Cerebral radionuclide angiography (RNA) and blood flow scintigraphy using emission CT (ECT) procedure with approximately 15 mCi of Tc-99m-HM-PAO (PAO)were evaluated in a total of 51 patients with ischemic cerebrovascular disease. These image findings were compared with each other or with the other findings on contrast angiography, X-ray CT, conventional RNA with 20 mCi of Tc-99m-DTPA, and conventional ECT with 3 mCi of I-123-IMP carried out about the same time in 31, 51, 15, and 12 patients, respectively.
RNA perfomed immediately after a venous injection of PAO was able to show the findings of carotid flow and cerebral perfusion, which were compatible with those on contrast angiography. And, RNA suggested a high clinical efficacy for diagnosing the etiology and condition of the disease, for example, an occlusion of the internal carotid artery and a decreased cerebral perfusion with some collateral flow, respectively. However, RNA was inferior to conventional RNA in its ability to detect a mild collateral perfusion.
ECT was superior to X-ray CT except for lacunar infarction and similar to conventional ECT for diagnosing a mild cerebral ischemia, while ECT with PAO was inferior to conventional ECT in image quality. And, ECT with PAO had a tendency to show the ischemic focus visualized as a cold area to be somewhat smaller than that detected by conventionalECT. However, ECT with PAO was apparently advantageous to conventional ECT in responsibility for emergency and rapidity for imaging.
These results suggest that RNA with PAO prior to ECT has some clinical efficacy complementary to ECT, and ECT with PAO is almost similar to conventional ECT in overall clinical usefulness.

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An auditory discrimination task was applied to elicit the P300 component of the eventrelated potentials in the two groups of cerebrovascular patients both with and without dementia. Results were compared to those from normal subjects. A sequence of tones of two different frequencies (1600Hz and 800Hz) was used. A patient was required to press a button as quickly as possible when he percepted the rare tone (p=0.2) in the sequence. Evoked potential waveforms were averaged separately for the rare and frequent tone, and single trial waveforms for the rare tone were also recorded.
The patients with dementia had significantly greater intra-subject variability of P300 latency and smaller P300 amplitude than the normal controls. Mean reaction time was prolonged in the patients with dementia. In the single trial analysis, the patients with dementia demonstrated a smaller single trial P300/reaction time correlations than that in the normal controls.
These results suggest that prolongation of P300 latency in the patients with dementia is mainly due to damage in the part of stimulus identification and also impairing of coupling ‘stimulus identification’ with ‘response execution’ could produce the delay of reaciton time.

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Eight patients with senile dementia were urged to take their places at table while they were exposed to the music A (Fine Kleine Nachtmusik by Mozart) before lunch. This procedure was done for 3 months.
Then two series of experiments were carried out. In the first series the EEGs during listening to the music A were compared with those at rest. In the second series the EEGs during listening to the music B (Zigeunerweisen by Sarasate) were compared with those at rest. The EEGs were recorded in a laboratory room and analyzed by the FFT method.
A significant decrease in theta wave in the right hemisphere was found (p<0.05) during listening to music A more than at rest. On the other hand a significant increase in the theta wave in the occipital region was found (p<0.05) during listening to the music B more than at rest.

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Evaluation of sociability by the social behavior schedule was performed in 48 long-term inmate females with intractable schizophrenics at the Shimofusa National Sanatorium, and the following conclusion was reached as reported here. The schedule was further classified into the five categories: (A) social interchange, (B) emotional disorder, (C) queer behavior, (D) problem behavior, (E) activity disorder, and (F) total score. Cases of adapta tion difficulty were classified into several types by producing profiles for the respective categories. Twelve types were obtained by giving capital letters to severe depression and small letters to minor depression. Capital letters were given at a very high rate implying that many of the patients were unable to live outside the institution. The rates were the highest for types AE and aE at 22.9 and 20, 8% respectively. Despite the fact that these patients represent only a small number of intractable cases among the schizophrenia population, psychiatrists will be responsible for enriching their life qualitatively and showing them a way of life worth living.

