The advance of modern immunology has enabled us to diagnose and classify human nephritis by using histological or sophisticated immunological techniques. IgA nephro-pathy, first reported by Berger, is considered to be an immune-complex-induced glomeru-lonephritis caused by immunopathogenic agents based on the following findings seen in this disease; mesangial deposition of IgA, IgE and C3; increased serum IgA levels; the presence of IgA containing complex; and a high recurrence rate of IgA nephropathy in renal transplant recipients.
So much information has been obtained about the function of HLA, major histocom-patibility complex of human, which is considered to regulate immune response. Among these investigations, HLA-DR locus, corresponded to Ia antigens in mice, appears to influence various aspects of humoral and cellular immune functions and it is observed to have the susceptibility to some immunopathogenic diseases.
Forty-two patients with primary IgA nephropathy underwent tissue typing for HLA antigens by the standard method using microlymphocytotoxicity test. Only the frequency of HLA-DR4 was significantly high in this disease. The HLA-DR4 was 57.196 in the patients with normal renal function, 85.7% in those with decreased renal function, 100% in dialysis patients and 39.2% in the control group. One instance of familial IgA nephropathy was found in the familial study of HLA in four dialysis patients.
Our data suggest that the HLA system may play an important role in the occurence and exacerbation of IgA nephropathy in Japan. Further investigations are required to clarify the correlation between HLA and abnormality in the immune response

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In 1967 Taguchi accomplished a method of closing the renal incision by one layer interrupted parenchymal suture without any particular hemostatic procedures. This ope- ration has been applied to 61 kidneys during 15 years with staghorn or multiple large calculi. By this method all the cases showed favorable results. None of the operated cases so far has ever developed a urinary fistula.
Surgical technique: After clamping the renal pedicle, a straight longitudinal incision is made along Brödel's line, then the renal parenchyna is disected. After removal of stones, a properly curved intestinal needle threaded 2-0 Dexon or catgut is inserted into the paren-chyma from the renal capsule down to the pelvic mucosa, then to the other side reversely. The sutues are tied with barely enough tension to approximate the planes of the incision. On releasing the clamp, the kidney will swell up so that the two opposite sides of the incised kidney will be compressed together snugly, thus preventing any excessive bleeding. If bleeding from the wound occurs, hemostasis can be accomplished by pulling up the knot of the Dexon. Then keeping up the tension, fine silk ligature is placed around the Dexon below the knot. Now this technique of reinfocement is done routinely. The hemostatic mechanism of this operation is to compress together the incised planes by renal pressure. Therefore the Dexons should be maintained for a certain period to maintain the minimal pressure necessary for hemostasis.
The followings are mean values from the 50 kidneys. The mean renal artery clamp time was 18 minutes 5 seconds and the mean length of nephrotomy was 6.7cm. The mean length of macroscopic hematuria was 5.4 days. In 5 cases, one calculus remained

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Fibronectin (Fn) is a high-molecular-weight glycoprotein, and exists on the cell surface and in the cytoplasma of fibroblasts or other cells, in the plasma, and in the cerebrospinal fluid. The role of plasma Fn is related to coagulation of blood, restoration process of wounds and removal of foreign substances by reticuloendothelial system, but it's precise roles are not yet determined. We measured plasma Fn by laser nephelometer and some interesting results were obtained. Seventy-six patients were studied: 36 cases of chronic renal diseases (age range 7-15 years), 19 bronchial asthma (7-17 years), and 21 progressive muscular dystrophy and it's related diseases (7-20 years). Plasma Fn levels in these patients were shown as percentage of Fn level of normal adult pooled plasma.
Results: 1) Chronic renal diseases: In patients with steroid sensitive nephrotic syn- drome (SSNS) the plasma Fn level was 11.5&21.9% (n=16) (in active stage 130.3&19.2%) and it was significantly high (p<0.001). The plasma Fn level was 104.0&18.4% (n=8) in patients with membrane-proliferative glomerulonephritis, and was 127.5&22.1% (n=3) in patients with other nephritic nephrosis. It's level was 113.9&10.3% (n=10) in patients with persistent glomerulonephritis, was low in patients with nephritis associated with liver cirrhosis (3 cases) and was within normal limits in patients with purpura nephritis (2 cases). Some patients with SSNS showed normalized Fn level as their nephrotic state improved. 2) Bronchial asthma: The plasma Fn level (104.3&20.8% (n=19)) was within normal limits in patients with bronchial asthma. In patients with atopic type asthma it was 105.1&23.0% (n=15), in infections type asthma it was 95.8&5.0% (n=2) and in mixed type asthma it was 107.8&4.4% (n=2). Most cases who had been free from asthma attack over one year had the Fn level above 100%. 3) Muscular dystrophy: In patients with Duchenne type muscular dystrophy the plasma Fn level was 107.4&10.0% (n=15), in congenital musclar dystrophy it was 97.0&7.596 (n=3) and in the other related diseases it was 108.9&11.596 (n=3).
Discussion: In chronic diseases in childhood (especially in SSNS of chronic renal diseases), plasma Fn level varied with change in disease condition, so it was suggested that it would be useful to serially measure plasma Fn for the understanding of the disease condition

