Mucocutaneous Lymph Node Syndrome (以下, 川崎病と略す) の急性期に生ずる冠状動脈 (以下, 冠動脈と略す) 拡大性病変の程度は, 急性期の冠血管障害の程度をおおむね反映していると考えられる.同時に, 血管機能の1つの指標とされるdipyridamole等の冠血管拡張剤に対する冠動脈の拡張能の障害も, 拡大の程度が強い程高度になることが認められている.この拡大性病変も経時的な観察により, 内径が8mm未満の拡大性病変は縮小してくることが多いと報告されている.しかし, 病理学的にはこれは内膜の肥厚を中心とした瘢痕形成であり, 厳密な意味での “正常化” とは異ると考えられる.このような形態的には改善がみられた冠動脈に, はたして機能的な面での回復も起ってくるのかどうかは興味深いところであり, 臨床的にも重要であると思われる.また, 形態面のみならず機能的な面からの冠動脈の検討は, 川崎病による冠血管障害をより詳細に検討し得ると共に, 長期にわたる治療計画においても1つの指針となると思われる.
筆者は川崎病罹患児22名にdipyridamole負荷冠動脈造影を平均21カ月の間隔で2回施行し, 形態学的観察を行うと同時に各時期の冠動脈拡張率を算出した.これを用いて川崎病後冠血管障害の経時的変化について検討を行い以下の結論を得た.
(1) 内径が8mm未満の冠動脈拡大性病変は, 経時的に縮小することが多かった.うち, 初回造影時の病変径が4mm未満の冠動脈では, 冠動脈拡張能の有意な改善も同時に認められた.
(2) 病変径が4mm以上であった冠動脈でも, ほとんどで有意な拡大性病変の縮小を認めたが拡張能の改善はみられず, むしろ悪化する傾向にあった.
(3) 造影上, 冠動脈径値は正常範囲内であるのに著しく拡張能の低下した部位が存在する場合は, 過去に4mm以上の拡大性病変がありそれが縮小した可能性も考慮する必要がある.
(4) 初回造影時, 形態上は異常のみられなかった冠動脈にも形態的, 機能的な経時的変化にはいくつかのパターンが認められ, 拡大性病変を生ずるには至らなかった軽度の冠動脈障害も, さらに詳細に評価することが可能と思われた.

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An analysis was performed of 51 patients who underwent ureterosigmoidostomy.
Blood sodium levels had a tendency to increase with time, and patients with hyperchloremia did not exhibit acidosis. Both these findings may be due to the administration of sodium bicarbonate. Postoperative IVP's revealed deterioration in 35.7% of the renal units, and renograms deteriorated in 47.6%. None of the patients were affected by colon cancer postoperatively and 94% were pleased with the procedure. We concluded that ureterosigmoidostomy, which enables urinary diversion without a stoma regardless of urethral function, will have its own place in urinary diversion.

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The localization of the cholestatic factor (CF), which induces intrahepatic cholestasis, was investigated immunohistochemically. Monoclonal antibody to guinea pig-CF was used in this immunohistochemical study. In liver biopsy specimens obtained from patients with various liver diseases, CF was immunohistochemically detected in seven of nine patients with drug-induced liver injury, three of four patients with acute viral hepatitis, three of five patients with alcoholic liver injury and in the two patients with autoimmune hepatitis. Of these 15 CF-positive patients, fourteen had jaundice during their clinical courses. CF was stained in a diffuse granular pattern in the cytoplasm of the hepatocytes. However, CF was not detected in liver specimens from normal controls and patients with primary biliary cirrhosis and extrahepatic biliary obstruction. Ultrastructural immunohistochemistry revealed that CF was localized on the ribosomes and polysomes as well as on the filamentous structures around the bile canaliculi. Experimentally, CF was immunohistochemically detected in cultured peripheral blood lymphocytes from patients with drug-induced intrahepatic cholestasis. When guinea pig hepatocytes were cultured with the supernatant obtained from human CF-positive lymphocytes culture, CF was stained in a diffuse granular pattern in the cytoplasm of the hepatocytes. However, CF was not present in cultured guinea pig hepatocytes incubated with IL-1, IL-2, IL-6, and TNF as controls. These findings suggest that CF is present in hepatocytes of patients with intrahepatic cholestasis due to various liver diseases and that CF or a CF-like substance is synthesized by hepatocytes in certain intrahepatic cholestatic state and induces intrahepatic cholestasis. It is concluded that CF plays an important role in intrahepatic cholestasis.

