Thirty six cases with pulmonary atypical mycobacteriosis (AM) (16% of 225 inpatients with pulmonary tuberculosis and AM) were investigated during the 3-year period from 1988 through 1990.
The age at the time of admission was over 70 years old in 63.9% of the total AM cases.
Primary infection (I-group) and secondary infection (II-group) were found in 7 (19.4%) and in 29 (80.6%) of the total cases.
In the cases associated with positive sputum smear or cultures for atypical mycobacteria, M. avium complex, M. kasasii and M. chelonae were observed in 91.7%, 5.6% and 2.8% respectively.
As to the prognosis, cured and improved cases and death cases were 85.8% and 14.2% in I-group. The former and the latter were 31.0% and 20.7% respectively in II-group.
Among positive PPD cases, cured and improved cases and death cases were 55.6% and 162%. Among negative PPD cases, the former and the latter were 37.8% and 22.2%.
The increase in proportion of OKT₈ cells and the low ratio of T4/T8 cells were ohtamed by the analysis of peripheral blood lymphocyte subsets in AM cases.

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We evaluated the exercise capacity in 52 patients with chronic lung diseases (39 male/13 female, age 66.2±8.8 years old, PaO₂≥60 Torr) using a treadmill exercise test. The arterial saturation of oxygen (SpO₂) was monitored continuously by a pulse oxymeter. The total course of 15 minutes (5 stages, each stage 3min) was completed in 57.7% of all patients. Exercise was stopped because of SpO₂≤85% (n=9), dyspnea (n=5), and leg fatigue (n=4). When the cases of pulmonary tuberculosis sequelle (PTB, n=28) were compared with the cases of chronic pulmonary emphysema (CPE, n=15), the exercise time was not significantly different. However PaO₂ after exercise was significantly lower in PTB than in CPE (63.9±12.7 Torr vs 77.5±1.4 Torr, p<0.001), although PaO₂ before exercise was similar in both groups. The exercise time of patients who showed hypoxemia (SpO₂≤85%) after exercise was significantly lengthened by the supplemental oxygen (723±161 sec vs 826±112 sec, p<0.001).

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Sixteen cases of Joseph disease were compared with 10 cases of olivo-ponto-cerebellar atrophy (OPCA) clinically and pathologically. In the patients with Joseph disease, age at its onset ranged from 17 to 58 (the mean was 32.9±10.9) and duration of illness ranged from 18 to 26 years (the mean was 24.2±3.1).
Clinical features in Joseph disease included ataxic gait in 100% of the patients, nystagmus in 100%, dysarthria in 94%, spasticity in 63%, brisk deep, tendon reflexes in 81%, dystonia in 69%, external ophthalmoplegia in 81%, and muscle wasting in 75%.
Pathological findings in Joseph disease demonstrated severe degenerative changes in the internal segment of the globus pallidus, subthalamic nucleus, dentate nucleus, the Clarke's column and spino-cerebellar tracts of the spinal cord.
With respect to clinical courses, patients with OPCA showed cerebellar signs for a long period. Though patients of Joseph disease showed cerebellar signs initially, pyramidal and extrapyramidal signs, furtheremore peripheral neuropathy predominated and masked cerebellar signs.

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To clarify the neuropathological hallmark of dementia, we evaluated cortical neuronal loss, senile plaque, and neurofibrillary tangle (NFT) in the senile brains with and without dementia neuropathologically. In the demented brains, neuronal loss was significant in temporal, parietal, cingulate, parahippocampal gyrus and in hippocampal formation. Senile plaques other than the diffuse plaque were found more than 15, NFT more than 20, and the diffuse plaque more than 50 per 200× microscopic field in demented cerebral cortices. Senile plaque was also found in striatum, thalamus, and cerebellum of a non-demented as well as all demented brain.
These results suggest that the histological hallmark of the senile plaque and NFT mentioned above could be available for a neuropathological diagnosis of senile dementia of Alzheimer's type.

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Between May 1986 to April 1991, 33 patients with brain metastases given radiation therapy at Ooita National Hospital were studied retrospectively. Primary lesions were lung cancer in 25 patients, and gastric cancer in 2. The others were colon cancer, hepatoma and so on. Age of the patients ranged from 33 to 77 years old (average 60). Radiation therapy was performed with external irradiation by Linac 10MV X-ray, 200 300 cGy, 5 Fr/W, a total of 28-65 Gy. Only 4 cases were given additional local irradiation of 15-30 Gy after whole brain irradiation of 30-45 Gy. Two cases underwent intraarterial infusion chemotherapy, too. The survival rate of all cases was 23% at one year and a mean survival time was 255 days. We obtained the good result of tumor size improvement on CT and the relief of the neurological symptoms. We conclude that the radiation therapy is a worthwhile palliative means for brain metastases.

