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This case involved an 82-year-old man with a history of diabetes mellitus and myocardial infarction. He was undergoing treatment with 2 oral antiplatelet agents. The patient presented to our hospital for carcinomatous pyloric stenosis caused by type 4 advanced gastric cancer. Although distal gastrectomy was planned, preoperative coronary angiography revealed triple- vessel coronary artery disease. Therefore, surgery was performed under management of intra-aortic balloon pumping (IABP)therapy. The patient's hemodynamics at the time of the operation were stable, and no perioperative cardiovascular complications occurred. However, the patient was not able to start an oral diet because of impaired swallowing function. Although he underwent daily swallowing rehabilitation, he died of aspiration pneumonia 40 days postoperatively. There are many reports of cancer resection under IABP management for patients with severe heart disease. Because the perioperative hemodynamics were stable in all 21 reported cases of digestive malignant tumor resections in Japan, an IABP is suggested to be very effective for patients with severe heart disease. However, early death has also occurred, as in the present case. Close attention to the indications for IABP therapy is needed, especially in elderly patients, in consideration of not only cancer and heart disease but also preoperative activities of daily living.

The treatment of bedsores is a particular problem in geriatric medicine. We selected standard drugs that may be effective for the decubitus ulcer, and investigated combination therapy to develop efficient treatment The subjects were 16 patients in whom the grade of the bedsore was evaluated as II to IV according to the Shea's depth classification. Treatment was performed while all patients were on air mats. We selected drugs and treatment methods based on the previously established experimental design of Taguchi. Based on this, we created and adapted 16 different component combination treatment programs in accordance with the L16 rectangular cross table. The following component factors were adopted: A: types of covering substances on the wound surface (Elase ointment, isodine sugar, isodine gel solcoseryl ointment); B: Isalopan powder; C: Spray of 10 ml physiological saline containing 500 microg of prostaglandin (concentration 0.005%); D: daily number of treatments; and F: presence or absence of tapping. We serially measured the wound surface area as an index of the speed of wound healing, and measured the interval (day) until the area decreased to one half of the original size (T1/2, half life). We analyzed data on one combination treatment each in 16 patients. Analysis of variance of the above factors showed significant F values for factors A, B, D and F. The contribution rates for factors A, B, D and F were 37.84%, 8.47%, 14.98% and 13.81%, respectively. The error term (e) was 16.37%. Optimal results were seen in the groups in which solcoseryl ointment had been applied twice a day. In this study, prostaglandin, which had been anticipated to be effective, did not show any effects. The error term (e) suggests the presence of other healing factors including individual differences. Concerning this point, it well be necessary to examine a larger number of patients in the future. With ointment treatment alone, without using an air mat, it was confirmed that bedsore area reduction was extremely unstable. Decompression of the affected part may be a basic prevention factor and essential treatment of bedsores.

The purpose of this study was to present the time-related imaging findings and correlative pathological findings of irradiated regions in the rabbit liver. RF ablation was carried out on 16 rabbit livers. Irradiated regions were imaged at 3 days, 4 weeks, and 12 weeks. At 3 days, the regions showed a two-zone structure on plain CT and peripheral enhancement on the arterial phase. The regions presented a three-zone structure on pathological study. At 4 weeks, peripheral enhancement had almost disappeared, and a two-zone structure obscured on plain CT. The CT findings reflected pathological changes after RF ablation.

We have performed bronchial artery embolization (BAE) in patients with hemoptysis using a superselective catheter system and a permanent-emboli coil. We performed an investigation because major complications were observed. Of a total of 57 BAE using this system, 7 cases of major complications as detachment of the large vessel were found. Although BAE using this system is effective because permanent emboli can be selectively in-dwelled in abnormally developing vessels, detachment of vessels were developed in 7 cases. They are found more frequently for embolization of the left bronchial artery and full attention should be paid to this phenomenon when performing this surgery.

