To determine the usefulness of imaging diagnosis for fatty liver, several image pictures obtained by ultrasonography and CT scan were compared with the histological degree of fatty liver. The 83 subjects of this study were underwent liver biopsy and the fatty infiltration ratio (FIR) was calculated. Fatty liver was diagnosed when FIR was above 30%. FIR was significantly correlated with cholesterol and triglyceride level in all patients investigated. Moreover, the correlation of FIR with thymol turbidity test, triglyceride and ICG and with triglyceride were observed in obese patients and patients with alcoholic liver disease, respectively. The fatty bandless sign on ultrasonographic examination was useful for the diagnosis of fatty liver (sensitivity, 97.9% ; specificity, 67.0% ; accuracy, 86.5%). The sign of deep attenuation also was useful for the diagnosis of fatty liver (sensitivity, 53.2% ; specificity, 97.2% ; accuracy, 72.9%). Furthermore, fatty score was calculated from liver-kidney contrast, vascular blurring and deep attenuation, which were ultrasonographic findings of fatty liver. The fatty score corresponded well to the diagnosis of fatty liver (sensitivity, 93.6% ; specificity, 75. 0% ; accuracy, 85.5%). By CT scan, fatty liver was below 0.83 in the ratio of the CT number of liver to those of spleen, and the diagnosis of fatty liver could be made by CT scan (sensitivity, 76.9% ; specificity, 90.9% ; accuracy, 81.1%). By combining the data of fatty score and CT scan, the diagnosis of fatty liver was improved to 96.2% sensitivity, 90.9% specificity and 94.6% accuracy. Therefore, this study suggested that combining ultrasonography and CT scan might be the most useful procedures for the diagnosis of fatty liver if liver biopsy is not performed.

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Gastrointestinal carcinoma was induced in male Wistar rats by administration of N-ethyl-N'-nitro-N-nitrosoguanidine (ENNG). During the carcinogenic process, blood polyamine levels were measured, and pathological investigation was conducted simultaneously.
The results were as follows :
1) Polyamine levels increased with the advancement of tumors.
2) When tumors invaded to the submucosal layer or deeper, the blood polyamine levels became higher than those in control rats ; the increases in spermidine and spermine levels were especially remarkable.
3) The level of each polyamine was significantly higher in tumor-bearing rats than in control rats.
These results suggest the usefulness of blood polyamine assay as a marker of carcinogenesis.

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To elucidate the morphological counterpart of the tubulo-glomerular feedback mechanism, kidneys of male rats were perfused for a short time with different ion solutions and at different pressures, then fixed for thin-section electron microscopy. The macula densa of distal tubules specifically responded to such perfusion conditions with the widening of intercellular spaces, whereas other parts of the renal tubules did not show any appreciable changes in epithelial structures. The intercellular spaces of the macula densa widened most extensively when perfused with 140 mM NaCl and less extensively with 140 mM NaHCO₃, but remained almost entirely closed with 140 mM CH₃COONa and 70 mM CaCl₂. When perfused at different pressures using the same solution, the intercellular spaces were widest at the perfusion pressure of 80 mmHg, and were narrower in the order of 40, 120 and 160 mmHg. The present observations are well consistent with the physiological analysis reported previously. Thus, the macula densa may change the intercellular space in response to the ion composition and possibly pressure of urine running down the distal tubule, suggesting its involvement in the tubulo-glomerular feedback mechanism.

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We performed stereotactic VIM (ventralis intermedius), VIM-CL (centralis lateralis) or VIM-Vcpc (ventralis caudalis parvo-cellularis) thalamotomy in 19 patients with thalamic pain. The electrophysiological characteristics of the thalamus in patients with thalamic pain were analyzed. Patients were classified into non-thalamic and thalamic lesion groups on CT scan. Of 19 patients 13 were men (46-76 years) and 6 women (43-69 years); 11 showed cerebral infarct and 8 hemorrhage. Abnormal sensations including pain developed 1 month to 6 years (mean 11 months) after stroke. The clinical features of thalamic pain were referred to as “superficial pain” and “deep pain”. In the non-thalamic lesion group, we could usually recognize more deep than superficial pain, while, in the thalamic lesion group, superficial pain was predominant. We analyzed thalamic electrical activities [unitary spike discharges and background neural activity (BNA)], and compared them with those of parkinsonian patients. Furthermore, sensory neurons identified mainly in the thalamic sensory nucleus were studied with regard to the modality of peripheral natural stimulation, the distribution of peripheral receptive fields and the location of response sites in the thalamus.
Thalamic electrical activity was correlated with the state of thalamic lesions on CT scan and non-thalamic lesions, respectively. In the non-thalamic lesion group, thalamic BNA was relatively preserved in the ventral thalamus, but was not uniform in the VIM nucleus (compared with that of parkinsonian patients). Furthermore, the peripheral receptive field of sensory (kinesthetic) neurons was predominantly the face or mouth area, deviating from standard thalamic topography in the VIM nucleus. These findings suggest that functional change or reorganization in the thalamic sensory nucleus occurred in this group. In the thalamic lesion group, BNA decreased markedly in the ventral thalamus, particularly in the VC nucleus, and sensory (kinesthesic) neurons were rarely identified. Additionally, in about half the operated cases irregular burst discharges in and around the VIM nucleus were frequently observed. It was suggested that the different character of thalamic pain, both deep and superficial, is associated with that of local pathophysiology in the thalamic sensory nucleus.