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There has been a variety of discussion concerning the surgical treatment, including surgical indications and procedures, of empty sella syndrome, in particular primary one. In six patients (1 male and 5 females) aged 22-59 years, we performed surgical treatment (3 with transsphenoidal approach and 3 via craniotomy), and assessed pre- and post-operative course and findings of various examinations. Indications for surgery included visual disturbance in 1 patient, amenorrhea in 2, and intractable hedache in 3. All the patients underwent a closure of intrasellar and adjacent empty space with muscular fragments and fibrin glue. In the all patients, there was an improvement of the symptoms. The pre-operative cerebrospinal fluid pressure of all cases was within normal limits, and it is suggested that diminution or disappearance of local cerebrospinal fluid pulsation due to the closure of empty space as mentioned above brought about the favorable results. Thus, it is considered that the surgical procedures should be selected taking advantage to the closure of empty space in consideration.

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We examined the usefulness of corneal sensitivity as a quantitative indicator of diabetic sensory neuropathy. Corneal sensitivity was measured with a Cochet & Bonnet aesthesiometer on 49 healthy volunteers and 77 patients with non insulin-dependent diabetes mellitus. The length of the filament was decreased by 10mm until a patient could perceive the exact number of the filament's attachments to the cornea. Estimation was carried out in 3 portions, the center of the cornea and sites at 6 and 12 o'clock. Although there was no significant difference among 3 portions and no big difference in values for both eyes, we performed the following study by using the mean value for a total of 6 portions in both eyes, to calculate corneal sensitivity more correctly.
The following results were obtained:
1) In healthy volunteers, corneal sensitivity was significantly decreased inpatients in their seventies or older.
2) Decreases in corneal sensitivity was more marked in diabetic patients with more progressed retinopathy.
These data indicate that the measurement of corneal sensitivity offers a simple and quantitative test of diabetic sensory neuropathy.

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The fetal hemoglobin (Hemoglobin F, Hb F), which is the dominant hemoglobin of late fetal life, was determined by an ion-exchange HPLC in patients with carcinoma of the breast (60), the lung (65), the liver (107) and the other non-hematopoietic organs (138). Patients with chronic hepatitis (17) and the healthy subjects (135) were studied as controls. Between day precision of the assay ranged from 12.1% (Hb F 0.4%) to 2.5% (Hb F 25.6%) as coefficient of variation.
In breast carcinoma, Hb F levels higher than 0.8% were found in 31.7% of the patients in the advanced stages and in 5.2% of the patients prior to radical surgery, respectively (P<0.005). A patient with breast carcinoma was found to have significantly elevated values of Hb F of 5.5% in total blood Hb. No systemic effects could be found of the administration of antineoplastic drugs to the elevation of Hb F. The value of Hb F was not correlated with the level of serum AFP in patients with hepatocellular carcinoma, the other non-hematopoietic malignancies and hepatitis. Levels of Hb F were found to have no correlation with the total concentration of hemoglobin and red blood cell count in patients with advanced cases of breast carcinoma.

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Calcification in gastric cancer is not so rare on histological studies. However, it seems very rare that plain abdominal X-ray film and CT scan demonstrate calcification it gastric cancer. We experienced a case of gastric cancer with calcification on the plain abdominal X-ray film and CT scan. The patient was a 24-year-old woman with the chief complaint of epigastralgia. Plain abdominal X-ray film revealed many tiny stippled calcifications in the left upper abdomen. The patient was diagnosed as advanced gastric cancer (Borrmann type 3) by upper GI series. Abdominal CT scan demonstrated high density area within the thickened wall of the stomach, and it was considered as calcification of gastric cancer. Subtotal gastrectomy was performed. Histopathologicaliy, the tissue was classified as poorly differentiated adenocarcinoma. So far, the finding of calcification in gastric cancer by abdominal X-ray examination has been reported in 52 cases including the present one until the year 1990. We discussed this patient in conjunction with other reported cases in Japan.

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Torsion of the gallbladder is a rare disease presenting the clinical picture of acute abdomen, because the gallbladder twists by some causes, becomes ischemic and is necrotized due to cessation of its blood supply. Its diagnosis has been difficult. Recent progress of imaging techniques such as ultrasonography and CT scanning enabled us to diagnose it preoperatively. Two cases of torsion of the gallbladder are reported. One of them was preoperatively diagnosed by a contrast-enhanced CT scan. In both cases an emergency operation was performed and each postoperative course was uneventful.
It should be kept in mind that torsion of the gallbladder is one of the diseases leading to the acute abdomen.

