We performed total joint arthroplasties in 37 rheumatoid patients with inabilityto walk, mainly using Charnley total hip prostheses and Yoshino total knee prostheses. Out of them 36patients became able to walk postoperatively.
From the above results it became clear that operative indication required the followings:
1) Strong motivation to walk again,
2) Good relationship with the patient,
3) No severe complications,
4) Possibility to control the activity of rheumatoid arthritis.
Moreover, we wanted to emphasize that restoration of walking ability was also effected by active use of medical treatment-steroids and D-penicillamine.

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The lower esophageal sphincter pressure (LESP) was measured by inserting a miniature semiconductor pressure sensor into the esophagus instead of the conventional open-tipped method. The data obtained with this method was in good agreement with those acquired with the opentipped method.
In the actual measurements with this instrument, the pull-through technique under normal respiration was comparedwith the rapid pull-through one: the latter proved to be superior to the formerin reproducibility, and easier in the analysis of wave patterns; consequently, the latter method seems to be more accurate.
In this study of the lower esophageal sphincter, the LESP was investigated in terms of age, obesity and intraabdominal pressure. There was no difference in LESP according to the age and the grade of obesity. The increase in the intraabdominal pressure caused by changing the posture (from supine to prone position) or by the presence of ascites increased the intragastric pressure, accompanied by an elevation in LESP.
There was no difference in LESP between the control, gastric ulcer and liver cirrhosis groups, while it was slightly low in the duodenal ulcer group, and obviously low in theesophagitis group. Irrespective of the presence of any disease, the LESP of patients with heartburn was significantly low, as compared with heartburn-free patients.
There was no significant correlation between LESP and the secretion of gastric acid either in the esophagitis, gastric ulcer or duodenal ulcer group.
Gastric alkalinization increased LESP, but gastric acidification decreased it. There occurred no obvious changes in serum gastrin level following the change ofintragastric ph.
Neostigmine and metoclopramide increased LESP, but hyoscine-N-butyl bromide decreased it.

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To improve the accuracy of diagnosing esophageal varices on x-ray, studies were conducted using various contrast media, drugs for premedication, positions of the body, and roentgenographic techniques.
Based on the data, a barium sulfate of180w/v% with a viscosity of1, 650 c Poise at 25° was most suitable as the contrast medium.
Of the drugs used for premedication, hyoscine-N-butyl bromide (40mg, intravenous injection) significantly enhanced roentgenologic visualization of esophageal varices by inhibiting esophageal peristalsis and relaxing the esophagealwall.
An intravenous injection of hyoscine-N-butyl bromide decreases lower esophageal sphincter pressure (LESP) in a prone much less than in a supine position, competing with the pressure decrease due to the premedication.
A picture taken with the patient head-down in the prone and the first oblique position enableda double contrast image to be taken of the lower and middle esophagus by causingthe barium sulfate to flow from the upper part of the esophagus to the cervical region. This double contrast technique with the patient in the prone and the head-down position using an anticholinergic premedication may be referred to as a hypotonic esophagography.
By using this method, it was possible to diagnose76%of endoscopic Grade I cases and100%of Grade II and III cases with an overall accuracy of91.5%among the129cases of esophageal varices diagnosed by endoscopic method.
These esophageal varices were classified into five categories based on the severity of the lesion, morphology, and size on x-ray examination. This classification is better than that of endoscopy because of its superior objectivity.

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Suppression of the micturition desire causes strain on the whole body. The cerebral apoplexy and the so-colled micturition syncope often occur during urination.
These facts indicate that the whole body can be influenced by the impulses arising in and/or around the urinary bladder. The present study was attempted to elucidate the mechanism underlying this, and the following results were obtainedon the human subjects.
1) Artificial distension of the bladder by physiological saline solution induced the following changes. Namely, the R-R interval of ECG became shorter; the blood pressure extremely higher; the plethysmographic fluctuation less; the activities of the plasma renin and plasma angiotensin I &II higher. But no changes were observed in the activities of the plasma aldosterone and the plasma cortisol.
2) The changes mentioned above were not observedif the wall of the bladder was anestetized with lidocaine hydrochloride.
3) Based on these results, it was considered that the distension of the bladder influences the whole body through autonomic reflexes.

