a standardized uptake value( SUV) max of 5.63. He underwent bronchoscopic examination, but a diagnosis was not established. We suspected that the tumor was primary lung cancer or metastatic lung tumor of rectal cancer which was resected prior to the treatment for pulmonary lesion. A right upper lobectomy with lymph node dissection was performed and the pathological diagnosis was high-grade fetal adenocarcinoma, stage IB (pT2aN0M0). The patient was treated with postoperative adjuvant chemotherapy. There has been no recurrence after surgery resection for 9 months.

An estimated 2~16% of primary lung cancers form cavities with cases that form thin-walled cavities being comparatively rare. We treated a patient with squamous cell carcinoma of the lung with a small cystic shadow that showed no changes for 3 years. The cyst then suddenly grew larger, after which the cyst wall thickened over time and a thin-walled cavity was seen. Here we report this important case showing the development process of lung cancer that formed a thin-walled cavity, together with a discussion of the literature.

A short length scatterer is adopted to measure the X-ray spectrum of computed tomography (CT) equipment with a wide irradiation field in the body axis direction. The purpose of this study is to compare X-ray spectra measured using different length scatterers and determine the most appropriate length for the scatterer. 320-slice CT equipment (Aquilion ONE) was used in this study. Circular carbonrods (3 cm diameter) with five different lengths (1-16 cm) were used as scatterers. The effect of the beam hardening phenomenon from different length carbon rods was evaluated according to the effective energy. The measurement accuracy for photon information was also evaluated based on the photon count corresponding to the characteristic X-ray. As a result, the beam hardening effect was scarcely observed when the 1 cm long scatterer was used, and the number of the photons measured for the characteristic X-ray was the most. Therefore, it was concluded that the 1 cm long circular carbon rod scatterer was the most suitable.

In an aging society, the high incidence of surgery for the patients with ischemic heart disease(IHD)or atrial fibrillation(Af) under antiplatelet or anticoagulant therapy is a great problem. Interruption of antiplatelet or anticoagulant oral agents in the perioperative period may increase the risk of coronary or cerebral events. We retrospectively reviewed the surgical outcomes for lung cancer patients with IHD or Af. We reviewed 135 patients with lung cancer(41~88 years;97 men) who had preoperative oral administration of antiplatelet or anticoagulant drugs for IHD or Af between 2005 and 2012 at 2 centers, and analyzed retrospectively the perioperative medications and complications. IHD, Af and vasospastic angina(VSA) were complicated in 94, 33 and 8 patients, respectively. Drugeluted and bare-metal stents had been placed in 18 and 19 patients. Oral agents were aspirin in 68 patients, ticlopidine in 10 patients, clopidogrel in 15 patients and warfarin in 25 patients. These agents were stopped 2 to 60 days before surgery. Perioperative heparinization was performed in 22 patients. Oral agents were restarted after confirmation of hemostasis and no need for further invasive treatment. The surgical procedures were lobectomy in 88 patients, segmentectomy in 19 and partial resection in 25. There were no hemorrhagic or thromboembolic complications in a perioperative period except 1 case of pulmonary hemorrhage and 1 case of cerebral infarction. No perioperative hospital death was documented. Short-term interruption of antiplatelet or anticoagulant drugs before lung cancer surgery and heparinization was acceptable from the view of perioperative outcomes.

Infrared thoracoscopy with indocyanine green (ICG) is a new method of evaluating lung perfusion. We succeeded in visualizing lung emphysematous lesions and intersegmental borders using infrared thoracoscopy with ICG in animals, and within clinical investigations. There are 2 methods in infrared thoracoscopy. One is the 2-wavelength method, and the other is the 1-wavelength method. The 2- wavelength method is based on ICG absorption, and the 1-wavelength method is based on ICG fluorescence. The 2-wavelength method is superior for the clarity of images. On the other hand, the 1-wavelength method is superior for the duration of staining and the dose of ICG. Commonly, the inflation and deflation line has been used to identify the intersegmental border, but lung reinflation narrows the surgical view and can lead to prolongation of operation time, particularly in the context of video-assisted thoracic surgery (VATS). Infrared thoracoscopy with ICG is based on blood flow rather than on ventilation and can thus achieve anatomical segmentectomy without lung reinflation. This article closely reviews the principle and usefulness of infrared thoracoscopy, and difference between 2- and 1- wavelength method.

