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The feasibility and safety of left-sided biliary drainage with ultrasound (US) guidance were studied prospectively.From July 1987 to July 1996, 208 consecutive patients underwent US-guided biliary drainage; all were evaluated for left-sided drainage. Drainage procedure was begun with puncture of the hepatic duct branch of the lateral segment of the left lobe when the branch was well visualized with US; otherwise, a right-sided approach was used. When the hepatic duct branch diameter was greater than 3 mm, puncture was performed with an 18-gauge needle; smaller branches were punctured with 21-gauge needles.In 147 (71%) patients, the left hepatic duct branch was well visualized with US, and the branch diameter was greater than 3 mm. In these patients, left-sided drainage with use of an 18-gauge needle was successful. In 26 (12%) patients, the left hepatic duct branch diameter was less than 3 mm, and drainage was initiated with a 21-gauge needle. In six (23%) of these 26 patients, left-sided drainage was unsuccessful, but five of these patients underwent successful US-guided drainage from the right hepatic duct branch. Two patients died of septic shock within 72 hours of completed drainage. Three patients experienced severe hemobilia.US-guided left-sided biliary drainage is a highly successful and safe method when the left hepatic duct branch diameter is greater than 3 mm.

Several reports have shown expression of cyclooxygenase-2 (COX-2) in malignant skin tumors. COX-2 has also recently been reported as a marker of malignant melanoma (MM).Our aim was to investigate whether there is a difference in the immunohistochemical expression of COX-2 between malignant and benign melanocytic lesions of the skin.We selected 40 archival cases of MM including 10 cases of superficial spreading melanoma, 10 of lentigo maligna melanoma, 10 of nodular melanoma, and 10 of acral lentiginous melanoma. For comparison, we also selected 35 benign melanocytic lesions, which included 15 nonatypical nevi and 10 atypical nevi. The remaining 10 cases were Spitz nevi. COX-2 immunohistochemical staining was performed, and intensities were assessed quantitatively.The MM group and the benign melanocytic nevi group showed a highly statistically significant difference in the intensity of COX-2 expression (P0.0001). Staining intensity in the dermal component of MM cases also showed a tendency to increase with increasing tumor depth. By contrast, the intensity of the dermal component in the melanocytic nevi group decreased with increasing depth as the nevus cells matured from type A to type C cells. No statistical difference was noted between the MM and Spitz nevi cases (P = 0.20).Malignant melanoma shows stronger immunohistochemical expression of COX-2 than benign melanocytic nevi. Although COX-2 cannot be used alone to differentiate MM from melanocytic nevi, it may serve as an aid in the differential diagnosis of melanocytic skin lesions.

We immunohistologically investigated 76 cases of primary colorectal cancer and 13 cases of adenoma to clarify the relationship of MHC class II expression with the grade of differentiation, the density of tumor-infiltrating lymphocytes, and the incidence of metastasis to lymph nodes. MHC class II expression was mostly negative in normal colonic epithelium. In contrast, 32 out of 76 cases (42%) of cancer and five out of 13 cases (38%) of adenoma were positive for MHC class II. MHC class II expression was higher in well-differentiated than in poorly differentiated adenocarcinoma. The density of infiltrating lymphocytes was higher in cancer than in the normal mucosa, and higher in MHC class II-positive tissues than in negative lesions. The incidences of lymphatic invasion and cancer metastasis to lymph nodes were definitely higher in MHC class II-negative cancers than in MHC class II-positive cancers. MHC class II was rarely expressed in metastatic cancer cells of lymph nodes. These results indicated that the loss of MHC class II is correlated with the incidence of metastasis to regional lymph nodes.

Fasting breath nitrous oxide (N2O) concentration was determined in relation to pH, nitrate (NO3-) and nitrite (NO2-) concentrations in gastric juice, and Helicobacter pylori infection in 86 successive patients. N2O was measured with an infrared-photoacoustic analyzer. NO3- and NO2- were measured using the Griess reaction. Fasting breath N2O concentration in controls (87 +/- 21 ppb) was not significantly different from that in patients with gastric ulcer or other gastric lesions. Breath N2O was significantly correlated with gastric NO3- (P0.01) and was higher in patients with elevated gastric NO2- (246 +/- 87 ppb) than in patients without NO2- (75 +/- 13 ppb). Breath N2O did not differ significantly between subjects who were positive or negative for H. pylori. In conclusion, fasting breath N2O concentration is in some manner related to intragastric NO3- and NO2- concentrations. The possible use of measuring breath N2O as predictors of cancer needs further research.

