Monoclonal gammopathies without evidence of multiple myelom, primary macroglobinuria (Waldenström) or other related diseases is defined benign monoclonal gammopathies (BMG).
BMG is usually classified into primary and secondary types. Many excellent reviews on BMG have been published, but reviews on secondary BMG are few. Secondary BMG have been occasionally found in patients with lymphoprolif erative diseases, cancer, infectious diseases, autoimmune diseases and chronic liver diseases. But the significance of secondary BMG is poorly understood and there is possibility that fortuitous coexistence with primary diseases and primary BMG are sometimes considered secondary BMG. Discussing these problems, clinical significance of secondary BMG is reviewed. Careful follow-up of relationship between M-component and clinical course is necessary in the diagnosis of secondary BMG.

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It recently became apparent that sicca symptoms in Sjögren's syndrome (SjS) have considerable heterogeneity, not being limited to so-called “dry eyes” and “dry mouth”.
Thirty-five reported items for sicca symptoms were checked among 31 patients with SjS (sicca alone type, 12; SjS with collagen disease, 19) and 19 control subjects among which age, sex, race, and underlying collagen diseases were matched.
Only 13 of the 35 items were clarified to be specific (P<0.05) to SjS. These contained some symptoms which had hitherto been considered less important. On the contrary, some well-known symptoms were dropped out of the 13 items. Extremely dried earwax, dryness of the skin, and hoarseness are examples of the former, and eye discharge, oral pain, burning sensation of the eyes and eye blurring the latter.

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Existing treatment for the sicca components of the Sjögren's syndrome patients is unsatis-factory. This study was done to determine whether bromhexine is effective or not on the sicca component of the Sjögren's syndrome. Twenty patients with the Sjögren's syndrome were assigned to two groups with bromhexine 24 mg and 48 mg/day orally given for 1 month. Before and after treatment period the frequency of clinical features on the sicca components, the gum test, and the Schirmer test were recorded. The improvement of sicca components were determined by the decreased frequencies of clinical features.
Twelve in 20 patients given bromhexine were improved; dry mouth was improved in 60% and dry eye in 53%, respectively. The improvement of dry mouth was higher after bromhexine 48 mg than 24 mg.
In the improved patients, values on the gum test were significantly higher after bromhexine than before, but it had no effects on the Schirmer test. Most patients of the improved were observed when the lymphocytic infiltration in biopsied labial gland specimen were few.
Bromhexine is therefore valuable in the treatment of the sicca components of Sjögren's syndrome and its effects could be done through not only quantitative but also qualitative changes of both the saliva and lacrimal fluid.

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Sixty of ventriculo-peritoneal (V-P) shunt operations for various types of hydrocephalus were performed in our Department in last five years and a half with 14 cases of ventricular drainages for the other patients of acute hydrocephalus after intracerebral hemorrhages and SAH. Some clinical considerations were reported by analyzing the operative results and, pre-and post-operative CT or angiographical findings of these patients. All the shunt operations were V-P using the Spitz-Holter's low pressure valves, 31 cases of them were for hydrocephalus after SAH, 8 of them were after the head injuries, 6 were intracerebral hemorrhages and the remaining 15 were after the other various lesions. Cranioventricular index (CVI) showing the width of the frontal horn of the lateral ventricles, periventricular lucency (PVL), and the other findings on CT or by angiographies were studied before and after the operation.
1. The width of the lateral ventricles as shown by the CVI was markedly lessened after the V-P in the shunt effective group which was consisted of 29 cases (48%) of the shunt operatives. The PVL disappeared or diminished postoperatively as well in the same group. Contrarily the CVI and PVL did not show the significant changes after the oper-ation in the fairly or poorly effective group as determined by the efficacy of the operations (fair group: 16 cases, poor group: 15 cases). 2. By analyzing the cases of NPH, the same results as mentioned in 1. were obtained. After the comprehensive considerations about various factors influencing on the CVI, it was supposed that the ability of keeping the high head positon in the shunt effective patients might be one of the most important factors resulting in the lessening the size of the postoperative lateral ventricles. 3. It was experienced in some cases in which V-P in acute stages unexpectedly adversely worsened the various clinical signs though previous ventricular drainage had shown significant efficacy on the disorders. This was explained that the quantity of the CSF flow through-the V-P was not sufficient enough as compared with the need for lessening the size of the ventricle or diminishing the PVL, because satisfactory clinical improvement was obtained after replacing the V-P with V-A (ventriculo-atrial shunt).
From these findings, the position of the head may be one of the most important factor influencing on the effectiveness of V-P shunt, and in case of unsatisfactory result after V-P in acute stage, replacement of V-P with V-A may be recommended as soon as possible with close and frequent CT examination before irreversible brain damage might occur.