As the clinical application of mesenchymal stem cell (MSC), we have engaged in the development of cell transplantation therapy for aseptic necrosis of femoral head. Based on the results obtained by in vitro and in vivo preclinical experiments, we established the protocol for the clinical trial combining MSC with vascularized bone grafts. The protocol was approved by IRB on November 25, 2007, and the first case was operated on February 22, 2008. Since then 10 cases have been successfully treated and were followed at least 24 months with satisfactory results.

We report a case of pulmonary carcinomatous lymphangitis and multiple pulmonary infarctions from gastric cancer. A 58-year-old housewife presented with a complaint of a worsening cough over the previous 6 weeks. Chest radiography and CT scans revealed infiltration and diffuse ground-glass opacities in both lung fields, and she was hospitalized for further examination. No specific findings were found upon screening examination, including bronchoscopy with bronchoalveolar lavage (BAL). However, a CT scan showed mediastinal, hilar and paraaortic lymph node swelling, and therefore we suspected the presence of a malignant tumor. On the 11th hospital day, she suddenly developed severe hypoxia and went into cardiogenic shock. Although there was no sign of a filling defect in the vessels on CT with an intravenous contrast, we diagnosed pulmonary thromboembolism based on other examination findings and began thrombolysis and anticoagulant therapy. Treatment with heparin and urokinase did not improve her condition, and she died on the 14th hospital day. The autopsy findings revealed widespread gastric cancer with pulmonary lymphangitis carcinomatosa and thrombus formation in arterioles throughout the pulmonary lobes: 'Trousseau syndrome'.

Visual scenes in daily life involve much variable information. This study examined how three types of variable information (viewing field, brightness, and chromaticity of flood-light illumination) would be retained in memory by varying the level of the information. In Experiment 1, discrimination performance between the test scene and its variation was measured using the constant stimuli method. The results showed worse performance with longer retention time, with no difference related to the type of variation. In Experiment 2, the stimulus variations were made four times greater. In a recognition memory task, participants discriminated between the test scene, its variation, and a new distracter. The results showed that discrimination between the test scene and its variation was worse, but the distracters were easily discriminated. Variations in the viewing field had the most detrimental effect on discrimination performance. These results suggest that the retention of variable information is affected by the frequency of daily experience.

A 52-year-old woman who was a pet trimmer by occupation and had four cats, presented with cold-like symptoms. Her chest radiograph and CT scan on admission showed a tumor about 4cm in size with spicula and ground-glass opacity in the right middle lobe. We performed fiberoptic bronchoscopy and CT-guided percutaneous needle lung biopsy on the suspicion of lung cancer, but the tissue consisted largely of granulation tissue with eosinophilic infiltration and no findings of malignancy. The cold-like symptoms subsided and C-reactive protein became within the normal range. Because of the histological findings, her occupation and her pets, we suspected pulmonary dirofilariasis. We asked the National Institute for Infectious Diseases for specific IgG antibody assays to various parasite antigens, which showed positive finding for pulmonary dirofilariasis. We therefore diagnosed pulmonary dirofilariasis and did not perform an operation.

The authors investigated the postoperative quality of life in 89 patients with metastatic spinal tumors. As the results of our study, it was found that spinal surgery could maintain or improve the quality of life, and then most of patients with poor quality of life had multiple spine/bone metastasis or brain/spinal cord metastasis.

Hyperphosphatemia cause not only renal bone disease but also poor prognosis in hemodialysis patients. We should control serum phosphate levels within near normal range. Although many patients are prescribed phosphate binder, they should restrict oral phosphate intake. There are poor prognosis in malnutrition patients, they should take sufficient protein. Contents of phosphate in foods increase proportionaly with protein contents. It is important that they should take foods with low phosphate contents and low phosphate/protein ratio. They should restrict preserved food, confectionary, seasoning which contain phosphate compounds as food additive. It is useful to take special low phosphate food.

