Serum prolactin (PRL) and TSH basal levels and the responses of serum PRL and TSH to thyrotropin releasing hormone (TRH) were investigated by radioimmunoassay in patients with breast cancer, who were classified in the following four groups : New T₁₃, M₀ breast cancer patients (N = 70), M₁ or recurrent breast cancer patients (N = 50), locally advanced breast cancer patients (N = 8) and post-biopsied breast caner patients (N =28).
Serum samples were taken 7 times before and for 3 hours after administration of TRH (0.5mg, i.v.). These were examined for basal and peak values, and reaction patterns.
PRL levels : Patients with locally advanced and post-biopsied breast cancer indicated high PRL levels in the basal and peak values (P < 0.01), and showed an excessive-prolonged pattern to TRH.
TSH levels : Patients with locally advanced and M1 or recurrent breast cancer indicated high TSH levels in the basal and peak values and showed an excessive-prolonged pattern to TRH.
To examine the detailed variations within the group of the patients with recurrent breast cancer, they were classified in the following 3 subgroups : locoregional recurrent breast cancer (N =10), skeletal metastatic breast cancer (N = 22), and visceral metastatic breast cancer (N =6).
The locoregional recurrent patients showed high PRL levels in the basal and peak values. The skeletal metastasized patients with breast cancer tended to show high TSH levels in the basal and peak values.
To comfirm whether local (intercostal nerve) stimulation gives any effect on high serum PRL levels in the patients with locally advanced breast cancer, epidural anesthesia was performed 24 hours in accordance with Keegan's dermatome.
As a result, basal PRL values tended to decrease in the cases blocked satisfactorily, but peak PRL values indicated no change even though blocked satisfactorily. It might be caused by short anesthetic duration.
Post-biopsied breast cancer patients indicated also high PRL levels in the basal and peak values, but compared post-biopsied breast cancer to post-biopsied benign mammary tumor, both indicated increment of serum PRL peak values. High serum PRL levels of post-biopsied breast cancer patients might be caused by manipulation of biopsy itself.

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A fully automated, fast and sensitive method has been developed for the analysis of polyamines, their derivatives and various other biogenic amines in body fluids and tissues. Putrescine, spermidine, spermine, cadaverine and unusual polyamines such as norspermidine, norspermine, homospermidine, aminopropylcadaverine and canavalmine can be completely resolved and assayed by high-performance liquid chromatography using a cation-exchange resin with stepwise elution. The column eluate is monitored by a fluorescence detector. It is possible to assay simultaneously other biogenic amines such as histamine, 1-methylhistamine, norephinephrine, normetanephrine and octopamine. Acetylated polyamines can be determined only after their occurrence is confirmed by acid hydrolysis and by other techniques. This method allows the simultaneous determination of these compounds at the picomole level within one hour. It can be directly applied to crude extracts xithout preliminary purification. No pretreatment of samples is required other than deproteinization. This technique could serve as a powerful tool for the diagnosis of malignant tumors and for monitoring the effectiveness of cancer therapy.

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A 45-year-old man was admitted because of discomfort of the upper abdomen and large abdominal mass could be palpable in the right upper quadrant. There were no remakable findings on laboratory data. The diagnosis was adrenal cyst by abdominal angiography. On Sept. 9, 1982, a cystic adrenal mass was removed through a right pararectal incision. The specimen contained about 4L of yellowish fluid. Histological findings revealed that the wall of the cyst was organized but few smooth muscle cells were seen in the wall and lymphatic vessels in adjacent adrenal tissue were dilated. Histological diagnosis was lymphangiomatous adrenal cyst. Probably, the present case is equal to the largest on record in Japan.

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Two cases with preoperative diagnosis of gallbladder carcinoma proved to be a gallbladder carcinoma and a chronic hypertrophic cholecystitis postoperatively were reported. On barium study, cholangiogram, echogram, CT & angiogram, all findings of gallbladder carcinoma were more pronounced and advanced than chronic hypertrophic cholecystitis. But the differentiation of gallbladder carcinoma from chronic hypertrophic cholecystitis purely under imaging diagnosis is very difficult.

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Based on the high plasma norepinephrine concentration and markedly increased urinary excretion of catecholamines, a possibility of pheochromocytoma was seriously suspected in a 30- year-old man admitted for evaluation of hypertension. Routine examination such as intravenous pyelography, thoracic and abdominal aortography and adrenal CT scanning failed to localize the tumor, but serial venous blood sampling demonstrated a localized significant elevation of plasma norepinephrine concentration in inferior vena cava at the level of the second lumbar vertebra. ACT scanning performed thereafter showed a 2.0x1.8x1.6cm mass in the corresponding region.Finally, an extra-adrenal pheochromocytoma weighing 3.5 g was excised. This is the smallest solitary extra-adrenal pheochromocytoma hitherto reported in Japan as far as we know.

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A 66-years-old male ICU-ID No-82050318, who was previously healthy, was suffered from severe respiratory distress after cholecystectomy with preoperative diagnosis of gallbladder cancer. Although 4, 000ml of whole blood transfusion was given during the first operation, continuous bleeding from the abdominal drainage was not controlled post-operatively. Reoperation was performed at about 24hours later.
At the time of admission to ICU, PaO₂ was 74.1mmHg, and PaCO₂ was 36.8mmHg under the mechanical ventilation with FIO₂ 1.0. His pulmonary arterial pressure was 32/14mmHg, pulmonary capillary wedge pressure 14mmHg, cardiac index 4.3L/min · m² and pulmonary vascular resistance 85 dyne sec/cm⁵.
DIC was denied because of supporting data of fibrinogen 265mg/dl, PT 54%, APTT 49.8sec and FDP 20μg/ml. His chest radiograph was normal. The diagnosis of ARDS was concluded and treated by mechanical ventilation with a step-like increase in PEEP level.
His respiratory parameters improved gradually by mechanical ventilation with PEEP level of 15 cmH₂O, but weaning from the respirator was delayed until 13th ICU days, because of suspected intra -abdominal infection.
Pulmonary microvascular pressure was between 10 and 20 mmHg and plasma colloid osmotic pressure was near 20mmHg. His complement titer (CHSO, C 3) were low at 1 st ICU day and reactive elevation of complement at the following postoperative course was not so high as in the uncomplicated postoperative patients. Pathophysiology and therapy for ARDS was discussed.

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