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Twenty-five patients (30 hips) have had a total hip replacement using the cup supporter developed in our department. This report describes the follow-up findings on these patients. The mean period after hip replacement was 2 years and 8 months (range from 6 months to 6 years). The cup supporter was used in patients with rheumatoid arthritis with acetabular protrusions, central migration of the prosthesis after hemi-arthroplasty, revision operation for a defecting acetabular floor, primary acetabular protrusions (including osteoarthritis with acetabular protrusions) and traumatic fracture-dislocation of the hip. In five cases, autograft of bone was used in addition to the cup supporter for reinforcement of a thin acetabular floor. This combination appeared to provide good clinical results. The cup supporter was of value in revision operations due to loosening of the acetabular cup with severe acetabular protrusions.

An autopsy case of hypertrophic cardiomyopathy showing clinical features of dilated cardiomyopathy was reported. The patient was a 60-year-old female complaining of chest discomfort from the age of 40. At autopsy, both ventricles were dilated. Microscopically myocardial loss, fibrosis and disarray of hypertrophic myocardial fibers were observed. The areas showing myocardial disarray were distributed close to the scar-like fibrotic areas. Coronary arteries and intramyocardial arterioles showed minimal stenotic changes.

"Smoldering acute leukemia", a variant of acute myelogenous leukemia, has been recognized with frequent incidence in recent years. This is chracterized by benign clinical course, poor physical findings, leukopenia and mild anemia in the peripheral blood, and apparent infiltration of abnormal myeloblasts in the bone marrow. Immunological studies of the host defence mechanism were made, because the pathogenesis of its "smoldering" course has never been well understood. Nine cases, seen during last 2 years, were investigated for immunological profile, especially the cellular immunity. Purified protein derivative (PPD) skin test, i.e., tuberculin test, was found to be positive in 8 of 9 cases (88.9%). Dinitrochlorobenzene (DNCB) sensitization test showed to be positive in 4 of 6 cases examined (66.9%). Peripheral lymphocyte balstogenesis by stimulating with phytohemagglutinin (PHA) was evaluated using the smear counting method. The blastoid lymphocyte ratio was 55% at the median value (range: 31-68%), compared with 63% in normal young control (age: 25-32) and 41% in normal aged control (age: 60-75). In this report, the cellular immunity in smoldering acute leukemia was proved to be preserved at the normal level and to be more competent than that in aged group. The preserved cellular immunity is considered to explain the phenomenon of "smoldering", in other words, the exacerbating proliferation of leukemic cells is suppressed by immuno-surveillance system.

With the purpose to elucidate the relation between the enzyme activity and the morphology of mitochondria the author carried out histochemical and biochemical investigations of cytochrome oxidase and succinic dehydrogenase activities of liver cells obtained at various intervals after the oral administration of CCl4, to male rats. And the data were compared with those reported in the first report. In the normal liver histochemically demonstrable cytochrome c oxidase activity and succinic dehydrogenase activity can be seen in parenchymal cells. In both cases the cells lying in the peripheral area show a more intense activities than those in the central part of liver lobules. The activity of cytochrome c oxidase falls markedly 5 to 6 hours after the CCl4, administration, while the activity of succinic dehydrogenase is retained almost at normal level for about 20 hours. Quantitative estimation of the succinic dehydrogenase activity of tissue homogenate revealed a transient rise in the activity 90 minutes after the CCl4, administration, and thereafter the values have been kept in almost normal level by 20 hours though a gradually fall has been seen in this period with a marked degree at 22nd hour. Taking the changes of minute structure occurring at each stage into consideration, which have been reported in the previous paper, the author concludes that the activity of succinic dehydrogenase is closely correlated with the maintenance of double membraneous structure of mitochondria, but the activity of cytochrome c oxidase is reduced by the swelling of mitochondria.

