Coenzyme Q is called by another name of ubiquinone and occurs as coenzyme Q10 (CoQ10) in the body. In this paper serum CoQ10, serum lipid and lipoprotein were measured pre- and postoperatively in order to clarify pre- and postoperatively in order to clarify hemodynamic changes in CoQ10 and the body response caused by surgery. Preoperative LDL-CoQ10 accounted for 42.9±8.0% of the total serum CoQ10 and VLDL-CoQ10 was rather lesser. On the first day after surgery the total serum CoQ10 and LDL-CoQ10 were both decreased, however, the LDL-CoQ10 to the total serum CoQ10 ratio was relatively increased. Serum cholesterol was not decreased on the 1st day but recovered to 93.0±13.2% of the preoperative level on the 7th day after surgery. Serum LDL also showed the lowest value on the 1st day, and recovered to 112.2±19.1% of the preopeartive level on the 7th day after surgery.
These findings indicate a possible existence of body These findings indicate a possible existence of body the liver to cells in recovery period from surgical invasion.

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Recently several coma scales have been advocated in assessing impaired consciousness and have been parallely used with such traditional but ambiguous terms as coma, stupor, somnolence and so on. In this study the usefulness of Glasgow Coma Scale (GCS) was compared with that of Edinburgh Coma Scale (E2CS).
The levels of E2CS was verified to have quite a good correlation with mortality and morbidity of the patients. On the other hand, correlation between outcome and the "scores" of GCS was apparently poorer exhibiting many parts of irregularity. The author showed that components of the GCS, namely the verbal, eye opening and motor response scales, if compared separately, did show a good correlation with the final outcome of the patients. It is futile, however, to depend on "scoring" system which simply add up numbers given to an order of each different functions. it is concluded that the E2CS is a clinically more convenient and useful scale in assessing impaired consciousness than the GCS.

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The management of cervical lymph node metastases in well-differentiated carcinoma of the thyroid has been controversial. In our department, node plucking was performed only in patients with cervical lymphadenopathy from 1963 to 1972. From 1973 to 1983, however, modified radical neck dissection was therapeutically or electively carried out. In order to determine whether the more extensive dissection is adequate or not, a retrospective analysis was performed by dividing patients into two groups which were differently managed for cervical lymph node metastases. This series of 206 patients with more than five years follow-up periods revealed that the rates of survival and lymph node recurrence were not different between the two groups. Since the well-differentiated carcinoma of the thyroid has a relatively indolent biological behaviour, however, further long-term follow-up seems to be necessary for demonstrating the efficacy of the neck dissection.

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In 12 cases of well differentiated thyroid carcinoma infiltrating into the larynx and trachea, one total laryngectomy and 11 partial resections of the thyroid were performed.
Anterior cervical tumor was the most common compliant. The half of the cases had symptoms such as dyspnea and hoarseness indicating infiltration into the larynx, trachea and recurrent nerve.
CT scan and tracheal endoscopy were useful for cases in which the tumor invaded the tracheal mucosa, but for the other cases it was difficult to diagnose the tracheal invasion before operation.
In the one case undergone laryngectomy, 3 circular resection and 8 luminar resection, the tumor was found to invade the mucosa in 3, circular ligamentum in 3, and external ligamentum in 3. Other 3 cases had no pathological invasion.
Their prognoses are favorable that all the patients are still alive with no local recurrence. Resection of the thyroid carcinoma with the larynx and the trachea are considered to be useful to control the local area.

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Sixty patients of gastric cancer with hepatic metastases were treated with four different methods, gastrectomy + hepatectomy (hepatectomy group) in 12, gastrectomy + hepatic arterial infusion (infusion group) in 11, gastrectomy + systemic chemotherapy (gastrectomy group) in 9 and no resection (no-resection group) in 28 cases. In hepatectomy group, survival rates were 33.3%, 25.0% and 16.7% after 1, 3 and 5 years respectively, which were superior to those in other three groups (p<0.05). Infusion group could not have better prognosis compared to gastrectomy and no-resection groups. Survival time in hepatectomy group was lengthened even in the cases with hepatectomy group was lengthened even in the cases with multiple metastatic lesions and bilateral lobar metastases as compared with non-hepatectomy groups.
On the relation with histology of primary lesion, the prognosis after hepatectomy was remarkably influenced with the depth of tumor invasion to gastric wall. Hepatic resection of more than segmentectomy could provide better survival period than wedge hepatic resection. Nine of 10 cases of recurrence after hepatectomy had metastases in the remanant liver (90%).
In conclusion, hepatecotmy should be performed in the treatment of hepatic metastasis of gastric as much possible even in the caes with multiple and bilateral lesions.

