In stead of the pancreozymin secretin test (PS-test) heretofore in use, a new method of exocrine pancreatic function test has been recently proposed by the committee of measuring and evaluating exocrine pancreatic juice. Therefore, we investigated on its clinical significance, especially comparing the secretin drip infusion test (S-test) with other diagnostic tests of chronic pancreatitis.
One hundred unit of Secrepan (Eizai & Co., Ltd.) was injected as secretin by drip infusion during 60 min. and the duodenal juice was collected for every 10 min. during the late half time (30min.). After that, (1) volume, (2) mean bicarbonate concentration, (3) bicarbonate output, (4) amylase output of the juice were measured. Normal limits of lower values were (1) 63.1ml, (2) 76.1mEq/l, (3) 6.11mEq, (4)85.0×10³ Somogyi U, respectively.
Pancreatic function was decreased in 76.9% of our cases with chronic pancreatitis (88.2% of group I chronic pancreatitis). Among those four factors, the bicarbonate output showed the highest frequency of abnormality, followed by the bicarbonate concentration, then the amylase output. The highest diagnostic rate of tests on chronic pancreatitis was found in ERP, followed by S-test, PS-test, US, CT, GTT, serum p-type amylase and lastly serum elastase 1.
In conclusion, the above mentioned pancreatic exocrine function test is more simplified, more accurate and with less side effects, and by which we can get adequate data on bicarbonate in pancreatic juice.

View full abstract

Autoantibodies indicate positive reaction in various hepatic diseases, however, the mode of emergence and clinical significance of such antibodies are not necessarily clarified. In the present study, we investigated the actual state of the emergence of autoantibodies and characteristics of its pattern observed in patients with hepatic diseases, especially those with autoimmune hepatitis. The subjects were 500 cases including 20 cases of autoimmune hepatitis, where we were able to detect antibodies, mainly anti-nuclear antibody, and who were, selected from those patients who received peritoneoscopy during the period from January 1982 to December 1985.
ANA was found positive in 105 cases (21.0%), the frequency of which was high in chronic hepatitis and liver cirrhosis besides autoimmune heptatitis. Further, it was higher in females (P<0.001) and in HBs Abpositive than in HBs Ag positive cases (P<0.05). However, except in autoirnmune hepatitis, the titers were low in dicating the tendency of transient posltivity. In the group of autoimmune hepatitic cases with γ-globulin value higher than 2.5g/dl at the initial examination, there were many in which steroid was effective, and in the majority, although γ-globulin as well as transaminase were lowered by treatment, ANA maintained higher titers. On the contrary, in the group whose γ-globulin value was less than 2.5g/dl, there were many cases that resisted to steroid, and the ANA titer was lowered by treatment. Therefore, it seems there is a difference pathologically between the two groups.
Incidentally, anti-DNA was positive in 55 cases (11.0%).

View full abstract

Fifty-eight patients with multiple primary cancers (5.9%) founding 91 patients with primary lung cancer were studied. The stomach cancer was most frequently associated with lung cancer. All patients with head and neck cancer were heavy smokers, and this fact might suggest that the possibility of the irritating effects of cigarret smoking in the respiratory tract. In patients with double cancer, patients with prior other organ cancer showed the following differences, compared with prior lung cancer. (1) The interval between the first and the second cancer was significantly longer. (2) The clinical stage of lung cancer was more advanced. (3) Lung cancer related death was more frequent. (4) Median survival time was shorter. Earlier diagnosis and treatment of the second cancer may prolong the survival time in patients with multiple primary cancer.

View full abstract

We made a drug history table for hospitalized diabetic patients using a personal computer.
While instructing diabetic patients with how to take medicine, informations concerning allergy, side effects and double prescriptions were collected. These were added to the drug history tables and utilized the reafter. A booklet was made for easier understanding and better communication with patients and pharmacists.
By these procedures, a better communication with patients and pharmacists was established and this could be a milestone for the instruction of medication by pharmacists.

