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Intraductal papillary mucinous carcinoma (IPMC) arising from the heterotopic pancreas is rare. A case of IPMC metastasis from the jejunal heterotopic pancreas was described. The heterotopic pancreas could be the source of the submucosal tumor-like lesion found in the small intestine with an elevated carbohydrate antigen (CA) 19-9 level. A 60-year-old woman was admitted to the hospital with pulmonary thromboembolism and anemia. The level of CA19-9, a tumor marker, was found to be 211.8U/ml. A tumor in the jejunum was discovered using contrast-enhanced computed tomography. There were also a number of hepatic tumors found. A submucosal tumor-like lesion in the jejunum was discovered during an enteroscopy, and a biopsy revealed it to be an adenocarcinoma. Partial resection of the jejunum was performed to control hemorrhage. Histopathology revealed an invasive IPMC arising from a heterotopic pancreas (Heinrich type II) and chemotherapy with gemcitabine and nab-paclitaxel was initiated. There have only been three cases of invasive IPMC from a heterotopic pancreas reported, and this is the first one to include chemotherapeutic treatment of distant metastasis.

We report a rare case of a patient with metastatic colorectal cancer who experienced hyperammonemic encephalopathy induced by 5 -fluorouracil(5-FU)and was continuously treated with capecitabine plus oxaliplatin(XELOX)therapy. A 60 years man with anorexia and weight loss was diagnosed with Stage IV rectal cancer, and chemotherapy with XELOX was initiated. When the second course of XELOX therapy was administered, the patient found it difficult to take oral capecitabine. Subsequently, modified FOLFOX6 was administered. Complications such as nausea and vomiting were observed on day 2, with confusion and cognitive disturbances on day 3 . Laboratory examination revealed hyperammonemia, and therefore, branched-chain amino acid solutions were administered as treatment. The patient's symptoms disappeared entirely on day 4. He is currently receiving XELOX therapy.

A 40's woman was seen at the emergency room because of severe back pain and vomiting. Abdominal CT scan revealed a tumor about 7cm in diameter located on the retroperitoneum. For 6 hours after admission, her body temperature was 39°C and respiratory failure occurred. After 30 hours, the patient died because of a complication in circulatory failure. From the abnormally high level of catecholamines in the blood and autopsy results, we determined that pheochromocytoma multisystem crisis had been caused by the retroperitoneal paraganglioma.

We report here two cases of advanced colorectal cancer which received chemotherapy, in which partial splenic embolization (PSE) had been effective for controlling splenomegaly and thrombocytopenia. Case 1: A 50-year-old man presented with bloody urine and bloody stool. Computed tomography (CT) showed rectosigmoid cancer with urinary bladder invasion. He underwent colostomy and received chemotherapy. After 3 courses of FOLFOX and 6 courses of bevacizumab/FOLFOX, he suffered from thrombocytopenia with splenomegaly, which led to discontinuation of the therapy. PSE improved thrombocyte counts and enabled him to resume therapy. Case 2: A 72-year-old man presented with bloody stool. Endoscopy and CT showed an advanced rectosigmoid cancer with multiple liver metastases. He underwent low anterior resection and received chemotherapy with FOLFOX and FOLFIRI, together with bevacizumab. After 13 courses of chemotherapy, he also suffered from splenomegaly and thrombocytopenia. PSE produced an increase in thrombocyte count and allowed for a restart of chemotherapy. Oxaliplatin-based chemotherapy may possibly produce hepatic sinusoidal dilation and induce splenomegaly owing to portal hypertension. PSE seemed to be useful for treating thrombocytopenia with splenomagaly, and allowed continuation of the chemotherapy.

A 79-year-old man was admitted on the suspicion of acute pancreatitis. Computed tomography showed acute fluid collection but not typical acute pancreatitis; it formed pseudocysts gradually around the pancreas. Endoscopic retrograde pancreatography (ERP) revealed pancreatic disruption and leakage. Endoscopic nasopancreatic drainage (ENPD) and endoscopic pancreatic stenting (EPS) resulted in collapse of pseudocysts, improvement of symptoms and laboratory data, and a mass in the pancreatic body became distinct. The specimens obtained with endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) showed pancreatic cancer. In conclusion, ENPD and EPS are effective for pancreatic leakage with disruption of the pancreatic duct, and we should take into consideration the possibility of pancreatic cancer when we see patients with pancreatic disruption.

