Spinal fluid enzymes activities, creatine phosphokinase (CPK), lactic dehydrogenase (LDH), glutamic oxalacetic transaminase (GOT) and glutamic pyruvic transaminase (GPT) were investigated in 22 cases of brain tumors and other neurologic disorders. The high activities in CPK and normal activities in the other were found in meningioma, multiple myeloma, porencephalia and astrocytoma grade I. CPK is present in brain tissue, especially in cerebral cortex, to a much higher level than in tumor tissue and this suggests that breakdown of cerebral cortex may play a part in the presence of the enzymes in the cerebrospinal fluid. Significant elevations of CPK, LDH and GOT activities were noted in astrocytoma grade I to II, spinal cord tumor, craniopharyngioma, malignant meningioma and benign intracranial hypertension. It supposes that the large breakdown of cerebral tissue relates the high levels of CPK, LDH and GOT activities. The great amount of high levels of LDH and GOT were seen in astrocytoma grade III to IV, chordoma, malignant choroid plexus papilloma, metastatic tumor, that related with prognosis and mortalities.
In subtentorial tumors (medulloblastoma, ependymoma) low activities were obtained in cerebrospinal fluid.
The enzymatic determination was found great applicability in the diagnosis and prognosis of brain tumors.

View full abstract

Since Australia antigen (hepatitis B antigen: HBAg) was reported by B. S. Blumberg et al, in 1964, many reports were published in its clinical applications and fundamental researches.
We studied relationships between HBAg findings and clinical features or liver functions in 30 patients with acute viral hepatitis who were admitted to our Akashi National Hospital or who visited as outpatients of our hospital, during one year from April 1973 to March 1974. Single radial immune diffusion method was used as our mesurement technique of HBAg.
In this study, HBAg-positive patients were 11 of 30 patients with acute viral hepatitis (36.7%), and 9 of 19 male patients and 2 of 11 female patients with acute viral hepatitis were HBAg-positive. It suggests that HBAg-positive hepatitis were frequently found in male than female. But there was no significant difference between the average age of patients with HBAg-positive hepatitis and negative.
There was no significant difference between HBAg-positive and negative patients, in the period of recovery of . the 26 patients healed within 6 months. The period of recovery was shorter in the patients with transient HBAg-positive, but longer in the patients with persistent HBAg-positive and with hepatitis caused of blood transfusion, and who had tendency to become chronic.
Serum GPT and serum Fe values were significantly higher in patients with HBAg-positive hepatitis than HBAg-negative, and values of serum GOT and serum bilirubin had the same tendency. But, values of serum alkaline-phosphatase had no significant difference between HBAg-negative and positive hepatitis, and the values of CCLF were more frequently positive in the patients with HBAg-negative hepatitis than HBAg-positive.

View full abstract

Since yearly increase of spontaneous pneumothorax has been reported, we reviewed, our hospital charts in which only 44 cases of spontaneous pneumothorax were experienced in last 28 years, without a tendency of yearly increase. In order to study the situation in other sanatoria, 430 cases of spontaneous pneumothorax hospitalized during the last 10 years were collected by the co-operation of 8 national sanatoria in Kinki districts. Number of cases of spontaneous pneumothorax varied in each hospital, without any relationship with the total number of hospitalized patients and population in the area for medical care. Yearly increase was noted in some area, while number of patients during the year scarcely changed in other area. In the whole Kinki area, especially during the last 5 years, spontaneous pneumothorax has definitely increased.
Among 430 cases of spontaneous pneumothorax, idiopathic pneumothorax was found in 307 and secondary pneumothorax in 123, occupying about 1/3 of cases. In 81% of these cases of secondary pneumothorax, tuberculosis was found as the basic disease. While this is partly due to the selection of the site of study at the sanatorium for tuberculosis, an important role of tuberculous disease of the lung as the background disease is suggested. More than one-half of patients with idiopathic pneumothorx were below the age of 29, while patients above the age of 50 occupied more than one-half of cases of secondary pneumothorax. Elderly patients are thus predominant in secondary pneumothorax, because pulmonary tuberculosis has become the disease of old age.
None of the patients with idiopathic spontaneous pneumothorax died, indicating favorable prognosis, while 13% of patients with secondary pneumothorax died. Patients with secondary penumothorax with tuberculosis as the background disease were therefore analyzed. High age, low pulmonary function and marked advance of tuberculous diseases appeared to be the main factors responsible for the poor prognosis of secondary pneumothorax.

