Evaluation of liver reserve function, i. e., the severity of cirrhosis is very important before hepatic resection. We studied the usefulness of the splee/liver volume ratio (S/L ratio) calculated from computed tomography (CT) images for evaluating the severity of liver cirrhosis.
The volumes of the liver and spleen were measured and the S/L ra tio was calculated and in 58 patients encountered at our department during the past 3 years,42 patients with liver cancer complicated bt liver cirrhosis and 16 with liver cirrhosis complcated by esophageal varices. We studied the possible correlation between the S/L ratio and ICGR15, serum bilirubin (s-bil), Serum albumin (s-alb), or cholinesterase activity (Ch E), which are indices of liver function. There was a correlation between the S/L ratio and each index of liver function. The S/L ratio was correlated positively with ICGR15 and s -bil, and negatively with s-alb and Ch E.
When the severity of live r cirrhosis is evaluted, consideration should be given not only to the liver volume resulting from decreased effective blood volume but also the increase in the spleen volume due to increased portal pressure. The measurement of the S/L ratio, which reflects both effective liver blood flow and factors increasing portal pressure, may be useful for evaluating liver function.

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To investigate the extent of coronary artery atherosclerotic changes and of the jeopardized myocardium, we performed coronary arteriography, left ventriculography and exercisE thallium-201 single photon emission computed tomography (SPECT) on 52 patients wit h non-Q wave myocardial infarction. Patients were divided into 3 groups according to the acute phase standard twelve-lead electrocardiographic findings: 11 patients with both the findings of the ST segment elevation in lead aVR and ST depression in any other leads except lead aVR (group 1); 16 patients with one of those (group 2); 25 patients without those (group 3). Mean value of the left ventricular ejection fraction in all subjects was 66%, and no significant differ. ences were observed among 3 groups. No significant major coronary artery stenosis (< 75% in diameter) were observed in 5 (31%) in group 2 and in 7 (28%) in group 3, however, none was observed in group 1. The incidence of multivessel disease, left anterior descending artery le sion and collateral vessels were significantly higher in group 1 compared to group 2 and 3 (p <.05) Gensini score and jeopardy score were also significantly higher in group 1 compared to group 2 and 3 (p <.01). Infarct region determined quantitatively by the unfolded map method using exersise thallium-201 SPECT was < 10% in each 3 group, and no significant differ ences were observed among 3 groups. On the other hand, ischemic region and transient ische mic region were significantly larger in group 1 compared to group 3 (p<.05, p<.01, respec tively) and had a tendency to being larger in group 1 compared to group 2. Thus, all the pa tients in group 1 had significant > 75% stenotic coronary artery lesion, and group 1 showed more extensive coronary artery sclerotic lesions and jeopardized myocardium than those in group 2 and 3.
Conclusion: Acute phase electrocardiographic findings of the ST elevation in lead aVR and ST depression in any other leads except lead aVR indicate advanced coronary artery atheroscler osis in nonQ wave myocardial infarcts.

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To investigate effects of irradiation on brain monoaminergic neurons, we measured the contents and synthetic rate of noradrenaline (NA), dopamine (DA) and 5-hydroxytryptamine (5-HT) in the cerebral cortex, brain stem and hippocampus of the rat brain one and eight weeks after ⁶⁰Co irradiation (1.5 and 10Gy) to the head. With 1.5 Gy-irradiation, the NA and DA contents in the brain stem only increas ed over one week. By week g, these contents had decreased in the cortex while the 5-HT content in the brain stem and hippocampus increased. Neither one nor eitht weeks after the dose, the others were unchanged. With 10Gy-irradiation, the DA content in the brain stem increased but that in the cortex and 5-HT content in all the three regions decreased on day 7, and the rest was unchanged. In week 8, the NA, DA and the 5-HT contents in all the three regions decreased. Since the monoamine contents were markedly affected with 10Gy-irradiation, we measured accumulation of dihydroxyphenylalanine (DOPA)and 5-hydroxytryptophan (5-HTP) after NSD-1015 administration, which represents syntheses of catecholamines and 5-HT, respectively. In all brain regions tested, irradiation had no effect on the accumulation in week 8. Accumulation of 5-HTP decreased after irradiation on both day 7 and week 8 in all the brain regions except for the cerebral cortex on day 7. These results suggest that cobalt irradiation impairs monoaminergic neuronal activities in the brain through the inhibition of monoamine synthesis.

