Investigations were made on clinical statistics and tumor markers of CEA in 106 cases of colorectal cancer whom we experienced at Fujigaoka Hospital, Showa University School of Medicine, for 5 years from 1978 to 1983. The lymph node metastasis was found more in n₀in both colonic and rectal cancers and the comparison between s factor and n factor showed n₀n₂cases up to n, in S₀. In S₁cases, it came only to n₂but n₀cases of n₃were shown. These indicated the possibility to cure and resect the cancers absoutely by operation of R₂ in S₀. The degree of the deep infiltration of cancer wall was found mostly in s and a₂ in both colonic and rectal cancer. In classification of different stages, stage II was mostly found in 19 cases by 35.8% in colonic cancer and stage II was found as high as 28.3% in 15 cases similarly in rectal cancer. The postoperative survival ratio for 5 years was 63% and 55%, respectively, in colonic cancer and rectal cancer. In relation between the degree of the deep involvement of cancer wall and the CEA values, the cancer infiltration reaching more than s¹and a¹showed elevated CEA values. In groups of liver metastasis, the CEA values were more evidently elevated than those in groups without liver metastasis was presumed. Moreovere, it was considered to be able to estimate preoperatively whether the cancer would be curable, noncurable or nonresectable from these results. In summary, the preoperative CEA values, though inappropriate for screening of cancer, were presumed to be a useful mean of investigation on the estimation of the degree of the course of cancer and prognosis.

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A total of 31 patients (45 joints) with arthrosis of the first carpometacarpal joint (CMJ) who visited our hand clinic in recent ten years were studied clinically and radiologically. Radiological, macroscopic and morphological observations were made on specimens of 30 first CMJ obtained from 19 cadavers, and three dimentional photoelastic experiments was also carried out. Following results were obtained: Diagnostic results were obtained in our patients: Sexual difference in the arthrosis was found twice in female as in male, but significant difference were not observed in CMJ of both side. Degree of pain was not correlated with radiological findings. The results from cadavers were as follows: (1) Arthrotic changes were observed in 21 joints (70%) radiologically. (2) Macroscopic degeneration of cartilage were observed in 25 joints (83%) . (3) Degeneration was often observed in dorsal and volar portions of metacarpus, and in center, radial and ulnar portions of trapezium. (4) Xray findings were directly proportional to of macroscopic degeneration. (5) Morphologically, in joint surface on adduction-abduction, apex of metacarpus and bottom of trapezium were shifted ulnarly, and radial curvature was larger than the ulnar. (6) In facet on flexionextension, curvature of metacarpus was larger than that of trapezium. (7) As volar tilt of metacarpal joint surface increased from radial to ulnar, farce aoting along the axis on metacarpus will make metacarpus rotated. In photoelastic experiment, compression was concentrated at the dorsal and radial portions of metacarpus in axial loading. As based on these results, subluxation of first CMJ will be occurred while rotation in a state of opposition if laxity of capsular ligamentous system due to stress of daily life is occured. It may be concluded that these morphological charactaristics cause the arthrosis of the first CMJ.

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The correlations between the macroscopic changes of articular cartilage of tibial plateau and some factors as the shape and degeneration of menisci, cartilaginous thickness, subchondral trabecular structure were studied in order to reveal the meaning of those factors in developement of degenerative arthritis of the knee. Previciously 52 cadaver knees from person aged 49 to 85, averaged 69.2, had been examined macroscopically. The topographical distribution of surface lesions were described separately; the submeniscal resion and uncovered resion of the tibial plateau. The changes were classified into the following four grades; normal, roughening (fibrillation), velvet formation (superficial ulceration), cartilage defect (sclerosis, eburnation) . 20 specimens with minimal change of articular surface among those 52 knees were chosen, then dehydrated by alcohol and perfused in polyester resins. The specimen was cut consecutively with a vertical milling machine in frontal and sagittal plane. The thicknees of articular cartilage in each slice was measured, and subchondral trabecular structure was assesed using Softex. Degenerative changes of the tibial plateau were more encountered at the uncovered region than the submeniscal region except its lateral posterior segment. Gross degenerative change such as cartilage defect, eburnation was almost localized at the posterior segment of submeniscal region in lateral tibial plateau, and at the intercondylar eminence of a few knees. There was no difference in the severity of surface lesions of tibial plateau, how degenerated the menisucus was. However, it was likely that enlarged one such as discoid meniscus increased degeneration of the articular surface and meniscus itself due to incongruity of the joint. Thicker cartilage was distributed from the area of uncovered region to the posterior segment of submeniscal region. Subchondral trabecular stracture was well developed in uncovered portion, and poor in submeniscal portion, especially at medial plateau. These results suggest that medial menisucus gives a great support to weight-bearing loads, and that the thickend articular cartilage in lateral tibial plateau makes up the disadvantage of convex surface and a mobile meniscus in loads transmission across the knee.

