It is well known that antibiotics such as penicillins and cephems may evoke allergic reactions especially anaphylactoid shock in high frequency. Two different antigenic structures in these particles are thought to be responsible for the allergic reactions. The first one resides in the openedβ-lactam ring combined with theε-amino residue of the lysine in the carrier protein. The second probably belongs to some polymerized particles in these drugs. The latter is suspected of the causative antigen of the anaphylactoid reaction, but the chemical analysis of the antigenic determinant still remains unknown.

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Recently, incidence of antibiotics-associated enterocolitis has increased. It is known that its typical disease is“pseudomembranous colitis”of which prognosis is poor. Also“acute hemorrhagic colitis (A. H. C.)”to be comparatively mild has been increasing, and this prognosis is good.
As we experienced five cases of A. H. C. which could be confirmed endoscopically, we tried to investigate clinical pictures of A. H. C.
The male/female ratio was 3/2, and the age range of the patients was among all ages. Antibiotics to be concerned with the cause were 2 AB-PC, 1 combinated drug of AB-PC and MCI-PC, 1 CB-PC and 1 CLDM. All antibiotics were administered orally. The daily dose was less than 2.0g. The period of administration was within 4-7 days, a short period. The symptoms of abdominal pain, slight fever and frequent diarrhea appeared within 4-8 days after the administration of antibiotics started. Then bloody stools appeared with subsequent 3 days, and the daily frequency of bloody diarrhea was 4-35 times.
Leucocytosis of moderate degree was present. No eosinophilia was observed. In spite of frequent bloody diarrhea, anemia was not observed in all cases.
We observed from the rectum to the splenic flexure by colonofiberscope (Olympus-CFMB 3), and the endoscopy demonstrated diffuse hemorrhage, edema, hyperemia and/or erosion. Their findings continued from the rectum or the sigmoid colon to the splenic flexure. But no pseudomembrane was found. The changes in the rectum might be observed, or not. Histologically their findings were nonspecific. Hemorrhage under mucosal epithelium and edema of lamina propria mucosae were showed in all cases, but infiltration of inflammatory cells was little. Barium enema revealed nonspecific findings.
The presence of Klebsiella oxytoca in fecal bacterial pure cultures was detected in 3 cases soon after the onset, but this Klebsiella oxytoca disappeared within 2-4 days, with the improvement of symptoms. By cessation of antibiotics, bloody stools disappeared within 3-7 days by symptomatic treatments, and the prognosis of A. H. C. was good. About second week after the onset, it improved as far as endoscopy demonstrated only mild edema.
Histologically edema in lamina propria mucosae became more slight. About second month after the onset, the mucosa was considered to become normal endoscopically, but extremely slight edema in lamina propria mucosae was continuing histologically.
The existence of Klebsiella oxytoca in fecal bacterial pure culture is important as a clue to make clear of the mechanism of A. H. C., but the mechanism is yet unknown.

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We handled 150 cases studied by endoscopic examination within 7 days after the onset of upper gastrointestinal bleeding, who visited our hospital from 1978 to 1981. These 150 cases included 69 cases of gastric ulcer, 24 cases of hemorrhagic gastritis, 15 cases of esophago-cardial varices, 14 cases of duodenal ulcer, 8 cases of gastric cancer, 8 cases of Mallory-Weiss syndrome, 6 unknown cases, and so on.
As for the therapeutic modalities, 116 cases were treated medically, 34 cases (23%)were operated on and 13 cases, including 7 cases of esophago-cardial varices, were fatal.
We checked pulse rate, blood pressure and EKG before the examination and we examined with setting up of an I.V. line and we experienced no accident. Emergent laboratory studies disclosed decreased serum protein, leukocytosis, etc. in all the cases. A decrease in the percentage of α₂ and γ-globulin and an elevation in the percentage of rod-shaped leukocytes were marked in the fatal cases.
It is re-confirmed that endoscopic examination is safe and significant in finding out the bleeding focuses in a hurry, deciding the therapeutic plans including operation and judging the patient's prognosis.

