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Although ileal conduit diversion is widely accepted in the treatment of the patients undergoing radical cystectomy, many patients would prefer other alternatives which allow continence. and urination through the urethra. We describe a new procedure in which a segment of detuburalized right colon is used as a continent reservoir. Eight patients, 7 after radical cystectomy for bladder cancer and one after total exenteration for rectal cancer, have undergone colon bladder replacement. New created bladder had a capacity of 300 to 600 ml. All patients could pass urine through the urethra but one is on self-catheterization. Five of the 8 patients had no residual urine. Three months after operations 4 were totally continent and 3 were satisfactorily dry during daytime but slightly enuretic. Excretory urography showed no abnormalities in their upper urinary tract. Considering the "quality of life' of a patient, this procedure can be an ideal option for selected patients.

Effects of xanthomegnin and duclauxin on mitochondrial respiration, L1210 culture cells of murine leukemia and Ehrlich ascitic tumor were compared. Both compounds exhibited similarly potent uncoupling effects on the oxidative phosphorylation of mitochondria and cyto-toxicities on the culture cells, but they were not equal in the anti-tumor activity on Ehrlich ascitic tumor. Duclauxin markedly increased the life-span of mice which were i.p. inoculated with Ehrlich ascitic tumor but xanthomegnin did not exhibit such effect as duclauxin.

(1) Superoxide dismutase activity in polymorphonuclear cells from human blood is considerably lower than that in lymphocytes. Macrophages from ascites show the middle level between the other two cells. (2) In myelocytic, monocytic, and lymphocytic leukemia cells, the enzyme activities are increased compared to those in the corresponding normal cells. (3) Gel electrophoresis patterns of all normal cells reveal bands corresponding to the cytosol and mitochondrial bands reported in previous studies. However, the mitochondrial Mn-containing superoxide dismutase activities are diminished or absent in leukemia cells. CN-insensitive superoxide dismutase activity in leukemia cells is not detected under the conditions.

The present study was performed to clarify the regeneration and splenic changes following hepatectomy. The processes were compared between the three classes (L greater than 50%, 30 less than M less than 50%, S less than 30%) categorized by the resection rate (%) calculated by CT scan in the 26 cirrhotics (LC) and 22 non-cirrhotics (N). Hepato-splenic volumes were serially measured by CT scan. The regenerative speed (cm3/day) of the remaining liver were significantly higher in the N group than LC and in the larger resection class. Liver functions tended to return to the initial levels behind the time of restoration of the liver volumes. The delay was partially caused by the posttransfusion hepatitis (PTH), which developed more frequently with an increase of fresh frozen plasma transfusion given. The changing pattern of splenic size was strongly regulated by the massiveness of hepatectomy. Newly developed posthepatectomy esophageal variceal ruptures were endoscopically determined in the 10% of the 129 late deaths after hepatectomies for hepatomas (1973-1987) with or without recurrences and its occurrence was found to be enhanced in the massive resection in the LC group ended with the poor regeneration of the liver and persistent postoperative splenic enlargement.

We examined the cerebrospinal fluid (CSF) of 17 myasthenia gravis (MG) patients for certain immunological parameters in order to assess signs of intrathecal immunoactivation. We have found oligoclonal IgG bands in the CSF of 6 of 17 by the agarose gel electrophoresis and enlarged lymphoid cells in CSF of 8 of 17 patients of MG. We measured anti-nicotinic acetylcholine receptor (AChR) antibody and anti-striational muscle antibody (AMA) in serum and CSF from MG patients and compared the serum: CSF ratio with total IgG. No evidence of intrathecal anti-AChR antibody synthesis was demonstrated while AMA was partly (50%) synthesized in myasthenic CSF. This difference suggested that there is either different immunological regulation in synthesis between anti-AChR antibody and AMA in the CSF or the different behavior after transfer to CSF.

