Body surface potential mapping is a method to obtain the temporal sequence of cardiac potential distributions on the thorax by computer using multiple leads and simultaneously recorded ECG. The body surface map was analyzed empirically from the isopotential map in the one direction, but also more quantitative and statistical technological approach evolved the information about electrical cardiac behavior by the theoretical development of the inverse problems in the other direction, As a method of the inverse problems, we developed the dipole analysis of cardiac electrical events, of which results will be shown in the followings.
Assuming an electrical dipole in the thorax, body surface potential was calculated, and the location and the movement of the dipole were selected so as to minimize the difference between the calculated body surface potential and the actual measured body surface potential. If the difference showed larger value, the more nondipolar component was considered in the body surface potential. The difference named the residue, which expressed the nondipolarity of the body surface potential and was the averaged ratio of the nondipolar component to the measured potentials over the thorax. (1) The residue during QRS of the normal increased sharply at early and later phase. These results were comparable with the data of Taccardi, and the high residue at early phase was due to the breakthrough of the right ventricle. The residue during T was small and stable, and a single dipole was suggestive. The main dipole of QRS moved smoothly within the actual cardiac area and its trajectory was inscribed in a clockwise direction in most cases, but the one during T moved in the limited area near the center of the heart. (2) The site of the preexcitation of WPW syndrome was presumed by the method to determine the location of main dipole, and there was about 70% agreement between the dipole location at delta wave and the location of Kent bundle deserved at the operation. (3) The value of the residue can be useful to determine the extent of myocardial infarction. There was high residue at the early part of QRS in the anterior myocardial infarction, but the residue at the middle of QRS tended to show the significant inverse relationship with the size of myocardial infarction, and the larger myocardial infarction had the lower residue, which may indicate the increased single dipolarity.

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Percutaneous brachial catheterization was performed in 70 cases. In 33 cases, a 5F introducer was inserted percutaneously into the left brachial artery and left heart catheterization, coronary arteriography and left ventriculography were performed using preformed (Judkins) catheters. In 37 cases, the right brachial artery was punctured and 5F or OF Sones type catheter or 5F left Judkins catheter was used. Percutaneousbrachial approach was impossible in 4 cases because of difficulty in puncture or catheter manipulation. Quality of obtained angiograms was sufficient for the clinical diagnosis. There was no serious complication. In conclusion, percutaneous brachial catheterization was a useful technique because it lessened patient's physical burden.

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In general, function and histological findings of the liver improved in patients who had seroconversion from HBeAg to anti-HBe.
However, we often noticed the fluctuation of serum transaminase level in seroconverted cases.
A total of 20 cases with positive anti-HBe, whose transaminase was fluctuated over 100 U were examined by clinicopathological methods. In the present study we examined localization of HBcAg in the liver tissue and correlation between liver function and staining condition of HBcAg stained by PAP method (Peroxidase-anti-peroxidase). Anti-HBe in serum and HBV, DNA-P, HBV-DNA were also examined.
This study suggests that there is a close correlation between HBcAg in the liver tissue and high level of serum transaminase. In such a case we think there is the replication of HBV in liver tissue even in the anti-HBe positive cases.

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Indication of hemodialysis (HD) in the elderly uremic patients has been expanding by the progress of the technology of HD recently. And the age of HD patients gradually became older. There are many problems including complications and control about HD therapy in the elderly.
We studied the present status and problems of HD for elderly patients at national hospitals and sanatoria.
1. HD patients over 65 years old occupied 27% of all HD patients at national hospitals and sanatoria in Japan. The half of those were hospitalized HD patients.
2. The number and ratio of the patients who started HD after becoming over 65 years old during the years from 1978 to 1986 had been increasing. The cause of most cases was chronic renal failure.
3. Fifty-five percent of the patients who started HD after becoming over 65 years old died within 3 months afterr the initation of HD.
4. There were eldely patients with senile dementia who could not do self-management in 40% of the institutions.
5. Elderly hospitalized HD patients had been increasing in 60% of the institutions, it was proposed that the countermeasure should be cooperation with surrounding institutions (satellite clinic), increased number of facilities and prevention of complications.
6. Severe clinical and phychological problems (i. e. dementia, neoplasm, etc) of the elderly patients should be major consideration in selecting cases for starting regular HD in half of the institutions.

