Clinical significance of EEGs in epileptics was described based on the papers that the author has reported until now.
1. The influences of paroxysmal cerebral activity on the monosynaptic reflex (H-reflex) were studied by means of simultaneous recordings of EEGs and H-reflex from the calf muscle. Multiple spike and wave complexes exerted facilitatory effects on H-reflex, while slow wave bursts and 3 Hz spike and wave complexes showed inhibitory effects on it.
2. Movements of the body during the seizures of petit mal absence with 3 Hz spike and wave complexes were examined by the statometer. Some patients showed arrest of body movements during the seizures and some had automatism-like movements.
3. Mirror-focal and multifocal spikes in EEGs were studied in epileptics. Mirror focus was seen mostly in the temporal or temporo-parietal area. It was postulated that the mirror focus resulted from inadequate control of seizures. On the other hand, random multifocal spikes were caused by organic brain damages in infancy and childhood.
4. A clinical and electroencephalographical follow-up study of 10 to 18 years was carried out in epileptics. Prognostically the EEG background was more significant than the paroxysmal discharges.
5. Episodes of autonomic and psychic disturbances developed inversely by controlling of the clinical seizures. During the episodes, paroxysmal discharges in EEGs disappeared or remarkably diminished in most of the patients and slowing of the basic rhythms was found in some of them.
6. Propagation of spike discharges in the cerebral cortex or subcortex was examined by measurement of time lag of spike discharges on the scalp. Spikes originated in the temporal lobe were easily spread to other portion of the scalp, whereas spikes in the occipital lobe were rarely spread.
7. Relationship between EEG focus and CT-findings was examined in epileptics. In the two-thirds of the patients, the abnormal regions of EEGs corresponded to the locali-zations found on CT, but not in one-thirds of the patients.
8. Clinical significance of 14-6 Hz positive spikes and 6 Hz phantom spike and wave complexes was investigated. These patterns were related to the autonomic seizures and emotional disturbances, and were regarded as age-dependent and prognostically favourable.

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Various aspects of double immunodiffusion for the detection of anti-nRNP antibody were studied. Whole calf thymus extract or rabbit thymus acetone powder extract was suitable for the antigen source. The optimal concentration of antigen was between 50 and 100 mg protein/ml. Forty-eight hours was most suitable for the incubation time. An optimal concentration of Agarose gel was around 0.6%. The volume of the antigen (50 mg/ml) poured was satisfactory when more than 100μg of the antigen was used. Antigenic activiy was still present in calf thymus extract which had been stored for three years at -20°C.

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Reference value of carcinoembryonic antigen (CEA) was usually below 2.5 ng/ml by Sandwitch method in serum. Upper limit of clinically reference value was calculated by Usui's logarithmic method using the data which contained abnormal data. The upper limit of reference value was 3.6 ng/ml from the data obtained from 261 out-patients. There were no significant differences of the constituent of diseases classifiedas benign or malignant among 3 groups, that is, a group of under 1.9 ng/ml of CEA, a group of between 2.0 and 2.5 ng/ml of CEA, and a group of between 2.6 and 3.6 ng/ml.
Rates of abnormality in CEA concentration were 66.7% in rectal cancer and lung cancer, 38.2% in gastric cancer, 36.4% in breast cancer and 33.3% in thyroid cancer.
In 183 cases with liver diseases, the rates of abnormality in CEA concentration were 0% in acute hepatitis. 12.1% in chronic hepatitis, 32.7% in cirrhosis of the liver and 21.9% in primary hepatoma.

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Of the high risk pregnancy (HRP) we experienced during the time from October 1981 until September 1983, 60 cases were subjected to clinical evaluation of their non-stress test (NST) monitoring with the scoring system worked out by Krebs et al. and the results of the evaluation were examined in conjunction with the prognosis of their newborns.
1. Those with high NST scores over 9 amounted to 49, while those with low NST scores below 8 were 11 cases. The perinatal morbidity was 69% in the former group and 91% in the latter group.
2. There was a close correlation between the NST score and the biochemical informa-tion. On the other hand, those without the correlation amounted to 21% in the group singly with urinary E₃and 27% in the group singly with serum HPL, while those in the group with both of them amounted to 18%.
3. Those with negative SFD and those with high Apgar score were present in the group with higher NST values both in high percentages.
4. Of the cases with perinatal morbidity which amounted to 91% in the group with lower NST values, the rate of so-called false positive cases were as low as 9%, which suggested the necessity of strict fetal monitoring for the expected poor prognosis of new-borns in the group of those with HRP and with low NST values.

