During the past 17 years, 1, 722 of 4, 832 consecutive patients investigated with endoscopic retrograde cholangiopancreatography (ERCP) were assessed by the radiological criteria of the Japanese Study Group of Pancreaticobiliary Maljunction (PBM). Out of these 1, 722 patients, PBM was found in a total of 52, representing 3.0%, of which gallbladder carcinoma was associated with 14. These 14 with gallbladder carcinoma consisted of 10 (62.5%) of the 16 with PBM without association of congenital bile duct dilatation (CBDD) and 4 (11.1%) of the 36 PBM with CBDD. The relationship between PBM and gallbladder carcinoma was closely examined; PBM was noted in 14 (32.6%) of a total of 43 patients with gallbladder carcinoma compared to 38 (2.3%) among the 1, 679 patients with various diseases excluding gallbladder carcinoma. Similarly, it was revealed that gallbladder carcinoma was predominantly noted in the 14 (26.5%) of the 52 patients with PBM in contrast to an incidence of 1.7% (29) among the 1, 670 patients without PBM.
As we studied the characteristic clinical features of the 14 gallbladder carcinoma patients with PBM when compared with 29 of those without PBM, the following was disclosed: on average, the patients with PBM were 10 years younger (49.4 vs 61.4 years in mean age); there was a preponderance of women (0/14 vs 12/17, male-female ratio); there existed a significantly lower incidence of associated gallstone disease (7.1% vs 72.4%). These figures were shown to be statistically significant. We concluded that the results prove a link between the crucial features of gallbladder carcinoma and PBM, and also suggest the promotive role of PBM in carcinogenesis of the gallbladder. (J Nippon Med Sch 1998: 65; 7-13)

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An immunohistochemical study of 63 cases of uterine cervical cancer was undertaken. It was confirmed that the biological character of the cancer cells derived from the reserve cells changed over the course of invasion. Squamous cell carcinoma had positive keratin antibodies such as CK 10/13 (DE-K 13), CK 14 (NCL-LL 002) and CK 7 (OV-TL 12/30). In invasive squamous cell carcinoma, CK 14 positive cells were piled up and tended to be stained positive by PCNA and laminin. There were two types of staining, one of which revealed CK 14 strongly positive, and the other weakly positive. The first type differed from the second in depth and localization. The cells on the margin of a cluster of cancer cells were stained positive with CK 14 as in normal basal cells. The results obtained suggested: 1) squamous cell carcinoma has not only the character of normal squamous cells, but also that of the cells derived from the cervical glands. 2) cancer cells may develop in accordance with the character of basal cells, and the patterns of invasion change according to the character of basal cells in cancer tissue. (J Nippon Med Sch 1998 ; 14-27)

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Electroencephalography (EEG) and its relationship to prognosis were studied in 105 patients with cerebrovascular disease in the acute to subacute stages. Twenty cases had normal EEG, and most of them recovered well. Fifty-five cases had mildly to moderately abnormal EEG with focal asymmetric or slow waves in the unilateral hemisphere. Among them, 41 cases (75%) recovered to the extent of being capable of independent walking, 38 cases (69%) recovered sufficiently to engage in independent activities of daily livings (ADL) and 42 cases (76%) returned home. On the other hand 30 cases who had severely abnormal EEG with diffuse slow waves in the unilateral or bilateral hemispheres showed a poor prognosis. Among them, 18 cases (60%) were confined to bed, 20 cases (69%) remained in totally dependent ADL, and 4 cases (13%) died. Thus, EEG is shown to reflect well functional recovery in stroke patients. (J Nippon Med Sch 1998; 65: 28-33)

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There is accumulating evidence that some substances which are originally transmitters affect neuronal development. Though noradrenaline (NA) containing neurons in the brainstem innervate motoneurons as well as interneurons in the spinal cord, little is known about whether or not NA may play roles other than neurotransmission during development. Therefore, we have examined the effects of NA on developing neurons in the spinal cords of chick embryos.
The dissociated cells were incubated with chemicals and the number of surviving cells was counted 2 days later. It was found that NA induced cell death in a dose dependent manner (EC50, 13μM). Phentolamine, an α-adrenoceptor antagonist, prevented the cell death induced by NA (K_D, 1.5 nM), whereas, alprenolol, a β-adrenoceptor antagonist, did not. Furthermore, prazosin, an α₁-adrenoceptor antagonist, prevented the NA-induced cell death, but yohim-bine, an α₂-adrenoceptor antagonist, did not. Dithiothreitol, an antioxidant, did not prevent NA-induced cell death. These results indicate that NA induces cell death in the developing neurons in the chick spinal cord through α₁-adrenoceptors. (J Nippon Med Sch 1998 ; 65: 34-41)

