Sixty-one cases of hypertensive intracerebral hematomata were evacuated by CT guided stereotactic method. The operation was performed in the CT room under general anesthesia using the KOMAI-NAKAJIMA STEREOTACTIC DEVDCE. This instrument has a micromanipulater that can be used for various kinds of stereotactic procedures. Three dimensional position of the target point (aspiration point of the hematoma) was determined on the film obtained from CT scanning of the patient in the stereotactic system. If the hematoma was small, the target point was enough to be one point at the center of the hematoma, but in case of the large hematoma, several target points were given according to the shape of hematoma. The probe, ordinarily a steel tube 4mm in outer diameter, was inserted through brain to the target point and the hematoma was aspirated through a silicon tube connected to a vacuum system.
Among 61 cases examined, 30 cases of thalamic hemorrhage were operated upon and 36 cases were not operated. They were classified according to the volume of hematoma into 3 groups as follows : A= less than 10ml, B=11-25ml, C=more than 25ml. The operated cases were compared with the non operated cases on the improving of the consciousness in each group.
In the A group, the operated patients in the level I ^* recovered more slowly than the non operated patients, but in the level II^** patients, this was reversed.
In the B group, the operated patients improved more quickly except the level I patients.
In the C group, almost all of non operated patients died. Thus, this operation was very useful in improving of consciousness of level II or III^*** patients independent of hematoma volume. It accelerated the recovery of motor function in the level I.
This non inversive technique in considered effective for the removal of deep intracerebral hematoma.
^*level I : nearly equal 1115 points in G.C.S.
or almost alertness-light somnolence.
^**level II : nearly equal 711 points in G.C.S.
or somnolencestupor.
^***level III : nearly equal 37 points in G.C.S.
or sever stupordeep coma.

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Measurement of right ventricular ejection fraction and right ventricular end-diastolic volume is important for evaluation of right ventricular function, however, the anatomical characteristics of the right ventricle have made clinical assessment difficult. The purpose of this investigation was to determine whether a modified Swan-Ganz catheter equipped with a rapid response thermistor could detect temperature change in the model heart to identify clinical problems occurring when right ventricular ejection fractions in ICU patients were measured by this method, and to determine whether problems encountered in clinical application were able to be analyzed in the model heart. Use of a commercially-available Swan-Ganz catheter equipped with a rapid response thermistor enabled analysis of the ventricular ejection fraction and ventricular end-diastolic volume without any time delay compared to measurements calculated from the impedance change in the model circuit which was composed of a peristaltic, artificial pump (Stakart, Cobe, USA) and artificial chamber. Next two hundred and sixty-eight records of right ventricular thermal washout curves from fifteen patients, who admitted to the ICU of Gurima University Hospital and were monitored using Swan-Ganz catheter equipped with rapid response thermistor were analyzed. From the clinical analysis two questions were proposed. The first considered why successive ejection fractions obtained from a single thermal washout curve were not always identical, and the the second considered why the difference among ejection fractions became apparent especially when the measured ejection fractions was high. To determine answers to these questions, an artificial heart was developed equipped with two one-way valves and a rubber base connected to a piston. We determined in this model heart that the injection port of the cold indicator had to be the ventricle; the cooled catheter and possibly the ventricle made successive ejection fractions decrease when the preset ejection fraction was high; the ejection fraction was calculated to be about 30% less than the actual one when cold water was injected in the atrium through a catheter running in the inflow tract; and that the ejection fraction in a thermal washout curve obtained first was the most accurate when cold water was injected in the ventricle. These results were good agreement with clinical findings. In conclusion, the ejection fraction in a thermal washout curve obtained first from right ventricular injection should be adopted when analyzing right ventricular ejection fraction by thermal washout method.

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For simultaneous measurement of multiple hormones in blood samples from small experimental animals, multiple radioimmunoassay (Multi-RIA) was developed for rat pituitary hormones (LH, FSH, TSH, PRL, and GH) and epidermal growth factor (EGF) using double antibody method.
Parallel RIA, where ¹²⁵I-and ¹³¹I-labelled hormones were employed together, could measure 2 hormones at a time, and their assay values correlated well with those obtained by ordinary single assays. Smaller assay values were obtained with TSH, PRL, and GH. However, the lower slope of the regression line in TSH assay could be overcome by changing the anti-TSH serum for another batch of antiserum, indicating that this problem may be due to the antibodies used. Assay results of parallel RIA for female rat serum LH and FSH with samples obtained on proestrus day agreed well with those by single RIA.
Serial RIA, where 2 hormones were assayed successively, also produced assay values which correlated well with those from single assays. The lower binding of hormones in the second assay of serial RIA was improved by increasing the concentration of normal rabbit serum in the dilutant for the antiserum without affecting assay sensitivity.
Multi-RIA, which was developed by combining parallel RIA and serial RIA, could measure up to 4 hormones at a time. Application of multi-RIA to serum samples from castrated and cannulated male rats gave results which suggested synchronous secretion of LH, FSH, and PRL, indicating the usefulness of this assay method.

