A tissue of neuroblastoma, which was found by mass screening and extirpated by surgery, was studied using both electron and fluorescence microscopy.
Ultrastructural study showed many cored vesicles of about 100mμ in diameter, which contained electron-dense granules with halo around it. Such granules were located mainly in the processes of the tumor cell, and were found often in groups of three to five or in groups of five to many granules. These granules were coincided with those of noradrenalin in their appearances.
Another sample from the same specimen was freeze-dried and treated with formaldehyde vapour. Fluorescence microscopic observation displayed that bright fluorescence located in the cytoplasm and also in the processes of the tumor cells.
This substance was considered to be noradrenalin judging from the condition of reactions.

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According to Selye's general adaptation syndrome, human body deffend itself by secretion of mineralocorticoid through ACTH, when infection and intoxication occurred. We measured ACTH, serum cortisol and urinary 17OHCS in patients with progressive muscular dystrophy suffering from akinesia, progressive exacerbation and anxiety.
Material and methods: Patients consisted of 22 subjects of Duchenne muscular dystrophy (DMD), 11 limb-girdle muscular dystrophy (L-G type) and 3 myotonic muscular dystrophy.
Urine specimens were measured by colorimetric method and blood samples by RIA method.
Results: Mean values of urinary 17OHCS were within normal range in patients with three types of the diseases. But values of urinary 17OHCS were over normal range in 11 out of 22 patients with DMD, 4 out of 11 with L-G type.

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Symptoms of stroke hemiplegia include motor and sensory disturbances, however, sensory disturbances are not easy to demonstrate. It is also hypothesized that sensory disturbances cause deterioration of motor disability. Therefore, the clinical measurement of sensation is essential to the treatment and the rehabilitation program. We tried to evaluate sensory testing, using tips of compasses for pain and two point discrimination, a thermometer (0C and 50C Sammi, Ufuseiki Co.) for tactile discrimination and tonometer for vibration sensation. Abilities to identify and to orientate the middle finger and the third toe were also examined.
More patients responded to the stimulation of pain and vibration compared to that of thermesthesia. The misconception of identification and orientation were noted bilaterally among patients who were rather resistant to the treatment. Many patients with putaminal hemorrhage suffering from disturbances of somatic sensation such as pain and thermesthesia, ameriolated their walking ability after rehabilitation therapy.
We conclude that the evaluation and the improvement of sensory disturbances should be essential parts of the rehabilitation medicine.

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Risk factors involved in the occurrence and progress of stroke are considered to be multiple, but are not yet clearly identified. Among the causes of death, stroke is still in the third position after cancer and cardiovascular diseases. The incidence of stroke is relatively high in Japan, compared with that in Western countries. We investigated risk factors of stroke by using 122 patients, consisting of 91 males and 31 females (mean age of 63.7±12.3 years), who were hospitalized due to stroke at Okayama National Hospital during the period of January 1985 to June 1987.
The cause of stroke was TIA in 8.2% of the patients, cerebral thrombosis in 39.3%, cerebral embolism in 5.7%, and cerebral hemorrhage in 46.7%. The lesion was detected in the internal carotid artery in 11.8% of the patients with cerebral infarction, in the cortical branch in 58.8%, in the perforating branch in 15.7%, in the cerebellum in 8.8%, and in the pons in 7.8%. Cerebral hemorrhage was found in the cortical branch in 21.2%, in the perforating branch in 54.4%, in the cerebellum in 8.8%, in the pons in 10.5% and in the cerebral ventricle in 3.5%. The incidence of stroke did not change with the seasons.
In cerebral infarction, hypertension and smoking were risk factors. In cerebral hemorrhage, alcohol drinking and high blood sugar levels on admission were found as risk factors. The primary vascular lesion was atherosclerosis in the cortical branch and was arterionecrosis in the perforating branch. Risk factor analysis was made separately in these two cases by discriminant function method. In the former case, cerebral infarction was related to smoking and cerebral hemorrhage was related to alcohol drinking and high blood sugar levels on admission. In the latter case, however, no such risk factors related to infarction and hemorrhage were noted. Analysis on risk factors in the responsible vessels revealed that hypertension was a risk factor in the perforating branch, but there was no risk factor in the cortical branch. Alcohol drinking and smoking seemed to be risky for the vertebrobasilary artery.