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From the results of pedigree analysis and carrier detection tests in Duchenne dystrophy, we thought, in the probable and definite families, maternal side was much predominant in this heredity, but paternal side was also concerned in this inheritant mode considerably. In possible families, total numbers of abnormalities out of 8 determinants in our carrier detection tests were almost equal fathers to mothers. That's the reason why we considered the paternal side shouldn't be ignored for carrier state and genetic counselling.
Our carrier detection test is based on the specific abnormalities for Duchenne dystrophy, such as deep Q and tall RV₁ in EKG findings and a panel of enzyms including CPK, ALD, LDH, ALP, GOT, GPT etc. From the test results of total 150 examples of parents and siblings of probands, we confirmed there existed considerable difference between definite, probable families and possible families. In each family group the average birth rate of affected sons among total boy's births was calculated.
We also demonstrated the 100% birth rate of affected sons to the boy's birth on family basis. The families with over 2 abnormal values in both father and mother were considered to be the most clustering in this inheritance showing the high rate of 72.7% and followed to the families of only mother having more than 2 abnormalities its 100% birth rate being 71.4% and the families of only father showing over 2 abnormalities having its rate of 43% and lastly, father and/or mother showing 1 abnormal value being the rate of 34.4%.
We supposed these 100% birth rate of affected son is the most meaningful calculation for presuming the risk of Duchenne dystrophy on each family basis.

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Serum activities of lactate dehydrogenase (LDH) and creatine phosphokinase are utilized for the diagnosis and the judgement of progression of progressive muscular dystrophy (PMD), but recently the proportions of their isoenzymes are needed for getting the information of this disease. The normal range of their isoenzymes varied by the differences of each methods, so normal range must be determined in every institutions. We measured the proportions of isoenzymes of LDH and CPK in normal adults and PMD patients, and investigated on some points.
In 8 samples of over than normal LDH 1 level the proportion of LDH 1 was higher than that of the each LDH 2, and it was suggested that the LDH 1 was derived from heart muscle. In 7 of this 8 samples, 5 to 10% of CPK 2 was detected and it was suggested that the CPK 2 was also derived from heart muscle. In 8 patients having high serum LDH 4 and 5 levels their liver function was normal and average of CPK activity was 602mu/ml, so it was supposed that the LDH 4 and 5 was derived from skeletal muscles.
It will be useful for the diagnosis of progression of muscular dystrophy and the judgement of heart muscle damage when the activities of LDH and CPK and their isoenzymes are measured at the same time.

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Purpose: Various treatments have been applied to cerebral palsy (CP) which is very difficult to cure among physical impediments. Those treatments are all transitive and their effects are limited. Clinical application of GSR biofeedback method (GSR value is directly feedbacked and controled into subjects through sound and light) was attempted in order to obtain ability to relax abnormal tension by subjects' own will.
Method: Biotrainer was used (OG Technology Research Co.). One application consisted of thirty minutes (with two or three sessions) per week was performed on subjects. When the ideal curve was achieved, training environment was gradually reduced into ordinary environment. At the introduction of the application, autogenic training (AT) was supplimentally used. Range of motion (ROM) of joints and speech ability test were observed and their correlation with training results were discussed.
Results and discussion: The result showed wide range of effects among individuals (subjects). Practice curve presented general control of tension and some signs of relaxation as training proceeded. Furthermore, there was a tendency of gradual shortening of the training period at each environmental step. Such concrete effect as improvement of speech function was observed and confirmed by introspection. The evaluation should be placed on the fact that though void of firm progress, subjects who had approached closer to the ideal curve, recognized their own relaxation.
However, there was no direct relation between physical and mental relaxation; neither was there any correlation between training progress and physical relaxation. The problem was that achieved functional improvements did not last long. As it is suggested that more sophisticated arrangement of control and evaluation methods would bring forth better preventive effects and clearer results, further study is under way.

