In Patients with multiple injuries where there is head involvement, it is sometimes not possible to make a precise neurological diagnosis. Intracranial changes taking place while non-cranial surgery is in progress under general anesthesia are particularly difficult to gauge accurately. The usefulness of continuous measurement of the intracranial pressure (ICP) and the cerebral perfusion pressure (CPP) was studied in 15 cases in which noncranial surgery was performed for multiple injuries with head involvement.
Marked ICP rises of over 35mmHg were noted during surgery in four cases. In seven patients who entered a state of shock, four were seen to have very low CPPs of 30mmHg or less. It was impossible to predict these symptoms from the patient's state of consciousness and the CT findings at the time of presentation at the hospital.
Shock frequently accompanies multiple injury, and when it does occur, even a mild degree of ICP elevation may be followed by a substantial reduction in the CPP. It is therefore risky to perform surgery in cases of this kind without monitoring the ICP and CPP, and we believe that ICP and CPP monitoring is quite essential in patients who are in shock or have CT findings.

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The authors investigated psychiatric aspects of leprosy in patients in Oku Komyoen National Sanatorium. The results were as follows: The subjects consisted of 301 males and 200 females with the mean age of 66.4 years.
About 87% of the subjects were complicated with somatic diseases other than leprosy. Ocular disease was the most common, followed by gastrointestinal disease and neuralgia. ADL was not impaired in 82.6% of the total subjects. This trend was better than those of the demented in the community and of the aged at nursing-homes.
By using Karasawa's scale to delineate the degree of mental senility, intellectual impairment, mostly mild, was observed in 18.2% of the total subjects. The combined prevalence of moderate and severe dementia was 7.7% of the subjects aged over 60 by the method of Mental Status Questionnaire. This rate was lower as compared with the figure at nursing-homes, but higher than that in the community previously reported by other investigators.
Psychiatric symptoms were observed in 18.0% of the subjects, and hypochondriasis was the most common, followed by sleep disturbance and depression. In order to determine the causative factors of psychiatric disturbunces, a further socio-psychological study remains to be done.

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Since there are many problems in the pathogenesis of postmenopausal or senile osteoporosis, we think it necessary to distinguish the L-group (below 8.4 KAU) from the Hgroup (over 8.5 KAU) by serum Al-p levels. The reactions of the L-group and H-group to treatment of osteoporosis, including the widely used treatment by active vitamin D (α-D₃), is expected to be different. We observed 75 osteoporotic patients (control group, 10; α-D₃ group, 42; α-D₃+ calcium, 23) by means of serum Al-p and calcium, and MD method.
Since all parameters in the α-D₃ treated group, except for MCI of MD method, were of significantly higher values than those in the control group, the utility of α-D₃ has been demonstrated. A one-year follow-up of the treated group showed a significant decrease in serum Al-p levels, but almost no changes in serum calcium levels. Regarding the means of treatment, for the L-group, a combination method of α-D₃ (1μg/day) and Calactate (3-6g) was effective. On the other hand, independent use of α-D₃ for the H-group was recommended, rather than a combined use, because of the risk of hypercalcemia due to calcium supplements.

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Polyamines are low molecular weight hydrocarbons with several amino groups.
Clinical studies have shown that the concentrations of polyamines are increased in the blood and urine of patients with malignancy. However, conventional methods of polyamine assay encountered with various problems. To overcome these difficulties an enzymatic method was developed. We report here an evaluation of this method.
Linear responses of the calibration solutions of putrescine, spermidine and cadaverine ranged from 28 to 300μmol/l. Within-run precision (CV) of this method ranged from 4.0 to 1.8%; day to day CV varied between 3.8 and 3.5%. Effect of storage of the urine specimens on polyamines was also studied. Little variation in the value of polyamine was noted between 24-hr urine and an aliquot urine, when the amount of polyamine was expressed per g of creatinine. The mean level of urinary polyamine in normal subjects was 25.0±9.2μmol/g creatinine.
We conclude that this system offers a new dimension in the determination of polyamine in urine.