Electron microscope study on the rat liver cells of carbon tetrachloride poisoning has been reported. Observations have been made on the osmic fixed tissue sections obtained from the liver at early stages of poisoning, 5 to 22 hours after carbon tetrachloride oral administration, 0.25ml. per 100g. body weight. Special attention is paid on the appearance of electron dense area, opaque area, in cytoplasm, which is compased of fibrous components, probably originated from endoplasmic reticulum. This will be an important sign of cell degeneration. Toluidine blue, PAS and methyl green-pyronin stainings of the thicker sections from the same samples as used for electron microscopy revealed that the opaque area is stained by toluidine blue and pyronin but not by PAS. The opaque areas appear already five hours after the carbon tetrachloride administration and show some continuity with elongated filaments of endoplasmic reticulum. At an advanced stage of paisoning the opaque area increases in its number and size, but some of them are shrunk as a mass, being separated from the surrounding cytoplasm with scanty area. Often they form denser masses in the center and loak like the lipid deposition. The picture suggests formation of lipid droplets in the case of fatty degeneration of the liver cell.

1. In application of ACTH on seven cases, we obtained dramatic effects on all of them this summer (1957). 2. We believe that the mechamism of ACTH actions are responsible to the diminution of inflammatory reactions in the brain. 3. We are now conducting a series of experiments with the use of animals, the results of which will be reported later.

The two rare cases with a high fever and anemia as the chief complaints were confirmed to be acute basophilic leukemia on the basis of the following findings, namely, 1) Numerous basophiloblasts and immature basophilocytes were found in the peripheral blood and bone marrow picture, but there were few neutrophils. 2) By the culture of bone marrow in cover-slips the growth type to acute leukemia, these basophilocytes appearing in the growth zone were clearly distinguishable from neutrophils, eosinophils or monocytes by the modus of their movement and cellular structure. 3) In vitro fluid medium culture revealed that blasts decreased in number along with lapse of time whereas immature and mature basophilocytes increased in inverse proportion. Having encountered these two rare cases of acute basophilic leukemia and being able to autopsy one of them, the authors report their case findings and confirm the distinction of basophiloblasts. Judging from these findings, the authors are of the opinion that some modification seems to be in the offering as regard the Naegeli's myeloblast theory.

According to the method presented in the first report the author mixed ferric iron solution and serum with the various proportions of serum and iron, limiting the pH level of the media wihin 5.4 to 8.3. It was found there was a certain level exceeding which the iron could no longer move with protein on the paperelectrochromatography. The maximum level was found to be81, 500γ% in the case of ferric chloride and 77, 200γ% in ferric ammonium sulfate, when the bovine serum was used as a protecting colloid. The iron added in excess of this level was found retarding at the starting line suggesting the formation of gross iron hydroxide colloid.

There are few reports on skeletal reconstruction using the bone transport technique to repair bone defects caused by resections of tumors associated with osteosarcoma. We attempted to reconstruct a 23 cm bone defect after resection of an osteosarcoma of the left femur, and succeeded in gaining 17 cm by bone transport. Five years after surgery, this patient remains alive without metastasis or local recurrence.

There are few reports on skeletal reconstruction using the bone transport technique to repair bone defects caused by resections of tumors associated with osteosarcoma. We attempted to reconstruct a 23 cm bone defect after resection of an osteosarcoma of the left femur, and succeeded in gaining 17 cm by bone transport. Five years after surgery, this patient remains alive without metastasis or local recurrence.