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In order to investigate the cause of antibiotic-associated acute hemorrhagic colitis, the bacterial flora of the feces from 13 patients with bloody diarrhea induced by treatment with synthetic penicillins (ABPC and AMPC) and CEX were determined by quantitative cultu-ral method.
Klebsiella oxytoca were isolatea in 10 cases (77%) from bloody diarrhea but only in 4 cases did this species predominate the fecal flora. Although much attention has been paid to Clostridium difficile as a probable causative agent for pseudomembranous colitis, it was not isolated in any fecal specimen. Any specific species was not detected com-monly including some pathogenic enteric organisms such as Salmonella, Shigella, Yersinia species, Bacillus cereus and Campylobacter jejuni.
Fecal bacterial toxin was examined from the standpoint of both cytopathic effect and permeability factor in 9 cases. Any toxic factor was not detected in bloody loose stool in all cases.
The bacterial flora showed a marked decrease both in numbers and in kinds of species of obligate anaerobes. To clarify the significance of the changes in bacterial flora, fecal short chain fatty acids were measured in coecal contents of guinea pigs. Short chain fatty acids decreased markedly in watery contents of ABPC treated animals compared to greasy contents of untreated animals.
These studies revealed that a single bacterial species may not be solely incriminated as the cause of acute hemorrhagic colitis and suggested the change of intestinal environment including the decrease of short chain fatty acids as the cause of diarrhea. The patho-physiological mechanism of intestinal bleeding was not yet clarified.

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In an attempt to evaluate the activity of pulmonary tuberculosis, bronchoalveolar lavage (BAL) was performed in 22 patients with this disease and in three normal controls.
BAL fluid (BALF) cultures grew Mycobacterium tuberculosis in seven patients: six with positive smear and culture and one with positive culture alone. In five of these patients, however, cultures of both sputum and gastric juice obtained immediately before BAL proved to be negative for the organism.
There was an increase in the absolute number of neutrophils when tubercle bacilli-positive BALF was compared with tubercle bacilli-negative BALF.
Based on “Gakken”classification of pulmonary tuberculosis, chest X-ray findings of right and left lungs were classified into groups A, B, C, D, F and O. The frequency of tubercle bacilli-positive BALF was 3/3 in group A, 3/7 in group B, 2/8 in group C, 1/5 in group D, 1/1 in group F and 0/13 in group O, respectively. In all but one (O) group, tubercle bacilli-positive BALF contained both increased percentage and absolute number of neutrophils compared with tubercle bacilli-negative BALF.
These findings suggest that BAL is one of the most useful and rapid methods to detect tubercle bacilli in patients with pulmonary tuberculosis who have negative cultures of both sputum and gastric juice and that neutrophils may be predominant inflammatory cells in the active lesion of the disease.

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In order to analyse the remained impairments of perfusion (Q) and ventilation (V) of pulmonary tuberculosis (TBC), 50 patients (40 cases without operation and 10 cases with thoracoplasty) were studied using the Tc-perfusion and Kr-ventilation scans.
The lung field was divided into six zones and an attempt was made to quantitatively relate the roentogenographic lesions with scintigraphic findings in each zone.
The following results were obtained;1) The Q scans preferentially demonstrated the remained functional impairments of TBC, whether or not the patients had undergone tho-racoplasty. 2) The degree of impaired Q scans were clearly influenced by initially affected severity, but a few of the fresh, mild cases seemed to improve to some extent following the healing processes. 3) The functional decrease in the Q and V scans accounted for the reasons why the patients often developed respiratory insufficiency or its preliminary states and why they had been repeatedly infected. 4) In most of far-advanced cases, both Q and V scans were concomitantly defected, but in mild or moderate cases Q scans were predo-minantly disturbed.
From these results, we considered that both scans, particularly Q scans, offered many informations about the regional functional impairments which could not be detected by the usual roentogenogram.

