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Ultrasound examination was performed in 2327 cases of breast lesion treated in our institusion from February 1989 to July 1994. One hundred and twelve cases of breast carcinoma and 121 cases of benign lesions diagnoses of which had been histologically confirmed were the subject of this study. There were 14 cases of false negative and 15 cases of false positive. Sensitivity of ultrasonography in breast cancers was 87.5%. Its specificity and accuracy were 87.6% and 87.6%, respectively. Solid-tubular carcinoma and papillo-tubular carcinoma were inclined to be misdiagnosed as false negative. Fibroadenoma and mastopathy were tended to be misdiagnosed as false positive. Tumor size was smaller in falsely diagnosed cases than that of accurately diagnosed cases. We conclude that there are limitations to diagnose on breast diseases according to the present criteria of ultrasonography. Aggressive biopsies of the breast tumors would prevent from the false diagnosis of breast cancer.

われわれは過去に,単球の誘導型nitric oxide合成酵素(inducible nitric oxide synthase; iNOS)によって産生される多量のnitric oxide (NO)が組織傷害性に作用し得ることを報告した。iNOSは各種サイトカインやlipopolysaccharide (LPS)によって誘導されることが知られているが,その機序は不明である。今回われわれは,in vitroで健常成人培養単球をinterferon (IFN) γおよびLPSで刺激し,iNOS messenger RNA (iNOSmRNA)発現の有無についてreverse transcription-polimerase chain reaction (RT-PCR)法を用いて検討するとともに,単球培養上清NO2値の測定を試みた(Griess法)。さらに代表的な炎症性サイトカインであるtumor necrosis factor (TNF) αのiNOS発現への関与を明確にするため,抗TNFαモノクロナール抗体を用いてiNOSmRNA発現が抑制されるか否かを検索し,また単球培養上清NO2値が変化するかどうかについて検討した。RT-PCR法に用いたprimerはhuman hepatocyte iNOSmRNAの塩基配列をもとに作成した。結果は,IFNγおよびLPSで刺激した培養単球には明瞭なiNOSmRNA発現を認め,単球培養上清のNO2値は高値を示した。これに対し,抗TNFαモノクロナール抗体を添加するとiNOSmRNA発現は著明に抑制され,また培養上清のNO2値は有意に低下した。以上より,ヒト単球においてIFNγ+LPSの刺激によりiNOS誘導に基づいたNO産生が行われることが推察される。さらに,このiNOS誘導はIFNγ+LPSの直接刺激ではなく,これらの刺激により単球で産生されるTNFαがautocrine的に単球を刺激しiNOSを誘導するものと考えられる。

Using a new transcutaneous magnetic stimulation technique, sacral nerve terminal motor latencies (SNTML) were measured after ileal J pouch-anal anastomosis in eight patients with ulcerative colitis, and the results were compared with those obtained from 15 normal subjects. The conduction delay of the SNTML in patients with soiling was significantly longer than that of the continent group as well as that of normal subjects (P < 0.01). There were no significant differences in the conduction delay between the continent group and the control subjects. These findings therefore support the hypothesis that such soiling, which is sometimes seen after ileal J pouch-anal anastomosis, is partly due to damage to the sacral nerves.

To clarify the correlation between the kinetics of nitric oxide (NO) production and the occurrence of organ dysfunction in acute pancreatitis, we examined the production of NO2 and NO3 by monocytes in five patients with severe pancreatitis and organ dysfunction (four males and one female, aged 24–52 years: group S), and compared the results with those in five patients with mild pancreatitis (three males and two females, aged 24–52 years: group M) and 12 healthy volunteers (9 males and three females, aged 25–44: group C). The time course of induced NO production by cultured monocytes obtained from these subjects was also examined, using a NO-sensitive electrode. The levels of NO2 and NO3 production by monocytes in vitro, with or without stimulation, were significantly higher (P

