The histological changes of 63 patients with primary glomerulonephritis and 48 patients with lupus nephritis, all of whom revealed numerous glomeruli in renal biopsy specimens, were assessed quantitatively and the relationship with renal function test results was studied. In the case of primary glomerulonephritis, there was a more favorable correlation of creatinine clearance with the extension of tubulointerstitial changes than with the severity of glomerular diseases. In lupus nephritis there was a favorable correlation of creatinine clearance with histological tubulointerstitial changes but not with glomerular diseases.

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Preoperative diagnosis of cervical lymph node metastasis is very important in determining a rational policy of treatment for esophageal carcinoma. Between July 1988 and December 1991, 101 patients with esophageal carcinoma were subjected to preoperative ultrasonography of the cervical region. Esophageal resection was performed for 72 of the 101 patients, and cervical lymph node dissection was additionally performed for 57 of the 72 patients. The relationship in these 57 cases between preoperative ultrasonographic findings and pathological findings relating to the dissected lymph nodes was studied. According to formerly accepted ultrasonographic diagnostic criteria, the results were as follow : sensitivity, 58.3% ; specificity, 97% ; accuracy, 80.7% ; false positive, 17.5%, and false negative, 1.8%. These results indicated that the expected diagnosatic rations could not be obtained with the former ultrasonographic diagnostic criteria. New ultrasonographic diagnostic criteria based on quantitative data for greater subjective judgement were esstablished to measure the occupational ratio of cancerous lesions within metastatic lymph nodes. These criteria were : 1. Ratio of lymph node short diameter to long diameter should exceed 0.5. 2. Long diameter of lymph node should exceed 0.5 cm. Lymph nodes satisfying these requirements should be considered as metastasis positive. According to these new diagnostic criteria, the aformentioned results were as follow : sensitivity, 71.4% ; specificity, 100% ; accuracy, 87.7% ; false positive, 10.5%, and false negative, 0%. A satisfactory diagnostic ratio was obtained.

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The distribution of arterial supply observed by injecting acrylic pigment into the arteries of the pectoralis major muscles of 25 adult Japanese cadavers (50 sides) is reported. 1. Classifications based on the points of origin of the arteries and their patterns of distribution. Type I : internal thoracic artery (Tin) distributing over the inner half of the sternocostal portion (SP) and the abdominal portion; thoracoacromial artery (Ta) distributing in the entire clavicular portion (CP) and the outer half of the SP, and the abdominal part artery (Pab, SATO '76) arising separately from both the subclavian artery and the axillary artery and distributing in the AP to the Tin and Ta. Type II : Ta and Pab from a common stem. Type III : Pab shares a common stem with arteries other than Ta. Subtype a : Pab distributing in the AP. Sub-type b : Pab lacking in the AP. The most frequently observed was Type I -a (40.0%), followed by Type n-a (26.0%) 2. Classifications based on Upper part branch (Upb, SATO-TAKAFUJI '90). Of Types A, B, C, and D, Type C (46.0%) in which Upb arose from pectoral branch of Ta was most frequently observed. 3. Classifications based on levels of development of Pab in its area of ditrbuition. Of Types a-1. a-2 and a-3, Type a-2 (68.0%) was mosty frequently observed. 4. Mean ratio of area of distribution of each artery to whole area of pectoralis major muscle was as follows : Tin, 41.8% ; Ta, 50.4% ; Pab, 9.3% 5. The numbers of arteries supplying the pectoralis major muscle and their occurrences were as follow : three, 80.0% ; two, 16.0%.