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Relation between cardiothoracic ratio (CTR) and echocardiographically determined pa-rameters in patients with chronic renal failure was studied immediately following hemo-dialysis. Sixty patients were classified into 3 groups according to the duration of hemo-dialysis. Group I (21 cases): the duration of dialysis was less than 2 years (mean 0.9&0.5 years). Group 11 (17 cases): 2 to 5 years (mean 3.5&0.9 years). Group III (22 cases): longer than 5 years (mean 8.0&2.2 years). The results were as follows:
(1) CTR of group II (50.0%) and group II (49.6%) were significantly (p<0.05) greater than that of group I (45.6%).
(2) There were no significant differences of left ventricular wall thickness (LVWT) among three groups.
(3) Left ventricular diastolic dimention (LVDd) of group III (51.6mm) was significantly (p<0.05) greater than that of group I (47.0mm).
(4) CTR correlated with LVWT in group II (r=0.69), and correlated with LVDd in group III (r=0.73).
These results suggest that left ventricular hypertrophy alone may account for enlarged CTR in cases of dialysis length of less than 5 years, whereas left ventriculardilation is an additional cause for enlarged CTR in cases of dialysis length of more than 5 years

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A 78-year-old male patient visited our hospital with chief complaint of an abdominal mass. Laboratory data were within normal limits except CRP and erythrocyte sedimentation rate. Drip infusion pyelography and computed tomography showed a large right renal tumor with multiple calcification. Following these examinations, he was scheduled for the operation. However, he was discharged because he did not accept operation. As he noticed the rapid growth of tumor about 2 months later, he was readmitted to our hospital. The right transperitoneal nephrectomy was carried out. There were dense adhesions to the duodenum and the colon. Four weeks after the operation he died of gastro-intestinal hemorrhage and duodeno-cutaneous fistula.
The weight of resected tumor was 3680g. In the cut surface, about one-third of the tumor was yellow in colour and soft which was close to the right renal parenchyma. The rest of the tumor was gray in colour and hard. Histologically the yellow part pf the tumor was typical clear cell carcinoma, however the gray part of the tumor was very similar to the histology of fibrosarcoma.
Reported cases of giant renal cell carcinoma in Japan weighing over 2000g were collected. Our case was the third in our country in terms of resected specimen's weight. Meanwhile, histological examination of the most part of our resected specimen showed unusual features interpreted as a sarcomatoid renal carcinoma. Previous literatures dealing with sarcomatoid renal carcinoma were reviewed and its histogenesis was discussed

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We report a case presumably thought to be in early stage of membranoproliferative glomerulonephritis.
A 19-year-old male was admitted to our hospital with a chief complaint of chance proteinuria. Since persistent hypocomplementemia was noticed, renal biopsy was performed, which revealed segmental membranoproliferative lesions in three out of eleven glomeruli. Immunofluorescence also revealed focal segmental deposition of IgG, IgM, β₁C and C₁q along the capillary walls with granular pattern. Intramembranous and messangial electron dense deposits and numerous virus-like particles were recognized by electron microscopic study.
Those findings resembld to that of lupus nephritis, however clinical findings did not fulfill the criteria proposed by American Rheumatoid Association.
Steroid was effective to this patient and urinary protein decreased. Focal segmental membranoproliferative glomerulonephritis may be an early stage and/or a mild form of idio-pathic (diffuse) membranoproliferative glomerulonephritis

