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Multiple ionization and subsequent ion-ion dissociation of ethylene was studied by using intermediate energy of Xe9+. Delayed dissociation of C2H4 2+ ? C2H3 + + H+ is discussed.

We report a rare case of carbohydrate antigen (CA) 19-9 producting mucinous gastric cancer with too much secreting. A 46-year-old man was pointed out high value of serum CA19-9 by a routine health examination. So He was admitted to the hospital in order to rule out malignant disease. He was diagnosed as having advanced gastric cancer at the posterior wall on the antrum by gastrointestinal endoscopy. Distal gastrectomy with regional lymph node dissection was performed. Microscopic examination revealed that the cancer was arose from mucous nodose and immunohistochemical stain of the resected material was positive for anti-CA19-9 monoclonal antibody was positive. The value of serum CA19-9 increased after admission and remarkaably decreased to the normal range after the gastrectomy. The normalized CA19-9 level has been kept up to nou for 3 years. Patients group with high CA19-9 valeu has a poor prognosis, and hence further strict observation of his clinical course will be nesessary. more...

大腸癌の血行性転移は肝,肺が多く脳転移は比較的稀である.症例1は74歳,男性.S状結腸癌で前方切除術を施行した,術後1年後に脳転移が発見された.同時期肝転移を認あたが,神経症状が高度で脳転移巣の摘出術を施行した.症例2は60歳,女性.局所に浸潤した直腸癌で低位前方切除左腎,子宮両側付属器切除術を施行した.術後2カ月後肝・肺転移は認めなかったが・第3脳室に転移が発見され外科的療法を施行した.2例とも,原発巣において著明な神経浸潤がみられ,神経接着分子であるNCAM発現がみられたことより血行性転移先での臓器親和性の関与が示唆される症例と思われる.神経浸潤が著明な症例には脳転移にも注意が必要と思われた. more...

今回われわれは,80歳以上の高齢者大腸癌の特徴を明らかにすべく,80歳以上の高齢者大腸癌手術症例について臨床病理学的に検討した.対象は1984年から1988年までの5年間における当教室で経験した50歳以上の大腸癌手術症例206例とした.また80歳以上の高齢者,70歳台,60歳台,50歳台の4群とした.高齢者群の入院時主症状はイレウス,下血・血便が多く,病悩期間は比較的長かった.高齢者群の57.1%に術前併存疾患が認められた.各年齢別の占拠部位,肉眼型分類,組織型分類,壁深逹度,組織学的Stage分類およびDukes分類では有意な差はみられなかった.高齢者群の55%に術後合併症を生じていた.各年齢別組織学的手術判定では,高齢者群で有意に非治癒切除例が多く認められた.高齢者大腸癌症例においては全身状態に充分注意し,QOLを考慮し,可能な限り非高齢者大腸癌症例と同様に治癒切除をめざすことが治療の向上につながると考えられた. more...

教室における過去5年間に経験した切除不能大腸癌肝転移症例中,集学的治療を施行した38例を対象とし,その予後について検討した.動注薬剤は症例により5 FU, ADM, CDDP, Epirubicin, MMCを投与した.温熱動注併用群では,温熱療法装置は周波数13,56 MHzのRF波誘電加温装置を使用した,温熱動注併用群(n=10)ではPR2例,奏効率20%,1年生存率70.0%,2年生存率40.0%,50%生存期間19.5か月であった.動注群(n=10)ではCR 1例,PR 1例,奏効率20%,1年生存率60.0%,2年生存率12.5%,50%生存期間14.4か月であった.全身化療群(n=18)は1年生存率27.8%,2年生存率11.1%,50%生存期間7.6か月であった.温熱動注併用群は動注群と比較し,生存率はやや良好であったが有意差は認めず,全身化療群と比較し背景因子に差はあるが生存率曲線に有意差を認めた.温熱動注併用群,動注群ともに,同時性,異時性による生存率に有意差は認めなかった. more...

