In patients with liver cirrhosis divided into 4 groups (from group A through D), amino acids involved in the urea cycle are studied. Group A: 25 patients with liver cirrhosis of so called "KOU"type and 15 with one of so called "OTSU"type. Group B: 10 patients with encephalopathy and 30 without encephalopathy. Group C: 10 patients with fatty liver causing OTSU type liver cirrhosis, 23 with hepatic fibrosis and 15 with subacute hepatitis causing KOU type liver cirrhosis. Group D: 5 patients with hepatic cancer and 10 in the terminal stages of liver cancers.
The findings were:
1. Amino acids levels in the blood associated with the urea cycle, namely, Orn, Glu, Aspn, Asn, Arg, Git, and Gln, are elevated in the cases of severe liver dysfunction. The elevations are marked in Orn, Asn, and Glu.
2. In these cases, Glu exhibits a greater increasing rate than Gln does. Therefore, it was found that Gln/Glu depression is much correlated to the progress of the liver dysfunction.
3. These findings suggest that the figures may be the reliable indices to know the amino acids metabOlism levels in the liver, which is the main organ of the protein metabolism in the urea cycle and that they may be useful to serve the patients with pre and postoperative alimentary therapy.

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Ceftizozime (CZX) was compared with piperacillin (PIPC) for prophylactic effect in patients undergoing elective gastric surgery, One hundred patients were randomized to receive either CZX or PIPC, which was given as an initial dose of 2g by i.v. drip infusion in the operating room before surgery, followed by 1g i.v. drip 8 hourly for 4 days. Forty-nine cass including 4 withdrawn ones were given CZX and 51 PIPC. The groups were comparable in age, sex, type of intervention and diagnosis. Eight patients in CZX group (17.8%) (2 with wound sepsis, 5 with intra-abdominal infection and 1 with other), and 19 in PIPC group (37.3%) (1 with wound sepsis, 12 with intraabdominal infection and 6 with others) developed postoperative infections, in which a significant difference was noted (p<0.05). There were no side effects such as diarrhea in either group. In the early postoperative period, abnormal liver function was noted in 25 patients (13 in CZX and 12 in PIPC group). Postoperative renal dysfunction was observed in 1 patient in PIPC group. No significant difference between the both groups was observed in the occurrence of adverse reactions or abnormal laboratory features. This study suggests that, compared to PIPC, CZX is a better prophylactic antibiotic for patients undergoing elective gastric surery.

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In tissue specimens resected from 314 primary breast tumors, immunohistochemical stain for estradiol (E₂) was carried out, and the results were compared with estrogen receptor (ER) measurements due to dextran-coated charcoal (DCC) method by factors such as heterologous degree assessed from tumor diameter and needle aspiration biopsy, age, and histological type.
The judgments whether the specimens were positive or negative by the both methods were coincided each other in as not so high as 69.1% of the subjects. The most major reason might be that, with an aging, E₂-positive rate decreased while ER-Positive rate increased. In younger subjects ER measurements might be lowered by endogenous E₂, and some of them might present false-negatives. Among ER-negative cases, those having E₂-positive cells in higher rate were expected to respond to endocrine therapy. Various correlations between ER and E₂ shown here have suggested that findings from E₂ stain in the resected breast cancer tissues is important in a relation to the efficacy of endocrine therapy. Furthermore, the estrogen-dependency of breast cancer should be investigated from both aspects of ER and estrogen.

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We compared a new tumor marker NCC-ST-439 (ST-439) with CEA and CA15-3 for clinical usefulness in the same samples obtained from 135 patients with breast cancer (9 with primary, 27 with recurrent, and 99 with non-recurrent).
When the sensitivity was compared for their serum levels, ST-439 (66.7%) was higher than CEA (41.6%; p=0.063) and CA15-3 (38.9%; p=0.031). On the other hand ST-439 (82.8%) showed a significantly lower specificity than CA15-3 (97.0%; p=0.0014), however, there was no significant difference betweenn ST-439 and CEA (91.9%). No significant corrleation between ST-439 and CEA or CA15-3 was found. Combination of ST-439 with CEA or CA15-3 exerted a significantly superior sensitivity than that of each CEA or CA15-3 alone, or that of their combinaiton. These findings have indicated the clinical value of ST-439 as a monitoring marker in postoperative breast cancer patients.