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Clinical and pathological observation has been carried out in 68 cases of oral leukoplakia examined in our department and results are as follows.
1) The patients consisted of 42 males and 26 females, and a high prevalence was observed in males in their forties.
2) Foci most frequently occured on the gingiva, then on the tongue, lips and buccal mucous membrane, and were found least frequently on the oral floor.
On the gingiva, a great many white-spotted types and plateau types occurred but on the tongue erosive types were seen most frequently.
On the lips and buccal mucous membrance, many white-spotted types were observed but on the oral floor only one white-spotted type and one erosive type were seen. Five cases were accompanied by cancer and four cases became malignant, all of these being derived from the erosive type.
3) In relation to smoking, the incidence was 70% in males and 44% in females and was higher than the average percentage of adult smokers in our country. Score of Brinkman index (B.I.) was 562 on average and this was higher then B.I. 400 which is a standard value of the high-risk group for lung cancer, therefore smoking is considered to be the cause of this disease.
4) Investigation of the relationship between metal restorations and dentures using patch testing revealed in 53% of a positive reaction cases. Many positive reactions were observed toward metals most commonly used in dental materials, and this suggested a great possibility of local stimululation by metal allergy. Cases associated with a local stimulus deriving from unfitted dentures, dental caries and metal allergies amounted to 56%.
5) In the results of glucose tolerance testing, a significant difference was not shown in comparison with healthy persons in the same age bracket. Levels of serum immunoglobulins IgA, IgG, IgM, and vitamin A, vitamin B₂ and cholesterol in blood were within normal values.
The above results indicate that systemic factors were not influencing factors as much as were local factors.
6) In histological studies, as to the first pattern (that without a differential pattern in epithelial cells, with a thin epithelial layer a great difference was not observed in comparison with other groups. However, as to the second pattern (that without a differential pattern in the epithelial cells, with a thickened epithelial layer) the epithelial layer was thickened and intercellular edema in the squamous cell layer and prolongation and acumination of the rete ridge were shown. As to the third pattern (one accompanied by a differential pattern in the epithelial cells) the tissues observed were similar to those in the second pattern, but cells with enlarged nuclei and increased chromatin content in the basement layer, and on increased mitosis rate were observed.
In electron microscopic examination, in the basement cell layer, Langerhans cells (L.C.) were often observed.
7) In the chemical examination of immunohistologic patterns clinically found, the degree of infiltration of sub-epithelial tissue, and S-100 protein-positive cells in the epithelium were analysed.
Results showed that the number of S-100 protein-positive cells in the epithelia were increasing significantly in plateaupatterns, accompanied by erosion and cancer patterns.
Pathologically, the relationship between degree of infiltration of sub-epithelial tissue and S-100 protein-positive cells was clearly observed to be correlative.
The increase in L.C. in the case of plateaupattern and erosivepattern leukoplakia and in cases where lesions developed into cancer is considered to suggest functional acceleration of antigen recognition mechanism in the foci, together with the acceleration of cellular infiltration to sub-epithelial tissue in these patterns.

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Serum α (1→3) -L-fucosyltransferase activity was measured in 90 patients with gastric cancer, 58 with lung cancer, 27 with benign disease and in 100 healthy controls. Levels of enzyme activity were significantly higher in sera of patients with cancer than in those from patients with benign disease and in healthy controls. The elevation in enzyme activity correlated not only with clinical stages but also with the size of primary lung cancer. Follow-up studies in patients with tumor in various stages of malignancy revealed that measurement of the enzyme activity was useful in tracking the clinical course of disease after surgery. To evaluate the usefulness of the enzyme activity as a tumor marker, CEA and sialyl Lewis X-i antigen levels were also measured. The results indicate that serum α (1→3) -L-fucosyltransferase activity could be a more sensitive and specific tumor marker than other tumor-associated antigens such as CEA and sialyl Lewis X-i antigen in gastric and lung cancer.

