H₂-receptor antagonists (H₂-blockers) block the H₂-receptors on gastric parietal cells and strongly inhibit acid secretion, resulting in an augmented gastrin secretion by gastrin (G) cells. The histamine-producing enterochromaffin-like (ECL) cells contain histidine decarboxylase (HDC), a histamine-forming enzyme, which is controlled mainly by gastrin. HDC has a short biological half-life and sensitive responses and, therefore, is a good marker for ECL cell function. To investigate the mechanisms of action of the H₂-receptor antagonists on ECL cells, we examined the changes of gastric mucosal histamine metabolism and gastrointestinal hormones after administration of five H₂-blockers. Cimetidine, ranitidine and nizatidine increased both the serum gastrin levels and mucosal HDC activity in a dose-manner. At high doses of famotidine and roxatidine, the gastric pH and serum gastrin levels were increased, but HDC activity was decreased. In addition, famotidine administration lowered the mucosal somatostatin levels and increased serum secretin levels. Famotidine and roxatidine may have acted directly on the ECL cells to lower the sensitivity to gastrin and suppressed HDC activity. The two H₂-receptor antagonists, apart from their pharmacological inhibitory effect on ECL cells, may also affect cellular function of gastrin of gastric mucosa by regulating secretion of somatostatin and secretin.

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On hundred sixty-one laparoscopic cholecystectomies (LC) have been performed at our institution since 1991. Fifteen patients (9.3%) had common bile duct stones, and 12 of them (80%) had cholecystitis and choledochitis. Open cholecystectomies (OC) were performed on 5 patients for inflammatory dense adhesion. Common bile duct (CBD) injuries occurred in 3 patients (0.02%) and were repaired by direct closure. To prevent CBD injuries, it seems important to perform intraoperative cholangiography.
Furthermore, it is recommended that repeated intraoperative cholangiography be performed by using on endoscopic nasobiliary drainage tube in inflammatory cases. We experienced CBD strictures in non-dilated CBD less than 15mm in diameter. Therefore we think that laparoscopic choledocholithotomy is applicable to a dilated CBD more than 15mm in diameter and choledocholithotomy with endoscopic sphincterotomy (EST), endoscopic papillary dilation (EPD), extracorporeal shock wave lithotripsy before LC is useful for a CBD less than 15mm in diameter. EPD is recommended for CBD stones less than 20mm in diameter, instead of EST.

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To assess the relationship between urinary tract symptoms and objective parameters in patients with prostatic disease, international prostatic symptom score (IPSS), quality of life score (QOL score), and parameters of transrectal ultrasonography (TRUS) and uroflowmetry (UFM). In new patients, Qmax in UFM was correlated with IPSS and QOL score. Parameters of TRUS were not correlated with symptoms. Total score of voiding component of IPSS was more highly correlated with QOL score than that of filling component of IPSS. In treated patients, patients with severe QOL score had low Qmax, high total score IPSS, and high scores of individual questions of IPSS. In patients with prostate cancer, irritative symptoms got severe and Qmax was not correlated with symptoms. To evaluate lower urinary tract symptoms in reference to other objective parameters is thought to be of great use in managing patients with prostate disease.

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Between September 1989 and May 1997, a total of 180 patients with lung cancer underwent surgical treatment. Twenty-two of them were diagnosed as having small-sized (under 2 cm in diameter) lung cancer. In 11 of the 22 patients, preoperative diagnosis as small-sized lung cancer was obtained by a combination of CT and thin-slice CT. The postoperative diagnosis was well differentiated adenocarcinoma with p-TINOMO, stage 1. Eight patients with right lung cancer underwent lobectomy R₂b. The remaining three patients with left lung cancer underwent lobectomy R₃. All 11 patients have been disease free from 6 to 52 months (mean 33 months) after surgery. In conclusion a combination of CT and thin-slice CT is useful for the diagnosis of small sized lung cancer.

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The respiratory function test and arterial blood gas analysis before and after 2-month rehabilitation programs in a pool filled with 38°C hot-spring water were examined in 19 patients with stable chronic pulmonary disease treated at our hospital between 1994 and 1996. Seven patients with bronchial asthma (66.3±8.9 years old), 7 with chronic pulmonary emphysema (70.0±6.6 years old), and 5 with constrictive pulmonary disease (69.6±4.7 years old ; 2 with pneumoconiosis, 2 with rheumatic arthritic lungs, and 1 with old pulmonary tuberculosis) performed a 20-minute breathing exercise by immersion twice a day for 2 months. The ratio of forced expired volume in one second to forced vital capacity (FEV_1.0%) was significantly increased after the exercise program (p<0.05) in patients with emphysema and asthma, while that in patients with constrictive pulmonary disease was not changed. The ratio of vital capacity to predicted normal value (%VC) and the maximal expiratory flow at 25% (V₂₅) were not changed in any patients. PaO₂ was significantly increased in patients with emphysema (p<0.01) while PaCO₂ was significantly decreased in those with emphysema and asthma (p<0.05). A trend toward an increase in % VC in constrictive pulmonary disease was observed after the 2-month exercise period but it was not significant (p=0.067). These results suggest that our breathing exercise is useful in the treatment of bronchial asthma and chronic pulmonary emphysema. In addition, this exercise could be recommended for constrictive pulmonary disease.

