Among 246 cases of pancreatic exocrine tumors from both autopsies and surgical resections, there were 16 pleomorphic carcinomas of the giant-cell type (PCGC), according to the Morohoshi and Klöppel classification. The profile of the patients was: ratio of males to females, 11: 5 ; median age, 63.6±11.4years: location of the primary tumor, pancreas head in 8 patients, pancreas body and tail in 7, and whole pancreas in 1; cumulative 1-year survival rate, 18.2%. Histologically bizarre mononucleated or multinucleated giant tumor cells were encountered in all cases where cellular cannibalism was seen. Immunohistochemical studies using the avidin-biotin peroxidase complex method demonstrated dominant staining of the pleomorphic tumor cells for CEA, CA19-9, EMA, keratin, and vimentin. The positive ratios were 100%, 73.3%, 100%, 90.9% and 81.8%, respectively. Electron microscopic examination revealed desmosomes between two tumor cells. The results suggest that co-expression of vimentin and epithelial markers was consistent with pleomorphic malignancy of epithelial origin and pseudosarcomatoid reaction of tumor cells.

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Biochemical components and cells in blood were measured to determine the reference values of infants, children and adolescents. This study was performed in 1461 patients suffered from cleft lips, cleft palate and scar, whom we found no abnormal finding in blood components. Components were classified into 4 groups with age-dependent changes, one was the group that had high level in infancy and decreased to the adult level with age. Almost all enzymes such as AST, ALT and LD, and potassium, inorganic phosphorus, white cell counts and platelet counts were into this group. On the other hands, total protein, BUN, creatinine, and red blood cell counts were lowest level in infancy and increased to adult level with age.
Sodium and chloride were no change with age, and alkaline phosphatase (ALP) had two peaks at around infancy and 10-12 years. Bone ALP played a main role in these ALP changes.

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Thirteen cases of macroamylasemia, detected by the electrophoresis, were studied. Serum amylase activity of these cases was 742±464 IU/1 (normal: 55-245 IU/1), and the amylase/creatinine clearance ratio (ACCR) was 0.95±0.74% (normal: 1.4-4.0%) . Six cases suffered from liver disorders, and 3 cases from diabetes mellitus, and pancreatic disorders. Amylase-linked immunoglobulins examined by counter immunoelectrophoresis or/and immunoprecipitation were 4 cases of IgA (κ), 8 cases of IgA (λ), and 1 case of IgG (κ) . Amylase isozymes bound to immunoglobulins were examined by the recombination test and acid dissociation. Six cases of immunoglobulin were bound to S-type amylase, 6 cases to P and S-type amylase mixed with amylase-linked immunoglobulin and recombinated macroamylase were analyzed by immunoinhibition (anti-S-type antibody) . The percentage of S-type amylase in three cases was below 70%, indicating careful use of immunoinhibition in macroamylasemia.

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Clinical and therapeutic responses of three patients suffering from severe diabetic foot gangrene are described. All patients had progressively enlarging foot ulcers exuding a putrid odor associated with extensive cellulitis. Roentgenograms showed osteomyelitis in two of them. Diabetic neuropathy was present in all patients. All three patients were strictly treated with subcutaneous injections of regular insulin four time a day to maintain plasma glucose levels of 70-150mg/dl through 24 hours. Incisions were made to drain the lesions and exudate was thoroughly debrided. Response to the treatment was excellent and cure with scars was achieved in all patients in three to four months. Ischemia, peripheral neuropathy and infection are the major factors leading to diabetic foot gangrene. Neuropathic gangrene is generally curable by conservative therapy, but the patient is occasionally treated erroneously by amputation, which is often carried out in patients with angiopathic gangrene. Therefore, from therapeutic and prognostic viewpoints, it is important that differential diagnosis of neuropathic and angiopathic gangrenes should be precise. Strict control of plasma glucose levels and drastic topical treatment are indispensable for patient with diabetic foot gangrene.

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By 1991, about 360 cases of limy bile were reported in japan, and limy bile with no symptoms is relatively rare. We diagnosed one case of limy bile (a 49-year old female) as a radiological finding of a gastric mass survey.