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A total of 103 patients with unresectable hepatocellular carcinoma (HCC) treated in the Second Department of Surgery, Nagasaki University Hospital from September 1969 to December 1987 were reviewed.
Unilateral ligation of the hepatic artery was done on 9 patients, unilateral ligation of the portal vein branch on 3, catheterization into the hepatic artery for infusion of anticancer drugs on 16, transcatheter arterial embolization (TAE) on 23 and other treatment with or without systemic chemotherapy on 52. The one, two or three year cumulative survival rate of the total cases was 14%, 9% or 4% respectively. The outcome of the 23 patients treated with TAE was better than that of the other patients. Macroscopic stage classification and clinical stage classification reflected the prognosis of the disease. However, the factors with or without hepatitis B-antigen, liver cirrhosis or high levels of serum AFP before the treatment did not influence the prognosis.
Recently, we have done a combination therapy with TAE, tumor reduction surgery and infusion therapy via both hepatic artery and portal vein on 4 patients with unresectable HCC. The average survival period of these patients were better than that of other patients, but not significantly.

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For an aid in selecting the most appropriate therapy for silent gallstones, a total of 220 cases operated on for gallstones were analytically studied. The 220 cases were divided into two groups: 32 asymptomatic (14.5%) and 188 symptomatic cases (85.5%), and the two groups were statistically compared for several clinical items. Moreover, in the asymptomatic group ultrasonographic and cholangiographic findings were discussed.
There was a significant difference between the two groups in that the asymptomatic group had a larger number of cases having gallstones only in the gallbladder lumen and in that asymptomatic gallstones were commonly found in patients of advanced age. No significant difference was found in the sex; type, size and number of gallstones; positive ratio of bacteriological examination of the bile; malformation ratio of the billiary tract; appearance ratio of other lesions of the gallbladder such as carcinoma, adenomyomatosis, intramural gallstones, cholesterosis, cholesterol polyp, and white bile.
In 30 of the 32 asymptomatic cases (93.8%), morphological or functional abnormalities were identified in ultrasonographic or cholangiographic findings. Since no essential clinical differences are found between asymptomatic and symptomatic gallstones, we consider appropriate at present to operate on for silent gallstones as for the ordinary type.

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Among 45 patients with carcinoma of the pancreas admitted to Fukui Medical School Hospital since October 1, 1983, twenty eight were concluded to be unresectable before or during surgery because of locally advanced cancer of the pancreas (Stage IV).
Multidisciplinary therapy, including intraoperative electron beam irradiation and chemotherapy with or without extrenal beam irradiation and radiofrequency hyperthermia, was adopted for recent 10 patients of these 28 with unresectable cancer of the pancreas. Depending on these combination therapies, remarkable effect on relief of pain was obtained in 80% of the patients and that on reduction of the tumor was also obtained in 3 patients. A prolonged median survival for the multidisciplinary therapy (250.0 days) compared with the non-multidisciplinary therapy (85.4 days) was demonstrated and one patient receiving in the multidisciplinary therapy was alive more than 1 year. Severe complications due to radiotherapy, such as hematologic and gastrointestinal toxicities, were not noted.
For unresectable cancer of the pancreas, multidisciplinary therapy might be effective for getting a long term survival and a good quality of life.

