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The use of TV white spaces as an alternative to overcome spectrum scarcity is a huge opportunity for new telecommunication systems and services. While being attractive for its desirable propagation characteristics, this part of the spectrum imposes a major difficulty from design and regulatory perspectives: how to optimize the use of spectrum and to ensure the protection of primary users, TV systems for example, at the same time. This paper discusses strategies to be adopted by geo-location database operators to calculate adaptive maximum permitted power levels for secondary devices, according to permissible levels of interference into the digital terrestrial television primary system.

Hepatitis E virus (HEV) has been considered to be the major cause of enterically transmitted non-A, non-B hepatitis in developing countries. However, little is known about viral replication and localization in the liver. The aim of this study was to examine the distribution of HEV-infected cells in experimentally infected animals. Seven captured wild rhesus monkeys were inoculated intravenously with faecal extract derived from a Myanmar strain of HEV. Animals were killed at different time-points of clinical illness: during early infection, during prehepatitis with viral-like particles in bile, during acute hepatitis and during convalescence. Intrahepatic localization of HEV was analysed using non-isotopic thymine dimer in situ hybridization (NITDISH). Both plus and minus strands of HEV RNA were found in hepatocytes during the early infection period. Staining in the submembranous cytoplasmic region of hepatocytes was observed. In the prehepatitis period, both plus and minus strand HEV RNAs appeared in the canalicular side of isolated bile epithelial cells. Subsequently, HEV RNA became universally distributed in the cytoplasm of medium-size bile epithelial cells. After recovery, HEV RNA disappeared.

The International Thermonuclear Experimental Reactor (ITER) magnet systems provide the magnetic field intensity and field geometry to contain and control plasma during the various phases of pulsed operation. During these pulses, the toroidal field (TF) coils operate with a constant current. The central solenoid (CS) and poloidal field (PF) coils, on the other hand, are each independently powered. The maximum terminal voltages during plasma operation and protective discharges are 15 kV for CS and 10 kV for TF and PF. The energy stored in the 20 TF coil system is 103 GJ; in each of the other coils it is approximately 10 GJ or less. This paper describes the protection requirements and selected design concepts being considered for the large superconducting coils for the ITER. Ground faults, short circuits and helium leaks are the major serious accidents to be prevented in the coils. All coils use a solid insulation system to avoid ground faults. The electrical circuits including coil and power supply are grounded through resistors that limit current in the event of a ground fault. In the case of a short circuit within the coil winding, a large energy would be dissipated close to the small shorted volume. The impact of the short circuit can be reduced by using a potential screen. Inside the cryostat, helium leakage is most likely at the electrical insulating breaks in the cryogenic cooling lines between the coils and helium manifolds. A double containment (metallic shield and glass-epoxy) is therefore provided for the insulation breaks to allow for the detection of small leaks and to limit the spread of helium to other locations.

PURPOSE: To determine the importance of a temporal line (the marginal line for the attachment of the temporal muscle to the skull) that is accentuated on frontal skull radiographs of hyperparathyroid patients owing to subligamentous bone resorption under the temporal muscle. MATERIALS AND METHODS: Radiographs from skeletal surveys of 134 surgically treated patients with primary (n = 102) or secondary (n = 32) hyperparathyroidism (HPT) and frontal skull radiographs of 63 age-matched control patients were reviewed. RESULTS: An accentuated temporal line was the most frequent finding (29.4% of cases) in primary HPT, followed by subperiosteal bone resorption in the hand (8.6%), salt-and-pepper appearance of the skull (3.5%), and rugger-jersey spine (1.1%). In secondary HPT, an accentuated temporal line became less obvious as subperiosteal bone resorption advanced. This finding was not seen in the control group. CONCLUSION: An accentuated temporal line is another radiographic indication of bone resorption in HPT.

ZnSe-ZnTe superlattices were grown on GaAs (100) surfaces by molecular beam epitaxy without buffer layer. The thicknesses of ZnSe and ZnTe layers were varied from 5/4 to 9/4 monolayer (ML) and from 1/9 to 1 ML, respectively. The photoluminescence (PL) spectra due to isoelectronic traps of Te atoms and clusters are independent to the thickness of ZnSe layers. We can tune the photon energy of PL emission from about 2.65 to 2.35 eV under the thickness of ZnSe layers of 2 monolayers constant. The green emission was achieved at room temperature by the superstructure with blue band layers sandwiched by ZnTe of 1 ML.

