Plasma free amino acid pattern in chronic hepatitis as a sensitive and prognostic index

To evaluate the diagnostic and prognostic significance of plasma amino acid imbalance in chronic hepatitis (CH), plasma-free neutral amino acid levels were examined in 47 patients with CH, consisting of 8 chronic persistent hepatitis (CPH), 26 chronic aggressive hepatitis (CAH) 2A and 13 CAH 2B, compared with those of 58 patients with liver cirrhosis (LC) and of 12 healthy controls. Fischer's ratio (a molar ratio of branched chain amino acids to aromatic amino acids) was found to be reduced in the order of normal subjects (3.5 +/- 0.4), CPH (3.0 +/- 0.2), CAH2A (2.7 +/- 0.3), CAH2B (2.1 +/- 0.3), compensated LC (LC-C, 1.5 +/- 0.4) and decompensated LC (LC-D, 1.1 +/- 0.2). Patients with CPH showed a significant decrease of the ratio compared with normal subjects (P less than 0.05). The ratio was significantly higher in patients with CAH 2B in comparison with LC-C (P less than 0.001). Especially, the ratio could be used to discriminate the three distinct stages of CH. Discriminant analysis, carried out using six amino acids, Fischer's ratio and conventional liver function tests indicated that Fischer's ratio was the most reliable parameter for differentiation of the three stages of CH. Furthermore, serial examinations of Fischer's ratio in patients with CH remained unchanged in CPH, whereas was significantly reduced in CAH during 2-3 years follow-up. These results strongly suggest that Fischer's ratio is a useful indicator for differential diagnosis and for prediction of the subsequent clinical course of CH as well as being a sensitive index for functional hepatic reserve in chronic active liver diseases.

Decrease in muscle glucose transporter number in chronic physical inactivity in rats

In this study, whole body insulin action on glucose uptake and muscle glucose transporter number of rats subjected to 14 days of physical inactivity conditions was examined. Unlike other suspension and denervation models of muscle disuse, this physical inactivity model allows voluntary contractile activity with minimal stress. Minimal depression of body weight gain and significant depression of gastrocnemius muscle growth were observed compared with that of control rats after 14 days of physical inactivity. The whole body insulin sensitivity and responsiveness were determined by the euglycemic clamp technique, with 1.4, 3.6, and 14 mU insulin.kg-1.min-1 perfusion and 2-deoxy-D-[3H]glucose incorporation. The rates of glucose disposal were the same in the restrained rats as in the controls with the 1.4 and 3.6 mU insulin perfusion; however, glucose disposal significantly decreased with 14 mU insulin perfusion. 2-Deoxy-D-[3H]glucose uptake into the gastrocnemius muscle was higher in the control rats than in the physically inactive rats. Glucose transporters in the gastrocnemius and quadriceps muscles, measured by means of the D-glucose-inhibitable cytochalasin B binding assay, were significantly decreased in number in the physically inactive rats. These findings suggest that the decrease in whole body glucose uptake might in part be explained by the decreases in the total glucose transporter number in muscles.

Diagnosis of biliary diseases via a naso-biliary catheter

Nasobiliary double contrast radiography and nasobiliary cytological diagnosis via nasobiliary catheter were performed in 30 patients with biliary diseases to assess the diagnostic usefulness and limitations of the procedures. The results showed that the contour and fine mucosal pattern of the extrahepatic bile duct could be demonstrated adequately (88%) by nasobiliary double contrast radiography. In contrast, the intrahepatic bile duct could not be fully demonstrated (56%) by nasobiliary double contrast radiography because of its anatomical structure. On the other hand the fine reticular pattern of the mucosa was defined in each section of the gallbladder by nasobiliary double contrast radiography. This procedure is thus a valuable method for detection of mucosal lesions of the extrahepatic bile duct and gallbladder, especially carcinoma. The cell collection rate was not as high (59%) using conventional nasobiliary cytological diagnosis. Brush cytology via a nasobiliary catheter was shown to be a useful adjunct to other diagnostic procedures.

