Therapeutic results of gastric cancer patients hospitalized in our Department were compared clinicopathologically between the old group (O group) for 10 years from 1949 to 1958 and the recent group (R group) for 10 years from 1982 to 1991. In O group, 267 out of 288 hospitalized patients were first admitted and 241 were gastrectomized. In R group, 365 out of 601 hospitalized patients were first admitted and 327 were gastrectomized. O group included mostly men in the fifties and R group men in the sixties. The abdominal mass was palpable in 70% on admission in O group. Gastrectomy was conducted in 643% and 92.4% in O group and R group, respectively. The cases of early gastric cancer was significantly greater in R group than in O group. The most frequent site of gastric cancer was the antrum in O group and the body in R group. The cumulative 5-year survival rate of the gastrectomized cases in O group was better in R group for both early cancer and advanced cancer. Endoscopy, lymph node dissection or adjuvant chemotherapy was not common in O group. Recent improvement in therapeutic results of gastric cancer will be attributable to the progresses in diagnostics, surgical techniques including lymph node dissection and adjuvant chemotherapy.

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In order to evaluate the clinical significance of the lymph node around common hepatic artery (No.8 LN) without malignant disease, 4173 cases of screening ultrasonographic examination, performed consecutively during 1991 to 1992 were investigated. We detected No.8 LN in 200 (4.8%) patients. The clinical diagnosis in those 200 cases were: chronic hepatitis in 57 (28.5%) cases;liver function disorder in 37 (18.5%);liver cirrhosis in 26 (13.0%);acute hepatitis in 6 (3.0%);digestive organs disease in 10 (5.0%);normal in 49 (24.5%);other in 15 (7.5%). In this study, 63% of the cases were liver disease. As regards the size of No.8 LN, liver disease, especially chronic hepatitis was significantly larger than others. In conclusion, ultrasonographic examination of No.8 LN is useful for the detection of liver disease.

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We examined the EEGs of 48 patients (23 male and 25 female) who were treated with lithium carbonate for a long time ranging from 5 to 15 years. Abnormal EEGs appeared on 33.3% of the patients who were younger than 55 years old and the rate increased up to 53.3% when patients were older than 55 years old.
Based on this result we assumed that the EEG changes with aging might be accelerated by the long-term treatment with lithium carbonate. Moreover, regarding the group of 33 patients younger than 55 years old, female patients had a much higher tendency to show abnormal EEGs than male patients;48.0% to 30.4% respectively. Much of the abnormality was a slight drop of brain function such as low frequency, overall activity of α wave and interference by θ wave, which differd little from what we used other anti-psychotic drugs.
Taking into consideration that lithium responders were more common in female patients than in male patients, we came to an assumption that the very mechanism that caused abnormal EEGs might have to do with anti-manic or preventive effect.
We didn't find any clear relationship between abnormal EEG findings and concentration of lithium carbonate in the serum, term of treatment, goiter, preventive effect and other factors.

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The levels of soluble interleukin-2 receptors (sIL-2R) were determined in the sera of 59 patients with hematopoietic malignancies, 36 patients with autoimmune disorders and 16 patients with aortic aneurysm. Serum samples from 39 healthy individuals were used as controls.
The mean serum levels of sIL-2R were extremely high at the time of diagnosis in five patients with malignant reticulosis, one patient with large granular lymphocyte (LGL) leukemia (CD^3- CD16⁺) and one patient with adult T-cell leukemia (ATL) [53, 268.70±49, 365.60 vs 397.90±131.57U/ml in controls (mean±SD)]. In 18 patients with malignant lymphoma, the mean sIL-2R level was significantly higher than controls and the level remarkably decreased after chemotherapy.
The mean serum sIL-2R levels in seven patients with chronic myelocytic leukemia (CML) in remission by interferon-α, 12 patients with paraproteinemia, six patients with myelodysplastic syndrome (MDS) and 16 patients with aortic aneurysm were significantly higher than controls. In seven of eight patients with AML, the serum sIL-2R levels were normal. The mean sIL-2R levels at the time of partial or complete remission in 17 patients with SLE and rheumatoid arthritis, and in 19 patients with ITP were significantly higher than controls.
We conclude that the serum sIL-2R can serve not only as a valuable tumor marker for monitoring patient's treatment, but also as atherosclerotic or immunological markers. In our case of LGL leukemia who showed extremely high sIL-2R (α chain) levels, the source of sIL-2R in serum might be released by normal T-cells activated by LGL leukemic cells.

