The effect of hypo- and hyperthyroidism, and hypothalamic ventro m edial-arcuate (VMH-ARC) nuclei lesions on plasma growth hormone (GH) response to human growth hormonereleasing factor (GRF) was studied in conscious, freely moving rats after they had received chlorpromazine (CPZ) or CPZ plus antiserum against somatostatin (ASS). CPZ was chosen, since the agent is known to inhibit episodic GH secretion mediated by endogenous GRF in conscious, freely moving rats.
Following results were obtained.
1) CPZ had no effect on GH secretion induced by GRF in rat pituitary rnonolayer culture. The plasma GH response to a small dose of GRF was consistently observed in rats pretreated with CPZ alone. The magnitude of the response was significantly augmented when rats were administered with CPZ and ASS.
2) In rats made hypothyroid by thyroidectomy or hyperthyroid by the administration of 1-thyroxine, basal and the peak plasma GH response to the minimum effective dose of GRF were significantly reduced as compared to their respective controls. The pituitary GH reserve was markedly reduced in hypothyroid but not in hyperthyroid rats as compared to their controls.
3) The magnitude of plasma GH response to a moderate dose of GRF was significantly higher in VMH-ARC lesioned rats than that attained in sham lesioned rats, when the observation was made after they had received CPZ alone. When a similar observation was repeated using the same rats after they had received ASS and CPZ, basal plasma GH levels of controls were significantly higher than those of VMH-ARC lesioned rats and the magnitude of plasma GH response to GRF was augumented in both groups of rats. Under the condition, plasma GH response to GRF was comparable between the two groups, though the peak plasma GH response to GRF was slightly but significantly lower in VMH-ARC lesioned rats as compared to controls. Pituitary GH content was reduced significantly in VMH-ARC lesioned rats as compared to controls.
The results demonstrate the following :
1) CPZ acts largely if not solely to reduce endogenous GRF secretion. Therefore, rats pretreated with CPZ and ASS can be used to quantitate GRF activity.
2) Although plasma GH response to GRF is reduced in hypo- and hyperthyroidism, the mechanism involved in the phenomenon appears to be different between the two conditions.
3) The pituitary responsiveness to GRF does not appear to be altered significantly in rats bearing VMH-ARC [source of endogenous GRF] lesions. In addition, the placement of electrolytic lesions in VMH-ARC causes reduced SS secretion into hypophyseal portal vessels and leads to an augumentation of plasma GH response to GRF.

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Since 1972, we have been performing transvenous epidural venography in our clinic as an auxiliary diagnostic procedure for lumbar disc herniation.
However, many “false-positive”findings were obtained when trying to apply this method to middle-aged and older patients. It should be noted first tha epidual venography was principally performed on patients with lumbar disc herniation. Thus, most venographic results were obtained for patients in their 20 s and 30 s.
During the period from 1974 until 1978, we studied epidural venogram in patients with various cases of low back pain and different ages ranging from young to old. We carried out epidural venogram on 74 patients (61 males, 13 females, aged from 5 to 65 years) suffering from various types of lumbar complications to establish the incidence of false-positive findings in regard to age.
In addition, optical pathological and morphological examinations were performed on the anterior internal vertebral vein of the L 5 spinal body level excised from fresh corpses of 36 cadavers (22 males, 14 females, with ages ranging from 0 to 85).
The results were as follows :
1) The false-positive findings included deficient venograms as well as venograms with a meandering, irregularly bent and narrowed-down pattern. Of these, the clinically most problematic ones were the deficient findings. For the age group of 0-20 years of age, no deficient findings were observed, but there was a tendency for these to increase very sharply with age, totalling 41% for patients in their 40s and 50% for patients in their 50s and 60s.
2) In terms of the contrast range, it was found that the younger the patients were, the greater the tendency for the contrast range to extend up to the superior lumbar vertebrae.
3) No spider's-web-like shadow was observed in patients up to 30 years old, whereas this pattern appeared at a 50% incidence in patients aged from 61.
4) The incidence of growth in the collagen fiber material in the media of the anterior internal vertebral vein was found to be 67% for light cases aged up to 20 years, but 8196 for medium cases aged more than 61.
5) The cross-sectional appearance of the anterior internal vertebral veins was divided into four types on morphological grounds. Among the young patients, the normal type occurred very frequently. Among the middle-aged cases, collagen fibrosis in the media of the vein or partial fibrosis and partial thinning tended to be the predominant types. In the older group, total circumferential thinning occurred at high incidence.
From the above results, it is clear that, with progressing age, the incidence of false-positivefindings increases proportionally. This is attributed to the changes of the anterior internal vertebral vein with aging, i. e., to the venosclerotic processes associated with aging.
Therefore, in diagnosing patients older than 40, it is necessary to exercise much more care in evaluating their venograms by taking the aging processes affecting the veins into account.