In order to have the White Spaces of the UHF broadcast band (470–790 MHz) in use by unlicensed users, new implementation challenges and special efforts still need to be done. Regulators can significantly impact the feasibility of implementation through requirements on sensing thresholds or by defining emission limits of unlicensed users. This paper addresses the emission limits of unlicensed users according to ECC approach, where the maximum output power is calculated for each location and for each device type/class. The problem of coexistence between white space devices and DTT broadcast service for the operation modes considered in CEPT is discussed and evaluated through simulations. With the obtained results, we discuss the relevancy of parameters stored in the geo-location database.

Effects of a ZnSe buffer layer on the optical properties in ZnTe on GaAs grown by molecular beam epitaxy (MBE) are investigated by photoluminescence (PL) and Raman scattering. From PL results an improvement of crystallinity of ZnTe films is recognized as the thickness of the ZnSe buffer layer increases. This is explained well by an exponential increase of the ratio of neutral acceptor-exciton complex to deep level emission with increasing ZnSe buffer layer thickness. Raman scattering results show an elongation of the ZnSe lattice by expansion due to accomodation of the ZnTe lattice. The large critical thickness of ZnTe/ZnSe is estimated experimentally to be about 30 nm in MBE growth on GaAs because of similar electronegativity in growth of ZnTe on ZnSe. The result obtained from the temperature dependence of LO phonon frequencies supports also an expansion of the ZnSe lattice obtained by Raman scattering.

The effects of a ZnSe buffer layer on the optical properties of ZnTe on GaAs grown by molecular beam epitaxy (MBE) have been investigated by photoluminescence (PL) and Raman scattering (RS). An improvement of crystallinity of ZnTe films is recognized as the thickness of the ZnSe buffer layer is larger than 0.2 μm, in that the PL intensity ratio of the neutral acceptor-exciton complex ( I 1 ) to the deep level emission increases exponentially. Raman scattering results show an expansion of the ZnSe lattice due to accomodation of the ZnTe lattice. The experimental critical thickness of ZnTe/ZnSe is estimated to be 500 A, which is quite large compared with the value expected.

Effects of growth temperature on optical properties in ZnTe on GaAs grown by molecular beam epitaxy (MBE) have been investigated by photoluminescence (PL) and Raman scattering. PL results show the decrease in Zn vacancies and in substitution of oxygen for excess Te as growth temperatures increase. An improvement in crystallinity of ZnTe is achieved by using ZnSe buffer layer. LO phonons of ZnTe shifted slightly to low frequencies and those of ZnSe largely to higher frequencies with respect to bulk values. Large compression of the ZnSe lattice and small elongation of the ZnTe lattice are explained by existence of misfit dislocations or Te associated precipitation near interface.

A conceptual design study of the Steady State Tokamak Reactor (SSTR) has been performed in order to provide a realistic goal for the fusion research. The SSTR is designed as a DEMO or power reactor to be built in the near future [Y. Seki et al., Proc. 13th Int. Conf. Plasma Phys. and Contr. Nucl. Fusion Res., Washington, USA, IAEA-CN-53/G-1-2]. The major feature of the SSTR is the maximum utilization of bootstrap current in order to reduce the power required for steady state operation [M. Kikuchi, Nucl. Fusion 30 (1990) 265]. This requirement leads to the choice of moderate plasma current (12 MA) and high poloidal beta (βp = 2) for the device, which are achieved by selecting moderate aspect ratio (A = 4) and high toroidal magnetic field (Bt = 16.5 T). A negative-ion-based NBI system is used for central current drive to realize steady state operation. It is shown that a tokamak system based on the small extension of the present physics and technologies can produce net electricity of ∼ 1 GW if the proper physics and engineering R&D are conducted.

A pool-cooled NbTi superconducting helical coil system (named TOKI-HB) has been fabricated as part of one of the research and development programs for the Large Helical Device (LHD). The main purpose of the construction of this device is to build an entire pool-cooled superconducting helical coil system which is large enough to be extrapolable to LHD. The helical coil has a major radius of 0.8 m and a minor radius of 0.2 m with a helical pitch number of 3. An operating current of 8.9 kA produces a maximum magnetic field of 0.75 T at the geometrical center of the poloidal cross section and 3 T at the coil surface. Basic design concepts of the TOKI-HB device are described together with some issues of the fabrication.

