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INTRODUCTION Single-incision laparoscopic surgery (SILS) is widely used in many surgical procedures in various specialties. Among the access methods used in SILS, the glove technique, which is typically similar to the multi-trocar approach, is simple, convenient, and inexpensive. However, given the absence of a fulcrum supporting the endoscopic surgical forceps, the technique is less advantageous than methods using commercially available access devices because of the poor maneuverability of the forceps. MATERIALS AND SURGICAL TECHNIQUE By creating a fulcrum as a support to use with existing surgical forceps in the glove technique, we designed and used a novel method known as the "ring technique." This technique aimed to improve the maneuverability of endoscopic surgical forceps. DISCUSSION Placing a fulcrum resulted in the improvement of the forceps' maneuverability, which helped to ameliorate a weakness of the glove technique. The ring technique could be a useful option as a method of access in SILS.

Highlights • Recurrent laryngeal nerve injury is a major complication of thyroid surgery. • Use of an electromyography endotracheal tube can prevent this injury. • We describe a case of extralaryngeal bifurcation of the recurrent laryngeal nerve. • Intraoperative neuromonitoring could identify and preserve this bifurcation., Introduction: Recurrent laryngeal nerve injury is a major complication of thyroid surgery. An endotracheal tube with electromyography electrodes attached to it was recently developed for intraoperative neuromonitoring during thyroid surgery. Here we describe the successful identification and preservation of an extralaryngeal bifurcation of the recurrent laryngeal nerve by intraoperative neuromonitoring in a patient undergoing thyroid surgery. Presentation of case: A 56-year-old woman presented for evaluation of a neck swelling found during a medical examination. Computed tomography (CT) revealed a tumor with a 5-cm diameter in the left thyroid lobe. Fine needle aspiration cytology revealed a Bethesda category III finding. Left thyroid lobe resection was scheduled. During surgery, the left recurrent laryngeal nerve was found to be adhered to the tumor. Careful exploration and intraoperative neuromonitoring allowed us to identify and preserve an extralaryngeal bifurcation of the recurrent laryngeal nerve. Discussion: The recurrent laryngeal nerve can demonstrate various anomalies and bifurcations. Failure to notice and correctly identify extralaryngeal bifurcation leads to recurrent laryngeal nerve injury. Motor branch injury has a particularly large effect. Intraoperative neuromonitoring has been reported to be useful for identifying and preserving the recurrent laryngeal nerve and its aberrations as well as the external branch of the superior laryngeal nerve during thyroid surgery. Conclusion: The findings from this case suggest that an extralaryngeal bifurcation of the recurrent laryngeal nerve can be identified and safely preserved by intraoperative neuromonitoring.

Background Renal cell carcinoma is well-known for its propensity to metastasize to unusual sites. However, metastasis to the gallbladder has been rarely reported in the literature. Case presentation A 75-year-old Japanese (Asian) woman presented for further evaluation of a gallbladder polyp, 15 years after right radical nephrectomy for renal cell carcinoma. Computed tomography revealed a 12 mm enhancing pedunculated tumor in the gallbladder fundus. Open simple cholecystectomy was performed and the tumor was histologically confirmed as a metastasis of renal cell carcinoma to the gallbladder. Our patient is alive and has been disease-free for 3 years after cholecystectomy. Conclusions Although metastasis of renal cell carcinoma is a rare differential diagnosis of gallbladder tumors, simple cholecystectomy is likely to offer a chance of long-term survival for patients with gallbladder metastases of renal cell carcinoma.

Cystic lymphangiomas of the mesocolon are very rare in adults. They are usually asymptomatic, but can present with an acute abdomen. We report an adult patient with cystic lymphangioma of the mesocolon that manifested with peritonitis. A 33-year-old man presented with fever and severe pain with muscle guarding in the left abdomen. Laboratory data indicated high-grade inflammation. Enhanced computed tomography (CT) showed multiple low-density masses with peripherally enhancing rims, strongly suspicious for cysts, in the left abdomen. Based on a diagnosis of peritonitis, emergency surgery was performed and revealed many cysts in the descending mesocolon. Histopathological examination findings indicated a cystic lymphangioma. The post-operative course was uneventful, and 1-year follow-up CT showed no recurrence. This case demonstrates that cystic lymphangiomas of the mesocolon in adults can present with acute peritonitis, although this is extremely rare. Complete resection is required for accurate diagnosis and for preventing recurrence.

