Some interesting clinical aspects of bile pigments mainly bilirubin were stated.
1) Bilirubin IXα, IIIα and XIIIα are stractural isomers of bilirubin and change from ZZ type to EE type bilirubin with light and heat. The latter explains the mechanisms of phototheraphy.
2) delta-bilirubin is the direct reacting bilirubin, which is tightly bound with albumin; the half-life of delta-bilirubin is the same as albumin. In the early icteric stage, a part that delta-bilirubin takes in direct reacting bilirubin fraction is low, but becomes high in the recovery stage.
3) Oxidative reaction of bilirubin is catching or vanishing reaction of active oxygen and it makes a physiological sence.
4) As the diseases related with dipyrrole bile pigments, congenital hemolytic anaemia with positive Heinz body and bronze baby syndrome were stated.

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In patients with sub-respiratory failure, the present study was undertaken to estimate T-lymphocyte subsets for immunological studies, and atrial natriuretic peptide (ANP) for overloading of right heart. Monoclonal antibody and flow cytometory method were applied to the peripheral lymphocytes.
In these patients, proportion of OKT₄ was significantly decreased (p<0.05), and OKT₄/OKT₈ ratio was significantly lower than that of control (p<0.05). A significant relationship existed between PaO₂ and OKT₄ or OKT₄/OKT₈ ratio (r=0.57 or r=0.60).
ANP was significantly increased in these patients (p<0.05) and not related to the plasma renin activity or plasma aldosterone concentration. A significant negative relationship existed between PaO₂ and ANP (r=-0.51).
It is suggested that the unballance of immunological activity and increase of ANP may be contributed by arterial hypoxia and overloading of right heart.

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Aspiration biopsy cytology (ABC) for the breast diseases was performed on 76 patients from 1985 to 1986, and on 339 patients from 1987 to 1989. From the historical comparative study, the following results were obtaind.
1) The over all accuracy rate of ABC improved from 72.4% to 77, 9%.
2) The accuracy rate for small breast cancer was remarkably improved.
3) False negative rate decreased from 20.5% to 14.3%, and false positive rate did from 6.3% to 4.3%.
From these findings, we confined that ABC was a useful examination for small breast tumor.

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We investigated the pathological findings of 74 autopsy cases of pancreatic ductal cell carcinoma at our clinic for 17 years (a case of cystadeno-carcinoma was excluded). By administrating multidisciplinary treatment, of which radiotherapy was the main, both prolongation of survival and living at home became possible. Firstly, all of our long survival cases had no liver metastasis (H₀) on the day of diagnosis. Secondly, due to the radiation, the pancreas was greatly damaged but metastasis to the abdominal lymph nodes decreased. However, infiltration and metastasis to the organs surrounding the pancreas or the lung occurred more often in the cases with radiotherapy. In addition, quite a few viable cancer cells remained near the tumor. Thirdly, there were some cases with complications, especially enteritis, which was sometimes the direct cause of death. Therefore, the following questions about pancreatic cancer therapy remain to be answered. (1) How metastasis to the liver can be prevented and treated. (2) How the remaining pan-creatic cancer cells can be destroyed. (3) How the radiation induced injuries can be reduced.

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This study investigated the serum markers of fibrogenesis and basement membrane formation in relation to the clinical and morphological severity of liver diseases. The concentrations of the aminoterminal propeptide of type III collagen, type IV collagen, and laminin were measured from 65 samples representing a wide range of clinical and histological seventies of the liver diseases. Significant correlations were found among these three markers of connective tissue metabolism and was indicated that these three markers correlated closely with the degree of fibrosis in chronic liver diseases. However, these three markers were suggested to reflect the different clinical significance. Serum concentrations of P III P correlated significantly with serum GOT and GPT levels in all samples as well as in acute hepatitis, suggesting that this marker might reflect the degree of inflammation and activity of fibrosis in liver diseases. On the other hand, serum concentrations of type IV collagen and laminin correlated significantly with serum level of albumin and fibrosis of HAI scoring for the biopsy specimens, suggesting that these two markers might reflect the established fibrosis in liver diseases.

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Prognosis of biliary tract cancer is very poor and the radiosensitivity of the cancer is very low. Therefore radiotherapy has not been indicated for biliary malignancy. Recently, the reports have been increasing that external, intraoperative and intra-cavitary radiotherapy with adjuvant chemotherapy is effective for biliary tract cancer.
At this time, we attemped to evaluate the efficacy of external radiotherapy with 45-50Gy for 10 cases of biliary tract cancer in our hospital during 3 years. As a result. improvement of clinical symptoms and reduction of tumor size were seen in 9 cases. Median survival rate was 6.2 months and the longest survival case was 14 months. Clinical course of the 3 cases that underwent local adjuvant chemotherapy with adriamycin injected into the PTCD tube was very good and subjective symptoms disappeared. Thus, external radiotherapy is considered to be the choice of therapy for advanced or inoperable biliary tract cancer.