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In a 23-year-old man, a sharply demarcated tumor with the size of an egg was palpated at the anterior margin of right sternocleidomastoid muscle. Cervical CT revealed a low density tumor with a relatively uniform internal structure. Extirpated specimen showed a smooth surface tumor with the size of 6×4×4cm filled with other pate-like content. Histopathologically the wall of the cyst was covered with stratified squamous epithelium and beneath the epithelium lymphatic tissues associated with embryonic center developed.
This disease is diagnostically characterized by having a tumor located at the anterior cervical triangle particularly at the anterior margin of sternocleidomastoid muscle; having a dense mucus or pate-like content; and the existence of cholesterol crystal and lymphatic tissues in the cyst wall histopathologically. In this case cholesterol crystal was not tested, however, the other findings indicated a lateral cervical cyst. It is important for operation to confirm whether a patient has a fistula and/or fistulation.

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Since carotid body tumor generally arises in the furcation of internal and external carotid arteries, the tumor often involves the internal and external arteries which causes not only a massive hemorrhage at the excision but also an inevitable simultaneous excision of the arteries as well as the tumor in some cases.
We have succeeded in safe surgery for carotid body tumor with hemorrhage by preoperative matas test using balloon catheter to confirm a cross circulation from the another paired internal carotid artery and further use of balloon catheter during surgery.
This method appears to be very valuable in prophylactic acid for postoperative complications when the another side of carotid artery is probably ligatured and/or excised.

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Two cases of adenoid cystic carcinoma in buccal mucosa were reported.
The first case was a 56-years old woman having a buccal tumor since 20 years ago. The tumor was removed and neck dissection was performed. Her cheek was reconstructed by using a temporal flap prepared from the forehead. Tumor was 3×3×2cm in size, and histopathological study revealed a cribriform of adenoid cystic carcinoma.
The other case was a 62 years old woman, who noticed a painless tumor at the cheek one year ago. Surgical procedure was performed, but margine positive was showed by histopathological sutdy. She rejected the additional surgery, it is unavoidable, and chemotherapy with Cisplatin was done.
Recently only five cases have been reported in Japan. It seems that the prognosis relates with the histopathological type, and careful surgical resection is the best treatment.

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Intracystic carcinoma of the breast is a specific type of cyst formation in its growth, and its incidence is said to be 0.5-3.5%. Only two cases of intracystic carcinoma of the breast were encountered at our institution during the past 12 years, representing 1.7% of the total 581 breast cancers treated.
Although pneumocystography, ultrasound, and cytologic examinations of the cystic fluid aspirated have been used for diagnosis, it has been recently reported that the cytologic diagnosis could be facilitated by ultrasound guided needle aspiration from the intracystic tumor mass. However, the cystic lesion should be removed surgically for histological examination if preoperative examination is inadequate for a definitive diagnosis.
This lesion should be considered as a variant of other types of the breast cancers. Formation of cyst should be considered secondary to the extent of disease with attention being given to the presence or absence of stromal invasion beyond the cyst wall. Although this lesion exhibits a slow growth potential and has a relatively favorable prognosis, it is capable of metastasis. We thus believe that modified radical mastectomy with axillary node dissection is indicated.

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Mucinous carcinoma of the breast is a relatively rare histological type of breast cancer and its prognosis is believed to be better than other types. Mucinous carcinoma was found in only six (4.5%) of 134 patients with breast cancer who underwent surgery in our hospital from 1983 to 1988. Neither lymph node metastasis nor remote metastasis was observed in any of the six. Carcinoma did not recur in any of them up to now. However, it has been reported by some groups that prognosis of mucinous carcinoma is not always favorable. In mixed type with ductal carcinoma, the lymph node metastasis rate was generally high, and there were no differences in prognosis from other histological types of breast cancer. We presumed, therefore, that preoperative classification into subtypes would be useful for determining operative procedure and prognosis, and carried out to classify mucinous carcinomas into subtypes by means of ultrasonography for a discussion.

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Hemothorax have too many causes to enumerate, however, it appears rape to be caused by pulmonary choriadenoma. This paper describes a case of pulmonary chorioadenoma presented with hemothorax.
A 42-year-old female, 80 days after artificial abortion, entered the hospital as an emergency case with complaints of chest pain, dyspnea and nausea. A plain chest rentgenogram showed left pleural effusion, and the specimen of needle evacuation was bloody. For controlling hemothorax, the patient underwent thoracotomy, and was found to have a chorioadenoma which was bleeding.
A partial resection of the left lung was performed. This might have a relation with artificial abortion in that the transmitted villi appeared to be causative.

