Sugar metabolism were studied upon twenty patients who were totally gastrectomized. They were survived for one year or more after operation for gastric cancer. Ten cases of partially gastrectomized patients and five healthy normal subjects were selected as control. Reconstruction after gastrectomy were performed with double tract method (in ten cases), jejunal interposition method (in three cases), Roux-en-Y method (in five cases), and other methods (in two cases) on totally gastrectomized patients and Billroth I method on all of partially gastrectomized patients.
Studies were performed upon oral glucose tolerance test (OGTT), intravenous glucose tolerance test (iv GTT), and oral xylose absorption test (OXAT) . Blood sugar, serum immunoreactive insulin (IRI), and xylose in urine were determined during those tests. The results were as follows ;
1) After OGTT, the blood sugar curve in the gastrectomized groups showed oxyhyperglycemic curve and this tendency was more dominant in the totally gestrectomized group. The IRI level reached its peak at thirty minutes in the totally gastrectomized group and began to fall thereafter, however, the IRI level reached its peak later in the partially gastrectomized group.
2) After iv GTT, the blood sugar levels were higher in the gastrectomized groups than in the healthy normal group. The blood glucose curve in the totally gastrectomized group was similar to that in the partially gastrectomized group. The IRI level in the totally gastrectomized group was lowest in the three groups.
3) After OXAT, although the xylose levels in urine in the three groups were in a normal range, there was slight difference in the blood xylose levels. Namely the blood xylose level in the totally gastrectomized group reached its peak earliest in the three groups.
4) Concerning the reconstructive methods after total gastrectomy, the blood sugar levels after OGTT reached their peak earlier in double tract method and jejunal interposition than in Roux-en-Y method. This seemed to be due to some factors in the intestinal tract, for instance, glucose absorption was accelerated by cibarian passing in the duodenum.
5) There was no significant change in the capacity of glucose tolerance among the totally gastrectomized patients combined with about resection of the pancreas.
6) Probablely, there is no possibility that repeated insulin hypersecretion following hyperglycemia after gastrectomy causes beta islet cell hypofunction and develops secondary diabetes.

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It has been said that the pancreatic secretion is related with autonomic nerves and humoral factors, but mechanism of the pancreatic secretion is not proved in detail. In this series, the effect of 6-Hydroxydopamine (=60 HDA) that causes the chemical sympathectomy, on the change of the pancreatic exocrine secretion was examined by measuring the pancreatic blood flow and the volume of pancreatic juice.
As the results, the volume of pancreatic juice was decreased and its bicarbonate concentration was deteriorated markedly after 6-OHDA administration.
In addition, the effect of secretin on the pancreatic blood flow was not affected after administration of 6-OHDA. On the other hand, the pancreatic exocrine secretion was increased by vagal stimulation, and the volume of pancreatic juice increased 146.2% on the average. But after administration of 6-OHDA, the pancreatic secretion was disappeared by vagal stimulation, but accelerated by L-Dopa administration.
Becausa 6-OHDA depletes the adrenergic amines from the sympathetic nerve terminals, if the pancreatic exocrine secretion is controlled only by the factor of blood flow, it should be accelerated with the increase of pancreatic blood flow after 6-OHDA administration. However in this studies, not only the nervous pancreatic secretion by vagal stimulation but also humoral secretion of pancreas was inhibited after 6-OHDA administration. From this, I considered that 6-OHDA acted on a factor except the blood flow. Namely, the inhibition of pancreatic secretion by 6-OHDA depends on the decrease of dopamine because 6-OHDA depletes not only noradrenalin but also dopamine. In this studies, the fact that the nervous and humoral pancreatic secretion were inhibited by 6-OHDA administration suggests the existence of charactor like the endocrine cell in the exocrine cell and the possibility that the production of pancreatic juice and synthesis of dopamine take place in the cells. Since amines contained in endocrine cells were concerned with the mechanism of endocrine secretion, exocrine secretion was affected by amines equally and then pancreatic exocrine secretion was caused by dopamine.