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The changes in splanchnic organ blood flow and systemic hemodynamics during hypotensive anesthesia with adenosine triphosphate (ATP) or sodium nitroprusside (SNP) were studied. The study was done in 51 mongreal dogs anesthetized with 0.5% halothene and 50% nitrous oxide. They were devided into six groups by the hypotensive drugs and the level of blood pressure. In groupe 1, mean arterial blood pressure (MABP) was reduced 20% by intraveanous administration of ATP. In group 2, MABP was reduced 20% by ATP but dipyridamole (DP), adenosine uptake inhibitor was pretreated. In group 3, MABP was reduced 20% by SNP. Although the hypotensive drugs that were used in groups 1, 2, and 3 were used in groups 4, 5, and 6 again. But MABP was reduced 50% in the later groups. Blood flow was measured using the hydrogen gas clearance technique. The results were as follows: 1) The organ blood flow to renal cortex, renal medulla and spleen was decreased. But, the liver blood flow did not change significantly. In the organ blood flow, there was no significant difference between ATP and SNP hypotension. 2) These changes in organ blood flow during the hypotensive anesthesia were not only affected by perfusion pressure but also done by duration of hypotensive period. 3) Pretreatment of DP decreased the requirement dosage of ATP, and prevent deterioration of base excess. It indicates that deterioration of base excess is due to other factors besides tissue hypoperfusion.

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Effects of gastrointestinal hormones on the growth of cultured human stomach cancer cells were studied with the microplate labeling assay (M. L. A.) and the human tumor clonogenic cell assay (H. T. C. A.) which are widely used asin vitrosensitivity tests of anticancer drugs. MKN-28 (well differentiated adenocarcinoma), MKN-45 (poorly differentiated adenocarcinoma), and KATO III (signet-ring cell carcinoma) were chosen as three different kinds of cultured cell lines. Effects of gastrin, secretin and G. I. P. on the growth of those cultured cells were evaluated with a³H-TdR up take rate in M. L. A. and a colony formation rate in H. T. C. A., respectively. Gastrin induced a marked increase in a³H-TdR up take rate but no significant change in a colony formation rate for MKN-45 and KATO III. On the other hand, gastrin did not induce any significance in an either measurement for MKN-28. Secretin induced no change in a³H-TdR up take rate or a colony formation rate for MKN-45 and MKN-28. As for KATO III, however, administration of 10.0 U/ml and 1.0 U/ml of secretin induced a 15% decrease in a³H-TdR up take rate and 20% decrease in a colony formation rate, respectively. G. I. P. lowered a³H-TdR up take rate for all of the three cell lines, but did not make significant changes in a colony formation rate for any cell line. This study clearly showed the inhibitory effect of secretin on the growth of KATO III. It may strongly suggest the effectiveness of G. I. hormones for the treatment of gastrointestinal carcinomas.

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Recently, together with the increase of alcohol consumption, it was reported that the number of alcoholists in our country amounted to 2.2 million people. Here, I took notice of solitary people's dependence to alcohol, and tried a reseach especially on the solitary who received medical support under Livelihood Protection Law. Medical history of each victim was sampled from Reports (concerning hospitalization of mental disorder victims) sent to Welfare Office of Tokyo, during Oct. -Nov. 1984, and completed with cooperation of hospitals in Tokyo and the vicinity. 88 out of 143 samples were available, and are summarized below. Average age of victims was 49.2 years (alcoholist's age advanced) ; Interrelation between hospitalized experience and age victims hospitalized 1-2 times and 7 times were the majority, and hospitalized experience increased in proporion to age; 62.5% victims only received compulsory education; and other mostly low education; 31.8% lived in Tokyo, 50.0% in other area (residence unknown 18.2%) ; this shows the tendency of alcoholists to live where they can make their living without regular occupation (like in Tokyo) ; 46.6% were once married or had a cohabitant (9.1% unknown) . In March 1984, Mental Hygiene Comittee of Tokyo manifested a report on“consolidation of medical organization for alcoholic mental disorder”followed by Welfare Ministry's View on alcoholic related problems. These consideration should follow in it's importance, emergency policy and physical amalgamation policy being discussed to consolidate mental hospitals of Tokyo, but it still seems difficult to apply them to solitaries. Sampled victims here need not only day-care, welfare facilities, facilities for women and aged, emergency and hospital treatment planned in the reports, but also training to adapt themselveds to society. More qualified counselors are needed to work this out and also staffs to educate these counselors must be prepared. Higher age society makes the environment surrounding alcoholists more complex. This indicates the need for intermediate facility in the future.

