Relationship between respiratory functions and the upper limit of the spinal cord anesthelized by epidural (157 cases) or spinal (77 cases) anesthesia was studied in 234 patients (age: 13.68 years) who underwent surgery in the abdomen or lower limb. Respiratory functions were measured with a spirometer (Minato-Ikagaku auto-spiro 500) before and after anesthesia. The following results were obtained.
1) Vital capacity (VC): VC did not change if the upper limit remained lower than the T7 spinal segment. As the upper limit ascended segment from T7 to C8 in epidural anesthesia, VC was linearly decreased. Decrease rate per spinal segment was 2.8%. At the level of C8, VC decreased to 70.9%. In spinal anesthesia, VC linearly decreased as the upper limit ascended from T9 to C8. The decrease rate per spinal segment was 3.9%. At the level of C8, VC decreased to 59.1%.
2) Inspiratory reserve volume (IRV): In epidural anesthesia, IRV began to drop when the upper limit reached the T7 and then decreased linearly as the upper limit ascended to the higher level of the spinal segment. Decrease rate per spinal segment was 3.5%. At the level of C8, IRV decreased to 69.6%. In spinal anesthesia, IRV also began to decrease at the level of T7 and then continued to decrease linearly as the upper limit ascended. The decrease rate per spinal segment was 4.6%. At the level of C8, IRV decreased to 56.4%.
3) Expiratory reserve volume (ERV): In epidural anesthesia, ERV began to decrease when the upper limit reached T8. When the upper limit ascended beyond T5, decrease of ERV was remarkable. At the level of C8, ERV was 55.6%. In spinal anesthesia, ERV remarkably decreased at the levels higher than the T8. At the level of C8, ERV was 48.5%.
4) Tidal volume (TV) and %FEV, were almost unchanged in both epidural and spinal anesthesia.
5) Respiratory gas flow factors had a general tendency to decrease in both epidural and spinal anesthesia, although their time courses varied considerably.
6) Analysis of the arterial blood gases indicated no significant changes in PaO₂, PaCO₂ and pH in both epidural and spinal anesthesia.

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The regulation of methemoglobin reduction in human erythrocytes was studied in vitro in association with glycolytic reactions, by using hemolysates prepared from the nitrate-treated erythrocytes. The results obtained are as follows;
1) The addition of cytochrome b₅ to the reaction mixture containing fructose 1, 6-diphosphate as the substrate for glycolysis caused a marked increase in the rate of methemoglobin reduction with a simultaneous increase of the level of 2, 3-bisphosphoglycerate and a decrease in the rate of lactate formation.
2) The effect on these reactions of the antibody against the human erythrocyte NADH-cytochrome b₅ reductase, and a cross-over plot of the metabolite concentrations in the reaction mixture revealed that the methemoglobin reduction observed was catalyzed by that enzyme, and was coupled with the glycolytic pathway at the glyceraldehyde 3-phosphate dehydrogenase reaction to affect the level of 2, 3-bisphosphoglycerate.
3) Essentially the same results were obtained with the reaction in which glucose 6-phosphate was used as the substrate of glycolysis.
4) The kinetic data obtained in vitro imply that under physiological conditions the rate of methemoglobin reduction firstly depends on the concentration of cytochrome b₅ in the erythrocytes.

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This study was designed to investigate the responsible region and the symptomatic flow and metabolism threshold for Broca's aphasia. The cerebral glucose metabolism in three patients with Broca's aphasia was examined by positron emission tomography (PET) using ¹¹C-glucose, and the images of PET were compared with the images of X-CT on the responsible region for aphasia. In two patients, both X-CT and PET demonstrated abnormal findings in the region which is generally thought to be responsible for Broca's aphasia, that was Broca's area, including cortex and subcortex in the anterior region to Sylvian fissure. In one patient, PET images demonstrated low ¹¹C accumulated area in the above mentioned region, and this region was isodensity on the images of X-CT.
Regional cerebral blood flow (rCBF) and oxygen metabolic rate (rCMRO₂) were measured by PET using ¹⁵0 steady state method in eight patients with Broca's aphasia and thirty patients without aphasia. During scanning, patients closed their eyes and were kept free from any stimulation. X-CT revealed abnormal low density in Broca's area, including cortex and subcortex in the anterior region to Sylvian fissure in three patients with aphasia. In the other five patients with aphasia X-CT showed no abnormal low density in Broca's area, but showed abnormal findings in the basal ganglionic region and subcortex. PET study revealed reduction of rCBF and rCMRO₂ in Broca's area in all cases with Broca's aphasia.
CBF and CMRO₂ of Broca's area of aphasic patients were compared to those of non aphasic patients to obtain the symptomatic threshold in rCBF and rCMRO₂. The values of symptomatic threshold were 20-27m1/l00g/min in rCBF and 2.0ml/100g/min in rCMRO₂. The symptomatic threshold differs from the threshold for development of abnormal low density on X-CT, therefore, the measurements of cerebral blood flow and metabolism were useful to study responsible region for aphasia.