Background The number of patients who have difficulty with mutual understanding has been increasing recently due to an aging society. This emerging issue needs to be addressed. We report an instructive case of a patient who had communication difficulties due to dementia and sequelae of alcoholic encephalopathy. Case presentation A 66-year-old man of Mongolian race presented with coronary arteriosclerosis, spinal canal stenosis, transverse colon cancer, and alcoholic encephalopathy. We had been requested to remove wires that had been used for the closure of his chest in a coronary artery bypass grafting procedure. However, on admission, a tortured expression and abdominal distention were observed, along with emaciation. We diagnosed terminal stage cancer, and palliative care was offered. An abdominal computed tomographic scan revealed rectal cancer with stenosis and invasion to the adjacent tissues. A metallic stent was inserted, leading to reduction of the abdominal distention and an improvement of tachycardia. However, the patient’s tortured expression was not completely relieved; therefore, an assessment of cancer pain was considered. The Abbey Pain Scale was applied. On the basis of the patient’s score, analgesics and an opioid, among other medications, were administered. These led to relief of the patient’s tortured expression and reduced his Abbey Pain Scale score. Following this, the patient’s vital signs continued to be stable, and he was transferred to the referral institution. Conclusions Management of cancer pain in elderly patients with mutual understanding difficulties must be performed carefully. In the case of our patient, staff at the referral institution informed us of the patient’s latent torture, and we applied the Abbey Pain Scale. There was some confusion and uncertainty regarding clinical management throughout the patient’s care; however, his condition eventually stabilized. We believe the application of the Abbey Pain Scale assists in the relief of cancer pain. However, accumulation of further cases and experiences to verify this assessment is required.

症例は56歳, 男性. 急性腹症で発症し上腸間膜動脈 (superior mesenteric artery : 以下SMAと略す) 解離と診断され, 同時に総肝動脈瘤も指摘されていた. 保存的治療で軽快し2年間, 経過観察中であったところ, 下血により胃癌が発見された. 今回, われわれは, 胃癌に対しては幽門側胃切除術を, 総肝動脈瘤に対しては瘤切除および血行再建術を行った. SMA解離は血栓化しているためそのままとした. 大動脈解離を伴わない孤立性のSMA解離は極めて稀な疾患である. また, 近年, 画像診断の進歩により総肝動脈瘤の発見は増えつつあるものの症状に乏しいため診断されにくく, 破裂時には救命率が低いと報告されている. われわれは, 孤立性上腸間膜動脈解離や, 総肝動脈瘤といったその一つのみを有していても稀な疾患を重複併存した胃癌手術症例を経験したので報告する.

症例は34歳男性,アルコールの多飲歴あり. H7年,腹痛を主訴に近医を受診,慢性膵炎と診断され,その後もたびたび腹痛を繰り返していた. H14年11月に慢性膵炎の急性増悪にて当院内科入院となった. CTにて膵頭部腹側に限局する石灰化を認めた. ERPにて膵管癒合不全を認め,腹側膵限局の慢性膵炎の診断にて外科紹介となり,幽門輪温存膵頭十二指腸切除術を施行した.切除標本造影にて完全型膵管癒合不全と診断した.病理組織検査では,腹側膵には膵石および慢性膵炎の像を認めたが,背側膵には著変を認めなかった.術後,腹痛,膵炎の再燃を認めていない.膵管癒合不全に起因する膵炎は通常背側膵炎が多い.腹側膵の限局性膵炎は非常に稀であり,その病因を考察する上で興味深い症例であった.

大腸憩室の穿孔に起因する尿膜管膿瘍を経験したので報告する.症例は78歳,男性.無熱,無痛性の臍部からの膿性分泌を主訴に当科を受診した.検尿は正常であったが,膿の培養にて大腸菌を認めた.腹部CTにて臍下から膀胱へと連続する5cm大の嚢胞性腫瘤を認めた.また, S状結腸に多発する憩室を認め,一部大腸壁と嚢胞壁との境界は不明瞭であった.大腸憩室に起因する尿膜管膿瘍の疑いで手術を行った.術中所見にて,腫瘤は7cm大で臍下方に存在し,内腔に黄白色の膿汁を有していた.腫瘤は臍部へと瘻孔をもって交通し, S状結腸とも瘻孔を認めた.膀胱とは接するものの交通は認められなかった.以上の所見と腫瘤の局在より,大腸憩室の穿通に起因した尿膜管膿瘍,尿膜管臍瘻と診断した.尿膜管膿瘍にて尿膜管臍瘻をきたした報告は稀に認められるが,大腸憩室症に起因したものは自験例が本邦ではじめてである.

