Endogenous infection was first proposed by Escherlich in 1589 as infection induced by a normal flora, which exists in the body. One case of herpes zoster in the face simulta-neously associated with pulmonary tuberculosis was observed, and its mechanism of occur-rence has been under investigation sionce then. Finally, a new general broad interpre-tation of endogenous infection has been developed. Endogenous infection falls into two categories. The first is infection caused by normal flora, which originally exists in the body. The second is infection caused by latent pathogens which have invaded into the body at a previous infection, whose occurrence depends on the host's condition. The lat-ter type includes herpes zoster and endogenous activation tuberculosis. The causes of endogenous infection exist mainly in the hosts. Therefore, investigation of the causes of endogenous infection requireshostology.

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An outpatient clinic for patients with chronic heart diseases has been opend at the pediatric cardiovascular division of the Iwaki Byoin National Sanatorium.
Recently, however follow up visits of patients with chronic heart diseases decreased significantly. We investigated the possible causes of decrease and considered the counter-plans.
The results in this study were as follows:
1) Concerning to the diseases, discussing was preferable to teaching with guardians or patients.
2) The date of follow up visits was not necessary requested in the long vacations by the patients.
3) The appointment card for follow up visits was useful.
4) Consulting doctors should be familiar with social problems of the patients to give a proper advice to the patients.

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Reversible bronchoconstriction is one of the fundamental characteristics of bronchial asthma.
We studied 28 asthmatic patients by different lung function tests and compared the data of each individual during the attack from during without attack to clarify the site and the extent of bronchoconstriction.
(1) The decrease of %VC and the increase of RV/TLC were found significantly in symptomatic stage. (p<0. 01) It was suggested that the overinflation of lung occurred by airway clousure.
(2) Peak flow and Vmax measured by Flow volume curve decreased in all cases in symptomatic stage. Though these findings were shown in the aggravation of broncho-constriction, these were not necessary to indicate the site of bronchoconstriction.
(3) CV/VC was not found to be significantly different between them, but the site of bronchoconstriction in symptomatic stage was found in two types, one indicated small airways constriction predominant type and another large airways constriction predominant type in view of the variation of CV/VC.
(4) A tendency to increase in %DLco was found in symptomatic stage. Further stu-dies are needed to clarify this mechanism.

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Fifty-two patients with herpes zoster were treated using new anti-viral agent, Ara A. Effectiveness of this drug, especially for post-herpetic neuralgia, was evaluated. Some of these patients were aged ones, others were immunocompromised hosts with internal malignancies or collagen diseases, and still others had very severe forms of herpes zoster.
Although the incidence of the post-herpetic neuralgia was 30% in these patients, that of very severe neuralgia was only 140. Other therapeutic factors such as timing of ini-tiation of Ara A therapy and addition of other therapies using intravenous globulins or nerve blocks seemingly had no effect to decrease the incidence of post-herpetic neuralgia.
The incidence of post-herpetic neuralgia was rather related to the background factors such as ages of the patients, affected sites, severites of the rashes and elevation of the CF antibody-titres of varicella-zoster virus.

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Seven adult patients with varicella (chickenpox) were treated using antiviral agent Ara A. These patients were relatively young (1832 years of age) and were otherwise healthy before they had suffered from this illness. Initiation of Ara A therapy was within 4 days from the onset, and high fever fell within 2 days after treatment. Skin rashes disappeared without any residual scars. Three patients revealed transient elevation of serum transaminases, but these were regarded as abnormal laboratory data due to vari-cella. CF antibody titres for varicella-zoster virus were raised significantly from 4 times to 16 or 256 times.
Varicella is a relatively common disease affecting young children, and because of its benign, self-limited nature, ordinary supportive therapy is usually sufficient for chil-dren with varicella. However, adult patients with this disease usually show relatively severe symptoms and signs, such as high fever and malaise. We considered that treat-ment using antiviral agent, Ara A be recommended for such cases.

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To clarify the role of transferrin receptors(TfR) in cases of altered iron metabolisms in clinical pathological conditions, 1) number; 2) affinity; 3) recycling kinetics of TfR and 4) iron uptake by erythroblasts were examined using 1251-and 59Fe-transferrin. 1) The number of TfR in cases of iron defficiency anemia was significantly greater than that seen in normal subjects (p<0.01). 2) The dissociation constants (Kd) was unchanged (about 10 nM/L) in patients and normal subjects. 3) The kinetics of endocytosis and exocytosis of '25I-transferrin, examined by acid treatment, was impaired in the two patients with erythro-leukemia. In patients with other disorders, there were no variations from normal subjects. 4) Iron uptake by erythroblasts in cases of iron deficiency anemia were greater than in normal subjects. These data indicate that iron uptake is regulated by modulation of the number of TfR, reflecting the iron demand of the erythroblast. In cases of erythroleu-kemia, the altered TfR cycle may play some role in the pathogenesis of defective heme synthesis and ineffective erythropoiesis.

