Relationship between staining by digital subtraction angiography and vascularity in breast cancer: analysis of the time-density curve and the results of staining for factor VIII-related antigen/von Willebrand factor

We performed intravenous digital subtraction angiography (IV-DSA) in 31 patients with primary invasive breast cancer, and calculated the maximum density of tumor staining from the time-density curve obtained. Specimens resected from the same patients were stained for factor VIII-related antigen/von Willebrand factor (vWF), and the amount of microvessels was calculated by image processing. A significant correlation (correlation coefficient: 0.85) was found between the maximum density of tumor staining and the vascularity determined by staining for vWF, indicating that the maximum density indirectly reflects the vascularity in the tumor.

[Portal hemodynamic changes from TIPS--evaluation with pulse Doppler method]

Transjugular intrahepatic portosystemic shunt (TIPS) was applied in three patients with Child C liver cirrhosis. Portal venous pressure was reduced by an average of 10.7 mmHg, and results such as the disappearance of esophageal varices and reduction in ascites were obtained. The portal hemodynamics of these three patients was observed before and after TIPS using the pulse Doppler method. When portal hemodynamics in the main portal vein was examined before TIPS, it was found that the mean blood flow velocity had decreased, the blood flow volume was reduced and the cross-sectional area of the vein had increased. The congestion index was high and there was definite congestion of the portal venous system. After TIPS, the blood flow velocity and volume increased, the cross-sectional area of the vein was reduced and the congestion index was lower. Congestion of the portal venous system was improved in these three patients and the clinical efficacy of TIPS was proven by these results. If the stent can be detected sonographically, stent patency is easily confirmed with the pulse Doppler method which is usefull examination technique for follow-up of patients undergoing TIPS.

Fatty acid hydroperoxide lyase is a heme protein

Fatty acid hydroperoxide lyase (HPO lyase) is an enzyme that cleaves hydroperoxides of polyunsaturated fatty acids to form short chain aldehydes and omega-oxoacids. Spectrophotometric analyses of HPO lyase highly purified from green bell pepper fruits indicate that it is a heme protein. The heme species was revealed to be heme b (protoheme IX) from the absorption spectrum of the pyridine hemochromogen. Although the spectrum highly resembles that of a plant cytochrome P450, allene oxide synthase from flaxseed, CO treatment of the enzyme caused no appearance of a peak at 450 nm, which is an essential diagnostic feature of a cytochrome P450. Internal amino acid sequences determined with peptide fragments obtained from the lyase showed no homology with any reported sequences.

Identification of DNA-binding proteins changed after induction of sporulation in Bacillus cereus

DNA-binding proteins were extracted from both exponentially growing cells of Bacillus cereus ts-4 and cells that were induced to sporulate at different stages of chromosome replication, by using a double-stranded B. cereus ts-4 DNA-cellulose column. Two-dimensional electrophoresis of the proteins found that the amounts of 17 proteins changed drastically after induction of sporulation at all the stages. For 8 of those proteins, the largest or the smallest amount was found in the cells which were induced to sporulate 40 min after the initiation of chromosome replication, the sensitive stage for sporulation. The N-terminal amino acids of 6 proteins among the selected proteins were sequenced. The sequence obtained from a 59-kDa protein had sequence similarity (> 45%) to GroEL from several bacterial species. In addition, the sequences from 76- and 52-kDa proteins matched deduced amino acid sequences of a Mycobacterium leprae gene showing homology to the bacteria atp operon and the B. subtilis guaB for IMP dehydrogenase, respectively.

End-to-end duodenojejunal bypass for unresectable periampullary carcinoma

Palliative operation plays an important part in the treatment of periampullary carcinoma. However, gastric bypass such as the widely practiced side-to-side gastrojejunostomy frequently fails to provide adequate drainage. Here we attempted to fashion an end-to-end duodenojejunostomy in the hope of establishing physiological continuity of the stomach and duodenum. Biliary bypass with side-to-side choledochojejunostomy is performed simultaneously. Eight patients underwent this surgery. In seven of these, radical resection proved to be impossible, and in one the duodeno-biliary decompression was attempted before the radical operation. Early results were satisfactory in all patients. They began to eat liquid meals within a week, and were discharged uneventfully within the third postoperative week, when they were able to eat a regular diet. No ulcer developed in any of the patients. Plasma gastrin levels following a test meal was significantly lower after the operation, but plasma CCK-N and GIP levels showed no statistical difference prior to and after surgery. This duodenojejunal bypass is recommended as a means of improving the quality of the remaining life of the patients.

