We performed percutaneous transhepatic gallbladder drainage (PTGBD) in 51 cases during the period of 5 years and 2 months beginning November 1984. PTGBD was performed in 22 cases of cholecystitis, 9 cases of cholangitis and 20 cases of obstructive jaundice due to malignant diseases. To evaluate its usefulness, cases of PTGBD were compared with 15 cases of percutaneous transhepatic bile duct drainage (PTBD) in terms of reduction of jaundice and with 37 cases of acalculous cholecystitis treated without PTGBD in terms of reduction of inflammation. PTGBD showed the same level of deicteric effectiveness as PTBD. However, two cases of PTGBD required subsequent PTBD. Seven out of 12 acalculous cholecystitis cases were treated with PTGBD only. One of these 7 cases involved a recurrence 7 months after discharge and repeated PTGBD was performed. A diagnosis of gallbladder carcinoma was able to be made through the cytological examination of the bile. However, the levels of CEA and CA19-9 were not more important than serum CEA and CA19-9 levels for diagnosis. One perforation of the gallbladder occurred but no other serious complications were noted. PTGBD was considered to be useful not only for the treatment of bile duct inflammation and obstrucive jaundice in poor-risk patients, but also for the differential diagnosis of malignant diseases.

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Seventy-five patients with herpes zoster infection were treated with intravenous drip infusion administration using newer anti-viral agent, acyclovir. Effectiveness of this treatment, especially prevention of recalcitrant postherpetic neuralgia was evaluated. These patients visited our hospital during 1987-1989. Some of them were aged ones, others were immunocompromised hosts with internal malignancies etc., and still others were suffered from very severe forms of herpes zoster infection.
The incidence of severe postherpetic neuralgia in these patients was 13.5%, which is similar to that of AraA-treated patients previously reported by us. The risk of residual postherpetic pain appeared to be closely related the background factors such as age, severity of the skin lesion, but not related to the dose of acyclovir or the timing of the initiation of anti-viral therapy. Marked elevation of the complement-fixing antibody titres against varicella-zoster virus predictively suggested the high risk of resultant postherpetic neuralgia, especially in older patents. In the present study, acyclovir was administered without any seious side effects.

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To study the clinical efficacy of acyclovir-human interferon-β combination against herpes zoster and postherpetic neuralgia, 7 cases were treated with this combination, while 11 cases were administered acyclovir only as control. The severity of the residual pain at 1 month after onset was evaluated in both groups.
One of the 7 cases treated with acyclovir-interferon combination had severe postherpetic neuralgia, although 3 of the 11 cases of the control group had such severe residual pain.
These therapy could be performed without any serious side effects such as high fever, abnormalities of laboratory data, etc., except that a transient mild elevation of serum transaminase level was observed in one case.
Complement-fixing antibody titres against varicella-zoster virus were markedly elevated (128×<) in patients with severe post-herpetic neuralgia.
The present study was performed on relatively small numbers of patients with herpes zoster infection, and the clinical efficacy was not clearly evident, although the significance of further study on acyclovir-interferon combination therapy against herpes zoster was implicated.

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We evaluated the effect of hyperbaric oxygen therapy (OHP) upon 204 cases of facial palsy in the last eight years. Of these, 185 cases were diagnosed as Bell's palsy and 19 cases as Ramsay Hunt syndrome. In the cases that the therapy was started within two weeks after onset, 82% of Bell's palsy and 81% of Ramsay Hunt syndrome were recoverd completely. The mean time for recovery was 28.3 days in Bell's palsy and 27.5 days in Ramsay Hunt syndrome. The milder the degree of the palsy was, the younger they were and the shorter the period from onset to the beginning of OHP was, the higher the rate of complete recovery was. Even in the cases that the therapy was started over two weeks after onset, 47% of Bell's palsy were recoverd completely. OHP is very effective therapy for facial palsy, since it is safe and can be adopted anybody regardless of another illness and age.

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Seven patients with SMON were recently anesthetized and operated in our hospital. Two of them underwent single general anesthesia, another two patients underwent epidural anesthesia and others underwent general with epidural anesthesia. Hypertension during operation occurred in the group of general anesthesia alone but hypotension occurred in epidural anesthesia group. Neurological findings of all patients became worse after anesthesia and operation. From the viewpoint of circulation control and postoperative analgesia, single epidural anesthesia or general with epidural anesthesia is considered to be useful for the patients with SMON.

