The authors examined acute intoxication by tetraethyllead from the point of view of symptomatology of the central nervous system by direct observation and the method of spontaneous motor activity with ANIMEX count. Fifty male Wistar rats, body weight between 250 g and 300 g, were used. The present study consists of two parts, observation of sysmptoms and motor activity count. In the first part, rats were divided into seven groups. The groups which consisted of 5, 5, 5, 5, 10, 3, and 2 rats ; were given tetraethyllead intraperitonealy in amounts of 0, 10, 20, 40, 60, 80, and 120 mg/kg body weight respectively. In the second part, rats were divided into three grous. The groups, which consisted of 2, 8, and 5 rats, were given tetraethyllead in amounts of 10, 20, and 40 mg/kg respectively. The following results were obtained : 1) Most of the rats administered with 20, 40, 60, 80, and 120 mg/kg of tetraethyllead died. The greater the dose that was administered, the faster the toxic symptoms appearred. However, the group given 10 mg/kg survived, and no toxic symptoms appeared. 2) After injection of tetraethyllead, body weight continued to decrease until death, and the amount of body weight loss was in the order of rats given 20, 40, 60, and 80 mg/kg injections. On the other hand, the body weight loss in the group given 10 mg/kg lasted for twelve days after injection of tetraethyllead, and recovered thereafter. 3) Motor activity in the rats in the 10 and 20 mg/kg groups which survived was examined, but daily changes of the motor activity were not seen. For the rats in the 20 and 40 mg/kg groups, which died, however, the greater the dose that was administered, the more the motor activity increased. The above results suggest that the count of motor activity by ANIMEX can be used for the estimation of symptoms of the central nervous system. Also, it is supposed that the minimum lethal dose (MLD) and 50% lethal dose (LD_<50>) are between 10 mg/kg and 20 mg/kg of tetraethyllead.

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Blood levels of catecholamine (CAs) increased abruptly to reach very high levels when blood samples were taken successively from decapitated rats, indicating that quick letting of blood caused stressful conditions to release and secrete CAs. If we want to know accurate levels of plasma CAs, it is necessary to take blood samples under non-stressful conditions. For this purpose, we have been trying to draw blood through a catheter into jugular vein of conscious rats under unrestrained conditions. Plasma levels of CAs in these rats (norepinephrine 1.11±0.05 ng/ml and epinephrine 0.45±0.1 ng/ml, mean±S.E.) were quite lower than those of decapitated rats (norepinephrine 5.5±1.3 and epinephrine 11.2±1.0). Successive draws of blood (2ml each time) resulted in abrupt rise in plasma CAs levels around 4 minutes of blood collections. Adrenal-medullectomy did not cause the rise on epinephrine levels. In 6-hydroxydopamine-administered adrenal-medullecto-mized rats, plasma norepinephrine was also not risen by successive draws of blood samples. Several blood draws at 10 min. interval did not change the plasma CAs levels at least for about 60 minutes. Frequency and interval of blood draws are important factors for obtaining constant and accurate level of CAs secreted from adrenal medulla.

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Changes in p-nitrophenylphosphatase (p-NPPase) activity in rat liver induced by selective bile duct ligation were examined by light and electron microscopy. Bile ducts draining the middle lobe were interrupted by ligation for 6-48 hours. p-NPPase activity was detected in the middle and right lobes from both ligated and non-ligated, intact animals, employing the lead citrate method (Mayahara, et al., 1980). In parallel with histochemistry, values of serum total bilirubin, ALP, LAP, GOT, GPT and total bile acid were biochemically measured. In the intact liver and also in the right lobe from ligated animals, p-NPPase activity was strongly positive along the cell membrane of each hepatocyte. Reaction product representing p-NPPase activity was primarily localized to the cytoplasmic side of the cell membrane, and occasionally found on the luminal surface of the cell membrane in the bile canalicular region. When incubated in the medium in the presence of 10mM Ouabain or in the absence of K^+, reaction product was observed exclusively in the bile canalicular region. In the middle lobe from ligated animals, p-NPPase activity in sinusoidal and lateral regions of the cell membrane of hepatocytes was weakened at 6th hour and essentially negative at 24th hour after ligation, respectively. Activity in the bile canalicular region remained unchanged. Values of serum GOT, GPT and total bile acid increased progressively after ligation, while those of total bilirubin, ALP and LAP remained unchanged.

