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原稿種別: 表紙
1990 年 30 巻 6 号 p.
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1990 年 30 巻 6 号 p.
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原稿種別: 目次
1990 年 30 巻 6 号 p.
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原稿種別: 付録等
1990 年 30 巻 6 号 p.
518-
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原稿種別: 付録等
1990 年 30 巻 6 号 p.
519-
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原稿種別: 付録等
1990 年 30 巻 6 号 p.
519-
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原稿種別: 付録等
1990 年 30 巻 6 号 p.
519-
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原稿種別: 付録等
1990 年 30 巻 6 号 p.
520-
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原稿種別: 付録等
1990 年 30 巻 6 号 p.
521-
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高橋 進, 鳴門 弘, 松岡 洋一, 関 育子, 渡辺 啓子, 小原 博, 石川 俊男
原稿種別: 本文
1990 年 30 巻 6 号 p.
523-530
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Today overseas activities by the Japanese are increasing rapidly. The onset of psychosomatic disease by culture shock in Japanese people living overseas is becoming a major problem. However, there is very little clinical investigation of this problem. Therefore, we conducted a psychosomatic research for the past 7 years from 1980 to 1986 in 4091 Japanese people of the Japan Overseas Cooperation Volunteers(JOCV), who left Japan for overseas service and lived in 35 different developing countries in tropical and subtropical zones. JOCV is a volunteer group of men and women with ages 20-35 who are sent to developing countries in Africa, Asia, Latin America, Middle East and Oceania for 2 years for the purpose of contributing to the social development of these countries. Of these 4091 volunteers, there were 172 who have returned to Japan for some clinical reasons during their terms of service. Among them those who came back because of the onset of psychosomatic diseases (PS group) or of mental disorders (MD group) were subjected to our present study. (1) The PS group consists of 37 case (among them 19 were women) and the MD group consists of 12 cases (among them 3 were women). The average age of the PS group was 25.1±2.8 years old (m±SD) and that of the MD group was 27.1±3.5 years old (Tab.1). (2) As to the presence of past history of the same symptom before leaving Japan, it was found in 29% of the PS group while none was in the MD group. (3) After leaving Japan, the average time before the onset of disease was 7.4±5.9 months (m±SD) in the PS group and early onsets of within 6 months were found in 51%. As to the MD group, the average time of onset after leaving Japan was 11.8±7.4months (m±SD) (Fig. 1). (4)The results of TPI test (Todai Personality Inventory test; a questionnaire including 500items) applied before leaving Japan, were compared in terms of Hypochondriasis (Hc). A total of 37 patients, the sum of PS group (25) and MD group (12), showed significantly higher scores (p<0.01) than the healthy 37 controls who were matched with the 37 patients by age, sex, country visited, year of visit and type of job. From these results, it was suggested that volunteers with highly hypochondrical tendency show a higher incidence of psychosomatic or mental symptoms in overseas (Tab. 2). (5)As to the ratio of number of cases among the PS group to that of total volunteers, African zone has a significantly higher (p<0.05) in number than other zones. This can be attributed to the seriously poor conditions of medical care in the African zone compared with those of other zones (Tab. 3).
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1990 年 30 巻 6 号 p.
530-
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田宮 聡, 田宮 裕子, 中原 俊夫, 更井 啓介
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1990 年 30 巻 6 号 p.