We report a rare case of metastatic colorectal cancer who suffered from hyperammonemic encephalopathy induced by 5- FU and was continuously treated with FOLFOX therapy. A 50-year-old man with ileus was diagnosed with ascending colon cancer Stage IV, and a right hemicolectomy was performed. Postoperative chemotherapy with modified FOLFOX6 was performed. Complications of nausea and vomiting were seen on day 2 , with confusion and cognitive disturbances on day 3 . None of the other radiographic examinations provided an explanation for his symptoms. Laboratory examination revealed hyperammonemia, so branched-chain amino acid solutions and high-volume drip infusion were started for its treatment. His symptoms entirely disappeared on day 4. We changed to chemotherapy for FOLFOX4 using branched-chain amino acid solutions and drip infusion. The tumor marker level normalized following two courses, and CT following ten courses showed that the size of the lung metastasis and abdominal lymph node had reduced significantly. The patient is currently receiving FOLFOX4.

A 65-year-old man was admitted to our hospital because of obstructive jaundice caused by a mass extending in the porta hepatis, neck of gall bladder and extrahepatic bile duct. The specimens obtained with ultrasound-guided needle biopsy showed malignant lymphoma (diffuse large B-cell lymphoma: DLBCL). CHOP with Rituximab therapy (R-CHOP therapy) was performed. The treatment resulted in remarkable reduction of the tumor size and improvement of the biliary stenosis. We should take into consideration malignant lymphoma when we see a patient with a tumor of the hepato-biliary system.

A 25-year-old man undergoing splenectomy at 3 years of age to treat idiopathic thrombocytopenic purpura but no history of Streptococcus pneumonia vaccination, and reporting high fever, nausea, and headache developed purpura, confusion, and hypotension the next day and was admitted. Detailed examination showed disseminated intravascular coagulation and multiple-organ dysfunction. Chest X-ray and computed tomography (CT) showed pneumonia and pleural effusion. Blood culture was positive for S. pneumoniae. Gram staining of sputa yielded numerous white blood cells and gram-negative rods, and sputa culture was positive for Pasteurella multocida and Haemophilus influenzae. The medical history and presence of these organisms yielded a diagnosis of overwhelming postsplenectomy infection (OPSI), and the patient responded to treatment with a combination of benzylpenicillin, cefotaxime, and meropenem. This case suggests that patients with a history of splenectomy may benefit from vaccination for S. pneumoniae and adequate education on OPSI.

A 74-year-old woman with hepatitis due to hepatitis C virus followed up using oral predonisolone (3 mg/day) for two years because of hypergammaglobulinemia-associated purpura reported fever and lumbago in February 2005. Upon admission in June, she was found in chest-computed tomography to have atelectasia in the right middle lung lobe and a nodule with a cavity in the right lower lobe. She tested positive for tuberculous glycolipid antibody. Gallium scintigraphy showed an abnormal accumulation in the lower lumbar vertebra. Magnetic resonance imaging showed abnormal enhancement at L4, L5, and their intervertebral disc. Mycobacterium intracellulare (M. intracellulare) was detected in blood culture, bronchoalveolar lavage, and a biopsy specimen from the intervertebral disc, yielding a diagnosis of disseminated nontuberculous mycobacteriosis (NTM) due to M. intracellulare. She was treated with clarithromycin (CAM), ethambutol (EB), and rifampicin (RFP), but EB and RFP were discontinued due to of the fever they induced. She was then treated with a combination of CAM, levofloxacin, and streptomycin and followed up as an out patient. Based on case reports of disseminated NTM infection in Japan, the prognosis is poor and a protocol must be established for its treatment.

A small lesion showing ground-glass opacity (GGO) by preoperative computed tomography (CT) is sometimes difficult to detect after lobectomy when it locates in the central part of the lobe. In order to facilitate to identify the lesion for marking pathological specimen, we developed a new method using CT. After surgery, the resected pulmonary lobe was expanded with airflow through the bronchial stump and the target lesion was examined with CT. The laser beam of the CT on the surface of the lung is used as a guiding line for cutting. Through the application of this method for 2 clinical cases, it was found to be possible to exactly identify the GGO lesion from the surface of the resected lung enabling to visualize a fresh surface of the lesion like a CT image with minimal destruction of the structure.

