The clinical effectiveness of a new protocol, the NCMP (N: neocarzinostatin C: cytosine arabinoside M: 6-mercaptopurine P: prednisolone) two-step regimen was studied in 19 patients with acute non-lymphocytic leukemia (ANLL). All patients were previously untreated and ages ranged from 15 to 75 y. o. (median: 54 y. o.). The ratio of male to female was 11 to 8. The doses and administration-routes of antileukemic agents were: N, 1, 400 u/m²/day, was administrated by i. v. drip on day 1, 2, 3 and 4 (Regimen 1) and N, 4, 000 u/m²/day, i. v. drip on day 1 and 2 (Regimen 2). C, 60-100mg/m²/day, was administered by i. v. drip and M, 60-100mg/m²/day, was given p. o. daily. P, 20-40mg/m²/day, was also given p. o. daily. As the first step, antileukemic agents were administrated until peripheral blood cell counts and bone marrow nucleated cell counts decreased to less than 1, 200/cmm and 15, 000/cmm, respectively. Treatment with or without N as the second step was started about 3-7 days after the first step treatment.
Eighteen patients were adequately treated by the NCMP two-step regimen and 12 of 18 patients, 66.7%, obtained complete remission (CR). On the basis of the types of leukemia, CR was achieved in 11 of 16 patients with AML, 68.8%, and 1 of 2 patients with AMoL, 50%. The ratio of CR was higher in younger patients (less than 49 y. o.) than in elderly patients (more than 50 y. o.). These ratios were 85.7% and 54.5%, respectively. On the basis of therapeutic regimens, 8 of 11 patients, 72.7%, achieved CR by Regimen 1 and 4 of 7 patients, 57.1%, by Regimen 2. The duration of CR ranged from 1.0 to 39.5+ M (median: 11.5 M). The survivals from the diagnosis of leukemia were from 13 to 41+ M (median: 12.1 M) in all patients and from 4.2 to 41+ M (median: 16.4 M) in responders. As toxic manifestations, digestive side effects such as anorexia, 68.4%, and nausea and vomiting, 21.1%, were marked, but were tolerable.
These results indicate that the NCMP two-step regimen is an effective induction chemotherapy for ANLL.

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In this study, the clinical effectiveness of 5 drugs as combination chemotherapy, NCDVP (N: neocarzinostatin C: cytosine arabinoside D: daunorubicin V: vincrisitine P: prednisolone) and NCyclo-cDVP (Cyclo-c: cyclocytidine), for refractory acute leukemia was evaluated. Twenty patients (12 patients relapsed and 8 patients with the first induction failure) were entered in this study; 14 patients with acute non-lymphocytic leukemia (ANLL) and 6 patients with acute lymphocytic leukemia (ALL). Their ages ranged from 15 y. o. to 73 y. o. (median: 39 y. o.) and the ratio of males to females was 15 to 5. Doses and administration methods were: N, 1, 400u/m²/day, was administered by i. v. drip on day 3, 4, 5 and 6 and C, 40-80mg/m²/day, was administered by i. v. drip from day 1 to day 6. D, 20-25mg/m²/day, was administered by i. v. bolus on day 3 and 5 and V, 1.4mg/m²/day, i. v. bolus on day 2. P, 20-40mg/m²/day, was administered by i. v. drip or p. o. from day 1 to day 6. The treatment was repeated with at least a 7 days resting period. All patients were adequatedly treated and 9 of them, 45%, obtained complete remission (CR). One patient showed partial remission. On the basis of types of leukemia, 7 of 14 patients with ANLL, 50%, and 2 of 6 patients with ALL, 33%, achieved CR. In order to obtain CR, one or 2 courses of the treatment were required (median: 1.4 courses) and the duration of CR ranged from 2 to 38 weeks (median: 6 weeks). In peripheral blood, the nadir of white blood cell counts, neutrophils and thrombocytes was 600/cmm, 200/cmm and 24, 000/cmm, respectively and the number of days to this nadir was 12 days for white blood cell counts, 11 days for neutrophils and 13 days for thrombocytes. The nadir of bone marrow nucleated cell counts was 7, 800/cmm and the number of days to nadir was 10 days. As toxic manifestations, digestive side effects were marked, but were tolerable. Eight patients showed alopetia and 4 patients complained of pain in the parotid gland. One patient complained of a sense of numbness in the fingers. Toxic effects on liver function were recognized in 5 patients, one of whom died of fulminant hepatitis.
The treatment of refractory acute leukemia is one of the major problems in the clinical management of leukemia. The results of the 5 drug combination chemotherapy presented here suggests its effectiveness in refractory acute leukemia in man.