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Using 123 gynecology laparotomy patients, 53 from preliminary experiment and 70 from multi-clinical experiment, who still were deeply sedated at the end of anesthesia, we studied the effect of flumazenil from anesthesia supplemented by benzodiazepine and pentazocine. The patients were intravenously inducted for anesthesia with one of the benzodiazepines, either diazepam 0.3mg/kg, flunitrazepam 0.03mg/kg or midazolam 0.3mg/kg and pentazocine 1mg/kg. The anesthesia was maintained with nitrous oxide, a muscle relaxant and additional pentazocine and benzodiazepine when needed. At the end of each operation, f lumazenil 0.3mg was administered intravenously. If after 4 minutes its effect was insufficient, additional flumazenil 0.1mg was administered. Results: 1 minute after the administration of flumazenil, 83.3% (preliminary), 90.0% (multi-clinical) of the patients in the diazepam group, 100.0% (preliminary), 70.8% (multi-clinical) in the flunitrazepam group and 87.5% (preliminary), 76.9% (multi-clinical) in the midazolam group were completely conscious. The effects of restoring cognizance and orientation were excellent but had a slight effect on anterograde amnesia. No side effects were encountered.

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To improve the quality of medical management of the prenatal and neonatal life, the forementioned joint study was conducted in 8 national hospitals in Japan. The mechanism which regulates immunological responses between the mother and the fetus is significantly involved in the maintenance of pregnancy. Namely, the immune response to the HLA antigen from their spouse or production of anti-HLA antibody is low in recurrent aborters. Inoculation of lymphocytes withdrawn from their spouse of the recurrent aborters enhances the antibody response, resulting in an elevation of the survival rate of the fetus. Statistical studies were performed with clinically important circumstances such as transmission of infectious diseases from the mother to the infant, and obstetric history in women with SLE, a typical autoimmune disease. Monoclonal antibody was used to prove the presence of the specific antigen in trophoblast. In the study of the neonatal period, the cord blood was compared with the maternal blood in terms of mobility of monocytes and IL-1 concentration. The process of establishing intestinal flora was clarified. Culture of cells from the cord blood revealed a difference in origin and way of proliferation between basophils and mast cells.

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Cases of cholelithiasis with the stones extending around the junction or the confluence of the three ducts, namely the common hepatic duct, the cholecystic duct and the common bile duct, often causes damage to the channel of the bile in the course of operation. This type of cholelithiasis is differentiated from other types and is termed as confluence stone.
The patient was a 66-year-old woman with the diagnosis of gall stone for 10 years.
This time, she came to hospital because of epigastric pain and jaundice. A diagnosis of confluence stone was made by ERCP, CT and PTCD, and she underwent a laparotomy after the jaundice subsided.
Opening of the abdominal space revealed the inflammatory thickening of the gall bladder, the strong contraction, and the expanded common bile duct as a whole. This expansion was especially remarkable around the junction of the three ducts, and there was a cholesterol stone of 4×2.7×2cm.
After the gall bladder was taken out, the stone was extracted, the common bile-duct was closed in a patch graft, normal part of common bile-duct was opened again, and a T-tube was inserted.
After the operation, there was no liver dysfunction, and the patient felt relieved and was discharged on the 37th day of operation.
In conclusion, preoperative diagnosis of a confluence stone is difficult, and the diagnosis of a confluence stone is often made during operation.

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A 76-year-old woman visited our hospital because of dysphagia. UGI series and endoscopic examination showed a pedunculated tumor in the upper thoracic esophagus. The tumor was soft and the surface was smooth but erosion was seen on its head. On CT examination, the tumor revealed low density with slight heterogeneity. The tumor was resected by intra-abdominal esophageal stripping. On histrogical examination, the tumor was covered with normal squamous epithelium and matured fatty tissue was seen in the submucosa. It was diagnosed as benign lipoma of the esophagus. Esophageal lipoma was reported only 15 cases in the Japanese literature.

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We report five cases of early stage, superficial spreading type malignant lymphoma of the stomach. Macroscopically, they may look irregular shallow ulcers or erosions diffusely spreaded or nodular elevated lesions around ulcers resembling “cobblestone” or “bull's-eyes ign”. Other diseases may sometimes present a similiar picture. Therefore, it is difficult to make a correct diagnosis at the beginning from reactive lyniphoreticular hyperplasia (RLH), depressed types of early gastric carcinoma and many other diseases. Our two cases were correctly diagonosed as maliganant lymphoma before operation. One case was saspected as IIc-type early gastric cancer. Two cases were followed up for many years as RLH.