To clarify how the kinetics of nitric oxide (NO) and active oxygen species are correlated with the occurrence of organ dysfunction in sepsis, the levels of monocyte-associated NO2, NO3, and active oxygen species were examined in severely septic patients with multiple organ dysfunction syndrome (group M; n = 5), and the results compared with those of postoperative patients who had undergone gastrointestinal surgery (group S; n = 5) and healthy volunteers (group C; n = 10). The production of NO2 and NO3 by monocytes was significantly higher in group M than in the other two groups, while the production of active oxygen species by monocytes was significantly higher in groups M and S, than in group C. A significant correlation between the production of NO2 and that of active oxygen species by monocytes was noted only in group M. These findings indicate that the simultaneous activation of NO and active oxygen species production by monocytes is a prerequisite for the onset of multiple organ dysfunction in severe sepsis.

Nitric oxide (NO) has recently been shown to be a neurotransmitter in the nonadrenergic noncholinergic (NANC) inhibitory nerves in the gastrointestinal tract. To clarify the significance of NO in Hirschsprung's disease (HD), enteric nerve responses in colonic tissue obtained from HD patients were investigated. Colonic tissue specimens were obtained from four patients with HD and from 11 patients without constipation who were used as controls. A mechanograph was used to evaluate in vitro colonic responses to electrical field stimulation (EFS) of the adrenergic and cholinergic nerves before and after treatment with various autonomic nerve blockers, and NG-nitro-L-arginine (L-NNA) and L-arginine with the following results: (1) NANC inhibitory nerves were found to act on normal human colon, but had no effect on aganglionic colon; (2) L-NNA concentration dependently inhibited the relaxation in response to EFS in the normal colon, but had no effect on aganglionic colon; and (3) this inhibitory effect was reversed by L-arginine in the normal colon, but had no effect on the aganglionic colon. Nitric oxide mediates the relaxation reaction of NANC inhibitory nerves in the human colon, but the effect of NO was absent in aganglionic colon. The loss of action by NO may be implicated in the impaired motility observed in aganglionic colon.

The incidence of hemangioma is the highest of all benign tumors of the liver, but subjective symptoms are few and surgical tretment is performed only in symptomatic cases of giant tumor. We experienced two interesting patients with giant cavernous hemangioma of the liver showing subjective symptoms. Case 1 was a 45-year-old woman complaining of general fatigue and an abdominal mass. A giant hemangioma in the lateral and posterior segments of the liver associated with coagulopathy (reduced platelet counts and fibrinogen, and elevated total serum FDP) was diagnosed and hepatectomy was performed. Case 2 was a 34-year-old woman diagnosed as to have a giant hemangioma in the posterior segment of the liver. After a 7-year observation period the tumor suddenly start to enlarge, and subsequently a right upper abdominal pain and slight fever developed. Hepatectomy was performed in order to avoid the risk of rupture. Good results were obtained in both cases with disappearance of subjective and objective symptoms.

We reported a 55 years old female with a unresectable giant metastatic liver tumor from malignant thymoma who underwent percutaneous microwave coagulo-necrotic therapy (MCT).She underwent thymectomy for thymoma 15 years ago, and right nephrectomy and left partial nephrectomy for metastasis from thymoma 3 years ago. During the follow-up, she was found to have a giant metastatic liver tumor and we performed the MCT three points of the tumor per 60W 60s, because of her poor general condition. No complications were observed. Two months later, a biopsy was done, showing necrosis of the tumor. A pertinent literature was reviewed.

回肛吻合術 (直腸短筋筒, J型回腸嚢) を行った12症例 (ulcerative colitis: UC8例, adenomatosiscolilAC4例, 男性8例, 女性4例, 14～56歳, 平均39.2歳) を, 回腸人工肛門閉鎖術後より最短1年6か月以上経過した時点 (UCは20～106か月, 平均51.6か月, ACは24～87か月, 平均58.5か月) で, soiling (一) 7例とsoiling (+) 5例の2群に分け, 排便異常のない体表手術例15症例 (男性8例, 女性7例, 27～69歳, 平均4910歳) を対照としてlow compliance infused open tip法を用いて直腸肛門内圧検査成績を比較検討した.その結果, soiling (+) 例は対照例, soiling (一) 例に比べて, 括約筋機能 (肛門管長, 肛門管最大静止圧, 肛門管最大随意収縮圧), 排便知覚 (最小知覚量), 貯留能 (コンプライアンスのみ) の低下を示した.soiling (+) 例において, 括約筋機能と排便知覚の低下は肛門括約筋群に対する手術損傷が, そして貯留能でのコンプライアンスの低下は, UC自体の炎症の残存直腸筋層への波及が, 影響したことが考えられる.