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Predonation of 400 ml of autologous blood was done in 19 patients for gynecological operations, including one adnectomy, one abdominal hysterectomy with adnectomy, two abdominal hysterectomies, seven semiradical hysterectomies and eight radical hysterectomies. Intraoperative blood loss was 231±95 ml for adnectomy and/or abdominal hysterectomy, 314±102 ml for semiradical hysterectomy. Six of eight radical hysterectomies were treated with simultaneous use of predonation of autologous blood and hypotensive anesthesia. Intraoperative blood loss was 463±152 ml. No homologous transfusion was required. The intraoperative blood loss of two cases without hypotensive anesthesia was 950±777 ml. One of these two patients required homologous transfusion. Autologus transfusion and hypotensive anesthesia seemed to be effective in reducing homologous blood transfusion.

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Experimental chemotherapy was performed using the human tumor-nude mouse system. The tumors were mucinous cystadenocarcinoma (OVA-1), undifferentiated carcinoma (OVA-2), endometrioid adenocarcinoma (OVA-3), serous cystadenocarcinoma (OVA-4) and three yolk sac tumors (YST-1, -2, -3).
1. A clear correlation between the antitumor activity of the drug and the histological type of the tumor was observed. The results indicated the importance of making a chemotherapeutic protocol according to the histological type of the individual tumor.
2. The antitumor activity depended on the dosage of the drug. The results suggested that it was necessary to increase the dosage of the anticancer drugs to obtain further clinical effects on patients with ovarian cancer.
3. The administration of a single drug in a sufficient dosage produced more effective antitumor activity than multidrug treatment. The results suggested that combination chemotherapy might not necessarily be the best way to effectively treat patients with ovarian cancer.
4. The maintenance chemotherapy after surgery for ovarian cancer was important in the effective treatment of the patient (tumor-bearing host).

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We performed 109 cases of outpatient cataract surgery with intraocular lens (IOL) implantation from November 1985 to October 1980. There was no difference in the visual prognosis between outpatient cases and inpatient ones. There was no complications particularly related to the outpatient surgery. We performed a questionnaire survey to find out how patients thought about outpatient surgery. In result we found that most of the patients wanted to be hospitalized for a couple of days after surgery.
Recently outpatient cataract surgery has been talked about on TV or in the newspapers. In the United States, outpatient cataract surgery is very popular and widely performed mainly from financial and social reasons. In contrast, in Japan it has many social problems. At this time, it should be restricted to patients who are healthy and young, and have strong motive and dwell near the hospital.

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Psychiatric studies were made in 120 patients with pulmonary diseases such as chronic obstructive pulmonary disease, bronchial asthma and hyperventilation syndrome and pulmonary symptoms such as idiopathic dyspnea and chest pain using three psychiatric screening tests of CMI (Cornell Medical Index), MAS (Manifest Anxiety Scale) and SDS (Self-Rating Depression Scale).
Proportion of III and IV areas of CMI which reveal character of neurosis is more in patients with asthma (61.6%) than in patients with chest pain (34.4%) (p<005). No significant difference was noted in SDS tests in the pulmonary diseases. A proportion of patients who had more than 25 points in MAS tests which reveals highly anxiety was larger in COPD (45.2%) than in patients with chest pain (10.3%) (p<0.1).
Tofisopam (new benzodiazepine and potential minor tranquilzer) was effective on 80% of patients with hyperventilation sysndrome but it had poor effect on COPD (28.6%) and asthma (3.8%). This drug was more effective in the patient group showing I area in CMI, up to 24 scores in MAS and up to 49 scores of SDS.
We did counseling and general psycologic treatment to the patients who were not improved by pharmacological treatment.
The results of psychiatric screening tests would be applied to the treatment of patients with pulmonary diseases.

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The skeletal maturation in the severely handicapped children in our sanatorium was studied.
The skeletalage was estimated by the method of Sugiura-Nakazawa's scoring points, and was compared with Sugiura-Nakazawa's normal standard score. The deviation from Sugiura-Nakazawa's standard curve, i. e. retardation, became most obvious, i. e. 3-5Years in 11 years of age, that is, in early pubertus. The osseus maturation in the severely handicapped children completed around 21 years of age. The osseur maturation pattern was similar to the maturation pattern of the gonadotropin system in the severely handicapped children in our sanatorium.
The effect of the anticonvalsants on the osseus maturation was not clear.
The close relationship between the skeletal maturation and the gonadal maturation was suspected.

