The role of granulocytes in ARDS-developing in the sepsis occurred by gram-negative rods and in the endotoxin induced pulmonary edema has been investigated. 1. The septic ARDS in clinical cases indentified were found in 30 cases of sepsis occurred gramnegative rods among 31 cases with all septic patients. Furthermore, 18 cases out of all patients were measured their serum endotoxin, and all cases of them showed positive sign in Limulus test. From these results, it suggests that endotoxin has closely relates to the outbreak of septic ARDS. Therefore, endotoxin was used in this experimental study. 2. The morphologic findigs of pulumonary edema were observed at 48 hours after the endotoxin injection to the experimental animals. 3. Peripheral polymorphonuclear leukocyte (PMN) count rapidly and immediately decreased after the endotoxin injection. These PMNs were strongly adhered to endothelial cells in pulmonary vessels. Their lysosomal enzymes were released out, shown by an electron-microscopic fiidings of PMNs. The serum level of β-glucronidase were rapidly increased. And the edematous changes in lung tissue were observed by the injection of free-β-glucronidase. From the results of the incubation of human PMNs and endotoxin in in vitro system, it is found that the superoxide production of PMNs was increased. Moreover, by the addition of human serum, the production of it increased more. The edematous changes of lung tissue in endotoxin rats suppressed by intraperitoneally contiuous treatment of superoxide dismutase. 4. The edematous change in endotoxin lung was remakably suppressed in the leukopenic animals which were made by pre-treatment with nitrogen mustard. In retrospective observation of 107 patients with sepsis occurred by gram-negative rods, the incidence of ARDS-developing was 28.8% in 93 patients whose leukocyte count was more than 3, 000/mm^3. However, no cases of ARDS was seen in 14 patients whose peripheral leukocyte count was less than 3, 000/mm^3. 5. From above results, it might be suggested that the PMN action was strongly related to the outbreak of ARDS in the cases with sepsis occurred by gramnegative rods. The mechanisms might be explained as follows. PMNs are activated by endotxin. They are more activated by addition of serum. Activated PMNs were adhered to capillary endothelium in lung tissue, and they were destroyed on the surface of endothelium. The β-glucronidase and O_2- are released from PMNs. Such releasing products injered the endothelial cell of pulmonary vessels. Therefore. The permeability of capillary wall is increased, and them pulmonary edema occurres. These experimental results on the changes of PMNs also suggest the mechanism of the outbreak of clinical septic ARDS, too. The PMNs actions that were observed in this experimental study might make an important role in the clinical developing of the septic ARDS.

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To survey the prevalence of coccidium infection in cats and dogs in the Tama area, Tokyo, fecal samples were collected from 834 kittens during 1975 to 1979 and from 224 puppies during 1978 to 1982, and examined by the sugar flotation method. Isospora felis oocysts were detected in 30 kittens (3.6%), I. rivolta in 5 (0.6%), Besnoitia wallacei in 6 (0.7%) and Toxoplasma gondii in 5 (0.6%). No oocyst of other coccidian species was observed in feces of these cats. This result indicated that 4 species of feline coccidia existed constantly in the Tama area, Tokyo. I. canis oocysts were detected in 4 puppies (1.8%), and I. ohioensis in 28 (12.5%). Two puppies were infected with both I. canis and I. ohioensis. No oocyst of other species was detected in dogs.

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As a series of studies of the arterial supply in the human muscle in our laboratory. In this paper, peroneus brevis muscle of ten Japanese adults' bodies with twenty side cases are examined to explore the origin of nutrient arteries, the branching condition and the distribution area in this muscle. 1) We classify this muscle into the following types by the distribution areas of artery. Type I-a : the branch of A. tibialis anterior (Ta) distributes in the upper portion, the branches from Ta and A. peronea (Pe) distribute in the middle portion and branches of Rr. malleolares laterales (Ml) and A. tibialis posterior propria (Tpp, SATO・1984) distribute in the lower portion of this muscle, (10%). Type II-a : Tpp lacks from Type I-a, (65%). Type III-a : Tpp and Ta lack from Type I-a, (10%). Type I-b : Ml lacks from Type I-a, (10%). Type II-b : Ml and Tpp lack from Type I-a, (5%). Type III-b : Ml, Tpp and Ta lack from Type I-a, (0%). 2) Pe has the largest distribution area of branch from artery, Ta has the second largest one and Tpp has the smallest one and highest frequencies of all numbers of arterial supply is six (40%). The frequencies of distribution of arterial supplies as common trunk in both peroneal muscles are observed that Pe has 19 cases and Ta has 15 cases. 3) The nerve (muscular branch arise from the superficicial peroneal nerve) of this muscle is branched into two branches, Ramus superior (RS) and Ramus inferior (RI). RS is distributed muscular bundles of the upper and the middle portions, while RI is distributed only the lower portion. In addition, the variational cases (M. peroneus digiti quinti, Wood) which inserted tendon extends and reaches little toe are observed in 14 cases (70%).

