Bacterial endotoxins are recognized as the major cause of pyrogenic reactions from parenteral solutions. Various large-volume parenterals, sodium chloride irrigations and distilled waters for injection were tested for their content of endotoxins. While, depyrogen methods were discussed. The following results were obtained. (1) Chromogenic substrate test conducted on 41 large-volume parenterals, 10 sodium chloride irrigations and 22 distilled water for injections revealed that endotoxin contaminated in 37 (90%), 4 (44%) and 12 (54%) respectively. (2) Positively charged asbestos-free filter media was used to remove endotoxins. Endotoxins obtained from E. coli O111: B4 and E. coli O55: B5, spiked to amino rcid solution, were remoued over 98%. While, amino acids were recovered c. a. 100%. (3) Differential thermal analysis (DTA) conducted to detect the degree that eodotoxins were destructed. Endotoxins obtained from E. coli O55: B5, S, tvphosa and S. inacrescens were destructed from c, a. 210°C. (4) Low level of endotoxin in distilled water was found tobe unstable at 121°C, and more unstable in sodium chloride irrigation.

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In the approach to clarify the central auditory pathway by the temporal aspect, auditory and visual response times were measured as a means of elucidating various auditory phenomena caused by dysacusia of central origin. Subjects examined were the patients with hemiplegia due to cerebrovascular disorder and normal volunteers having no hear loss except physiologial changes attributable to aging.
The subjects were instructed to switch on just as soon as they perceived auditory and visual stimuli delivered to them (tapping) . The results of the testing with statistical analyses of data are summarized as follows : Normal subjects : 1) The auditory response time was 293msec with biaural hearing, which was shorter than a corresponding value with monoaural hearing of 323-326msec. 2) The visual response time, regardless of whether binocular or monocular sight, was between 277 and 279msec. 3) There was no significant difference between auditory and visual response time values. Hemiplegic patients : 1) Auditory and visual response times measured in all tests were significantly prolonged by 100-150msec as compared to the normal group. 2) Whilst little differences were observed between the right and left sides in auditory and visual response times, the auditory response time was prolonged with right ear hearing as compared with left ear hearing in patients with right hemiplegia. 3) Even though differences between visual and auditory response times hardly attained statistical significance if present at all, a significant difference was noted between auditory response time with right ear hearing and visual response time with right eye sight in patients with right hemiplegia. Through these findings and based on the neurological considerations on auditory and visual paths, it is warranted to assume that the observed prolongation of auditory response time might be related to an injury to the path connecting between the superior colliculus and the Heschl's gyrus.

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It was found previously that 1) analgesia measured by tail flick latency of rats, was produced by stimulation of the tibial muscle as an acupuncture point (AP), while was not produced by stimulation of the abdominal muscle as a non-acupuncture point (NAP), 2) analgesia was produced by stimulation of NAP after lesion of the lateral centromedian nucleus of the thalamus (L-CM) or the part of the posterior hypothalamus (I-PH), and 3) AP-stimulation-produced analgesia was abolished by lesion of the dorsal part of the periaqueductal central gray (D-PAG) and NAP-stimulation-produced analgesia was abolished by lesion of the lateral part of the PAG (L-PAG) . In present experiments, the differentiation of the AP and NAP, and the manner of inhibitory action of the analgesia inhibitory system on NAP-stimulation-produced analgesia were examined by recording evoked potential in the D-PAG and L-PAG of rats. Evoked potential was produced in D-PAG by stimulation of AP, not by that of NAP. Evoked potential was produced in the L-PAG by stimulation of both AP and NAP. Stimulation of the L-CM or I-PH with 80 Hz repetitive gradually increasing biphasic train pulses in 600 msec at 1 Hz completely inhibited the L-PAG evoked potential when the recording electrodes were located in the rostral L-PAG and was not inhibited when these were located in the caudal L-PAG. Similar result was obtained in the neuronal activites in the L-PAG produced by NAP stimulation. Evoked potential was produced in the L-CM and I-PH by stimulation of both AP and NAP. The inhibition of the L-PAG evoked potential by I-PH stimulation was abolished by L-CM lesion. L-PAG evoked potential caused by 1 Hz repetitive stimulation of AP or NAP was gradually declined and abolished finally about 10 minutes after stimulation, while D-PAG evoked potential was not influenced by repetitive AP stimulation. Abolition of L-PAG evoked potential by repetitive stimulation of AP or NAP disapperared after lesion of the L-CM. It was concluded that both analgesia producing systen through LPAG and analgesia inhibitory system were activated by stimulation of AP or NAP, while D-PAG was activated only by stimulation of AP. Therefore, analgesia was produced by stimulation of AP but not by stimulation of NAP.

