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Progressive occlusions of the intracranial portions of ICAs are already established phenomena in childhood-onset moyamoya disease, but they have not yet been demonstrated in adult-onset patients. A patient with moyamoya disease manifested at 25 years of age was examined with cerebral angiography at 27 and 45 years of age. The angiograms taken at 27 revealed that the right ICA was completely occluded at the clinoidal portion, while the left one was patent and the occlusive/stenotic change was limited to the terminal portion. Angiograms taken 17 years later revealed that the right ICA was occluded at the origin, while the left one concentrically narrowed at the origin, then tapered off and was occluded at the clinoidal portion. The present case suggests that the ICA occlusion of moyamoya disease is not limited to the intracranial segment but progresses to the cervical segments, even in adult-onset patients. Based on these findings, two different groups of adult-onset moyamoya disease may exist; one in which the occlusive disorder has been completed by the time clinical manifestations appear and thereafter decreases, while the other group consists of occlusive disorders that steadily progress to the original portion of ICA.

To study the role of autonomic nervous innervation in the etiology of peptic ulcer, we investigated the blood pressure in patients with peptic ulcer.In 100,085 Japanese adults who were undergoing health screening examinations, including barium meal study, there were endoscopic evaluation-confirmed diagnoses of gastric ulcer in 769 cases and of duodenal ulcer in 344 cases. The blood pressure in those patients was compared with that in 57,208 normal Japanese controls with no gastrointestinal abnormalities, as confirmed by barium meal study.The blood pressure of younger and middle-aged men with gastric and duodenal ulcer were lower than those of normal control men. In women, except for the diastolic pressure of those in their 50s, the blood pressure in patients with peptic ulcer and normal controls did not differ significantly. The incidence of duodenal ulcer or of gastric ulcer in men was inversely related to the systolic and diastolic pressure. No definite relationship in this respect was seen in women.An inverse relationship was observed between the occurrence of peptic ulcer and the blood pressure level in Japanese men, but not in women. The relationship may be mediated by an inhibitory effect of the sympathetic nervous system on ulcer formation in hypertensive subjects. The reason for the sex difference in this respect is unknown.

Gap junctions present in the primate fovea may electrically couple cone photoreceptors to average out noisy voltage fluctuations at no cost to spatial acuity at low luminance.

The objective of this study was to evaluate the function of the minor duodenal papilla and to investigate the relationship between the history of acute pancreatitis and individual dorsal pancreatogram findings and the minor papilla function in pancreas divisum.Eight of the 21 patients with PD diagnosed by endoscopic retrograde cholangiopancreatography had a history of acute pancreatitis (group A), and 13 patients did not (group B). The reaction of pancreatic juice excreted via the minor papilla was evaluated after intravenous administration of secretin, by observing the repulsion of indigo carmine dye scattered on the surface of the minor papilla.The function of the minor papilla was classified into two types. In 12 patients, all of the pigment on the minor papilla was repelled within 5 min of secretin administration (type I), and in the remaining nine patients it was not (type II). After secretin administration, the pH of the minor papilla surface in type I was significantly higher than that in type II. There was no significant difference between the type I and type II patients in exocrine pancreatic function, as evaluated by a BT-PABA test. In the group A patients, the rate of occurrence of dorsal duct dilation (including changes of the terminal shape) was significantly greater than in the group B patients. The function of the minor papilla in the group A patients was significantly worse than in the group B patients. Outflow obstruction of pancreatic group B patients. Outflow obstruction of pancreatic juice, i.e., "relative stenosis of the minor papilla," was considered to be present in the patients with type II papilla, and, therefore, the patients with type II papilla might suffer from acute pancreatitis resulting from poor drainage of pancreatic juice and excessive pressure in the dorsal duct.The finding that patients with PD have one of two types of minor papilla will be useful for understanding the condition and selecting the therapeutic plan for individual patients.

Our objectives in this study were to differentiate between pancreatic cancer (PC) and chronic pancreatitis (CP) in cases with localized stenosis of the main pancreatic duct (MPD) by an intraductal ultrasound (IDUS) probe which were detected on pancreatogram.We inserted the IDUS probe (30 MHz) into the MPD in all cases and scanned the stenotic site in 23 of 26 cases (88.5%) in vivo. In all 26 patients, the stenotic site was surgically resected, and IDUS scanning was also performed on the resected specimens. Findings from IDUS were compared with those from histology. The diagnostic ability of IDUS was compared with that of endoscopic ultrasonography (EUS), computed tomography (CT), and endoscopic retrograde pancreatography (ERP).The IDUS images of localized stenosis were classified into two types: type I showed an echorich area surrounded by an echo-poor margin and was found in 14 PC patients and one CP patient; type II showed a ring-like echolucent band surrounded by a fine reticular pattern and was found in 11 CP. Therefore, we considered that type I tended to be characteristic of PC, whereas type II tended to be characteristic of CP. Sensitivities of EUS, CT, ERP, and IDUS in diagnosing PC were 92.9% (13/14), 64.3% (9/14), 85.7% (12/14), and 100% (14/14), respectively. Specificities of EUS, CT, ERP, and IDUS were 58.3% (7/12), 66.7% (8/12), 66.7% (8/12), and 91.7% (11/12), respectively.IDUS examination might be useful in the diagnosis of patients with localized stenosis of the MPD, but its precise role in the diagnostic work-up of patients with pancreatic diseases remains to be determined by further studies.

