An enrollment system for diabetics was made using UCD micro mumps.
Data stored in the data base constructed by a simplified data processing language were transfered to mumps by short routines. In this program, double checking of data was performed. Thus, errors in the data could be eliminated.

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Development of diabetic nephropathy is related to the prognosis of diabetic patients. It is important to detect diabetic nephropathy at earlier stage so as to delay or prevent its progression. Recently, the elevated levels of urinary albumin is expected to be a predictor of subclinical nephropathy. In this study, the 24 hour urinary albumin excretion (urinary Alb) was measured by radioimmunoassay for 100 NIDDM patients whose urine was negative for protein by sulfosalicylic acid method and the relation to their clinical features was studied. The mean urinary Alb of NIDDM was 15.9±18.3mg/day (significantly higher than controls) and 39% of patients disclosed microalbuminuria above the normal limits. Urinary Alb was not related to age, sex, fasting blood glucose, HbA_IC and type of treatment. The urinary Alb began to increase 6-7 years after the onset of diabetes and tended to increase along with the duration of diabetes. The elevation of urinary Alb was not accompanied by diabetic retinopathy which was related to the duration of diabetes itself. The measurement of urinary Alb was thought to be a useful predictor of early diabetic nephropathy. Further studies will be necessary to clarify the relationship between urinary Alb and the progressoin of diabetic nephropathy.

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During the 10-year period, 1976—1985, a total of 8741 women were delivered at Sendai National Hospital and 56 women (0.64%) of them were diabetic pregnant patients. The clinical outcome of 56 diabetic patients was analyzed.
The incidence of diabetic patients increased about three-fold from 0.43% to 1.17%. Mean maternal age for diabetic patients (31.2±4.1 years) was significantly older than normal preg-nant women (28.5±3.8 years). Over 19 per cent of the diabetic patients were 30 years of age or greater and nullipara. According to the classification of White, 27 of the 56 cases were in GDM, 12 in class A, 11 in B, 2 in C and 4 in D. Twenty-five per cent of the patients were treated with insulin. Forty-nine per cent of diabetic patients had at least 1 diabetic relative. The patients with toxemia were found in 33.9% and hydroamnion in 3.6%. Cesarean section was performed in 43.80 of diabetic patients. The duration of gestation at the moment of delivery was 39.4 weeks in GDM and progressively less in classes A through D according to the severity of the diabetic disorders. There was significant difference in the mean birth weight of diabetic patients and no diabetic patients (3550 g versus 3140 g). There were 14 infants (24.6%) who weighed 400 g or more. The perinatal mortality was 3.50. Infant morbidity was demonstrated by the following percentages: hyperbilirubinemia requiring treatment, 10.5%; hypoglycemia, 8.8%; respiratory distress syndrome, 3.5%; and hypogalcemia, 1.8%. One infant had congenital anomaly of external auricle.

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We studied clinical significance of the measurement of sorbitol concentration in the erythrocyte of diabetics in relation to the duration from onset, sex, type of the therapy and its complications.
Sorbitol concentration in the erythrocyte revealed significantly high level in the diabetic patients compared with healthy persons. As compared to the duration of diabetes, the higher sorbitol level was observed in long-term diabetes.
There was higher sorbitol concentration in the erythrocyte noted in insulin-treated group than in hypoglycemics-administered group. In this study no significant differences were noted in the diabetics with retinopathy.
Clinical effects and adverse reactions of aldose reductase inhibitor (Sorbinil®) on diabetic neuropathy were evaluated.
Along with lowering sorbitol concentration in the erythrocytes, there was improvement of the rate of nerve conduction without adverse reaction. From the above-mentioned results, it is considered that sorbitol concentration in the erythrocyte partially indicates altered long-term glucose metabolism, which are related to diabetic complications.

