Mechanism of renal tubular injury induced by nephrotoxic drugs were investigated. Aminoglycoside antibiotics, cephalosporin antibiotics and cisplatin were used as nephrotoxic agents. Aminoglycoside antibiotics absorbed into the renal tubular cells by phagocytosis made the lysosome membrane instable. Then, tubular cells were autolyzed by the lysosomal enzymes released from lysosome damaged by aminoglycoside antibiotics. Protein synthesis in ribosome of the renal cortical cells were also inhibited by aminoglycoside antibiotics. Cephaloridine, nephrotoxic cephalosporin antibiotics, inhibited the ³H-Leucine uptake into the rat renal cortical cells in vivo. The inhidition of protein synthesis seemed to be one of the possible mechanisms of cephaloridine induced nephrotoxicity. The destructive effects of cisplatin on mitochondria of rat renal cortical cells were shown by morphological and cytochemical study. DNA synthesis in nuclei of rat renal cortical cells were inhibited by cisplatin in vitro and in vivo. These results demonstrated that nephrotoxicity was induced by mitochondria damage and/or nuclear DNA damage, but the details of the mechanism were still unknown. Several mechanisms concerning drug-induced renal tubular injury were shown in our recent studies. However, many questions are still remain to be answered in this field.

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We performed scintiscanning with Tc-MAA lung perfusion in thirty cases of chronic pulmonary emphysema (CPE) and thirty cases of bronchial asthma. In the former group, all of the cases showed the definite emphysematous changes on computed tomography (CT).
It seemed that the whole impression to scintigram could diagnose CPE almost correctly.
As the most important abnormality in scintigrams of CPE was their filling defects, we examined the characteristics of the defect-lesions.
The results were as follows: firstly, the main lesions extended to the lobar to halflobar size; secondly, defects were multiple in general; and thirdly, the distribution of defects was diffuse.
Whereas the lesion in the scintigram is nonspecific for diagnosis of CPE in contrast to CT, we conclude that perfusion scintigram is valuable to evaluate the severity of CPE.

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In this study, we reported the optimal condition of the assays and glutamate dehydrogenase (GLDH) activities which were clinically useful indicators for the degree of liver damage. Resulting from this investigation, successful results were obtained with good accuracy (C. V=0.92-4.85%) and linearity. We measured GLDH activities in serum from healthy controls (42 men, 37 women), and from patients with chronic hepatitis (n=39), liver cirrhosis (n=31), liver cancer with liver cirrhosis (n=16), liver cancer (n=27), acute hepatitis (n=4) and acute circulatory failure (n=2). When we measured GLDH activities of various liver diseases, chronic hepatitis was clearly distinguished from other liver diseases, especially, liver cancer. In every case of acute hepatitis, the GLDH activities became normalized more rapidly than GPT activities.
On the other hand, in acute circulatory failure, liver cells in the zone 3 were also damaged and GLDH activities were abnormally increased. Because the volume of circulating blood in zone 3 decreased and oxygen pressure subsequently decreased, liver hypoxia occurred and cells in zone 3 were severely injured.

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The binding property of serum AFP with lectin (such as Con A) is of great help in differentiation of yolk sac-type AFP from hepatic-type AFP. Sera from patients with yolk sac tumors (YSTs) have been found to contain a high proportion of AFP that does not bind to lectin. In contrast, lectin can bind with a very high proportion of AFP derived from patients with hepatocellular carcinomas (HCCs). This heterogeneity of AFP depends upon different degrees of glycosylation.
In order to clarify the histogenesis of AFP-secreting tumors, formalin-fixed, paraffinembedded serial sections of these tumors were examined immunohistochemically by the peroxidase-antiperoxidase (PAP) method for AFP, and paradoxical Con A (P-Con A) staining which had been reported to detect glycoprotein including AFP. The following results were obtained: 1. Yolk sac-type AFP was found in YSTs, (Yolk sac) endodermal cell tumors, embryonal carcinomas, solid teratomas, metastatic liver cancers, and stomach cancers. 2. Hepatic-type AFP was demonstrated in HCCs, solid teratomas, and a stomach cancer. 3. In solid teratomas, yolk sac-type AFP was seen in the endodermal gland. On the other hand, hepatic-type AFP was observed in hepatoblasts. 4. Yolk sac-type AFP was found mainly in the perifocal liver cells of metastatic liver cancers.
It is concluded that the PAP method for AFP and P-Con A staining might facilitate the immunohistochemical differentiation of two types of AFP in various AFP-secreting tumors, and that it would be possible for clarifying the histogenesis with deeper consideration on these tumors.