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A. Regional cerebral metabolism in patients with thalamic pain
PET studies were performed in 11 cases of thalamic pain after CVD (cerebrovascular disease) to elucidate its metabolic features in the brain. They consisted of either a C¹⁵O₂-¹⁵O₂ continuous inhalation study to measure regional cerebral oxygen consumption (rCMRO₂), regional cerebral blood flow (rCBF) and regional oxygen extraction fraction (rOEF), or an ¹⁸F-fluoro-2-deoxy-D-glucose (¹⁸FDG) study to measure regional cerebral glucose utilization (CMRGL) Subjects (patients and controls) in the gas (C¹⁵O₂-¹⁵O₂) study were divided into 4 different groups : a thalamic lesion group with pain (P-Th group) (4 cases), a putaminal lesion group with pain (P-Put group) (6 cases), a thalamic lesion group without pain (NP-Th group) (2 cases) and a normal control group (N group) (3 cases). An FDG study was performed in 4 cases : 3 cases of thalamic pain and 1 normal control. Gas study was additionally performed in pain cases.
In the P-Th group, rCMRO₂ was relatively well maintained in most brain structures except lesioned sensory-thalamus. In the cerebral cortex around the central sulcus, the rCMRO₂ level was almost normal. Furthermore, rOEF and the relative value of CMRGL, compared with rCMRO₂, also increased in these structures. In the P-Put and NP-Th group, however, rCMRO₂ decreased in all brain structures, as did rCBF, rOEF and CMRGL, and in the P-Put group, the oxygen-glucose molar utilization ratio (OGMUR) was within the normal limit. Therefore, CBF and oxygen metabolism in the thalamus on the CVD lesion side decreased in all cases with thalamic pain. In the P-Th group, it was suggested that the function of the nonspecific activating afferences, including the thalamic intralaminar nuclei, was maintained, and abnormal (excess) neural activity had occurred in the cerebral cortex around the central sulcus.
B. Pathophysiology of thalamic pain
CT study in cases with thalamic pain showed that the damage to the ventral postero-lateral part of the thalamus was an important factor in the development of spontaneous pain. In the pain group the size of lesions was apparently smaller than that of other sensory disturbance groups in the chronic stage. Furthermore, thalamic electrophysiological study showed that the character of thalamic pain, both deep and superficial, was associated with that of local pathophysiology in the thalamic sensory nucleus. In the non-thalamic lesion group, we could recognize more deep than superficial pain, and BNA (background neural activity) was relatively well preserved in the ventral thalamus. It was also suggested that functional change or reorganization in the thalamic sensory nucleus occurred in this group. In the thalamic lesion group, superficial pain was predominant, and BNA decreased markedly in the ventral thalamus, particularly in the VC nucleus. Cerebral metabolic study in this group indicated that rCMRO₂ was relatively well maintained in the cerebral cortex around the central sulcus, and rOEF and the relative value of CMRGL, compared with rCIVIRO₂, also increased. These findings suggest that the function of the nonspecific activating afferences, including thalamic intralaminar nuclei, was maintained, and abnormal (excess) neural activity had occurred in the cerebral cortex around the central sulcus (senrori-motor cortex).
These studies lead us to postulate that thalamic pain may be ascribed to both dysfunction of the thalamic relay nucleus and sensory cortex.

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To investigate the relationship between bodily cognition and environmental cognition, 88 chronic schizophrenic patients were examined using three tests for body image (left-right orientation test, face-hand test, and graphesthesia test) and three tests for viewpoint manipulation (viewpoint exchange task test, cognitive map test, and bush test). Correct and incorrect responses were tallied for each test. The type III quantification method was used to explore the relationships among response categories (correct and incorrect responses) of the two types of tests. Two axes were extracted : axis I and axis II were respectively labelled “good-poor adjustment of viewpoint” and “decreased-persisting cognitive activity.” Response categories were classified into 7 groups as related to the axes. The groups located on the minus side of axis I were characterized by patients' inability to identify the right and left sides of their own body that was associated with an inability to imagine the examiner's perspective. The findings from the group located on the plus side of axis II indicated that rigidity of the body image was associated with unstructured cognition of the environment. And the findings from the group located on the minus side of both axes indicated that distortion of the body image was associated with partial cognition of the environment.
Next, the relationship between the sample score for each axis and background factors (intelligence quotient, scores of the Brief Psychiatric Rating Scale, etc.) of the patients was examined. The sample score of axis I was positively and significantly correlated with the intelligence quotient. This showed that the intelligence quotient of patients whose adjustment of viewpoint was poor was lower than that of the patients whose adjustment of viewpoint was good.
The sample score of axis II was negatively and significantly correlated with scores on three items (hallucination, delusion, and uncooperativeness) in the Brief Psychiatric Rating Scale. This indicated that hallucination, delusion, and uncooperativeness were pronounced in the patients that maintained cognitive activity.

