We performed endoscopic Nd-YAG laser irradiation using intratumoral ethanol injection in 7 cases (6.7%) with central airway stenosis out of 104 lung cancer cases. There were 5 male and 2 female cases including 6 patients with squamous cell carcinoma, and 1 with adenocarcinoma as the histological diagnosis. Before and after laser irradiation, each 0.4-1.2ml ethanol was injected into the tumor.
This treatment was effective in 4 cases, slightly effective in 2 cases and ineffective in 1 case. There were no significant side effects. Intratumoral ethanol injection revealed an excellent hemostatic effect in all cases.
Ethanol injection had an excellent effect on tissue consolidation and hemostasis. Laser irradiation had an immediate tumor vaporization. In conclusion, it was considered that combination of these two endoscopic therapeutic regimens is useful in lung cancer patients with severe stenosis and obstruction of the central airway.

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The clinical value of aspiration biopsy cytology (ABC) in the diagnosis of breast tumor was reported.
This report reviewed the results of 533 ABCs during a period of 8 years from 1983.
Sixtyfour cases out of 97 indicating Class III, IV and V by ABC were confirmed pathologically. Fortyseven cases were diagnosed breast cancer and other 17 cases including 9 benign mammary dysplasia, 4 fibroadenoma, one papilloma, one duct ectasia, one phyllodes tumor, and one lactating breast were reported no malignancy.
The ratio of the patients with breast cancer in Stage I and Stage II without lymphnode metastasis indicated beyond 60 percent. The larger size in diameter of tumor had the tendency to be diagnosed malignancy. However, some tumors of which size were smaller than 2cm in diameter could be identified breast cancer using the method of ABC. As fluid specimens aspirated from 5 cystic lesions out of 17 benign cases showed features of atypical cells, we should be very careful to diagnose by ABCs only.
Clinically, ABC is a very useful examination for screening breast cancer, however, these results suggested that careful consideration was needed regarding ABC as definitive diagnosis. Therefore further diagnostic studies such as open biopsy or intraoperative frozen section were recommended.

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We investigated the effects of combination treatment with both anticancer drugs and radiation on a human pancreatic cancer cell line (KP-1N) in vitro. A variety of anticancer drugs (MMC, ADR, EPIR, 5FU, FT, CDDP, CPT-11) were added to the cultured cancer cells for a period of two days. After this, the same cells were irradiated by ⁶⁰Co. A month later the cells were examined morphologically and the quantity of DNA in the cells was measured. We found that the cells were damaged. Their numbers were also significantly decreased by the irradiation in a dose-dependent manner to 30Gy. The effects of the anticancer drugs were evident, except for FT. The effects of combination treatment with both anticancer drugs and radiation were greater than those of the drugs or radiation alone. These results suggest the usefulness of combination therapy (radiotherapy and chemotherapy) for pancreatic cancer treatment.

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Examination using limulus amebocyte lysate test (LAL test) revealed a high concentration of endotoxin detected in the blood of patients under artificial heart lung, explaining some of postoperative pyrexia and heart lung dysfunction. However, the recently-developed endotoxin specific reaction test indicated only low concentration of endotoxin but high in limulus amebocyte lysate-reactive material in patients under artificial heart lung. We studied on the origin of the LAL-reactive material. Albumin preparations in use for artificial heart lung filler contains a high concentration of the above material, and the gauze ordinary used inside the pericardium elutes a high concentration of the above material in the blood.

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A 52-year-old alcoholic man with liver cirrhosis was admitted because of jaundice, ascites, increases in serum transaminases, leucocytosis and fever. Leucocytosis and fever continued in spite of administration of antibiotics. From 35th hospital day, projection of his left eye and paralysis of his left III-IV cranial nerves appeared. He gradually became unconscious and died at 39th of hospital day. Autopsy findings revealed cerebral hemorrhage due to basal meningoencephalitis by mucormycosis infiltrated to the pia mater. In a patient with alcoholism and advanced liver cirrhosis, it is often difficult to discriminate neuropsychic symptoms of meningoencephalitis from alcoholic psychoses and hepatic encephalopathy. However, this case indicates that immediate and active antimycotic therapy is recommended, if characteristic findings of rhinocerebral rnucormycosis such as orbital symptoms with prolonged fever resistant to antibiotics are observed in a compromised host like a patient with alcohoic liver cirrhosis.