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Inflammatory cytokines in plasma and bronchoalveolar lavage fluid (BALF) from 16 post-esophagectomy patients with and without preoperative methylprednisolone administration were studied. Interleukin-8 (IL-8), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) concentrations in plasma and BALF were measured by ELISA immediately after surgery (0-POD) and on the postoperative day 1 (1-POD). In patients without methylprednisolone treatment, IL-8 levels in BALF were 362 ± 67 pg/ml on 0-POD and 948 ± 359 pg/ml on 1-POD, and were approximately 10 times higher than those in plasma levels. IL-6 levels in plasma were significantly higher than those in BALF. The TNF-α concentration was similarly low in plasma and BALF. The patients with preoperative methylprednisolone treatment had significantly lower IL-8 levels in BALF and plasma compared with the patients without the treatment. Immunocytochemically, each cytokine was identified in the cytoplasm of bronchoalveolar macrophage. The percentage of polymorphonuclear cells (PMN) among BAL cells was significantly increased on 1-POD when compared with that of 0-POD, and tended to be decreased by preoperative methylprednisolone treatment. These results suggest that IL-6 was markedly increased in the peripheral circulation and that increased pulmonary IL-8 might be related to an accumulation of PMN in the lung under surgical stress. Further, methylprednisolone administration could possibly reduce postoperative cytokine responses at the local and systemic levels. (J Nippon Med Sch 1988; 65: 42-49)

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There is much evidence indicating that indicates end-stage renal failure induces insulin resistance. We examined the effects of renal transplantation on insulin resistance with an insulin clamp technique. Insulin sensitivity and insulin secretion rates were measured in 13 renal transplant patients, 7 hemodialysis patients, and 6 healthy controls. Insulin sensitivity was assessed with the euglycemic insulin clamp technique. The clamp was applied for 120 minutes and the average of the glucose disposal rates measured from 90 to 120 minutes was regarded as insulin sensitivity. There was a significant increase in the glucose disposal rate in the renal transplantation patients (6.67 ± 1.44 mg/kg/min) compared to the hemodialysis patients (4.54 ± 1.44 mg/kg/min) (p<0.05). Also, there was a significant decrease in the glucose disposal rates in the hemodialysis patients (4.45 ± 1.44 mg/kg/min) compared to the healthy controls (7.25 ± 2.07 mg/kg/min) (p<0.05). There was no significant difference in the glucose disposal rates between the renal transplant patients and the healthy controls. However, patients treated with, β-blockers had lower glucose disposal rates compared to patients without β-blockers (4.67 ± 1.58 vs 6.67 ± 1.44 mg/kg/min, p<0.05).
In this study, we fould that insulin resistance, shown by the euglycemic insulin clamp technique, was recovered after successful renal transplantation that but, β-blockers affected insulin resistance. In conclusion shows that, the hyperglycemic clamp technique. although many factors such as medication may affect insulin sensitivity, renal transplantation restores insulin resistance found in renal failure patients, but not insulin secretion. (J Nippon Med Sch 1998; 65: 50-54)

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A spigelian hernia is an uncommon hernia of the anterior abdominal wall. We herein report a case of spigelian hernia, pre-operatively diagnosed as an incisional hernia. A 61-year-old woman had undergone an abdominal hysterectomy 14 years prior to her admission to our hospital complaining of a left lower abdominal mass with recurring pain. At the time of the operation the hernial orifice appeared not to be related to her previous surgical scar, but was located at the spigelian fascia below the level of the umbilicus. The hernial sac was dissected and the defect of the abdominal wall was closed. The diagnosis of a spigelian hernia can be difficult because of its nonspecific clinical findings and insidious nature. Diagnostic procedures and differential diagnosis are herein discussed with a review of the literature. (J Nippon Med Sch 1998; 65: 55-57)

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