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Surgical results of reconstrution for hemiplegic equino varus foot were assessed.
The indications of the surgery for hemiplegia included: 1) the lapse of time being over 1 year after the onset 2) absence of dementia or other mental disturbances, and 3) presence of pains related to the deformities and/or shoe-brace wearing difficulties.
Surgery consisted of lengthening of Achilles' tendon (if there were static contractures lengthening of Z form tendon, and if there were no static contractures but the dynamic deformity: Baker's lengthening).
For the varus deformity, the tibialis posterior intramuscular lengthening (Majestro) were indicated if the deformity appeared on stance phase.
When the varus deformities was apparent in swing phase related to the flexion synergic pattern, SPLAAT (splite anterior tibial tendon transfer) was indicated.
Generally, tenotomy of the distal flexor was added.
The follow-up results (mean: 2 years and 3 months) were satisfactory.
Gait and laboratory examination suggested the advantages of the surgical correction which were related to the stability on stance phase.
Indeed the disabilities in hemiplegia are muti-factorial problems.
The qualities of surgical correction of the foot should be discussed in its relations with those many factors, and this follow-up study suggests the results of the foot surgery of younger patients are slightly better than the older ones especially in walking speed.

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We examined several items about patients with apoplexy who were the outpatients in Hypertension Center of Hirosaki National Hospital.
The items were as follows : (1) patient's sex and age (2) address (3) occupation (4) onset of apoplexy (5) differential diagnosis of apoplexy (6) blood pressure (7) daily activity and others.
Results: Outpatients were consisted of 90 male and 41 female patients. Most of male patients were in their sixties and seventies. Most of female patients were in their seventies, and sixties.
The ages of male patients at their onset of apoplexy were mostly in their sixties, and fifties. The ages of female patients were mostly in their sixties and fifties, too.
As to the diagnosis of apoplexy, most cases were brain thrombosis or brain hemorrhage in both male and female patients.
The mean blood pressure on admission was 141.8±18.7mmHg/83.5±11.8mmHg in male patients and 146.7±22.2/87.3±13.3mmHg in female patients.

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A case of ruptured cerebral aneurysm is reported in which cerebellar hemorrhage following epidural hematoma developed after combination therapy of hypertension, hypervolemia (albumin) with some other drugs (Can antagonist plus anticoagulant) for symptomatic vasospasm due to subarachnoidal hemorrhage.
The causative factors of the hemorrhage associated with therapy are discussed in this paper.
This case suggests the pitfalls of combination therapy for ischemic complications of vasospasm of cerebral arteries.