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To 16 patients with prostatic carcinoma who received no treatment, including 14 with stage B, 2 with stage C, trans-urethral radiotherapy (TUI) with use of a ⁶⁰Co radioactive source was performed by means of remote after-loading methods. This radiotherapy was actually given on the 16 patients with prostatic carcinoma who have been examined at Okura National Hospital since 1985.
TUI was performed to the prostatic area, 4.5 Gray twice a week with a total dose of 27 Gray, after 40 Gray of external irradiation by Linac X ray to the same area. Three months after the radiotherapy was completed, needle biopsy and/or transurethral resection (TUR) of the prostate was performed to judge the remedial value.
All patients tolerated the procedure well, and serious complications were not seen. The result showed that 4 cases of the patients showed denaturization in their prostatic carcinoma, and the other cases showed no malignant cancerous cells. For that reason, this transurethral radiotherapy was considered to be an effectual cure for localized prostatic carcinoma.

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It is known that the ratio of the neurinoma among cerebral tumors with tumoral hemorrhage (intratumoral hemorrhage, subarachnoid hemorrhage, subdural hemorrhage and intracerebral hemorrhage) is considerably less. This time, we experienced a case (a 46-year-old female) of acoustic neurinoma who showed sudden aggravations of the unilateral headache and trigeminal symptom during hospitalization. The high density area of the hematoma was observed in the tumor by X-ray CT after acute aggravation, and intratumoral hematoma was further clearly visualized by MRI. As histological pattern, mixed type of Antoni-A and -B, and many dilated thin-walled blood vessels were observed.
Total 19 cases with tumoral hemorrhage of the acoustic neurinoma including this case have been reported in detail so far, and large tumor more than 2-3cm was a common finding and hearing difficulty or cerebellar ataxia was almost always noted in the past history. It was considered that subarachnoid hemorrhage (12 cases), intracerebral hemorrhage (3 cases) and subdural hemorrhage (1 case) among tumoral hemorrhage were caused by leakage of the intratumoral hemorrhage (19 cases). The prognosis was especially favorable after introduction of the X-ray CT.

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The authors have performed 22 procedures of high cervical (C1-C2) percutaneous cordotomy for 16 patients with intractable cancer pain. Satisfactory pain relief was obtained' Immediately following cordotomy, patients considered themselves to be pain free or so comfortable that no analgesics were necessary in 75% of the cases.
The complication rate was low. Ipsilateral hemiparesis appeared temporarily in 2 patients. Urinary retension was present transiently in 2 patients. Post-cordotomy dyse-sthesia in 2 cases was appeared about 1-2 months later.
Authors believe that this procedure is the best method for the relief of intractable cancer pain.

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The rate of malignant transformation of gastric hyperplastic polyps is relatively low.
We have recently encountered a case of multiple gastric hyperplastic polyps with malignant change.
The patient was a 54-year-old male who had been known to have multiple gastric polyps since 5 years before.
This time, he was admitted to our hospital for surgical treatment of gastric polyps because the latest endoscopic biopsy had revealed cancerous focus in one of the hyperplastic polyps.
Total gastrectomy was performed considering the distribution of the polyps in the stomach and possibility of overlooking latent cancer in other hyperplastic polyps.
Macroscopically, the resected specimen demonstrated 14 polyps, 13 in the gastric corpus and one in the gastric antrum.
Histologically, the antral polyp which was semi-pedunculated and 7mm in diameter had cancerous focus at the top of hyperplastic polyp.
Other 13 lesions were all hyperplastic polyps without malignant change.
Concerning the histogenesis of malignant transformation of hyperplastic polyp, we have no conclusion about whether that cancer arose from dysplastic area in hyperplastic polyp or directry from hyperplastic epithelium.
In order to elucidate the histogenesis of malignant transformation of hyperplastic polyp and prevent malignant change of the polyp we should perform aggressive polypectomy under endoscopic control when gastric polyps are encountered.

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We present a case of chronic pancreatitis (CP) accompanied by afferent loop syndrome (ALS) which suggested a new clue to treat an intractable type of the disease. A 51-year-old man suffering from alcoholic CP underwent total gastrectomy because of bleeding gastric ulcer. He stopped drinking subsequently, but abdominal pains and hyperamylasemia persisted. Total parenteral nutrition and intravenously infused nafamostat mesilate improved hyperamylasemia, but were unsuccessful in managing abdominal pains accompanied by intermittent symptoms suggesting ALS and cholangitis such as vomiting of bile stained fluid, pyrexia and so on. Therefore trimebutine maleate were orally administered, and all of those symptoms disappered. From this point of view, we conclude as follows:
1) The pathophysiology of chronic ALS consists in not only mechanical obstruction but also functional dyskinesia of afferent loop in various degrees, and trimebutine maleate, recognized as gastrointestinal motility regulator is effective as the treatment. 2) In managing intractable CP with a history of gastric resction, the bile or pancreatic juice reflux due to raised intraduodenal pressure has to be considered as a factor of intractability.

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