A 52-year-old man with a 4-year history of rheumatoid arthritis, and who had an episode of suspected BOOP in early 1994, was admitted to our hospital because of cough and fever. A chest X-ray film on admission showed small patchy infiltrates, and a computed tomographic (CT) scan showed centrilobular nodules and patchy infiltrates with thickened broncho-vascular bundles in both lungs. Transbronchial and thoracoscopic lung biopsies disclosed the coexistence of interstitial pneumonia with BOOP pattern, follicular bronchiolitis, and diffuse panbronchiolitis-like purulent and obliterative bronchiolitis. Due to findings of chronic sinusitis, the patient was treated with erythromycin for 8 weeks, and the abnormal CT shadows regressed. This was an interesting case of various pulmonary lesions associated with rheumatoid arthritis, and successfully treated with erythromycin.

A 40-year-old man with glycogen storage disease type 1a (von Gierke disease, GSD1a) developed hepatocellular carcinoma (HCC). Cold single-strand conformation polymorphism (SSCP) with 12% glycerol identified the G727T mutation in the glucose-6-phosphatase (G6Pase) gene, which has been reported to be the most common mutation in Japanese GSD1a patients. This case report is the first documentation of HCC in a case with G727T mutation. Given the prevalence of HCC in GSD1a with various germline mutations, analysis is needed to confirm that the germline mutation in this case is really related to hepatocarcinogenesis. DNA analysis of the family pedigree of this case, revealed three individuals with GSD1a and seven heterozygous carriers of the G727T mutation. As the diagnosis of GSD1a in this family was made only after these three patients reached adulthood, DNA diagnosis may help early identification of GSD1a patients and prevention of the progression of the disease. This DNA-based diagnosis permits prenatal diagnosis in at-risk patients and may facilitate screening and counselling of patients clinically suspected of having this disease.

To clarify the clinicopathologic features of neuroendocrine carcinomas (NECs) of the stomach, we reviewed 56 cases of surgically treated gastric carcinomas with a solid growth or with areas containing patterns characteristic for neuroendocrine (NE) tumors.Of the 56 cases reviewed, we selected 33 cases of NEC based both on histologic patterns common to NE tumors and on histochemical/immunohistochemical results.The average age of patients with NEC was 69.8 years (range, 44-92 years). The majority of patients were men (male-female ratio, 23:10). The most frequently affected site was the upper third (46%) of the stomach. Grossly, 9 cases of NEC were fungating and 24 were ulcerated. As compared with 23 patients with non-NEC tumors, the patients with NECs had a worse prognosis. Histologically, NECs had a variety of histologic patterns, including solid, organoid, trabecular, pseudoglandular, spindle cell, and rosettelike. Based on both cell size and morphologic features, we subdivided NECs into 2 variants, namely, small cell NEC and large cell NEC. Our series included 12 cases of small cell NEC and 21 cases of large cell NEC.Compared with small cell NECs, large cell NECs had a higher mitotic count, larger polygonal cells, a lower nuclear-cytoplasmic ratio, coarser nuclear chromatin, and more frequent conspicuous nucleoli. Large cell NEC was an aggressive tumor with a very poor prognosis (median survival time, 15.2 months; 1-year survival rate, 58%), which approached that for small cell NEC.

To clarify the clinical feasibility of getting a long-term arterial access at the subclavian region by directly puncturing the artery under ultrasound guidance.Percutaneous placements of arterial infusion catheters with implantable ports were performed in 30 patients with malignant abdominal tumors. The axillary artery in the subclavian region was punctured directly with an 18G needle under ultrasound guidance. Using the Seldinger technique, a 5Fr catheter was placed with its tip in the hepatic or the other tumor-supplying arteries. The catheter was connected to an implantable port, and both of them were embedded in the subcutaneous pocket.Percutaneous placements of infusion catheters were successfully performed in 29 cases. Transarterial chemotherapy through implanted ports was done uneventfully in 26 patients, while in the other three cases, catheter dislodgment occurred. Two local haematomas, one wound infection and one cerebellar infarction were also experienced.Ultrasound-guided subclavian approach is a minimally invasive way of implanting an infusion catheter for chemotherapy, although its indication for severely atherosclerotic patients should be limited.

A 45-year-old male presented with sudden onset of severe headache. Computed tomography and magnetic resonance imaging demonstrated an irregularly enhanced suprasellar mass with intratumoral and subarachnoid hemorrhage. The mass was removed in two operations. Histological examination of the tumor revealed pilocytic astrocytoma. The relatively rich vascularity and perivascular tumor cell proliferation observed in this benign lesion were probably the causes of this extremely rare association.