The aim of this study was to evaluate the usefulness of endoscopic ultrasonography (EUS) in the staging of superficial esophageal carcinoma (SEC).We examined the histopathologic findings of 28 patients with SEC which was confirmed in the postoperative histologic evaluation. The EUS results preoperatively estimated were compared with them.There were nine patients with mucosal carcinoma (two intraepithelial carcinomas and seven carcinomas limited to the mucosal layer) and 19 patients with submucosal carcinoma. The mucosal carcinomas revealed no lymph node metastasis or vessel permeation, whereas the submucosal carcinomas revealed lymph node metastasis (71%) and vessel permeation (lymphatic, 58%, vascular, 21%). The accuracy rates of depth of invasion by EUS were mucosa, 67% (6/9); submucosa, 79% (15/19); and total, 75% (21/28). EUS could not detect microinvasion to the submucosa. The overall accuracy rate of EUS in the evaluation of periesophagogastric lymph node metastasis was 72%: sensitivity 58% and specificity 85%.It has been clinically proved important to differentiate mucosal carcinoma from submucosal carcinoma in the staging of SEC, and EUS is recommended in differentiating between them.

The relationship between titrated acidity and pH was studied using the 3206 samples of human gastric juice, which were collected by the intragastric tube in the basal and gastrin stimulated conditions. The pH of samples subjected to the present study ranged from 0.95 and 6.9. The results showed that a certain value of pH did not always indicate an identical value of titrated acidity, and that the coefficient of variation was greater as pH value rose. As a whole, however, the acidity became lower with the increase of pH value. Thus, the relationship between pH and titrated acidity could be expressed closely as "Y = 369.19 - 424.09X + 203.66X2 - 48.29X3 + 5.57X4 - 0.25X5), where X = pH and Y = acidity. The conversion table from pH to acidity, which was calculated by this expression, was presented for the clinical use.

This study was designed to determine the influences of methylprednisolone (MP, CAS 2375-03-3) on the genesis and healing of gastric lesions induced by 50% ethanol in relation to the changes in gastric mucosal prostaglandin (PG) and leukotriene (LT) contents and vascular permeability. Intragastric administration of 1 ml of 50% ethanol induced hemorrhagic lesions in the fundic portion, and these lesions were not affected by 20 mg/kg of MP injected subcutaneously 30 min before ethanol administration. In untreated rats, 4 kinds of PGs, i.e., 6-keto-PGF1a, PGF2a, PGE2, and PGD2, were determined in gastric mucosa by high performance liquid chromatography (HPLC), but no LTs were detected. Administration of ethanol significantly reduced all PG contents and increased production of peptide-LTs in gastric mucosa. Pretreatment with MP did not influence ethanol-induced changes in PG and peptide-LT contents. Ethanol-induced lesions required 96 h for total healing. Ulcer healing was not affected by MP, which was injected subcutaneously twice daily from 1 h after ethanol administration until the end of the experiment, and complete ulcer healing was observed after 72 h. MP did not affect ethanol-induced decrease in PG contents, their recoveries, or peptide-LT contents. Ethanol increased vascular permeability and MP reduced this increase. These results suggest that MP does not have a hazardous effect, but is rather beneficial with regard to healing of ethanol-induced gastric lesions through prevention of the increase in vascular permeability caused by ethanol, and that it affected neither gastric mucosal PG nor peptide-LT contents.

The carbon films with 7-35at% hydrogen content for overcoats of magnetic thin film disks were prepared using DC-magnetron sputtering. Physical properties, chemical structure, surface topography and mechanical properties of the films, and the interaction between carbon and lubricant have been investigated. The carbon film hydrogenation improves CSS performance because of increase in film hardness, while excessive hydrogen content in the film leads to decrease in hardness and surface smoothing, resulting in poor CSS performance and high friction.

SUMMARY We investigated the effect of sucralfate on angiogenesis in granulation tissue of gastric ulcers induced by acetic acid in rats using the carmine dye method. Intragastric administration of sucralfate at a dose of 500 mg/kg twice daily for 9 days significantly accelerated ulcer healing and significantly increased the extent of angiogenesis in the ulcer base on the tenth day after ulcer induction. As we reported previously, intragastric administration of cimetidine at a dose of 100 mg/kg once daily for 9 days decreased the extent of angiogenesis on the tenth day. However, combination treatment using sucralfate and cimetidine accelerated ulcer healing significantly, without altering the extent of angiogenesis. It is concluded, therefore, that the treatment with sucralfate may be effective in peptic ulcer disease from the standpoint of angiogenesis in the ulcer base.