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Neurogenic tumor arising in the chest wall is rare and only 34 cases have been reported in Japan. We experienced four cases of neurogenic tumor (3 schwannoma, one ganglioneuroma) of the chest wall during the past 4 years.
Simple X-ray film and CT of the chest are available diagnostic methods and in the 4 cases abnormal shadows were observed in the chest simple film. While CT is good at differentiating whether a lesion is intrapulmonary or extrapulmonary, as well as knowing a relation with surrounding tissues. However, needle biopsy and perioperative histological examinations often failed to offer a satisfactory outcome in differentiating benign neurogenic tumor from malignant one, accordingly active surgical resection appears to be first recommended for the tumor arising in the chest wall.

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A rare case of resected multiple intestinal metastases from lung cnacer was reported, together with a review of the Japanese literature in which authors were able to collect 77 similar cases.
The patient was a 43-year-old male, complaining of melena. Tumors were detected in the right lung, bilateral adrenals and upper jejunum after meticulous examinations.
An enteroenteric intersusception caused by a walnut sized tumor 20cm apart from the ligament of Treitz was found on laparotomy. And a total of 34 flat submucosal tumors, up to finger-tip sized, ranged 200cm distal from the intersusception. No hepatic or peritoneal metastasis was found at this time. Subtotal jejunal with partial ileal resection including all lesions was done. The patient died of multiple organ failure on the 36th postoperative day.
Autopsy and microscopic findings supported the opinion that these rare intestinal lesions have been originated from the lung cancer. Moreover, this was also clinically postulated, because adrenal metastases were less in intestinal cancer and more in lung cancer.

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We have observed interesting findings in twice performed direct sagittal CT scan in the course of the elongation method treating of esophageal atresia without tracheoesophageal fistula. A patient with esophageal atresia type A was placed in the plane of the gantry so that sagittal scanning could be performed for the mediastinum and peritoneal cavity.
So far, plain esophagogram with stretched pouches by the bougies has been routinely carried out for the planning of surgery of esophageal atresia. As compared to the plain esophagogram, however, direct sagittal CT scan is less invasive and able to provide more accurate information of the pouches in natural state.

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A 70-year-old woman underwent emergency operation 7 hours after the onset of spontaneous rupture of the esophagus which was diagnosed by esophagofluoroscopy.
The ruptured site was found in the left anterior wall of the esophagus which was located right above the diaphragm. The site was bistratally sutured by one-step method and two intrathoracic drainages were made. After surgery insufficiency of the suture and empyema developed, in which sustained washing and sustained hypotonic aspiration leaded to a fistulization of the empyema with a slight decrease in size. However, the patient also had a syringeal bronchial fistula, and the contamination with saliva as well as digestive liquid made the therapy difficult. After careful observation of this refractory fistula by endoscopy, it was filled with a fibrin-paste preparation while the contamination was prevented by two balloons. In a relatively short period, the fistula could be successfully closed.

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Amyloidosis is a systemic metabolic disease characterized by abnormal protein deposits in a whole body, and is often diagnosed for the first time by necropsy. This paper describes a case of pyloric stenosis due to amyloidosis, in which we could definitely diagnose by biopsy preoperatively.
A 68-year-old woman complained of abdominal distention and loss of appetite. Biopsy of the pyrolic submucosal layer revealed amyloidosis and subtotal gastrectomy was performed. Circular thickness of the antral wall wa found where the submucosa and proper muscle were pathologically composed of amyloid.
Because of the progress in endoscopical biopsy, the frequency of accurate diagnosis of pyloric stenosis due to amyloidosis has been increasing. Therefore, it is mandatory to keep this condition in mind to differentiate the benign pyloric stenosis.

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Three cases of carcinoid tumor associated with gastrointestinal cancer have been reported.
Case 1 had eraly gastric cancer and carcinoid tumor of the transvers colon, for which radical operations were performed. Case 2 has an advanced gastric cancer and pancreatic carcinoid, for which palliative excision of the stomach and transverese colon was done. After 6 months the case 2 died from cancer, and the autopsy revealed a further complication of multiple endocrine neoplasia of I (MENI). Case 3 was found to have a carcinoid which looked like a hematoma of the omentum najus at radical operation for sigmoid colon cancer. The case 3 can have a disease-free period for 2 years after surgery.
In the three carcinoid tissues PAP method could demonstrated serotonin, somatostatin and gastrin, and serotonin, respectively, however, these substances could not be detected in each tissues.