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As part of a series of studies of the arterial supply of human muscles, the extensor digitorum longus muscles of 10 adult Japanese adult cadavers (20 sides) were examined to determine the origin of nutrient arteries, their networks, and the areas of distribution within the muscle. The muscle mainly is supplied by a branch from the A. tibialis anterior (Ta). The A. peronea (Pa) distributes in part of this muscle. In cases where the lower muscle bundles are well developed, they are partly supplied by a branch from the A. dorsalis pedis (Dp). Among arterial branches in the muscle are the R. extensor digitorum longus (Redl) which supplies this muscle alone and branches common with other muscles (om). 1) The following classifications were based on the origin of the nutrient arteries and their distribution. Type I-a : The A. recurrens tibialis (Rta), which branches from Ta, is distributed in the upper muscle bundles, and the Ta (om), Ta (Redl) and Pe are distributed in the lower upper, central and lower muscle bundles‥‥85.0% Type I -b : Same as Type I-a except Dp is distributed at bottom of lower muscle bundles‥‥5.0% Type II-a : Same as Type I-a except Pe is lacking‥‥10.0% Type II-b : Same as Type I-b except Pe is lacking‥‥None 2) Areas of distribution of nutrient arteries are as follow. Type I-a : Ta (Rta)‥‥12.8%, Ta (om)‥‥77.0%, Ta(Redl‥‥3.9%, Pe‥‥6.3%, Type I-b : Ta (Rta)‥‥3.8%, Ta (om)‥‥85.2%, Ta (Redl)‥‥6.5%, Pe‥‥1.7%, Dp‥‥2.8% Type II-a : Ta (Rta)‥‥19.2%, Ta (om)‥‥80.9% Ta is present in 94.4% of all cases. Of the Ta branches, Ta (Rta) is present in an average 13.0% of all cases, and Ta (om) in 77.8% (including Ta (omp) in 35.8%). Ta (omp) enters this muscle after running through muscle bundles around the origin of the extensor hallucis longus muscle. 3) The total numbers of nutrient arteries range from 8 to 20. The largest numbers of 13 and 17 was found present in 3 cases.

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In order to confirm the clinical characteristics of liver cirrhosis in the aged, 293 patients diagnosed with this condition were studied. They were divided into three age groups : a comparatively-young group of patients under 49 (40 cases), an elderly group of patients aged 50 to 69 (166 cases), and an aged group of those over 70 (87 cases). There was no evidence of gender domination in the aged group, and etiology was cryptogenic. Serologically positive hepatitis virus (HCV) cases accounted for 72.0%. The incidence of HCV positive cryptogenic etiology cases was lower than that in the elderly group. There were similar incidences of ascites and encephalopacy inthese groups. Other outstanding clinical features of the liver cirrhosis aged group were : lowlevels of albumin and cholinesterase and high value 15-minute retention of indocyanine green in liver function tests; a high incidence of such complications as liver cancer, gastric and esophageal varices, peptic ulcer diabetes mellitus and cholelithiasis. There was a low incidence of liver cancer as an immediate cause of death. It was concluded from these observations that the aged liver cirrhosis patient was highly susceptible to various complications because of a decrease in hepatic reservation function. Aged patients should therefore be provided with close, and strict, attention.

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During peritoneoscopic examination in cases of chronic liver diseases, a characteristic pattern of liver surface staining after intravenous injection of indocyanine green (ICG) became evident. A total of 431 cases, including 254 cases of chronic hepatitis and 177 cases of liver cirrhosis, were studied to determine the relationships among ICG staining intensity, liver function, and histological findings. In cases of severe liver dysfunction, ICG staining of the liver was weak or negative. The intensity of ICG staining decreased with increasing progress of the inflammatory process. There was a greater frequency of spotty ICG staining (S) in Type B chronic liver disease than in Type C. Spotty ICG staining (S) represented patchy markings on the liver surface in chronic hepatitis, and regeneration nodules in liver cirrhosis. The ICG staining method is very useful not only for observation of the liver surface, but also for study of function in peritoneoscopy.

