The mechanism of the electrical silence caused by the sudden unloading during voluntary isometric contraction in normal man, was investigated in terms of the unloading latencies of the Brachialis (BA), the Brachioradialis (BR), the Vastus medialis (VM), and the Vastus lateralis (VL) compared with the stretch reflex latencies of the same muscles.
Healthy adult males were seated with the elbow or the knee joint kept at 90 degrees. A load was applied isometrically via a chain at the wrist joint in elbow flexion and at the ankle joint in knee extension. The applied loads were in a range from 20 to 60%of the maximal strength exerted in elbow flexion or knee extension. The load could be released instantaneously by cutting a connecting loop in the chain and the tension change, the angular displacement of the joint, and the electromyograms of the BA and BR in elbow flexion and at the VM and VL in knee extension were recorded simultaneously via surface electrodes,10 mm in diameter with an electromagnetic oscillograph with a paper speed of 400 mm/sec. Under identical recording conditions the latencies of the stretch reflex in the same muscles for the same postures were measured.
The following results were obtained.
1. The unloading latency gave larger values than the stretch latency of the same subject and muscle under the same preload condition.
2. The unloading latencies of the VM and VL were markedly larger than those of the BA and BR.
3. The unloading latency was not affected by changes in the angular velocity of the joint movement after the sudden unlaoding.
4. The electrical discharge pattern appearing between the time of mechanical load release and complete electrical silence varied widely.
5. These findings strongly suggest that after sudden unloading polysynaptic spinal and/or supraspinal pathways can contribute to the latency of the electrical silenc e in the EMG under such conditions.

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This report is concerned with a survey of medico-social services and emergency care for patients in myasthenia gravis (M. G. ) crisis. This survey was carried out in March-June 1976.
1. From the survey of 167 M. G. patients:
1) 34% had ocular and bulbar phenomen on with muscle weakness,38% had ocular phenomenon with muscle weakness,25% had complications (thyroid grand disease 1/4) and 61%had change of syndrome.
2) Activity of daily life: 5% were bedridden,10% could lay down or get up and 35%sometimes reclined.19% needed help to dress, bathe, etc.
3) Nearly 50% of males were without occupation, s u spended from work or laid-off.
4) Medical treatment: 81% were under doctor's care (in hospital 8% and b eing treated at home 92%). Only 40% of patients under the doctor's care were able to receive emergency medical care in crisis (and below 20% were able to be treated while on holiday.)
5) Nearly 80% of answers confessed that they recognized themselves motives which caused fell in M. G. disease and their motives were fatigue, mental stress and cold. Many of patients who had experienced crisis were in fatigue or caught cold before crisis. Therefore fatigue and cold must be carefully recognized as motives caused of M. G. disease and crisis and we must consider this view point is one of the important methods of protection against crisis of which M. G. Patients have fears.
6) In order to put emergency medical care into practice it is necessary to make connection between M. G. patients, including their family, with a team of family doctors, specialists and medical social workers forming a Community Health Care Service.
7) It is necessary to offer a practical training in emerg ency medical care for crisis attack, to patients themselves and also their families.
8) It is necessary to maintain a home nursing service and home helper to reduce the burden of patient families.
9) It is necessary to establish special hospitals, sanatoria and after-care M. G. institutions.
10) Also, it is important to arrange for consultation with patients, at their w orkplace or school.
2. From the survey of M. G. fatalities:
1) The bereaved families answered that most of the M. G. patients had dyspnea and crisis just before death and lack of adequate emergency care.
2) The bereaved families had not adequate kn owledge, ither of the crisis or emergency care.