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The cerebrospinal fluid (CSF) levels of somatostatin-like immunoreactivity (SSLI) and substance P-like immunoreactivity (SPLI) were measured by radioimmunoassay in 12 cases of amyotrophic lateral sclerosis (ALS), 20 cases of Parkinson's disease (PD), 19 cases of spinocerebellar degeneration (SCD) and 20 normal controls.
In the control group, the levels of SSLI and SPLI were 15.3±2.1 (mean± SD) fmol/ml and 5.36±1.66 fmol/ml, respectively, and these levels were not related to age or sex, nor was diurnal fluctuation observed.
In the ALS group, the levels of SSLI and SPLI were 19.2±3.0 fmol/ml and 5.05±2.05 fmol/ml. respectively, with the former being significantly increased (P<0.01). However, duration of the disease, degree of neurological impairment and spasticity were not related to the increase of SSLI. This suggests that the elevation of SSLI level occurs as a consequence of the pathological process of ALS.
In the PD group, the levels of SSLI and SPLI (14.9±3.6 fmol/ml and 4.59±1.51 fmol/ml, respectively) were not significantly changed. We divided parkinsonian patients into those with the slight disability (stage I, II), moderate disability (stage III) and severe disability (stage IV, V). The last group showed significant reductions of SSLI (10.6±1.4 fmol/ml, P<0.0 1) and SPLI (3.91 ± 0.97 fmol/ml, P<0.05) levels compared with those of controls. However, there was no correlation between SSLI and SPLI levels and the clinical characteristics of the parkinsonians including duration of disease, symptoms and duration of drug treatment. These findings support the speculation that somatostatinergic and substance P containing neurons as well as dopaminergic neurons are involved in patients with advanced Parkinson's disease.
In the SCD group, the levels of SSLI and SPLI (16.1±4.6 fmol/ml and 4.76±1.73 fmol/ml, respectively) were similar to those in controls. Classifying SCD into 4 groups : olivopontocerebellar atrophy, Menzel type of hereditary ataxia, late cortical cerebellar atrophy, and Holmes type cerebellar atrophy, the SPLI levels were slightly decreased in olivopontocerebellar atrophy (4.37±1.53 fmol/ml) and Menzel type of hereditary ataxia (4. 53 ± 0.90 fmol/ml), especially in those with orthostatic hypotension, whereas the SSLI level was slightly elevated (20.2±4.8 fmol/ml) in the latter. This suggests that the reduction of CSF SPLI in SCD may reflect autonomic dysfunction.

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DNA : DNA in situ hybridization (ISH) using a biotinylated cDNA probe was carried out to investigate the presence of herpes simplex virus (HSV) genome in formalin-fixed, paraffin-embedded tissue sections from human autopsy cases. In cases of HSV infection, HSV DNA was clearly identified by ISH in the nuclei of cells with Cowdry type A or full type inclusions. No background staining was observed. None of the control sections from esophagus or brain from a case of necrotizing encephalitis hybridized with the HSV DNA probe. This study suggests that ISH using a biotin labeled HSV DNA probe is a specific and convenient method for confirming the diagnosis of HSV infection.

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During the eighteen years from 1970 to 1987, 431 patients with advanced gastric cancer underwent curative resection. Their five-year survival rate was 54.1%. The factors influencing survival were the tumor sige, the stage of the disease, the depth of tumor infiltration, lymph-node metastases, and the degree of tumor resection.

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Prostatic cancer is one of the most common malignant tumors in the field of Urology. The number of the patients is increasing rapidly and its importance as a mortal disease is getting attention. In 1985, we organized a registration system for prostatic cancer patients found in and around Gunma prefecture. In this study, we analyzed the clinical characteristics of the 295 patients registered from 1987 to 1988. The results were as follows.
1. Mean age was 74.5 years old and the number of the patients was the greatest in the eighth decade.
2. Voiding disturbance was the most common chief complaint, followed by pollakisuria and miction pain.
3. Stage and grade distribution were as follows. Stage A 20.3%, B 16.9%, C 15. 2%, D 47.6%, well differentiated 25.9%, moderately differentiated 49.6% and poorly differentiated 24.5 %, respectively. A statistically significant relationship between stage and grade was observed.
4. Bone was the most common metastatic site. The highest incidence of bone metastasis was in ribs, followed by lumbar vertebra, ilium, thoracic vertebra and ischium.
5. The value of PAP, ALP and ESR tended to be higher in the patients with bone metastasis and that of Hb lower.
6. The serum testosterone was decreased rapidly from the ninth decade.
7. Twenty patients were detected by mass screening. Most of these patients were in an early stage.
8. Most of the patients were treated by hormonal therapy. LH-RH agonists constituted 46.3% of the hormonal therapy.

