Truth telling of cancer as informed consent is one of the medical techniques. Truth telling has three factors. The first is the selection of cases with indication, the second is technique of conversation of truth telling and the third is support system as management after truth telling.
To select the cases with indication of truth telling, the most important factor is the purpose of truth telling. The evaluation of safety and/or risk is also important.
Through the acceptance of death we can evaluate the success of truth telling.
The acceptance of death is thought as good result. The author observed 62% acceptance of death in cancer patients who were told truth.
We can find the good conditions for truth telling by analysing the relations between acceptance of death and the conditions of the cancer patients before truth telling.

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Total pelvic exenteration (TPE) was performed in 9 colorectal cancer patients. TPE was very excruciating operative procedure. Operating time was long, ranging from 5 hours to 8 hours and 20 minutes. There was massive bleeding, between 1531 and 11, 000 ml, and severe postopetative complications such as intestinal fistula, ileus, leakage or occlusion of ileal conduit, and severe infection including MRSA infection, were presnt.
Of the 5 patients in the primary TPE group, two survived for a long-term of 10 years and 11 years 4 months, respectively. But three of the four patients in the secondary group (those operated on for local recurrences) eventually succumbed to cancer.
These data suggest that TPE is a limited procedure applying only to patients who can cope with the severity of operation and the postoperative complications and only to tumors that can be removed leaving sufficient tumor-free margin to insure against local recurrences in either primary or secondary operations.

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To evaluate the activity of the autonomic nervous system in chronic respiratory failure, we performed the spectral analysis of heart rate variability obtained by 24-hour Holter ECG in 22 healthy subjects and 22 patients with chronic lung diseases. In healthy subjects low frequency components (LF, 0.04-0.15 Hz) of the heart rate power spectrum showed the biphasic circadian variation, that is it was low during the night, and high during the daytime. The high frequency components (HF, 0.15-0.40 Hz) showed the mirror image of the pattern of LF. In patients with chronic lung diseases both LF-power and HF-power were lower than those obtained in healthy subjects. The magnitude of the circadian variations of LF, HF, and LF/HF ratio of patients was smaller than that of healthy subjects. In 5 of 22 patients with chronic lung diseases, the circadian variations of LF and LF/HF ratio showed the opposite pattern, that is they were higher during the midnight than during the daytime. These Eire patients received home oxygen therapy. These results suggest that the magnitude of the circadian variation of autonomic nervous system decreased in patients with chronic lung diseases, and also that in some patients with chronic repiratory failure the sympathetic nerve activity was in-creased during the night.

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Hypertriglyceridemia is seemed to be recognized as a key risk factor of coronary heart disease (CHD). To elucidate further risk factors of CHD, it is necessary to assess not only lipid metabolism but also combined risk factors known as syndrome X, and not all of CHD patients have been claimed hyperlipidemia. Therefore, serum cholesterol, triglyceride and HDL cholesterol alone are not sufficient to estimate the whole risk caused by lipoprotein abnormality. Lipoprotein disorders must be examined as metabolic disorders of VLDL and remnant cholesterol. In this study we used the Lipophor system and classified the electrophoretic patterns into four groups according to the variety of shape of LDL portion (S, A, N, and D classification).
In normal subjects and patients with old myocardial infarction, diabetes mellitus, we examined the S, A, N, and D classification on their electrophoretic pattern and obtained the high frequency of abnormal electrophoretic patterns such as type N and type D. These abnormal electrophoretic patterns were markedly improved by administration of fibric acid derivative.
In conclusion, the Lipophor system is easy to carry out and the classification of electrophoretic pattern is useful to assess the metabolic abnormality of lipoproteins.

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An abnormal chest X-ray shadow was pointed out in a 42-year-old woman in 1987. She was admitted to our hospital in 1990. Her chief complaints were cough, sputum and fever. Since the aortogram demonstrated anomalous artery originating from the aorta and flowing into the right lower lobe, this case was diagnosed as pulmonary sequestration. At thoracomy, the anomalous artery was found within the pulmonary ligament. The vessel was cut, and right lower lobectomy was performed. The angiogram of the surgical specimen revealed that the anomalous artery was confined to the mass. This case was diagnosed as Pryce type 1. The patient has been free of the disease three years after the operation.

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We report the results of pacemaker (PM) implantations, and rare complications and few ideas during perioperative period in our clinic.
Eleven patients underwent PM implantations, 5 with A-V block and 6 with sick sinus syndrome. Their average age was 73 years old. Three of them were treated with tempo-rary pacing, and two received isoproterenol urgently before the operation. PM generators were implanted in anterior chest wall, and leads were inserted via subclavial vein. All patients have been checked at regular intervals in our clinic.
The following three interesting cases are also reported, #1: A chest rentogenogram of an 81 old female exhibited the lead with tines in the left pleural cavity 3 months after the operation, so she was diagnosed as right ventricular perforation of the lead. However, she showed neither subjective nor objective complaints except abnormal ECG findings. A new lead was introduced at the same location. #2: In a case with difficult lead insertion via subclavian vein, the lead was introduced from cervical subcutaneous vein and connected to usual PM location. #3: In a case with a larger anterior chest pocket and formation of seroma, rapid healing of the wound was achieved by a use of a PORTBAG.