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Hospitalized schizophrenic patients, whose acute psychiatric signs had been relieved, were daily treated either with nitrazepam or nitrazepam plus one neuroleptic drug just before their bedtimes, and the continuous administration of nitrazepam on chronic psychiatric symptoms was followed up for a 8-week period by the open trial method.
Seventeen subjects completed the full 8-week treatment period, their mean ages and mean durations of the illness and hospitalization being 36.5 years, 13 years and 7 months and 3 years and 3 months, respectively. The mean duration period of nitrazepam was 2 years.
Of the seventeen patients, twelve showed occasional insomnia when nitrazepam was replaced by placebo. The global judgement of the psychiatric symptoms at the end of 8-week study gave the following results; symptomatic“improvement”was observed in two patients (11.8%), “slight improvement”in three (17.6%), “no change”in eleven (64.7%) and“deterioration”in one. A comparative analysis between the improved and the unimproved group revealed that significant clinical factors involved in the former group were younger ages (>30 years), short-term hospitalization (>1 year) or relatively short duration of treatment (>3 months) with a daily dose of 5mg/day of nitrazepam. However, there could be detected no significant changes on individual items for the psychiatric symptoms throughout the 8-week study.

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In order to know the current status of the spa treatment in Japanese national spa hospitals a questionnaire survey was carried out in November 1980. A total of 3, 309 in-patients of 15 hospitals were contacted by a questionnaire. Of these 3, 309 patients, 1, 106 (33.4%) were receiving spa treatment and 870 (78.7%) of them gave an answer. A detailed analysis of these answers revealed the following Of the entire patients who replied to the questionnaire, 62.7% were above 50 years of age and 16.4% were aged 70 years or above. There were 256 patients with rheumatoid arthritis and 211 with cerebrovascular accident, totalling 467 or 53.7% of the entire patients. This fact indicates that in Japan spa treatment constitutes a part of the rehabilitation program for those affected with motor disturbance.
Among various therapeutic baths, exercise bath was found to be in most frequent use, followed by Hubburd tank and bubble bath in that descending order of frequency. Peloid bath is being used in 2 hospitals and spa drinking, in only one hospital.
Spa treatment was evaluated as effective by 78.39% of patients, as ineffective by 5.9% and as uncertain by 15.9%. Patient's dissatisfaction with spa treatment related to the temperature of bath in 14.0%, to the frequency of bathing in 34.6% and to the kind of therapeutic bath in 5.5%.
A majority of patients (72.4%) started to receive spa treatment in expectation of its beneficial effect either from their own experience or on others' recommendation.
The incidence of bathing reaction among the entire patients studied was 18.4% a figure lower than corresponding values reported previously.
CMI test was performed in 284 patients of 11 hospitals. The frequency with which the test result was categorized as group 3 or 4 was higher in patients with rheumatoid arthritis than in those with cerebrovascular accident. This suggests that spa treatment is effective in the treatment of neurosis also.
Even now spa treatment is in favorite use by many patients as an adjunct to various therapeutic measures. The results of the present survey led us to firmly belief again that spa treatment is of therapeutic value.

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A 14-years-old boy received injury in his right eye hit accidentally by a ball during a soccer game. He was diagnosed by a near-by general practitioner as right commotio retinae and treated as an out-patient. In the course of treatment, he felt something abnormal in the field of vision, so visited our department of the hospital. At the initial examination, blood opacitas floating in the upper part of the right vitreous body was observed, and funduscopic findings showed sector shaped chorioretinal degeneration developing from right disc circumference to external upper circumference, in accordance with which, visual field defect was observed. Fluorescein angiography revealed that retiform fluorescein angiographic finding appeared in the atrophic focus with the distinct lesion, and at the latter period of the fuorescein angiography, the finding showed hyperfluorescence, and the lesion was distinct. The results of the ERG test revealed that both waves a and b were subnormal, but oscillatory potential diminished. Peripheral circulatory dilators, etc., were administered to the patient, and the result was observed. However, the range of the chorioretinal degeneration was not enlarged, and pigmentation became definite, thus showing degenerative findings.

