胃十二指腸の良性疾患で緊急処置を要するものとして, 急性出血, 穿孔, 軸捻転, 外傷性破裂, 新生児胃破裂等があり, いずれも臨床像は急激である.このうち出血, 穿孔は日常臨床でしばしばみるものであり, 中でも穿孔については一般的に絶対的手術適応とされ, 外科では重要な疾患の1つである.
胃十二指腸穿孔については外科のみでなく, 内科はじめ他科医師の理解と協力が必要との考えを従来より持っているが, ここに我々の経験例を中心に, 十二指腸潰瘍穿孔について検討し報告する.
なお, 胃にしろ十二指腸にしろ, 大部分の穿孔例は消化性潰瘍と強い関連を有しているが, 胃潰瘍と十二指腸潰瘍では臨床的に区別されると指摘されている.私も同様の立場で, 原因についての攻撃因子, 防禦因子の関与, 消化液依存性の差と治療法, 術後管理の差, 癌を考慮した場合の手術上の注意等は重要な相違点と思われ, 本論文においては, 十二指腸を中心に述べる.

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陸棲の食用カエルと水棲のサカナ (コイ及ひナマス) の嗅上皮に色々なニオイ物質を気相と液相て与えて, その応答を比較生理学的に研究した.
1これら2種類の動物の嗅球から誘起脳波を記録したところ, 食用カエルは気相と液相のニオイに応答を示したか, サカナは液相のニオイにのみ応答を示した.従って陸棲動物と水棲のサカナの嗅上皮活動には明らかな相違か認められた.
2 食用カエルの嗅球に微小電極を刺入してその細胞のニオイに対する応答を記録した.嗅球の単一細胞は, 色々なニオイ物質を液相と気相とで与えた時, 同じニオイに対して時には同じ, また時には違った応答パターンを示した.
3 嗅球の単一細胞の応答は, 種々のニオイ物質の濃度を変化して与えた時も, 液相と気相の同じニオイに対して, 時には平行的に, また時には非平行的に, 同じ, または違ったパターンで応答した.
4 これらの応答の相違は, 気相のニオイの与え方, 液相のニオイの与え方と投与法の違いによることも考えられた.従って, 同じニオイを同じ濃度で気相と液相とで与えた時, 同じニオイの感覚を起すか否かという問題は, 嗅球の細胞の応答について研究した限りでは結論が得られなかった.

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1. Plasma catecholamine concentrations were determined in eight young patients with essential hypertension and eight normotensive healthy volunteers before, during and after the exercise bybicycle ergomter, 60 Watt for 10 minutes.
2. The plasma norepinephrine concentration at rest was significantly higher in the hypertensive patients than in the normotensives. A significant positive correlation was demonstrated between the plasma norepinephrine concentrations and the systolic and mean blood pressure.
3. Although plasma norepinephrine and epinephrine were increased during the ergometer exercise both in the hypertensives and the normotensives, the changes were statistically significant only in the hypertensives. In the hypertensives, the increase in plasma norepinephrine was observed 5 min after the exercise.
4. The above results suggest the hyperactivity of sympathetic nervous system and that it may play an important role in maintaining an elevated blood pressure in the young essential hypertensives.

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In order to determine the clinical reliability of currently available methods for determination of cardiac output, comparisons were made between the values obtained by thermodilution, earpiece dye-dilution, echocardiography and impedance cardiography in 46 cardiac patients. The case materials consisted of 2 cases of ischemic heart disease, 17 cases of idiopathic cardiomyopathy, 20 cases of rheumatic valvular disease, 5 cases of conduction disturbance, 1 case of myocarditis and 1 case of acute pericarditis.
There was a good agreement between the values obtained by earpiece dye-dilution and those by thermodilution, especially when the cases with valvular diseases were excluded. Among the cases other than valvular disease, the regression equation was Y =0.99X-0.1 (r = +0.83, p <0.01), where X and Y represent the values by tehrmodilution and earpiece dye-dilution, respectively.
The cardiac output calculated from the echocardiographic measurements were also closely correlated with the values obtained by thermodilution, when the cases with regurgitant flow and/or atrial fibrillation were excluded. The regression equation was Y =0.98X +0.5 (r = +0.82, p < 0.01), where X and Y represent the values by thermodilution and echocardiography, respectively.
Although the previous reports indicated that the impedance cardiography might be a reliable method for the determination of cardiac output, the present study failed to demonstrate a good correlation between the values obtained by this method and those by thermodilution or earpiece dye-dilution.
From the above observations we think that both the thermodilution and earpiece dye-dilution are clinically reliable methods for the determination of cardiac output, while the echocardiographic measurements may also give reasonable values in the absence of regurgitant flow, shunt and/or arrhythmias. On the other hand, the absolute values of cardiac output based on the impedance cardiography are clinically unreliable.

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Frank lead vectorcardiograms (VCGs) were recorded in 81 women between the age of 21 and 35 years during the course of uncomplicated pregnancy. No consistent changes were observed in the VCGs recorded in 6th and 8th month as compared with those recorded in 4th month. The changes of the VCGs following the postural changes during pregnancy were almost the same as in nonpregnant cases except a slightly greater lengthening of the maximum T vectors in left lateral position in 8th month. Brody effect was thought not to be playing important roles in postural changes of VCGs.

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This is a case report of 50 year old male patient, post-anterior resection of carcinoma of sigmoid colon with known hepatic metastases. CEA level was 20.1 ng/ml.
On infusion hepatic angiogram, multiple hepatic hypervascular areas are presented in right hepatic lobe. Successful embolization of proper hepatic artery with 2 pieces of MMC soaked Gelfoam was done. On 16 days post-embolization, CEA level decreased to 5.2 ng/ml. GOT & GPT raised 110IU/dl, 86 IU/dl immediately after the procedure, but returned to normal in 6 weeks. The patient was discharged 45 days post-embolization.

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A 17-year-old girl was first admitted to the hospital because of recurrences of syncopal attacks due to ventricular tachyarrhythmia. Bilateral adrenal pheochromocytoma was recognized and excised 2 years later. Retrospectively, the syncopal attacks were the only suggestive signs of pheochromocytoma during the first admission in this patient.

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