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The skeleton is the most frequent of all possible sites of distant metastasis of mammary carcinoma. The diagnosis of metastasis generally is based on plain bone X-ray, bone scintigraphy, bone biopsy, bone marrow puncture and clinical examination combinedly. Among these diagnostic procedures for metastatic bone tumors, bone scintigraphy is by far the most sensitive, but still has the disadvantages in that it is poor in specificity and false-positive are by no means infrequent. Fine needle aspiration biopsy (ABC), being safe and easy to perform at the outpatient service, was studied for its competence to diagnose skeletal metastasis of mammary carcinoma by collating findings yielded by ABC with those obtained by clinical examination, bone scintigraphy and plain bone X-ray. The results are summarized as follows: 1) ABC was proved reliably useful in diagnosing metastasis of mammary carcinoma to the rib and skull. Thus it is justified to performe ABC at the outpatient service, when there is a suspicion of metastatic involvement of such a thin and easily palpable bone. 2) As for spinal metastasis, on the other hand, false-negative were frequently found with ABC. It is considered difficult for ABC to diagnose metastasis to the thick and hard bones such as spine, unless a more sophisticated technique is devised.

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In 255 cases of gastric, 198 of lung, 27 of esophageal cancer, and 23 of esophageal varices (a total of 503 cases), the occurrence of postoperative respiratory complication especially atelectasis has been investigated by operative procedures.
Atelectasis was most frequently occurrd in elderly (over 70 years) patients with gastric and lung cancers who often developed preoperative respiratory complications, too. No significant difference between the atelectasis group and non-atelectasis group was found by diseases. When viewed by operative procedures, atelectasis was more frequently observed in lung cancer patients undergone lobectomy (upper lobe), in gastric cancer patients done total gastrectomy, and in the most patients operated on for esophageal cancer. The complications were commonly located at the upper and/or middle lobes on the open chest side in lung cancer, and at the left lower lobe in total gastrectomy and esophageal cancer patients. Most of atelectasis episodes developed on the 3rd day after operation in gastric, from the 1st to 2nd day in lung, on the 3rd day in esophageal cancers, and until the 3rd day as a whole.
For a good management of postoperative atelectasis in the aged patients, we should pay careful attention for a difference of operative procedures of thoracolaparotomy during surgery, and after surgery endoscopical aspiration of sputum and alleviation of pain are needed in appropriate timing, thinking over the time after the onset of the complication developed and location of the lesion.

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During the 13-year period from 1975 to 1987, one hundred seventyfour patients underwent total gastrectomy, and the survivors (53) for one year or longer were subjected to a questionnaire study hearing about postoperative complains or daily activities. Fiftythree patients answered quetionnaire. These patients were divided into two groups: along-term follow-up group (21 patients) surviving more than five years and a short-term follow-up group (32 patients) surviving one to four years. The both groups were well comparable each other in background factors such as sex, age, and histological stage. When considered reconstruction procedure, Roux-en-Y including distal pancreatectomy and splenectomy were significantly common in short-term group. The patients of long-term group showed a decrese in food intake, and postoperative recovery in weight to the preoperative level could be achieved in only 5% of them. In the paients of this group undergone reconstruction with Roux-en-Y and jejunal interposition, symptoms of reflux esophagitis fairly improved in the postoperative course. Postoperatively 80% of them were able to lead their normal lives again.

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The intestinal splinting has been retrospectively evaluated for postoperative results in 50 patients operated on for intestinal obstruction due to adhesion, based on longtem observation as longest as 15 years.
The 50 cases were compared with 44 undergone freeing of adhesions alone and 19 undergone the freeing plus excision of the intestine. Recurrent rate was as lowest as 4.0% in intestinal splinting group, versus 15.9% in freeing alone group and 5.3% in freeing plus excision group. Postoperative complications developed in 3 cases in intestinal splinting group, however, all of them were reliaved. No death cases due to the splinting were observed. A follow-up study of 38 cases including a case of which observation could be continued during 15 years as the longest period revealed favorable postoperative courses in all the subjects. From these findings, the intestinal splinting appears to be a convinient and useful method for preventing the recurrence of adhesive ileus.

