The angle between the auricular long axis and the nasal dorsal line (Angle Z) is used during operation for microtia and the expectation of growth of auricle and maxilla. It is said that these lines are parallel in caucasians. In Japan, the mean of this angle was report-ed by Kamiyama to be 16.0° for a male group, 14.6° for a female group, and 15.3° for the total group. An age-related change of this angle was reported by Gyoutoku, but the method of taking photographs was complicated due to the use of a special appliance. To simplify the method of taking photographs, change of the angle between the auricular long axis and the nasal dorsal line (Angle Z) during rotation of the head was studied. This study was perform-ed using two methods, cylindrical models and real persons. The following results were obtained :
1) When using a cylindrical model, the Angle Z was not changed by slight rotation of the model.
2) Theoretically, the following expression was derived
Z= tan^-1 (tanθ _??_× cosω) -tan^-1 (tanη _??_ × cosω)
ω: angle of rotation
θ _??_: the angle of the nasal dorsal line to a vertical line (ω=0)
η _??_: the angle between the auricular long axis line and a vertical line (ω=0)
3) In individual persons, changes of the Angle Z are unbalanced, but the statistical data of Angle Z is useful.
4) During more or less rotation of the head, the Angle Z changed only slightly. Therefore, we can get useful data from photographs taken by measuring with the eye.
5) Errors of Angle Z from photographs taken by measuring with the eye were less than errors of Angle Z measured by construction on photographs.

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To clarify the relation between articular cartilage and subchondral bone in the pathogenetic process of osteoarthritis of the knee, the natural course of this disease in the knee joint and the effects of mechanical loading were studied in C57 black mice, animal models of spontaneous osteoarthritis. The animals were assigned to two different groups according to treatment: Group I (natural course), mice were reared in cages under ordinary conditions until 18 months after birth, and group II (running load), mice were subjected to running loads using a treadmill over 1-5 weeks at 12 and 18 months of age. After the knee joint was excised en bloc from the animals of both groups, demineralized samples were prepared. Morphological changes in articular cartilage, subchondral bone and the menisci were observed in the sagittal plane. Subchondral trabeculae of the proximal tibial epiphysis were quantitatively analyzed for bone morphometric factors, such as unit bone mass, mean trabecular thickness and relative osteoid mass, using a semiautomatic image analyzer (Nikon Cosmozone) . Results of observation suggest that osteoporotic changes of the hypermetabolic turnover type are important in the pathogenetic mechanism of osteoarthritis in C57 black mice. It is also suggested that morphological changes in subchondral bones are concurrent with progressive articular cartilage degeneration ; and that when the mechanical structure of subchondral bone tissue, which supports articular cartilage, is unstable, the progression of osteoarthritis is accelerated with participation of physiological and/or excessive mechanical exercise loading.

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To investigate morphological change in acute myocardial infarction complicated by cardiogenic shock, we performed autopsy on the heart after death due to cardiogenic shock certified by the criteria of MIRU. Method: We made 1 cm thick sections parallel to the atrioventricular ring. The sections were embedded in paraffin, stained by the immunoperoxidase technique (ABC method) using anti-myoglobin antibody (DAKO), and then observed by light microscopy. We considered myocardial infarction to be significant when reduction of myoglobin was detected 2 cm or more above, in each myocardial wall. Results: The pump failure groups included 26 cases of cardiogenic shock and 25 cases of congestive heart failure; in contrast with the control groups there were 26 cases of cardiac rupture and 14 cases of septal perforation. There was a significantly higher frequency of recurrent infarction (58 % in pump failure groups : 15 % in control groups) and three vessel disease (60 % : 20 %), and broader infarcted area and a lower rate of coronary thrombus formation (60 % : 90 %) . Staining of myoglobin revealed surprisingly broader area of myoglobin loss than expected, especially in the cardiogenic shock group which had markedly extended myoglobin loss in the right ventricle (14 cases, 53.8 %) . In the heart failure group, the infarcted area was recognized as circumferential transmural or non-transmural infarction in the left ventricle, and the infarcted area in the right ventricle was significantly smaller than that in the cardiogenic shock group. This may suggest the importance of function of the right ventricle correlating with the outbreak of cardiogenic shock.