症例は75歳,女性.突然の腹痛と嘔気を主訴に来院された. 7年前に胃原発性形質細胞腫に対し胃全摘術(loop-esophagojejunostomy (Graham法)+Braun吻合)の既往があった.臍周囲に圧痛を伴う腫瘤を認め,腹部超音波検査およびCT検査にて腸重積と診断し緊急手術施行した.輸出脚空腸がBraun吻合部を越えて輸入脚空腸へ重積しており,用手的整復するも腸管循環不全を呈していたため空腸部分切除を行った.なお,先進部に器質的病変は認めなかった.胃切除後腸重積は稀な疾患であり,なかでも自験例のような重積様式の本邦報告例は8例のみである.術後合併症において本症も念頭におき,早期診断・治療を行う必要があると考えられる.

Aerodynamic stability of π section, which is structurally economical, was studied. By locating the main girders at inward location, so that the ratio of the floor deck overhang C to the girder height D′, C/D′, to be 2.0, and also setting solid barriers at inward location, the wind-induced responses were much suppressed even under various angles of attack. Although, some wind-induced responses were still observed with the improved section, the magnitude of the negative aerodynamic damping that caused the vibration was found to be small, thus the section could be thought as a probable choice for long-span bridges. The stability due to the solid barrier location was accomplished by the separated flows mutual interference effect; the unsteady pressure on the upper surface of the deck decreased significantly for the torsional motion.

From an economical point of view, a two-plate-girder bridge section has been examined as a bridge section for a long span suspension bridge. The two-plate-girder bridge section of H or π section inherently does not have good aerodynamic performances, as shown by the accident of the Tacoma Narrows Bridge with H section-type bridge girder. On the contrary, in the present paper, there has been an attempt to find the possibility of the aerodynamic performance improvement of the two-plate-girder bridge section of the π section by changing the intervals between the two plate girders. With respect to wind tunnel test results, in the vortex-excited vibration in heaving vibration mode, the on-set wind velocity and the vibration amplitude decrease with interval between two plate girders, and the flutter on-set wind velocity increases. These results show the possibility of aerodynamic performance improvement of the two-plate-girder bridge section.

ショック状態に至った大腸穿孔例は予後不良であるが,今回われわれは腎移植患者において1救命例を経験した.患者は52歳女性で, 1993年3月に生体腎移植を受けている. 1999年11月2日に急激な腹痛を生じ,約10時間後に当院を受診,血圧52/13mmHgで,腹部緊満著明であった.胸部単純X線で腹腔内遊離ガス像を認めたため,緊急開腹手術を行った.横行結腸脾彎曲部付近の腸間膜付着部反対側に直径約3cm大の穿孔を認め,同部および肛門側には,腫瘍を認めなかった.病変部横行結腸を局所切除・吻合し,口側横行結腸にストーマを設置した.術後にエンドトキシン吸着を2度行った. 術後graft lossに陥ることもなく,第131病日に退院した.病理組織学的所見上穿孔以外には明らかな所見はえられなかった.致死率の高い病態を腎移植患者に合併しながら救命し,さらにはグラフト機能を温存しえた症例であった.