1. With a view to grasp more simply and clearly the characteristics of this disease and in order to find a clue for prompt discovery of cases when encountered in future, the authors undertook a statistical study of the cases already reported by various authors. 2. The cases reported so far amount to 17 familial groups which consisted of 38 acatalasemic cases. These groups were distributed widely throughout Japan. The disease seemed to be prevalent in the rural communities where adherence to the custom of consanguineous marriage occurs. As yet, we have not heard of the occurrence of this disease in other countries. 3. The disease has equal distribution in both sexes. About one half of patients showed a peculiar oral gangrene (Takahara's disease). The great majority of these were noted in those less than 10 years of age. 4. The great majority of them were children whose parents were united in consanguineous marriage and have siblings with acatalasemia. 5. As for the treatment of oral lesions in this disease, extraction of tooth at the site of the lesions, removal of the diseased tissues en masse by resection, and penicillin treatment given concomitantly are effective. The course and the length of time required in healing of the wound due to the operation are about the same as in the case of normal persons. 6. The authors wish to call special attention to the phenomenon peculiar to the acatalasemic blood. The blood of acatalasemic individuals changes to brownish-black color in the absence of foaming or bubble formation upon the application of hydrogen peroxide to blood.

It is well known that human serum contains some sialic acid and its contents increase markedly in the blood serum of the patients bearing malignant tumors. Recently YAMAKAWA2, BHOM3, SAITO4 and YUI5 observed the sialic acid contents in the blood sera from the patients of various diseases and clarified that its contents increase not only in the sera from the cases bearing malignant tumors but also in those of rheumatic or tuberculous diseases. BOHM6 et al. measured the sialic acid contents in the cerebrospinal fluid of several diseases and ascertained that its contents increase in the cerebrospinal fuid from the cases of inflammatory diseases. In connection with these works we have observed the sialic acid contents in the cerebrospinal fluid of the patients suffering from the diseases of central nervous system, prior to the surgical operation, and revealed the markedly increased contents in the sialic acid in the patients bearing tumors of the nervous system. In this paper the data are reported in detail.

A 40-year-old man with valvular heart disease was successfully treated using a left ventricular assist device (LVAD) after open heart surgery. Echocardiography revealed left ventricular ejection fraction (LV-EF) at LVAD on/off: 23.4%/14.6% on the 4th, 23.8%/23.8% on the 5th, and 23.8%/26.8% on the 6th postoperative day (POD), respectively. The patient was weaned from LVAD on the 8th POD and discharged from the hospital on the 58th POD. The LV-EF improved to 54% 6 months after surgery and increased from 57% to 64% in response to exercise stress testing 1 year after surgery.

Endoscopical segmental piecemeal tumorectomy (ESPT) for nodular elevation of colorectal tumor is advantageous in terms of minimizing both surgical invasion and postoperative burden to the patients. Nodular elevation of colorectal tumors is said to occur when the body of the tumor is adenomatous and the surface of the focal cancer grows more horizontally into the lumen than vertically. We report here four cases of nodular elevation of colorectal tumors which were each treated by different surgical procedures.

We report the first case in Japan, i.e., the first case among oriental subject of Farber's disease. This is a rare disorder of lipid metabolism in infancy subsequent to a genetically-determined defect in ceramide degradation. Main features are characterized clinically by hoarseness, joint swelling, subcutaneous nodules and retarded psychomotor development. Lipid analysis and pathological investigation on the material obtained from a subcutaneous nodule confirmed clearly the presence of ceramide and intracytoplasmic inclusion bodies characteristic for Farber's disease. In this case, we experienced also corneal opacity and striking abnormalities in electroencephalogram, which have apparently not been noticed in the 17 cases hitherto reported.

The case of a patient with repeated attacks of collapse induced by sublingual isosorbide dinitrate is reported. The patient was an 81 year-old female who was admitted to Yura Hospital because of attacks of precordial pain. Several minutes after the sublingual administration of isosorbide dinitrate (10 mg) for an anginal attack, she developed a sensation of general weakness, and thereafter because unconscious. Arterial blood pressure fell and became unmeasurable. Electrocardiograms recorded during the syncopal attack showed sinus tachycardia and significant elevation of ST-segment in right precordial leads. In response to a drip infusion of noradrenaline, arterial blood pressure returned to normal with recovery of consciousness. Two similar syncopal attacks induced by sublingual isosorbide dinitrate occurred in the next three days. These attacks were not due to augmentation of the vagal reflex. Decrease of venous return probably was the primary etiological factor.