531-537
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Recently there have been many reports regarding sleep-wake rhythm as an index of circadian rhythm. From the clinical standpoint also, it is becoming increasingly necessary to judge the style of sleep-wake rhythm. It is said that there are two styles of human behavior : the morning type and the evening type. In the present study, judgement of these styles was made by Oquist's morningness-eveningness questionnaire and the validity of this questionnaire when used in Japan was investigated. As it is generally said that the style of human behavior changes from the evening type to the morning type with age, an investigation was also made on the relationship between style of human behavior and aging. Judgement of behavior type was made by Oquist's morningness-eveningness questionnaire in Japanese with a total of 230 subjects composed of 95 males and 135 females (116 remitted patients and 114 healthy individuals). Each of 19 questions in the questionnaire had its own criterion for rating. Based on the total score, behavior was divided ino five types : definitely evening type (total score 16-30), moderately evening type (total score of 31-41), neither type (total score of 42-58), moderately morning type (total score of 59-69), and definitely morning type (total score of 70-86). The validity of each question was examined by G-P analysis in order to improve the overall validity of the questionnaire, and questions with significantly lower validity than others were excluded. Than, the scores of other questions were added. Cases with total scores within mean±1SD, cases with total scores under mean-1SD, and cases with total scores over mean+1SD, were judged as neither type, evening type, and morning type, respectively. Another method of judgement was attempted by a question in which the subjects themselves were asked to judge their own type. The following results were obtained. (1)There were three questions which had significantly lower validity than others. (2)The older the subjects, the higher was total scores and the larger was the number of cases of morning type. These results were observed from judgement by both the original questionnaire (total score of 19 questions) and the revised questionnaire (total score of 16 questions excluding the three questions with low validity) and also from judgement by the subjects themselves. As the questionnaire used in this study was originally developed in Europe and as the concept of morning type and evening type was poorly defined, it is considered necessary to standardize this questionnaire for use in Japan. We expect that this questionnaire would be very useful in investigating the relationship between behavior types and psychosomatic problems.
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原稿種別: 付録等
1990 年 30 巻 6 号 p.
537-
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岡 孝和, 前川 高天, 直木 正雄, 西田 直生志, 西田 真弓, 佐竹 弘, 生田 篤也, 清水 一良, 梶谷 幸夫, 粉川 皓仲, 三 ...
原稿種別: 本文
1990 年 30 巻 6 号 p.
539-545
発行日: 1990/10/01
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We studied psychosocial factors affecting the healing time of gastric ulcers. We compared following factors between 33 patients with gastric ulcers cured by Famotidine 40 mg per day in 3 months (Group 1) and 20 patients with intractable ulcers over 6 months (Group 2). Cornell Medical Index, Self Rating Questionnaire for Depression and MMPI Alexithymia Scale were carried out, but in each score there was no significant difference between Group 1 and Group 2. Background factors mainly focused on the style of living were compared. The results indicated that 1) patients with intractable gastric ulcers drank more cups of coffee (p<0.05), 2) had more irregular working time (p<0.05), 3) felt more mental stress (p<0.05), 4) experienced more recurrence of gastric ulcers (p<0.05), 5) and eventually ulcers became difficult to treat despite young age (p<0.01), 6) had less past history of other diseases (p<0.01). This study showed that life style and biological factors played more important roles in the prolongation of healing time of gastric ulcer than psychological traits.
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1990 年 30 巻 6 号 p.
545-
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岡部 憲二郎, 林 道治, 田内 圀彦
原稿種別: 本文
1990 年 30 巻 6 号 p.
547-552
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Obiya-Yurushi (Grant of Safe Childbirth : GSC) of the Tenrikyo Religion is believed to ensure an easy and safe delivery. We examined whether this religious service is really effective or not objectively and subjectively. Objective findings (length of labor, volume of postpartum hemorrhage, Apgar score, and rate of Cesarean section) were studied in the GSC receiving group (n=631) and control subjects (n=696). Mean age of the former was 28.1 yrs. and that of the later was 28.3 yrs. The GSC receiving group consisted of 43% primiparas and for control subjects of 46% primiparas. Mean hours of length of labor were shorter in the GSC receiving group (p<0.05), even though the rate of usage of oxytocics was lower in this group (p<0.10). No differences were found in volume of postpartum hemorrhage and Apgar score between the two groups. The rate of Cesarean section was lower in the GSC receiving group (p<0.05). Subjective scores were also studied in the GSC receiving group (n=97) and control subjects (n=107). No differences were there in mean age or the rate of primiparas between the two groups. STAI (State and Trait Anxiety Inventory) was performed at admission and self-rated scores of severity of labor pain, severity of after-pain, degree of tension and fears about labor and degree of safe and easy childbirth were taken 5 days after delivery. State anxiety in STAI was lower in the GSC receiving group (p<0.05), though for trait anxiety there was no difference between the two groups. Self-rated scores of severity of labor pain and degree of tension and fears about labor were also better in the GSC receiving group (p<0.05). The scores, however, of severity of after pains and degree of safe and easy childbirth showed no differences. Active members (n=42) of the Tenrikyo Religion answered that the degree of tension and fears about labor were less than those of non-active members (n=41) of the GSC receiving group (p<0.05) and severity of labor pain also tended to be lower in active members (p<0.10). The results show GSC has beneficial effects for easy and safe childbirth physically and psychologically.