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It was previously found that D-phenlylalanine (DPA) had two actions on acupuncture analgesia (AA) and intraperitoneal 0.5mg/kg morphine analgesia (MA) . One is that DPA abolished the individual variations in effectiveness of AA and MA, and the other is that DPA antagonized the analgesia inhibitory system., However these results were explored in combined experimental procedures. In present experiment, these results were confirmed in separated experimental conditions for these two DPA actions. After lesion of the lateral cen-tromedian nucleus of the thalamus (L-CM) or the part of the posterior hypothalamus (I-PH), both AA and MA measured by tail flick test in rats were augmented, therefore both L-CM and I-PH act as the analgesia inhibitory system, and the new analgesia is added to AA and MA. This new analgesia contained two analgesias, namely the naloxone reversible and dexamethasone reversible analgesias. It was shown that the individual variations in analgesia were found in the naloxone reversible analgesia. The newly appeared analgesia after lesion of L-CM or I-PH ascended through the lateral periaqueductal central gray (L-PAG) . In present experiment, the effect of DPA was examined under lesion of the L-PAG. The relation between AA and MA was highly correlated each other and was not changed after lesion of the L-PAG. Under pre-treatment with intraperitoneal 250mg/kg DPA, the individual variation in effectiveness of AA and MA was abolished and similar analgesia was obtained in all animals. It was previously found that evoked potentials in the L-PAG caused by stimulation of the tibial muscle as an acupuncture point, and of the abdominal muscle as a non-acupuncture point were inhibited by stimulation of the L-CM or I-PH. This inhibition was completely antagonized by pre-treatment of DPA, and this DPA action lasted for several hours. Repetitive stimulation at 1Hz of the tibial or abdominal muscle gradually depressed evoked potential of the L-PAG and finally abolished it. After treatment with DPA, this depression was reversed and hence L-PAG evoked potential appeared again. From these results, it was shown in separated experimental procedures. that DPA abolished individual variation of naloxone reversible analgesia and that DPA antagonized the analgesia inhibitory system .

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The involvement of endogenous morphine like factors in production of acupuncture analgesia (AA) caused by low frequency stimulation of the acupuncture point had been suggested by the fact that AA was antagonized by naloxone. Among of many kinds of the endogenous morphine like factors, the involvement of β-endorphin in AA have been investigated in present experiment by the intraventricular (3rd ventricle) application of anti-serum of β-endorphin. Pain threshold was measured by the tail flick test of the rats, and analgesia was expressed by percent changes of the tail flick latency. AA was completely abolished by intraventricular application of anti-serum of β-endorphin. Morphine analgesia (MA) caused by intraperitoneal 0.5mg/kg morphine, which is equivalent to AA, was also abolished by anti-serum of β-endorphin. Analgesia produced by electrical stimulation of the dorsal part of the peri-aqueductal central gray (D-PAG) or of the part of the anterior hypothalamus (AH₂), which was identified as the part of the acupuncture afferent pathway from the acupuncture point to the hypophysis, was also abolished completely by anti-serum of the, β-endorphin. Analgesia was not produced by stimulation of the preoptic nucleus or of the median eminence, which was known as the reqions connected to the hypophysis. From these results, it was concluded that β-endorphin might involve in production of AA, and intraperitoneal 0.5mg/kg morphine analgesia. The sites of involvement of β-endorphin in production of such analgesias was still unknown, although stimulation-produced-analgesia in the AH₂ which had been found as the final region to the hypophysis, was abolished by anti-serum of the β-endorphin.