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Discharge possibilities of 424 cases with schizophrenia during hospital stay in Karasuyama hospital as of July, 31, 1989 were investgated and analyzed. Long-term rehabilitation therapy had been conducted for 194 of the cases who had been afflicted for more than 10 years from the onset, whose last stay was longer than 3 years, and who were younger than 60. The long-term stay group was presented with the conditions, and the policy for staying was dicussed. Subjects were divided into a group for whom it would be difficult to leave the hospital because of psycosomatic signs (A group), and a group for whom it might be possible to leave the hospital (B group) . The means and the policy of future rehabilitation were discussed with both groups by considering the psychiatric signs, ability to lead a social life, and social adaptation as indicators of individual factors in both groups, the prognoses were divided into good, intermediate and poor. Results were as follows : In the A group, scores were high for psychiatric signs ; and low for ability to lead a social life and social adaptation (distributed in the intermediate and poor groups) . The A group was thus inclined toward a poor prognosis. In the B group, all 3 indicators were intermediate with some distribution toward the good group. The social factor, the main problem of the B group, was analyzed. The attitudes of the families were relatively good, but ability to accept and care for the patients was low because of few members to take charge of the patients. A prominent cause for reluctance to take charge of a patient was economic dependence and inadequate pension and allowance. Housing conditions were extremely bad and there were other problems that were difficult to solve, including the difficulty of renting a house because of the psychiatric patient. The possibility for rehabilitation aimed at employment and independence was low in both groups, and slow progress and aging resulted in poor rehabilitation of the A group. Guidance for living techniques is greatly needed, and there are many patients who should live in supporting dormitories, welfare homes, or relief facilities to obtain training to live.

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The myofibrous organization of human pectoralis major muscle was investigated to clarify the functional characteristics of this muscle. The muscle was obtained from 22 pathoanatomical cadavers (10 males and 12 females), the muscle fibers were stained by Sudan Black B to classify them into three types. The following results were obtained : 1. The total numbers of the muscle fibers in both sexes decreased in the order of p. sternocostalis, p. clavicularis and p. abdominalis. Those in the p. clavicularis and p. sternocostalis of the males and those in the p. abdominalis of the females were larger than their counterparts in other areas. These tendencies did not depend on age. 2. The percentages of the three types of muscle fibers decreased in all the three parts examined in the order of white, intermediate and red muscle fibers. These percentages of white muscle fibers were larger in the males than in the females. The percentage of white muscle fibers was largest in the p. sternocostalis. 3. No sexual and partial differences were observed in the thickness of the white and intermediate muscle fibers, whose thickness was larger than that of the red muscle fibers. The thickness of the muscle fibers in the males decreased in the order of p. clavicularis, p. sternocostalis and p. abdominalis. In females, the white and intermediate muscle fibers in the p. clavicularis were thicker than their counterparts in other parts, whereas the thickness of the red muscle fibers, which was significantly larger than the other two types, decreased in the order of p. clavicula-ris, p. sternocostalis and p. abdominalis. Especially, the white muscle fibers in the p. clavicu-laris and p. abdominalis of females were thicker than those of the males. 4. The density of the muscle fiber was 80 % in both sexes. Only the density of the p. sternocostalis in the males was greater than that of the females. The density decreased in the order of white, inter-mediate and red muscle fiber. The density of white muscle fibers in all of the three parts examined was higher in males than in females, and that was more obvious in the p. sternocostalis. Only the density of the intermediate muscle fibers of the p. abdominalis was greater in females than in males. Most of the difference in the density occurred in the white muscle fibers. 5. Comparing with other published data on human muscles, the total number of the pectoralis major muscle fibers exceeded that of psoas major and brachial flexors. The percentage of white muscle fiber of the pectoralis was the highest and this tendency was more obvious in females. The thickness of each type of muscle fiber in pectoralis major muscle was greater than that of the psoas major and iliacus muscles, and was less than that of most brachial muscles, except the female red muscle fiber.

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A total of 183 cases treated as outpatients for over 5 years at Karasuyama Mental Hospital, affiliated with Showa University, were selected from among those with typical schizophrenia for analysis of their life styles. On the basis of their clinical findings, they were divided into 2 types : symptom-relieved type (124 cases) and symptom-revealed type (59 cases) . Factors pertaining to their social lives, were then reviewed, and the possibility of cure of the schizophrenia was established. In the symptom-relieved type : 1) Most of the patients had marriage experience and are married at present. 2) Most are employed, and their work is favorable. 3) They are socially and economically independent, at least to some extent, and do not depend on others for their revenue. 4) After discharge from the hospital, they showed favorable social adaptability, and some did not need the rehabilitation which might be an intermediate stage in the process of complete social return. These facts imply that these patients showed scarcely any mental symptoms, and had a high social adaptability level, for long constancy. Accordingly, we actively evaluated these patients, in view of socialpsychiatry, as a social therapeutic group, and suggest that this therapy is one indecatecl type of treatment for schizophrenia.

