[in Japanese]

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Conditions for measurement of mean platelet volume (MPV) by an automated blood cell analyzer (Coulter Counter STKS ; Coulter Electronics Inc., USA) were studied. Relations between MPV and platelet activity, and the clinical significance of measuring MPV were evaluated. Chronological change of MPV after sampling was almost absent after increasing to 105.8±2.1% after 30 minutes by using EDTA-2K as an anticoagulant. Decrease of aggregation activity by the low specific gravity platelets was observed in ADP and collagen aggregation tests. In 65 cases of diabetes mellitus, MPV increased significantly in the group with higher than 10% HbA_1ccompared to that in the groups with less than 10%. The MPV of patients suffering from acute myocardial infarction (AMI) on admission was significantly higher (9.27±0.84fl) than that of control subjects. The MPV during AMI decreased to about 90% of the admission level in the 2nd to 3rd hospital week, and returned to 98% in the 5th to 6th week.

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Serum CEA, CA19-9 and AFP concentrations were measured in 91 cases of gastric cancer, and immunohistology of resected tumor tissues and lymphonode was performed. Abnormally high levels of serum CEA, were observed in 2.3 cases (25.3%), of CA19-9 in 17 cases (18.7%), and of AFP in 4 cases (4.4%) . Combined assay with these tumor markers improved the positive rates to 26.3% in early and 47.2% in advanced stages of cancer. Positive immunochemical staining was observed in 83.5% of CEA, 46.3% of CA19-9, and 37.4% of AFP. Positive immunohistology of tumor markers was abnormally high in 100% of CEA, 82.4% of CA19-9, and 75% of AFP. In the staining localization patterns of tumor markers in cancer tissue, cytoplasmic or stromal types were highly concentrated in serum. In metastatic lymphnodes, 96.1% of CEA, 29.4% of CA19-9, and 70.6% of AFP were positive to immunohistological staining. In 9 recurrent cases, 4 cases of liver, 2 cases of peritoneum, 2cases of lymphnode, and 1 case of lung cancer abnormally high levels of serum tumor markers were observed in 77.8% of CEA, 44.4% of CA19-9, and 11.1% of AFP. Immunohistological examination was considered to have great value if cancer was still suspected in cases of negative serum tumor marker.

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Details of the mechanism of anterior cruciate ligament injury are still indefinite. The purpose of this study was examine, by motion analysis, factors that will enlarge anterior translation of the tibia relative to the femur. Subjects were 36 persons total [ACL reconstruction 17, ACL insufficiency 4, normal 15] . After a subject's knee joint had been fixed at 30 degrees flexion by a brace, the subject was asked to sway the body forward and backward. This movement was measured by three dimensional motion analysis, a force plate, electromyogram, and a knee motion analyzer. Anterior-posterior translation of the tibia was significantly correlated to movement of the center of gravity, center of pressure, and knee joint moment. Anterior translation of the tibia, corresponding to backward movement of the center of gravity and center of pressure, increased knee extension moment. Because knee moment is the product of muscular strength and moment arm, the knee extension moment, influenced by posture is the main factor in moving the tibia anteriorly.

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Crohn's disease causes bowel stricture, partcularly in the small bowel and cecum. Releasing the stricture by resection and primary anastomosis may lead to the danger of restricture at the anastomosis and short bowel syndrome. To avoid this problem, we have adopted stricture plasty since 1989. The technique is as follows : Longitudinal incision across the stenosis by diathermy cutting. Begin the incision proximal to the maximal stenosis, entering a relatively normal bowel. Complete the incision aross the stenosis from the normal proximal to the normal distal bowel. Hold each edge and the middle portion of the incision by Alice forceps. Notch sutures layer to layer to complete the process. Stricture plasty is a safe and valuable adjunct to resection in the surgical treatment of symptomatic Crohn's strictures. It preserves small bowel length and may be a viable alternative to repeated ileal resection in suitable cases.

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The patient was a 59-year-old man. who sufferes from Type C viral hepatitis. The diagnosis of non-insulin dependent diabetes mellitus was made in 1985. His plasma glucose had been well controlled by diet and oral hypoglycemic agent (glibenclamide 5.0 mg/day) until interferon-α (IFN-α) was started. After IFN-α was started in November, 1992, a marked increase in fasting plasma glucose concentration was found and insulin administration was required. The insulin dose was increased. Then, IFN-α was discontinued and IFN-β was started. After IFN-β was started, fasting plasma glucose concentration decreased abruptly and glycemic control was improved. It is known that IFNs induce hyperglycemia due to reduction of insulin secretion and/or increase of insulin resistance. However, in this case, it is suggested that the effect of IFN-α on the process of glycemic control differed from that of IFN-β.

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A 65 years old female visited our hospital with chief complaints of left hypochondralgia and left back pain. Abdominal-ultrasonography showed a cystic lesion in the pancreas body, and a dilated main pancreatic duct. She was hospitalized. She had been going to our hospital because of chronic hepatitis, type c, and diabetes mellitus. In an ERP-CT (Computerized tomography performed immediately after endoscopic retrograde pancreatography) and endoscopic pancreatic biopsy (EPB), under diagnosis of a mucus producing pancreatic adenoma, the pancreatic body and tail (DP), and the spleen were resected. Histological examination of the tumor indicated a mucus producing pancreatic adenoma. As is often the case, the diagnosis of a mucus producing pancreatic tumor was difficult. However, the ERP-CT finding was better than other image diagnoses, so we report it here.

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A 63-year-old male, in and after mid-May 1992, had a continuous episode of melena. After late October, constipation and a sense of abdominal distention developed, so the patient came to our clinic for examination. Initial colonoscopy revealed a type 3' tumor occupying almost the entire circumference of the sigmoid colon about 20 cm from the anal edge. Examination by fiberscope, which had been inserted beyond the stenosed site, revealed normal mucosa extending 15 cm from the oral side, slightly edematous mucosa extending about 20 cm orally from the normal mucosa, and a shallow ulcer running vertically in three lines. The mucosal surface from the ulcerous lesion to the oral side was normal, and the mucosal border of the lesion was well demarcated. Our report of this case is presented here along with relevant references. We believe that obstructive colitis accompanied by intestinal obstruction is relatively rare, and that disease observable beyond a stenosed part by endoscopy is even more rare.

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