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Preoperative evaluation of lung cancer by CT scan and magnetic resonance imaging (MRI) is effective, but not perfect. A surgical case of lung cancer treated with preoperative chemotherapy was reported. A 62-year-old female was admitted with a large abnormal shadow in the left upper lung field on a chest X-ray. The clinical diagnosis was advanced squamous cell lung cancer with cT4N2 disease. This patient received 3 cycles of combination chemotherapy with CDDP, ADM and VP-16 prior to surgical resection and showed partial response (PR) . However, no downstaging of T4 to T3 disease after chemotherapy was observed. Left pneumonectomy with combined partial resection of the adventitia of the descending aorta was performed. Histologically, lung cancer (moderately differentiated squamous cell carcinoma) infiltrated the adventitia of the aorta, to less than 5 mm. The existence of lipoid pneumonia was seen at the peripheral margin of the lung cancer lesion. We conclude that the clinical diagnosis in this case was overestimated due to the presence of lipoid pneumonia.

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A 45-year-old male, complaining of upper abdominal pain, was diagnosed at another hospital as having liver tumor, and was admitted to our hospital on March 2. Laboratory data showed inflammatory change and high serum levels of ALP, γ GT, and DUPAN-2. A liver tumor (5×5cm) with a daughter nodule and hepatic hilar invasion were observed upon morphological examinations. There was no pathological finding in the biliary tract, pancreas, or gastrointestinal tract. The tumor was hypovascular on abdominal angiography, and histological findings in needle biopsied specimens from the tumor revealed moderately differentiated tubular adenocarcinoma, so the diagnosis was cholangiocarcinoma. Because the tumor seemed to be unresectable, induated treatment was intra-arterial injection chemotherapy (IA) with ADR, MMC and 5-FU. Four weeks after IA, the tumor size was reduced 27%. The first IA was repeated in 6 weeks, and simultaneously an IA-line was placed in the common hepatic artery with an implantable access device. Nine weeks after the first IA, an ADR bolus injection (40mg/4weeks), MMC (6mg/2weeks), and intermittent continuous IA with 5-FU (500 mg/m²/day×4/week) were begun. Tumor size diminished 50% at 10 weeks, and 65% at 16weeks after the first IA. The serum level of DUPAN-2 was reduced concomitantly. There has been no evidence of new lesion development for 8 months, and partial response was obtained. Recently IA with an implantable access device has been applied to various malignant diseases, but there are few reports of partial response of cholangiocarcinoma by IA only.

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A case of typical Wilson's disease was reported with clinical and pathomorphological study. An 18 year old man was admitted with liver dysfunction including Kayser-Fleischer ring, hypo-ceruloplasminemia and hypo-copperemia in the serum. Hepatic tissue obtained by open biopsy included 292μg of copper per g dry weight. Histologically, the hepatic tissue showed normonodular cirrhosis demarcated by thin fibrous connective tissue with irregular and focal copper deposition in hepatic parenchymal cells. Electronmicroscopic inspection revealed that Ito cells (Fat Storing cell: FSC), which characteristically include multiple fatty droplets in their cytoplasm, increased in the peri-hepatocellular space with fine fibrogenesis. These finding may support the idea that fibrogenesis in Wilson's disease depends not only on secondary fibrosis, which appears after hepatocytic necrosis, but also on primary fibrosis due to Ito cells.

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A 29-year-old female with no past history was admitted to this hospital as an emergency with suboccipital pain and vertigo. Clinical examination revealed typical Wallenberg's syndrome. A computed tomographic scan revealed no abnormalities, magnetic resonance imaging (MRI) demonstrated a left lateral medullary lesion consistent with infarction. Digital subtraction angiography and left vertebral angiography showed a dissecting aneurysm at the proximal posterior inferior cerebellar artery (PICA) . A clipping operation was carried out with no difficulty and the patient was discharged with no deficits. As soon as possible, patients suspected of Wallenberg's syndrome should be subjected to MRI. Those who are fairly young and have no risk of cerebral infarction, but may have vertebrobasilar aneurysm, should be subjected to vertebral angiography.

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