[Clinicopathological evaluation of intralaryngeal ultrasonography].

We used a miniature ultrasonic probe to study its diagnostic application in the detection of laryngeal lesions. Using the immersion method and an extracted human larynx, we evaluated ultrasonic images, identified the layered structure of vocal folds, and examined clinical cases following the study of diagnostic application. By the immersion method, ultrasonic images revealed that the membranous vocal fold was separated into three layers. We identified the histological structures of these three layers by comparing the ultrasonic images with the corresponding histologies. The first layer (hyperechoic) was the epithelial and the superficial layer of the lamina propria; the second layer (hypoechoic) was the vocal ligament; and the third layer (hyperechoic) was the deep layer of the lamina propria. On the basis of this study, we then evaluated ultrasonographic images of clinical cases. Benign lesions such as vocal nodules or vocal polyps were noted on the layered structure of the mucosa, especially, polyps as hyperechoic images. Furthermore, glottic cancer lesions demonstrated hypoechoic images and sometimes revealed destruction of the layered structures. These results suggest that intralaryngeal ultrasonography can be useful as a clinical application for the detection of tumor involvement in the vocal folds.

[Rhabdomyolysis due to paraphenylenediamine (hair dye)--report of an autopsy case].

An autopsy case of rhabdomyolysis following homicidal intoxication of paraphenylenediamine was reported and the toxicological mechanism of PPD against skeletal muscles was discussed. The case was a 44 years old, previously healthy male, drinking a beverage containing PPD, prepared for a homicidal use. Total intake of PPD was about 3 g (63 mg/kg). Principal clinical manifestation of the patient was muscle rigor with tenderness, initially developed in the lower extremities and subsequently extending to all over the skeletal muscles. Laboratory examinations disclosed high CPK (137,600), LDH (3895), GOT (3400) and GPT (545), and leukocytosis (26600), indicating massive skeletal muscle necrosis. ECG revealed mild depression of ST junction in the II and aVF leads. Urine showed dark brownish discoloration and diminished in volume subsequently. Scattered necrosis of muscular fibers was observed in a biopsy of the femoral muscles. The consciousness was rather clear during the course. The patient collapsed suddenly and soon died in the course of about 30 hours. Clinically, the cause of death was thought to be acute renal failure due to rhabdomyolysis. Afterwards PPD was detected in the urine obtained in the hospital. Autopsy confirmed the clinical diagnosis: Renal collecting ductules and distal tubules were occluded by dark brownish myoglobin casts and its epithelium massively necrotized; Skeletal muscles showed scatteredly coagulation necrosis and were partially associated with inflammatory cell infiltration.

[Intraperitoneal administration of anti-cancer drug with cisplatinum (CDDP)].

Six patients were administered cisplatinum (CDDP) i.p. There were four cases with peritoneal dissemination of gastric cancer after gastrectomy and the other two, for whom prophylactic intraperitoneal administration of CDDP had been attempted to prevent peritoneal metastasis. The dose of CDDP was 75-140 mg/body (58-90 mg/m2). The results were 1 PR, 2 NC and 1 PD. The PR case was given intraperitoneal CDDP combined with RF thermotherapy. Liver dysfunctions, renal dysfunctions, bone marrow suppressions, and GI tract disturbances were observed as toxic reactions. The degrees of side effects after i.p. administration were less severe than after i.v. administration. However the indication of CDDP i.p. administration should be decided after case conferences. On pharmacokinetics, non-protein bound platinum was detected at 24 hours after i.p. administration, in ascites and plasma. The concentration of platinum in ascites was about three-fold than in plasma. It was considered that CDDP absorption from ascites into plasma depended on the state of peritoneal dissemination of cancer.

[Clinical studies on patients with legal communicable diseases encountered from 1981 to 1986].

Patients with legal communicable diseases admitted to Kawasaki Municipal Hospital between 1981 and 1986 were studied. Ages of patients were over 15 year-old. During this period 115 patients were admitted. Out of these patients 84 had Shigellosis, and 9 had amebiasis. Out of 20 Salmonellosis, 18 were due to Salmonella typhi and 2 were due to Salmonella paratyphi-A, respectively. Two were admitted because of Cholera. Out of the patients with Shigellosis, 27 were domestic and 57 were foreign infections, respectively. Most of patients were infected in South Asia or India and its neighbour countries. Shigella flexneri were mainly isolated from these patients. On the contrary, Shigella sonnei was the main causative organism of patients infected in Japan. Three amebiasis patients had liver abscesses with peritonitis, and 1 patient was a bisexual person. Out of Salmonellosis, 11 were patients with typhoid fever and 9 were carrier. One Cholera patient with severe diarrhea and acute renal failure was successfully treated and already reported elsewhere.