View full abstract

In the past three years, we had 30 necropsies of the primary bronchogenic carcinoma. The relation between their histologic types and disseminations was studied, 30 cases consisted of nine cases of squamous cell carcinoma, 17 of adenocarcinoma and four of anaplastic carcinoma.
The direct tumor invasions were demonstrated almost equally in three types of tumors. Lymphogenous disseminations into the mediastinum and remote lymph nodes were found in rather high percentage in the adenocarcinoma and anaplastic carcinoma as compared to the squamous cell carcinoma.
Hematogenous disseminations into other organs except for the lung were found obviously in low percentage in adenocarcinoma and anaplastic carcinoma.
Our studies may suggest better methods of treatment and also may help to estimate the prognosis of each type of the bronchogenic carcinoma.

View full abstract

The diagnosis was made by endoscopic pancreatocholangiography (EPCG) in five patients with carcinoma of the body and tail of pancreas.
All the cases had been examined, before EPCG, by intravenous cholangiography (i, v. C), hypotonic duodenography and scintiscanning. Positive rate of abnormal findings, contributory to suspicion of the carcinoma, was 60 per cent in i. v. C and 100 per cent in both HDG and scans.
Based on the results obtained, these three methords seemed to be the most efficient as routine diagnostic procedures for the pancreatic tumors, especially used in combination.

View full abstract

Cancer of the pancreas is one of the most unfavorable in respect of the prognosis among cancers of the gastrointestinal tract. Especially, surgical operation of cancer evolving in the body and tail of the pancreas is highly unsuccessful and few papers have described concerning long-term survivals in Japan. The present paper is related to the postoperative course of total pancreatectomy in a patient now in good health even five and a half years after the surgical operation due to cancer of the body and tail of the pancreas. Preoperative chief complaint was epigastralgia without jaundice and the cancer cells were found in the pancreatic juice. The patient received total pancreatectomy at the Center for Adult Diseases, Osaka and was sent to the Department of Internal Medicine, Osaka-Minami National Hospital for postoperative control. The patient is satisfactorily controled with only 16 units of insulin daily (14 units in the morning and 2 units in the evening), which is lower dosage than that for severe primary diabetes. The blood sugar level shows considerable fluctuation and is apt to reach mild hypoglycemia even following low amount dosage of insulin.
Examination revealed disturbance of digestion and absorption of fat so that considerably large amount of pancreatic enzyme preparation is required. There are observed neither evidences of hyperlipemia nor other primary-diabetic alterations in the f undus, bones and others.
The patient is a 14-years-old man and still in relatively good health.

View full abstract

For the purpose of this study 76 cases (out of 205 cases from August 1968 to December 1971) of the gastric cancer administerd by MMC 40 mg or 5Fu 4, 000mg for the postoperative two months as the adjuvant chemotherapy were studied with contemporary 92 cases of control from the viewpoint of three year's survival.
On classifying according to the general rules for the gastric cancer study in surgery and pathology, no remarkable differences may be observed among the stages of I, II, and IV. In stage III cases, however, the group treated with anti-cancer drug showed the survival rate with the difference of 28% more.
The cases of stage III were respectively studied from the standpoint of different factors and it was clarified that the cases of s₂ according to the above-mentioned rule showed the effect by the administration of anti-cancer drugs.

View full abstract

In the previous report we emphasized that the occurence of this illness is not only evoked by taking Quinoform, but some other causes including biotic susceptive factors would perticipate it. In this present report we inquired 18 cases who developed by taking Quinoform for a short period of time, and we investigated the particular treatment for long-standing cases, i. e. 18 cases of continuous epidural spinal anesthesia and 13 cases of intrathecal administration of adreno-cortico steroids, and then we traced prognosis upon 123 cases.
Results obtained as follows:
1, There is occurence of SMON by taking Quinoform for a short period of time among Japanese adults, mostly received Quinoform below 1.5 Gm/day, Females are affected approximately 4 times as frequently as males, it was often found among slender type of administrator, office worker and housewife. These facts suggest there is some sort of the susceptive factors of body in participation.
2. Eighteen cases received continuous epidural spinal anesthesia as the particular treatment for long-standing cases with 2 markedly effective, 3 effective, 7 slightly effective, one obscure and 5 ineffective results. 13 cases received intrathecal adreno-cortico steroids administration with one effective, 4 slight effective, 2 obscure, 3 ineffective and 3 aggravated results.
3. Aged person used to take better course in regard to the prognosis.
4. Considering from the amount & period of Quinoform administration, the one taking Quinoform a much amount of and for long period of time showed unfavorable course in the both far advanced and mild cases, while the moderately advanced cases showed indefinite results.
5, The Quinoform administration after the onset of illness does not have so closed relationship with the prognosis. There is no apparent difference in prognosis in the equally affected cases regardless of taking Quinoform after the onset, although that may possibly be related with the difference of the age, the period of survey and the way of treatment.