Endogenous pancreatic prostaglandin production in control and obstructive jaundice was investigated using isolated and parfused dog pancreas. In both groups, spontaneous production of prostaglandin E 2 and prostaglandin I 2 was recorded, and the levels did not change in both groups. The production of both prostaglandins in jaundice, however, was higher than that in the control on stimulation by 8 x 10 -11 mol of cholecystokinin-octapeptide. Amylase release with cholecystokinin-octapeptide at an amount of 8 x 10 -11 mol in jaundice was higher than in the control. The amylase release in both groups, however, showed further elevation on indomethacin pretreatment. On incubation of pancreatic dispersed cells in both groups, prostaglandin production in jaundiced cells was higher than that in control cells. These data showed that enhanced endogenous prostaglandin in obstructive jaundice might be caused by the characteristic change of pancretic cells, which increased susceptibility to cholecystokinin-octapeptide because of long-term exposure to abnormal blood components, and enhanced prostaglandins might act as a cytoprotector of acinar cells in the pancreas damaged by cholecystokinin-octapeptide administration.

On the basis of a high bootstrap current fraction observation with JT-60, the concept of a Steady-State Tokamak Reactor, the SSTR, was conceived and was developed with the design activity of the SSTR at JAERI (Japan Atomic Energy Research Institue). Results of ITER/FER (International Thermonuclear Experimental Reactor/Fusion Experimental Reactor) design activities have enhanced the SSTR design. Moreover, the progress of R&D for fusion reactor engineering, especially in the development of superconducting coils and negative-ion-based NBI at JAERI, has promoted the SSTR conceptual design as a realistic power reactor. Although present fusion power reactor designs are currently considered to be too large and costly, results of the SSTR conceptual design suggest that an efficient and promising tokamak reactor will be feasible. The conceptual design of the SSTR provides a realistic reference for a demo tokamak reactor. Notably, a reduction of the circulating power of the power station facility, owing to spontaneous bootstrap current, may ensure the high Q around 50 necessary for a commercial power reactor. >

A patient with isolated pulmonary valve infective endocarditis without congenital heart disease was diagnosed at an early stage. Simple valvulectomy without replacement was successfully performed during the active stage of infection.

In a preliminary study carried out in the study area we found that 19.1% (173/907) of patients with chronic liver disease and 51% (35/68) of hepatocellular carcinoma cases were infected with Japanese schistosomiasis. Analysis of data from 571 autopsies revealed a similarly high incidence of schistosomiasis among cases of hepatoma and other liver diseases. A prospective case-control study conducted over 10 years showed that hepatoma developed in 5.4% (26/484) of chronic schistosomiasis cases and in 7.5% (23/307) of patients with chronic liver disease (hepatitis, cirrhosis, etc). The difference was not statistically significant (P = 0.228). A high incidence of hepatitis C virus (HCV) antibody (HCVAb) was found in the schistosomiasis group (36.5%; 95% CI = 44.9-28.1%) and in the chronic liver disease group (56.0%), 39% of whom had chronic hepatitis (P = 0.028). Various factors that might have contributed to the development of hepatoma and schistosomiasis were investigated, but no evidence of a significant correlation between schistosomiasis and hepatoma was found. The high incidence of HCVAb was considered to have been responsible for the development of hepatocellular carcinoma in chronic schistosomiasis patients. The role of HBV infection in the development of hepatoma in schistosomiasis patients was not confirmed after an assay for HCVAb was included in the study.