To improve the diagnostic accuracy of computed tomography (CT)-guided biopsy of small lung nodules.The usefulness of fine-needle core biopsy combined with immediate frozen-section diagnosis by pathologists was prospectively studied. Forty-six biopsies of small lung nodules (less than 3 cm in greatest diameter) were performed under CT guidance in 46 patients with 31 malignant and 15 benign processes. Initial biopsy was always attempted with a 20 or 21G histological needle; tissue samples were sent to the pathology department immediately after biopsy for pathologic diagnosis of the frozen sections.In 41 of 46 lesions (89.1%), sufficient material was obtained for diagnosis, permitting a correct final diagnosis. For malignancy, the sensitivity was 100%, whereas 81.8% of the benign lesions were diagnosed as specifically benign. Pneumothorax occurred in 41.3%.Histological diagnosis using frozen sections is a useful adjunct for CT-guided biopsy of the chest.

We resected 158 cases of hepatocellular carcinoma (HCC), including 20 (12.6%) cases of large HCC. These 20 cases were divided into group 1 (curative resection, n = 9) and group 2 (noncurative resection, n = 11). The clinicopathologic features and long-term survival of the cases were evaluated. In groups 1 and 2, portal vein invasion (Vp+) was noted in 44.4% and 63.3%, intrahepatic metastasis (IM+) in 77.8% and 100%, absence of a fibrous capsule (Fc-) in 55.6% and 63.6%, and stage III or IV in 77.8% and 100%, respectively. The DNA ploidy pattern was aneuploid in 44.4% of group 1 and 100% of group 2. In group 1, the 1-, 3-, and 5-year cumulative survival rates were 75%, 62.5%, and 62.5%, respectively (the longest survivor is alive after 11 years 1 month). Five cases survived more than 3 years in group 1, and all were Vp(-) and nonaneuploid. On the other hand, in group 2, the 1-year survival rate was only 33.3%; none survived more than 2 years. These results suggest that even patients with large HCC have a favorable long-term prognosis if their clinicopathologic factors are Vp(-) and nonaneuploid, and if curative resection can be performed.

We report four cases of acute pneumonitis due either to interferon, or a herbal drug, "Sho-saiko-to", or both in combination, in patients with chronic active hepatitis, focusing on its pathogenesis and response to prednisolone therapy. These cases shared common clinical features: fever, dry cough, dyspnoea, hypoxaemia, diffuse infiltrates both on chest radiography and chest computed tomography, restrictive pulmonary functional impairment, and alveolitis on examination of transbronchial lung biopsy, all of which suggest acute interstitial pneumonia. Furthermore, lymphocytosis was observed in association with the dominant CD8+ T-cell subset in bronchoalveolar lavage fluid. A lymphocyte stimulation test using peripheral blood was positive to interferon in one case and to Sho-saiko-to in another. All patients responded to oral prednisolone therapy. Peripheral soluble interleukin-2 receptor levels decreased in parallel with improvement in the clinical course. All patients were free of symptoms with a follow-up of 1-3 yrs. We conclude that interferon- and/or Sho-saiko-to-induced acute pneumonitis may be due to allergic-immunological mechanisms rather than toxicity, and that peripheral levels of soluble interleukin-2 receptor appear to be good markers of disease activity.

alpha 2-macroglobulin-trypsin complexlike substance (MTLS) was determined in plasma of pancreatic and nonpancreatic diseases using a two-step enzyme immunoassay to study the diagnostic and pathophysiological significance of MTLS. Plasma levels of MTLS in acute pancreatitis (mean +/- SD = 265.6 +/- 346.2 ng/ ml, n = 9), calcified chronic pancreatitis (128.6 +/- 257.4, n = 13), and noncalcified chronic pancreatitis (13.5 +/- 12.5, n = 10) were significantly higher than that in controls (3.6 +/- 1.8, n = 81). In other diseases such as gastric cancer, hepatoma, diabetes mellitus, and gallstones, MTLS values were not different from those of control. Plasma MTLS values showed low correlation with serum trypsin, elastase 1, pancreatic amylase, lipase, and pancreatic secretory trypsin inhibitor (PSTI). The elevation of plasma MTLS values in acute pancreatitis suggests that plasma MTLS levels reflect that protease is inappropriately activated in pancreatic acinar cell and released into the circulation and that the determination of MTLS can be useful for diagnosis and pathophysiology of acute pancreatitis and chronic pancreatitis.

