It is already well established that systemic immunologic abnormalities have close correlation with the occurrence and progressoin of lupus nephritis. In this paper, the positive incidence of anti-T cell antibody, chronological changes of T, B, and Tγ cells subpopulations and the relation between serum IC levels and renal immunohistologic findings were examined in 46 patients with lupus nephritis. Following results were obtaind ; (1) Anti-T cell antibody was positive in 87% of patients with lupus nephritis. (2) During the exacerbation periods numbers of T and Tγ cells decreased, while those of B cells increased. (3) Marked immune deposits in glomerulus as well as extraglomerular tissues were observed in patients with high serum immune complex levels. It was concluded that serial measurements of T, B, Tγ cells, anti-T cell antibody and serum IC level serve as one of the best indicators to predict the exacerbation and further progression of lupus nephritis.

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Five cases of clear cell carcinoma of the ovary, ranging from 41 to 73 years of age, have been examined in this study, light-microscopically and histochemically. The findings, thus obtained, were analysed in comparison with those of the other malignant ovarian tumors. So far as our cases are concerned, the clear cell carcinoma develops as a monolocular cystoma, giving an impression of its occurrence with an intimate relationship to the serous and endometrioid cyst. Although the histological features of these tumors are varing in a wide range, we have confirmed that the cystic structure with variable papillary projections is nothing but the fundamental architecture on study by serial sections of the tumor tissue. Various types of tumor cells such as clear cells and dark cells admixed with transitional cells and hobnail cells are demonstrable in the tumor per se, especially the clear cells dominating the histological picture. Those tumor cells, however, are mostly same in the cellular type, since intracytoplasmic glycogen as well as acid mucopolysaccharides, probably sulfomucin in nature, is simultaneously demonstrable on histochemical study, with the morphological and histochemical findings similar to those of serous cystadenocarcinoma, endometrioid carcinoma and malignant mixed Mullerian tumor. Based on these findings with review of literature, we come to a conclusion that clear cell carcinoma may originate from the pluripotential paramesonephric coelomic or surface epithelium of ovary. Furthermore, we are considering that those histological pictures may be characteristic in this tumor. If this is true, the clear cell carcinoma should have a morphological entity among the other types of ovarian cystomas.

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Astrocytoma, ependymoma, hemangioblastoma, craniopharyngioma and pituitary adenoma make a cyst in the brain frequently. In these cystic brain tumors, it is diagnosed histologically if a mural nodule is found or if the inner wall is partially covered by tumor. However, when the inner wall of the cyst is smooth and the mural nodule is not found, histological diagnosis can be hardly obsteined. So we analyzed the encysted fluid of brain tumors obtained at the operation for the examination of the nature of tumor. Cyst fluid of 30 cases in total has been examined : the tumors taken from these patients at operation were diagnosed histologically on 29 occasions. Cystic fluid and blood serum were examined for total protein, amino acid nitrogen, electrolyte, enzyme, lipid and others in these 30 cases respectively. In general there is a reasonable degree of agreement between the biochemical and histological diagnosis. Lipid : Phosphatic acid, cholesterol and total lipid in glioblastoma multiforme showed higher level than those in astrocytoma and hemangioblastoma. In the level of cholesterol, astrocytoma was below 130mg/dl, hemangioblastoma between 50 and 60 mg/dl and glioblastoma multiforme above 150mg/dl. Enzyme : Glutamic oxalacetic transaminase (G. O. T.), glutamic phosphatic transaminase (G. P. T.), lactate dehydrogenase (L. D. H.) and alkaline phosphatase were examined. In the level of L. D. H., astrocytoma was between 150U. and 500U., glioblastoma multiforme above 700U. and cranioparyngioma between 800U. and 4, 800U.. In L. D. H. isozyme, astrocytoma and hemangioblastoma showed high level in L_1, L_2, L_3 isozymes and craniopharyngioma in L_4, L_5 isozymes as well. Even if we cannot obtain the histological diagnosis, we can diagnose the nature of tumor, i. e., benign or malignant, by examining L. D. H., L. D. H. isozyme, total lipid, and cholesterol of the encysted fluid of tumor. With regard to cause of encystment fluid, our findings support that cyst fluid was a filtrate of serum. Therefore the genesis of encystment fluid should be rather ascribed to some local increase of permeability in the blood-brain barrier than to increased general metabolic demans for a specific meterial or lysis ol neoplastic cells.

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The effect of an ischemic exercise on venous outflow, hematocrit, total plasma protein and plasma crystalloid osmolality through microcirculation in skeletal muscle were investigated in the 'in situ' hindlimb preparation of anesthetized rabbits. A partial ischemic exercise was produced by electrical stimulation of sectioned sciatic nerve end during a 5-min occlusion of the femoral artery, and venous outflow from the muscle was measured by a photocell drop-counter equipped with a D-A converter. A spontaneous input pressure of the femoral artery into the hindlimb was observed to be kept constant during a series of experiment. Results observed are as follows : 1) A 40-60% decrease of venous outflow was observed following the occlusion of the femoral artery. During 5-min occlusion, the normalized change of Hct (the ratio (%) of Hct against pre-occlusion Hct) was 98.6% at the early stage, 102.4% at the final stage and 105.3% after the release of occlusion, respectively. Normalized plasma protein was 97.5% and 102.3% at the early stage and after the release, respectively. Osmolality showed no significant change during 5-min occlusion. 2) The maximal percent change of Hct produced by the ischemic exercise at 5 Hz muscular contraction was 108.8% and 111.3% at 50 Hz. Normalized plasma protein was 113.2% at 5 Hz and 121.5% at 50 Hz, and osmolality was 111.0% at 5 Hz and 113.0% at 50 Hz, respectively. The changes of Hct, protein and osmolality observed during the ischemic exercise were significantly higher than those observed during the non-ischemic exercise. It is suggestive that the increase of Hct during the exercise is caused mainly by the plasma fluid loss from the capillary, and that such hemorheological phenomena as decreased flow rate in the capillary, increased collateral flow and relative decrease of plasma layer to the radius during the ischemic exercise are relatively less effective causes. Much higher increase of protein during the 'severe' exercise may be explained by introducing a speculative such as protein back flux.