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It is well known that the incidence of alcoholic fatty liver is intimately related to cumulative alcohol consumption. Recently, it has been shown that alcoholic fatty liver can be reversed by total abstinence. However, there are no reports of morphological or quantitative analysis of serial liver changes during total abstinence. Ten patients with alcoholic fatty livers underwent serial liver biopsies, and quantitative change of fatty droplets was analyzed by an automatic image analyzer during total abstinence. The ratio of the area of fatty droplets to the surveyed area varied from 0.92 % to 18.33 % (average, 6.96 %) . Distribution of fatty droplets tended to be greatest in the central (pericentral vein) zone. Small sized fatty droplets were 0.72 %, intermediate sized were 4.61 % and large sized were 1.63 % of the total area. Of 10 patients with alcoholic fatty liver that were followed up, 8 showed remarkable decrease in the area of fatty droplets (8.7 %, of first biopsy) within several months of total abstinence. Especially, 4 improved patient with no complications of diabetes mellitus nor obesity, showed remarkable decrease of fatty droplets (4.17 %), and 2 diabetic patients showed less decrease (22.01 %) . Obese patient in the improvement group improved to 4.56 % improvement. In the other 2 obese patients (over 20 %), fatty droplets increased during total abstinence. Judgement of fatty metamorphosis by light microscopy seems to lead to overestimation compared to the results of the automatic image analyzer.

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We examined the conduction system of the sick sinus syndrome (SSS) . For this purpose, serial sections were prepared by the method of Lev in all cases. In 35 cases of SSS, one case was Rubenstein type-I, 6 type-II, 21 type-III, and 7 atrial fibrillation with slow ventricular response. Permanent pacemakers were implanted in 15 patients. Electrophysiological examinations were performed in 10. Causes of death were : 10 cases of cerebral vascular disorder ; 12, congestive heart failure : 1 death was presumably due to pacing failure ; 2 to ventricular arrhythmia ; and 11, other complications. Seven cases were treated for hypertension, 3 for thyroid disease, 3 for collagen disease, 2 for hypertrophic cardiomyopathy, 6 for dilated cardiomyopathy, and 2 for ischemic heart disease. Results : Type-I was myocardial degeneration due to polymyositis. In 6 cases of type-II, 4 were degenerative change such as amyloidosis (2 cases), drug toxicity against chronic myeloid leukemia (1 case), and hypertensive heart disease (1 case) . In 21 cases of type-III, 15 cases revealed lymphocytic perimyocarditis or its sequale, especially in sinoatrial junction, atrial septum or crista terminalis. Conduction system lesions in the sinus node and its junction were : 11, fibrosis ; 10, inflammatory infiltration ; and 4, fatty infiltration. In the AV node and His bundle, 2 were inflammation, 7 were fatty infiltration, and 3 were fibrosis. In both bundle branches, 8 were fibrosis. Conclusion : Fibrosis of the SA junctional area might be derived from chronic perimyocarditis.

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Development of the maxillary dental arch after cleft lip repair using buccal mucous flap method was examined from a plaster model based on three-dimensional computer analysis. The sample contained 22 cases of unilateral cleft lip and palate (UCLP) at 3 months of age before the lip repair operation, 22 cases of UCLP at 1 year before palatoplasty, 20 cases of UCLP at 4 years after palatoplasty, and 10 cases of cleft palate (CP) at 3 months, 1 year and 4 years. UCLP and CP were evaluated by the following provisions : 1) width and length of the dental arch, 2) angle of the dental arch from the palate and height of the dental arch of a transverse section, 3) classification of longitudinal growth of the dental arch. The result were as follows : 1) The molding action and growth of the maxillary dental arch was shown after lip repair operation at 1 year of age. 2) A high degree of medial collapse of the maxillary dental arch was seen in 30 percent of UCLP at 4 years after palatoplasty. 3) Remarkable narrowing of the angle of the dental arch was noted in UCLP as much as in CP. Scar contracture at the hard palate was suspected to cause a high degree of medial collapse, and mucous flap might not affect the maxillary dental arch at 4 years.

