Purpose: The purpose of the present study was to investigate whether rotational digital angiography add new diagnostic informations concerning the localization and feeding artery of hepatocellular carcinoma.
Materials and methods: Rotational digital angiography was performed in 100 patients with hepatocellular carcinoma. There are 70 males and 30 females, ranging in age from 40 to 81 years. At first, abdominal anterior-posterior digital subtraction angiography was performed in C-arm system using 12/9/7 inch I.I.-TV camera. After that, rotational digital angiography was carried out using SF-VA 100 system in all patients. In the processing of images, the pulse modes were taken during 360 degrees transverse rotation of the X-ray system at a speed of 4.8 sec. The pictures were displayed in real time on a CRT screen with high resolution, and 3 D images were observed.
Results: New diagnostic informations concerning the localization and the feeding artery of the tumor were added in 20 patients using this rotational digital system. The tumors in segment 7/8 (n=10) were clearly visualized by -90.0° and 90.0° to 135.0◊ while tumors in segment 4 (n=5) were revealed by -45.0°, 49.0° and 60.0°. On the basis of this information, segmental transcatheter arterial embolization could be performed.
Conclusion: The device has, therefore, been found to be of great value in diagnosing hepatocellular carcinoma, particularly for the feeding artery and the localization of the tumor. (J Nippon Med Sch 1997; 64: 401-410)

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Hemorrhagic ovarian cyst (HOC) which is one of the functional cysts, is often involved in acute abdomen leading to laparatomy intervention. The reason for this mainly lies in the fact that it is easily misdiagnosed as an organic mass because of the presence of lower abdominal pain and the variable appearance of ultrasonographic images at presentation. We analyzed 15 cases of HOC associated with acute abdomen, of which in 2 cases the disease was confirmed by laparotomy. The remaining 13 cases were followed-up clinically and by daily transvaginal sonography (TVS) from the first detection of the cyst until complete resolution. The TVS images showed a variety of changes; however, when the images or their magnified iews were observed precisely, important diagnostic characteristics were found which were classified into 3 categories: type 1 images showed mixed hypoechoic and hyperechoic areas, the demarcation line between which appeared as a thin or thick septum-like echo of smooth formation; type 2 images showed hypoechoic background and vertical, horizontal, or lamellar thin or thick thread-like echoes with an overall reticular-like or sponge-like pattern; and type 3 images showed an overall hyperechoic and solid pattern. Type 1 and 2 images occured more frequent (93.3%), and only 1 case had a type 3 image.
In all image types, septum-like or thread-like echoes were seen. TVS type 1 and 2 images showed a clear division into hyperechoic and other areas with the passing of time which was finally changed into a cystic pattern and disappeared. Severe lower abdominal pain was present for 1 to 3 hours in 12 cases (80%), 4 to 6 hours in 2 cases (13.3%), and 11 hours in 1 case (6.7%).
Other characteristics of HOC may be its most frequent occurrence in the young age group (10 to 20 years old, 80.0%) and in the luteal phase (84.6%). With operative cases, histopathological diagnosis was HOC.
The clinical and particularly TVS findings described in the present study are of signifi-cant value in differential diagnosis of HOC with acute abdomen from other disorders presenting with acute abdomen. (J Nippon Med Sch 1997; 64: 411-415)

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The effect of FK 506, an immunosuppressant which is widely used in the transplantation of liver, kidney and bone marrow, on cerebral infarction volume in transient focal ischemia was investigated. Focal cerebral ischemia was produced by 2h occlusion of the left middle cerebral artery in rats. FK 506 (0.3mg/kg body weight) and vehicle were administered intravenously immediately after induction of cerebral ischemia. After 24h reperfusion the rats were sacrificed and brain infarct volume and edema volume were determined. The FK 506 treatment group showed a significantly reduced infarct volume in the cerebral cortex when it was compared with the vehicle treatment group, but infarct volume was not significantly reduced in the striatum which was the ischemic core in this focal ischemia model.
However, FK 506 did not reduce the edema volume significantly. These results suggest that the reduction of infarct volume is a result of the neuroprotective effect of FK 506. This immunosuppressant may be useful in the treatment of cerebral infarction. (J Nippon Med Sch 1997; 64: 416-421)

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The main objective of this study was to evaluate the relationship between maternal infection induced by pyrogen administration and the changes in maternal and fetal plasma levels of prostaglandin E₂ (PGE₂) and F₂ α (PGF₂ α) and uterine contraction. We administered one mg of pyrogen (E. coli endotoxin) into the maternal femoral vein; then the changes in maternal and fetal core temperatures, plasma levels of PGE₂, [PGE₂] and PGF₂ α, [PGF₂ α], pO2, pCO2, pH and maternal uterine contractions were measured in late-gestation pregnant goats (n=8).
Maternal and fetal core temperatures were elevated significantly 30 min after pyrogen administration (p<0.05), reached their peak levels after 3 hours, and after 5 hours mean core temperatures returned to levels indistinguishable from initial control. Maternal plasma [PGE₂] and [PGF₂ α] increased to 4318±321 pg/ml after 1 hour and to 670.8±58.4 pg/ml after 3 hours respectively (p<0.05). Fetal plasma [PGF₂ α] increased significantly (p<0.05) to 811.0±64.0 pg/ml after 1 hour; however, plasma [PGE₂] did not change throughout the study. Periodic uterine contractions appeared after 3 hours and disappeared after 5 hours. These results suggest that pyrogen induces the elevation of maternal and fetal core temperatures and prostaglandin production, and that eventually causes uterine contractions. (J Nippon Med Sch 1997; 64:422-427)

