The principal chemotherapeutic agents which seem to be effective for advanced or recurrent gastric cancer are mitomycin C (MMC), 5-fluorouracil (5-FU), adriamycin (ADM) and cisplatin (CDDP). Used as a single agent, these drugs have shown response rates about 20%. Therefore, various combined therapies including MMC plus 5-FU (MF), 5-FU plus ADM plus MMC (FAM), etoposide plus ADM plus CDDP (EAP), 5-FU plus ADM plus CDDP (FAP), 5-FU plus CDDP (FP), methotrexate (MTX) plus 5-FU (MTX/FU) and 5-FU plus ADM plus MTX (FAMTX) have been investigated. A unique 2-drug combination of MMC and CDDP (MP) has also been developed in our institute. Among them, FP and FAMTX appear promising in several phase II trials. However, the response rates to these therapies did not exceed 50% and the median overall survival times ranged from 6 to 9 months. Moreover, few combination therapy demonstrated survival advantages over 5-FU alone in phase III trials. Although FAMTX is showing encouraging superiority compared with FAM, the previous standard and the “supportive care only” in recent randomized trials, the standard regimen has not yet been established in the treatment of advanced or recurrent gastric cancer. Chemosensitivity testing may be a useful approach to prefer the most active regimen and to improve clinical efficasy of the treatment

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In order to clarify psychophysiological mechanisms of benzodiazepine-induced cognitive impairment, we conducted an experimental study; the effects of triazolam (TRZ) 0.125mg on cognitive function and subjective sleepiness were investigated in 10 normal male volunteers (age range 28-39). The ERP recording under an oddball paradigm in eye-opened state, as well as the polarity profile questionnaire (PPQ) was carried out before and at 1, 2, 4, 6, and 8 hours after TRZ administration (10:00am). Each of the P 300 latencies was significantly longer at 1-6 hours after TRZ treatment and each of the P 300 amplitudes was significantly lower at 1-4 hours, compared with that of the premedication period. It was noted that these findings indicating cognitive impairment at 1-6 hours after TRZ treatment were not associated with increase in subjective sleepiness. These results suggest that benzodiazepine-induced cognitive impairment may be due to a direct effect on human cognitive system possibly independent of the sleep inducing property of benzodiazepines

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We investigated the effect of Chinese medicine on injured pancreas by using isolated pancreatic acinar cells which were incubated under a hypercalcemic state. The cells were prepared by the Amsterdam & Jamieson method. They were incubated for one week in two kinds of 199 medium; one had a normal concentration of calcium (1.8mM) and the other a high concentration of calcium (6mM). Chinese medicine (saiko-keishi-to or kanzo) was added to each medium in a concentration of 80-320μg/ml. The following tests were performed; 1) observation by optical microscope, 2) measurement of amylase and LDH released from the cells, 3) measurement of cellular content of amylase, LDH, protein and DNA. The results indicated that saiko-keishi-to or one of the constituents, kanzo, suppressed pancreatic injury due to hypercalcemic state (as shown in the presence of damaged cells, decreased DNA content, etc. ). The above mentioned phenomenon suggests the usefulness of these medicines for the treatment of pancreatic injury

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Peripheral blood stem cell transplantation (PBSCT) has recently been used in the treatment of hematologic malignancies and solid tumors, however, the application of PBSCT has not yet been established in advanced ovarian cancer. This study evaluates the indications, clinical response, and toxicity of ultra-high dose chemotherapy in 3 patients (FIGO Stage IIIc-1, IV-2) with advanced ovarian cancer.
A second look operation (SLO) in case 1 (Stage IIIc) showed up positive at the microscopic level and the patient received ultra-high dose chemo therapy (CBDCA: 1300mg/m², VP-16: 1300mg/m², Cyclophosphamide (CPM): 3000mg/m²) follwed by PBSCT, and there was no recurrence. In case 2 (Stagelv), although CBDCA: 1500mg/m², VP-16: 1500mg/m² and CPM: 3800mg/m² were administerad, followed by PBSCT after residual tumors were recognized on SLO, the patient died of the tumor. Case 3 (StagelV), operated on secondary cytoreductive surgery (SCS), received ultrahigh-dose chemotherapy (CBDCA: 1200mg/m², VP-16: 1200 mg/m²) followed by PBSCT, and experienced no recurrence. granulocytosis and thrombocytpenia recovered more than 500/μl in day 8-10 and more than 100×10³/μl in day 14-16 after PBSCT respectively. Toxicity was acceptable in all cases.The number of colony forming unit granulocyte-macrophage (CFU-GM)/kg correlated well with that of CD34⁺ (r=0.693). This method should be indicated in patients capable of SCS as well as those who showed up microscopically positive on SLO. Further, dose intensification through PBSCT may offer an effective therapeutic option for advanced overian cancer in the future