Chemotherapy combining 5-fluorouracil (5-FU) with leucovorin is now used as a standard regimen for chemotherapy of inoperative, recurrent or distantly-metastasized colorectal carcinoma. We recently treated a patient with multiple metastases of sigmoid colon cancer by sigmoidectomy and oral drug therapy using a combination of Uzel (dl-leucovorin) and UFT (uracil and tegafur). Three courses of this therapy were administered, with each course consisting of treatment for 4 consecutive week (UFT 400 mg/day, Uzel 75 mg/day) and a one week interval between successive courses. The therapy resulted in marked reduction of tumor and this response was rated as PR (partial response). The lower lobe of the right lung, which showed the largest tumor (34.5 x 35.7 mm), was resected, and the upper lobe of the same lung, showing a small metastastic tumor (4.4 x 4.6 mm), was partially resected. Oral chemotherapy, which had begun before surgery, was continued after lobectomy and partial pneumonectomy. To date (January 15, 2005), the patient has received 5 courses of this therapy and has shown no signs of tumor exacerbation. Because this therapy has allowed satisfactory control of metastatic tumor for about one year since surgery without causing any adverse reaction or requiring re-hospitalization, it is fair to say that the therapy has successfully maintained the quality of life (QOL) of this patient.

Predictivity of mediastinal lymph nodes metastasis of 201Tl SPECT were examined before operation in 113 patients with non-small cell lung cancer (69 adenocarcinoma, 31 squamous cell carcinoma, 10 large cell carcinoma, 2 bronchiolo-alveolar carcinoma, 1 neuroendocrine cell carcinoma). Patients were classified into two groups, with or without lymph nodes metastasis according to the pathological diagnosis. We calculated parameters of 201Tl SPECT early ratio, delayed ratio, retention index (RI) and maximal diameters. In addition, we calculated optimal cut-off value of RI to estimate the mediastinal lymph nodes metastasis. Mediastinal lymph nodes metastasis was confirmed pathologically in 62 patients. ER and DR did not show any statistical significance between two groups. Maximal diameters of primary tumor were also comparable between two groups. RI was significantly higher in mediastinal lymph node metastasis positive group compared to that in mediastinal lymph node metastasis negative group. The sensitivity (Sen), specificity (Spe), positive predictive value (PPV), negative predictive value (NPV) and accuracy (Acc) of 201Tl SPECT were 82.2%, 82.3%, 85.0%, 79.2% and 82.3%. These parameters were similar of higher than 72.6%, 82.4%, 83.3%, 71.2% and 77.0% of chest CT. The RI of 201Tl SPECT was useful tool for predicting lymph nodes metastasis in non-small cell lung cancer. The optimum cut-off value of RI in the prediction of mediastinal lymph nodes metastasis was 35%. We should take into account of upstaging in cases with higher RI (>35%).

The use of percutaneous endoscopic gastrostomy (PEG) has widely spread in recent years, even in Japan. In our hospital, we have performed this procedure in over 20 patients per year recently. In this study, we investigated the usefulness of PEG in home health care from the view point of cost effectiveness. We found that medical expenses decreased remarkably when patients underwent PEG because they could switch from hospital care to home health care, shortening there by the period of hospital care. The role of PEG in home health care will be more important also from cost effectiveness.

The use of percutaneous endoscopic gastrostomy (PEG) has widely spread in recent years, even in Japan. In our hospital, we have performed this procedure in over 20 patients per year recently. In this study, we investigated the usefulness of PEG in home health care from the view point of cost effectiveness. We found that medical expenses decreased remarkably when patients underwent PEG because they could switch from hospital care to home health care, shortening there by the period of hospital care. The role of PEG in home health care will be more important also from cost effectiveness.