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The Békésy audiometry, the speech discrimination test, the distorted speech test, the directional hearing test, the binaural integration test and the binaural differentiation test were performed in 23 patients treated with hemodialysis and 13 normal subjects, and following results were obtained 1. 29 ears (63%) of 46 patients' ears had sensorineural hearing loss and it was more significant in higher frequencies.
2. Békésy audiogram showed 5 cochlear disturbances (22%) in patients with hemodialysis and other tests showed 14 retrocochlear disturbances (61%).
3. All means of the speech discrimination test, the distorted speech test, the directional hearing test, the binaural integration test and the binaural differentiation test of patients were lower than those of normal subjects.
4. The relation between anemia and retrocochlear hearing loss in patients with hemodialysis and the hearing loss was appeared to be improved by hemodialysis.
5. Retrocochlear hearing loss inpatients with hemodialysis is not so much the organic disturbance as the functional disturbance.

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An inclusion-bodies bearing cell was described, that appeared in the urine of patients with mumps.
Inclusion bodies were demonstrated in the urine examination of 46 out of 60 children with mumps.
In controls, 6 out of 20 children showed inclusion bodies.
In serial studies on urine, the most inclusion-bodies appeared as early as 3 days after onset of the disease.

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Increasing utilization of electron microscopy on surgical and autopsy material for diagnostic purpose has been appreciated in recent years. However, because of their poor preservation of ultrastructural morphology, formalin fixatives has not been applied for routine use on electron microscopy.
In this study, we investigated ultrastructural preservation of modified buffered formalin fixative and compared its ability with that of glutaraldehyde-osmium tetroxide double fixation (for electron microscopy).
Our results showed that this buffered formalin revealed excellent ability for preservation of the ultrastructural morphology even in comparison with glutaraldehyde-osmium tetroxide fixation with few exception on intercellular junctional complexes and that it preserved ultrastructural morphology even after one and a half year in the fixative. Since this fixative leaves practically no problem for routine, paraffin embedded light microscopy, it seems to be a great advantage to use this fixative for routine. In addition, it is also an advantage that this fixative is not only very easy to prepare, but also very inexpensive.

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A modified Millonig's buffered formalin fixative is extremely useful when examine tissues by electron microscopy retrospectively. We have used this fixative routinely and have already investigated its usefulness in a comparative study with a conventional gluta-raldehyde-osmium tetraoxide fixative.
Using the buffered formalin, we studied a case with recurrent malignant fibrous histiocytoma characterized by prominent xanthomatous features by electron microscopy.
In general, tumor cells have a stellate shape with no apparent ruffled cell margins. Cytoplasmic microorganelles are scanty with only a few mitochondria and rough surfaced endoplasmic reticulums observed. Golgi complexes in the tumor cells are also poorly developed and no Langerhans' granules could be found.
Xanthomatous cells seen by light microscopy contain various sized lipid droplets with increased numbers of mitochondria. Some of the lipid droplets are membrane-bound, while some others reveal no membrane structures around the lipid droplets suggesting that the lipid is produced by tumor cells and that the lipid laden cells are somehow related to lipoblastic cells.
Most of the tumor cells exhibit a thin layer of electron dense homogenous material with a few showing stratified accumulation of these layers suggesting basement membrane formation. However, a methenamine silver stain for this basement membrane-like structure is negative by electron microscopy.

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Porphyria cutanea tarda is a disease characterized by skin lesion, hepatic disorder, diabetes mellitus, and increase of serum iron. The disease is said to be caused by hereditary enzyme deficiency decreased activity of uroporphyrinogen decarboxylase (UD) J and manifested when acquired factors are also present. Our case is a 56-years-old male whose acquired factor may be the intake of a large amount of alcohol over many years. As the skin lesion, facial hypertrichosis, skin pigmentation, bulla formation, erosion, scar and skin incrassation were observed, while no difference from the control was found in the photosensitivity test with 400 nm UV. In PAS stain of skin tissue for biopsy incrassation of basement membrane and of vascular wall, and PAS positive substance around them were observed. Fluorescent antibody method showed deposition mainly of IgG on these areas. Hepatic function is slightly disordered; deposition of hemosiderin and deposition of porphyrin body in the hepatic tissue was observed in biopsy of the liver by laparoscopy and by 400 nm UV irradiation, respectively. In addition UD activity in hepatic tissue was remarkably decreased, which is said to be the cause. Diabetes mellitus was recognized while insulinogenic index (1 hr) was as low as 0.1, and therefore the disease is difficult to be considered secondary to the hepatic disorder. Both reserve iron and serum iron were increased; urine was reddish brown; Δ-Ala level in urine was normal; levels of uroporphyrin and coproporphyrin were high, the former being predominant. At present the patient is being subjected to blood-letting; the clinical symptoms have not been improved yet.