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Electroencephalogram (EEG) potentially contains much information about the function of the brain.It is however often difficult to get the information in understandable forms without resorting to pertinent analytical methods.The analytical method most frequently used requires 5-second analysis time.This means that any event whose duration is less than 5-second is undetectable.
It has been recently proposed that the analysis time can be made as short as 1.5-second (the sectional analysis).Namely, the data obtained during a period of 1.5-second are divided into 150 equal parts, thus each part corresponding to 1.5/150 second, then each part is added in succession and repeatedly until exactly 5 seconds are reached.Two lines of investigations have been carried out.
First, sectio nal and 5-second analytical methods were applied to the EEGs of the cerebrovascular diseases and the results obtained with these two methods were compared with each other.Secondly, the EEGs of the cerebral arteriosclerosis and the apoplexy were categorizedaccording to the results obtained with the sectional analysis.
The results are as follows: 1 Bi-parietal EEGs in the acute stage of cerbrovascular diseases were analyzed during waking and relaxation by means of the sectional and the 5-second analytical methods.While both methods revealed a higher density in the power spectrum from 1 to 4 Hz on healthy as well as lesioned sides, it was only through the sectional analysis that a small peak corresponding to a-rhythm was distinguished on the healthy side.In the case of the cerebral infarct, both methods disclosed a higher density from 5 to 7 Hz on the lesioned side whereas it was only through the sectional analysis that peaks corresponding to a-rhythm were detectedon both sides.
2 The EEGs of the arteriosclerosis and the apoplexy were analyzed continuously for 40 seconds by the sectional analysis.The patients with cerebral arteriosclerosis exhibited either a normal or higher blood pressure.In the former, the highest density in the power spectrum was observed at 10 Hz while in the latter it was seen at 8 or 9 Hz on both healthy and lesioned sides.In patients with a long-standing hemiparesis, the EEG on the lesioned side remained abnormal.On the other hand, in patients who had almost completely recovered from the paresis, the EEG was similar in pattern to that of the cerebral arteriosclerosis.
Key words: frequency analysis, cerebrovascular dise ases, sectional analytical method, digital data, power spectrum density

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The most important problem in treating the survivors from cerebrovascular accident (CVA) is the rehabilitation of hemiplegia.In the present study, the relationships of the findings in cerebral angiography (CAG) to the effect of rehabilitation were investigated using 92 patients of postapoplectic hemiplegia: 69cerebral infarction, 21 cerebral hemorrhage and2subarachnoid hemorrhage. The diagnosis was made according to the criteria proposed by the research group supported by the Ministry of Education. The CAG findings were classified into the following categories: stenosis, occlusion, elongation, and tortuosity.
In order to evaluate the results of rehabilitation, following classification was used: 4 stages for the function of upper extremities (non-functioning, aided, subnormally and normally working hand), 5stages for the function of lower extremities (bedridden, not walking, assisted walking, independent but incomplete walking, and independent walking) and4stages for activities of daily living (ADL)(totally dependent, partially dependent, partially independent and independent). Evaluation of the degree was made at the times of admission and discharge.
The improvement of upper and lower extremities and ADL was observed in 28.2%, 71.6% and 61.2% of the cases, respectively. In either of cerebral infarction and hemorrhage the improvement of the function of lower extremities and ADL was observed significanly more frequently than that of upper extremities.
Function of lower extremities was improved in significantly more cases of cerebral hemorrhage than cerebral infarction, while no difference was found in upper extremities and ADL. Patients with cerebral infarction having occlusion or marked stenosis showed much lower incidence of improvement of upper extremities than those without marked stenosis. In cases with lesions in all 3 vessels of internal carotid, anterior cerebral and middle cerebral arteries the improvement was not always inferior to those with one or 2 vessel lesions.
The visibility of the lenticulostriate arteries was not related to the outcome of abilitation.
The patients who began rehabilitation within three months after the attack showed significantly better improvement than those who began rehabilitation later.
From above findings it is concluded that CAG is a very useful indicator to predict the potentiality of the rehabilitation.
Key words: cerebrovascular accident, cerebral angiography, rehabilitation, hemiplegia, prognosis

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Dressler described the cases having body temperature elevation and chest pain, which developed following acute myocardial infarction, accompanied with pericarditis, pleuritis, pneumonia, acceleration of erythrocyte sedimentation rate, leucocytosis, eosinophilia, etc.and named this condition as postmyocardial infarction syndrome (PMIS).Tendency of recurrence of these symptoms were also noted by Dressler and he suggested that autoimmune mechanism might be responsible for these manifestations.Although several reports have been published since that time, its clinical features are not always clear yet and laboratory examinations have not been carried out in detail.Its pathogenesis is not elucidated sufficiently.
The purpose of the present study is to investigate the clinical features of PMIS, using 30 cases.The laboratory studies showed the exudative or bloody pleural fluid in all cases in which fluid was taken by pleuroparacentesis.Leucocytosis more than 10, 000 was found in 10 cases and acceleration of erythrocyte sedimentation rate in 19.CRP titer was significantly higher in PMIS than usual congestive heart failure.These findings indicate that PMIS is of inflammatory nature.
In addition, eosinophilia more than 6% was observed in 16 cases (53.3%).Its count was varied in parallel with increase or decrease of pericardial and pleural effusion and other clinical as well as laboratory findings.Immunoserological studies revealed the significantly higher antibody titer to the intact and infarcted human heart muscle antigens in patients with PMIS than ordinary myocardial infarction without PMIS.At postmortem examination of two cases, histology of myocardium was observed not contradictory to autoimmune disease.These findings suggest the pathogenesis of the PMIS can be ascribed to the autoimmune mechanisms.
PMIS was observed in 3.9% of myocardial infarction.In about a half of the cases, PMIS developed from 2 to 6 weeks after the onset of acute myocardial infarction.Pericarditis, pleuritis and pneumonia were found in 29 cases (96.3%), 25 cases (83.3%) and 6 cases (20.0%), respectively.Recurrence of pericarditis was noted in 13 cases and that of pleuritis in 12. Steroids were effective in all cases in which they were employed, but some cases were observed to improve by use of antibiotics and/or diuretics without steroids.
Key words: myocardial infarction, autoimmune mechanism, pericarditis, pleuritis, eosinophilia