Autoantibody against human liver-type arginase was detected in blood of patients treated with partial liver transplantation and consisted of all subclasses of IgG, i.e., IgG1, IgG2, IgG3 and IgG4, and IgM. We newly constructed an ELISA system for the antibodies by the aid of arginase protein immunopurified from extracts of human liver tissues. Addition of 2.0 mol/l urea in 0.1 mol/l citrate buffer(pH 4.5) was effective for elimination of immunoglobulins, such as IgG and IgM, and rheumatoid factors adsorped non-specifically to liver-type arginase-autoantibody complexes on the plate. We found that, during a short period of about two months after operation, in successful cases, liver-type arginase increased, remarkably and repeatedly, in blood of recipients followed by elevation of IgM level within a week and also IgG2 level two or three weeks later. Thus the change in IgG2 level seemed to depend on those of the arginase and/or IgM. However, in unsuccessful cases, such fluctuation was not so clear as the successful cases. To be noteworthy was production of autoantibodies directed to liver-type arginase in blood of patients with liver injury although the arginase, as well as AST and ALT, is an enzyme which leaks out of liver tissue. Appearance of the autoantibodies in blood supports occurrence of liver injury, in part, in graft liver because the enzyme exists exclusively in the liver. Among immunoglobulins to liver-type arginase, IgG2 seemed to be the most helpful index to know rightly postoperative conditions of recipients of liver transplantation, and its measurement could be useful for long-term follow-up of the patients.

This interim analysis of the JFMTC study as of May, 1998 covers 321 gastrectomized patients with far-advanced stomach cancer from 135 institutions between November, 1993 and March, 1996. The intensive therapy group (I-group) received CDDP i.p. administration on resective surgery with 70 mg/m2 followed by CDDP i.v. of 80 mg/m2 (day 1, i.v.), accompanying 5-FU of 350 mg/m2/day (day 1-5, c.v.i.) in the 4th, 8th and 12th weeks. The I-group was randomly compared with the standard therapy group (S-group) of MMC of 6 mg/m2 i.v. in the 4th, 8th and 12th weeks and UFT of 3-4 capsules daily for postoperative one year. The results obtained were that 1. adverse reactions were found more in the I-group than in the S-group, particularly notable in the decrease in blood cells, loss of appetite and nausea/vomiting, and incidence of grade 3 or more being 13% (neutrophile leukocytes), 26% and 21%, respectively; 2. there was no significant difference between I- and S-groups in terms of 3-year survival or disease-free survival rates. (JFMTC: Japanese Foundation of Multidisciplinary Treatment for Cancer).

This interim report, for findings as of May, 1998, covers data on 435 gastrectomized patients with semi-advanced stomach cancer collected from 144 institutions between November, 1993 and March, 1996. The active arm of the study involved CDDP i.p. administration of 70 mg/m2 at the time of resective surgery, followed by UFT oral administration for one year at 3-4 capsules daily. A randomized control involved no adjuvant therapy after CDDP i.p. administered as in the active arm. The results obtained indicated no significant difference between the groups in terms of 3 year survival or disease free survival rates. Reports appearing elsewhere have suggested that 3-4 capsules/day of UFT may be insufficient to reach the threshold of the effective tissue level, and that 6 capsules may be necessary to obtain the expected results. (JFMTC: Japanese Foundation of Multidisciplinary Treatment for Cancer).

This is a case report of a 37-year-old Japanese married female with laryngeal sarcoma, treated by direct electric current so as to obtain remission for more than 4 years without signs of recurrence. Due to her hoarseness and laryngeal numb feeling she underwent a laryngeal examination including a biopsy, resulting in a diagnosis of sarcoma. She refused a total laryngectomy and was given Cobalt treatment of 40 Grey. In the following several months, no improvement was observed, objectively or subjectively. In Nagoya University Hospital the patient then received direct electric current therapy of 36 Coulombs through two platinum electrodes inserted into the tumor under a CT guide, pericutaneously. Two months later, as the hoarseness remained in spite of some improvement, she underwent another session of direct electric current therapy of 14.4 Coulombs through the platinum electrodes by bronchoscope-guided direct insertion. Her hoarseness soon disappeared thereafter and there was a regression of the tumor in 6 months. She did well thereafter without any signs of recurrence for 4 years. Clinical treatment of solid tumors with electric treatment with direct electric current has been done in more than 8,000 cases with CR in 25% of all cases and PR in 50%. Its mechanism, however, remains unclear. In our experimental animal studies, apoptosis was observed. It is considered that this electric therapy using direct electric current will be recognized as one method to treat solid tumors.