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Peritoneal dialysis (PD) was done for a 57-year-male patient, who had undergone hemo-dialysis for three months and one year because of chronic renal failure due to polycystic kidney. The reason why the PD was started was frequent episodes of A-V shunt troubles with no accessible vascular sites left.
A method of PD was commonly used intermittently (IPD), and continuously (CPD) for one week. Two liters of dialysate were usually delivered using automatic cycler machine. Total dialysate exchanged during one dialysis was usually 15 liters a day and 45 liters weekly.
In order to increase efficacy of the dialysis, application of vasodilator such as dipy-ridamole and nitroglycerine on PD, hyperosmotic or alkaline dialysate solution with 7% NaHCO₃ were useful for significant augmentation of peritoneal clearance, 10% in urea and 60% in creatinine. But when adding further hyperosmotic solution, reduction of a great deal of water from the body led to hypotension despite the increased efficiency. In such a case, drip infusion was required.
Introducing the low osmotic dialysate dwell during the night was also effective while the patient was sleeping, whereas the drained solution was equivalent to the blood in urea and creatinine.
CPD using low osmotic dialysate was performed for one week and compared with IPD. The clearance for urea and creatinine in CPD was two to three times as great as IPD.
The most common complication was related to infection and seven episodes of peritonitis was seen during the total PD duration. Early recognition of peritonitis was based on cloudy appearance and white cell count in the drained solution before clinical presentation of abdominal pain, nausea, vomiting and fever. If any chance for peritonitis occurred, PD was performed frequently and successively with addition of antibiotics guided by culture, heparin and urokinase until clearing of abdominal fluid.
Finally, IPD is a simple and useful method for chronic renal failure. More recently, the technique of CAPD for maintenance dialysis has been introduced and this appears superior to IPD. But it is necessary to overcome high incidence of peritonitis, for which Tenckhoff catheter has much less risk

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Percutaneous transluminal angioplasty was performed in a 16-years-old patient with right renal artery stenosis and severe hypertension (220/140mmHg). The procedure led to dilatation of the stenotic lesion. Shortly after dilatation, the patient's blood pressure fell dramatically to normal range. Hypersecretion of renin from the right kidney was supressed strikingly. The procedure was well tolerated by the patient and no complications occurred. However, he had mild hypertension for four months after the procedure. In this case report we described successful percutaneous transluminal angioplasty and discussed the mechanisms of his mild hypertension

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It is recently said that enzyme immunoassay (ETA), one of the non-isotopic immuno-assay, is almost equal to radioimmunoassay (RIA) about accuracy and sensitivity, and ETA is utilized in clinical laboratories.
In the present paper basic studies were perfomed to measure serum Ig E by EIA kit (Phadezym Ig E PRIST). The measurement theory is sandwich method similar to RIA method, and the measurement was done under explanation attached to the kit. In every 10 samples of 3 different concentrations, reproducibility was investigated and the coefficient of variation (CV) were 5.8% (x=39.8IU/ml), 18% (x=458.5IU/ml) and 19% (x=2030IU/ml), respectively. CV of reproducibility of each day (n=5) were 8.9% (x=23.4IU/ml), 12.4% (x=326IU/ml) and 13.6% (x=1530IU/ml), respectively. In samples of high Ig E level accuracy was slightly low, so in such samples determination of dilution rate will be difficult points. But it will be within permissible limits for routine examination, and this method will be useful for measuring serum Ig E level in the moderate or small-size laboratories. Development of more accurate method for high concentration of Ig E will be expected

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Since Basler developed the force plate in 1935 many researches of gait analysis have been carried out. But the traditional force plates were so small in size that one could measure only one step during ambulation, the data were unreliable and were not always suitable for the clinical use.
In 1981, a large scale force platform, 10.8m. in length and 1.2m. in width, was created in order to improve the reliability of data, to make less interference with a gait pattern and to measure as many steps as possible. In this paper, the methods of measurement, transaction and gait evaluation system are described.
Through the force platform, three dimensional floor reaction factors, i. e. vertical, fore and aft and right and left, and paths of center of pressure are given. Then, these data are sent to a mini-computer through an A/D converter and are expressed on a display. A print-out table and flexible discs are also available to store the records. Moreover, an os-cillograph, by which we can preserve the analog data, and a data recorder were imported for the exploitation of researches.
To evaluate the gait pattern, we use quantitative evaluation indices which are calcu-lated by Fourier analysis of vertical and fore and aft components in the waves of the total reaction forces. That is to say, the sum total of amplitude of the specific wave to amplitude of the fourth harmonics in the total reaction forces, which are basic oscillating com-ponent of two gait cycles, (I=∑Ai/A4), is defined as each evaluation index of reappearance (i=2n-1), symmetry (i=4n-2) and smoothness (i≥5). Besides, the acceleration of the center of gravity is double integrated, and amplitude of the double integrated wave, which has relations with displacement of the center of gravity, is defined as an evaluation index of sway.
The followings are the characteristics of our system.
1) It is able to measure many steps of gait and to obtain more reliable data than the one step type force plate.
2) It is able to utilize the system multipurposely, e. g. transfer activity, wheel chair evaluation.
3) It is able to obtain the results of the gait evaluation rapidly and conveniently by using a software for gait analysis, and so is it suitable for the clinical use

