Review of the routine chest X-ray films in 14 cases of SLE, 14 cases of RA, 26 cases of RA, 26 cases of Behcet's disease and 33 normal controls revealed more frequent nodular changes in the pulmonary field and abnormal elevation of the diaphragm along with a definitely less distinct visualization of A3a and A8a in the pulmonary field in SLE than in other groups. Tracing A3a appeared to be useful for differentiation of SLE from RA, Behest's disease and normal controls.

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To evaluate reversible myocardial ischemic areas in acute myocardial infarction (AMI), we have developed the following methods : (1) 2mCi of thallium-201 was injected intravenously and myocardial per fusion images were obtained ; (2) immediately thereafter, 5 mg of isosorbide dinitrate (ISD) was administered sublingually ; and (3) 10 minutes after the administration, another bolus of 2 mCi of thallium-201 was given and myocardial per fusion imaging was repeated (double scan method). Ten patients with AMI (within 24 hours after onset) were studied by the double scan method. Myocardial per fusion defect areas were reduced from 29±3% of the entire left ventricle to 19±4% by ISD administration, indicating that there were reversibly ischemic areas in AMI which could be transiently reduced by ISD. For clinical implication, 80 patients with AMI were divided into 2 groups at random : Group I-40 patients treated with conventional methods, and Group II-40 patients treated with continuos ISD administration (every 3 hours for 3 days). There was no significant difference in prognostic indices at the time of admission. Final MI sizes estimated by thallium-201 2 months after onset (percent of per fusion defects to the total left ventricle) were significantly smaller in Group II (19.8±3.1%) than in Group I (32.1±3.7%) (p<0.02). Mortality was 25% in Group I and 10% in Group II. This preliminary report indicates that nitrates have possibly beneficial action in decreasing ischemic injury of acute myocardial infarction.

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Although various side effects of diphenylhydantoin have been reported, there are few case reports of diphenylhydantoin induced hemolytic anemia. A 54-years-old female, who had received 100-170 mg diphenylhydantoin for eight weeks, was presented with oliguria and dark urine. The findings : transient anemia with marked reticulocytosis, increased lactic dehydrogenase activity, decreased haptoglobin levels, and hemoglobinuria ; were indicative of hemolytic anemia although direct and indirect Coomb's test was consistently negative. The evidnces of hemolysis disappeared spontaneously four to six weeks after discontinuation of diphenylhydantoin administration and there has been no recurrence of hemolysis during a two years follow-up period. These facts lead us to suggest that this was a case of diphenylhydantoin induced hemolytic anemia.

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The serum amylase of an 83 year old man with no abdominal complaints, continuously high serum amylase activity and a remarkably low amylase clearance/creatinine clearance ratio was investigated and found to be IgA-binding type macroamylase. In electrophoresis of the serum amylase, a great majority of the phoretic band was in the globulin fraction. In Sephadex G-200 column gel chromatography, almost all amylase activity was found between the first and second protein peaks. When the patient's serum was acidified in vitro (pH 3.4), the amylase became normal in size and the change was reversible. The macroamylase was precipitated with anti-human IgA sheep serum. In enzymo-immunoelectrophoresis, amylase activity was found only in the IgA band. The urinary and salivary amylase in this patient was normal in size.

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A case of acute disseminated encephalomyelitis (ADEM) accompanied by muscle atrophy is reported. A man of 30 was admitted with acute onset of clouded consciousness, fever, paraplegia and sensory loss, following an upper respiratory tract infection. A week later, marked muscle atrophy was noticed in both legs. A biopsy of the quadriceps femoris muscle showed groups of small angular fibres indicating neuropathic change, and also fibres with round contour and varying diameter suggestive of myopathic change. Some fibres contained vacuoles, basophilic material and or eosinophilic mass. Histochemical examinations suggested that the basophilic material contained mitochondria, lipid and glycogen, while the eosinophilic mass was regarded as hyaline degeneration. Cellular infitration was not observed in the interstitium. Electron micrographs showed disarray and loss of myofibrils, abundant mitochondria and glycogen granules, myelin figures and honeycomb structures. The cause of the muscle changes is uncertain. However, as conceivable causal mechanisms, the possibility of polymyositis is discussed as well as the effect of immobilization and probable involvement of the nerve roots and peripheral nerves.

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The frequency of reports with ectopic ACTH syndrome is increasing year by year. But the intermittent function by hormone producing tumor has been reported rarely. We report a patient with ectopic ACTH syndrome caused by a carcinoid tumor of the thymus in whom remarkable fluctuating hormonal production was closely associated with the fluctuation of clinical features such as pigmentation, acne, edema, polyuria, and hypokalemia.

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In this paper, our recent experiences and studies on the main pituitary disorders, namely acromegaly, pituitary gigantism, Cushing's disease, hypopituitary dwarfism, and diabetes insipidus were presented. It has been estimated that in Japan there are more than 10, 000 patients with these diseases. In view of the recent advances in the diagnosis and the treatment of these disorders, the importance of early diagnosis was stressed.

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