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Background: Appendicitis caused by a foreign body is extremely rare. We report a case of chronic appendicitis caused by a perforating fish bone. Case Report: The patient was a 50-year-old Japanese man. He felt dull lower abdominal pain for 2 months and diagnosed as appendicitis caused by a perforating fish bone. He underwent emergency laparoscopic surgery. The fish bone had perforated through the appendix wall. The fish bone was initially removed followed by laparoscopic appendectomy. Pathological investigation revealed a transmural cut line of approximately 0.5 mm that was surrounded by fibrous tissue with inflammation. Conclusion: This is the first reported case of fish bone-induced chronic appendicitis that underwent laparoscopic appendectomy. For optimum outcome, a correct diagnosis based on a detailed consultation and imaging tests, and an operation performed after careful planning are needed.

The accidental ingestion of foreign bodies is a common clinical issue. While most foreign bodies pass through the gastrointestinal (GI) tract without complications, a few cases unfortunately result in GI perforation. Fish bones are one of the most frequent foreign bodies found in the GI tract, and they are high-risk objects for GI perforation due to their hard and sharp-pointed ends. Here, we present a rare case of a 64-year-old man with perforation of a colorectal tumor by a fish bone. The patient received emergency Hartmann's operation with lymph node dissection. Although the patient experienced recurrence in the liver rather than peritoneal dissemination, systemic chemotherapy was considerably effective, and conversion therapy with hepatectomy was successfully performed; the patient achieved 5-year relapse-free survival after the operation. To our knowledge, this is the first report of the perforation of a GI tumor by a fish bone. This rare case suggests the significant clinical implication that proper preoperative diagnosis and prompt surgical treatment lead to better postoperative outcomes for patients with tumor perforation by a foreign body.

Perirectal abscesses often occur in the dorsal portion of the perirectal tissues. We report a patient who presented with fever, pain on defecation, and dysuria. He was found to have a perirectal abscess in the anterior perineum pressing on the urethra. After emergency surgery to drain the abscess, the symptoms improved., We present a case of perirectal abscess causing dysuria due to pressure on the urethra.

症例は46歳，女性．検診の腹部超音波検査で下腹部に約6cmの腫瘤を指摘され当院を紹介された．直腸指診で直腸後壁に弾性軟，表面平滑な腫瘤を触知した．骨盤CT，MRI検査で仙骨前面に内部がほぼ均一で境界明瞭な約6cmの嚢胞性腫瘤を認めた．40歳時に骨盤内の類表皮嚢腫で手術歴があることからその再発を疑い経腹的腫瘤摘出術を施行した．腫瘤は表面平滑，弾性軟，単房性嚢胞で内容物は灰白色の粥状物だった．病理組織学的には，嚢胞壁には角化をともなう重層扁平上皮がみられ炎症のため広範囲に上皮欠損をともなっていた．皮膚附属器はみられず類表皮嚢腫と診断された．本症は，悪性化の報告がまれにあり外科的な完全摘出が望ましいと考えられる．

In recent years, the opportunity to deal with classified information in a computer has increased, so the cases of classified information leakage have also increased. We have developed a function called “diffusion tracing function for classified information” (tracing function), which has the ability to trace the diffusion of classified information in a computer and to manage which resources might contain classified information. The classified information exchanged among the processes in multiple computers should be traced. This paper proposes a method which traces the diffusion for classified information among multiple computers. Evaluation results show the effectiveness of the proposed methods.

IgD multiple myeloma is a unique type of multiple myeloma which is characterized by increased serum IgD and IgD type M-component in immunoelectrophoresis. It frequently shows renal involvement but it is a rare form of myeloma. The distinctive features of IgD myeloma are the dominance in males, high frequency in younger persons, and the uncertain appearance of M-component in serum electrophoresis. We experienced 3 cases of IgD multiple myeloma with renal failure which required hemodialysis before IgD myeloma was diagnosed. It is important to consider IgD myeloma when treating the patients with renal involvement of unknown origin.