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Acute metabolic and hormonal effects of exercise were studied in 66 non-insulin-dependent diabetic patients (42 male, 24 female cases, mean age 52 y. o.). They were told to walk for 30 minutes with subjective intensity of 500 1 hour after breakfast.
In total, plasma glucose level fell from 245±80 mg/dl to 190±79 mg/dl and plasma lactate was increased from 12.8±7.6 mg/dl to 24.7±16.4 mg/dl. Non-esterified fatty acid (NEFA) and ketone-bodies showed almost no changes. As to the amino acids, only alanine increased significantly, and weak correlations were found between lactate and alanine.
Basal serum cortisol levels were slightly high (17.4±4.8 μg/dl), but exercise did not induce any significant changes. Serum growth hormone increased and serum insulin decreased significantly in response to exercise.
According to the level of plasma glucose before exercise, patients were divided into three groups; well controlled (<200 mg/dl, 22 cases), moderately controlled (200-300 mg/dl, 26 cases), poorly controlled (≥300 mg/dl, 17 cases) group. In the poorly controlled group, exercise induced minimal plasma glucose and IRI, and led to a significant rise in GH.
In the five cases, which showed a rise in plasma glucose level, metabolic indices such as lactate, NEFA, ketone-bodies and alanine before exercise were already higher, and exercise of mild intensity (mean HR: 103 bpm) led to an excessive rise in lactate, alanine and GH.
The results suggest that exercise might have adverse metabolic and hormonal effects in poorly controlled patients, so that patients should be, at least, moderately controlled before prescription of exercise.

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Recently, the importance of practical education for taking medicine has been pointed out for a successful drug therapy because of progress in drug therapy or an increase in dosage forms. We have performed some practical education for diabetic, outpatients at the pharmacy in Kure National Hospital, The following practical guidances were given to the patients. 1. Making a list of the participants 2. Explanation of diabetes mellitus 3. Explanation of the drug therapy 4. Explanation of hypoglycemia and its prophylaxis 5. Selfmeasurement the blood glucose level and its practice.

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Twenty-eight cases of diabetic gangrene treated in the department of orthopedics during the period between 1977 and 1986 were reviewed. There were sixteen males and twelve females. Clinical appearance of diabetic gangrene was divided into three typical lesions, which consisted of ischemic gangrene, neuropathic ulcer and septic gangrerne. Our cases were composed of nine ischemic, six neuropathic and thirteen septic lesions. Ischemic lesion was caused by macroangiopathy, that was arteriosclerotic obstruction of the major vessels. Mean age of nine patients was 62.4 years, which was higher than the other two groups. Amputation was required for the treatment of ischemic gangrene. Minimal re-section of the toe or the foot would be preferable to preserve ambulation. In these cases, reoperations were common. An average number of the surgery for one case was three. We recommended better functional recovery by minimal amputation in spite of disadvantages of reoperation and a long stay in hospital. Neuropathic ulcer was caused by microangiopathy and/or neuropathy. Mean age of the cases was 51 years. The lesion responded well to conservative treatment. Wound was treated by debridement, cleansing and ultraviolet rays. Intravenous administration of prostagrandin E₁ (PGE₁) was combined in some cases. Septic gangrene usually followed ischemic gangrene or neuropathic ulcer, though it occur-red without precedent lesions in some cases. Septic lesion was also responded well to coservative treatment, which was the same wound treatment as neuropathic ulcer and administration of antibiotics and PGE₁. But, in case of severe defect of the bone or the skin, amputation or skin plasty was necessary. Mean age of septic gangrene cases was 53.2 years. Regarding the prognosis, 700 of the all cases had recurrence of foot lesions. Motality rate of the twenty-two follow-up cases was 36%.

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We are the members who participated in the group work scheduled among the National Hospitals. We investigated the backgrounds, the beginnings, the home environments and the characters of school refusal children who became the center of public attention in Japan. We also studied the results of various therapeutic modalities and the preventive methods for school refusal.
This study group experienced a total of 216 cases of school refusal consisting of 114 boys and 102 girls. These cases included 132 primary school pupils and 84 junior high school students.
The following results were demonstrated: School refusal started from failures in studying (63 cases; 21.2%), chronic somatic diseases (59 cases; 27.3%), being bullied by friends (48 cases; 22.2%) loneliness (43 cases; 19.9%) and changing one's school (28 cases; 13.0%). It was noticed that a considerable numbers of such children were nervous (50 cases; 23.1%) or introverted (46 cases; 21.3%).
Excess intervention (47 cases; 21.8%), patronage (37 cases; 17.1%), strict upbringing (29 cases; 134%), blind love (31 cases; 14.4%) and denial (42 cases; 19.4%) were recognized in their mother's attitude towards a child care.
The positive results from therapy were recognized in 98 cases (78.4%) of junior high school students and in 60 cases (71.4%) of primary school pupils. In addition, 43 cases (51.1%) of primary school pupils and 48 cases (38.4%) of junior high school students were cured, so it can be mentioned that the younger the patients are, the more curable they are. Twenty-six cases (86.7%) returned to school out of 30 cases who had visited a pediatric clinic within one year from the first symptoms.
Only 3 cases returned to school out of 9 cases who had visited a pediatric clinic after one year from the onset.
It may be concluded that the earlier the patients visit the hospital, the better their prog-nosis is.

