Hansen's disease exhibits a wide spectrum, ranging from the lepromatous type with defective cell-mediated immune response to Mycobacterium leprae to the tuberculoid type showing high cell-mediated immunity. Studies on the role of macrophages or T-lympho-cytes in defective cell-mediated immunity in lepromatous leprosy are reviewed.
At present, the generation of suppressor cells (suppressor T-lymphocytes and macro-phages) during clinical course is supposed to contribute to M. leprae antigen-specific unre-sponsiveness in lepromatous patients. However, it seems reasonable for the under-standing of the immunological spectrum in Hansen's disease to assume that in human popu-lations there is a variety in helper T-cell receptors to M. leprae antigens.

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After carring out a nationwide questionnaire on congestive heart failure (CHF) in Du-chenne's muscular dystrophy(DMD), we compared the clinical features of 14 juvenile DMD patients who died of CHF with those of DMD patients who died of respiratory failure.
In the patients with CHF, the mean stage of functional disability of skeletal muscle (STAGE) was 4.6 degrees at 10 years old. They had cyanosis, edema, dyspnea, cardiome-galy, pulmonary edema and abnormal Q wave on electrocardiogram (ECG) at 15 years old.
The STAGE in the patients with respiratory failure was significantly lower than that in the patients with CHF (p<0.05). Cyanosis, edema and dyspnea in the patients with respiratory failure appeared at 18.9, at 20.4 and at 19.5 years old respectively, and p-values of those cardiac signs seen in respiratory failure were significantly higher than those in the CHF, that is, they were 0.05 for cyanosis, 0.0005 for edema and 0.005 for dyspnea. Cardiomegaly and pulmonary edema were not found in the patients with respiratory fail-ure at all.
We conclude that clinical markers such as cyanosis, edema, dyspnea, cardiomegaly, pulmonary edema and abnormal Q wave on ECG are useful in the early diagnosis and treatment of CHF in juvenile DMD.

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Cecum transit and gastric emptying after thirty minutes were examined by routine radiological barium method in stomach mass survey.
In 135 (58.7%) of a total of 230 cases, the barium rapidly reached to the cecum, and in 22 (9.6%) of the 230 cases to the distal descending colon.
In 12 (5.2%) of the 230 cases the gastric emptying was recognized, and in 8 (3.5%) the cecum transit with the gastric emptying.
These results suggest that the condition of the small intestine is more hyperkinetic and no significant gastric emptying than the previous data.

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Ten patients with malignant lymphoma of the stomach were treated in our institutions for these thirteen years. The average age of 7 male and 3 female patients was 60.5 years old (range 50-72). Seven of these underwent gastrectomy. Total gastrectomy was per-formed in 4 cases and distal gastrectomy was performed in 3. One case undergoing rela-tive curative resection was survived for 53 months with chemotherapy (CHOP-regimen). Another case undergoing relative non-curative resection was survived without chemo-therapy. Chemotherapy was performed for 9 patients. Six of these received chemotherapy and surgical treatment. Remission was attained in 5 out of 9 patients, 4 cases of these were treated with CHOP-regimen.
It is concluded that main tumor and metastatic lymph nodes should be resected corn-pletely for the treatment of malignant lymphoma of the stomach, and chemotherapy might be more effective than surgical treatment, when it is an absolute non-curative resection.

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Of 1, 341 patients who had undergone gastrectomy at the National Kyushu Cancer Center Hospital in the period of 10 years from January 1978 to December 1987, 63 were found by histopathological examination to have atypical epithelial lesions (adenoma), 73 lesions among them. These lesions were studied in comparison with 134 other lesions that were resected in the same period and classified as types I and IIa and early gastric cancer of type IIa+IIc.
As much as 60.3% of stomachs with an atypical epithelial lesion had been affected by cancer, and 12.8% of early gastric cancers of elevated type had an atypical epithelial lesion.
The patients with an atypical epithelial lesion alone had such an age distribution that those in their 50s were the largest in number and younger by ten years than those with an early gastric cancer of elevated type.
The most common site of atypical epithelial lesions was lesion A defined in the general rule for the gastric cancer in surgery and pathology (Japanese Research Society for Gastric Cancer), and those in lesion C were very limited in number. The atypical epithelial lesions for the most part were 2.0 cm in the longest diameter or smaller, and cancer in adenoma was found in 4.1 cm or larger atypical epithelial lesions.
According to the gross classification of early gastric cancers, the frequency of type IIa+IIc was significantly higher with early cancers of elevated type than atypical epithelial lesions (p<0.001), and the frequency of superficial erosion and ulceration on the elevated lesions was also significantly higher with early cancers of elevated type (p<0.005), while the frequency of a smooth surface on the elevated lesions tended to be higher with atypical epithelial lesions than early cancers of elevated type (p<0.025). The frequency of red-colored lesions was significantly higher with early cancers of elevated type than atypical epithelial lesions, while the reverse was the case with the frequency of discolored lesions (p<0.001).
Of 73 atypical epithelial lesions, 10 or 13.7% had an cancer in adenoma.