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Analgesic nephropathy which was first described in 1953 in Swiss watch-makers by Spuhler and Zollinger and is now one of world wide health problem, since chronic tubulointerstitial disease associated with prolonged analgesic abuse often develops chronic renal failure. In Japan this disease is relatively rare at present because of no habituation of analgesic abuse. In this report the precise clinical course in a 33 years old house wife who have abused commercially available analgesics for not less than 12 years due to intractable headache was described. It was emphasized that in middle aged female patients associated with anemia and depressed renal function analgesic nephropathy should be differentiated from other causes of chronic renal failure by taking careful history of analgesic abuse.

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[in Japanese]

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Two patients of the testicular tumor with lung metastases who resulted in well effection by chemotherapy are reported. The multiple, large nodular shadow were found in their Chest Xray. One of them was 35 years old man. Right high orchiectomy was performed. The removed mass was measured 9×8×7cm in size and 300g. in weight. Seminoma was diagnosed by the histopathological examination. Postoperatively, chemotherapy with cis-diamminedichloroplatinum (CDDP) was commenced. The other one 33 years old man. Right high orchiectomy was performed. The removed mass was mesured 5×5×3cm. The embryonal carcinoma was diagnosed by histopathological findings. Postoperatively, chemotherapy with CDDP, bleomycin and vinblastin was commenced. Those metastases has completely disappeared by the chemotherapy.

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Eighteen cases of chronic schistosomiasis japonica with stenosis of the large intestine that have been diagnosed at Kofu City Hospital during the past 16 years were observed. The results were summarized as follows : 1) There was no significant difference in the rate of stenosis between male and female, but the disease seemed to occur more frequently in the aged. 2) A presumptive diagnosis of cancer was made preoperatively in some cases. This disease should be seriously considered when stenosis of the large intestine is discovered in a patient from the Kofu basin area. 3) The location of lesion was found most frequently in the rectum, in 44.4%, 8 cases out of 18. 4) In the endemic area, Schistosoma japonicum infection should be considered as a cause not only for cancer or polyposis, but also for stenosis of the digestive tract among the inhabitants or native of the area. 5) In view of relationship between the stenosis of large intestine and the histological finding of liver, it's frequent occurrence in patients with hepatic lesion, especially marked hepatic fibrosis suggests a high frequency in patients with dense infestation by this parasite.

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A 32-year old man was admitted because of right abdominal tumor sized 4.5×5.0 cm and right upper abdominal pain on July 6th 1980. High fever and lower abdominal pain had occurred a year earlier. White blood cell counts and erythrocyte sedimentation rate were within normal range. Both CRP and tuberculin-test were positive. Cystic tumor was revealed in the right abdominal wall by ultrasonography, CT and peritoneoscopy. On Sept. 11th, laparotomy was done. There was a smooth 8 cm mass in the abdominal wall beneath the peritoneum, which contained 50ml of yellowish white pus. A drainage tube was introduced and streptomycin was instilled into the abscess cavity. The pathological specimen showed epithelioid granuloma and caseation. His postoperative course was uneventful and he was recovered completely with chemotherapy. Cases of tuberculosis of the abdominal wall reported in Japan for last twenty years are only 13 including this case. Cases of tuberculosis of abdominal wall are becoming rarer and tend to occur only in higher age group.

