Sexual differentiation of brain structure and function is dependent on the hormone environment during perinatal life. Especially, estrogen has been implicated in the process of masculinization of brain. Aromatase, converted androgen to estrogen, in the brain was reported that it was associated with sexual differentiation and sexual behavior, and regulated by androgen. However, the regulation system and physiological significance of aromatase in the brain remains obscure. In this present study, it has examined that distribution and change with age of aromatase activities in the brain, and effects of androgen, antiandrogen, progesterone and hypophysectomy on aromatase activity of hypothalamus-preoptic area (HPOA), and effects of aromatase inhibitor on sexual behavior.
The greatest amount of aromatase activity have found in HPOA and amygdala, associated with sexual differentiation and sexual behavior, but cerebral cortex, cerebellum, pituitary and thalamus all contained negligible aromatase activity. HPOA aromatase activity increased at perinatal period, which was critical period of sexual differentiation in the brain, and declined to 3 weeks after birth. HPOA aromatase activity was increased by androgen, progesterone and progesterone derivatives, and decreased by castration, non-steroidal antiandrogens and drugs decreased serum testosterone concentration. Moreover, it found that there was no relation between the hypophysis and regulation of HPOA aromatase activity.
Pregnant female rats were given daily injections of aromatase inhibitor, throughout the latter half of the pregnancy. Significant reductions were detected in HPOA aromatase activity of the male fetuses and pups. Behavioral consequences of the prenatal treatment were examined in adulthood. Partial but significant protection of the behavioral defeminization was associated with the decreased HPOA aromatase activity during the prenatal period. However, aromatase inhibitor treatment as adult male rats failed to produce any detectable change in sexual behavior.
These results suggested that aromatase in the brain played an important role in the sexual differentiation of the brain for defeminization at the critical period. And, it was regulated by androgen and progestin independently of the hypophyseal system.

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In order to assess the usefulness of repeated exercise tests for prediction of prognosis in patients with myocardial infarction, serial treadmill exercise testing (4.5 tests/patient during 32 months) was performed on 73 patients with the first attack of acute myocardial infarction. A significant ST depression was observed at the first test in 28 cases (38%). Regardless of the results of the first test, the pressure-rate product (PRP) at the same exercise level decreased significantly at the last test. On the other hand, the time to onset of 1 mm ST depression increased significantly at the last test in those with a positive first test, although the PRP at 1 mm ST depression remained unchanged in most of these cases.
A significant reduction of more than 10% of PRP at 1 mm ST depression was demonstrated in 4 patients with multi-vessel disease during the follow-up period.
Unstable angina pectoris developed in 2 of these 4 patients with decreased exercise tolerance as well as in 1 patient whose exercise test result changed from negative to positive. The exercise tolerance was unchanged during the follow-up period in 3 patients of reinfarction and 1 patient of sudden death. Thus, the repeated treadmill exercise tests are of value for the prediction of development of unstable angina pectoris, but not for the prediction of sudden death and reinfarction.

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Three monoclonal anti-A (3H9, 5C6, 4D8) and one monoclonal anti-A, B (2D10) antibodies were obtained from a mouse by immunization with blood group A secretor saliva. The agglutination of erythrocytes of A subgroups by 3H9 was similar to that by human anti-A serum, and 3H9 was directed to the type 2 chain A structure. 5C6 agglutinated A₁ erythrocytes and reacted especially with difucosyl type 2 chain A and type 3 chain A structures. Antibody 4D8 showed stronger agglutination of A₂ erythrocytes than the others, and reacted with both type 3 chain and type 4 chain A structures. By using these antibodies, the determination of A subgroups and characterization of conformational structures of the A determinants are possible. Antibody 5C6 was inhibited rather strongly by A non-secretor saliva. Thus, this antibody is useful for application to test specimens of legal medicine, such as examination of blood or salivary stains for A antigens.
The reactivity of these antibodies with erythrocyte membrane glycoproteins was analyzed by immunostaining after SDS-polyacrylamide gel electrophoresis. 3H9 reacted with band 3 and band 4.5, 4D8 with glycophorins, and 5C6 did not react with glycoproteins. These results suggest that blood group A determinants are present in erythrocyte membrane glycoproteins and that their sugar chain structures are different depending on the glycoproteins, polylactosaminoglycan type 2 chain A in band 3 and band 4.5 but GalNAcα1→3 (Fucα1→ 2) Galβ1→3GalNAc in glycophorins.

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Diurnal rhythm of blood pressure and pulse rate were analyzed by the cosinor method in 7 normal volunteers and 9 patients with mild essential hypertension. Noninvasive ambulatory blood pressure monitoring, ABPM-630 (Colin, Japan) was used, which was reliable judged from the values compared with the recordings of the direct method or the readings of a sphygmomanometer. The cosinor method revealed that 1) all normal individuals had significant diurnal rhythm in which the acrophase was in the afternoon ; 2) hypertensives also had significant diurnal rhythm, 5 in systolic blood pressure and 6 in diastolic blood pressure : 3) fluctuation of the pulse rate also showed significant diurnal rhythm with acrophase in the afternoon in both normals and hypertensives, though the diurnal rhythm in 2 hypertensives was obscure. Mesor values in systolic and diastolic blood pressure correlated well with their respective readings of blood pressure determined at the outpatient clinic. We concluded that the cosinor method is useful for analyzing the diurnal rhythm of blood pressure and pulse rate.

