It was supposed that, in the Clq microplate ELISA for the detection of a circulating immune complex, the accurate results could not be obtained, if either the Clq or soluble heat-aggregated human IgG (SAHG) and the both were contaminated with monomeric IgG. Thus, an attempt was carried out to clarify whether monomeric IgG has inhibitory effects on the binding of SAHG to Clq in the ELISA. In order to use the Clq and SAHG not contaminating with monomeric IgG in the study, a Clq material that was partially purified by Yonemasu method was purified highly on Protein A Sepharose CL 4B column chromatograph, with PBS-E, pH 7.4. This material was demonstrated to not contaminate with monomeric IgG by SDS- polyacrylamide gel electrophoresis, and also to retain the activity by latex agglutination with rhumatoid arthritis reagent. Subsequently, insoluble residues in heat-treated human IgG solution was removed by centrifugation. The supernatant contained both the SAHG and monomeric IgG. The solution was subjected to Sephadex G 200 column chromatography for separation of the two components. When an ELISA assay for examining the binding of SAHG to Clq was carried out with the purified Clq and SAHG materials, the binding of SAHG to the purified Clq-coated wells on the microplate was found to be concentration-dependent. However, when added to either the purified Clq or the SAHG solution, monomeric Ig G gave an inhibitory effect on the binding of SAHG to Clq. Especially, monomeric IgG exhibited more inhibitory activity in a case of addition into the Clq solution than in that of addition into SAHG. In addition, it was observed that enzyme-linked anti-human IgG (Fab) anyibody was more strongly bound to monomeric Ig G in the mixture of Clq and monomeric IgG coating wells of the microplate than to the only monomeric Ig G coating wells. The results indicated that, if Clq and/or SAHG which were contaminated with monomeric IgG, were used as standard materials in ELISA, the assay could not give accurate results in detecting circulating immune complex.

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It is already well known that aspirin is one of the representative antiplatelet drug. To confirm the clinical usefulness of aspirin as an antiplatelet drug, its influences on platelet functions in various arteriosclerotic patients were examined. The patients with arteriosclerosis were consisted of those with myocardial infarction (10), angina pectoris (5) and cerebral infarction (10) with the ages of 67.2±7.3. Normal controls were consisted of healthy young adults with the ages of 28.4±3.8 years and middle aged persons with the ages of 61.6±4.0 years. As indices of platelet functions, platelet aggregation test and the determination of prostanoids and platelet releasing substances were performed. Those parameters were determined after the first administration and during the consecutive administration of the drug of 300 mg once everyday for 4 weeks. The results thus obtained could be summarized as below : 1. The enhanced platelet aggregation of the patients with arteriosclerosis before the administration normalized throughout the whole periods of aspirin adminisration. 2. The serum levels of TXB_2 and 6-Keto-PGF_<1α> simultaneously decreased, but significant decrease was observed in the latter. The ratio of TXB_2 to 6-Keto-PGF_<1α> also decreased throughout the study. 3. In cases of arteriosclerosis serum levels of β-TG and PF4 significantly decreased which were similar to that of platelet releasing reaction. 4. The inhibitory effects of aspirin on platelet functions tapered, although those were still present even after 4 weeks. It was concluded that aspirin almost normalized the platelet aggregation even at the low dosis of 300mg per day. The administration of aspirin in this dosis could prevent the formation of thrombosis and improve hemodynamics in patients with arteriosclerosis.

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The diagnosis rates by mammography and the microcalcification observed in X-ray films of patients with breast carcinoma were investigated. Of the 45 breast carcinoma cases treated in this department from February 1980 to November 1983, accurate diagnosis amounted to 37 cases (82.2%). In breast carcinoma classified by size, the accuracy rate was 44.4% for T_1 ; 92.3% for T_2 ; 83.3% for T_3 ; and 100% for the 4 cases of T_4. In breast carcinoma histological types, the accuracy diagnosis rate for papillo tabular carcinoma was 64.3% ; for medullary tabular carcinoma, 90.0% ; scirrhous carcinoma, 92.9% ; and for special types, 85.7%. Microcalcification was acknowledged in 12 cases by mammography diagnosis and in 6 cases by histological findings.