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The results and characteristics of 606 cases of urolithiasis treated from July 1982 to February 1989 at Gunma University Hospital and Jomo Urological Hospital were compared and a new treatment policy for urolithiasis was determined. Sixty patients were treated with open surgery, 30 with percutaneous nephroureterolithotomy (PNL), 317 with extracorporeal shock wave lithotripsy (ESWL) for renal and upper ureteral calculi, 74 with transurethral ureterolithotomy (TUL), 93 with ESWL for mid and lower ureteral calculi, 16 with stenting ESWL and 16 with combined PNL-ESWL therapy for large calculi. For each treatment, we studied removal rates of calculi, postoperative hospital stay, minor complications, trauma to the collecting system, renal parenchymal damage and the simplicity of reoperation. ESWL was first and TUL second in cost-benefit ratio as represented by removal rates of calculi and postoperative hospital stay. ESWL was the best and TUL ranked second in patient's accessibility to operation as represented by postoperative hospital stay, minor complications and trauma to the collecting system. ESWL was the best, followed by TUL, pyelolithotomy and ureterolithotomy in the extent of invasion of the urinary tract of the patient as represented by trauma to the collecting system and renal parenchymal damage. ESWL was the best and TUL second in doctor's accessibility to operation as represented by renal parenchymal damage, simplicity of reoperation and removal rates of calculi. We concluded that ESWL followed by TUL was the best procedure and that removal of urinary tract calculi should be performed mainly by ESWL, with consideration given to combination with other treatments. The choice of treatment depends on the diameter of the calculi. For upper ureteral and renal calculi with a maximum diameter of less than 20mm, ESWL alone is recommended as the first choice. For upper ureteral and renal calculi that are small in volume and have a maximum diameter greater than 20mm, stenting ESWL is the first choice. For large volume calculi, PNL-ESWL combination therapy preceded by PNL is the method of choice. For mid and lower ureteral calculi, ESWL including lifting with a ureteral catheter is the method of choice, and in case of failure, TUL or ESWL preceded by lifting with TUL should be performed.

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We report an experiment to determine the effects of an atherogenic diet on muscular-type arteries in (heart, mesenterium, pancreas, kidney) hypertensive rats (SHR) for up to 1.5 years. The rats (SHR and nonSHR) were fed a high fat diet with to 10% lard, 1% cholesterol, and 0.5% cholic acid. Some of the SHR showed increased accumulations of foam cells, fibrinoid substances and myointimal cells. Typical atherosclerotic intimal lesions were also found in SH R. There was evidence that both blood mononuclear cells and smooth muscle cells were converted into foam cells in the intima. It is postulated that blood mononuclear cells, fibrinoid substances and myointimal cells play an important role in the formation of intimal foam cell-rich lesions in experimental dietary atherosclerotic lesions. In contrast no atherosclerotic lesions were found in normotensive rats for a period of up to 3 years. Thus hypertension and hypercholesterolemia play important roles in producing foam cell-rich intimal lesions.

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The immunohistochemical aspects of 18 patients with autonomously functioning thyroid nodules (AFTNs) examined between 1984 and 1988 are investigated. The diagnosis of AFTN is made by the thyroid scintigraphy, which shows increased radioiodine uptake (hot nodule). Histologically, follicular adenoma was present in 5 patients and adenomatous goiter in 13.
For the immunohistochemical investigations, paraffin sections were stained for thyroglobulin (Tg), thyroxine (T₄), and triiodothyronin (T₃) using the avidin-biotin peroxidase complex method. The positivity for Tg, T₃ and T₄ was found to be stronger in AFTN tissues than in the extranodular thyroid tissues. In particular, they were strongly positive in the areas of papillary structure and microfollicles, or some eosinophilic cells in the foci of lymphocyte infiltration associated with focal thyroiditis. In conclusion, the immunohistochemical examination of T₃, T₄ and Tg is useful for differentiating AFTN from a nonfunctioning nodule or carcinoma of the thyroid.