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The use of morphine solution (modified Brompton cocktail, M sol.) given orally to cancer patients in Tatebayashi Kosei Hospital, 1983-87 inclusive was studied. A total of 15 patients (67.1 ± 3.0 years) included 2 with gastric cancer (Ca), 3 with lung Ca, and 1 each with mammary Ca, myeloma, pancreatic Ca, renal Ca, liver Ca, aplastic Ca, osteosarcoma, prostatic Ca, cerebral Ca and lymphoma were treated with M sol. Use of M sol. tended to increase according to the year, but 151 patients were also treated with Brompton cocktail (B.P). M sol. (5 or 10 ml containing 7-20 mg of morphine) was administered to 1 patients once a day, 2 patients twice a day, 4 patients 3 times a day, 6 patients 4 times a day and 2 patients 6 times a day (i.e., daily doses ranged from 7 to 62.5 mg) for 3 to 58 days. Clinical effects in the 15 patients were good in 11, unknown in 1 and poor in 3. The efficacy rate was 73.3% (11/15). The adverse reactions observed were nausea and vomiting in 2 cases, constipation in 2, drowsiness in 2 and a strange taste in I. These did not improve with drug treatment. It is suggested that M sol. is similar to B. P in efficacy for the relief of severe cancer pain and in the high frequency of gastrointestinal symptoms after its administration.

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Between March, 1975, and March, 1988, 51 patients with esophageal varices due to portal hypertension were treated and thirty-eight of these underwent direct interruption surgery. One patient was carried out decompression surgery (distal splenorenal shunt).
Twenty-two patients had liver cirrhosis, seventeen were diagnosed as idiopathic portal hypertension.
We preferred the one-staged combined procedure of transabdominal transection using an autosuture apparatus, splenectomy and paraesophagogastric devascularization. The direct interruption procedure for the remaining patients were transthoracic esophageal transection, splenectomy with devascularization and others.
The overall operative mortality rate within one month was 5/38 or 13%. Five-year survival rate in the 30 cases of transection surgery were 71%.
Surgical therapy should be carried out as electively as possible, because of high mortality of emergency operation.

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A total of 654 bacterial strains were isolated from urine specimens of 1, 219 female patients with uncomplicated cystitis from 1975 to 1987 in Sato Hospital, Takasaki City. Escherichia coli strains were isolated at the highest frequency 66%, followed by Staphylococcus epidermidis (9.5%), and Klebsiella pneumoniae (6.9%). Strains of the major causative bacterium, E. coli, were then examined for their drug resistance and their conjugal transferability. The frequency of isolation Ap-resistant strains and km-resistant strains did not change during 12 years, while those of Tetracycline-, Chloramphenicol-or Streptomycin-resistant strains decreased. The frequency of isolation of strains that could transfer their drug-resistance was about 60% in 1975 and decreased to 20% in 1987.

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I studied liver transplantation for 10 months from May 1987 to February 1988 at Cambridge University. In that period I witnessed 80 liver transplantations and also saw many kidney and some pancreas transplantations.
Recently in Japan there has been considerable discussion of the diagnosis of brain death and the possibility of the recommencement of organ transplantation from a cadaver in which the heart is still beating. I would like to contribute to the debate by writing this report on liver transplantation that I saw at Cambridge University.
At the university, Prof. Roy Caine performed 366 liver transplantations between May 1968 and September 1987, and recently the number has increased markedly. At Cambridge University alone, 103 liver transplantations were performed in 1987, 74 in 1986 and 64 in 1985.
In this report, I will discuss the actual operation, the results of liver transplantation, the diagnosis of brain death and the organ transplantation system in the United Kingdom.
I would like to express my appreciation to Prof.Y. Nagamachi for. help in making it possible for me to study abroad in Cambridge.
I wish to thank Prof. Sir Roy Calne, Dr. R. Williams, Mr. K. Rolles, Mr. P.J. Friend, Mr. S.J. Collier, Mr. N.V. Jamiesen, Miss G. Bronz, Miss A. Campbell, Mrs. C. Weight, Miss G. Hopkins and Miss S. Falvey for their kind help in the study of liver transplantation, and also for their friendship I thank Dr. Susan Lim, Mr. P.S. Johnston, Mr. M. Hoffman, Mr. M. Bonatsos, Mr. K. Tanaka, Mr. Y. Harihara and Mr. K. Umeshita who came as visitors from overseas to study liver transplantation.

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1) A follow-up study was performed on two patients whose femoral shaft fractures caused by traffic accidents were cured by conservative treatment ten years earlier, in their infancy. The present paper reports the course of their treatment, and hyperosteogeny in the affected femur and scoliosis.
2) Both patients presented with hyperosteogeny in the fractured femur. Scoliosis due to a difference in leg length was also noted in both, one of whom showed flexion of 24 degrees at the lumbar region as assessed by Cobb's method.
3) The paper also discusses height supplementation to correct the difference in leg length in order to prevent scoliosis.

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The case of 41-year old woman with a ruptured rectum due to endometriosis is reported. A perforated appendix was initially suspected but rupture of the rectum and a solid tumor distal to it was found during surgery. The surgical procedure include resection of the affected colon, proximal colostomy and closure of the distal end of the bowel. Microscopic examination revealed endometrial gland structure in the submucosal and muscular layers. The patient received an end-to-end anastomosis 4 months later and currently in good physical condition. Intestinal endometriosis is thought to be a rare disease and to our knowledge a perforation due to it has not been reported previously.

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