Objectives: The severe inflammatory reaction caused by acute myocardial infarction and reperfusion affects both the heart and other remote organs. The occurrence of retinopathy was evaluated in patients with acute myocardial infarction who underwent reperfusion therapy., Methods: We investigated 29 patients with first acute myocardial infarction who underwent successful reperfusion therapy within 24 hr of the onset. Ophthalmic examinations including visual acuity test and ocular fundoscopy were performed within 3 days, 2 weeks, and then monthly up to 3 months after the onset of acute myocardial infarction. Plasma levels of intercellular adhesion molecule-1(ICAM-1), interleukin-6 and high sensitivity C-reactive protein were measured on admission., Results: Soft exudates around the optic disc appeared in 17(58.6%) of the 29 patients, among whom 5 also developed superficial hemorrhages(17.2%). The retinopathy became most remarkable between 1 to 2 months after the onset of acute myocardial infarction and then faded away without any specific treatment. None of the patients had impairment of visual acuity, although 4 of the 17 patients with retinopathy complained of either blurred vision or metamorphopsia. Hypertension and/or diabetes mellitus tended to be more common in the retinopathy group than in the non-retinopathy group(59% vs 33%, p = 0.096). Plasma ICAM-1 levels were significantly higher than in the non-retinopathy group than in the retinopathy group(p = 0.017). There was no significant difference in plasma levels of interleukin-6 and high sensitivity C-reactive protein between the two groups., Conclusions: Retinopathy may occur after reperfusion for acute myocardial infarction. The dominant manifestation is transient soft exudates reflecting spotty retinal ischemia, probably due to microvascular obstruction.

Mycoplasma pneumoniae (M. pneumoniae) pneumonia is a common disease which usually shows a good prognosis, however, it can develop a very serious state such as respiratory distress syndrome. We experienced 2 cases with M. pneumoniae pneumonia from identical twin sisters. Case 1, who was 22 years-old and was the senior sister of the twin, complained of fever and cough on August 1st, 1999. Her chest radiograph revealed consolidation in the right lung. When she was admitted to our hospital on August 11, she revealed severe hypoxemia and the titer to M. pneumoniae was markedly elevated. She was diagnosed as M. pneumoniae pneumonia with acute respiratory distress syndrome and treated with clarithromycin and methylprednisolone. Although it was necessary for her to be in the intensive care unit for 8 days, her condition gradually improved and was discharged on the 30th of September. Case 2, who was the younger sister of Case 1, complained cough and fever on August 21, 1999. Her chest radiograph showed consolidation in the left lung. She was treated by sparfloxacin because the intrafamilial infection of M. pneumoniae was most likely. The diagnosis was confirmed by the increased antibody-titer to M. pneumoniae later. There have been several reports that hyperimmune reaction may be related with the worse course of M. pneumoniae pnuemonia. However, the clinical courses of twin sisters, who should be very similar in their immune response to the same antigen, were very different from each other. The time of administration of effective antibiotics seemed to be a crucial factor to determine their courses. These results emphasized the importance of early diagnosis of the patients with M. pneumoniae pneumonia and the adequate chemotherapy to prevent developing severe respiratory failure.

The patient was a 68-year-old woman. She was referred to our hospital because of advanced gastric cancer. Endoscopic examination showed that the tumor was located in the Subcardia, with its oral margin invading the esophagus. Histologic examination of biopsy specimen led to a diagnosis of moderately to poorly differentiated adenocarcinoma. Apparent lymph node swellings (No. 7, No. 11) on enhanced CT examination indicated the metastasis of the gastric cancer. Consulting with her family, we decided to treat the cancer with chemotherapy using the peroral carcinostatic "UFT", and started it on November 18, 1997. Follow-up endoscopic examination confirmed that the tumor was reduced in size immediately after starting chemotherapy, and then finally disappeared on December 10, 1999. Since then, there has been no recurrence of the tumor. This is a rare case of gastric cancer showing complete response to chemotherapy using a peroral carcinosatatic alone.

A 49-year-old woman was admitted to our hospital because of frequent postprandial esophageal angina. After successful pyloric plasty, chest oppression lasting 5 to 15 min developed postprandially as well as symptoms of dumping syndrome. Electrocardiography showed ST-segment elevation in the II, III, aVf and precordial leads (V2 to V6). Finally, giant positive T waves and U waves were uniquely noted in the V1 to V5 leads. Intracoronary administration of acetylcholine (20 micrograms) provoked severe diffuse spasm in both right and left coronary arteries, chest pain and ST elevation. The conventional treatment for vasospastic angina, such as Ca2+ antagonists, nitrates and K channel opener, achieved no response. However, the combination with serotonergic receptor blockade reduced anginal attack. These findings suggest that the spastic angina in this case was partly caused by serotonin.

