Recently, drug induced hepatitis is being widely noticed.
We have experienced nine (4.9%) cases of drug induced hepatitis in 182 cases of liver scans during six months since December 1971.
Liver scan was performed with about 200μCi of ¹⁹⁸Au colloid.
The induced drugs of these nine cases were INAH, PAS, Ethambutol, Rifampicin, Ilosone, Lincocin, Ajmaline and Honvan.
On the sex distribution, these nine cases were all male.
All scans showed hepatomegaly in which two cases of right lobe and seven cases of both lobes were included. The space-occupying lesion and the spleen were not seen in all cases. The time of the improvement of the scintigraphic pattern was later than the improvement of liver function, particularly transaminase.
The liver scan of drug induced hepatitis is important to the diagnosis and the development of the disease

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Deposition and clearance of inhale particles of water solution of Au and Tc were studied in normal subjects and patients with various pulmonary disease.
For this purpose, heterodisperse aerosols of particles were produced in a ultrasonic nebulizer. Thoracic counts and images with a Gamma camera were obtained after inhalation of the aerosol and some cases were examined from beginning of inhalation.
Results are as follows:
1) We compared the patterns of deposition and clearance observed in normal subjects and pulmonary patients. The difference of clearance among pulmonary diseases were not detectable by the methods used, because of deposition pattern of particle in the lung were varied by underlying disease.
2) Between smokers and non-smokers who showed similar deposition patterns, there were marked difference in their clearance. Tracheobronchial clearance in non-smokers occured immediately after inhalation, but in smokers clearance was delayed two-hours after inhalation

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It is no doubt that there exists close relations between light and color vision, and that the mechanism of defective color vision as well as normal color vision should be explored keeping this in mind. Previous studies, however, have based too much upon the concept of trichromatic vision. The present authors maintain that normal and anomalous color vision should be reconsidered from the observations on natural color sensations. The author's proposal is that the color vision is induced not by three primary colors but by five primaries, i. e. red, yellow, green, blue and purple, and for the further detailed analysis ten primaries should be considered, i. e. red, yellowish red, yellow, greenish yellow, green, bluish green, blue, bluish purple, purple and purplish red.
The above arguments are based upon many experiments having been done by the author, on the subject's ability of discrimination of ten colored lights of different spectral composition, in combinations of low or high saturation and dim or bright luminance, and also on the recovery of hue shift after adaptation to intense white light

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A study was made of the annual incidences of posttransfusion hepatopathy in 303 patients who received the transfusion of preserved blood in the ten year period from June, 1963, through March, 1973, with the S-GOT level as criterion.
The incidence was as high as 57.4% in 1963, but it sharply fell to 18.4% in the following year, namely, 1964. It remained mostly on the order of 10% thereafter, and below 15% since 1968, and the disorder occurred in no patients in 1972.
The marked fall in the incidence of the hepatopathy since 1964 may be considered chiefly attributable to the effect that the preserved blood supply system was improved from the blood-buying system to the blood-depositing and blood-donating system. The change from the blood-depositing system to the blood-donating system could not, however, be considered to have largely improved the incidence of the hepatopathy.
It may be anticipated that the change in the blood-supplying system in October, 1972, that only the Australia antigen-negative, donated blood only would be supplied will further lower the incidence of posttransfusion hepatopathy.
The larger the amount of blood transfusion, the higher was the incidence of posttransfusion hepatopathy, and a marked difference was noted in the incidence between the amounts of transfusion with 2000ml, as the border line. Further, the infusion of large amounts of γ-globulin to cases transfused with not less than 1000ml, of blood failed to markedly reduce the incidence of the hepatopathy