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In cases of obstructive jaundice, it is very important for the patient to restore the bile that was taken out by percutaneous transhepatic cholangial drainage. But it is difficult for the patient to take the bile, because it has characteristic stenchs and bitter tastes.
Then we collected the bile, concentrated it with rotating evaporator under reducing condition for 15 hours at 37°C±3°C. After powdering it, corn starch was added, then it was administered to the patient with a wafer.
Consequently we were able to solve the problems such as stenchs_ and bitter tastes in all of the 8 cases. And investigating the clinical effects of 2 of the 8 cases, we found that they improved the clinical symptoms such as malaise and the liver function in both cases.

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We studied the efficacy and safety of the recombinant HB vaccine prepared from Chinese hamster ovary cells in 52 healthy volunteers who were negative for HBsAg and HBsAb, 10 males and 42 females, the mean (±SD) age was 35.2±9.4 years old (range, 18 to 57). They were grouped by subcutaneous and intramuscular injections and received three doses of the vaccine (10μg each), at 0.1 and 6 months. HBs antibody was induced in 48 (92%) out of 52 subjects at the 4th week after the third vaccination. There was no significant difference in positive rate of HBs antibody between subcutaneous and intramuscular groups. Slight adverse effects were seen in 30 occasions (15.4%) out of 159 injections.
Thus, immunization of this HB vaccine appeared to be useful and safe, if compared wtih the plasma-derived HB vaccine.

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A new method for a selective or superselective angiography devised by us was attempted to the clinical evaluation. The catheterization was performed through the brachial artery instead of the femoral route using a long, soft and slender catheter led to the target artery with a guidewire. DSA-apparatus was applied in order to obtain the high resolution images by the injection of a small quantity of contrast media with resulting little adverse reactions. This procedure was named TB-SDSA (Trans Brachial Selective Digital Subtraction Angiography.)
The insertion of a catheter into the target artery was technically achieved in 97.5% of 80 examinations in 29 patients with hepatoma by this procedure and in failed two by transfemoral, In this series hepatoma recognized as definite darker stains was found in 27 patients. In eleven out of the 27, small solitary or multiple tumors with diameter less than 1 cm were confirmed and all of these were undetected by a routine CT and US. It was considered to be metastatic focuses in the nine patients and primary in the two of the 11 patients.
Serious complications such as bleeding from the catheter punctured arteries, hypotension, discomforts or the others were not experienced in outpatients as well as in inpatients. No patients refused the re-examination even at short intervals because of minimal side effects, restoration of full activities after the operation and lack of the mental repugnance against the trans-femoral catheterization.
These advantages enabled us to repeat the examination, TAB-treatment and infusion of drugs into the target artery.
The TB-SDSA is believed to be very useful in the examinations, especially the early detection and treatment of hepatoma.

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The prognosis of renal cell carcinoma is one of the worst in the urological area due to the difficulty in its early detection and an immediate metastasis as well as the lack of effective treatment except surgery.
We conducted clinical observations and collected statistics on twenty-three patients who were admitted to the Atami National Hospital in the past eleven years (1975-1986) and were histologically diagnosed as renal cell carcinoma. We also analyzed both clinical and pathological factors relative to the prognosis. The results of this study were summarized as follows.
The observations included sixteen male and seven female patients aged between fortynine and eighty with the average age of sixty-four years old. The actual one-year survival rate was 907%, the three-year 78.9% and the five-year 70, 2%. Among the clinical factors, i. e. sex, clinical symptoms, ESR, α₂-globulin and the weight of tumor, only ESR; α₂-globulin and weight of tumor were found to be statistically significant factors influencing the prognosis.
As to the pathological factors, we evaluated stageg, rade and cell type. The stage was the only factor influencing prognosis. The survival rate was 75.0% for stage 1, 45.7% for stage 2 and all patients at stage 3 and 4 died within four years. It was clear that the prognosis became worse as the stage advanced.
By grade classification, the five-year survival rate among grade 1 patients was 83.3%, grade 2 33.3% and grade 3 71.4%. Although the survival rate of the grade 2 was markedly low, it was not statistically significant. Consequently we found no clear correlation between the pathological grade classification and the prognosis.