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The CNS involvements of Mycoplasma pneumoniae infection are relatively rare though it's existence is well known. This paper described a case of M. pn. meningoencephalitis confirmed by high titer of CF antigen againts M. pn. in CSF as well as in serum. 16-year old male student was admitted because of high fever and severe headache for 2 days. On admission he was somnolescent and restless and stiffness of the neck with positive Kernig's sign was observed. No pathological reflexes were seen. Chest x-ray film showed no abnormal findings. Results of CSF test were as follows : appearance clear and colorless, cell count 1864/3 with 93% lymphocyte, protein concentration 113mg/dl, glucose concentration 73 mg/dl. Since the M. pn. CF titer was 1 : 512 in serum and 1 : 32 in CSF, and cold agglutinin titer in serum was 1 : 1024, the diagnosis of M. pn. meningoencephalitis was made. He recovered completly by predonisolone and erythromycin treatment continued for about one month. It should be considered that there might be some cases of M. pn. infection among the meningitis or meningoencephalitis of unknown origin.

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A rare case of Stevens-Johnson syndrome associated with acute hepatitis was described. A 47-year-old man was admitted to the hospital because of generalized eruption. He had suffered with shoulder pain. Chlormezanone 600 mg a day was given for 9 days. Five days after cessation of this drug, he had fever with chill, and consulted us. The patient was diagnosed pharingitis, and prescribed talampicillin hydrochloride and diclofenac sodium. About two hours after taking talampicillin 500 mg and diclofenac 25 mg, generalized skin eruptions developed. Blood chemistry revealed GOT 1884 mIU, GPT 1434 mIU, T-Bil 2.6 mg/dl. Bullous and erythematous eruptions on general skin and erosive lesions on mucosa were seen. He was diagnosed Stevens-Johnson syndrome associated with acute hepatitis. Predonisolone (40mg a day) therapy was started, and the symptoms were improved rapidly. Both Stevens-Johnson syndrome and hepatitis are presumed to be induced by some of these drugs, although Lympheocyte Transformation Tests and patch tests were all negative.

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A 68-year-old woman with hypertension suddenly developed dysphagia and hoarseness. Physical examination revealed paralysis of the right soft palate, pharynx and vocal cord. The symptoms gradually improved and finally disappeared in about 1 month. During that time, no other neurological symptoms and signs appeared. Labolatory examination including cerebrospinal fluid and brain CT scan offered no positive results. Her disorder was diagnosed as Avellis' syndrome, and its lesion was supposed to be a small infarction around the right ambiguous nucleus in the medulla. Only 7 cases of Avellis' syndrome have been reported in Japan. The site of lesion was mostly in the medulla and a frequent cause was cerebral vascular lesion. The syndrome was often accompanied by Horner's syndrome and contralateral hemihypalgesia below neck. A case of Avellis' syndrome like our patient without any other neurological abnormalities throughout the course, indicating an extremely localized lesion, seems to be rare in the literature.

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Legal theories concerning the civil liability of the so-called "New Health Practitioner" (the PA or NP) in the United States were considered with reference to recent legal situations in that country. The "New Health Practitioner" is placed under the direction of a physician, and so the physician might sometimes be liable for the actions of his PA or NP, and charged with negligence under the theory of respondeat superior. In connection with establishing the standard of care owed by the PA, it can be pointed out that some States are beginning to abandon the customary locality rule and adopt medical treatises as a means of establishing the standard of care. However, since the PA was trained to be an assistant to the physician, it will not be possible to require of him or her the same standard of care as in the case of the physician. As for the standard of care owed by the NP, the national standard of nursing practice is applied, but, strictly speaking, the NP has a more advanced education and training than the RN or PN, and so a higher standard of care will be required. There are some discussions as to whether or not the statute of limitations should be applied. Recently some States have made law amendments shortening the period within which the right of starting a legal action will be guaranteed concerning medical malpractice. The above considerations will give useful suggestions to legal theories concerning the civil liability of paramedics of our country.

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[in Japanese]

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