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The recent development and progress in hemodilution perfusion without donor blood have made it possible to perform extracorporeal circulation for two to three hours with reasonable safety.However, this procedure, being unphysiologic in nature, is still fraught with many difficulties that remain to be overcome.Remarkably, hemolysis resulting from the use of a pumpoxygenator is related to the postoperative occurrence of acute renal failure and lung complications.Its presence or absence is thus determinant of operative results in many instances.Anothertype of hemolysis that is caused by prolonged assisted circulation for respiratory insufficiency hasalso become a significant problem of lethality.Such circumstances prompted the author to undertakethe present experimental study which was intended to minimize the degree of hemolysisthat occurs in association with the use of a De Bakey Roller-pump, a device in routine favoriteuse.Using a model circuit, measurements were made of flow rate, pressure in circuit and plasma Hb level under varying experimental conditions in order to determine the critical occlusion of Latex tube.The results indicated that the flow rate per minute was kept most stationary andthe correlation between the degree of hemolysis and the number of revolutions of pump wasfound to be closest when physiologic saline was used for the regulation of occlusion.Actualclinical patient subseuently underwent extracorporeal circulation with the use of physiologic salinefor the regulation of occlusion.From a series of patients undergoing open heart surgery duringthe period from February 1, 1974 through February 28, 1979, thirteen cases in whom a No.7 or No.9 arterial cannula was employed were chosen for the study.They had an average age of28.3 years, with the male-to-female ratio being 1: 1.2 and the average perfusion time, 1 hourand 14 minutes.The time course of hemolysis was evaluated in terms of plasma-hemoglobin, haptoglobin and hemoglobinuria.The plasma-hemoglobin was found elevated immediately afterthe completion of extracorporeal circulation and returned to normal on the first postoperative day.In two cases of AVR, however, the amount of free hemoglobin was well in excess of the bindingcapacity of haptoglobin with plasma-hemoglobin and there was mapifest hemoglobinuria onthe first postoperative day.The renal threshold for plasma-hemoglobin was at around 120 mg/dl.The haptoglobin level, on the other hand, was lowest on the first postoperative day and returnedto normal by the third postoperative day.In all clinical cases the postoperative course was uneventful, none developing acute renal failure and/or lung complications.

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A macroscopic study of the cortical branches of the middle cerebral arteries wasperformed in five Japanese cadavers.The diameter, length, and branching-angle weremeasured in 1290branches of ten hemispheres.Waddington's nomenclature (1974) was used for the cortical branchesof the middle cerebral artery.When it was not applicable exactly, the arterial diameters weretaken into consideration in naming.
The results are as follows
1) The following relationships are observed among the branches of the middle cerebral artery [MCA]
i) The orbitofrontal artery [Or FA] arises from the operculofrontal artery or the MCA in75% of the cases examined.
ii) The operculofrontal artery [Op FA] arises from the central sulcus artery or the angularartery in 75%.
iii) The central sulcus artery [CSA] arises from the posterior parietal artery or the angularartery in 71.4%.
iv) The posterior parietal artery [PPA] arises from the angular artery in 91.7%.
v) The temporal artery [TA] has five cortical branches.Of these branches, four arise fromthe angular artery.They are named the recurrent temporal artery [RTA], the posterior temporalartery [PTA], the anterior branch of posterior temporal artery [APTA], and the posterior branchof posterior temporalartery [PPTA].The remaining one branch, the anterior temporal artery [ATA], arises either from the ANA or from the MCA.
2) Of the 1290 branches of the MCA, ninety-two (7.1%) were recurrent branches.They presentedthe following patterns of running
i) Of the ninety-two branches, fifty-seven (62.0%) arise from the three main branches, the ATA, the RTA, and the Or FA.They were divided intotwenty-seven (47.4%) arising from the ATA, five (8.8%) from the RTA, and twenty-five (43.8%) from the Or FA.
ii) Of the fifty-seven recurrent branches, twenty (35.1%) arise from the begining of the ATA, the RTA, and the Or FA.They were 21.7% of the total recurrent branches.
iii) The ATA has 128 peripheral branches of which twenty-seven (21.1%) were recurrent.The RTA has 23 peripheral branches of which five (21.7%) were recurrent.The Or FA has 134peripheral branches of which twenty-five (18.7%) were recurrent.
iv) The closer a recurrent branch was to the origin of the MCA, the greater the branchingangleformed by this branch.
v) When the whelelength of the MCA (under 240mm) was divided into 50-mm sections fromits' origin fifty-two branches (56.5%) of the 92 were in the first section, twenty-seven (29.4%) in the second section, twelve (13.0%) in the third section.

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