We evaluated clinical, efficacy of pleural biopsy to make a diagnosis in pleurisy, com- paring to the other examination sucli as examination of pleural effusion (ADA activity, tumor marker, cytology, bacteriology) and sputum examination. The diagnostic rate of pleural biopsy in tuberculous pleurisy was 42% and the diagnostic rate of pleural biopsy in carcinomatous pleuritis was . 36. 80. Theses;values were not high. The diagnostic rate in tuberculous pleurisy was high in order of ADA activity in effusion, pleural biopsy, bacteriological examination of sputum, bacteriological examination of effusion.
The diagnostic rate in carcinomatous pleuritis was high in order of tumor marker in pleural effusion, cytology of sputum pleural biopsy and cytology of effusion. The pleural biopsy is an easy procedure, however it is a rather blind procedure. This is a limitation of this procedure. Use of adjunctive examination such as radioisotope examination and ultrasonic examination will be helpful to make a diagnosis concomitant with pleural biopsy after the location of the lesions is determined. In the future, pleural biopsy under thorac- oscopy will make a complete diagnosis.

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Among 1540 patients who underwent surgery for gastric cancer at the surgical de-partment of Kyoto National Hospital between January 1978 and December 1991, 230 patients with se gastric cancer (gastric cancer with serosal invasion) and 310 patients with ss gastric cancer (gastric cancer invading the subserosa) were studied. Obviously the cases of se gastric cancer were in more advanced stage than ss gastric cancer. There were significant differences between se and ss, in terms of peritoneal dissemination (P, p<0.0001), liver metastasis (H, p<0.05), and histological lymph node metastasis (n, p<0.05). Prognosis of se gastric cancer was worse than that of ss. However, only among patients with POHOnO gastric cancer, there was no significant difference between se and ss concerning survival times. This may prove that prognosis of se gastric cancer could be improved similarly to that of ss.

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We experienced an autopsy of multiple colorectal cancers associated with ulcerative colitis, 20 years having passed since the onset of UC. Analysing 184 cases with color-ectal adenomas or carcinomas associated with UC reported in Japan from 1962 to 1991, we discussed about the following four points. Those were 1) the age at the diagnosis of adenomas or carcinomas, 2) the duration of UC, 3) the extent of the lesions in UC and the distribution of the adenomas or carcinomas, and 4) the frequency of dysplasia. ?From these points of view, colorectal carcinomas associated with UC had those char-acters. 1) The diagnosis of carcinoma was performed at younger age than that of other colorectal carcinomas or adenomas. 2) The duration of UC was long. 3) Total colitis was the most common type. 4) Dysplasia was seen frequently. And these points showed the possibility of the inflammation of the colonic mucosa having much connection with the onset of cancer. The surveillance system to follow the UC cases is requested.

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Carcinoma of the pancreas (pancreatic ductal carcinoma except for pancreatic cyst-adenocarcinoma) and of the liver (hepatocellular carcinoma) are still incurable. In this paper we first reported clinical examination and treatment of these 2 diseases which have been performed at National Kyushu Cancer Center. We then discuss recent progress in improving the quality of life (QOL) of patients with these diseases. The survival time increased in patients with hepatocellular carcinoma as a result of improved medical tech-niques (follow-up examination of high risk groups, PEIT, interferon therapy etc. ). However survival time has not yet been noticeably prolonged in patients with pancreatic carcinoma. “Keep in mind the patients' feelings” and “keep in mind the feelings of the family” are two mottos at our institution. Therefore, team therapy by all clinical departments (multidisciplinary treatment) has been performed on all pancreatic cancer pa-tients, whose quality of life can be improved; consequently, pains are decreased and pa-tients can spend normal home life. In parcreatic carcinoma cases with a short survival time, how to make maximum use of their remaining life is a great problem. In he-patocellular carcinoma patients who have prolonged survival, finding activities to occu-py the patients' lives is a problem. Patients at our institution have stress because it is a cancer center. Informing patients themselves about their disease is not necessarily al-ways done, but it should be done in such a way as to decrease anxiety and to ensure pa-tients do not lose their will to live. We thus need the help of a counsellor who can ap-ply psychooncology at our institution.

