The authors has accidentally had an opportunity to observe a severe case of sepsis accompanied by distinct leucopenia and anemia. The case did not show any cardiac symptoms, and both of the liver and spleen were not palpable. The only symptom was high remitting fever with perspiration. In serveral instances, Gram-positive diplococci were detected from blood as well as from the exudate collected from right pleural cavity. An intensive chemotherapy and blood transfusion were applied for this case. Sulfonamide and penicillin were also administered. Especially in the case of penicillin, a total of 80, 000, 000 units were administered. Two injections of 1, 500, 000 units of water soluble penicillin were given daily in the beginning, and later they were substituted by penicillin in oil. Despite the above intensive treatment, no antifebrile effects were noticed. Just at that moment, aureomycin was made available for the treatment, which was administered as follows. For the first two days, two capsules every three hours totalling sixteen capsules or 4 g daily, for the next three days, two capsules every four hours totalling twelve capsules or 3 g daily, and for the next two days, two capsules every six hours totalling eight capsules or 2 g daily were given. Starting from the following day, one capsule every six horns totalling four capsules or 1 g daily were given. Thus a total of 100 capsules or 25 g of aureomycin were administered. The fever dropped 9 days after the initiation to the 37°C level of the treatment, and recovered normal temperature after 13 days. The blood sedimentation rate was 21 within 1 hour after 24 days since the initiation of the treatment. The diplococci had disappeared during the course of penicillin treatment. As side reaction of the drug, nausea was noticed on the third day, which was not sufficiently distinct to discontinue the treatment. Thus, as stated above, aureomycin demonstrated a striking effectiveness to improve all clinical symptoms on a case, for which penicillin failed to show any effectiveness inspite of the administration of a known sufficient dose in the past literatures. The present paper reports the details of the treatment.
This is a case of 19 years old female with the principal complaint of languor in both of the upper extremities. In the anamnesis, she claimed that she could feel pulsation up till her age of 7 or 8. However, during her course in the primary school, no particular illness was experienced. Since her age of approximately 18, she had been becoming easily get tired, had been complaining of shortness of breath, palpitation of the heart. At times, she had to lower her head with pale face. In the present status, she had no disturbances in her eyesight. According to the results of the physical examinations, 1) pulsations could be felt only at inner carotid and femoral arteries, but not at the radial artery or other places, 2) in the hematological findings, blood sedimentation rate after 1 hour was 70, after 2 hours, 120; coagulation time, 20 minutes ; circulation time, 16 seconds ; plateletts count, 300, 000 per cmm ; no increment in blood globulin content, 3) in the tests for vegetative functions, pharmacologically, atropin test was strong positive ; physically, Czermack reaction was positive, 4) the enhanced carotid sinus reflex showed Type IV according to Prof. Saito, 5) ophthalmologically, no particular abnormality in the eye ground or other places. In this case the patient stated that occasionally the immage of electric light blurred, but no particular symptomes were noticed otherwise. However, the case furnished every symptomes of so-called “myaku-nashi byo”, therefore, the case was entirely different from Burger's disease. Although Prof. Shimizu, Tokyo University, claims that “myaku-nashi byo” is caused by the obliteration of carotid artery and subclavian artery, the severity of this case seemed slightly milder. Most probably, this case was caused by the relatively strong obliteration of subclavian artery and slight obliteration cf carotid artery.