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Of a total of 1, 051 cases of primary breast cancer operated on in the Shikoku Natioal Cancer Center Hospital during a period of 20 years from 1967 through 1986, those cases of discord between prognostic factors for breast cancer (histological lymphnodal metastasis and tumor size) and the clinical course were clinicopathologically examined with respect to other factors.
Of 504 n₀ cases (excepting cases of T₄) with presumed good prognosis. 60 cases of recurrence (no recurrent group) were examined comparatively with 448 cases of the n₀ non-recurrent group.
Of 194 cases comprising those of a high degree of lymphonodal metastasis (more than 8 points of axillary lymphonodal metastasis or positive subclavian lymphnodal metastasis) and those of T₄, 61 cases without recurrence for more than 3 years (non-recurrent advanced cancer group) were examined comparatively with 133 cases of the recurrent advanced cancer group.
The following results were obtained. Compared with the non-recurrent group, the n₀ recurrent group showed, at a high frequency, pathohistological prognostic factors (histological type, degree of spreading, degree of heteromorphism, mode of infiltrating proliferation, degree of lymphatic invasion) of a high degree of malignancy, suggesting necessary postoperative supplementary therapy for such cases of even n₀.
For cases of advanced cancer, no definite difference in pathohistological factors was observed between both these groups, making it impossible to extract these factors. This was regarded as being ascribable to the effect of the positive supplementary therapy including preoperative arterial infusion.

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Three hundred and fifty-five kidney specimens obtained from diabetic patients were studied to elucidate the role of mesangiolysis on the process of diabetic nodule formation. Mesangiolyses were found in 56 specimens. These were characterized by focal and segmental dissociation of mesangial matrix, and classified into three phases; “tornoff phase”, “structureless phase” and “re-constructive phase”. Mesangiolyses initially appeared as dissociation of the pivotal structure of the mesangium, and then consecutively transformed into the diabetic nodular lesions through the above three phases. As the grade of the diffuse lesion and of arteriolosclerosis advanced, the prevalence of mesangiolyses and nodular lesions became significantly higher. The grades of diffuse lesions in the specimens with both mesangiolyses and nodular lesions were significantly higher than those in the specimens with mesangiolyses but without nodular lesions. On the other hand, the grades of arterioloscleroses were equally high both in the specimens with mesangiolyses and nodular lesions and in the specimens with mesangiolyses but without nodular lesions. Based on these results, we conclude that 1) the mesangiolysis consecutively transformed into the nodular lesion, 2) presence of moderate to severe diffuse lesion was essential for transformation of the mesangiolysis to the nodular lesion and 3) the mesangiolysis might be a consequence of glomerular ischemia caused by arteriolosclerosis.

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Recently operations for colorectal cancer have been performed more frequently and the number of ostomy patients have been increasing. We investigated the present situation of stomatherapy using questionnaires in national hospitals during the period of 1975 to 1986.
The total number of operations was 236451 and 12767 cases were those of colorectal cancer.
There were 6135 ostomy patients and those with colostomy formed 96.7 per cent. According to the classification of the structure of the stoma, the rate of the single-barelled colostomy was 66.3 per cent. The rate of permanent colostomy was 80.0 per cent and this result suggested the importance of the care after hospitalization. About 70 per cent of ostomy patients were operated on because of colorectal cancer.
In the majority of the hospitals the method of stoma was primarily opened and mucosaleverted colostomy with an extraperitoneal technique.
In only about 30 per cent of the hospitals, enterostomal therapists and workers educated the patients about stoma management.
These results suggest that the standard operative technique of the stoma is performed in most hospitals but the management of ostomy patients after discharge is nots, ufficient.

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During the past two years (1985-1986) the members of our group have clinically analyzed and examined 343 cases treated with blood products in hospitals of the members of our group. Taking the results of this clinical analysis and examination into account, we made recommendations regarding appropriate use of plasma products.