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From May 1967 to January 1990, 20 patients with a clinical diagnosis of primary hyperparathyroidism (P-HPT) were treated surgically at our department.
In this series, histological types were 16 adenomas (80%), 2 hyperplasia and one carcinoma. There were five men and 15 women, aged from 17 to 69 years (a mean age of 48. 5 years). Abnormal parathyroid gland could not be found intraoperatively in one case.
In the adenoma cases, histologically, 3 cases showed cellular atypism and findings suspicious of capsular invasion which were defined as borderline.
On biochemical data, all cases showed high values for C-PTH and serum level of calcium excluding two cases of normocalcemia.
The equivalent diagnostic value of ultrasound sonography (US), CT scan (CT) and 201T1-99m Tc subtraction in preoperative localization studies revealed values of 100%, 83.3% and 50% respectively. US and CT were thus concluded to be very useful examination for localization of the pathology.
The prognosis showed a very satisfactory outcome excluding one death case of carcinoma.
It is important that P-HPT is diagnosed and treated as early as possible.

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A 74-year-old man was diagnosed as having B chronic lymphocytic leukemia in June 1989. In 1940, when he was 25 years old, he was found to have tuberculoid leprosy and treated for 10 years. He subsequently received no therapy. As chronic stimulation by mycobacterium leprae might lead to malignant transformation in the lymphatic system, it was suspected that in this case leprosy may have played some role in the development of the chronic lymphocytic leukemia. However, no evidence to support such a hypothesis was obtained.

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The patient was a 70-year-old woman with back pain and gait disturbance. Destructive changes of Th 12 and L 1 were detected on x-ray of the vertebrae. Laminectomy and biopsy of the tumor tissue was performed. The histology of the specimen showed metastatic follicular carcinoma of the thyroid. However, no tumor was palpable in the anterior neck region. Echography revealed a small nodule in the left lobe of the thyroid. A preoperative diagnosis of the occult carcinoma with vertebral metastases was made, and total thyroidectomy with bilateral cervical lymph node dissection was done. In the resected specimen, a firm tumor measuring 1.0 × 1.0 × 0.6cm in size was found in the left lobe. Histologically, the firm nodule in the left lobe showed the sclerosing type of follicular carcinoma, and no metastases of the lymph nodes were found. After operation, radiation therapy using ¹³¹I (100mCi) was done.
In our department, we have had 757 cases of primary thyroid carcinoma. These include 10 cases of occult carcinoma, 9 cases (1.1%) found by lymph node metastases, and only one case (0.1%) detected by distant metastasis. It is considered that occult carcinoma of the thyroid found by distant metastasis is very rare.

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Patients with syringomyelia are usually diagnosed by its characteristic symptoms and signs including dissociated sensory loss, muscle weakness and atrophy of hands and arms, pyramidal tract signs in the lower extremities and disturbed autonomic nerve function. It is difficult to diagnose cases lacking in these classical clinical features, especially in those lacking sensory deficit. Recently developed MRI, however, has been reported to reveal the spinal cavitation in abortive cases of syringomyelia. We found a 49 year-old female who showed no sensory disturbance in spite of having a large syrinx demonstrated by MRI.
Her neurological findings were as follows : absent or diminished deep reflexs in the upper extremities and hyperactive reflexes in the lower extremities with positive extensor plantar responses : muscle weakness and atrophy of hands and forearms with occasionally observed fasciculation ; and mild thoracic scoliosis. Sensations to touch, pain and temperature were preserved as well as deep sensation. MRI clearly delineated a large syrinx and swollen spinal cord below the third cervical segment with a narrowed subarachnoid space. Chiari-Arnold type 1 malformation was also demonstrated. Myelography and CT myelography with metrizamide confirmed the MRI findings.
Her neurological findings might have led us to diagnose her as motor neuron disease if the neuroradiological examinations were not performed. Therefore, it should be noted that because the diagnostic importance of sensory loss in syringomyelia is stressed, a patient without definite sensory loss is apt to be misdiagnosed as motor neuron disease. It is essential to differentiate the two disorders, since a shunt operation is known to improve the neurological deficits in syringomyelia while motor neuron disease is still a fatal disorders. For this purpose, our case clearly showed the diagnostic usefulness of MRI.
It is generally accepted that dissociated sensory loss in syringomyelia is caused by disruption of the ventral white commissure distended and compressed by a expanded syrinx. Although the syrinx seemed large enough to damage the commissure in the present case, there was no sensory disturbance. Several authors have recently reported that there is no significant relationship between the neurological deficit and the dimensions of the syrinx. This means that the clinical symptoms and signs are not produced simply by intraspinal tissue being directly damaged by the expanded syrinx. The effects of disturbed circulation secondary to the compression, the difference in sensitivity to the ischemia or the compression, the rate of growth of the syrinx, and the compensatory or reserve capacity of the tissue should be all considered.

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An autopsy case of ruptured splenic artery aneurysm is reported. A 44 year old woman who had been suffering from liver cirrhosis, was admitted with severe abdominal pain. She died four hours after admission. An autopsy revealed two splenic artery aneurysms within a massive blood clot in the left retroperitoneal space. Cirrhosis of the liver and splenomegaly were also present. An increased blood flow in the splenic artery due to portal hypertension is suggested to be a factor which may have contributed to the formation and rupture of the aneurysm.

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