当センターでこの12年間に経験したpositive selectionのCAPD症例59例中, 死亡15例, 血液透析 (HD) への移行23例の計38例 (64.4%) が, CAPD脱落症例であった.これらの脱落原因の50%がCAPDに関連したもので, 中でもHD移行の主な理由は, 限外濾過不全, 難治性・頻回のCAPD腹膜炎, 硬化性被嚢性腹膜炎 (SEP) であった. また, 開腹手術を要した6例中5例がHDへ移行した. 脱落関連因子として, CAPD施行期間の長さ, CAPD腹膜炎罹患が有意に相関があると考えられた.SEP症例は, 59例中3例, 5.1%であった. 限外濾過不全のためHD移行後, この前段階と考えられる著明な腹水貯留4症例に, 発症早期からのステロイド治療が有効であった.CAPD排液中のamylase値は, 平常時およびCAPD腹膜炎時には, それぞれ, 5.6±2.7, 19.3±22.6mU/mlで, 後者で有意に高値を呈した. 穿孔性腹膜炎2例 (S状結腸, 回腸) と急性膵炎1例に緊急開腹手術を施行したが, 術前のこれらの値はさらに著明な高値を示し, 一般のCAPD腹膜炎との鑑別に極めて有用であった. 回腸穿孔例では, 術後に縫合不全を合併し手術死亡となったが, このような後期の腹膜硬化症を呈する症例においては, 腸管吻合に重大な危険性が存在すると考えられた.脱落症例38例中16例に, カテーテル抜去時や開腹手術時に腹膜のサンプリングが行われ, 病理組織学的検索がなされた. CAPD施行期間が8-18か月の3例では, いずれも腹膜線維症の所見であった. しかし, 60か月以上の13例中12例, 92.3%では, 腹膜機能障害が非可逆性といわれる中期以後の腹膜硬化症の所見 (中期5例, 後期7例) が認められ, 極めて注目すべき結果が得られた. この事実は, かかる長期CAPD症例においては, SEPとの関連から, その中止時期も含めて, 注意深い経過観察が必要であると考えられた.

The acceleration noise generated in the ordinary usage of mobile devices (e.g. when “taking out” the devices or operating them) interferes with estimation of the means of migration using accelerometers on the devices. We developed a correction method for the noise generated when users take out devices, change their posture, and operate the devices. The method uses the changes of acceleration and the operation events acquired from the operating systems of the mobile devices to detect the period of noises. The result of evaluation shows that the method using the acceleration changes improves the precision of the context inference approximately 5 %, and the method using the operation events corrects the inference mistaking resting for boarding.

症例は51歳の男性,心窩部痛を主訴に来院した.諸検査の結果,肝S4, S7の転移性またはリンパ系の悪性腫瘍の診断の下に肝切除術を施行した.術後の病理学的検索では悪性リンパ腫(Non-Hodgkin's lymphoma, B-cell type)であった.本症例では術中に肝門部リンパ節に軽度の腫脹を認め病理学的にも同様の所見が認められたため,原発が肝であるか,リンパ節であるかは確定的でなかったが,腫瘍の局在からは肝原発が疑われた.肝原発の悪性リンパ腫の報告例は我々の検索した限りでは英文77例及び邦文30例の107例にすぎず,特に肝切除例は英文19例,邦文4例の23例が報告されているにすぎない.肝に限局した悪性リンパ腫は,積極的な切除療法と,多剤併用による化学療法により,予後の改善が期待できると考えられた.

We propose a novel human activity recognizer for an application for mobile phones. Since such applications should not consume too much electric power, our method should have not only high accuracy but also low electric power consumption by using just a single three-axis accelerometer. In feature extraction with the wavelet transform, we employ the Haar mother wavelet that allows low computational complexity. In addition, we reduce dimensions of features by using the singular value decomposition. In spite of the complexity reduction, we discriminate a user's status into walking, running, standing still and being in a moving train with an accuracy of over 90%.

症例は53歳男性.computed tomography(CT),超音波検査にて肝左葉の2cmの孤立性の腫瘤と肝門部に3cmと5cmの2個の腫瘤を指摘され来院した.各種画像診断を行い,肝内の腫瘤は肝細胞癌(以下HCC)と考えられたが,肝門部の腫瘤の1つは胃壁に接して存在し胃原発平滑筋肉腫との鑑別が困難であった.HCC+胃平滑筋肉腫+リンパ節転移の診断により手術を施行したところ,肝門部の2個の腫瘤はいずれもHCCのリンパ節転移であった.HCCは手術時にリンパ節転移をきたす頻度は低いとされ,2cmのHCCがリンパ節転移を合併した症例は報告がない.しかし,HCC手術例におけるリンパ節転移の正確な頻度,転移経路についてはまだ十分な検討が行われているとはいい難く,今後手術時のHCCリンパ節転移の検索並びにリンパ節郭清術に対する検討が必要であると考えられる.