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A 63 year old male with an advanced gastric cancer (Borrmann type 2) was treated by endoscopic direct injection of OK-432. The case was inoperable due to respiratory dysfunction caused by old pulmonary tuberculosis. OK-432 (10 KE) was directly injected into thet umor endoscopically every one or two weeks for the duration of six months. Although cancer tumor and crater disappeared and no cancer cells could be detected in biopsy specimen, endoscopic ultrasonography revealed residual submucosal cancer. The same protocol was continued for another six months and the submucosal cancer subsided. Additional endoscopic administration of OK-432 was continued for another one year. We discontinued the treatment after 75 times of direct injection (total dose of 750 KE). It is already more than three years after the initiation of the treatment, the patient is alive without no evidence of recurrence or metastasis.

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Diffuse infiltrative carcinoma of the colon is rare and it has several problems in its diagnosis, growth, extention, and prognosis. The majority of this disease is metastasis from the carcinoma of stomach, breast and prostate, and the cases in which the colon is primary is especially rare. This is a case report of the diffuse infiltrative carcinoma of the sigmoid colon.
Forty-three-year-old man was admitted because of abdominal pain, abdominal distension, tenesmus and bloody stool for about 1.5 months.
A stenotic area as long as 16 cm between descending and sigmoid colon was seen and diffuse infiltrative carcinoma of the sigmoid colon was suspected by barium enema. Endo
scopic study revealed the stricture of sigmoid colon at about 50 cm from anal verge. The findings of cancer was not demonstrated in the biopsy specimen taken from the anal side of the stricture. A tentative diagnosis of carcinoma of the colon was made and a part of the descending and sigmoid colon was resected.
Histologically, there was a diffuse cancerous invasion with a predominant pattern of poorly differentiated adenocarcinoma accompanied with remarkable invasion to the lymphatic vessels through the entire wall below the submucosal layer.

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We report an autopsy case of cancer of the pancreas accompanied with insulin-dependent diabetes mellitus (IDDM) which mainly showed direct metastasis to other organs.
A 56-year-old man was admitted because of edema and ascites with IDDM for the past 2 years. The patient complained of lancinating pain on his left back.
After 2 months, obstructive jaundice and acholic stools were recognized, and he died by bleeding of digestive organs.
Autopsy findings showed that the body and tail of the pancreas was replaced by adenocancer cells and the cancer infiltrated to the head of the pancreas resulting in obstructive jaundice. Tumor embolism in the portal vein was the cause of ascites. We think that diabetes mellitus in the middle age must be carefully examined to rule out pancreatic cancer.

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Obturator hernias are relatively rare but the symptoms of small bowel obstruction may develop and a resection of the small bowel as an emergency operation is often required. Since the advanced age group are more commonly affected, the operative mortality rate is high. We experienced one case of obturator hernia showing typical Howship-Romberg symptoms. At the emergency operation, the ileal loop was found to be incarcerated into the left obturator canal, and the incarceration was completely repaired without any bowel resection. With the anticipated aging of the Japanese population, the incidence of this abnormality is expected to increase. Early diagnosis and early treatment are therefore extremely important in the management of this abnormality.

