The clinical symptoms and prognosis of 13 longterm cases of autoimmune hepatitis were studied. Discrepancies of liver functions (T-Bil, GOT, γ-Gl, Ch-E, HPT, ESR, ICR-R₁₅) were examined and compared at the begining and end of the observation period. All subjects were females, aged 18 to 64 (mean, 43.7) years at the onset of the disease. Over half of the patients had exhibited extra-hepatic manifestations such as arthritis and pyrexia. The observation periods were from 1 to 21 (mean, 7.5) years. One patient deteriorated and died from lung abscess during observation. The other 12 patients were alive and liver function tests were shown statistically to have no significant difference between the onset and end of the observation period. The results indicate that autoimmune hepatitis of Japanese will not get rapidly worse and the prognosis is better than that for Europeans or Americans.

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Effects of moxibustion on cutaneous blood vessels and microvascular permeability have been studied in ddY mice. Moxa was divided into 1, 2, and 5mg cones, and each weight of cone was burned on the shaved abdominal skin of a mouse. After moxibustion, the small venulae at the sites under the moxibustion spots contracted, whereas those around the edges of the moxibustion dilated. The area of blue dye-diffusion into the abdominal skin and muscle increased dose-dependently after graded doses of moxibustion (1, 2, 5mg of moxa/mouse) . This enhancement of vascular permeability coincided with mast cell degranulation induced by moxibustion. Moreover, pretreatment with diphenhydramine, an H₁-receptor antagonist, significantly reduced the amounts of dye diffused by moxibustion. Electron-microscope observation after intravenous injection of carbon revealed no apparent openings of the endothelial intercellular junctions at 30 and 180 min after moxibustion, although many carbon particles could be seen between the endothelial cells and pericytes. In addition, many vesicles with carbon-like particles were observed in the endothelial cells of moxibustion treated mice. Therefore, it is possible that leakage of carbon from the blood vessels occurs via small vesicles through endothelial cells after moxibustion. This investigation demonstrated that moxibustion induces some kind of inflammatory response, that can be considered to be a host defense mechanism.

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The myofibrous organization of the suboccipital muscles (rectus capitis posterior major, rectus capitis posterior minor, obliquus capitis inferior and obliquus capitis superior) was studied in 11 human subjects (6 males and 5 females) . Muscle slices were embedded in celloidin and sections were stained with hematoxylin and eosin. The following results were obtained: 1) In the total cross sectional area of the muscle belly and the total number of muscle fibers, obliquus capitis inferior was most predominant, followed by rectus capitis posterior major, obliquus capitis superior and obliquus capitis inferior in males and females. The cross sectional area in males was greater than that in females in each muscle. The total number of muscle fibers in both sexes was not different except that the obliquus capitis inferior was superior in males. 2) The number of the muscle fibers per sq. mm, was greater in the obliquus capitis muscle than in the rectus capitis posterior muscles, in general. Fibers of obliquus capitis inferior were most predominant, followed by fibers of obliquus capitis superior, and rectus capitis posterior major and minor. The number of the muscle fibers per sq.mm in the suboccipital muscles was less than the number in obliquus externus abdominis or transversus abdominis, and belonged to the moderately muscular group. 3) In fiber size, rectus capitis posterior minor was the largest, followed by rectus capitis posterior major, obliquus capitis superior and inferior. In comparison with other human muscles, the size of fiber in the suboccipital muscles was much smaller than that in the intermediate portion of the trapezius, was larger than that in psoas major, and was approximately equal to the size in muscles that functioned for maintenance between the bones. 4) The density of muscle fibers in the obliquus capitis inferior was equal to that in rectus capitis posterior minor and obliquus capitis superior, and was equal to that in rectus capitis posterior major. The former muscles exceeded the latter in males. In females, the density was equal in the suboccipital muscles. In obliquus capitis superior and rectus capitis posterior major, the density in females was superior to that in males. The density in the suboccipital muscles was lower than in obliquus externus abdominis, obliquus internus abdominis, transversus abdominis and iliacus, and showed features of support muscles in the body. 5) Histological observation revealed frequent variation in the fiber size in rectus capitis posterior minor, and muscular atrophy in obliquus capitis superior. In males, increased connective tissue at the perimysium was observed in rectus capitis posterior major and obliquus capitis inferior. 6) In the distribution pattern of muscle fiber size, most of the rectus capitis posterior major and minor had low peaks and most of the obliquus capitis superior and inferior had high peaks. Therefore, obliquus capitis muscles were more affected by muscular atrophy and tended to deviate toward the smaller fiber sizes.