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We report a case of pseudomyxoma pertonei of which diagnosis was made by an extremely small quantity of mutinous ascites obtained through ultrasonographic examination. The patient was 64-year-old male. His chief complaints were lower abdominal discomfort and diarrhea. He was hospitalized because of a small amount of ascites recognized by ultrasonography and CT scanner. Serum CEA levels gradually showed a high value (11.1mg/m). Only one drop of mutinous ascites was obtained by abdominocentesis. Cytological findings of the ascites showed atypia (class IIIb) and the diagnosis of pseudomyxoma peritonei was strongly suggested. Barium enema showed that pseudomyxoma peritonei was originated from appendix vermiformis. Ileocaecal resection and intraabdominal administration of CDDP (chemotherapy) were performed. No signs of recurrence have been found until two years later.

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In this paper, we present a case of unresectable common bile ductal carcinoma treated with combined external irradiation and radiofrequency hyperthermia. A 72-year-old female with bile ductal carcinoma was referred to this hospital for palliative irradiation. At the point of the external dose of 2400 cGY, the expandable metallic stent was successfully placed at the stenotic site of the bile duct to maintain its patency. Thereafter, the intraluminal temperatures were accurately monitored without difficulty. So hyperthermia was safely administered for 40-60 minutes once a week for a total of four times combined with the cumulative external radiation dose of 5600 cGY. At the end of this treatment, the bile duct was almost completely re-canalized. So it was considered that this combination therapy effectively provided good palliation. However, it seemed likely that the external dose of 5600 cGy was too small to control this type of tumor because the patency of the bile duct was maintained for only three months. Therefore, it was considered that the intracavitary irradiation might contribute to deliver much more higher dose to the local tumor.

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We studied pathophysiology and diagnosis of pancreatic diabetes by investigating exocrine and endocrine pancreatic functions in a male patient with both primary diabetes (NIDDM) and chronic pancreatitis and those in his sister who had primary diabetes alone. The former showed pancreatic calcification, significantly decreased pancreatic exocrine functions and low levels of serum fat-soluble vitamins. Furthermore, hyperglycemia and elevated HbA₁ values were not as drastic as the latter's. However, in the male patient, the secretion of endogenous insulin (CPR) was greatly decreased and the arginine tolerance test demonstrated a gradual decrease of blood IRG (pancreatic glucagon) with time. He first suffered from primary diabetes and later pancreatic diabetes. His diabetes is now thought to have originated from pancreatic diabetes and the treatment should be according to that of “pancreatic diabetes” patients. Measurement of IRG is commonly useful for the diagnosis at this moment.

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Diabetic foot is caused by a combination of neuropathy and vascular insufficiency. We studied the effect of administration of argatroban for approximately 4 weeks in 10 diabetics with diabetic foot. The mean age of the patients was 67.1 years, and the mean duration of diabetes mellitus was 12 years. Foot ulcer observed in one patient disappeared after the treatment period, and foot pain was reduced in 80% of the patients. The sensation of cold in the foot was improved in 63%, and intermittent claudication was diminished in 75%. The mean value of thrombin-antithrombin complex (TAT) before argatroban administration of 3.4±1.6mg/l, which was higher than that in controls, decreased after argatroban administration. Ankle pressure and toe pressure indices were frequently increased after therapy, especially in patients with low index values before therapy. This increase was usually followed by improvement of subjective symptoms. The vibration sensation and motor nerve conduction velocity were significantly improved in 81% and 75%, respectively. Because glycemic control status did not change during the therapy period, the effects observed are considered to be directly due to the argatroban itself.
In conclusion, we consider argatroban to be an effective therapy for diabetic foot, which improves peripheral circulation and nerve function.

