During the last 10 years among the cases which have undergone total hip replacement in our department we were able to conduct follow-up studies on 54 cases (62 joints) and conducted clinical x-ray studies. Also the author devised a method for determining the resultant force of the hip joint-measurement method using x-ray photography and conducted studies from the biomechanical standpoint and obtained the following results.
1) Results during the last 10 years of THR cases in our department show that (mainly the Charnley-Muller prosthesis) was excellent or good (above 80 points) in 74 % of the cases which cannot be considered satisfactory results, but, in regard to pain alleviation effect, it was considered satisfactory compared with previous methods of therapy.
2) We were able to obtain uniformly favorable results up until the second year following the operation, but from the second year a reduction tendency was observed. The reason for this is thought to be due to the involvement of the ectopic bone of the hip joint or to fragmentation.
3) Postoperative complications developed in 18 % of the cases. These included dislocation 2 cases (3 %), deep infection 2 cases (3 %), loosening of femoral components 2 cases (3 %) ; and loosening of acetabular components 3 cases (5%) .
4) The resultant force of hip joint-measurement method using x-ray photography devised by the auther is simpler in comparison with other methods and useful for both the preoperative diagram and the postoperative x-ray evaluation. However, no clear correlation was observed between the resultant force of hip joint and the clinical results.
5) We measured the thickness of the acetabulum at two points in the case of acetabular dysplastic osteoarthritis (21 joints) and found that the thickness of the cotyloid cavity was twice the thickness of normal females. Also hypertrophy of double acetabular flour in the acetabular foveal area was present in 9 out of 21 joints (43%) .
6) To certain extent in the case of acetabuler dysplastic osteoarthritis if a hole is bored near to the inner plate of the pelvis, it is possible to make an ideal socket placement. In a case where a favorable boring is made, the resultant force is small. However, this is not suitable for RA hips.
7) After THR, bone atrophy of the trochanter was observed in 76 % of the cases. It is thought that an important factor is the functional failure of the abductor muscle. Following THR to improve the function of the abductor muscle it is important to carry out extensive follow up therapy over a long period of time.

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In order to minimize complications during THR, we applied two-dimensional photoelastic method and soft x-rays and we carried out both dynamic and structural studies, and obtained the following results.
1) The point where stress is concentrated in the acetabulum is always the same even if there is a change in the abductor, adductors or neck-shaft angle. This means that there is little change in the loading position of the trunk of the body onto the acetabulum and it is thought that the friction area of the socket will be limited.
2) If the abductor muscle of the hip joint is activated, the stress of the hip joint increases and this stress is directed toward the area below the sacroiliac joint.
3) The structure of the trabecular bone in the acetabulum matches well the principal stress line graphs formed from a union of the functional and non-functional groups of the abductor muscles. The results we obtained support the trajectorical theory which is concerned with the principal stress on the trabecular bone.
4) The main loading area of the acetabulum is at the frontal plane from the cotyloid cavity to the outer edge and is thought to be a sagittal plane extending from 1/3 of the frontal edge to the 1/3 of the posterior edge (middle-third), but the subchondral bone area is quite dense. At the frontal plane the main factor strongly affecting the structure of the trabecular bone is the pressure more than the abduction movement within the hip joint and in the sagittal plane the bending and stretching of the hip joint is more important than the pressure.
5) The coxa vara of the prosthesis with a strong curvature of the stem often induces fatigue fracture. Therefore, it is better introduce the prosthesis in coxa valga. Then, it is necessary to study on the form of the stem with cement.

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The distribution of sulffhydryl (SH) and disulfide (S-S) groups in pilomatrixoma and several diseases with abnormal keratinization was observed by the new histochemical staining method using n- (7-dimethylamino-4-methylcoumarinyl) -maleimide (DACM) after Ogawa's method. The results obtained were as follows : 1. Pilamotrixoma : The distribution of SH groups was great in transitional cells as the other authors' observation. 2. Trichlemmoma : SH groups were observed in basaloid cells rather than in clear cells. 3. Pilar cyst and epidermal cyst : The distribution of SH groups was the same as normal epidermis. However, in pilar cyst, there was no keratogeous zone which was rich in SH groups. 4. Squamous cell carcinoma and Keratoacanthoma : SH groups were abundant in cytoplasma and nuclei of the tumor cells. A brilliant fluorescence of S-S groups was revealed in individual cell keratinization and horn pearls. 5. Hyperkeratosis lenticularis perstans : It was suspected that SH rich protein was overproducted in granular layer. 6. Darier's disease : SH groups were observed not only in cell membrane of horny and granular layer, but also in cytoplasma of horny layer and acantholytic cells. 7. Psoriasis vulgaris : The distribution of SH groups was great in granular and parakeratotic horny layer befor treament. These results suggested that the new histochemical staining method using DACM had the advantage over previous techniques and much more usefull for the studies of the differentiation and keratinization of epidermis.