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[in Japanese]

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The right hind leg of each adult rabbit was plaster-immobilized for 2-8 weeks. 1 ml of 4% HRP was directly injected into the articular cavity of the knee joint. After 30 min, the articular cartilage of the distal end of the femur was taken out. The specimens were prefixed with aldehyde, cut into frozen sections, exposed to DAB, and then examined by light and transmission electron microscopy. In the non-treated group, the HRP activity was detected in the matrix throughout the cartilage, and also in chondrocytes in all the layers of the cartilage. In the plaster-immobilized groups, on the other hand, the degree of the HRP penetration was much reduced in depth. With 4 weeks or longer immobilization, the HRP penetration was almost restricted to the surface and the superficial layer of the cartilage. Specimens from the joint without the HRP injection showed no positive reaction. Thus, changes in permeability of the articular cartilage induced by the artificial joint contracture was clearly visualized by light and electron microscopy using HRP as a marker.

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Radiological examination of the small intestine was done by the double contrast method using Argyle-Dennis tube. The tube was inserted into the duodenum and the balloon was inflated to prevent reflux of barium and air. Three hundred to 400ml 50w/v% barium was infused into the intestine and delivered to the terminal ileum with air. Fine image of mucous membrane of the small intestine was obtained without any difficulty. This study was performed in 32 patients. Double contrast image of the jejunum was obtained in all patients examined, of the upper ileum in 93.8% of cases, and of the lower ileum in 84.4%. Pathological findings were revealed in 11 cases including lymphoid hyperplasia of the terminal ileum, benign stricture of the jejunum, leiomyosarcoma, Dego's disease, Crohn's disease and nonspecific ulcer of the ileum. This technique was useful in diagnosis of diseases of the small intestine.

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Between 1976 and 1981, 11 patients' spermatic cord torsion were treated in our hospital. These 11 cases are reported. The incidence was 0.14% of outpatients, and increasing gradually. Spermatic cord torsion occured in 4 patients on the right, and in 6 patients on the left, bilateral was in 1. External torsion was in 6, and internal torsion was in 4. The most oldest patient was 38, and teenage patients were 7. The onset of symptom was testicular pain in 8 patients, and inguinal or lower adbominal pain in 6 patients. The sudden onset was in 5 patients. Three patients had nausea and vomiting. Low grade fever was seen in 5 patients, and leucocytosis (over 8000/nm^3) was in 7 patients in which 3 patients required orchiectomy were all included. Miction pain was seen in only one patient who was performed orchiectomy. The time of the onset of symptom was all in from 2 Am to 11 AM. The onset of symptom came on during sleep in 8 patients, morning erection in 1, going to school in 1. Orchiectomy was carried out in 3 patients, and orchiopexy in 8. All patients performed orchiopexy were treated within the first 9 hours after the onset of symptoms. Three patients required orchiectomy were all missdiagnosed them initially as acute epididymitis. First diagnosis suspected from the histry, the age and the local findings is the most important.

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A 13-year-old, previously healthy schoolgirl subacutely presented with muscular weakness of the limbs and dysesthesia of the hands and feet after suffering from common cold. Neurological examination revealed loss of deep tendon reflexes in addition to muscular weakness, but the sensation was objectively normal. Laboratory examination disclosed albuminocytological dissociation in CSF, and marked reduction of the nerve conduction velocity. Serum CPK was elevated slightly in this first admission. Prednisolone, initially 80 mg/day, was effective, and she returned to home about 6 months after the onset of the neurological symptoms Although the muscle strength was not enough for physical activity, she was able to attend school with some help of her family and friends About 10 months after the discharge, she was admitted again, because of worsening of muscular weakness following common cold Neurological and laboratory examinations showed almost the same results as those in the first admission, except for moderate elevation of serum CPK which subsequently normalized in about 2 months. Prednisolone was effective again in this second admission, but the recovery of muscle power reached only the same level as that after the first treatment. Chronic relapsing polyneuropathy is not common. Actually only 31 cases have been reported in Japan. One case among these showed an elevation of serum CPK. Although the mechanism is not known, some transient influence on muscular tissue is likely to have occurred in our case as well as in the case in the literature.