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1990 年 30 巻 6 号 p.
552-
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松森 基子, 佐藤 ゆかり, 児玉 和宏, 野田 慎吾, 星野 敬子, 山内 直人, 岡田 真一, 花澤 寿, 佐藤 甫夫, 竹内 龍雄, ...
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1990 年 30 巻 6 号 p.
553-562
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In Japan, there exist considerable literatures on psychological and psychosomatic aspects of eating disorders such as Anorexia Nervosa and Bulimia, but rather little study has been done on those of obese patients. In this study, we investigated the personality traits of severely obese patients using projective techniques. The subjects were 24 inpatients of simple obesity, 5 males and 19 females, who had been treated with Very-Low-Calorie-Diet in the Second Department of Internal Medicine of Chiba University. Subjects were administered the Rorschach test, and as we examined their responses to the test, we found four types of personality in our subjects : Type I : Subjects who have neurotic personality organization. Ia) Indifferent type. They tend to deny undesirable realities and indulge in wishful thinking. They are passive, peaceful and indifferent. Ib) Immature type. They are similar to the Type Ia subjects, but are younger, more conflicting and less stable. They have difficulty expressing their emotions freely. Type II and Type III : Subjects who have more primitive personality organization. II) False stable type. They use not only neurotic defenses but also more primitive ones. While they are apparently well-adjusted to the society, most of them are suffering from psychological distress. III) Maladjusted type. They have failed to develop effective ego defenses. They can adapt themselves only to the limited and protective environment. Among these, Type I obesity seems to be the typical obesity. This is most frequent type among our subjects, and their personality traits have something in common with these characteristics which had been attributed to the fat people. Although they appear to be well-adjusted, the test results and their personal data suggest that they have only little recognition about their own difficulties, especially about their problematic eating behaviors. In addition, this limited capacity for reflection may be a factor of their poor response to the weight reduction program. In terms of Type II and Type III obesity, the results suggest that rather severe personality disorder underlies obesity. Actually, in these types of obesity, eating problem is closely related to psychological problems. Thus, in a therapeutic context, it is perhaps more productive to counteract their psychological difficulties directly. The Rorschach test demonstrates that the personality and its relation to the eating behavior of obese patients are not homogenous, but that levels of the personality organization of the obeses are various. Therefore, it is necessary to pay much more attention to the process and psychological factors of overeating, as well as the result of overeating.
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原稿種別: 付録等
1990 年 30 巻 6 号 p.
562-
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原稿種別: 付録等
1990 年 30 巻 6 号 p.
562-
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岡部 憲二郎, 久保 克彦, 柏木 哲夫
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1990 年 30 巻 6 号 p.