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To determine relation between clinical features and cytomegalovirus (CMV) viruria in children with several CMV infections, CMV titers in urine were tested. CMV titers in urine were 10^0.5TCID₅₀/0.2ml in five of six asymptomatic patients and 10^2.0 in one patient. Meanwhile, 10^2.5-3.5 of CMV were excreted in urine in three infants with neonatal hepatitis and four with infectious mononucleosis, and greater than 10^5.5/0.2ml of CMV were excreted in four infants with severe CMV infection in early childhood, who were combined with remarkable hepatosplenomegaly, pneumonia, and/or thrombocytopenia.
These results suggest that severity of CMV viruria is well correlated with severity of clinical features of CMV infections, and that titration of CMV in urine may be a helpful method to make diagnosis of symptomatic CMV infections.

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The interferon treatment of viral hepatitis type C has been payed attention, because of some cases with complete responses, many patients with viral hepatitis type C in our country, the drugs and so on. The cost of this treatment may exceed 200 billion yen per year, which affects the total medical care expenses.
The outcome of this treatment has been reported as follows: more than 30% of the treated cases were successful responders, however, the rest of them were not.
Many problems of this treatment should be solved, such as the indications (age, sex, or stages; acute, chronic inactive, chronic active, cirrhotic or quantity and/or subtypes of the virus), the selection of interferons (netural α, β, recombinant α2a or α2b), the doses and durations of the treatment, the side effects and how to prevent them, and how to reduce the cost.
In this symposium, the specialists reported these problems and suggested how to solve them, which would contribute to the selections of the patients and interferons, the estab-lishment of better results, reduction of the side effects, and benefit to both doctors and patients.

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A 77-year-old woman was admitted for the acute inferior myocardial infarction com-plicated with shock (Forrester grade 3 and Killip grade 4). After the insertion of the temporary pacing and intraaortic balloon pumping (IABP), emergency coronary arteriog-raphic study confirmed that she had an inferior myocardial infarction with severe triple vessel disease. The target lesion showed spontaneous recanalization, with 99% stenosis of segment 2 (TIMI grade 3). The stenosis of the diseased vessel improved to the stenosis of 75% by the intracoronary thrombolysis of t-PA. After the treatment of cathecolamine and IABP therapy for 10 days, we could take off the supporting of IABP and her heart function began to improve slowly. After 2 months of the hospitalization, her ECG showed Qrs pattern in II, III and aV_F without perfusion defect on ²⁰¹TI-myocar-dial scintigram with normal LV wall motion. The target vessel of the acute myocardial infarction (AMI) enlarged the diameter size of 5 mm of coronary aneurysm with mild stenosis of the proximal and distal lesions. We conclude that this event of the AMI occurred by the rupture of the atheromatous plaque in the lesion of coronary aneurysm, and that the salvage of the area of myocardial damage was effectively achieved by the therapy of intracoronary thrombolysis and IABP even in the delayed phase of recanaliza-tion after the onset of myocardial infarction.

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A 71-year-old ma e visited our hospital for evaluation of an abnormal shadow on a chest X-ray film. The tumor was diagnosed as invasive thymoma by percutaneous needle biopsy. Neoadjuvant chemotherapy with CDDP and VP-16 was given. Four weeks later, his chest CT film revealed pneumonia and MRSA was detected on culture of the bronchial lavage fluid. He was effectively treated by arbekacin and minocycline and subsequently underwent curative operation. He is doing well 4 months after operation.

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Influenza infection is known to cause serious respiratory symptoms especially in asth-matic patients. Recently some reports say intranasal inoculation of influenza vaccine induces secretary IgA antibody in respiratory mucosa which acts as main barrier to local spread of the virus without major adverse effects. We studied whether it can induce antibody and affect nasal symptoms in allergic patients. We employed 22 children (ran-ging 3 to 12 years old) with allergic disease including 75% of allergic rhinitis. Mixture of three inactivated influenza viruses (A/Yamagata/32/89, A/Kitakyushu/159/93, B/Bang-kok/163/90) were given intranasally once a month twice. Nasal symptom scores were assessed monthly. Serum HI titers to each virus were measured and staining of nasal smear were analyzed before and 2 months after initial inoculation. Results showed se-rum HI titers to all of three viruses increased significantly, whereas no significant change was seen neither in nasal symptom scores nor in nasal smear findings. No sys-temic side effects were seen. These data suggest intranasal vaccination of influenza vi-rus to allergic patients can induce serum antibody response without systemic or local ad-verse reactions.

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A case: 51-year-old woman. Chief complaint: an upper abdominal tumor. Family history: multiple hepatic cysts in both the patient's mother and a younger sister of her mother. Present illness: She visited our hospital as an upper abdominal mass was felt in July of 1993. Present status: The hard liver was palpable 5 transverse fingerbread-ths on the right mid-clavicular line below the costal arch, 3 transverse fingerbreadths on the abdominal median line below the umbilicus. Laboratory findings: a mild liver dys-function and multiple liver cysts by which almost all parts of the liver were occupied on US and CT examinations. Cytological findings of fluid of the cysts showed class I. This case is under observation without treatment. Including the familial case, we ex-perienced six cases of huge liver cysts with the maximum diameter equal to or greater than 10 cm during the recent 4 years. All cases were female. Their ages on the first consultation were 38 to 79 year old (61.7 on the average). Three cases had a single cyst and the other 3 had multiple cysts. The operation (cystectomy) was performed in 1 and the treatment with ethanol injection into a cyst in 4 cases. No recurrence has been observed until now in all of them. The treatment of hepatic cyst with ethanol is considered to be a safe and reliable method.

