Present paper reports our experiences on the second case of alpha-chain disease in Japan.
Alpha-chain disease was reported for the first time by Seligmann in 1968 as the disorder of the Fc segment of secretory Ig-A system. Shortly after that, there were successive reports of 65 cases mainly from the near-and middle east areas, and this was thought to indicate the racial relationship to the etiology of this disease. Later on, there were sporadic cases here and there in the world, and now the etiology of the disease is thought also to have something to do with the factors of circumstances. In Japan, the first case of this disease was reported by Kitani in 1973, and our case is the second.
The patient (S. H.) is 54-years-old pure Japanese male. He was admitted to the Second Tokyo National Hospital with the complaints of abdominal pain, watery diarrhea and loss of body weight. His past, and family history was nothing contributory. The physical examination revealed emaciation, pretibial and dorsal pedic edema, dabbed finger, epigastric tenderness and weakness of the extremities. The laboratory data was followings: C. B. C. showed slight anemia. Urinalysis was normal and negative of Bence-Jones protein. Blood chemistry revealed hypoproteinemia of high grade (3.7g/dl). Serum iron, Ca and total cholesterol was low, but alkaline phosphatase was high.
Electrophoretic pattern of serum protein showed low albumin, increase of alpha-1, -2, and β-γ linking. M-protein was always negative. Ig-A was extremely high (1030.4mg/dl) and showed double precipitation ring by SRID method. On immunoelectrophoresis by anti-Ig-A serum, there was a broad precipitation line at the area of alpha-2 and gamma area, and aside from this, slight residual normal Ig-A precipitation line was recognized. The extract from the anodic reacted part to anti-Ig-A on the agar gel plate was examined by Ouchterlony method. This extract reacted to only anti-Ig-A, and did not to anti-K, and -γ serum: this is the evidence of absence of light-chain in the patient's serum. On the examination by immunoselection plate method by Rüdl, there was also no reaction to anti-K, and -γ serum, and residual free alpha-chain migrated to the anode.
The fluoloscopic examination of the gastrointestinal tract revealed narrowing of the intestine in distal to the duodenum. Biopsy of the intestinal mucosa showed mononuclear cell infiltration in the proper mucosal layer.
All of the findings of this patient were characteristic of the alpha-chain disease according to the report of Seligmann.

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The thyroid scanning of thirty five patients with chronic thyroiditis (Hashimoto's thyroiditis) in whom the diagnosis was confirmed by the needle biopsy of the thyroid gland was studied. The results were as follows:
a) When the images were classified into four patterns by the distribution of the intrathyroidal radioactive isotope (ITRI), normal and homogeneous appearance (type I) was seen in eight cases (23%). Mottled and/or heterogenous appearance (type II) thirteen cases (37%). Prominent defect appearance (type III a) ten cases (29%). And equivocal defect appearance (type III b) four cases (11%).
b) Twenty three patients with ¹³¹I-scan (66%) and twelve patients with ^99mTc-scan (34%) were studied. ¹³¹I-uptake at twenty four hour was 4 to 42 percent (the mean value is 24.5%) in type II. Therefore, mottled type with ¹³¹I-scan could not be due to the low thyroidal uptake of ¹³¹I-iodine.
C) About the thyroid function at the time of scanning, 30 patients were euthyroid, 4 patients hypothyroid, and 1 patient hyperthyroid respectively.
d) Anti-thyroglobulin titer was higher in type II and type IIIa, and was lower in type I and type III b.
e) There were two patients with microscopically mixed presentation of the chronic thyroiditis and the thyroid carcinoma. They belonged to type III a.

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The statistic studies of 20 cases of adult Pickwickian Syndromes (PWS) which have been already reported in Japan including our reported 3 cases in the past, were performed. The incidence in males is two times as much as in females, and most frequently in thirties in men and fifties in women. The average age diagnosed as PWS were 43 years. It took about 10 years for the symptoms of PWS to appear since beggining of obesity. The overweight of average 60% above ideal weight was shown. The chief complaints without obesity were shortness of breathing, somnolence, and dyspnea. Though Burwell described that eight characteristic symptoms were seen in the PWS, average number of the sign which patients showed, was only 4, and obesity, somnolence, periodic breathing and cyanosis were most frequently observed. Slight restrictive ventilatory disturbance was observed in pulmonary function test. Blood gas measurement revealed a fall in Po₂ and a rise in Pco₂ even during awakening. These change were further aggravated on sleep. In electrocardiogram, the findings which were associated with right ventricular hypertrophy were observed in 35%. Cardiac enlargement, hypertension, diabetes and impairment of liver function test were accompanied. All cases were well treated by decreasing body weight.