当教室において過去9年間に経験した大腸癌は手術例468例であり,そのうち緊急手術を施行した68例(14.5%)について検討した.緊急手術例は非緊急手術例に比べ,stage Vの進行例が多く,切除率は低かったが(77.9%),治癒切除率および治癒切除例5年生存率は両者に有意差は認めなかった(p

To investigate the correlation between interleukin-6 and urothelial neoplasms, interleukin-6 activities in blood and urine samples of patients with bladder carcinoma were measured with a proliferation assay using an interleukin-6 dependent murine hybridoma clone, MH60.BSF2. A total of 43 patients and 15 normal volunteers were entered into this study. All of the patients were examined preoperatively and 26 were reexamined more than 6 days postoperatively to eliminate the effect of surgical injury on interleukin-6 secretion. The interleukin-6 titers in urine and serum increased in accordance with the progression of the tumor stage, and tumor removal induced a remarkable decrease in the titer of urinary interleukin-6. Although the interleukin-6-producing site has not been elucidated yet, our study suggests that interleukin-6 activity in bladder carcinoma patients may reflect the immunoreaction against the tumor in local urothelium. more...

肛門管癌は比較的稀な疾患であるとともに,特徴的な臨床症状はない.このため早期発見に難渋することがある。今回,肛門周囲膿瘍を契機として発見された症例を経験した.そこで早期発見への注意を含め報告する.症例は62歳,男性.肛門痛を主訴として受診.肛門周囲膿瘍の切開排膿後,痔瘻根治手術を施行したが,手術創の治癒が不良であった.約1年6カ月後手術創に硬結を触知し,生検で粘液癌と診断されたため,腹会陰式直腸切断術を行なった.手術所見を含めた摘出標本の肉眼的,病理学的診断は, P, 5型, A1, N0, H0, P0, Stage IIで,間質に著明な粘液貯留と印環細胞の浮遊を伴う粘液癌であった.本症例のような粘液産生肛門管癌は肛門周囲膿瘍の形で発見されることがあり注意が必要である. more...

This paper presents a case of perineal epidermal cyst. Diagnostic imagings by ultrasonography, CT scanning and MR imaging described the mass as a cystic tumor on the perineal median raphe. It was excised for the histological diagnosis. The removed mass was shown microscopically to be filled with laminated keratin and to be lined with differentiated cornified squamous epithelium. The pathological diagnosis was benign perineal epidermal cyst. more...

"Stunned myocardium" was defined by Braunwald et al in 1982 as reversible postischemic myocardial dysfunction. We report a case of a 57-year-old woman for cholesystectomy who developed stunned myocardium during endotracheal intubation. She was free of any risks of heart disease. While the endotracheal tube was smoothly inserted after rapid induction, the blood pressure was remarkably elevated and electrocardiogram (ECG) showed ST segment elevations in leads I, aVL, as well as V2-V6, and ST segment depressions in leads II, III and aVF. The coronary angiography, performed 2 weeks later, revealed a normal coronary finding, but the left ventriculogram showed asynergy in its anterior and apical walls (AHA segments 2, 3 and 6). Left ventricular dysfunction in this case was possibly due to a direct effect of excessive cathecholamines secreted during an acute episode of hypertension triggered by intubation. more...

Plasma concentrations of atrial and brain natriuretic peptides (ANP and BNP) are high in patients with hypertension and congestive heart failure. The present study examined changes in plasma ANP and BNP concentrations during 1 year of monotherapy with enalapril in elderly hypertensive patients with left ventricular (LV) hypertrophy. Eight elderly hypertensive patients with LV hypertrophy were treated with enalapril for 1 year, during which time serial changes were recorded in LV mass index, LV systolic function, and plasma concentrations of ANP and BNP. Enalapril maintained systolic and diastolic blood pressure in the normal range for over 1 year. Treatment significantly reduced posterior wall thickness at 6 months, and more so at 1 year, and tended to reduce septal wall thickness and LV mass index at 1 year. LV ejection fraction was slightly but significantly increased at 1 year. Plasma ANP and BNP, which were markedly elevated at study entry, both decreased after 1 year of enalapril. These results suggest that 1 year of treatment with enalapril caused both a modest regression of LV hypertrophy and a modest improvement in LV systolic function in our selected group of elderly hypertensive patients. The drug reduced elevated plasma ANP and BNP levels but did not alter BUN and serum creatinine levels. Enalapril appears to be useful for the treatment of elderly hypertensive patients with LV hypertrophy. more...