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We sent both a questionnaire and a booklet to 310 bereaved families of patients who have been administered the morphine formulations at the National Cancer Center Hospital, in order to analyze the influence of explanation about the drug on the analgesic effects and usefulness of the booklet. The recovery rate was 48.6% The results indicate that the explanation about morphine were not directly relevant to the degree of cancer pain. But the patients who received an explanation about morphine usually also received an explanation about cancer pain. Conversely, those who didn't receive an explanation about cancer pain tended not to receive an explanation about the drug.
The analgesic effects were significantly superior in patients who received an explana-tion about the drug compared with patients who didn't (p<0.05). In addition, the rate of patients who understood the drug well was significantly higher in patients who received an explanation about it than in patients who didn't (p<0.005).
Thus, the results of our investigation suggest that providing an explanation to the patients who need morphine for cancer pain, which is administered by the medical staff can enhance the analgesic effects of morphine and that the booklet can help the patients understand the drug well.

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A test to measure serum 1, 5 AG (anhydroglucitol) levels for detection of diabetes mel-litus has recently been introduced. We evaluated the clinical usefulness of the test. Serum 1, 5 AG, HbAI and fasting plasma glucose (FPG) were measured in 86 outpatients i. e. 18 pancreatic diabetes (due to chronic pancreatitis) and 68 NIDDM patients. Serum 1, 5 AG levels were sigificantly low in patients with pancreatic diabetes treated with insulin injection compared to diabetics treated by other treatment modalities. A significant cor-relation was also found between HbAI and 1, 5 AG and between FPG and 1, 5 AG in primary diabetes patients. Both types of diabetes showed frequent abnormalities in 1, 5 AG, HbAI and FPG values, which, as a result of treatment, moved to around 10μg/ml, 10% and 100 mg/dl, respectively. Standard deviation of 1, 5 AG values was the greatest of the three pa-rameters. 1, 5 AG seemed to increase to normal levels after HbAI or FPG had been nor-malized, i.e. 1, 5 AG levels often remained low even if HbAI or FPG decreased to within normal limits.
The present data show that low serum 1, 5 AG levels are present in almost all diabetic patients with chronic pancreatitis treated with insulin, and that normal levels of 1, 5 AG indicate persistence of good control of blood glucose level.

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A case of leiomyoblastoma growing completely outside of the stomach is described. The patient was a 65-year-old male who was admitted to our hospital for gastric polypec-tomy under endoscopic control. An unidentified mass was found by abdominal ultravon-ography and CT scan incidentally. The mass, measuring about 5 cm in diameter, was located between the stomach and the spleen under the left subphrenic space. Upper GI series demonstrated only an antral hyperplastic polyp which was already known and no definite findings caused by the mass except insufficient distension of the f ornix. Preop-eratively, the original organ of the mass was not defined.
On celiotomy, the goose-egg sized tumor was located in the same site as shown by preoperative diagnostic imaging and was barely connected to the gastric fornix with a narrow tape-like stem. Then wedge resection was performed. Histopathologically, the well-defined tumor with edematous fibrous stroma and partially hemorrhagic change is composed of proliferation of slight atypical round or spindle tumor cells with vacuolar change of the cystoplasm, leading to a diagnosis of leiomyoblastoma. Then, we diag-nosed the tumor to be gastric leiomyoblastoma growing completely outside of the stomach. It has been thought that gastric leiomyoblastoma has malignant potential and a long-term follow-up may be required after operation.

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CASE (1) A 22-year-old woman in 31 weeks gestation was admitted to the hospital because of an abdominal pain which started in the preceding evening before admission. The pain was intermittent in its nature and existed all over the abdomen. On the next day, the pain was inclined to shift toward the the right side of the abdomen. Laparotomy, performed two days after the admission, revealed perforation of appendix and pus discharge in the right side peritoneal cavity. She delivered a normal female infant vaginally.
CASE (2) A 25-year-old woman in 33 weeks gestation was admitted to the hospital because of an abdominal pain, which started with epigastric pain in the preceding evening and became sevre all over the abdomen in the morning of the day of the admission. In the afternoon, pain became to be localized in the right side. Operation revealed a re-markably inflamed appendix and regional pus retention. She delivered a healthy male infant by the cesarian section in 38 weeks gestation.
In the last trimester, diagnosis of appendicitis may be difficult for atypical or indiffinite signs and symptoms caused by enlarged uterus and migrated appendix. We should not be reluctant to perform an operation, because appendicitis with peritonitis has a high risk of fetal death or premature labour.