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Twenty-six patients with bronchial asthma underwent bronchial inhalation chall-enge with house dust or aspergillus fumigatus. Venous blood samples were collected before inhalation of allergen and 5 minutes, 3 hours and 8 hours after inhalation. Plasma histamine, leucotriene C₄ (LTC₄) and thromboxane B₂ (TXB₂), a metabolite of thromboxane A₂ (TXA₂), were then measured. These twenty-six patients were divided into three groups: Six had no asthmatic responses (group N) . Eight had immediate asthmatic responses (group I) . Twelve had dual (immediate and late) asthmatic responses (group D) . In the three groups, plasms histamine was unchanged. The plasma LTC₄ rose when immediate asthmatic response appeared in both the I and D groups. The percentage increase of LTC₄ correlated with the percentage fall of peak flow and V₂₅. The plasma TXB₂ increased slightly when immediate asthmatic responses appeared in both the I and D groups, and it also increased slightly in the D group 3 hours after inhalation of allergen. The results suggest that LTC₄ and TXA₂ are important in the appearance of an immediate asthmatic response and that TXA₂ is ivolved in appearance of the late asthmatic response.

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This is a case report of unresectable large parotid cancer, successfully treated by using a mixture of Isobutyl-2-cyanoacrylate (IBCA) and Lipiodol (IBCA & Lipiodol mixture) . A 55-year-old man was referred to our department with massive bleeding from his right internal carotid artery (ICA) which was invaded by parotid cancer which had already been treated by radiotherapy and interaarterial chemotherapeutic embolization using Adriamycin. First, prior to embolization, a 7 Fr. balloon catheter (Meditech Inc.) was inserted via the femoral artery into the right common carotid artery (CCA) . Subsequently, a 5 Fr. catheter was inserted via the ruptured portion of the right ICA. An IBCA & Lipiodol mixture was occluded into the carotid artery from the tip of the balloon to the ruptured portion of the ICA. During the initial embolization, slight leakage from the ruptured portion persisted and an IBCA-Lipio-dol mixture was injected again from the 7 Fr. balloon catheter. Aiter the second embolization, bleeding stopped. The successful interventional procedure was fortunately achieved, without intracranial migration of IBCA-Lipiodol mixture and without neurological deficits. This is considered to be very useful for patients in whom the ICA (or CCA) cannot be ligated because of both a large malignant tumor and difficulty of ligation.

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We developed a new interventional technique of intraarterial embolization using microfibrillar collagen (MC), polyvinyl alcohol (PVA) and isobutyl-2-cyanoacrylate (IBCA) for patients with malignant tumor of the right mandible. The purpose of this report is to demonstrate the methodology of an interventional technique using MC, PVA and IBCA. Case: a 50-year-old man, suddenly suffered bleeding from his right facial artery. Both the facial and lingual arteries were occluded by MC. Recanalization and re-bleeding occurred on postoperative day 14, although distal vessels of the facial or lingual artery were shown in an agiogram to be occluded. He received a 2 nd interventional procedure by using MC, PVA, and IBCALipiodol mixture (IBCA: Lipiodol=1: 0.7) . This stopped the bleeding. At this embolization, we selected the MC clinically to obstruct the distal vessel ; later, we selected PVA to embolize the tumor itself; finally, we selected IBCA-Lipiodol mixture to obstruct the feeder to the tumor. It was concluded that the interventional technique of intraarterial embolization by using MC, PVA and IBCA-Lipiodol mixture is very reliable and safe at the time of tumor bleeding.

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A case of myxoid leiomyosarcoma (MLS) of the uterus associated with pregnancy was revealed by histopathological examination. The patient, 38 years old and married, was at thirteen-weeks of gestation. A large abdominal tumor was observed by ultrasonography. Diagnosed as a subserosal leiomyoma, the tumor was enucleated. Histology showed it to be a leiomyomatous tumor with intensive mucous changes and low grade malignancy. The tumor showed partial infiltrative proliferation with slight nuclear mitosis (1-4/10 HPF) . After enucleation the patient was well and delivered a normal baby by cesarean section at 40-weeks of gestation. Recurrence was revealed in the specimen biopsied after derivation. More than ten cases of MLS have been reported in the literature and the entity of this tumor may be determined by more intensive examination.