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Up to date Donaggio reaction positive substances derived from serum protein have been shown to be from the α₁-globulin region, mainly α₁-AG. One purpose of this study was to purify α₁-AG from Cohn fraction VI of human serum by means of starch block electrophoresis and to measure the Donaggio titer in it. The other purpose was to compare α₁-AG with the other protein subfraction.
The results were:
1) Pure (about 98%) α₁-AG was obtained from Cohn fraction VI after heating. The Donaggio titer of α₁-AG solution was 1.7-2.2/mg/dl. Whole Cohn fraction VI was 1.2, human albumin was 0.7 and α₂-HS was 0.8.
2) The Donaggio specific activity was indirectly proved to be in the order of α₁-globulin>α₂-globulin contained in the Cohn fraction VI. This result supports the previous report.
3) A solution of Cohn fraction VI was almost equal in Donaggio titer per the same concentration of protein to urine after exercise, after treatment by heating at 100°C for 10 minutes and acidification to pH. 5 by acetic acid.
4) α₁-AG was concluded to have the highest Donaggio titer of the whole protein subfraction.

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Readiness potentials on voluntary hand movements were recorded from the scalp (C3: left central, C4: right central), premotor cortex, subcortical white matter and VL nucleus of the thalamus. The subjects were 6 healthy right-handed men and 23 patients with involuntary movement disorders.
The subjects lay on a bed in a dark room where they performed quick, repetitive voluntary contractions with the left or right fist. The contractions were self-paced at a frequency of about one every 6 sec. Linked mastoid electrodes served as a reference throughout the experiment. The EEG was amplified with Nihonkohden RDU-5 DC amplifiers. Clenching of the fist triggered the pulse-generator which produced an immediate pulse and a one second delayed pulse. An EMG was also recorded. These signals were recorded on magnetic tape. Analysis of the data was acoomplished by playing the tape back. The EEG and EMG activity were summated by Nihonkohden ATAC 501-20 computor.
In most subjects, readiness potentials were obtained before the voluntary movements. Readiness potentials were measured as the amplitude of premovement potential (N) and the interval between the beginning of the potential and the initiation of motor action (T).
1. Readiness potentials with negative shift were recorded on the scalp (C4, C3). In 6 right-handed healthy men, the means of T and N were 0.8 sec. and 7.0 μV, respectively, in C4, and 0.8 sec., 8.6 μV in C3 on right-hand movements. Conversely, the means of T and N on left hand movements were 1.0 sec., 9.2 μV in C4, and 1.0 sec., 8.4 μV in C3, respectively. The amplitude (N) in C3 on right-hand movements was significantly higher than in C4 (p<0.05 t-test).
2. Readiness potentials on the scalp were also recorded in 16 patients who had involuntary movement disorders, such as Parkinsonism, torsion dystonia or intention tremors. The means of T and N were 1.3 sec., 7.7 μV in C4 and 1.3 sec., 8.2 μV in C3 on right-hand movements. Conversely, the means of T and N on left-hand movements were 1.2 sec., 8.2 μV in C4 and 1.2 sec., 6.3 μV in C3. The mean T value was longer than the control group (p<0.01, t-test).
3. In Parkinsonian patients, the mean T value of readiness potentials on the central region contralateral to the hand movements was 1.1 sec. in 6 patients without akinesia (stage I, II). Conversely, that in 4 patients with akinesia (stage III) was 1.4 sec., which was longer than the control group (p<0.05 t-test). The length of T rather than the rigidity seemed to correlated with akinesia in patients with Parkinsonism.
4. Simultaneous recordings from the premotor cortex, subcortical white matter (2cm below the cortex) and VL nucleus of the thalamus were done during stereotactic surgery in the nonanesthetic state. Patterns of readiness potentials recorded from the premotor cortex were similar to those recorded from the scalp, but those recorded from the VL nucleus and the white matter were reversed in polarity. According to simultaneous recordings from the cortex and VL nucleus, readiness potential began approximately 0.2 sec. earlier at the cortex than the VL nucleus (p<0.01 t-test). This result is some evidence that the readiness potential initiates from the cortex of the motor area contralateral to the moving hand.
5. Readiness potentials were recorded 2-4 weeks after stereotactic VL thalamotomy. The mean T and N values of readiness potentials were almost the same as those before the surgery. The readiness potential was also recorded in a patient with thalamic syndrome who had a vascular lesion in the right thalamus. The potential showed a normal pattern from the intact side of the scalp, but on the lesion side, no potential could be obtained.
These results suggest that the thalamus plays an important role in the origin of the readiness potential of the motor cortex.