A 29-year-old woman experienced Raynaud's phenomenon, swelling of her fingers, eruptions on her face, and muscle weakness in 1990. She was diagnosed as having mixed connective tissue disease (MCTD) and was treated with prednisolone (PSL) for 3 years. Most of her complaints disappeared after the treatment. In March 1997, she experienced fever, erythema, and lymphadenopathy. Although she was treated with PSL (20 mg/day) again, muscle weakness, mental disturbance, and recto-urinary disturbance appeared. When she was re-admitted to our hospital, increased levels of muscle-derived enzymes and positivity of anti-RNP antibody were found. High signal areas in her cerebrum were shown by magnetic resonance imaging, and slow and spike pattern was shown by electroencephalography. Hypoperfusion of the cerebral blood flow was suggested on single photon emission computed tomography. The number of mononuclear cells, amount of protein and level of interleukin-6 were found to be elevated in her cerebrospinal fluid (CSF). Her neurological manifestations were diagnosed as being due to MCTD, and showed characteristics similar to those of systemic lupus erythematosus. She was treated with PSL (60 mg/day) followed by steroid pulse therapy. Because the response to this treatment was partial, oral administration of cyclophosphamide (CPM) (100 mg/day) was added. Muscle weakness and neurological abnormalities as well as abnormal laboratory findings gradually improved over the following two months. We conclude that the treatment with CPM combined with PSL may be useful, when neurological manifestations of MCTD are serious and resistant to conventional therapy.

Glucose or other reducing sugars in plasma or tissue fluids react with proteins by a nonenzymatic, post-translational process called glycation or Maillard reaction which leads to the formation of advanced glycation end products (AGEs). AGEs are implicated in the multiorgan complications of diabetes because of their multipotent bioactivities through their receptors as well as the functional and structural derangement of the AGE-bearing proteins. AGE inhibitors such as aminoguanidine have been shown to have beneficial effects on the progression of a full range of diabetic complications in animal models. Furthermore, a recent clinical study showed that aminoguanidine therapy resulted in significant improvements in several key measurements; it reduced urinary protein, LDL-cholesterol and triglycerides as well as blood pressure. A novel class of AGE-antagonists, AGE breakers have been also developed and waiting for the clinical evaluation.

Ocular neovascularization contributes to severe visual loss of the patients with diabetic retinopathy (DR) which is the leading cause of blindness on adults of working age. The mechanisms of ocular neovascularization are not fully understood. Several growth factors, particularly vascular endothelial growth factor (VEGF), vasoactive peptides such as angiotensin II and adhesion molecules such as integrins are considered to contribute to the ocular neovascularization. VEGF is believed to play the key role in the development of DR. Ischemic hypoxia of retina is well known to be the potent stimulus for the production of VEGF. In addition, we have reported that reactive oxygen intermediates, advanced glycation end products and insulin-like growth factor-1, also all, may participate in the pathogenesis of DR through their ability to increase VEGF production. The trials for anti-angiogenic drugs is developing now for the treatment of DR. VEGF may be the most suitable target for the inhibition of the ocular neovascularization.

We report on two patients with sulbactam/ampicillin (SBT/ABPC)-induced pneumonitis. Both patients were being treated with SBT/ABPC for respiratory-tract infections. Following the initiation of SBT/ABPC chemotherapy, however, chest X-ray films showed a shift of shadow in patient 1 and new pulmonary infiltration shadows in patient 2. Bronchoalveolar lavage fluid (BALF) findings showed a marked increase in the total cell count and percentage of eosinophils in patient 1 and of lymphocytes in patient 2. The results of lymphocyte stimulation tests were SBT/ABPC positive for both patients. SBT/ABPC therapy was therefore discontinued and corticosteroid therapy started. Both patients were subsequently relieved of their symptoms demonstrated significantly lower and pulmonary infiltrate levels. Based on these findings, both patients were given a diagnosis of SBT/ABPC-induced pneumonitis. It has been widely reported that CD 4/CD 8 ratio in BALF decreases in cases of drug-induced pneumonitis. However, some reports have cited increase in the CD 4/CD 8 ratio. In our two patients as well, the CD 4/CD 8 ratio increased. These results, together with the findings from several other case reports, indicate that the CD 4/CD 8 ratio may not be good basis for diagnosing drug-induced pneumonitis. Recently, the incidence of drug-induced pneumonitis has been rising. To our knowledge this is the first report documenting cases of SBT/ABPC-induced pneumonitis.