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By the development of micro-computer and accompanying reduction of its cost, it became possible to attempt the computerization of clinical psychiatric chart by our hand.
For this purpose it was neccessary first of all to convert the materials described in the chart to the codes to which the computer was accessible. In this paper, an effort for coding of the psychiatric symptoms was reported.
It was an easy way to use one of the rating scales already prepared. However, in consideration of them it was judged that those were insufficient for the rating of affect blunting as well as for the rating of symptoms manifested in everyday life behaviour.
From this viewpoint, we produced another psychiatric rating scale. This contained 420 items. Among them, severals were rated within the computer by a programm, actual items to be checked by the rater being 340.
Whether this was feasible or not was examined by pairs of our 5 doctors interviewing 50 inpatients. Consistency of rating was 95% in avarage. Symptoms manifested in behaviour were lower in consistency of rating from an interview, being about 70%. Including these symptoms, however, reliability for the rating affect blunting and abulia was sufficient, consistency of rating being above 80%.
Moreover, these symptoms of affect blunting and abulia were high in the frequency of appearance, and their importance was discussed in the computerization of the psychiatric chart

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For the computerization of psychiatric chart, it was neccessay to convert the materials described in the chart to the codes to which the computer was accessible. In this paper codings of the items were reported except those of psychiatric symptoms which were reported previously. Several problems concerning the computerization by micro-computer were also discussed.
Items of administration data numbered 294, which needed 422 bytes and 2 sectors on the flexible mini-disk supporting micro-computer NEC 8001 with 32K RAM. Those for pychiatric symptoms were 369 items, 391 bytes and 2 sectors. For somatic symptoms including side effects of drugs, 127 items, 148 bytes and 1 sector. For examination data, 344 items, 603 bytes and 4 sectors.
Limitation of memory in micro-computer was most apparent in the registration of drugs administered. Daily dose were recorded only for the latest 1 month. For the previous 12 months averaged doses for month were recorded, and for additional previous 10 years averaged doses for year were recorded. Using theses strategy, numbers of the kinds of drugs were limited to 13, which were insufficient for the registration of drugs except anti-psychotica, so parkinsonian drugs, hypnotica and others had no share to be registered.
In spite of this limitation, this program worked well practically, for the analysis of patients under a new therapeutic program in relation to the shortening of administration period, as well as for the establishment of correlation between the clinical data and positron CT findings

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Ten years ago we reported one autopsy case of Echovirus Type 11 infection of a male baby who died at the age of 7 days. Recently we had another one autopsy case of Echo-virus Type 11 infection of a male baby who also died at the age of 7 days. We have compared these two cases and obtained following findings.
1) Both cases had hemorrhage of the renal medulla, adrenal medulla, lung and intestine et al. Especially the second case had thrombosis in a small vessel of the gastric sub-mucosa. These were evidence for disseminated intravascular coagulation.
2) Both cases showed lymphocytic meningitis.
3) Both cases showed adrenal cortical cysts and starry sky phenomenon of the thymus. We thought that these findings were combined response to the infections stresser.
4) The second case showed remarkable lymph duct dilatation in the lung, intestinal serosa and thyroid gland. Ascites and pleural effusion were also found but not lymph node enlargement macroscopically. Microscopically the mesenterial lymph nodes showed hemor-rhage but no abnormal finding was seen in the mediastinal lymph nodes

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We report a 5-years-old boy with hypohidrotic ectodermal dysplasia, He was sensitive to hot environments and had frequent episodes of body temperature elevation, especially in summer. The family history was negative for hypohidrotic ectodermal dysplasia. The sweat gland distribution test showed that his sweat glands guantitative defect and patchy anhidrosis. His sweat glands response to acethylcholine was lowered than the control.
A biopsy from the sole, which responded to the sweating test, showed that sweat glands were present but they were decreased in number. We think that some genetic and environmental factors affected his ectodermal organs in the embryonic stage, and resulted in his abnormal sweat glands

