In our country, the progress on the study of clinical anatomy seems to be rather inferior to that in western countries, and the number of the graduate of medical school who engages in this field as the staff of the department has also gradually decreased. These tendencies are thought not to be overlooked by the anatomist. Very recently, the first issue of an international medical journal “ANATOMIA CLINICA-Springer International” is published. The author has introduced firstly the editorial and prospect of this journal in this paper, because the author believes that these contents are very significant and necessary for the purpose of the present paper. Secondly, the author has written our several works relating to clinical problems. The contents are following: 1. The topographical anatomy on the splenic vessels-Relationship to the splenic surgery 2. Study of the Meralgia Paraesthetica-Anatomical relation to N. cutaneus femoris lateralis 3. Basic research and clinical investigation of the thymic angiography and 4. Morphological study on the Rami communicantes of the sympathicus-Discussion on the pains of the loin region.
As conclusion, the author intends to emphasize that the contribution of anatomical research will be more essential not only in surgery, but also in all clinical sections, therefor the young doctors who are interested in this scientific field should be encouraged by the importance of their mission.

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Changes in left ventricular function during the attacks induced by exercise and by rapid atrial pacing were studied in patients of angina pectoris of effort.
1. Exercise-induced angina : A supine type bicycle ergometer was used to induce the attack in 13 cases. Exercise was discontinued when the signs of myocardial hypoxia (ischemic ST depression and/or anginal pain) appeared. There was no significant difference in the hemodynamic parameters, such as heart rate (HR), systolic blood pressure and double product, in exercise-induced angina between with and without left heart catheterization.
Then the hemodynamic parameters obtained by left heart catheterization at the time of induction of myocardial anoxia were compared with those before exercise. There was the signi-ficant increase in HR, mean blood pressure (BPm), left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), cardiac index (CI), left ventricular work (LVW), tension-time index (TTI), LV max dp/dt and V_max, except left ventricular stroke work index (LVSWI).
There was no difference in these parameters between the attacks with and without pain, ex-cept LVEDP, which was higher in attacks without pain, and V_max, which was larger in attacks with pain.
2. Pacing-induced angina: Rapid atrial pacing was used to produce ischemic ST depression and/or anginal pain 9 times in 8 patients.
There was the significant increase in TTI, LV max dp/dt and V_max and the decrease in CI, LVW and LVSWI as compared with before pacing. LVEDP was normal or only slightly elevated at the time of induction of myocardial ischemia, but rose significantly soon after cessation of pacing. The latter value did not show a significant difference from that observed on exercise.
3. Comparison between exercise-induced and pacing-induced angina : BPm, CI, TTI and V_max were significantly higher in exercise-induced angina than pacing-induced angina. LVEDP was also significantly higher in exercise-induced angina than in pacing-induced angina at the time of occurrence of myocardial anoxia, but after cessation of pacing there was no difference. HR, in contrast, was significantly higher when angina was provoked by atrial pacing.
The fact that this elevation was accompanied with increase of LV max dp/dt and V_max suggests that it might be resulted from the decreased left ventricular diastolic compliance rather than left ventricular failure.
4. Intravenous propranolol : Administration of 2 to 4 mg suppressed significantly not only HR, BPm and TTI at rest, but also the increase of HR, LVSP, TTI, LV max dp/dt and V_max on exercise. This indicates that the effects of propranolol on angina pectoris of effort can be ascribed the suppression of the increase of myocardial oxygen consumption on exercise.

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Gold salts and D-penicillamine have been found to be especially beneficial therapeutic agents for rheumatoid arthritis. But the pharmacological action of these drugs on rheumatoid arthritis was not exactly known. So we have paid attention to lymphocytes which play an important role in pathogenesis of rheumatoid arthritis, and studied on the effect of these drugs to lymphocytes, especially on the membrane of human lymphocytes.
The results obtained were as follows.
1. Only in the lymphocytes treated with both aurothiomalate and D-penicillamine the dec-rease of percentage of T-lymphocytes was observed with a statistically significant difference (P< 0.01 or P < 0.05) between the control and the treated lymphocytes. But the percentage of B-lymphocytes did not decrease, in comparison with the control. In addition, the viability of the control and the treated lymphocytes was over 90% by the 0.1% trypan blue exclusion test.
2. Only in the lymphocytes treated with 50 mM D-penicillamine, about 50% of smoother cells disappeared. The surface changes of smoother cells were investigated for irregular outlines, granular structures and cavitations by the scanning electron microscopic technique. But control and the lymphocytes treated with 10 mM aurothiomalate showed no surface changes.
3. The values of protein volume in the supernatants treated with 50 mM D-penicillamine and 5 mM aurothiomalate and control were 0.68 mg, 0.32 mg and 0.22 mg/ml, respectively.
4. Only supernatant of lympocyte suspension treated with 50 mM D-penicillamine inhibited hemagglutinat ion.