Immature teratoma of the ovary

The purpose of this study was to establish the optimal management of immature teratoma of the ovary. Pursuant to this, 20 previously untreated patients with immature teratoma were evaluated. Nine patients were at stage I of the disease, 2 had progressed to stage II, and 9 to stage III. Eight patients had grade 1 tumors, 11 had grade 2 tumors, and 1 had a grade 3 tumor. Postoperative chemotherapy was performed in 19 cases. Vincristine, actinomycin D, and cyclophosphamide (VAC) were administered in 9 cases, chemotherapy including cisplatin (P) was administered in 8 cases, and other regimens were followed in the 2 remaining cases. The median follow-up period was 62 months (range 19-108 months), and no patient was lost to follow-up. After completion of the follow-up period, 18 patients were alive and disease free, 1 was alive with liver metastasis, and 1 had died. The patient who died had suffered from a grade 3 tumor, and the recurrent tumor was a rhabdomyosarcoma. As a result of this study, it was found that immature teratoma of grades 1 and 2 can be managed successfully with VAC or P therapy. Thus, a hysterectomy should not be automatically performed in patients who still hope to give birth, yet suffer from a grade 1 or 2 immature teratoma at the time of a second operation.

Efficacy of endoscopic retrograde cholecystoendoprosthesis (ERCCE) for cholecystitis

Fourteen patients with cholecystitis were treated by endoscopic placement of an endoprosthesis into the cystic duct. In these patients the administration of antibiotics had failed to change the clinical picture of cholecystitis. Clinical and ultrasonographic findings before and two months after stenting were compared. There was an improvement in abdominal pain in 9 out of 14 cases (64%); fever, present in 5 patients, disappeared in all. No clinical complications were observed. Sonographic findings in terms of gallbladder wall thickening and sludge present within the gallbladder improved in 57% and 88%, respectively. Our results indicate that this endoscopic procedure may be effective in the treatment of cholecystitis.

Prognostic factors in yolk sac tumors of the ovary. A clinicopathologic analysis of 29 cases

Twenty-nine ovarian cancer patients with yolk sac tumors and germ cell tumors with yolk sac tissue as a component of their disease (16 endodermal sinus tumor, 11 mixed germ cell tumors, one embryonal carcinoma, and one polyembryoma) were treated with cytoreductive surgery and combination chemotherapy. Prognostic factors were investigated in this group. Patients with Stage I disease had a more favorable prognosis (P less than 0.003) than those with Stages II and IV disease. The difference in prognosis was significant in cases where residual tumor was absent (P less than 0.003) and in cases where ascites was either absent or less than 100 ml in volume (P less than 0.05). Endodermal sinus tumor with either an intestinal (P less than 0.05) or microcystic pattern (P less than 0.01) was more common in survivors than in those who died. The age, preoperative serum alpha-fetoprotein level, maximum tumor size, and tumor weight had no significant correlation with prognosis. In advanced cases, chemotherapy regimens including cisplatin gave better results than those containing vincristine, dactinomycin, and cyclophosphamide (P less than 0.05). The optimal treatment of yolk sac tumors or tumors with yolk sac tissue as a component of the ovary is discussed in light of these results.

Alpha-fetoprotein in malignant germ cell tumors of the ovary

To investigate the clinical significance of alpha-Fetoprotein (AFP) in malignant germ cell tumors of the ovary, we studied 46 patients who were treated by the Tokai Ovarian Tumor Study Group. The 46 patients had the following tumors: immature teratoma (IT), 17 cases; endodermal sinus tumor (EST), 16 cases; mixed germ cell tumor containing EST, 11 cases; embryonal carcinoma, 1 case; polyembryoma, 1 case. In all 29 non-IT cases, AFP was positive, and in 27 cases (93%) the level was above 1000 ng/ml. In 11 of 17 cases of IT (64.7%), AFP levels were elevated and in 1 case the level was above 1000 ng/ml. Elevation of the AFP level above 1000 ng/ml suggested the presence of EST. AFP levels were monitored in 27 of 29 cases without IT during treatment and follow-up. It was found that AFP levels should be monitored closely for at least 1 year after induction of remission. No recurrence was observed when AFP continued to be negative longer than 1 year. The mean interval to clinical recurrence from the reelevation of AFP was 4 months (1.4-9 months). An increase in the AFP to a positive level, even without clinical signs of recurrence, should be regarded as a recurrence. AFP was found to be a useful tumor marker for the diagnosis and management of malignant germ cell tumors of the ovary.