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Abnormal test findings among these cases were minute calyceal calcification in 2 cases, intrarenal cyst in 2 cases, combination of these two in 1 case, minute aneurysm in 2 cases, minute aneurysm complicated by histopathological abnormality in 1 case, phlebostasis and histopathological abnormality in 2 cases, and histopathological abnormality alone in 35 cases. The cases undergoing renal biopsy demonstrated the following changes: normal in 5 cases, minute changes in 17 cases, focal glomerulonephritis in 2 cases, proliferative glomerulonephritis in 15 cases, membranous glomerulonephritis in 1 case, focal glomerulosclerosis in 3 cases and arteriosclerosis in 1 case. The therapeutic agents used as systemic treatment in these 56 inpatients were general hemostatics alone in 18 cases, gabexate-mesilate (FOY) as an enzyme inactivator in 16 cases, aprotinin (Trasylol) in 7 cases and steroids in 29 cases. As topical treatment silver nitrate solution was infused into the renal pelvis in 2 cases, and as operative treatment, desquamation of the periphery of the left renal vein was performed on 1 case. Looking at the results of change in urinary findings in the judgement of therapeutic effects, urinary findings were normalized in 40 cases, improved in 22 cases, remained unchanged in 11 cases, and use of drugs were discontinued in 2 cases due to side effect.

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We analyzed 253 patients with diabetes mellitus who visited Sagamihara National Hospital. There were more female patients than male patients. Many patients were in the 50s and 60s and 77% of patients had history of diabetes mellitus for over 10 years. Ischemic heart disease and hyperlipidemia were more common among female patients while hypertension was equally common between male and female patients.
We speculate that the prevalence of ischemic heart disease among female patients is related to the co-exisitng hyperlipidemia.

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Recently it has been reported that Kanpo (traditional Chinese medicine) is effective on abnormal sensation in the throat. But most of reports were not based upon “Sho” (traditional Chinese diagnostic approach).
The authors analyzed Sho of 30 patients with abnormal sensation in the throat. After that, according to Sho, we administered Tsumura Kanpo-medicines (7.5g daily for two weeks) to patients and evaluated the efficacy of the drugs by analyzing patients' subjective symptoms.
1) Kyokyokuman (right hypochondrial stiffness), in 47%, Shinkahiko (epigastrial tenderness or stiffness) in 33%, paranavel tenderness in 20% of patients were observed.
2) In addition to Kitai (stagnation of Ki, abnormal sensation in the throat is said to be one symptom of Kitai), Oketsu (Stagnation of blood) was seen in 20% of patients.
3) The efficacy of the medication according to Sho was evident in 87% of patients.
It is indicated that medication based upon Sho is important to treat patients with abnormal sensation in the throat.

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During 1969-88 there were 370 patients with a diagnosis of breast cancer on discharge from the hospital. Seventy-one of all patients with breast cancer developed metastases. In 13 patients (18%), pulmonary metastases represented the first evidence of disease dissemination. In 8 patients (13%), pleural effusion was the first site of metastases. In only five instances was there nodule focuses of thoracic disease unaccompanied by extra thoracic metastatic disease. Three of five patients underwent pulmonary resection, but they relapsed with metastases within the lung after surgery. Small metastatic foci undetectable at the time of surgery may be responsible for subsequent relapse. Two patients were treated either chemotherapy or hormonal treatment. The prognosis of patients with breast cancer with pulmonary metastases remains poor.

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We have studied the role of central biogenic amines in blood glucose regulation in rats. In rats, blood glucose level was 65mg/dl and serum insulin level was 45μU/ml. Streptozotosin evoked high glucose level (107mg/ml) and lowered the insulin level by 30μU/ml. Catecholamines such as adrenalin, noradrenaline enhanced the blood glucose level. On the other hand, serotonin lowered the blood glucose level. The treamtent which lowered brain noradrenaline content or increased brain serotonin content lowered the blood glucose level. These data suggest that central noradrenergic system has hyperglycemic action and serotonergic system has hypoglycemic action.

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We have studied the absorption of theophylline in restraint water-immersion stressed rats, The absorption of theophylline administered by mouth to the restraint water-immersion stressed rats for 7hs increased with time and its peak was reached after 5hs. In these stressed rats, the theophylline absorption was augmented by 95% over control rats. When the rats were pretreated with sodium bicarbonate, and then were restrained for 7hs in water immersion cage, the increased absorption of theophylline was inhibited dosedependently. Theophylline absorption was increased about 32% over control by rectal administration. Metoclopramide, picosulfate, which increase the movement of gastrointestine increased the theophylline absorption
These data suggested that the potentiation of theophylline absorption was partly influenced by the movement of gastrointestine.

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It is very important to control one's own blood glucose level within appropriate range for the sake of preventing the complication of diabetes. In this studies, we showed the patients some knowledges which are necessary for self monitoring of blood glucose. That is, how to match the adjusting number displayed in the apparatus and the one showed in the glucose test paper was taught. Temperature in measuring, mixing of water or alcohol in the test paper, application of blood to the paper, wiping the blood from the paper were also taught.
It was found that these factors influenced on the valures of glucose levels.
It is necessary for us to teach the patients how to measure their own glucose level accurately.