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One case of leiomyosarcoma was reported and literatures concerned were reviewed. The case presented was a 45-years-old female patient who complained an anemia caused by unknown origin. The tumor, which was relatively small, size of 3.5 cm×4.0 cm×5.0 cm. and was generated at the upper portion of duodenum, was revealed to be the proliferation in intra-and extra- canal. The anemia was proved to be hyperchromic and globular type, however, the hemorrhage site that caused an anemia was not found throughout the pre-and postoperative period. After the tumor resection, an improvement of anemia was observed. One year after the operation, the patient restored good health and continued to have regular check-up at the out-patient clinic while keeping housework at home.

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General anesthesia for tonsillectomy and adenoidectomy requires much care because 1) the patients concerned are mostly infants, 2) as the operative site is the upper respiratory tract, obstruction of airway and aspiration of blood must be avoided during and after operation, and 3) epinephrine is applied to the operative site for hemostasis.
Since May 1977 we have combined general anesthesia consisting of nitrous oxide, oxygen and pancuronium with local anesthesia consisting of 0.5% lidocaine solution containing 1: 100, 000 epinephrine for tonsillectomy and adenoidectomy in infants. The present report concerns a retrospective study of 240 cases that were anesthetized with this method from May 1977 to April 1979.
Compared with the preoperative values obtained at the induction of anesthesia, the maximum values of systolic pressure and pulse rate after the start of operation increased 29.1±17.0% and 17.5±15.6% respectively. In most cases, however, the rise was transient, with the values gradually returning to the preoperative level. Serious arrhythmia that might cause hypotension developed in none.
Not less than 0.2 ml/kg of 0.5% lidocaine solution containing 1: 100, 000 epinephrine was used in 34.8% of the patient undergoing adenoidectomy, in 83.3% of those undergoing tonsillectomy and in 100% of those undergoing both operations. This means that in most of the patients the volume of epinephrine solution exceeded the safe dose suggested by Johnstone and Kats as concurrently usable in general anesthesia with halothane.
Recovery of consciousness and reflex after anesthesia were rapid, thereby permitting early removal of the endotracheal tube.
In summary, combination of inhalation anesthesia consisting of GO-pancuronium with regional anesthesia consisting of 0.5% lidocaine containing 1: 100, 000 epinephrine is considered to be useful for tonsillectomy and adenoidectomy in infants. The reasons are 1) epinephrine can be used concurrently with general anesthesia. 2) analgesia can be brought to the operative site by local anesthesia, 3) the respiratory tract can be maintained by endotracheal intubation during anesthesia, and by rapid recovery of consciousness and reflex activity after operation.

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Over 5 years follow-up study was made on 29 THR, 19 for osteoarthritis, 8 for intracapsular femoral neck fracture, 1 for the failed replacement of the femoral head and 1 for the central fracture-dislocation of the hip. As much as 64% of the total cases were determined as poor in overall results under the evaluation standards of Japanese Orthopaedic Association. Conclusions drawn from these findings are that skillful and precise techniques are essential for this operation and that the indication for THR has to be strict.

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Numerous problems have been reported on the hemiplegic patients who are complicated with the femoral neck fracture. Recent studies have shown that the prognosis of these cases are grave, not only the walking, but the life.
The following results were obtained by us with 41 cases of these patients including outpatients.
1. The incidence increases markedly in the latter half of the sixth decade in women.
2. In many cases, the fracture occured accidentally by the falling down on the floor, during their hospitalization.
3. For the prognosis of walking, there was no differences between the types of the fracture (trochanteric or intracapsular), among 33 cases, who were able to walk before the accident. For the treatment, it is suggested that the walking prognosis of the open reduction is better than that of the traction method.

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An attempt was made to analyse the situation of the mental health care in the southernmost islands, “Yaeyama District”, of Okinawa prefecture.
The major source of information was 1249 sheets of the clinical chart which had been recorded during the period from 1962 to 1979 and kept at the psychiatric clinic of prefectural Yaeyama Hospital.
The data obtained were summarized as follows
1. The psychiatrist was first send to this area (Yaeyama) for a short term in 1966, and the clinic was officially opened two years later.
In 1972 the psychiatric ward has started with a full-time psychiatrist (who came in Feb. of the following year) and other medical staffs.
2. The crude distribution of mental illnesses according to those clinical charts were; 27.3% of all patients were schizophrenics, 2.6% manic-depressives, 19.2% neurotics, 15.7% epileptics, 8.2% mentally retarded, 5.2% psychic disorders in the elderly, and 17.3% miscellaneous groups, respectively.
3. These figures were found to be quite similar to those in the neiboring islands “Miyako Jima”. However, the prevalences of schizophrenics, epilepsy and neuroses except for that of mental retardation were exceedingly higher in our present survey at Yaeyama, as compared to those of the nation-wide Mental Hygiene Survey performed in 1963.

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