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1) The effects of pharmacotherapy with psychotropic agents were determined in 529 patients with schizophrenia who were treated in eleven national mental sanatoria as either in-patients or out-patients. Their illness has gone on for ten years or more.
2) Of them 504 had chronic schizophrenia, the prognosis of which was so unfavorable that their illness only showed a slight improvement or remained unchanged after treatment.
3) With shock therapy, the proportion of improving patients decreased with time till at least 10 years after the onset of illness, whereas the proportion of those requiring careful attendance and assistance increased.
4) With pharmacotherapy, the proportion above was reversed, and the condition requiring confinement was prevented, especially when patients were started by drugs in early course of illness. These effects were common to phenothiazine and reserpine.
5) Even in the patients with old schizophrenia who failed to respond to shock therapy, the occurrence of the condition requiring careful attendance and assistance was reduced and the proportion of adaptable patients for sanatorium increased after medicinal treatment. The frequency of this improvement was higher in those requiring such rigid supervision as confinement than in those who were capable of performing simple tasks. It should also be noted that the condition improved more than two years after the onset by medicinal treatment in many instances. These effects were common to phenothiazine and reserpine.
6) The long-term results above are in agreement with the clinical observations made in the Japanese national mental sanatoria over ten years. This long-term study is of deep significance in the sense that the effects of drug therapy could be statistically determined in more than 500 patients with chronic schizophrenia.

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The patient was 69-years-old farmer, who had an operation for the right gynecomastia on December, 1967. About 6 years later, on October, 1973, he was admitted to the hospital, complaining of a mass of the left breast for about 3 months. Physical examination on admission revealed a small finger tip-sized, movable and painless subareolar mass of the left breast. No enlarged lymphnodes were palpated in the left axilla, and laboratory findings were within normal limits. Excisional biopsy was performed and the tumor was reported as adenocarcinoma. As the patient refused radical operation, he was treated with radiotherapy and chemotherapy.
Now he is well without recurrence.
The relationship between male breast cancer and gynecomastia was discussed.

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Thrombosis of the superior longitudinal sinus is reported only 30 cases including autopsy cases in Japan since 1917, and is generaly characterised by a clinical picture made up of paralysis, convulsive seizures, mental disturbance with confusion or loss of conciousness in various combinations. The venous phases of carotid angiography is most valuable for diagnosis. Many cases of this are followed by signs of increased intracranial pressure, so that V-P shunt operation will be done if necessary.
In our case, a 44-years-old man was admitted because of restless confusion with epileptic seizure and right hemiparesis.
He received chemotherapy, low molecular dextran, anticoagurant and anticonvulsant drugs. V-P shunt operation was done for increased intracranial pressure. After treatment and operation the signs and symptomes were remarkably improved, now he is able to work without any neurological deficit and epileptic attack.

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Foville described a case of paralysis of the left side of face and the right side of the body. This is, so-called, Foville's syndrome, and very rare.
We had two cases of Foville's syndrome. First case is a 48-years-old man with the palsy of right oculomotor nerve, left abducens nerve, left facial nerve and the right side of the body and vertical nystagmus. Second case is a 75-years-old woman with the palsy of left oculomotor nerve, abducens nerve, left facial nerve and the right side of the body and horizontal nystagmus. According to clinical course and neurological signs, it is seems that the origin is cerebral thrombosis.

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A case of complex odontome of the mandible in a 19-years-old woman and a case of compound odontome of the maxilla in a 10-years-old boy were reported.
The clinical and histological findings were typical in each cases.
Rentogenological examination was the most useful method to make a conclusive diagnosis of odontome.

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Although pain is an alarm of the living body, alleviation of pain is an important facet of treating a patient. This paper is a report of application of acupuncture with electrical stimulation. The authors' method is a needles-to-plate electrical stimulation with selection of the ‘points’ according to the meridian theory and peripheral neuroanatomy.
In order to determine the physiological effects of this method in the human body, the following studies were performed in twelve patients before and 30 minutes after the treatment, the results of which are as follows:
1. WBC and platelets counts: slight increase with slight shift to the left.
2. Electrolytes: no change.
3. Fasting blood sugar: moderate increase.
4. EKG: prolongation of PQ and decrease in pulse rate.
5. Blood pressure: no change.
6. P lethysmography: increase in amplitude after electrical stimulation of the meridian points in the upper extremity, suggesting increase in circulation.
7. EEG: slight increase in the number of α-wave.
8. EMG: increase in the number and the amplitude of spikes.
The interim results of clinical application of the method on 183 cases showed improvement in 145 cases (79.2%). Good results were uniformly obtained in the patients with posttraumatic cervical syndrome with bizarre complaints and in the patients with frozen shoulder. Muscular and fascial pain seen in the patients with shoulder stiffness and low back pain are good candidates for this treatment. In the patients with sciatica, improvement of pain and paresthesia was also obtained after stimulation of the meridian points and direct stimulation around the sciatic nerve. Little improvement was obtained in the myelography-positive lumbar disc hernia. For hip joint pain in the patients with definite osteoarthritis of the hip, no improvement was observed.
This electrical acupuncture has no or little side effects in the human body so that it is considered to be a safe treatment. The authors think that it would be an important and effective armamentarium in the pain-clinic along with nerve, ganglion and epidural blocks.

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