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The patient was a 84-year-old man with chief complaint of abdominal distention and anorexia. On laboratory data, various kind of tumor makers were makedly increased, especially CA19-9, NCC-ST-439 and SLX, CEA, CA125 and Du-Pan-2 were also slightly to moderately elevated. Abdominal CT study revealed a mass lesion with irregular surface and multiple cysts in pancreatic body. Aspirated ascites contained adenocarcinoma cells. By these findings, pancreatic cystadenocarcinoma was highly suspected. He died 2 weeks after admission and autopsy was performed. The pancreas was from its body to tail, occupied by the huge tumor which had multiple cysts and nodular lesions. Metastasis was found in liver, lungs, peritoneum and numerous lymphnodes. Histologically, the cyst were lined by atypical cuboid or columnar foamy epithelial cells, some of which grew in a papillary fashion into the lumen. The tumor cells also infiltrated into adjacent interstitial tissue associated with fibrosis. The neoplastic cells contained mucus in its cytoplasm and the diagnosis of pancreatic mucinous cystadenocarcinoma was made.

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Nine patients with transitional cell carcinoma of the bladder were treated with intravesical instilation of bacillus Calmette-Guerin (BCG).
The patients (7 males and 2 femeles) ranged in age from 52 to 82 years (average 70). All patients had multiple tumors. Eighty mg of Tokyo 172 strain BCG was suspended in 40ml of normal saline and administrated intravesically 3/week for 3 weeks. Six patients had a complete response and one had a partial response (50% or more reduction in size and numbers of tumors), resulting in 78% of response rate. In two of 9 patients with T3 depth of invasion, favorable effects was not obtained. A correlation between PPD skin reaction and response by BCG instilation was not observed.

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Pancreas carcinoma is sometimes notoriously difficult to diagnosis. Although it is well known that pancreas carcinoma can invade contiguous organs, no attention for urinary tract involvement is paid. Although urinary tract is usually involved at a late stage, it may represent the first symptomatic evidence of the disease. In such case pancreas carcinoma can present initially as urologic disease and patients' symptom may not be differentiated from urinary tract disease. Computed tomography (CT) images and medical records of 50 patients with histologically proved pancreas carcinoma were reviewd.
There were 10 patients, 8 males 2 females, with urinary tract involvement. Eight of those patients were studied by IVP. There was a high incidence of left urinary tract involvement (right:left:bilateral=2:7:1). All 10 cases were with pancreas body and tail carcinoma in stage IV. All cases were confirmed to have the urinary tract involvement at autopsy within 4 months after CT studies. We compared those IVP, CT images and findings of autopsy.
In those patients, 4 cases showed direct invasion to the kidney, 5 cases showed ureter involvement mainly due to retroperitoneal invasion, and 1 case showed metastasis to the uinary bladder and ureters.
IVP showed inferior displacement of the kidney and/or ureteral displacement on the affected side, collecting system distortion including hydronephrosis secondary to ureteral compression.
CT scan showed abnormal masses which were contiguous to the pancreas and compressed the kidney and/or retroperitoneal extension with ureteral involvement. Metastasis to the urinary bladder was also identified.
The autopsy findings were almost the same as the CT images. Pancreas carcinoma characteristically remains silent until there is little chance for cure. Although urinary tract involvemant is rare, it can mimic renal and ureteral pathology.
The radiologist and urologist must include, in the differential diagnosis of urinary tract lesion, disease process originating in the pancreas as well as in the contiguous organ.

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Twelve cases of 129 profoundly retarded in-patients had chromosomal anomalies. Three of them revealed to have another karyotype or got details by high resolution G-banding method.
The first case was 9-year-old girl with chromosome 3q+. Her karyotype revealed to be 1q trisomy (q42-qter) by high resolution. Her face was long and narrow with heavy eyebrows. She also exhibited cleft palate, talipes equinovarus, hypoplastic finger ridges and hypotonia.
The second case was 16-year-old girl with karyotype 46, xx, dup (2) (q31-q36). At first, the chromosome was found to be 2q-, but this time, it revealed to be 2q+. The following anomalies were recorded, short umbilical cord, hypoplasia of processus alveolaris missing of incisors, flat palate, stiff and straight hair, bulbous nose, hypoplastic digital ridges, hypoplastic pelvis, wide spaced toes and hypotonia.
The third case was 8-year-old boy with karyotype 46, xy, ins (18) (q+). In the first analysis, no chromosomal aberration was found. This time, it was found to be the insertion in the long arm of the chromosome 18, with the break point (q21.1:q21.2). The physical anomalies were, high nasal bridge, fused incisors, inguinal hernia hip dislocation, flexed right fingers and Lennox syndrome. These were not like that of trisomy 18, except flexed fingers.
The progress of banding method renewed chromosomal diagnosis.
The partial revise for chromosomal aberration syndrome may be necessary in the near future.