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In order to establish high-risk pregnancy for neonatal hyperbilirubinemia, 8, 548 infants delivered at the Fukuyama National Hospital were studied. As a result, fetomaternal Rho blood group incompatibility, A- or B-blood group infant from O-blood group mother, infant from toxemic mother, premature rupture of the membrane, dystocia, vacuum extraction, neonatal asphyxia, neonatal respiratory distress, cephalohematoma, hypothermia, abnormal reduction in neonatal bodyweight, pseudomelena, neonatal hemoconcentration were estimated to be high-risk for neonatal hyperbilirubinemia. Administration of anti-Rho immunoglobulin, qualitative manage-ment of pregnancy toxemia, delivery of newborn at the optimal gestational week, prevention of low birth weight, fluid therapy for low birth weight and distress infant, prenatal enzyme induction for high-risk pregnancy, light therapy and so on were also thought to be effective for prevention of neonatal hyperbilirubinemia. Frequency of neonatal hyperbilirubinemia could be reduced to 1%

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This paper concerns the origin and treatment of jaundice of the newborn, giving an outline of the condition from the view-point of the obstetrician, and dealing with essential factors in the management of the pregnant woman and the newborn.
Carbohydrate metabolism in the mature erythrocyte is mainly via the Embden-Meyerhof's pathway, differing from that in other cells, which is generally via the TCA cycle. Differences are seen between fetal and adult erythrocytes in their type of hemoglobin, activity of carbohydrate metabolic enzymes, stability of reduced glutathione, osmotic pressure, functional resistance, and degree of oxygen dissociation. The fetal erythrocyte contains large amounts of hemoglobin F, and its metabolic system differs from that of adult erythrocytes; it is easily influenced by drugs, and its life span is short. Likewise the life span of the erythrocyte of the premature baby is less than that of the mature infant, while factors such as hemolytic disease of the newborn also shorten its life.
Concerning jaundice of the newborn, in addition to the nature of the metabolism of the fetal erythrocyte and its life span, the binding and transport of bilirubin by albumin and its (distribution in the body, the uptake of bilirubin in the liver), the development of specific enzymes and factors which influence them, and the excretion of bilirubin are also important, as are also the activity of glucuronyl transferase in the liver, and the absolute level of the blood-brain barrier. Further, in an investigation of the serum bilirubin concentration we must take into consideration total plasma and extravascular fluid, their bilirubin binding function, the bilirubin affinity of all the body tissues, albumin concentration, respiratory distress, hypoxia, acidosis, hypoglycemia, and dehydration.
The obstetrician's main concern with regard to hemolytic disease of the newborn is diagnosis of the disease, and its management before birth. This necessitates investigation of blood-type, indirect Coombs' test on the mother, and spectrophotometric scanning of the amniotic fluid. In deciding the method of treatment, consideration must be given to such factors as whether the labour was abnormal, whether an obstetric operation such as vacuum extraction was employed, obstetric background such as the condition of the baby immediately after birth, and the results of each test made.
Now, phenobarbital therapy, phototherapy, and exchange transfusion are often used; the problem with these methods of therapy, however, is which one to be used and when to be used. Another treatment is the administration of human anti-D immune globulin immediately after the first labour of a RH negative woman.
All these various aspects will be investigated from the view-point of the obstetrician in this paper

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Exchange transfusion, phototherapy, pharmacotherapy and elimination of jaundice-aggravating factors are the four therapies available for treating low birth weight infants for hyperbilirubinemia. Today, phototherapy is chiefly employed; exchange transfusion is performed less freqently; and pharmacotherapy is rarely adopted. Ever since 1971, we have adopted phototherapy, early use of parenteral fluids and early feeding. As the result, there is virtually no case where exchange transfusion is required, though it had used to be necessitated in five to ten cases in each year before 1971, and the incidence of serum bilirubin level over 15 mg, per 100ml, has decreased from the order of 30% to the order of 10%.
Phototherapy is, in principle, used when the serum bilirubin level rise 10 to 12mg. Per 100ml. In infants weighing about 1000g. at birth and infants whose serum bilirubin concentration reaches the level of 7 to 8mg, per 100ml, within three days after birth, phototherapy is used even if the serum bilirubin level is below 10mg, per 100ml. During phototherapy, care should be exercised so as not to miss the right time for exchange transfusion by frequently dermining the bilirubin level in the serum.
If infants are under phototherapy, exchange transfusion should be started with the serum bilirubin level being 18 to 20mg, per 100ml, in infants weighing 2500 to 1000g. at birth, 15 to 18mg, per 100ml, in infants weighing 2000 to 1500g. at birth, and 13 to 15mg, per 100ml, in infants weighing not more than 1500g. at birth. If infants are not under phototherapy, the exchange transfusion should be initiated with the bilirubin level being higher by 2 to 3mg, per 100ml, in the respective.
Early use of parenteral fluids is effective in preventing hypoglycemia, dehydration and acidosis, and also in eliminating jaundice-aggravating factors. Early feeding should be positively executed because it decreases the enterohepatic circulation of bilirubin.
It should be emphasized that care be exercised so as not to miss the right time for exchange transfusion while adhering to phototherapy