To study increase of the Salmonella population in the cecum of chickens infected with Eimeria tenella, quantitative changes in mannose residues on the cecal mucosa were investigated. Inhibition of S typhimurium adherence to the cecum by a 2% carbohydrate (D-mannose, D-galactose, L-fucose, alpha-methyl-D-glucoside) in phosphate-buffered saline solution was examined. Only D-mannose had inhibitory effects. Whereas, D-galactose had somewhat enhancing effects on adherence of S typhimurium to the cecal mucosa of uninfected germ-free chickens. In infected and uninfected chickens, D-mannose inhibited adherence of S typhimurium. D-Mannose significantly (P0.05) increased adherence of Bacteroides sp. In infected and uninfected chickens, D-mannose did not have any effect on adherence of Clostridium perfringens and Bifidobacterium thermophilum. Under microscopic observation, only concanavalin A and Lens culinaris agglutinin, of 8 lectins examined, were recognized as lectin-positive staining lines or spots in the cecal mucosa, indicating presence of mannose residues on the cecal mucosa. In E tenella-infected chickens, lectin-positive staining was seen strongly on the coarse surface of damaged cells and at the bottom of the crypts. These results indicate that coccidial infection may induce increase of mannose residues on the intestinal surface and allow adhesion of more salmonellae to the intestine.

Accurately determining the surgical resection line is essential for improving the prognosis of patients with gastric carcinoma. Endoscopic ultrasonography (EUS) was used to assess the horizontal extent of cancerous invasion below the mucosal layer. In 105 patients (110 lesions) with gastric carcinoma, ultrasonographic images of resected specimens were compared with histological findings. The horizontal extent of the hypoechoic region of in vitro ultrasound was compared with the horizontal extent of the cancerous invasion and fibrosis in histological sections. In cases showing echo patterns characteristic of peptic ulcerations within the tumor focus, the horizontal spread of the echo-poor region correlated well with the spread of fibrosis, but not with the cancerous lesion. In other cases with no ulceration, the horizontal spread of the echo-poor region corresponded well with the cancerous lesions. To evaluate oral invasion of the cancerous lesion below the mucosa, 16 patients with gastric carcinoma who had clips placed during endoscopy were subsequently examined by EUS. The use of EUS combined with the clips allowed for a more accurate diagnosis of the invasion, not only in the mucosa, but also into the submucosa and beyond. This combined diagnostic method was safe and useful for determining a suitable surgical resection line.

Purpose We examined the effects of prostaglandin analogues on the blood-aqueous barrier(BAB) permeability in rabbit eyes at an early phase of endotoxin-induced uveitis(EIU). Subjects and methods One drop of 0.005% latanoprost or 0.12% unoprostone were applied to rabbit eyes. Escherichia coli lipopolysaccharides were injected to induce uveitis. The changes in flare intensity in normal eyes and EIU eyes after application of eye drops were evaluated. The effect of cyclooxygenase inhibitor on the flare intensity changes caused by the application of unoprostone was also examined. Results Flare intensity increased significantly after a single instillation of unoprostone, and the increase was not prevented by pretreatment with cyclooxygenase inhibitor. In eyes with EIU, unoprostone caused an additional increase of flare intensity to uveitis induced flare change. Latanoprost had no effects on BAB in eyes with normal and with uveitic conditions. Conclusion Latanoprost and unoprostone did not cause an excessive inflammatory reaction in rabbit eyes at an early phase of EIU.

This study was designed to elucidate the role of leukotrienes (LT) in indomethacin-induced gastric ulcers in relation to effects of clinically available anti-allergic drugs, azelastine (Azeptin, CAS 58581-89-8) and oxatomide (CAS 60607-34-3). Azelastine (2 mg/kg) or oxatomide (30 mg/kg) was administered intragastrically once 15 min before intragastrical administration of 12 mg/kg of indomethacin. Mucosal prostaglandins (PGs) and LTs were measured by high-performance liquid chromatography (HPLC). In the control rats, 4 kinds of PGs, i.e., 6-keto-PGF1 alpha, PGF2 alpha, PGE2 and PGD2, were detected in gastric mucosa, but no LT was detected. Administration of indomethacin caused severe gastric ulcers (lesion scores; 31.2 +/- 11.1 mm), and all prostaglandins were diminished completely. In contrast, LTC4 and LTD4 (peptide-LTs) were detected and the sum of their levels was 18.5 +/- 7.1 ng/g tissue. Irrespective of indomethacin administration, lesion scores were remarkably reduced in rats treated with azelastine or oxatomide (17.0 +/- 8.1 and 16.0 +/- 8.0, respectively). Azelastine and oxatomide treatment did not improve mucosal PG levels, however, both drugs reduced significantly increases in peptide-LT level, 9.3 +/- 4.6 and 8.6 +/- 4.4, respectively. These results suggest that increases in mucosal LT levels are also involved in the formation of indomethacin-induced gastric ulcers. Combined therapy using anti-allergic drugs and non-steroidal anti-inflammatory drugs might be recommended.