[Comparative case-control analysis of gastric and duodenal ulcers]

A case-control analysis was conducted comparing gastric and duodenal ulcers involving 369 cases with gastric ulcer, 127 cases with duodenal ulcer an 3,104 control subjects based on a questionnaire survey of subjects who received gastroscopic examination at the Aichi Cancer Center Hospital from April, 1985 to March, 1989. Risk of gastric ulcer was positively associated with smoking (relative risk (RR) = 3.67, 95% confidence interval (CI): 2.63-5.13), irregular time of meals (RR = 1.39, 95% CI: 1.06-1.81) and milk intake (RR = 1.60, 95% CI: 1.25-2.04) and inversely associated with fruit intake (RR = 0.73, 95% CI: 0.57-0.95), while the risk of duodenal ulcer was positively associated with smoking (RR = 1.94, 95% CI: 1.16-3.26), a preference for foods that are not rich (RR = 1.55, 95% CI: 1.03-2.32), intake of pickled vegetables (RR = 1.76, 95% CI: 1.21-2.55) and presence of methods of diversion (RR = 1.77, 95% CI: 1.16-2.71). These results suggest that life style is involved in the etiology of both diseases and that there are some differences in the associations between both diseases.

A comparative case-control analysis of stomach cancer and atrophic gastritis

We conducted a comparative case-control analysis of stomach cancer and atrophic gastritis involving 427 cases with stomach cancer, 1414 cases with atrophic gastritis, and 3014 control subjects based on a questionnaire survey conducted for the subjects who received gastroscopic examination at Aichi Cancer Center Hospital from April 1985 to March 1989. The risk of atrophic gastritis in both males and females was not associated with any environmental factors. The risk of stomach cancer compared with the control subjects was positively associated with an intake of salted fish guts or cod roe [relative risk (RR) = 1.52, 95% confidence interval (CI) = 1.08-2.15] and smoking (RR for 20 or more cigarettes per day = 2.84; 95% CI = 1.79-4.51) and inversely associated with Western-style breakfast (RR = 0.68; 95% CI = 0.48-0.96) in males. Additionally, the risk of stomach cancer was inversely associated with a daily intake of raw vegetables (RR = 0.56; 95% CI = 0.34-0.94) in males when compared with the patients with atrophic gastritis as controls. Several environmental factors, such as intake of green-yellow vegetables, fruit, and meat, and a family history of stomach cancer, were only associated with intestinal types of cancer in females, whereas a clear difference between diffuse and intestinal types was not observed in males. The results of the present study suggest that risk factors for stomach cancer may be different from those for premalignant lesions.

Simultaneous measurement of CA 125, CA 19-9, tissue polypeptide antigen, and immunosuppressive acidic protein to predict recurrence of ovarian cancer

We studied the utility and limitations of CA 125 for the early diagnosis of recurrence of ovarian cancer and investigated whether the precision of diagnosis could be enhanced by combining CA 125 with other tumor markers. Of 181 patients with epithelial ovarian cancer, 149 were in clinical remission and 35 had developed recurrence. Thirty-four women with recurrence had preoperative CA 125 values of 35 U/mL or more, and 21 (62%) had CA 125 levels of 35 U/mL or more at the time of detection of clinical recurrence. Eleven had levels that remained elevated 3 months before identification of the recurrence. However, in 13 cases CA 125 was below 35 U/mL at the time recurrence was detected. To enhance the efficacy of tumor markers to predict recurrence, patients in whom multiple tumor markers had been measured were studied retrospectively. At the time of clinical recurrence and 3 months earlier, the diagnostic sensitivity of CA 125 alone for recurrence was 64 and 33%, respectively, whereas the sensitivity of a combination of tumor markers (CA 125, CA 19-9, tissue polypeptide antigen, and immunosuppressive acidic protein) was 89 and 66%. Thus, prediction of recurrence of ovarian cancer can be improved by the use of a combination of these tumor markers.