Proliferative activity (PA) and p53 over-expression were assessed in 68 cases of primary ovarian epithelial tumors of variable grades of malignancy by immunohistochemical methods using antibodies to PCNA (proliferative cell nuclear antigen) and p53 molecule. First, we compared the values in benign tumors, tumors of borderline malignancy and malignant tumors. Malignant tumors possessed higher PA value (26.8 +/- 14.7%) than benign tumors (1.6 +/- 1.4%), and tumors of borderline malignancy exhibited an intermediate value (11.4 +/- 5.1%). Intranuclear accumulations of p53 product were more frequently observed in malignant tumors (16/32, 50%) than in tumors of borderline malignancy (3/9, 33%). None of the benign tumors exhibited p53 over-expression. In malignant tumors, PA correlated well with the histologic grade of tumors, although the histologic type and stage of the diseases did not correlate significantly with PA. Then, we focussed on the cases of malignant ovarian cancer composed of heterogeneous lesions showing a different grade of malignancy; invasive lesion (IL), non-invasive lesion (NIL), and benign appearing lesion (BAL). PA of NIL was almost identical with that of IL (19.6 +/- 13.5% vs. 23.3 +/- 12.6%), while BAL showed significantly lower PA (2.1 +/- 3.0%, p0.001) than the above two lesions and was similar to that of benign tumors. Furthermore, p53 over-expression was never observed in BAL, even in cases in which IL and/or NIL showed p53 over-expression. Thus, the results indicated that histologically benign-appearing lesions of malignant ovarian epithelial tumors possessed a biologic character similar to benign tumors. Collectively, all these findings would support the concept that a part of malignant ovarian epithelial tumors would be derived from benign tumors through progressive transformation.

In order to define the roles of the K-ras and p53 genes in the development of lung cancer, especially in young adults, we compared the clinicopathological features of the patients between younger (or = 45 years, n = 47) and older (55 years, n = 50) groups. The gene alterations were examined by the polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) method. The K-ras gene alterations were detected only in adenocarcinomas, and the p53 gene alterations in all histologic types of lung cancer. There were no significant differences in the frequency of both K-ras and p53 gene alterations between the younger and older groups (9 vs. 11%, 36 vs. 32%). In the younger group, but not in the older one, the percentage for smokers was significantly higher in the p53 gene alteration-positive group than for the negative group (65 vs. 30%). As to the prognosis, there were no significant differences between the p53 gene alteration-positive and -negative cases in both the younger and older groups as well as in all subjects, while a tendency of poorer prognosis was observed in K-ras gene alteration-positive cases than for the -negative ones with adenocarcinomas. These results suggest that (1) the K-ras and p53 gene alterations would have no special roles in terms of the lung carcinogenesis in young adults; (2) a positive relationship between smoking and p53 gene alteration would exist in young adults with lung cancer, and (3) K-ras gene alteration would become a prognostic factor in lung cancer.

Clinicopathological features of surgically-treated peripheral T1 adenocarcinoma of the lung were compared between 30 females and 26 males, and the following sex differences were observed; 1) Females were younger than males, 2) There was a higher percentage of smokers among males, 3) The acinar histologic subtype was less frequently found in females, 4) Well differentiated tumors were more frequently found in females, 5) K-ras gene mutations were observed only in males, 6) Prognosis was slightly better in females. As to other factors such as N-factor, tumor ploidy or central fibrosis, there was no statistical difference between the two groups. Although we were not able to explain the causes for the above sex differences, it was speculated that smoking was mainly responsible for them.

We reported a rare case of mediastinal cystic lymphangioma, which happened to be discovered on chest X-ray. CT density level of the mediastinal tumor was 20 HU and the tumor was homogeneous cystic lesion. Multilocularity of the cyst and the relationship to the adjacent inferior vena cava were clarified by pre-operative transesophageal and intraoperative ultrasonographic examination, and the tumor was successfully excised without mishap.

Calcification such as psammoma body is sometimes found especially in spinal cord meningioma but ossification of the meningeal tumor was rarely observed. Two cases of ossificated spinal cord meningiomas, located extramedullary intradurally apart from spinal bone, were clinicopathologically analyzed. The patients were 75-year-old female with meningioma at T9-10 level and 60-year-old female with one at T6-8 level. With pathological examination, concentration of psammoma bodies is not related to the formation of bone tissue. Metaplasia of arachnoid cell is seemed to be the origin of the bone structure.