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Clinical evaluation of measuring serum pancreatic amylase levels in patients with pancreatic diseases was investigated, in special reference to its usefulness for looking at the exocrine pancreatic function. There were significant correlations between serum pancreatic amylase values and the exocrine pancreatic functions (volume and bicarbonate output of the secretin test in 121 cases, and values of the PFD test in 43 cases) when a ratio of serum pancreatic amylase to serum total amylase (%P/T) was calculated. However, there were no correlations between them when absolute values of serum pancreatic amylase (P) were observed. The serum pancreatic amylase was suggested to move gradually from high to low levels when the stage of chronic pancreatitis advanced. No correlations were found between serum total amylase (T) and serum pancreatic amylase (P), serum elastase 1, serum phospholipase A₂ levels, respectively, though significant correlations were found between serum pancreatic amylase (P) and serum elastase 1, serum phospholipase A₂ levels, respectively. The present results indicate that measurement of serum pancreatic amylase levels is useful for estimating the exocrine pancreatic function and its values are well correlated with other serum enzyme levels specific for the pancreas.

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In a sanatorium which specializes in treating patients with Hansen's disease, surgical diseases including cancers have increased with aging of the patients. In order to early diagnose and treat these diseases, our sanatorium has introduced endoscopic and ultrasonographic examinations since 1986, because they are reliable methods for diagnosis.
The study was conducted on 350 patients. Seventy-two percent of them received an examination of the upper digestive tract. The results were as follows: Three had esophageal carcinoma, and 2 had advanced gastric carcinoma, 4 had early gastric carcinoma and 1 had gastric sarcoma. Sixty-two percent of all the patients underwent an examination of the lower digestive tract. Of these, 1 patient had advanced cancer and 9 early cancer. Ninty-two percent of all the patients had ultrasonographic examination. Of these, 2 patients had hepatic carcinoma, 1 bladder carcinoma and 1 uterine carcinoma, which were all malignant. Furthermore, esophageal varices existed in 9 patients and gallstone in 23. Most of these cases were treated by operation, or procedures under endoscopy or ultrasonography. As a result, the mortality from cancer was 50% in 1985, 45% in 1986 and 50% in 1987, but in 1988 it decreased to 14%. Since the last death from the cancer in April 1988, the mortality of zero has lasted for more than 2 years.
It is concluded that early detection of cancer brings about less invasive treatment and gives good quality of life to the patients.

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Two, middle-aged women with no apparent organic heart disease underwent programmed electrical stimulation (PES) because of palpitation and syncope, or rapid, nonsustained ventricular tachycardia, respectively. The QTc intervals and serum potassium and magnesium were within normal limits. PES from the right ventricle induced nonsustained, polymorphic ventricular tachycardia with the morphology and rate characteristic of torsades de pointes (TdP). Both patients have been asymptomatic with PES-guided, antiarrhythmic drug therapy for 5 or 6 months. However, it remains uncertain whether PES-induced TdP affects the prognosis of these patients, thereby antiarrhythmic drug therapy is urgent.

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Introduction of a pacemaker that senses and paces in both the atrium and ventricle (DDD) has presented the problem of pacemaker mediated arrhythmia. Endless loop-tachycardia (ELT) is a reentrant arrhythymia, involving artificially placed accessory pathway as the antegrade limb and ventriculoatrial (VA) conduction as the retrograde limb. In three cases with ELT, the trigger, frequency and duration of it, and its clinical features were analyzed.
All patients underwent implantation of DDD pacemaker for treatment of atrioventricular conduction disturbance. One of them had retrograde VA conduction, but others showed no predicitive findings for tachycardia in pre-implantation electrophysiological study. Post-implantation Holter ECG revealed that the patient with VA conduction had the most frequent attacks of ELT and the duration of it was the longest among them. All patients were asymptomatic during ELT attacks. ELT was prevented by reprogramming some parameters of pacemaker.
These results suggest that not only the evaluation of retrograde VA conduction before implantation, but also the follow-up study of patients with Holter ECG and intracardiac ECG from the implanted pacemaker, is important for the detection and prevention of ELT.

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A 58-year-old man was admitted to our hospital because of dyspnea. He had a past history of bronchial asthma at the age of 6, spontaneous pneumothorax at 43, and began to develop dyspnea on exertion at 49. He was diagnosed as having multiple pulmonary emphysematous cysts on chest X-ray films, specially giant bullae at right lower lobe. After that, he developed mild respiratory failure, died of viral pneumonia in 1989. On post mortem examination, there were multiple bullae in both lungs, specially giant bullae in both lower lobes, The right ventricle was enlarged. It was considered that the check valve mechanism between bronchi and alveoli might play important roles in the development of giant bullae.