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The various types are seen in the hypoglycemic responses after the administration of disopyramide in the rats (Donryu & Long-Evans strains). Two main types extracted from them are named the initial hypoglycemia and the sustained hypoglycemia, respectively. Initial hypoglycemia, which is found to be dose-dependent and insulin-independent, is observable in all animals treated with disopyramide. Sustained hypoglycemia, which is insulin-dependent, can be observed in a part of the tested rats at the rate of approximately 1/5. This appearance rate for the cases showing the sustained response is found to rise to approximately 4/5 after the pretreatment with propranolol, while the rates are not given any change by the pretreatment with C₆ or phentolamine.
Disopyramide is concluded to have two action-sites in pancreas ; namely, the first one is the direct stimulation of B-cell in the islets and the second one is the elevation of the activity of the β-adrenergic neuron which is suspected to suppress the insulin liberation.

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We recorded the fetal heart rate 189 times in 89 normal pregnant women in 1982-1984 at the First Hospital of Nippon Medical School. The total time of the recordings amounted to 40 minutes. The recordings were studied and the following results were obtained.
1) Amplitude of fetal heart rate acceleration (FHR acceleration) increased as the gestational week advanced.
2) After 27 weeks of gestation, incidence of FHR acceleration with amplitude of more than 15 bpm increased, whereas that of FHR acceleration with amplitude of 10-15 bpm decreased. As a result, the total incidence of FHR acceleration remained constant.
3) As for fetal heart rate-baseline variability, it was found that as the gestational week progressed durations of both reduced and undulatory phases were prolonged. The same was true of durations of active and rest phases.
The above findings show that to obtain the information about the fetal heart rate is of significance in assessing the maturation of the fetus.

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In order to clarify the relationship between cardiovascular complaints and electrocardiographic changes during an attack of neurocirculatory asthenia (NCA), 64 patients with cardiovascular complaints, but without organic heart disease, were studied. The findings of the patient-activated pocket electrocardiograph (PECG) were analyzed and compared with the results of psychological tests [Cornell Medical Index (CMI) and Yatabe-Guilford (Y-G) test].
Among the 64 patients studied, 307 attacks were recorded by PECG. Subjective complaints during the attacks were as follows : palpitation in 129 attacks, 41 patients, respiratory symptoms in 85 attacks, 33 patients, chest pain in 138 attacks, 45 patients and other symptoms in 120 attacks, 34 patients. Heart rate (HR) during the attacks was significantly higher than basal HR (p<0.01).
HR was higher during the episodes of palpitation and respiratory symptoms than during chest pain and other symptoms with statistical significance.
HR during the episodes of palpitation and respiratory symptoms was significantly higher than basal HR (p<0.001). However, HR during chest pain and other symptoms was not significantly different from basal HR.
All of the basal HR, HR during attacks and maximum HR in the abnormal CMI group were significantly higher than those in the normal CMI group (p <0.01, p<0.001, p<0.01, respectively).
In Y-G test, only HR during attacks in the abnormal group was significantly higher than in the normal group (p<0.01).
There was no significant difference in HR during episodes of palpitation and respiratory symptoms between the normal and abnormal CMI groups. However, HR during chest pain and other symptoms was significantly higher in the abnormal CMI group than in the normal CMI group.
Concerning ECG findings other than HR change, ventricular premature contractions were found in 17 attacks, 5 patients, T wave inversion in 5 attacks, 4 patients, atrial premature contractions in 5 attacks, 2 patients, sinus arrhythmia in 7 attacks, 2 patients, ST depression (J type) in 1 attack, 1 patient, and ST elevation in 2 attacks, 1 patient.
Thirty-two cases showed CTR smaller than 42%, indicating that the small heart itself is a possible cause of cardiovascular complaints of NCA.
A statistically significant difference was also found between the respiratory abnormalities of the normal and abnormal CMI groups (p<0.05).
In summary, (1) The most characteristic ECG change during attacks of NCA is change in heart rate. (2) Heart rate changes are related to the kind of symptoms and psychological test results.