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Seventeen cases of peripheral arterial occlusive disease of the lower extremities for the past 3 years and 6 months are subjected to a study of clinical availability of Doppler flow wave. Doppler flow waves were classified into 4 categories, and compared with angiogram, volume pulse wave, and ankle/arm pressure index (API). In the femoral arteries, doppler flow wave was well correlated with angiogram, however, in the tibialis posterior and dorsalis pedis arteries, the patent arteries in angiogram sometimes showed type III or IV by Doppler flow wave measurment. Such cases often revealed remarkable angiographic occlusive figures in central-side rather than the measured sites. Moreover, Doppler flow wave had a good correlation with volume pulse wave, API or Fontaine classification. On the other hand, acute experiment using dogs revealed that 100% of blood flow indicated type I, 80% type II, 50% type III and less than 30% type IV.
From these findings, the classification of Doppler flow wave appears to be available not only for screening or follow-up of peripheral occlusive diseases, but also for providing the informations of peripheral run-off which might be a possible index to confirm the success of the operation.

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Two cases of mammary adenolipoma successfully diagnosed by ultrasonography are reported, together with a review of the literature.
Case 1 was a 49-year-old housewife complaining of a left mammary mass. In the left mammary ABE resion, an elastic, soft, smooth surface mass was palpated, and extirpation was carried out under a diagnosis of lipoma. The extirpated tumor measured about 7×5×3.5cm was egg-shaped, having a surface covered with thin capsule, a light yellow outside, and a cross section in which white net portions like mammry tissues were found here and there among yellow adipose tissues. Case 2 was a 61-year-old housewife who was found to have a right mammary mass at medical examination for breast cancer. An elastic tumor with smooth surface in the right mammary BD resion was expirpated under a diagnosis of adenolipoma. The extirpated tumor, 3×2.8×1, was oval and had a surface covered with thin capsule the same as case 1, and white portions which seemed like mammary tissues was mixed among adipose tissues.
Ultrasonography visualized these tumors as hyperechoically well-defined but innerechoically unequal masses, which might be reflected a variety of the unequal acoustic feature of tumor tissues.

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A rare case of tubular adenoma of the breast in a 19-year-old female is presented with a reference of the literature. The patient complaining of a right breast mass was found to have a tumor 2.5cm in diameter with smooth surface, elastic hard in consistence and well movable. Ultrasonographic examination revealed a hypoecho lesion. Under the diagnosis of fibroadenoma, excisional biopsy was carried out.
Histological findings revealed tubular structure and minimal stromal components. The tumor was diagnosed as tubular adenoma of the breast.
Preoperative diagnosis for tubular adenoma is difficult to be drawn from clinical findings and supplemental diagnostic methods, accordingly minute histopathological examinaiton is important to differenciate the disease from other breast tumors under an understanding that it is an independent disease.

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It is a well-known fact that breast cancer is estrogen-dependent, however, there are fewer findings on the relations with other hormones. We report a relation between breast cancer and growth hormone (GH) through our experience of a rare case of breast cancer associated with acromegary, together with a review of the literature.
A 43-year-old female underwent extended radical mastectomy due to left breast cancer, which was a hard cancer histologically and in stage II with T2n1βm0. Before surgery her characteristic looks made us suspect of acromegary, and endocrinologic examinaiton, pituitary fossa X-P, CT scanning of the head revealed a pituitary adenoma (GH producing tumor). After mastectomy excision of adenoma was carried out transsphenoidally. Histologically it was oxyphilic adenoma.
As shown in this case in which the cancer was a histologically hard type, regional lymphnodes were positive, and DNA histogram due to flow Cytometry was aneuploid, as well as the cumulated findings reported up to now, it has been suggested that GH possibly enhances proliferation of the tumor and worsens the malignancy.

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Fourteen patients undergone surgery for ruptured abdominal aortic aneurysms, with a postoperative mortality rate of 35.7% (5 cases), are statistically analyzed in a correlation between the mortality and several factors largely influencing surgical outcome. Increased postoperative mortality rates were associatied with preoperative shock, Fitzgerald classification, and the rupture site. There were no statistical correlations between the mortality rate and (1) age, (2) the duration of the operation, (3) abdominal aortic cross clamping time, (4) blood transfusion and (5) the elapse from onset of symptom to arrival in the operating room. The patients with preoperative shock showed significantly higher mortality rates (56%), as compared to patients without preoperative shock (p<0.05). Preoperative shock was the most frequently cited prognostic factor related to survival. Five non-survivors belonged to 4 grades of Fitzgerald classification. Of the four patients whose rupture site was the anterior wall of the aneurysms, three died postoperatively. Postoperative complications in the fourteen patients included: renal failure (5), colon ichemia (4), respiratory insufficiency (2), acute cholecystitis (2) and myocardical infarction (1). All 5 died patients had postoperative renal failulre. These findings support the general concept of recommendable aggressive and elective resection of abdominal aortic aneurysm.

