Atomic absorption spectrometry using a flameless graphite cuvette method to measure serum copper was evaluated for its sensitivity, accuracy, and precision. The following results were obtained;
(1) linearity: 0-600 μg/100ml, (2) recovery: 99% (98-103%), and (3) reproducibility, within-run C.V.: 1.38%(99.1μg 100ml), 1.85% (46.8μg/100ml), and day to day C.V.: 3.91% (97.8μg/100ml). Other cations, anions or various blood substances did not interfere the measurements. A blood sample of 0.1ml was enough for this analysis and this amount is smaller compared to the previous methods.
The present method yields values for serum copper comparable to those obtained by colorimetric procedures.

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Salivary proteins of patients with Sjögren's syndrome (SjS) were studied biochemicaly. Twenty two cases of SjS, 10 cases of rheumatoid arthritis(RA) and 13 cases of normal subjects were studied. Polyacrylamide slab gel electrophoresis in the presence and absence of sodium dodecylsulfate (SDS) and 2-mercaptoethanol (2 ME) and flat bed isoelectrofocusing using Sephadex IEF were used for the analysis of the salivary proteins. When polyacrylamide gel electrophoresis was used in the absence of SDS and 2 ME, salivary protein with the mobility of 0.36 was found more frequently (P<0.001) in SjS patients than in RA or normal subjects. This method may be an additional aid for the diagnosis of SjS.

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Lymphocytes from 5 Fukuyama Type Congenital Muscular Dystrophy(FMD) (5 female), 10 normal contrasts (5 male, 5 female), and healthy parents of FMD (4 male, 4 female) were examind to the frequency and location of the sister chromatid exchanges(SCE) by the BrdU-Giemsa method.
The results show:
1) There were no large differences in the incidence of SCE between blood leukocyte chromosome from healthy parents of FMD and normal contrasts and that similar frequencies were found in cells from FMD patients with cerebral disorders.
2) There was no considerable variation in the distribution of SCE among chromosomegroup between them.
3) It was found that the distribution of SCE within chromosome of FMD indicate an increase in the short arm region of chromosome 1, 9 and in the long arm region of chromosome 15, 18 than the normal contrasts and healthy parents of FMD, and that it is an increase of exchanges in the short arm region of chromosome 1 as compared with the Duchenne type of progressive muscular dystrophy.
4) It is suggested that lymphocytes in FMD may have a defective DNA repair system and an increased frequency of SCEs.
It is possible to that the yield of SCE may be related to the gene expression.

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Rapidly frozend blood were transfused to the chronic dialysis patients to improve the anemia of chronic renal diseases and to the patients who underwent cardiovascular operation at the Cardiovascular Division of Kanagawa-Byoin National Sanatorium.
1) Treatment of anemia in hemodialysis patients: Frozen homo-blood were given to 11 cases (i4 times, 44 units).
2) Transfusion during and/or after the cardiovascular operation: Frozen auto-blood were given to 9 cases. Six cases are still on a waiting list and their blood is already in preservation.
None of these patients developed hepatitis and any other adverse effects were not observed. This transfusion of frozen blood is thought to be most adequate for the blood component therapy and should be extended to the larger number of patients in the future.

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During the 1971-1980 period, 27 infants weighing less than 1000 gm at birth were artificially ventilated (Nasal CPAP in 10 cases, and mechanical ventilation in 17 cases) in our hospital. The purpose of this paper was to review their morbidity and mortality.
Mean birth weight of these 27 babies was 838 gm (575-980 gm), and mean gestational age was 26 weeks (24-28 weeks). Thirteen babies (48.1%) had neonatal asphyxia, and ten had PROM. Their underlying respiratory problems were RDS (11), recurrent apnea (10), Wilson-Mikity's syndrome (4), and transient tachypnea (1). Seven infants received intensive respiratory care for over one month, and one of the seven for as long as 141 days. Major complications or associated abnormalities were PDA (13), septicemia (10), bronchopulmonary dysplasia (BPD) (9), rickets (6), acute renal failure (5), pneumonia (5), and pulmonary air leak (2).
Thirteen infants died of acute respiratory failure, intraventricular cerebral hemorrhage, septicemia, and acute renal failure in the neonatal period (the neonatal mortality rate was 48.196. Among the 12 survivors 7 had following sequelaes; mental retardation (3), infantile spasm (2), total blindness (2). And only 5 infants (18.6%) were intact survivors.
These findings suggests that so-called non-invasive care is considered to be most important for managing these extremely premature infants.