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Fourty two cases of kernicterus were reported by sixteen national hospitals during 1966-1968, and the types of hyperbilirubinemia that coused subsequent kernicterus were discussed. 86.4% of the hyperbilirubinemia in full term infants were caused by ABO- or Rh- incompatibility, while most (66.7%) of that in premature infants were idiopathic.
According to my experiences added to the opinions of many authors, the serum total bilirubin value as the indication of exchange transfusion in full term infants may be employed as 25-27mg%.
The phototherapy is a relatively harmless and effective procedure to drop the serum bilirubin level, next to the exchange transfusion. But it must not be used to the case with slight degree of jaundice for the purpose of prophylaxis against hyperbilirubinemia. The bilirubin level as the indication to begin a phototherapy may be about 20-22 mg% in the cases of full term infant during 4-7 days of age. But in the case that the jaundice appeared early and increased rapidly within 3 days of age, the phototherapy must be immediately performed even in the lower bilirubin level. But it can not be almighty in such cases, so we must be ready to switch to give immediate exchange transfusion if necessary

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It is said that many drugs are used in combination more frequently in Japan than the foreign countries.
The purpose of these studies, therefore, is to investigate the status of combined use of drugs in Japan, especially in tuberculosis patients.
Investigation was made on 5, 296 tuberculosis patients and 175 doctors in twelve national sanatoria. All drugs including those for internal and external application and injection which were prescribed for tuberculosis who had been in these sanatoria for a week since April 9. 1973 and medicated with antituberculous drugs were investigated. Incidentally, the names of symptoms and diseases for which the doctors prescribed and the reasons for the prescriptions were also investigated.
The results are as follows:
The frequency of use of antituberculous drugs in these sanatoria is shown in Fig. 4. INH, EB, SM and RFP were most frequently used, among which 75% of tuberculosis were medicated with INH as an antituberculous drug.
The frequency of combined use of antituberculous drugs in these sanatoria is shown in Fig. 5. Three drugs in combination were used in 56, 6 % of tuberculosis investigated. Four, five or six drugs were sometimes used in combination. Figs. 7 and 8 show the frequency of prescriptions for combined use of antituberculous durgs in these sanatoria.
Combined use of INH-SM-PAS was prescribed in 9.8% of tuberculosis investigated. Next to this use, INH-SM-AI· PAS, INH-SF, INH, INH-EB, and INH-EB-RFP were prescribed frequently in turn. Especially, increase of the use of EB and RFP was remarkable.·Fig. 9 shows the number of durgs used per patient except antituberculous drugs. The maximum number was 37.
There were much difference in occurrence of symptoms for which the doctors prescribed among the sanatoria where investigation was carried out. For example, the difference of occurrence of functional disorder of liver is shown in Fig. 14

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We experienced about 2, 000 cases of cardiovascular surgery up to March 1973. In this report we described 440 cases in 1972, especially of Tetralogy of Fallot, Endocardial Cushion Defect, valvular disease and open heart surgery in infant.
Furthermore we pleaded significance and importance of cardiovascular clinic in national sanatorium