5 cases of small-sized insulinoma of the pancreas were studied to evaluate the ability of diagnostic imaging techniques to determine tumor location. Techniques used were extracorporeal ultrasonography, endoscopic ultrasonography (EUS), angiography, percutaneous transhepatic portal catheterization and CT. EUS was superior to the other modalities in diagnosing the location of insulinomas. We employed Color Doppler (CD) ultrasonography in one case and obtained color expression in the tumor and a pulsatile wave in the FFT analysis. Intraductal sonography of the pancreas (IDSP) was also performed in this case resulting peripheral echo-lucent, central echogenic mass. From these results, we expect that CD and IDSP will be useful in clinical application for diagnosing various tumors.

The prevalence of gallbladder polyps was investigated in apparently healthy Japanese who underwent abdominal ultrasonography as part of their health screening examination. The polyps found were differentiated from gallstones, adenomas, or carcinomas as much as possible, and were considered to be cholesterol polyps. The prevalence of such gallbladder polyps was higher among males in every decade of age evaluated. The subjects with gallbladder polyps were more obese than the control group without gallbladder polyps, on abdominal ultrasonograms. The prevalence of gallbladder polyps rose in accordance with a rise in obesity index. At each range of obesity index, the prevalence of gallbladder polyps was higher among males. The prevalence of gallbladder polyps was highest among the middle-aged (40- and 50-yr-old) males, similar to the curve of the obesity index. In females, the obesity index increased with age, with no accompanying rise in the prevalence of gallbladder polyps. These data suggest that obesity contributes to the formation of cholesterol polyps of the gallbladder.

This study was undertaken mainly to establish the quantitative parameter to evaluate the tongue atrophy on midsagittal MRIs and to show the clinical usefulness of such quantitative evaluation. Midsagittal MRIs of the tongue of consecutive 103 patients were analyzed. They were classified into 67 patients showing normal size (group without atrophy), 11 patients showing atrophy (group with atrophy) and 25 patients showing unsatisfactory MRIs with artefacts based on the routine evaluation. The patients in the group without atrophy did not show any pathologic processes to produce tongue atrophy on clinical findings. The area and perimeter of tongue and oral cavity, and the ratio of tongue area to oral cavity area and the ratio of tongue perimeter to oral cavity perimeter on midsagittal MRIs were obtained in each patient of groups with and without atrophy by using quantitative image analysis system. In the group without atrophy, regression analysis of the data on age was made and the 95% confidence interval of the data for age was obtained. No evidence that the tongue becomes atrophic with aging was obtained in the group without atrophy. Patients in the group with atrophy were best separated from those in the group without atrophy statistically when the ratio of tongue area to oral cavity area was regressed on age. Among 11 patients in the group with atrophy, 6 patients were not regarded as having tongue atrophy on clinical neurological examinations. Therefore, the evaluation of midsagittal MRIs is clinically useful.

Peptic ulcers treated with a proton pump inhibitor heal more quickly than those treated with a histamine H2 receptor antagonist. Although satisfactory healing without relapse is desirable in the medical treatment of peptic ulcers, the relapse rate after treatment with proton pump inhibitors has not been sufficiently studied. Up to now, several reports have suggested that peptic ulcers treated with omeprazole recur less frequently than those treated with H2 antagonists. Our experimental studies on angiogenesis in granulation tissue of acetic acid-induced gastric ulcers, gastric mucosal collagen synthesis etc., show that H2 antagonists have an inhibitory effect on wound healing, but that proton pump inhibitors do not. It is suggested, therefore, that proton pump inhibitors may at least have no undesirable effect on the natural history of peptic ulcer.

We evaluated the effects of different antisecretory agents (H2-receptor antagonists and a proton pump inhibitor) on collagen regeneration in rat gastric lesions induced by intragastric administration of 50% ethanol +0.15 N HCl (EtOH-HCl). The lesion indices showed the highest value 30 min after administration of EtOH-HCl and a significantly decreased value 15 h later. The mucosal hydroxyproline concentration was significantly increased 30 min after EtOH-HCl administration, reached a maximum 6 h later and subsequently decreased as time passed. Intraperitoneal administration of cimetidine at a dose of 100 mg/kg or famotidine at a dose of 5 mg/kg 30 min after EtOH-HCl administration could not reduce the lesion indices in less than 24 h and suppressed the increase in mucosal hydroxyproline concentrations significantly compared with the control group. On the other hand, treatment with 10 mg/kg of E-3810, a proton pump inhibitor, had no effects on the lesion healing nor on the fluctuation of mucosal hydroxyproline concentrations. These facts suggest that H2-receptor antagonists might delay the healing of EtOH-HCl-induced gastric lesions through the suppression of collagen regeneration under the condition of exclusion of gastric acid secretion.

