The malignancy of a brain tumor has mainly been assessed by histopathological examination of the tumor. However, the use of more quantitative criteria than histological findings to evaluate the malignancy is anticipated. In the present study, the author examined the amount of nuclear DNA by microfluorometric analysis and the Ki-67 labelling index, using immunohistochemistry, in 132 cases with various brain tumors. These results were compared with the histopathologic findings of the tumors to assess the validity of these criteria as indicators of tumor malignancy. The DNA histogram showed an increase in the DNA index and a diversity of ploidy patterns in association with an increase in the histological grade of tumor malignancy. The DNA index and ploidy diversity were correlated with cellular pleomorphism, mitotic figures, and vascular endothelial proliferation. The Ki-67 labelling index also showed a positive correlation with the histological grade of tumor malignancy. There was no significant relationship between Ki-67 labelling and nuclear DNA parameters. This means that the two indices are mutually independent criteria in the evaluation of tumor growth potential. It is suggested that microfluorometric DNA analysis shows tumor cell abnormalities at chromosomal and genetic levels, and that the Ki-67 labelling index indicates the size of the growth fraction of a tumor. It is concluded that these two parameters are useful in evaluation of the proliferative potential of a given brain tumor.

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Using enzyme-linked immunosorbent assay (ELISA), the levels of β-lactoglobulin (BLG) specific IgM and IgG antibodies were examined in healthy neonates. In exclusively breast fed neonates, BLG-specific IgM antibody titres were significantly increased on days 30-44 as compared to day 0. On the contrary, specific IgG antibody titres were not increased. In formula fed neonates, IgM and IgG antibody titres were both increased on days 30-44. A comparison of the IgM titres of both groups showed no difference on days 3-8 or 30-44. IgG antibody titres were significantly higher in formula fed neonates than in breast fed neonates on days of 10-24 and on days 30-44. In a comparison of 13 paired maternal sera and cord sera, both specific IgM and IgG antibody titres were higher in maternal sera than in cord sera. Especially, specific IgG antibody titres were higher in maternal sera in all paired cases. The above results showed stimulation of BLG in the immune systems of healthy neonates through breast milk, sensitization of the fetus by BLG, and the selectivity of placental transport of specific IgG. To clarify the roles of these antibodies, further studies are required.

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The effects of mental stress and isometric handgrip exercise on peripheral white blood cell counts and plasma active renin concentrations were studied in 20 patients with mild essential hypertension. The increases in blood pressure and pulse rate were similar for both provocations. Mental stress increased white blood cell (10.3±2.1%), platelet (2.8±1.6%), and red blood cell counts (1.7±0.3%). Isometric exercise also increased these blood cell counts (6.2±1.2%, 1.9±0. 8%, 1.0±0.3%, respectively). The increase in white blood cell counts with mental stress was significantly greater than that in response to isometric exercise. With both provocations, the increase in white blood cell counts was significantly greater than those in platelet and red blood cell counts. There was a positive correlation between the increases in white blood cell counts and systolic blood pressure with mental stress (r = 0.49, p<0.05). Mental stress increased plasma concentrations of active renin and aldosterone, but isometric exercise did not affect these hormones. These results indicate that both white blood cell counts and concentrations of renin and aldosterone are higher in mental stress than in isometric exercise. It is possible that leukocytosis induced by mental stress damages target organ in hypertensive patients.

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Olsen et al, reported that changes simulating hypertrophic cardiomyopathy were produced in newborn rats when triiodothyroacetic acid (triac, an analogue of thyroxine) was given during the fetal period. However, triac is barely transported across the rat placenta, while thyrotropin releasing hormone (TRH) is readily transported across the rat placenta and acts directly on the fetus. In this study, TRH was administered to pregnant female rats and its effects on the hearts of their offspring were studied using morphologic and immunohistochemical techniques with Bromodeoxyuridine (BrdU). The hearts of the TRH-treated newborn rats showed disproportionate septal hypertrophy and frequent septal myocardial fiber disarray. The labeling index of BrdU in the septum was significantly higher in the TRH-treated newborn rats than in controls. In the TRH-treated newborn rats, the labeling index of BrdU was significantly higher in the septum than in the free wall. These results indicate that TRH administration during the fetal period causes an increase in myocardial cellular proliferation, especially in the septum, resulting in disproportionate septal hypertrophy in the newborn rats.