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A 74 year-old man was admitted to the Second Department of Surgery, Kyorin University hospital with chief complaints of dysphagia for 6 months. Under the diagnosis of esophageal carcinoma, surgical resection of esophgus was done. An ulcerative carcinoma, 5×4.5cm in dimension, was seen in the middle thoracic esophagus. The structure of tumor mass was complicated ; histologically mostly being composed of malignant lymphoepithelioma with adenoid cystic carcinoma in the adjoining part. Apart from this main tumor, there was a small node of tran sitional cell carcinoma which developed in the esophageal glands. Their histogenesis was interesting and has been discussed in details in the present communication. We guess that the tumor might be originated from the esophageal glands and their ducts.

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The author observed an anomalous middle colic artery (A. colica media accessoria) derived from the splenic artery in a 78 year old female at autopsy in 1979. The accessory middle colic artery in this case, about 14cm long, after originating from the splenic artery, went downwards and to the left, crossed behind the pancreatic body, and then gave off the pancreatic branch, before arriving at the left colic flexure. It supplied the distal section (about 20 cm) of the transverse colon and the upper section (about 7 cm) of the descending colon, and communicated with the left branch of the middle colic artery from the superior mesenteric artery superiorly and with the left colic artery from the inferior mesenteric artery inferiorly. In addition, variation of the hepatic artery (A. hepatica accessoria dextra derived from the celiac trunk, Adachi's classification : Type I, Group 7, 1928) was also observed in this case.

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A 55 year-old previously healthy man admitted to the hospital because of pretibial edema. Laboratory examination on admission showed marked proteinuria and low albuminemia, and a diagnosis of nephrotic syndrome was made. A first renal biopsy was performed on Febr. 1, 1982. Because the specimen showed circumferential crescentic formation in about 60% of the observed glomeruli, the cocktail therapy using prednisolone, cyclophosphamide, dipyridamole, heparin, warfarin and urokinase was done for about two months. After this therapy, his urinary protein excretion decreased and elevated serum IgA value also decreased. Creatinin clearance increased. The second renal biopsy was performed on May. 21, 1982 after the end of cocktail therapy. On immunofluorescent study, IgA deposited in the mesangial area of the glomeruli and partially extended along the capillary walls. Other IgG and complements were all negative. Therefore, a diagnosis of crescentic IgA nephritis was made retrospectively. On light microscopic study, the specimen showed the decrease of crescentic formation from 60% to 20%, suggested that crescentic glomerulonephritis have a tendency to resolute through the cocktail therapy. It was considered that the cocktail therapy might be one of the effective therapy to improve the prognosis of crescentic IgA nephritis.

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During the last 4 years, 10 patients with antibiotic induced hemorrhagic colitis were admitted to our department complaining of bloody diarrhea and cramping abdominal pain. There were 5 males and 5 females. Their age ranged 19 to 58 year. Eight cases had had ampicillin and 2 cases amoxicillin before the onset. In 7 cases symptoms appeared 2 days after the antibiotics were stopped, while in other 3 cases during antibiotic-administration. Fecal culture disclosed Klebsiella oxytoca in 7 of 10 patients. Colonoscopy were done in 3 patients and revealed multiple linear ulcers in the transverse colon in one case and scattered red spots and erosions in the sigmoid colon in two cases. Barium enema studies were performed in 6 cases and showed loss of haustration with rigidity of sigmoid colon in only one case. Lymphocyte stimulating tests done in 2 cases were positive with ampicillin and amoxicillin, respertively. The course was self-limited and complete recovery was seen within 2 weeks.

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