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A survey was made on esophageal hiatal hernia in a series of 169 roentgenologically proven cases, with an investigation made into the pathophysiology an clinical implications of gastroesophageal reflux from the aspect of lower esophageal sphincte pressure (LESP).
The incidence of hiatal hernia was 0.91% in outpatients withdigestive syndrome who were treated in this Internal department ; it was most frequent in elderly women, its incidence increasing with advancing age. In 31.9% of the cases there was a concomitant esophagitis and all such cases developed subjective symptoms, notably beartburn, with 39.2% of them having a complication of ulcerative lesions.
Abnormal lordosis was present in 69.6% of the patients with esophageal hiatal hernia while complicating esophagitis tended to be frequent in the presence of abnormal lordosis. These facts suggest that abnormal lordosis is a etiologic factor of the greatest importance for esophageal hiatal hernia.
Esophageal manometry demonstrated a high pressure zone with two distinct peaks in the lower esophagus in 86.8% of hiatal hernia cases, with both of these peaks being lower than LESP of normal subjects.
There was no noticeable difference in LESP between cases with complicating esophagitis and those without it, although the former showed a less marked rise in LESP in response to pentagastrin or metoclopramide. The size of the esophageal hiatal hernia was found not to have any relation with the concurrence of esophagitis.
Endoscopic esophageal manometry, if performed under appropriate conditions, yeilds values approximate to measurements obtained by the conventional nonendoscopic method and would hence serve actual clinical purposes.
The endoscopic dye reflux test reflects LESP and provides a useful easy-to-use means of assessing gastroesophageal reflux.

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In an attempt to define clinically the heterogeneity of age-related glucose intolerance, the plasma insulin responses to glucose load were studied mainly in relation to the atherosclerosis.
Both oral (OGTT) and continuous intravenous (C-IVGTT) glucose tolerance tests were performed in 87 non-obese subjects whose ages ranged from 23 to 83 years. For the C-IVGTT a 10% glucose solution was administered at a constant rate of 8.7 ml/min via an antecubital vein for 20 min. The insulin responses to glucose during both tests were calculated as SIRI/SBs ratios (the area under the plasma insulin curve/the area under the plasma glucose curve). The results obtained were as follows :
1) The mean SIRI/Sss values during both the OGTT and the C-IVGTT in elderly (60 years and over) borderline diabetics were not significantly different from those for elderly normal subjects, and were significantly higher than those for adult (59 years and under) borderline diabetics.
2) The insulin response curve during the C-IVGTT resulted in a uniphasic pattern in normal subjects and borderline diabetics, and was flat in diabetics.
3) There were significantly positive correlations between the SIRI/SBs values of the OGTT and the C-IVGTT in both adult and elderly subjects.
4) In elderly subjects, the mean SIRI/Sss values of both the OGTT and the C-IVGTT for borderline diabetics with atherosclerosis were not significantly different from those for normal subjects with atherosclerosis, and were significantly higher than those for borderline diabetics without atherosclerosis. On the other hand, they were significantly lower for borderline diabetics without 'atherosclerosis than for normal subjects without atherosclerosis.
5) In order to confirm the effect of atherosclerosis on insulin response, an additional OGTT was performed in 34 non-obese elderly subjects whose HbA₁ values were 7.0 to 7.9%. The mean STRI/Sss values were significantly higher for those subjects with atherosclerosis than for those without.
These findings suggest that there is a subgroup, which has clinically evident atherosclerosis without low insulin response to glucose load, in elderly subjects with mild impaired glucose tolerance. The subgroup may have decreased insulin sensitivity to peripheral tissues.

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Seroepidemiology of diphtheria in Chiang Mai, North Thailand through 1977 to 1982 and development of the antitoxin in the blood of children immunized with the toxoid were studied. Antitoxin titers of 763 sera with unknown immunization history and of 1, 059 sera with known immunization history were determined by using the microneutralization-cell culture method.
Among persons with unknown immunization history, the percentage of the antitoxinpositive in 10-14 years old subjects in 1979 was higher, as compared with the same age group in 1977, while that in 20 or more years old subjects in 1977 and 1980 were lower than in 1979. Percentage of the antitoxin-positive sera increased according to age. Geometric mean titer of the antitoxin-positive sera in 15-19 year-old subjects was higher in 1979 than in 1977, and higher also than in 5-9 year-old subjects in 1979.
All of the children being immunized in accordance with strict regulations of the Comprehensive Child Care Clinic, Chiang Mai University had the positive antibody. In experiments with this group, a significant increase in the antitoxin titer was observed one month after the booster immunization, and a gradual decrease of the antitoxin titer was observed through 1 to 37-71 months after the last booster immunization in the group of 5-9 years old. Decline of the titer was not observed in the group of 10-17 years old through 16 100 months after the last booster immunization, and the geometric mean titers of this group were 0.580 or more IU/ml.
In Wat Kau Khum school in the suburbs of Chiang Mai, one shot of the immunization produced the seroconversion in 88.2% of the children, and the geometric mean anti-toxin titer of the antibody-positive sera was 4.491 IU/m/ after the one shot.

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