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Readiness potential is a slow negative shift of brain electrical potential preceding voluntary movements. The amplitude of the potential is maximum over the area of the contralateral motor cortex which represents contraction of muscles. But this is distributed in a rather diffuse fashion and can also be obtained in bilateral regions.
In this study, the readiness potential was obtained by averaging the EEG synchronized with repetitive hand movements. The potentials were recorded in the central scalp region in two groups; Group 1 as control consisted of six healthy right-handed persons, and Group 2 of seventeen patients with occlusive cerebro-vascular disorders who had varying degrees of motor weakness and who had undergone superficial temporal artery-middle cerebral artery anastomosis. The potentials in group 2 were obtained by carrying out voluntary movements on the unaffected side, if not mentioned. The relationship between preoperative readiness potentials and surgical results was studied.
1. In the control group, hand movements elicited the potential (N) with the amplitude being 7.7±0.8 μV (mean+standard error of means) on the ipsilateral side to the movement and 8.9±1.0 μV on the opposite side. N on the opposite side was significantly higher than on the ipsilateral side (p<0.02 t-test).
2. In group 2, N was 3.2±0.7 μV on the side of the hand movements and 5.4±0.8 μV on the opposite side. These values were signigicantly lower than those in group 1 (p<0.02 t-test).
3. Four patients with normal amplitudes (more than 5 μV) on the scalp of the lesioned side showed good results from surgery. On the other hand, four patients with very low amplitudes (less than 2 μV) had poor results. One patient out of eight with low amplitude (between 2 μV and 5 μV) showed good results, five patients showed fair results, and the other two patients showed poor results.
4. Readiness potentials after surgery were recorded in 10 patients. N was 3.6±0.8 μV on the ipsilateral side to the movement and 6.0±1.4 μV on the opposite side.
5. Readiness potentials recorded by repetitive hand movements of the affected side were mostly very low in voltage (less than 2 μV ).
These results suggest that readiness potentials could be a useful criteria for STA-MCA anastomosis.

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The diagnosis of pancreatic diseases is difficult and examination techniques such as hyp tonic duodenography, ERSP, and PTC have been used to facilitate this. Computerized tomo graphy (CT) has recently been introduced for the diagnosis of abdominal organs, and grea hopes were held for its application in pancreatic disease. However, according to reports base on numerous clinical experiments, it is concluded that its value is not so high as expected Therefore, under present conditions, we are obliged to depend on other diagnostic technique which require great skill and cause pain to patients. This report deals with investigation o the image in cases we have experienced.