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Two resected cases of metastatic lung cancer from stomach cancer, which is referred as a relatively rare disease, are reported.
Case 1 is a 77-year-old man undergone total gastrectomy for gastric cancer, who received lung partial resections for nodular lung metastases 12 and 23 months after gastrectomy. He has been alive with no recurrence for 79 months after gastrectomy, and 53 months after lung partial resections.
Case 2 is a 58-year-old woman undergone pancreatoduodenectomy for gastric cancer, who received lung partial resections for nodular lung metastases 36 and 44 months after the first surgery. She died at 65 months after gastrectomy and 21 months after the last lung partial resection.
Metastasis of stomach cancer to the lung mainly presents with lymphngitis carcimatosa or pleuritis carcimatosa, and almost of the metastases are inoperable. But if the metastasized lesion in the lung is resectable, it should be resected positively.

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Spontaneous rupture of the esophagus often followed by vomiting is a grave disease which causes severe thoracic and/or upper abodminal pain. Yet, because of its relative infrequency, the diagnosis is often mistaken or delayed, resulting in the increased morbidity and mortality. A recent case of the disease cured by surgical treatment is reported together with a review of its literature.
A 39-year-old man who often had nausea and vomitings after meals visited a practitioner because of sudden severe pain in the chest to epigastrium just after vomiting. The patient was referred to our department with a diangosis of cholelthiasis, however, abdominal ultrasonography and CT revealed no gallstones and ECG, chest and abdominal films also did not show any abnormal findings. Because of his excessive pain, sufficient endoscopical examination of the upper GI tract could not be made. However, subcutaneous and mediastinal emphysemas developed after the examination, and chest films showed a liquid collection and pneumothorax in the left thoracic cavity. Subsequent esophagofluoroscopy revealed a leakage of contrast medium to his left thoracic cavity from the lower esophagus. He immediately underwent thoracotomy with a diagnosis of rupture of the esophagus. The perforation site was sutured and closed. The postoperative course was uneventful and he was discharged on the 28th day after surgery.

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This paper describes 3 cases of esophageal carcinoma associated with achalasia, as well as 330 cases of esophageal carcinoma and 10 operated on for achalasia during the recent 8 years, in which clinical findings were comparatively investigated among the three disease groups. In the 3 cases of carcinoma associated with achalasia, female sex was predominant like in achalasia. The average age was 61 likewise in esophageal carcinoma. An average length of these tumors measured on the esophagogram was 9cm, i.e. larger than in esophageal carcinoma. Most tumors were located in the upper third of the thoracic esophagus. All cases were fairly advanced (stage IV). In two cases palliative resction was performed and one underwent no surgery. The prognoses of these cases were extremely poor, therefore we have realized that early detection of carcinoma is very important in patients with achalasia of the esophagus.

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A 39-year-old man was admitted to our hospital, because of abdominal tumor and epigastralgia. That tumor was very movable and abdominal CT showed an abnormal great cystic lesion in the abdominal cavity of which origin was unknown. Laparotomy was performed and the tumor was pedunculated from great curvature of the stomach wall and was excised by wedge resection. The pathological diagnosis of the excised tumor was extragastric leiornyosarcoma. Microscopically mitosis was found 9/10 High Power Field, and tumor size was 18cm in diameter, so that his prognosis was seen very poor but he is healthy for 15 months after operation. Moderate abdominal bleeding was found at operation, but tumor wall was not perforated. It is unclear wheher prognosis of gastric leiomyosarcoma was affected by abdominal bleeding or not.