[Study on intratumor administration of lentinan--primary changes in cancerous tissues]

Lentinan was administered for gastric cancer in order to determine what type of changes would occur as a consequence. In an experimental study, the intraperitoneal administration of lentinan on cancerous tissues caused a marked development of reticular fibers, along with an enhanced interstitial response. Findings which support the relationship between a marked development of reticular fibers and an anti-tumor effect, were also obtained. Furthermore, lentinan was administered for human gastric cancer to evaluate whether or not an increase in interstitial response would be observed. As a result, reticular fibers developed in tumor sites with a resultant fragmentation of cancer cell nests. Many T lymphocytes infiltrated cancer sites where the lentinan was administered. These findings suggest that the intratumor administration of lentinan enhanced an interstitial response and also activated an anti-tumor immune response in the human gastric cancer tissues.

Clinical studies of type-I procollagen carboxyterminal peptide in serum of patients with gastric cancer: comparison with CEA and CA19-9

The serum level of a newly developed monoclonal antibody against type-I procollagen carboxyterminal peptide (P-1-P) was determined in patients with gastric cancer. The location of P-1-P in gastric cancer tissue was also investigated. We found that: (1) The serum P-1-P level and the positivity rate in patients with gastric cancer were similar to those in patients with other malignant or benign GI diseases and healthy individuals. (2) In patients with gastric cancer, the P-1-P positivity rate was significantly lower than that of CEA or CA19-9. (3) In patients with gastric cancer, the P-1-P positivity rate increased as the disease stage advanced. (4) Among patients with gastric cancer, the P-1-P positivity rate was significantly higher in those with scirrhous type than in those with medullary or intermediate type. (5) P-1-P was detected in the cytoplasm of cancer cells. P-1-P staining was stronger in scirrhous type and histologically undifferentiated gastric cancer. These results show that P-1-P can serve as a good marker for scirrhous type gastric cancer. The production of collagen by cancer cells themselves seems to be involved in collagen production in scirrhous type gastric cancer.

The state of recurrence and the role of hepatectomy in hepatocellular carcinoma

The subjects involved in the present study were 113 patients with hepatocellular carcinomas who had undergone hepatectomy in our hospital during the past 10 years. During the surveillance, 79 of the 113 patients (69.9%) had recurrence in the residual liver. The cumulative non-recurrence rate at 2 and 5 years was 48.4% and 18.1%, respectively and the cumulative survival rate at 2 and 5 years was 83.8% and 47.5%, respectively. The recurrence in the residual liver tended to occur in the group with the larger tumor size, in the single nodular surrounding proliferative types and in the aneuploid types. There were no differences in the recurrence rate and state relating to the operative procedure. To improve the prognosis of hepatocellular carcinoma, it is necessary to consider the hepatic functional reserve after hepatectomy, and to make plans for multidisciplinary therapy, including such further treatment as transcatheter arterial embolization, infusion chemotherapy and preoperative percutaneous ethanol injection.

[Clinical evaluation of CGS16949A in advanced or recurrent breast cancer--a multi-institutional late phase II clinical trial]

A multi-institutional late-phase II clinical trial of CGS 16949A was conducted at the dose of 1 mg twice daily in postmenopausal patients with advanced or recurrent breast cancer. Seventy patients entered into the study; 65 were eligible and 53 were complete cases. There were 3 CR, 11 PR, 10 long-NC, 14 NC and 25 PD with an overall response rate of 22.2% in 63 evaluable cases. The median period of overall duration of responses was 327.5 days. There were 22 cases that drug was found useful or better, and global usefulness rate was 33.8%. Forty six (76.7%) of patients experienced no side effects in this therapy. Grade 2 toxicities included anorexia (1 pt.), feeling of distension of abdomen (1 pt.), vomiting (1 pt.), fatigue (1 pt.), and only one patient experienced Grade 3 toxicity (anorexia). Grade 2 laboratory abnormalities were confirmed in two patients; one with elevated gamma-GTP and another with elevated LDH, and both were in the absence of liver metastasis. From these results, it is concluded that CGS16949A seemed to be a useful hormonal agent in the treatment of postmenopausal breast cancer.

[Phase II study of CGS16949A, a new aromatase inhibitor--a dose finding study]