Cunninghamella bertholletiae, a rare causative agent of human deep seated mycosis, has been reported with increased frequency in the Western countries, in recent years. We experienced a case of Cunninghamella bertholletiae pulmonary infection in a 63-year-old male with pulmonary fibrosis and mild diabetes mellitus. In spite of intensive anti-fungal chemotherapy following clinical diagnosis, he died of exacerbation of the underlying diseases. Postmortem examination showed Cunninghamella infection in the cavity of the lung and massive pulmonary fibrosis. There was no fungal invasion outside the cavity. This is the third report of Cunninghamella human infection in Japan.

The Klippel-Feil syndrome is one of the spinal malformations characterized by fusion of the cervical vertebrae. It is well known that the malformation can cause some neurologic disorders. However, an aneurysm in the vertebral artery associated with the Klippel-Feil syndrome is extremely rare, with only one case having been reported in the literature. We present a 39-year-old female with a sudden onset of disturbed consciousness. Lateral cervical x-ray films showed the Klippel-Feil syndrome and hypermobility between C1 and C2. MRI showed multiple infarctions in the posterior circulation, including bilateral thalami. Right vertebral angiogram identified the extracranial vertebral artery aneurysm as the source of the emboli. The patient gradually recovered with conservative therapy. The aneurysm was thought to be produced by chronic arterial trauma secondary to excessive movement between C1 and C2. We conclude that an extracranial vertebral artery aneurysm is a serious complication in a patient with the Klippel-Feil syndrome.

To determine the association of a hypoxia-induced, vascular endothelial cell selective growth factor: vascular endothelial growth factor (VEGF) on proliferative diabetic retinopathy (PDR), undiluted vitreous fluids were collected from 10 eyes with PDR at the time of vitrectomy. Vitreous fluids from 10 eyes without PDR were used as control. All samples were electrophoresed with a 14% sodium dodesyl sulfatepolyacrylamide gel, and electrically transferred to a Durapore membrane. Immunoblot detection of VEGF was done by standard western blotting using rabbit polyclonal anti-human VEGF antibody. Positive immunoreaction bands were observed on lanes of 7 samples from PDR, and they were comigrated with recombinant human VEGF. No reactions were observed on lanes of all samples without PDR. The presence of VEGF within the vitreous fluids of eyes with PDR was determined, and suggesting the association of VEGF with PDR.

To reduce the high immunogenicity of mouse monoclonal antibodies (MAbs) in man, mouse/human chimeric antibodies have been generated in two ways. The more simple method is to construct chimeric antibodies in which the variable regions from the mouse MAbs are linked to human constant regions. The second is to graft the complementarity determining regions from the variable regions of mouse MAbs into human variable regions. So far, more than a hundred of chimeric antibodies have been reported and about twenty-five have been tried for immunotherapy of various human diseases. In the near future, many mouse/human chimeric antibodies will be commercially available.

The levels of 23 protein components of the sera of 84 patients with uterine cervical cancer undergoing radiotherapy were determined by a single radial immunodiffusion method, before radiation therapy, after whole pelvic irradiation, and after intracavitary irradiation using a remote after roading system (RALS). We examined the correlations between changes in serum protein fractions and the prognosis of the patients. The patients with uterine cervical cancer were treated with combined external irradiation of 60Co gamma-rays or 10 MV X-rays, and RALS therapy. The levels of the same protein components were also measured in 21 normal adult women as a control. All patients were observed between 4 years and 8 years after radiation therapy. In the pretreatment sera obtained from patients with uterine cervical cancer, the concentrations of prealbumin (Prealb), alpha 2HS glycoprotein (alpha 2 HS), alpha 2-plasmin inhibitor (alpha 2PI), transferrin (Tf), plasminogen (Pmg), albumin (Alb), IgM and hemopexin (Hx) were significantly lower than those normal controls. However the serum concentrations of: alpha 1-antichymotrypsin (alpha 1 X), haptoglobin (Hp), C9, fibrinogen (Fib), ceruloplasmin (Cp), alpha 1-acid glycoprotein (alpha 1AG), alpha 1-antitrypsin (alpha 1AT) and C4 were elevated. At the completion of whole pelvic irradiation and RALS therapy, the Hp, C4, and Fib levels were significantly lower than those before radiation therapy, whereas Prealb, alpha 2HS and alpha 2PI were elevated. In patients who had lived between 4 years and 8 years after radiation therapy, the Cp, alpha 1 AG, Hp and C9 levels measured before radiation therapy were reduced significantly, while Tf was elevated compared with patients who died within 4 years. In those who had lived more than 4 years, the alpha 1 AT, Hp, alpha 1X, Cp and C9 levels measured after whole pelvic irradiation were reduced significantly; while the C4 level was elevated. In cases of uterine cervical cancer followed for a period of 4 to 8 years after radiation therapy, multiple regression analysis was used to determine whether increased concentrations of serum protein fractions were associated with good prognosis for the original disease. Tf, Pmg, and alpha 1AT before radiation therapy were positively correlated with survival, whereas AT III, Cp, C1Inh, IgA, alpha 1 AG and C9 showed negative correlations. After whole pelvic irradiation,Pmg, C4 Prealb, Alb,alpha 2M and Hp were found to be positively associated with survival, whereas Tf, alpha 2PI, AT III, alpha 1 AT,C1Inh, C9 and IgA were negative factors.