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A 61-year-old woman, who had a past history of Behcet disease, underwent emergency laparotomy because of hemorrhagic shock due to massive intestinal bleeding from an intestinal ulcer which perforated the iliac artery, and her life could be saved. In 1971 she had been admitted to another hospital complaining of melena and diagnosed as Behcet disease by aphtous stomatitis, genital ulceration, uveitis and nodular erythema, then had experienced three episodes of melena with Behcet symptoms which disappeared without treatment. Emergency laparotomy at our hospital revealed that the ileum adhered to the right external iliac artery; on ileal ulcer perforated the right external-iliac artery and formed a fistula between the ileum and artery and formed a fistula between the ileum and the iliac artery; resulting in massive bleeding from iliac artery to the intestinal canal. Partial ileal resection and paching of the arterial wall were performed. The resected ileum exhibited non-specific penetrating ulcer (3.5×2.0cm) without malignancy. The wall of the iliac artery was markedly thickened. Microscopically panangitis was noted. As mentioned above, this case is rare in the association of intestinal Behcet with angio-Behcet disease.

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A rare case of primary malignant lymphoma of the samll intestine which caused perforated peritonitis is reported, together with a review of its literature.
A 61-year-old man, who had abdominal pain and bloating abut one month ago, was admitted. Upper and lower abdominal series and endoscopy revealed no abnormality. However, he suddenly complained of intensive abdominal pain, his abdomen presented a board-like hardness, and white blood cell count was elevated to 11, 400/mm³. Chest X-ray film disclosed a free air under the diaphragma. The patient underwent emergency operation with a diangosis of perforated pedtonitis. In laparotomy an elastic hard tumor and a perforation were found oral-side approximately 30cm distant from the ileocecal valve, and the ileum was resceted by approximately 50cm. The tumor, about 10cm in length, presented a stricture rounding the ileum. Histopathologically it was a malignant lymphoma with diffuse and large cell type.
This disease is so rare that only 66 cases have been reported in Japan.

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Primary adenocarcinoma of the appendix, a rare disease, commonly presents with symptom such as apendicitis or abdominal mass. Recently we encountered a patient with adenocarcinoma of the appendix presenting with right strangulated inguinal hernia.
A 81-year-old female, with the chief complaint of painfull (bulging) in the right inguinal area, was operatied on for suspected strangurated hernia. In the hernia sac, a 2×2×2cm tumor of appendix, its' peripheral area was infected and necrosed, was found. Neoplasm of the appendix presenting with hernia is so rare that only 4 cases has been reported in the foreign literature and this case is the first report in Japan

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In this paper, two cases of so-called simple ulcer of the colon locally recurred after resection for primary ulcer are presented.
The first case, a 47-year-old man, had undergone ileocecal resection due to ulcer 10 years previously. 4 years after the resection, recurrent ulcer was found at the site of ileo-ascending anastomosis, then the second resection was performed. However, clinical symptoms such as right lower abdominal pain, recurred 3 years after the second resection, and ulcer was detected again at the site of anastomosis.
The second case, a 55-year-old woman, had undergone right hemicolectomy for caecal ulcer 8 years ago. 6 years after this operation, recurrent ulcer was found at the site of ileo-ascending anastomosis.
All ulcers in the resected specimens from both cases are sharp-bordered and histologic sections showed a nonspecific inflammatory reaction, i.e., so-called simple ulce, with no signs of malignancy.
In the cases of recurrent simple ulcer, differential diagnosis from "Entero-Behcet's disease" is usually difficult just only in histological study, then intensive follow-up study should be necessary to clear such problem.

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This paper describes a 72-year-old male patient with megacolon successfully undergone artificial anus This paper describes a 72-year-old male patient with megacolon successfully undergone artificial anus cerebral infarction and suffered from incontinence of urine and constipation since 4 years ago.
In the resected specimen psuedomelanosis coli was found on mucous membrane but no organic stricture was shown. Histologic feature of the dilated sigmoid colon revealed a decrease in mumber and atrophy of nerve plexus, vacuolation of nerve cells, and hypertrophy of muscular tunics.
Idiopathic megacolon is a relatively rare disease and 30 cases have been reported in Japan during the past 10 years. In this case his history of cerebral infarction and a decreased number and degeneration of nerve plexus of enteric wall suggested a possible denervation due to cerebral infarction. However, from two, facts, no organic lesion on the colon and a negative result in acetylcholine esterase stain by colon biopsy, a possibility of adult megacolon could mot be denied. Further accumulation of experience for this disease including neurological investigation might be essential.

