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This study was undertaken to determine whether the direction of trunk rotation would have any effect on trunk muscle performance of post-stroke hemiplegic patients. The design consisted of a nonrandomized control trial in a setting of secondary care (rehabilitation unit at hospital facility). The subjects included 65 hemiplegic patients (50 males) and age-matched 80 healthy controls (38 females). Isokinetic trunk rotatory muscle performance at angular velocities of 60, 120, and 150 degrees per second was measured by using an isokinetic dynamometer (Cybex Torso Rotation Unit). There were no significant differences in the peak torque and best work between the right and left directions of the trunk rotation in the hemiplegic patients or in healthy controls, regardless of the gender of the subjects (paired t test, P0.05). The muscle performance of the hemiplegic patients was significantly lower than that of the controls for both genders (t test, P0.05). In the hemiplegic patients, the direction of trunk rotation does not affect the trunk rotatory muscle performance, although the performance itself was slightly decreased.

To evaluate the relationship between diabetic neuropathy and retinopathy, we examined autonomic nervous function, postural hypotension, nerve conduction velocity and coefficient of variation of R-R intervals. Forty-five non-insulin dependent diabetic cases were classified as no diabetic retinopathy (group A), simple diabetic retinopathy (group B) and proliferative diabetic retinopathy (group C). These groups did not differ in age or gender. The rate of postural hypotension (depression of systolic blood pressure over 30 mmHg) was 0% in group A, 7% in group Bs and 53% in group C. Nerve conduction velocity in both motor and sensory nerve was delayed over 20% in 0% of group A, 8% of group B, and 33% of group C. In CVR-R, 11% of group A and 7% of group B were decreased, and 44% (during rest) and 33% (during deep breathing) of group C was decreased. Between groups A and B there was no statistical difference. But group C had statistically significant difference from other groups, particularly in postural hypotension. Peripheral neuropathy might be closely related to diabetic retinopathy.

A 54-year-old man had a 7 x 8 cm hard mass in the epigastrium. Sonography showed an isoechoic tumor in the body of the pancreas. CT showed two contrast-enhanced masses in the pancreas and two low-attenuating masses, one in the left adrenal gland and the other in the upper pole of the left kidney. ERCP showed almost complete obstruction of the main pancreatic duct in the head of the pancreas (Fig. 1A). Constriction of the main pancreatic duct in the head and body of the pancreas was not evident. A computer image analysis system was used to improve the ERCP image. With the Interactive Build Analysis System (IBAS; Carl Zeiss, Oberkochen, Germany), input of the original ERCP image was generated with an image resolution of 512 x 512 pixels (8 bits, 256 gray levels) [1]. Image analysis was done by combining the functions of contrast normalization, edge enhancement (delineation and emphasis) (Figs. 1 B and 1C), and enhance contour and image arithmetics (added and combined) (Fig. 1D). The image analysis system allowed visualization of secondary branches of the main pancreatic duct in the body and tail of the pancreas (Figs. 1 B and 1 C). Afilling defect was seen in the main pancreatic duct suggesting a columnar mass (Fig. 1 D). These findings were interpreted as a renal cell carcinoma of the left kidney and its hematogenous dissemination in the pancreas and adrenal gland. At surgery, a renal cell carcinoma in the left kidney and metastasis in the pancreas and left adrenal gland were found. Tumor was seen invading the main pancreatic duct in the body of the pancreas. The main pancreatic duct in the head of the pancreas was filled with a columnar tumor mass, but was not constricted. The tumor mass in the main pancreatic duct of the pancreatic head was successfully resected, along with the main tumor in the distal part of the pancreas. Nephrectomy, left adrenalectomy, splenectomy, and distal pancreatectomy were performed. The pathologic diagnosis was clear cell carcinoma in the left kidney with hematogenous dissemination to the pancreas and left adrenal gland. The resected pancreas revealed two nodular tumors in the parenchyma that extended into the main pancreatic duct.

Surgical specimens of carcinoma in the papilla of Vater were studied histologically. Adenomatous residue which suggested that the carcinoma was derived from a pre-existing adenoma was found in 18 cases (81.8%) out of 22. The histological transition of adenoma into carcinoma was also frequently seen.