Liposarcoma occurring in the retroperitoneum is relatively rare and is often found as a giant mass. In this paper, we reported a case of well-differentiated retroperitoneal liposarcoma. A 43-year-old man was admitted to the hospital because of feeling of abdominal fullness and lumbago. An infant-head-sized tumor was palpable in the left upper abdomen. Scout film of the abdomen revealed a mass shadow in the left upper abdomen. In an abdominal ultrasonic examination, the tumor mass showed an irregular pattern. Abdominal CT scan visualized a low density area with a clear boundary, and with enhancing, a low density ara filled with heterogenous reticular shadow was observed. From the above findings, a diagnosis of well-differentiated retroperitoneal liposarcoma was entertained. Celiotomy was performed with confirmation of the preoperative diagnosis by microscopic examinations. Postoperative course was satisfactory and he was discharged on the 12th postoperative day. Excision of a retroperitoneal liposar-coma is relatively easy due to poor blood supply and its prognosis is favorable in well-differentiated type. For a preoperative diagnosis, abdminal CT scan is useful.

In order to investigate the duodenal motor activity after subtotal gastrectomy (Billroth-I, R2 lymph node dissection) for gastric cancer, migrating motor complex (MMC) of the duodenum was recorded using a micro-tip force transducer in 19 patients. At the same time serum levels of gastrointestinal hormone were measured. The following results were obtained. 1) MMC were observed in 12 patients, but not in the other 7 patients in whom only phase II was sustained. 2) It was suggested that the vagus nerve might not contribute to occurrence of MMC. 3) Possible participation of motilin and somatostatin as well as the necessity of their cooperation action in occurrence of MMC were also indicated.

A case of duodenal varices successfully treated by a systemic obliteration of the varices, which has been employed at the department, is reported with a review of the Japanese literature. A 52-year-old woman was admitted to the hospital because of tarry stool. An upper gastrointestinal endoscopy showed an enlarged and tortuous varices with redness in the second portion of the duodenum. Transileocolic vein portgraphy revealed collateral veins composed of the supperior and inferior pancreaticoduodenal veins. From these findings a diagnosis of duodenal varices was made, and a systemic obliteration of varices which composed of an embolization by coils and endoscopic embolization was performed. After that, endoscopical examination revealed that morphology of the varices was improved but the redness persisted. Endoscopic obliteration was carried out two times. No recurrence of the varices has been observed during the follow up period of two years after the treatment. Duodenal varix is rare and the etiology mainly attributable to portal hypertension. It can cause gastrointestinal bleeding. A systemic obliteration of the collateral veins, which has been employed for esophageal varices at the department, was useful.

A case of cavernous hemangioma of the duodenum causing massive bleeding is reported on, with a review of 6 cases seen in the Japanese literature.A 69-year-old female was admitted to the hospital because of a sudden onset of hematoemesis. An urgent duodenal endoscopy disclosed hemorrhage from anterior wall of the duodenal bulb which was controlled by an endoscopic treatment. The patient was diagnosed as having a duodenal hemangioma by a repeated duodenal endoscopy and selective angiography. A partial resection of the duodenal bulb was performed. The macro-and microscopic examinations of the specimen revealed a cavernous hemangioma.Hemangiomas of the intestinal tract is rare, representing only 0.3% of al tumors of the intestinal tract, and among them, hemangiomas of the duodenum are extremely rare which represent 2.7% of those of the intestinal tract. This disease demands an operative intervension because of a tendency to massive bleeding. Upon surgery the importance to avoid oversurgery by pre and intraoperative examinations should be emphasized.