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From 1970 to 1985, 286 cases were operated on for colon or rectal carcinoma, and out, of the 286 cases 5 with rare histological findings were reported.
Case 1-A man aged 34 years had an undifferentiated carcinoma of the rectum. Around 3 months after Mile's operation he experienced liver and lung metastases and died with the prognosis of 2 months. Case 2-A man aged 62 years had small cell carcinoma of the rectum, who died of the recurrence 9 months after surgery. Case 3-A man aged 63 years was found to have a caecal carcinoma and caecal resection was carried out. Histologically it was undifferentiated carcinoma. His prognosis was 8 months. Case 4-A woman aged 60 years admitted because of peritonitis carcinomatosa had a colon ascendens carciona. Excisional biopsy revealed adenoacanthoma. She died 3 months later. Case 5-A woman aged 61-years was diagnosed to have a malignant melanoma of the rectum and underwent Mile's operation, with the prognosis of 6 months.
In those 5 patients no chemotherapy could yield cures and their prognoses were very poor.

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Refractory fistula of the perineum is rarely formed after abdominoperineal excision of rectum or pelvicevisceration for progressive carcinoma of the lower rectu. Once the fistulation occurred, it demands considerable days for the treatment and severe pains from a patien. Curettage alone may be beyond a cure and it is recommended to be for the treatment and severe pains from a patien. Curettage alone may be beyond a cure and it is recommended to be
In 2 cases of refractory fistula of the perineum following operation of rectal cancer, authers have succeeded in shortening a period for cure by plastic operation using myocutaneous flap prapared from femoral gracilis muscle. Such application of gracilis muscle should be positively considered because of a sufficient movability of the tissues and a lack of ploblematic impaired function after surgery.

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Recently we have encountered a case of accessory liver attached to the right lobe of the liver.
A 31-year-old man underwent laparotomy and accessory liver attached to the segment six of the right lobe of the liver through restiform tissue, measuring 1.2×0.8×0.3cm, was found incidentally. The accessory liver was resected. Histopathologically, bile duct, portal vein and arterial branch were noted in the part of the restiform tissue and this case was interesting from the standpoint of the genetics of accessory liver. Glisson's sheath was tissue and this case was interesting from the standpoint of the genetics of accessory liver. Glisson's sheath was
Accessory liver is a developmental anomaly of the liver, the incidence of which is very low, and in Japan, since when Tasaki reported in 1904, only 48 reports have been available.
We discussed the age distribution, sex difference, opportunity of the diagnosis, location, size, number, pathological findings, and the communication with the primary liver in the light of these reports.

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A 25-year-old woman was admitted to our hospital with the chief complaint of hepatomegary. Her liver was palpable three finger breadths below the right costal margin. Laboratory studies showed a normal liver function. Plasma CA19-9 was elevated up to 10000U/ml, while CEA and AFP were within normal limits. Ultrasonography and cornputed tomography revealed a cystic lesion of 17cm in diamater with septum and a few papillary processes in the right hepatic lobe. Angiography demonstrated a hypovascular tumor with focal tumor stains. Ultrasonicallly guided percutaneous fine needle aspiration cytology of the cyst showed no malignant cells. The levels of CEA and CA19-9 of the cyst were 4470ng/ml and over 10000U/ml, respectively. Right hepatic trisegmentectomy was then performed under the diagnosis of bilialy cystadenocarcinoma, which was confirmed by pathologic examination pOstoperatively. CEA and CA19-9 were demonstrated in the tumor cells immunohistochemically. Tissue contents of CEA and CA19-9 were higher in the tumor compared to the normal liver tissue. We reviewed 60 cases of biliary cystadenocarcinoma reported in the Japanese literature and discussed the clinical significance of the aspiration assay for this disease.

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[in Japanese]

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This paper describes that a 56-year-old male patient presenting with massive gastrointestinal bleeding and megalgia at the upper abdomen was finally diagnosed as cholecystocolonic fistula and successfully surgically treated. The patient, who had been diagnosed as cholelithiasis 3 years ago, experienced gastrointestinal bleeding and shock 4 times, in which the bleeding was first considered to be arisen from somewhere of the colon because endoscopy of the colon revealed a Borrmann type 3-like lesion. During an observation of his course, however, pneumobilia appeared and inner biliary fistula was suspected. ERCP gave a feature of the colon through the gallbbladder that lead to the diagnosis of cholecystocolic fistula which was confirmed by operation.
It is relatively rare for massive gastrointestinal bleeding to have the cause in the billiary tract, but is common in the upper GI tract which occur as hematemesis in the most cases. Moreover, the bleeding caused by cholecystocolonic fistula is so extremely rare that only 3 cases have been reoprted in Japan. When a patient suffers from melena or hematemesis, a serial examination of the GI tract should be first performed, then a possible billiary bleeding should be remembered if no remarkable change could be found on the series.