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A retrospective study on the effects of postoperative adjuvant immunotherapy for gastric cancer was made. In order to evaluate the efficacy of immunotherapy, this study was undertaken from a different point of view, that is, immunotherapy was put on a basic treatment and immunochemotherapy was used as a control.
Six hundred and three patients subjected to non-curative resection were selected from 699 patients having been operated palliatively and recorded in the registration form of The Research Institute of Vaccine Therapy for Tumors and Infectious Diseases, Nippon Medical School from April 1979 to March 1980. 460 patients were excluded from this study because they were not satisfied with the criteria; e.g., 208 out of 460 excluded patients from this study gave no reply for the questionnarie, and other 252 cases had not been confirmed histologically the cancer and/or the initial therapy for some of these 252 cases was not SSM. Therefore, this report is based on 143 patients. In 69 cases immunotherapy with an extract from human tubercle bacilli (SSM) as sole treatment was carried out (immuno group), and combined therapy with SSM plus chemotherapeutic agents, mainly Mitomycin C, 5-Fluorouracil, FT-207 and Cytosine arabinoside, was given to 74 patients (combi group).
There were no significant differences in the back ground factors of the two groups. The survival rate was higher in the immuno group, 3 and 5 year survival rate in the immuno group was 32.4% and 27.7%, and that of the combi group was 15.9% and 8.9% respectively. It showed that the survival rate of the immuno group was significantly higher than that of the combi group.
In addition, stratifying the back ground factors caused non-curative resection, the influence for the prognosis was studied by means of statistical analysis. In comparison between the two groups, all survival curves in the immuno group were surperior to those in the combi group. Especially, those on H factor positive cases were exceedingly.
These results suggested that immunotherapy with SSM was effective in patients undergone a non-curative resection for gastric cancer, and it was emphasized that the establishment of sole treatment group with immunotherapy was significant for the evaluation of effectiveness of immunotherapy.

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Forty-one cases with paroxysmal atrial fibrillation (PAF) recorded on Holter's ECG were analysed. They were classified into two groups: 22 cases with heart disease (Group H) and 19 without heart disease (Group N). An additional classification was performed on which the CTR was more than 50% (Group L) in 22 cases and less than 50% (Group S) in 15 cases. For the latter classification, the measurement of CTR during the record of Holter's ECG was carried out. The frequency of PAF attacks was higher in Group H (5.0±4.8 vs 2.9±2.6/day) and the duration of attacks was more prolonged in Group N (29.7±84.5 vs 87.5±204.5min). Heart rate immediately after PAF attack was 121.2±29.7/min in Group H and 136.9±32.0/min in Group N. The frequency of SVPC just before the attack was higher in Group H (13.7±18.5 vs 7.5±8.6/min, p<0.001). The PAF attacks in Group N occurred more frequently at the awaking period than in the night. Group HL had the highest frequency of PAF attacks, the shortest duration, the highest frequency of SVPC. These attacks occurred more frequently during the sleeping periods. On the other hand, Group NS was contrary to Group HL. In 10-13.6% PAF attacks were terminated by the appearance of premature beats with the wide QRS pattern. In conclusion, it was suggested that the difference in the onset and termination of PAF attacks between four groups reflected the severity of atrial muscular dysfunction.

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Many reports have stated that blood coagulo-fibrinolysis is considered to be one of the most important factors at the onset or during the progress of cerebral thrombosis. There have been many reports particularly concerned with the relationship between the changes in coagulo-fibrinolytic factors and the severity of cerebrovascular disturbance in the acute stage. However, reports concerned with the relationship between the changes in coagulo-fibrinolytic factors and prognosis or the lesion site from the acute to the chronic stages are extremely few.
The plasma coagulo-fibrinolytic factors (fibrinogen, factor XIII, fibronectin, α₂-plasmin inhibitor, antithrombin III, α₁-antitrypsin, α2-macroglobulin, plasminogen) and euglobulin lysis time (ELT) were measured in 36 patients with cerebral thrombosis from the acute to the chronic stages on the 1st, 3rd, 7th, 14th, 28th and 56th day after the onset of the stroke, and were compared about the changes of coagulation fiblinolytic factors in the three groups of cerebral thrombosis cases (good prognosis group, moderate prognosis group and poor prognosis group) which were classified according to the evaluation of prognosis on the basis of ADL and in the two groups of cerebral thrombosis cases (cortical arterial system group and perforating arterial system group) which were divided according to the position of cerebral infarction.
Hypercoagulable state as indicated by high level of fibrinogen, low level of antithrombin III were noted among the patients with poor prognosis and in the perforating arterial system group.
From the results described above, both the poor prognosis group and the cortical arterial system group need a sufficient anticoagulant therapy for their hypercoagulable state.