It is usually impossible to perform a complete systemic mediastinal lymph node dissection in left-side pulmonary carcinomas because the aortic arch gets in the way. The purpose of this study was to determine if incomplete lymph node dissection influences late mortality. We retrospectively analyzed 222 patients who had complete resection of non-small-cell lung cancer, 141 on the right lung and 81 on the left lung. There were 155 men and 67 women. They ranged in age from 35 to 78 years. 146 patients were in Stage I, 41, in the Stage II and 35, in the Stage III A, except for T3 diseases. The 5-year survival rates of left lung cancer were 82% and 35% in the Stage I group and the Stage II group, respectively. There was no difference when compared with the corresponding groups with right lung cancers. The 3-year survival, however, was 0% in the Stage III A group with left lung cancer excluding T3 diseases; this was significantly lower than that of right lung cancer (p < 0.01). The results recommend extended mediastinal lymph node dissection on the left-side squamous cell carcinoma to improve the survival of patients with left-side N2 diseases, when the tracheobronchial lymph nodes are involved.

In lesions of atherosclerosis, various cytokines and growth factors, which are generally not expressed in the normal artery, are upregulated. Several of them including PDGF, bFGF, HB-EGF, IGF-1, IL-1 and TGF-beta and TNF play key roles in atherogenesis by stimulating chemotaxis and proliferation of vascular smooth muscle cells and production of extracellular matrix substances such as proteoglycans, collagen and elastic fibers by those cells. Endothelial cells and macrophages are also the targets as well as the sources of those cytokines and growth factors. The production of those cytokines or growth factors are regulated by molecules of each other or by themselves forming a complex cytokine network. Understanding and control of the roles of those cytokines in vascular walls will provide an insight on the mechanism of atherogenesis and contribute to the development of better ways to its prevention.

Involvement of the central nervous system associated with SLE (CNS lupus) is not rare. Two types of CNS lupus are noted clinically; one group manifesting focal neurological symptoms and another group showing mental symptoms. Though it is well known that neurological symptoms are caused by arteritis and thrombus, pathophysiological mechanisms leading to mental symptoms remain obscure and there is no established clinical evidence responsible for these symptoms. A 41-year-old woman was confused and her attention was markedly impaired. Her mental symptoms consisted of disorientation, restlessness, euphoria and emotional incontinence. There were neither focal neurological signs nor meningeal signs. Cerebrospinal fluid (CSF) examination showed increased number of polymorphonuclear cells and permeability of the blood-brain barrier, calculated based on the CSF/plasma protein ratio, was also elevated. Repeated bacteriological examinations revealed to be negative. Gd-DTPA MRI demonstrated diffuse enhancement of the cerebral leptomeninges. Methylprednisolone pulse therapy ameliorated her mental deterioration effectively, and subsequently the leptomeningeal enhancement with Gd-DTPA MRI disappeared in parallel. These radiological and laboratory findings suggest that SLE itself causes inflammation of vessels in the leptomeninges and adjacent cerebral cortex. We consider mental symptoms associated with SLE may be caused, at least in part, by this mechanism. To our knowledge, we could not find similar reports in the literature. Gd-DTPA enhanced MRI seems to be of clinical use for making diagnosis, evaluating clinical activity and understanding of CNS lupus.