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A 45-year-old man was admitted to the hospital because of back pain and lumbago. He had no history of serious diseases, and drank about 700 cc of “Sake” every evening. A diagnosis of pancreatitis was made and he fell into a critical condition with complications of bone necrosis, fat necrosis, rhabdomyolysis and multiple organ failure. He was treated with intravenous injection of urinastatin and other drugs for amelioration of multiple organ failure, and had intensive care such as repeated drainage and lavage. An incision about 5cm was made in the right thigh, and yielded 2000cc or more of necrotic fluid every day, which revealed marked increase of amylase, lipase and trypsin.
His general condition improved to go back to his work after conservative treatment, and resulted in insulin dependent diabetes mellitus and mild motor dysfunction due to deformity of the right knee joint. Pancreatic enzymes and phospholipase A₂ are responsible for multiple organ failure with severe pancreatitis. It should be emphasized that intensive treatment including repeated lavages at the early stage is needed for making a recovery from multiple organ failure.

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A case of leiomyosarcoma of the jejunum with extraluminal growth is reported together with a review of the literature.
A 67-year-old woman without any symptoms was admitted to our hospital for further investigation, because a mass in the pelvic cavity was incidentally found at a local hospital. Abdominal CT and ultrasonography revealed a solid mass about 6cm in diameter, locating just above the uterus in the pelvic cavity. Moreover, magnetic resonance examination was added, but failed to offer preoperative definite diagnosis. On laparotomy, the tumor was slightly connected with the jujunum and was adherent to the mesocolon of the rectosigmoid portion. The complete resection of the tumor was carried out. The resected tumor measured 7.5×6.0×4.5cm in size, and was diagnosed leiomyosarcoma of the jejunum histologically.
Here we described a case and discussed its clinicopathological features and some problems in diagnosis.

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It is well recognized that the concomitant presence of autoimmune diseases and autoimmune endocrinosis can happen.
The pathogenic causes of Addisonian pernicious anemia which is relatively rare in our country and Graves' disease are thought to concern with immunological mechanisms.
A case of Addisonian pernicious anemia associated with Graves' disease is reported here. A 36-year-old woman was admitted to our hospital because of palpitation and dyspnea on exertion. Blood picture showed hemoglobin 3.9g/dl, MCV 111.6fl and MCH 34.8pg. Bone marrow picture was hypertrophic with megaloblasts 13.8%. Serum VB₁₂ was 290pg/ml on the 7th day of mecobalamin 1000γ/day i. m. administration and the Schilling test was 3.44%. On the other hand, although there was no thyroid swelling, thyroid function was in the state of hyperthyroidism, which showed free T₃ 4.25pg/ml, free T₄ 2.35ng/dl and TSH 0.06uU/ml. Antibodies against gastric parietal cells, intrinsic factor, TSH receptor and microsome were found to be positive. As both thyroid and stomach develop from the embryonic foregut, it was thought that the concomitant presense of Addisonian pernicious anemia and Graves' disease was interesting from the points of embry ology and immunology.

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This paper reports a case of sarcoidosis showing orbital mass as the initial symptom.
A 36-year-old man complained of a swelling of his left upper eyelid. There was an elastic hard, mobil mass in the outer aspect of the left upper eyelid. Orbital CT scans showed a mass lesion in the left lacrimal fossa. Laboratory studies showed liver disfunction, leucocytosis, and negative Mantoux's reaction. No abnormalities were observed in the chest X-ray studies. Histpathological studies showed granuloma with epithelioid cells and Langhans giant cells. Cultures of sputum and gatric washout for tuberculosis came back negative.
Four months after the operation, the patient complained of hazy vision in his left eye. On examination there was a granulomatous iritis of the left eye. A diagnosis of sarcoidosis was made.

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This case was a 68-year-old man with liver cirrhosis who had left ureter stone untreated for many years, Percutaneous nephrostomy was performed for hydronephrosis due to ureter stone. The blood level of CA 19-9 was markedly increased to 1957.0U/ml postoperatively, declined gradually thereafter and returned to the preoperative level after 3 months. The elevated blood level of CA 19-9 following percutaneous nephrostomy was reproducible. The level of CA 19-9 in the renal pelvic fluid obtained through the renal fistula was as high as 106350U/ml. The patient died of liver cirrhosig. Autopsy did not reveal a tumor in the renal pelvis on the affected side. CA 19-9 was detected in the epithelium of the renal pelvis.

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An infestation of scabies was found in Kumamoto National Hospital on January 8, 1992
To prevent the transmission, 112 persons including 51 inpatients, 5 outpatients, 17 nurses, 30 student nurses, 3 assistant nurses, 2 doctors, and 4 family members were examined. Nine definite and seventeen suspected cases were determined and they were treated well by 1% γ-BHC ointment, 10% Crotamiton and sulfur containing bathing. The following preventive measures were considered. 1) The scabies patients should be isolated from the other inpatients. 2) The gown and disposable gloves were recommended to wear at a time of medical care. 3) Underwears, clothes and bed sheets used by patients should be disinfected by autoclave after washing.

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