In view of the great importance of grasping the number of health examination subjects according to the Health and Medical Services Law for the Aged in epidemiological survey, evaluation of health examination and the like, the Author added the results of a new survey to those which the Author had already finished by proposing a stochastic formula, and examined possible improvement in the formula and its reliability. On the results of inhabitants surveys which have been made in 7 cities and towns of 4 prefectrures across the nation, the above subjects were examined by health examination, sex, age-group, medical care insurance (national health insurance and others), etc., and from populations and numbers of national health insurance by age, the following stochastic formula for the number of subjects by health examination, and by sex, which can be estimated in consideration of the composition of population was devised :
T=Σ {K (A+BK/P) + (P-K) (A'+B'K/P) }
where K=number of national health insurance by age-group,
P=population by age-group, and
A, B, A', B'=constants.
Furthermore, when those subjects just under medical care are excluded, another stochastic formula was devised by multiplying the above formula by (1-regional prevalence) . Interval estimation also revealed that errors of these formulas were within ca. 10% with a probability of 95%. These stochastic formulas, which can be calculated while correcting the population composition of each city, town or village by use of the number of national health insurance of easy access, and when those subjects just under medical care are excluded, by use of both the above number and the prevalence, and that their errors are within ca. 10%, is an effective means of stochastics, which may well be contributive to epidemiological surveys, evaluation of health examinations and the like.

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Tisdalls' method for the identification ofmycobacteriausing gas-liquid chromatography (J. Clin. Microbiol. 10 : 506, 1979) was modified in order to extend its application to the identification of clinical microorganisms in a clinical laboratory. The microorganism used in this experiment was a strain ofM. catarrhalisATCC 25238. This organism has recently shown to be an agent of opportunistic infections. A method for pretreating the cellular fatty acid methyl esters of the orgnanism was established, under conditions in which the bacterial wet weight was approximately 30mg and the dry weight was 6mg, saponification time was reduced 30 to 5 minutes at 70°C, methyl esterification was carried out with 50% boron trifluoride-methanol complex at 70°C for 5 minutes, and extraction of the fatty acid methyl esters was done only once using a chloroform : hexane (1: 4) mixture. On the other hand, the results of experiments on culture conditions were as follows. There were significant differences between growing temperatures of 35 and 30°C by t-test (p<0.01), with regard to the cellular fatty acid compositions of organisms incubated on trypticase soy agar medium and its medium containig 6% horse blood in an aerobic condition. However, there were almost no significant diffrences among 18, 20, and 24 hours. Significant differences of cellular fatty acid compositions were observed, especially C10: 0, C16: 0, C16: 1, C17: 1, and C18: 1, upon comparison among trypticase soy, Mueller Hinton, heart infusion, brain heart infusion, their media containing 6% horse blood, and their chocolate agar media upon incubation in a normal atmosphere or in an atmosphere containing 5-10% CO₂gas at 30 and 35°C for 20 hours. The time required for this shortened procedure was approximately one hour and two hours for one sample and six samples, respectively. Therefore, this experiment verified that the authors' mehtod of application of gas-liquid chromatography to the identification of clinical microorganisms was practical in a clinical laboratory.