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Although it is recognized that hyperkinesie volitionnelle (HV) is related to the lesion of basal ganglia, dentatorubrothalamic system and peripheral nerves, the precise pathogenesis of HV still remains unknown and only a small number of cases of HV have been reported in Japan.
Only one case concerning HV following thalamic hemorrhage was reported in Japan. We examined three patients with HVs after thalamic hemorrhage and reported these three cases.
Ages and sexes of three patients were 61-year-old female, a 65-year-old male and a 49-year-old female. They had been treated for hypertension but had left-sided thalamic hemorrhage. The motor and sensory disturbances improved fairly in all patients. However, involuntary movements of the right upper extremities when moving and posturing developed and worsened. They visited the Murayama Byoin National Sanatorium. On their visits, cerebellar signs were not noted in any of the patients. Muscle tone was increased and tendon reflexes were hyperactive in the hemiplegic side. The abnormal movements were coarse shakings with frequent jerk and they were noted when they moved the affected upper extremities or postured, and culminated in the vicinity of the nose on finger to nose testing. Surface EMG showed 4 cps reciprocal, rythmic grouping discharges between agonist and antagonist muscles in two of the patients examined. Clonazepam was therapeutically effective on HVs in all patients.
HVs did not immediately develop but did at the various intervals after thalamic hemorrhage in three cases of our own as well as in only one case reported previously. The periods between the thalamic hemorrhage and the recognition of HV varied between 4 to 44 months in our cases. In consideration that Vim-thalamotomy was therapeutically useful not only for tremor but also for HVs, such interval might give rise to a significant change to induce HV at the Vim nucleus. It was recognized that palatal myoclonus did not develop at the time of the vascular accident but did with the time. Matsuo et al. postulated the possibility of denervation supersensitivity secondary to lesions involving the dentatorubroolivary system. Therefore, we hypothesize that HV following thalamic hemorrhage also might be attributable to denervation supersensitivity at the Vim nucleus involved in the hemorrhage.

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Experience with hepatic and intraabdominal abscesses has been characterized by significant recurrence and mortality. Until recently, open surgical drainage was recommended. But, US-guided percutaneous drainage is now the best technique in the management of hepatic and intraabdominal abscesses.
The purpose of this study was to present our experience with 18 patients with hepatic and intraabdominal abscesses treated by percutaneous drainage. The drainage was guided by ultrasonography and the results were excellent. The drainage technique was set out in detail. The cases with abscess over 5cm in diameter were treated with catheter drainage, and the cases with abscess less than 5cm was treated with one puncture drainage and washing with antibiotics by fine needle. The subsequent approach for drainage was determined primarily by anatomic location, and the most direct route from the skin to the abscess cavity was chosen. The drainage was successful without any complications.
The prognoses of these cases were very good, 17 cases were cured. Only one case died of sepsis and DIC. Consequently, percutaneous drainage technique of abscess is an effective, simple and safe method of treatment.

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Of the diseases showing abnormal secretion of the nipple, single papilloma is often found in the milk duct relatively proximal to the nipple and there is little possibility of its becoming malignant. In contrast, since multiple papilloma is found in the milk duct more distal to the nipple and this has the possibility of cancerization, importance of this disease should be emphasized. In 1964, Atkins & Wolff published a method for resecting only the secretory milk duct and the glandular lobe in the region concerned (micro-dochectomy).
As for the surgical technique, there are two methods, namely, (A) one in which a probe is inserted into the secretory milk duct and a radial incision is made along the probe from the nipple and (B) the other in which an arc-shaped incision is made on the outer rim of the areola and a radial incision is made additionally when necessary. We made an arc-shaped incision on the outer rim of the areola to leave the nipple in good shape, scooped out the main secretory milk duct in the nipple with a cylindrical cutter and additionally made a radial incision to resect the glandular lobe distal to the main milk duct in almost all cases. For the procedure of scooping out this main milk duct in the nipple, we devised a cylindrical cutter and used it for a trial. As a result, the secretory main milk duct was scooped out neatly without impairment in a short time and no deformities of the nipple was left after operation. In this paper we describe the structre and using technique of the cylindrical cutter (a probe for the cylindrical cutter, the cylindrical cutter, and cutter holder).

