The step test is widely accepted as a simple method of measuring endurance, but due to the lack of special apparatus necessary, it takes time to complete the test when many subjects are involved. Difficulties arise in estimating the subjects tested at different times.
In order to solve this problem, I devised the burpee push up test, which, without apparatus, makes it possible to measure many subjects at one time. The test requires only simple actions which cause the main muscles of the body to work. With male subjects from the age of 10 to 29 participating in the test, the following results were obtained:
1) The heart rate and its tendency to increase during exercise in the burpee push up test showed a remarkable similarity to those of the step test. The highest heart rate during physical exercise appeared just 30 seconds before the end of the exercise. There was a very close correlation in the heart rate between the two exercises. Hence appears a remarkable resemblance in the amount of simulation to the body caused by both tests.
2) The heart rate during recovery and its tendency to decrease showed a similarity between both exercises. The heart rate was measured three times, and there was a very small difference in the total combined rates between the two groups, which shows an extremely close correlation in the total heart rate.
3) Regarding the step test, an index whereby endurance is judged is calculated. The index of the burpee push up test was almost the same as that of the step test : an extremely close correlation was found between the indexes. Thus the tables of various items in a physical fitness test and of different ages can be used in the burpee push up test.
4) Since no apparatus is used for the burpee push up test, subjects themselves can make measurements by taking each other's pulse.
In conclusion, endurance can be estimated by using the burpee push up test, and the results obtained from the test are almost the same as those of the present step test.

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Seroepidemiological studies were carried out on the outbreaks of swine type influenza in swine and human beings. The studies consisted of two surveys one was conducted on the employees of a slaughterhouse in Asahi City, Chiba Prefecture for the period from Jan. 1979 to Mar. 1982, and the other was on the swine and workers in a breeding stock farm in Saitama Prefecture for the period from Jan. 1982 to Mar. 1982.
The following results were obtained :
1) The positive rate of HI antibody against the swine type virus strain among the workers in the slaughterhouse was 10.7% in 1979, 13.0% in 1980, 20.6% in 1981 and 25.3% in 1982, thus showing a yearly increase.
2) An outbreak of a respiratory disease was observed clinically in the swine of the breeding stock farm in the middle of Jan. 1982. From 5 of the swine, serum samples were collected in the acute and convalescent stage and was examined for changes in HI antibody against the swine type influenza virus strain. As a result, 4 of them were found infected by the strain, and it was demonstrated that an epizootic of swine type influenza had broken out.
3) Seven to ten days after the onset of the epizootic among swine, several workers in the breeding stock farm began to complain of pyrexia with a temperature of 38-39°C, coughing, sputum, rhinorrhea, encephalagia and anorexia. Serological examination on 10 samples revealed swine type influenza virus strains in five.
It was concluded that the swine type influenza prevailing in swine had been transmitted to human beings on the breeding stock farm.

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The author has made statistical studies on 31 suicidal cases of schizophrenics admitted to CCM of Nippon Medical School during the three years from April 1, 1978 to March 31, 1981.
The items studied were age and sex, their suicide measures, scenes of suicide, their motives for suicide, the time of suicide, the clinical course of schizophenia, and their response to resuscitation.
Twenty three persons (74.2%) out of 31 (17 males, 54.8%, 14 females, 45.2%) were aged from 21 to 40. Eighteen persons were in the acute stadium (58.0%), 9 in the chronic stadium (29.0%), and 4 in the remission (13.0%).
(1) Acute group
1) Their suicide measures : 8 persons (44.4%) tried to commit suicide by jumping to the railroad track, 6 (33.396) by cutting, 1 (5.6%) by firearms, 1 (5.6%) by poisoning, and 1 (5.6%) by poisoning and cutting.
2) Scenes of suicide : 9 persons (50.0%) tried to commit suicide in their houses and 9 in the open air.
3) Their motives for suicide : 17 persons (94.4%) tried to commit suicide influenced by their pathological abnormal experiences.
4) The time of suicide : 16 persons (88.8%) tried to commit suicide in the daytime from 6 a.m. to 6 p.m.
5) Their response to resuscitation : 8 persons (44.4%) were disturbed, and 6 (33.3%) were indifferent.
(2) Chronic group
1) Four persons (30.896) tried to commit suicide respectively by jumping to the railroad track and plunging from heights, 2 (15.4%) by cutting, 2 (15.4%) by poisoning, and 1 (7.7%) by domestic gas.
2) Eight persons (61.5%) tried to commit suicide in their houses.
3) Seven persons (53.8%) tried to commit suicide by reason of the pain of sickness.
4) No persons tried to commit suicide from 0 a.m. to 6 a.m.
5) Seven persons (53.8%) were indifferent.