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The result of arthroscopic synovectomy in 68 knees of 36 patients with chronic syno-vitis of rheumatoid arthritis were reviewed. The short term result of this procedure was rather good and almost 60% were good or excellent at two years follow up. There was a statistically significant difference of the postoperative improvement between the patients whose preoperative activity of the disease was high and low. Compared to open synovectomy, the arthroscopic synovectomy has several advantages as follows. Lessor damage, easier rehabilitaion and shorter hospitalization. If the remission of the symptom is temporary, the arthroscopic synovectomy will be useful for the patients to prevent joint destruction. So this procedure seems to be indi-cated not only in the patients who can be controlled systemically by medical therapy, but also in those who cannot be controlled medically.

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Using the Hypercard, we made a CAI system which proved to be useful for both medi-cal personnel and diabetic patients. In this system, we added audio-explanations for patients with impaired visual acuity, and animations to help understanding. In order to educate patients individually as their clinical informations, artificial intelligence procedure (Macsmarts) has been incorporated in this system. This system has been used in outpa-tient education as an aid of group teaching. This method seemed to be useful in clinical teaching.

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Egogram of mothers of normal mature infants who visited our clinic for examination one month after birth, and the condition of pursuit eye movements of babies were examined. Egogram showed the following results in the breast-feeding group including mixed feeding, and in an artificial feeding group: Critical Parent:12.6±3.4 and 14.0±2.6; Nurtur-ing Parent (NP):18.9±4.0 and 19.7±4.5; Adult: 16.7±a.9 and 18.1±3.7; Free Child:13.8 5.1 and 14.4±3.5; and Adopted Child:14.2±3.5 and 14.9 ±4.7, respectively. Although both groups revealed high NP values, no significant difference was noted between these two groups. Mean values for NP and Adult was slightly lower in the breast-feeding group than in the artificial feeding group. Moreover, the percentage of mothers who recog-nized pursuit eye movements in the breast-feeding and artificial feeding groups were 760 and 80% respectively when the baby was the first child, and 84% and 100% respectively when the baby was not the first child. Thus, the percentage was higher when the baby was not the first child in both groups. Furthermore, the percentage was lower in the breast-feeding group than in the artificial feeding group, against my expectations. Conse-quently, the mothers' recognition of pursuit eye movements of the baby was consideredto be associated with psychological satisfaction in fostering and ample time in lac-tation.

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Recently, several reports about ultrastructural localization of taurine in nerve cells by means of electron microscopic immune histochemistry were seen. But localization of taurine in skeletal muscle cells has been unclear. We think that an electron microscopic radioautography (EMRAG) is available to study the ultrastructural localization of taurine in cells.
The hind, leg muscles of a normal mouse and a muscle dystrophy mouse were cut into small pieces and were cultured with medium containing 3H-taurine for 60 minutes. Then these muscle pieces were prepared for electron-microscopy specimens by routine process and were studied by EMRAG.
In the results of this study, the silver grains of ³H-taurine appeared on sarcoplasmic reticulum, mitochondria, myofilament, sarcoplasmic membrane and endothelial cells of capillary. Any grain was not recognized on T-tubules, Golgi-apparatus or satellite cells.

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Approximately 6% of dialysis cases of patients under 18 years of age in Japan, resulted from Henoch-Schönlein purpura nephritis. We conducted a research on cases of Henoch-Schönlein purpura nephritis, from 15 medical centers, with a total of 92 patients, mean age at onset 8.0±2.7 (years).
The prognosis was classified into the following groups;
1st group-cured, 2nd group-improved,
3rd group-unchanged, 4th group-worse.
71.6% of the patients belonged to the 1st and 2nd groups, with a favorable prognosis. 6.5% including 3.2% dialysed patients, had a poor prognosis.
With respect to the degree of hematuria, proteinuria and prognosis there was no recognized correlation in each group. The findings of renal biopsy indicated a favorable prognosis in II of the ISKDC (International Study of Kidney Disease in Children) classification.
On the other hand, cases with a poor prognosis were distributed in 111 a of the above classification.
No significant difference was recognized for prognosis by use or non-use of steroids.
At present repeated biopsy as well as clinical findings is considered to be important, for determination of long-term prognosis of purpura nephritis.

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Pacemaker implantation for congenital complete A-V block was underwent in a six-day-old male newborn. An epicardial electrode (suture on type) was fixed on the anterior wall of the right ventricle through midsternotomy and pacemaker generator (Nova-II, Intermedics) was implanted under abdominal rectal muscle on the left upper abdomen. Reoperation was required on the postoperative 141 days because of the generator pocket infection. Staphylococcus aureus was found in this pocket. A new generator was implanted into extrapleural space and a new epicardial electorode (screw in type) was attatched to the left ventricle through left antero-lateral thoracotomy. The infected generator wsa removed, but the old epicardial electorode was remained. Twenty-two months after initial implantation, the patient developed normally at pacing rate of 100 per minutes without cardiac failure.