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Many instances of acute pulmonary edema in persons without cardiopulmonary disease after ascending to high altitudes have been reported. In 1787 de Saussure, during his ascent to Mont Blanc, was affected by mountain sickness. Houston (1960) recorded the first case of high-altitude pulmonary edema, thereafter many cases have been reported by Hultgren (1962), Fred (1962) Menon (1964), Marticorena (1964) and Kapila (1965).
Authors have observed in recent years eight cases of high-altitude pulmonary edema. This paper presents two cases of the disease treated.
Case 1. A 23-years-old male, resident in Yokohama, climbed on August 2, 1972 to Karasawa-take, an altitude of 3103 M. That evening he had dyspnea, headach and general malaise, He was diagnosed as pneumonia at mountain clinic and received antibiotics. On August 4, he was transfered to our hospital. At the time of admission he complained dyspnea and general malaise, and was cyanotic. The X-ray film of the chest taken during acute phase showed diffuse mottled areas in both lungs. The patient received oxygen shortly after the admission and the dyspnea and headach improved. He was discharged 10 days after admission.
Case 2. A 33-years-old male climbed Yarigatake (3180 M.) on August 14, 1973. That evening he had fever 38°C, pink-colored sputum and dyspnea, and developed syncope on the next day. The patient was transfered to our hospital by helicopter. At the time of admission, dyspnea, sputum, cough, fever and chest pain persisted, but he was conscious. The arterial blood gas analysis showed PH 7.53, PaO₂34.0mmHg, PaCO₂ 33.4mmHg and Sao 74%. He was treated by oxygen with a remarkable improvement. He was discharged on August 28.
Pulmonary edema at high altitude usually appears shortly after rapid elevation to the high altitude with cablecar or automobile.

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A case of medullary carcinoma of the thyroid developing in a 80-years-old female is reported.
Diagnostically two important points of this tumor were studied: parafollicular cell origin of this tumor cells and amyloid of the stroma.
Histopathologically tumor cells were round or polygonal in shape with uniform-appearing nuclei and solid nonfollicular pattern. The cytoplasm was finely granular and under electron-microscope contained many secretory granules, averaging 100mμ to 150mμ in diameter. A striking similarity to the thyroid parafollicular cell suggests these cells as a source for this tumor.
In the stroma amyloid was present, which stained strongly by congo-red stain. Electror-microscopically fine amyloid fibrils, about 100Åin diameter, were found. We made a test of DMAB reaction (tryprophane reaction) for this amyloid and confirmed its negative reaction, then amyloid of this case was in agreement with APUD amyloid.

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Two cases of progressive facial hemiatrophy are presented.
Case 1.-A 37-years-old female had been in good health until the age of 34 when she first noticed a hollow in her left cheek. Since then this hollow has gradually developed.
Examination revealed atrophy on the left side of her face most noticeably over the cheek and wasting of the left side of the tongue. It also disclosed anisocoria, the left pupil being slightly larger than the right. The EEG revealed low voltage 9-10 per second activity in all areas with bursts of 4-5 per second bilaterally synchronous high voltage wave and disorganized spike&wave complex in the anterior part of the head. Minor's test revealed slight diminution of the sweat secretion on the left side of her face.
Case 2.-A 30-years-old female noticed an indentation in her right forehead and cheek, two years prior to examination, which since then has slowly increased in depth. The skin overlying the affected area in her right forehead was brown, which had been noticed since her childhood.
Examination revealed atrophy on the right side of her face and brown pigmented area on her right forehead. No other abnormality was presented on the physical examination, The EEG presented low voltage 8-9 per second activity in all areas with some sporadic or rhythmic, moderate voltage 7 per second activity in the anterior part of the head.
The etiology in progressive facial hemiatrophy was discussed and the trophoneurosis theory was supported.

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We report 27-years-old and 23-years-old females, diagnosed juxtacortical osteogenic sarcoma. The chief complaints of a 27-years-old female were pain and limitation of movement at the knee joint. Prior to her visit to our hospital, she had been treated several times in some hospital. Another female had a chief complaint of swelliug of the entire leg, which was amputated at the thigh in our hospital. Al-P-tases of both patients were high level, especially that of latter was generally correspond to her phase. And ⁶⁰Co radiation was a effective treatment.

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