A dose finding phase II study of a novel aromatase inhibitor CGS16949A was performed in postmenopausal patients with advanced breast cancer. The daily dose of 1 mg (0.5 mg b.i.d.), 2 mg (1 mg b.i.d.) or 4 mg (2 mg b.i.d.) CGS16949A was administered orally for 8 weeks or more on dose escalation schedule. The response rates (CR+PR) in the evaluable cases were 13.6%, 22.0% and 13.3% in 1 mg/day group (1 mg group), 2 mg/day group (2 mg group) and 4 mg/day group (4 mg group), respectively. There was no statistically significant difference in the response rates among the three treatment groups. Median time to the onset of PR was 99, 113 and 114 days in 1 mg, 2 mg and 4 mg group, respectively, and the median duration of response was 276 days, 391 days and 277 days in 1 mg, 2 mg and 4 mg group, respectively. Five patients in each treatment group showed prolonged stabilization of disease ("long NC", lasting > or = 6 months). Median durations of stabilization were 223 and 241 days in 2 and 4 mg group respectively. The incidence of adverse effects were 11.9%, 7.5% and 13.0% in 1 mg, 2 mg and 4 mg group respectively, and 30 out of 33 symptoms (90.9%) were of mild. Laboratory abnormalities were observed in 12.2%, 22.9% and 23.8% in the respective groups of 1, 2 and 4 mg, and no patient experienced clinical symptoms related to these changes. Plasma estradiol concentration at one month after initiation of the treatment decreased significantly in comparison with pretreatment levels, and was slightly exceeding the limit of detection. Plasma cortisol was not changed. As shown in this results, CGS16949A showed sufficient efficacy and good tolerability in postmenopausal patients with advanced breast cancer. It was considered that the optimal dose in clinical use judged as 2 mg/day.

Lymphangioma of the duodenum: report of a case

A case of lymphangioma of the duodenum with a successful preoperative diagnosis is reported herein. A 76-year-old man who complained of tarry stool was found to have a hemorrhagic polypoid tumor in the third portion of the duodenum. The tumor was diagnosed histologically as cavernous lymphangioma by endoscopic biopsy. Since such a tumor is essentially benign, a partial resection of the duodenum including the tumor was performed. Therefore, an endoscopic biopsy seems to be valuable in the diagnosis of duodenal lymphangioma.

2 cases of gastric-cancer remarkably reduced with a combined dosage of irsogladine maleate preparation and uft

Irsogladine Maleate intensifies the degree of intercellular contact so we expected that a combination of Irsogladine Maleate and UFT would cause tumor-reducing effect and normalization of the malignant cells. A combination of Irsogladine Maleate and UFT was administered to 2 patients with inoperable gastric cancer (Case 1: An 83-year-old male: Borrmann type I, Case 2: A 93-year-old female: A relatively wide early gastric cancer), marked tumor reduction was obtained in both cases. The doses administered were 4 mg/day of Irsogladine Maleate and 200 mg/day of UFT.

An analysis of sit-to-stand movements

We analyzed the movements involved in rising from a knee-high chair in 12 healthy men weighing within +/- 10% of standard body weight. A regular series of transition points was observed in the angles of the hip, knee, and ankle joints throughout the sit-to-stand movement, which was classified into six stages. As the duration of sit-to-stand movements increased, the duration of Stage 2 decreased, whereas Stage 3 grew longer. The durations of stages 4 and 5 remained constant. We also calculated the minimum unilateral hip and knee extension torque per weight in kilograms required for natural sit-to-stand movements, or N-Stand (1.7-2.3 seconds), and found that minimum hip extension torque was 0.7Nm and minimum knee extension torque was 0.9Nm. The minimum hip and knee extension torque required for N-Stand corresponds to a mean 27% and 30%, respectively, of the actual maximum hip and knee extension torque.

Successful gonadotrophin treatment of hypogonadism in postoperative patients with macroprolactinoma and persistent hyperprolactinaemia

We report on two males with prolactinoma in whom hyperprolactinaemia and hypogonadism persisted for several years postoperatively despite the administration of a dopamine agonist or bromocriptine. In these patients, a GnRH test revealed no response in the levels of serum LH or FSH. An hCG stimulation test provoked no response in the serum levels of testosterone. Case 1, who was 28 years old at the first visit, received parenteral testosterone and appreciable virilization of the genitalia was noted within a few months. When he married and desired to father a child, the treatment was switched to hCG/hMG combined therapy and spermatozoa appeared subsequently in the ejaculate, although their numbers were low. His wife conceived and delivered a healthy baby girl. Case 2 was a single young man who presented with hypogonadotrophic hypogonadism and hyperprolactinaemia. He was started on hCG injections three times per week and the maturation of his genitalia was advanced rapidly. Semen analyses showed sperm concentration and motility to be within the normal range. Post-treatment GnRH test revealed no improvement in gonadotrophin responses for LH or FSH. In both cases, the hCG test repeated after the gonadotrophin treatment showed normal basal and stimulated testosterone levels. During the course of gonadotrophin treatment in these cases, serum prolactin levels remained elevated, and it is suggested that, in the two cases, the hypothalamo-pituitary function was disturbed by the tumour or its manipulation and the capacity of the pituitary gland to secrete gonadotrophin was impaired. Under such circumstances with persisting hyperprolactinaemia, hCG and/or hCG/hMG combination treatment can induce normal virilization and advance spermatogenesis sufficiently to achieve fertility.