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Thrombin for oral administration is only available as a commercially vial-form preparation, which is easily mistaken for a injectable preparation. Therefore, we developed a tablet of thrombin to make oral administration easier. The thrombin 5, 000-and 10, 000-unit tablets from human and bovine origins were prepared and a study on various pharmaceutical factors possibly affecting the enzyme activity in thrombin tablets were conducted. The results of weight variation and disintegration tests of both tablet dosages conformed to the standards of the Japanese Pharmacopeia (JP) XI. Furthermore, enzyme activities of thrombin were about 90% of those original vial forms. Under condition of refrigerated storage, there was no change in the enzyme activity up to 21 days after the preparation of each thrombin tablet.
A study of various factors affecting the enzyme activity resulted in that the enzyme activity of each thrombin tablet was influenced by compressing pressure and long-term preservation at refrigeration temperature. The activity in the thrombin tablets prepared at a compression pressure between 800 and 2, 600 kg decreased by 10% at 1, 000 kg, about 20% at 2, 000 kg and 23% at 2, 500 kg and long-term storage in refrigerator for 44 weeks showed that remaining activity in thrombin 10, 000-unit tablet, thrombin-A tablet and thrombin-B tablet was 33%, 87.1% and 75.9%, respectively.

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We report a case of tertian malaria in a 27-year-old Israeli woman. After traveling in the South-East Asia, she reached Japan. Two months after the arrival, she developed headache, fever and shivering. The examination of the peripherl blood revealed Plasmodium vivax, and the diagnosis of tertian malaria was made. Her symptoms improved by antimalarial drugs. A relatively long term latent period and atypical fever type as tertian malaria were thought to be due to the antimalarial drugs having been taken by the patient for prevention. The change in the platelet count was considered to be a better indicator fpr the clinical diagnosis of tertian malaria.

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A 41-year-old man had a history of cardiomegaly on chest x-ray examination and electrocardiographic abnormalities at the age of 25, but remained asymptomatic. On admission to hospital, a chest radiograph showed a marked cardiac enlargement of 78% of cardiothoracic ratio, an electrocardiogram showed first-degree atrioventricular block and intraventricular conduction abnormalities, an echocardiogram showed a massive pericardial effusion, and myocardial imaging perfusion with thallium-201 showed a defect of anterior left ventricular wall. Histologic findings of pericardial biopsy were consistent with nonspecific active pericarditis. Subsequent cardiac catheterization showed decreased left ventricular ejection fraction of 30%, elevated left ventricular end diastolic pressure of 24 mmHg and enlarged left ventricular enddiastolic volume of 125 ml/m², Coronary angiography revealed no coronary atherosclerotic lesions. Myocardial biopsy demonstrated marked muscular fibrosis, but no evidence of myocarditis.
Based on these findings, we concluded that the myopericarditis lasting more than seventeen years caused a myocardial damage and, as a result, progressed to a dilated cardiomyopathy.

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Two cases of insulin dependent diabetes mellitus and Graves' disease who have islet cell antibodies (ICA), poor endogenous insulin secretion and no family history of diabetes mellitus were reported. These cases were considered to be polyglandular endocrinopathy type III-a proposed by Neufeld et al. It has been suggested that HLA class II expression may play an important role in the development of both IDDM and Graves' disease. In our cases, they had HLA DRw9 and DR4, respectively, in addition to positive test results for ICA. Therefore it was suggested that there were some common immunological mechanisms in the development of IDDM and Graves' disease.

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Pneumatosis cystoides intestinalis is a rare disease with multiple cystoma containing gas seen under the mucosa or serous membrane of the intestinal tract. We recently experienced such a case combined with multiple gastric cancer, on which a report is pre-sented as follows.
The case was a 74-year-old female with the chief complaint of loss of weight and epigastric discomfort. She was first seen in the Department of Gastrointestinal Medicine of our hospital for close examination, which led to the diagnosis of multiple gastric cancer (Borrmann type II on the greater curvature in the antrum and type II-C on the lesser curvature in the body of the stomach). This brought her to the Department of Surgery of our hospital for hospitalization. In the course of the operation, besides the gastric cancer, many bulging phymas were found in the ascending colon by palpation and endoscopy revealed a large number of pathological changes with hemispherical bulges of various sizes, some of which were found united with one another. The surfaces were smooth with hemorrhages in part but otherwise were covered with normal mucosa. Since pneumatosis cystoides intestinalis was suspected, we reexamined the preoperative plain roentgenogram of the abdomen to find pneumatic cysts on the intestinal wall as a shadow appearing like a grape cluster at the site of the pathological changes in the right lower abdomen, which proved our suspicion to be the right diagnosis. The operation performed involved subtotal gastrectomy and partial resection of the ascending colon. There have been a number of reports giving gastric or duodenal ulcer or association of trichloroethylene as the cause of this disease but we could not definitely identify the cause of the disease in our case.
In this case we happened to find out the identity of the disease involved in the course of the operation. The fact that the transparent picture of the gas in the shape of a cluster of plenty grapes on the preoperative plain roentgenogram of the abdomen served as an important clue to the diagnosis of the above-mentioned disease was considered to imply that careful observation should have been made preoperatively in this case.