Aromatic hydrocarbons, including benzol[a]pyrene, in tobacco smoke first require metabolic activation by phase I enzymes, cytochrome P450s (CYP450s), and then are subjected to detoxification by phase II enzymes, the glutathione-S-transferases. A high risk lung carcinoma group has been reported to have specific polymorphisms of the cytochrome P450 (CYP1A1) gene and the glutathione-S-transferase (GSTM1) gene. In this study, the authors investigated whether such genotypes were also risk factors for esophageal carcinoma.Subjects were comprised of 89 esophageal carcinoma patients and 137 noncancer controls. Forty-nine of the patients and 60 of the control subjects were smokers. Genotypic studies of both CYP1A1 and GSTM1 were performed in the cancer tissues of all 89 patients. Genotypes of peripheral blood leukocytes taken from the control subjects were also determined. Genotypes of the CYP1A1 and GSTM1 genes were determined by the polymerase chain reaction.Patients who were heavy smokers with the genotypes Val/Val (V/V) for CYPIAI and the combined genotype of V/V for CYP1A1 and GSTM1- were a statistically high risk group compared with control subjects (P0.01, chi-square = 10.6 vs. P0.01, chi-square = 11.0). The association of V/V for CYPIAI with a smoking indexor = 600 in esophageal carcinoma patients was estimated at 6.63 (95% confidence interval [CI], 1.86-23.7). The association of combined genotypes of V/V of CYP1A1 and GSTM1 with a smoking indexor = 600 in esophageal carcinoma patients was estimated at 12.7 (95% CI, 1.97-81.8)Specific genotypes of the CYP1A1 and GSTM1- genes are related to the incidence of esophageal carcinoma, especially in heavy smokers.

We investigated the immunohistochemical expression of three carbohydrate antigens, sialyl-Lewisa, sialyl-Lewisx and sialyl-Lewisx-i, in human lung cancer tissues using monoclonal antibodies, 2D3, SNH3 and FH6, respectively, and compared the expression rate of these three antigens with clinical and pathologic findings. The expression rate of all the three antigens in adenocarcinoma was higher than that in squamous cell carcinoma and that of sialyl-Lewisx was highest in adenocarcinoma. Sialyl-Lewisx antigen was expressed in all cases of positive nodal metastasis or postoperative distant metastasis in adenocarcinoma. In squamous cell carcinoma, however, there was no relationship between the expression rate of sialyl-Lewisx antigen and nodal or distant metastasis. These results suggest that expression of sialyl-Lewisx antigen in adenocarcinoma of the lung may be correlated with nodal or distant metastasis.

Conservative management with intrapleural drainage and total parenteral nutrition (TPN) has been the first choice of treatment for postoperative chylothorax. With this approach, however, it usually takes several weeks for the chylothorax to resolve and it is sometimes unsuccessful. In this study, we reviewed seven patients who had chylothorax develop after pulmonary resection for primary carcinoma of the lung.The patients were treated according to a "one-week trial" that consisted of one week of observation with intrapleural drainage and maximum parenteral nutritional support followed by operative intervention if the effect of the conservative therapy was not adequate. When the chylous leak was decreased to less than 100 mL/day or less than 15 percent of the maximum daily drainage volume after the "one-week trial," the conservative management was continued for two more weeks. After observation for three weeks, oral intake was begun and a final evaluation of the treatment was made.One patient did not consent to the "one-week trial" and underwent operative treatment on the third postoperative day. Two patients had chylous leaks less than 100 mL/day or less than 15 percent of the maximum daily chylous leak after one week observation. Conservative management with TPN was continued in these patients for two more weeks and operation was performed in one on the 20th day and in the other on the 22nd postoperative day. The remaining four patients underwent operative treatment on the seventh or eighth postoperative day. All of the operations for chylothorax were successful, and chest tubes were removed promptly. These results show that operative management of chylothorax was reliable and safe. The "one-week trial," however, offered few advantages in determining the therapeutic strategy for postoperative chylothorax.

Since January 1991, we have been performing thyroid surveys and hematologic and immunologic screening on children in Chechersk, Belarus, a city situated in one of the areas most seriously contaminated with high levels of radionuclides after the Chernobyl accident. Ten children selected from 713 children because of goiter did not show a decrease in humoral immunity or in the number and function of T cells. By contrast, natural killer (NK) cell activity against K562 cells was depressed in 4 of these 10 children. The clinical and laboratory findings indicated that previously reported diseases with NK cell dysfunction could be excluded. A comparative analysis of NK cell activity in children from areas with and without high 137Cs levels revealed a high frequency of abnormal NK cell activity only in children from the area contaminated by radioactive fallout. In addition, there was no correlation between NK cell activity and NK cell number as percentage in the children from the area with high 137Cs levels. Neither activity nor number of NK cells was correlated with the body content of 137Cs. Thus, the frequent abnormality of NK cell function may not have been due to actual internal exposure to the long-lived radionuclide.