Using an endoscope we collected fasting gastric juice for estimation of gastric acid in subjects examined by upper gastrointestinal endoscopy. Subjects were 53 in- and out-patients (46 males and 7 females) at our hospital. Seventy-five gastric secretory studies were performed in this population before and after stimulation by tetragastrin, following the guidelines of The Japanese Society of Gastroenterology and using a specially devised endoscope of narrow caliber under direct vision. Acid in fasting gastric juice was correlated with basal acid output (BAO) and with maximal acid output (MAO). There was a statistically significant correlation between them. Thus, an estimation of gastric acid secretion can be obtained from the fasting gastric juice which we usually aspirate and discard during the routine endoscopic examination.

We report that the Günther vena caval filter was successfully inserted in a case of recurrent pulmonary embolism resulting from ilio-femoral venous thrombosis. A 42-year-old woman was admitted to Osaka City University Medical School Hospital for dyspnea and chest pain on April 19, 1988. Pulmonary perfusion scintigraphy and pulmonary arterial angiography proved pulmonary emboli. The combination therapy of heparin and urokinase was performed, and her condition markedly improved. Then an ilio-femoral venography revealed only iliac vein compression but no thrombi. Therefore she was followed as an out patient with anticoagulant therapy. Nevertheless on April 10, 1989 she was admitted again complaining dyspnea and cyanosis. By venography at this time, some filling defects due to thrombi in right iliac vein were found. Therefore, we decided the insertion of the Günther vena caval filter for recurrent pulmonary embolism using Seldinger method via right internal jugular vein. We expect that the Günther vena caval filter will be useful for preventing pulmonary embolism resulting from ilio-femoral venous thrombosis because its procedure is easy, non-invasive and without significant complications.

We investigated the patency of minor duodenal papilla in 25 cases that had presented normal pancreatogram by using the endoscopic retrograde pancreatographic (ERP) method and a pH sensor-combined indigo carmine pigment method. The pigment method allowed us to classify the function of minor papilla into three types according to pancreatic juice excretion pre- and post-secretin administration (Type I), excretion after secretin administration (Type II), and no excretion even after secretin administration (Type III). Twelve cases belonged to Type I, 4 cases to Type II and 9 cases to Type III. By ERP method, terminal shapes of the Santorini's duct were classified as stick type, cystic type and branch type. 19 cases were considered stick type, 2 cases cystic type and 4 cases branch type. Eighteen cases were identified as patent minor papilla under ERP method. There were two cases alleged to be patent under the ERP but without pancreatic juice excretion. Therefore, the necessity of pigment method was confirmed for investigation of the function of minor papilla.

To elucidate the hemodynamic changes in the course of acute pancreatitis in dogs, various parameters were monitored non-invasively and real-timely by the ultrasonic flow probes which had been placed in advance. The dogs were divided into two groups, i.e., control group (CG) and infusion group (IG). In the infusion group, lactated Ringer solution was infused intravenously for 12 hours in order to maintain LAP or CVP at the mean +/- 1 mmHg of its control value before inducing pancreatitis. In the control group, lactated Ringer solution was not infused. Cardiac output (CO) and LV dp/dt abruptly decreased in a few hours and remained low levels in a control group (CG), but not in an infusion group (IG). It shows that the decreased CO was caused by a decrease in preload but not by a depression of contractility. Gastroduodenal arterial flow (GDAF) and GDAF/CO decreased in a few hours and kept low level in CG, but not in IG. Therefore, a decrease in GDAF is mainly caused by an increase in vascular resistance due to an increase in Hematocrit. Superior pancreatico-duodenal venous flow (SPDVF) and SPDVF/CO decreased immediately in both groups, revealing that there is severely depressive outflow from pancreas because of hemorrhage and destruction of pancreatic parenchyma immediately after the onset of pancreatitis. In CG, Total hepatic flow (THF) and Portal vein flow (PVF) gradually decreased in a few hours and kept low levels, but Common hepatic arterial flow (CHAF) did not decrease. This suggests that decrease of THF is due to decrease of PVF. THF/CO increased in CG. PVF/CO decreased in CG, while CHAF/CO increased in both groups. The increased CHAF compensated for the decreased PVF, which may play an important role in protecting the liver.