There is now good evidence that a series of genetic lesions in both dominant oncogenes and tumor suppressor genes are involved in the pathogenesis of human digestive tract carcinomas. Small intestinal carcinomas are very rare, accounting for only about 0.19% of all primary gastrointestinal malignant tumors in Japan, so there are few reports investigating genetic changes of small intestinal carcinoma. We analyzed 3 microsatellite loci and the status of K-ras and p53 genes isolated from tumors and surrounding normal tissue samples obtained during surgery. The polymerase chain reaction (PCR) technique used frequent genetic instability to assess differences between tumor and matched DNAs. Replication errors (RERs) were observed in 3 of the 29 cases (10%) of gastric carcinoma and in 11 of the 72 cases (15%) of colorectal carcinoma. None of the 13 (0%) esophageal carcinoma cases showed any RER, but 5 of 11 cases of small intestinal carcinoma (45%) had RERs, reflecting a significantly high incidence. None of the 11 small intestinal carcinoma cases exhibited K-ras gene mutations. Of 7 case amplified successfully by polymerase chain reaction (PCR) in exon 5-8 loci in p53 gene, 2 exhibited abnormally migrated bands in polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis. It is thus clear that the genetic carcinogenesis in the small intestine is different from other parts of the digestive tract. These results suggest that genetic instability plays an important role in the pathogenesis of small intestinal carcinomas.

The enhanced effects due to the combined use of oral administration of S-1 and intraperitoneal administration of Cisplatin (CDDP) were examined with gastric cancer xenografts (NUGC 4). S-1, a new anticancer drug, was daily administered at 10 mg/kg (qld x 5 x 3 weeks). 5-FU level in blood was 1 microgram/ml at two hours after the treatment. Antitumor activity was not found in mice with only the CDDP treatment. But antitumor activity by S-1 and daily low-dose (1 mg/kg) or intermittent treatment (5 mg/kg) of CDDP showed better results than daily S-1 treatment. The daily low-dose CDDP treatment showed similar efficacy to the intermittent administration at the same total dose, but the daily low-dose CDDP treatment was better in the light of toxicities. These results suggest that treatment with S-1 and daily low-dose CDDP was effective for gastric cancer.

The accurate and early diagnosis of the tumor in the point of the size, the location, the depth of invasion of other organs or the stages of the recurrent cancer became much more important than before, not only for the selection of the treatment method but also for the decision of the quality of the operation for preserving the function as much as possible for the quality of the life of the patient. The usefulness of positron emission tomography (PET) and immunoscintigraphy by means of 131I or 111In anti-CEA onoclonal antibody for the diagnosis of the recurrent colorectal cancer had been confirmed in clinical use of colorectal cancers. No adverse effect of this monoclonal anti-body of the mouse was seen in this studies. The differential absorption ratio (DAR) was useful indicator in PET-imaging to differentiate the true tumor tissue from the scar tissue or granulation-tissue around the tumor. Even though the imaging, structure of PET is inferior to those of CT or MRI, the imaging of PET reflects the biological character of tumor, itself and makes the more accurate diagnosis possibly by combined use with regular CT and MRI.

The experimental studies in vitro and in vivo were performed to investigate the effects of carcinostatic agents in the adhesion of cancer cells to endothelial cells. Certain carcinostatic agents induce the expression of E-selectin on endothelial cells and enhance the expression of carbohydrate ligands on cancer cells. Consequently, increased adhesion of cancer cells to endothelial cells was observed by the treatment of carcinostatic agents. In the trans-splenic hepatic metastasis model using nude mice, the augmentation of cancer metastasis was observed by the treatment of carcinostatic agents. From the above, we concluded that carcinostatic agents may increase the metastatic ability of cancer cells in patients with cancer.