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The interaction between human pancreatic carcinoma cells in culture and an extracellular matrix extracted from EHS sarcoma was morphologically and biochemically investigated in vitro.
The PANC-1 cell line used in the present experiments was derived from undifferentiated carcinoma of a human pancreas. The cells were positively stained with anti-CA19-9, anti-AFP and anti-CEA sera and were found to have undiferentiated characteristics.
When the cells were plated on the extracellular matrix, Matrigel, the tumor cells underwent organogenesis in vitro and formed the acinus-like structure with many lumens. The cells were shown to contain numerous immature zymogen (secretory) granules and secreted amylase into the culture medium.
These tumor cells were found to dedifferentiate again, when they were replated on dishes having no extracellular matrix.
These results suggest that a morphological and functional differentiation of the pancreatic carcinoma cells can be reversively induced with the extracellular matrix in vitro.

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Morphology of the parotid gland and the parotid plexus was studied using 31 sides of 19 cadavers. Investigated points and the results were as follows:
1) External form of the parotid gland.
(i) The accessory parotid was observed in 4 cases (12.9%).
(ii) The anterior process was found in 7 cases (22.6%).
(iii) The superior margin of the gland was on the same level as the highest part of the mandibular head, or as the inferior half of the external acoustic meatus.
(iv) The lowest point of the gland was, either (1) lower than the mandibular angle (9 cases, 29.0%), or (2) the same level as the mandibular angle (15 cases, 48.4%), or (3) higher than the mandibular angle (7 cases, 22.6%).
(v) Anterior and posterior margins of the inferior border of the gland made either an acute angle (20 cases, 64.5%) or an obtuse angle (11 cases, 35.5%).
2) The maximum thickness of the parotid gland in the retromandibular fossa and the depth of a bifurcating point of the facial nerve into superior and inferior branches.
Under 60 years old, the parotid gland from younger subjects was thicker than that from the older the subjects. However, the thickness tends to increase again in the ages of 70 and 80 years.
The facial nerve stem bifurcates into the superior and inferior branches in the parotid gland. Therefore, the bifurcating point is deep when the gland is thick, and it becomes more superficial as the thickness decreases (or as age increases).
3) Morphology of the parotid plexus of the facial nerve in the parotid gland.
(i) Anastomoses among twigs of the superior division were observed in 30 cases (96.8%). In 12 cases (40.0%), the anastomotic depth ranged from the superficial layer to a depth of about 10mm. These anastomoses were found near the temporomandibular joint.
(ii) Anastomoses between the superior division and the facial nerve stem were found in 5 cases (16.1%).
(iii) Anastomoses among twigs in the inferior division were found in 28 cases (90.3%), and most of them were formed along the posterior margin of the mandibular ramus in the retromandibular fossa.
(iv) Anastomoses between the stem and the inferior division were observed in 21 cases (67.7%), They were found at various depths.
(v) Anastomoses between the superior and inferior divisions were observed in 20 cases (64.5%). They were found in a rather superficial area near the parotid duct.
4) Bifurcation patterns of the superior and inferior divisions of the facial nerve.
Bifurcation patterns were classified into 7 types. Type IV, which has one or two anastomoses between the inferior division and the facial nerve stem, was dominant and found in 9 cases (29.0%). Type I, simple bifurcation without any anastomosis, was rather rare and found in 3 cases (9.7%).

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Three anomalous cases were encountered of the right subclavian artery as the last branch of the aortic arch during dissection practice at Nippon Medical School from 1976 to 1987. One of these cases dissected in 1976 was reported in 1980.
The present report describes the remaining two cases found in 1985 (an 81-year-old male) and 1987 (a 53-year-old male). These two cases belonged to type G according to Adachi's classification.
The aortic arch gave off the right common carotid artery as the first branch, the left common carotid artery as the second branch, the left subclavian artery as the third branch and the right subclavian artery as the last branch.
The right subclavian artery originated from the posterior wall of the aortic arch, a little distal to the origin of the left subclavian artery, at the level of the third thoracic vertebra. This artery ran between the spinal column and esophagus toward an area to the right of the first thoracic vertebra.
The vertebral artery arose from the subclavian artery in each side as the first branch, and penetrated into the 6th transverse foramen of the cervical vertebra.
The right recurrent nerve was absent but the right inferior laryngeal nerve arose directly from the right vagus nerve.
The cervical sympathetic trunk was normal and represented a normal subclavian loop.
The thoracic duct was normal and opened into the left venosus angle.

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