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It was found previously that 1) analgesia (acupuncture analgesia) caused by low frequency stimulation of the acuppuncture point was produced finally by the serotonergic and noradrenergic descending pain inhibitory systems (DPIS) and 2) the dopaminergic neurons of the arcuate nucleus (ARN) of the hypothalamus play a role as the more proximal part of the DPIS. In present experiment, the relation bteween ARN and serotonergic descending system had been investigated. Analgesia, measured by tail flick test of rats, produced by stimulation of ARN was abolished by electrical lesion of the ventromedial nucleus of the hypothalamus (HVM) . The lesions of the upper or lateral parts of the HVM did not influence on the stimulation-produced analgesia of the ARN (ARN-SPA) . Evoked potential was produced in the HVM by stimulation of the ARN. Analgesia was produced by stimulation of the HVM. Like ARN-SPA, this analgesia 1) was limitted during stimulation, 2) did not exhibit the individual variations of the effectiveness which was observed in acupuncture analgesia, and 3) was not influenced by hypophysectomy or intraperitoneal 1mg/kg naloxone. Unilke ARN-SPA, HVA-SPA was not influenced by intraperitoneal 2mg/kg pimozide, dopamine antagonist. The HVM-SPA was partially blocked by electrical lesion of the ventral part of the periaqueductal central gray (V-PAG) or by intraperitoneal 2mg/kg methysergide, serotonergic antagonist. Evoked potential was produced in the V-PAG by stimulation of the HVM. It was concluded from these results that the HVM was the part of the DPIS between the ARN and V-PAG which is the origin of the serotonergic DPIS. The neurotransmitter of the HVM neuron to the V-PAG and the relation between HVM and noradrenergic DPIS were still obscure.

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As previously reported, acqunceure analgesia caused by 1 Hz repetitive stimulation of the tibial muscle of rats was abolished by hypophysectomy, and the pathway from the tibial muscle as an acupuncture point to the hypophysis was defined as the acupuncture afferent pathway, and the pathway of the descending pain inhibitory system activated by some unknown substances liberated from the hypophysis was defined as the acquncture efferent pathway. Acupuncture stimulation was not always effective to produce analgesia in every animal. Animals are able to be classified into responder or nonresponder by a significant increase (p<0.05) of tail flick latency. Stimulation-produced-analgesia of the raphe magnus (RM) was different between responder and non-responder. In present experiments, involvement of the acupuncture afferent and efferent pathways in the reticular gigantocellular nucleus (NRGC) and the reticular paragigantocellular nucleus (NRPG) was examined by stimulation-produced-analgesia (SPA) of these regions and by microinjection of morphine. SPAS of the NRGC and NRPG were different between responder and non-responder. SPA of the responder lasted for several minutes after termination of stimulation, while that of the non-responder was limited only during stimulation. After lesion of the dorsal part of the periaqueductal central gray (D-PAG) which was identi-fied as the acupuncture afferent pathway, the character of SPA of the responder changed to that of non-responder which was not influenced by lesion of the D-PAG. SPA after D-PAG lesion was abolished by intrathecal 20μg phentolamine, a noradrenergic antigonist. Microinjection of morphine (0.5, μg/μl) into the NRGC and NRPG produced different analgesia in responder and non-responder. Analgesia was only produced in the responder by NRGC microinjection of morphine, but not in the non-responder. This analgesia was abolished by D-PAG lesion. On the ther hard, almost similar analgesia was produced by NRPG morphine microinjection in both responder and non-responder. Analgesia caused by 2μg/μl morphine injection to the NRGC was different between responder and non-responder. Analgesia in the responder was developed rapidly while that of the non-responder was developed slowly. After lesion of the D-PAG, rapidly developed analgesia dispppeared and analgesia changed to that of non-responder which was not influenced by D-PAG lesion. Remaing analgesia after lesion of D-PAG was abolished by 40μg intrathecal phentolamine. Microinjection of 5μg morphine to the RM did not produce analgesia. It was concluded that both acupunctre afferent and efferent pathways were activated by stimulation of the NRGC and NRPG, while opiate receptor containing afferent and efferent pathways were found in the NRGC and NRPG respectively.