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Cardiac amyloidosis, which has so far been regarded as a relatively rare disease, has now become easily diagnosable while alive thanks to the development of various kinds of examinations. We have experienced 7 cases during the past 10 years. We would like to report these cases and especially one case in detail. Average age, male to female ratio and morbid period were 58.4 years, 6:1, 10.6 months, respectively. Diagnosis was possible while alive in 6 of 7 cases. Main clinical symptoms were heart failure and arrhythmia. ECG revealed arrhythmia in 6 cases and conduction disturbance in 4 cases. Echocardiography revealed diffuse hypertrophy of the septum and posterior wall, of the left ventricular enlargement of the left atrial diameter, etc, as well as granular sparkling of myocardial wall in all cases. Heart failure was frequently responsible for the death and one case died suddenly. Of these cases, one case was reported in detail who presented symptomes of autonomic nervous system as chief complaints and who was observed from before the onset of cardiac amyloidosis.

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A 26 year old male patient had a fall with the resulting depressed open compund skull fracture involving the frontal and parietal bones over the sagittal suture, intracranial hematoma and fracture of the femur. As an intracranial aneurysm was suspected from the angiogram, radical operation was performed with the reduction of depressed fracture. A superficial middle cerebral artery in the frontal lobe was torn, and its stump on the central side was retracted to adhere to the remaining artery to form an interesting deformity, while distal branches of this artery were not detected. The patient received postoperative physical therapy to become able to walk unassisted, and was discharged.
Medical treatment was continued thereafter for abnormalities in EEG and convulsions until he was restored to the former job. Since the term “intracranial aneurysm” seemed not appropriate for the present case, we call it “suspected case of aneurysm after injury of superficial cerebral arery”.

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The authors report the results of single photon emission computed tomography (SPECT) using N-isopropyl p-[¹³¹I] iodoamphetamine (¹³¹I-IMP) in a case of amnestic syndrome following left thalamic infarction.
The patient was a 73-year-old right-handed female. She was confused and disoriented on admission and improved to alertness after several days, but remained amnestic. After more than 2 weeks, neuropsychological tests revealed prominent impairment of short-term verbal memory, of mental arithmetic and of abstract thinkings. CT scan showed a low density area in the anteromedial part of the left thalamus.
The SPECT scan performed 18 days after the onset of the infarction indicated decreased regional cerebral blood flow in the left frontal and temporal cortices as well as in the left thalamus. The follow-up SPECT scan 41 days after the onset revealed significant improvement, showing hypoperfusion only in the left frontal region.
According to the digital subtraction angiography there was no obtruction or stenosis in the carotid artery or in the proximal part of the middle cerebral or of the anterior cerebral artery. These results suggest that the mechanism of “diaschisis” explains the influence of the thalamic lesion on the related cortex and that cortical hypofunction is related to her neuropsychological deficits.

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We presented a quite rare case of non-Hodgkin's lymphoma with cardiac metastasis which was demonstrated and confirmed by radionuclide studies and autopsy. A 57-year-old male with Superior Vena Cava syndrome underwent radionuclide angiography using ^99mTc-HSA prior to ⁶⁷Ga-citrate and ²⁰¹Tl-chloride studies for suspected right atrial metastasis from non-Hodgkin's lymphoma. The radionuclide angiography revealed a filling defect in the right atrium. ⁶⁷Ga and ²⁰¹Tl studies showed increased accumulation of both nuclides in the right atrium, in congruence with the region showing a filling defect by the radionuclide angiography. These result suggests that radionuclide study might be useful in detecting metastatic tumor in the heart. And general condition was improved by radiation to the heart.

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A 71-yr-old man with gastric cancer was admitted for gastrectomy. The patient also suffered from pemphygoid for three years. General anesthesia under tracheal intubation was performed with great caution not to hurt tracheal membrane by the inflated cuff of tracheal tube, considering the possibility of existing bullous membrane.
When tracheal intubation is needed for patients with pemphygoid, we propose the use of tracheal tube with high volume-low pressure cuff to avoid inadvertent rise in intra-cuff pressure.

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