A total of 43 patients with brain disease were examined 48 times by intraarterial dig-ital subtraction angiography (DSA) and/or conventional angiography using a transbrachial approach (16 times via the right brachial, 32 times via the left). Selective catheteriza-tion of the right carotid artery (CA) was possible in 81%, the left CA in 81%, and the right vertebral artery (VA) in 63% through right brachial approach, while the right CA was possible in 78%, the left CA in 97% and the left VA in 78% through left approach. However, the 25 examinations of the last 24 cases were successful in the catheterization of the right CA (9696), the left CA (96%), and the left VA (9296) through left brachial approach using 4 F ITO-ILL catheter.
No major complications were encountered, and minor ones were local hematomas in 6 patients (13%) and transient brachial paresthesia in 8 patients (17%).
Those results suggest that this approach are not inferior to the Seldinger's method. Furthermore, thinking of the quality of life of examined patients and the anatomical dom-inancy of VA, the left brachial approach for cerebral angiography is better than the right approach.

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Hypercholesterolemia is one of the major risk factors for coronary heart disease (CHD), but there is a dyslipidemic group involving CHD, which shows normocholestero-lemia.
In order not to overlook this dyslipidemic group, in addition to TC, other three lipid parameters, such as HDL-C, apolipoprotein Al and apolipoprotein B were determined.
The ratio T/CHDL-C×apo B/apo Al is defined as coronary atherogenic index (CAI).
In this study, the clinical usefulness of CAI over 5 predicting ischemic heart dis-ease is presented.

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We investigated about adenosine deaminase activity (ADA) in pleural effusion in tube-rculous pleurisiy patients, in view of the type of tuberculosis (Tb), the rusults of sputum examination of Tb, the result of pleual effusion examination of Tb. The detective rate of pleural effusion examination for Tb in tuberculous pleurisy patients was 9.4% in all of tuberculous pleurisy. In view of the type of Tb, 17.6% in type 2, 10% in type 3, and 6.7% in type pl were positive for Tb bacillus in effusion.
According to progression of the disease, detective rate for Tb was increasing. ADA activity of pleural effusion was high in all patients, however in view of the type of Tb, type 2 was high in ADA activity in pleural effusion compared to type 3, and type pl. Also there was no differeniation of ADA activity in view of the result of sputum exami-nation for Tb. However there was high ADA activity in Tb-bacillus-positive cases in pleural effusion compared to Tb-bacillus-negative ones.

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The patients with liver cirrhosis frequently demonstrate anemia, most of which is hemolytic one. One of the mechanisms which cause the hemolysis is hypothetically as follows: hemoglobin molecules suffer oxidative stress and form degenerative bodies, Heinz bodies, which shorten the life of erythrocytes by their binding to erythrocyte mem-brane. The number of Heinz bodies in cirrhotic patients is reported to be high, sugges-ting that oxidative stress is relevant to pathogenesis of liver cirrhosis. Many studies showed that active oxygen played an important role in pathogenesis of a variety of dis-eases. Reduced glutathion (GSH) works as a scavenger of active oxygen in living cells and suppresses production of Heinz bodies in erythrocytes.
In order to verify the relation of GSH to oxidative stress in liver cirrhosis, we meas-ured concentration of GSH in erythrocytes in cirrhotic patients. Low concentration of GSH in erythrocytes was detected in the patients, suggesting the oxidative state in liver cirrhosis.

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An experimental study on the effects of hypercalcemic state on the pancreas was pe-rformed. Isolated pancreatic acinar cells were prepared by the Amsterdam & Jamieson's method. The cells were incubated for 1 week at 37°C, under 5% CO₂ and 95% O₂.(1) The cells in hypercalcemic medium (11.4 mM) produced by addition of CaCl₂ were compared to those in normal control medium (1.8 mM). An optical microscopic examination showed presence of damaged cells and diminished number of the cells after 1 week incubation in the hypercalcemic state. Cellular content of DNA and protein were decreased, while cellular content of amylase, release of amylase (per DNA content) and LDH from the cells were increased in the hypercalcemic state. (2) Cellular content of DNA, protein and amylase decreased by administration of the CCK (3.3×10^-7M) and did not decrease by additional administration of the CR1505 (2.5×10^-6 W/V %), a CCK receptor antagonist, while release of amylase and LDH from the cells increased by administration of the CCK and did not increase by addition of CR1505 at the same time. These phenomena were more signifi-cant in the hypercalcemic state than in the normocalcemic state.
The above mentioned data suggest that hypercalcemic state has a possibility of causing pancreatitis.

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A 56-year-old female who had been diagnosed as having primary pulmonary hyperten-sion 6 years earlier was admitted to our hospital with increasing dyspnea and orthopnea. Pulmonary hemodynamic study was performed on the 12th hospital day. We adminis-tered theophylline 200 mg, along with trials of various vasodilators such as prostaglandin E₁10μg, nilvadipine 4 mg and isosorbide dinitrate 80 mg. However, only the administra-tion of theophylline produced a marked reduction in pulmonary arterial pressure, from 80/24 mm Hg to 49/11 mmHg, and in pulmonary vascular resistance index, from 1615 dyne·sec/cm⁵/m² to 485 dyne·sec/cm⁵/m². Because this patient's condition had progressed to cor pulmonale, we consider that theophylline demonstrated a pronounced effect on pulmo-nary hemodynamics.