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Gallstone ileus is a relatively rare complication of cholelithiasis and it is hardly diagnosed preoperatively. This paper describes a such case in which we could successfully diagnosed preoperatively, together with a review of about 200 cases in the Japanese literature.
A 66-year-old male was admitted because of a half-day history of abdominal pain with nausea on June 6, 1988. He had moderate leukocytosis and his abdomen was slightly distended with mild tenderness at the epigastrium.
Abdominal plain X-ray films revealed a small bowel obstruction, air in the gallbladder and a oval-shaped calcificated mass of which position was changed daily on it. The upper G-I series showed a cholecystoduodenal fistula and an impacted gallstone in the terminal ileum. Laparotomy was carried out under a diagnosis of gallstone ileus 7 days after the admission. The impacted stone, measured 5×3×3cm, was milked back from the terminal ileum and was removed through enterotomy. Cholecystectomy and closure of the cholecystoduodenal fistula were performed. Postoperative course was uneventfull.

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A 29-year-old woman who complained of pain in left hypochondrial region underwent splenectomy under a diagnosis of splenic cyst. Histopathologically, it was epidermoid cyst because of stratified squamous epithelium in its lining and several microcysts.
Epidermoid cyst is very rare and classified as the true cyst owing to the epithelial lining. The genesis of epidermoid cyst in the spleen has been presumed the migration from the other tissues in embryonic period, but it is not quite clear. We have reported a epidermoid cyst in the spleen found at a woman who is 5 weeks pregnant, together With some consideration about 46 cases already reported in Japan.

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[in Japanese]

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A 46-year-old male patient complaining of upper abdominal pain and diarrhea underwent echographic examination of the abdomen and it incidentally disclosed a mass lesion in the lower portion of right lobe of the liver. He was referred to our hospital for further examination and treatment. Echography at admission revealed a round and smooth-surfaced mass, 4cm in diameter, in the posterior segment of the right lobe and a CT scan confirmed the low density mass with fine reticular structure which was not enhanced on contrast CT. From these findings hepatocellular carcinoma with fatty degeneration was most suspected and surgical treatment was scheduled. But on the day before operation he developed marked hypotension and shock. Fortunately, he recovered from such serious conditions with supportive reatments and posterior segmentectomy of the liver was electively carried out. The tumor, measuring 4.5×4.5×3cm, was embedded in the posterior segment and wellcircumscribed from the surrounding liver parenchyma. Histological diagnosis of the tumor was an adrenal myelolipoma embedded in the liver. We reviewed the literature on the adrenal myelolipoma.

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It is a well-known fact that acid-phosphatases in the blood are excellent markers for prostatic carcinomas in the susceptibility and specificity, however, even these markers rarely exhibit false-positive reactions.
A 62-year-old man visited our hospital complaining of a feeling of residual urine lasting for 2 years. All of palpation findings, DIP, urethrography and ultrasonic scanning revealed a benign prostatic hypertrophy, but 3 enzymes as markers for prostatic carcinoma, such as total-acid-phosphatase (ACP) and prostatic-acid phosphatase in enzyme assay and prostatic-acid-phosphatase (PAP) in radioimmnoassay, exhibited abnormally high levels. Preoperatrive biopsy and histological examination for the removed prostate also revealed a benign hypertrophy. Thus, we have discussed the occurrence of false-positive reactions to acid phosphatases in benign prostatic hypertrophy by quoting 252 cases already reported, in whom ACP and PAP were determined simultaneously.

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A 64-year-old male patient was admitted because of fever, abdominal pain, and shock state. Ultrasonography and CT scanning of the abdomen revealed massive intra-abdominal hemorrhage. Palliative operation was performed and a fist-sized hematoma was found on the mesocolon transversum. Histopathologic examination revealed a rupture of the mesenteic artery and necrotizing angitis, accordingly he was diagnosed as periarteritis nodosa.
Periateritis nodosa presents with various clinical symptoms indeed, but a case presenting with intraabdominal hemorrhage like this case has nerver been reported in Japan.

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