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The reported abdominal complications of ventricnloperitoneal (VP) shunt surgery include infections, kinking or occlusion of the shunt tube, intraperitoneal cyst, ascites, and penetration of viscera by the shunt tube. We encountered a patient with persistent refractory diarrhea after VP shunt revision, whose symptoms improved after removal of the intrape-ritoneal shunt tube. No other possible causes of the patient's diarrhea were detected, so the symptoms seemed to be attributable to colonic irritability secondary to direct mechanical stimulation by the VP shunt tube. This seems to be a very rare case, because diarrhea have not been previously reported as the complications of a VP shunt.

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A case of polycythemia vera (PV) accompanied with cerebral hemorrhage is reported. A 66-year-old man with a previous history of hypertensive cerebral hemorrage in the left putamen 2 years ago was admitted with complaints of headache and left hemiparesis. The general examination revealed no other abnormalities but polycythemia. The CT scan revealed right thalamic hemorrhage and CT-guided stereotactic aspiration and drainage of hematoma was performed. Because polycythemia persisted scince admission, a further hematological examination was performed and revealed PV. At approximately 2 weeks after admission, gastro-intestinal bleeding was complicated, then polycythemia was improved. PV should be noticed as one of the causes of cerebral hemorrhage as well as ischemic deseases.

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We report a case of neonatal idiopathic cerebral infarction. A 4, 352 g full-term male infant was born by vaginal delivery to a 28-year-old mother. Apgar score at 1 minute was 8. General status was good after birth. At the first day of life, clonic seizure in right upper and lower extremities appeared. Computed tomography and magnetic resonance imaging revealed homogeneous hypodensity in the distribution of the left middle cerebral artery and right posterior cerebral artery. Because no perinatal predisposing factor had been found, this case was diagnosed as neonatal idiopathic cerebral infarction. Recently, the reports of a case with neonatal idiopathic cerebral infarction are increasing. However, there have been few reported cases with multiple cerebral infarction.

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We investigated amylase isozyme of patients with non-pancreatic hyperamylasemia. Ten patients with hyperamylasemia excluding pancreatic, renal or liver disease were chosen. One patient wsa a macroamylasemia (IgA-λtype) with a specific pattern of amylase isozyme. Isozyme patterns of other 9 patients with salivary-type hyperamylase-mia showed P/S ratio between 0.20, -0.59 (mean value was 0.4). The values of S2 fraction were high between 10-2296 (mean value was 13.296). And also, 6 of 9 hade S3 fraction. Seven of those patients had some diseases and were taking medicines, but other 2 patients did not have any diseases or were not taking medicines.
The investigation of amylase isozyme is very useful for the differential diagnosis of hyperamylasemia. And, some patients have salivary-type hyperamylasemia with unknown causes.

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Diversion colitis which is noticed lately is an inflammatory process in the segments of the colorectum after surgical diversion of the fecal stream. We experienced a case with diversion colitis. A previously healthy 74 year old patient underwent left hemicolectmy, loop ileotomy and gastrotomy under the diagnosis of advnced sigmoid cancer. Ten months after the operation, colonofiberoptic examination of the diverted colon was performed for the closure of loop ileotomy. The mucosa from the coecum to the rectum was erosive, erythematous and demonstrated frank bleeding. Mucosal biopsy showed non-specific, erosive colitis. Under the diagnosis of diversion colitis, instillation of a solution containing longchain fatty acid (Intrafat) twice weeKly at the peroid of 5 weeks resulted in the disappearance of the inflammatory changes observed at endoscopy.

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Acase of renin-dependent hypertension associated with unilateral hydronephrosis due to ureteropelvic junction stricture is reported. A 39 year old woman was admitted to our hospital for an evaluation of hypertension that was resistant to multiple antihyper-tensive agents. Hypertension was found at a health examination. She visited to a general practitioner and several antihypertensive agents were administered, however, her blood pressure did not respond to these medications and she was referred to us. On admission, her blood pressure was 210/140 mmHg, left enlarged kidney was palpated on physical examination. Mild renal dysfunction and increased plasma renin activity were noted on laboratory examination. Marked left hydronephrosis was found on ultrasound examination and computed tomography. There was no significant renal artery stenosis on renal arteriogram, but plasma renin activity in left renal vein was 2.8 times higher than that of right renal vein. Simple left nephrectomy was performed, and her blood pressure became normal and plasma renin activity was normal 10 days after operation. Hypertension associated with unilateral hydronephrosis was rare, only 9 cases were reported in the literatures in recent 15 years in Japan.

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A case of imperforate hymen causing hydrohematometrocolpos is presented. The patient was a 21-year-old female, complaining lower abdominal pain for every 2 or 3 months (menstrual molimen) since the age of 18. Pelvic examination revealed a bulging, closed hymen. Ultrasonography and CT scan showed distended cavity of vagina and uterus (hydrohematometrocolpos) and no other anomalies were found in urogenital organs.
The closed hymen was excised circularly and the bloody fluid was drainaged. Posto-perative course was uneventful and hormonal response of the endometrium was confirmed.

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