The usefulness of in vivo skin test reaction to phytohemagglutinin to assess cell-mediated immunity was investigated in 109 subjects, including 37 normal controls, 35 patients without brain tumor and 37 patients with brain tumor. Intradermal injection at forearm of 10 microgram of Bacto-phytohemagglutinin-P (PHA-P) produced an erythema within 24 hours. Upon PHA skin reaction the mean diameter of erythema was 25.3 mm with the normal in the control and 18.6 mm with other diseases than brain tumor, while it was 13.0 mm with brain tumor. Furthermore when mean diameter of those with longer than 15.0 mm are classified as positive in the PHA skin test, the normal in the control revealed 89.2% positive and the patients with brain tumor indicated only 37.8% positive. A positive reaction was observed in 10 (77.0%) of 13 benign brain tumor and 5 (26.3%) of 19 malignant brain tumor. A correlation was found between in vivo and in vitro responses to PHA, and between PHA and PPD skin reaction. In repeated PHA skin test at intervals of about one month, the skin reaction to PHA of patients with brain tumor varied depending on the clinical states. Other advantages of this test are no presensitization and it can be used repeatedly. The PHA skin test is a useful and simple screening test for cellular immune function of patients with brain tumor and as a simple method applicable clinically indicating accurate immuno-reactivity the PHA skin tests have been carried out during the course of treatment with an interval of about one month repeatedly.

An infant with a large occipital hemangioendothelioma with thrombocytopenia, anemia, and hypofibrinogenemia--Kasabach-Merritt syndrome--was reported. The case, a male neonate is unique, for this is the first report with this syndrome in whom the large hemangioma was noted at birth on the midocciput simulating the occipital encephalomeningocele. With the development of thrombocytopenia of 84,000 per mm3, hypofibrinogenemia of 92 mg/dl, anemia (erythrocyte 193 X 10(4) per mm3, hemoglobin 5.9 g/dl, hematocrit 16 vol%), hepato-splenomegalia, enlargement and bluish discoloration of the tumor noted on the 21/2 months of life, total excision was intended prior to the expected occurence of the systemic purpura. The patient received fresh whole blood transfusion immediately prior to surgery, and the total excision was successfully performed. Excessive bleeding was not encountered. Abrupt rise in the platelet count, red blood cell count, hemoglobin and hematocrit to normal range was noted at the first postoperative day; he was discharged on the 17th day after surgery. Nineteen months' follow-up showed normal hematologic findings with good somatic and mental development. The specimen weighing 250 g. revealed benigh hemangioendothelioma. Silver impregnation demonstrated lobular aggregates of small vascular channels. Papillary projection of interstitial cells into the lumen, reaction of the endothelium of the vessels, newly formed thrombus, ishemic necrosis and hemorrhage, hyaline degeneration of interstitial tissue were noted. These findings suggested the disseminated intravascular coagulation within the tumor followed by fibrinolysis accounts for loss of blood corpuscles, platelet, fibrinogen and clotting factors, which leads ultimately to the consumption coagulopathy and diffuse bleeding.

Twenty-six undescended testes in 22 patients between 1 and 31 years old were evaluated with ultrasonographic examination between October, 1981 and December, 1985. All 22 patients were operated on, and the accuracy of the ultrasonic diagnosis was evaluated in comparison to that of palpation diagnosis. Fourteen of 26 testes could be palpated preoperatively and these were all identified ultrasonographically and surgically. Twelve testes could not be palpated. On these 12 testes, surgical exploration revealed 9 testes in the inguinal region and absence of 3 testes. Ultrasound examination predicted its presence in 5 of 9 testes and its absence in all 3 testes. Both sonography and palpation failed to identify their presence in 4 tests. Thus, sensitivity of ultrasound examination was 82.6%, specificity 100% and accuracy 84.6% retrospectively. We conclude that ultrasound examination is useful in diagnosis of impalpable undescended testes in inguinal region.