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Specific studies of labelled insulin binding to insulin receptors on human placental crude membrane particulate were carried out.
Specific binding of ¹²⁵I-insulin to human placental membrane particulate was affected by temperature and pH of the incubation buffer and by the protein concentrations of the insulin receptor.
Scatchard analysis showed that human placental insulin receptor has two affinity constants, high affinity-low capacity component (K₁) and low affinity-high capacity component (K₂). The K₁ and K₂ values were 1.410×10⁹ M^-1 and 0.257×10⁹ M^-1, respectively. The average affinity (K_e) was 0.259×10⁹ M^-1.
Dissociation of labelled insulin from the placental insulin receptor demonstrated negative cooperativity.
Specific binding of ¹²⁵I-insulin to the placental insulin receptor was not affected by the sera of patients with various auto-immune diseases, such as systemic lupus erythematosus, rheumatic arthritis, hyperthyroidism, and mixed connective tissue disease, or by the sera of patients with lipoatrophic diabetes and insulin dependant unstable diabetes.
Furthermore the binding of labelled insulin to the placental insulin receptor was not related to various hormones such as glucagon, C-peptide, GH, ACTH, cortisol, GABA, L-DOPA, TRH, TSH, and testosterone.
Anti-insulin receptor antibodies in a patient with insulin resistant diabetes were measured by RRA using placental membrane particulate and by PEG and immunoprecipitation using solubilized placental insulin receptor.
The inhibition rate by polyethylene glycol method using solubilized insulin receptor corresponded well with the inhibition rate by RRA. Immunoprecipitation using solubilized insulin receptor and goat anti-human IgG is thought to be indispensable to detection of antireceptor antibodies in type B insulin resistant diabetes.
The change in clinical features of the patient with type B insulin resistant diabetes correlated closely with change of titers of anti-receptor antibodies. Immunosuppressive therapy consisting of prednisolone and cyclophosphamide resulted in complete remission of clinical diabetes and disappearance of anti-receptor antibodies. Scatchard analysis showed that antireceptor antibodies decreased the affinity constant of the insulin receptor, but did not affect the numbers of receptors. This finding suggests that anti-receptor antibodies bind to near the insulin receptor and inhibit binding of insulin to the insulin receptor, thereby causing an extremely insulin-resistant condition.

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Radioreceptorassay using particulate membrane of human placenta, liver and kidney of guinea pigs were carried out to investigate the effect of insulin antibodies on insulin receptors.
¹²⁵I-insulin binding to insulin receptors at 24°C increased slowly, binding in an apparent steady-state was reached within 1 h and continued for 3 h. ¹²⁵I-insulin binding to insulin antibodies at 24°C increased rapidly, binding in an apparent steady-state was reached within 0.5 h and continued for 3 h. ¹²⁵I-insulin incubated with buffer at 24°C was not degraded until 2.5 h, but ¹²⁵I-insulin incubated with 300μg of particulate membrane of human placenta at 24°C was degraded and its degradation rate was 37.5% at 1 h, 50.9% at 2 h, 60.4% at 3 h. The degradation rate of particulate membrane of human placenta in the same condition was 4.3% at 0.5 h, 1.8% at 1 h, 19.6% at 2 h. After these studies, the following four experiments were performed.
Group 1: ¹²⁵I-insulin was preincubated with insulin antibodies for 90 min., then insulin receptor was added to the incubation material. The mixture was incubated for 120 min..
Group 2: ¹²⁵I-insulin, insulin antibodies and insulin receptor were incubated together for 120 min..
Group 3: ¹²⁵I-insulin was preincubated with insulin receptor for 120 min., and insulin antibodies were added to the incubation material. The mixture was incubated for 90 min..
Group 4: Insulin antibodies were preincubated with insulin receptor for 30 min., then the mixture was washed once, ¹²⁵I-insulin was added, and the mixture was incubated for 120 min..
¹²⁵I-insulin binding to insulin receptor was inhibited in group 1, group 2, and group 4, but was not inhibited in group 3. The inhibition rate correlated positively with the titers of insulin antibodies. Different insulin target organs: human placental insulin receptor, and hepatic and renal insulin receptors of guinea pigs showed different inhibition rates. Insulin antibodies obtained in the insulin resistant period showed the most inhibition, but insulin antibodies from a patient with insulin resistant diabetes in the remissive state and from a patient with steroid induced diabetes showed decreased inhibition. The dissociation rate of ¹²⁵I-insluin from the insulin receptor was increased by insulin antibodies. Scatchard analysis showed that affinity constants of insulin antibodies (high affinity-low capacity component (K₁), low affinity-high capacity component (K₂) and average affinity constant (K_e) in the insulin resistant period) were 1.810×10⁹M^-1 (K₁), 0.046×10⁹ M^-1 (K₂), 0.083×10⁹ M^-1 (K_e), respectively, and K₁, K₂ and K_e of insulin antibodies in the remissive state of the insulin resistant diabetic were 0.542×10⁹ M^-1, 0.025×10⁹ M^-1, 0.060×10⁹ M^-1, respectively. K₁, K₂ and K_e of insulin receptor in the presence of insulin antibodies were 0.600×10⁹ M^-1, 0.132×10⁹ M^-1, 0.176×10⁹ M^-1, respectively. The numbers of insulin receptors decreased in the presence of insulin antibodies.
The inhibition rate is thought to be influenced by affinity constants as well as titers of insulin antibodies. Comparing the affinity constants of insulin receptors and insulin antibodies in the insulin resistant period, the ratio of K₂ of insulin receptor to K₁ of insulin antibodies was 1:8.30 and the ratio of K₁ of insulin receptor to K₂ of insulin antibodies was 1:0.058.