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This study was carried out to investigate the factors influencing to the results of speech aid appliance and the indications of it, examining the improvement of speech and velopharyngeal function, and asking the patient's adaptation by means of opinionaire.
The subjects of this study consisted of 92 patients with cleft lip and palate, and congenital velopharyngeal incompetence.
As a result, following conclusions were obtained.
1. Good results were obtained in cases having well-shaped soft palate under 4 years old, and taking speech aid appliance under 7 years.
2. Poor results were obtained in cases having ill-shaped soft palate, treated at older age, and associated with little movements of the lateral pharyngeal walls.
3. In 26 cases (28.3 %), speech aid appliances were removed as the result of good velopharyngeal closure, almost of them were treated at early age.
4. As the complaints of patients for speech aid appliance, unsuitable feeling, contact pain, decrease of appetite, hearing loss, snore, and inconvenience were recognized, but they were very few.
5. In 24 cases (26.1 %), speech aid appliance were reconstructed due to unsuitability and breakage.
6. As the other therapy, operations were desired in 13 cases (20.6 %) of the patients with good result, and 1 case (7.7 %) with poor result.

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By the recordings of the serial echocardiograms of the patients with acute myocardial infarction, analysis of aortic root motion and prognosis in the acute phase was investigated.
The subjects employed were 62 cases, in which 49 alive and 13 died (21%) in the hospital.
(1) Significant correlations were observed between aortic wall excursion (AWE) and stroke volume (r=0.51) .
(2) In most cases, AWE and mean aortic wall velocity (mAWV) on admission were smaller, and they were increased gradually.
(3) In the group with smaller AWE, more cases with heart failure were observed.
(4) AWE was smaller (under 7 mm) in eleven of thirteen died cases. In the group with small AWE, wide left ventricular dimension, wide left atrial dimension, small mitral valve excursion and short PR-AC time, five cases out of six were complicated with heart failure and five out of six died. On the other hand, in the group with normal AWE, left ventricular dimension, left atrial dimension, mitral valve excursion and PR-AC time, only one case was complicated with heart failure and none of them was died and the prognosis for this group was considered to be good.

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The M. rectus abdominis of man was examined, noting the cross-sectional area of venter musculi, the number of muscle fibers per sq. mm., the total number of muscle fibers, the thickness of muscle fibers and the occupational area of muscle fibers in cross-section of the right abdominal rectus specimen of 22 adults. The results obtained were compared with the previously reported pertinent data of the other muscles.
1. The average values (M) of each data of the M. rectus abdominis examined was 205 mm² in cross-sectional area, 172, 327 in total number of muscle fibers, 1151 μ² in muscle fiber size and 91% in occupational ratio of muscle fibers.
2. Those muscle specimens which have large cross-sectional area tend to be inferior in number of muscle fibers and to be superior in total number of muscle fibers, size of muscle fibers and occupational ratio of muscle fibers than the specimens which have small cross-sectional area. But the muscle specimens with broader cross-sectional area do not always have a larger size and larger density of muscle fiber while some one of them do contain rich interfibrous connective tissue.
3. As to the relationship of the size of muscle fiber to cross-sectional area of venter musculi, a positive correlation was found to exist, and its of number of muscle fibers per sq. mm. to those showed a tendency of negative correlation.
4. Comparing the myofibrous organization of Rectus abdominis with the other muscles, we found that the cross-sectional area and the total number of this muscle was smaller than that of adductor longus and biceps brachii, and that the size of muscle fibers of this muscle was larger than that of the other muscles except adductor longus.

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It is generally known that acupuncture analgesia is not always observed in all individuals. In this study, the effectiveness of acupuncture analgesia was examined by measuring tail-flick latency of rats. A significant increase (P<0.05) of tail flick latency was observed in about half of the examined rats. Accordingly, animals were classified into an acupuncture effective group and a non-effective group by this criterion.
In another experiment, it was found that acupuncture effective animals (n=10) contained more endogenous morphine-like factors (MLF) in whole brain except cerebellum than acupuncture non-effective animals (n=9) . The contents of MLF unit in acupuncture effective animals were 25 times greater than those of acupuncture non-effective animals. The close correlation between individual acupuncture effectiveness and the individual amount of MLF (in the brain) was obtained and its coefficient of correlation was 0.71. No correlation was observed between pain threshold in normal state and the contents of MLF in the brain, and also any difference was not observed in the contents of opiate receptor in various parts of the brain between acupuncture effective and non-effective animals
Above results indicate that the individual variation in effectiveness of acupuncture analgesia might be attribute to that in contents of brain MLF.