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A case of Meigs' syndrome with ovarian leiomyoma is presented. The patient was a 72-year-old postmenopausal female complaining a persistent cough. Examination re-vealed pleural effusion and bilateral adnexal masses with ascites. Total hysterectomy and bilateral adnexectomy were performed owing to the findings of bilateral multilocular ovarian tumors and abnormal values of tumor markers (CA-125, CA-602, SLX). Cyto-logy of hydrothorax and ascites were negative and ovarian mass was liomyoma pathologi-cally. Postoperatively the pleural effusion disappeared and abnormal values of tumor marker declined to normal level.

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Those patients with chronic neurological diseases accidentally die during bathing. On speculation of vasomotor control disorder in those cases, we evaluated blood prssure changes at bathing in 19 cases of neuro-degenerative diseases. There were five cases of multiple system atrophy (MSA), five hereditary spinocerebellar degeneration (SCD), two cerebellar cortical atrophy, two Parkinson disease, two amyotrophic lateral sclerosis (ALS), one SMON, one Wilson disease and one multi-infarcted dementia. The blood pressure was estimated with sitting position at the time point of before bathing, five minutes in bathtub, and just after bathing. The temperature was 42 to 43 centigrade, which was routine bathtub temperature of our hospital. Three MSA, one Menzel type SCD, one Parkinson disease and one ALS showed remarkable decrease in the systolic pressure just after the bathing (more than 37 mmHg). Then, to examine the effects of temperature changes, 5 MSA and one Parkinson disease were estimated at 45 and 40 cen-tigrade, respectively. All cases showed significant decrease in the systoric pressure at 45 centigrade, and more remarkable reduction was observed in 3 MSA. One MSA showed greater decrease at 40 centigrade compared with that of at 45. There were no significant changes in other patients. Then, we conclude that the systolic pressure remarkably falls after bathing in those patients with dysautonomia, and that higher tem-perature of bathtub may cause a greater decrease. We should manage dysautonomia in taking consideration of hypotension at bathtub.

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We identified a 39-year-old male patient with primary aldosteronism (aldosterone- producing adenoma) which was detected following sudden cerebral hemorrhage. We tried to evaluate in detail the cerebrovascular damage morphologically and functionally by MRI and cerebral blood flow measured by intravenous injection of ¹³³Xe because significant vascular damage underlying the hemorrhage was expected. MRI specified multiple lacu- nar infarctions in the bilateral basal ganglia and deep white matter, in addition of old putaminal hemorrhage and a bit of atrophy in the left hemisphere. Cerebral blood flow already declined considerably in the bilateral hemispheres. These results showed the similar features as found in essential hypertension. This clinical case suggests that cer-ebrovascular damage in primary aldosteronism develops through a process similar to that in essential hypertension.

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A 96-year-old woman was admitted to our hospital because of her head trauma. Neurological examinations reveald no abnormal findings. A computed tomography (CT) scan showed mass effect caused by a subdural hematoma over the right hemisphere. She gradually developed impairment of consciousness and weakness of left limbs. An evacuation of the hematoma was carried out urgently through right frontotemporoparietal craniotomy. She had several postoperative complications including pneumonia, brain infarction, stress ulcer, delirium and so on. But she recovered and discharged home without a neurological deficit. We discuss an indication of operation and pre- and post-operative managements for super old aged.

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The patient was a 28-year-old female with neuro-Behçet's disease, intestinal-Behcret's disease and vasculo-Behçet's disease simultaneously which are three special types of the Behçet's disease. She had been diagnosed and treated as aplastic anemia or idiopathic thrombocytopenic purpura in childhood.
Her hematological examination revealed no abnormal values at the onset of Behçet's disease. With aggravation of Behçet's disease, the blood picture showed myelodysplastic syndrome. The most intrinsic pathogenesis of the Behçet's disease is abnormally increásed activity of neutrophils. In our case, postmortem examination revealed erythrocyte-eating neutrophils and macrophages in liver, spleen and bone marrow. On the other hand, neutrophils had no response to bacteremia. Autoimmunological hyperactivity of neutrophils coexisted with defensive dysfunction of neutrophils inconsistently.
Three special types of the Behçet's disease in our case are severe and extensive. Autoimmune mechanism and circulatory disturbance are both considered to be concerned with the onset of special types of the Behçet's disease.

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