1) The binding curve of bilirubin with bovine serum albumin (B.S.A.) was of Michaelis type, but the curve of β-globulin-bound bilirubin was of sigmoid type without saturation point in our experiments of bilirubin concentration. 2) The binding molar ratio of bilirubin with B.S.A. was caluculated at 0.968 under the formula or γ/bilirubin concentration and γ. 3) No relation of γ/bilirubin concentrtion with γ was found on β-globulin-bound bilirubin, as the curve ran parallel with X-axis. 4) Calculation of Hill's coefficient using binding curve of bilirubin with β-globulin resulted in 3.22. The coefficients obtained from the bilirubin bindings with dialyzed human serum and with B.S.A.-added β-globulin were 1.56 and 1.55 respectively and the two curves quite resembled each other.

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It was the purpose of this paper to report a new analytical method for direct determination of blood ammonia (NH_3) by gas permeation/gas chromatography (GC). The apparatus was mainly composed of GC and a thermoregulator, in which a permeation plate assembly used for a measurement of urine NH_3 was installed. A blood sample of 1.0ml was injected into the stream of pH 7.4, 0.01M Tris/HCl buffer solution and carried in two the permeation plate assembly with the buffer solution. Ammonia in the sample was permeated from the buffer solution through the membrane into GC carrier gas (He). The permeated NH_3 was determined by GC. The precision for the measurement was within 6% in terms of coefficient of variation. A minimal detection limit of NH_3 was 0.25μg in the injected sample. An analytical time required for NH_3 measurement was less than 13min. Correlation between the proposed method and the indophenol method was 0.99 (n=17) in terms of correlation coefficient.

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The outbreaks of Mycoplasma pneumoniae infections are characterically occur every 4 years in Japan. Sporadic cases are also found between the outbreaks. The year 1980 was the year of an outbreak, and 170 patients were seen at our department from October, 1978 to November, 1981. Present report described the seasonal or monthly distribution, age distribution, clinical symptoms, and chest X-ray and laboratory findings of these patients. The antibody titer was low in infancy and the incidence of the antibody was increased with age. In addition, there were fewer Mycoplasma pneumoniae infections in infancy than in older childhood. These facts way be considered that the initial infections were mild or inapparent and the antibody was not necessarily raised. Recurrent infections, therefore, caused the development of the classical symptoms and the prominent increase in the antibody. The conclusion is that the pattern of the outbreaks may be related to the incidence of the antibody and to the age of the people in a given area.

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In order to control post-herpetic neuralgia, reflex sympathetic pain syndrome and post traumatic pain syndrome, repeated nerve blocks and infiltrations of local anesthetic agents into the area of the dependents segments were carried out until the disired results are obtained. The complications of these methods are pain, hemorrhage, scar and abcess etc. To minimize the possibility of unfavourable reactions by repeated injections to control the intractable pain syndromes, the effects of the topical applications of local anesthetic agents with C_7H_5NaO_3 (T.A), intravenous regional infusion or perfusion of neurotropin, reserpin, alplostadil, O_2, local anesthetics and heparine Na (IVRP or IVRT) combined with transcutaneous nerve stimulation were investigated. Analgesic effect on the dependent area appeared in 2-3 minutes on the chest, and 5-8 minutes on the fingers. The duration of the effect of the analgesics with C_6H_<12>Na was 3-8 hours by the topical application. Post traumatic pain syndrome and vasospastic disease of the extremity were relieved by IVRT of local anesthetics, reserpine, O_2 and PG E_1.

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Urokinase antigen, urokinase activity and α_2PI antigen were measured in various types of thrombotic diseases before urokinase administration. The values of urokinse antigen and urokinase activity in normal adults were 36.3±15.0μg/ml and 5.8±6.1IU/ml, respectively. In thrombotic diseases these values were higher than normal value. A positive correlation was observed between two values, but the correlation coefficient was r=0.36. When the level of α_2PI was low, urokinase activity was high in most cases of thrombotic diseases. These observations suggest that the enhancement of fibrinolysis would exist in thrombotic diseases and that the way and the dosage of urokinase administration would be influenced by the urokinase activity in these diseases. Urokinase antigen was purified by DEAE Sephadex A-50 and anti-urokinase Sepharose chromatography from the plasma of nephrotic syndrome. Two proteins were eluted from anti-urokinase Sepharose, showing 6.2×10^4 or 20-25×10^4 of molecular weight on SDS-PAGE. These proteins showed no urokinase activity. It is suggested that these proteins are urokinase precursor or urokinase inhibitor complex.