To elucidate mechanisms responsible for susceptibility of the palatine tonsil to infections in patients with recurrent tonsillitis, we studied 46 patients with recurrent tonsillitis (RT), simple hypertrophic tonsil (SHT) or focal tonsillitis (FT) in regard to the participation of viral infections, especially Epstein-Barr virus (EBV) infection by using ELISA and immunostaining methods. Culture supernatants of tonsillar lymphocytes in RT group had antibodies to respiratory syncytial (RS) virus at greater positive rate (26.3%) than that of SHT group (16.7%). About 70% of patients with RT had serum antibodies to viral capsid antigen (VCA) of EBV in high titre over 160X, but only 30% in SHT group. Furthermore, in RT group 2 patients possessed IgM antibody to VCA and IgG antibody to early antigen (EA). In RT group, IgG, IgM and IgA antibodies to VCA and IgG antibody to EA presented in the supernatant in 58%, 17.6%, 11.7% and 17.6% respectively. In the 35 tonsillar lymphocyte suspensions tested 20% contained EBNA-positive lymphocytes. In RT group, 5 of 21 patients (23.8%) had EBNA-positive lymphocytes, but only one of 9 (14.3%) in SHT group. These results suggest that EBV infection and its reactivation in the palatine tonsil may be one of major mechanisms in recurrent episodes of tonsillitis.

The surgical treatment for hepatocellular carcinoma must be chosen by considering some factors such as liver function, position and involved area of the tumor. This article reports our guide line for surgical treatment based on liver function and long term survival. In severe cirrhotic patient with ICG retention rate ranging 30 to 40%, hepatectomy can be indicated only when they mach several conditions as follows; KICG from 0.06 to 0.08, superficially located tumor removal by resection of small area with curability. In patients with ICG retention rate lower then 30%, resection range is determined by the multiple regression equation indicating safety limit of hepatectomy. The predictability of the equation has been as high as 93%, the long term survival depends on following factor, i.e.; tumor size, VP factor, and IM factor. Hepatectomy should be first option when the tumor is less than 5 cm in size, VPO, IMO, and can be safely removable with segmentectomy or larger resection.

Fifty-nine patients with hepatoma associated with advanced esophageal varices who received a variety of therapeutic modalities in the past 10 years at our department were reviewed. Our therapeutic modalities are hepatic resection, hepatic artery ligation (HAL) and trans-arterial embolization (TAE) for those with hepatoma and non-shunting treatment (NST; esophageal transection or Hassab's procedure) and endoscopic sclerotherapy (ST) for those with esophageal varices. A patient selection was made by our own criterial developed by a multiple regression analysis for the hepatoma and KICG value for esophageal varices. Out of 59.16 underwent hepatic resection and NST. Eight survived more than 2 years. The longest survivor has been living for 4 yr and 4 months. Two-year survival rate is 69.8%. Another 16 underwent HAL and NST. Two-year survival was 14.6%. Another 7 underwent ST following hepatic resection or HAL. Five of the 7 received an emergency ST. Hemostasis was achieved in all of them. Two-year survival was 21.8%. The remaining 20 underwent ST and TAE; 13 received an emergency ST with 85% of hemostasis rate. None of them survived more than 2 years. From these data, it is suggested that a proper selection of patients for a proper therapeutic modality improves the prognosis even in those with hepatoma associated with advanced esophageal varices.

The DNA chain breakage effect of bleomycin A2 on isolated nuclei was enhanced over 150-fold by the reduced nicotinamide adenine dinucleotide phosphate (NADPH)-dependent electron transport system of isolated microsomes. The enhancement of bleomycin A2-induced DNA chain breakage by NADPH was also shown at the level of the intact AH66 cells. Furthermore, it was found that the simultaneous administration of bleomycin and NADPH apparently inhibited the growth of Erhlich tumors in mice compared with the administration of bleomycin alone. These results indicate that the action of bleomycin on DNA is stimulated by the microsomal NADPH-dependent electron transport system not only in vitro but also in vivo.