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The inoculation with epidermophyton floccosum (E. floc.), a kind of anthropophilic dermatophytes, on the skin of guinea pigs and a dog was carried out and following results were obtained. 1. E. floc. was able to be inoculated on the skin of guinea pigs and a dog. A freshly isolated strain revealed to be preferable to the inoculation and a shaking culture strain was more suitable than a stationary culture strain for inoculation. The successful inoculation was obtained with the spores of the number of 10⁵/ml or more. 2. The inoculation on a dog was more successful than on guinea pigs. 3. Arthroderma vanbreuseghemii, a zoophilic dermatophyte, revealed ectothrix microid on the hair. However, E. floc. showed only coiling around the hair. 4. Arthroderma uncinatum, a geophilic dermatophyte, was unable to inoculate on animals. 5. E. floc. proliferated vigorously on the keratin substance in hair baiting method as well as nail baiting method. This study suggests that E. floc. can carry infection from human being to animals.

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In rabbits, depilation has been known to occur in experimental xanthoma developed by means of cholestrol feeding. However, the mechanism of depilation is unknown. Rabbits were breeded with 5 % choresterol for 10 weeks. The skin biopsy preparations were examined with light and electron microscopy on 2 or 3, 5, 8, 10 weeks.
The results obtained were as follows : 1. Light microscopic observations showed that the number of catagen and telogen hairs increased, proportional to the increasing number of xanthoma cells infiltrated in dermis. Xanthoma cells did not infiltrated within hair follicles. 2. Electron microscopic observation of the sections of 2 or 3 weeks showed that lipid droplets existed within endothel, in the intercellular spaces between endothels and pericytes. Lipid droplets observed in histiocyte and fibroblasts. 3. After 8 weeks' cholestrol feeding, a large number of degenerated and vacuolated mitochondria was observed in both inner and outer root sheath. 4. The trichogram of depilated hair after 8 weeks showed that the majority of them were telogen hair. These observation suggested that depilation phenomenon in experimental xanthoma of rabbit was telogen effluvium presumably due to lipid metabolism disorder in the hair mathrix.

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Lymphocyte in the cutaneous infiltration was studied with acid α-naphtyl acetate esterase (ANAE) staining method (Horwitz et al.) using paraphin embeded specimen. Materials were 30 (33 Specimens) of verruca senilis, 22 of benign diseases and 20 of malignant tumors.
The results obtained were as follows : 1. As preliminary examination, the staining was applied to peripheral blood smear preparations and T, T′, B.and M patterns were confirmed by staining behabier. 2. It was then confirmed that E-rosette forming lymphocyte revealed T pattern and EAC-rosette forming lymphocyte B pattern. 3. As for 33 specimens of verruca senilis, the majority of lymphocyte revealed T pattern among 12 of hyperkeratotic type and 3 of irritated seborrheic keratosis. However, the majority of lymphocyte revealed B pattern among 16 of acanthotic type and 2 of adenoid type. 4. Almost all cases of malignant tumors showed T pattern predominance. On the specimens of cutaneous T-cell lymphoma, the great number of lymphocyte in the vicinity of epidermis showed T pattern befor treatment. However, after treatment, almost all of lymphocyte had been disappeared and remnant lymphocyte showed B pattern. 5. The majority of lymphocyte showed B pattern predominance among ? 2 of benign diseases. But lupus miliaris disseminatus f aciei showed T pattern predominance. It has been reported that not all the lymphocytes showed T pattern, but only helper T cell showed T pattern and there were false positive, thus lowerer number of T cell than actual number of them would be indicated. However, this study showed that the method had the advantage of the short time of reaction and the staining result was excellent. The method are not so available in Japan, but the method is useful to observe the distribution and localization of T and B cell in the cutaneous infiltration in situ.

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For more than 10 yrs., as of Sept. 30, 1979, we have treated 501 chronic schizophrenic patients at Karasuyama Mental Hospital, affiliated with Showa University. We chose 25 patients (6 men and 19 women) who were unable to leave our hospital after the rehabilitation program until now. And we induced them into prehostel ward admission, temporarily. This facility neighbors our hospital, and, there, we apply successful approaches to rehabilitation and training in daily social life behaviors. Consequently, we got the following results : 1) There were 14 patients who had been at work over 1 yr. We called them the successful group. While we called all patient unsuccessful who, as of investigation, could not leave the prehostel or returned to the hospital ward. 2) Because the prehostel is a point of contact with medical treatment and after-care, including social service, the prehostel must give complex and sensitive attention to patient treatment. So, in the treatment of patients in the prehostel group, who were inpatients, we focused our efforts on selfsupport and avoided a hospital-like atmosphere as much as possible. 3) When we examined the base of our scale to assess socialization, we could confirm improvement fully on the ability to successfully live in the prehostel. And we could also confirm a little improvement in even the unsuccessful group. 4) We determined that the prehostel period was an average of 7.7 mon through successful example. 5) We think that a few chronic schizophrenics in hospital are clients of community-care services in the process of switching over from the prehostel to the hostel and then a community apartment house.

