Changes of treatment for pancreatic diseases were investigated during the period from January 1988 to December 1998 in our department.
1. Invasive ductal carcinoma of the pancreas
The total number of invasive ductal carcinoma of the pancreas were 94 cases, according to the classification of pancreatic carcinoma (Japan Pancreas Society) ; the surgical stages of the patients were as follows: one patient in Stage I, 2 in II, 10 in III, 41 in IV a and 40 in IV b. The total number of pancreatic resections were 38; non-resection but surgically treated cases were 20 and treated non-surgically cases were 36. In patients with pancreatic resections, 50% of the patients' survival time was 10 months. The cumulative survival rate were 45%, 25%, 10% at 1, 2, 3 years. In patients with non-resection but treated surgically cases, 50% survival time was 3 months and cumulative survival rate was 0% at 1 year. In non-surgically cases, 50% survival time was 3 months and the cumulative survival rates were 15%, 10% at 1, 2 years. The cumulative survival rate was significantly higher in patients with pancreatic resections than in patients with non-resection but treated surgically cases and in patients with non-surgically cases. However these treatment results of invasive ductal carcinoma are not yet satisfactory. It is essential to establish a diagnostic concept of early pancreatic carcinoma and develop a more effective treatment protocol originating from the surgical stages.
2. Pancreatic tumors (except for pancreatic carcinoma)
The resected cases of pancreatic tumors (except for pancreatic carcinoma) were: 23 intraductal papillary tumors, 6 cystadenomas, 5 endocrine tumors 3 solid cystic tumors and 3 others. Recently, patients with pancreatic tumors have increased and various operative methods are performed for the pancreatic tumors. The development of treatment procedures for pancreatic tumors are necessary.
3. Pancreatitis and pancreatic trauma
In 32 patients with pancreatitis and pancreatic trauma associated with chronic pancreatitis, 31 had acute pancreatitis and 6 had pancreatic trauma. Operations for chronic pancreatitis have increased recently, and new methods such as pylorus preserving pancreaticoduodenectomy and endoscopic placement of a pancreatic stent have been performed. In order to prevent injury of the main pancreatic duct, pancreatograms in patients with pancreatic trauma should be performed.

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Prognostic factors of hepatic resection for hepatic metastasis from colorectal cancer was studied from the percentage of tumor involved area (PTIA) . We perf omed an univariate and multivariate analysis of 22 patients of heptic resection. In the univariate analysis, a five-year survival rate of patients with less than 10% of the PTIA was significantly better than that of patients with more than 10% of the PTIA (p<0.01) . The PTIA was selected by multivariate analysis as the significant and independent prognostic factors affecting hepatic resection for hepatic metastasis from colorectal cancer. These results suggest that the PTIA in the cases of hepatic resection for hepatic metastasis from colorectal cancer is an important factor which reflects the prognosis.

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It is known that“voluntary teeth crunching” has an effect on the performance of various sports. However, reports about the effectiveness have not always been accorded. Therefore, we investigated into the influence of“voluntary teeth crunching” on the function of the spinal reflex circuit using Soleus H-Reflex, which enables an objective evaluation of motion function. For this, we dismissed the usual way to assume force level of“voluntary teeth crunching” from integral value of the electromyogram (EMG) and measured the muscular strength directly using an Occlusal Force-Meter. We imposed the movement tasks on examinees, voluntary teeth crunching at 10kg, 20kg, and 30kg, putting them on controls. The results were as follows:
The facilitation effected 7 out of 8 persons in the case of 10 kg (29.7% H-wave increase), 7 out of 8 persons in the case of 20kg (39.9% H-wave increase), were confirmed. Although these effects were recognized in all 8 members in the case of 30 kg, the increase ratio was a mere 32.0%.
Because the information from inside the mouth and the movement instruction from the brain is considered as the mechanism of facilitation, this rate may increase, under the motion condition that controls muscular strength outputs, by a strength in voluntary teeth crunching, but it is not always proportional.
The method of measuring muscular strength directly using an Occlusal Force-Meter is handier than that of assuming the force level from an integral value of EMG and more effective in reducing various influences from inside and outside the examinees' bodies.