Nebulisation chemotherapy, a chemotherapeutic method for the treatment of lung cancer that involves the administration of anticancer agents through the inhalation of nebulised aerosols, has been found to be highly effective (Tatsumura et al., 1983a,b). We confirmed that 5-FU administered by this method accumulates in the trachea, bronchi and regional lymph nodes of patients treated before surgery, along with 5-FU metabolites, FUR and FUdR, indicating that 5-FU is directly incorporated and metabolised in the respiratory tract. Parallel result were obtained using mongrel dogs. The 5-FU levels in other organs, such as the heart and liver, were found to be extremely low. Only a trace of 5-FU was found in the serum of both the patients and the dogs. We further investigated the anti-tumour effect of this therapy in ten selected patients and observed a satisfactory anti-tumour response of 60.0%. These results, along with our previous finding that the retention time of isotope tracers inhaled as aerosol is considerably longer in tumour tissues than in normal parts (Tatsumura et al., 1983a) explain the high antitumour action of this therapy and the absence of adverse effects of administered 5-FU. Images Figure 1

Fifteen cases of small-size rectal carcinoid tumors (RCTs) were discovered among a total of 21,522 healthy teachers who received proctosigmoidoscopy. Adding another case seen in the outpatients, a total of 16 RCTs were clinicopathologically studied. The average age of the patients was 48.8 yr, and the incidence was predominantly among males. Prior to endoscopy, digital examination of the rectum revealed a palpable firm nodule in 13 patients. On endoscopy, RCTs were generally round, yellow-discolored polyps with a size less than 13 mm in diameter, covered by a normal-appearing mucosa. An erythematous change or depression was seen in three tumors. Histologically, they showed pure insular, trabecular, or mixed structures, and tumor cells were confined to the mucosa and/or submucosa in all cases. Immunohistochemically, RCTs never failed to show focal or diffuse positivities for chromogranin A and/or neuron-specific enolase. Pancreatic polypeptide was immunostained in 14 tumors to a varying degree. The tumors having been safely treated by endoscopic polypectomy and/or surgical excision, all of the patients are alive and clinically free of disease during the average observation period of 79 months.

To clarify the clinical and histological features of polyps in the duodenal bulb (DB), we studied, clinicopathologically, a total of 263 patients (179 male, 84 female) with polyps in the DB. The patients were 13-86 yr of age (average age, 57.1 yr). On endoscopy, a semipedunculated or pedunculated polyp with a relatively large size was seen in 33 patients, and small polyps, either single or multiple, were incidentally discovered in 230 patients. Histological examination of the biopsied specimens from polyps revealed gastric tissue in 182 cases (69.2%), cyst formation in 51 (19.4%), and other miscellaneous lesions (tubular adenoma, Brunner's gland hyperplasia, etc.) in 30 (11.4%). With regard to the gastric tissue, a "full-thickness" or "incomplete" body-type mucosa was identified in 27 cases of polyps, and hyperplastic surface epithelium was recognized in 155. Forty cases of hyperplastic surface epithelium-type polyps were subclassified as "pyloric"-type mucosa, because pyloric gland-like components seen under the surface epithelium were identical to those of the gastric antrum. It was reconfirmed that small polyps with little or no clinical significance could be produced by various histological features.

Of 17 cases of small cell carcinoma of the stomach, three were early and 14 were advanced. Grossly, the tumors were mostly polypoid at the early stage, and as they advanced, deep ulcerations developed. Histologically, only one tumor was "oat cell type," and the other 16 were "intermediate cell type." With regard to tumor components, five were "pure" tumor, and 12 were "composite" admixing glandular and/or squamous differentiation. Argyrophil cells were seen in eight tumors. Immunohistochemically positive cells for chromogranin, neuron-specific enolase, and keratin were seen in 12, 10, and 7 tumors, respectively. Carcinoembryonic antigen was negative in the small cell component of most tumors as opposed to strong positivity in the glandular component. Electron-dense core granules were evident in seven of nine tumors examined. These findings suggest that histologic variety is quite characteristic of the small cell carcinomas of the stomach, and this type of carcinoma takes an aggressive clinical course like its counterparts in other organs.