A 79-year-old man had a history of pneumothorax induced to treat pulmonary tuberculosis when he was 40 years old, and of chronic pyothorax when he was 60 years old. He was admitted to our hospital because of chest pain and swelling of the right lateral chest wall. Soft tissues of the chest wall and rib had been destroyed, and a fistula had formed at the skin. The diagnosis was confirmed by examination of a biopsy specimen from the chest wall tumor. The tumor was successfully treated by radiation therapy. 67Ga scintigraphy, CT, and MRI were useful for diagnosis and follow up. Pyothorax and the tumor could be distinguished only with MRI. more...

The ambulatory blood pressure (BP) was recorded for 24 hours in 28 untreated hypertensive patients, and mean values of systolic (SBP) and diastolic BP (DBP) were measured over 24 hours, during the day-time (6:00 to 19:30), and during the night-time (20:00 to 5:30). M-mode echocardiography was performed and several parameters of left ventricular size were calculated. In addition, 13 men of 18 patients with left ventricular hypertrophy (LVH) received long-term treatment with enalapril, and ambulatory BP monitoring and echocardiographic measurement were performed in 10 of these patients 6 months after active treatment ended. In all 28 patients, left ventricular mass index (LVMI) was significantly related to 24-hour, day-time and night-time SBP. Other parameters of hypertrophy were correlated with 24-hour and/or night-time BP, but not with day-time BP. In patients with LVH, night-time DBP was significantly higher and the night-time decline in DBP was significantly less than in those without LVH. The 6-month treatment with enalapril clearly decreased casual and ambulatory BP and reduced LVMI. The reduction of LVMI was strongly correlated with the decrease in night-time SBP and DBP compared with the decrease in day-time BP. These observations indicate that LVH is related to 24-hour BP (especially night-time BP) and that the regression of this condition may be related to a decline in night-time BP. more...

The production of neopterin is closely correlated with activation of cell-mediated immunity. Neopterin appears to be produced by human macrophages specifically stimulated with interferon-gamma (IFN-gamma). Interleukin-4 (IL-4), a B and T stimulatory factor, has recently been shown to inhibit monocyte/macrophage functions, including the ability to suppress monocyte-generated cytokines. In this report we confirmed previous studies that identified the monocyte/macrophage as the main producing cell among human blood cells and that secretion is stimulated by IFN-gamma and lipopolysaccharides (LPS). IL-4 inhibits the generation of neopterin from unstimulated monocytes. This inhibitory effect was dose dependent and occurred at concentrations lower than 0.01 ng/ml. However, IL-4 had only a minimal inhibitory effect on LPS-induced generation of neopterin and could not reverse IFN-gamma-induced neopterin secretion from adherent monocytes. Furthermore, we report that LPS induced IFN-gamma production in monocyte culture. This production is strongly inhibited by IL-4 treatment. These findings indicate that IL-4 can regulate the synthesis of neopterin by adherent blood mononuclear cells and provide further evidence that LPS-induced neopterin in macrophages may act by IFN-gamma-independent mechanisms. more...

A 37-year-old man was admitted to our hospital because of abnormal shadows on chest X-ray film at routine medical examination. The chest X-ray showed diffuse granular shadows in the bilateral upper and middle lung fields. Chest CT showed multiple cystic lesions and nodular lesions. Bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) were performed. Electron microscopic examination of BAL fluid revealed Langerhans' cells, and lung tissue specimen obtained by TBLB showed granuloma with infiltration of histiocytes and eosinophils. During the clinical course, the patient complained of cough and decrease of right visual acuity in association with an increase of abnormal shadows on chest X-ray. The lung disease gradually resolved after the cessation of smoking in spite of no therapy. In the right eye, an exudative lesion with retinal elevation was noted in the ocular fundus. Corticosteroid administration was effective for the treatment of this lesion. There was no pathological evidence of the right ocular lesion. However, the correlation of its clinical course with the lung disease suggests a relationship between the ocular lesion and pulmonary eosinophilic granuloma. more...

Pyelocystography on a 61-year-old man with a ureteral stone incidentally revealed the inguinal bladder hernia. He had no complaint of urinary disturbances. During the operation for the hernia, we could not find the bladder without transurethral saline instillation; only the intestine covered with peritoneum was in sight. Utility of preoperative cystography on the cases of inguinal hernia is discussed. more...