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A method for identifyingM. catarrhalisin a clinical laboratory was examined using the authors' pretreatment method. This organism is one of normal members of the flora of the respiratory tract, particularly the nasopharynx, but may occasionally cause chronic respiratory infection, otitis media, bacteremia, and bacterial meningitis. Recently, the organism has a source of opportunistic infection. It was possible, by the naked eye observation, to read differences in the cellular fatty acid profiles betweenM. catarrhalisATCC 25238 and related species, for example, Neisseria gonorrhoeaeIID 828, N. meningitidisIID 850-853, N. perflavaIID 856, N. subflavaIID 857, Gemella hemolysansATCC 10379, Acinetobacter antitratusATCC 15308, andM. lacunataATCC 1767. Furthermore, by adding fatty acid profiles of clinical isolates, it was quantitatively proved that C18: 1 fatty acid was specific toM, catarrhalis, and that it was greatly increased in comparison with related species, taking into account of the relative area percentage and the common peak ratio (the ratio of each fatty acid area to the common peak area of C 16 : 0 included in most bacteia of clinical significance) . The data were processed by discriminant analysis a multivariable statistical technique, using a personal computer. This analysis was able to discriminate clearly three groups, namely, M. catarrhalis (n=22), the genusNeisseria (n=21), and the genusAcinetobacter (n=11) . It was demonstrated from these results that an automatic system combining gas-liquid chromatography with a personal computer was a method with considerable potential as an identification tool in a clinical laboratory. It was still necessary to confirm the presence of gram-negative diplococci by staining and non-hemolysis on blood agar medium, so that the organism could be differenciated from other the subgenus, Branhamella spp., prior to the application of gas-liquid chromatography for the identification ofM. catarrhalis.

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A study was made on the effect of HK302 (freeze-dried powder of ethanol extract from roastedPanax Notoginseng) on the animal models for acute inflammation. Oral administration of HK302 (2000mg/kg) inhibited slightly rat paw edema induced by carrageenin, but did not inhibit increasing vascular permeability in the mouse peritoneal cavity induced by acetic acid. While Indomethacin, used as a positive drug, (30mg/kg, p.o.) showed strong inhibitory effect on both animal models. These results indicate that oral administration of HK302 does not provide remarkable effect on the inflammatory response.

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Effects ofPanox notoginsengextract (HK 302) on lipid metabolism were studied in male Wistar rats, fed a high-cholesterol diet (HCD) contained 1 % (w/w) cholesterol, 0.2% (w/w) cholic acid and 2.5% (w/w) olive oil for 30 days. In the experiment, HK 302 was orally administered at daily doses of 200 and 1000mg/kg for 30 days to rats feeding on a HCD. The results obtained are summarized as follows. In the serum lipid levels, HK302 inhibited the elevation of β-lipoprotein (β-Lipo), total lipid (TL), total cholesterol (TCH), phospholipid (PL) and free fatty acid (FFA) in a dose-dependent manner. HK302 also inhibited HCD from decreasing high-densitylipoprotein cholesterol (HDL) and thus significantly lowered the atherogenic index (AI) . Clofibrate (CF), which was used as a reference, inhibited the elevation of FFA, TCH and TL, but increased β-Lipo. In the liver lipid levels, HK302 inhibited slightly the elevation of liver triglyceride (TG) and CF also inhibited markedly. Both drugs, did not influence the amount of liver TCH. From these results, it can be assumed that HK302 was effective in preventing of hyperlipidemia of rats fed a HCD. The detailed hypolipidemic mechanism of HK302 is not yet clear, but as shown, it seemed to decrease exogenous lipid absorption from the intestine mainly in rats. These results also suggest that the lipid-lowering urofiles of HK302 differ from those of CF but very similar to those ofPanax ginseng.

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According to our previous experiments, analgesia was not produced by stimulation of the non-acupuncture point with same intensity and frequency of acupuncture point stimulation, and that same stimulation of the non-acupuncture point induced an analgesia after lesioning of the analgesia inhibitory system (AIS) such as lateral centro-median nucleus of the thalamus (L-CM) and of the part of the posterior hypothalamus (I-PH) . Similar results were obtained after treatment of D-phenylalanine (DPA) . However it is not known whether DPA directly inhibits the AIS or DPA antagonizes the inhibitory transmitter of the AIS in the lateral periaquaductal central gray (L-PAG), which was found as the inhibition acting site from AIS on the pathway connected to the non-acupuncture point. In present experiment, the non-acupuncture point stimulationproduced-analgesia was examined by micro-injection of DPA into the L-CM, I-PH and L-PAG to find out the manner of the DPA action on the AIS, observing the tail flick latency of rats as the index of the pain threshold. Non-acupuncture point stimulation-produced-analgesia was induced after micro-injection of DPA (84 ng) into the L-CM or I-PH, while such analgesia was not produced after injection of DPA to the L-PAG. Therefore DPA directory inhibits the AIS. It was reported that proglumide, antagonist of cholecystokinin, potentiates morphine analgesia. After treatment of intra-peritoneal 20 μg/kg proglumide, analgesia was produced by non-acupuncture point stimulation. Same kind of analgesia was also produced by microinjection of proglumide (5-8 ng) into the L-CM and I-PH and not by application to the L-PAG. From these results it was concluded that both DPA and proglumide inhibit the AIS directly and it was strongly suggested that cholecystokinin acts as the transmitter in the AIS. Relation between DPA and proglumide is not known yet.