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A rare case of α-fetoprotein (AFP) producing gastric tumor histologially resembling embryonal carcinoma is reported with a review of the literature.
A 59-year-old male with an elevated serum AFP level (2651ng/ml) underwent palliative gastrectomy with transverse colectomy for an advanced gastric tumor. Histological examinations revealed that the tumor was largely composed of embryonal carcinoma including yolk sac elements. Production of AFP in the tumor was demonstrated by immunohistochemical technique (peroxidase-antiperoxidase method) and radioimmunoassay. Postoperative combination chemotherapy with cis-platinum, vinblastine and peplomycin resulted in a rapid decrease of serum AFP level but the patient died of severe leukopenia accompanied by intestinal obstruction two months after surgery.

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A case of primary duodenal carcinoma at the 4th portion was reprted, which was accidentally found by an obstinate abdominal pain after cholecystectomy. The case was a 45-year-old woman complaining of upper abdominal pain and back pain. Upper gastrointestinal series and endoscopy of the stomach revealed a scar after gastric ulcer. Ultrasonography of the abdomen which was carried out for the long-lasting symptoms showed cholecystic stones, and cholecystectomy was carried out. However, no symptomatic remission was attained after surgery, and she was diagnosed as postcholecystectomic symptom. It has passed 8 months when the repeated various examinations indicated a primary duodenal carcinoma at the 4th portion. She underwent pancreatoduodenectomy.
Carcinomas developed at distal-side of the duodenum usually have no characteristic clinical symptoms, and are possibly overlooked even by alimentary examinations of the upper gastrointestinal tract. When we encounter a case presenting with such symptoms as we can not reasonably explain in spite of some actual lesions detected on the gastrointestinal tract, a possible another lesion on the small intestine including duodenum should be remembered.

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Recently we have carried out emergency operation on a patient with postoperative adhesive ileus who developed intussusception of the small intestine following insertion of an ileus tube.
The patinet was a 91-year-old woman who had undergone laparotomy in the treatment of gallstone 10 years previously. She was admitted for ileus, and underwent aspiration with an ileus tube. Although her symptoms initially imporved, abdominal pain, fever and intestinal hemorrhage occurred on the 10th hospital day, and she underwent surgery because of suspected strangulated ileus.
During surgery, 3-segmental antrograde intussusception was found in both the jejunum ileum, and the tip of the ileus tube was located on the anal side of the ileal intussusception. The ileal intussusception could be repaired manually, whereas partial resection of the small intestine was needed for the jejunal intussusception because of the presence of necrotic changes.
In this case, the ileus tube presumably induced the intussusceptions. In using an ileus tube either for aspiration or prevention of postoperative ileus, full attention should be paid to possible changes in the patient's symptoms and the properties of the drained fluid.

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A 66-year-old male with stricture-type ischemic colitis was operated on for bowel obstruction due to descending colon stenosis. He was admitted complaining of sudden-onset of upper abdominal pain and melena. Plain X-ray film revealed bowel paralysis and leukocytosis was prominent on admission. Colon fluoroscopy showed rough mucosal surface with thumb-printing sign, and there was no malignant findings on the biopsy. In spite of conservative therapies for several weeks, severe descending colon stenosis reamined. Left hemicolectomy was done at 70th day after admission. The resected specimen showed a thickened bowel wall and marked irregularity of the mucosa accompanying by ulcers, and he was diagnosed as ischemic colitis microscopically.

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For successful one-stage operation of obstructive left colorectal cancer, the method of inserting a decompression tube through the obstructive lesion using a colonoscope was tried.
The decompression tube was inserted beyond the obstructive lesion through the guide-wire after confirming the lesion in colonoscopy. This method was applied to 7 cases, resulting in 4 successes and 3 failures. Successful cases were two sigmoid colon cancers, one descending colon cancer, one recurrent sigmoid colon cancer. One-stage operations were performed after preoperative examinations and adequate colon preparation with intravenous hyperalimentation. If possible, one-stage operation after conservative decompression is desirable for the cases of obstructive colorectal cancers. In cases of the obstructive left colorectal cancers, the method of inserting a decompression tube using a colonoscope was effective.

