L-Dopa was administered to 122 patients with Parkinson's disease over a time period oup to 14 years. The results were summarized below. 1) The akinesia and postural instability scores were significantly improved up to the 9th year. 2) The rigidity and static tremor scores and the Parkinson score were significantly improved up to the 11th year. 3) The Yahr stage was significantly improved up to the 8th year. 4) The time course of Parkinson score was investigated in three groups, Yahr stage I/II group, Yahr stage III group, and Yahr stage IV/V group, taking into account the time interval between the onset of the disease and initiation of L-dopa therapy. No significant difference was found among the three groups. The above results suggested that the long-term prognosis of patients on L-dopa therapy in Japan was better than in Western countries. It was also thought that L-dopa therapy should be instituted at the earliest possible stage of the disease.

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The additive bronchodilating effect of isoproterenol-phenylephrine aerosol following ipratropium bromide was examined in seven intrinsic asthmatic patients and seven chronic bronchitic patients. FVC, FEV₁ and Z_rs were measured before and 30 min. after inhalation of ipratropium, 40 μg. Then inhalation of isoproterenol, 600 μg and phenylephrine, 570 μg was added and the pulmonary functions were measured 30 min. later. The age, baseline values of FVC and FEV₁, and the increases in FEV₁ and 1/Z_rs with ipratropium did not differ between the two. Isoproterenol-phenylephrine aerosol following ipratropium produced further increases in FEV₁ and 1/Z_rs in asthmatic patients but no additive increases in bronchitic patients. These findings indicate that the role of autonomic nervous system, especially adrenergic system, on airway obstruction maybe different between asthmatic and bronchitic patients arid the method applied in this study may be helpful in differentiating these airway disorders.

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A monoclonal antibody YH206 (IgM, κ) was prepared using human lung adenocarcinoma A549 cell line as an immunogen. The histological distribution of antigenic determinant of the YH206 antigen was highly restricted to adenocarcinomas of various organs including the lung, the pancreas and the stomach, but it did not react with 10 cases of colonic adenocarcinomas by the immunoperoxidase technique. It did not stain non-cancerous tissues of 16 different organs, except for the renal tubules and for the secreting glands of the pancreas with which the antibody faintly reacts. It did not react with either granulocytes, lymphocytes or red blood cells. Positive staining was observed in various fetal tissues. Periodic acid and neuraminidase treatments on tissue sections suggested that the chemical nature of the antigenic determinant of YH206 antigen was carbohydrate in nature which might be masked by sialic acids.

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To identify the activation of alveolar macrophages as a direct measure of disease activity in pulmonary sarcoidosis and to evaluate the possible relationship with serum angiotensin-converting enzyme (ACE) levels, we studied the morphology and function of alveolar macrophages obtained by bronchoalveolar lavage from patients with active disease (n=12) and inactive disease (n=5), and from normal controls (n=11). At the time of lavage, 6 of 12 patients with active disease showed an elevation of serum ACE levels. When alveolar macrophages were cultured, more cells from active disease adhered to glass, spread out, and were positive for NBT reduction (p < 0.001). Lysosomal enzyme (β-galactosidase) activity was higher only in patients with active disease (p < 0.001). In active disease, there were no significant differences in morphology or function of alveolar macrophages betweeen higher and normal serum ACE levels. Thus, alveolar macrophages were activated in active pulmonary sarcoidosis and no correlation was found with serum ACE levels. These results suggest that serum ACE levels do not accurately reflect the activity of disease in the lung.

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The activities of the interferon-induced enzyme 2'-5' oligoadenylate synthetase in peripheral blood mononuclear cells were determined in patients with viral hepatitis. Increased levels of the enzyme were found in patients with acute type B hepatitis at the early phase and also in those with chronic type B hepatitis at the active stage. The levels of this enzyme activity were not significantly increased in patients with acute type A hepatitis or in those with acute type non A non B hepatitis. However, in two patients with acute type A hepatitis the levels of this enzyme were elevated shortly at the onset. These results support the hypothesis that an endogenous interferon response in patients with acute type A hepatitis and in those with acute type B hepatitis may be instrumental in the modulation of these types of hepatitis virus infections. Whereas hepatitis non A non B virus replication in patients with acute type non A non B hepatitis may be associated with poor interferon response. The activities of the enzyme in peripheral blood mononuclear cells were determined in patients with chronic type B hepatitis during interferon therapy. Increased levels of the enzyme were found in all patients during interferon therapy. This increase correlated well with the decreased DNA-polymerase activities. The data also showed that assay of this enzyme activity is useful to determine the optimal dosage and means of interferon therapy for chronic type B hepatitis.

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The effect of captopril and a mixture of captopril and copper on natural killer (NK) activity of normal human peripheral blood mononuclear cells (PBMC) was examined. Preincubation of PBMC with captopril alone did not affect their NK activity at concentrations of 5-50 μg/ml. However, in the presence of copper sulfate, captopril inhibited the NK activity in a dose-response fashion. Similar inhibition was observed when adherent depleted fraction was treated with captopril and copper. In the time course study, significant inhibition of NK activity by captopril and copper was already observed at 3 hr preincubation. The inhibition of NK activity by captopril and copper was completely abolished by the addition of catalase, but not by superoxide dismutase, interleukin-2, or indomethacin. Preincubation of PBMC with captopril and copper for 18 hr decreased its viability. This decrease was also reversed in the presence of catalase. These results suggest that immunosuppression by captopril in the presence of copper was mediated by hydrogen peroxide.

