The respiratory disease caused by Mycoplasma pneumoniae (M. pneumoniae) may result from the immunological mechanisms after the onset of infection. To elucidate the pathologic mechanisms of this disease, infection was induced by inoculation of 3-week-old Golden hamsters with M. pneumoniae. After 20 weeks the animals were re-inoculated to cause a second infection. Mycoplasma count and histopathological chages in the lung and serum antibodies were determined at regular intervals after each inoculation. The mycoplasma count in reinfected hamsters was lower than that in animals undergoing a single inoculation. On the other hand, lung lesions were severer in the reinfected animals. Specific anti-M. pneumoniae IgG antibodies were detected in high titers early after reinfection, and the severity of lung lesions paralleled IgG antibody titer. These results suggest that hosts are sensitized by the first infection with M. pneumoniae, and that severe histopathological changes may be caused by immunological mechanisms involved in reinfection.

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Statistical averges (M) and standard deviations (SD) were calculated in 8062 data for serum Na and K, and in 8063 data for serum Cl, which were obtained at Clinical Laboratories, Kyorin University Hospital in 1981. There were little differences between these valus and those obtained at other universities. Besides, appearance rates of abnormal values deviating from the clinical reference range were examined. The appearance rates of abnormal high values over M+2SD were 1.0% in Na, 6.6% in K, and 5.1% in Cl, while those of abnormal low values under M-2SD were 9.8% in Na, 3.8% in K, and 10.1% in Cl. Especially, in Na, a big difference in the appearance rate was obtained between the abnormal high values and the abnormal low values. With a view to establishing the homeostatic limit values (the panic data), 1% part of the appearance rate in the both ends of abnormal values were cut away, and some consideration which seemed to be of clinical importance were added to the data. As a result, it seemed adequate to consider the high limit values to be about 160 mEq/l for Na, 7.0-7.9 mEq/l for K and 116-120 mEq/l for Cl, and the low limit values to be about 116-119 mEq/l for Na, 2.4mEq/l for K, and 75-79 mEq/l for Cl. Improvement in the method of treating sera has made the appearance, compared with the previous data. It is yet necessary to take sufficient care in reading hyperkalemic data. The canges in values due to age and sex were also discussed.

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As a series of studies in our laboratory, the distribution of nutrient arteries in skeletal muscle has been studying. In this paper, the origin of nutrient arteries, the branching condition, their distribution area in the soleus muscle and the structure of muscle about were studied in 10 Japanese adults with 20 side cases. The upper portion of this muscle is usually supplied by the branches of popliteal artery (Po) and anterior tibial artery (Ta). The bottom of the upper portion, the middle portion and the lower portion are usually supplied by the branches of common posterior tibial artery (Tpc), proper posterior tibial artery (Tpp) and peroneal artery (Pe) (Type I-a). Distribution of the arteries within soleus muscle can be described in the following six types. These are (1) Type I-a (for the reason above), (2) Type I-b (Tpc lacks from Type I-a), (3) Type II-a (Talacks), (4) Type II-b (Ta and Tpc lack), (5) Type III-a (Po lacks) and (6) Type III-b (Po and Tpc lack). Each frequencies of above six types' existence are 45%, 10%, 15%, 15%, 10% and 5% respectively. The ratio of the distribution area of nutrient artery is as follows. Pe has the largest area and Tpp has the second largest. The total range of numbers of the nutrient arteries are from 8 to 19. Among them from 8 to 11 are obrerved in most cases.