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Lipomas of the digestive tract are very rarely observed and reports on small intestinal lipoma have been remarkably few. On this occasion, we observed a case of lipoma in the jejunum and in this paper we report this case.
The patient was a 20-year-old man and underwent an appendectomy at the age of 7. Subsequently, he was admitted to a nearby clinic three times, with the diagnosis of ileus, and repeatedly received symptomatic treatment. Recently he was hospitalized with the diagnosis of ileus because he complained of severe abdominal pain and vomiting. The insertion of the Dennis tube relieved the obstructive symptoms to a certain degree. Nevertheless, as the tube did not pass the left mid-abdominal region, a double contrast study of the small intestine was performed, and an irregular stenosis caused by a protuberant lesion was discovered. It was certain that the ileus was caused by the tumor of small intestine.
A laparotomy was carried out. A tumor covered by a mass of fatty tissue was observed in the jejunum at a distance of about 2 meters from Treitz's ligament, however, neither infiltration nor metastasis was noticed. About 50cm of the jejunum, including the tumor, was resected.
The tumor was a submucosal tumor of yellowish color, measuring 10.5×6.5×3.5cm in size, showing an intraluminal, intramural, extraluminal, and a partially annular growth.
The pathohistological diagnosis was infiltrating lipoma.

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A 40-year-old man visited a clinic because of mucous and bleeding stool and diarrhea. He was diagnosed as ulcerative colitis (left-sided colitis) by barium enema, colonoscopy and histological findings. Prednisolone acetate 30mg/day and salicylazosulfa pyridine 4.0g/day were administrated for one year. However, the patient was not able to have remissions and came to our hospital. After admission symptoms disappeared by elemental hyperalimlentation and administration of prednisolone and salicylazosulfa pyridine. Despite of conventional therapy mucous and bloody stool occurred. Active colitis was proved by endoscopic and histological findigs. Prednisolone was increased to 60mg/day with Saireito (Kampo medicine). Symptoms have been disappeared and the dose of steroid have been decreased to 20mg/day and he has been well as an outpatient. It is considered that a successful decrease in doses of steroid might be due to the modulation effect of Saireito.

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We report two patients with autoimmune chronic hepatitis who developed hepatocellular carcinoma. Hepatocellular carcinoma is thought to be a rare complication of autoimmune chronic hepatitis. The first patient, a 65-year-old woman, was admitted to our clinic in Feb. 1987, complaining of abdominal distension. On admission to hospital, laboratory data showed the positive LE test, LE cell and ANA (×80) and hypergammaglobulinemia. A liver biopsy showed liver cirrhosis and severe chronic inflammatory cell infiltration. The patient was diagnosed as having lupoid hepatitis developing liver cirrhosis. In 1989, she complained of foot edema and ascites which necessitated hospital admission. Laboratory data showed hypothyroidism and positive thyroid test and microsome test, diagnosed as having chronic thyroiditis. In addition, anti-HCV in her sera was positive, but negative for HBsAg and HBcAb. Ultrasonographic examination and CT scanning revealed mass lesion in the liver. After TAE, partial lobectomy was performed. Hepatocellular carcinoma was diagnosed by the resected liver specimens. The second patient, a 78-year-old man, was admitted to our clinic in Jan. 1990, complaining of abdominal distension. On admission to hospital, laboratory data showed the positive AMA (>320) and anti-M2, high level of ALP and hypergammaglobulinemia. HBsAg, HBcAb and anti-HCV were negative in this case. The patient was diagnosed as having PBC developing liver cirrhosis. Ultrasonographic examination and CT scanning revealed multiple mass lesions in the liver, although serum alphafetoprotein level was not so high. The patient deteriorated rapidly and died in May 1990. Autopsy confirmed the diagnosis of hepatocellular carcinoma complicating PBC.

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The reports of cases of splenic cyst have increased with the progress of imaging techniques of diagnosis, and as their images have become more clear, the therapy method has been changing.
Recently, we experienced two cases of splenic cyst, and report chiefly about the indication for operation with some review of the literatures.
A 61-year-old female (case 1) underwent resection of calcificated multilocular pseudocyst of 10cm in diameter.
A 22-year-old male (case 2) was operated upon for splenic pseudocyst including bloody mass of post-abdominal injury.
As to the indication for operation of splenic cyst, patients have been operated by this time, as far as thier general conditions are good, because cysts may compress other organs, rupture, be infected, and become malignant.
But now, small splenic cysts below 500g can be resected easily, so we should reevaluate the indication for the operation.

