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In recent years, because of advances in diagnostic techniques and therapy for malignant tumors, it is not rare to encounter cases of primary multiple malignant neoplasms. However, triple cancer is still rare. We report a case of triple cancer--gastric cancer, sigmoid colon cancer and malignant fibrous histiocytoma. To our regret, we could not make a diagnosis while the patient was alive. Careful examination of a cancer patient is important because malignant tumors may develop at any time.

Two autopsy cases, a 77-year-old man and a 66-year-old woman, of cardiovascular amyloidosis with many giant cells were reported. These cells were always found adjacent to amyloid masses which were deposited mainly in small arteries and arterioles, and some of them contained amyloid substance in their cytoplasms. The incidence of these cells was high in the heart and in the kidneys of both cases, and in the latter case the cells were found in the majority of the organs varying in degree. The significance of the giant cells, which probably originated from macrophages, were discussed and that giant cells might appear as a foreign body reaction to amyloid substance was presumed.

The effects of fleroxacin and other new 4-quinolones on cellular functions and topoisomerase II of HeLa cells were investigated. The potency of cytotoxicity increased in the order fleroxacin less than nalidixic acid less than ofloxacin less than norfloxacin less than ciprofloxacin. The cytotoxicity was well correlated with inhibitory effects of 4-quinolones on topoisomerase II. However, the cytotoxicity did not correlate with antibacterial activity, and cytotoxicity was observed only at greater than 100-fold higher concentrations than the minimum inhibitory concentrations of new 4-quinolones for Enterobacteriaceae. Judging from the serum levels attainable after oral administration, new 4-quinolones, especially fleroxacin, will have little effect on topoisomerase in eukaryotic cells.

A number of studies have shown short term hemodynamic and symptomatic improvement in patients with essential hypertension under treatment with diltiazem. The long-term efficacy of the oral calcium antagonist, diltiazem, remain to be established in patient studies. We evaluated this drug in 70 patients with WHO classification 1-3 hypertension. Diltiazem was tested alone in 25 patients, in combination with diuretics in 14 patients and other drugs in 31 patients with essential hypertension. The fall in blood pressure after oral diltiazem was maximum with 24 weeks and then the fall continued steadily with significant improvement as judged by subjective patients impression in each group. The efficacy ratio of diltiazem was 57.1% in remarkably effective cases, 22.9% in effective, 10% in moderately effective and 10% in not effective cases. And this efficacy ratio was most prominent in other drugs concomitant group, followed by the diltiazem monotherapy group and in the diuretic concomitant use group. We concluded the oral calcium antagonist, diltiazem, is effective in patients with essential hypertension, providing significant blood pressure and symptomatic benefit with long-term treatment.

We have found that charcoal hemoperfusion is effective in removing bromvalerylurea (BVU) from circulation. A patient poisoned with BVU showed a marked lightening of coma after 3 h of hemoperfusion. The BVU concentration in the patient's serum was decreased significantly by hemoperfusion. In an experiment with dogs without hemoperfusion, the BVU concentration had its peak at the fourth hour after oral administration and decreased in 24 h. In an experiment with hemoperfusion, BVU concentration in dogs decreased markedly during hemoperfusion. After hemoperfusion a rebound of concentration was observed.

The pathogenic factors of Candida albicans involved in invasion of the skin were studied. Strains of C. albicans differing in their abilities to secrete proteinase in vitro and to produce germ tube were inoculated onto the skin surface of newborn mice, and the invasion of the yeast cells into the horny layer was examined by histological techniques. The strains capable of producing germ tubes could penetrate into the skin, but those incapable of germ tube formation could not. The penetration of the yeast cells into the skin was independent of the ability to secrete proteinase, but, once penetrated, Candida cells from the proteinase-producing strains proliferated more profusely than those of proteinase-deficient ones. The results suggested that the invasion of C. albicans into the skin consisted of two processes; penetration and proliferation of the yeast cells in the tissue. The former might depend on the ability of germ tube formation and the latter on the secretion of proteinase.