Extensive gastric mucosal lesions developed in rats after the administration of compound 48/80 at a dose of 0.75 mg/kg daily for 3 days. The hydroxyproline content of gastric mucosa was significantly increased 4 h after the last injection of compound 48/80, and subsequently decreased as the lesions healed. Treatment with cimetidine (CAS 51481-61-9) at a dose of 50 mg/kg (twice a day for 3 days) did not affect either the development or the healing of the compound 48/80-induced gastric lesions. However, the increase in mucosal hydroxyproline content was significantly reduced by treatment with cimetidine. This fact suggests that cimetidine might have an inhibitory effect on the regeneration of collagen in gastric mucosa.

This report describes successful therapeutic results of a huge and high flow arteriovenous malformation (AVM) in the left basal ganglionic region. A 39-year-old female was admitted to our hospital presenting recent progression of aphasia, hemianopsia, hemiparesis, hemisensory disturbance on the right side. Progression of disturbance in consciousness was rapid, and the patient became comatose shortly after admission. A CT scan revealed a densely enhanced lesion in the left basal ganglia which caused aqueductal obstruction and hydrocephalus. Angiography demonstrated a huge and high flow AVM that was supplied by the anterior and posterior choroidal arteries, the lateral striate arteries and the insular branches of the middle cerebral arteries. This AVM drained into the vein of Galen via the inferior ventricular and basal vein. The draining vein was markedly dilated at the level of midbrain by a prominent stenosis of the junction between the vein of Galen and straight sinus, and it severely compressed the midbrain. Superselective embolization of the feeding arteries was done in two sessions. This was followed by surgical intervention for the embolized AVM one month after the second session. Embolization and surgery were carried out under barbiturate protection to reduce the risk of normal perfusion pressure break-through. The patient recovered well from these interventions without any hemodynamic changes and showed dramatic improvement of all focal neurological abnormalities. Postoperative angiography showed only a small residue of AVM.

A 64 year-old man was performed pneumoplication for his left-sided giant bulla on December 15, 1983. After five years, consciousness loss and right hemiplegia occurred. Brain CT revealed a cystic lesion with enhancement in the left occipital lobe. Brain biopsy disclosed metastatic small cell carcinoma. Lung biopsy showed the same histopathology, so primary lesion was considered to be from the site of the previous pneumoplication. Lung cancer associated with emphysematous bulla have been mostly characterized by tumor shadow or niveáu in the bulla. In this case, the postoperative infiltrating shadow of pneumoplication had made early diagnosis difficult.

The aim of this study was to assess the accuracy and limitation of Endoscopic ultrasonography (EUS) in the preoperative evaluation of the cardiac cancer (cancer in the area less than 2 cm from the esophago-gastric junction). EUS was preoperatively performed in 20 patients with cardiac cancer. These cases were visualized by the water immersion method and balloon contact method. The results were correlated with the histology of resected specimens. EUS was accurate in assessing the depth of tumor infiltration. Over all accuracy of EUS for cardiac cancer was 90%. Recognition of ultrasonographic patterns had enabled us to judge the mode of tumor infiltration whether expansive or infiltrative. Microscopical spread over 5 mm to the esophagus of the cardiac cancer could be detected by EUS. EUS was accurate in diagnosing thoracic lymph nodes (No. 110, 111, 112) metastasis of the cardiac cancer (accuracy 86%). EUS was valuable in the clinical diagnosis of the cardiac cancer.

In order to clarify the usefulness of EUS in the diagnosis of gastrointestinal carcinoid tumor, we examined 15 patients, who had carcinoid tumors of gastrointestinal tract (stomach: 5, duodenum: 2, rectum: 8), on the diagnosis in quality and depth by comparing endoscopical ultrasonography (EUS) with resected specimen. Carcinoid tumors of gastrointestinal tract were detected as homogenous hypoechoic tumors with sharp border in all site by EUS. Especially, it was characteristic that 14 of the 17 lesions (82%) which invaded into submucosa were mainly located in the third layer, and the second layer covered the tumor at the foot, and near the top, it touched the tumor and got indistinct. We decided the depth of invasion by comparing the hypoechoic tumor with normal structure of 5 layers. The accuracy rate was 88%. In conclusion, EUS was thought to be useful in the diagnosis and choice for treatment of carcinoid tumors of gastrointestinal tract.

A 46 year-old man was transferred to our department with a pulsating abdominal mass and back pain. On arrival he suddenly developed hematemesis. CT suggested the presence of an infrarenal aortic aneurysm and the jejunum was filled with contrast medium. An emergency operation was done. We found an aorto-jejunal fistula at the branching point of the renal artery. We directly sutured the aortic wall laceration and the jejunum wall in two layers. Then we resected infrarenal pseudoaneurysm as completely as possible, with replacement by a Dacron Y-shaped prosthesis. Culture of the aortic wall showed gram-positive cocci, but the species could not be identified. Gram stain of the aortic wall also showed infection by gram-positive cocci. The patient is alive and well 3 months after surgery.