Hepatic invasion is an important factor in the selection of an operative procedure for patients with carcinoma of the gallbladder. Imaging modalities to detect the hepatic invasion were evaluated for accuracy, and postoperative patient outcome was analyzed.Thirty-six patients who were treated for carcinoma of the gallbladder at our institution between 1984 and 1993 were studied. The imaging results of ultrasonography (US), computed tomography, and angiography were compared with histologic findings regarding intrahepatic invasion of the carcinoma.Histologic examination of the operative specimens removed from 21 patients revealed that the detection of hepatic invasion with preoperative US was superior to that with the other two modalities. The preoperative US showed a diagnostic value that was almost the same as that of the intraoperative US. The postoperative patient outcome was not satisfactory, although extended radical operation was performed using image guidance in the 21 patients. The patients died as a result of nodal recurrence rather than hepatic recurrence.Preoperative US should be performed initially for detecting hepatic invasion from carcinoma of the gallbladder and can be substituted for intraoperative US. Considering the operative treatment for patients with carcinoma of the gallbladder, lymph node dissection is as important as the extent of hepatectomy.

Although reflux esophagitis after subtotal gastrectomy has been noticed by surgeons, the mechanism of its development is obscure. This study was undertaken with the aim of clarifying the role of the lower esophageal sphincter in the development of this abnormality. Manometric studies were carried out on 42 patients with gastric cancer, and on 19 with cholelithiasis. The lower esophageal sphincter pressure was measured using a catheter tip pressure transducer and a rapid pull-through technique, and the results presented as the mean of three measurements. The technical error of this experiment was estimated to be within 2 mmHg by a study of the cholecystectomy patients. After gastrectomy, the lower esophageal pressure decreased in 17 patients, increased in 4 and remained unchanged in 21. A more pronounced decrease in the lower esophageal sphincter pressure was found after Billroth II. Clinical evaluation of the 42 patients revealed symptoms of postgastrectomy regurgitation in 10. Preoperatively, these 10 had lower values of the lower esophageal sphincter pressure followed by a more marked postoperative decrease, as compared with the patients with no regurgitation symptoms. Oral administration of a test meal revealed regurgitation after subtotal gastrectomy. This study suggests that a low value of the pre-operative lower esophageal sphincter pressure, a marked decrease in the pressure after gastrectomy, and Billroth II anastomosis, may be factors that predispose to regurgitation.

Prostaglandins are widely known to have cytoprotective effects in a variety of conditions. Thromboxane A2 has the opposite effect of prostaglandins. In this study the effects of the thromboxane A2 receptor antagonist ONO 3708 on ischemia and subsequent reperfusion in the dog liver was evaluated.Mongrel dogs weighing from 10 to 15 kg were divided into three groups: a control group, a group with induced liver ischemia and subsequent reperfusion, and a group that received ONO 3708 and then underwent induced liver ischemia and subsequent reperfusion. Liver ischemia was induced by the Pringle procedure for 60 minutes. The concentrations of total free amino acids, aromatic amino acids, and branched-chain amino acids in blood taken from the portal and hepatic veins were examined before and after the Pringle procedure in the latter two groups and at the corresponding points in the control group.Disturbances in amino acid metabolism in the liver occurred 5 minutes after the declamping in the ischemic group, and prostaglandin I2 and thromboxane A2 levels and lipid peroxide production, were increased. In contrast, hepatic amino acid metabolism was unchanged, and prostaglandin I2 and thromboxane A2, and lipid peroxide production, were normalized in the group that was treated with ONO 3708.ONO 3708 appears to protects hepatic tissue from ischemia-reperfusion injury through free-radical scavenging, by increasing prostaglandin I2 levels, and by decreasing thromboxane A2 production.

Neoadjuvant therapy combined with intra-arterial continuous infusion of CDDP and external radiation was evaluated in a patient with locally advanced breast cancer. Although only MR was observed on the primary tumor, PR was found in several metastatic lymph nodes and daughter nodules. All tumor markers elevated before treatment decreased to normal ranges only by this therapy, and histological damage was also recognized remarkably with a high concentration of free Pt (8.89 micrograms/g) in cancer tissues. Since no severe side effects appeared during the present therapy, extended radical mastectomy with wide skin resection could be performed following additional intra-arterial chemotherapy using 5-FU, epi-ADM and MMC. From this experience, it was suggested that CDDP was an useful drug in the chemotherapy for breast cancer.