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Creutzfeldt-Jakob disease (CJD) is transmissible, subacute spongiform encephalopathy with many symptoms. It shows psychotic symptoms such as apathy, depression, memo-ry disturbance, anxiety, and delirium, and neurotic symptoms such as headache, visual impairment, vertigo, gait disturbance and myoclonus. Unfortunately, there is no effec-tive therapy yet. Pellagra, well known as 3D (dermatitis, diarrhea and dementia), is undernutritional disease due to the lack of nicotinic acid. Therefore nicotinic acid im-proves this disease remarkably. Both CJD and pellagra show similar symptoms, such as apathy, depression, memory disturbance, gait disturbance, myoclonus and so on. Clin-ically it is difficult to discriminate between CJD and pellagra.
We experienced a case of ‘pellagra sine pelle agra’ in a 50-year-old female patient who showed apathy, gait disturbance, memory disturbance without dermatitis and diarrhea. For 3 years prior to the onset of pellagra, she had been prescribed anti-tuberculous agents (etionamide et al). After a half year since the onset she fell in vegetable state accompa-nying myoclonus. Her clinical diagnosis was CJD at that point. After autopsy, her pathological diagnosis was pellagra.
In Japan recently, the number of pellagra patients has been decreasing due to the improvement of general nutrition. In such condition less attention has been paid to pel-lagra as diagnosis distinguished from CJD. But ethionamide inhibits the conversion of tryptophan to niacin and may induce pellagra. We must pay more attention with pella-gra to tuberculous patients developing mental or neurological symptoms under treatment with ethionamide.

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A 61-year-old female having undergone radical mastectomy 4 years previously was readmitted because of dyspnea. Chest X-ray and CT scan revealed multiple metastatic pleural nodules and effusion. The patient had thrombocytopenia and leukopenia due to liver cirrhosis and was treated with a combined chemoendocrine therapy consisted of epirubicin, mitomycin C, UFT, tamoxifen and medroxyprogesterone acetate. The patient lost her consciousness temporarily with respiratory acidosis but emerged 5 days later. Six months after the introduction of the therapy the metastatic nodues completely disappeared on chest X-ray and CT scan. Her performance status improved markedly and the duration of a complete response has lasted 21 months to this day.

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Pneumonitis (or fibrosing alveolitis), which is occasionally associated with rheumatic diseases, is important because it is difficult to treat and has a poor prognosis.
We report a 17-year-old female patient who had severe pneumonitis due to adult-onset Still's disease, who was successfully treated by methylprednisolonone pulse therapy.

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We report an autopsy case of tuberous sclerosis. A 19-year--old man had shown fa-cial adenoma sebaceum, convulsive seizure and mental retardation. Brain computed to-mography showed a massive calcification from the left frontal pole to the edge of the left thalamus and a few subependymal calcifications. Electroencephalograms demonstrated 3-6 Hz background activity with multifocal spikes and poly spike and wave complex, which is called hypsarrhythmia. Neuropathologically, there were cortical tubers, sub-ependymal nodules and white matter nodules in the cerebrum. Many giant cells which were variable in size and shape were present in these lesions. Immunohistochemistry was employed in these lesions. In the cortical tubers, the majority of the giant cells were positive for both neurofilament protein (NFP) and vimentin (VM), but a few were positive for glial fibrillary acidic protein (GFAP). All of them were negative for myelin basic protein (MBP). In the subependymal nodules and white matter nodules, the ma-jority of the giant cells were positive for NFP, but a few were positive for VM, and none were positive for either GFAP and MBP. In the light of the previous reports dealt with tuberous sclerosis and our present findings, we discussed the origin of the gi-ant cells in tuberous sclerosis.

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A case with idiopathic hypoparathyrdism (IHP) associated with right aortic arch is re-ported. A 41-year-old man developed hypocalcemia with no symptoms of hypoparathyro-idism, after consulting an ophthalmologist due to cataracts. The serum level of high sensitive parathyroid hormone (HS-PTH) was below 50pg/ml, and that of intact PTH was 8pg/ml. Ellsworth-Howard test showed that the urinary both phosphate and cAMP excretion responses were positive. Posterior radiograph of the chest revealed a mass region in the right superior mediastinum, vhich was diagnosed later as right aortic arch, with intravenous digital subtraction angiography (IVDSA). The association of IHP and right aortic arch indicated that IHP in the patient was included in branchial dysembryoge-nesis. In addition, T-cell lymphotropic virus type-1 (HTLV-1) antibody was positive in our patient. Therefore, transplacental infection of HTLV-1 may be one of the causes for branchial dysembryogenesis.