We investigated the role of leukotrienes (LTs) in the genesis of water immersion stress-induced gastric ulcers. Peptide LTs were detected after 4 h stress (3.7 +/- 0.5 ng/g tissue), although they were not detected after 2 h stress, and considerable amounts (20.3 +/- 2.3 ng/g tissue) were detected after 6 h stress. In contrast, AA-861 (100 mg/kg, p.o.), a 5-lipoxygenase inhibitor, reduced ulcer indices significantly after 6 h stress, although no significant changes were observed after 2 or 4 h stress compared with the control group. Peptide LTs were not detected after 4 h and those detected after 6 h stress were remarkably reduced by AA-861 treatment. The role of LTs in the healing of water immersion stress-induced gastric ulcers was also investigated. Significant ulcer healing was not observed within 24 h after stress but was significantly recovered after 48 h. Peptide LTs decreased time-dependently and 48 h after treatment they were not detected. In the rats treated with AA-861, ulcer indices and peptide LTs levels were remarkably reduced after 12 h, concomitantly. These results suggest that the increase in mucosal peptide LTs might be an inhibitory factor to ulcer healing.

To clarify the mechanism of gastric ulcer recurrence, we studied acetic acid-induced gastric ulcers. The healing of these gastric ulcers was then studied for 4-21 weeks after the injection. Forty-eight ulcers were examined by macroscopic observation and scanning acoustic microscopy (SAM) and by histologic study of the ulcers. SAM has a higher radio frequency and provides more detailed information about the gastric wall than endoscopic ultrasonography (EUS). Thirteen healed and 35 non-healed gastric ulcers were observed by macroscopic observation over 4-21 weeks. SAM enabled us to observe the normal gastric wall of the rat in five different layers. The SAM echo patterns of the healed ulcers were all one pattern. On the other hand, we were able to classify the echo patterns of the non-healed ulcers into two different patterns; one pattern consisted of a high-echogenic region in the first and second layers with an underlying relatively high echogenic region in a horizontal pattern. The other pattern showed a poorly defined and spotted low-echogenic region in the first and second layers which fanned out toward the fifth layer. However, these two different ulcers could not be distinguished macroscopically. Histologic findings supported the results of the SAM study which showed one pattern in healed ulcers and two patterns in non-healed ulcers. In the non-healed ulcers the two different patterns may be ascribed to the proliferation of collagen fibers. SAM makes it possible to image the proliferation of collagen fibers and identify the two different types with an accuracy of 97%.(ABSTRACT TRUNCATED AT 250 WORDS)

The function of the minor duodenal papilla in humans was studied by duodenoscopy using indigo carmine dye and a pH sensor. By this method it was possible to classify the function of the minor papilla into three types: Type I: pancreatic juice excretion without secretin administration; Type II: pancreatic juice excretion following secretin administration; Type III: no pancreatic juice excretion despite secretin administration. To determine the relative numbers of each type, the findings in 23 normal subjects were compared with those in 26 patients with benign papillary stenosis. In normal individuals, there were 11 Type I, 4 Type II and 8 Type III, while in patients with papillary stenosis we observed 20 Type I, 4 Type II and 2 Type III function, indicating that in patients with papillary stenosis, the incidence of Type I minor papilla was significantly high. From this it can be inferred that a minor papilla that does not excrete pancreatic juice spontaneously may begin such excretion, if pancreatic duct pressure persistently increases.

Many hemodialysis patients are still suffering from secondary hyperparathyroidism although 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) has been used to treat renal osteodystrophy for the last two decades. The main reason for its failure to correct the secondary hyperparathyroidism is that in patients, hypercalcemia occurs before adequate parathyroid hormone (PTH) suppression is obtained when a large daily dose of 1,25(OH)2D3 is started. In this study, the oral dose of 1,25(OH)2D3 (4.0 micrograms) was administered only twice a week at the end of hemodialysis ('oral 1,25(OH)2D3 pulse therapy'), in 19 patients with severe secondary hyperparathyroidism. Serum immunoreactive PTH started to decrease after 6 weeks of therapy, and the original level of 41.2 +/- 7.24 was reduced to 24.4 +/- 6.12 ng/ml by the end of the 6-month therapy (p less than 0.001). Serum alkaline phosphatase also was reduced by 64.4%. Three out of 19 patients suffered from hypercalcemia during the 4th month of therapy. Calcium supplement given to 6 other patients with severe secondary hyperparathyroidism did not lower serum PTH levels significantly after 6 weeks of therapy, although serum calcium levels increased and were sustained above 10 mg/dl for the last 5 weeks. These findings strongly suggest that the suppressive effect of the oral 1,25(OH)2D3 pulse therapy was attained by a direct action of 1,25(OH)2D3 on the parathyroid gland rather than by its ability to elevate serum calcium levels. In conclusion, the oral 1,25(OH)2D3 pulse therapy effectively lowered PTH levels in hemodialysis patients who cannot tolerate large daily doses of 1,25(OH)2D3.

