I have, first of all, the pleasure of offering as a citizen of the free world my warmest congratulations to the American people for the successful flight of their space shuttle Columbia. I am deeply honored at being granted the Yant Memorial Award and being invited to lecture before this distinguished audience. I feel that these honors are not for myself alone but for all the people working in the field of industrial health in Japan. I had diffculty deciding what would be the most appropriate theme to talk about before such a distinguished audience, but if I may, I would like to trace the development of industrial health in our country over the years.

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This is a review of the study concerning a new plethysmography for the noninvasive measurement of cardiac output and limb blood flow using electrical admittance technique in place of impedance technique. The principle, method of measurement, accuracy, practical usages, application and safety of this technique were recited showing the data obtained through the correlation studies with another plethysmography technique. Advantages and disadvantages were discussed comparing with those in impedance technique. (From the Special Invitation Lecture given at the 11th Japanese Impedance Plethysmography Research Meeting, Tohoku University, January 17th, 1981)

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High doses NSP therapy and Ara-C micro injection in to the adjacent region of trigeminal, spinal, or sympathetic ganglion combined with nerve (ganglion) block were carried out to the patients suffering from herpetic neuralgia. This reports included 4 cases of acute type and 9 post herpetic neuralgia. Pain intensity was rated by using a visual analogue scale. Pain ratings of patients were reduced respectively 3-4 weeks after treatment from pretreatment values. The side effects during the course of treatment, such as nausea, vomitting, headache or cytopenia were not observed. It is suggested that this is the treatment of choice in herpetic neuralgia.

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High sensitive determination of hemoglobin (Hb) in the blood was investigated without such hazardous chemical reagents as potassium cyanide or sodium azide. At first, Hb was separated from the blood by high performance aqueous gel permeation chromatography (HPAGPC) with refractive index detector (RID). Hb effluent from HPAGPC was led to atomic absorption spectrometer (AAS) through a T piece's type interface. Hb was determined on iron atoms contained to Hb molecule with AAS such as a high sensitive detector to metal containing compounds. With 20 μl of preliminarily prepared standard Hb solution, the calibration curves for the Hb measurement were obtained to RID and AAS. The calibration for Hb was linear up to 7g/l and a limit of detection was 0.02g/l with AAS. Also, it was linear up to 5g/l and the limit was 0.3g/l with RID. In comparison with the both calibration curves, the more practical calibration was obtained to Hb detection with AAS and AAS was ten-odd times as high sensitive for Hb detection as RID could. Correlations between HPAGPC with AAS and, HPAGPC with RID or the cyanmethemoglobin method (HiCN) or the azide-methemoglobin method (HiAz) were good, and their coefficients of correlation (r) were, rAAS-RID=0.998, rAAS-HICN=0.999 and rAAS-HIAZZ=0.998, respectively. The precision of the proposed method was also good, and the coefficient of variation was within 2.1%. The time required for the determination was within 100 min.

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Intravenous contrast media have been used for contrast enhancement at the time of CT scanning. Concentrations of such agents in blood have been measured by various methods in an attempt to know how to maintain their blood levels and also to investigate the relationship between their blood levels and the degree of enhancement of lesions. We investigated the feasibility of a simplified method for the quantitative determination of the concentration in body fluids of contrast agents, the ultraviolet absorption method, in which blood samples are measured for the concentration of meglumine iothalamate (Conray) at 3 different wavelengths with correction made for absorbency of impurities. This assay method was found to be convenient and very useful as a means of determining serum levels, but with a questionable accuracy of measurement of low concentrations. However, by using deproteinized sera its accuracy was improved to the level of conventionally used ultraviolet absorption methods. This assay method is simple, reliable and clinically useful and might reasonably be applicable to the quantitative determination of contrast media.

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Hepatitis B virus (HBV) has been considered to be replicated solely in human or primate liver cells, thus, an organotropic virus. However, recent studies indicated the possibility of extrahepatic replication of HBV including in the pancreas. The purpose of the present study is to see if HBs Ag and HBc Ag and HBc Ag are detected in the pancreas by immunohistochemical study. Forty four patients with HBs antigenemia were studies by indirect are direct peroxidase methods, using formalin-fixed, paraffin-embedded section of pancreatic tissue, to detect HBs Ag and HBc Ag. Shikata's orcein technique was also used for HBs Ag detection. Specificity was checked by absorption test for indirect method, and blocking test for direct method. HBs Ag was positively stained in 24 patients out of 44 patients, the localization of HBs Ag was proved in pancreatic acinar cells, particularly centrilobular acinar cell, intralobular and interlobular ductal cells. HBc Ag was detected only in pancreatic acinar cells in the 7 cases which also had HBs Ag in the pancreas. HBV antigens were not found within islets of langerhans. Control studies using 25 patients were all negative. This study proved the localization of HBs Ag and HBc Ag in pancreatic acinar cells are ductal cells, and probable HBV replication in the pancreas.