In addition to the expression of HLA antigens on tumor cells and of the adhesion molecules both on tumor cells and tumor infiltrating lymphocytes (TIL), the degree of TIL and subpopulations of them were determined by applying monoclonal antibodies and immunoperoxidase technique. Subjects were 55 patients operated on for hepatocellular carcinoma (HCC), 24 of whom had undergone transcatheter arterial embolization (TAE) before surgery. The percentages of HLA class 1, DR and CD54 positive tumor cells were 0.08±0.07%, 0.21±0.31% and 0%, respectively in the patients without TAE, while they were 0.18±0.26%, 0.14±0.27% and 0%, respectively in those with TAE. The percentage of TIL in the total nucleated cells was 7.0±7.2% in the patients without TAE, versus 11.1±9.3% in the others. The majority of them was comprised of T cells in both patients groups. The percentages of LFA-I and CD2 positive TIL were 34.0±12.9% and 35.0±12.6%, respectively in the patients without TAE. They were 29.9±4.7% and 34.5±12.6%, respectively in those with TAE. These results suggest that, in HCC patients, (1) the exressions of HLA antigens and adhesion molecules on tumor cells are poor, (2) the degree of TIL is scanty, and (3) TAE to the tumor is not effective in strengthing the ability of TIL to recognize and attack the tumor cells.

結腸憩室症の合併症に瘻孔形成がある.今回,S状結腸憩室瘻の2例を経験したので文献的考察を加えて報告する.症例1は41歳男性で,気尿と糞尿を訴え来院した.注腸造影でS状結腸に多発性憩室を認め,その一部より膀胱が造影され,膀胱鏡検査で瘻孔開口部が確認された.また腹部CT検査で膀胱内ガスと瘻孔が描出され,S状結腸膀胱瘻と診断し,手術を行ったが,局所の炎症所見が強かったため二期的手術とした.症例2は70歳女性で,下腹部痛と帯下を訴え来院した.注腸造影でS状結腸に多発性憩室を認め,その一部より左卵管,子宮,腟が造影され,子宮卵管造影で左卵管よりS状結腸への造影剤の流出を認めた.また腹部CT検査で子宮腔内にガス像を認め,S状結腸卵管瘻と診断し,一期的に根治手術を行った.S状結腸卵管瘻は本邦初報告と思われる.

Spigelian hernia is a protrusion of a sack of peritonum, an organ or a preperitoneal fat through a defect in the Spigelian fascia, which was named after Adrian Van der Spighel who first described the lineasemilunaris. We report a case of Spigelian hernia in a 21 years old female. Generally diagnosis of Spigelian hernia can be difficult because of it's uncharacteristic symptoms and a failure to consider a possibility of this hernia. Findings such as palpable hernia sack and orifice facilitate to make the correct diagnosis. Ultrasonic and CT scannings can offer available informations for the diagnosis of this hernia. Surgical treatment is the first-choice reginen and the recurrence is hardly found.

A rare case of transepiploic hernia is presented, together with a brief review of the literature. A female, aged 86 years, was admitted with a 24-hr history of an increasing severe right lower quadrant pain accompanied by nausea and vomiting. The abdomen was distended and abnormal masses with generalized tenderness were present. White blood cell count was 14300/mm3. Abdominal plain film showed dilated loops of the intestine and a soft-tissue mass. A diagnosis of strangulated intestinal obstruction was made and a laparotomy was carried out. The greater omentum was not free but attached to the bilateral sides of the abdominal cavity and colon. One hundred and twenty cm of small gut had prolapsed through a hole in the omentum and was gangrenous due to constriction at the neck. The affected bowel was resected (25% resection), and the hole in the omentum was closed. The patient made an uneventful revovery following operation. A review of the Japanese literature revealed only 15 recorded cases of omental hernia, and one further case is considered worthy of report.