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A 29-year-old woman was admitted to Okayama National Hospital on the 7th day of the illness because of fever, myalgia and headache followed by non-productive cough. Three days prior to admission, a rash developed on her wrists and spread over her face, chest, abdomen and thighs. She had received a killed, live vaccine for measles when she was 6 years old.
The patient was acutely ill with a fever of 4p°C. Her pharynx was erythematous but without exudates. Her respiration was normal and she had no rale. Her liver was palpable 1 cm below the 12th costal margin. The rash was maculopapular, erythematousand non-pruritic.
The Ieucocyte count was 6300/mm³ with 87% neutrophils, and the number of thrombocyte was 87000/mm³. The erythrocyte sedimentation rate was 80 mm per hour. CRP was 3.2 mg/dl, and LDH was 843 IU. PPD and antibody for serum measles were negative. A chest roentgenogram disclosed cardiomegaly and small nodular shadows throughout the chest. Non-specific ST segment changes were noted on an electrocardiogram.
On the fourth hospital day, she developed severe gastrointestinal bleeding with hemat-emesis and tarry stool. Bleeding time was 3 minutes. Gastroendoscopy revealed multiple hemorrhagic erosion through the body to the antrum.
On the seventh hospital day, she underwent bronchofiberscopic examination. Her bronchial alveolar lavage fluid (BALF) showed an increase in lymphocytes primarily of atypical lymphocytes but no giant cells. Antibody titers for measles increased to 128.
This was a case of adult onset of atypical measles presenting with various symptoms, in which BALF was a useful diagnostic procedure.

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Recently the number of cases of non-clostridial gas gangrene accompanied by diabetic gangrene have been increasing in Japan with the change of eating habit.
We report a case of non-clostridial gas gangrene cured by the amputation of the in-fected extremity.
A 61-year-old woman visited our department because of the diabetic gangrene in the right foot.
Her clinical course was observed under conservative therapies. Gas gangrene was noticed by palpation for the first time on the 6th day after admission.
Clostridium was negative in the bacterial culture before and after the operation. So, this case was diagnosed as non-clostridial gas gangrene.
It is said that the best therapy for non-clostridial gas gangrene is amputation of the infected extremity at the higher position as immediately as possible after the detection of that.
However, when non-clostridial gas gangrene is noticed only by palpation, the site of lesion might be usually spread farther than expected in many cases, so that it might be necessary to take serial X-ray films of the infected lesion in order to find out non-clostridial gas gangrene as early as possible. And we consider that in amputating the affected extremity, it would be safer to define the real infected lesion during the operation.

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The authors present an acquired and transient retinitis by rubella. The patient was a 17 year old boy. He noticed a central scotoma on his right eye on March 10, 1986. The corrected visual aquity was 1.0 on the right eye and 1.2 on the left eye. The scotoma was very slight on the Komoto scotometer. Fundus examination revealed multiple small yellow white dots on the mid-periphery of the right retina, which were seen only on nasal and temporal side. On the posterior pole, there was a sheath on the supero-temporal vessels. The macula was granular and no foveal reflex. ERG revealed the reduction of the oscillatory potentials. The symptoms were transient and disappeared in two months. The antibody titer of rubella elevated from ×32 on May 28 to ×128 on April 18. This case was one of the multiple evanescent white dot syndrome by rubella. It seems that acquired rubella retinitis is not a so uncommon disease.