[Systemic hemodynamics and oxygen transport and consumption during the anhepatic phase of orthotopic liver transplantation in dogs]

During the anhepatic phase of orthotopic liver transplantation, the veno-venous bypass has been used to keep systemic hemodynamics (SHD) in a stable condition. In this study, changes of SHD and oxygen transport and consumption (OTC) during the anhepatic phase used the passive bypass (PB) with Anthron bypass tubes were compared with those used the pump-driven bypass (PDB) with a centrifugal pump in mongrel dogs. Moreover the effects of the increased instillation rate and administration of dobutamine on SHD and OTC were evaluated. The portal venous and inferior vena caval pressure were increased in PB group, but not in PDB group. Whenever PB or PDB was used, cardiac index and oxygen consumption were markedly decreased caused by hypovolemia. In PDB group trebled the instillation rate, SHD and oxygen consumption were not improved. These results suggested that the primarily cardiovascular depression during the anhepatic phase was related to the disturbance of SHD. When dobutamine was administered and the instillation rate was trebled in PDB group, SHD and OTC were maintained in a favorable state. It is concluded that PDB, administration of dobutamine and sufficient instillation are advantageous to maintain systemic hemodynamic stability during the anhepatic phase of orthotopic liver transplantation.

[Dermal anesthesia: comparison of the analgesic effects of 2% and 10% lidocaine gel patch]

The analgesic effects of aqueous gel containing 2% or 10% lidocaine with 3% glycyrrhetinic acid mono 3-0 hemiphthalate sodium as an absorption promoter were compared in two volunteer groups of 12 persons each. A round sponge (25 mm in diameter and 1mm in thickness) filled with approximately 0.3g of either gel was applied on the volar surface of the forearm and kept covered with an adhesive plastic film (Tegaderm) for two hours. The analgesic effect was assessed every 30 min by pin-prick method at five places under the coverage for two hours, and after the gel was wiped away. The result from each place was scored 0 (no pain) or 1 (needle pain). The mean pain scores at 1 hr and 1.5 hr in the 10% group were 1.0 and 0.7, and significantly lower than 2.2 and 1.3 of the 2% group (P less than 0.05). Two hour application of the gel, five volunteers in the 2% group and eight volunteers in the 10% group produced a pain score under 1.0. In these subjects, a 26 gauge needle was stuck into the skin for further pain analysis. Four of the 5 subjects in the 2% group and 7 of the 8 subjects in the 10% group did not complain of any pain. Transient local redness under the coverage was observed in 3 subjects in each group. They were all known to be sensitive to alcoholic beverages. No other side effects were found. The plasma concentration of lidocaine was lower than 0.01 microgram.ml-1 at all times.

[Indications for endoscopic treatment of early gastric cancer in the aged]

There are few data on the quality of life of patients with early gastric cancer before and after surgery or endoscopic treatment. We reported the long term effect of endoscopic laser therapy as a local curative procedure and discussed appropriate treatment of choice for early gastric cancer in the aged more than 70 years old based on the results of a comparative study of a group of 56 endoscopically treated group of patients and a group of 57 surgically treated patients. Fifty-six patients with endoscopically diagnosed early gastric cancer whose surgical risk was critical or who refused surgery were treated by either photocoagulative effect of Nd:YAG laser or photodynamic therapy with hematoporphyrin derivative and argon dye laser (PDT) or both. The efficacy (negative biopsy for cancer) of laser therapy is 73% at present. All the lesions of superficially elevated mucosal cancer less than 20mm and well demarcated flat or superficially depressed mucosal cancer less than 10 mm (10 elevated lesions, 8 flat or depressed lesions) were completely eradicated and negative for cancer on follow-up biopsy for more than 12 months. Risks of lymph-node metastasis in these lesions are reportedly negligible. Fourteen of the 56 patients (25%) treated by lasers died within 5 years after the initial therapy. Two of them died of gastric cancers too large to eradicate and were presumed to have submucosal invasion. On the other hand, 11 of 57 (19%) treated by surgery died within 5 years following surgery. One patient died from surgery and another of gastric cancer. Quality of life score did not decrease when the patients were treated by lasers but did so statistically significantly in the surgically treated group of patients. Although surgical death in the aged has decreased, death associated with surgical complications is significantly higher than with patients younger than 69 years old. Therefore, we conclude that endoscopic therapy is the treatment of choice for early gastric cancer as a local curative procedure in the aged, if they have a curable lesion as mentioned above.