The data obtained by ECG-gated radionuclide angiography were collected simultaneously with right ventricular pressure and thermal cardiac output (CO) obtained by a Swan-Ganz catheter in Scintipac 1200 ( Shimazu Co) in order to create a right ventricular pressure-volume (RV P-V) loop. Subjects consisted of 15 patients with old myocardial infarction (MI group), seven with angina pectoris (AP group), six with congestive cardiomyopathy (CCM group) and five with neurocirculatory asthenia (NCA group). Right ventricular end-diastolic volume ( RVEDV ) was calculated as RVEDV = CO/(EF X HR) (CO = cardiac output; HR = heart rate). Systolic work (Ws), diastolic work (WD) and net work (WN) were calculated from a RV P-V loop by Simpson's method. The measurements were performed before and 5 min after sublingual administration of nitroglycerin (NG) (0.3 mg). The results were as follows: RV P-V loops shifted towards the left lower part of the P-V plane after sublingual administration of nitroglycerin, indicating the reduction of pressure and volume of the right ventricle. Right ventricular ejection fraction (RVEF) in the MI, AP and CCM groups showed smaller values than that of the NCA group. The CCM group presented a significantly smaller value than the NCA group (p less than 0.005). RVEF of each group increased after NG. In the AP and CCM groups, it increased significantly (p less than 0.005). Right ventricular end-diastolic volume index ( RVEDVI ) showed a converse relation with RVEF. The MI and CCM groups demonstrated significantly higher values (p less than 0.05). After NG, RVEDVI of each group decreased significantly (p less than 0.001 in the MI and NCA groups, and p less than 0.005 in the AP and CCM groups). Cardiac index in all groups decreased after NG and a statistical significance was seen in the MI, AP and NCA groups (p less than 0.05). RV Ws, RV WD and RV WN showed no difference among each group in the control state, and significantly decreased after NG. This was due to the reduction of RV pressure and volume. It was indicated that the principal cause was the systemic volume reduction. We conclude that the present method using RV P-V loop might be useful as a noninvasive bedside monitoring and permits the evaluation of RV function in a clinical setting.

Case 1, a 49-year-old male who had been engaged in repair and reclamation of automobile tires, developed symptoms of vibration syndrome (Raynaud's phenomenon, numbness of both hands, tinnitus and impaired hearing) after some 30 years' use of a grinder and impact wrench. Two years thereafter, multiple sclerodermic lesions appeared over the trunk, upper extremities, and thighs; these disappeared about 2 years later. Histologically, hyperplasia and nodular swelling of collagen bundles were present in the dermis. An immunological study showed the serum to be positive for anti-centromere antibody, but no visceral lesions were demonstrable. This case corresponded to generalized morphea. Case 2, a 53-year-old male, developed symptoms of vibration syndrome (Raynaud's phenomenon, numbness of both hands, impaired hearing and arthralgia) after 25 years' use of a jack hammer in a quarry. Thereafter, sclerodermic changes of the forearms, lower legs, face and abdomen occurred with an associated sclerodactyly. Histological examination of involved skin revealed diffuse hyperplasia and homogenization of collagen bundles throughout the entire thickness of the dermis. These findings, together with serum positivity for anti-RNP antibody and dilation of the lower portion of the esophagus, led us to a diagnosis of progressive systemic sclerosis. We inferred that the vibration syndrome in the present cases might be related etiologically to these forms of scleroderma.

Comparative morphological studies on the coronary arteries of the left ventricular free wall were carried out on human, dog, pig, and monkey hearts by using postmortem coronary arteriography, soft X-ray photograms, and the clearing method. The results showed that the types of coronary arteries (types I, II, and III) and connecting portion of anastomotic vessels in the pig and monkey hearts closely resembled those in man. Whereas the dog hearts showed the following characteristics: numerous Type III vessels and anastomoses in the epicardial layer, the existence of only the left predominant type of coronary artery, and the supply of blood to the papillary muscles of the left ventricle mostly through a single branch of the coronary artery. Therefore, it is necessary to take into consideration the basic difference in the structure of the coronary arteries of human and dog hearts, when dogs are used experimentally for research of human ischemic heart disease. The fact that only the papillary muscles of the human heart-compared to animal hearts-are supplied blood from two sources may be advantageous to rescue the papillary muscles from ischemic necrosis.