A 21-month-old girl with physical and mental retardation is described. She excreted an increased amount of lysine in urine but no excessive quantities of arginine, ornithine, or cystine. Serum level of lysine was found to be low but the levels of the other amino acids were within normal limits. The endogenous renal clearance rates of amino acids showed a marked high value of lysine and normal values of the other dibasic amino acids. Oral loading test of amino acids revealed an imparied absorption of lysine and normal absorption of arginine, ornithine, and cystine in the intestine. These results indicate a specific defect in transport of lysine in the intestine as well as in the renal tubule.

By use of computed tomography measurements, preoperative estimations of the safe limits of hepatic resection have been attempted in 38 patients with primary hepatocellular carcinoma who underwent hepatectomies of varying degrees. Twenty eight (73.7%) of these 38 patients had cirrhosis. Preoperative computed tomography estimations of volume of liver and hepatocellular carcinoma have been compared with measured volume of the resected specimens. The average differences between the estimated and actual volumes of resected liver and hepatocellular carcinoma were within 10% and 7%, respectively. To quantify the extent of hepatectomy, the "parenchymal hepatic resection rate" (formula: see text) was provided. As an indicator of functional impairment of the liver, the retention rate 15 minutes after an intravenous injection of indocyanine green dye (ICG) at 0.5 mg/kg (ICG R15) was used. A close correlation was observed between the parenchymal hepatic resection rate and ICG R15 relative to the patients' outcome, indicating their potential use in the prediction of the safe limits of hepatectomy and the probable development of posthepatectomy liver failure.

An extremely rare case of renal leiomyoma presenting as a cystic mass, involving the upper pole of the right kidney in a 59-year-old woman, complaining of right flank pain is reported. Some discussion regarding pathogenesis of leiomyoma with cystic change, diagnostic feature, malignant potential of leiomyoma and others was done. Since 1948, 19 cases including our own case of renal leiomyoma have been reported in the Japanese literature.

Plasma membranes were isolated from lymphoid cells of benign thymomas obtained from inbred BUF/Mna rats (21 mo old) and from normal thymocytes obtained from young rats (7 wk old) of the same strain. The isolated plasma membranes were electron microscopically pure, and the specific activities of Na+, K+-ATPase, and 5'-nucleotidase were enhanced. The lipid compositions of the plasma membranes from these two sources were analyzed and compared. The cholesterol and plasmalogen contents of membranes from both sources were similar, but the phospholipid content of the benign thymoma lymphoid cell membranes was slightly lower than that of the normal thymocytes, resulting in a somewhat higher molar ratio of cholesterol to phospholipid. The plasma membranes of the thymoma lymphoid cells also exhibited a slightly higher microviscosity as measured with fluorescence polarization. No significant differences were observed in the phospholipid compositions of the two membrane preparations.

The present study was aimed at determining a criteria for curability of hepatic resection in the treatment of hepatocellular carcinomas. The 239 patients hepatectomized from 1973 through 1987 were included for analysis. The patients with the tumor thrombi(V) or intrahepatic metastasis(IM) scattered over the unilateral lobe(IM2) showed very poor prognosis in spite of macroscopically complete resections. Consequently, these conditions were categorized into non-curative group(NC). The 5-year survival rate of the tumors less than 2 cm was 42%, which was much better than that of 5 cm or more group but no better than that of 2 to 5 cm group. When the prognosis was compared by an extent of resection among the patients with the tumors of less than 5 cm in size and V(-), the patients with lobectomy showed a 5-year survival rate of 84%, much better than 45% of those with segmentectomy or less range. The surgical margin (SM) negative patients showed a better prognosis than the SM positive patients with a slight difference. The tumor backgrounds of the 39 patients who survived three years with disease free condition were as follows: V(-) in all, no intrahepatic metastasis(IM0) in 79%, no IM2, massive resection for all IM1 in whom IM was confined to the area close to the main tumors, a tumor size of 5 cm or less in 82%, SM(-) in 62%. From the findings described above, we defined a complete resection for V(-) and IM0-1 as a curative condition, of which absolute curative resections(AC) corresponded to the patients with the tumors of 5 cm or less and SM(-), and relative curative ones(RC) to the remainders.(ABSTRACT TRUNCATED AT 250 WORDS)