This study was undertaken to investigate whether thyrotropin binding inhibitor immunoglobulins (TBII) values at and after subtotal thyroidectomy correlated with the outcome or the histologic grade applied to the appearance of intrathyroidal lymphocytes at the time of surgical treatment. In addition, the main reason for the study was to determine whether or not it was possible to predict the outcome after the operation by the data obtained. There was no relation between the TBII results and the grade of the appearance of intrathyroidal lymphocytes at the time of operation or the TBII postoperative results (whether positive or negative) and the final outcome. However, it was of interest that patients with a recurrence of hyperthyroidism had the TBII values of more than 50 percent at the time of surgical treatment, and also manifested continuously positive TBII values after the operation. They also had moderate grades of lymphocytic infiltration and lymph follicle formation in the surgical specimen. It seemed impossible to predict the outcome of each instance in accordance with TBII values and the grade of the appearance of intrathyroidal lymphocytes at the time of the operation. However, it might be possible to predict at least the recurrence of hyperthyroidism by the consideration of changes of TBII values postoperatively.

Ninety-four esophageal squamous cell carcinomas were examined for loss of heterozygosity at several loci on the long arm of chromosome 17 (17q), using restriction fragment length polymorphism markers. Loss of heterozygosity was observed in 56 (62%) of 91 tumors that were informative with at least one marker. Comparison of these results with clinicopathological data indicated that the losses on chromosome 17q had occurred at an early stage of carcinogenesis. Detailed deletion mapping in these tumors revealed that the region commonly deleted was within the segment between loci defined by two markers at chromosomal band 17q21.3.

Malignant lymphoma of the thyroid was rare condition and it was difficult to make a diagnosis of malignant lymphoma preoperatively. Both ultrasonographic appearance and diagnostic significance of ultrasonography in malignant lymphoma of the thyroid were investigated in this study. Ultrasonography of 10 patients with malignant lymphoma of the thyroid was analyzed. Only 3 cases of 10 were diagnosed as malignant lymphoma by ultrasonography. Five cases were misdiagnosed as thyroid carcinoma, 1 as adenomatous goiter accompanied by cystic degeneration and 1 as chronic thyroiditis. Nine cases were nodular type i.e. limited extremely hypoechoic mass as contrasted with surrounding thyroid tissue, occupying asymmetrically in the thyroid gland. One case was diffuse type i.e. diffused hypoechoic area without surrounding residual thyroid tissue. The tumor size of the 2 cases in which no accumulation was observed in the 67Ga scintigram was 2 cm or less. By ultrasonography of these 2 cases, one case was diagnosed as malignant lymphoma and the other as thyroid carcinoma. Ultrasonography can be regarded to be very significant method as a screening test to make a diagnosis of malignant tumor for nodular type, especially small sized malignant lymphoma of the thyroid.

The study describes a comparison between molecular hybridization using a non-radiolabeled, thymine-thymine (TT) dimerized synthetic oligonucleotide complementary DNA probe and electron microscopy for the detection of hepatitis E virus genome in bile. Spot hybridization with the TT dimerized probe was found to be more sensitive and specific compared to electron microscopy.

Exocrine function of the pancreas in obstructive jaundice was examined using dogs. Jaundice induced by choledochal ligation over 3 weeks showed pancreatic hypersecretion in response to cholecystokinin octapeptide (CCK-8) stimulation. To clarify the mechanism of pancreatic hypersecretion in obstructive jaundice, three experiments were undertaken. In a perfusion experiment performed on isolated pancreas, hypersecretion in obstructive jaundice was observed in response to CCK-8 stimulation. An incubation experiment showed an increase in secretion in response to CCK-8 stimulation in a dose-dependent manner, producing a greater increase in dogs with obstructive jaundice than in controls, despite the fact that basal secretion in both groups was the same. This would suggest that at least one of the mechanisms of pancreatic hypersecretion in obstructive jaundice may be related to the degree of sensitivity of acinar cells to CCK-8. In morphological observation of acinar cells by electron microscopy, the average number of zymogen granules and total granular area per unit of cytoplasm in both groups before and after stimulation with CCK-8 were compared. There was no difference between the groups before stimulation. Following stimulation, values for the control group decreased but appeared to increase in the jaundiced pancreas. These results strongly suggest that pancreatic acinar cells in obstructive jaundice may retain their secretory potential after stimulation for 60 min, though the potential in nonjaundiced pancreatic acinar cells may decrease after stimulation.