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Extramedullary plasmacytomas are rare and plasmacytomas of the ovary are very rare. We report a case of a plasmacytoma arising in the ovary of a 45-year-old woman.
Immunohistochemistry was carried out by PAP and ABC technique: the cells showed cytoplasmic lambda light chains. Electron microscopy of the tumor tissue showed appearances with plasma cells.

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The prognosis of ovarian tumors of low malignant potential has been appreciated to be better than that of a frank ovarian carcinoma. However, there have been few reports describing the recurrent cases of ovarian tumors of low malignant potential in Japan. Here we report a patient with recurrent ovarian tumor of low malignant potential who has been alive and free of disease for 12 years and 11 months since diagnosis. The patient was a 34-year-old woman, who underwent a right salpingo-oophorectomy followed by a radiation therapy based on the gross findings of stage Ia right ovarian cancer. Histology of the resected tumor was a serous cystadenocarcinoma of low malignant potential. The tumor developed recurrence in the retained ovary eight years later. A total abdominal hysterectomy with left salpingo-oophorectomy was performed. Histological appearance of the recurrent tumor was a serous cystadenocarcinoma of low malignant potential which was similar to that of the primary tumor. At present, though 12 years and 11 months have passed since initial diagnosis, the patient is still free from disease.

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An autopsy case of Huntington's chorea is reported and its psychotic features is discussed. A 38-year-old man showed chorea of extremities and gait disturbance. Six years later, personality changes developed and he became unrestrained, irritable, and aggressive. Furthermore, in addition to calculation disturbance and disabled understanding, symptoms of so called “subcortical dementia” such as forgetfullness, slowing of thought processes, and depressed drives were observed. He died of pulmonary edema at the age of 48. Neuropathologically, severe atrophy of the striatum with a marked loss of small neurons was observed. The neuronal loss of the cerebral cortex, especially in the frontal and occipital lobes, as well as atrophy and myelin pallor of the cerebral white matter were found. From the clinicopathotogical standpoint, the personality changes in this case could be attributed to the degeneration of the striatum and the frontal lobes. Furthermore, the dementia characteristic of so called “subcortical dementia” in this case might be contributed not only to the striatal lesion but also to the degeneration of the cerebral cortex and the cerebral white matter.

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Pyelocaliceal diverticular abscess is a rare disease. We experienced a case with a pyelocaliceal diverticular abscess as a complication during pregnancy.
The patient was a 29-year-old primigravida who visited a local doctor because of lower abdominal pain. On the following day, she was introduced to the department of obstetrics and gynecology of our hospital because of sharp pain. From week 27 of pregnancy, she developed a fever of 39.3°C. She was examined in the departments of internal medicine and urology, and an abscess was found around the right kidney by USG, etc., which was considered to be an infectious renal cyst. An emergency drainage operation was performed, about 200g of pus was drained and staphylococcus aureus was detected. Urine was found with the pus from the puncture region. In the beginning, there was 300 to 2, 200cc/day of urine, but it decreased to the amount of 70 to 200cc/day from week 29 of pregnancy. Since priority was given to the continuation of pregnancy, the drainage was performed by the conservative method. Thereafter, the fetus showed AFD in USG, and reactive pattern was seen in NST.
The neonate weighed 3, 490g and showed no abnormalities.
Since 110 to 430cc/day of urine volume was drained from the puncture region even after delivery, she underwent an operation in the department of urology one month after delivery. The resected specimen did not show an infectious renal cyst but indicated a pyelocaliceal diverticular abscess. No recurrences have occurred for two years since the operation.

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A survey of the social opinion about the terminal care using simulation was made. Opinions were collected from the patient's family members, medical workers, medical students and persons of religion (Buddism).
Two questions were asked. The first one was “whether the terminal care would be given at the hospital or the home of the patient”. The second one was “whether aggressive care would be done or passive care”. The data of this survey were analyzed statistically using logistic regression analysis, according to personal background of individual subject including sex, age, religion and marital history.
The present investigation indicated that the younger desired aggressive care at the home, whereas the older passive care at the hospital and that man desired aggressive care and woman passive care.
Patient's family tended to desire passive care at the hospital, whereas Buddist passive care at the home.

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