Hepatic angiomyolipoma pre-operatively diagnosed by imaging

An asymptomatic patient with pre-operatively diagnosed solitary angiomyolipoma is reported. The tumour was a well defined, fat density mass on computerized tomography (CT) and magnetic resonance imaging (MRI), and a hyperechoic nodule with a sharp margin on ultrasonography (US). The lesion was hypervascular on arteriography and CT during hepatic angiography. Chemical shift MRI confirmed the fat component within the lesion. Although a review of the literature shows this tumour to be rare and difficult to differentiate from a malignant lesion pre-operatively, the pre-operative diagnosis of angiomyolipoma is considered feasible when the characteristic findings as described here are present.

[A giant esophageal ulcer in a hemophiliac with HIV infection]

A 21-year-old man with hemophilia B and human immunodeficiency virus (HIV) infection was admitted with hematemesis and melena. After admission, esophagogram and endoscopy showed a single giant ulcer with ovoid shape and slightly irregular margins in the middle esophagus. Biopsy specimens of the esophageal ulcer showed non-specific granulation and etiology was unknown. Therapeutic trails of famotidine, sodium alginate, acyclovir, and amphotericin B did not result in favorable response. With a combination therapy of dexamethasone and sucralfate, the swallowing pain was rapidly disappeared with gradual improvement of the ulcer. To our knowledge, this is the first report of a giant esophageal ulcer in a HIV infected patient in Japan.

Rapid degradation of cucumber cotyledon lipoxygenase

The lipoxygenase activity from cucumber cotyledons grown with their embryonic axis was separated into two fractions having M(r)s of 90,000 and 96,000, respectively, by hydrophobic chromatography. However, from de-embryonated cucumber cotyledons, only one form of lipoxygenase having a M(r) of 90,000 was purified. The three lipoxygenases could not be distinguished from each other either immunologically or by their enzymatic properties. Furthermore, peptide maps of the 90,000 and 96,000-lipoxygenases were identical. In a crude homogenate of cucumber cotyledons, the 96,000-lipoxygenase was rapidly degraded to the 90,000-form. Thus, it was inferred that the 90,000-lipoxygenase was probably the 96,000-form which had lost a peptide fragment of 6,000. It is suggested that there is a specific proteolytic activity for the degradation of 96,000-lipoxygenase. Estimation of changes in the proteolytic activity during seedling growth suggests that the activity at least partly contributes to the rapid in vivo degradation of cucumber cotyledon lipoxygenase.

The presence of a common antigen between human gastric cancer cells and OK-432

Twenty two surgical specimens of gastric cancer resected after administration of OK-432 for the skin reaction test were examined to determine whether the cancer cells had the same antigens as OK-432, a product of hemolytic streptococcus cells. When the tissues were stained by the PAP method with anti-Su streptococcus antibody used as the primary antibodies, the common antigens were demonstrated in 10 (45.5%) of the 22. The presence or absence of the common antigens was independent of the degree of skin reaction to OK-432, and the relations of the common antigens to other host responses were not clear in this study. This is the first report for the presence of such common antigens between human gastric cancer and OK-432.

Breast cancer in a male patient with prolactinoma

A 68-year-old man was diagnosed as having left primary breast cancer. Systemic bone roentgenography showed no evident metastasis, however, skull roentgenography revealed ballooning of the sella turcica, suggesting a pituitary tumor, which was subsequently confirmed by computed tomography. Because there was a high serum prolactin level, the pituitary tumor was diagnosed as a prolactinoma. A modified radical mastectomy was performed for the breast cancer, and bromocriptine therapy given for the prolactinoma. Prolactin is known to initiate and promote breast cancer in mice and rats but little is known about its role in human breast cancer. If hyperprolactinemia plays an important role in the tumorigenesis of human breast cancer as it does in mice and rats, the incidence of breast cancer in patients with hyperprolactinemia may be high. To our knowledge, however, only four such cases have been reported. The present rare case of male breast cancer with prolactinoma is discussed with reference to the literature.

Detection of the testis determining factor in an XX man

An XX male patient was examined for the presence of 25 loci on the Y chromosome. Only 2 loci, the proximal border of the pseudoautosomal region Y and the sex determining region Y, were detected in this patient. The other 23 loci, including the zinc finger protein Y, were absent. We presume that a crossing over between the X and Y chromosomes occurred at the region proximal to the sex determining region Y but distal to the zinc finger protein Y during meiosis of the father.