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A case of primary biliary cirrhosis (PBC) complicated with Hashimoto's thyroiditis and alcoholic hypoglycemia was reported.
On Feb 7. 1992, a 61-year-old man was admitted to our hospital, because of loss of consciousness. He was a hard drinker. His blood suger level was 32 mg/dl, so the loss of consciousness was thought to be alcoholic hypoglycemia. He had goiter. Bio-chemical studies, radiological studies, and needle biopsy were performed. The biochem-ical studies revealed hypothyroidism, and histological study revealed chronic thyroiditis. So he was diagnosed as Hashimoto's thyroiditis. The findings of liver biopsy and bio-chemical studies were compatible with asymptomatic PBC. It has been reported that PBC is relatively infrequently complicated with Hashimoto's thyroiditis. Although such cases are frequently observed in females, this incidence occurred in a male.
The patient was treated with levothyroxine sodium. His thyroid function returned to normal and his abnormal hepatic biochemical data also improved.
The etiology of PBC is not clear, and the etiology of Hashimoto's thyroiditis is not clear too. But the autoimmune mechanism is thought to be an important factor in the development of both diseases.

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The case was a 67-year-old male patient who presented with depressive state, and later on with disturbance of consciousness. He was diagnosed as having primary para-thyroidism from 16. 6 ng/ml of elevated value of parathyroid hormone (PTH-C). Therapy of psychiatric symptoms were administration of antipsychiatric drugs, antidepressants and other drugs and parathyroidectomy. There have been few reports published concerning the psychiatric symptoms associated with primary parathyroidism in Japan. We report here in a case of primary parathyroidism with psychiatric symptoms together with a re-view of the literature.

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A 21-year-old man suffered from severe colic pain frequently. DIP showed a small caliceal diverticulum in the left kidney. We performed small partial nephrectomy in the upper pole of the left kidney. His postoperative course was uneventaful, and his flank pain subsided
We described a rare case of caliceal diverticulum and discussed the pathogenesis of the disease briefly.

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We report a 42-year-old male case with lung cancer effectively treated by chemother-apy and the subsequent curative operation. He was diagnosed as epidermoid carcinoma of riht upper bronchus of clinical stage IQ A (cT3N2MO). After 3 courses of CMV chom-otherapy, the tumor disappeared on chest roentgenography and chest CT findings, and the right upper lobectomy with bronchoplasty was done. Pathological stage was I (pT1NOMO) and T factor was within the category of hilar early lung cancer. The efficacy rates of CMV chemotherapy against non-small cell lung cancer are reported over 40%, higher curative operation rates will be expected for stage IIIA non-small cell lung cancer with neo-adjuvant chemotherapy.

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Two patients with subarachnoid hemorrhage of unknown etiology localized mainly in the cisterns around the midbrain are reported. Case 1 was a 46-year-old male with es-sential hypertension. He was referred to our hospital for his sudden severe headache. He was conscious, but CT on admission showed high density areas localized in the left ambient cistern and the quadrigeminal cistern. The 3-vessel angiography could detect no vascular lesion. He was discharged with no neurological deficit and has never suf-fered from rebleeding for 10 years. Case 2 was a normotensive 49-year-old man who complained of moderate headache coming on within a few minutes. CT immediately after admission showed a high density in the interpeduncular cistern. We could not de-tect any aneurysms and vascular malformations by 4-vessel angiography. He was doing well and discharged with full recovery. For about 22 months he has had no episode of rebleeding. Although no pathological evidence has obtained yet, CT findings of perim-esencephalic subarachnoid hemorrhage like that of our cases provided us with a useful information as most benign form of subarachnoid hemorrhage of unknown etiology.

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A 40-year-old man complained of repeated attacks of muscle weakness in legs associ-ated with drinking. Frequency and duration of attacks had been increased for 2 years. Myelogram showed a worm-like appearance. Gd-enhanced MRI showed an enhancement at the dorsal region of the lower thoracic spinal cord and a conus swelling. Spinal fluid examination indicated obstruction of subarachnoid space. Spinal angiogram proved a single coiled abnormal vessel feeding from the right first lumbar artery toward the upper thoracic region. Collateral vessel was shown from the left first lumbar artery. Adamkiewicz ar-tery was intact and branched from the left tenth intercostal artery. The diagnosis was compatible with meningeal arteriovenous fistula, so trans-arterial embolization (TAE) to the main feeder was carried out. After embolization, bilateral plantar numbness persisted but weakness of the legs disappeared. After one month, the follow-up angiogram showed no abnormal vessels. Venous pooling or stasis in the spinal cord caused by A-V fistulamade the conus swelling and subarachnoid space obstruction. These factors are consid-ered to de the principal causes of weakness.

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