Seminoma is a malignant tumour exclusively found in testicle, which was denominated by Chevassu in 1906. However, at that time, it was reported as a testicular tumour of large cells, This denomination by Chevassu was based on the theory that this tumour is originated from the epithelium of the convoluted seminiferous tubules. Nevertheless, even at present, some claim that this is a tumour of epithelial origin, and some claim that this is a sarcoma, thus no conclusive theory has yet been reached. Resently, authors happened to attend a case of 34 years old suffering from undescended testicle in the left inguinal region accompanied by this tumour, and had the opportunity to observe clinically and to perform pathological and histological examinations on the enucleated testicle. The present paper reports the results of the above findings and discussions Pathological and Histological Findings. The parenchyma of the tumour is encapsulated by connective tissue membrane, and further separated into cellular masses of various irregular shapes and sizes by septa The relationship between the cells and interstitial tissue is generally irregular and they are intermingled forming cellular masses of various sizes. The cells of the tumour is combined in a complicated picture. In certain portion, the tumour is consisted of gatherings of small cavities, the walls of which is covered by endothelial cells or reticuloid cells with small rodshaped nuclei. In certain other portion of the tumour, cells suggesting of syncytium are observed. However, the major part of the tumour is consisted of large epithelial polygonal cells, weakly stained nuclei are seen in a fairly large number of the cells. The interstitium is infiltrated by small round cells, which are loosely separated by a substance to be called “lymphatic stroma”. This is one of the characteristics of this tumor.In view of the above findings, this tumour is considered to be a seminoma with the characters of mixed tumor to large extent. Clinical Symptoms. The plincipal c inical symptoms are relatively chronic swelling and sense of opression. In most cases of the age in which the patients have perfect sexual ability, it occurs in the right testicle. However, this case occurred in the left testicle. This tumor is believed to be originated from the stem cells related to the semen production. Since the stem cells are undifferentiated cells, in case the proliferation of such stem cells occurred, the formation of teratoma or mixed tumour, which contains tissues developed from three germ layers, is considered quite probable. Specifically in the cases of seminoma, a good number of the cases shows the characters of mixed tumour demonstrating various histological pictures in one same specimen. Each case develops to a particular direction showing a specific histological picture. The above are the descriptions by various workers in the past. Chorion epithelioma is one of them, which was reported by Friedlander and Takano. Beside the above, myoma, fibroma, mixoma and chondroma are recognized as complications of this tumour. As to the so-called primary genital stem cell theory, no decisive conclusions have yet been reached. Stieve claimed that the tumour is originated from endodermic wandering cells rather than from the pre-stage of seminal epithelial cells. As for the treatment for this case, due to the proximate cause (undescended testicle in this case) and unfavorable prognosis, early enucleation of testicle and inguinal lymphnodes combined with X-ray treatment is considered to be rational and adequate.
The following experiments were performed in order to investigate the significance of bile or biliary acid administered as enema in combination with calcium preparations, thereby further to elucidate the mechanism of absorption of calcium from the large intestine. First of all, the methods of administration of biliary acid in combination with calcium preparation were scrutinized, and then the influence of ligature of common hepatic duct and cystic duct on the absorption of calcium from the large intestine. On the other land, the bilifaction by. the rabbit, the common hepatic duct of which was ligatured, was investigated. Further, in order to examine the occasional absorption of calcium from the large intestine even when it was administered alone as enema, the correlationship with the room temperature was also investigated. 1) When calcium preparation alone was administered as enema, the absorption of calcium chloride was influenced by the room temperature most extensively. At the temperature exceeding 25°C., the content of calcium in the serum demonstrated an increase of 16.57 mg/dl at the maximum 210 minutes after the enema. Following the above, calcium salicylate demonstrated an increase of 14.38mg/dl at the maximum at the temperature exceeding 25°C. In the cases of calcium lactate, calcium glycerophosphate, calcium carbonate or calcicol, the absorption was not affected by the room temperature. They were not absorbed when they were administered alone as enema. 2) When calcium chloride alone was adminstered as enema after the subcutaneous injection of taurocholic acid, the absorption of calcium from the large intestine was observed. In the case of calcium salicylate, the absorption was noted on some occasions, but not on others. No absorption was observed in the case of calcium lactate. 3) A similar tendency was observed with the intravenous injection of taurocholic acid. Calcium lactate was not absorbed even at 30°C. 4) When calcium lactate or calcicol combined with taurocholic acid was administered as enema, both of the calcium preparations were absorbed very well. 5) In the cases of calcium lactate or calcicol combined with glycocholic acid, both of the calcium preparations were absorbed. In the case of calcium carbonate, no absorption was observed. 6) The enhancement of calcium absorption from the large intestine by cholic acid was weaker compared with those of taurocholic acid or glycocholic acid. 7) In the cases of calcicol or calcium lactate combined with bile of various animals (ox, pig and rabbit) administered as enema, the calcium content in the serum was increased indicating the presence of the absorption of calcium from the large intestine. In the case with rabbit bile, the enhancement seemed strongest, which might be attributed to the higher room temperature at the time of experiment. 