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The effects of methionine on deoxyribonucleic acid (DNA) synthesis of B₁₂-deficient megaloblastic bone marrow cells were investigated over a wide concentration range. Deoxyuridine (UdR) incorporation and the UdR suppression test were employed as an indicator for DNA synthesis. Only a low and limited concentration range of methionine improved significantly the impaired DNA synthesis of megaloblastic cells, although the extent of improvement was less than those by either B₁₂ or folate. Higher concentrations of methionine ( ?? 150 μg/ml), however, were suppressive for both megaloblastic and normoblastic cells. In contrast, homocysteine did not affect DNA synthesis of megaloblastic cells at low concentration. Improving effect of methionine at low concentration appeared to be characteristic to megaloblastic cells, since such effect disappeared on hematologic recovery following B₁₂ administration.

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Colonic per fusion studies were performed to evaluate regional differences in water and electrolyte absorption across the human colon. In 19 healthy male volunteers, a 5-lumen tube with two balloons was inserted into the colon by the endoscopic retrograde bowel insertion (ERBI) method and a 25 cm segment of either the right or the left colon was per fused with an isotonic electrolyte solution simulating the fasting ileal content at a rate of 5 ml/min. Additionally into 5 subjects of the right colon and 5 subjects of the left colon, PSP solution was injected and mean transit time was calculated by the dilution method. Higher absorption rates of water, Na and Cl were observed in the right than in the left colon. Mean transit time was longer in the left than in the right colon. It was considered that the right colon had greater absorptive capacity than the left. The colonic per fusion study by the use of ERBI method made it possible to determine the absorption of water and electrolytes in the right and left colon directly in man, and would be useful to elucidate the pathophysiology of colonic diarrhea.

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It was shown that intersterno-costoclavicular ossification often appears together with pustulosis palmoplantaris by Sonozaki et al., 1980. We report here a patient of Graves' disease associated with intersterno-costoclavicular ossification and pustulosis palmoplasntaris, and discuss the relationship with these conditions.

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Nonclostridial gas gangrene in diabetics results in poor prognosis. In this paper, a survived case of diabetic nonclostridial gas gangrene caused by Proteus vulgaris and Streptococcus faecalis is described and microbiological findings of 31 cases of the literatures including our own case were reviewed. Twenty of 31 cases died (64.5%). The microbiological findings in 30 cases revealed an average of 1.8 organism per case. Predominant aerobes were E. Coli (56.7%), Streptococcus faecalis (16.7%), aerobic Streptococcus and Proteus (both 13.3%) in that order. Anaerobes were found in 12 of 20 cases and isolated anaerobes were Bacteroides (8 cases) and Peptococcus (4 cases). The role of specific bacteria in causing severe form of nonclostridial gas gangrene in diabetics was suggested.

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A case of an LDH-IgG complex formation which causes low plasma LDH activity and an abnormal LDH isozyme pattern was reported. A patient had pericarditis and myocardial hypertrophy of asymmetrical septal hypertrophy type. The same IgG was recognized in pericardial effusion. From a column chromatographic study, the molecular weight of LDH-IgG complex was estimated as being about 490, 000. This complex was speculated as the IgG₁ -LDH₂. The mechanism by which LDH-IgG is formed and the relationship between the complex itself and cardiac diseases remain unknown.

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A 38-year-old Japanese man had cholangiocarcinoma in association with typical features of Werner's syndrome. Thereplicative capacity of fibroblasts in culture was characteristically reduced, and the in vitro natural killer cell activity was deficient. He died of massive G-I tract bleeding 8 months after admission.

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In the criteria of alcohol-induced pseudo-Cushing's syndrome (APCS) hyperlipemia has not been included. We encountered the first case with hyperlipemia.

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A 37-year-old male with total thyroxine-binding globulin (TBG) deficiency associated with Graves' disease is described. Both TBG immunoreactivity and TBG capacity were not detectable in his serum. Serum concentrations of thyroxine-binding prealbumin and albumin were normal. He was initally hyperthyroid. During methimazole-treatment he was maintained in an euthyroid state except for two short hypothyroid periods. His plasma triiodothyronine/thyroxine (T3/T4) ratios during both the untreated hyperthyroid and the methimazole-induced hypothyroid states were higher than those during his methimazole-induced euthyroid state. These findings on changes in his T3/T4 ratio accompanying thyroidal dysfunction were qualitatively comparable with those in patients with Graves' disease with normal TBG levels: that both untreated hyperthyroid and methimazole-induced hypothyroid patients showed higher T3/T4 ratios than methimazole-induced euthyroid patients. These results may provide indirect evidence that changes in hormonal secretion and conversion that raise T3/T4 ratio can occur in thyroidal dysfunctions even in the complete absence of TBG.

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We report a case of chronic recurrent polymyositis associated with increasing antibody titers of coxsackievirus A9 in serum during clinical exacerbations. Muscle biopsy specimens showed pathologic changes consistent with chronic myositis, including perivascular mononuclear cell infiltration and hyalinization of muscle fibers with cytoplasmic vacuolations. The specific fluorescence was observed in the muscle fibers stained with antiserum for coxsackievirus A9. These findings indicate that this viral subtype as the etiologic agent in this case and virus plays a pathogenic role in some cases of chronic polymyositis.

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We describe here a case of a man with Kartagener's syndrome, whose parents were cousins each other, associated with infundibular pulmonic stenosis, chronic renal failure and azoospermia. These combined abnormalities have not been previously reported in one patient with Kartagener's syndrome, as far as English literatures are concerned.

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