The ability of computed tomography (CT) in the qualitative assessment of centrilobular emphysema (CLE) was studied, with special reference to the morphological relationship between emphysematous change and relatively large bronchovascular bundle forming the margin of secondary pulmonary lobule. Three autopsied lobes with mild, moderate and severe CLE were fixed by the method of Heitzman. Then high resolution CT (HRCT) was applied to those inflation-fixed lobes, which allowed for direct one-to-one pathologic correlation. Furthermore, HRCT findings of these clinical cases with emphysema were analysed. Emphysematous change in CLE was observed as low-attenuation area (LAA) within the homogeneous background on Ct images. In mild and moderate cases, LAA's were round or oval in shape, however in severe case they were observed to be irregular in shape. The border between LAA and parenchyma was not clearly defined, however in severe case LAA was found to be bordered partially or rather subtotally by the bronchovascular bundle. In mild and moderate cases, LAA's were observed to be distant from relatively large bronchovascular bundle. On the other hand, in severe case, only a small amount of lung parenchyma was left between LAA and bronchovascular bundle. These findings correspond to morphologic characteristics of CLE, that is, the process of emphysematous change tends to take place in the center of the secondary lobule, and even if the lobe is severely destroyed, some portion of the peripheral acinus is still preserved at lobular margin. Thus, CT can help to identify the presence of CLE. Furthermore, CT scan analysis of severe grade emphysema may lead to the differentiation between CLE and panlobular emphysema. more...

Localization of androgen receptors (ARs) in the human testis Leydig cells was examined with an AR assay and Northern blot analysis. Leydig cells, highly purified on a Percoll gradient, were used for the experiments. AR concentration in the total cell extract containing both the cytosol and nuclear fractions in Leydig cells was measured using [3H]methyltrienolone. ARs in Leydig cells showed a high affinity for [3H]methyltrienolone and the Kd and Bmax of the receptors were 1.24 nM and 11.7 fmol/mg protein, respectively. Northern blot analysis, using a 32P-labeled full-length human AR complementary DNA (cDNA) detected a 9.5-kb hybridizing band in the total RNA extracted from Leydig cells. These data can be interpreted as evidence of the existence of ARs in human Leydig cells. more...

We measured immunoreactive endothelin-1 in plasma of a patient with malignant hemangioendothelioma. A 74-year-old female first visited our clinic in July, 1989. Physical examination revealed reddish nodule measured 4 x 5 x 1 cm and erythematous plaque with erosion on her scalp. A biopsy specimen showed extensive proliferation of atypical tumor cells intermingled with a large number of capillary vessels in dermis. Some of tumor cells were positively stained for factor VIII related antigen by PAP method. From these findings we diagnosed malignant hemangioendothelioma and resected the tumor on August 3. The measurement of immunoreactive endothelin-1 in plasma was performed by radio-immunoassay on August 2 (before operation), October 20 and December 27 (after operation). The results were 16.2, 4.3 and 5.6 pg/ml, respectively (normal range: 0.5 +/- 0.2 pg/ml). Plasma endothelin-1 level may be run parallel to quantity of tumor cells in malignant hemangioendothelioma. more...

13503 Background: Dendritic cells (DCs) play a pivotal role in T cell-mediated immunity. Usually, mature DCs were cultured using resected tumor tissue, but for inoperable cases, this method is impractical. The injection of immature DCs into the tumor after appropriate chemotherapy is reasonable, if DCs come to maturity capturing the specific cancer antigen . The aim of this study is to assess the toxicity and efficacy of combined treatment with immunotherapy and chemotherapy for locally advanced pancreatic carcinoma. Methods: Five patients with pathologically confirmed pancreatic ductal carcinoma using EUS-FNA were enrolled, median age 56 years (range, 46–70 years). All cases without distant metastasis were diagnosed as surgically unresectable . Patients underwent leukapheresis, immature DCs were prepared from peripheral blood by a culture with granulocyte macrophage colony-stimulating factor and interleukin 4. Lymphokine-activated killer (LAK) were also prepared from peripheral blood. Immature DCs were injected biweekly in the mass by endoscopic ultrasound-guided fine needle injection (EUS-FNI), LAK were administered intravenously. Patients received the treatment of gemcitabine 1000 mg / m2 by intravenous injection 3 days before the immunotherapy. One course with 6 times combined therapy was continued until the judgment of progressive diseases (PD) was given. The toxicity and efficacy of this treatment were assessed. We also assessed whether tumor associated antigen (TAA)-specific IFN-?producing cells increase after treatment. Results: Hematological toxicity occurred in one case, leucopenia of grade 2. No severe toxicities of grade 3 to 4 occurred. One had a partial response (PR), stable disease (SD) was observed in 2 patients for more than 6 months (long-term SD). PR patient could undergo curative operation after this therapy. The number of TAA-specific IFN-?producing cells in PR patient increased 12-fold higher than that seen before treatments. Conclusions: These results support the safety and efficacy of combined treatment with immunotherapy and chemotherapy for locally advanced pancreatic ductal carcinoma. This treatment may be a useful for the treatment of pancreatic ductal carcinoma. No significant financial relationships to disclose. more...