A case of myxoglobulosis of the appendix with perforation was reported. The case was a 25-year-old man who was admitted to the hospital complaining of lower abdominal pain. Characteristic signs of peritonitis were confirmed. Ultrasonographic and barium enema examinations disclosed a cystic mass in the ileocecal region. Laparotomy revealed a greatly swollen and perforated appendix with many scattered mucinous round bodies measuring 2mm in diameter in the peritoneal cavity. Thus, appendectomy with intensive peritoneal lavage was done. Pathological examinations of the specimens revealed that the residual mucosa of the appendix was hyperplastic and there was no evidence of malignancy. The round bodies were composed of mucinous materials with stratified structures containing fractions of histiocytes. Myxoglobulosis of the appendix is a form of appendicular mucocele characterized by the presence of round mucinous bodies. Ultrasonography and barium enema are useful diagnostic tools, however, in cases with perforation such as this case, we have difficulties in making correct diagnosis preoperatively. Adjunctive chemotherapy and additional treatments are required for pseudomyxoma peritonaei when the mucinous scattering involving carcinoma cells is found.

Heterotopic pancreatic tissue in the small-bowel mesentery is an extremely rare anomaly: no such case has been reported in the English literature. We report a 5-year-old boy in whom the aberrant tissue formed a retroperitoneal cyst. The condition was further complicated by a ventral pancreatic duct defect. The unique clinical manifestations and difficulty in making the diagnosis are discussed.

Pudendal nerve terminal motor latencies (PNTML) were measured in eight patients with ulcerative colitis who underwent colectomy with mucosal proctectomy and ileal J pouch-anal anastomosis, using a new digitally directed transrectal stimulation and recording technique, and the results were compared with data obtained from 15 control subjects. The conduction delay of PNTML in the patients with some degree of fecal incontinence was the longest, followed by those without any incontinence, and then the control subjects. These findings support the hypothesis that fecal incontinence after this procedure may be partially caused by damage to the pudendal nerve.

The interim analysis of the JFMC study as of May, 2001 covers 190 gastrectomized patients with advanced gastric cancer from 82 institutions between May, 1996 and March, 2000. Patients were randomly assigned to the following two regimens. Group-CD: cisplatin (CDDP) 5 mg/body/day (i.v.) plus 5-FU 300 mg/body/day (cvi) day 1-5, given for 6 weeks, followed by UFT 200 mg (as tegafur) x 2/day for as long as possible. Group-UF: UFT only was administered after surgery as long as possible. The primary endpoint was survival and the secondary endpoint was disease-free survival. The 4-year survival rates were 47.6% in CD and 41.3% in UF, and the hazard ratio of CD versus UF was 0.74 (95% CL: 0.47-1.16, p = 0.189) according to a stratified (with stage) logrank analysis. The 4-year disease-free survival rates were 50.1% in CD and 39.3% in UF, and the hazard ratio of CD versus UF was 0.65 (95% CL: 0.42-1.00, p = 0.049). Cox's regression analysis using time-dependent dummy variables, revealed that the effect on the survival was accentuated within 9 months, that on disease-free survival within 6 months. The quality of life (QOL) of patients for one year after surgery in CD was significantly lower than that of patient in UF, as assessed using a QOL questionnaire. Although the present interim analysis does not statistically confirm the efficacy of the "low-dose CDDP plus 5-FU" regimen, an expectation for better results is suggested if this regimen is administered for a longer period of time. The JFMC Clinical Trial Committee permitted the release of this report on the condition that further study to verify the present study will be conducted.