[Dermal patch anesthesia to prevent pain from dermal puncture--10% lidocaine aqueous gel with 3% glycyrrhetinic acid 3-0 hemiphthalate disodium]

The clinical efficacies of 10% lidocaine aqueous gel with and without 3% glycyrrhetinic acid 3-0 hemiphthalate disodium (GAHPh) applied as a skin patch for reduction of pain from venous cannulation were evaluated in a double blind study. Twenty-four adult patients, who were scheduled for surgery under general anesthesia, gave informed consent to participate in this study. The patients were allocated randomly into two groups: one for a dermal patch GAHPh (GAHPh group) and the other for a dermal patch without GAHPh (plain group). Approximately 0.3g of either gel with or without GAHPh, soaked in a round sponge (25mm in diameter, 1mm in thickness), was applied over the selected vein on the arm and was covered with an adhesive plastic film (Tegaderm). Pain score was graded by the number of painful spots out of the 5 tests in the treated skin area. In patients with a pain score under 1, venous cannulation was carried out without an intradermal injection of a local anesthetic and pain associated with the cannulation procedure was graded by patients on a scale of 5, where 0 = no pain, 1 = little pain, 2 = moderate pain, 3 = painful, 4 = very painful. The mean application time periods were 59.3 min for the GAHPh group and 60.3 min for the plain group. Transient local redness was observed in 8 patients after removal of the gels; 3 in the GAHPh group and 5 in the plain group. The mean pain score (1.3 +/- 1.5) in the GAHPh group, was significantly lower than that (2.5 +/- 1.7) in the plain group (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Granulation tissue that developed after a minor trauma in a psoriatic patient on long-term etretinate therapy

Synthetic analogues of retinoic acid, isotretinoin in particular, are known to cause granulation tissue in the nail sulcus and healing cystic acne. We observed granulation tissue that developed in a psoriatic patient on long-term oral etretinate therapy (30 mg/day for 3 years), another synthetic analogue of retinoic acid. In August of 1988, the patient, a 44-year-old male, hit his lower leg against a wooden stick, resulting in a laceration. At that time he had relatively limited patches of psoriasis, but his skin was generally thin with telangiectasia, even in areas without psoriasis, probably due to the long-term use of oral etretinate and topical steroid. In spite of treatment with topical disinfectants and oral antibiotics, the wound progressed into granulation tissue surrounded by erythema and multiple punctate erosions with marked secretion of a clear exudate. The histological findings of the granulation tissue included the presence of proliferating microvessels and a relatively dense cell infiltration with a predominance of plasma cells on the sparse edematous connective tissue. Based on these findings, the rash was considered to be retinoid-induced granulation tissue. As compared with previous reports, our case had the following characteristics: development of rash after minor trauma, rash on the lower leg, eosinophil infiltration into the rash. We believe that long-term users of oral etretinate should be cautioned about the potential for delayed wound healing and the formation of granulation tissue.