T cryptantigen can be exposed on the red cell membrane as a result of removal of terminal glycosides, either by bacterial enzymes or by incomplete synthesis of the cell membrane due to somatic mutation, usually caused by a neoplasm. T-activated erythrocytes have been observed in different pathologies, but they have not been seen associated with other abnormalities of red blood cell proteins described in myelodysplastic syndromes or acute leukaemias. A patient with initial diagnosis of refractory anaemia that evolved into erythroleukaemia showed prolonged T-activation, a depressed A blood-group antigen and an increase of foetal haemoglobin, simultaneously. The evolutive pattern of T-activation suggests more an abnormal erythropoiesis than an enzymatic effect and a certain relationship with the haemolytic syndrome.

Localization of ferritin in testicular tumors was studied by the immunohistochemical method and the usefulness of ferritin was evaluated compared with the clinical course. Seven cases of seminoma and 9 cases of non-seminoma were used for the study. Formalin-fixed, paraffin-embedded tissue sections were stained by the avidin-biotin complex method. Commercial rabbit anti-human ferritin polyclonal antibody in 1/100 dilution was allowed to react at room temperature for one hour. In normal testicular tissues, the epithelium in germinal cells was not stained for ferritin. In seminomas, some tumor nests were stained for ferritin. Interstitial cells, especially histiocytes, were also stained for ferritin. In stained tumor cells, cytoplasm was stained uniformly. Necrotic cells were not stained. The same findings were obtained in non-seminomas. In metastatic lesions and tumor thrombi in the vessels, some tumor cells were stained as intensely as in the origin. A case was calculated positive if more than 5% of the tumor cells in the specimen were stained. The positive rate in ferritin immunostaining was significantly higher than that of human chorionic gonadotropin (beta-HCG), alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA) immunostaining with the same materials. The specimens from cases with abnormally high serum ferritin level, were stained more intensely than those from cases with normal serum ferritin level. The result suggests that ferritin might be a useful tumor marker in some of testicular tumors.

We designed a prospective trial of the mass survey for pancreatic disease, especially pancreatic cancer in consecutive 2576 subjects undergoing periodical health examination during 1989. In order to detect abnormality of the pancreas we measured serum amylase, elastase-1 and SPan-1 as serum markers and used ultrasonography (US). When abnormal elevation of serum markers or abnormal findings of US were obtained at the first screening, re-examination or further examination using ERCP, CT and endoscopic US were performed. Frequencies of elevated amylase, elastase-1 or SPan-1 were 0.9%, 3.4% or 1.7%, respectively. However, no pancreatic diseases were detected among the cases of elevated serum markers after subsequent further examination. Frequency of abnormal US findings of pancreas were 2.3% (59/2576), including dilatation of main pancreatic duct, cystic lesion, space occupying lesion and calcification. Subsequent further examinations on subjects with abnormal US revealed 8 cases of pancreatic diseases including one small pancreatic cancer. US may be an efficient tool of mass survey for pancreatic cancer in the health examination at present.

To confirm the respective influence of chronic alcoholism and liver disease on exocrine pancreatic function in cholecystokinin secretin (CS), tests were performed on patients with chronic liver cirrhosis (LC) and non-cirrhotic (nLC) disease of alcoholic (A) and nonalcoholic (nA) etiology. Results were compared in four subgroups (ALC, N = 26; AnLC, N = 45; nALC, N = 18; and nAnLC, N = 43). Volume of duodenal juice and bicarbonate output (BO) were increased and maximal bicarbonate concentration was decreased in ALC, compared with those in normal controls. Comparison of LC and nLC indicated that the volume, BO, and amylase output (AO) were greater in LC than in nLC of alcoholic etiology, but not in those of nonalcoholic etiology. The initial disappearance rate (KICG) of indocyanine green (ICG) excretion correlated with a parameter of CS test in alcoholic liver disease (vs. volume: r = -0.51, p less than 0.01 vs BO: r = -0.40, p less than 0.01), but not in nonalcoholic liver disease. Concurrent chronic pancreatitis with pain and definite exocrine insufficiency was observed in only one ALC patient and in four AnLC patients, but in none of the nonalcoholics. In alcoholic liver disease, exocrine pancreatic secretion tends to increase with severity of liver damage, but concurrence of definite chronic pancreatitis is not correlated with the severity.

A case of Grawitz's tumor metastasizing to the cauda equina is presented. A 51-year-old male was hospitalized due to severe low back pain radiating to the left lower extremity. Neurological examination showed only hyporeflexia of the left patella reflex and positive Lasegue's sign. MRI showed intradural mass at the L4 level. Preoperatively, we diagnosed a cauda equina tumor. A laminectomy of both L3 and L4 was performed, and total removal of the cauda equina tumor was performed. Microscopically, the tumor cells were large, the appearance of the cytoplasm ranging from optically clear with sharply outlined boundaries, to deeply granular, with many transitional forms. These histological findings were typical findings of Grawitz's tumor, and were the same as those of this patient's renal tumor. Finally, we diagnosed Grawitz's tumor metastasizing to the cauda equina. Metastatic cauda equina tumor from outside the central nervous system is very rare and only 7 cases have been reported. This case is the first one of Grawitz's tumor spreading to the cauda equina.