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An extremely rare case of malignant lymphoma arising in the appendix is reported, together with a review of 16 cases in the Japanese literature.
A 60-year-old man complaining of right lower quadrant pain underwent laparotomy with a diagnosis of acute appendicitis. The appendix enlarged to be as large as 7×4×3cm, and postoperative histopathologic examination revealed a primary malignant lymphoma arising in the appendix which belonged to non-Hodgkin's lymphoma, diffuse and large cell type by LSG classification. On the 14th day surgery right hemicolectomy with regional lymphnode excision was carried out for radical treatment.
Malignant lymphoma arising in the appendix is an extremely rare disease and only 16 cases including this can be found out in the Japanese literature. Almost of the cases were first diagnosed as acute appendicitis and were definitely done as the disease by postoperative pathologic examinations. Like another carcinomas extensive excision with regional lymphnode excision and sometimes follow-up therapy are performed for this disease, however, the prognosis is generally poor.

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We have experienced two cases of anorectal malignant melanoma.
Cae 1 was a 62-year-old man with the chief complaint of anal pain. Rectal carcinoma was suspected and abdominoperineal excision of rectum was carried out, however, it was found to be a malignant melanoma postoperatively. Though the patient underwent absolute curative resection, he died of renal failure 4 months after operation. Case 2 was a 79-year-old woman complaining of rectal bleeding. Biopsy and sponge cytology revealed anorectal malignant melanoma, and abdominoperineal excision of rectum was carried out. In spite of absolute curative resection, she also died of acute renal failure one week after surgery.
Any effective therapies have not been established for anorectal malignant melanoma and the prognosis is still extremely poor. From this, the significance of early detection and early surgery should be emphasized. In addition, sponge cytology is a recommendable diagnostic method for the disease, because it offers considerably large quantity of information if the method is appropriate to a case, and can be carried out safer and easier than biopsy.

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A series of ten patients with liver abscess during the past 6 years (1982-1987) was subjected to an analitical study of diagnosis, treatments and prognosis of the disease.
Of the 10 patients, with the average age of 57.7 years and the male-to-female ratio of 6-4, nine had pyogenic abscesses and the rest one amebic abscess. The source of infection in 6 out of the 9 pyogenic abscesses might be of biliary except the remaining 3 in which the causes were unknown. Each 5 patients had single or multiple abscess respectively, and the abscesses in 7 patients were located in the left lobe and the other 3 in the right lobe. Of the 10 patients, 6 underwent hepatic resections and 4 were amenable to surgical drainage. Seven patients with benign abscess were all healed, but the others related to malignant diseases all died.
Liver abscess was once a life-threatening diease, but recent development of techniques in diagnosis and treatment have reduced the mortality in benign cases. But the cases related to malignancies have poor outcomes and are sometimes difficult to diagnose. Hence it is necessary to think about a possible accompaniment of malignancies in treating patients with liver abscess.

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The authers report a case of hepatocellular carcinoma with hematogenic metastasis to the adrenal gland together with a review of the literature.
A 53-year-old man with the chief complaints of lumbago, dorsalgia, and anorexia was pointed out to have a tumor in the right upper abdomen at a near practitioner, and was admitted to our hospital. On admission no tumor was palpated in the abdomen. Impaired liver function, α-fetoprotein level of 529.5ng/ml, and a slightly elevated noradrenaline were shown. Abdominal computed tomography and ultrasonography revealed the tumor with clear border between the right liver and right kidney, and some tumors in the right lobe of liver. Furthemore, angiography demonstrated the tumor with vascularization, accordingly he was diagnosed to have an adrenal carcinoma with liver metastasis and operated on. But the tumor enlarged the adrenal gland with the capsule, and was enucleated with parts of the liver and kidney. after operation the tumor was ecognized to be hepatocellular carcinoma with adrenal metastasis histopathologically. On ten months after operation he lives a healthy life.