Two hundred and eighty-seven patients with bleeding gastroduodenal ulcer who were admitted with the chief complaints of hematemesis and/or melena were clinicopathologically studied. The operation was performed in 155 (54.0%) patients. Bleeding rates were 78.0% in UL-II, 44.0% in UL-III, and 47.0 in UL-IV. The rates needed emergency operation were 76.5% in UL-II, 42.9% in UL-III and 46.6% in UL-IV. Both bleeding and emergency operation rates were higher in UL-II cases. From an examination of the diameter of exposed vessels in vascular stump-positive cases, the inner-to-outer diameter ratio of the vessels was significantly smaller in UL-II (0.074) compared to UL-IV (0.125) cases. This fact indicates that UL-II cases less frequently associate with intimal hypertrophy, and once the vessels are broken, thrombosis is hard to be formed, accordingly more efforts being demonded for its hemostasis.

With the development of a car-mounted navigation system and an in-car network, improved information services for creating drive plans automatically have been realized. We propose a method of developing telematics services through combination of a context-aware agent framework and a planner that provides the predicted feature situation to the framework and creates drive plans composed of POIs (Points Of Interest) proposed by the framework.

The purpose of this study was to determine whether a combination of transcatheter arterial chemoembolization using doxorubicin and radiofrequency ablation can increase tumor destruction compared with radiofrequency alone in the treatment for hepatocellular carcinoma. SUBJECTS AND METHODS. Twenty-one patients with 26 nodules smaller than 3 cm in diameter were treated with radiofrequency ablation. Of these, 10 nodules were treated with a combination of radiofrequency ablation and chemoembolization using doxorubicin. All nodules were evaluated for size of induced coagulation, local recurrence, and complication.The therapeutic areas averaged 27.6 x 22.3 mm using an electrode with a 2-cm tip and 37.2 x 29.1 mm using an electrode with a 3-cm tip. With respect to the results for 14 nodules treated using an electrode with a 3-cm tip with or without chemoembolization, the greatest dimension of the area coagulated by combined therapy was significantly larger (longest axis dimension, 39.9 +/- 4.4 mm; shortest axis dimension, 32.3 +/- 5.2 mm; n = 7 nodules) than areas without chemoembolization (longest axis dimension, 34.6 +/- 2.6 mm; shortest axis dimension, 26.0 +/- 3.3 mm; n = 7 nodules) (longest and shortest axis dimensions, p0.05). No recurrence occurred in the nodules smaller than 2 cm in diameter. Among the nodules larger than 2 cm in diameter, one local recurrence was observed in seven nodules treated by combined therapy, while two local recurrences were observed in seven nodules treated by radiofrequency alone. Minor complications developed in three patients, two with persistent high fever and one with biliary stenosis.The combination of radiofrequency ablation and transcatheter arterial chemoembolization using doxorubicin markedly increased the extent of induced coagulation compared with radiofrequency alone, despite a small number of patients and the preliminary nature of this study.

We studied the relation of perioperative blood transfusion and the outcomes in 175 patients with hepatocellular carcinoma (HCC) who underwent hepatic resection from 1986 to 1994 in our hospital. Hepatectomy was performed in 23 (13.1%) patients with and 152 (86. 9%) without blood transfusions. The cumulative cancer-free survival rates for patients who had received blood transfusion was significantly lower than that for patients who had not received blood transfusions (p = 0.003). Further examinations revealed a significant difference in cancer-free survival rates for stage I-II patients (n = 75) of HCC (p = 0.02) but not for stage III-IV patients (n = 56) (p = 0.06). Cox regression analysis for recurrence revealed that blood transfusion was the most significant prognostic indicator (p = 0.001) for recurrence in stage I-II patients but not in stage III-IV patients (p = 0.99). These results suggest that a perioperative blood transfusion may be a significant prognostic indicator for patients with HCC who had underwent hepatectomy, especially in stage I-II patients of HCC.

Reaction of 1,1-dihalogeno-2-phenyl-1-alkenes (I) with phenylmagnesium bromide in the presence of NiCl2(dppp) in THF has been studied. Mono-cross-coupling accompanied by partial reduction gave (E)-1,2-diphenyl-1-alkenes (III) as the major products. Use of a large excess of Grignard reagent increased the yields of III and the (Z)-isomers (II), with a decrease in the yield of double cross-coupling products, 1,1,2-triphenyl-1-alkenes (IV). The highest ratio of the sum of the yields of the monophenylation products to the yield of the double cross-coupling product, (II + III)/IV = 36.5, was found for the reaction of PhMgBr with 1,1-dibromo-2-phenylpropene (Ib) in a 12.0/1 molar ratio. A possible reaction mechanism is described.