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A case of heparin-induced hypoaldosteronism is reported, A 59-year-old man was admitted to our hospital because of weakness of his right extremities. He had been followed for the treatment of diabetes mellitus with a oral hypoglycemic drug. A diagnosis of progressive cerebral infarction was made, and intravenous heparin at a dose of 1000 units/hr was started. His plasma aldosterone decreased and serum potassium increased during heparin administration. Plasma renin activity, plasma cortisol, serum sodium and urinary sodium excretion did not change, but urinary excretion of potassium increased. Plasma aldosterone and serum potassium returned to normal after discontinuation of heparin.

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We analized 9 patients with acute myeloid leukemia (AML), aged greater than 60 years old, during these 6 years in our hospital. Among the 9 AML cases including 4 de novo cases and 5 from myelodysplastic syndrome (MDS), five patients had the concomitant disease of silent gallstone, perianal abscess, chronic bronchitis, atypical anti-acid bacteriosis and pulmonary tuberculosis respectively at diagnosis. Although piatents with de novo AML showed a tendency of higher peripheral WBC counts and higher cellularity of bone marrow than those from MDS, it was difficult in some cases to distinguish these two types just from hematological findings. Of the 4 de novo AML cases, three had achieved complete remissions (CR) by standard doses of combination chemotherapy, but with relatively short first CR durations of 6.5 to 9.5 months. Remission induction therapy had caused persistent neutropenia less than 500/μl for days of 14 to 25, and brought about a prolonged hypocellularity of bone marrow after CR. Among 5 patients from MDS, two had no chances of chemotherapy due to the concomitant infection, and one attained CR using low dose Ara-C therapy. Several items, such as characteristics of AML, indication of chemotherapy, concomitant diseases and complications by therapy and appropriate treatment, are remained to be settled.

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A 16-year-old boy with atopic dermatitis complained of poor vision in his left eye from mature cataract. After the cataract was surgically treated by phacoemulsification, retinal detachment with retinal tear at the infero-nasal vitreous base was found. The retina was reattached by scleral buckling, but then redetached later. The inferonasal ciliary processes were adherent to the posterior lens capsule, and this appeared to be the cause of the retinal tear. The retina was reattached by posterior capsulectomy and vitrectomy.
In some cases of atopic cataract associated with retinal detachment, the cataract must be surgically treated by phacoemulsification or extracapsular extraction in conjunction with posterior capsulectomy and anterior vitrectomy to relieve the traction to the vitreous base.

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The case was a female aged 60 who had been treated under the diagnoses of chronic hepatitis from 16 years before and rheumatoid arhritis from 5 years before. The patient underwent total left artificial knee joint replacement at the orthopedic department in our hospital on October 8, 1990. As a result of inserting a urethral catheter postoperatively, gross hematuria developed. Because urinary bladder tamponade and hemorrhagic shock occurred on October 25, removal of hematoma in the urinary bladder was performed. Bleeding from the bladder and weakened bladder wall was observed as the intra-operative findings, for which partial cyctectomy was made on a region including the bleeding site. Histologically, it was cavernous hemangioma of the bladder. The postoperative diagnostic imaging revealed hemangioma being residual. Though hematuria disappeared, bladder fistula developed due to sutural insufficiency in the weakened bladder. Despite that the urinary fistula was closed on December 12, the bladder fistula recurred, and the patient died of acute heart failure on January 5, 1991

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Neonatal mass screening for inborn errors of metabolic disease started in 1977. A screening program for cretins started in 1979. Neonatal screening for 21-OH deficiency started in 1989. A total of 344, 844 neonates were screened. Three cases were diagnosed as classical PKU and 2 cases as HPA. There were 2 cases of MSUD. No homocystinuria was found. Epimerase deficiency was detected in 8 infants. A total of 289, 831 neonates were screened for CH. Fifty-three cretins were confirmed and well treated. The frequency was 1/5, 500. A total of 63, 878 neonates were screened for CAH, and 5 cases were detected. Long-term intellectual development in these patients demonstrated good results.

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