Nitric oxide (NO) has recently been shown to be a neurotransmitter in the non-adrenergic non-cholinergic (NANC) inhibitory nerves in the gastrointestinal tract. To clarify the the role of NO in the human lower esophageal sphincter (LES), enteric nerve responses in lower esophageal tissue specimens obtained from patients with esophageal cancer (n = 7) and patients with gastric cancer (n = 6) were investigated. A mechanographic technique was used to evaluate in vitro LES muscle responses to electrical field stimulation (EFS) of adrenergic and cholinergic nerves before and after treatment with various autonomic nerve blockers, including NG-nitro-L-arginine (L-NNA) and L-arginine. Findings were: (1) Cholinergic nerves were those mainly involved in the regulation of enteric- nerve responses to EFS in the steady state, and NANC inhibitory nerves acted on the LES; (2) L-NNA concentration-dependently inhibited the relaxation in response to EFS in the LES; and (3) this inhibitory effect in the LES was reversed by L-arginine. These findings suggest that cholinergic and NANC inhibitory nerves play important roles in regulating contraction and relaxation of the human LES, and that NO plays an important role as a neurotransmitter in NANC inhibitory nerves of the human LES.

Several investigators have reported that alterations of the multiple tumor suppressor 1 (MTS1) gene frequently occurred in certain types of tumors. We examined the expression levels and somatic mutations of the MTS1 gene in primary colorectal carcinomas. The MTS1 transcript was quantitatively detected in 14 of 17 tumors, but in only one case of adjacent normal mucosa. Direct sequencing of the amplified MTS1 gene showed no somatic mutation in 17 primary colorectal carcinomas. These results indicate that inactivation of the MTS1 gene is not involved in pathogenesis of primary colorectal carcinomas, and that its enhanced expression is, instead, associated with primary colorectal carcinomas, especially markedly in the early stage of tumor progression.

PURPOSE : To clarify neurologic function with respect to external anal sphincter and puborectalis muscles after J configuration ileal J-pouch-anal anastomosis for patients with ulcerative colitis and adenomatosis coli, we examined the terminal motor latency in the pudendal and sacral motor nerve (S2-4). METHODS : Latency of the response in the external anal sphincter muscle following digitally directed transrectal pudendal nerve stimulation (PNTML) and in the puborectalis muscle following transcutaneous magnetic stimulation of the cauda equina at the levels S2-4 (SMNLTSS) were measured in 12 patients with ileal J-pouch-anal anastomosis ; they were divided into a group with continence (7 cases) and a group with soiling (5 cases). Results were compared with data obtained from 12 patients before operation and 15 controls. RESULTS : Conduction delay of PNTML and SMNLTSS in patients with soiling was longest, followed by delay in those without any soiling, then delay in patients before operation, and then controls. In addition, significant differences were also noted between conduction delay of PNTML in controls and those who are incontinent and experience soiling (P < 0.05 and P < 0.01, respectively), and there were significant differences also noted between conduction delay of PNTML in patients before operation and those who are incontinent and experiencing soiling (P < 0.05 and P < 0.01, respectively). Conduction delay of PNTML and SMNLTSS were found in patients before operation rather than in controls. No significant differences were noted between conduction delay of PNTML and SMNLTSS in patients before operation and controls. Significant differences were also noted between conduction delay of PNTML and SMNLTSS in patients who are incontinent and experiencing soiling (P < 0.01, respectively). CONCLUSION : These findings support the hypothesis that soiling after this procedure may be partially caused by damage to pudendal and sacral motor nerves (S2-4).

The authors examined the biological characteristics of a neuroblastoma with spontaneous tumor reduction. A 6-month-old boy with a pelvic neuroblastoma underwent surgical extirpation of the tumor 1 month after diagnosis. The size of the tumor reduced spontaneously while he was awaiting operation. The low proliferative activity of the tumor cells and the presence of apoptosis in the tumor tissue were shown by an immunohistochemical method using anti-PCNA antibody and a DNA fragmentation analysis, respectively. These results suggest that the spontaneous tumor reduction seen in this patient may well be caused by the overwhelming apoptosis of tumor cells.

For a local control of the tumor, it is important for T lymphocytes to recognize tumor cells. For these, the expressions of HLA and adhesion molecules such as ICAM-I and LFA-3 on tumor cells are essential. The expressions of HLA-DR, ICAM-I and LFA-3 on tumor cells were highest in patients with Dukes A and decreased as the disease advanced to Dukes B and C. The populations of CD3(+), CD4(+) and CD8(+) cells in TIL were significantly higher in the cases in which HLA Class I or HLA-DR was highly expressed on tumor cells. IFN gamma and OK432 elevated expressions of these molecules on tumor cells as well as the percentage of certain subsets of T lymphocytes in TIL.