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The general trend in the prognosis after resection of gastric cancer can be grasped by studying the 3-year survival and 5-year survival. As to details, however, a study on the 10-year survival would be appropriate since recurrence is often observed even after the lapse of 5 years. We studied clinicopathological characteristics of the cases with 10-year survival by computing the cumulative 10-year survival rate and comparing the cases with 10-year survival with the cases which died of recurrence within less than 5 years after resection concerning 13 factors, that is, age, sex, macroscopic findings of gastric cancer such as location of cancerous lesion, macroscopic type, size (major diameter), and histologic findings such as depth of invasion, histologic type, lymph invasion (ly), vascular invasion (v), lymph node metastasis. infiltrative growth (INF), stroma of cancerous lesion and histrogic stage which were considered to affect the prognosis after resection of progressive gastric cancer. The subjects used in this study were 527 cases of progressive gastric cancer out of 740 cases with curative resection of single cancer among 1.098 cases of primary cancer which we had resected in the past 26 years (1956.3-1981.12) . The age ranged from 17 to 82 years (average age : 55.7 years), the male to female ratio being 1.5 : 1. Of these cases, 99 were the cases with 10-year survival (hereinafter referred to the 10-year survival group) and 193 were the cases who died of recurrence within less than 5 years (the recurrence group) . Results obtained are as follows : It was 7 factors, namely, location of cancerous lesion, macroscopic type, depth of invasion, vascular invasion, lymph node metastasis, INF and stroma of cancerous lesion that showed a significant difference in the 10-year survival rate and comparison between the 10-year survival group and the recurrence group. That is, the 10-year survival group included many cases that showed the area M, macroscopic type 1.5 type, pm, v (-), n (-), INFα, and medullary type in stroma of cancerous lesion as the clinicopatholgical characteristics. By stage, the 10-year survival group had many cases of stage I and II, while the recurrence group had many cases of stage III and IV. The 10-year survival rate fell off with the advance of stage, with stage I 79.7%s, II 48.2%, III 24.3% and IV 15.3%. The stage classification approved by the Japanese Research Society for Gastric Cancer well reflected the prognosis after resection of gastric cancer. Furthermore, the influence of lymph or vascular invasion on each stage was studied by comparing the 10-year survival group with recurrence group. For ly, the influence on each stage was less than expected and no difference was observed between the two groups. For v, there was no difference so far as stage I is concerned, but stage II and N included many cases with v (+) in the recurrence group (p<0.05), and even stage III tended to include many cases with v (+) in the recurrence group. This means that the presence of vascular invsion may be an important factor in achieving the 10-year survival. There were 66 cases with curative resection at stage N. Of them, 7 were the case with 10-year survival. Of these 7 cases, 6 were type 1.2 by macroscopic type, that is, localized type. In the case of localized type, therefore, prognosis can be improved and long-term survival can be expected by performing combined resection positively and removing lymph node thoroughoingly even at stage N.

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The purpose of this study was to evaluate the utility of image analyze system with personal computer and to determine the potential improvement in the morphometric quanti-tation of the fibrous connective tissue in liver and pancreas. A total of 131 cases were studied-14 with normal liver, 52 with liver diseases, 60 with normal pancreas and 5 with chronic pancreatitis. An application of hepatic and pancreatic slides stained with aniline blue method is evaluted. We calculated the ratio of fibrous connective tissue (excluding the elastic fiber) in liver and pancreas, and the results demonstrated a marked improvement with the aniline blue method for fibrous connective tissue : fibrous connective tissue stained with aniline blue versus others not stained. The mean ratios of fibrous connective tissue in normal liver, and pancreatic head and tail were 3.36±1.51% and 4.39±1.56% and 4.10±1.56% respectively. The ratio of fibrous connective tissue increased with age. The use of aniline blue method for fibrous connective tissue and of image analyze system to determine the quantity of the fibrous connective tissue in liver and pancreas was feasible and they facliltated to observe the fibrous connective tissue in details.

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Biopsied and autopsied liver specimens with fatty liver, acute and chronic hepatitis, and with liver chroisis, were analyzed for hepatic fibrosis by a image analyze system. The series included seven patients with acute hepatitis or fatty liver, forty with chronic hepatitis, forty-five with liver cirrhosis. Peritoneoscopic findings were classified by degree of lobular distortion into six types as follows : I. Smooth II. Irregular (a. slight b. moderate c. severe) III Nodular (a. not established b. established) . The mean ratios of fibrous connective tissue excluding the elastic fiber to hepatic parenchyma (F/H) of the each type were 2.70±1.05%, 6.20±2.37%, 9.95±4.08%, 10.41±5.97%, 14.46±6.01%, 13.92±3.10% respectively. The hepatic fibrosis was severer in the petients with chronic hepatitis type B classified type IIIb than in the others. In five autopsy cases the mean ratio of F/H of patients with liver cirrhosis classified IIIb, was greater than in biopsy cases. The ratio of F/H in small biopsied specimens obtained at a single, randomly chosen site was different from in autopsied, because the hepatic fibrosis of hepatitis and cirrhosis was not always diffusely distributed.
The degree fo nodular formation as a peritoneoscopic characteristic and the progression time moving on next classification are helpful in clarifing progressive cases from chronic hepatitis to liver cirrhosis.