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Objective: Although the pathology of chronic hypoperfusion in rat following bilateral carotid artery occlusion has been documented, long term changes in cerebral blood flow and metabolism have not been reported. In this study regional cerebral blood flow (rCBF) and regional glucose utilization (rCGU) were analyzed by autoradiographical methods, pathological observation of the brains was also conducted.
Methods: Male Wistar rats aged 12 weeks were anesthetized and the bilateral carotid arteries were occluded. Physiological parameters, ABG, MABP, and rectal temperature were measured before and through occlusion. After 2 days, 1, 4, and 8 weeks and controls of rCBF (Sakurada) and rCGU (Sokoloff) were measured (n=6). Evaluated regions included frontal cortex (Fcor), parietal cortex (Pcor), temporal cortex (Tcor), occipital cortex (Ocor), genu corpus callosum (gCC), corpus callosum (CC), splenium corpus callosum (sCC), caudate putamen (CPu), globus pallidus (GP), internal capsule (IC), thalamus (Thal), hippocampus CA 1 (CA 1), hypothalamus (HypoTh), amygdal (Amygd), and substantia nigra (SNR). In separate animals (n=3) tissue sections were stained using Kluver-Barrera (KB) and Hematoxylin-Eosin (HE), and pathological changes were observed.
Results: After 2 days the rCBF values were significantly reduced to 33-58% of control values in the Fcor, Pcor, Tcor, Ocor, gCC, CC, sCC, CPu, GP, IC, and Amygd. The reductions were observed from the 2nd day to the 1st week. From the 1st week to the 4th week values began to recover to control levels. However, after 4 weeks they were still significantly reduced in the Ocor, gCC, CC, sCC, GP, IC, and SNR (51-63%). After 8 weeks, the rCBF values in the areas except white matter, CPu, GP, and Ocor, etc., recovered to approximately 90% of control levels. However, in the Ocor, gCC, CC, sCC, CPu, GP, and IC, they were still 70-89% of control levels.
After 2 days the rCGU values were reduced to 56-95% (except Amygd) in the measured regions, although not as reduced as the rCBF levels. From the 2nd day to the 1st week, the rCGU values were reduced further and after 1 week the rCGU values were significantly reduced to 39-69% in the Fcor, Pcor, Tcor, Ocor, gCC, CC, sCC, CPu, GP, IC (Lt), Thal (Rt), Amygd, and SNR. From the 1st week to the 4th week, the values began to recover to control levels. After 4 weeks, rCGU improved to approximately 90-100% of controls, and remained at that level through 8 weeks occlusion.
Rarefaction of the myelinated fibers was observed in the white matter from the 1st week to the 4th week in the KB stained sections, while little change in cortex was observed throughout 1st to 8th week.
Conclusion: In this chronic hypoperfusion model rCBF remained depressed after 8 weeks in the Ocor, white matter, and basal ganglia, and rarefaction of the white matter was observed. These results indicate that this model is suitable for the study of chronic cerebral hypoperfusion. (J Nippon Med Sch 1997; 64:428-439)

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The purpose of this study was to evaluate the efficacy of external high-frequency oscillation (EHFO) in patients with hypercapnia following upper abdominal surgery. Seven patients were ventilated with EHFO for 2 hr at 60 oscillations/min, with cuirass pressures of 36 cm H₂O (-26 to +10), and an inspiratory to expiratory ratio of 1 : 1. Blood gases and cardiac functional parameters were examined during the 2 hr on EHFO. Pulmonary functional parameters were analyzed prior to the institution and after the termination of EHFO. PaCO₂ significantly decreased from 61±8 mmHg to 48±7 mmHg after 10 min on EHFO (p<0.01). PaO₂ significantly increased from 74±10 mmHg to 95±26 mmHg after 1 hr on EHFO (p<0.01). The heart rate decreased significantly from 108±27 beats/min to 101±24 beats/min after 30 min on EHFO (p<0.05). The FEV, and FVC significantly increased from 1.09±0.54 L to 1.50 ± 0.46 L (p<0.01) and from 1.90±0.74 L to 2.18±0.60 L (p<0.05), respectively. The other parameters of lung function also significantly improved after the termination of EHFO. The significant changes in all of the pulmonary functional parameters continued for 1 hr after the termination of EHFO. EHFO is an effective method of gas exchange which is associated with earlier return to preoperative lung function. (J Nippon Med Sch 1997; 64:440-445)

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The 10-year survival rate was evaluated in 92 patients with invasive bladder cancer (stages T 2 to 4) who were treated between 1966 and 1985 using bladder-sparing methods such as intravesical instillation of antineoplastic agents, transurethral resection, partial cystectomy, arterial infusion chemotherapy, radiation and embolization of the internal iliac artery. The overall 5-year and 10-year survival rates were 68.4% and 53.9% respectively at a median follow-up period of 60 months. The 10-year survival rate for patients with clinical stage T 2, T3a, T3b and T 4 were 83.7%, 58.9%, 50.8% and 0%, respectively. Our data were comparable or superior to those following radical cystectomy combined with pre- and post-operative radiation or chemotherapy.
In conclusion, our bladder-sparing conservative method is thought to be an alternative treatment for advanced bladder cancer and provides a favorable survival rate as well as an improved quality of life with preservation of bladder function. (J Nippon Med Sch 1997; 64: 446-454)

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