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Experiment was undertaken to examine whether or not human mammary carcinoma cell line (MRK-nu-1) and human gastric carcinoma cell line (KATO-III) induce the osteolysis, and whether or not the osteolytic mechanism of these cell line is different. Using the Messer's method, mice calvaria was cultured with human carcinoma cell line (MRK or KATO-III) . In the present study, the histochemical appearance and the extent of bone resorption were examined by Von Kóssa's test and the percentage release of radioactivity (⁴⁵Ca) from bone. To elucidate the mechanism of bone resorption, the content of cAMP in calvaria, prostaglandin E₂ (PGE₂) contents in the culture medium, and acid and alkaline phosphatase activities in the calvaria were measured. From the result of Von Kóssa's test, the mode of bone resorption of PGE₂group occurred continuously from outer edge at suture area as butterfly-like shape, in MRK group and KATO-III group, many holes and wide bone defect were irregularly seen. In MRK-LYO group and KATO-III-LYO group, the mode of bone resorption was different from PGE₂group, but osteolysis was occurred at suture area. From the result of %⁴⁵Ca release ratio, osteolysis were induced by PGE₂group, MRK group, MRK-LYO group, KATO-III group, and KATO-III-LYO group. The extent of bone resorption in KATO-III group was higher than MRK group. PGE₂concentration in the culture medium in KATO-III group was higher than MRK group. When osteolysis has occurred, it was shown that cAMP content in calvaria and PGE₂production in the culture medium increased. Particularly in tumor cell group, cAMP content in calvaria was remarkably high. As indomethacin inhibited bone resorption by tumor cells, one of these bone resorption stimulating factors may be PGE₂, but this inhibitory effect was not perfect. In addition LYO which don't contain PGE₂induced bone resorption, therefore there may be other bone stimulating factor except PGE₂. Moreover acid phosphatase activity increased 4 days period in culture in the groups which showed bone resorption. Besides alkaline phosphatase activity increased in PGE₂, MRK, KATO-III group, but in LYO group did not. Intracellural acid phosphatase activity in both cells was high, and this enzyme activity was seemed to be concerned with osteolysis. From the facts described above, the mechanism of both bone resorption by both cells was seemed to be similar.

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The local changes in the left ventricle (LV) of spontaneously hypertensive rats (SHR) were compared with those of Wister rats (WR) in reference to the onset of hypertension and the duration maintaining hypertensive state. Two strains of rats, SHR from Zichi Medical College colony and age-matched normotensive WR were examined at 6, 16, 30, 40 weeks of age. After measuring arterial systolic blood presser (BP), the hearts were fixed at diastolic phase and then isolated. Histological preparations at three transverse levels of LV (Apex, Middle, Base) were made, in all of which wall thicknesses, ratio of external to internal circumflex areas of transverse sections of LV and numbers of myocardial cells per unit area were studied. It was investigated, furthermore, whether or not degenerative changes of myocardium were observed in every specimen. As the results, BP in SHR was significantly higher than that in WR except 6 weeks of it. Both ventricular septum and left ventricular free wall in SHR were significantly thicker than those of WR, and the form of LV in SHR was symmetrical and concetric from 16 to 40 weeks of SHR. Cell numbers per unit area in SHR decreased, and the areas of left ventricular cavity in SHR were smaller than those of WR from 6 through 40 weeks of rats. These indicate that LV of SHR is pathologically different from that of WR already before the onset of hypertension. The fibrosis and fatty degeneration were recognized at 30, 40 weeks of SHR, and the same slight degenerations in 40 weeks of WR. Consequently chronic hypertensive state influences on the advance in cardiac hypertrophy and tissue degenerations, and also local hypertrophy of LV as seen in human's were not observed in SHR. The pathological differences in 6 weeks of SHR from WR are not due to hypertensive state, but may be related to congenital and other unknown factors.

