At the beginning of penile erection, blood flows rapidly into the cavernous sinuses. In order to increase the blood flow, relaxation of the smooth muscles in the trabeculae and arterioles is required. This is induced by secretion of vasoactive intestinal peptide (VIP). When the sinuses are expanded by the blood, the ischiocavernous muscles contract. As a result, the intracavernous pressure rises markedly, and a closed system is created, separate from the body's main blood circulation. This condition, known as the rigid stage, is maintained by prevention of arterial backflow into the helicine arteries and venous outflow into the post cavernous venules.

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Serum acid phosphatase (ACP) is known as an useful marker for diagnosis of metastatic carcinoma of the prostate. However, measurement of ACP requirs prompt treatment of the samples due to unstable and low activity levels in serum. Therefore the analysis of serum ACP has been one of the most difficult biochemical tests for automatic analysis. We evaluated an automated procedure for the assay of serum ACP activity employing 2, 6-dichloro-4-acetylphenylphosphate as substrate by Hitachi 7150.
Linearity was confirmed up to 1344IU/l by dilution of elevated patient's specimen. Within-run and day to day precision (CV) were 2.0 and 3.7%, respectively. No interference from bilirubin, or turbidity was observed. But high concentration of hemolysis showed positive error for ACP activity. Relation between serum ACP activity as determined manually by the Bessey-Lowry's method (x) and current method (y) yielded the following equation. y=0.95x-0.66, r=0.966.
The proposed method has advantages for the accurate, precise and rapid assay on the automated analysis with use of analyzer, Hitachi 7150.

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We describe a quantitative analysis of major urinary organic acids by stable isotope dilution method as a chemical diagnosis of metabolic disorders. In this report, we discuss extraction procedure recoveries, accuracy and analytical recovery by this method, and the effects of urinary albumin and urinary pH values. The solvent extraction can be simply and rapidly prepared during routine screening test, although pyrimidine metabolites and citric acid and pyroglutamic acid levels yielded were extremely low. The accuracy and analytical recovery of this method were found to be good. There was no effect of urinary albumin below the levels of 1g/l, and optimal pH was 0.5 to 1.0. Change in excreted levels of some acids were observed when the subjects were on unrestricted diets. In comparison with the conventional method, this method has the advantage of being an analytical procedure which can supply a useful data in the differential diagnosis of metabolic disorders with similar profiles of urinary organic acids.

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We present herewith some knowledges obtained through the clinico-pathological observation of 30 cases diagnosed as epulis during the 10 years and 9 months from April 1978 to December 1988 at the Department of Dentistry and Oral Surgery in the Nagoya National Hospital.
With regard to the chief complaints, 16 cases complained of the tumor in the gingiva (56.5%) followed by 9 cases of the puffiness in the gingiva, 4 cases of the proliferation in the gingiva, and 1 case of the hemorrhage from the gingiva. In view of the age, the majority was those in the fifties, accounting for 29.0%, followed by those in the forties, and in the sixties in the order mentioned, and those from 40 to 69 years accounted for 64.5% of the total patients. In view of the sex distinction, the ratio of male to female was 1:6.8, indicating female preponderance. In view of the histologic classification, we made an arrangement according to the descriptions by Ishikawa and Akiyoshi. Seventeen cases showed fibrous proliferation, taking 54.8%, followed by 8 cases with granulomatous proliferation taking 25.8%, 4 cases showed vascular proliferation taking 12.9%, one showed osteoplastic proliferation taking 3.2%, and 1 case of the congenital origin.
The surgical excision was done in all cases, and among them the tooth-extraction was performed simultaneously in 8 cases, or in 25.8%.

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Now it is presumed that there are about one million demented elderly and 700, 000 bedbound elderly in Japan. The proportion of the elderly among the whole population is increasing rapidly. The Ministry of Health and Welfare has taken steps in order to treat this very up-to-date problem. In 1987, the Ministry of Health and Welfare reported a treating strategy for demented elderly. In 1989, it held a conference on the problem of demented elderly inviting specialists and recommended a plan how to carry it out concretely in the community care system. Since 1987, national sanatorium has carried out a medical treatment as a model for the demented elderly with psychotic symptoms and investigation of the treatment and nursing technique and caring system and so on. What would be the role of national medical institutes in the medical care system for the demented and the bed-bound elderly? As for the medical treatment of the demented and the bed-bound elderly, treatment on the community basis should be required. So the role of the regional office and the private institute is thought to be very important. Finer support and treatment is possible there. From now on, national medical institutes which are small in number should play a more comprehensive role, while it has regional basis.
Today present status of the medical care system and result of the investigation for the demented and the bed-bound elderly were discussed actively. And future role of the national medical institutes was made clear.

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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.
After examining 144 school refusal children, we found many undesirable influences on Japanese children. The number of nuclear families is increasing, fathers are working away from home too long, divorces are increasing, mothers working outside of the home have less time for bringing up their children, difficulty with entrance examinations, bulling by friends, unnecessarily strict school regulations and physical punishment at school become popular.
So it is no exaggeration to say that any child could easily become a school refusal child due to the numerous factors contributing to the problem at home, at school and from the Japanese society.
The positive results from therapy were recognized in 107 cases (74.3%) of 144 school refusal children. According to the long term observation of 20 cases, 17 children (85%) were recognized to be well adapted to their daily social lives after graduation from junior high school.