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The authors have developed the stereotactic high dose rotatory irradiation using a Komai's CT guided stereotactic apparatus and Microtron 10 MV X-ray for the lesions under 3 cm of inoperable metastatic brain tumors. After determining precise target lesion using a Komai's CT guided stereotactic apparatus, Microtron 10 MV X-ray was irradiated 30 Gy at once. Namely the Microtron gantry was rotated 360 degrees around the center of the irradiated target on each of three different planes by exchanging the angle of therapeutic bed by 15 degrees. A result of irradiation for 15 lesions of 10 cases in this method have been followed up, using CT or MRI, 1 and 14 months after the irradiation, 4 lesions showed complete response and 6 lesions showed partial response. And seven cases out of 10 cases (70%) had effective responses. We have not experienced side effect of irradiation. Radiosurgery in our stereotactically rotatory irradiation is simple and useful method and it could maintain quality of life of the patiets with metastatic brain tumors betler, even though who do not have good long term prognosis, and can shorten the in hospital treatment similarto gamma knife therapy

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This report describes oriental medicine therapy on two practical problems frequently observed in patients with chronic cerebrovascular diseases.
Long-standing headache is one of the most common subjective symptom in patients with cerebral stroke. We assessed clinical effectiveness of oriental medicine for this symptom, Cho-to-San 7.5 grams/day in 60 patients (averaged ages of 61.8 year-old) with cerebral stroke selected randomly from the list of our institute. Cho-to-San administration for 8 to 32 weeks (averaged 12 weeks) relieved 78.3% patients from their chronic headache. Out of 60, 7, 29 and 11 patients showed complete, moderate and slight improvement in degree, respectively. It was ineffective in semaining 10 patients.
Prominent edema which frequently develops in the hand and fingers following motor paresis in patints with cerebral stroke is one the most cumbersome problem both on a daily life and rehabilitation practice. Oriental Medicine, Sairei-tou 9 grams/day was administrated in 35 patients (averaged ages of 65.7 year-old) with typical edema following cerebral stroke.
Out of 35, 34.3, 34.3 and 17.1% patients showed complete, moderate and slight improvement after 2-9 weeks (averaged 4.4 weeks) of oral administration, respectively.
In this study, we confirmed practical effectiveness of oriental medicine both on chronic headache and edema in paratic limbs frequently seen in cerebral stroke patients

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Diagnosing accuracy for pancreatic carcinoma is improving with advances in imaging diagnosis, but occasionally the primary tumor is not visualized even by CT or MRI. We encountered two patients with advanced pancreatic carcinoma whose primary tumor could not be visualized, in whom thickened vessel sign (findings of the disappearance of fat layer around the superior mesenteric artery or celiac artery and of thickened vascular wall) was useful for the diagnosis. The first patient was a 73-year-old male and the second a 60-year-old male. Angiography revealed an association with wide-ranging vascular infiltration in both patients, but the pancreatic tumor was not clear on CT or MRI. The thickened vessel sign was the only positive finding. Although thickened vessel sign is not necessarily specific to pancreatic carcinoma, it is considered to be useful in making a diagnosis of advanced pancreatic carcinoma

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We confirmed homozygous type of relatively small expansion of CAG triplet repeats (57 repeats) in the short arm of chromosome 12 in a male patient with dentatorubral-pallidoluysian atrophy (DRPLA) by the polymerase chain reaction. He showed early onset (age 17yr) of DRPLA. His family history showed that his father and mother were first cousin, but neither showed any signs of DRPLA at the respective ages of 73 and 71. They had expanded 57 triplet repeats of the same size as the patient's but as a heterozygous state. Their normal alleles were 15 triplet repeats. There was good correlation of the age of onset with the number of triplet repeats in DRPLA. The homozygous state for the expansion of the triplet repeats was responsible for the early onset of his DRPLA