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Long-term survival cases after unilateral mastectomy for breast cancer are increasing as a result of improvement in both diagnosis and treatment. Under those circumstances, bilateral breast cancer (BLBC) is encountered frequently. The knowledge concerning BLBC may be important to follow up the patients who had already undergone unilateral mastectomy. Therefore, we evaluated clinically the risk factors and diagnostic problems of patients who had to have a second mastectomy after their initial mastectomy.
Nineteen cases of BLBC which were operated on at Sagamihara National Hospital from 1959 through 1986 were studied. The patients were separated in two groups: 13 cases of primary BLBC (p-BLBC), and 6 of metastatic (m-BLBC). Their age at time of first mastectomy was found to be a factor of high risk; the younger the age of patients with unilateral breast cancer was, the higher the incidence of BLBC was. A family history of cancer and past history of abortion and interrupted pregnancies were of higher frequency in BLBC patients. The cellular immunoactivity of some breast cancer patients was low, but cellular immunoactivity was individually different. Most of the patients with BLBC noticed the second tumor. But, about half of the tumor were not detected by mammography.
Thus, we conclude that the occurrence of a second breast cancer after a unilateral mastectomy may be related with some factors of patient's hormonal conditions, heredity and survival over a long period of time. These results were almost in agree with the experiences of other investigators. But, the relationship between an occurrence of a second breast cancer and the patient's immunoactivity remains unclear. Self-examination should be regulary performed over a long period of time by patients undergoing first mastectomy, and a biopsy should be immediately done if a occurrence of second breast cancer is suspected.

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Hepatodiaphragmatic interposition of intestine is known as Chilaiditi's syndrome. It is known that the incidence of the condition is 0.2-0.03 per cent of the chest roentgenograms in routine examinations of the chest. The condition was observed in 6 of the 40 physically and mentally retarded patients at our hospital. Vomiting and constipation were frequently observed in these 6 cases. One patient developed ileus. The causes of the condition included abnormally high diaphragm, malrotation of the intestinal tract and abnormal accumulation of gas in the intestinal tract due to aerophagia.

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We came across 2 cases of microgeodic disease which was originally reported by Dr. Maroteaux in 1970. Case 1 was a 14 year old boy with swelling and pain of right index finger, x-ray film showed an increase in density at diaphysis with small round radiolucency and radiolucent layer at metaphysis of the middle phalanx. Case 2 was a 5 month old boy with redness and swelling of left little finger. X-ray film showed radiolucent zone at diaphysis and metaphysis with periosteal reaction at the proximal phalanx. Both cases recovered spontaneously within several months.
Only a few cases of this disease were found in foreign articles, but in Japan we have had more than 130 reports of microgeodic disease since Dr. Sugiura reported; 8 cases in 1974. This disease are characterized by the facts that it occurs in fingers and toes of children sporadically especially in winter and that it shows typical abnormalitles of x-ray findings, and that it regresses spontaneously within several months.
Although it was reported that this disease disappeared without any residual deformity in cases before 1981, complications and remaining deformities were reported after 1982. In case 1a ulnar tilt of the middle phalanx was noted and in case 2 a short and thick deformity of the proximal phalanx. The case of metaphyseal involvement as well as diaphysis is liable to cause a pathological fracture, shortness and thickness of phalanx, so careful observation of the disease is required.
Etiology of this disease is unknown so far but most reports suggest that impairment of local microcirculation might be a cause, but it is also proposed that mild infection of a kind of virus may be involved. In case 2, liver function was abnormal, but HB virus antigen, antibody, and HA virus antibody were all negative, so he was thought to have infantile hepatitis. When we consider the unknown etiology of microgeodic disease, it is interesting that case 2 had a cold for a month and also had infantile hepatitis.

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Round atelectasis is a form of collapse of which little is known. It appears as a masslike lesion that often mimics a pulmonary neoplasm. Radiographic diagnosis is made by several distinctive features. It is a round or oval shadow with 2.5 to 5cm in greatest diameter, usually located along the posterior surface of a lower lobe. The blood vessels near the mass appear to gather together in a sheaf as they converge in a curved cource toward the mass, much like the tail of a comet. The mass itself is always in contact with a chronically thickened pleura. The authors present a case of typical RA occurring in a 79 year old man. He was pointed out the round pulmonary mass shadow on chest radiogram, The patient underwent various kinds of examinations, and we could not deny the possibility of malignancy, so the right lower lobectomy was performed. The mass was macroscopically an atelectasis with inflammation, and the diagnosis of RA was established by the pathological examination.

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