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We report a case of aplastic anemia following hepatitis treated with allogenic bone marrow transplantation (BMT). This patient, a 19 year old male, developed pancytopenia 3 months after acute viral hepatitis (non A, non B type). He was diagnosed as having severe aplastic anemia which was refractory to any conservative therapy.
He was considered to be a candidate for bone marrow transplantation from HLA identical sibling. Preconditioning was performed with antilymphocyte globulin (40 mg/kg/day for 7 days) and high dose cyclophosphamide (50 mg/kg/day 4 days). Adequate number (more than 10⁸ cells/kg) of bone marrow cells were infused to the recipient. Engraftment was confirmed at 10 days after the BMT. The patient developed acute graft versus host disease (GVHD) with the manifestation of skin eruption, diarrhea and liver damage, but it was managed with steroid hormone. Thereafter, sicca syndrome, a kind of chronic GVHD, developed 100 days after the BMT, which was treated again with steroid hormone and azathiopurine.
At the present time of writing this manuscript, he has survived 3 years after BMT and is free fromany disease. BMT could be the first choice of therapy for posthepatitic aplastic anemia.

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An atypical case of ‘continuous spike-wave discharges during sleep’ (CSWS) on electroencephalogram (E. E. G.) is reported.
The patient was an 8 year old boy and right-handedness. He had non-progressive hydrocephalus and his I. Q. was 77 points, but thereafter deteriorated. Absence seizure developed at the age of 7, but no convulsive seizures were seen. The CSWS were found at the age of 7 years and 6 months. The CSWS showed laterality, and right hemisphere was dominant.
Telemetory E. E. G. during awakening demonstrated similar continuous spike-wave discharges recorded during sleep, but his consciousness was not disturbed except during attacks of absence seizures.

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A 37 year old man was admitted to our hospital because of muscular atrophy and complete heart block treated by implantation of a permanent pacemaker. His two sisters had the same muscular atrophy as he had, and permanent pacemakers were also implanted due to complete heart block. His mother was told to have the muscular atrophy similar to his. His muscular atrophy and weakness had been developing from childhood, and at the age of 36, a permanent pacemaker was required for his complete heart block. Neurological findings revealed a scapulo-humeral type muscular atrophy and weakness. The exercise test on a bicycle ergometer under aerobic condition (15 watts for 15 minutes) suggested that there existed the decreased utilization of lactate in mitochondria. Histological examination on the biopsied muscle revealed the aggregates and abnormal shapes of mitochondria in the cells (ragged-red fibers) and we diagnosed his illness as mitochondrial myopathy.
We report a case of familiar mitochondrial myopathy manifesting (facio-) scapulohumeral type muscular atrophy accompanied with complete heart block, and a further investigation is being made on the mitochondrial enzymes of this patient.

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A 16-year-old male with typical features of rigid spine syndrome orginally reported by Dubowitz in 1970, was studied by x-ray computed tomography (CT), histochemistry and electron-microscopy.
A CT scan of the muscles showed characteristic findings of remakable hypodensities of the cervical multifidus, semispinalis cervicis and capitis, multifidus of the back, erector spinae, long heads of biceps femoris and soleus muscles.
Histochemical studies of the left rectus femoris muscle revealed increased variation in fiber diameters with type I fiber atrophy, partial necrosis and fatty degeneration, infiltration of phagocytes and no ragged red fiber. An electron microscopic examination disclosed increased vacuoles and lipid bodies, dilatation of sarcoplasmic reticula, deformed mitochondria and cytoplasmic bodies associated with derangement of myofibrils. The feature of Z band streaming strongly suggested that the cytoplasmic body originated from Z band degenaration.
A review of the histopathological findings of the past literatures was also made.

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We present 3 cases of DMD. The disease developed at their infant period in all 3 cases. They were admitted at 4-9 years old. They fell in stage V at 9-10 years old. The height and body weight were small compared with normal children. Vital capacity had been progressively decreased to 610±25 cc at their terminal stages and tracheotomy was done in 2 cases.
CPK, LDH, Aldolase, GOT, GPT showed high values in the beginning of the disease, and they decreased gradually with the progression of the disease. PaO₂, PaCO₂ demonstrated abnormal values and the patients fell into a delirious state. The serum pH showed respiratory acidosis.
We used several methods including postural drainage, vibrator and, tapping in order to discharge sputum. All of these 3 cases died of respiratory insufficiency, pneumonia and bleeding from tracheo-arterial fistula, respectively.

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