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It is commonly said that differential diagnosis between mixed cellularity of Hodgkin's disease and immunoblastic lymphadenopathy is histologically often very difficult. We attempted here to find out the difference of ATPase activity of the two diseases. In a few cases there were distinct differences each other, but the mean value of ATPase positive cell of mixed cellularity of Hodgkin's disease was 45.71 % and that of immunoblastic lymphaden-ophathy was 52.25 %. These results showed no significant difference. As mentioned above, it is not sufficient to examine only cytochemical study, in order to differentiate the lymph node diseases, which show especially very similar hitsolgical picture each other. The combined cytochemical and immunological studies must be inevitable, in addition to seek information from clinical data.

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Using lymph node imprints ATPase and ANAE stains were examined on 18 cases of Hodgkin's disease. Differing from our previous report on lymphocytic lymphomas of B-cell type which have shown a clear anti-correlation between the both enzymes, there were various activities of the both enzymes case by case in this time. Diverse reaction phenomena were seen in each case, that is, the both enzyme activities were increased, or the one stain showed an increased activity, or the both enzymes revealed decreased activities. Although the recent progress of various immunological techniques is remarkable, Hodgkin's disease remains one malignant lymphoma of obscure cell origin in comparison with the other lymphomas which proliferate series of lymphocyte of monoclonal nature.

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To assess non specific bronchial hyperreactivity, the effect of inhaling ultrasonically nebulized distilled water and isotoic (0.9 %) saline was studied in 22 asthmatic patients and eleven normal subjects. In asthmatic patiens, FVC, FEV_1.0, PFR, V₅₀, and V₂₅ showed a siginificant reduction while normal subjects showed no apparent change after inhaling ultrasonically nebulized distilled water. None of the subjects investigated showed obvious change in pulmonary function after inhaling ultrasonically nebulized solution of isotoic saline. From these results, it is suggested that the method used for this challenge is rapid, simple, safe and inexpensive and provides a new means of diagnosing nonspecific bronchial hyperreactivity.

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Myofibrous organization of M, quadratus lumborum was analyzed and these results were compared with those of the other muscles in man. Materials were obtained from 13 humans (7 males who were from 46 to 76 years and 6 females who were from 57 to 94 years) . The muscular slices were embedded in celloidin and the sections were stained with hematoxylin and eosin. The average muscular weight of males (23.9 g) was 2.5 times as heavy as that of females (9.6 g) and all specimens of males were heavier than those of females. The average cross sectional areas of muscles were 244.3 mm² in males and 101.2mm² in females and the former was 2.5 times as large as the latter. The averages of the total number of muscle fibers were 182, 970 in males and 57, 636 in females and the former was 3 times as much as the latter. The sizes of muscle fibers were from 945.2 to 1346.6μm² in males and from 936.0 to 1179.3 μm² in females and one specimen in female was 2222.7μm². The sex difference was not observed for the fiber size. The specimens, whose peak of the distribution pattern in the muscle fiber size was above 25 %, were 60 years old or older and those sizes were small. The averages of the number of muscle fibers per sq. mm were 752 in males and 578 in females. The average densities of muscle fibers were 85.1 % in males and 68.9 % in females. The averages of the total area of muscle fibers were 207.3 mm² in males and 69.8 mm² in females and the former was 3 times as large as the latter. The following characteristics of M. quadratus lumborum in man was considered. The remarkable sex differences were observed in this muscle. The muscular atrophy was observed obviously over 60 years old and in females before that. The atrophy in the senescence had the individual variation remarkably.