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We studied 14 patients undergoing PTCD due to obstructive jaundice for malignant tumor, who were older than 65 years and admitted to National Kyushu Cancer Center between May 1987 and February 1989. In the patient population of 5 men and 9 women, the age ranged 65 to 88 years, with a mean of 72.2 years. Seven of the 14 patients were primary malignant tumor originated in the bile duct system. The obstructive points were hepatic hilus in 6 cases, common hepatic duct in 3 and common bile duct in 5. The liver function at PTCD mainly showed elevation of ALP, γGTP and LAP, whereas in some cases transaminase was elevated. There was significant relationship between reduction effect of jaundice and discharge volume/day of bile. No significant relation-ship was seen between reduction effect of jaundice and age, obstructive point, liver func-tion and birilubin at PTCD. There are other problems in elderly patients;difficulty of communication etc. Therefore, particular consideration is needed for them.

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We have established an assay system of monoamines, indolamines, and their metabo-lites by means of high performance liquid chromatography with electrochemical detection (HPLC-ECD). We measured MHPG, 5-HIAA, DA, DOPAC and HVA levels in lumbar cerebrospinal fluid (CSF) of 19 patients with Parkinson's disease, 13 patients with senile dementia, and 22 neurologic controls. The senile dementia group consisted of 8 patients with vascular dementia (VD) and 5 patients with senile dementia of Alzheimer type (SDAT). The mean HVA level and the mean 5-HIAA level in the group of Parkinson's disease without L-DOPA administration were significantly lower than those of the controls. In the group of Parkinson's disease during L-DOPA therapy, the mean 5-HIAA level was significantly lower in comparison with that in controls. The HVA level in Parkinson's disease during L-DOPA therapy was normalized. In both VD and SDAT, 5-HIAA levels were significantly lower than those of controls. It was concluded that the determination of CSF biogenic amines and metabolites was useful for reasonable and logical diagnosis and therapeutic strategies in neurological diseases such as senile dementia and Parkinson's disease. Such biochemical investigation should be widely performed among clinicians.

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Ornithine carbamoyltransferase (OCT, EC 2.1.3.3) is a key enzyme in the urea cycle and is present almost exclusively in the liver mitochondria. This organ specificity is used as a clinical test to detect hepatocelluar damage. In this study, OCT activity was determined based on diacetylmonoxime reaction, simultaneously with other enzymes such as GOT, GPT, ALP, GGTP and LDH, in 119 cases of malignancy and in 98 normal subjects, to clarify its clinical significance.
The correlation coefficiency of OCT and GOT in malignancy was the highest (r=0.735). Graphic displays of 6 serum enzymes, OCT, GOT, GPT, ALP, GGTP and LDH, demonstrated peculiar pattern for carcinoma of the stomach, the lung, and the breast, respectively. Notably, the pattern of graphic displays of serum enzymes was different between hepatocellular carcinoma and metastatic liver carcinoma. In the serial determi-nation of serum enzymes in a patient with hepatocellular carcinoma, correlative elevation of OCT and GOT was observed during hepatic encephalopathy. Measurement of OCT in the serum is of considerable value in the differential diagnosis of malignant disease af-fecting the liver and hepatocellular carcinoma.

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By using Camit system, SMBG data can be handled without any burden for diabetic patients. For clinical hospital staffs, this system supplies summarized data by which clinical profile of the patients can be assessed easily. Therefore, this is a useful aid for the management the outpatient diabetic clinic.

