Acute coronary syndrome is a typical life-threatening condition. Nevertheless, 1-8% of patients rushed to the emergency outpatient unit are sent home. One of the reasons for that is the absence of pain in a minority of myocardial infarction cases. It is said that 25% of the patients with acute coronary syndrome visit hospitals without complaining of chest pain, and about 1% of the patients complaining of nausea and vomiting only. In this paper, we present a case diagnosed as anteroseptal myocardial infarction at the outpatient department of internal medicine. The patient had symptoms of queasy feeling and vomiting. Coronary artery bypass grafting was indicated. We examined the case, focusing on the diagnostics with bibliographical consideration. Acute coronary syndrome cannot be ruled out in the elderly, even if they have fewer risk factors. In cases like the present one, when no other accessory symptoms are noted, the condition should be considered in the differential diagnosis. We believe that this will prevent life-threatening acute coronary syndrome from being overlooked.

In the context of energetics related to a pendular model, the mechanical power (W) and ‘pendular motion efficiency’ (PME) were determined during walking of the subjects who consist of 37 healthy elderly women (65-85 years) and 21 young women (18-25 years) . Using a force plate, the potential and kinetic energies of the body's centre of mass were measured at various constant speeds. Walking speeds were selected and controlled by a newly devised pace-maker. PME, which is equivalent to ‘% recovery’ by Cavagna (1976), indicates a sort of efficiency in transforming potential energy into kinetic energy and vice versa. The external power to accelerate the body (Wext ), which is thought to be supplied by muscles, increased with walking speed, and the rate of increase in Wext tended to be greater in the elderly than in the young subjects. It was noted that the maximal PME values at the optimum speed in both age groups were comparable, but PME values in the elderly decreased more markedly than in the young subjects as walking speed deviated from the optimum. This fact suggests that an adaptability to different walking speeds reduced in the elderly population.

Allergological characteristics were studied on 36 patients with respiratory diseases (30 cases of bronchial asthma, 3 cases of diffuse panbronchiolitis, 3 cases of allergic granulomatous angitis, and 1 case of bronchiectasia) who received spa therapy at Misasa Branch Hospital.
1. The results obtained in patients with bronchial asthma were as follows:
Serum IgE levels were generally low, and many cases with less than 301IU/ml were observed (185±184/ml in female patients and 469±532IU/ml in male patients). The rate of positive skin reactions to various allergens was low in these asthma cases. A rather low rate of positive skin reaction to house dust, in particular, was characteristic. In regard to the rate of releasing chemical mediators such as bistamine and leukotrienes from leukocytes stimulated by Ca ionophore A 23187, a wide variety of cases were observed (histamine, 3.4-51.1%; LT B₄ 9.8-119.8ng/10⁶ cell; LT C₄, 3.5-43.8ng/10⁶ cells). By analyzing cell components in bronchoalveolar lavage fluids (BALF), notable increase in the number of eosinophils were observed especially in male patients, although no other significant differences were shown between the two groups.
2. In those patients with respiratory diseases other than asthma, a remarkable increase in the number of neutrophils in BALF was seen in diffuse panbronchiolitis cases and a remarkable increase in the number of eosinophils in BALF was seen in the cases of allergic granulomatous angities. Serum IgE levels were low in both of these cases.

Annual changes in age, age at onset, incidence of cases with steroiddependent intractable asthma, clinical asthma types and clinical efficacy rate were examined in 256 patients with chronic respiratory diseases, especially in 203 cases with bronchial asthma, admitted to Misasa Branch Hospital from 1982 to 1989.
1. A number of patients with respiratory diseases as well as asthmatics admitted each year, having spa therapy, increased from early year (1982) to later year (1989).
2. A number in cases with 40 year or over of age (also with 60 year or over of age) and cases with 40 year or over of age at onset showed a tendency to increase in later three years (1987-1989). A decreased frequency of cases with steroid-dependent asthma and of cases with type II (bronchiolar obstruction type) was observed in the later three years.
3. The clinical efficacy of spa therapy for bronchial asthma was Niger in the later three years than in early three years (1982-1984).