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The purpose of this study is to find the best fixation for each of the four malleoral fracture types, which Lauge-Hansen classified, using two-dimensional photo-elastic experiment and free body technique analysis. To the various model, the fixations and the loading methods are the following : 1) The horizontal fracture of the medial malleolus were fixed by (1) Kirschner-wire (K-wire), (2) (1) +Zuggurtung and (3) Screw, and were loaded by the abduction. 2) The oblique and vertical fractures of the medial malleolus were fixed by the screws which were inserted obliquely and horizontally respectively, and were loaded by the adduction. 3) The horizontal fractures of the lateral malleolus were fixed by the methods which were (1) K-wire and (2) (1) +Zuggurtung, and they were loaded by the adduction. 4) The oblique fractures of the lateral malleolus were fixed by (1) Plate and (2) two screws, and each one of them was loaded by the abduction and by the adduction. 5) The fixations of malleoral fractures were the same as the both cases in 1) - (2) and 4), and were loaded by the adduction and by the abduction.

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1. Seven actual cases (4 males and 3 females) who inflicted an injury on his/her own body in various ways were depicted and their clinical images were described. The cases of self-inflicted injury we encountered so far varied from the damage of his own neck imagining the development of a tracheaesophagus fistula, or mutilation of his own penis, to injury of the skin of her wrist. The diagnosis also varied, but we classified them according to the ICD-9. 2. Generally speaking, we refered to these cases as self-mutilation, after confirming the facts that these cases correspond to those in the findings of our preceding researchers and to those in the classic works. 3. Among them, K. H. Stauder showed, in his“akute todliche Katatonie”, his effort not just to depict the symptoms, but also to try to classify them. While H. J. Weitbrecht proposed“guilt” (Schuld (G.) ) -a theme in psychopathology that“raises” (aufheben (G.) ) diagnosis of depression in his case of upper-extremity mutilation. 4. All dictionaries that carry the definition of self-mutilation agree that it means“the behavior that inflicts injury to his/her own body”. However, we have found differences in opininons on the relation of the behavior to suicide. In textbooks, the behavior is treated in the pathology of will and expression, and the relation to schizophrenia is emphasized. 5. Ross and Makay cited 33 terms that correspond to the self-mutilation behavior. I examined each of these 33 terms on what point of view it was used, and I classified them in to 5 convenient categories. 6. Many researchers referred to the self-mutilation behavior as syndromes: Munchhausen syndrome, Wrist-cutting syndrome, Trichotillomania, Factitious anemia, Lasthenie de Ferjol syndrome, Cornelia de Lange syndrome, Gilles de la tourette syndrome. Thus I have found this phenomenon rather ubiquitous. 7. The etymological meaning of self-mutilation is“to cut off own extremity”. We emphasized that the relationship of Japanese term“Jisho”to the English term has been regarded much too simplistically. I explained this in detail. 8. The affinity between self-mutilation and suicide was confined in the phenomenon of Wrist-cutting. The internal relationship between selfmutilation and suicide becomes undeniable by introducing the concept of parasuicide. However, I considered these two phenomena independent entities, because I could not think self-mutilation as the precursor of suicide, for none of the patients who consist the care of the sel-mmutilatuon group wished to die. 9. No pain is felt in any of these self-mutilation cases. The reason is considered to be the masochistic pleasure and pervertic psyche. Narsissistic ecstasy and enjoyment can not be denied, either. 10. I pointed out that the problem of self-injury or the phenomenon of attacking his/her own body does not lie on the behavioral results which are seen on the skin. Rather, it seems that loads by the deed but also evade their responsibility. I also mentioned in the discussion of aggressiveness that the role of selfsacrifice is strongly related to this behavior. 11. I considered self-mutilation to be the direct expression that passes over the linguistic communication-in other words, a kind of “body language” (Körpersprache (G.) ), and I concluded that the solution of the problem of self-mutilation has an important clue to the solution of somatic problems.