[Assessment of the autonomic nervous activities under nitrous oxide-enflurane anesthesia by heart rate fluctuation analysis]

For numerical expression of the autonomic nervous activities during 60% nitrous oxide (N2O), enflurane (Enf) and oxygen anesthesia, heart rate fluctuations were studied in 13 female patients undergoing a laparoscopic examination. Atropine (0.5 mg im) and hydroxidine (50 mg im) were given one hour prior to induction of anesthesia with thiamylal (5 mg.kg-1 iv). Following the induction, succinylcholine (1 mg.kg-1 iv) was administered, and the trachea was intubated. Enf concentration was monitored throughout the study and expressed by the end-tidal values. An electrocardiogram in lead 2 was recorded on a magnetic tape for 3 minutes each time, before the induction of anesthesia (baseline value), during anesthesia with both 1.9% Enf and 1.0% Enf, then 5 and 20 min after tracheal extubation. These data were subjected later to computer analysis for heart rate fluctuations. At 1.9% Enf and after the skin incision, the R-R intervals and the coefficient variation of R-R interval (CV-RR) were significantly reduced to 90% (P less than 0.05) and 32% (P less than 0.01) of the baseline values respectively. A significant reduction (P less than 0.01) was also observed in both the high frequency component (HFC: 0.15-0.4 Hz) and the low frequency component (LFC: 0.05-0.15 Hz) of the power spectrum of heart rate fluctuations. The peak amplitude and the band area of the HFC were reduced to 20 and 35% of the baseline values, while those of the LFC was reduced to around 14%.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of intraperitoneal transplantation of microcarrier-attached hepatocytes on D-galactosamine-induced acute liver failure in rats

A study was conducted to investigate morphologic as well as metabolic characteristics of microcarrier-attached hepatocytes in culture, and also to evaluate the effect of intraperitoneal transplantation of the microcarrier-attached hepatocytes on acute hepatic failure in rats induced by D-galactosamine (GalN). Rat hepatocytes were isolated by collagenase perfusion, and cultured on collagen-coated microcarriers. Protein synthesis estimated by [14C] leucine incorporation was four-fold higher in microcarrier culture than in cell suspension. The rates of albumin, transthyretin and bile acid syntheses in hepatocytes cultured on microcarriers were similar to those in monolayer culture. When microcarrier-attached hepatocytes were intraperitoneally transplanted into rats with Galn-induced acute liver failure, a marked improvement in survival rate was observed as compared with control rats which received injections of microcarriers alone (80% vs 0% beyond 6 days of transplantation). Mean serum glutamate oxaloacetate transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), methionine and glucose levels were similar in both groups, while serum bilirubin and ammonia levels were lower (P less than 0.1, P less than 0.05) in rats transplanted with the microcarrier-attached hepatocytes. Immunohistochemical examinations revealed that the transplanted hepatocytes around microcarriers had albumin synthesis activity, whereas almost no albumin synthesis was demonstrated in recipient liver. In conclusion, intraperitoneal transplantation of the microcarrier-attached hepatocytes will provide sufficient metabolic support, representing detoxication of ammonia (and presumably bilirubin) and synthesis of albumin, to allow GalN-damaged liver function to restore. Microcarrier culture of isolated hepatocytes seems to be one of the most appropriate tools for an artificial liver support.

[Intraoperative intraperitoneal administration of CDDP against gastric cancer with peritoneal dissemination]

This study was undertaken in order to evaluate the effect of intraoperative intraperitoneal (i.p.) administration of CDDP on patients who underwent gastrectomy for gastric cancer with peritoneal dissemination, compared with MMC or OK-432 i.p. administration group and untreated group. The median survival time was 11 months in CDDP i.p. group (35 patients), 8 months in MMC or OK-432 Ip group (33 patients) and 7 months in untreated group (25 patients). 1- and 2-year survival rates were 30.4% and 12.1% for MMC or OK-432 i.p. group, and 28% and 8% for untreated group, while in CDDP i.p. group, the rates were higher at 46.4% and 14.7%, respectively (CDDP i.p. group vs. untreated group, p less than 0.05). In vitro chemosensitivity test by succinate dehydrogenase inhibition (SDI) test supported the clinical results. CDDP had higher sensitivities than MMC and ADM on poorly differentiated cases as well as peritoneal dissemination cases. Our results suggest that intraoperative i.p. administration of CDDP was useful for the treatment of gastric cancer with peritoneal dissemination.