フェニル酢酸ο-トリル[1]の沸騰クロロベンゼン中におけるAlCl3を触媒として用いたFries転位では,58.0%の収率で4-ヒドロキシ-3-メチルフェニル=ペンジル=ケトン[8]が得られたが,2-ヒドロキシ-3-メチルフェニル=ベンジル=ケトン[9]の収率はきわめて低かった(図1)。この反応で生成した[9]は逆Fries転位によって[1]に変わるが[8]から[1]への変換はわずかであって,このためクロロペンゼンを用いた[1]のFries転位は低いオルトーパラ比([9]/[8])を与えている(図1,表4)。沸騰ニトロメタン中フェニル酢酸m-トリル[2]のFries転位では,2-ヒドロキシ-4-メチルフェニル=ペンジル=ケトン[15]の収率が反応時間とともに増加し,4-ヒドロキシ-2-メチルフェニル=ベンジル=ケトン[16]の収率は減って,3時間後には高いオルトーパラ比([15]/[16]=15.3)を与えた(図2,表2)。フェニル酢酸p-トリル[3],フェニル酢酸2,4-キシリル[4]およびフェニル酢酸2,6-キシリル[5]を同じ反応条件でFries転位を行なって,得られたそれぞれの転位生成物収率を比較したところ,4-ヒドロキシ-3,5-ジメチルフェニルニペンジル=ケトン[13]の収率が,2-ヒドロキシ-3,5-ジメチルフェニル=ペンジル=ケトン[14]や2-ヒドロキシ-5-メチルフェニル=ベンジル=ケトン[17]の収率より高かったので,パラ転位はオルト転位より速く進むことがわかる(表3)。[4]および[5]をそれぞれAlCl3存在下トルエン中で還流すると,[14]と[15]の収率はいずれも低くなり,2-トリル=ベンジル=ケトン[6]と4-トリル=ベンジル=ケトン[7]が生成した(表3)。[6]と[7]の収率および生成物比([6]/[7])のいちじるしい違いを考慮すると([4]から[6]:7.0%,[7]:4.1%,[6]/[7]=1.71。[5]から[6]:3.8%,[7]:47.2%,[6]/[7]=0.08),パラ転位は分子間性であり,オルト位への転移は分子内転位であると考えられる(表3)。

As a compound internal combustion engine, it can be considered several combination of high pressure and low pressure cylinders. The compound internal combustion engine considered in this investigation, consists of two HP cylinders which act as four cycle engine and LP cylinder which acts as two cycle. The crank angle between HP and LP cylinder is 180° and the bottom side of the LP piston is used as a supercharger for HP cylinder. The theoretical formulas of work done and thermal efficiency are reduced and form the results of numerical calculation, the effects of ratio of stroke volume of HP and LP cylinder, volume of transfer passage between HP and LP cylinders etc. on thermal efficiency are discussed.

A hydrocarbon fuel has its inherent ignition quality based on the chemical structure, and, for the family of normal paraffins, the characteristic value may be supposed to be in proportion to the carbon number. The project of the present study was to verify the relationship in such a way that the variations of ignition lag in CFR Diesel engine were measured when several kinds of high-carbon normal paraffins were added to or solved in a base fuel by varied amount and the rates of change in ignition lag were used for evaluation. Kogazin I (nearly Octane) was adopted as base fuel, and two liquid higher paraffins (C16, C17) and three solids (C19, C21·5, C31) were examined. It was found that the inherent ignition quality increases with the carbon number irrespective of whether liquid or solid paraffins. The characteristic values obtained for the above paraffins except Cetane are 104, 115, 136 and 202 in the order in terms of cetane value.

燃燒後過不足なく水を生ずる様な割合の酸水素と酸素を内燃機関に供給してこれを動かした場合及び上の酸水素に種々の割合に水蒸気を混じたものを用ひた場合の、シリンダ内ガスの温度、理論的熱効率、單位行程容積當りの出力等の算式を導き、計算例に依てこれ等の値を算出し、これ等の値をガソリンと空気及び水素と空気とを用ひた場合のものと比較考察し、尚内燃機関の排気即ち水蒸気に依て蒸気タービンを動かすものとし、排気の熱を利用するには如何にすべきかに就て考察し、且内燃機関とタービンの組合せの熱効率の式を導き、計算例に依て熱効率が種々の條件に依り如何に変るかを明かにしたものである。