A statistical analysis of 22 patients with malignant tumor of the nose and paranasal sinuses treated at the Department of Otolaryngology, Kyorin University Hospital, for the past 10 years from 1971 to 1980, revealed followings : 1) Histologically, squamous cell carcinoma was that of highest frequencies. 2) Incidences of those among men were higher than those of women by the ratio of 1.75 : 1. 3) The highest incidence of those were at 5th and 6th decades. 4) Cheek pain and nasal stuffing were the most common and characteristic symptoms of those carcinomas.

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Chest injuries greatly influence the outcome of the trauma victims in adults. Eighty one children with chest trauma treated at our institution during the past 3 years and 6 months period were reviewed and the critical care of pediatric chest trauma was discussed. All of 81 children sustained thoracic injuries by blunt forces and a road traffic accident in the form of automobile vs pedestrian was the major cause of injury in 65 (80.2%) children. Pulmonary contusion was the most frequent injury of the chest (34.6%). Pneumothorax or hemothorax was noted in 8 (9.9%) children and fractures of the ribs were accompanied in 5 (6.1%) children. The elasticity of a child's thorax may account for the presence of these intrathoracic lesions without rib fractures. Twenty three (28.3%) children were polytraumatized and 3 deaths occurred in this group of patients. All deaths were attributable to the associated neurological or abdominal damage. It became clear that significant chest injuries are frequently a component of mulitisystem injuries in children. Thus, a proper sequence must be followed in the management of the poly-traumatized children with chest trauma. A well organized system of evaluation and resuscitation is mandatory for the best care of children with major blunt injuries.

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This study was performed to investigate the effects of 27-hour and 40-hour total sleep deprivation upon the later sleep pattern. The subjects were 18 healthy males of whom eights were assigned to 27-hour sleep deprivation, and ten to 40-hour sleep deprivation. As the results, while both S4 and SWS were found to significantly increase in the day sleep following 27-hour sleep deprivation, and in the first recovery night sleep after the 40-hour sleep deprivation, the rate of sleep increase was more pronouced under the latter condition. On the other hand, a reduction of REM latency and a significant increase in the amount of REM sleep were observed in the day sleep following the 27-hour sleep deprivation, but not in the first recovery night after the 40-hour sleep deprivation. In the second recovery night sleep, only the REM sleep increased significantly. From these results it was concluded that the amount of S4 might be dependent on the amount of sleep loss, the length of prior wakefulness, and the REM sleep in the circadian rhythm.

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I have examined pathological religious experiences in 35 patients who were observed in the Neuropsychiatric Clinic of Kyorin University School of Medicine, Sankei Hospital, Tokyooume Hospital and the Neuropsychiatric Clinic of Sakuramachi Hospital. Modern Japanese religion involves Christianity, Buddhism, Shinto and so called New religion. Such variety of religion and development of so called New religion are to be the feature of modern Japan. Analogous involvement of such variety of religion was seen in the symptomes of the cases studied. Thirty-one cases were diagnosed as schizophrenia, 2 as psychogenicreaction, 1 as atypical psychosis. As to male-female ratio, female was dominant (24 cases). Such tendency may be due to the basic character of female and female superiority in number of believers. Then as to clinical pictures confusion and possession were dominant. Especially possession was considered as one of the features of pathological religious experiences in modern Japan. The object of possession was various such as god, devil, Jesus Christ, soul etc. But few was possession of animal. Although many objects of worship were expressed by the word god, the meaning of the word is complex. It is called that Japanese are affective and inspirational, by contrast European are rather logical and reasonable. I think that possession and confusion are associated with such Japanese feature. My conclusion is that pathological religious experiences in modern Japan are based on fundamental and archaic spirit of our nationality.

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Delayed skin test by SU-Polysaccharide (SU-PS) solution of 20μg per 0.1ml separated from the cell-wall fraction of the SU-strain of streptococcus pyogens A3 were performed to study the immunological status in 18 patients with malignant disease administrating more than 20KE (Klinishe Einheit) of the OK-432 (Picibanil) which is one of the bacterial immunopotentiater, and correlation between SU-PS skin test and delayed skin tests (PHA, PPD), lymphocyte count, monocyte count, serum total protein, serum albumin were studied. There was a significant correlation between SU-PS skin tests and PHA skin tests (r=0.86, p<0.01) and also there was a significant correlation between SU-PS skin tests and PPD skin tests (r=0.85, p<0.01). SU-PS skin tests correlated with lymphocyte count (r=0.43, p<0.01), but there was not a significant correlation between SU-PS skin tests and monocyte count. There was a significant correlation between SU-PS skin tests and serum total protein (r=0.577, p<0.01) and also a significant correlation between SU-PS skin tests and serum albumin (r=0.768, p<0.01). These correlations showed that the nutritional status of the host give influence on the reactivities of the SU-PS skin responses.