A 63-year-old woman presented with painless, firm, subcutaneous nodules on her legs and trunk. The lesions were annular or serpiginous and their surface was livid-red to pale-red. Superficial lymph nodes were not palpable. Upper gastrointestinal series, barium enema, Ga scintigraphy, and CT findings were negative. Histological examination revealed deep dermal vessels occupied by neoplastic cells and fibrin thrombi. We diagnosed her as having neoplastic angioendotheliosis. Electron microscopically, tumor cells lacked Weibel-Palade bodies. Immunohistochemically, the tumor cells were positive for leukocyte common antigen, T11, MT-1, HLA-DR and S-100 protein. They were negative for Factor VIII-related antigen, epithelial membrane antigen, carcinoembryonic antigen, B-1, and B-2. Immunoelectron microscopic study showed that their nuclei, cytoplasma, and cell membranes were positive for S-100 protein. Based on these findings, we diagnosed her as having T cell lymphoma. The patient rejected chemotherapy and was discharged. Three months after discharge, right hemiplegia developed. Brain CT scan revealed enhanced masses in the left frontal, temporal, and occipital lobes. Craniotomy showed only gliosis and hemorrhage. She died of cerebral bleeding three months after craniotomy.

In a multi-center study, nifedipine (Bay a 1040, Adalat) (10 mg capsule) was administered, in liquid form and via sublingual route, to 22 cases who were diagnosed to have clinically severe systolic hypertension, and the depressor effect of the treatment was studied over a period of 4 h. In patients of "emergent" admission (cerebral hemorrhage n = 8, cerebral thrombosis n = 4, subarachnoid hemorrhage n = 1, renal failure n = 6, essential hypertension n = 3), 3 bouts of blood pressure measurement at intervals of 10-15 min during the control period were carried out. In case of systolic blood pressure higher than 200 mmHg, at least one time, nifedipine at a dose of 10 mg was sublingually administered. Thereafter, blood pressure and pulse rate were recorded at intervals of 15 min up to the end of the first one hour, then at intervals of 30 min up to the end of 4 h. Results were as follows. In terms of the average values for all cases, blood pressure fell to near lowest levels by the end of about 30 min after the administration and it stayed at near lowest levels up to the end of 120-240 min. During this period of time, pulse rate remained substantially unchanged. In terms of the pattern of the blood pressure fall, all cases could be classified generally into two types, namely (a) the "dip" group (7 cases) in which blood pressure fell to the lowest level to form a "dip" and remained below the control level, although it showed a trend to return to control level for 4 h and (b) the "flat" group (15 cases) in which blood pressure declined gradually for about 1 h and, then, remained low or below the control level, although it showed a trend to return to control level throughout the rest of the observation period of 4 h.

Diltiazem hydrochloride was administered at a dose of 180 mg/day for 12 weeks to 10 essential hypertensive patients with slightly or moderately decreased renal plasma flow (RPF) in order to study its antihypertensive effect as well as the effects on cardiac and renal functions. The administration of diltiazem hydrochloride produced significant decreases in systolic pressure, diastolic pressure, and mean blood pressure. Right and left ventricular ejection fractions, max. dv/dt, and min. dv/dt assessed by cardiac pool scintigraphy were slightly increased, but these changes were not statistically significant. The glomerular filtration rate (GFR) and RPF were slightly increased, while renovascular resistance (RVR) was significantly reduced. No consistent tendency was observed in changes in plasma renin activity (PRA) and plasma aldosterone level. From these results, it was suggested that diltiazem hydrochloride is a potent antihypertensive drug which has no adverse effects on cardiac and renal functions in the treatment of essential hypertensive patients with slightly or moderately decreased RPF.