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Two main theories have been proposed related to the causation of the pulmonary thrombosis and infarction. The former one is proposed by Virchow and it justifies the mechanical obstruction of the distributing arteries and the latter one is recently offering a view that the functional derangement of the distributing arteries as the another noteworthy causative factor. The present study has been performed to evaluate the latter theory. The author has investigated 12 cases of the pulmonary thrombosis occuring in the main trunk of pulmonary arteries and 22 cases of pulmonary infarction and the following results were obtained.
1) The most conspicuous atheromatous changes were observed in the main trunk of the hilar region which were associated with organizing or organized thrombus.
2) It was postulated that the initiation of the early circulatory disturbance, being manifested by mechanical destruction of the vascular wall as well as imbibition of the serous component might play an important roll in causation of the changes. The causative mechanism of these circulatory disturbance will be essentially identical with these of heart, brain and kidneys which were previously reported by associates in this laboratory. In spite of the fact that these cases were involved in rather striking pathological changes they failed to show rather outspoken clinical manifestation. The discrepancy between them constitutes the most outstanding feature of these conditions.
3) The ectatic changes of the peripheral region as well as the vascular stasis and hemolysis also constitute the cardinal pathological changes, while the proximal portion reveal rather striking stenotic change which was induced by thrombotic adhesion to the intimal surface.
4) The most frequently encountered site for the pulmonary infarction is assumed to be the dorsal aspect of the lower lobe and localized in peripheral region. In spite of the occlusive mechanism in the proximal region, the distal portion is induced in ectatic process and prominent stasis.
5) Based on these observations, the pulmonary thrombosis occuring in the main trunk of the pulmonary arteries or pulmonary infarction may be resulted from the antecedent atherosclerotic changes which may be formed by persisting increased vascular resistence and increased intravascular pressure.
6) It is concluded that the far advanced circulatory derangement will be the most cardinal causative factor of the thrombosis and infarction and pathological significance of these findings are fully discussed in this communication.

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A laparoscopic examination was held in order to consider the differences between intrahepatic and extrahepatic cholestasis. The subjects included 32 cases of acute intrahepatic cholestasis (20 viral and 12 drug-induced cases) and 38 cases of extrahepatic cholestasis (13 stone and 25 cancer cases) to make a total of 70 subjects.
Cholestasis was classified into 4 types based on the patterns of the patchy green colorations on the surface of the liver. In Type I, the patchy green colorations were relatively circular and uniform and distributed in a regular mesh-like pattern. In Type Ila, adjacent patchy green colorations tended to join together to form varying types of polygons and were distributed in an irregular mesh-like pattern. In Type IIb, the joining of adjacent patchy green colorations was even more marked and the surface resembled a map-like or a brindled pattern. In Type III, no reddish areas remained on the surface of the liver, and the entire surface of the liver was colored green. Type I was intrahepatic and Type III was extrahepatic cholestasis, but it was necessary to discriminate intrahepatic from extrahepatic cholestasis in both Types II a and II b.
The dilatation of the bile ductules and lymph vessels as well as micro-abscesses and hepatic matastasis of cancer on the surface of the liver were characteristic findings of extrahepatic cholestasis and were seen in 29 out of 38 cases (76.3%). These findings were discovered in 61.5% of the stone group and 84.0% of the cancer group.
Relaxation of the gallbladder was found in 56.3% of the intrahepatic cases, 57.1% of the cases with the obstruction at the hepatic hilum or the common hepatic duct and 50.0% of those with the obstruction at the junction of cystic duct, but not in those with the obstruction at the common bile duct or at the Papilla of Vater. Distension of the gallbladder was evident in 50.0% of the cases with the obstruction at the junction of the cystic duct and 76.2% of those with obstruction at the common bile duct or at the Papilla of Vater, but not in the cases with intrahepatic cholestasis or in those with the obstruction at the high biliary duct.
Laparoscopic diagnosis of cholestasis was possible in 68.8% of the intrahepatic cases and 92.1% of the extrahepatic cases. However, the diagnosis rate of Type Ila at 54.2% and Type II b at 66.7% was lower when compared with Type I and Type III. From these results, differential diagnosis of cholestasis was possible in 57 cases (81.4%) out of 70.

