A 53-year-old woman had difficulty in walking, raised titres to human T-lymphotropic virus type 1 A 53-year-old woman complained of difficulty in walking. The disorder was slowly progressive and was followed by spastic paraparesis. Results of routine tests were negative or within the normal range. Raised titres to HTLV-1 in the serum (1:1024) and cerebrospinal fluid (1:32) were found. Myelography, computed tomogra- phy, and magnetic resonance imaging showed normal findings. The patient was treated with prednisolone, 100 mg/day; thereafter the drug was tapered to 15 mg/day.In July 1990 no retinal lesions were found. In August her right visual acuity had decreased to 20/30. Cells were noted in the right anterior chamber. Whitish yellow lesions were found in the right temporal fundus (Fig 1). In addition multiple whitish dots were noted round the retinal veins. Fluorescein angiography showed that the retinal venous lesions did not leak (Fig 2). Routine laboratory test results were negative or within normal range, including blood pressure; blood glucose level; serum titres to adenovirus, herpes simplex virus, cytomegalovirus, varicella zoster virus, immunodeficiency virus, and toxoplasma; angiotensin-converting enzyme level; IgG; IgM; C-reactive protein; Treponema pallidum haemagglutinin; antibody to DNA; antinuclear antibody; rheumatoid arthritis factor; tuberculin skin test; and chest x ray findings. No oral aphthae or genital ulcers were noted.In September 1990 systemic prednisolone, 100 mg/day, diminished the cells in the right anterior chamber but had no effect on the yellowish white lesions or the retinal vasculitis.

Two cases of histologically confirmed pancreatic cancer are reported. Histological diagnosis was obtained after pancreatic biopsy was carried out under visual control in conjunction with laparoscopy using pancreatic biopsy forceps designed by us. In Case 1, localized swelling of the pancreas was observed on abdominal ultrasonography (US) and computer tomography (CT) scan, and interruption of the main pancreatic duct was demonstrated by endoscopic retrograde cholangiopancreatography (ERCP). In Case 2, a pancreatic tumor was detected by abdominal US and CT scan, but ERCP findings were only those of chronic pancreatitis.

The role of laparoscopy in the diagnosis of gallbladder cancer was evaluated. Fifeen patients who were suspected of having gallbladder cancer, following physical examination, laboratory tests, and imaging techniques, received laparoscopy at our clinic, and the laparoscopic findings and histologies were analyzed. Five patients in whom the gallbladder was observed were laparoscopicallv confirmed as having gallbladder cancer, and in 2 of these cases metastases to the liver were observed. Among the 10 patients in whom the gallbladder could not be observed, metastases to the liver and the peritoneum were observed in 6 and 3 cases, respectively. I n 3 cases neither the gallbladder nor metastases to other tiisceral organs could be observed. Thus, the qualitative rate of laparoscopic diagnosis was 80% (12115 cases). Five cases (42%) among the 12 cases in which laparoscopy suggested gallbladder cancer, were histologically confirmed after biopsy specimens were obtained. Only one of these cases was diagnosed by direct forceps biopsy of the gallbladder wall.

An endoscopic retrospective study was performed on five lesions in four patients with gastric malignant lymphoma, in order to elucidate the characteristics of the initial lesion and the growth process of these lymphomas.In case 1 (protruding type of malignant lymphoma), an area of small macular redness and a shallow ulcer, which had neither a surrounding elevation due to edema nor the circumscribed redness caused by regenerative epithelium, were observed 23 and 11 months before, respectively, when a cobblestone appearance, indicative of early lymphoma of the stomach, was found. A shallow ulcer was also recognized in the initial stage of the disease in case 2 (giant rugal type). Discolored and lustrous granules were obserued as a first endoscopic finding in cases 3 and 4 (ulcerative type). These endoscopic findings were thought to be key findings indicative of gastric malignant lymphoma in the initial stagg. For the early diagnosis of gastric malignant lymphoma, a careful follow-up with a skillfully performed biopsy, i. e. an exactly aimed biopsy using large, sharp-edged forceps, should be carried out if the findings described above are once obserued,