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Ethanol-induced alterations in pancreatic blood flow have been investigated in relation to pathomorphological and biochemical aspects. Twenty-seven rabbits free from any anesthetic influences were studied at two levels of 40% ethanol infusion. Higher and lower doses were 15 ml/kg (n= 21) and 2.5m1/kg (n=6), respectively. The ethanol was administered directly into each rabbit's stomach. Experimental period provided three groups, consisting of one time infusion, up to 4 weeks, and 8 weeks. Following one time administration, pancreatic blood flow (measured by hydrogen gas technique with Height-Area Method on computer), tissue amylase, lipase and the ratio of RNA/DNA were all increasing after the lower ethanol dosage. Contrary to this, after the higher dosage, all of those were decreasing. As to ethanol dosage, the pancreatic alterations indicated a biphasic reaction. Administering higher dosage ethanol caused marked ischemia in pancreas after 30 to 45 minutes. In the ischemic stage, the pancreas provided swelling of rER and mitochondria. In the recirculating stage, those damages were much more aggravating, and a part of swelling mitochondria were turned into vacuoles at the vicinity of the basement membrane. In the same stage, active oxygen and hydroperoxide increased with an decrease in vitamin E and T-cholesterol. The results indicate that radical production has occurred in the post-ischemic stage during recirculation. In a long term up to 8 weeks, the ratio of RNA/DNA decreased with time, reversely hydroperoxide increased. Histologically, the collagen fibrils in the surrounding acinar cells were thickening with time. After 8 weeks, those were determined as mature collagen fiber under an electromicroscope. This fibrosis provide an active fibrosis without caused through any necrosis. It is concluded that since active oxygens can promote the polymerization of collagen fibril, the experimental ethanol-induced fibrosis and the active fibrosis can be affected by the active oxygen.

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Even nowadays, it is difficult to diagnose accurately the submucosal tumor or tumorous lesions by the upper GI X-ray examination, endoscopy with ultrasonic tomography (US), computed tomography (CT), cintigram, and abdominal angiography. We showed 3 cases of the submucosal tumor in the stomach and discussed on the diagnostic ability of each examination. Case 1: submucosal cyst on the stomach. 18 y.o. female with elevated lesion on the upper gastric body was performed the upper GI X-ray examination and endoscopy. We could not have the accurate diagnosis before operation. Case 2 : cavernous hemangioma in the left hepatic lobe. 44 y.o. female with the submucosal tumor on the fornix stomach was performed the upper GI X-ray examination, endoscopy, US, CT, cintigram and angiography. We suspected the sarcoma on the stomach or liver tumor, probably hemangioma. Accurate diagnosis could be gotten during the operation. Case 3: leiomyoma on the stomach. 59 y. o. male with the typical submucosal tumor on the upper gastric body was done the routine examination with US, CT and angiography showed the intramural submucosal tumor, probably benign, leiomyoma.

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In primary carcinoid of appendix, mucin secreting tumors are rare and difficult to distinguish from adenocarcinoma. This tumor is called“mucinous carcinoid”. We experienced a case of mucinous carcinoid in appendix which was excised under the diagnosis of acute appendicitis. A 38-year-old male was admitted with the complaint of right lower abdominal pain and diagnosed as acute appendicitis and appendectomy was carried out. The tip of the excised appendix swelled and pus issued by incision. Histological specimens were made from the whole length of the appendix, and they were examined by light microscope. Mucin secreting, relatively small cells contained signet-ring type cells and infiltrated in the area: about 2 cm distant from the tip to about 1.5 cm distant from the base and from the mucosa to the subserosa. These cells showed positive stain by PAS, Alcian blue and Grimelius. We propose that histological specimens must be made as many as possible from the excised appendix and be examined carefully from the tip to the base, because there is the example as this case which was diagnosed as benign acute appendicitis macroscopically, however mucinous carcinoid microscopically.

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