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Cerebral atrophy and regional cerebral blood flow (rCBF) of patients with Parkinson's disease were studied. The study included 25 Parkinson's disease patients and 25 normal control subjects. Patients with symptomatic Parkinsonism, stroke, hypertension and cerebral arteriosclerosis were excluded from this study.
The rCBF was measured with the intra-arterial Xe-133 injection method via 8 channel detection. The rCBF was calculated by an initial slope analysis.
As to the cerebral atrophy, the ventricle size and cortical atrophy were studied by images of the brain CT scan.
The results obtained were as follows:
1) Sixty four % of Parkinson's disease patients showed ventricular dilation, and 76% of Parkinson's disease patients showed cortical atrophy on the CT scan, but we had to allow for the effects of the natural aging process on these results.
2) No correlation was recognized either between cerebral atrophy and the severity of Parkinson's disease, or between cerebral atrophy and the duration of Parkinson's disease.
3) In Parkinson's disease patients, the mean rCBF was lower than that of normal control subjects. The difference was even more remarkable in older patients. Only 40% of Parkinson's disease patients showed hyperfrontal pattern.
4) There was no correlation either between the mean rCBF and the severity of Parkinson's disease, or between the mean rCBF and the duration of Parkinson's disease. There was no significant difference between the mean rCBF of Parkinson's disease patients receiving levodopa and that of untreated patients.
5) The mean rCBF decreased in patients with cerebral atrophy on the CT scan.
6) Parkinson's disease patients with intellectual impairment showed cerebral atrophy and a remarkable decrease of the mean rCBF.
7) The effect of aging on cerebral atrophy on the CT scan had to be allowed for, but judging from the decrease of the mean rCBF, the cerebral cortex is evidently involved in Parkinson's disease.
8) The rCBF decline in Parkinson's disease patients may be related with the diminished cortical metabolic rate due to a remote effect of striatal dysfunction and a disturbance of mesocortical dopaminergic pathways.

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A very rare gallstone containing L-cystine in the most outer layer was disoovered in 972 specimens of gallstones which were removed from 341 patients with cholelithiasis at The First Department of Surgery and were analyzed in Department of Legal Medicine, Nippon Medical School.
1) The gallstone measuring 30×30×60mm in size removed from a 51-year-old housewife in April 1975 was judged pure cholesterol stone.when inspected macroscopically However, infra-red spectrometry and X-ray diffraction patterns proved main components to be as follows:cholesterol andL-cystine in the brown part of the most outer layer, cholesterol and Ca₃(PO₄)₂ in the green part of the most outer layer, cholesterol and Ca₃(PO₄)₂ in the outer layer and the intermediate layer, and cholesterol in the central layer including the nucleus.
2) The fraction of the brown part of the most outer layer was positive in ninhydrin and nitroprusside reactions.Thin layer chromatography and gas liquid chromatography revealed Rf value and r-Rt value (n-butylstearate) of the sample to be in accord with those of conventionally available L-cystine. By GC/MS, mass spectrum and quasi-molecular ion(QM⁺529)of the sample showed the same patterns as those of L-cystine.The content of L-cystine was measured to be 31.65%w/w by the amino acid autoanalyzer.
The sample was identified as L-cystine based on these findings.