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In order to establish the effective urokinase administration, urokinase was administered to various types of thrombotic diseases and the role of α_2PI in the appearance of fibrinolysis was examined. In the patients treated with less than 10×10^4 IU/day of urokinase, fibrinolytic activity was weak. On the contrary, in those treated with more than 30×10^4 IU/day of urokinase a marked fibrinolytic activity was induced, and α_2PI was decreased. α_2PI was significantly related to the fibrinolytic activity and thought to be a useful monitor for urokinase therapy. Urokinase activity in plasma was assayed by chromogenic substrate S-2444. Urokinase activity appeared and was increased when α_2PI was decreased to 50% by urokinase infusion. Urokinase activity was regulated mainly by the level of α_2PI. In vitro study, plasmin activity was markedly increased in α_2PI depleted plasma and its degree was related to the level of α_2PI. High dosage of urokinase (48×10^4 IU/4hours) was administered to the patients with arterial thrombosis, myocardial infarction and renal diseases. In all cases, a marked fibrinolytic state was observed. Thus, the urokinase dosage was confirmed to be useful for the treatment of thrombosis.

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Subjective complaints such as occulusion feelings of ears so-called "Mimitsun", otalgia, tinnitus and impaired hearing were frequently made by conductors of high-speed express trains from Tokyo to Hakata (maximal speed 210 km/h). Their complaints were mainly observed at the time in/out of long tunnels, and the complaint rates (ringing 40.1%, impaired hearing 25.7%) were signifcantly higher than those by the conductors in another train. We measured the barometric pressure in the conductor rooms of the train using a conventional Aneroid barometer. The maximum change observed in 30 seconds-interval measurements was 20.0 mb, and that in 5 secondsinterval measurements was 9.9 mb. From these results it was suggested that these complaints would be caused by the rapid change in the inner barometric pressure of the train going in/out of tunnels.

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With an increase in thoracotomy under extra-corporeal circulation, especially cardiac operation under aortic cross-clamping, protection of the myocardium during operation has become an essential measure. The authors assessed the efficacy of various myocardial protection methods comparatively during aortic cross-clamping of 120 min. in 19 adult mongrel dogs which were divided into 3 groups as follows : Group I : included 5 of fibrillation elecrically. Group II : included 7 animals undergone topical cooling of the heart surface. Group III : 7 animals undergone coronary perfusion of the cold myocardial protection fluid through aortic root puncture combined with Young's solution and topical cooling of the heart surface. Cardiac fucntions before aortic cross-clamping and after release of it in each group were compared in terms of discontinuance of use of artificial heart and lung, myocardial ectopic enzyme, myocardial metabolism and hemodynamics. In Group I, cardiac resuscitation following the release of aortic crossclamping was poor with impossibility of discontinuance of use of artificial heart and lung in all cases. Moreover, the results of comparative studies on myocardial ectopic enzyme, myocardial metabolism and hemodynamics revealed poor protection of the myocardium as compared to the other 2 groups. In Group II, use of artificial heart and lung could be discontinued in only 2 out of 7 cases, suggesting that the protection method used in this group is superior to that in Group I. However, aortic cross-clamping as long as 120 min. appeared to be in adequate and in agreement with other authors we also had an impression that the duration of aortic cross-clamping should be about 60 to 100 min. In Group III, the ues of artificial heart and lung could be discontinued in all cases with better recovery of cardiac functions as compared to the other 2 groups in terms of myocardial ectopic enzyme determinations and hemodynamic studies. Thus, the myocardial protection method used in this group was proven to be superior to the methods used for the other 2 groups. From these results, it was found that coronary perfusion of the cold myocardial protection fluid combined with Young's solution through the aortic root puncture associated with topical cooling of the heart surface can provide protection against the cardiac arrest as promptly as possible, followed by homogenous cooling of the myocardium. Thus, it could recover most stable cardiac fucntions even after relase of aortic cross-clamping. This method exhibited good myocardial protection, permitting safe performance of aortic cross-clamping continuously for up to 120 min. Its clinical efficacy was also indicated.