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Various reports on the prognosis of childhood asthma are generally characterized by confusion and discrepancies.
The results of conventional therapy for childhood asthma was examined by questionnaires. The episodes of asthma and allergic disorders in their childhood of 144 adult outpatients with bronchial asthma were also examined by ques tionnaires.
It was concluded that childhood asthma was not different from adult bronchial asthma. More than 90 per cent of all asthma patients seem to have its onset before school age. They usually have a strong family history of bronchial and/or allergic hypersensitivity. The asthma attack is precipitated by respiratory infections, allergens and other causes. In some cases irreversible changes occur 1n their long course of the disease, and some of them may develop intractable asthma. It is impor tant to make a correct diagnosis in the childhood, to avoid various causes of asthma attack, and to continue various effective methods for remission from their childhood.

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Orbicularis oculi reflex evoked by electrical stimulation of the supraorbical nerve on one side consists of early reflex ipsilaterally and late reflex bilaterally. Early reflex is fairly constant and occurs with a latency of about 10 msec. Late reflex which occurs with a latency of about 30 msec is more unsteady than early reflex. It is described that orbicularis oculi reflex obtains adult normal values beginning at age between 5 and 6 years.
The electrically elicited orbicularis oculi reflex was studied in 13 normal adults and 12 asthmatic children.
In all adults and children, the third component, which has not been described in the literature, was found bilaterally following the late reflex. We could not make clear the correlation between the third component and electrical intensity.
There were no difference in latency, duration and amplitude of early and late reflexes except the duration of late reflex. The duration of late reflex was significantly longer in asthmatic children than in normal adults (P<0.001). This finding is presumably reflecting brainstem maturation.

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A 12 year-old boy with systemic lupus erythematosus (SLE) visited us because of sudden visual disturbance. Physical examination revealed mydriasis and loss of light perception and near reflex, but no other neurologic abnormalities. The mydriasis seemed to be due to ciliary ganglion degeneration apparently related to SLE. There has been no such a case as this patient in the previous literatures available. The levels of rubella antibody increased in his blood, and this might be related to the above episodes.

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A five-year-old girl developed severe visual disturbances of both eyes when she woke up and was hospitalized in the pediatric department of our hospital for scrupulous examination. She was diagnosed as having papillitis of both eyes. No abnormalities were found in viral, or bacterial examinations and leukocytosis or other positive findings for positive infectious diseases were not recognized. Moreover, no abnormal findings were observed in CT scanning, EEG, cerebrospinal fluid and cranial neurological and otorhinological examinations.
She was treated with darge-dose steroid therapy and observed during this course of treatment. Findings of eyegrounds were improved about three weeks later and vision was also recovered. The patient has been carefully observed since then, but no sings of recurrence or multiple sclerosis have been recognized so far.

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Two autopsy cases of congenital tuberculosis of babies who died at the age of 19 days and 70 days were reported. These two cases occured in November 1980 and in March 1981. The mother of the first case was diagnosed as tuberculosis and treated following the delivery. The mother of the second case died on the 8th day after the delivery and was not diagnosed as tuberculosis. The infant of the second case was separated from his mother two hours after birth and admitted to Yodogawa Christian Hospital because of prematurity. And this infant was kept free from tuberculous infection in the hospital. Hepatosplenomegaly and primary tuberculous lesion in Lig. teres of the liver were found on postmortem examination, but the placenta were not examined in both cases. The infant of the first case showed erythema with erosion on the skin, but no definite histological features of tuberculosis were found in this lesion. Cultures for M..tuberculosis were all positive except for gastric contents in the first case and cultures of the lung and spleen were positive in the second case. On histological examination, both cases showed miliary tuberculosis. The tubercles of the liver and spleen were small and showing tendency to fibrosis in the second case. The other tubercles were so called soft tubercles. In these soft tubercles, almost all portions showed caseous necrosis containing a large number of M..tuberculosis. Langhans giant cells were not found and epitheloid cells were few. In both cases, the thymus showed marked involution with caseous necrosis in its parenchyma. The cortex was very thin and Hassall bodies were small in size and number. We reviewed the criteria for the diagnosis of congenital tuberculosis established by Beitzke in 1935 and some of them were not suitable nowadays since a great change of the disease profile has occurred in tuberculosis.