We reviewed treatment and prognosis in 7 operative and 7 non-operative cases of renal cell carcinoma with venous tumor thrombosis formation, 14 cases in total. Treatment after around 1983 involved the use of biological response modifier (BRM), chiefly interferon (IFN), and operation by thoracoabdominal approach. Before that, chemotherapy, radiotherapy and operation by peritoneal approach were used, with many cases judged inoperable. Even in non-operative cases, life-prolongation was frequently achieved by embolization of the renal artery and administration of various BRMs. On the other hand, in cases judged operable which were always treated by resection, early postoperative death sometimes occurred. These facts brought home to us the difficulty of choosing appropriate treatment. Though it is hard to determine the relative merits of various treatments from the present data, since the series is small and contains cases from 1963 onwards, the clinical and pathological pictures should be carefully evaluated for each case, and the most suitable course of treatment should be selected individually. We describe a non-operative case in which a combined use of embolization, IFN-gamma and tumor necrosis factor (TNF) elicited a lasting partial response, and an operative case in which postoperative complications such as pulmonary infarction and renal failure occurred after operation under extracorporeal circulation and patient died at 2 months after operation.

4, 6-0-Benzylidene-D-glucopyranose (BG), a derivative of benzaldehyde (BA), whose anti-tumour action has often been reported, showed responses in 10 out of 24 patients (41.7%). These patients consisted of 11 cases of primary lung cancer, 4 of metastatic lung cancer, 5 of gastric cancer, and one each of cancer of the sigmoid colon, liver, pancreas and prostate. There were two complete responses (one each of ipsilateral lung metastasis from breast cancer and metastatic liver lesions due to gastric cancer). The mean total dose of BG was 392.6 g, given by intravenous infusion of 1.2 g BG in 100 ml saline twice daily. The treatment was discontinued when no response was observed after two months. Careful monitoring showed no toxic action of BG at these large doses. Complete necrotic liquefaction of tumour, without any damage to surrounding tissue, was seen in 2 of 3 cases in which histological examination was feasible. It is apparent that BG, like BA, is not a cytotoxic agent in the ordinary sense, but its mechanism of action is still unknown. Images Figure 2 Figure 3

201T1 SPECT was performed in 84 patients with suspected lung cancer. Both early and delayed scans demonstrated abnormal accumulation in 67 of 68 malignant pulmonary lesions and in nine of 18 benign conditions. All of 64 lung cancer were clearly visualized. Delayed ratio (uptake ratio of the lesion to the normal lung on delayed scan) and retention index (degree of retention in the lesion) were helpful to differentiate malignant from benign lesions. This method was also useful to evaluate mediastinal involvement from lung cancer.

Introduction Although an increasing number of drugs have been implicated in the aetiology of eosinophilic pneumonia characterized by the development of pulmonary infiltrates and peripheral blood eosinophilia, eosinophilic bronchitis without alveolitis due to some pharmacologic agents has not been reported. Bucillamine [N-(2-mercapto-2-methylpropionyl)-Lcystenine] is a commonly used drug for treatment of rheumatoid arthritis in Japan, which has recently been added to the growing list of pharmacologic agents associated with infiltrative pulmonary lesions. A case of eosinophilic bronchitis induced by this drug presenting with only severe dry cough is described. The results of transbronchoscopic bronchial biopsy, a lymphocyte stimulation test, and a challenge test supported this diagnosis.

A streptococcal preparation, OK432 was evaluated as the adjuvant immunotherapeutic agent for superficial bladder tumors. Twenty-nine cases were treated with complete transurethral resection and then randomized prospectively into two groups. One group had adjuvant therapy of OK432 intradermal administration and another group had no adjuvant therapy. OK432 administration significantly reduced the recurrence rates as compared to the control group. Although further studies were required for its full significance, in a short-term study, OK432 intradermal administration produced a beneficial effect in reducing the recurrence rates.