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More patients visiting urologists with complaints of dysuria, reflect the recent increase in the number of aged persons, many of whom are suffering with benign prostatic hypertrophy. We conducted a histopathological study of prostate glands obtained at autopsy. We also measured the weights, and maximum diameters (lateral and anteroposterior) of these glands for comparison with the histopathological findings. The results indicate that hypertrophy usually begins histologically in the late 40 s, and was observed in more than 50 % of the patients in their 50 s. The possibility of histological hypertrophy appears to be high when the weight of the gland exceeds 20 s and the dimensions of the inner gland exceed 2.0 cm × 1.5 cm. Significant correlation was observed between the laterial and anteroposterior diameters, especially in the hypertrophy group. Correlation between the lateral or anteroposterior diameter and the weight was also significant in the hypertrophy group, but not in the normal prostate group.

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From our clinical experience, we have suggested that the absence of liver uptake during Ga-67 scintigraphy was mainly due to markedly decreased unsaturated iron-binding capacity (UIBC) . We have succeeded in producing a rat model of absent liver uptake by administration of iron and vincristine to markedly decrease UIBC. However, the possibility of decreased liver uptake of Ga-67 due to liver dysfunction caused by these drugs can not be denied, so we performed further experiments. The changes of uptake by liver and other tissues, and UIBC induced by administration of apotransferrin (ATF) and deferoxamine (DEF) before the second scan were determined. The abscess uptake of Ga-67 during the absence of liver uptake was also determined. The administration of ATF one day before the second scan made liver up-take recover to almost normal levels and UIBC recover considerably. No recovery was produced by administration of DEF. The mechanism of Ga-67 uptake in various tissues is not completely clear. The theory that the amount of strage iron in the liver affects liver uptake has been proposed. The possibility is also suggested that antineoplastic agents may damage the synthesis of transferrin (TF) and intracellular Ga-67 carrier molecules, and/or block TF receptors in the hepatocyte to decrease liver uptake. The fact that liver uptake recovered rapidly after administration of ATF refutes these hypotheses, at least in vivo, and serum UIBC level is the decisive factor in liver uptake of Ga-67. The lack of significant decrease in abscess uptake of Ga-67 during the absence of liver uptake may suggest that the pathway to the abscesses is different from that to the liver.

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Eight patients with acute leukemia and eleven cases with non-Hodgkin lymphoma were given streptococcal agent, OK-432 as maintenance therapy combined with chemotherapy after achieving complete remission (CR) . OK-432 prolonged the duration of remission, especially in ANLL patients. To examine the immunological enhancement by OK-432, PPD, Su-Ps reaction, lymphocyte count and Ig-G were tested every three or six months. These parameters in-creased within a year among ten patients continuing CR.

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Goblet cell carcinoid of the appendix, a variant of carcinoid, is a relatively rare tumor in Japan. However, its histological characteristics, clinical behaviour, and prognosis present many problems. Although light microscopy shows this tumor to be composed of mature epithelial cells, such as mucous-producing cells and silver-positive cells, clinical behaviour of the tumor appears to lie between the typical behaviour of an ordinary carcinoid and that of a well differentiated adenocarcinoma. This tumor can generally be treated by simple appendectomy, although more radical procedure in sometimes indicated. Prognosis of this tumor is quite favorable, but there are some patients who contract a more virulent form of the disease. We report a case of goblet cell carcinoid of the appendix that required a subsequent right hemicolectomy after appendectomy.

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We report here, two cases of thoracic spinal operation while monitoring spinal cord evoked potentials. One case was meningioma at the T11/T12 disc level. The other case was caries of the thoracic spine. Both cases suffered severe myelopathy, and to be operated without damage to spinal cord functions. During and after the operation the amplitude of N1 and N2 did not change, and the wave patterns were almost the same as preoperation controls. We were able to operate with no anxiety, and avoided paralysis by measuring spinal cord evoked potential frequently.

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A 72 year-old male, complaining of a persist cough, was admitted to our hospital. Chest X-ray, tomography and bronchofiberscopy revealed a foreign body in the carina that had entered the right main bronchus. Tracheal stenosis, caused by granulation due to the touch of the foreign body, was found by bronchofiberscope. The foreign body was an artificial tooth that had been lost more than seven years previous. The tooth was removed under local anesthesia, 2 %-Xylocaine spray, with a forceps (FG-4L) designed to handle foreign bodies through the bronchofiberscope (Olympus 1T-10) . No bleeding and little purulent sputum was found. The patient was discharged 19 days after removal of the foreign body.

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