Twenty-one evaluable patients with primary gastric cancer/local invasion, liver metastasis and peritoneal metastasis were entered in a pilot study of neoadjuvant chemotherapy that used continuous 24-hour infusion 5-FU, 330 mg/m2/day plus low dose CDDP, 6 mg/m2 daily by bolus infusion d1-5. This regimen was repeated for 4 weeks. The overall response rate was 52%, including one complete and ten partial responses. The response rate of differentiated adenocarcinomas was significantly higher than that of poorly differentiated adenocarcinomas. In 15 patients (71%), gastrectomy and lymphadenectomy could be done after this regimen. chemotherapy-induced downstaging from the initial clinical stage was pathologically found in 5 patients who underwent gastrectomy. Toxicity was primarily hematologic. Leukopenia and thrombocytopenia of grade 3 or 4 occurred in 19% and 14% of patients, respectively. The patients were able to take meals during therapy and preserved good quality of life. Median survival time was 11 months for the cancers with liver metastasis and five of the 8 locally advanced cancers are alive 11 months after the therapy. This therapy was effective for patients with high-grade advanced gastric cancer.

An epidemiological investigation of osteoporosis was carried out in a community in which fishing is the primary industry, and correlations were investigated between the bone mass and various risk factors for osteoporosis and biochemical findings. In 852, who could be examined directly, of the 3541 males and females aged 40 years or above living in Nansei Town, Watarai District, Mie Prefecture, the age, sex, height, body weight, years after menopause, married or unmarried, area of residence, daily activity, and intakes of milk, fish, and alcohol were studied by direct oral inquiry, and the serum calcium, inorganic phosphorus, alkaline phosphatase, and total protein were measured. The subjects were divided into a decreased bone mass group who showed grade I or more advanced loss in bone mass and a normal bone mass group who showed no or only slight loss in bone mass on the basis of microdensitometry (MD). Eighty-two subjects (9.6%) were classified as the decreased bone mass group. Items that showed a close correlation with sigma GS/D, which is an index of bone density, were age, years after menopause, serum alkaline phosphatase level, height, and body weight in females, age and serum alkaline phosphatase level in males. In the decreased bone mass group, 79 of the 82 subjects were females. Significant differences were observed between the decreased bone mass group and the normal bone mass group in age, years after menopause, serum alkaline phosphatase level, height, and body weight. From these results, a high age, being a female, low height, and a low body weight were found to be factors correlated with osteoporosis. Also, the bone mass was correlated with the serum alkaline phosphatase level and years after menopause.

The general pharmacological study of iodixanol, a non-ionic isotonic contrast medium, was conducted. 1) Iodixanol administered intravenously over a dose range of 320 to 3,200 mgI/kg had little or no effect on the general behavior, spontaneous locomotor activity, hexobarbital sleeping time, pain response, electroshock- or pentylenetetrazol-induced convulsion (mouse), EEG or body temperature (rabbit), gastrointestinal propulsion (mouse) or skeletal muscle contraction (rabbit). Iodixanol had no specific interaction with acetylcholine, histamine, serotonin, nicotin, BaCl2 (ileum), methacholine (trachea), isoprenaline (atrium) or oxytocin (pregnant uterus), nor had any effect on spontaneous contractility (atrium and uterus), or transmural electrostimulation-induced contractility (vas deferens) at concentrations of < or = 3.2 x 10(-3) gI/ml in vitro. Iodixanol had no effect on the cardiovascular system of dog, except that it increased femoral blood flow and respiratory rate at doses of > or = 1,000 mgI/kg. Iodixanol at 3,200 mgI/kg i.v. reduced urine output with a decrease in Na+ and Cl- excretion, whereas at 320 mgI/kg i.v., it slightly increased urine output (rat). 2) Injections of iodixanol into the cerebroventricular (0.96, 9.6 mgI/mouse and 3.2, 32 mgI/rat), left ventricular (1,920, 6,400 mgI/dog) or coronary artery (640, 1,920 mgI/dog) had no conspicuous effect on the central nervous system or the cardiovascular system, respectively. There was no marked difference among iodixanol, iohexol and iopamidol in this respect. Vascular pain during injection into the femoral artery (300-320 mgI/guinea pig) appeared to be less intense with iodixanol, compared with the other contrast media iohexol and iopamidol. These results suggest that intravenous injection of iodixanol is relatively free from pharmacological activity, and effects of iodixanol on the central nervous system (intracerebroventricular injection) and cardiovascular system (intra-left ventricular and -coronary injections) are comparable to those of iohexol and iopamidol. Furthermore, intra-femoral injection of iodixanol has less of a tendency to produce vascular pain than those of iohexol and iopamidol.