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The usefullness of drainage of subdural hematoma cavity in the treatment of chronic subdural hematoma of adults with combination of burr hole evacuation is reported.
Seventeen adult patients of chronic subdural hematoma of unilateral side have been treated after the introduction of CT scanner. One patient was treated by single burr hole without subdural drainage and re-operation was performed because of considerable postoperative subdural fluid collection on CT. 16 patients were treated by one or two burr holes with subdural drainage, 6 patients with single burr hole and single subdural drainage, 5 patients with two burr holes and double subdural drainages, and 5 patients with single burr hole and double subdural drainages.
Postoperative course was uneventful in every patients with subdural drainage and no patients were needed re-operation. Follow-up study of postoperative CT revealed some degree of subdural fuluid collection and midline shift in spite of patients recovery. Such postoperative CT findings do not mean the nessecity of re-operation and disappeared about two months later.
In conclusion, single burr hole with single subdural drainage is enough to treat adult cases of unilateral chronic subdural hematoma.

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In this study we examined the correlations between neurological findings before surgery and prognosis in 24 cases with acute epidural hematoma. There was a good correlation between the state of consciousness before surgery and prognosis. Patients with a consciousness level of semi-coma at the time of admission had a good prognosis, however patients with coma at the time of admission had a poor prognosis. In 8 cases with coma at the time of operation, 4 of those cases with semicoma at the time of admission had good prognosis. On the other hand, two cases with bilateral mydriasis died.
We also described the limitation of surgical treatment based on these results.

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Cervical epidural analgesia has been applied to 48 cases of cardiovascular surgery and 100 cases of thoracic surgery.
The ages of these cases ranged from 20 to 76 years. Epidural catheter was inserted at the level of C7-Th3 interspace. Epidural analgesia was induced using 8.62±1.52 ml of 1% mepivacaine because the cardiovascular depression was more remarkable with 2% than 1% mepivacaine. There was a significant decrease in arterial blood pressure and heart rate and thus a decrease in the rate pressure product was observed during anesthesia.
It is important to keep blood transfusion balance negative at the end of operation and infusion balance not over+1500 ml in patients with disturbed pulmonary function or in the eldery.
Thus, epidural analgesia seems to be best for the elderly patients.

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Epidural morphine analgesia was assessed in 134 patients after upper abdominal surgery under neuroleptanaesthesia (NLA), modified NLA and GOF. Two and 3 mg of morphine were given before surgery through an indwelling epidural catheter. After surgery, satisfactory analgesic effect was obtained in more than 80% of all the patients.
Duration of action was slightly longer in the group which received 3 mg of morphine (mean 27.3h) than in the group which received 2mg of morphine(mean 21h). The analgesic effect of epidural morphine was excellent both in elderly patients and in patients less than 160 cm tall.
Arterial blood gas was measured both before and after surgery, and the values for blood gas analysis showed statistically significant elevation of Paco₂ postpoeratively. In modified NLA group, 2 mg of morphine was unsatisfactory to relieve postoperative pain. The values for blood gas analysis, however, showed significant respiratory depression in the early postoperative period.
It is concluded that under neuroleptanaesthesia, preoperative administration of epidural morphine 2 mg, gives satisfactory postoperative analgesia of long duration with minimal side effects.

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Recently, Emergency Medical Service Centres have been established in many National Hospitals in Japan.
Accordingly, the working facilities of anaesthesiologists are largely expanding in both medical and surgical fields, especially in intensive care medicine. For these reasons, Senior House Officers of the Department of Anaesthesia are required to have a wider knowledge of clinical medicine.
In the Department of Anaesthesia, Kyoto National Hospital, the principles and practice of anaesthesia are being taught to the SHO for two years. These include the basic science of physiology and pharmacology and the applied pharmacology of clinical anaesthesia. During the clinical practice period, the education of the SHO places an emphasis on the technique of cardio-pulmonary resuscitation, monitoring and treatment of critically ill patients in the intensive care unit.
Following two years period of training in the department, they proceed to a course which specializes in anaesthesiology.
Finally, a list of some textbooks concerning anaesthesiology and intensive care medicine are given to the SHO.

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