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We surveyed on the prevalence of IVH nutritional support for terminal cancer patients who were hospitalized in 15 public hospitals in Kumamoto prefecture.
IVH nutritional support had been used from 29.4% to 94.4% of the terminal cancer pa-tients in each hospital. Initial performance status according to the karnof sky index under-gone IVH nutritional support was mostly PS 3(41%) and PS 4 (47.7%). The starting point of IVH nutritional support was earlier than one month before death in 63.3% of the cases and during the final month in 367%.
Numerous anticancer agents combined with IVH nutritional support were given in 38.9% of the patients in the last 5 months before death but these treatments were reduced re-markably within the final month.
Taking these results into consideration, we are unable to set up a medical policy re-garding whether or not to use IVH nutritional support for terminal cancer patients. At present the decision to use or not to use IVH nutritional support for these patients depends on individual hospitals and doctors. However we are of the opinion that the general criteria for the use of IVH nutritional support for these patients should be established.

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There is a matter of opinion to insert T-tube after choledochotomy. Increased hospitalization and medical cost caused by T-tube insertion is out of keeping with Japan. In most institutions, T-tube is indicated mainly as an information drain and preventive treatment to reduce pressure in biliary tract and residual stones after choledochotomy. T-tube trouble is divided into before or after removal, troubles before removal of T-tube are prevented by inserting a T-tube carefully and having an intraoperative cholangiography from T-tube drainage. Trouble after removal of T-tube is generally serious, for instance bile peritonitis. Postoperative cholangiography 2 weeks after operation and removal of T-tube 3 weeks after operation are usually, we had a case of bile peritonitis in spite of removal 3 weeks after operation because of fistulasion insufficiency. The present paper describes necessity of removal of T-tube after one month of operation in aged or high risk patients.

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A 47-year-old woman was admitted to our hospital with complaining of disturbance of consciousness, nausea and vomiting. At first she was diagnosed as diabetic ketoacidosis triggered by urinary tract infections, since her blood glucose level was 586mg/dl, urine acetone was strongly positive, and arterial blood pH was 7.19 and HC₃ was 8.3mEq/l. After admission, the ketoacidosis and infections were improved, but tachycardia unresponsive to digitalis, and low-grade fever (37.5°C) persisted. In addition, thyroid function test showed hyperthyroidism, indicating that it was a case of masked hyperthyroidism devoid of such typical symptoms as goiter and exophthalmos. From her CT encephalography and past history indicating the appearance of a slow movement behavior from 20-year-old and a difficult self-walking from 40-year-old, she was also diagnosed as olivo-pontocerebellar atrophy (OPCA). We report here a rare case of OPCA complicating with diabetic ketoacidosis and masked hyperthyroidism.

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A 68 year old male patient was admitted with complaints of epigastralgia and thirst. He was in a slightly somnolent state and his skin was dry. The blood glucose level was 600mg/dl and the ketone bodies were strongly positive in the serum and the urine. However, the islet cell antibody and the islet cell surface antibody were negative. Endoscopic examination showed a giant gastric ulcer at the angulus of the stomach. The patient recovered from ketoacidosis by a low dose of continuous insulin infusion and gastric ulcer became smaller by a rest cure, diet and cimetidine therapy. Then the dose of insulin was decreased and finally discontinued. At this time glucose tolerance was still impaired. The specimens of the gastric mucosa biopsied 6 weeks after admission showed a well differentiated adenocarcinoma. When partial gastrectomy was performed, an obtained biopsy specimen of the pancreas was investigated and no lymphatic infiltration was found in the Langerhans' islands. It is known that ketoacidosis is caused by severe infection or stress in non-insulin dependent diabetes mellitus. In the present case no infection but a giant ulcer with early gastric cancer were recognized. In addition diabetes mellitus had never been pointed out before admission. Various conditions involved in ulcer formation are suggested to have been a cause of the unexpected ketoacidosis and further examinations made an earlier therapy of gastric cancer possible.

