Licorice is a herb which has been extensively used as medicine in the Orient and Occident for over 2000 years. Because it tastes sweet, it is also used in various foods. In 1946, licorice was found to exert an action resembling that produced by adrenocortical hormones. Since then, the mechanism for its action has been studied. Some investigators proposed that the active ingredient glycyrrhizin inhibited steroid metabolism or bound to steroid receptors. More recently, glycyrrhetinic acid was found to inhibit 11β-hydroxy-steroid dehydrogenase. In patients with glycyrrhizin-induced pseudoaldosteronism, we recently detected a new conjugate (3-monoglucuronyl-glycyrrhetic acid) and found that this substance inhibited the above-mentioned enzyme.

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We reviewed 142 cases of chest trauma during the last eight years from January, 1981. Age of the patients distributed from 3 years to 81 years with the mean age of 41.6 years. One hundred and six cases were male and 36 were female with the ratio of 2.9 to 1.
Among them, 136 cases sustained blunt trauma and 7 penetrating trauma (one sustained both). Simple chest trauma happened in 75 cases (52.8%) and 67 cases (47.2%) suffered from complicated injuries.
While surgical procedures were performed for 6 cases, most cases were administrated conservatively. Twenty seven cases including 6 of the flail chest were managed under mechanical ventilation. In one case of lung contusion, the intra-bronchial hemorrhage was successfully treated by bronchial artery embolization.
There were 19 deaths (13.4%) in which 16 were early death within 16.4±4.7 hours (Mean±SD)of the trauma. Five deaths (3.5%) were considered to be directly related to the chest trauma itself. Compared with the mortality rate of all trauma (8.7%), the one associated with chest injury was high during the same eight-year-period. It is suggested that we should make more effort to improve the survival rate of the chest trauma.

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Clinico-statistical analysis on 32 patients with oral lichen planus who visited and diagnosed histopathologically at the Nagoya National Hospital revealed the following:
1) The 32 patients included 18 males and 14 females, ranging in age from 19 to 76 years, with the peak incidence in the 60ties followed by 50ties, 30ties and 40ties.
2) The presumed duration of the disease was commonly within 6 months followed by 6 months to 1 year, followed by more than 5 years.
3) Subjective symptoms included in the order of paresthesia, irritable pain, erosion, feeling of roughness, and burning pain.
4) The location of the lesion was most commonly at the buccal mucosa followed by gingiva and gingivobuccal fold, tongue and lip.
5) The histopathological features composed of parakeratosis in 840, Sawtooth extension of epithelial protrusions in 31.3%, humoral degeneration of the basal cell membrane in 81.3%, partial loss of the basement membrane in 90.6% and lymphooytic invasion of the lamina propria in all cases.

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We estimated serum levels of cardiac muscle myosin light chain I(MLC-I) in 109 patients with neuromuscular diseases including progressive muscular dystrophy. The localization of cardiac type MLC-I is not only in the cardiac muscle but also in the red fiber of the skeletal muscle. Most patients with Duchenne dystrophy showed an elevated serum MLC-I level, which had significantly negative correlation with age in a mode of an exponential formula. And, in some cases in the advanced stage, we could not detect significant elevation. Becker dystrophy also revealed an increased serum level. In these patients with X-linked muscular dystrophy, serum MLC-I level demonstrated a significant positive correlation with serum CK level. Elevated serum MLC-I level was also observed in several cases of limb-girdle dystrophy, myotonic dystrophy and neurogenic amyotrophy. These findings suggested leakage of the fragment of muscle structural protein into the circulation. Further studies are needed for the establishment of clinical usefulness such as assessment of muscle breakdown in the neuromuscular diseases.

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Among the patients with acute lymphocytic leukemia treated at Sapporo National Hospital from January, 1973 through December, 1987 a total of 15 cases (10 males, 5 females, ages 0-12 years, mean 5.5 years) developed central nervous system (CNS) leukemia as a initial site of relapse. As re-induction therapy, the effects between the groups in which treatment only against CNS was given and those who received combined therapy of CNS and systemic chemotherapy were compared. In the latter group, the duration of second relapse from the time of attaining the second complete remission seemed longer than in the former group, but no statistically significant difference was revealed. This might mean that change of policy for the treatment would be essential. All three cases who received bone marrow transplantation from their siblings following after successfully reaching complete remission, have remained in event-free survival. Further follow-up and detailed observations concerning these cases are mandatory.