We report a case of double cancer of esophagus and stomach treated with 5-fluorouracil and consecutive low-dose cisplatin. The patient was a 58-year-old man with liver cirrhosis. Using upper gastrointestinal fiberscopy, a superficial depressed lesion (O-IIc) in the middle thoracic part of the esophagus and Borrmann 2 type lesion in the fundus of the stomach were also detected. Microscopic examination of the biopsy specimen revealed moderately differentiated squamous cell carcinoma and adenocarcinoma. But laparotomy could not be done due to impaired liver function (KICG 0.051, ICGR15 45.2%). The patient was treated for 28 days with continuous 24 hour infusion 5-FU, 250 mg/body/day plus low dose CD-DP, 10 mg/body daily by bolus infusion d1-5, 8-12, 15-19, 22-26. One month after the chemotherapy, both the gastric cancer and the esophageal cancer were remarkably reduced (diagnosis: PR), and showed no malignancy in the histology. There was no change in the histological findings of the esophageal lesion at 31 months after the chemotherapy. This therapy is effective for patients with gastric cancer and esophageal cancer.

We investigated the mechanisms of CPT-11-induced diarrhea. 1) CPT-11 (80 mg/kg, i.v.) induced watery diarrhea within 1 hr after dosing in saline-loaded (10 ml/kg, p.o.) rats. This was partially inhibited by subcutaneous injection of atropine (1 mg/kg) or ondansetron (1 mg/kg) and almost completely inhibited by a combination of atropine and ondansetron or by clonidine (0.3 mg/kg) or morphine (10 mg/kg) alone. 2) CPT-11 at the same dose reduced intestinal fluid absorption, which was blocked by the anti-diarrheal agents mentioned above. Intraluminal injection of CPT-11 (20 mg/2 ml) inhibited fluid absorption and induced fluid secretion. 3) CPT-11, 60 mg/kg, by single intravenous injection induced fewer enzymological and histological changes in the small intestine than 5-FU at 270 mg/kg, while 4 consecutive dosings of CPT-11 induced delayed diarrhea (days 5-7) associated with disruption of intestinal integrity. Co-administration with anti-diarrheal agents, except for ondansetron, protected against watery diarrhea appearing within 1 hr after CPT-11 on days 3 and 4, but worsened delayed diarrhea. These results suggest that single injection of higher doses of CPT-11 causes watery diarrhea at an acute phase at least partly by reducing fluid absorption or increasing secretion, and that while conventional anti-diarrheal agents protect against watery diarrhea, their co-administration in repeated CPT-11 administration has no ameliorative effect on CPT-11-induced delayed diarrhea.

A randomized controlled study was carried out by the envelope method with 491 institutions in participation across the country in order to find an optimal surgical adjuvant chemotherapy for curatively resected colorectal cancer. The schedules for drug administration were different in four districts: ACNU + Futraful (FT) group and FT alone group in the Hokkaido-Shikoku district; the same schedule groups plus untreated group in the Chubu-Kinki district; MMC+FT group, FT alone group in the Tohoku-Kanto district; and ADM+FT group and FT alone group in the Chugoku-Kyushu district. The numbers of patients admitted to this study were 2,450 cases with colon cancer and 2,456 cases met the evaluation criteria of this study. The 5-year survival rate on the whole did not differ from combination therapy to single drug therapy in either colon cancer or rectal cancer, but in Dukes C rectal cancer the five-year survival rate tended to be higher with the combination therapies. In n2 (+) or a2(s) rectal cancer in particular, combination therapies with MMC and FT and with ADM and FT achieved significantly higher five-year survival rate, and the rate of local recurrence was significantly lower with ADM+FT.