The effects of ingested Al on the essential metals were investigated using mice. Animals were divided into 4 groups: 1) Control, 2) Al, 3) EtOH and 4) Al+EtOH groups. Powdered commercial food, containing 1.26% P, 1.36% Ca, 70ppm Zn, 15ppm Cu, 200ppm Fe and 3.1ppm Al, was used to prepare the diets. For Al-treated groups, Al(AlCl3) was added to powdered food at a concentration of 4000ppm. The co-existing effect of EtOH which is known to affect the essential metals, was also investigated as a possible modulater of Al toxicity at a concentration of 5% for 22 days, followed by 10% for 36 days in the drinking water. After 58 days feeding with food containing Al and / or EtOH containing water, the Al effects on serum and femur P and Ca were found to be slight except for a significant decrease of serum P concentration in the Al+EtOH group. In this group, femur weight was less and femur Al concentration was more compared with the Al group. The effects on Fe and Cu were little. We observed a significant decrease of serum Zn concentration with 4000ppm Al diet in both the Al-treated groups. The fact that serum ALPase activity, a Zn enzyme, increased in disregard of a significant decrease of serum Zn concentration suggested the enzyme release from injures tissues. It is noticeable that a significant decrease of serum Zn concentration was observed when dietary Zn was sufficient. It is reported that the dietary intake of Zn is under the recommended allowance for many people. Since Al compounds are widely used as drugs, food additives and a conditioned latent Zn deficiency is rather common in human diseases, the effects of Al on the Zn metabolism are to be investigated further. more...

We have had 3 cases of bronchial foreign bodies, which were peanut, chloramphenical tablet, and chocolate coated raisin.These objects were easily softened and hardly seen on the x-ray picture. For that reason, we had difficulities of making diagnosis and treatment of foreign bodies without bronchoscopy.From the results of our studies about the easily softened objects, mentioned above, and their appearences on the x-ray pictures, we suggest to perform bronchoscopy to make a definite diagnosis of such foreign bodies. more...

Interleukin-6 (IL-6) was found to be a growth factor of renal cell carcinomas. Furthermore, renal cell carcinomas freshly isolated from the patients expressed mRNA of IL-6 and secreted biologically active IL-6 under the culture conditions where the tumor cells could grow, but they did not produce IL-6 nor proliferate in the absence of fetal calf serum. The production of IL-6 by the tumor cells was also demonstrated by immunostaining of the IL-6-producing cells utilizing anti-IL-6 antiserum. Moreover, anti-IL-6 antiserum specifically inhibited the in vitro tumor growth. All data indicated that IL-6 functions as an in vitro autocrine growth factor of renal cell carcinomas. more...

We report a case of invasive squamous cell carcinoma of the urinary bladder, which was perforated intraperitoneally after intra-arterial chemotherapy. The patient was a 67-year-old woman complaining of macrohematuria and body weight loss. After thorough examination, the diagnosis of clinical stage C of squamous cell carcinoma of urinary bladder was made. At first, balloon occluded intra-arterial infusion with 80 mg, cis-dichlorodiamine platinum 10 mg mitomycin C and 1 mg vincristine was performed, followed by radiotherapy and 15 mg bleomycin injection. On the 5th day, the patient fell into shock with abdominal expansion, and bladder perforation into peritoneal cavity was confirmed by rapid cystography. Emergency cystohysterectomy and drainage were performed. Resected bladder had a large defect on its posterior wall, and tumor had fallen into severe necrosis. Since January, 1986 we performed balloon occluded intra-arterial infusion of antineoplastic drugs for 3 other cases. We obtained a partial response for 2 of these cases. The outcome of intra-arterial chemotherapy in our hospital is also reported. more...