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A 32-year-old man was admitted our hospital, complaining of severe dyspnea. The night before the admission, he had used 220ml of water proof spray containing fluorocarbon polymer, 1-1-1-trichloroethan and LPG.
The findings of his chest CT were interesting. The peripheral change was slight but high density area was observed in the central zone. After admission, he was treated with steroid hormones, and his clinical course was good. He was discharged on the 16th day

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We describe two cases of vulvar lichen scleruosus et atrophicus with pruritus. One patient was a 75-year-old woman, whose clinical features included depigmentation, keratosis, erosio and purpura on the vulva, depigmentation on the perineum and the perianal skin. The other patient was a 67-year-old woman characterized by atrophic loss of vulvar architecture with a pale white appearance. Histological findings were diagnostic of lichen sclerosus et atrophicus and topical corticosteroid controled the pruritus in both of the patients.
Case 1 has not developed any maliginancy for 4 years since the onset of the disease, nor has case 2 within the last 6 years

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Intravesical instillation of Maalox, known to be effective in the protection of gastric mucous epithelia, was performed in 3 cases with intractable massive bladder hemorrhage, resulting in successful hemostasis Three patients, comprising two cases of radiation cystitis and one case of cyclophosphamide-induced hemorrhagic cystitis, were seriously anemic because of severe bladder hemorrhage that was resistant to any other hemostatic therapies. Fifty to one hundred ml of undiluted Maalox was instilled into the urinary bladder and left in place for 30-60min, and this technique was performed once or twice a day every day. Bleeding ceased within 1 to 10 days (average 6.8 days) after initiation of Maalox therapy without any notable side effects in all cases. Because this treatment controls bladder hemorrhage using a simple technique without side effects, we suggest that intravesical instillation of Maalox may be one of the beneficial treatment for serious and chronic hemorrhagic cystitis like these cases

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We observed 3 peculiar cases of tonic spasms resembling infantile spasms in EIEE or West Syndrome in patients without suppression burst pattern or hypsarrhythmia by video-EEG monitoring. Seizures are characterized by periodic flexor or extensor jerks of extremities in awaking state.
Each of the cases was not uniform in quality, but cured by antiepileptic drugs or Vit B6 followed by improvement of psychomotor activity. We are unable to identify another reports in the literature that our cases might afford some information to clarifying the epileptogenous processes of periodic spasms

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Histological extra large specimens are suitable for the observation of operative specimen, over all.
Histological extra large specimen are capable of assessment of the direction or aspects of cancer invasion to maxilary or mandibular bone after operation.
And so, histological extra large specimens are capable of the definition of bone resection. We suggest that therapeutic results might be improved using these histological study of extra large specimen

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We have reported here a case of ACTH producting lung cancer with Cushing syndrome.
The patient was a 56 years-old male. He had been diagnosed as diabetes mellitus and treated from 1981. He had been pointed out a coin lesion in the superior lobe of left lung in 1991. He received left superior lobectomy and diagnosed pathologically as spindle cell carcinoma of lung. He admitted our hospital for the treatment of hyperglucosemia at December in 1992. At the same time as the size of upper abdominal tumor increased, serum levels of ACTH, NSE and cortisol increased and that of potassium decreased. The autopsy revealed a giant tumor in the upper abdomen, pathologically diagnosis of which was metastasis of lung cancer. As there was no case report of Cushing syndrome by ACTH producting-spindle cell carcinoma of lung, our case was thought to be very important

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We reported a patient with Alzheimer's dementia at the presenile onset exhibiting a marked logoclonia. She frequently reiterated one or two syllable (s) several times in her speech, so that what she had intended to say could be hardly understood. Logoclonia is a famous speech symptom with a long history. It was described by Kraepelin (1910), but has been scarcely ever studied systematically. We discussed several problems of logoclonia from a clinical symptomatological point of view. (1) Logoclonia, which is sometimes observed in dementing diseases, for example in Alzheimer's disease, dementia paralytica, etc., is characterized by a horizontal iteration of a single (or two) syllable (s) without a semantic value. (2) Logoclonia must be caused by organic damages in the brain. (3) An initiative of speech preserved to some degree may be necessary for logoclonia. (4) Logoclonia is considered as a special phenomenon of desorganization of the psychomotor function, so that (5) it may be related to the organic damage of the frontal lobe. (6)Logoclonia appears between the last stage and the terminal apallic stage (mutism) in the clinical course of Alzheimer's disease. We finally discussed problems on the differential diagnosis of logoclonia

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