In the previous report in this magazine, the auther gave his own view on the condition causing and developing biliary typhoid carrier state and on its treatment, based upon his experience with 16 cariier cases.
In this report, adding 16 more cases to the previous ones-including two cases of continuous observation from the previous study time-the author reviewed the results of antibiotic treatment including Aminobenzyl-Penicillin treatment, long-term-small-everyday-dosis Tetracycline administration, and some other antibiotic treatment and the effect of post-operative Kanamycin instillation method through T shaped tube.
The followings are principles of the treatment believed to be recommendable at the present stage of this field:
1) Relatively large amount (2g or more daily dose) of Aminobenzyl-Penicillin should be administrated from the beginning of the treatment regardless the outcome of cholecystography. The other antibiotics were proved to be ineffective.
2) In unsuccessful and stone-bearing cases, cholecystectomy should be performed. Post-operatively, Kanamycin solution of high concentration should be instillated into the bile tracts 2 times a day through a T shaped tube.
3) If encountered yet unsuccessful cases, there can be some possibilities that the tube itself began acting as a foreign body like stone and becoming rather harmful in the course of protracted manipulations. In this case, the tube should be removed. Instead, observations with or without antibiotics administration must follow for some time. The author experienced two cases showing spontaneous recovery after having undergone these procedures.
The author believes that typhoid or paratyphoid carriers are no longer hopeless or intractable.

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Distribution of Pseudomonas aeruginosa (Ps) in sputa was investigated in the ward of pulmonary tuberculosis during two years and the results had been reported previously in the Japanese Journal of Experimental Medicine 35 (5): 371, 1965 and the Journal of the Japanese Association for Infectious Diseases 38 (9): 311, 1964.
The carriage of Ps in sputa was found at the rate of about 9% among the patients. The Ps strains isolated at that time have been stored.
The serological typing of 0 antigen of these Ps strains was perfomed tentatively and, based on the results obtained, the epidemiological survey in this ward was made.
Ps of several types were isolated from the sputa of the pulmonary tuberculosis patients and the distribution of these types was found quite different from that in other wards or in other hospitals. Among these types, 2. types were predominant in the ward and one of these two was especially dominant for four months. It was believed that the transmission of Ps in the ward was caused not only by cross-infection but also by autogenous infection.
The clarification of the Ps carriage in the human intestinal tracts seems to be important to solve this problem.
The results of final typing of Ps will be reported in the near future.

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A total of 313 patients with bacillary dysentery admitted to this Hospital from April 1966 to March 1967 were treated respectively with Lincomycin (51 patients), Erythromycin (39), Triacetyloreandomycin (84), Kanamycin (41), Nalidixic acid (46) and Dihydroxymethylfuratrizine (52) for a comparative study of clinical and bacteriological redults of these antibiotic therapies.
All patients on each antibiotic therapy demonstrated reduced frequency of diarrheaand eradication of fecal blood, pus, mucus and turned to be bacteriologically negative for the causative organisms in 3-7 days, though 3-8% of them showed a sign of bacillary reemergence in the second week of medication. Thus, on the whole, no definite gap exists among these drugs in the clinical effectiveness. It is noteworthy, however, that in the case of Lincomycin therapy, like Kanamycin therapy, the quickest eradication of causative organisms was obtained, though the improvement of diarrheal frequency and fecal findings was slightly retarded compared with the other antibiotics cases.

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Aspergyllosis was investigated with our own cases and contributed records from other 44 universities and hospitals with a special consideration to the relation with steroid therapy.
The incidence in our hospital is as follows: Among 3596 cases admitted to the department of internal medicine, Kawasaki City Hospital, during a four-year-period from Jan., 1962 to the end of Dec., 1965, 365 cases were treated more or less with steroid hormone, of which 12 (3.3%) were considered to be socalled steroid induced infection, out of which 6 were Aspergyllosis.
The number of Mycosis cases associated with steroid therapy including both our cases and contributed ones was 73, of which 32 were Aspergyllosis, 31, Candidiasis, 8, Cryptococcosis and 2, Mucor Mycosis.
The number of Aspergyllosis cases including cases without steroid therapy was 66. Thus, the cases of Aspergyllosis with steroid therapy, 32 in all, occupies 48.4% of all Aspergyllosis cases recognized.
There were two types in these secondary Asper gyllosis, localized and disseminated type. Of those 32 Aspergyllosis cases, 17 were of localized type and 15, of disseminated type. There have been no cases of disseminated type in the cases without steroid therapy. This fact suggests the influence of steroid to the developmental mode of Asper gyllus infection.
Frequently encountered underlying diseases in those 32 Aspergyllosis cases were blood disease, especially leucaemia, respiratory disease, and liver disease in order. It is noteworthy that in the cases without steroid administration, only respiratory disease was found to be underlying ailment, and the Aspergyllosis was of localized type in all.
Antibiotics administration was most common to accompany with steroid therapy. In some cases, anti-cancer agents were added. In the cases to which such three kinds of medicine were given, disseminated type predominated. And further tendency is that disseminated type was apparently increased in the choice of broad spectrum antibiotics rather than narrow-spectrum ones.
Although it should be admittable that the definite factor causing and developing secondary Aspergyllosis was diminishing resistance of the hosts, it is undeniable from the data in this survey that steroid hormone itself or, accompanied by antibiotics or cytotoxic agents, also played the significant role to it. It is quite impossible at this stage to clarify precise mechanisms of steroid action to the infection like mycosis, but, it would not be so inconsistent to regard most of the cases here as steroid induced infection. Especially, the role of steroid to the development of disseminated type Aspergyllosis should never be underestimated.
Some clinical data are also presented: The clinical diagnosis was extremely difficult. Here, only 3 out of 32 could be ascertained before autopsy. Consequently, clinical applications of anti-fungal agents were very rare. Although the symptoms of underlying illness were apt to overshadow the clinical manifestations of Aspergyllosis, fever, respiratory disorders, anemia and hypoproteinemia were most commonly encountered symptoms of it in order. The data about prognosis were also discouraging. The death rate as a whole was 81.2%. There were no survival cases of disseminated type. The autopsy revealed lung was the most frequently involved organ.

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