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Numerous cases of metastatic brain tumors, particularly those derived from the lung and breast cancers, have been documented.
We report a rare case of brain metastasis. Patient was a 60-year-old man, who initially presented with cerebellar and spinal symptoms.
Laboratory tests including biopsy failed to reveal the primary site, and the disease was identified by autopsy as a multiple metastatic cancer with primary lesion at the corpus et cauda pancreatis and metastases in the posterior cranial fossa, chiefly the cerebellum, and spinal cord. As far as our literature search shows, in total 24903 cases of pancreatic cancer with metastases in the brain were reported, post mortem examination of the whole body including the head was performed on 4913 cases, of which only 370 cases verified pancreatic cancer. Metastases to the central nervous system was confirmed in as few as 6 of 370 (0.016%).

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In liver cirrhosis, impaired intrahepatic blood flow leads to portal hypertension and portal flow stagnation. As a result, gastro-esophageal varices occur and, together with thrombocytopenia by hypersplenism and reduced synthesis of clotting factors in the cirrhotic liver, a massive bleeding can happen. Recently, endoscopic injection sclerotherapy for variceal bleeding has been prevailing, but it's long-term efficacy appears to be unsatisfactory, because the procedure may develop portal hypertension as a result of collateral outflow interruption. The authors performed partial splenic embolization in a 57-year-old man with gastric variceal bleeding due to liver cirrhosis. The procedure led to improvement of pancytopenia and T-cell subset, elevation of serum choline esterase, total cholesterol and total protein in addition to normalization of gastric mucosa, he remained without rebleeding more than one year after embolization. It is suggested that partial splenic embolization could be used with variceal sclerotherapy as a useful and safety method by which hematologic improvement, retaining of splenic function and portal decompression are expected simultaneously.

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A case of 63-year-old man with multiple myeloma complicated by acute renal failure (ARF) following natural leukocyte interferon therapy is reported. Multiple myeloma (IgG-λ) was diagnosed 3 years before on this patient and he was followed at our outpatient clinic. He was admitted to our hospital because of lumbago, and was treated with natural leukocyte interferon 1.5 million units par day intramuscularly for 7 days. After interferon administration, ARF developed (serum creatinine 4.7 mg/dl and urea nitrogen 99 mg/dl), and the patient died from pneumonia complicated during the recovery period from ARF. None of the predisposing factorsother than interferon therapy such as dehydration, infection, fever, hypercalcemia and hyperuricemia were not found. Although two cases of ARF induced by interferon were reported in English literature, this is the first case of ARF in Japan.

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Drug fever without manifestation of so-called drug eruptions was studied so as to clarify its clinical characteristics.
Between 1983 and 1988, eight patienus, three men and five women with a mean age of 90 years (range 38-75 years old), were identified according to the following criteria for drug fever: (1) It was an unexplained fever under a condition that might itself have caused a febrile state. (2) Fever coincided with the administration of the drug and then improved after discontinuation of the drug without other therapeutic measures. (3) The temperature remained normal thereafter, accompanied with a recovery of general condition from the unexplained fever. (4) There was no so-called drug eruption.
Diagnosis was confirmed in four of the eight patients by rechallenge of the causative drugs. All patients had fever caused by the antibiotics which were administered; for infectious diseases in 7, for prophylactic use in 1. Other manifestations occurred in 2 patients (lymphnodes swellings in 2, polyarthritis in 1, and erythema nodosum in 1). Only 3 patients had prior histories of allergy. Fever pattens were high (≥36°C) in 6 patients, medium (38-39°C) in 1, low (<38°C) in 1. Duration of the drugs before the occurrence of drug fever ranged widely from 5 to 34 days. A relative eosinophilia was detected in only 2 patients. Erythrocyte sedimention rate, C-reactive protein and nuclear shift of neutrocytes were not helpful in making a differential diagnosis of drug fever against infectious disease. White blood cell counts ranged from 3500 to 6200/cmm. All intradermal skin tests of causative drugs showed negative. Patch test examined in 2 patients showed negative for both. Drug-induced lymphocyte stimulation test examined in 5 showed positive in 4. Circulating antibodies examined in 2 showed positive in 2. Drug fever disappeared within 24 hours in 5 patents, 3 days in 2 patients, but continued for more than 7 days after the drug discontinuation in 1 patient. Our data showed no specific clinical patterns to confirm the diagnosis of drug fever against the infectious disease. In conclusion, we reconfim that drug fever must be among first considerations for unexplained fever in any patient receiving medications.

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