Forty-eight patients were evaluated. These cases were classified to stage I in 17, stage II in 11, stage III in 13, and stage IV in 7 by Masaoka staging. In 43, a complete resection was performed and in 5, an incomplete resection was carried out. Twelve patients between stage III and IV received postoperative radiotherapy because of incomplete resection and advanced invasive case (defined as high-risk group). Survival at 10 years was 55% for patients who were in high-risk group. This result was disappointed because survival was low in spite of surgical resection combined with postoperative radiation. From that reason, more concentrated therapy might be necessary with not only enlargement of radiation field but also chemotherapy for vascular invasive thymoma in addition to resection.

Cerebrospinal fluid (CSF) leakage is a rare complication of prolactinoma treated with bromocriptine (BC). BC is known to be effective for reducing the volume of a prolactinoma and for decreasing the serum level of prolactin (PRL). In cases of pituitary tumors, CSF leakage is thought to be caused by shunting between the subarachnoid and extradural spaces. We had a case presenting with CSF rhinorrhea and CSF otorrhea during BC therapy which was treated successfully. The mechanism and treatment of CSF leakage were studied. A 55-year-old woman complaining of nasal obstruction and headache was admitted to our hospital on Nov. 22, 1988. CT scan showed a huge intracranial mass lesion involving the sella and the supra-sellar region and invading the sphenoid sinus and ethmoid sinus. Serum PRL level was 18,000 ng/ml. The patient was diagnosed as having an invasive prolactinoma, and BC therapy (5.0 mg per day) was instituted. Three days later, CSF rhinorrhea developed, and BC treatment discontinued; radiation therapy was started. After 36 Gy irradiation the size of the tumor was same on CT, and serum level of PRL was still high. The patient underwent trans-sphenoidal operation. The tumor was removed partially and the presumed CSF fistula was repaired. The sella and sphenoid sinus were packed with fat. BC treatment was reinstituted, and the serum PRL level decreased gradually without recurrent CSF rhinorrhea. Two weeks later the patient returned complaining of bilateral hearing disturbance. With a diagnosis of exudative otitis media she underwent bilateral tympanostomy. Immediately after tympanostomy, pulsating discharge from the middle ear was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary artery bypass grafting was performed in two patients with left ventricular dysfunction (EF 16%). In both cases they had chest pain at rest and ischemic myocardium were detected by the SPECT. We considered them candidate for the operation regardless of LV dysfunction. They were eventful in the postoperative course. One case was discharged and is free from chest pain now, but another unfortunately died for multiple organ failure.

Using an equipment with sensitive vibretor-controller oscillater of elactrostatic drive system, we sought for the difference between elastic modulus of various kinds of dental porcelain and elastic modulus by firing method. We examined the relation between temperature of firing and elastic modulus as well. The obtained results are as follows: 1). Elastic modulus of low fusing porcelain of enamel color was 4.32 times 10(11) dyn/cm2 by air firing 3.95 approximately 4.63 times 10(11) dyn/cm2 by vacuum firing. Low fusing of porcelain of dentin color and the one of enamel color had the same elastic modulus. 2). Elastic modulas of high fusing porcelain of enamel color was 3.58 times 10(11) dyn/cm2 by air firing, 3.41 approximately 3.64 times 10(11) dyn/cm2 by vacuum firing. High fusing porcelain of dentin color and the one of enamel color were of the same elastic modulus. 3). Porcelain of opaque color for metal bond was 3.22 times 10(11) dyn/cm2 by air firing 3.97 approximately 4.22 times 10(11) dyn/cm2 by vacuum firing. When dentin color was added to opaque color elastic modulus was low (3.90 times 10(11) dyn/cm2). 4). Alumina porcelain of opaque color was 5.42 times 10(11) dyn/cm2 by air firing, 6.50 approximately 6.80 times 10(11) dyn/cm2 by vacuum firing. When dentin color was added to opaque color elastic modulus was very low (3.90 times 10(11) dyn/cm2). 5). Elastic modulus to various kinds porcelain changes according to temprature of fusing. And the highest elastic modulus is at the temperature which is 50 approximately 100 degrees C lower than final firing temperature.