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The pulmonary resections for 137 patients with primary lung cancer were performed from January,1971 to December,1978. One hundred and thirty-seven patients (95 males and 42females) aged 20 to 79 years (mean 59.3 years) were histologically classified into 68 of squamous cell carcinoma (49.6%),61 of adenocarcinoma (44.5%),5 of large cell carcinoma and 3 of small cell carcinoma. The surgical procedures consisted of 10 right pneumonectomies,25 left pneumonectomies,30 two-lobes-lobectomies and 72 lobectomies, and the curative operations were undergone for 65 cases of 137 (47.4%). The patients, whose ages were over 60 years old, were 75 of 137 cases (54.7%), inclusive of 15 cases of advanced aged patients over 70 years old. The surgical procedures for 75 patients of old aged group over 60 years old consisted of 5 right pneumonectomies,12 left pneumonectomies,15 two-lobes-lobectomies and 43 lobectomies, and the curative operations were performed for 35 of 75 cases (46.7%).
In the measurement of preoperative pulmonary functions including arterial gas anal ysis, cardiac index, mean pulmonary arterial pressure, total pulmonary vascular resistance and mean pulmonary arterial pressure during the occlusion of unilateral pulmonary artery, no significant difference was demonstrated between the younger aged patient-group below 59 years old and the older aged patient-group over 60 years old.
Postoperative five year survival rate of 137 pa tients was 33.2%, and, in the cases, whose surgical treatment was done in stage I or curative surgery was performed, five year survival rate was more than 50%. No significant difference was found between overall five year survival rate of 62 cases below 59 years old and that of 75 cases over 60 years old. However, the results of the younger patient-group below 59 years old were some little better than those of the older patient-group over 60 years old in squamous cell carcinoma and the results of the older patient-group over 60 years old were a few better than those of the younger patient-group below 59 years old in adenocarcinoma. Moreover, in the curative onelobelobectomy, five years survival rate of old aged patients over 60 years old was significantly better than that of the younger patients below 59 years old either in squamous cell carcinoma or in adenocarcinoma, and, on the contrary, the result of the younger patients below 59 years old was better in the curative two-lobes-lobectomies or pneumonectomies.
No definite correlation was demonstrated between the preoperative pulmonary functions and the cause of early death after surgery. However,3 of 4 cases dead within one month after surgery and 14 of 17 patients died from 1 to 6 months after surgery were belonged to the old aged patient-group over 60 years old. More particularly,2 of 3 cases dead within one month after surgery and 6 of 14 patients died from 1 to 6 months after surgery in the older patientgroup died of pulmonary complications (pneumonia or pulmonary insufficiency with pneumonia), although their preoperative pulmonary functions were so good as those of the younger patientgroup.
The surgical results in the advanced aged patients over 70 years old were 67.2% for one year survival rate,48% for two year survival rate,24% for five year survival rate and 19.5months for median survival time, which were almost similar to those of the patients below 69years old.

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Patients with complaints of paroxysmal cardiac episodes are very often encountered at the out patient clinic and in not a few cases is it difficult to make a diagnosis for them. That is because there are many cases in which a diagnosis cannot be established without electrocardiograph (ECG) during attacks is taken.
If ECG can be recorded and vi ewed anytime and anywhere while he is living socially, it will obviously have an important clinical significance. To meet such a request there has been developed an ECG test method whereby a patient is made to carry an ECG making use of a small-sized tape recorder so that ECG can easily be recorded anytime and anywhere in the daily life.
Usin g this method, we tried to find out any useful index usable for differential diagnosis in daily practice by comparing presumptive diagnosis with portable ECG findings obtained as to various paroxysmal cardiac episodes and also studied paroxysmal cardiac episodes by analyzing ECG on attacks obtained.
The subjects were 330 patients for whom no diagnosis was established by other methods at this hospital and its related hospitals for 48 months from 1973 to 1977.