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In the typhoid fever recording cards in the period from 1973 to 1976, 1015 cases were available in this study. Among these cases typhoid fever germs were detected in 740 patients and 130 cases were carriers. Epidemiological study on typhoid fever was performed mainly on these cases, and the following results were obtained.
(1) Typhoid fever appeared frequently in Kinki District centered at Osaka and Hyogo Prefectures. In the aspect of the phage type, E 1, D 2 and M 1 frequently appeared recently; the type transfers with time and many phage types have locality; thus, pursuing the phage type serves to establish the policy to control the disease.
(2) The incidence of the female patients were less than that of the male ones, but the female carriers were twice as many as the male ones; and the age distribution shifted to the older side.
(3) Administration of antibiotics before a confirmation of the diagnosis was not so influential to the clinical decision of diagonosis, but the term required for establishment of diagnosis was surely prolonged.
(4) The past history of the typhoid fever was found in 3.8% of the patients, in whome the germs were detected and in 13.1% of the carriers as well.
From the above result obtained, it will be necessary for the typhoid fever policy with more precise information and control to know the tendency of typhoid fever more scientificly and to perform a consistent control through diagnosis, therapy and treatment after curing, as well as to grasp the cases in the early stage where they are only doubted to be infected in the system of information management.

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It has been recognized that the burn is one of the most important trauma in the field of emergency medicine. The treatment of the burn shock consisted of the fluid therapy, serum electrolyte control and application of new topical creams which are claimed for effective in treat-ment of Gram-negative infection have been widely adopted in clinical aspect of burn treatment. Above all, one of the most remarkable change is a decrease of the burn wound sepsis due to the improvement of topical applications of sulfamylon cream and silver sulfadiazine, and an increase of the pulmonary complications, such as pneumonia, pleuritis, pulmonary edema etc.. Importance of pulmonary complication is well recognized by many surgens. However, patho-physiological analysis of it is rather scanty. From this point of view, the author tried to elucidate a pathological changes of the lung of critically burned patients who had received treatment and died at Kyorin Medical School and Tokyo Women's Medical School from 1972 to 1976 respectively.

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A remarkable progress in clinical therapeutic aspects on the thermal burns has been made recently. Preventions of the infections and subsequent septic shock with Gramnegative bacilli have been achieved by virtue of silver sulfadiazine or mafenide acetate cream. It is, however, noteworthy that the prolongation of the life eventually lead to cause the serious complication of respiratory impairment. The patho-physiological analysis of the respiratory impairment is rather scanty. Cooper, Tepliz and Foley described the morphological changes of the lungs in the case of the thermal burns. But the pathological changes mentioned above await further analysis. From this viewpoint, author has studied the changes of the alveolar cells of the lungs in the case of experimentally induced severe thermal burns, adult rabbits of both sexes were as materials. Their back hair was shaved and thermal burns were produced after Sternberg's method. The animals were divided into two groups. The first group was permitted free access to water and diet. The second group was treated topically with mafenide acetate cream once a day or more. They were sacrificed 3 hrs., 1 day, 3 days, 7 days and 14 days after the burn was induced by the nembutal injection and small cubic pieces of the lungs were quickly removed and pre-fixed in 2% glutar-aldehyde and rinsed in propylene oxide and embedded in Epon 812. After polymerized by heat, ultra-thin sections of greysh-white interference color were cut with the ultramicrotomes. An observation was made after uranyl acetate and lead hydroxide double stain, Dermer's tricornplex flocculation method, ruthenium red and PAM staining procedures. At the early stages in both groups, the alveolar lining layer was destroyed in disintegration and fragmentation, and subsequent decrease and loss of the osmiophilic bodies in the type II alveolar cells were encountered. The alveolar septum also shows swelling and edema as well as the endothelial cell hyperplasia of the vasculature. In the late stages, focal desquamation of the alveolar cells and focal edema were seen. The disintegration and fragmentation of the alveolar lining layer as well as the phospholipid were also confirmed, suggesting that the decreased pulmonary surfactant materials may be related to the respiratory impairment.

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Anther's study on 32 cases of progressive systemic sclerosis and reviewing 437 cases of this disease reported in literature in Japan during past 15 years presented the following results.
1) Clinical manifestations: The incidence of induration, Raynaud's phenomenon and hyperpigmentation of the skin were high. In particular, Raynaud's phenomenon was the most important sign in the initial stage. Arthralgia, exhaustion, emaciation and pyrexia were also commom, related with the growth of the width of induration.
2) Laboratory studies: Hypergammaglobulinemia and increase of sedimentation rate were noted. The date of the tests mentioned above were correlated with the width of induration. Both tests may reflect the prognosis of patients who suffer from progressive systemic sclerosis.
3) Histopathologic findings: Atrophy of the epidermis and flattening of the rete ridges were prominent through the stage of induration and atrophy. Hyperpigmentation of the basal layer was also seen associated with the progress of lesions. In the edematous stage, inflammatory infiltration, teleangiectasia and edema in the dermis were observed. In addition, hypertrophy of collagen fibers, thickening of the walls of the vessels and atrophy of sweat glands were conspicuous in the all stage.

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