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Two cases of primary carcinosarcoma of the lung are described and the literature is reviewed. An autopsied 84 year-old man had pulmonary carcinosarcoma, which consisted of squamous cell carcinoma and spindle cell sarcoma with necrosis. In this tumor, the spindle cell sarcoma occupied the center of the tumor, and the squamous cell carcinoma surrounded it. In the second case, a 58 year-old man who received a lobectomy, showed a carsinosarcoma composed of adenocarcinoma and spindle cell sarcoma in the right lower lobe. Primary pulmonary carcinosarcoma is a rare neoplasm. The literature states that males constitute 85.1% of the patients who have had this carcinosarcoma, and the mean age is 62.4 years. Histologically, the major component of carcinoma is squamous cells, and the major component of the sarcoma cell is fibrosarcoma. Although keratin immunoreactivity was observed in both carcinoma and sarcoma cells, and vimentin appeared limited to the sarcoma cells. These two cornponents shared epithelial features, which suggested that carcinoma cells transform into sarcoma cells.

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Since the variety of arteriosclerotic diseases has increased and the average lift-span has been prolonged in recent years, surgical cases of abdominal aortic aneurysm have increased in number. Surgery, however, is still believed to be contraindicated in many high risk cases. By virtue of marked progress in surgical techniques as well as improved management before, during and after operation, surgery is becoming more and more acceptable, with expected mortality being not more than 5 percent. However, the mortality rate in high risk patients is about 10 percent; the mortality rate for rupture cases is high, and it is given as more than 60 percent in many reports. We recently performed surgery on 4 high risk cases of abdominal aortic aneurysm involving rupture, renal insufficiency, pulmonary emphysema and advanced age. One case ended in death, and postoperative complication with ileus and subdural hydrops appeared in 2 cases. Details are reported here.

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A 33-year-old male patient was admitted with complaints of thoracic and back pain. An enlarged descending aorta due to dissecting aneurysm was found by CT scan, so this being the 3 rd operation, it was necessary to perform transplantation of thoracic aorta under cardiopulmonary bypass. During the operation, spinal cord evoked potentials were recorded using DISA 1500 system to monitor spinal function. Control ascending and descending potentials under anesthesia consisted of two negative peaks (N1, N2) and one broad spike. As perfusion volume of FF bypass decreased to 0.871/min from 4.371/min, the amplitude of N1 decreased to 26% of controls, and these potentials recovered to 92% 17 min later with 3.14 l/min of perfusion. Negative spikes disappeared 5 min after perfusion completely stopped, and amplitude recovered to 95% of controls 15 min after perfusion resumed. When body temperature descended 10°C, N2 disappeared and N1 amplitude increased as did the delayed peak latency of both N1 and N2. In conclusion, we should attempt a test clamp of the thoracic aorta to recognize spinal cord dependence on Adamkiewicz artery or reconstruction of intercostal arteries in case of wide ranging thoracic aortic transplantation.

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Weil's disease, an infectious disease by Leptospira haemorrhogica, is often found in farmers and cooks who are frequently exposed to the virus contained in urine or stool of wild rats. Recently, a few cases have been reported in Japan. A 23 old male cook was admitted to our hospital with fever, general fatigue, jaundice, and myalgia of the lower extremities which are thought to be charactaristic symptoms of the disease. When he was hospitalized, he was conscious, but showed renal insufficiency, such as oliguria and elevated serum BUN level, suggesting a severely advanced stage. These refractory symptoms were rapidly alleviated by 4 times plasmapheresis for the treatment of jaundice and renal insufficiency. The patient recovered completely on the 60 th hospitalized day. Various symptoms, especially jaundice and the renal failure, of Weil's disease are considered to be induced by Leptospira toxin. Plasmapheresis is the most effective therapy for the treatment of severe conditions of this disease, because this treatment may eliminate the toxic substance from the plasma.

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