In general, drug interaction means interplay between one drug and the other drugs. Recently, attention has been drawn to the significance of interaction between drugs and
foods.
When one considers the effect of foods on drug administration, drug absorption, metabolic steps, rate of excretion and pharmacological active metabolites must be borne in mind.
In some cases, even similar drugs are differently affected by foods depending upon drug characteristics and physical and physiological properties such as irritation to stomach.
As stated above, there are various causes for the effect of food on drug administration and these causes are getting more and more complicated.
At this stage, we collected the articles about influence of foods on drugs from journals and member magazines and then they were summarized in order to guide patients to proper administration of the drugs.

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To evaluate the clinical effect of immunostimulator, the lentinan and chemotherapeutic agents were administered together in 9 patients with inoperable gastroenterological cancer (5 with hepatocellular cancer, 1 with cholangioma, 2 with pancreas cancer and 1 with advanced gastric cancer).
The ratio of OKT 4/OKT 8 was increased because of the increment of OKT 4 activity and the decrease in OKT 8 activity during lentinan administration, suggesting that lentinan might influence as a immunomodulator. The successful efficacy of treatment was found in two cases with hepatocellular cancer and advanced gastric cancer. In those cases, the activity of NK cell maintained high levels or tended to increase during lentinan administration. The activity of Leu 7 and Leu 11 was correlated with the activity of NK cell, although it was difficult to conclude which of them was more reflected to the activity of NK cell in our subjects.
In some cases with hepatocellular cancer, associated liver cirrhosis were fatal, suggesting that management of liver cirrhosis as well as treatment of cancer was important to improve the prognosis of cancer.

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We studied the effects of Marzulene-S, Glumin, Maalox, and Gentiana+Distase+Sodium Bicarbonate (1:2:6) mixture on development of acute gastric lesions induced by aspirin or water-immersion stress in rats. All drugs except Marzulene-S given p. o. for 1 week dose-dependently inhibited the development of gastric lesions induced by aspirin (300mg/kg, p. o. pH 2.0). However, all drugs inhibited the development of gastric lesions when they were given 30min, before aspirin administration or water-immersion stress. The rats were given the drugs for 1 week and they were fasten for 30 hours. In this experiment, the pH of rat's gastric mucosa was changed from 5.0 to 2.0. This acidification of pH was prevented by PGE₁ 100μg/kg p. o., which was rapidly administered. The absorption of aspirin was not significantly influenced by these drugs.
These results suggest that these drugs have protective effect on gastric mucosa, but that acid rebound develops after discontinuing administration of the drugs, which is prevented by PGE₁.

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Of the 840 patients who underwent operation under a diagnosis of cholelithiasis during a 7-year period from January 1981 to December 1987, 149 patients (17.73%) consisting of 62 males and 87 females were aged 70 years or above. Seventeen were 80 years old or above with a 91-year-old male being the oldest. Stones were found only in the gallbladder in 84 (56.37%) and in both the gallbladder and intrahepatic and extrahepatic bile ducts in 52 (34.89%). The remaining 13 (8.72%) had cholecystitis without stones. Pigmented stones such as black stones and bilirubin stones were observed frequently.
Bile collected during the operation was positive for bacterial infection in 59.84%. Although Gram-negative bacilli such as E. coil and Klebsiella were predominant, Grampositive bacteria such as Streptococcus has become common in recent years.
In these patients, cholelithiasis was often complicated by cancers of the stomach, biliary tract and colon, and the high incidences of background diseases involving other organs as well as biliary complications were considered to increase the risk of operation.

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From 1980 to 1986, at the department of surgery, Zentsuji National Hospital, 11 patients with solitary abscess of the liver underwent surgical treatment. Four cases of them were amebic, 6 cases were pyogenic and one was tuberculosis in etiology.
A case of tuberculosis underwent dorsal segmental resection.
About 4 amebic cases, ages of the patient ranged from 53 to 78. All of them were male. Two patients underwent emergency surgical treatment because of rupture of the abscess. Three patients had a past history of amebic dysentery. The right lobe was involved in 3 patiente and left lobe in one. One patient extended to thoracic amebiasis but recovered with antiamebic drugs (Metronidazole). Only one ruptured case of 78 years old associated with CML died on the 17th postoperative day.
About 6 pyogenic cases, the ages ranged from 36 to 84. They were 3 males and 3 females. The causes of liver abscess were unknown or cryptogenic in 3 patients, the infection of biliary tract in 2 patients and the spreading from the portal vein system was strongly suspected in one. The location of the lesion in the liver was right in 5 patients, left in one. Klebsiella was observed in 5 of 6 patients by bacteriological examination and 3 patients had septicemia. One patient underwent PTCD, the other 5 underwent drainage primarily by transabdominal approach. All 6 patients recovered and were alive.