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Although it has been considered that the transverse level of chest electrodes (I, E, C, A, M) is important to the accuracy of the dipole component derived from the lead system of vectorcardiography, there are few papers available which deal with this problem.
Using a Japanese male torso model with a homogeneous volume conductor, the following two points were investigated: 1) indication of the correct level of artificial dipole with a three step technic and a Y-Precordial technic, 2) effects of shift in the level of the dipole and of chest electrodes from the fifth to the third, fourth or sixth intercostal space on the lead vector.
The following results were obtained:
1) The three step and Y-Precordial technics indicated the correct level of artificial dipole.
2) The magnitude of lead vector Z and the elevation of lead vector X and Z were changed markedly by moving chest electrodes upward or downward from the artificial dipole level.
A concomitant shift of the chest electrodes with the dipole, however, caused trivial changes in the components of the lead vector, regardless of the level moved upward or downward from the fifth intercostal space
The results indicate that in the homogeneous torso model, chest electrodes should be present at the same level as the dipole, which can be detected by the three step and Y-Precordial technics.

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The transverse level of chest electrodes is important in the accuracy of the dipole component derived from the Frank lead system of vectorcardiography. The transverse level of the electrical center of the heart vector was determined in supine subjects utilizing a three step technic and a Y-Precordial technic, and the effect of shift in the electrode level from the fifth intercostal space to the level of electrical center was studied.
Vectorcardiograms were obtained from 154 adult male subjects: normal men (46), hypertensive patients with normal electrocardiogram (45), hypertensive patients with high voltage of the QRS complex (34.) and hypertensive patients showing high voltage of the QRS complex with S-T segment and T wave changes (29).
The following results were obtained:
1) The cases in which the electrical center were present above the fifth intercostal space were more than those in which it was below that intercostal space. However, in most cases (101 out of 126 cases, 80.2%), the electrical center was present within±20 mm of the level of the fifth intercostal space. In 28 out of 154 cases, these technics could not indicate the level of the electrical center.
2) With chest electrodes shifted from the level of the fifth intercostal space to the level of the electrical center, the magnitude of each component of the vectorcardiogram changes; especially the maximum posterior component increased in all groups regardless of whether the electrical center was above or below the fifth intercostal space.
However, in most cases these changes were equal to or smaller than beat-to-beat or observer variation.

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中央手術部における過去のデータを詳細に分析し,その結果をふまえて合理的な手術部の運営方法に改めるべきであると考えた.そこで昭和53年度の全手術患者3,879例について,手術明細表に記載されている事項をコンピュータに入力し,必要に応じて種々のデータが引き出せるようなシステムを試作した.今までこのような解析ができなかった理由は,病名および手術名があまりに多岐にわたっていてコード化することが困難であったからである.今回改訂発表されたInternational Classification of Diseasesの日本語版は,あらゆる病名を網羅していて使いやすく実用的であることが確認できた.またわが国の社会保険診療報酬規定の甲表区分番号による術名コードも,普遍性と実用性の面ですぐれていることが実証できた.

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Cold cardioplegia has been appreciated as a superior method of myocardial protection, but the ideal coronary perfusate has not yet been established. In this study three types of solutions were tested as a coronary perfusate to choose the most suitable solution by comparing hemodynamics, enzymes and histology before and after clamping the aorta for 2 hours.
In 6 canine hearts that were perfused with cold Ringer's solution (Group I), only one heart was able to be resuscitated and serum enzymes (GOT, LDH, CPK and CPK-MB) were prominently increased. Interstitial edema of the myocardium was severe histologically. In 9 hearts that were perfused with cold Collins' solution (Group II), 5 hearts were able to be resuscitated. The enzymes were all increased and myocardial interstitial edema was prominent. In 6 hearts that were arrested with cold Collins' solution and immediately thereafter perfused with cold Ringer's solution which contained 30 mEq/l of potassium (Group III), resuscitation was successful in all hearts. CPK-MB was not significantly increased and interstitial edema was mild.
In Group I, myocardial dysfunction was thought to be due to anoxic injury. In Group II, the dysfunction was thought to be secondary to the excessively high concentration of potassium. In Group III, it was concluded that anoxic myocardial injury was prevented because cardiac arrest was maintained with 30 mEq/l potassium and the injury due to the perfusate itself was also minimized because potassium concentration was lowered to 30 mEq/l and that the induced myocardial dysfunction was minimal.