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Platelet-activating factor (PAF) is one of the potent proinflammatory agents and associated with a number of disorders, including asthma, endotoxin shock and cardiovascular diseases. Additionally, plasma PAF-acetylhydrolase (PAF-AH) activity to inactivate PAF is regulated by hormones. In this study, we elucidated the effects of estrogen and progestin on plasma PAF-AH and also the effects of PAF on rat tissues to investigate the mechanisms involved in the thrombotic episode.
Plasma PAF-A H activity in female adult rats treated with 17a -ethynylestradiol (50 pg/kg,5 days) was decreased by 50%. However, medroxyprogesterone (50 mg/kg,5 days) increased the enzyme activity by 50%. Plasma PAF-AH activity in female adult rats treated with either progeserone or 17a -hydroxyprogesterone (50 mg/kg,3 days) did not alter significantly. Both medroxyprogesterone and megestrol acetate (50 mg/kg,3 days) significantly increased plasma PAF-AH activity. However, both norethindrone acetate and norethynodrel (50 mg/kg,3 days)decreased the enzyme activity significantly.
When PAF (5 to 60 nmol/kg ) was injected intravenousely to nontreated female adult rats,80% of the animals died at 20 nmol/kg of PAF. Macroscopic findings showed hemorrhage, hyperemia and congestion in lung and heart and necrosis-like change in gastrointestine. Microscopically, thrombus was observed in lung and heart.
When PAF (10 nmol/kg) was administered to female adults rats pretreated with sex seroid hormones, the mortality of the rats with low plasma PAF-AH activity caused by 17a ethynylestradiol or norethindrone acetate was increased. These findings suggest that imbalance between PAF and plasma PAF-AH is one of the mechanisms involved in the thrombotic episode and that estrogen is related to the event by regulating the plasma PAF-AH activity. Additionally, some progestins, which have estrogenic effect on the enzyme activity, may be related to the thrombotic episode observed in oral contraceptive users.

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Organ culture method was applied to estimate the condition of implantation in human endometrium. Estrogen and progesteron were added to the culture media and cultured tissues were observed with light and electron microscopes.
The organ culture of human endometr ium was successfully done for 72 hours. The tissues maintained their features in each phase of menstrual cycle, but degenerative appearance progressed in the endometrium of secretory phase.
Single addition of estrogen caused any specific change in the endometrial tissue by the observation of light and electron microscope. When prgesterone was added singly, mitochondoria tended to increase in number in proliferative and ovulatory phase. In implantation phase progesterone accelerated degenerative change as increase of lysozome and lipid droplet.
Specific findings were observed when both estrogen and progesteron were ad ded together to the media rather than when each of them was added singly. Both hormones stimulated to show remarkable accumulation of glycogen and giant mitochondoria in proliferative and ovulatory phase. Glycogen and prolactin were measured after culture as an parameter of energy source and decidualization respectively.
Glycogen contained in endometrial tissue increased during the culture in proliferative and ovulatory phase by adding both steroid hormones. On the contrary, they decreased in implantation phase.
Prolactin values increased in every phases after organ culture. They decreased by addition of progesteron singly and estrogen and progesteron togther, however single addition of estrogen accelerated secretion of prolactin.
In conclusion, cooperative actio ns of estrogen and progesteron is a requisite condition to achieve implantation of human embryo.