View full abstract

We evaluated clinically the effect of surgical treatment in cases of intractable secondary hyperparathyroidism associated with chronic renal failure, and briefly discussed the clinical, biochemical and surgical characteristics of our series of patients.
Between 1980 and 1988, we operated on 8 patients for renal hyperparathyroidism.
The indication for parathyroidectomy included recognition of enlarged parathyroid glands and hyperparathyroid hormone, severe bone change in X-ray films and such symptoms as bone pain, arthralgia, pruritus, irritability, etc., in all patients.
We usually chose a total parathyroidectomy plus parathyroid autograft in the forearm.
The mean weight of the totally resected parathyroid glands was 3.7g, and the pathological diagnosis was secondary hyperplasia in all cases.
After the operation, parathyroid hormone and serumcalcium decreased rapidly, and adequate calcium replacement therapy was necessary.
One of the patients complained of persistent hyperparathyroidism postoperatively. The grafted tissues in all cases functioned well.
Recurrence was also diagnosed in 2 of the 8 cases postoperatively, and underwent excision of the transplanted parathyroid tissues under local anesthesia.
In our experience, total parathyroidectomy and autotransplantation is an adequate treatment for secondary hyperparathyroidism.

View full abstract

Thirteen patients with primary adenocarcinoma of the uterine cervix between January, 1969 and April, 1987 were evaluated clinicopathologically. Nineteen patients were stage I, 6 patients stage II, 4 patients stage III, one paitent stage IV, respectively. Twenty-four patients were followed up for more than 5 years. Three of 3 with surgery alone, 9 of 14 patients with surgery and post-operative radiation, and 2 of 5 with radiation alone, have survived for more than 5 years. Both groups of surgery alone and surgery and postoperative radiation had a greater five year survival than those treated with radiation alone. Two of 3 patients with lymphnode metastasis, and one of 11 patients without lymphnode metastasis died. The prognosis of patients with lymphnode metastasis was poor.
Advanced clinical stage, vessel permeation and deep invasion were related to lymphnode metastasis and, therefore, showed, poor prognosis.

View full abstract

Malignant schwannoma is often associated with von Recklinghausen's isease.
A 26-year old man, who was previously diagnosed as von Recklinghausen's disease by cutaneous lesions, developed right facial numbness. CT revealed a large tumor in the region of right fossa pterygopalatina, and the tumor also extended to the right middle fossa. The tumor was surgically removed, and histopathologic diagnosis of the tumor was neurofibroma. The tumor showed a rapid local recurrence, and symptoms and signs of compression of the brain were seen. The tumor compressing the brain was removed by craniotomy, and histopathologic diagnosis was malignant schwannoma. The tumor extended widely to the right orbit, nasal cavity, pharynx and oralcavity. He died eight months after the first operation.
Such a case seemed to be rare in the literature.

View full abstract

A case of bilateral occlusion of vertebral artery is reported. The patient is a 70-year-old female, who was admitted to our hospital complaining of speech disturbance and muscle weakness on the extremities. she had experienced mild head injury six months before and neck pain persisted after then Brain CT scan showed cerebellar infarction. Angiological examination revealed occlusion of the vertebral arteries on both sides. Right vertebral artery was thought to have been occluded sometime before the admission because of its abundant collateral circulation in its distalarea. Left vertebral artery was almost occluded at C5/6 level by means of lateral osteophytes and complete occlusion was confirmed at C1 level. The patient was treated conservatively and muscle weakness improved after one month. She was able to walk with some help at the time of discharge.

View full abstract

A 47-year-old male in whom periodic lateralized epileptiform discharge (PLEDs) appeared in electroencephalogram (EEG) in association with transient disturbance of consciousness is presented. The patient who had undergone an oparation of clipping the left anterior communicating artery displayed a low density area in left frontal lobe on cranial computed tomography (CT). Three months postoperatively he suddenly developed impairment of consciousness, frontal lobe signs and PLEDs in left frontal and temporal lobes on EEG but with no noteworthly abnormalities on CT. The PLEDs were of transient duration and disappeared as clinical symptoms subsided.
When a region of the brain is disturbed, this can, at times, give rise to functional impairment not only of that region but also of distant brain regions, though of transient. duration. Such a phenomenon was termed diaschisis by von Monakow (1914). It seems plausible to interprete, in the light of his theory, the phenomena that occurred in the present case as follows: some disorder occurred initially in the left frontal lobe, which by diaschisis led to impaired function of an extensive brain regions manifested by PLEDs from left frontal and temporal regions and delta slow waves from left and right frontal regions on EEG and by such clinical symptoms as frontal lobe signs and disturbance of consciousness.