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Three cases of vertebral artery insufficiency caused by cervical osteoarthritic spur were presented. Their peculiar symptom is vertigo precipitated by neck rotation. It is essential to confirm compression and narrowing of vertebral artery due to osteoarthritic spur and also aggravation by neck rotation using angiographic study.
With respect to surgical technique, we prefer uncectomy and unroofing of transverse foramen to discectomy.
Previous reports emphasized, for the development of symptom, the functional inadequacy of contralateral vertebral artery such as hypoplasia or other vascular abnormality.
Nevertheless, one of our cases (case 1) whose contralateral vertebral artery is normal, did have a ischemic symptom and post-operatively symptom became free.
We believe that the factor causing symptom is the transient abrupt change of arterial blood flow rather than total amount of blood flow. So in such a case, even if only one of the vertebral artery is affected, surgical intervention should be indicated

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Of the 20 patients who had a Charnley total hip replacement at Toyohashi National Hospital from May 1976 to Jan. 1983 17 (19 hips) were reevaluated over 6 months post-operatively about the prognosis, the complication and the operative procedure by personal examination and roentgenogram. These were also evaluated with hip score of Japan Or-thopedic Association and devided into two groups; (1) OA groups (2) RA groups.
Hip score of OA group improved more after operation than RA group. About pain, score increased well in both group. About ROM, remarkable improvement did not occur, but the score became worse slightly in RA groups. In only 4 hips (21.1%), perforation of acetabulum occurred at operation. Post operative complications were loosening of stem in 1 hip (6%), ectopic ossification in 6 hips (32%) and rupture of wires in 6 hips (32%).
The total replacement of the hip joint was performed for a 70-years-old man with OA who has ectopic ossification around the hip and loosening of stem due to ankylosis of hip joint.
When one compared the operative approach with and without osteotomy of greater tro-chanter, procedure with osteotmy was superior to one without osteotomy on follow-up study

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This study was performed from April 1, 1981 to March 31, 1982. The results are summarized as follows. The percentage of senile patient is high in new outpatients. The number of new outpatients with MDI is high, whereas there are few new outpatients with schizophrenia. The percentage of new cases for Liaison-Consultation in outpatient clinic are 58% in all. Of these, 43% of patients are from other departments in our hospital, especially from the departments of internal medicine, pediatrics, neurosurgery. Serenace, Levotomin, Tryptanol are well-used drugs as neuroleptics. Average length of new hospitalization is about 3 months. Twenty-five patients stay in the hospital for more than two years

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The present paper describes the situation of the utilization of Stroke Care Unit (SCU) in our hospital in 1982, two years after the establishment of Department of Neurosurgery.
There are four beds for SCU, but practically patients with diseases other than cerebral stroke who requires intensive care, have been admitted to SCU. Thus the name of Neurosurgical Care Unit may be a more appropriate term. The total number of patients admitted to SCU in a year was 135.
Of these 135 patients, 39 were cases of intracerebral hematoma, 36 were cerebral aneurysm, and 26 were cerebral infarction. One hundred and five out of 135 cases(84%)were cerebral apoplexy. The remaining patients were 15 cases of brain tumor and 15 cases of head injury. There were 77 male and 58 female patients. The number of patients over 50 was 97 cases because of high incidence of apoplexy.
Most patients were transferred to our hospital from all Southern Hokkaido areas including Kitahiyama Township, from where it took two hours for transfer of patients by ambulance. The remaining 42% of patients were transferred from Hakodate City, which is close to our hospital.
The number of patients referred to us from other clinics was 95 cases(70%), including 55 cases admitted to SCU after emergency operation. This fact means that our Department has been referred as the third emergency faciliy for Neurosurgery in Southern Hokkaido area.
According to our records, 106 cases were admitted to SCU after operation. The time of admission was usually between noon and 11 p. m. and the duration of admission was within one week in the majority of cases, but some patients stayed there for three weeks. The number of cases hospitalized for more than six months due to the sequelae, such as disturbances of consciousness, hemiparesis, and aphasia, was 47. One reason for this is that our Department takes care not only of cerebral apoplexy surgically, but also gives medical therapy to our patients, and we manage the patients in the acute stage and at chronic stage including rehabilitation as well. In terms of prognosis, 30% returned to social activities and 3696 died. The causes for death were complications at the chronic stage

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