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Definite and classical rheumotoid arthritis cases were examined in our clinic (2 to 4 stage) . Objects were 28; 54 feet, male 1 and female 27, from 34 to 84 yr of age We observed several roentgenological changes and obtained the following results : 1) Erosion and destructive changes were most remarkable at the 5th metatarsophalangeal joint. Ankylosis was observed only one time at the 1st metatarsophalangeal joint. 2) There were pes planus in 55 %, hallux valgus in 35.2 %, spread foot in 50% and Hammer toe in 32 %.

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Effects of intrathecal morphine on postoperative pain and complications were studied in 75 patients who received gynecological laparotomy under spinal anesthesia. On spinal anesthesia, 50 patients were injected intrathecally, 0.3% dibucaine with 0.5mg of morphine HCl as morphine group, and 25 patients were injected intrathecally with 0.3% dibucaine only as a control group. Postoperatively, 50% of the morphine group did not require analgesics, but 96% of the control group required analgesics. Except for the patients who did not require analgesics, the mean analgesic duration was 27.3 hr in morphine group, 6.1 hr in control group. Analgesics, used postoperatively, were indomethacin (suppository) and pentazocine (injection) . 72% indomethacin in the control group, 42% in morphine group, and 88 % pentazocin was used in the control group, 14 % in morphine group. The dose of both analgesics used in morphine group was significantly less than that used in control group (p<0.05) . No patients showed severe respiratory depression. Nausea was observed in 48% of the control group, 32% in morphine group. Vomitting was observed in 28% of the control group, 22 % of the morphine group. As for the time to postoperative initial flatus, there was no significant difference between control group and morphine group. After postoperative 4 day's bladder catheterization, no patients developed urinary retention. From these results, when gynecological laparotomy was scheduled under spinal anesthesia, intrathecal injection of dibucaine with 0.5 mg morphne was recommended for the postoperative pain.

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In March 1976, a 63 year old male was admitted to our hospital due to fever and heart palpitations. Laboratory tests revealed severe hypochromic anemia, leukocytosis and thrombocytopenia. Juvenile granulocytes in various stages and nucleated red blood cells were observed in the peripheral blood. The number of nucleated cells increased and the megaloblastoid cell level in the bone marrow was found to be 2 %. Sideroblasts were increased and 75 % of them were of the ringed-type. Serum iron level was elevated and the utilization of iron in the red blood cells was impaired. These findings showed both characteristics of sideroblastic anemia and erythroleukemia. The patient died due to gastrointestinal hemorrhage in June 1976. It is well known that in some cases acute myelogenous leukemia is the sequel to primary-acquired sideroblastic anemia. Dameshek reported that the first stage of erythroleukemia was often identical to refractory sideroblastic anemia. This case is assumed to be an internal-type of erythroleukemia and refactory sideroblastic anemia.

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A 75 year old housewife was admitted to our hospital because of generalized itchy eruptions which had been present for about 3 years. On admission, physical examination revealed generalized eruptions and necrosis in the bilateral fingertips. Spleen and superficial lymph nodes were not enlarged. Her leukocyte count was 38, 300/cmm with 88% abnormal leukocytes. These abnormal cells showed T cell characteristics, except blastoid transformation with PHA and ConA and had IgG-Fc receptors. Lymphangiography revealed enlargement of deep lymph nodes. Transmission electron microscopy of abnormal cells showed cerebriform nuclei with homogenous chromatin pattern that is similar to Sézary cells. Abnormal cell infiltration was found in the biopsied specimen of the skin. Combined chemotherapy with vincristine, procarbazine and cyclophosphamide was performed with effect. The patient, however, died of pneumonia on the 55th day of hospitalization. Autopsy revealed cytomegalo virus inclusion bodies in the lung, adrenal and ovarium. Abnormal cell infiltration was not found in the skin, lymph nodes or bone marrow. This case was diagnosed as T cell lymphoma based on the following : 1) no systemic involvement of superficial lymph nodes, 2) bone marrow invasion was significant, 3) eruptions were not identical to those of Sézary syndrome, 4) abnormal cells wer Fcr R⁺T cells. Although some differences in the clinical picture are present between T cell lymphoma, adult T cell leukemia, Sézary syndrome and mycosis fungoides, they belong to the same entity, that is T cell malignancy. Skin effects of various types have been reported in many cases of T cell malignancy. But, necrosis of the fingertips is rare in T cell malignancy. Fingertip necrosis may be caused by the infiltration of vessels and/or of surrounding tissue of fingertips with abnormal T cells.

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