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Multiple carcinomas of the large intestine are not rare. This report indicates a marked increasing tendency in recent years, especially in cases of multiple carcinomas of the large intestine. During the years 1973 through 1984, 119 patients with large intstine carinoma were enrolled in our department of surgery. A retrospective examination of these data revealed that four patients has multiple large intestine carcinomas (3.5%). Of these, three patients (2.5%) presented simultaneous lesions while one patient (1%) presented metachronous lesions. This paper reviews the experience of this problem. The incidence of multiple carcinomas of the large intestine was 3.5%. The sex ratio was more predominant in the male. In age, when compared with operated cases of usual large intestine carcinoma, the average age of multiple carcinoma operated cases was about 14 years higher. Participation rate of the segments was 100% for the sigmoid, 50% each for the rectum and ascending colon and 25% for the descending colon. Accompanied benign large intestine polyp was found in 75.0% of the cases, which was a significantly higher rate than in usual large intestine carcinoma. Four patients were found to have multiple lesions before resection. The possibility of a second carcinoma makes it imperative for the surgeon to obtain good diagnostic studies, barium-enema studies and proctoscopy of every patient preoperatively. The resected specimen should be examined by the pathologist at the time of operation. Patients who have had colonic resections for carcinoma should be very carefully followed at yearly or shorter intervals with examination, barium-enema studies and proctoscopy. The number of second carcinomas discovered after an interval of time will probably increase with increasing thoroughness and persistence of follow-up studies.

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The influences of aging, menopause and obesity of females to total cholesterol (T-ch), HDL cholesterol (HDL-ch) and systolic and diastolic brachial arterial blood pressure (SBP & DBP) were epidemiologically surveyed. The subjects were 887 healthy 30-64 year-old women working at a speedboat race place as ticket sellers. The mean values of T-ch, SBP and DBP significantly increased with advancing age while HDL-ch/T-ch (% HDL-Tch) decreased with ages. There was little change in HDL-ch. The T-ch values were higher in the postmenopausal females than in the premenopausals. HDL-ch, % HDL-Tch, obesity index, SBP and DBP showed no significant relation between the two groups. In all age groups, it was observed that HDL-ch and % HDL-Tch had an inverse correlation with the obesity index. On the other hand, obesity index was correlated with both SBP and DBP in all age groups. However correlation of this index with T-ch was found in the age group 40∿49 only.

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Reliability of 17α-hydroxyprogesterone (17-OHP) values determined by direct extraction with mixed solvent and enzyme immunoassy (EIA) in dried serum samples on filter paper disc (disc serum) was evaluated as a means for mass-screening of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. Furthermore, to clarify the cause of false positive cases, serum 17-OHP concentrations were followed during neonatal period in low birth weight infants and compared with normal infants and the infants with high risk disorders. Values of 17-OHP determined by EIA in disc serum were in good correlation with those determined by radioimmunoassay and 17-OHP concentrations in the same serum samples. Depending on the duration of storage, 17-OHP values in disc serum decreased gradually but were not influenced by the temperature of storage. In contrast to normal infants in whom serum 17-OHP concentrations decreased rapidly after birth, low birth weight infants tended to remain their serum 17-OHP concentrations in high level during neonatal period, particularly remarked in the infants under 1000g of body weight at birth, less than 32 weeks of fetal life or 35 weeks of equivalent gestational age. In the infants with high risk disorders showed almost as same course of serum 17-OHP concentrations after birth as normal infants. There were no significant correlations between 17-OHP, dehydroepiandrosterone-sulfate, cortisol and ACTH concentrations in the same serum samples in normal and in low birth weight infants. In conclusion : (1) estimation of 17-OHP in disc serum by direct extraction and EIA is useful for mass-screening of CAH due to 21-hydroxylase deficiency, but caution must be given to the duration of storage of samples, (2) low birth weight infants are major cause of false positive in mass-screening of CAH due to 21-hydroxylase deficiency because of persistent high level of 17-OHP concentration in serum during neonatal period probably through functioning fetal adrenal cortex.

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Plasma exchange was performed in 4 cases with fulminant hepatitis. Two out of 4 cases, who were 27 year-old female and 37 year-old female with excellent prognostic score by Takahashi, survived after plasma exchange therapy. Other two cases, 41 year-old male 54 year-old female, failed to recover from hepatic coma and died in spite of a large amount of plasma exchange. The prognostic scores in these two cases were poor. Treatment by plasma exchange seems to be effective in the cases of fulminant hepatitis who have more than +0.38 Takahashi's prognostic score.