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In 711 neurosurgical operations (696 clean operations, 15 operations of open head injuries) performed during 6 years (1976-1981), there were 48 postoperative infections including central nervous system infections and bacteremias.
The overall infection rate was 8.2%, which was higher than any result in literature. The yearly change of the overall infection rate indicated the increase of postoperative infections in these two years (1980-1981).
To investigate the cause of the high overall infection rate, the author made various classifications of the infections based on the underlying disease, operative method and operated region, and calculated the infection rate according to the classifications. To find out what was responsible for the increase of postoperative infections in these two years, the author analysed yearly incidences of etiologic agents according to a method of Infection Control Committee in addition to these classifications.
As a result of these analysises, brain tumor operations (the underlying disease), operations using a foreign body (the operative method) and infratentorial operations (the operated region) showed high infection rates respectively.
The analysis of yearly incidences showed that infection rates of the brain tumor group and the ratio of gram-negative rods in the etiologic agents were correlated with the overall infection rate.
In these two years, there was an outbreak of glucose non-fermentative gram-negative rods, and it was responsible for the increase of postoperative infections.
Susceptibilities in the disc method of these unidentified glucose non-fermentative gramnegative rods were similar to each other, and the three of them identified in National Institute of Health Center were all P. alcaligenes.
Minimal inhibitory concentrations of these Pseudomonases were similar to the results of the susceptibilities in the disc method. They were resistant to antibiotics which we used locally in operations. A phenol coefficient test to dysinfectants revealed that they were resistant also to chorhexidine gluoonate which we used routinely.
A few clinical data suggested the contaminated scalp of the patient as the direct contamination route of these nosocomial infections.

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Biological and immunological properties of serum factor that offers a resistance to the infection by K. ozaenae was studied with sera from healthy human subjects and a patient suffering from pneumonia caused by K. ozaenae. Eighty four out of 100 sera obtained from healthy human subjects offered passive protection against a challenge infection with strain KO-2 of K. ozaenae in mice. Also sera obtained from pneumonia, patient infected with K. ozaenae showed quantitative passive protective activities in accordance with bacterial agglutination titers.
Passive protective activity of the patient's serum was abolished by the absorption with either whole cells and cell surface polysaccharide of strain KO-2, or anti-human IgG, IgA and IgM serum. Serum contents of IgG, IgA and IgM were measured after an absorption with cell surface polysaccharide, but the reduction of specific immunoglobulin was not observed and the reduction percent of each immunoglobulin was only 10 to 14.
These results indicate that protective factor in human serum against infection with K. ozaenae would be antibodies against cell surface polysaccharide containing in these immunoglobulins.
Furthermore, the specificity of the passive protective activity of each surface polysaccharide of K. ozaenae or K. pneumoniae was demonstrated from the experiment employing the above patient serum and rabbit anti K-9 strain of K. pneumoniae serum.

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Lower esophageal sphincter pressure (LESP) in man was measured by using a miniature semiconductor pressure sensor and the effects of clinical drugs on lower esophageal sphincter (LES) were examined. In total, 183 clinical cases were studied; 88 cases as controls, 38 esophagitis cases, 31 gastric ulcer cases, 21 duodenal ulcer cases, 4 liver cirrhosis cases and 1 scleroderma case. Drugs studied were pentagastrin, metoclopramide, domperidone, NaHCO₃, maalox, cimetidine, secretin, glucagon, nifedipine, and nicardipine hydrochloride. There results obtained were as follows.
Continuous intravenous drip infusion of pentagastrin (12μg/min) tentatively raises LESP. Also both metoclopramide and domperidone showed a tentative LESP-raising effect when administered either intravenously (10mg) or orally (10, 20mg) . The peak of the effect was 3-10 minutes after the intravenous injection and 20-30 minutes after the oral administration. The effect of oral administration lasted long and its effectiveness was as good as that of an intravenous injection. NaHCO₃ and maalox also raised LESP tentatively. The ordinary dose of NaHCO₃ (1.0g) or maalox (10ml) had the effect of raising LESP for approximately 30 minutes. LESP raising effect of intravenously injected cimetidine (200mg) was not clear. An intravenous injection of secretin (1u/kg) or glucagon (1.0mg) clearly lowered LESP. Also, orally administered nifedipine (10mg) or nicardipine hydrochloride (10mg) tentatively lowered LESP. LESP-lowering effect of nifedipine was tentatively inhibited by metoclopramide.

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