Des-gamma-carboxy prothrombin (PIVKA-II) and alpha-fetoprotein-producing IIc-type early gastric cancer

We describe the case of a 56-yr-old man with primary gastric adenocarcinoma, who had an extremely high plasma level of des-gamma-carboxy prothrombin (2.45 AU/ml) and of serum alpha-fetoprotein (2810 ng/ml). Histopathologically, the gastric cancer was a IIc type of early cancer which consisted of a combination of a poorly differentiated adenocarcinoma and a well-differentiated tubular adenocarcinoma. The association of a hepatic tumor including hepatocellular carcinoma or liver metastasis was ruled out by ultrasonography, computed tomography, radiocolloid liver scan, magnetic resonance imaging, and angiography. Foci strongly resembling hepatocellular carcinoma (hepatoid differentiation) were noted in the gastric tumor. Localization of des-gamma-carboxy prothrombin and alpha-fetoprotein within the tumor cells, especially within the hepatoid differentiated foci, was demonstrated by the immunohistochemical staining of tissue obtained at biopsy and the resected specimen. This case seems to be the first case reported in which des-gamma-carboxy prothrombin was produced by the gastric cancer. This finding supports the theory of hepatoid differentiation of a gastric cancer.

[Conservative surgery and radiotherapy of early breast cancer]

Radiation dose-effect relationship is reviewed. In conservative treatment of early breast cancer, necessity of radiation is discussed and surgery with radiotherapy technique in our hospital is presented. Our procedures consist of lumpectomy which is removal of 1 cm of normal tissue containing primary breast cancer and complete axillary dissection and postoperative radiotherapy of 46 Gy with 9 Gy of electron boost. Since November 1987, 51 patients treated by this procedure have shown a good local control and a satisfactory cosmetic results. We can conclude that the positive aspects of radiotherapy in the management of conservative therapy for early breast cancer are overwhelming.

[Application and technique of breast conservative treatment of breast cancer]

In patients with breast cancer who had undergone breast conservative treatment involving lumpectomy, axillary lymph node dissection and irradiation, the surgical results and risk factors for remaining cancer foci in the conserved breast were investigated. This form of surgery was performed in 25 patients with T1,N0,-Ia,M0 breast cancer. The cut end of the resected specimen was histopathologically positive for cancer cells in 48% of the patients, but there has been no local or distant recurrence in any patient to date with a mean follow-up period of 17.2 months after surgery. In most breasts resected after lumpectomy, slight cancer foci remained in mammary glands at the sites within 1.0cm distant from the cut end. Extensive remaining cancer lesions were found among cases with advanced intraductal spread or central necrosis in the intraductal foci. The above findings indicate that breast conservative treatment by lumpectomy may result in histopathologically remaining cancer foci, although these can be controlled by irradiation therapy. However, application for this treatment requires much caution when severe intraductal spread or central necrosis is present in the intraductal foci, because extensive cancer foci may remain postoperatively in such cases.

Complete disappearance of metastatic abdominal tumors from gastric cancer after treatment with irsogladine maleate

A 60-year-old woman with gastric cancer had undergone partial gastrectomy in September 1989. Pathological examination revealed a poorly differentiated adenocarcinoma of pT3pN3pM0 (not resected for cure), stage IV. Postoperative adjuvant therapy comprised 1-(tetrahydro-2-furanyl)-5-fluorouracil plus uracil and OK-432. On 11 August 1990, two forefinger-tip-sized tumors were palpated beneath the operation scar. They increase in size, the superior tumor reaching 4x3 cm, the inferior tumor 5x3 cm on 5 September. Then, on 17 September, the inferior tumor was resected but the superior tumor remained; the histological type was poorly differentiated adenocarcinoma. After the operation, from 20 September, she was given 4 mg irsogladine maleate orally every day. On 8 October, there was no increase in the size of the superior tumor. By 29 October, the superior tumor had disappeared and no further tumor appeared thereafter; the patient showed no sign of relapse.

A study of right unilateral spatial neglect in left hemispheric lesions: the difference between right-handed and non-right-handed post-stroke patients

We report 20 cases of right unilateral spatial neglect caused by lesions in the left cerebral hemisphere. Differences in neuropsychological symptoms and lesions sites are discussed in connection with handedness. Of the right-handed patients, 6 had severe aphasia, 4 had Gerstmann's syndrome, and 1 had pure agraphia, but unilateral spatial neglect in these cases disappeared after a number of months. Six of the non-right-handed patients had moderate-to-severe aphasia, while the other 3 cases had no aphasia at all. Eight of the 9 cases in this group continued to have right unilateral spatial neglect for more than 6 months. Lesion site as determined by CT differed as to hemisphere, but all fell into the common area previously mentioned in connection with such disorders: i.e., the temporal, parietal and occipital lobes.

Odor-structure relationships in n-hexenols and n-hexenals

The relationships between the chemical structures and the odor characteristics were examined on a series of highly purified n-hexenols and n-hexenals-(14 isomers). The C6-enals and the corresponding alcohols resembled in odor characteristics each other. However, the odor strength of the aldehydes was 100-1000 times higher than those of the alcohols. In the principal components analysis, the position of carbon-carbon double-bond in the C6-compounds was closely related to the scores of the first principal component, whereas the functional groups, hydroxy and formyl groups, were related to those of the second principal component except for (Z)-3-hexenol.