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In the past 4 years, 12 extraanatomic axillo-unifemoral and 7 axillo-bifemoral bypass grafting have been performed on 17 patients regarded as poor risk for conventional procedure with aortic and iliac arteriosclerotic occlusive disease. Fifteen of the patients were men and 2 were women with an average age of 67.2 years. Prior to the bypass grafting, they had been suffering from ischemic symptom for an average of 20 years and 5 months. Sequential femoro-popliteal bypass was required simultaneously in 5 paitents with segmental occlusion in the peripheral end of superficial and popliteal arteries. On one patient, femoro-popliteal bypass was performed one month after axillo-bifemoral bypass grafting. For all the extraanatomic bypasses, we used externally supported Dacron and enforced or ringed PTFE prostheses and for femoro-popliteal bypass PTFE or saphenous vein graft. There were one perioperative death (for 3.5% hospital mortality and one death (6.3%). Graft thrombosis occurred in 3 patients and one patient was salvaged by thrombectomy. Two of the 15 surving patients were lost in the follow-up. Excluding these patients, there was patency in 12 of 13 patients (92.3%) with symptomatic improvement during the limited follow-up period from 3 to 26 months (mean 14.2). It is concluded that extraanatomic axillo-femoral bypass is indicated for limb ischemia in high risk patients with acceptable functional patency.

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In 26 patients with adult-onset diabetic nephropathy on dialysis, investigations were made of the clinical course and the risk factors in terms of progression to end stage renal failure requiring the dialysis treatment. The mean time between the diagnosis of diabetes and the undergoing to chronic dialysis was 13.2±7.9 years. Hypertension appeared about 4 years before the onset of proteinuria. End stage renal failure developed about 6 years after the onset of proteinuria. At the start point of dialysis, 88.4% of the cases showed hypertension, 61.5% showed ischemic change on ECG, 66.9% showed increase of CTR ratio and 26.9% showed heart failure. The result of the reciprocal serum creatinine analysis indicated that diabetic nephropathy showed a more rapid progression to end stage renal failure compaired with other causes of renal failure. The risk factors concerning the progression of renal failure in patients with diabetic nephropathy were uncontrolled hypertension, coronary arteriosclerosis and cardiomegaly. It was considered that these risk factors as well as low albuminemia and overhydration accelerated progression of renal failure to end stage kidney resulting in the introduction of chronic hemodialysis.

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We performed the radionuclide angiography in a patient with left atrial myxoma. The patient was 42 years old female. Pre-operative right-sided intracardiac catheterization revealed slight elevation of pulmonary capillary wedge (Pcw) pressure (13 mmHg), and pulmonary artery (PA) pressure (33/13 mmHg, mean 20 mmHg). Angiography showed filling defect in the left atrium and echocardiogram showed tumor echoes behind the anterior leaflet of the mitral valve during diastolic phase. We discussed the diagnostic value of cine-mode imaging and phase imaging, and evaluated left ventricular function using ejection fraction (EF) and peak filling rate (PFR). On cine mode imaging, we could observe the filling defect produced by atrial myxoma moving in left atrium and obstructing the mitral orifice in diastolic phase. Left ventricular PFR was low (2.32 sec^<-1>). It improved to 2.99 sec^<-1> after operation. Right ventricular EF and the standard deviation (SD) of left ventricular phase angle also improved, from 26% to 38%, from 28°to 18°, respectively, after operation. Radionuclide angiography is a valuable non-inva-sive test in the case of left atrial myxoma, not only to confirm the existence of tumor, but also to evaluate the pre- and post-operative hemodynamic change in this disease.

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A questionnaire survey on 643 clerical VDT workers in an agricultural wholesale company was carried out to evaluate the relationships between the time factors of VDT work and their subjective complaints. Most of them operated VDT machines to manage the computer on-line data more than three days per week, about three hours a day. The questionnaire includes 16 visual related complaints such as visual accomodation, eye-attached organs, asthenopia and color perception. The rest of questionnaire covers four musculo-skeletal complaints, four vegetative complaints and thirty cumulative fatigue complaints. As a result, visual-related complaints rates except color perception significantly incresed in the group using VDTs for 5-6 days per week, over 2 hours per day, and over continuous 30 minutes in comparison with the less operating groups, respectively. Furthermore these similar tendencies were showed in the musculo-skeletal complaints. On the other hand, the rates of cumulative fatigue complaints increased in proportion to the years of tenure as VDT operaters, especially in the components of irritability and general fatigue.