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In previous work from our labolatory, it was found that 1) morphine like factor (MLF) is involved in acupuncture and periaqueduct central gray (PAG) stimulation produced analgesia (SPA), 2) the individual variation in effectiveness of acupuncture analgesia fairly corresponed to that in contents of brain MLF and 3) the individual variation in effectiveness of acupuncture analgesia also fairly corresponed to that of PAG-SPA and of morphine analgesia. It is known that MLF includes several types of peptides, such as methionine and leucine enkephalins and α-, β-and γ-endorphins and that D-phenylalaine is a inhibitor of carboxypeptidase acting on above peptides.In present experiment, the effect of D-phenylalanine on acupuncture, PAG-SPA and morphine analgesia was investigated to clarify the underlying mechanism of individual variations in effectiveness of such analgesia.
Inhibitory effect of D-phenylalanine in peptidase was confirmed by biological assay methods. The inhibition of guinea-pig illeum contraction by enkephalin was reversed by presence of supernatant of rat brain hemogenate which contains peptidase. However in the presence of 10μg/ml D-phenylalanine, the above reversal action of brain homogenate on encephaline inhibition disappeared. Administration of 200μg of met-enkephalin to brain ventricule of rat caused analgesia measured by tail-flick latency. Intraventricular administration of same doses of met-enkephalin after intraperitoneally application of 250mg/kg D-phenylalanine caused more potent and prolonged analgesia.
Rats were classified to acupuncture effectvie and non-effective animals by criterion of a significant increase (p<0.05) of tail-flick latency. After treatment of 250mg/kg D-ph-enylalanine, acupuncture analgesia in acupuncture non-effective animals increased markedly and reached to that after administration of D-phenylalanine in acupunctue effective animals.
Simillar results were also oserved in PAG-SPA and in 0.5mg/kg morphine analgesia. PAG-SPA or morphine analgesia was not obvious in acupuncture non-effective animals, while it was prominent in acupuncture effective animal. Aftear treatment of D-phenylalanine, PAG-SPA or morphine analgesia was enbanced markedly in acupuncture non-effective animals and was slightly increased in acupuncture effective animals and hence the indivdual variation of effectiveness of such analgesia disappeared.
These data indicate that 1) the iudividual variation in peptidase activity might cause and individual variation in effectiveness of analgesia. 2) morphine may liberate analgesic peptides to cause in contents of MLF analgesia.

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Afferent pathways to cause acupuncture anesthesia was investigated by recording acupuncture stimulation-induced evoked potential in the brain.
The acupuncture stimulation was applied to the base of the ear which is known as an effective site to cause acupuncture anesthesia, and evoked potential was recorded through chronic implanted electrode in unanesthetized and unrestained rabbits.
Evoked potential was induced in the restricted dorsal part of the mesencephalic periaqueductal central gray (PAG), and the configuration of evoked potential was initial positive (P₁) and negative (N₁) waves.
The threshold stimulous intensity to cause evoked potential was that to cause muscle contraction of acupuncture stimulated point As increasing of stimulation intensity, the magnitude of evoked potential increased. When stimulous intensity increased to noxious one, later appearing positive (P₂) and negative (N₂) waves were induced. Intraperitonealy applied 10mg/kg morphine had almost no effect on configuration of evoked potential. Evoked potential was hardly induced by body acupunctural stimulation which was known as an uneffective site to cause acupuncture anesthesia. Other brain structures in which evoked potential was induced by acupuncture stimulation of ear base were centro-medial part of thalamus, septal nucleus, cingulate bundle and hippocampus which are pain motivational-affective dimension. Evoked potential was not recorded from caudate nucleus.
PAG stimulation also caused evoked potential in septal nucleus, cingulate bundle and hippocampus.
The sum of latency in evoked potential from PAG to cingulate bundle and from periphery to PAG is almost equal to that from periphery to cingulate bundle.