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Somatosensory evoked potentials (SEPs) were recorded from sites overlying the 7th cervical vertebra, Erb's point and the scalp, following percutaneous stimulation of the median nerve at the wrist in 53 normal subjects. SEPs recorded from the scalp (reference : earlobe) consisted of P15 (peak latency 12.6±1.1ms), N20 (17.1±1.0), P25 (21.7±1.9), N35 (29.2±2.6), P45 (40.0±3.5) and N55 (57.4±6.6) in order. Peak-to-peak amplitudes of these components were as follows, P15-N20 (2.9±1.0μV), N20-P25 (4.1±1.8), P25-N35 (3.5±2.5), N35-P45 (4.5±2.3) and P45-N55 (6.1±2.8). In recordings made over the 7th cervical vertebra, it was possible to distinguish at least three components, namely N8 (peak latency 8.0±0.6ms), N11 (10.3±0.7) and N13 (12.0±0.9), in all subjects. From Erb's point a large amplitude potential (N9 : 8.7±0.5ms) was recorded and N20 (17.6±0.9ms) was recorded over the contralateral somatosensory cortex. These recordings employed a mid-frontal (Fz, 10-20 system) reference. The difference between peak latencies of N20 and N13 (central conduction time) was 5.7±0.5ms. The peak latencies of N9, N13, P15, N20, P25 and N35 each correlated positively with arm length, but the central conduction time did not correlate significantly with it. The differences between men and women were observed in N8, N9, N11, N13, N14, P15, N20, P25 and N35 latencies. These differences were probably due to the difference of the arm length.

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An autopsy case of Paroxysmal Nocturnal Hemogobinuria (PNH) was repoted. A 57-year-old woman was admitted to Kyorin University Hospital with complaints of general fatigue. She showed severe anemia. Ham test and Crosby test were positive and RBC acetylcholine esterase level was low. Diagnosis of PNH was made. A therapy using washed red cells transfusion, prednisolone, fluoxymesteron and ferrous sulfate were started. Fourteen month later from the diagnosis of PNH, physical examination revealed complication of femoral vein thrombosis and died of endotoxin shock due to gram negative rods. In our case, sugar water test was negative during the whole course. Thus the present case was different from the other PNH report. As PNH is rare disease, autopsy case is few. Our case was however thought to satisfy the criteria of pathological diagnosis of PNH described by Remmele and Leder.

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A 45-year-old female had a history of having Billroth II gastrectomy for duodenal ulcer. Fifteen days after the operation, the serum amylase level was 2, 012 Somogyi units/dl and arterial blood gas showed an arterial PaO_2 of 60.4mmHg. The diagnosis of postoperative pancreatitis was established by re-exploration of the abdomen. She complained of watery diarrhea following antibiotic therapy and died 4 days after the onset of diarrhea. Post-mortem examination disclosed acute pancriatitis resembling to that experimentally induced with trypsin. The lung was voluminous revealing "shock lung" without thrombosis. Pseudomembranous colitis was evident. Acute pancreatitis in this case was probably due to reflux of duodenal content after luminal obstruction occurred in the operated proximal jejunumloop. The mechanism causing pulmonary changes complicated with acute pancreatitis may be related to the activity of serum phospolipase A and to the result of complement catabolism in this disease. Although many factors have been implicated in the etiology of pseudomembranous colitis, it has been suggested that Clostridium difficile is the causative agent of antibiotics-associated pseudmembanous colitis during last few years. Therfore, the authors confirmed the importance of detection of this organism from the patient treated with antibiotics.

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A 40 year-old male sustained multiple blunt traumas in an industrial accident. On admission, physical examination and chest x-ray revealed multiple fructured ribs, thoracostomy evacuated about 200ml of blood. Chest x-ray taken 10 hours after admission demonstrated further, localized elevation of the right hemi-diahragm, suggesting to be the traumatic rupture with partial herniation of the liver. Ultrasonic and CT examinations showed discontinuity of the right hemi-diaphragm and herniation of partial portion of liver. Right thoracostomy at 14 hours after admission revealed the right hemi-diaphragm, about 15 cm in length, with partial herniation of the right lobe of the liver. The herniated portion of the liver was pushed back into the abdominal cavity and the ruptured diaphragm was repaired. The postoperative course of the patient was uneventful. In general, the early diagnosis of the traumatic rupture of the diaphragm, especially on the right side, is considered to be difficult. Although many diagnostic procedures have been advocated, we believe that noninvasive Ultrasonic and CT tests are useful armamentarium for early detection of the right hemi-diaphragmatic rupture with liver herniation.

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This paper is a case report of anesthesia of a 66-year-old female patient with the femoral neck fracture and Idiopathic Hgpertrophic Subaortic Stenosis (IHSS). IHSS was found in the patient before surgery. We used epidural anesthesia with local anesthetics and morphine supplemented with light general anesthesis to the patient. The anesthtic course was uneventful, and the patient has had no problem postoperatively. IHSS was characterized by decrease of left ventricular diastolic compliance and narrowing of systolic left ventricular outflow tract. In order to maintain adequate cardiac output, we had to control myocardial contractility within limited range. Other anesthesiologic cares were taken to avoid circulacory failure effected either by excessive increase or decrease in cardiac contractility and resultant rapid dynamic change of circulatory condition by the increased catecholamine, and accelerated sympathic and inhibited parasympathic activites.

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