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Renal osteodystrophy (ROD) is one of the complications of chronic renal failure managed by long-term hemodialysis. These patients with severe secondary hyperparathyroidism (2°HP) who cannot be controlled with medical treatment require surgical intervention.
We experienced seven patients with 2 °HP treated by total parathyroidectomy with forearm autotransplantation. These patients had goad postoperative results and no preoperative complaints.
In addition, their extremely high levels of c-PTH and alkaline phosphate in serum were reduced to the normal range. Total parathyroidectomy with parathyroid autotransplantation should be recommended for patients with 2°HP who have moderate or severe renal osteodystrophy, bone pain and palpable parathyroid nodules.

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過去11年間に多野総合病院で施行した消化器外科領域における早期再手術症例について検討した. 症例は32例で全手術数の1.7%, 平均年齢60歳, 男女比は3.3 : 1である.原疾患では胃・十二指腸癌13例, 結腸直腸癌9例で再開腹症例の69%を占めており, 死亡率は19%であった.再手術の原因別頻度は腹壁創〓開27%, イレウス21%, 縫合不全15%, 膿瘍12%, 出血12%で全体の85%を示した.創〓開は全開腹例の0.5%に発生し全層〓開が70%を占める.発生因子として術後肺合併症の関与が大きいと考えられた.イレウスは全開腹術の0.4%に発生し小腸腹壁問の癒着が原因となっていることが多く, 術中の創保護が重要である.縫合不全, 腹腔内膿瘍の発生率はそれぞれ0.5%, 0.2%で死亡率は20%及び0%である.早期に適切なドレナージ術を施行できたものの予後は良好であった.出血は全手術例の0.3%にみられ, 全身循環動態の変化を認めてから10時問以上経過したものは予後不良であった.その他, 腹腔内異物, 初回手術時の誤診に基づくもの, 難治性腸瘻による早期再手術例を認めた.再手術による死亡率はきわめて高いのが現状であり術後合併症の予防に細心の注意をはらうことは言うまでもないが一旦発生した場合には早期に病態を把握し再手術の時期を失しないことが治療成績の向上に重要である.

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A 19-year-old male underwent right orchiectomy for testicular tumor on December 25, 1986, Histopathological examination revealed teratocarcinoma and embryonal carcinoma. Three courses of salvage chemotherapy with cisplatin, VP-16 and bleomycin (PEB) were preformed for multiple lung and abdominal retroperitoneal lymph node metastases. Re-elevation after chemotherapy showed clearing of the chest lesions, normal tumor marker levels and decreasing size of the abdominal mass. Residual retroperitoneal lymph node metastasis was resected. A potion of aorta denuded by tumor dissection was reconstructed from a patch of a knitted graft. After salvage surgery, the patient experienced abdominal and back pain, subfebrile temperature, and upper gastrointestinal bleeding. Aortoduodenal fistula was diagnosed intraoperatively.

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The first patient was a 42-year-old female with angiomyolipoma. The second was a 55-year-old female who had been operated on for distal pancreatectomy and left nephrectomy for right renal cell carcinoma. Partial nephrectomies were performed for the preservation of renal function. Postoperative renal functions were no problem. One year after the operation, they have no sign of recurrence or metastasis.

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Mediastinal malignant lymphoma is not uncommon, but rarely occurs primarily in the posterior mediastinum. A case of primary malignant lymphoma in the posterior mediastinum diagnosed by CT-guided biopsy is reported.
The CT appearance was similar to that of malignant lymphoma in the anterior mediastinum, as previously reported, : 1) relatively homogenous density on plain CT, 2) inhomogenous density on enhanced CT, 3) no evidence of calcification or cyst formation, 4) normally demonstrated great vessels in the mass lesion, and 5) pressure the lung laterally with smooth margin.
The CT-guided extrapleural paravertebral approach to the posterior mediastinum was previously reported as useful and safe for needle biopsy and drainage, because CT allows accurate localization of the lesion and surrounding structures. The bones and neural foramens were easily avoidable because of good demonstration on CT, though the intercostal vessels and nerves were not demonstrated on CT. Life-threatening hemorrhage from the internal mammary artery during CT-guided needle biopsy of the anterior mediastinal lesion was previously reported. Hence a safe technique is needed. However, no important complications occurred in our patient.

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A case of multiple bilateral intra-thoracic meningoceles without neuro-fibromatosis is reported.
The patient complained of back pain and consulted a doctor. An abnormal mass- like shadow was detected on chest Xp, and CT scan was performed. Multiple tumors at the paravertebral lesion were pointed out, so she was admitted to our hospital. She was examined with CT scan and MRI. The diagnosis was intrathoracic meningocele. Intrathoracic meningocele is uncommon and bilateral or multiple lesion are rarely seen. Intrathoracic meningocele is usually associated with neurofibromatosis. While CT scan with metrizamide is useful, MRI is useful and safe in differentiating meningocele from other posterior mediastinal tumors.

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