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Along with the prevailing application of various imaging modalities in daily clinics, the number of reports for diagnostic radiology has rapidly been increasing. Referring to the results of the previous questionnaire carried out in Gunma University Hospital in 1992, another questionnaire for clinicians working at community hospitals in Gunma prefecture was conducted to ascertain the utilization, archiving, and assessment of the report system. The recovery rate was 87%. Reports of ultrasonography, CT, MRI, angiography, and nuclear medicine were utilized by more than 80% of referring doctors. The reports of plain films and contrast enhanced roentgenography were also highly utilized, particularly in small-sized hospitals. In hospitals that have full-time diagnostic radiologists these reports are also frequently read. Most of the referring clinicians unanimously commented that reports should correspond with actual clinical problems and by easily legible with adequate schemes. The difference from the study of Gunma University Hospital was thart the requests for the contents were surely based on daily clinics and subjective comments, as well as objective imaging findings, made by the diagnostic radiologists. However, the addition of subjective comments differs from hospital to hospital, with respect to the size of the hospital and presence or absence of full-time diagnostic radiologists. For the increased utilization of radiology reports, an exchange of information between radiologists and clinicians seems to be essential. Improvement of reporting system is anticipated with the employment of recently developed database software or word processors which handle imaging files.

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We studied the usefulness of transcatheter arterial embolization (TAE) for initial control of gastrointestinal and intra-abdominal bleeding. Four patients had gastrointestinal bleeding and four had intra-abdominal bleeding. Five patients underwent TAE and three laparotomy. The results were as follows :
1) TAE identified bleeding arteries in all the patients.
2) TAE controlled bleeding in four patients (80%) with no complications.
3) The TAE treatment group required significantly (P<0.005) lower transfusion volumes than the surgical series.
In conclusion TAE is useful for gastrointestinal and intra-abdominal bleeding.

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A 37-year-old man who was suffered from abdominal pain and melena was hospitalized in 1984. Gastrointestinal examination indicated the presence of ulcers of the terminal ileum, however, pathological diagnosis could not be performed because of its location. Continuous melena led us to perform an exploratory operation. Macroscopic observation indicated that three small punched out ulcers at the terminal ileum seemed to be benign. These ulcers were revealed to be simple ulcers microscopically. Any findings which might indicate Behcet disease were not observed. So we diagnosed this case as simple ulcer of the terminal ileum.
This report contains an analysis of 231 cases of simple (or non specific) ulcers which were reported in Japan within the last 5 years.

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A 60 year-old man with Wolff-Parkinson-White (WPW) syndrome was admitted to our hospital because of atrial fibrillation and heart failure. He had a history of paroxysmal atrial fibrillation which had increased in frequency as mitral stenosis progressed over a period of 10 years. Since heart rate-dependent torsades de pointes appeared after DC defibrillation due to class IA antiarrhythmic agents, the drug was withdrawn and an intravenous infusion of isoproterenol was started. Sinus rhythm was restored and maintained by restarting the administration of the class I A antiarrhythmic agent. Electrophysiological examination revealed a single accessory conduction pathway and no retrograde conduction, the effective refractory period was prolonged to 330 msec. After the heart failure had improved, mitral valve replacement and transection of the bundle of Kent were performed. Because of the possibility of grave hemodynamic derangement induced by marked tachycardia, surgical treatment should be seriously considered in patients with mitral stenosis when associated with WPW syndrome and atrial fibrillation, even in those not classified as high risk patients.

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We recently experienced two patients who underwent surgical resection of pericardial diverticulum in the right middle mediastinum. The diagnosis was obtained during surgery.Fifty-nine percent of reported pericardial diverticula in Japan were located in the right upper or the right middle mediastinum ; the majority were in “cephalad recess of azygos vein” which is between the superior vena cava and the azygos vein. This seems to be the noteworthy position for pericardial diverticulum. Therefore, the frequency of a cystic tumor in the right upper or right middle mediastinum being a pericardial diverticulum may be high.

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