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Although the incidence of endometrial carcinoma of the uterus (cancer of corpus uteri) has been increasing in recent years, the etiology of this disease has yet to be fully elucidated, unlike that of cervical carcinoma, and especially that of squamous cell carcinoma. Therefore, we performed clinicopathological studies of endometrial carcinoma, evaluated the therapeutic outcome, and discussed problems in the treatment of 120 patients with endometrial carcinoma who were treated at the OB-GYN Department, Kansai Medical College during the past eleven years (1983to 1993).
1. The incidence of endometrial carcinoma has been increasing in this department; it comprised 14.1% of all cases of uterine carcinoma in 1983, and 27.7% of all such cases in 1993.
2. The mean age of patients with endometrial carcinoma was 57.0 yeas; that of patients which clinical stage I was 47.7 years, while that of patients with disease of clinical stage II or higher was between 56.7 and 58.0 years. Thus, patients with disease of clinical stage II or higher were a mean of 10 years older than those with clinical stage I disease. Three patients were less than 30 years of age. Endometrial carcinoma was seen more frequently among who had few pregnancies, and 78 (65.0%) of the patients were postmenopausal.
3. The chief complaint was genital bleeding in most cases (94 cases (78.3%) of all cases).
4. Endometrial cytology was performed for preoperative diagnosis, and the rate of coorect diagnosis was 69.2%. Tumor markers were also studied in 91 cases,42.9% of the patients were positive for CAl25, while 47.3% were positive for CA19-9. In addition, endometrial carcinoma was discovered postoperatively (e. g. following surgery for uterine myoma) in nine patients.
5. As a rule, the patients in this study underwent hysterectomy, and radical resection of uterine carcinoma or simple total resection was performed in accordance with the extent of tumor infiltration. Since 1986, chemotherapeutic agents (primarily cisplatin (CDDP) were adminis tered concomitantly during surgery or postoperatively, and maintenace therapy was performed with 5-FU.
6. The five-year survival rates for the 59 patients were as follows (up to 1988); patients: with stage I disease: 84%, with stage II disease: 83%, with stage III: 75%, and with stage IV\disease: 40%. The percentages of patients surviving at present are as follows: stage I: 87.8%stage II: 91.7%, stage III: 80.0%, and stage IV: 30.8%. Recurrence of disease and mortality was: observed in 21 cases (17.5%). The sites of recurrence in the 21 patients who died were as fol lows; local (intrapelvic): 10 cases (25.0%), peritonitis carcinoma-tosis: 9 cases (22.5%), and distant metastasis: 21 cases (52.5%).
7. Factors related to morta lity were then evaluated for patients who died. Histologically poorly differentiated (G3) disease, lymphonode metastasis, and tumor infiltration deeper than 2/3 of the uterine musclare layer were closely associated with mortality. Taking these findings together, the degree of histological differentiation was found to be the most important prognos tic factor.
8. Tumor metastasis was frequently observed in distant organs in patients with poorly diffe rentiated disease and in the peritoneal cavity in patients with tumo rinfiltration deep in the muscular layer of the uterus. Most of the recurrences were discovered three years after the ini tial diagnosis.
9. Radiation therapy was primarily used to prevent postoperative recurrence, and chemotherapy (primarily consisting of cisplatin (CDDP)) has been employed concomitantly since 1986. Chemotherapy was effective in 60% of patients with canceous peritonitis, but less effective in patients with local recurrence or distant metastasis. In particular, chemotherapy was usually ineffective in patients with poorly differentiated (G3) disease. The findings presented adove indicated that early detection of endometrial carcinoma and improvement