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In the present experiment, it was found that the ratio red- : intermediate- : white muscle fibers of the tibialis anterior muscle in the adult male rats which had been castrated neonatally and given daily 0.1mg of testosterone propionate for 15 successive days, differed from the muscle in non-injected gonadectomized rat on in intact rat ; white fibers increased and intermediate fibers decreased in number. On the contrary, in the animals orchiectomized at their neonatal life, successive administrations of androgen after the growth brought about little change in the composition of the muslce fibers. It seems to reveal that the endogenous androgen during infantile period plays an important role for the determination of the fiber composition of the skeletal muscles.

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The records of 26 patients with multiple rib fractures due to blunt chest injury treated either at Center for Critical Care Medicine of Kyorin University Hospital or at Mejiro IInd Hospital during 17 month period from Jan. 1, 1979 through May 31, 1980 were reviewed. Of seventeen patients admitted to ICU after initial treatment at the emergency room, only one patient died at 19 hour from shock, severe head injury and more associated injuries. Thus, overall mortality rate among the patients admitted to ICU was 5.5%. On the contrary, 8 patients died at the emergency room on arrival or within 3 hours. Higher mortality rate was found in patients with hemopneumothorax, shock, severe head injuries and other concomitant injuries. In three indivisuals, immediate operations were undertaken for rupture of diaphragm, subdural hematoma, or lacerated liver respectively, without any mortality. Two additional patients required delayed operations for stabilization of flail chest with steel wires. It is concluded that the initial supportive cares for improving the disturbed function of respiration and circulation at the sites of accidents and at the emergency room are mandatory to reduce morbidity and mortality in patients with severe chest trauma and more concomitant injuries.

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Nuclear cardiography has made a remarkable progress during the past several years. This is a nonivasive technique, requiring only the intravenous injection of a radionuclide. During past one year, Thallium-201 (^<201>Tl) myocardial scintigraphy and radionuclide angiocardiography with Technetium-99m Human Serum Albumin (^<99m>Tc-HSA) were performed in 133 and 83 patients in our hospital respectively. The purpose of this study is to describe the radionuclide techniques and to introduce our clinical experience in nuclear cardiography.

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The electrocardiographic readings by a newly developed direct writing vectorcardiograph (VA-3F, Fukuda Denshi Co. Ltd.) have been compared with recordings made by a conventional vectorcardiograph (VA-3D). The study was made on the scalar and loop measurements taken from 50 patients who had been randomly selected. No significant difference could be observed between the readings by VA-3 F and VA-3D, except for the amplitudes in scalar measurements.

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Fractures in children differ in many ways from those seen in adults ; healing is rapid, pseudoarthrosis is an almost unknown occurrence, and there is a pronounced capability for remodelling. Therefore, we commonly handle children with fractures conservatively. This gives us certain freedoms as to the exact method of reduction, but obliges us to take into consideration the simultaneous effects of the healing of the fracture and the normal growth process. According to the literature, there have been many considerable achievements, but there has also some somewhat contradictory information concerning these problems. There has been a large increase in the number of traffic accident cases, and as a result of these we are increasingly expected to make accurate prognoses, and moreover the changes caused by the remarkable improvement over the last twenty years in growth and physical development. We have had experience with one hundred and nineteen (119) children with fractures in their lower limbs who were treated by traction and casting, and were re-examined 1-12 years later. The results of the radiological measurement of femoral and tibial length and alignment were analysed. Remarkable longitudinal overgrowth occurred most commonly in the 3-8 year-old range, and persisted for a very long time. The degree of the overgrowth in the femur was about 10mm., in the tibia, about 6mm. and the limit for longitudinal displacement was the same. We consider that about a 15° lateral deformity (in the tibia. about 10°) is without clinical significance and will correct itself spontaneously. However, torsional deformity will not correct itself. The prognosis for any remodelling after ten years old is very poor.

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When various extraarticular symptoms that originated from systemic angitis appeared in a patient with rheumatoid arthritis (RA), the patient is diagnosed as malignant RA (MRA). Although the progression of RA to MRA is rare, once the the patient with RA shows the symptoms of MRA, the prognosis is usually poor. We have recently experienced a case of RA who has progressed to MRA within a year after the start of RA. In this report, details of clinical course, EMG and muscle biopsy findings, and results of serially examined immunologic abnormalities of this case were described. It is concluded that precise chronological check of immunological abnormalities, such as serum complement levels and serum immune complex levels are very important to predict and control the progression of RA to MRA.

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A 21 years old businessman was admitted owing to acute hepatitis. His hospital course had been uneventfull before temporary out-staying when he enjoyed skiing without our permission. Thereafter, his serum transaminase level was elevated again remarkably, and it took about a mouth to return to normal level. Chalmers and others studied influence of exercise during course of acute hepatitis, and reported that no different outcome was observed between a group with exercise and that with bed-rest. In this case, however, re-elevation of serum transaminase was observed in convalescent phase of acute hepatitis by exercise. This suggests that period of bed-rest should be decided carefully case by case.

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