A case of postpartum silent thyroiditis misapprehended as malignant lymphoma of the thyroid is reported. The patient was a 30-year-old female who had received irradiation therapy to the neck for malignant lymphoma 9 years ago. She was referred to our department owing to a struma accompanying rapid aggravation of chronic thyroiditis after delivery. The mechanism of this case was possible to be explained by immune rebound theory. It was difficult to make differential diagnosis of this case from malignant lymphoma of the thyroid clinically and cytologically when immune rebound phenomena with invasion of lymphocyte and appearance of lymph follicle were the strongest. Immune state of the patients with chronic thyroiditis accompanied by morphological change should be taken into consideration in the process of making diagnosis of malignant lymphoma of the thyroid.

An extensive upper mediastinal dissection in advanced differentiated thyroid carcinoma is occasionally required. This investigation was undertaken to clarify the indications for mediastinal lymph node dissection and the route of upper mediastinal metastases.Twenty-one patients with differentiated thyroid cancer, who underwent their first radical operations with mediastinal dissection through a partial midline sternotomy, were enrolled in this study. Of 21 patients, 10 (48%) were found to have mediastinal lymph node metastases.The tumor size in the group with metastatic disease was much bigger than that in the group without metastatic disease. Histologic type and age were similar between the two groups. The extent of cervical lymph node metastases was more significant in the group with metastatic disease; in particular, all 10 patients showed more than two metastatic nodes along the internal jugular vein of the tumor-free side.This study indicates that metastases to the internal jugular chain on the side contralateral to the primary tumor would be an extremely important factor for indication of extensive upper mediastinal lymph node dissection after median partial sternotomy in patients with differentiated thyroid carcinoma.

Eighty-five patients with gastric carcinoma developing at or involving the cardia were operated on under a newly established principle to prevent a cancer-positive proximal margin. The choice of operative procedure, standard total gastrectomy or extended total gastrectomy, was determined by the degree of proximal extension of carcinoma as confirmed by preoperative examinations. The cancer-positive rate was decreased in this manner to 1.2% from the 13.8% of the controls operated on before the principle was established. Extended total gastrectomy without sternotomy should be used more frequently than that with sternotomy because of the technical advantages. Survival rates of the 85 patients were 48.3% at three years and 30.4% at five years after the operation, and were not significantly different from the controls. As post-operative survival rate is influenced by factors other than transmural extension of the tumor, this study should prompt us to focus on the problem of the proximal surgical margin in surgery for carcinoma of the gastric cardia.

For evaluating the endoscopic staining of the esophageal carcinoma with lugol solution, 50 patients who underwent esophagectomy for carcinoma were subjected to this study. Among the 50 patients, 21 were radiated before surgery and 29 were not radiated. The findings of the lugol staining were compared between endoscopic staining and staining on removed specimens. Non-staining area demonstrated by endoscopic procedure almost agreed with that by the procedure on removed specimen in non-radiation group, but both areas of 28.6% cases disagreed in radiation group. On the second step, the extent of non-staining area demonstrated by the procedure of removed specimen was compared with histological extent of carcinoma. The non-staining area on the removed specimen was more extended than histological extent of carcinoma; 10.3% in the non-radiation group and 71.4% in the radiation group. As one of the causes of the large non-corresponding rate in the radiation group, radiation esophagitis was demonstrated. It can be finally concluded that the reliability of endoscopic lugol staining is reduced by preoperative irradiation.

A patient with thyroid carcinoma showing a hot nodule on radioiodine scintigraphy was examined by ultrasonography and was revealed to have occult carcinoma co-existing with adenomatous goiter. Ultrasonography should be performed to establish the diagnosis even if radioiodine scintigraphy reveals a hot nodule, as should fine-needle aspiration biopsy.