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A new kit for angiotensin converting enzyme (ACE) assay which was developed by Kasahara was examined as to their practical usefulness. The principles of the method are as follows;p-hydroxybenzoylglycyl-histidyl-leucine is hydrolyzed by ACE, and the re-leased p-hydroxybenzoyl-glycine is hydrolyzed again by hippuricase into p-hydroxy-benzoic acid which is oxidized with 4-aminoantipyrine under the existence of NaIO4, and then qui-nonimine dye is produced, This quinonimine dye is measured spectrophotometrically at 505 nm. Actually, 0.1 ml of serum is incubated with substrate-enzyme (hyppuricase) mixture solution for 20 min, then stop solution with colorization is added to incubation mixture. The quinonimine dye is measured with 505 nm.
The reproducibility is very high (r=0.998). The time course of the reaction with serum is linear until 2 hours.
The relationship between the reaction velocity and enzyme concentration is tested using semipurified ACE from human kidney. The linear relationship is observed until the en-zyme concentration is as highas 300 nmol/ml/min, which is about 20 times higher than normal serum ACE level.
The correlation of values of serum ACE activities measured by Cushman's method and Kasahara's method is Y=0.84 X+1.41 when Y is the value of Kasahara's method and X is the value of Cushman's method (r=0.933).
Kasahara's method is an excellent method which can overcome disadvantages observed in Cushman's method.

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Xylitol is a sweet, tasty pentitol (C₅H₁₂O₅), which is a normal metabolite of Touster cycle. The exogenous xylitol is metabolized almost exclusively in the liver, and a major portion of xylitol is converted to glucose or glycogen. Therefore, hepatic function, espe-cially, activity of Touster cycle can be suggested by the elimination curve after xylitol loading.
In this study, the development of a quantitative gas chromatographic method for the detection of xylitol in human blood is reported.
Serum and dulcitol solution as internal standard were deproteinized by ultrafiltration, and the filtrate was lyophilized. Trimethylsilyl ethers were prepared by reacting the lyophilized powders with trimethylsilylating reagent (hexamethyldisilazane and trimethyl-chlorosilane in pyridine) for 15 minutes at 70°C. The supernatant was injected into the gas chromatograph.
The gas chromatograph used was a Shimadzu Model GC_-4CM, equipped with a hydro-gen flame ionization detector. Silicon OV-17/Silanox, 30m (L.), 0.3 mm (I. D.), Glass SCOT column was used, the column temperature was kept at 100°C for 5 minutes, and then was raised up to 200°C at the rate of 5 degrees a minute. The injector and the detector temperature was 230°C. Nitrogen was used as carrier gas with a flow rate of 1.8 ml/min, and a ratio of split was 1: 24.
Calibration curve was made from a plot of xylitol concentration versus the ratio of the peak height of xylitol to that of dulcitol.
As little as 2.5 ng xylitol can be detected. And better still, the recovery and the accuracy is satisfactory.
The blood concentration of xylitol had a individual difference after oral administration. After a long-term oral administration, an adaptive increase of absorption was observed. The elimination rate of xylitol after one intravenous dose had been studied in normal subjects and liver cirrhotics.

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A case of Larsen synrome was studied as to the recurrent chromosome breaks (fragile sites). The lymphocytes in the peripheral blood were cultured in a folic acid deficient (FA-MEM) medium supplemented with 10% fetal bovine serum. Air-dried chromosome preparation was stained by the trypsin giemsa method.
The presence of the fragile site chromosome in 2% or more of the metaphases was judged as positive.
The patient is a 9-year-old girl and mentally retarded.
She was characterized by multiple congenital dislocations of the knees, and had a depressed nasal bridge, wide-spaced eyes, abnormal segmentation of the spine and cylind-rical-shaped fingers.
Cytogenetic investigations showed the karyotype 46, XX.
We found chromosome gaps (16 q 22 or 23, D-group: 13 q 11 or 12).
Frequency of the chromosome gaps were 16 q 22 or 23: 2%, 13 q 11 or 12: 10%.
It is possible that the patients with Larsen syndrome may have mutant genes (fragile sites).

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Skin reactions caused by intradermal injection of histamine were reported to be inhibited by simultaneously administered noradrenaline. The degree of the inhibition of the skin reactions was reported to be an indicator of the autonomic nerve damage of the skin.
In this study, this intradermal test was performed on 33 diabetic subjects. The decrease of histamine skin reaction by noradrenaline tends to be smaller in subjects with minimal variations of RR interval of ECG.
However, since the sizes of the skin reactions varied so much in diabetic individuals, and the intradermal injection method itself caused various reactions, the clinical implication of the histamine skin reactions as an autonomic nerve funcion test had some limitations.