Over the past 10 years, we have experienced 11 cases of early gastric cancer limited to the mucosa and submucosa, with a widespread lymph node metastasis over the perigastric node. These cases represented 3.8% of all the early gastric cancer cases treated at our hospital during this period. The average age of these patients was 49.1 years, and consisted of 7 males and 4 females. Of these 11 cases, 10 cases (90.9%) were, macroscopically, the depressed type. Histologically, 7 cases (63.6%) were poorly differentiated carcinoma. Curative resections were possible in 8 cases (72.7%). The cumulative 5-year survival rate was poorer than for other types of early gastric cancer, and amounted to 66.7% in cases that were curative, and 0% for non-curative cases.

Twenty-two cases of primary gastric lymphoma have been clinicopathologically reviewed and factors influences the prognosis were examined. An increased tumor size of more than 10 cm, an increased tumoral penetration, a lymph node involvement, and stage IV classification decreased the survival rates. All patients given stage I classification have remained alive without having received chemotherapy. The survivors of stages IIIIV amounted to only three patients who were treated by surgery and systemic chemotherapy. A radical operation is the choice of treatment for a gastric lymphoma but aggressive chemotherapy should be supplemented for advanced cases.

The results of treatment of 40 cases of primary malignant tumor of the small intestine are reported. The malignant tumors included 14 leiomyosarcoma, 12 malignant lymphoma and 14 adenocarcinoma. Our standard treatment for these tumors was segmental resection of the small intestine with its mesentery including the regional lymph nodes and we used additional adjuvant chemotherapy for some cases of malignant lymphoma and adenocarcinoma. Curative resection was performed in 57.1% of leiomyosarcoma, 50.0% of malignant lymphoma and 61.5% of adenocarcinoma. Cumulative 5-year survival rates were leiomyosarcoma 21.4%, malignant lymphoma 53.0% and adenocarcinoma 43.3% respectively. Serosal infiltration, lymph node metastasis and operative curability proved to be the prognostic factors. In particular, the 5-year survival rate of patients on whom curative resection could be performed was significantly better for each tumor type than that of patients for whom this was not possible, the figures being leiomyosarcoma 40.0%, malignant lymphoma 83.3% and adenocarcinoma 83.3%.

Adenocarcinoma, malignant lymphoma and leiomyosarcoma are the main malignant tumors found most frequently in the small intestine and adenocarcinoma should be differentiated from these lesions as well as benign tumors. Ten cases with primary adenocarcinoma of the duodenum and 14 of the small intestine (the jejunum and ileum) were diagnosed and treated surgically in our clinic during recent 22 years. Analysing the clinical signs, symptoms and roentgenological features of these patients, the diagnosis, treatment and prognosis for these lesions were discussed and reviewed. To enhance the 5-year survival rate for these patients, the early diagnosis in the curative stage should be established.

We report two cases of carcinoid tumor of the stomach together with a collective review of the Japanese literature. Case 1 was preoperatively diagnosed as carcinoid, and the lesion, measuring 10 X 7 mm, and located in the body of the stomach, had no metastases. Case 2 was preoperatively diagnosed as gastric cancer and was recognized as a submucosal tumor measuring 5.8 X 4.7 cm in the antrum of the stomach. There were metastases to the brain and the skin, and the patient died on the 50th day after the operation. From a collective review of previous cases, it was ascertained that small carcinoid tumors sometimes had metastases. For this reason, we feel gastrectomy should be performed together with local lymph node resection.

Seventeen cases of a recurrent gastric cancer that were treated by a resection of the remnant stomach have been studied retrospectively. For first management 12 cases were given a Billroth 2 procedure, 4 cases a Billroth 1 procedure and 1 case a fundectomy. For the recurrent cancer, 13 cases were given a total resection of the gastric remnant and 4 cases a partial resection. The overall mortality rate was 12% and the survival rate was 58% at 1 year, and 8% at 5 years. We thus have concluded that a resection of the remnant stomach should be carried cut in cases of a recurrent gastric cancer whenever possible.