From the pathohistological point of view, the mechanism of hemorrhage from peptic ulcer was analysed. Rupture of esophageal varices could be more dangerous than a hemorrhage from upper gastric ulcers.
However, if these invariable characteristics of hemorrhage of peptic ulcer are previously understood, they are useful for the diagnosis and differential diagnosis of the hemorrhagic source.

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1. Experimental study
Optimal conditions for the assay of human serum γ-Glutamyltransferase (s-γ-GT) activity and the distribution of it in rabbit organs were investigated.
A few experiments were carried out to elucidate the mechanism of rise in s-γ-GT activity, using rabbits as a experimental animal.
Obtained optimal conditions were pH 8.4-8.8, 6.5 mM γ-Glutamyl-p-nitroanilid as ubsstrate concentration and 30 mM glycylglycine as activator.
The activity of s-γ-GT was determined in 206 normal human subjects by means of Orlowski's modification.
It showed a log-normal distribution. The normal range was 2-26 mU/ml and C. V. was 4.5%.
The highest γ-GT activity was obtained in the rabbit kidney, but only 0.92% of γ-GT activity was present in the liver and mainly localized in the microsomal fraction.
Slightly increased γ-GT levels in both rabbit liver and serum were observed in 48 hrs after treatment with CCl₄, while marked elevation of γ-GT activity was recognized in both of them after bile duct ligation.
γ-GT activity in microsomal fraction of the rabbit liver was distinguished from that of the kidney or the pancreas in its origin by their electrophoretic mobility.
Two peaks of γ-GT activity were found in the elevated γ-GT sera by sephadex G-200 gel filtration. The first peak was considered to consist of rather high molecular weight.

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2. Clinical study ; Correlation between change of γ-Glutamyltransferase activity and prognosis in acute viral hepatitis
In 119 cases of acute viral hepatitis (AVH), which were classified into 6 types according to clinical and histo-pathological criteria, serum γ-Glutamyltransferase (s-γ-GT) was assayed in comparison with other hepatic enzymes and was estimated in prognosis of this disease.
Level of s-γ-GT did not reflect hepatocellular injury, but moderately elevated at the crisis of the disease and delayed recovery to normal level.
The change of s-γ-GT level was not always paralleled with that of s-alkaline phosphatase, s-Leucine aminopeptidase and s-Bilirubin in AVH.
The γ-GT/GPT ratio was thought to be the most useful indicator to evaluate clinical type, stage and severity in AVH.
Estimation of the clinical course in AVH could be obtained from the correlation between γ-GT and transaminase in early stage, although the γ-GT/GPT ratio never indicated the tendency to chronicity or fibrosis. However, no elevation of γ-GT could be found even if liver parenchymal damage was fatal.
The dissociation between s-γ-GT and s-Bil, was considered the severe sign in prognosis of this disease.
Determination of γ-GT activity and the γ-GT/TA ratio was extremely valuable to differentiate acute alcoholic hepatitis from AVH, but it was not useful in acute exacerbation of chronic liver disorders.

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1. The measured average: the height and width of the lung field and heart shadow among all of the boys and girls up to 15 years old are greater in values when they are compared with those of the older. The angle of the inclination of the heart increases as one grows older. The difference between the right and left lung field among boys and girls: both show greater values in height in the left, and in width in the right. The difference between sexes: girls show higher value only in height, and boys show higher values in the rest.
2. The average indexes: as one grows, both among boys and girls, heart-lung-field-height indexes become smaller; the height in the lung field become proportionately higher when they are compared with the height in the heart shadow. And heart-lung-field-width indexes, A and B, have both greater values, and width of the lung field becomes proportionately higher when it is compared with the width of the heart shadow. It may be added, that the right has greater values than left but there is little difference among the sexes.
3. Correlations: As the angle of the heart shadow becomes larger, the value of the above mentioned three indexes have an apparent correlation to the angle in the left and right and also among both bodys and girls.
The height in the heart shadow becomes proportionately greater as it is compared with the height in the lung field. Width of both middle and lower lung field become proportionately greater in values as they are compared with those of the widest and lower parts of the heart shadow.
It is clearly proven in the above mentioned study that the morphology of the lung field and heart shadow is determined by the angles of inclination of the heartand that there is a definite morphological relatioeship between the two.

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A 59-year-old woman had a abdomen tumor, so that she was hospitalized. Roentgenogram, endoscopy and super selective celiac angiograpy of the stomach revealed a walnutsized tumor on the anterior wall of the angle. The tumor had an ulceration in its midst with central necrosis. It also showed bridging folds, but otherwise it was covered with normal mucosa. As danger of bleeding was considered to have arisen from the ulcer, operation was performed. Gastrectomy was done according to Billroth I method. The resected neoplasm was a very localized one, measuring 6.5 × 6.5 × 3.5 cm, elliptical protruding with ulceration. Histologically it was diagnosed as neurimona of the stomach.

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Many experiences of the non-surgical treatment of perforated duodenal ulcer were reported in the foreign countries. In Japan, it is generally believed that perforated duodenal ulcer should be operated immediately. We had succesed to cure a perforated duodenal ulcer by non-surgical treatment.
A 55 years old man was admitted in our hospital because of the severe attack of the epigastric pain in April 1975. The scout film of the abdomen showed free air under the right side of diaphragm, by which diagnosis of perforated duodenal ulcer was confirmed and which enforced us the immediate operation. However he had the severe complications with myocard infarction and diabetes mellitus, so we had to begin the non-surgical treatment, such as the continuous gastric suction and the intravenous administration of antibiotics.
After systemic control for myocard infarction and diabetes mellitus, the surgical operation for duodenal ulcer was performed in 18 th day after perforation. The resected specimen showed perforated ulcer of the size of 4 × 8 mm on anterior wall of duodenum.
He was discharged in the 41st day after complete cure.

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Thirty-two out-patients of our department who came with a complaint of sleeping disturbance (16 males and 16 females), were given with 10-20 mg of flurazepam free base, and 16 patients among them were given further 5-10 mg of nitrazepam in turn before going to bed. The following results were obtained.
1. Among 32 cases received with flurazepam free base, the drug was very effective in 6 cases, moderately effective in 16 cases, effective in 9 cases, and ineffective in 1 case ; among 16 cases received with the drug and nitrazepam in turn, flurazepam free base was more effective in 7 cases and was almost equally effective in 7 cases, and nitrazepam was more effective in 2 cases.
2. The actvities to induce sleeping and fast sleeping and to keep it were almost equal between these two drugs ; it may be said as the characteristic of flurazepam free base that it gave refreshing feeling when waking up and was free from hangover of the drug.
However, in some cases, nitrazepam was more effective, and it will be further studied, which drug must be used in individual cases.
3. The used dose of flurazepam free base was 10-20 mg, and when increasing it, some complained unpleasantness on waking up. Usually a dose of 10-15 mg will give good sleeping.
4. No noteworthy side effect was observed in the biochemical test, complete blood count and urinalysis performed on 13 cases receiving flurazepam free base before and after the treatment.

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