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Among 873 cases gastric cancer operations in our department, 190 cases with Stage IVgastric cancer were studied for treatment and strategy. The mean survival time for those undergoing curability B resection was significantly longer than that of curability C resection and non-resection. There are four factors (T, N, H, P) which decide clinical stage. In these factors, cases with two or more than two determinants regarding Stage IV were poor prognosis compared with th one factor. 3-year survivors were characterized by more extensive lymphadenectomy, less invasive of venous invasion and curability B. It therefore should be performed curability B operation in Stage IV gastric cancer patients, especially in cases with one determinant regarding Stage IV it should be considered extensive operation. With regard to curability C, there was tendency to be good prognosis in patients with one determinant regarding residual tumor comparison with those with two or more than two determinants. While extensive lymph node dessection was not improve for prognosis in curability C patients. Wiyh respect to un-resectable cases, as mean survival time was short (3.9 months), it required re-consideration of oprative indication. As a result of these clinical consequences of Stage IV gastric cancer, it should be considered to decide an adequate treatment and strategy dependent on each cases in Stage IV gastric cancer.

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The authors observed the human digastric muscle to study precise morphology of the intermediate tendon which unites the anterior and posterior bellies; in particular, the shapes, supporting tissue such as the f ascial sling attached to the hyoid bone, synovial sheath-like lining structures, angles and distances from the hyoid bone were examined. Morphology of the fascial structures at the anterior belly side and the supporting structures of the intermediate tendon can be classified into four types, respectively. Morphometric evaluations of the intermediate tendon and its surroundings have been conducted. Synovial sheath-like lining structures increased with aging at the intermediate tendon. Discussions were conducted including morphometric evaluations concerning the shapes of the digastric muscle in relation to the hyoid bone. Textbook descriptions, including changes of aging, must be revised.

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A47-year-old man was admitted to Showa University Fujigaoka Hospital in January 1998, with complaints of fever, abdominal pain and pleural effusion. The chest X-ray revealed hazy inf iltrative shadows in both the lower lung fields, and an upper gastrointestinal (GI) endoscopical examination disclosed a mass located in the duodenum. A malignant lymphoma, non-Hodgkin, angiocentric type was suggested by the microscopic examination of the hematoxylin-eosin (HE) staining materials prepared from the transbronchial lung biopsy (TBLB ) specimens. Immunohistochemically, malignant cells were positive for CD3, CD8, CD56, as well as for the cytotoxic cell-associated molecules such as granzyme B and TIA-1. A cytoloxic examination of the pleural effusion indicated that malignant cells morphologically resembled large granular lymphocytes, and molecular biological analysis revealed that the T cell receptor (TCR) β gene of these cells was rearrenged. On the basis of these findings, we reached the conclusion that this case represented natural killer-like (NK-like) T cell lymphoma. The patient was initially treated with chemotherapy but died about three months after the diagnosis was made. Autopsy findings suggested that the primary focus of the NK/T cell lymphoma was the Duodenum.

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The case reported here is of a 37-year-old man who was admitted to the Department of Hematology at this hospital because of fever and general fatigue on December 28, 1998. Examination of this patient showed cytopenia, hepatosplenomegaly, hepatic dysfunction and a high serum level of lactate dehydrogenase (LDH) . Specimens obtained by bone marrow puncture and liver biopsy indicated that lymphoma cells had infiltrated both organs. The hematoxylin-eosin (HE) staining and immunohistochemical findings obtained from biopsy of the cervical lymph node revealed that this case was non-Hodgkin lymphoma and belonged to the peripheral T-cell and NK-cell neoplasms (WHO classification) . A NK cell lymphoma was suspected to be most likely amongst this group. Although chemotherapies such as CHOP, CHOP-E and E-POOH were performed, the patient had poor responses to these therapies and died on March 27, 1999, three months after admission. Since molecular biological analysis failed to detect the T-cell receptor (TCR) gene rearrangement of lymphoma cells obtained from the autopsy specimens, this case was finally diagnosed as NK cell lymphoma. This is a rare case because the primary foci of the NK cell lymphoma which expressed cytotoxic molecules such as granzyme B and T cell-restricted intercellular antigen (TIA-1) was suspected to be the spleen.

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