To clarify the prevalence of gallstone disease in Bolivia, all the X-ray films of the biliary system in a total of 656 cases taken during 10 months in La Paz were checked. Gallstones were found in 103 cases (15.7%). The ratio of male to female was 1:1.9. Cholecystolithiasis comprised 76.7% of them, while choledocholithiasis was rare. The analysis of gallstones removed surgically by an infrared absorption spectroscopy revealed that cholesterol was main constituent of stones in 62 cases (93.9%) out of 66 cases.

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Plasma cyclic AMP responses to adrenaline administration in normal volunteers, patients with spinocerebellar degeneration, bronchial asthma, pulmonary emphysema, and diabetes mellitus were studied. Intramuscular administration of low doses (0.1 - 0.4 mg/person) of adrenaline caused a dosedependent increase in plasma cyclic AMP. The increase in cyclic AMP was completely prevented by propranolol, while it was not affected by phentolamine or atropine. In patients with spinocerebellar degeneration, the concentrations of plasma cyclic AMP both before and after adrenaline administration were lower than in normal subjects. In asthmatic patients, the plasma cyclic AMP increase after adrenaline administration was smaller than that of the healthy controls. The plasma concentration of cyclic AMP in patients with insulin-dependent diabetes reached the peak level more slowly than in diabetic patients with dietary control alone. Examining changes in the plasma cyclic AMP level after adrenaline administration appears to be a useful means for assessing the degree of β-adrenergic dysfunction.

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We studies peripheral nerves electrophysiologically in 15 cases of spinocerebellar degenerations (SCD). Three patients showed abnormalities in 40% or more of the 13 items examined in this study. Two patients showed abnormalities in 20 - 40% of the items. Ten patients showed abnormalities in 20% or less of the items; six of them showed no abnormalities in any of the items. The incidence of abnormalities was slightly higher in the sensory nerve than in the motor nerve and was slightly higher in the peripheral areas than in the proximal areas in both the motor and sensory nerves. A high incidence of abnormalities was observed in cases of olivo-ponto-cerebellar atrophy (OPCA), the longer the history of the disease, the higher the incidence of abnormalities. This finding supports the idea that OPCA, not being only a single system, will develop into multiple system atrophy in a broad sense through rigidity and peripheral nerve disorders during a long course of the disease. Twopatients with talipes cavus with muscular atrophy had peripheral nerve disorders.

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With the view of evaluating the relative utilization of methionine isomers, the pulmonary exhalation of dimethyl sulfide and methyl mercaptan and the urinary excretion of α-keto-γ-methiolbutyrate were studied in normal healthy subjects following oral or intravenous administration of L- or D-isomerof methionine. Dimethyl sulfide concentration in the expired alveolar gas (mean ± SD) before methionine loading was 2.1 ± 1.4 ng/dl (N=23). Maximumconcentrations of dimethyl sulfide in oral methionine loading tests were: 56.0 ± 24.9 ng/dl (D-2g) (n=4), 66.0 ± 42.1 (D-lg) (N=6) and 4.6 ± 2.6 (L-2g) (N=4);and in intravenous loading tests: 60.0 ± 19.9 (D-lg) (N=4) and 4.2 ± 2.1 (L-2g) (N=3), respectively. The changes in methyl mercaptan in the expired alveolar gas were small and were disproportional to the changes in dimethyl sulfide following administration of both isomers. Preloading concentration of α-keto-γ-methiolbutyrate in urine was 0.15 ± 0.10 μg/mg Creatinine (mean ± SD) (N=5). Postloading values during the initial two hours were 578 and 156 μg/mg Creatinine following 3g of D- and 0.20 and 29.7 μg/mg Creatinine following 3g of L-methionine ingestion, In view of the results obtained, significant amounts of D-methionine seem to be metabolized through the transaminative pathway of methionine metabolism.