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The cingulate bundle in acupuncture analgesia was investigated by lesion and stimulation experiments. The pain threshold of tail-flick test in rats was increased by acupuncture stimulation or by intraperitoneally injected 0.5 mg/kg morphine in acupuncture effective animals which showed a significant increase (P<0.05) in tail-flick latency by acupuncture stimulation.
Insertion electrode (0.4 mm in diameter) to caudate nucleus through cingulate bundle or just to cingulate bundle abolished acupuncture analgesia and morphine analgesia, while insertion electrode to the cortex above cingulate bundle did not abolish both kinds of analgesia. Lesion of septal nucleus by insertion electrode also abolish both kinds of analgesia.
Stimulation of septal nucleus caused analgesia which was abolished by intraperitoneally injected 1mg/kg naloxone. Periaqueduct central gray (PAG) stimulation-produced analgesia was abolished by lesion of cingulate bundle.
Since it was reported that evoked potential was induced in periaqueduct central gray, septal nucleus, cingulate bundle and hippocampus by acupuncture stimulation and that PAG lesion abolished acupuncture and morphine analgesia, the abolishment of both kinds of analgesia by lesion of cingulate bundle might be due to lesion of acupuncture afferent pathway through PAG and cingulate bundle. Morphine analgesia might be caused by this pathway.

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Neuronal unit activities responded to noxious stimulation were recorded extracellulary with metal microelectrodes from brainstem reticular formation in rats. The various types of responses in unit discharges to noxious stimulation were observed and classified to 1) the responses were limitted to stimulation periode (Type I), 2) the responses occured beyond stimulation periode (Type II), 3) combination of Type I and Type II. The responses to noxious stimulation were characterized by increase or decrease in firing rate.
Therefore, the elemental types of responses were Type I excitatory (I _ex), Type II inhibitory (I _in) Type II excitatory (II _ex) and Type II inhibitory (II _in) . Combined responses of two types were I _ex+II _ex, I _ex+II _in, I _in+II _ex and I _in+II _in
Acupuncture stimulation inhibited the noxous responses in 40 of 81 noxious responded neurons. In I+II neurons, I or II response alone, or both I and II responses were inhibited by acupuncture stimulation.
Electric stimulation of periaqueduct central gray (PAG) changed unit discharge rate in about half of noxious responded neurons. PAG-stimulation inhibited the noxious responded brainstem neurons in which firing rate were not changed by PAG stimulation. This inhibition last for long time beyond stimulation periode. Naloxone did not antagnize the inhibition during PAG stimulation, but antagnize the inhibition after termination of PAG stimulation.
Above observations indicate that 1) I and II responses were caused by afferent impulses of different orgins which convergence in recorded neurons. and this difference was a basis of above classification of noxious responses. 2) acupuncture inhibtion might be presynaptic inhibition since one of two kinds of noxious responses was inhibited by acupuncture stimulation in some neurons.
Inhibition of after termination of PAG stimulation was mediated by endogenous morphine like factor (MLF), while inhidition during PAG stimulation might be mediated by direct descending inhibitory system with other neurotransmitter than MLF.

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We investigated the distribution in the chest of ⁶⁷Ga-citrate. 14 cases with diffuse lung accumulation of ⁶⁷Ga-citrate include as follows;
1) pleural invasion 2) disseminated lung lesion 3) carcinonmatous lymphangitis 4) chronic diffuse lung disease and 5) liver fuuction desorder.
Diffuse lung accumulation of ⁶⁷Ga is able to help diagnosis of several lung diseases, even when chest x-ray films have scarecely abnormal findings.

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A 38-year-old man underwent continuous lumbar epidural anesthesia for laparoscopy.
When removal of the catheter was attempted, it was found to be firmly fixed in the back and could not be removed even with the patient maximally flexed.
After laparoscopy, anterior-posterior and lateral roentgenographs were taken by injection of contrast media through the catheter, and it was found that the catheter looped in the epidural space.
After making another attempt, we succeeded to remove the catheter without severance. But examination of the catheter revealed that it was severely extended and almost severed.
We warned that there is the possibility of difficult removal and severance of epidural catheter at any time.

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Definite and classical rheumatoid arthritis (R. A.) in our clinic were examined in relation of the period of contraction and roentgenogram. Sixty-nine patients of R. A., 138 hips were studied by roentgenography, who were male 9 and female 60, ranged from 24 to 76 years of age. We observed several roentgenological changes and obtaind the following results :
1) The narrowing of joint space were observed in 7 cases, i.e. 9 joints. The past history were 12.3 years on the average.
2) The desetruction of bone were observed in 5 cases, i.e. 8 joints. The past history were 13.6 years on the average.
3) The luxation were observed in 8 cases, i.e. 12 joints. The past history were 14.3 years on the average.
4) In one side of 6 cases which undergone T. H. R., in other side roentgenological changes were observed in weigting 4 cases, on which undergone T. H. R. soon after.

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