Dynamic mechanism of severe head injury was studied and analyzed clinically with special reference to the brain damage and the outcome of it in 149 cases, in which more accurate mechanism of severe head injury could be informed during these three years. The outcome of the head injury had a significant correlation with the occurrence of intracranial lesion, especially with the degree and extent of the brain damage, and the severity of consciousness disturbance was most important as the clinical presentation of the brain damage and had a relation to the prognosis. Dynamic assessment performed in the present series showed that the dynamic force and direction closely related to the occurrence of intracranial lesion, especially brain damage. In other words, fatal brain injury such as diffuse brain injury or brain stem injury occurred when an extremely severe force was delivered on the head. It was suggested that a rotational accelerating force and shearing force to the he ad would be most important as the characteristics of dynamic force in the development of severe brain damage. In the present report, the above mechanism was discussed. Not only clinical and morphological assessment by CT but also dynamic assessment of the head injury has much more value for the diagnosis, prediction of the outcome, and treatment.

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Acute subdural hematoma was studied clinicallly in 62 cases, with special reference to the prognostic factor and the complicated brain injuries seen on the initial CT.
Furthermore, serum fibrin and fibrinogen degradation products (FD P) in acute stage were measured in 19 cases and their significance was discussed.
Though the prognosis proved to correlate with the complicated brain injuries and to be very poor, it was suspected that it varied according to some basic pathophysiology in acute subdural hematoma, that is, the location and the degree of brain tissue injuries and associated edema or brain swelling.
Since the initia l CT does not necessarily mirror the whole brain tissue damages or their pathophysiology in acute subdural hematoma, a quantitative study of the brain injuries becomes more significant.
The measurement of serum FDP in the present series showed a good correlation with the prognosis and, also, it was suggested that serum FDP would possibly reflect the degree of the brain tissue injuries (both of primary and secondary injuries). Thus, measurement of serum FDP may be of much value as an aid for analytical study of the clinical state and the quantitative evaluation of brain tissue injuries in acute subdural hematoma.

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The His bundle electrogram (HBE) was first used clinically to study the conduction block in the atrioventricular conducting system. ' The exact site of the conduction block is found through the record of the His potential which was recorded between A wave (depolarization of she atrium) and V wave (depolalization of the ventricle). Various grade of block is found at every site of the conducting system by using this technique and it has become clear that the site and the grade of the block is related to the prognosis. It is also used to decide the indication of the pacemaker implantation.
The old classification and the new classification of the atrioventricular block were shown. New classification: 1) intra-atrial block.2) A-V nodal block.3) intrahisian block,4) infrahisian block.5) mixed lesions. Cases of each block were shown and the ind ication of the pacemaker implantation related to each block was described.

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Wild type strains of type 2 dengue virus which were isolated from viremic human sera of Dengue hemorrhagic fever (DHF) or Dengue schock syndrome (DSS) patients in Burma, and proto-type strain were investigated these virulence, plaque distribution, temperature sensitivity and influence of characteristics by passage with mouse and Vero cells to find out available marker for evaluation of pathogenicity.
Additionaly, pathomorph ology of suckling mouse brains after intracerebranl (ic) or intraperitoneal (ip) inoculation were also investigated to get indicator which determines the severity of DHF and DSS was discussed. And following results were obtained.
1. The virulence of proto-type strain Tr 1751 to mouse was 10⁸LD₅₀/ml after ic inoculation. The virulence of parent strains of BR 006 and BR 116 were less than 10²LD₅₀/ml after ic inoculation. However, virulence of wild type viruses to mouse was increased stepwise and 50%lethal dose was increased up to 4 logo ic LD50/m1 after 10th passage in mouse brain. And virulence of 2 log₁₀ ip LD₅₀/ml was showed after same passage level.
2. Wild type strains BR 006 and BR 116 were genetically mixed, th at is, wild type viruses were demonstrated large (L), medium (M) and small (S) size plaques, while proto-type strain Tr 1751 was demonstrated uniform small plaques by plaque assay method with Vero cells.
3. The plaque distribution of Tr 1751 was demonstrated as uniform small plaques at every passage level, while BR 006 and BR 116 were demonstrated that 90% of plaques showed S size after 10th passage in mouse brain.
4. The virulence to mouse followi ng ic and ip inoculation were compared between L and S clone which were purified from parent strain of BR 006. Maximum titer of S clone strain was higher (2 log₁₀ ic LD₅₀/ml) than L clone strain.
5. Plaque size of S cloned virus was not influe nced by passage with mouse and Vero cells but plaque size of L cloned virus became small, and approximately 100% of plaques were S size more than 5th passage.
6. L clone strain was not indicated temperature sensitive (Ts), but S clone strains were sensitive. This was suggested that mouse virulent, S size plaque forming and Ts positive virus may be a mutant strain, which developed from parent strain of wild type viruses.
7. Infected suckling mouse brain following ic inoculation with wild type viruses showed that mononuclear cells infiltration in subarachnoidal space and marked edema and necrosis formation in piamater and cortex after 10th passage by hematoxylin-eosin staining.
8. Electron micrographic study of Vero cells and suckling mou se brains following ic and ip inoculation with Tr 1751, BR 006 and BR 116 showed the same findings that large numbers of enveloped electrondense 50 nm virus particles were observed in distended cisterna of endoplasmic reticulum mostly in the perinuclear region. Type 2 dengue viruses acquired their envelope from the host cell membrane and mature virions were completed through the budding.
From these results, followings are concluded. Type 2 dengue virus wild type s trains, isolated from DHF or DSS patients were originaly composed of L plaque virus, which was not temperature sensitive and avirulent to mouse. And passage with suckling mouse and Vero cells, which are different from the original host, was not available for virological analysis of virulence to human being and severity of DHF and DSS.

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Nonsurgical treatment of benign postoperative biliary stricture with the aid of percutaneous transhepatic choledochoscope (PTCS) was performed in an 80-year-old female. She had experienced recurrent episode of biliary colic and jaundice since seven months after cholecystectomy, and was refered to our hospital for thorough evaluation. Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography revealed band-like stricture at the junction of cystic and common hepatic duct. Postoperative biliary stricture was indicated and PTCS was performed. Endoscopic findings revealed no abnormality on the mucosal surface. Biopsy specimen concomitantly obtained from narrowed lumen revealed chronic inflammatory reaction as its etiology, and ruled out malignancy. A straight guide wire was passed through the markedly narrowed lumen easily under endoscopic guidance. A remnant silk probably left at the surgical procedure was found at the reopened nassowed lumen and was removed endoscopically. Stricture dilatation with baloon catheter was performed followed by retention catheter left in place for a month. She became free of symptoms and no sign of recurrence has been found till now, seven months after the procedure. PTCS was found to be of value at the treatment of these biliary strictures.

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