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Recently, the ultrasonic wave test has been rapidly employed in the various clinical fields and highly evaluated clinically. We employed the ultrasonic wave test for 5 cases with tumor in the soft parts and the results observed were as follows, ; The cases were smooth membrane sarcoma on right forearm region in a 18-year-old female, round cell sarcoma on right femoral region in a 18-year-old male, ganglion on left forearm in a 36-year-old female, hematoma on right forearm region due to hemophilia in a 13-year-old male and hematoma on right femoral region in a 52-year-old male. The ultrasonic wave test was effective for 2 cases with malignalt tumor from the viewpoint of the presence or absence of tunic involucre, differentiation of massive type or cystic type, and diagnosis of tumorous region, but the detail tests such as presence or absence of infiltration, types of tumor were difficult. The diagnostic method by ultrasonic waves was effective for hematoma, and especially useful for the observation of its chronological changes in hemophilia. The diagnostic method by ultrasonic waves had defects such as problem of artifact or unfavorable propagation by ultrasonic waves in bone in the orthopedic field, but it was considered that this method is useful because there were many advantages such as easy manipulation without pain, low cost, etc.

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Cases showing abnormal findings in barium enema radiography due to malignant tumor of the other organs than the large intestine were studied and the significance of barium enema radiography in malignant tumor of the other organs was discussed. Of 1, 515 cases which had undergone barium enema examination at this department of surgery in the past 6 years (1976-1981), 12 cases (0.8%) showed abnormal findings on the radiographs due to malignant tumor of organs other than the large intestine. As for the primary location of lesion in these 12 cases, gastric cancer was found the most, 5 cases, followed by cancer of the ovary, 3 cases and cancer of the head of the pancreas, cancer of the uterus, osteosarcoma and retroperitoneal tumor, each 1 case. As for the site of the large intestine showed abnormal findings on the radiographs, the transverse colon was the most, 7 cases, followed by the sigmoid colon, 4 cases and the rectum, 1 case. As the reason for many abnormal findings found in the transverse colon, mention may be made of the association with the anatomical position since primary lesions included many cases of gastric cancer. In gastric cancer, the transverse colon showed hardening, shortening and poor stretching of the wall in many cases, while in ovarian cancer the sigmoid colon showed displacement, irregular wall and stenosis. Even in malignant tumor of organs other than the large intestine, barium enema radiography is useful, for it can serve as a clue to find the primary lesions where the primary lesions are not diagnosed, and also provides important informations on the procedures of operation in the primary and secondary cases.

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Four cases of allergy to mercury were reported. All of the patients had broken the mercurial thermometers before onset. One to three days later, the eruption appeared. The eruption distributed on the anterior trunk, axillary fossae, antecubital fossae, inguinal regions, inner thighs and popliteal fossae. This distribution of the lesion was very helpful to diagnose. Two of the patients (case 3. and 4.) had histories of contact dermatitis by mercurochrome. Patch tests were carried out in case from L and 2, and were positive with mercuric chloride and mercurochrome. Interestingly in case 2, the relapse of the eruption was induced following patch tests. These four cases were diagnosed as systemic eczematous contact-type dermatitis associated with aspiration of mercurial gas.

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Adenocarcinoma is the most common histological type of gastric carcinoma, and on the other hand squamous cell carcinoma is very rare. A case of primary squamous cell carcinoma of the stomach was reported in this paper. A 63-year-old man was admitted to our hospital, complaining of back pain. He was diagnosed as gastric carcinoma, and subtotal gastrectmy was performed. A Borrmann II type gastric carcinoma, measuring 9.0×8.0cm, was confirmed on the lesser carvature in the body of the stomach, extending to the antrum. Histologically, the carcinoma cosisted mostly of well differentiated squamous cell carcinoma, and partly of well differentiated tubular adenocarcinoma. The lesion was completely separate from the esophageal mucosa. Neither heterotopic squamous epithelium nor island of benign squamous metaplastic epithelium could be demonstrated in the adjacent mucosa of the stomach. Additionally, there were some portions, concurrently lined partly by glandular carcinoma and partly epidermoid carcinoma in the same carcinomatous gland. We supposed that these histological pictures showed abrupt transition from adenocarcinoma to squamous cell carcinoma.

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