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Weston and Palmer (1978) recently described their radiological research on the fat pad tissues and their intraarticular location along with their diagnostic value in various disorders of the human knee joint.
As early as 1938 Kling already drew attention to these fat pad tissue and explained their anatomy. The author, while performing knee joint synovectomy, observed clearly the existence of these fat tissues which cover the suprapatellar pouch in every instance.
In spite of such uniformity of the fat tissue in their anatomical location, their nomenclature varies from one textbook to another. For example, some describe their location as being extrasynovial or subsynovial, and others as lying on the synovial capsule of the knee joint.
In this study, the author, using human cadaver specimens, designates these fat pad tissues as being located in 5 different places which are named as follows: 1. infrapatellar fat pad; 2. anterior suprapatellar fat pad; 3. posterior suprapatellar fat pad; 4. fat pad surrounding the patellar margin; 5. popliteal fat pad.
Then, the specimens from infrapatell ar fat pad and ant. and post. suprapatellar fat pads are sectioned, stained and examined using ordinary microscopic techniques so that the location of these fat pad tissues were identified in relation to the surrounding tissues and it was found that the infrapatellar fat pad is located right beneath the synovial lining whereas the ant. and post. suprapatellar fat pads are located in between the tendinous membrane of quadriceps muscle and the layers of collagen fiber bundles running in parallel with the synovia just on the o utside of the subsynovial tissue.
From these findings the aut hor concludes that the suprapatellar pouch, having the tissue structure comprizing both Stratum fibrosum and Stratum synoviale, can be regarded as the joint capsule itself and therefore the suprapatellar fat pad can be interpreted as being extracapsular in nature.
In the second part of the article, the fat pad specimens taken surgically from the rheumatoid arthritic knee joint were studied macroscopically and microscopically.
In gross eye examination fat pads in rheumatoid knee joints were found to be more or less edematously swollen in comparison with the normal joint. In microscopic study, however, findings of various types of angitis and connective tissue inflammation were observed in the interlobular connective tissue of these fat pads.
The connective tissue dividing these fat pad tissues into smaller lobuli is rich in fibers as well as in fibrocyt but is poorly supplied with capillary, and moderately supplied with small vessels which are arterioles and venules. Various kinds of infiltration or proliferation of immunocytes such as lymphocytes and plasma cells surrounding small vessels, capillaries and in the interstitial stroma tissue and also the proliferation of fibroblast, angioblast and collagen fibers in various degree were very common findings in the microscopic specimens in these studies.
In addition, edematous swelling of the stroma and disintegration or segmentation of edematously swollen collagen fiber were seen in the interlobular connective tissue of these fat pads which findings could be interpreted as a tissue response to the recurrent rheumatoid inflammation of the knee joint.
The findings of matured fibrosis formation in the interlobular connective tissue were very rarely seen in this study. The angitis and connective tissue inflammation of various kinds seen in this study can well be interpreted as allergic in nature as well as the evidence of the selfperpetuation mechanism of this disease.
And since these obvious his tological findings of rheumatoid inflammation are abundantly demonstrated, we conclude that in almost every patient fat pad tissue removal in conjunction with knee joint synovectomy seems to be justified in the treatment of R. A.

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In order to investigate the existence and function of alpha-receptors in myocardium, the effect of noradrenaline (NA) and the influence of tolazoline (TLZ), phentolamine (PTL), propranolol (PRP), or carteolol (CTL) on the NA effect were studied on the isolated rat spontaneously beating atria as well as the electrically driven left atrium and papillary muscle.
NA in concentrations (10^-8-10^-5 g/ml) increased both the rate and contractile ten sion of spontaneously beating atria as well as the tension of left atrium while transiently decreased the tension of papillary muscle and then increased it.
The dose-response curve for NA of the rate in spontaneously beating atria was shifted downwards by the presence of TLZ in a high concentration (10^-5) suggesting the non-competitive antagonization but not influenced by PTL even in the same concentration, while the curve was dose-dependently shifted parallelly to right by low concentrations of either PRP (10^-8-10^-6) or CTL (10^-9-10^-7) suggesting the competitive antagonization for NA. The do seresponse curve for NA of the contractile tension in the atria was slightly shifted parallelly to right by PTL (10^-8) but shifted non-parallelly downwards by the drug (10^-7-40-5) or TLZ (10^-8-10^-5), while markedly shifted parallelly to right by low concentrations of either PRP or CTL (10^-9-10^-7).

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