The effect of indomethacin, a prostaglandin synthetase inhibitor, on lymphocyte responses to phytohemagglutinin (PHA) was studied in 111 breast, stomach and colorectal cancer patients. Indomethacin exerted no mitogenic activity and the ethanol in which the indomethacin was dissolved produced no significant effect on the lymphocyte responses to PHA. Compared with the control group (13 healthy subjects and 30 patients with benign disease), indomethacin significantly enhanced the lymphocyte responses to PHA in the cancer patients. The degree of enhancement induced by indomethacin was independent of the primary site of the tumor, but was associated with tumor load. A significant inverse correlation was observed between the degree of enhancement and that of the original lymphocyte responses to PHA. Sequential determinations of the degree of enhancement in selected stomach and colorectal cancer patients revealed that it fell to a low level after curative tumor resection.

A 48-year-old woman who developed fibroadenoma in accessory mammary breast tissue in the right axilla is reported. The extramammary gland consists of accessory and aberrant mammary glands, depending upon the presence or absence of 1) nipples, 2) areolae and 3) common ducts. Toumor formation in the extramammary breast tissue has rarely been reported. Of the 44 cases reported in the literature during the last 50 years, 34 were malignant, seven mastopathies and three fibroadenomas including our case. In the majority of cases. They occurred in the axilla and originated from the accessory mammary breast tissue. The case described here was suspected to involve malignant changes on admission, but the histology revealed fibroadenoma in the accessory mammary breast tissue. When confronted with a patient possessing a large axillary mass without a nipple or an areola, it is important to consider not only the various subucutaneous axillary tumors, but also the possibility of malingnant changes in the extramammary breast tissue.

Leiomyosarcoma of the stomach is a rare disease, and it's main metastatic forms are blood-borne metastasis and peritoneal dissem ination. Thus, the most common metastatic sites are the liver and peritoneum. However, resection of the liver for metastasis of this disease has rarely been reported. We present a patient with leiomyosarcoma of the stomach with liver metastasis who underwent total gastrectomy and liver resection twice for the metastasis. The patient was a 59-year-old woman who was admitted to a hospital associated with out university with gastric leiomyosarcoma and in whom liver metastasis was found in the lateral segment during total gastrectomy. She was readmitted to our clinic and underwent resection of the left lobe of the liver. Subsequently, she again developed a liver metastasis in S8 at 18 months after the resection of the liver and underwent a resection of that segment. Liver metastasis is considered to be an end-stage of cancer and has not been treated positively. However, the case presented here suggests that resection is the most effective treatment for liver metastasis of leiomyosarcoma of the stomach.

Conservative therapy was given to four cases of senile, acute purulent cholecystitis (two with stones and two without) for 24 to 48 hours after hospitalization, but their clinical conditions did not improve. Thus, in order to drain pus-beaing bile and inject an antibiotic drug into the gall bladder, the patierts receives percutaneous trashepatic gall bladder puncture under ultrasonic guidance as an emergency therapy. Immediately after the puncture, all cases began to be relieved of abdominal pain, which disappeared entirely by the following day. Pyretolysis was achieved with in 2 days in all cases. The general conditions of all the cases continued to improve remarkably after this, and cases having stones received cholecystectomy after two or three weeks. The cases without stones could be spared surgery and were discharged in 4 weeks with improved conditions, with no recurrences reported up to the present time, and their clinical progresses have been excellent. This method is condidered to be an excellent one in comparison with conventional drainage surgery, being particularly useful for senile patients with seriously infected acute cholecystitis or those having the same condition complicated with serious functional disturbances of other organs. We recommened that this method be more positively applied to such cases.