563-566
発行日: 1990/10/01
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Anxiety, depression and anger are feelings that the cancer patient cannot avoid. Sometimes anxiety develops into panic. This report is of a severe case of panic disorder that developed after an operation for gastric cancer. A 40-year-old woman was admitted in May, 1984,with recurrent panic attacks which had begun one month earlier. Two months before admission, she had a total gastrectomy for advanced gastric cancer. Her early postoperative course was uneventful. However several days after the operation she developed a panic attack with nausea and vomiting during the course of a drip infusion of antineoplastic drugs. The attack subsided immediately after discontinuation of the infusion. Two weeks later a panic attack appeared again during another course of intravenous antineoplastics. Except for short term interval, attacks persisted for the next month prior to her admission to our hospital. Physical examination revealed tachypnea, tachycardia and emaciation. The patient was in distress from fits of crying and chest discomfort. Even having a meal or passing urine could easily bring about panic with hyperpnea, which persisted in duration from 20 minutes to several hours. Arterial gas analysis showed no abnormalities. She was dependent, aggressive and regressive. She was not informed of the diagnosis, but she seemed to be aware of it following the operation and the administration of antineoplastics, and as a result she went into a state of panic. She was extremely afraid of the radiographic examination of the upper gastro-intestinal tract and of the drip infusion, though she denied fear of death or cancer. Tranquilizers or antidepressants had little effect on attacks, and training in abdominal breathing, hypnotherapy or behavioral therapy were also in vain. We diligently supported the patient to try to enable her to cope with anxiety and to release emotions with her family and friends. The patient was discharged in July, 1985,because attacks decreased in frequency. She had never experienced a day free from attacks until May, 1986,when panic attacks suddenly subsided. Thereafter she has had no relapse for this three year period and has adapted well to society. To our knowledge, panic disorder following an operation for gastric cancer has not been previously reported in medical literature. An interesting feature of this case was that panic attacks were in hyperpnea without hypocapnia and they were quite severe in frequency and duration, but they did eventually subside.
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原稿種別: 付録等
1990 年 30 巻 6 号 p.
566-
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藤尾 裕宣, 大升 宏一, 夏目 高明, 荒木 登茂子, 手嶋 秀毅, 中川 哲也, 永田 頌史, 吾郷 晋浩
原稿種別: 本文
1990 年 30 巻 6 号 p.
567-570
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We reporeted a case of factitious disorder who, during the clinical course, was suspected to inject her own chest with a needle to make pneumothoraces and even pneumoperitonea. The patient was a 17-year-old female. From childhood, she was an "obedient and good girl" who showed rich academic achievement. When 13 years old, she had suffered from very severe hyperventilation syndrome and finally come to enter T-Hospital where she improved. But since then she became ambivalent toward the doctor in charge. Making herself a very troublesome patient, finally, she was referred to our hospital on July 8,1986. On physical examination and laboratory data, she had no problems except for hyperventilation and mild dehydration. During the clinical course, she began to show many curious symptoms including anorexia, difficulty in walking, diarrhea, "stopping the breath" etc. We treated her as occasion demands, although her clinical course was becoming more curious and complicated, until her selfmade pneumothoraces and pneumoperitoneum. Diagnosing her disease as factitious disorder, we entrusted the treatment of her somatic disorder to a surgeon, and started supportive psychological therapy. As we continued the therapy perseveringly, her inadequate behavior improved gradually. We consider that it's important "to know" the concept of factitious disorder, and even if the case were seemed irrecoverable, persistent continuation of supportive therapy is very significant.
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菊地 孝則
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1990 年 30 巻 6 号 p.
571-577
発行日: 1990/10/01
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It seems that one of the most important themes for our Society of Psychosomatic Medicine, which has practiced holistic medicine and accomplished an important role in enlightening Japanese medical circles, is the subject of postgraduate education and its training system. In this paper, I first report on my own postgraduate training experiences in the Department of Psychosomatic Medicine at Tokyo University. When I received my training in 1983,the system was not as yet well equipped. We used a number of clinical systems in our postgraduate training, but as we had few dedicated training systems in our department, we used the systems of clinical practice and research as opportunities for training. In spite of these limitations, I was able to experience the role of physician in charge of 47 outpatients and 9 inpatients. Of these, 45% suffered from psychosomatic disease, 25% from neurosis, 16% from depression. 6% were diagnosed as 'borderline cases, ' 4% as psychogenic reaction, and 4% were classed as 'others.' In addition to the regular pharmaceutical drug-based treatments, I was able to experience a variety of treatment methods. Among these were Supportive Psychotherapy, Autogenic Training, Psychoanalytical Psychotherapy, Biofeedback, Behavior Therapy, Sandplay, Transactional Analysis, Morita Therapy and Fasting Therapy. Next in this paper I discuss the subjecdts of 1) Identity and the Goal of Training, 2) New Understandings of the Importance of Postgraduate Education and Training, 3) Communicability of Information in Training, and 4) Structuring and Independence in Training. Finally, I suggest that it behooves our Society of Psychosomatic Medicine to establish a method of nurturing the growth of the psychosomatic education and training "seeds" which our founding leaders have planted in Japan.