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The determination of phospholipase A₂ (PLA₂) activity was investigated in human sera of normal subjects and patients with acute pancreatitis by the modified method of Shakir's in which procedures, the ultrasonication was used to make the substrate more homogenous. With this method, the calibration curve by porcine pancreas phospholipase A₂ (p-PLA₂) showed good linearity, while the PLA₂activity in the serum showed no dose relation and the activity in serum of patients with acute pancreatitis was undetectable low value as normal subjects. The PLA₂activity was inhibited by the addition of human serum. These results suggested that the presence of endogenous inhibitor in serum. The facts that the activity was also inhibited by the addition of the ammonium sulfate precipitated protein containing 95% of albumin on electrophoresis or by the addition of purified human serum albumin in dose-related manner led us assumption that the endogenous inhibitor in human serum was albumin. When the sera were diluted to fifteen times by physiological saline solution, the inhibitory effect of albumin on PLA₂activity was not observed and thus by the dilution of sera and by the prolongation of incubation time, PLA₂activity in patients with acute pancreatitis increased two to three folds when compared to that before dilution. This may support this method is available to clinical use for serum PLA₂assay. The detailed mechanism of inhibitory effect of albumin on PLA₂activity is not clarified and further investigation should be continued.

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We studied the effects of the period of blood preservation and the existence of extracellular electrolytes on the human blood hemolysis. The human blood was obtained intravenously. The packed RBC was stored in a CPD package after centrifugation. Since no hemolysis occurred, the free RBC immersed in the saline was used as a control. The 5ml of the free RBC of the fresh, 1 wk, reserved, 3 wks, reserved blood were mixed with seven different kinds of Na ion concentration solution which were maintained in the isotonic state. Then we checked the degree of hemolysis at 2 hrs., 6 hrs, and 24 hrs, inorder to know what roles the ion concentration in the extracellular environment and the lapse of the blood preservation play in hemolysis. We found that the lower the extracellular Na ion contained, the more intense hemolysis observed. There was no significant difference among each condition of preserved time.

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Four kinds of solution (10% maltose, 5% xylitose, 5% glucose, and 10% glucose) were used to study the hemolytic nature of human blood. The human blood was obtained intravenously. The packed RBC was stored in a CPD package after centrifugation of the blood. The free RBC immersed in the saline was used as a control since no hemolysis occurred. Four kinds of solution were mixed with the sample of fresh, 1 wk. reserved and 3 wks. reserved blood. The samples were mixed with 5 ml of each solution. All procedures were carried out at room temperature. The relation between the hemolysis and the changes of the extracellular pH caused by the different solutions was also studied. The results were as followed: 1) no hemolysis occured when the free RBC mixed with either 10% maltose or 5% xykitose, 2) strong hemolysis occured in the case of free RBC mixed with 5% glucose; 3) moderate degree of hemolysis waf found when the free RBC mixed with 10% glucose; 4) there was no correlation between hemolysis and the extracellular pH gradient.

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Intrahepatic cholelithiasis is a disease being difficult to be identified and treated. We encountered 18 cases having Intrahepatic stones among 584 cases with cholelithiasis during the recent decade (August, 1975 to June, 1985) . Excepting 7 cases undergoing hepatectomy, the remaining 11 cases received lithotomy in aid with cholangioscopy; namely, operative cholangioscopy (OC) was employed in 1; postoperative cholangioscopy (POC) in 7; and percutaneous transhepatic cholangioscopy (PTCS) in 3. Since we should be careful with residual stones, regardless of treatment methods, we tried directly to observe bile ducts using a baby scope through a cholangioscope in the cases showing poor cholangiograms due to the presence of pneumobilia or obstruction of peripheral bile ducts; however, clear observation was impeded by the structure of the liver. Selective cholangiography was then applied to 7 cases examined with POC, and this method provided satisfactory results. In these cholangiograms, peripheral bile was replaced by contrast medium through the use of a balloon catheter, and clear features of stones without air bubbles were seen, resulting that residual stones, which cholangiograms using a conventional catheter failed to show, could be detected in 3 cases. Since gram-negative organisms were isolated as highly as 91.5% (54 strains: n=60) by cultures of the bile collected from a fistula of a T tube, the occurrences of retrograde infection with these bacteria to the blood and cholangiovenous reflux were apprehended during the use of a balloon cathter, where bile ducts exposed to slightly high pressure. However, when changes in body temperature, WBC, S-GOT, S-GPT, LDH and AL-P before and after examination were compared between cases (n=15) examined by the method using a balloon catheter and control subjects undergoing ERC (n=20), there were no significant differences. These results indicated that selective cholangiography performed using a balloon catheter under cholangioscopic observation was a safe and useful device for the confirmation of the presence or absence of residual stones which were stuck in peripheral bile ducts and could not be directly seen during cholangioscopic lithotomy of intrahepatic stones.