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Lymphocytotoxins have been described in systemic lupus erythematosus and several viral infections. The presense of these antibodies have been discussed with the close relation of the pathogenesis and progression of these diseases through the modulation of lymphocyte subsets. With these respects, we have been investigating the anti-T cell antibodies in various glomerulonephritis, which disclosed the simillar findings to SLE although the titers of antibodies were lesser degrees. We have recently found a case of MPGN type I which was demonstrated to have the antibodies to Tγ cells as well as to T-cells in the nephrotic stage. These immunological abnormalities were associated with loss of Tγ and T-cells in the peripheral blood. These antibodies were not detected in remission when Tγ and T-cell became within normal numbers. These labolatory data indicate that these antibodies may play important clues with the change of lymphocyte subsets which are closely related with the pathogenesis and progression of the nephrotic syndrome in this patient.

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We administered lidocaine intravenously during hemodialysis for intractable, generalized pruritus in three chronic hemodialysis patients. Two patients claimed total relief of pruritus after 200 mg of lidocaine, which was continued for over 40 hours. Another patient had moderate relief after 200 mg of lidocaine, and claimed total relief of pruritus after another infusion of lidocaine, 200 mg, which was also continued for up to two weeks. Two patients had three side effects ; drowsiness, thirst and nasal obstruction after 200 mg of lidocaine administration which were all slight. Another patient had no side effect. We think that lidocaine was effective in relieving intractable pruritus in chronic hemodialysis patients but its mechanism of action is unknown. Parhaps the continued relief from pruritus for over 40 hours after lidocaine suggests either that lidocaine itself and its normal metabolites excreted by the kidney are active as antipruritic agents or that lidocaine is acting in a pharmacokinetic compartment with a very slow rate of egress of the drug.

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The patient, 79 years old farmer, was admitted to the hospital due to polyarthralgia, dry cough and exertional dyspnea. He was diagnosed as classical RA (stage III, class III). One month after the admission, marked reticular shadows appeared in middle and upper fields of both lungs on chest x-ray followed by pleural effusion of right side. Hyper-γ-globulinemia, high titer of RAHA, decrease of serum complement and elevation of circulating immune complex (CIC) was observed simultaneously. Pleural fluid showed the character of exsudate and contained significant amounts of IC and low complement. Fibrofibrinous pleuritis and interstital pneumonia were observed by percutaneous pleural and lung biopsy. From these date the episode of respiratory disorder of this case was diagonosed as rheumatoid lung and its pathogenesis was assummed to be immune complex origin. By the treatment with large dosis of steroid, both articular and respiratory symptoms improved remarkably. Since there have been no reports of rheumatoid lung with such marked increase of IC in pleural fluids as this case, we described the clinical course and laboratory data of this case in detail.

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The clinical course and renal autopsy findings of a case with acute form of scleroderma kidney was described. The case was 61 years old female. One year later the onset of sclerodactylia, polyarthralgia and Raynaud's phenomenon, malignant hypertention and congestive heart failure developed and she died of uremia. At this time anti-DNA antibody, rheumatoid factor and circulating immuno complex were positive, although serum complement level remained normal. Autopsy revealed kidneys were enlarged and multiple cortical infraction existed. Histologically, marked intimal thickening of arterioles and hyalin sclerosis of vas afferens were noticed. Only fibrinogen was found in arteriolar walls by immunofluorescence and glomeruli were free form deposits of immunoglobulin and complement. It was suggested that renal injury of this case might be originated from the immunologically mediated intra-vascular coagulation in the narrowing arterioles.

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There is no consensus of opinions concerning how to legally grasp the doctor's duty of explanation. Many cases and juristic theories related to this problem have been accumulated in West Germany. In the present report, doctrines in that country were studied from the collected matter. As a result, it was pointed out that this duty of explanation is based on personal rights and can be applied to two typical situations ; that the determination of criteria of explanation is made by deliberating various interests ; and that, even in the case of inquiring into the responsibility for the breach of duty on the ground of tort, the burden of proof on the part of the plaintiff is reduced considerably. However, concerning the contraindication of this duty, such situations are found to exist in West Germany as are fundamentally different from those in Japan where the right of self-determination is not so much emphasized.

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