A rare case of a thrombus in the inferior vena cava (IVC) after retroperitoneal lymphadenectomy for a testicular tumor is reported. A computed tomograph performed after the operation incidentally showed a filling defect in the IVC. However, it was impossible to decide whether the defect was due to an ordinary or a neoplastic thrombus. For this reason, a thrombectomy was performed, and postoperatively it was diagnosed as an ordinary thrombus. The cause of thrombi found only in the IVC is reviewed and the indication for thrombectomy is discussed. more...

We describe a rare case of a primary retroperitoneal ganglioneuroma that was found accidentally during preoperative examinations conducted due to a suspicion of ovarian cancer. Computerized tomography was not able to differentiate the retroperitoneal mass from an adrenal tumor. We diagnosed the retroperitoneal tumor by means of selective adrenal angiography. more...

By use of indirect immunofluorescence, this study demonstrated the presence of calcitonin gene-related peptide-like immunoreactive (CGRPI) fibers in the bladder of the rat. These fibers were abundant in the muscle layer, in which they ran parallel to the muscles, submucosa, and epithelium. No immunoreactive cells were detected. We also examined the origins of these fibers, using a method that combined biotinized retrograde tracer (biotin-wheat germ agglutinin) (B-WGA) and immunocytochemistry. Injection of the tracer into the bladder resulted in the demonstration of small to medium-sized labeled cells that contain CGRPI structures in single dorsal root ganglion cells mostly at the level of L6 and S1, but also a few at L2. Double-staining for CGRPI and immunoreactive P-like substance (SPI) indicated that there are cells in the dorsal root ganglia at the level of L6 and S1 that react to both, but that there are many CGRPI-positive cells that contain no demonstrable SPI; most of the latter are large. more...

A case of cystic pheochromocytoma is reported. A 64-year-old man was referred to our hospital because of right flank pain and gross hematuria. Excretory urography showed an inferior displacement of his right kidney, and right suprarenal mass was suspected. CT and ultrasonographic findings suggested that the most likely diagnosis was cystic adrenal tumor. Right adrenal tumor was removed through a transverse abdominal incision on October 15, 1986. During the procedure, the blood pressure rose to 260/100 mmHg at the time of tumor manipulation. The histological diagnosis was pseudocystic pheochromocytoma. Pathogenesis of cystic adrenal tumor is discussed briefly. more...

A case of non-traumatic rupture of the urinary bladder is reported. The patient, a 52-year-old woman, was admitted to our clinic with the chief complaints of dysuria and gross hematuria after hemorrhoidectomy. Ultrasonography and CT scan showed a huge mass in Retzius' cavity. Then, rupture of the bladder was diagnosed through subsequent cystoscopy and cystography. During surgery, we recognized a large defect in the anterior wall of the urinary bladder associated with reddish-yellow fluid in the pelvic cavity. Histological findings showed no malignant change in the bladder. Various factors were suspected to be related to this spontaneous rupture of the urinary bladder. more...

The overall distribution of substance P-like immunoreactive (SPI) fibers in the rat urinary bladder was examined by means of frozen sections and whole mount preparations. Two types of SPI fibers entered the urinary bladder from the neck; one forming thick fiber bundles and the other around the blood vessels. These SPI fiber bundles branched into several thinner segments which often project many collaterals to the smooth muscle and submucosal layers. In the smooth muscle layer, single SPI fibers were seen running parallel to both longitudinal and circular muscle bundles. They appeared to be evenly distributed in the smooth muscle layer. SPI fiber bundles located in the circular muscle layer dissociated SPI fibers which entered the submucosal layer, where they directed to the epithelium and formed a meshwork just beneath it. SPI fibers often left the meshwork to enter the epithelium where abundant arborization of fine SPI fibers was seen. The density of SPI fibers in the submucosal layer and epithelium was not even. The highest density was identified in the neck and the trigonum area. more...