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methotrexate (MTX)-induced changes in the rat small intestinal mucosa accompanied by the malabsorption syndrome were studied morphologically and histochemically in association with their biochemical aspects. The values of GOT, amylase, and lipase in the circulating blood remained unchanged after the MTX administration. This may indicate that the biochemical functions of the liver and the pancreas were not affected regardless of the MTX-treatment. By light microscopy, MTX-induced changes were characterized by the flattening of the intestinal villi, cytological disturbances of the abosorptive epithelium, and the dilatation of the lymphatic capillaries in the lamina propria. Transmission and scanning electron microscopic observations revealed the shortening of microvilli and the accumulation of fatty droplets in the degenerated absorptive epithelial cells. Enzyme-histochemically, alkaline phosphatase activity was markedly reduced in intensity and practically disappeared in the luminal surface of the absorptive epithelial cells after the MTX-treatment, while remained unchanged in the lamina propria. Lipase activity which was originally present in the epithelial cell cytoplasm in the untreated animals also disappeared after the MTX administration.

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The platelet aggregation induced by ADP was studied for 65 patients with angina pectoris, myocardial infarction and cerebral infarction at mean age of 66.1±9.6 years both before and after administration of antiplatelet agents. The dose of the agents was 300mg daily for aspirin, ticlopidine, trapidil, and dipyridamole and 60mg daily for ifenprodil, both for 4 consecutive weeks. The results were as described below. (1) Significant decline of maximum optical density (Max O.D.) was observed following administration of the antiplatelet agents such as aspirin (P<0.001), ticlopidine (P<0.001) and trapidil (P<0.05), and a tendency of decline was also observed in the groups of dipyridamole and ifenprodil. (2) The rate of decline (Diminution rate) in the Max O.D. was 49.7% in the group of ticlopidine, 29.5% in the group of aspirin, 12.5% in the group of ifenprodil, 10.8% in the group of dipyridamole and 9.8% in the group of trapidil.

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A 56-year-old woman who had been diagnosed as striato-nigral degeneration died after about 4 years' duration of worsened Parkinsonism accompanied with minor degree of cerebellar and pyramidal signs. Her symptoms and signs consisted initially of rigidity of the left limbs and akinesia. In a year from the onset, dysarthria and resting tremor of the left upper limb developed later. Medications including levodopa showed no effect, and her Parkinsonism gradually progressed to the right limbs. After two years from the onset, Babinski's sign became positive. Moreover, broad-based standing and gait as well as decomposition of the movement were observed. Orthostatic hypotension with positive Schellong's test also appeared in the later stage when brain CT scan revealed obvious atrophy of the cerebellum, especially the vermis, and pons. The post-mortem examination confirmed the clinical diagnosis as striato-nigral degeneration. Macroscopically the basal ganglia, pons and cerebellum were atrophic, and the lateral part of the putamen was significantly brownish in colour. Histological examination revealed marked loss of nerve cells with a heavy fibrillary gliosis in the putamen. These degenerative changes were also moderately observed in the substantia nigra and external part of the globus pallidus, and slightly in the caudate nucleus, cerebellum and medulla. Remarkable deposition of iron-containing pigment granules was detected in the putamen. These abnormal pigment granules were also observed in a part of the substantia nigra and pallidum in slight degree. These findings were compared to those reported in the literature.

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A 70-year-old male was admitted to our hospital in a critical condition because of hematemesis accompanied by epigastralgia and severe anemia. Gastro-fiberscopy revealed a smooth, elevated lesion with three ulcerations at the cardia of stomach. A cytological examination of tumor showed cells suggestive of leiomyosarcoma. X-ray examination of stomach supported the presence of tumor shown by gastro-fiberscopy. A CT scan of abdomen and angiography revealed a hypervascularity of the tumor. Total gastrectomy revealed a tumor of leiomyosarcoma measuring 8.5×9.5cm originated from muscle layer of the cardia of stomach. The tumor was growing intra-and extra-luminally continuously from the original site, however, no metastasis of tumor was present. We attempted to report the experience about this case which might help to establish the preoperative diagnosis of rather rare this type of malignancies.

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