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Torsion of the gallbladder was described in 1898 by Wendel, and is a relatively rare condition. It is more often found in elderly female patients. We present two cases of complete torsion of the gallbladder and one case of incomplete torsion of the gallbladder treated at our hospital.
Case 1: An 85-year-old woman complaining of right hypochondralgia with a high fever and vomiting was admitted to our hospital. An abdominal examination revealed localized tenderness and fullness in the right abdomen without guarding and rebound tenderness. Ultrasonography revealed a large cystic mass with a thickened wall in the right abdominal cavity. The presumptive diagnosis was acute cholecystitis or periappendicular abscess. The patient was operated on 64 hours later. The bladder exhibited a 180° counterclockwise rotation with complete gangrene. The gallbladder was attached to the liver by a narrow mesentery at its neck. After derotation, cholecystectomy was performed. No gallstones were found inside the gallbladder.
Case 2: A 69-year-old man suffering from right hypochondralgia with nausea and vomiting after the second postoperative day since he had undergone a radical operation for a left indirect inguinal hernia. A physical examination revealed localized tenderness in the right upper quadrant with rebound tenderness. Ultrasonography demonstrated a distended gallbladder with a thickened wall. From our experience of case 1, we suspected the lesion was torsion of the gallbladder. At operation, gangrenous gallbladder suspended only by a narrow mobile mesentery. The gallbladder had rotated 360° counterclockwise. Detorsion of the gallbladder was performed, followed by cholecystectomy. No gallstones were found inside the gallbladder.
Case 3: A 43-year-old man was admitted to our hospital with acute upper abdominal pain and vomiting. An abdominal examination revealed localized tenderness in the right upper quadrant without guarding and rebound tenderness. Subjective pain increased at the right decubitus position and upright position. Tenderness in the right upper quadrant shifted to the medial side at the left decubitus position. DIC showed ptosis and easy mobility of the gallbladder with posture changes. A few transient attacks subsided spontaneously. The presumptive diagnosis was incomplete torsion of the gallbladder. At operation, normal gallbladder suspended only by narrow mesentery. Cholecystectomy was performed. The postoperative course was satisfactory.
The possible predisposing factors of this disease include congenital anomalies of the gallbladder (floating gallbladder), visceroptosis and kyphosis. It has been considered difficult to make a preoperative diagnosis of this disease. If an elderly woman with kyphosis has signs and symptoms of acute cholecystitis, we can strongly suspect that she may be suffering from torsion of the gallbladder. An abdominal ultrasonic tomography may be a very useful means to diagnose this disease, if itreveals dilatation of the gallbladder with an narrowing of the neck as in case 1.

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A case of severely handicapped boy with tracheomalacia is reported. He was admitted to our institution at the age of 3 years and 4 months because of severe psychomotor retardation. At the age of 12 years and 7 months, an episode of stridor and dyspnea was seen at first and developed following several years. These episodes were thought as “laryngospasms” due to unknown origin untill the extreme collapse of the trachea was endoscopically revealed 5 years later. It was well controlled by a tracheostomy done with use of cannulation, but succumbed to sudden tracheal bleeding 10 months following the procedure.
The etiology of the tracheomalacia was suggested to be the weakness of the airway wall caused by recurrent laryngospasms, the cause of which remained to be searched thereafter.
It is necessary to recognize such an airway disorder as one of those factors which may lead a handicapped child to critical condition.

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Eight patients with bone and joint tuberculosis were seen in Sendai National Hospital during the last 3 years. Lesions of the disease were located at spine in 3, hip joint in 2, greater trochanter in 2 and metacarpalphalangeal joint in 1. The age of the 8 patients was almost over 50 years ranging from 32 to 71 years of age.
Tuberculosis were suspected before their visit to our hospital in only 3 caces of the 8 and the remaining 5 were diagnosed as tumor in 2, as osteomyelitis in 2 and as spinal degeneration in 1. In laboratory examinations, the erythrocyte sedimentation rate was highly elevated and the tuberculin skin test was positive in our series. The fluid obtained from the lesions was positive for Mycobacterium tuberculosis in 4 of 7 patients. The histologic findings of the operation samples suggested tuberculosis in 6 of 7 patients.
Treatment by minor surgery combined with antituberculous drugs resulted in recurrent infection.
To prevent the recurrent infection and the prolonged treatment, we believe that operation should be followed by radical debridement of caseous tissue.

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Specially-made, self-prepared insulin-sugar ointment (ISO), containing 4 units/gram weight of actrapid insulin, commercially available sugar (40% of total ointment) and hydrophylic macrogol was applied to the decubital and plantal ulcers of seven patients with leprosy.
During the fourteen months' period of the trial (from April 1986 to July 1987), we had four cases with excellent improvement, two with fair improvement and one discontinued case because of no effect. The mean period required for the complete healing of lesions was 11.8 weeks and the shortest one was 4 weeks. At least, through our experience, no troubles like infections, worsening of the lesions and so on occurred.
In conclusion, ISO is effective against plantal and decubital ulcers and is also easy for preparation.

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