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To analyze effects of thyroid hormone on the central nervous system, we recorded visual evoked potentials (VEPs) by photic and electrical stimulations in normal, thyroidectomized (Tx) and T3 or T4-supplemented (Tx-T3, T4) adult rats under pentobarbital anesthesia. The latencies of VEPs recorded in the visual cortex (VC) and lateral geniculate nucleus (LGN) and b-wave of electroretinogram (ERG) were compared in these three groups. A significant prolongation of latency in the visual system of Tx rats 14 to 28 days after operation was observed compared with that in intact control rats. The prolonged VEP latencies in the LGN and the VC showed a positive correlation with the prolonged b-wave latency of ERG between the three groups. These prolonged latencies observed in the VC, the LGN and ERG were partially normalized 24 hours after T3 supplement (50μg/kg, sc) and completely restored to normal levels by 48 hours after T4 injection (100μg/kg, sc). There was a positive correlation between recovered latencies to observed in the LGN and VC and those in b-wave of ERG. When electrical stimulation was delivered to the optic chiasma or the LGN, and evoked potential were recorded in the VC and LGN, neither latencies recorded in the VC nor those in the LGN were significantly different in intact and Tx rats. Moreover, there was no significant difference between optic nerve conduction velocities in these two groups.
These results suggest that the prolongation of latency of VEPs observed in hypothyroid rats are mainly attributed to that occurring in the retina, indicating the essential role of thyroid hormone in maintaining retinal function in adult animals.

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Heavy metals on human prostate were studied by sulfide-silver method and X-ray microanalysis. Samples were obtained from two normal prostates, fifteen hyperplastic prostates, two prostate cancers and one atrophic prostate which was castrated condition for 50 years period.
In the normal prostate, positive reactions were found in the prostatic epithelia and secretory products in the acini. Most nuclei did not show positive reaction, but some nuclei showed weakly positive. Hyperplastic prostate showed strongly positive reaction, especially in the apical part of cytoplasm and secretory products. Nuclei did not react positively. Silver granules could not find in the stroma. Moderately differentiated adenocarcinoma and castrated prostatic epithelial cells did not react positively by silver-sulfide method.
By X-ray microanalysis, reaction products by light microscopy were revealed the silver particles. Their locations were cytoplasm, especially in the apical part and secretory products in the lumen. Our results demonstrated the localization of the heavy metals on the prostatic tissues.

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Using transrectal ultrasonography, horizontal tomograms of the canine prostate were obtained for cross sections at every 5 mm. Prostatic volume was estimated as the sum of volumes determined for each section. Prostatic weight was calculated from the volume and the specific gravity of the prostate. A highly significant correlation was observed between actual prostatic weight determined gravimetrically and that estimated by ultrasound. The relationship between the two parameters was described by regression equation : estimated weight (g) =0.97×gravimetric weight (g) +0.60, R=0.91, p<0.005, n=11. This demonstrates that transrectal ultrasonography can be used to accurately estimate change in prostate size during experiments without surgical intervention.

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The Activity-Sensing Rate-Responsive Pacemaker (RR-PM) varies the pacing rate in response to the level of physical activity.
The effect of RR-PM was compared with that of conventional fixed-rate pacing (VVI-PM) on symptoms and exercise capacity (peak oxygen consumption and anaerobic threshold) during treadmill exercise in 6 patients between the ages of 38 and 75 years with complete atrioventricular block. A newly programmed treadmill exercise protocol was used for the measurement of anaerobic threshold.
In the Rate-Responsive (RR) mode, the heart rate increased from 61±4 beats/min (bpm) to 103±12 bpm during maximal exercise ; the peak oxygen consumption and oxygen consumption at the anaerobic threshold significantly increased to a greater extent in RR mode than it did in fixed rate pacing mode. Thus, the use of RR-PM leads to better exercise tolerance than VVI-PM in complete atrioventricular block patients.