Since 1903, 744 cases of megaloblastic anemia have been reported in Japan: 490 cases of pernicious anemia; 95 cases associated with pregnancy; 66 cases after gastrectomy; 22 cases of megaloblastic anemia of infants; 21 cases of folic acid deficiency other than pregnancy and 19 cases of vitamin B12 malabsorption after ileal resection. It is generally agreed among hematologists in Japan that pernicious anemia is relatively rare, as in other Asian countries. The diagnosis of pernicious anemia in Japan is usually made by stained marrow films, radioisotopic assay of serum vitamin B12, Schilling test and good response to vitamin B12 therapy. Serum folate level, intrinsic factor or its antibody, methylmalonic acid excretion, formiminoglutamic acid excretion and deoxyuridine suppression test are performed only at a small number of laboratories. The drugs of choice are hydroxocobalamin, deoxyadenosylcobalamin and methylcobalamin. Cyanocobalamin has nearly disappeared from commercial sources in Japan. Vitamin B12 administration is common in patients with neurological disorders. Megaloblastic anemia due to folic acid deficiency is extremely rare in Japan. Low serum folate levels are frequently observed among patients receiving anticonvulsants or in pregnant women, but in such samples megaloblastic anemia is almost never detected. The folic acid content of hospital diets indicates that satisfactory amounts of folate are taken in Japan. The intake of folic acid from rice is well over the minimum daily requirement of folate. Other factors in folic acid deficiency, such as food taboos, severe alcoholism and malabsorption syndrome are not frequently found in Japanese. The inadequate intake of folate was the critical factor in most reported cases.

The female patient initially showed the acquired type of total lipoatrophy at about 8 years of age. At 12 years of age, the onset of diabetes mellitus was speculated from advanced pyodermia and dedentition. At 29 years of age, glucosuria was found, and she developed proteinuria, ascites, and pretibial edema. The physical examination revealed: hepatosplenomegaly, complete absence of subcutanous fat, cutaneous xanthomas, and emaciated facies with pronounced zygomatic arches. Diabetic retinopathy was revealed in the ophthalmological examination, and nephropathy was evident in renal biopsy specimens. She also had peripheral diabetic neuropathy. No adipose tissue was found in the mesenterium under peritoneoscopy. The hepatic biopsy specimen revealed advanced portal liver cirrhosis. Laboratory findings included: hyperlipidemia, elevation of BMR without evidence of hyperthyroidism, impaired renal function, and undetected anti-insulin antibodies and anti-insulin antibodies. Endocrinological examinations revealed normal value, except for an impaired hGH response in the arginine test. C-peptide immunoreactivity was high. Her condition was fairly well controlled by 140 units of insulin injection daily.

A 38-year-old female presented with cough and fever. A chest X-ray examination revealed an abnormal shadow in the posteroinferior portion of the left hemithorax, and a laboratory examination showed that the serum carbohydrate antigen 19-9 (CA19-9) level was markedly high (1000 U/ml). A left thoracotomy showed an intralobar pulmonary sequestration of the left lower lobe, and after a left lower lobe lobectomy, the serum level of CA19-9 decreased to normal. Increased CA19-9 activity was detected by immunohistochemistry in the epithelia of bronchioles in the pulmonary sequestration. This communication is the first to report a case of increased activity of CA19-9 in pulmonary sequestration.

A case of malignant lymphoma associated with complete heart block in a 30-year-old woman is reported. The patient progressively deteriorated despite temporary pacing and died 24 days after being admitted. Microscopic examination of the heart revealed marked infiltration by lymphoma cells in the atrioventricular node and the bundle of His. A diffuse lymphoma (large cell type, B cell) was diagnosed. This case is considered to be rare, since complete heart block was the first and only manifestation of the malignant lymphoma.