Renal autotransplantation has been a treatment of choice for renovascular hypertension, renal artery aneurysm, complicated staghorn calculi, ureteral disorders and others. The paper reports 5 cases of extensively damaged ureter and discusses the indication and the results of operation. There were three cases of postoperative extensive ureteral stricture. One patient had postoperative ureteral injury with retroperitoneal abscess. The last one showed renal foreign body calculi with recurrent pyelonephritis after ureterocutaneostomy. The postoperative course of four patients had been uneventful revealing well functioning autotransplanted kidneys without hydronephrosis and infection during the follow-up period of 22 to 42 months. However, the patient with the ureteral injury and retroperitoneal abscess died of bleeding from renal vein anastomosis on the 15th postoperative day, since the renal pedicle showed marked inflammatory change including renal vein wall. Subsequently, autotransplantation is contraindicated in the cases with marked inflammation in the renal pedicle. In cases of various other ureteral lesions including long distance ureteral stricture, this procedure is recommended when neither the end to side ureteral anastomosis, Boari's bladder flap operation nor bladder hitch operation is feasible.

Allylestrenol at the daily dose of 50 mg was administered to 45 patients with benign prostatic hypertrophy. The treatment was performed for more than 12 weeks in 40 patients, and improvements, marked and moderate, were observed in 22 patients (55%) in the overall judgement. As side effects of this drug, decrease of potency was observed in 3 cases, decrease of libido in 1 case, pigmentation on breasts in 2 cases, palpitation in 2 cases, short breath in 1 case, and gastrointestinal symptoms in 1 case. However, these side effects were not serious. Our trial suggests that the treatment of benign prostatic hypertrophy with allylestrenol can be useful in urological clinics.

For investigation of the incidence of pulmonary thromboembolism, the sites of thromboemboli, pulmonary vascular changes, detailed clinical and autopsy records, and histological sections of a series of 103 autopsied adults were reviewed. Pulmonary thromboembolism was observed in 38.8% of these cases. Pulmonary thromboembolism tended to be more frequent in older, younger, female, and cancer patients. Thromboembolism was found most frequently in arterioles, followed by muscular arteries. A significant correlation (P less than 0.02) was found between the incidence of pulmonary thromboembolism and the histological changes of endothelial protrusion and vacuolization of the intima in these small pulmonary arteries, but no correlation was found between that of pulmonary thromboembolism and constriction figures. These endothelial changes probably represent previous vasoconstriction. The present observations suggest a significant relationship between pulmonary thromboembolism and vasoconstriction of small pulmonary arteries and suggest that widespread vasoconstriction of pulmonary arteries is important in the pathogenesis and pathophysiology of this condition.

Since 1983, eight cases of adrenal incidentaloma were experienced at the Department of Urology, Wakayama Medical College and affiliated hospitals. Six adrenal masses were incidentally detected by computed tomography, and two were first noted by either ultrasonography or intravenous pyelography. Surgical exploration was performed in all cases as the final diagnostic measure. Of them, three had adrenocortical adenomas, three had adrenal cysts, one had adrenal metastasis and one had pheochromocytoma. Preoperative evaluation revealed that all patients except one with pheochromocytoma had no endocrinological abnormality. The management of the adrenal incidentaloma, which will be discovered more frequently accompanied with the increasing use of computed tomography, was discussed with special references to its precise indication of surgical treatment.

Dolichoectasia usually causes neurological symptoms because of the pressure it exerts on adjacent intracranial structures and/or impaired circulation distal to ectasia. However, it rarely induces subarachnoid hemorrhage. The authors report just such a rare case of dolichoectasia, which caused subarachnoid hemorrhage following extensive cerebral infarction distal to ectasia. On October 18, 1982, a 47-year-old man came to our hospital with dementia which had started 7 days before, as his chief complaint. Neurological examinations revealed no positive findings. However, plain CT scan showed the presence of small multiple low density areas with a round-shaped high density area at the tip of the right temporal lobe. Angiogram taken on February 18, 1983, revealed that all main cerebral arteries, especially the C1 portion of the right internal carotid artery, and the M1 portion of the right middle cerebral artery were abnormally tortuous and distended. There was also pooling of contrast medium in the distal part of the M1 portion of the right middle cerebral artery which corresponded to the site of high density area on the plain CT scan. On January 31, 1987, he was admitted to our hospital with his chief complaint being the sudden onset of weakness in his left extremities. On admission, he was confused (II-10 on the Japan Coma Scale), dysarthric, and hemiparetic on the left side. Plain CT scan showed extensive cerebral infarction of the right middle cerebral artery territory distal to the ectasia.(ABSTRACT TRUNCATED AT 250 WORDS)