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A case of duodenal carcinoid tumor presenting with tarry stool was experienced. A 49-year-old man was admitted to the hosipital because of tarry stool. Upper gastrointes-tinal X-ray examination showed filling defect and upper gastrointestinal endoscopy showed a submucosal type tumor with central ulceration adjacent to papilla.
By biopsy at that time an adenocarcinoma was suspected, and pancreatoduodenectomy was performed under a diagnosis of duodenal carcinoma. In the resected specimen, there is about 2.5×2×1.5cm mass in the duodenal submucosa just adjacent to papilla Vater with a shallow tiny ulcer on the tip. Microscopically, tumor cells showed round nuclei with scant cytoplasm, and invaed to the muscle layer in ribbon like fashion. Althogh Gri-melius staining were negative, NSE and Chromogranin stainings were positive. Electron microspically, there were a few small dense core granle in the cytoplasm, then the tumor was diagnosed as carcinoid.

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We report a 67-year-old female of multifocal demyelinating neuropathy with persistent conduction block (Lewis-Sumner syndrome). The OKT4/8 ratio and the T-lymphocyte blastogenesis were decreased and the anti-myelin IgG antibody was positive. These im-munological abnormalities may relate to the pathogenesis of this disease. We treated this case with immunomodulating agents and following resuls were obtained, 1) Admin-istration of oral predonisolone (PSL) improved conduction block, but the hand grasping power did not change. 2) Combination of PSL and cyclophosphamide (CP) was applied. Again the conduction block improved furthermore but the hand grasping power did not improve at all. But after the stop of the CP therapy becase of the decrease of white blood cell, the conduction block and hand grasping power became worse. Therefore we concluded that the combination therapy PSL and CP was somewhat effective, but CP lim-ited for its hematological side effects. 3) We then treated with the combination therapy of PSL and mizoribine (MZB) which is reported to be low toxic. She showed improve-ment of the conduction block and anti-myelin IgG antibody became negative. But the hand grasping power decreased gradually. MZB showed no side effect, but insufficient effect. 4) Now, we have been treating the patient with y-globulin, but the effect has not been obtained.

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A 75-year-old woman was admitted because of severe anemia (RBC: 170×10⁴/μl, Hb: 6.1g/dl, Ht: 19.1%). The peripheral blood leukocytes were 3, 700/μl with 15% myeloblasts and total bone marrow cells were 10.5×10⁴/μl with 73.2% myeloblasts. The surface marker on the blasts expressed CD13(+), CD33(+), CD34(+). Based on these results, a dignosis of acute myelocytic leukemia (AML) was made. She was treated with 2 courses of inten-sive induction chemotherapy (BHAC-DM and MA), but did not attain any remission. Then, granulocyte-colony stimulating factor (G-CFS) was applied in combination with anticancer chemotherapy in order to enhance the sensitivity of leukemic cells to anticancer agents. G-CSF was given intravenously at a dose of 300μg/day since 3 days prior to chemothrapy untill the peripheral neutrophil counts were fully recovered. A-triple-V regimen, namely, cytosine arabinoside (ara-C) [90mg/day continuous, day 1-7], VP-16 [100 mg/day, day 1-7], vincristine [1 mg/day, day 10], and vinblastine [6 mg/day, day 12] were given. Thirty-three days after the start of this therapy, complete remission was achieved. Combination of G-CSF and anticancer chemotherapy was considered to be useful for the treatment of refractory AML.

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Seventeen cases of endometriosis were treated with danazol at Nagoya National Hos-pital between 1978 and 1980. Most of the follow-up studies of this drug have been per-formed whthin five years after the treatment;reports over a 10-year period are very rare. However, 12 to 15 years have passed since the drug was administered to these pa-tients, so a relatively long-term follow-up was possible.
Findings showed that although short-term efficacy of the drug was excellent (94 per-cent), recurrence was common within two to five months after the therapy. Of the 17 cases, only five patients preserved both uterus and ovaries. Twelve underwent radical surgery after the treatment with this drug. One patient, who had surgery four years after the administration of danazol, was diagnosed with endometrioid carcinoma arising from an endometrial cyst. Her malignant tumor size was very small, but the patient died one year after her operation, due to a relapse in the retroperitoneal area.
Six pregnancies were observed in three patients, but only three live-births resulted.
The dramatic efficacy of danazol cannot be denied, but equally undeniable is its tran-sience. The real clnical value of the drug can only be determined in connection with a larger accumulation of data, after the treated patients have passed a climacteric period.

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The method of enzyme-immunoassay for prostate specific antigen (PSA) in serum was evaluated. Present method is considered to be available for clinical use. Serum PSA levels in four patients with prostatic cancer ranged from 0.34 to 94.1ng/ml (x=38.7ng/ ml). The positive ratio exceeding the cut off values was 75%. In the seven patients with benign prostatic hypertrophy the PSA concentration ranged from 0.52 to 3.96 ng/ml (x=1.56 ng/ml), and from 0.21 to 0.95 ng/ml (x=0.64 ng/ml) in 22 normal males.
A close relationship among serum PSA levels and another tumor markers in suspec-ted prostate cancer patients was observed. These findings suggest that the PSA results obtained with present method is useful in the diagnosis and the treatment of prostatic cancer patients.

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