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Estimation of genetic risk is of importance in genetic counseling. Recently, remarkable advances have been made in the methods of prenatal diagnosis and detection of carriers, but when these cannot be employed, estimation of genetic risk must be made on the basis of the Mendelian segregation ratio. The authors, therefore, devised equations for estimating genetic risk which simultaneously take into account such genetic parameters as mutation rate, gene frequency, penetrance and prenatal selection coefficient under the assumption of simple autosomal dominant and recessive inheritance. We studied the influence of these parameters, in particular the latter two genetic parameters, on the estimation of genetic risk and the following results were obtained. The influence of penetrance is very large in autosomal dominant inheritance and in many cases low penetrance increases the genetic risk with increase of healthy carriers. The influence of penetrance in autosomal recessive inheritance is smaller than in dominant inheritance and in many cases low penetrance decreases the genetic risk. When prenatal selection exists, the genetic risk slightly decreases in both dominant and recessive inheritance.

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It has been reported that thyrotropin releasing hormone (TRH) induces growth hormone (GH) secretion in many cases of chronic liver diseases as well as in the patients with acromegaly, anorexia nervosa, depression, chronic renal failure and insulin dependent diabetes mellitus. Luteinizing hormone releasing hormone (LH-RH) has been noted also to stimulate GH secretion in one third of acromegalics and a few cases of anorexia nervosa, shizophrenia and pseudohypoparathyroidism. However, no studies were reported concerning the effect of LH-RH on GH secretion in patients with chronic liver diseases. To investigate whether LH-RH, like as TRH, increases GH secretion in the patients with chronic liver disease we studied the effects of TRH and LH-RH on GH secretion in seven patients with liver cirrhosis and one patient with chronic active hepatitis. These diagnosis were established by liver function tests, liver scintigram and the findings of laparoscopy and liver biopsies. In the group of chrnoic liver diseases the basal GH levels were higher than those of control subjects and plasma GH was increased after TRH administration significantly. Negative correlation between the basal GH levels and the ratios of peak to basal levels of GH after TRH injection was observed. No significant relationships were found between the effect of TRH and any clinical findings of the patients with chronic liver disease. LH-RH did not show stimulating effect of GH secretion in control subjects and in the group of chronic liver diseases except one case, but showed tendency to suppress the GH secretion though not significantly.

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Lectin binding patterns were examined by light microscopy in the normal human kidney tissue from 10 individuals using HRP-labeling techniques and were compared to those of the renal cancer tissues from 23 cases, infant kidney tissues from 6 cases, and tissues of glomerulonephritis from 8 cases. Specimens were obtained on operation or by autosy and/or biopsy. Lectins used were concanavalin A (ConA), Ricinus communis agglutinin (RCA), wheat germ agglutinin (WGA), Peanut agglutinin (PNA), Soybean agglutinin (SBA), Dolichos biflorus agglutinin (DAB), and Ulex europeaus agglutinin (UEA-1). In the normal kidney tissue, the renal corpuscle and the proximal tubule were stained with ConA, RCA, and WGA, but not with DBA, PNA, SBA or UEA-1. All the lectins used except for UEA-1 were positive in the loop of Henle, the distal tubule and the collecting duct. The binding patterns did not change regardless of differences in age, sex, or blood type of the patients. In the renal parenchymal carcinoma, ConA, RCA and WGA, stained tumor cell as well as the renal corpuscle and the proximal tubule cells in the normal tissue. These results reveal that renal parenchymal tumors may arise from the proximal tubular epithelium or mesenchymal tissues including the renal corpusele. The tissues of glomerulonephritis and infant kidney showed similar binding pattern to those of the normal kidney.

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The case was an 81 years old female patient who was admitted into our hospital with chief complaints of fever and anorexia. She died 9 days after hospitalization. The autoptic findings identified highly differentiated adenocacinoma in the lungs plus non-Hodgkin lymphoma. Reference survey revealed that there had been only 2 cases of complication of squamous cell cancer of the lungs with malignant lymphoma in Japan, and we have experienced none of such case of complication. In checking a patient at high age, it would be important to carefully examine the status praesens with regards to complication of some malignant tumor.

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A 83-year-old male was admitted complaining of anorexia. He had been treated for four years for gastric ulcer. Gastroscopy performed 6 days before admission revealed complete scarring of ulcer at the angle of the lesser curvature. He began to feel epigastric distress after the gastroscopic examination. The day after admission he suffered suddenly from severe abdominal pain and vomiting. Laparotomy was immediatly done with a diagnosis of perforation of GI tract and revealed perforation of gastric ulcer : It is very rare for gastric ulcer to perforate within a short period of 6 days.

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