In 47 patients who had undergone roentgenography, ultrasonography, 201 Tl-scintigraphy, and aspiration cytology and on whom a pathological diagnosis had been made, the diagnostic value of the above-mentioned 4 examinations was evaluated. The correct diagnosis rate for aspiration cytology and 201 Tl-scintigraphy was 76.6%; for ultrasonography and roentgenography it was 70.2%. The false-negative rate of cancer for aspiration cytology was 14.9%; for the other examinations it was 10.6%. The false-negative rate upon combining 3 examinations, except roentgenography (soft tissue technique), proved to be 0% and 24 patients with thyroid cancer were preoperatively correctly diagnosed as "malignant" by means of the combination method.

Six patients with esophageal cancer with liver metastasis are reported and the clinicopathological features are discussed based on collected autopsy cases. 1) The incidence of liver metastasis was higher when the primary site was in the lower part of the esophagus. 2) There were many cases without abdominal lymphnode metastasis. 3) Metastasis was noted primarily as small nodules in the left lobe of the liver. 4) The prognosis was poor; liver metastasis was rarely the cause of death. In esophageal cancer, liver metastasis seems to occur via the portal route and combined liver resection is indicated when possible.

In our department, hepatorenal syndrome was highly associated with obstructive jaundice and was seen in 9.2 percent of patients with obstructive jaundice. This syndrome developed when in underlying hepatic disease, acute renal failure supervened. Histological findings of renal failure caused by obstructive jaundice were summarized as tubular necrosis and the presence of protein-like substance in the glomerulus, which were mostly reversible and similar to those seen in shock. To investigate the pathogenesis of hepatorenal syndrome, experimentally the common duct in dog was ligated to produce obstructive jaundice and B. Klebsiella was injected into the bile duct to produce cholangiolitis. From this study, it was evident that cholangiolar infection was closely correlated with the manifestation of renal failure. In fact, without acquiring infection, renal failure did not occur. Moreover, this infection produced endotoxemia with high incidence. Therefore, it is assumed that this cholangiolar infection plays an important role in the pathogenesis of hepatorenal syndrome caused by obstructive jaundice.

Four cases of Plummer's disease were experienced and its clinical and pathological characteristics were considered. Clinically, three cases were thyrotoxic or slightly toxic, but one was non-toxic. Thyroid scintigrams showed hot nodules which revealed autonomic production of thyroid hormone, and the depleted uptake of 131I in the thyroid glands around the nodules was recovered to normal after the surgical extripation of the nodules. Histologic findings of the extripated nodules were follicular adenoma or adenomatous goitor. On electron-microscopy, epithelial cells of the thyroid follicules in the nodules from all cases contained numerous secretory granules significantly increased in number, while development of the general cytoplasmic organelles varied from case to case. Capillaries in the nodules were fenestrated. Thus, the nodules were electron-microscopically revealed active secretion of thyroid hormone. The electron-microscopical examinations may be useful in the study of Plummer's disease.

An antibiotic drug of aminoglycoside group, dibekacin (DKB) for parental use was used in 48 patients hospitalized due to acute or subacute infection of abdominal organs: 36 appendicitis, 9 cholecystitis and 3 others. DKB in a dose of 100 mg was given intramuscularly in 38 cases, and in 10 cases was given intravenously by single or drip infusion before the operation. The materials of A-bile, B-bile, wall of gallbladder, the appendix wall, ascites with pus and serum were taken during the operation. DKB concentration was measured by bioassay method with Bacillus Subtilis ATCC 6633 strain. With a few marked exceptions, DKB concentration in B-bile were higher than those in A-bile. DKB concentrations in gallbladder wall and appendix wall were directly proportional to the degree of pathological changes of inflammation. DKB concentrations in infected tissues after intravenous drip infusion, they were higher relatively than those after intramuscular administration. DKB concentrations in serum after intravenous drip infusion reached to peak immediately the end of infusion, and in the infected tissue they reached to peak at the same time and stayed for a relatively long time, then they were declined slowly. For the therapeutic purpose, DKB was given to the 6 patients with acute peritonitis of the above cases. DKB in a dose of 100 mg were administered by intravenous drip infusion for 2 hours, twice in a day for 3 - 10 days. Clinical response was excellent in 2 cases, good in 3 cases, fair in 1 case and poor in none. No adverse effect was observed. Therefore, it was supposed that DKB could be used safely by intravenous drip infusion.