16560 Background: This is a pilot study to assess the efficacy and safety of combination chemotherapy of intraperitoneal (IP) carboplatin and intravenous (IV) taxane (paclitaxel or docetaxel) in ad...

Heat evolution associated with the germination of radish seeds was quantitatively studied in a calorimeter. After incubation at 30 degrees C for 20 to 50 h, the total heat evolved was correlated with the length of buds and roots, and with the increase in weight of the germinating seeds. By regression analysis, the heat produced per unit of bud and root growth was found to be a1 = 0.5723 J/mm of bud and a2 = 0.7093 J/mm of root, respectively, with a correlation coefficient of 0.9577. From these results we conclude that the calorimetric determination of the heat generated during germination is a valid reflection of the germination activity of radish seeds. Our calorimetric method is applicable to the quantitative investigation of the viable activity of plant seeds.

Two cases of sacrococcygeal teratoma in female infants are reported. Case 1. A newborn baby with a hemispheric mass on her hip underwent surgery 3 days after birth and the lesion proved to be an immature teratoma. The serum AFP level was very high but became normal one month after the operation. The child also had agenesis of the corpus callosum and arachnoid cysts in right middle fossa. She died after developing shunt infection. Case 2. A newborn baby with a mature teratoma was operated on the day following birth. The tumor was subtotally removed, and there has been no recurrence after 6 months. Sacrococcygeal teratoma in female infants is often associated with agenesis of the corpus callosum and arachnoid cysts. They tend to develop almost at the same time as the teratoma. It is often difficult to determine whether the infant should be treated by chemotherapy or not if the teratoma is immature, especially when it has been totally removed, the serum AFP is normal, and the tumor is pathologically of a low grade.

CT findings and the results of radiotherapy were retrospectively evaluated on 11 patients with primary malignant lymphoma of the brain treated at UOEH Hospital from November, 1979 to March, 1989. CT mostly showed an isodensity or slightly high-density round masses with marked contrast enhancement and was useful both for an initial diagnosis and an evaluation of the response following treatment. Radiation therapy was given to the whole brain in 9 patients. Two patients were irradiated only locally to the tumor bearing area, but no long-term effect was observed. The total dosage ranged from 30 to 51.2 Gy. The 8 patients who received 50 Gy or more to the tumors had higher survival and local control rates than the other 3 who received less than 40 Gy. We conclude that whole brain irradiation with at least a total dose of 50 Gy to the tumor area is necessary to control malignant lymphoma of the brain.

The subjects were 64 cases of gastric cancer. In all 64 cases, resected specimens (formalin fixed) were subjected to endoscopic ultrasonographic examination by the water immersion method in order to assess the horizontal spread of the invasive gastric cancer. Ultrasonographic findings were compared with the histopathological findings of resected specimens. The tumor which invaded the submucosa or deeper layers was visualized as low echogenicity region in the third layer (corresponding to the submucosa) or deeper layers. The horizontal spread of the low echogenicity region represented that of the tumor or the associated fibrosis, but not the tumor itself. In the cases showing echo patterns which were characteristic of the peptic ulceration in the tumor focus (Type II-1, II-2, UL), the horizontal spread of cancer invasion in the submucosal layer or deeper layers (L Ca) was smaller than that of low echogenicity region depicted by ultrasonography (L U). In the other (Type II-3, III, A, B) cases, L Ca was almost comparable to L U.

This study was designed to analyze PGs in human gastric mucosa using biopsy specimens at femtomole level by the combination of microcolumn HPLC and He/Cd laser induced fluorescence detection. Biopsy specimens were taken along the greater curvature at the corpus of the stomach, in which no gastric disease was revealed by endoscopic examination. PGs extracted from human gastric mucosa were derivatized with ADAM, and ADAM-derivatized PGs were injected into the column for analysis. The mobile phase of acetonitrile-water (73:27) containing 0.01% of phosphoric acid was used at a constant pressure of 20 kgf/cm2. Using this system, PGs in few mg of human gastric mucosa obtained by biopsy were well separated and detected; i.e., 1653 +/- 254 (femtomole/mg tissue), 279 +/- 56, 729 +/- 153, 831 +/- 199 for 6-keto-PGF1 alpha, PGF2 alpha, PGE2, and PGD2, respectively. In conclusion, the microcolumn HPLC system with laser induced fluorescence detection is a reliable method for determining individual PGs in human gastric mucosa. In addition, PGI2 is the predominant PG in human gastric mucosa and probably plays an important role in gastric function.