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1990 年 30 巻 6 号 p.
577-
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鈴木 仁一
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1990 年 30 巻 6 号 p.
578-
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原稿種別: 付録等
1990 年 30 巻 6 号 p.
578-
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村上 幹彦, 中野 照子
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1990 年 30 巻 6 号 p.
579-
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服部 陵子, 原 敬三
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1990 年 30 巻 6 号 p.
579-
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松田 弘, 高村 真, 麻生 正美, 渡辺 晋, 中川 哲也
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1990 年 30 巻 6 号 p.
579-
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百合野 公庸, 三島 徳雄, 岡田 隆雄, 中川 哲也, 加藤 元博
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1990 年 30 巻 6 号 p.
579-580
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古賀 靖之, 添島 裕嗣, 菅原 功一郎, 武井 美智子, 真辺 豊, 野添 新一, 田中 弘允
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1990 年 30 巻 6 号 p.
580-
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牟礼 利子, 藤井 英雄, 鹿井 博文, 堀 康子, 松本 啓, 中江 孝行
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1990 年 30 巻 6 号 p.
580-
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西村 浩, 井田 能成, 津田 彰, 田中 正敏
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1990 年 30 巻 6 号 p.
580-
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福迫 剛, 鹿井 博文, 上野 健一, 松本 啓, 上田 昌史, 山本 五十年, 澤田 祐介
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1990 年 30 巻 6 号 p.
580-581
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渡辺 朋之, 奥村 幸夫, 佐々木 勇之進, 牛島 定信
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1990 年 30 巻 6 号 p.
581-
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坂本 倫子, 松本 紳一郎, 渡辺 朋之, 脇元 安, 梅田 征夫, 奥村 幸夫, 古賀 勝, 佐々木 勇之進
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1990 年 30 巻 6 号 p.
581-
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米坂 好一, 竹内 康三, 鹿井 博文, 牟礼 利子, 亀井 健二, 松本 啓
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1990 年 30 巻 6 号 p.
581-
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藤尾 裕宣, 荒木 登茂子, 大升 宏一, 夏目 高明, 永田 頌史, 手嶋 秀毅, 吾郷 晋浩, 中川 哲也
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1990 年 30 巻 6 号 p.
581-582
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森岡 洋史, 鹿井 博文, 野間口 光男, 牟礼 利子, 上山 健一, 松本 啓
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1990 年 30 巻 6 号 p.
582-
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菅原 英世, 永田 頌史, 三島 徳雄, 玉井 一, 松岡 洋一, 中川 哲也, 松田 弘
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1990 年 30 巻 6 号 p.
582-
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窪田 純久, 岡田 隆雄, 楊 思根, 岡 秀樹, 荒木 登茂子, 松岡 洋一, 夏目 高明, 宍戸 和幸, 中川 哲也
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1990 年 30 巻 6 号 p.
582-
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野間口 光男, 福迫 博, 長友 医継, 上山 健一, 松本 啓
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1990 年 30 巻 6 号 p.
582-583
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石津 宏
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1990 年 30 巻 6 号 p.
583-
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江口 智, 井上 博之, 宮田 晃一郎, 野添 新一
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1990 年 30 巻 6 号 p.
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岩永 通子, 岡 孝和, 花田 基典, 橋口 悦子, 松浦 達雄
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1990 年 30 巻 6 号 p.
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綾野 義博, 青木 宏之, 西間 よしみ
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1990 年 30 巻 6 号 p.
583-
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冨士 泰恵, 野田 敏之, 浜田 美保, 美根 和典
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1990 年 30 巻 6 号 p.
583-584
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西間 よしみ, 青木 宏之, 綾野 義博
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1990 年 30 巻 6 号 p.
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竹川 隆, 玉井 一, 松林 直, 森 研二, 小牧 元, 中川 哲也
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1990 年 30 巻 6 号 p.
584-
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