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Chickens were visually isolated immediatly after hatching. Twelve hours after hatching, the animals were first exposed to an electrically driven toy dog. For consecutive 5 days starting the next day after the first exposure, chickens were placed in an circular field, for 4 minutes once a day each. "Following response" was evaluated with criteria which was invented by us. The animals were divided into 2 homogeneous groups, experimental and control, with regard to the scores of the following response. For the following 7 days, both groups were subjected to "Recognition at reunion test." The experimental group's animals were subjected once a day to "Recognition at reunion test" which consisted of 2 exposures of 2 minutes each, phase 1 and phase 2, to a toy dog, interrupted by one minute isolation. Those animals were rated with the scores in the following response. The control animals were subjected to the same test of an exposure to a toy dog for 4 minutes once a day each, this time without interrupting isolation. In the experimental group animals the degree of attachment behavior was stronger in phase 2 than that in phase 1. And after 2nd experimental day, the attachment behavior was stronger in phase 1 of the experimental group animals as compared with that in the control group animals. These results were not in accordance with those implicated in a report by Depaulo et al, in which they suggested the possibility that attachment behavior may result from learning.

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Five daily intraperitoneal injections of subdiabetogenic dose (40mg/kg) of streptozotocin produced a progressive increase in blood glucose in CD-1 male mice. Light microscopy revealed insulitis with striking mononuclear cell infiltration in mice pancreatic islets sacrificed 6 days after streptozotocin injections. Comparing to the control mice, dexamethasone treatment significantly suppressed the blood glucose elevation induced by multiple small-dose injections of streptozotocin. Mononuclear cell infiltration was also suppressed remarkably in the pancreatic islets of dexamethasone treated mice. Sulpyrine or indomethacin suppressed hyperglycemia slightly and transiently in this model of diabetes and blood glucose level in those animals became as high as control mice. Treatment with arabinofuranosyl-adenine, an antiviral agent which is supposed to possess no effect on humoral and cellular immunity, also attenuated the hyperglycemia produced by multiple small-dose injections of streptozotocin in mice. The suppressive effects of arabinofuranosyl-adenine, however, was less marked and shorter durated than the effects of dexamethasone treatment. These results support a possible role of endogenous virus induction and cell mediated autoimmunity in the development of diabetes syndrome in mice treated with multiple small-dose streptozotocin injections.

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It has been reported that beta cell toxicity of streptozotocin (STZ) is dependent on the injected dose as well as on the injection time. In this study we examined whether the circadian susceptibility of beta cell to STZ exists in the case of experimental model of diabetes produced by multiple small-dose injections of STZ in mice. Twenty mg/kg of STZ, subdiabetogenic dose, was intraperitonealy injected daily for ten days at 10 : 00 a.m. in one group of CD-1 male mice and at 4 : 00 p.m. in another group. Blood was taken from tail vein weekly and glucose concentration in plasma was determined using glucose oxidase method until 46 days after STZ injection. In the mice recieved STZ at 10 : 00 a.m. blood glucose concentration was almost unchanged throughout the experiment except slight elevation at the 6th day of injection. On the contrary, injections of STZ at 4 : 00 p.m. produced a progressive increase in blood glucose after about 20 days of latent period. In those animals the level of blood glucose reached 312±124mg/dl finally. Thus, the initial toxic effect of STZ may be important in this model of diabetes like the case of diabetes produced by one large dose of STZ injection. Elucidation of metabolic and/or immunological derangement during the latent period of this model appeared to be useful for studies on the pathogenesis of insulin dependent diabetes mellitus in human.

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An intramedullary fat necrosis in bone following traumatic pancreatitis is extremely rare in literature. This paper presents such a case that has been treated by us. Case : K. I. 20-year-old female had been treated after abdominal injury incurred in a traffic accident for abdominal pain and fever by a first doctor for three weeks. Abdominal pain and fever, however, did not subside, and pain and swelling of many joints occurred on extremities. Therefore, she moved to the University Hospital and had many kinds of laboratory tests. X-rays at that time showed lots of osteolytic lesions without periosteal ossification of tibia, radius and ulna. Tentative diagnosis was osteomyelitis of multiple bones. Abdominal pain disappeard and general condition improved absolutely after surgery for pseudocysts of the pancreas but the pain and swelling of joints of extremities recurred several times after the surgery. Culture of blood and pus from bones and joints was carried out several times but it was always negative. We diagnosed her condition as an intramedullary fat necrosis in bone following traumatic pancreatitis at 10 months after the surgery. She has been treated by us for pain, swelling and deformity of joints for total of one year and a half at the outpatient clinic. She is very well at present time and is still under observation.

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Problems on emergency medical treatments in Japan and clinical evaluations of the cases treated at our Critical Care Center are discussed with our attitudes toward Emergency Medicine in the concept of Primary Care. Our Critical Care Center was opened in October, 1979, and total number of the patients cared in the Center in these three years is 1959. Our Critical Care Center is operated not as an independent unit but as a cooperative one of our Hospital, so that patients may get sufficient treatments and services and also it puts great emphasis on education and training of the students and young staffs. Although the concept of Primary Care for promotion of health and prevention and treatment of diseases seems to be related with distribution of medical personnel, institutions and funds, the most important factor for success of this medical philosophy, we think, would be our warm understanding of pain and distress of the patients, families and residents around us.

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