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Three patients with Philadelphia (Ph) chromosome positive chronic myelogenous leukemia(CML)who had platelets counts over 2 million/μl were described. Patient 1. This 31-year-old woman had been treated for essential thrombocythemia for 2 years until 1984, when a blood test showed excess platelets and immature white cells with marked basophilia. Bone marrow cells were found to be Ph-positive. Four years later, she developed massive splenomegaly with 15% blasts in blood and soon later she developed a frankmyeloid blastic transformation.
Patient 2. Excess platelets and 45% blasts were found in the blood of a 41-year-old man in Apr. 1989 following the treatment of CML for 4 months. The bone marrow showed the marked proliferation of blasts characteristic of megakaryocytic transformation. He received the alogeneic bone marrow transplantation in July, 1989 and is now healthy with normal platelet counts.
Patient 3. This elderly woman presented with a 2 month history of gum bleeding. The blood showed increased platelets and the bone marrow was hypercellular with increased megakaryocytes, compatible with the diagnosis of CML in chronic phase. Under the treatment with busulphan, she is well with normal blood counts. The incidence of excess platelet counts over 1.5 million/μl in CML is about 5% in the literature. Prognostic significance of excess platelet in CML was discussed.

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Recently, secondary leukemia has been increasingly reported. This paper presents a case of myelodysplastic syndrome, which occurred during the treatment of pulmonary tuberculosis, with various chromosomal abnormalities including aberrations characteristics of secondary leukemia.
The patient was a 64-year-old man. During the treatment of liver cirrhosis as an out-patient, the patient was admitted due to fever and general malaise. Under the diagnosis of pulmonary tuberculosis, chemotherapy with streptomycin, isoniazid and rifampicin was begun. The patient developed rapid pancytopenia at 4 months after the start of chemotherapy. The diagnosis of myelodysplastic syndrome was established by bone marrow centesis. Various chromosomal abnormalities were detected. These included the deletion of Y chromosome, monosomy of chromosomes no. 5, 7 and 16 and ring chromosome no.4.

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The authors report a classical case of progressive supranuclear palsy in which CT, MRI (magnet resonance image), SPECT (singlephoton emission CT) studies were performed.
CASE: A 68-year-old female initially presented with slurred speech and movement accompanied with inclination to fall two years before. The symptoms did not become worse after then, however she developed dementia and unsteadiness of gait, yielded to all day bed rest about 20 months after the initial symtoms. And voluntary speech and movement became rare. On admission in January 1989, neurological examination revealed supranuclear vertical gaze palsy, subcortical dementia, peculiar nuchal rigidity with retroflexion, increased deep tendon reflexes without pathological reflexes, marked rigidity in extremities, pseudobulbar palsy and retropulsion.
1) CT scan revealed the atrophy of the midbrain and diffuse cerebral atrophy, developed for two years.
2) MRI sagittal image, considered to be essential radiological diagnostic method for PSP, clearly revealed the atrophy of the midbrain and tegmentum of the pons.
3) SPECT revealed relative low blood flow in the bifrontal base as well as midbrain and basal ganglia.

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This case is a 42-year-old female with a chief complaint of pain in the right knee joint. Hyperuricemia and elevated carcinoembryonic antigen level were pointed out at a local hospital and the patient was referred to us. The patient had hypotension, hypopotassemia and elevated plasma renin activity. Barium enema showed an elevated lesion in the ascending colon. CT disclosed low density areas in the liver and calcification of both renal medullae. Right hemicolectomy, hepatectomy and biopsy of the right kidney were perfomed. The tumor of the colon was adenocarcinoma. The liver showed a similar histological picture and a diagnosis of metastasis of colon cancer to the liver was made. In the kidney, hyperplasia and hypergranulation of the juxtaglomerular cells and sclerosis of almost half glomeruli were found. This patient had experienced repeated episodes of vomiting and taken diuretics and laxatives over a long term. Anorexia nervosa was also considered. This case was considered to be pseudo-Bartter syndrome due to these predisposing causes. This case, together with 67 cases reported previously in Japan, is described here with same discussion.

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Transurethral resection of prostate was performed in seven male patients with infravesical obstruction who had been suffering from severe dysuria after the operation for rectal cancer and in whom two had complained of urinary incontinence (overflow type). Cystometrogram showed various degrees of low compliance bladder in all patients.
After transurethral resection of prostate, the volume of residural urine was decreased in all patients. All of three showing slight or moderate bladder dysfunction and two of four showing severe bladder dysfunction became free of catheter. Postoperative deterioration of incontinence was seen in one patient, while another case improved by time.
It is considered that transurethral resection of prostate is clinically effective for mictional dysfunction after the operation for rectal cancer.

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A long-term follow-up study was performed on 440 cases of neurologically handicapped children who had undertaken early treatment and reached school age. Complete followup informations were obtained from 373 out of 440 cases. The results were as follows.
1) One hundred twenty three out of 374 cases were severely handicapped children.
2) Of these severely handicapped children, 61 cases (49.6%) had cerebral palsy as underlying disease.
3) Sixty two cases were hospitalized and 61 cases were under care in their own homes.
4) The death rate of children under home care was twice as high as that of hospitalized cases.
Furthermore we discussed the complications of severely handicapped children and emphasized the importance of early treatment.

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