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The purpose of this study was to prove the form of lumbar facet, concerning in narrowing canal in degenerative lumbar spinal canal stenosis. Using contact microradiogram (CMR) and decalcified section by Yoshiki's method, trabecular bone tissue was observed histologicaly and histomorphometricaly. The results were summarized as follows.: 1) Regardless of facet levels, angles, forms and cutting levels of lumbar facet, trabecular bone showed higher density in neural canal side than extra neural canal side. 2) Decalcified sections of control revealed that tVsp, oVsp in neural canal side were higher than those in extra neural canal side, but MTT had no difference in several areas. 3) In neural canal side of patient, tVsp, oVsp and MTT of superior and inferior articular processes and FrFs of inferior articular process were remarkablly higher than those of control, the other parameters had no discrepancy. 4) In addition, tetracycline double labellings in neural canal side of patient showed active bone formation and calcification. These results suggested the dynamic bone remodeling in neural canal side of lumbar facet in patient.

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A total of 130 cases that fulfilled the diagnostic criteria of major depressive episode by DSM-III (examined at the our outpatient clinic) was divided into a group with quick recovery (93 cases, total scores of DRS-S₇₈reduced to 20 points within 8 weeks), and a protracted group (37 cases, total scores reduced to less than 20 points in more than 8 weeks) . DRS-S₇₈is a depression inventory, revised in 1978 of the Showa University System. The possibility (if any) of protracting prospect, protracting factors, and background factors was reviewed. There was no significant difference between the two groups in total scores at the first examination. However, after 1 or 2 weeks, the total scores of the group with quick recovery were significantly lower, whereas there was no significant decrease in the total scores of the protracted group after 2 weeks. Thereafter, no tendency of the total scores to decrease was observed. The two groups were compared with reference to distribution of the various clinical factors: type, sex, heredity, premorbid personality, age at first onset and at this onset, period up to the time of receiving an examination after this onset, psychosocial stressors, and suicide. As a result, the incidence of manic-depressive psychosis in first degree relatives (parents, siblings, children) and the rate of Typus melancholicus or immodithymic character were significantly high in the protracted group. Also, the incidence of suicidal tendency, of which about 40% had first degree relatives with histories of manic-depressive psychosis, was significantly high in the protracted group. The protraction tendency might be due to biological factors… estimated to be the expression of heredity and resistance against antidepressants, so personality is estimated to be greatly involved, and protraction signs are reflected in the alterations of total scores after 1 or 2 weeks. Without a decrease in the total scores of cases of Typus melancholicus or immodithymic character after 1-2 weeks, there is a protraction possibility, so it is important to make a therapeutic plan taking into consideration the danger of suicide.

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Meningiomas are frequently seen among intracranial tumors, but multiple meningiomas are rare. The incidence of multiple meningiomas is about 1 to 8.9% of all meningiomas. We report a case of multiple meningioma without Von Recklinghausen's disease. The patient was a 57-year-old housewife. Her chief complaints were headache and disturbance of gait. Neurological examination revealed right homonymous hemianopsia and chocked disc. Deep tendon reflexies increased on the right side. Plain and enhanced brain CT confirmed two well demarcated tumors. Tumor stains were observed by cerebral angiography; these tumors were surgically removed. Pathological examination of the tumors disclosed that they were meningothelial meningiomas. Clinical analysis of multiple meningioma is discussed in this paper.

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We report two cases of rectal foreign bodies. Case 1: a 25-year-old male, inserted a mini whisky bottle into his rectum. The bottle was removed transanally after spinal anesthesia, but sever abdominal pain and abdominal free air appeared on the second postoperative day.. The finding upon operation was perforation of the anterior rectal wall. Case 2: a 36-year-old male inserted a shampoo bottle into his rectum. We removed the foreign body transanally after spinal anesthesia. No postoperative complication appeared. In Japan, reports of rectal foreign bodies are a few but are expected to increase in the future. We report two cases of our experiences with some additional consideration from the literature.

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A 74-year-old woman with squamous cell carcinoma of the gallbladder was reported. The patient was admitted to our hospital because of hemorrhage from the ulcerative lesion in the duodenum. Histological examination of endoscopically biopsied specimens revealed adenocarcinoma and this lesion was seemed to be due to the invasion of gallbladder carcinoma from the findings of abdominal echogram, CT scanning and angiography. The patient died of cachexia on the 65th hospital day and at the autopsy, the most of the tumor was consisted of well differentiated squamous cell carcinoma with prominent keratization. The squamous cell carcinoma of the gallbladder is generally characterized by a well localized growth with rare or no metastasis. Therefore radical operative procedures would be recommended even in the case with large tumor, especially when a squamous cell carcinoma is found histologically even in a part of the specimen showing adenocarcinoma.

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