View full abstract

We present a case of severe mental retardation with voluvulus of the stomach. A 20-year-old woman presented with a sudde nonset of appetite loss and distention of the upper abdomen. On past history, she has been in our sanatorium as autistic mental retardation from age of 4 years. She has been found aerophagia from infancy and complicated with Chilaiditi syndrome from 12 years of age. Physical examination revealed marked distention of the upper part of the abdomen. The epigastrium was soft and fluctuated, and splashing sound was heard. The plain X ray film revealed marked dilatation of the stomach. She was diagnosed as an acute gastric dilatation. But an upper gastrointestinal series showed an organoaxial voluvulus of the stomach. At operation, it was found that her greater omentum was short and not fused with mesentery of the transverse colon. Also, hepato-transverse colic band oppressed the duodenum, and transverse colon was severely distended. The stomach rotated upward around the long axis of the stomach between cardia and this band. The band was removed and greater omentum was fixed with the transverse colon.
In this case the etiology of a voluvulus of the stomach was idiopathic, and the factors were a hypoplasia of greate romentum and distended transverse colon. The megacolon, which may be expanded by swallowing air for a long time, seemed to have oppressed the stomach directly and increased pressure in abdominal cavity.
This entity is rare but it is important for a cause of passage failure in upper alimentary tract in severely retarded patients.

View full abstract

The post operative course of acute dissecting aortic archaneurysm is still stormy. We experienced a successful repair of this disease in a case of a 78-year-old woman, Her complaints were nausea and horacodorsal pain, and contrast-enhanced CT and intravenous digital subtraction angiography indicated De Bakey type I dissecting aortic aneurysm.
Pericardial hemorrhage was noted and the lesion was dissected beyond the orifice of coronary artery with entry of 5×5mm in size at the posterior wall of the aortic arch. The extracorporeal circulation was stopped at 20°C of laryngeal temperature, and the ascending aorta was replaced with artificial graft by means of open distal method. The resected edges of the aorta were reinforced with two-layered felt. Respiratory support for 13 days was necessary to control convulsion. Though the left hemiplegia was remained, she was discharged on foot after her rehabilitation.
Findings from one year post operative contrast-enhanced CT and intravenous digital subtraction angiography revealed successful formation of thrombus in entire false lumen.

View full abstract

CEA levels in nipple discharge were measured in eighteen patients with bloody nipple discharge, by dot-immunobinding assay using monoclonal antibody. The results were as follows.
1) Six out of eight patients with breast cancer had higher CEA levels than cutoff value (200ng/ml). On the other hand, CEA levels of six benign lesions (5 intraductal papilloma, 1 fibrocystic disease) were lower than cutoff value.
2) Sensitivity and specificity of this examination was calculated to be 75%, 100% respectively. High accuracy rate of 85.7%, therefore, was obtained.
3) CEA levels in nipple discharge were compared with cytological findings. As a result, we confirmed that either elevated CEA levels or positive cytology strongly suggested the presence of cancer.
4) In addition, the characteristics of patients with breast cancer discovered with CEA measurement were listed. It was noteworthy that four out of eight cases were non-invasive Cancers.
These results suggest the importance of application of CEA measurement in nipple discharge into the screening method of non-palpable breast cancer.

View full abstract

Ultrasound-guided aspiration cytology was performed on 3 patients with an abdominal mass in which conventional diagnostic modalities failed to provide a definite diagnosis. Aspiration cytology confirmed a gastric malignant lymphoma, splenic lymphoma and a fishbone perforated granulation of the descending colon. There were no complications following the procedure. Ultrasound-guided aspiration cytology can be applied effectivelly to the diagnosis of a suspicious abdominal mass with minimal risk of complications.

View full abstract