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An assessment has been made regarding 139 patients undergone dialysis whom we experienced from August, 1980 (when Life-Saving Center was established) to June, 1991. The cases of acute renal failure were 70, and occurred mainly in aged patients. The mortality rate was high at 61.4%. The causal diseases were acute postoperative renal failure and gramoxon poisoning in many cases with high mortality rates, but with other causal diseases the mortality rates were low. Chronic renal failure was found in 69 cases, and the causal diseases were chronic glomerulonephritis, cystic kidney and diabetes in many cases, and the mortality rate was 27.5%.

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The authors studied the circadian variation of blood pressure and factors influencing on it in 23 in-patients (8 hypertensives, 9 stroke rehabilitation, 6 bedridden subjects) using 24-hour ambulatory blood pressure monitoring. The circadian variation in hypertensives showed the bimodal pattern which had two peaks both in the morning and in the evening. The circadian variation obtained in patients with stroke rehabilitaion was almost the same as that in hypertensives except another peak during rehabilitation. The bedridden subjects showed no specific pattern of circadian variation. Factors elevating blood pressure were meal, urination, smoking, emotional stress, interview, and rehabilitation. Blood pressure was reduced by rest, antihypertensives, and after meal. Blood pressure in the bedridden subjects was influenced by various medical care (intratracheal suction, change of body position, etc.). Although blood pressure measured at 10 A. M. was significantly correlated with the mean value of 24-hour blood pressure monitoring, the correlation coefficient was not so high (r=0.67, p<0.01).

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It is well known that the onset of majority of the epidural hematoma is acute, and this disease is one of the representative traumatic ones, for which emergent removal of the hematoma must be carried out without delay. However, pathology of the epidural hematoma with slight or asymptomatic state has been recently clarified by X-ray CT. Under these circumstances, several cases of epidural hematomas which were reduced by absorption have been reported, and we also experienced a similar case of epidural hematoma. The hematoma with 18mm of the maximum thickness was observed on the right temporal lobe, and associated with midline shift of 2.5mm, and linear fracture of the skull was observed on directly over the hematoma. The consciousness was clear and local neurological abnormality was never observed. The headache and vomiting were observed in the early stage, while these were rapidly disappeared, and the size of the hematoma tended to decrease after two weeks, and almost disappeared at the 4th week of the hospitalization. We report that conservative treatment is possible in some cases of the epidural hematoma like our case with some discussion on terms diciding the therapeutic approaches and absorption mechanisms.

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Two cases of epidermoid cyst of the testis are reported.
‹Case 1› A 26-year-old man was admitted with the chief complaint of a mass in the right scrotal content and miction pain. Physical examinations revealed an induration with slight tenderness in the right scrotal content. All testicular tumor markers were within normal limits. Right high orchiectomy was selected under the diagnosis of testicular tumor. Macroscopic examination of the resected specimen revealed an encapsulated tumor of 2.2×2.0×1.6cm in size within the testicular parenchyma. Histological diagnosis was epidermoid cyst of the testis.
‹Case 2› A 20-year-old man was admitted with the chief complaint of a painless mass in the right scrotal content. All testicular tumor markers were within normal limits. Ultrasonography showed the well-circumscribed heterogenous solid mass at the upper part of the right testis. Right high orchiectomy was performed under the diagnosis of testicular tuomr. Macroscopic examination of the resected specimen showed a 2.0×1.8×1.8cm tumor within the testicular parenchyma. Histological diagnosis was epidermoid cyst of the testis.
An epidermoid cysts is a rare and benign testicular tumor and represent about 1% of all testicular tumors. We reviewed and discussed 114 cases of the epidermoid cyst of the testis including our two cases in Japan.

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The present case was born with Apgar score 0 and birth weight of 950g at 31 weeks of gestation. Emergency cesarean section was performed under lumbal anesthesia because of fetal distress and separation of the placenta when his mother's blood pressure fell down to 62/26mmHg in the state of shock. He was born with generalized cyanosis and hypotony, without heart beat and breathing.
He underwent artificial breathing and heart massage immediately after birth but his condition could not be improved at all. Therefore he was given a parenteral dose of bicarbonate from the umbilical vessel, resulting in the recovery of skin colour and heart beat. Thereafter intermittent mechanical ventilation and glucose transfusion were initiated to rapidly improve generalized condition and the crisis of apnea and hypoglycemia, but hypocarbia persisted.
At presnt time he is 8 years old with normal development and enjoying a normal school life. This case suggests the importance of an early use of bicarbonate for resusciation from neonatal asphyxia.

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Sleep-related respiratory disturbance was observed in six severely handicapped patients, by means of polygraphic sleep EEG and monitoring of arterial oxygen saturation (SaO₂) and end-tidal CO₂ pressure (PetCO₂). All patients were bedridden with spasticity and/or athetosis. Five cases were classified as the sleep apnea syndrome; 4 cases obstructive sleep apnea and one case central sleep apnea. In one case, hypopnea and low SaO₂ continued for hours during sleep. Five cases showed an increase of more than 10mmHg of PetCO₂ in a sleep. In spite of the increase of PetCO₂ or of the marked decrease of SaO₂, arousal and ventilatory responses were poor in these patients. The sleep-related respiratory disturbance in the severely handicapped patients might result from the dysfunction of brain stem respiratory center both combined upper central nervous system, the abnormal muscle tone or the increase of threshold of chemoreceptors of PaCO₂ and PaO₂.

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