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Two patients with primary malignant lymphoma of the spleen were surgically treated. The first case, a 86-year-old female, admitted with complaints of general fatigue and high fever. With a preoperative diagnosis of abscess of the spleen, a splenectomy was performed and the spleen was adherent to the diaphragm, stomach and great omentum. The spleen measured 15 by 13 by 6 centimeters, weighted 580 grams and was almost replaced yellowish white tumor with a centrally necrotic tissues. Histological diagnosis was malignant lymphoma, diffuse large cell type, and the patient died 3 months later. The second case, a 66-year-old female, had no complaints but a splenic tumor was detected at the ultrasonographical mass examination. A clinical diagnosis of malignant lymphoma of spleen was made, then a splenectomy was undergone. The spleen weighted 168 grams and the tumor measured 6 centimeters in diameter. The microscopic examination established the diagnosis of malignant lymphoma, diffuse small cell type. This case has the lightest primary splenic malignant lymphoma among those ever reported in the medical literature of Japan. The patient is alive and well for 1 year and 2 months with no signs of malignant disease after splenectomy and chemotherapy.

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Myelolipoma of the adrenal gland is a rare, benign and nonfunctioning tumor which consists of hematopoietic and adipose tissues. We report a 46-year-old male patient with left adrenal myeloipoma associated with hypertension, hyperlipidemia and obesity. The initial symptom was left upper abdominal pain, which took place suddenly and was very severe. Abdominal computed tomographic scanning showed a round tumor, 12cm in diameter, located between spleen and left kidney as if it connected to the tail of pancreas. The tumor had a low density area in it. Further suspicion of pheocromocytoma was arisen and endocrinological examination revealed a transient elevation of noradrenarin in serum and urine. The symptom and endocrinological abnormality disappeared before surgery. The resected tumor was 18×11×11cm in size, 620g in weight and contained old blood. Histopathological diangosis was adrenal myelolipoma. And the initial symptom was considered to be caused by massive hemorrhage within the tumor.

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We encountered an extremely rare case of bilateral nonhormonal carcinoma of the adrenal cortex, still moreassociated with lung adenocarcinoma.
A 45-year-old man complaining of left hypochondrial-back pain was referred to our hospital under a suspicion of bilateral carcinoma of the adrenal cortex, because CT of the abdomen revealed tumor shadows measured about 7cm in diameter at the left retroperitoneum and about 3cm at the right lower part of the liver. Hormonal examination of the tumors resulted in negative and no uptake into the adrenal gland was observed in adrenal scintigram due to¹³¹I-aldosterol. MRI of the abdomen performed about one month after CT scanning revealed that left and right tumors enlarged to about 9cm and 5cm respectively. Thus he was diagnosed to have bilateral nonhormonal carcinomas of the adrenal cortex and operated on. In laparotomy the tumors were found to invadelarge vessels directly and the extirpation was impossible. He died on day 90 after surgery. Autopsy showed a complicated primary lung adenocarcinoma.

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A strong correlation has been suggested between deep vein thorombosis (DVT) and the presence of an in vitro plasma coagulation inhibitor, named "lupus anticoagulant" (LA). LA is detectable not only in patients with systemic lupus erythematosus (SLE) but also in a number of clinical states. We report a case of recurrent DVT associated with LA after gonadotropin therapy. A 26-year-old woman with infertility underwent a gonadotropin therapy (HMG-HCG) and four months later, DVT of the legs broke out. While this patient had no family history of thorombosis, nor of any other unerlying systemic disorder, blood coagulation tests, revealed prolonged APTT and PT. The reuslts suggested existence of some circulating anticoagulants, and then more specific examinations verified the presence of LA. Since there were no clinical findings of SLE and other disease inducing LA in this patient, it seemed reasonable to conclude that the gonadotropin therapy was an initiating stimulus for production of LA. After that, gonadotropin therapy was repeated two times and recurrence of DVT was observed for each time. This clinical progress indicates that gonadotropin therapy may increase the risk of thorombosis in patients coexisting with LA. We emphasizes that LA should be investigated in all patients with recurrent DVT to determine real cause of vein thorombosis.

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