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A 44-years-old male patient was referred to our hospital with complaint of fever, tremor and loss of consciousness. Myogloburin, CPK, blood urea nitrogen and creatinine levels in the serum were elevated. He was diagnosed with acute renal failure associated with rhabdomyolysis. The rhabdomyolysis seemed to be due to pneumonia. He recovered well after hemodialysis.

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Adrenectomy and grafting of the ascending aorta were successfully performed in a 44-year-old woman with Cushing syndrome associated with a DeBakey type I dissecting aneurysm. The patient, who had hypertension, complained of sudden of pain attacks in her anterior chest. A DeBakey type I dissecting aneurysm was diagnosed by thoracal CT scans. During the period of conservative therapy with antihypertensive agents, a mass on her left adrenal gland was detected by abdominal CT scans. Endocrinological and functional examinations suggested Cushing syndrome caused by an adrenal adenoma. First, the ascending aorta was replaced with a 24-mm woven Dacron graft under cardiopulmonary bypass. Six weeks later, a left adrenal tumor was removed under a posterolateral approach. Her postoperative course was uneventful with good control of her blood pressure. Pathological findings for the resected tumor confirmed a benign cortical adenoma. To our knowledge, Cushing syndrome associated with a dissecting aneurysm has not been previously reported.

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A systemic convulsion occurred in a 63-year-old woman with chronic renal failure undergoing aorto-coronary bypass grafting on postopretive day 4. The origin could not be determined in spite of various examinations. Anticonvulsion drugs were not effective. Amino acids and rare elements were finally administered, and the convulsions gradually disappeared. Various examinations for serum levels of electrocytes, rare elements and drugs, and cerebrovascular diseases are necessary in the postoperative management of patients with chronic renal failure.

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A 77-year-old man was referred to Honjo General Hospital for his asymptomatic hematuria. Bladder tumor was found in his urinary bladder. The screening of serum PSA level showed a gray zone data of 6.6ng/ml of EIKEN kit. No tumor was palpable on digital rectal examination and hypoechoic lesion was found on transrectal ultrasonography. Bladder tumor was resected transurethrally, and sextant systematic biopsy and hypoechoic directed biopsy were performed on his prostate. Bladder tumor was transitional cell carcinoma of grade 2, pT1b. Bladder instillation therapy was started. Moderately differentiated adenocarcinoma was exclusively found in the specimen obtained by hypoechoic directed biopsy. Hormonal therapy was started. Some discussion on primary double cancers, especially on bladder and prostate cancers, were made.

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Surgical treatment was successfully performed in a 78-year-old male with intestinal perforation due to metastasis from lung cancer. Intestinal perforation due to metastasis from lung cancer is rare and its prognosis is poor.
The patient who was taking anti-cancer drugs for lung cancer was admitted to our hospital because of abdominal pain. An abdominal X-ray film showed free air in the subphrenic space. Panperitonitis due to gastrointestinal perforation was diagnosed. On laparotomy, an intestinal tumor with the size of 2.5 × 1.5cm was perforated 30cm apart from the ligament of Treitz. A wedged resection of the lesion was performed. The patient was discharged 3 weeks after the operation, and he has been doing well for 4 months after surgery. We report this case with a review of the Japanese literature on 33 cases.

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We experienced two patients with mediastinal malignant lymphoma, in whom preoperative diagnosis was difficult. A 36-year-old man with multiple tumors in the thymus underwent a total thymectomy. Another man fo the same age with a solitary tumor in the left second carina underwent resection of the tumor. Ga scintigraphy of the two cases was negative. Pathohistological diagnosis for both patients was B-cell lymphoma, and they received chemotherapy. Their postoperative courses have been uneventful for 30 months and 28 months, respectively.

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We report a patient with lymphomatoid granulomatosis which was improved by MCNU-CHOP therapy. A 43 year-old male was admitted because of dyspnea and an abnormal shadow in the lung. He was diagnosed as having B-cell dominant lymphomatoid granulomatosis according to histological examination of the lung specimen obtained by intrathoracic endoscopy. CHOP therapy was ineffective against the lymphomatoid granulomatosis. The more potent MCNU-CHOP therapy was started immediately. Fours weeks after the start of the treatment, the tumor was reduced by 36.8% of initial total tumor size. Finally, the total tumor size was reduced by 7.9% after twice repeated MCNU-CHOP therapy. The present case indicates that the combination of MCNU with ordinary CHOP therapy may be more effective against lymphomatoid granulomatosis.

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We experienced a case of adrenal hemorrhage presenting as an abdominal emergency. A 46-year-old man was admitted to our hospital complaining of a sudden onset of severe left lumbago and back pain. Abdominal CT revealed a large hematoma in the upper portion of and around the left kidney in the left side of the retroperitoneum. An emergency operation was performed under the diagnosis of retroperitoneal hemorrhage of unknown origin. On incising the abdomen, a diffuse hematoma was found to be present mainly in the left side of the retroperitoneum. On removing the coagulum medial to the upper pole of the left kidney, bright red blood, which was presumed to be arterial blood, spouted from the lower pole of the left adrenal gland. On removing the adrenal gland, the blood spouting stopped. On pathological examination, the extracted specimen was found to be the adrenal gland with hemorrhage, and no tumor, for example a pheochromocytoma, existed. Hypertension, which was difficult to control, continued postoperatively, and he was transferred to another hospital for blood pressure control. Conservative treatment is the basic principle for controlling an adrenal hemorrhage. However, it is important to perform an emergency operation if the bleeding cannot be controlled by conservative treatment.

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