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1. Four items. nuclear diamener, N/C ratio, nuclear density and high density area of nucleus were measured as fundamental data necessary for screening. Then, clearly distinguishing differences were observed between normal cell group and abnormal/malignant cell group.
2. Specimens were screened with these 4 items as parameters. The linear di s crimination of the results clearly showed distinction of each cell.
3. Field tests were tried for specimens gener ally utilized in population screening. The rate of correct diagnosis was satisfactory in abnormal group. In normal group, however, the false positive rate came up to 40%. Such factors as cluster of cells, dusts and leucocytes were difficult to be discriminate from abnormal cells by the automatic sieving apparatus. Therefore, each specimen was made into cell suspension of 250cells/0.01ml. After shieving and syringing them using a combination of stainless mesh and nuclepore filter (12μ), specimen were smeared on the slide glass. In field tests using such smear specimens, the false positive rate was 34% in case of the false negative rate taken as 0, though it was difficult to make a judgment about bloody specimens.
Nowadays, mass population screening of uterine carcinoma has been greatly increasing the number of specimens for cytodiagnosis, giving a great burden to cytoscreeners. However, the larger part of the specimens belongs to the normal group.
As shown above, screening by the automatic sie v ing apparatus with 4 basic items as parameters has revealed that nearly half of the normal specimens are accurately excluded as normal. And so, remained half of normal specimens diagnosed as abnormal and other abnormal specimens must be examined by cytoscreeners.
This is the reason why we atte m pted to make the present study.

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The in vitro effects of interferon (IFN) on drugmetabolizing activity in the human liver were investigated. The activities of 7-methoxycoumarin (7-MC) O-demethylase and 7-ethoxycoumarin (7-EC) Odeethylase in liver microsomes were measured in the absence and presence of IFN-α2a.
The peak blood concentration reached during clinical IFN-α2a treatment has been reported to be 10¹to 10³ IU/ml. At a high concentration (10⁶ IU/ml), IFN-α2a inhibited the activities of both enzymes, to 75.6% and 72.4% of the control activity, respectively, but few effects were observed at concentrations of 10¹ to 10⁵ IU/ml.
These res ults indicate that the depression of drug metabolism during IFN treatment is not due to the direct inhibition of drugmetabolizing enzymes by IFN molecules, but that other factor(s) are needed for IFN to exhibit this action.

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Many taxi drivers in Japanese large cities work 24 hours at a time on a 1 day-on 1-days off 48-hour work cycle. The working shift lasts from morning of the first day to early dawn of the second day. We investigated the schedule of eating, slepping and alcohol intake over this twoday period for 287 taxi drivers (mean age,48.1) working for companies in Osaka Prefecture. The peak meal times on the first day were 6: 00,12: 00 and 20: 00, and 12: 00 and 19: 00 on the second day, but there was no peak on the morning of the second day. Subjects were divided into 5 groups depending on the time they start taxi-driving. When these groups were compared, meal times on the first day differed, but we found no difference in noon and evening meals on the second day. Mean value of total length of sleeping time over the 48-hour period was 13.6hour, of which 37.5% occurred during the day of the second 24-hour period. Sleeping periods during the second day were interrupted or ended by meals. On the second day,73.9% of the drivers consumed alcoholic beverages. The number of drivers consuming alcohol several times on the second day was higher than that of drivers consuming alcohol only once, and 13.5% of drivers consumed alcohol three times or more. Alcohol was consumed most frequently after 17: 00 on the second day, followed by the time periods 0-11: 00. We concluded as follows; 1)meal intake of the taxi drivers on the first day followed a normal pattern based on the time they start taxi-driving; 2) from directly after getting off work until the middle of the second morning, there was no fixed pattern; 3) sleep was interrupted in the afternoon of the second day and normal pattern was forcibly re-established.

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To know the psychological effect of two-jaw surgery, we evaluated patients' reaction to the result of the surgery which were performed to them retrospectively with questionnaire by mail. Twenty-seven out of 44 (61.4%) patients, we operated between 1990 and 1991, responded to a questionnaire and most of them rated the result as satisfactory, but some shows mild disappointment especially in elder patient or big changed case. Two jaw surgery changing face significantly for adult patient is an important consideration.

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