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To study the clinical significance of HBeAg seroconversion, we determined blood HBV markers in anti-HBe positive hepatic diseases. 1) In 19 cases of B-type acute hepatitis in which HBsAg had become negative, the anti-HBc antibody level according to the IAHA method was 2¹⁰ or below in all these cases. Thus, if judgement is only based on HBsAg and anti-HBc, HBsAg negative and anti-HBc below 2¹⁰ would be criteria for judging a cure. 2) On the other hand, in 55 cases of chronic hepatitis positive for anti-HBe, there were 23 cases (41.8%) positive for HBsAg and with an anti-HBc antibody titre above 2¹¹. Of 38 cases with cirrhosis of the liver, 11 cases (28.9%) showed similar findings and it was assumed that these cases had not been cured of HBV infection. 3) Therefore, in 23 cases with HBe antibody positive chronic hepatitis, when DNA-P and HBV-DNA were determined, only one case (4.3%) was positive for both these factors, but 7 cases (30.4%) were positive only for HBV-DNA. 4) Following seroconversion, in 3 cases of anti-HBe continuously positive chronic hapatitis for at least 3.5 years, a rise in transaminase was observed repeatedly 4 or 5 times and in each of these cases, the anti-HBc titre was high and transient positive periods of HBV-DNA and DNA-P were also observed. From the above facts, if anti-HBe is positive and HBV-DNA or DNA-P become negative, this alone cannot be a basis for judging a cure. For judging a cure of HBV infection, the HBsAg must become negative and the anti-HBc must become negative and their titres must be lower than 2¹⁰.

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The clinical and pathologic characteristics of colorectal cancer in patients younger than 40 years were compared with those in patients over 75 years of age.
The number of cases of colorectal cancer who underwent operation was 1007 from 1965 to 1986. The younger group represented 72 cases (7.1%) and the elderly one represented 93 cases (9.2%). In both groups the male were affected predominantly by colorectal cancer. The incidence of the right colon cancer was higher in the elderly group. The stage of the tumor at the operation had no significant differences between the two groups. The other associated neoplasms were common in the elderly patients and the incidence of stomach cancer was the highest. Though the incidence of the association of adenomas was higher in the elderly group, the incidence of multiple carcinoma of colon and rectum was not different between the two groups. This fact suggested that adenoma of the elderly case had low malignant potential. Macroscopic appearance of the tumor demonstrated no significant differences.
The incidence of highly differentiated adenocarcinoma was most common in both groups. The rate of the curative operation was almost the same. The survival rate of the two groups increased by the curative operation and this result suggested that the surgical treatment was effective. Peritoneal dissemination was the common cause of non-curative or palliative resection in the younger cases. The colorectal cancer of them had a tendency to extend rapidly comparing with that of the elderly cases because the several factors of noncurative or palliative resection were found in one patient.

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Esophageal leiomyoma is a relatively uncommon disease. It usually originates from the middle or the lower portion of the esophagus, and it is quite rare originating from the esophago-cardial junction (ECJ).
We experienced two cases of esophageal leiomyoma originating from the ECJ and the lower esophagus respectively, and they were both successfully polypectomized under endoscopy.
Case 1 was a 57-year-old male patient, who was admitted with chief complaint of hematemesis. On endoscopy a small and yellowish polyp was found on the esophageal side of the ECJ besides acute gastric ulcer, which was successfully polypectomized under endoscopy. Case 2 was a 52-year-old male patient, who was found to have a polyp in the lower esophagus and admitted for the polypectomy. Polypectomy was smoothly performed without any complications.
The esophageal leiomyoma is a relatively uncommon disease. It is very rare in the ECJ and only 24 cases have been reported till now. It is clinically important to perform elective polypectomy for the esophageal submucosal tumor such as leiomyoma. Thus, we report here two cases with some bibliographic considerations.

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A Case of repeated massive bleeding from leiomyoblastoma of the stomach is reported. A 60-year-old man was referred to our hospital because of massive bleeding from submucosal tumor of the stomach. Endoscopically hen's egg sized gastric submucosal tumor was found in the lesser curvature of the antrum and bleeding was found from small holes in the tumor.
We performed partial gastrectomy. A 12×6×5cm size tumor exsisted in the lesser curvature of the antrum and developed exogastric space. Lymphonode swelling and remote metastasis was not found. The tumor was solid combined with partially blood-clot change and had septa. Histologically it was made up of round or polygonal cells. The each nucleus was surrounded by eosinophilic cytoplasma and by a peripheral clear halo.
It is generally accepted the majority of leiomyoblastomas have a benign clinical course. The clinical and pathophysiological characteristics including 160 cases reported in Japan were reviewed.