In Japan the outbreak of typhoid fever has rapidly become scarce after World War II and it is now disregarded as the “disease of the past” in our clinical sphere. We have lately come across five cases of typhoid fever on which clinical and epidemiological studies were made. The five cases broke out from August 1976 through November 1979. Patients were four females (20, 19 and 52 years old respectively) and one male (26 years old). Suspected places of their contraction of the disease were Korea for two patients and Kagoshima and Ibusuki cities, Japan for the others. Phage types of causa-tive bacilli were E, 53 and A degraded (found in patients infected in Kagoshima and Ibusuki cities, Japan) and 53 and A degraded were detected in patients who had visited Korea. Initial symptoms developed with the patients were chill, headache and high fever (39.7 C-40.6 C). One of the patients suffered from diarrhea. On the contrary, three of them complained of constipation. Deep red-colored papules appeared on the chest-abdomen region of a patient. There was splenomegaly in two patients while hepatomegaly was found in another patient. Increased LDH level and slight liver function deficiency were seen in all five patients. White blood cell counts varied in the course of the disease. There was leukopenia in all cases ranging from 1, 600/mm3 to 5, 000/mm3. Positive urine protein was noticed in four patients, which turned negative afterwards. Diazo reaction test was performed on two patients who were found to be negative. Intestinal fluoroscopy was done on one patient. An irregular longitudinal niche along a long axis of the intestinal tract and convergence of the intestinal folds were found by press technique. A nodular picture was also seen around the niche. Clinical diagnosis of septicemia was made in four patients and severe infection in one patient. Definite diagnosis was confirmed as a result of arterial blood culture. Periods elapsed from onset of initial symptoms until the time when definite diagnosis was made were 14, 17, 18, 28 and 37 days in each case. The bacilli detected were sensitive to most of the antibiotics tested. Especially, almost all the bacilli detected were sensitive to chloramphenicol. A patient who was supposed to be infected with the bacilli in Korea had joined a Korean tour group from August 4, 1976 through August 11, 1976. Two of 75 tourists on the group contracted the disease. Concurrently, it was reported that 21 patients in a group and six in the other (51 and 73 tourists on each group), both of which tourist groups had traveled Tokyo and Osaka area, contracted typhoid fever. Those facts showed that we should bear imported cases of typhoid fever in mind. However, three of the five patients had never visited any foreign countries and the other three patients were strongly suspected of being infected with Salmonella typhi in Kagoshima and Ibusuki cities, Japan. The fact should carefully be paid attntion to.

血液透析が免疫応答系, 特に末梢血リンパ球subpopulationに及ぼす影響について検索した. 対象は週3回の維持透析を受けている安定期の患者で, cuprophan膜を用いて透析を行っている者10例とpolycarbonate membrane (PCM) を用いている者2例とした. 方法はこれらの症例で, 透析前, 透析開始後15分, 60分, 120分に採血を行い, 白血球算定, アナリーゼ, 補体価の測定, 及び矢田らのmixed rosette法を用いてリンパ球subpopulationの測定を行った. その結果, 1) 血液透析の初期 (15分) にdouble-RFCは透析前値の38.7±13.6%にEA-RFCは52.2±18.0%に著明 (P

血液透析 (HD) 患者の末梢血リンパ球サブポピュレーションに対する輸血, HD期間, human T cell leukemia vlrus-I (ATLV/HTLV-I) およびHB virus感染の影響を検討し, 以下の結果を得た. 1). HD期間の増加に伴いOKT8+細胞比率の増加がみられ, OKB1+細胞比率は減少した. 2) 輸血によりHD患者のLeu7+細胞比率は減少したが, OKT4/OKT8比は変化を認めなかった. 3) 抗ATLA抗体陽性を示すHD患者ではOKT4/OKT8比の幅広い分布がみられるが, 抗ATLA抗体陰性者に比しOKT4/OKT8比の有意な低下がみられ, 輸血群でのOKT4/OKT8比低値例のほとんどは抗ATしA抗体陽性あるいは長期HD例であった. 4) HBs抗原陽性群と抗HBs抗体陽性群では, リンパ球サブポピュレーションの差異はみられなかった.以上の事から, HD期間あるいは抗ATLA抗体の存在がHD患者のリンパ球サブポピュレーションの変動に関与し得ることが考えられ, 輸血によりOKT4/OKT8比が低下するという今までの報告は, ATLV/HTLV-Iあるいは他のvirus感染による可能性もうかがわれた.

We report 2 cases of adult T cell leukemia (ATL) from hemodialysis (HD) patients with chronic renal failure (CRF) in the Kagoshima district, an endemic area of human T cell leukemia virus type I(HTLV-I) in Japan. The positivity of antibodies to ATL-associated antigen(anti-ATLA) in HD patients, regardless of whether or not blood transfusions were given, has been higher than in healthy persons in the district (p less than 0.01). ATL is considered to break out from HTLV-I carriers. Further study should be conducted to clarify the relationship between HTLV-I infection and CRF, and moreover, attention should be directed not only to treatment of HD but accompanying ATL as well, particularly in HTLV-I-endemic areas.

輸血を受ける機会の多い血液透析中の慢性腎不全患者234例について, 血清抗ATLA抗体を測定, HTLV-1感染と輸血との関連について検討し, 以下の結果を得た. 1) 鹿児島県下の血液透析患者の抗ATLA抗体陽性率は33.8%で, 鹿児島県一般健常人の陽性率11.7%より高率であった (p