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Hypocalcemia associated with blood transfusion results from the binding of citric acid contained in the ACD solution to calcium ions in patient serum.
We recently experienced dramatic recovery from a shock state with the administration of a calcium preparation in a patient with rupture of gastric varix due to liver cirrhosis. The patient, a 65-years-old male, was hospitalized as an emergency case and was given rapid, massive blood transfusion immediately. He lost 6, 500ml of blood in hematemesis and received 6, 000ml of blood transfusion. Blood pressure was imperseptible. While receiving tranfusion, he was conscious but was in a shock state, not responsive at all to vasopressors and steroids. EKG showed gradual prolongation of Q-oTc interval, depression of ST segments, and high T waves. Femoral arterial pulsation became impalpable when ventricular arrhythmia began to appear frequently. The patient was then given 10ml of 8.5% calcium gluconate and 20ml of sodium bicarbonate. Soon after pulsation became palpable, the systolic pressure rose up to 90mmHg, ventricular extrasystole disappeared, and ST segments and Q-oTc interval improved. As the ionized serum calcium value then was 0.55mM/L, however, another 15ml of 8.5% calcium gluconate was given before subjecting the patient to an emergency operation. The patient survived the operation, which consisted of devascularization and splenectomy. He received 2, 500ml of blood transfusion during the operation. Thus, combined with the preoperative transfusion, a total of 8, 500ml of blood transfusion was given. He was also given 30ml of 8.5% calcium gluconate during the operation. Despite high total doses of 55ml of the calcium gluconate, the ionized calcium value determined at the termination of the operation was as low as 0.843mM/L.
Decline in the ionized calcium level due to blood transfusion is usually transient, the normal level is gradually regained once transfusion is over. In patients with liver cirrhosis, however, massive blood transfusion causes a prolonged decrease in serum ionized calcium level because the metabolism of citric acid is impaired. Therefore, in patients with this disease, calcium agents should be given positively as we did in the present case.

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During the past 8 years from 1973 through 1981, 26 patients were treated for perforated gastroduodenal ulcer at Toyohashi National Hospital. There were four deaths (15%). Three of 4 deaths, who were older than 60 years of age, underwent surgical treatment more than 31 hours after perforation. Post-operative complications were seen in high frequency, including 8 instances of liver failure, three leaks of duodenal stump and two renal failures. Selective proximal vagotomy plus pyloroplasty has been successfully performed in three patients since 1978. We recommend SPV procedure for perforated duodenal ulcer in early stage.

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Lately the morbidity rate of cardiovascular disease has increased, especially of myocardial infarction. Simultaneously C. C. U. has been recognized for its importance and has spread throughout Japan. We have studied about the aspect of our C. C. U. using for one year from April, 1980 to March, 1981. The total number of patients received in the C. C. U. for one year were 103, including 26 myocardial infarction patients (19 men and 7 women) whose average age was 64.
About all 26 myocardial infarction patients, we got some results as follows. 11 (42%) were received in our C. C. U. within 3 hours and 18 (69%, including 11) were within 24 hours. 5 died; 2 of cardiogenic shock, 1 of congestive heart failure, 1 of cardioclasis and 1 of apoplexy.
As concerns the rest of cases of 103, 28 died of arrhythmia, 17 of congestive heart disease, 5 of angina pectoris, 11 by cerebro-vascular disease and 16 died of others.
How have been they received? 60% of them were taken in through the general practitioners and more than 70% of them were from the neighboring towns and villages including Beppu city where our hospital is located.
The results we have shown seem to indicate the character of our hospital as the second or the third one. And also they show the present condition of the national hospital in the rural areas where the medical system and equipment aren't popularized that the reception rate of patients is high who don't have coronary heart disease.

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