[The autonomic nervous activities in man under thoracic epidural anesthesia assessed by heart rate fluctuation analysis]

The R-R intervals of an electrocardiogram, the coefficient variation of R-R intervals (CV-RR), and the power spectrum of heart rate fluctuation were studied just before surgical operations in a group of 10 patients who underwent high thoracic epidural anesthesia (TEA), and before anesthesia in a control group of 10 patients who were scheduled for general anesthesia without TEA. When TEA was performed, the CV-RR increased significantly (P less than 0.05). An increasing tendency (P less than 0.1) was also observed in the R-R intervals and the spectral analysis of the peak amplitude of the low frequency component (LFC) of 0.05 to 0.15 Hz. This tendency was found, too, in the band areas of the LFC and the high frequency component (HFC) of 0.15 to 0.4 Hz. These data indicate that the sympathetic innervation of the heart might have been interrupted by TEA and the vagal tone might have become dominant. Subsequent intravenous administration of atropine 0.5 mg reduced the R-R intervals, the CV-RR, the peak amplitude and the band areas of the LFC and HFC (P less than 0.01), as were seen in the control group. These evidences will show that the heart rate regulation of man in a supine position is dominantly influenced by the vagal tone, and it will become more prominent under TEA by blocking the cardiac sympathetic innervation at spinal level. Present study also suggests that a contribution of the cardiac sympathetic nerve on heart rate fluctuation, even on LFC, is only slight.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of adrenal metastasis of hepatocellular carcinoma effectively treated with local ethanol injection]

We experienced a case of hepatocellular carcinoma with adrenal metastasis that was effectively treated with ultrasonographically guided percutaneous ethanol injection. Effectiveness was proved by various imaging procedures and decreased serum alpha-fetoprotein. No complications during and after the treatment were deserved.

Three-year prospect of patients with common epithelial carcinoma of the ovary

In order to forecast the survival of patients, we collected 417 cases of common epithelial carcinoma of the ovary as a population for this study, then selected 141 cases who had survived more than 3 years and 131 cases who had died within 3 years as a sample of statistical inference. The sample was computerized inputting 25 factors which were obtained mainly on the first surgery. We selected 8 factors with 46 items considering their weight to forecast the prognosis on convenience. The selection of factors was carried out by following three basic principles. First, we selected factors that retained high partial correlation coefficients. Second, we selected factors which did not overlap each other in their contents. Third, we selected factors which were not decided intentionally. Accordingly, the score for forecasting the 3-year survival of patients with ovarian carcinoma was framed. The correct discrimination rate of the score when it was judged at the 0 point was 86.8% in the sample group. However, in the sample group outside the population, it was 83.1%.

[Preoperative localization of supernumerary and ectopic parathyroid glands in patients with secondary hyperparathyroidism]

The undetectable supernumerary and ectopic parathyroid glands have a high risk of persistent and recurrent hyperparathyroidism, especially in the patients with secondary hyperparathyroidism. Preoperative image diagnosis, CT scan, echogram and 201T1C1 scintigram were very useful for detecting supernumerary and ectopic parathyroid glands in our 132 patients who underwent parathyroidectomy for secondary hyperparathyroidism. Among these methods the scintigraphy showed the highest detection rate of the glands in the thymic tongue and in the upper mediastinum. CT scan showed the best detection rate of the glands located in the thyroid gland and those located between the thyroid gland and trachea. The echography was useful in detecting the glands in the thyroid gland, but could not offer easy visualization those located in the mediastinum. Even the ectopic parathyroid glands, weighing more than 500 mg were identifiable at about 90% when all the methods were applied routinely. In our experience, four patients had a supernumerary gland which was detected by the preoperative image diagnostic procedures at the initial surgery. One patient had a supernumerary gland in the mediastinum which was detected by image diagnosis after the initial operation and was removed at reoperation.