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A 44-year-old male had been treated with the diagnosis of chronic myelocytic leukemia since March 1989. The patient was admitted because of shock from blood loss on 18 March 1991. Endoscopic examination revealed duodenal ulcer. On 20 March, he under-went gastrectomy and splenectomy. Transfusions of fresh blood, CRC and platelet-rich plasma were given before, during and after the operation. Five days after the operation, he developed severe bloody diarrhea and high fever, followed by diffuse erythrodermia and liver dysfunction with jaundice. White blood cell count decreased rapidly and the patient died of multiple organ failure on 10 April, although cyclophosphamide and high dose methyl-prednisolone were given. Findings of skin biopsy were consistent with those of transfusion-associated graft-versus-host disease. Autopsy revealed hypoplasia of bone marrow and no leukemic infiltration in the various organs. Prophylactic irradiation to donated blood should be necessary in immunodeficient patient such as present case.

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A case of diuretic-induced hyponatremia is reported. A 65-year-old man was admitted to our hospital because of hyponatremia. He had been followed at a general practitioner's clinic for the treatment of hypertension. One and a half month before, trichlormethiazide 2mg/day was prescribed. Two weeks before admission, he had several episodes of unconsciousness and then general malaise and anorexia appeared. He visited to our hospital, and hyponatremia, 118mEq/l was found and admitted. After admission, trichlormethiazide was discontinued and water intake was restricted to 1000ml/day. Consequently, his serum sodium (Na) concentration gradually increased toward normal level in about ten days. At the time of admission, despite severe hyponatremia and low serum osmolarity, urine osmolarity was high and plasma antidiuretic hormone (ADH) was normal. During re-administration of trichlormethiazide, serum Na decreased, however, urine osmolarity remained high and plasma ADH did not decrease.

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A case of tuberculous extrathoracic fistula at 44 years after thoracoplasty was reported. The patient was a 66-year-old man, who had a history of right thoracoplasty 44 years ago. He was admitted on April 23th 1990 because of the painless mass and fistula on the right axillary thoracic wall.
Tubercle bacilli were isolated from the discharge of fistula. Fistulography showed that the fistula was not associated with intrathoracic cavity, but associated with right axillary lymph nodes. Histological findings of the right axillary lymph node showed tuberculous lymphadenitis. He was diagnosed as tuberculous extrathoracic fistula caused by gravitation abscess of tuberculous axillary lymphadenitis. Six months after starting the chemotherapy with streptomycin, isoniazid and rifampicin, the fistula was closed and swelling of the right axillary lymph nodes disappeared.

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Most of the reported cases of atypical mycobacteriosis are pulmonary diseases, and generalized tuberculosis cutis orificialis cases are very rare. We report one case of atypical mycobacteriosis with ulcerative skin caused by Mycobacterum chelonei subspecies chelonei. The patient, a 65-year-old male, was admitted to a nearby hospital with asthma. His lower extremities had skin lesions, some of which became pustular. The culture from the lesion at 28°C grew Mycobacterium chelonei and continued to be positive for 86 days. The property of the organism was slightly different from the one in the proposed Commission Version of the Japanese Society for Tuberculosis, working group of Mycobacterial Taxonomy. These isolated colony strains were resistant to all anti-tuber-culosis agents except for Ethionamide (TH). Amynogycosides antibiotics were effective by susceptibility testing. Treatment using Gentamicin (GM), anti-tuberculosis agent and Minocycline (MNC) was successful to control the infection.

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In Mie National Hospital, the acute disease ward (1st ward) was opened in 1976. Over the past fifteen years the ward has played the role as the center for pediatric secondary emergency medical care in Mie prefecture particularly near Tsu city where the hospital is located.
The number of hospitalized patients in the acute disease ward in 1977 was 363 and in 1981 it increased to 745. After the system of secondary emergency was built up in September 1988, the number of hospitalized patients increased more and in 1990 it reached to 1139. The number of referred patients and patients hospitalized during night shift also increased after the system was built up in 1988. In 1990 the number of referred patients was 503 (44%) and the number of patients hospitalized during night shift was 455 (40%).
Thirty-seven percent of hospitalized patients lived in Tsu city. Eighty-five percent of hospitalized patients lived within a 20km radius. Also 88% of patients hospitalized during night shift lived within a 20km radius.
The system of the open hospital was admitted in November 1991 and Mie National Hospital now can serve as the first one in Mie prefecture. Mie National Hospital will play the role as the center for pediatric secondary emergency medical care after the relation between the hospital and clinics becomes more tighter.

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