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Hemorrhage or infarction in a pituitary adenoma, which is known as pituitary apoplexy, induces various symptoms, such as headache, nausea, vomiting, weakness of visual field and loss of consciousness. Death case is also reported in severely involved one. The exact mechanism of this condition is not still unknown. We have a case of pituitary apoplexy with sudden onset of loss of consciousness, apnea and cardiac arrest in 63 years old male. The plain X-ray film of the skull on admission showed enlarged sella turcica. CT-study revealed the hemorrhagic lesion within the tumor. Several hormonal studies performed subsequently, confirmed the panhypopituitarism. The patient was transferred to the neurosurgical division for the resection of pituitary tumor.
Histological study of the resected specimen revealed chromophobic cells mixed with necrotic degenerative tissue. These changes were compatible with the lesion of pituitary apoplexy. While weakness of visual field, disturbance of visual acuity, contraction of external eye-movement were observed thereafter in this patient, pituitary tumor was not detected by post-operative CT-study. He is livining well on supplementary hormonal therapy consisted of 2.5μg of DDAVP, 20mg of hydrocortisone and 0.1mg of thyroxine.

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Two cases of pulmonary inflammatory pseudotumor are reported. The first case was a 41-year-old male. The second case was a 62-year-old male. In both cases, chest roentogenograms showed a well-defined mass. Both masses were surgically resected in view of the possibility of malignancy. Histological diagnosis was pulmonary inflammatory pseudotumor, Sixty-six cases of pulmonary inflammatory pseudotumor including our cases have been reported in Japan.

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A 71-year-old man admitted to Respitatory Department in our hospital because of further examination of abnormal mass shadow at the right cardiophrenic angle on chest xray film which was accidentally discovered when he visited to his local clinic with a complaint of back pain. On admission, laboratory data were all normal and the findings of chest CT and scintigram, bronchoscopy, bronchogram and pulmonary angiography were also normal. Liver scintigram showed a bulge directing antero-superiorly on right lateral view, so he was transfered to our department of Gastroenterology with a tentative diagnosis of liver tumor. Abdominal US and CT showed a slight bulge with a smooth surface and a normal internal pattern. Hepatic angiography revealed neither tumor stain nor avascular area. Laparoscopy was finally performed with the following findings; the bulge was smooth in surface and reddish-brown in color, and its biopsy specimen re-vealed normal liver tissue. The diaphragm above the bulge was not relaxed probably be-cause of pneumoperitoneum and the findings of inferior surface was normal.
From the above findings, the diagnosis of partial diaphragmatic eventration was made and the etiology of this case was supposed to be congenital. In general, the diagnosis of partial diaphragmatic eventration is possible, to some extent, by US, scintigram and CT, however a laparoscopy is more useful and makes its diagnosis more decisive.

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Fifty-eight year old female with left-sided intracerebral hemorrhage underwent surgical removal of hematoma and received 3 packs of red blood cell transfusion. Following the good postoperative course, she became anemic remarkably two month after the operation. Then she was given 6 packs of red blood cell transfusion and fever, jaundice, hematuria and oliguria developed. The laboratory findings at this point were as follows; LDH 1617 IU/l (I type isozyme was 43%), haptogloglobin 15mg/dl, BUN 104mg/dl, Cr 9.3mg/dl. These findings suggested the presence of intravascular hemolysis and acute renal failure. She was transferred to Tokyo Metropolitan Komagome Hospital and had supportive therapy for renal failure. We detected anti-E and anti-Dia antibodies in her blood. We hypothesize that this disorder occurred because irregular antibody caused intravascular hemolysis and acute renal failure. To our best knowledge, acute renal failure caused by irregular antibody is very rare.

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We reported two cases of primary splenic malignant lymphoma and discussed on diagnostic considerations.
Ultrasound (US) findings revealed multiple hypoechoic nodules. Plain CT demonstrated multiple low density areas which were enhanced by dynamic CT. Angiography revealed avascular masses. Tumors were visualized as cold nodules in splenic scintigram.
In case 1 histological verification was made by splenectomy and in case 2 US-guided aspiration cytology of the spleen provided pathological findings. Bleeding time was less than 5′30″ and blood loss was less than 20g in amount after splenic puncture in two surgical cases.
US-guided aspiration cytology of the spleen may provide useful pathological informations in the diagnosis of malignant lymphoma of the spleen.

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