The clinical value of tissue carcinoembryonic antigen in breast cancer

The relationship of tissue carcinoembryonic antigen (CEA) to clinicopathological factors and prognosis was investigated in 168 patients with invasive ductal carcinoma of the breast. Tissue CEA was determined by radioimmunoassay and a level of 5.1 ng/ml or more considered to be positive. Tissue CEA was positive in 31.5 per cent of the patients overall and, of the clinicopathological factors, tumor size and the presence or absence of lymph node involvement were not found to be correlated with tissue CEA. However, the tissue CEA positivity rate was significantly higher in patients who had four or more metastatic lymph nodes (p less than 0.01). Tissue CEA-positive patients showed earlier recurrence than CEA-negative patients (p less than 0.01) and had a poorer outcome (p less than 0.05). Thus, tissue CEA is considered useful as a prognostic index for primary breast cancer patients.

[A case of Plasmodium vivax malaria with findings of DIC]

We reported a rare case of Plasmodium vivax malaria who showed findings of disseminated intravascular coagulation (DIC). A 50-year-old Japanese male was sent to our hospital with the diagnosis of Plasmodium vivax malaria on the 26th of April, 1990. He had stayed in the Solomon Islands from Oct. 1987 to Dec. 1989, and had febrile episodes during his stay in the island. On April 18, 1990, he complained of a high fever with chills, and showed the same episodes on the 20th, 22th and was diagnosed as malaria. He was treated successfully with the sulfadoxine 500 mg and pyrimethamine 25mg (Fansidar), following the normal temperature on the 4th day and disappearance of malarial parasites in the peripheral blood smear on the 6th day. Interestingly, he had thrombocytopenia and a high titer serum level of fibrin degradation product (FDP) supporting the questionable diagnosis of DIC. Even on the 12th day after improved thrombocytopenia by treatment with Gabexate (FOY), the serum level of FDP, D-dimer and thrombin-nati-thrombin (TAT)III complex still remained at high titer levels. One month later he was readmitted for a relapse of Plasmodium vivax malaria, when he showed thrombocytopenia but the serum level of FDP, D-dimer, TAT III complex and PM.alpha 2 PI complex were normal levels. We concluded that the thrombocytopenia and the high titer of FDP at his first admission was a manifestation of DIC.

[Two case reports of maxillary prognathism. Some considerations of treatment for different facial type cases]

Generally, prognathism has been just identified as a large overjet. However, for the purposes of treatment, it should be noticed that different facial types are included in this malocclution. Facial pattern is classified into 2 groups; dolico and brachio facial types. The dolico facial type is generally a high angle case. It has a weaker natural anchorage than the brachio facial type. Consequently, it has a downward component in its mandibular growth. The classification of the two different facial types of maxillary prognathism would influence orthodontic treatment. When deciding on the treatment, the differences between the two facial types--in type of anchorage, growth direction, and control of toothaxis--should be taken into account.

[Evaluation of correlation between the disappearance rate of indocyanine green and the maximum removal rate]

The disappearance rate of indocyanine green (K.ICG) and the maximum removal rate (Rmax) usually correlate with each other. However, in some cases it was shown there was a dissociation between them. We investigated the relationship between the two rates in 146 subjects. K.ICG and Rmax correlated strongly with a correlation coefficient of 0.749 (p less than 0.001). Sixty-six cases were included in the limits of 95% confidence, and the other 80 cases outside the limits were defined as dissociated cases. Among them a lower Rmax rate as compared to the K.ICG rate was found in many cases of obstructive jaundice. Particularly a lower K.ICG rate compared to the Rmax rate was found in many cases of liver cirrhosis accompanied by esophageal varices and idiopathic portal hypertension. On the other hands, we performed multiple regression analysis on 12 other liver function tests. K.ICG was strongly related to platelet count, circulatory blood volume, and albumin, all factors relating to portal hypertension. Rmax largely depended on LCAT, A/G ratio, and cholinesterase, which are Therefore, the dissociation between K.ICG and Rmax was caused by differences in the characteristic of each disease.