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¹⁴C·denatured (d-) DNA, ¹²⁵I·d-DNA and ³H·Actinomycin D·d-DNA were used as radioabelled DNA antigens for radioimmunoassay of antibody to d-DNA. The ¹⁴C·DNA derived rom E. Coli was the most suitable antigen for simultaneous detection of antibodies to native n-) DNA and d-DNA. ¹²⁵I·d-DNA was easily prepared by iodination of heat denatured alf thymus DNA in vitro. ³H·Actinomycin D·d-DNA was also easily prepared by mixing -DNA with ³H·Actinomycin D in vitro. Using normal human sera and systemic lupus ery hematosus (SLE) sera that had contained antibody to d-DNA, half saturated ammonium ulfate method and filter method were employed to separate immunoglobulin-bound antigen rom free antigen. To avoid nonimmunological bindings to d-DNA, pH and ionic strength f assay system were determined as 8.3 and 0.15 respectively. In the filter method, application f sonication to radiolabelled d-DNA prevented nonspecific binding of the antigen to the filter embrane. However, in the half saturated ammonium sulfate method, d-DNA binding between LE sera and sonicated radiolabelled d-DNA decreased markedly.
When ³H·Actinomycin D·d-DNA was the antigen, neither the half saturated ammonium ulfate method nor the filter method was suitable for evaluation of antibody to d-DNA.
There was fairly good correlation between the half saturated ammonium sulfate method nd the filter method, using either ¹⁴C·d-DNA or ¹²⁵I·d-DNA as the antigen. The half satu ated ammonium sulfate method and the filter method were reproducible, quantitative, sen itive and specific enough to detect antibody to d-DNA.

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Antibodies to native (n-) DNA and denatured (d-) DNA were detected simultaneously and quantitatively in the sera of patients with systemic lupus erythematosus (SLE) and other rheumatic diseases by a filter method using ¹⁴C·n-DNA or ¹⁴C·d-DNA as the radiolabelled antigen. In a group of patients with SLE, most of the sera had antibodies to both n-DNA and d-DNA, only a few sera had antibody to d-DNA alone. In contrast, none of the sera reacted with n-DNA alone. On the other hand, sera from patients with progressive systemic scleroderma, dermatomyositis, polymyositis or Sjøgren's syndrome had antibody to d-DNA alone. In order to estimate the participation of anti-d-DNA antibody in lupus nephritis, patients with SLE were classified into two groups according to immunofluorescent glomerular staining. In the group of patients that had lumpy or granular staining, the sera reacted predominantly with n-DNA. In contrast, sera from the other group of patients that had mesangial or linear staining had antibodies that mainly reacted with d-DNA. The difference in reactivity between these two groups was statistically significant (p 0.02).
In the other group of sera from patients with non-rheumatic diseases, anti-d-DNA antibodies were detected by the half saturated ammonium sulfate method using ¹²⁵I·d-DNA as the antigen. Positive incidences of anti-d-DNA antibody in these group were as follows: lung tuberculosis 21%, Graves' disease 55%, Hashimoto's thyroiditis 73%, chronic hepatitis 52%, cancer patients 25%, and patients undergoing hemodialysis 24%. Significant correlation between antinuclear antibody and anti-d-DNA antibody was seen in a group of patients with Hashimoto's thyroiditis, in patients undergoing hemodialysis, and in lung tuberculosis. In patients with chronic hepatitis, significant correlation was seen between HBsAg and anti-d-DNA antibody.
These results suggest that the anti-d-DNA antibody has an extremely wide distribution in rheumatic and non-rheumatic diseases with the highest titer and incidence in SLE. In SLE sera, however, anti-d-DNA antibody is less relevant to the severity of lupus nephritis and has a close correlation to anti-n-DNA antibody.

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