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Patients with malignant intracranial lymphoma have increased in number recently, and we investigated the clinical features of 8 cases treated at our department. The subjects were 4 males and 4 females with a mean of 54 years of age. The results were summarized as follows.
1. Typical initial symptoms were hemiplegia, disorientation, and raised intracranial pressure in that order.
2. All cases had an avascular mass on cerebral angiography.
3. CT scanning showed that most lesions were located in the paraventricular area and in the midline structures in the vicinity of the ventricular system, and multiple lesions were noted in four cases in these areas. A typical CT appearance was noted in all cases, but one patient did not show enhancement and the lesion was extremely difficult to distinguish from glioblastoma in other patient.
4. In 2 cases, abnormal findings were obtained by MRI although the lesions had resolved on CT during the process of the illness.
5. In 3 cases, recurrence was noted with their locations different from the initial sites.
6. Temporary remission was obtained in all cases, but four patients died of pulmonary complications.
The results suggest that it is possible to follow up these patients by imaging techniques including MRI, and that pulmonary complication is an important factor in determining the final prognosis.

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We report a case_ of bronchial atresia examined by magnetic resonance (MR) imaging.
MR imaging demonstrated morphological details of the mucoid impaction within the bronchial tree by coronal sectional images. And the mucoid impaction showed high signal intensity on T₁ augmented images characteristically.
MR imaging is considered to be a useful modality in the diagnosis of bronchial atresia.

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A 44-year-old woman was hospitalized for pyrexia and weakness. Weakened myodynamia, especially in the proximal muscles was observed. Abnormally high values of myogenic enzymes such as CK, ALP, GOT, GPT and LDH were found by a blood biochemical test. Diagnosis of delomorphous polymyositis was based on the findings of electromyography and muscular biopsy. The abnormally high serum CK value was observed between MB and MM fractions by electrophoresis and thin layer filtration by the use of Sephadex-200 as carrier. It was confirmed that the abnormal value was due to the immunoglobulin-affinitive macro CK which became macromolecule by binding to lg-A. Presence of macro CK has been reported in malignant diseases and hereditary muscular disease, suggesting a possibility of some immunological abnormality.
We observed in this patient a decrease in the macro CK values along with improvement of polymyositis. This may suggest a possibility of macro CK regulating the activity of polymyositis.
Accumulation of similar cases may be necessary to better understand the cause of polymyositis.

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A case of Fukuyama type congenital muscular dystrophy (FCMD) presenting with rapidly progressive heart failure is reported. This 15-year-old boy was diagnosed as having FCMD at 8 months of age, because of the pathological findings of biopsied muscle and clinical symptoms such as hypotonia, weakness, multiple joint contractures, facial muscle involvements and psychomotor retardation. At 15-year and 4-months, dyspnea, oliguria and edema developed. A chest X-ray film and echocardiogram disclosed a marked cardiomegaly and decreased left ventricular ejection fraction. Then his heart failure became progressively worse. At 15-year and 7-months, he developed a cardiac arrest induced by infection, and was successfully resuscitated. At 15-year and 9-months, he had pneumonia. His heart failure became even worse and he died. An autopsy examination revealed heart muscle involvement such as heart muscle hypertrophy, degeneration and fibrosis, predominantly in the right ventricle.
To our knowledge, there were no reports regarding FCMD presenting with such a rapid progression of heart failure. The present case suggests that FCMD shows various kinds of cardiac involvement, and we should take care of cardiac involvement in FCMD.

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Segmental dose requirement of 2% mepivacaine in thoracic epidural anesthesia was examined. Two groups of patients scheduled for upper abdominal surgery were studied. Patients in group I (n=35) were over seventy years old and patients in group II (n=34) were younger than fifty years old. A Tuohy needle was inserted into the epidural space at one of the seventh to ninth thoracic interspace. Patients in group I and group II received 3ml and 6ml of 2% mepivacaine, respectively. Fifteen minutes after injection of mepivacaine, the extension of analgesia was evaluated by the pin-prick technique. As there was a significant difference in height between the two groups, segmental dose requirement per patients' height (ml/seg/M) as well as segmental dose requirement (ml/seg), was calculated. The doses in group I and II were 0.57 and 1.01ml/seg, respectively. The doses per patients' height in group I and group II were 0.37 and 0.61ml/seg/M, respectively. Both ml/seg and ml/seg/M were significantly smaller in group I than group II (p<0.01). Present results indicate that less anesthetic solution is needed in elderly patients for thoracic epidural anesthesia.

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Penile cancer is a relatively rare disease and regarded as having a very poor prognosis in case of distant metastasis. This paper presents a case of recurrent penile cancer with lung metastasis in which partial lobectomy was performed following neo-adjuvant chemotherapy with methotrexate, bleomycin, and cis-platinum.
A 72-year-old male had undergone partial amputation and ingunal irradiation for penile cancer. Pathological diagnosis of the partial amputation was moderately differentiated squamous cell carcinoma. After four months, he was readmitted because of local recurrence and lung metastasis. After combination chemotherapy with methotrexate, bleomycin, cis-platinum, we perfomed the resection of remnant local tumor and partial lobectomy.
The patiant has been very active in his daily life without evidence of local recurrence or new metastasis for more than two and a half years.

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