View full abstract

Cystosarcoma phyllodes is one of tumors of the mammary gland which are of relatively rare occurrence. We have recently experienced two cases of this tumor, a short time period apart, which will be presented in this paper, together with some relevant data reported in literature.
Case I: a 26-years-old female with a chief complaint of indolent induration of the right breast. History of present illness: She became aware of a small induration of her right breast 2 years previously. After intercurrent child birth the hard mass rapidly grew to attain the size of a hen's egg, for which she visited us to seek help. Local findings A hen's egg-sized mass was palpable beneath the areola. The tumor was elastic in consistency, not adhering to the skin nor to the pectoralis muscles, and its surface was uneven. Local excision was performed; the excised mass measured 6 × 5 × 4cm, weighed 100g and its cut surface was greyish white in color.
Case II: a 55-years-old female whose chief complaint was a tumor of the right breast. History of present illness: About 6 years previously she became aware of a thumb's tipsized induration in her right breast, which she left untreated. The mass grew gradually then to become as large as a child's head, with spontaneous ulcer formation, just before she was seen by us. Local findings: grossly the child's head-sized tumor had a cauliflowerlike appearance with multiple frond-like masses. It was elastic in consistency, adherent to neither the skin nor pectoral is muscles, and looked like a malignant tumor. Surgery performed: simple mastectomy. Excised mass: 1, 500g in weight; cystic spaces were seen on cut surface.

View full abstract

The patient is an 8-years-old girl who was first seen at our clinic on July, 10, 1973. Since the time when she started walking, and each year, after around rainy season up to mid-October, she had a tendency to develop bullae on the sole of her feet and at present, she complains of pain in the sole of her feet occurring even while going to school by 10 minutes' walk, followed by the appearance of blisters of varying size at the same site on the next day. Also while exercising on iron poles, she easily gets blisters on her palms. These skin lesions develop where external mechanical power is exercised and usually heal up within several days without leaving a scar.
No abnormalities were noted on routine clinical and laboratory examinations. Her growth, nails, oral mucosa and sweating were all normal. Histological examination revealed that the lesions, for the most part, were located beneath the epidermis. The dermis showed telangiectasis and a slight degree of round cell infiltration.
Scrutiny of her four-generation family disclosed 12 members, 9 males and 3 females including her mother and sister, to have similar symptoms. There was no history of consanguineous marriage.

View full abstract

A primary aspergilloma of the lung is rare. Recently, a 42-years-old woman was admitted to our hospital for a coin lesion on the chest X-ray film, that revealed a welldefined mass (3.5 × 2.5×3cm) with a cavity in the right upper lobe. Bronchogram showed the obstruction of Rm, lobi superioris horizontalis. Transbronchial biopsy smears were negative for malignant cell and it's culture failed to yield any significant pathology. Inner surface of the cavity was completely covered with a squamous epithelium and the lumen was not patented to the bronchus. We are interested in this disease in the points of differentiation from a lung cancer with a cavity or cavitary other lung lesions.

View full abstract

A sixty-six-years-old parkinsonism was reported. He died of pneumonia after twenty days of admission, during which he showed many reactive signs; those were (1) gastrointestinal disturbances (nausea, vomiting, anorexia), (2) cardiovascular disturbances (postural hypotension, palpitation, dysrhythmia, flushing), (3) neurological signs (involuntary movement, dizziness, tinnitus, sweating) and (4) psychiatric signs (depressive episodes, hallucination, vivid dream, confusion, sleeplessness, somnolence). Those many signs were shown in only several days prior to admission, during which he had been treated by L-Dopa that was given for twelve months already with daily amount of 800 mgm, It was considered that these signs were not caused by the side effect of L-Dopa directly, but developed subsequent clinical signs indirectly, and many factors were involved in their production.

View full abstract