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There were 1, 157 over-reading samples among a total of 22, 525 electrocardiograms by autoanalysis. There was a discrepancy between autoanalysis and thorough analysis by phy-sicians in 184 samples (15.9%) of these 1, 157 tracings. The most common diagnosis that had discrepancy between these two analyses were myocardial infarction, third degree A-V block and W. P. W. syndrome. This fact can not be approved from the clinical view-point. The diagnosis of complete right bundle branch block and myocardial infarction by autoanalysis had a high sensitivity. On the contrary, the sensitivity of autoanalysis was low as to third degree A-V block and W.P.W. syndrome.
The specificity of autoanalysis revealed as high as 95% or more in almost all electro-cardiographic findings.

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We measured the level of serum mitochondria GOT (m-GOT) by immunological method (Eiken Kit) in healthy adults and patients with progressive muscular dystropy (PMD) or the other similar muscular diseases, and the following results were obtained.
The m-GOT levels were 3.2±1.7 IU/L (mean±SD) in 50 healthy adults, 5.6±3.7 IU/L in Duchenne type PMD (28 cases), 5.3±2.4 IU/L in limb girdle type PMD (11 cases), 4.0±2.0 IU/L in congenital muscular dystrophy (3 cases) and 13.6±11.4 IU/L in myotonic dystro-phy (5 cases). The m-GOT levels in various PMD were higher than in healthy control and the cases with the high ratio of m-GOT to total GOT (m-t ratio) had severe functional handicaps except a few cases.
Measurement of m-GOT levels and m-t ratio in PMD is useful in order to examine the functional damages.

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Recently TDX analyzer^®(ABBOTT Lab.)for the therapeutic drug monitoring system has been available, which is based on the method of fluorescence polarization immunoassay. We have used this system for assays of four antiepileptic drugs, i. e. phenytoin, phenobar-bital, carbamazepine and valproic acid. We described here the investigation of this system especially for feasibility, accuracy and interference with mesaurement by various plasma components.
The reproducibility of consecutive measurements and that between measurements at different time was satisfactory for every assays. Using same standard curve that was made on the first day, measured levels of the control serum drugs were stable for two weeks. Consequently, it was not necessary to redraw up standard curve every day. This is one of the merits in this system.
Concerning the interference with measurement by serum components, 7% undere-stimation of carbamazepine level was obtained in the sample to which high dose of lipid (triglyceride 389 mg/dl and total cholesterol 525 mg/dl) was added. Therefore, we should take care of measurement of chyloid plasma.
To compare this system with EMIT system^®(enzyme immunoassay) which has been already widely used, the simultaneous determinations of the level of the above antiepileptic drugs were done in fifty epileptic patients, and we found that its correlation was excellent.
Our data demonstrated that TDX analyzer possessed certain advantages in terms of accuracy, precision, quickness and simplicity.

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Recently, remarkable improvements have been achieved in the field of automated clinical examination laboratories, particularly in the biochemical and hematological exami-nation as well.
A few years ago, we introduced a new leucocyte autoanalyser “Hemalog D”(Technicon Co. Ltd.) which is totally automatic and can classify the leucocytes into lymphocytes, mon-ocytes, eosinophils, basophils, large unstained cells, and neutrophils in company with high-peroxidase active cells by means of cytochemico- enzymatic staining and light scattering sizes. These principles of classification of leuocytes are quite different from usual staining and microscopic analysis.
Hence we examined the correlation between the two methods, the reproducibility of the data, the influences of the temperature and the duration of the storage of the blood samples.
Hemalog D showed a good correlation with the usual microscopic analysis with respect to counting all kinds of leucocyte-classes except monocytes and basophils. The storage of the blood samples within 24 hours at 5°C had little influence on the analytical data.
In the particular cases of leukemia, or low esterase or high peroxidase active cell carrier, for example, there are great differences in the analytical data between the Hemalog D and the usual microscopic analysis.
Knowing these characteristics of the Hemalog D, it would be quite useful in the routine leucocyte analysis, and new cytochemico-enzymological inforomation of the leucocytes would be given by this new analyser “Hemalog D”.

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