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The authors report a case of cholecystectomy in a non-typhoid salmonella carrier.
Salmonella sp(1) serovar Give was detected from feces in a 51-year-old male patient. The administration of antibiotics for 22 months the disease failed to cure. Ultrasonography revealed gall stones and salmonella sp (1) serovar Give was detected in bile and gall stones. The patient underwent cholecystectomy and postoperative administration of antibiotics were performed. Salmonella in feces became negative for 12 months after the treatment.
In conclusion, the excision of gall stones by cholecystectomy and the administration of antibiotics are thought to be necessary in the treatment of non-typhoid salmonella carriers as well as typhoid and paratyphoid carriers.

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Bacteriological studies were carried out for middle ear effusions (MEEs) in patients diagnosed as having otitis media with effusion (OME). A total of 133 specimens of MEEs taken by myringotomy from 104 children were studied and the following results were obtained.
1) Microorganisms were isolated from 43 MEEs (32.3%); 22 (16.5%) were pathogenic and 21 non-pathogenic. The most common bacteria isolated was coagulase negative staphylococcus and the second common was H. influenzae.
2) Three frequent pathogens (H. influenzae, S. aureus, and S. pneumoniae) were fairly sensitive to eight antibiotics tested.
3) The cases treated by antibiotics for upper respiratory tract infection (URI) within a month showed high incidence of bacteria positive MEE. This suggested that URI was involved at the onset of OME and that bacteria in middle ear was not easily sterilized by a short-term administration of antibiotics.
4) Recurrence of MEE was frequently encountered in the cases with bacteria-positive MEE upon examination one month after the myringotomy.
5) It is concluded that microorganisms may play an important role in the pathogenesis of onset of, as well as delayed recovery from OME in children.

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Neuroleptic Malignant Syndrome (NMS) is the most severe complication of antipsychotic drug treatment, characterized by hyperpyrexia, extrapyramidal symptoms and autonomic dysfunction. However, its clinical criteria and treatment have not been established. We made 8 items of nquiries about NMS to all psychiatric hospitals in Japan. Of 1455 hospitals 836 (57.5%) answered the questionnaires. Most of them were interested in NMS (97.6%). and have already known the clinical features of NMS (95.1%), and also recently read the articles of NMS (76.4%). More than half of them knew the case report of NMS induced by antidepressants and the treatment with dantrolene or bromocriptine. Of these 836 hospitals 576 (68.9%) experienced NMS. The number of typical cases was 919, and that of imcomplete cases was 747.

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A case of adrenocortical carcinoma in a 45-year-old woman is reported. Hypertension and hypokalemia were observed and serum hormonal analysis demonstrated high level of aldosterone. Computed tomography showed the large mass of left adrenal gland. Complete resection of the tumor weighing 470gm was carried out. She has been showing no evidence of recurrences one year after the operation.

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A case of giant aneurysm associated with persistent primitive trigeminal artery (PTA) was reported. A 66-year-old man was admitted because of gait disturbances. Cerebral angiography demonstrated giant aneurysm of left internal cerebral artery (C2) and PTA (C4). Computed tomography (CT) revealed high density in the left frontal lobe. The authors discussed the pathogenesis and inferred that the genetic abnormality at the stage of development of cerebral vessels could play one part of the formation of aneurysms, because of the fact that the cerebrovascular anomalies showed high incidence of coexistence of aneurysms.
A CT scan gave us many new information for cerebral giant aneurysm, such as, the true size of aneurysm, calcification of wall and thrombosis of cavity.

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A case of traumatic cerebral arterial spasm presenting with left hemiparesis which developed 13 days after head injury is reported.
A sixty-eight year old man fell from upstairs and was struck on the head. He was admitted to our hospital on the next day. Neurologically, he showed disorientation. A CT-scan on admission revealed traumatic subarachnoid hemorrhage in the interhemisphere, the right sylvian fissure and the right ambient cistern. Carotid angiography performed 7 days after head injury demonstrated diffuse narrowing of bilateral anterior and middle cerebral arteries, and narrowing of supraclinoid portion of left internal carotid artery. The patient developed left hemiparesis 13 days after the head injury, and a CT-scan taken on the 14th day showed low density area in the right frontal lobe. Right carotid angiography 32 days after head injury showed segmental narrowing of the right anterior cerebral artery, however, findings of diffuse narrowing was improved. Bilateral carotid angiography taken 122 days after the accident showed no arterial narrowing. Considering these angiographical findings, the patient seemed to develop ischemic symptoms due to traumatic delayed cerebral arterial spasm. Traumatic subarachnoid hemorrhage and mechanical irritation to cerebral arteries may play an important role in the pathogenesis of such a delayed arterial spasm.

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A 43 year old female with a tumor in her right breast underwent acupuncture for this tumor. Since then, the tumor increased in size. When she came to our hospital 4 months after the acupuncture, a tumor of 12×12cm was identified in the lateral side of her right breast. The tumor showed a large hematoma and the histopathological study revealed mucinous adenocarcinoma. So she underwent a right standard radical mastectomy, and was disease-free for 17 months after the operation.

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