[Study of conservative treatment of breast cancer in view of the spread of primary lesion]

Two hundred and six patients with breast cancer t1 or t2 were subclassified histologically into the following 8 types; comedo type, papillary type, mucous type, papillotubular or cribriform type, small solid alveolar type, large solid alveolar type, sclerotic type and pure scirrhous type. The risk of remaining cancer with lumpectomy was investigated clinicopathologically in relation to intraductal spread and lymphatic invasion of cancer cells. The tumor invasion was classified into intraductal type, localized type or extraductal spreading type, and lymphatic invasion was divided into 2 grades, i.e., vicinity of the tumor and 5mm or more distant. 1. In cases of intraductal spread, the comedo type was the most frequent, followed by the papillary type and mucous type. 2. The small solid alveolar type accounted for the highest proportion, 22.7%, in the group with distant lymphatic invasion. 3. The incidence of lymph node metastasis was as high as 63.6% and 61.7% for the small solid alveolar type and pure scirrhous type. 4. In cases of intraductal spread, t1 accounted for 32.6% and t2 for 47.0%. 5. The incidence of positive lymph node metastasis was 28.9% for t1 and 52.0% for t2. Tumors associated with a higher risk of remaining cancer are those of the comedo type and papillary type in terms of intraductal spread, those of the small solid alveolar type and pure scirrhous type in terms of lymphatic invasion, and those measuring 2cm or more.

[Case report of long-term treatment of a cleft lip and palate patient]

Cleft lip and palate patients have narrow maxillary arches and mesio-distal disharmony between the jaws caused by cicatricial contracture from cleft lip and palate surgeries. In such cases, early orthodontic treatment is required including improvement of the mesio-distal disharmony of the jaws. Following orthodontic treatment, prosthodontic treatment is required to improve the masticatory function and esthetic appearance in the cleft area. Thus, improving the occlusion of cleft lip and palate patients takes a long time. This case report concerns such a longterm handling of over 17 years from the initial treatment at 5 years 3 months till the final prosthodontic treatment for an under-developed maxilla with partial closure of the fistula to which ilium was later grafted following orthodontic treatment. Considerations are discussed about timing of the initiation of orthodontic treatment, closure of the oronasal fistula and the final prosthodontic restoration.

Glanzmann's thrombasthenia associated with a transient deficiency of factor XIII

A three-year-old girl suffering from ecchymoses developed severe epistaxis. The diagnosis of thrombasthenia was made on the basis of platelet aggregation studies, flow cytometric analysis with monoclonal antibodies and gel electrophoretic analysis. In addition, coagulation studies at the time of epistaxis repeatedly showed a transient deficiency of factor XIII activity and antigen.

Effects of NSAID on collagen and proteoglycan synthesis of cultured chondrocytes

Three major NSAID (tiaprofenic acid, indomethacin and acetylsalicylic acid) were studied with regard to their effects on the biosynthesis and gene expression of collagen and proteoglycan of chondrocytes. We found that the biosynthesis of type 11 collagen was suppressed in 60-70% of the controls by either indomethacin or acetylsalicylic acid; tiaprofenic acid did not suppress collagen synthesis. Although the biosynthesis of proteoglycan was suppressed to 80-90% of the control by indomethacin or acetylsalicylic acid, tiaprofenic acid did not suppress proteoglycan synthesis. In order to investigate the gene expression of type 11 collagen and proteoglycan, dot blot hybridization was performed using type 11 collagen and proteoglycan cDNA. The effects of NSAID on the amount of type 11 collagen and proteoglycan mRNA were consistent with those on collagen and proteoglycan biosynthesis. Thus, we concluded that tiaprofenic acid has less effect on cultured chondrocytes.

[Histopathological study on the safety of conservative breast surgery in terms of the degree of axillary dissection for breast cancer]

The subjects were 15 patients with primary mammary cancer who underwent radical mastectomy. Axillary dissection (level I, II and III) with an incision 7 cm below the axilla was performed. After radical mastectomy, the presence/absence of remaining lymph nodes and fatty tissue was determined. All operations were performed by the same surgeon. The number of lymph nodes dissected by means of subaxillary incision ranged from 10 to 32 (mean 20.4). The proportion of remaining lymph nodes found after radical mastectomy was 0/142 (0%) for level I, 0/113 (0%) for level II and 3/54 (5.6%) for level III. In the subclavian Halsted area, fatty tissue partially remained in 60.0% of the patients and more than half in 13.3%. It was shown that complete dissection of level III lymph nodes is difficult when this surgical technique is employed. Although fatty tissue did remain in some cases after level II dissecting, this technique presented hardly any problems in the case of level I and II dissection. Therefore, from the viewpoint of axillary dissection alone, the present technique can achieve results similar to those obtained by radical mastectomy, suggesting its applicability to mammary cancer at a relatively early stage.

[Rational surgery of early gastric cancer]

Reduced operation for gastric cancer (R1 operation) is indicated for early gastric cancer without lymph node metastasis. We examined which cases can be regarded as early gastric cancer. Mucosal cancer of macroscopically I, IIa, and IIb type that is 2 cm or less in diameter and located at C and macroscopically IIa type submucosal cancer 1 cm or less in diameter appeared to be indicated for this operation. However, preoperative selection of these cases is difficult, and at present, reduction surgery cannot be performed with confidence. Therefore, we have proposed rational surgery for early gastric cancer consisting of removal of the tumor and dissection of group 1 lymph nodes, the lymph node along the left gastric artery, that along the common hepatic artery, and that around the celiac artery. This procedure seems to be appropriate in terms of antitumor immune response of regional lymph nodes and surgical results.