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Early gastric cancers with submucosal invasion were categorized into the following four subtypes : 1) cancerous invasion mucosal layers and lucer scars (sm₀), 2) slightly infiltrative type with minute and partial submucosal invasion (sm₁), 3) moderately infiltrative type, and intermediated type with invasion down to the submucosal layer (sm₂), 4) deep infiltrative type with deep and massive invasion almost to the proper muscle (sm₃). 258 mucosal invasion cases and 205 submucosal invasion cases were investigated with regard to the clinicopathological factors.
The results were as follows;
1) The deep infiltrative types were frequent in the protruded, elevated, and depressive types than in the other types of early gastric cancers.
2) The rates of lymph node metastasis and lymphangitic and blood vessel invasion was increased in the deep infiltrative type.
3) The survival rate in this deep infiltrative type at five years was lower than in the other type.
4) The recurrent death group's characters were as follows : macroscopically depressive types, histologically well-or moderately differentiated types, and highly invasive types to lymphangitic and blood vessels. 40% patients died within a year and metastasis occured via blood vessel route.

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Deep mycotic infection (DMI) is now being recognized in adult acute leukemia (AAL) patients with increased frequency. Fever, which is resistant to antibiotics and continue despite subsequent attainment of hematological remission, in one of the characteristic feature of DMI in AAL patients. The aspergillosis of lung and candidiasis of liver are most common. fungal infection in AAL patients. The trans-bronchial lung biopsy (TBLB) is the most useful technique for the diagnosis of lung aspergillosis. The AAL patients with lung aspergillosis must be received high dose amphotericin B (Amp-B) intravenously. Additionally, trans-bronchial administration of Amp-B is one of effective therapy in patients with lung cavity. The liver abscess in successfully diagnosed by ultrasonography or CT scan. Even if percutaneous liver aspiration or surgical excision are performed, the decision of pathogenic agents is very difficult. The administration of Amp-B must be tried through a catheter inserted into the portal vein at laparotomy in these patients.

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A case of torsion of the gallbladder is reported. An 80-year-old woman presented with complaints of abrupt attack of right upper quadrant pain and nausea. On admission, a remarkably enlarged gallbladder was palpable, and tender. After a conservative period of observation and ineffective antibiotic therapy during which rebound tenderness worsened, we decided to operate under a provisional diagnosis of gangrenous cholecystitis and peritonitis, about 48 hours from onset. At laparotomy, the gallbladder was freely hanging in the peritoneal cavity and was twisted in a counterclockwise rotation about 270°. It was gangrenous but not perforated.
Among many acute abdominal diseases, torsion of the gallbladder is a relatively rare disorder of the biliary system, and should be promptly treated surgically. Most cases reported in the literature were diagnosed at laparotomy as in our case, but recently a few cases have been diagnosed preoperatively by means of ultrasonography and CT scanning. Accompanied by the development and prevalence of modern imaging procedures, more instances will be diagnosed noninvasively by these modalities in the future, and establishment of reliable diagnostic criteria consistent with this disorder, if possible, will allow early diagnosis and treatment.

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Five patients with hepatic failure (4 with acute hepatic failure and 1 with chronic hepatic failure) were treated by plasma exchange.
Improvement of coma grade was observed in 2 patients. but 3 patients died without recovery from coma.
The death in 1 of the 3 fatal cases was due to chronic hepatic failure.
PT in the 2 patients whose lives were saved showed recovery progressively at each plasma exchange, but PT in the 3 fatal cases remained below 50% of normal.
It was concluded that measurement of PT is useful for the early diagnosis of acute hepatic failure and that it is essential to perform plasma exchange as quickly as possible once diagnosis is established.

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Retroperitoneal liposarcoma is a relatively rare disease.Recently we treated a case of a huge retroperitoneal liposarcoma weighing 9.0 kg. This case involved a 48-year-old female who complained of abdominal swelling and was admitted to our hospital. We diagnosed a retroperitoneal tumor and performed surgery.
At operation, a huge orange-yellow tumor with a soft elastic consistency occupied most of the intra-abdominal space. As the tumor was wrapped in a pseudocapsule, we easily separated it from the surrounding organs except for the left adrenal gland. Eventually we resected it completely with a part of the left adrenal gland.
The tumor size was 42×30×15 cm and the weight was 9.0 kg. In histological examination, some tumor cells were observed to be spindle shaped, some ones were star-like and others were round. The interstitial tissue was myxomatous and many blood vessels were included. A few lipoblast cells existed and most tumor cells had granules positive to oil-red-O stain. No tumor cells were seen in the left adrenal gland. The final diagnosis was myxoid-type liposarcoma. The total number of cases of liposarcoma in Japan is 178. However only four of these hal tumors weighing more than 10 kg which could be resected. The capsule of the liposarcoma is a so-called pseudocapsule and it causes frequent invasion and difficulty of complete resection. In our case, a very small part of the pseudocapsule may have remained so that we must carefully follow up the patient's course.

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