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Activated macrophages (mφ) exhibited cytotoxic effects on isolated liver cells and produced plasminogen activator (PA) in vitro. A high molecular φweight fraction of normal human serum (Fr-1) was shownto reduce the mφ-mediated hepatocytotoxicity and enhance the PAactivity of activated mφ. Conversely, a lower molecular weight fraction of serum (Fr-3) was found to enhance the hepatotoxic potential and decrease the PAactivity of activated m. Although similar effects were seen with serum fraction prepared from patients with acute hepatitis, somewhat different influences were observed with serum componentsfrom patients with chronic active hepatitis or liver cirrhosis: Fr-1 from patients with chronic active hepatitis was less active in reducing mφ-mediated hepatocytotoxicity, and Fr-3 was more active in enhancing it, in comparison with fractions from individuals or patients with active hepatitis. Fr-3 from patients with liver cirrhosis was shownto be remarkably less active in enhancing mφ-mediated hepatocytotoxicity. Furthermore, Fr-1 from patients with liver cirrhosis reduced PA activity, Fr-3 was less active in decreasing such activity. These findings suggest that the serum componentsmayregulate mφ-mediated hepatocytotoxicity as well as PA secretion of activated mφ. Our studies also suggested the possibility that relative doses of these serum components maydiffer in various pathological conditions of the liver.

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Total 105 Japanese cases of systemic amyloidosis were analysed in terms of Congo red staining with potassium permanganate, anti-amyloid serum staining by immunoperoxidase and the occurrence of monoclonal proteins (ie. plasma cell dyscrasia, PCD). Thirty three cases of primary type amyloidosis and 22 cases of myeloma-associated amyloidosis were mostly associated with PCD, with 3 exceptional cases without PCD. In contrast, 45 cases of secondary type amyloidosis were demonstrated as AAtype, with no association of PCD.Predominance of lambda light chain in amyloidosis was contrasted to kappa chain predominance among the non-amyloidotic myeloma cases.

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A rare case of metastatic lung cancer from the tonsil associated with ectopic ACTH, β-LPH and β-endorphin production was presented. A year after the tonsillectorny and lymphadenectomy, the patient had metastatic lung cancer. Three years later he died. Brownpigmentation remained evident for a month before his death. Both ACTHand cortisol levels were high in the plasma. ACTH, β-LPH and β-endorphin were found in the tissue extracts (squamouscell carinoma).

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A 17-year-old female who had hypokalemic periodic paralysis with arrhythmia developed syncopal attacks. Although syncope in this rare disorder has been attributed to ventricular tachycardia or ventricular fibrillation, the clinical manifestation, electroencephalogram, serum electrolytes and blood sugar at the attack, and the results of lumbar puncture indicated that idiopathic generalized epilepsy was the cause of the syncopal attacks in the present case. To our knowledge, this is the first case report of the association of epilepsy with periodic paralysis and arrhythmia in the literature.

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A case of 49-year-old Japanese house wife with a functioning parathyroid carcinoma was reported.Because of lack of bone and renal involvements, she was classified as chemical type of primary hyperparathyroidism.Abnormally high levels of serum calcium and a small palpable tumor on the right anterior neck had suspected a functioning parathyroid carcinoma, which was proved histologically after operation.Preoperatively, she had a labile hypertension (1 16-190/68-126 raraHg) with high plasma renin activity (PRA; 2.3-8.4 ng/ml/h). The marked responses of PRAto furosemide and captopril were accompanied by inappropriate low response of aldosterone. After removal of the tumor, her blood pressure returned to normal with lowered PRAand normal serum calcium. These observations strongly suggested that her elevated PRAmight be a main role to yield hypertension.

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A 65-year-old male with eosinophilic fasciitis associated with positive rheumatoid factor and strongly positive Coombstests (direct and indirect) is described. No Coombs positive case in this syndrome has been previously reported in the literature. Studies of the monocytefunction suggested abnormalities of the monocyte-lymphocyteinteraction which maypartly explain the immunologicabnormalities found in this patients.

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A 50-year-old Japanese womanshowed hypercalcemic crisis due to hyperthyroidism, accompanying with high blood pressure. High blood pressure, which did not decrease in spite of normalization of serum calcium and thyroid function, was only reduced after the administration of calcium channel blocker. It may suggest that her high blood pressure related with the vascular changes due to hypercalcemia andhyperthyroidism.

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