8) When calcium chloride alone was administered as enema after the ligature of the common heptic duct and cystic duct, the increase of serum cak ium was observed indicating the presence of the absorption of calcium from the large intestine. However, no major difference from the control test was noticed in this case. In the cases of calcium carbonate, calcium lactate, calcium glycerophosphate and calcicol, the content of serum calcium remained unchanged. In the case of calcium salicylate, no remarkable difference from the control test was noted. 9) The content of biliary acid in the serum after the ligature of common hepatic duct indicated increment up to the 9th day from the ligature though slight in the amount. 10) When calcium chloride or calcium lactate was administered as enema in combination with rabbit bile, cholic acid or glycocholic acid, the content of biliary acid in the serum demonstrated an increment. In short, when calcium preparations are to be administered as enema in combination with bile of various animals or biliary acids,
In view of the fact that bile or biliary acid enhances the absorption of calcium from large intestine, thus extremely increases the calcium content in the blood causing acute intoxication death of rabbit, the author believed that, if the absorption of calcium is enhanced by substances other than bile or biliary acids, it will be of extreme significance in the elucidation of the absorption mechanism, and he also presumed that it will further clarify the calcium absorption enhancing activity of bile or biliary acid in the large intestine. Hence he attempted the following experiments. In the first place, glycocoll and taurin as amino acids, which are presumed to be easily absorbed from the large intestine when administered alone as enema, glucose and sucrose as sugars, peptone and gelatin and starch as substances hardly absorbed, were selected and each of them was administered respectively combined with calcium preparation as enema. In addition, blood pressure and respiration rate were observed in order to note the effect of the enhanced 'calcium absorption from the large intestine on the circulatory system of the rabbits. 1) In the cases of glucose, sucrose or starch solution given alone as enema, no significant change of calcium content in the serum was observed. 2) In the case of glucose combined with calcium chloride, the calcium content in the serum extremely increased indicating the enhanced absorption of calciu.n from the large intestine. The enhanced absorption of calcium sulfate or calcium lactate were not clearly noted. 3) In the case of sucrose combined : with calcium chloride, calcium content in the serum was increased when a highly concentrated solution of sucrose was used. Absorption of calcium sulfate or calcium lactate were generally not affected. 4) In the case of starch combined with calcium chloride, the calcium content in the serum was distinctly increased and intoxication symptoms were observed in the rabbits. The absorption of calcium sulfate or calcium lactate were almost not affected. 5) In the case of glycocoll combined with calcium chloride, the calcium content in the serum was extremely increased, and intoxication death was also noted. The absorption of calcium sulfate was not affected, but that of calcium lactate was enhanced. 6) In the case of taurin combined with calcium chloride, the calcium content in the serum was increased, and intoxication symptoms and intoxication death were also observed. The absorption of calcium sulfate and calcium lactate were not affected. 7) In the case of peptone combined with calcium chloride, the calcium content in the serum was increased and intoxication death was also observed. The absorption of calcium sulfated and calcium lactate were almost not affected. 8) In the case of gelatin combined with calcium chloride, gelatin did not clearly affect the absorption of calcium from the large intestine. 9) when calcium preparation combined with the mixture of glycocoll and glucose was administered as enema, the absorption of calcium chloride as well as of calcium sulfate and calcium lactate were remarkably enhanced, and intoxication death of rabbits were also frequently observed. 10) AA remarkable lowering of blood pressure was caused by the administration of calcium chloride combined with glucose or glycocoll as enema. Further, in the case of the mixture of glucose and glycocoll combined with calcium chloride, the blood pressure was remarkably lowered, and the respiration rate was also decreased in he course of time. In short, the acute intoxication death seen in rabbits when calcium preparation combined with amino acids or glucose was administered as enema, is considered to be induced by rapid absorption of calcium from the large intestine followed by the remarkable lowering of blood pressure. Further, the absorption of amino acid and glucose, which were administered in combination, was also considered to be enhanced.
The present paper reports a case of meningeal apoplexy which demonstrated Stieda's shadow during the treatment in our Department of Internal Medicine. The case was a 45 years old male. His occupation was tin-smith. On the bases of myocardiac disturbances, arteriosclerosis and nephritis, he had an attack of meningeal apoplexy after 2-3 months' prodromal symptoms. During the course, on approximately 24th day of disease, f e complained of pain, slight redness, swelling, diflculty in flexion and jumping patella in the left knee joint. Later (on the 55th day of disease), two bow-shaped independent osseous shadows were recognized by X-ray examination in the proximity of the tibial condyle of femur in parallel with the surface of the condyle. Opressive pain and slight bulging in this region was noticed. This indicated the complication with Stieda's shadow. The present paper describes the general process of these two symptoms (the case was discharged on the 81st day of disease), and also considers as to whether there exist any logical inference in the correlationship between meningeal apoplexy and Stieda's shadow.