With the advance of hemodialysis, it has become apparent that immunity, especially cellular, is lowered in patients on maintenance hemodialysis. We administered Venoglobulin I (VGI) to the patients on maintenance hemodialysis to study the change in the immune system and the episodes of infection. VGI was administered to twelve cases, eight males and four females, and their mean period of hemodialysis was three years. Administration of VGI started in February 1981 an mean duration of administration was 7.8 months. As a rule, 2.5g of VGI was administered every 20 days. Counts of white blood cells, lymphocytes, T cells and B cells were measured every two months. The cases were divided into two groups according to the duration of hemodialysis: Group A, less than a year and Group B, more than a year and a month. Results and conclusions 1) VGI increases the lymphocytes and T cell counts in Group B to suggest the improvement of cellular immunity. 2) In Group A, lymphocytes and T cell counts were decreased because the effects of VGI were overcome by the effect of hemodialysis to distort the immune system. 3) The magnitude of effects of VGI was proportional to the period of administration. The effect appeared at least within eight months, and once it appeared, it kept stable level. 4) There had been no episodes of infection during the period of study. 5) With these results, it was indicated that administration of VGI to the patients on maintenance hemodialysis was useful because VGI could support their lowered cellular immunity to some extent.

A new antibiotic drug of cephalosporin group, with marked resistance of beta-lactamase, cefmenoxime (CMX) for parenteral use was tested in 15 patients with acute peritonitis. CMX in a dose of 500 mg was given intramusculary before the operation, to 8 cases with appendicitis, and 2 cases with intestinal obstruction. In 3 cases with appendicitis and a case with intestinal perforation, CMX in a dose of 500-1,000 mg was given by intravenous injection before or during the operation. And in a case with appendicitis, CMX in a dose of 1 g was given by intravenous drip infusion before the operation. Tissue specimens of different sites or body fluids were taken during the operation and from the removed organs. The materials of purulent ascites were subsequently taken at intervals. Determination of CMX concentration was performed according to cup bioassay method with Proteus mirabilis ATCC 21100 strain. The peak of CMX concentration in purulent ascites of patient with panperitonitis for intestinal perforation was 39.5 microgram/ml at 41 minutes after 1 g intravenous administration. Concentration of CMX in pus in the appendix was 52.5 microgram/ml at 20 minutes after 1 g intravenous administration. In 15 patients with acute peritonitis, 11 patients were given CMX in a dose of 500 mg by intramuscular administration twice a day, and the serious 4 patients were given in a dose of 500 mg to 1 g by intravenous drip infusion twice a day. Clinical response was excellent in 10 cases, good in 5 cases, fair and poor were none.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors treated a total of 23 patients (15 were outpatients, 8 were hospitalized), employing an injectable preparation of cefpiramide (CPM) a new antibiotic of the cephems. Included in this total were 10 cases of acute infectious diseases of skin and soft tissues, 5 cases of acute localized peritonitis, 5 cases of acute urinary tract infection and 3 cases of acute and subacute cholecystitis. To 15 cases of outpatients, CPM in a dose of 500 mg were given by intramuscular injection once a day, and to 8 cases of hospitalized patients were given 500 mg of CPM by intramuscular injection twice a day. The duration were 3 to 15 days. The clinical efficacy obtained was excellent in 4 cases, good in 17 cases, and fair in 2 cases. In no case was CPM found to be completely ineffective. Clinical adverse effect was not recognized. Therefore, CPM will be a useful drug when used for chemotherapy of acute or subacute infectious diseases on surgical field following intramuscular administration.

In a phase II study of THP, fifty-six patients with advanced or recurrent breast cancer were evaluated, and a response rate of 23.2% including 1.8% with complete response and 21.4% with partial response, was obtained. Response rates of THP varied according to the location of metastasis and the highest rate was shown to be 38.5% in patients with soft tissue metastasis. The median dose for inducing response was 100 mg with a range from 60 mg to 160 mg. Toxicities such as leukopenia and gastrointestinal disorders were observed during THP treatment. The favorable response to THP was close to that of adriamycin, but it was noteworthy that a lower frequency of alopecia occurred.