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Regional cerebral blood flow (rCBF) in patients with major depression and in normal controls was measured by single photon emission computed tomography (SPECT) using N-isopropyI-p[^<123>I]-iodoamphetamine (IMP). The subjects were 22 patients with major depression and 14 normal controls. The rCBF was calculated by the ratio of activity per pixel in the cortical regions to activity per pixel in the cerebellum. IMP-SPECT was conducted twice in the case of patients with major depression, one in the depressive state and the second in the state of remittence. The results were as follow : 1) rCBF values in the frontal, parietal, temporal, basal ganglia and the occipital regions, and the mean rCBF values were significantly lower in the patients than in the controls. 2) Increased rCBF values were observed, and the mean rCBF normalized, in the state of remittence. There was no significant difference in mean rCBF between patients and the controls. It therefore is suggested that, as the lower rCBF was normalized following improvement in expressive symptoms, the rCBF values could be useful as "state dependent markers" in the case of patients with major depression.

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The postoperative mediated immunity in cases of digestive organ cancers was clinically studied, particularly differences in surgical intervention that influence mediated immunity. A total of 174 cases were studied, including 46 cases of esophageal cancer 53 cases of gastric cancer (subtotal gastrectomy) ; 40 cases of gastric cancer (total gastrectomy), and 35 cases of colorectal carcinoma. Regular blood examinations and periodic cell-mediated immunity examinations were carried out from the preoperative stage and up to six postoperative months. In esophageal carcinoma, serum albumin displayed a low value for up to two postoperative months, and low values for up to one postoperative month in the other diseases. Again, in esophageal carcinoma, CD 4/CD 8 displayed low values for one postoperative month ; the other diseases did not display distinct low values. In PHA blast transformation reaction transitions decreases were seen at two postoperative weeks in esophagealcarcinoma, gastric carcinoma, and colorectal carcinoma; esophageal carcinoma and gastric carcinoma patients displayed low values for up to one postoperative month. The postoperative cell-mediated immunity distinctly decreased in esophageal carcinoma, but the decrease in colorectal patients was comparatively slight. These results indicate that differences in surgical intervention do influence cell-mediated immunity control.

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Colon cancer tissue specimens were subjected to proton NMR spectroscopy (MRS) to evaluate the potential clinical usefulness of this technique. Ninetytwo excised colon cancer and normal mucosae specimens were obtained from 46 patients during surgery. As a preliminary study, colon cancer biopsy and cultured human colon cancer (cell line SW-620) specimens were subjected to MRS. Colon cancer and normal mucosae spectra of good reproducibility were easily acquired in this study. The spectra of both were similar. Although, in the cases examined, there was no significant change among all normal mucosa specimens and colon cancer specimens in choline/creatine peak area ratio (Cho/Cr ratio), colon cancer specimens obtained in cases associated with known metastasis demonstrated a significantly increased Cho/Cr ratio in comparison with that of normal mucosae (P<0.05). However, there was no significant change of this parameter in cases not associated with known metastasis. A high incidence of colon cancer showing prominent increase in Cho/Cr ratio was noticed in known metastasis cases with histologically confirmed well-differentiated adenocarcinoma (P<0.01). There was a significant decrease in this parameter (P<0.01) in cases with moderately differentiated adenocarcinoma.These results suggest that the potential of cancer metastasis is correlated with enhancement of the Cho/Cr ratio in well-differentiated, and could be a prognostic marker of this tumor. It also was shown that there could be diverse metastasis mechanisms in different degrees of cell differentiation.

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The phagocytosis of monocytes, cell surface markers and cytokines in colostum was studied. Comparing maternal peripheral blood and colostrum, the phagocytosis of monocytes is more active in the latter. The number of CD14 postive cells in colostrum is small, but the numbers of vimentin positive cells and TfR positive cells are significantly large. However, there is no difference in phagocytosis between each class of cell. When the cytokine content of colostrum and mature milk is compared there is a significant difference, with IL-2, IL-4, TGF β1 and INFγ showing high values in colostrum. IL-1β, IL-6 and GM-CSF, however, showed no difference. TGF β1 in mother's milk that could be measured with time showed a decrease with the advance of age in days to reach a level below our measuring sensitivity, but IL-1β fluctuated within a range of means of colostrum and mature milk. The results suggest the possibility that phagocytosis and cytokines in colostrum may have a great influence on the immunity of newborn.

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