CMF therapy (according to the method of Bonadonna et al.) and CMFT therapy, in which CMF therapy and the administration of tamoxifen are simultaneously undertaken, were performed as postoperative adjuvant therapy for breast cancer in postmenopausal cases of stages I-III (excluding T1nomo and T4) during a period of about four years from 1981 to 1985. In the present study, the results were compared between the CMF group (n=23) and the CMFT group (n=21). The disease-free survival rate was more favorable in the latter than in the former group. As a result of a comparison between the two groups according to the presence or absence of estrogen receptor (ER), the CMFT group with ER-positive findings showed favorable results. Since only a few cases were examined, however, no statistically significant difference was obtained. These groups were retrospectively compared as a reference with postmenopausal patients (n=7) who had undergone 60Co irradiation only after radical surgery. Significantly favorable results were obtained in the CMFT group (p

Splenectomy has been established as a safe and effective treatment for hereditary spherocytosis (HS). However, we believe that, from the standpoint of preserving the immunological function of the spleen, splenctomy should be avoided. In this paper, we present a case of HS in which partial splenic embolization (PSE) was performed with good success. The case was a 26-year-old male who was admitted to hospital with a diagnosis of acute pancreatitis and HS. After the acute pancreatitis was cured, he was transferred to our department for the treatment of HS. No gallstones were demonstrated. Serum bilirubin decreased form 2.23mg/dl to 0.57mg/dl on the 10th day after PSE. The RBC count decreased from 103‰ to 2‰, both on the 20th day after PSE. No severe complications were encountered after the procedure. It has been 27 months since PSE was performed and no recurrence of hemolysis has been recognized. This case suggests that PSE would be a safe and effective treatment for HS.

It is known that non-Hodgkin's lymphoma patient presenting as a bulky mass has a poor prognosis, even if it is localized, because of its poor response to conventional treatment. A case of non-Hodgkin's lymphoma with a bulky mass in the left lumbar region is presented. She responded well to a combined radiochemotherapy. A 64-year-old female who complained of a left lumbar mass was admitted to the hospital. The mass was smooth at the surface and hard on physical examination. On CT scan a solid mass 11cm in diameter involving the rib had pressed the left kidney. A biopsy disclosed non-Hodgkin's lymphoma of diffuse large cell type, 50 Gy of radiation followed by Vincristine, Endoxan, Predonine and Adriamycin (VEPA) chemotherapy was given and the mass disappeared on CT scan by the end of the 9th cycle of chemotherapy. The clinical course after the 20th cycle of chemotherapy was uneventful, without any evidence of recurrence and metastasis. Careful follow-up is being observed.

Immunotherapy may be an effective treatment for neuroblastoma. It is of importance to delineate changes in various parameters of tumor immunity over an extended period, before and during the course of treatment, in any given case. In our patients with neuroblastoma, tumor-associated cell-mediated immune-reaction showed a good responsiveness before treatment. However, delayed cutaneous hypersensitivity reactions were shown to be negative in many cases, particularly in those with advanced tumor, and T gamma cells were enormously increased in some cases. During the course of therapy, the tumor-associated cellular immune responsiveness showed a tendency to become negative when the patient was tumor free or was in remission, but showed a tendency to become positive on regrowth, recurrence or metastasis of tumor. The T gamma cells showed much the same fluctuations as did the tumor-associated cellular immune responsiveness.

Lymphocyte-rich monomuclear cells (MC) were prepared from spleens removed at the time of surgery for gastric cancer and the suppressor cell activity on autochthonous peripheral blood lymphocyte (PBL) responses to PHA-P and Con A was assessed. Suppressor cell activity of MC on PBL responses to at least one mitogen, either PHA-P or Con A, was observied in 52 percent (11/21) of the gastric tissues studied. MC of patients with state IV disease appeared to exhibit the highest frequency of the presence of the activity. MC of patients with cancer with microscopically proven metastasis to group 2 lymph nodes or to more distant lymph nodes were preponderant in showing the activity. MC of patients with cancer occupying the greater curvature or the entire circumference of the stomach were also preponderant in the activity. The implications of these findings are discussed.