Malignant fibrous histiocytoma of the liver

Malignant histiocytoma of the liver, a rare liver tumor, has not been reported in the radiological literature. The differential diagnosis of liver mass should be expanded to include primary malignant fibrous histiocytoma. Embolization of the mass was ineffective.

[Cerebral aspergillosis as a cerebral vascular accident]

Cerebral aspergillosis is one of the most common mycotic infections in the central nervous system causing different clinical features such as brain abscess, granuloma, meningitis, and encephalitis. Cerebral aspergillosis, however, may lead to a cerebral vascular accident such as intracranial hemorrhage or cerebral infarction. In this report, we present two patients with cerebral aspergillosis accompanied by intracranial hemorrhage. A total of 124 reported cases of cerebral aspergillosis are reviewed to ascertain the pathogenesis of the associated vascular lesion. The first patient was a 9-year-old girl, who developed drowsiness with a headache during the medical treatment for acute myelocytic leukemia. CT disclosed subarachnoid and intraventricular hemorrhage. The autopsy revealed that the aspergillus arteritis was the cause of repeated hemorrhage. The second patient was a 15-year-old boy with allergic purpura and renal failure, who suddenly developed a stupor with convulsive seizure. CT disclosed an intracerebral hemorrhage in the right parieto-occipital area. The patient gradually deteriorated and died in spite of the surgical removal of the hematoma. The autopsy revealed that the hemorrhage was caused by the aspergillus arteritis. Cerebral aspergillosis has two routes of infection to the central nervous system: hematogenous dissemination from the distant site (usually the lung) and direct extension from the contiguous site (usually the paranasal sinuses or orbit). The primary mechanism of neuropathology is different between these two types. Primary cerebral arteritis is most often seen in patients with the former type, whereas primary basal meningitis occurs in the latter. The incidence of clinico-pathological features is different between hematogenous dissemination type and direct extension type.(ABSTRACT TRUNCATED AT 250 WORDS)

Variations in the disappearance rate of indocyanine green

Time-associated changes in the disappearance rate of indocyanine green from the blood (K.ICG) as an index of liver function, were studied. Blood was drawn 5 times at 3-minute intervals from 32 patients. Early, intermediate, and late K.ICG values were 0.087 +/- 0.040, 0.082 +/- 0.038, and 0.076 +/- 0.033 min-1, respectively, showing serial decreases. When blood was drawn 8 times at 2-minute intervals from 22 other patients, the means of the K.ICG values at 11 time points showed a nearly linear relationship (r = -0.986). These findings indicated that K.ICG is approximated by a linear function of time, K(t) = -K'.t + K0. According to this function, K.ICG is considered to decrease by 1.96% every minute. The K.ICG value determined by the conventional method is, therefore, a mean disappearance rate of 15 minutes, and K0 is considered to reflect the initial reaction speed.

Exocrine and endocrine stomach after gastrobulbar preserving pancreatoduodenectomy

Exocrine and endocrine stomach was studied serially in 13 patients who had gastrobulbar preserving pancreatoduodenectomy (GPPD). In most of them, acid output temporarily increased just after operation but recovered. Gastrin response level decreased transiently but returned to the preoperative level. A negative correlation was observed between the acid and gastrin levels, which suggests that the negative feedback mechanism between parietal cells and G cells was maintained. Acid and gastrin levels in GPPD were higher than those in conventional pancreatoduodenectomy (cPD) but not remarkably different from those of the controls. No peptic ulcer was detected after the operation. These findings indicated that GPPD poses little problem concerning offensive factors. Postoperative ulcer formation is considered to be prevented by the authors' procedure, which is devised to best preserve defensive mechanisms so that duodenectomy is minimized and the gastrointestinal continuity is reconstructed physiologically from mouth to anus by end-to-end duodenoduodenestomy, end-to-side pancreatojejunostomy, and end-to-side choledochojejunostomy.

[Clinical evaluation of tumor markers in patients with colorectal cancer]

In 117 patients with colorectal cancer, the serum levels of CEA, TPA, CA 19-9, IAP, and, AFP have been compared with the clinical findings. The combined assay of 5 tumor markers were found to be useful for the screening of colorectal cancer. Excluding the AFP, positive rate of the markers for colorectal cancer was higher than that for breast cancer (p less than 0.01) and similar to that for gastric cancer. The serum levels of TPA, CEA and CA 19-9 correlated with the histological progression. Thus, they may be an indicator of the degree of lymph node metastasis, liver metastasis, the histological depth, and also may be useful in evaluating the prognosis of patients with colorectal cancer.