The follow up study of treatment of the cholelithiasis is quite useful on making choice of surgical or medical procedure on handling the patient at the time of admission. We have been studying the cases of gallstones from 7 months to 15 years after treatment by postcard examination, and we had 85 answers of the surgically treated cases (86.9%) and 15 answers of the medical cases (50%).
The incidence of the disease is slightly higher in females, The stone in gallbladder is more frequent than the cystic-duct-stone. Six patients became disabled post-operatively (7.7%), this would be better than the published report in past (10%), whereas two medically treated cases lost their activities (14%).
The subjective symptomes after treatment are rather few in the medical cases, but 22% of the operated cases complain of slight stiffness of the back. About 10% of the patients relapsed and 39% (33 cases) recovered completely. We agree with the opinion of Hayashida, who stated 2/3 of the cases had some complaints post-operatively. Considering of the patient's activities and the subjective symptomes, complete recovery would be figured as 74% and incomplete would be 7.2%, these would be the same figure as reported in past. Many relapses occured from one to five years after operation, and recovery rate is 87% more than five years after surgery. There were quite few cases, however, had no complaints, this could be responsible to the most of cases were aged. On the contrary, the young surgical and medical cases had been doing well. There are many relapses in the cases of cystic-duct-stone, in which prognosis would be related with number of stones.
Jaundice itself did not have any specific relation with prognosis, but severity of the liver damage had a great influence upon prognosis. Even during treatment of preoperating period, repeated liver function test is necessary for determination of adequate time and procedure of operation. Dilatation of the cystic duct and shape of the gallbladder through the X-ray examination are considered to be of no values on surgery.
There were 6 mortal cases; 4 of them died of the other kind of diseases, one died of malignant change and the other diseased by myocardial infarction. We must pay attention on the biliary tract cancer caused by cholelithiasis and coronary diseases.
Six cases were reoperated and 2 cases were recovered well with the successful treatment by making the outer fistula, Among the relapse cases after removal of the gallstone we often found another stones in the cystic duct, that is probably characteristic feature of cholelithiasis in Japan. Therefore it is quite necessary to adopt after-care of the patient as a prudential method.

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An original classification of the severe pulmonary tuberculosis was attempted from the surgical point of view, especially in aspects of the pulmonary function and the findings of the chest films. According to this classification we discussed the indication of operations for each groups and the results of operations as well.
Type I: The cases in which the lesions indicating pneumonectomy are found in the entire lung field of one side and some lesions in the opposite lung. In this type, pneumonectomy or thoracoplasty showed better results than cavernostomy, so that pneumonectomy was thought of the first choice, In cases showing cavity formations in the opposite lung or high resistance to antituberculous drugs, however, thoracoplasty was thought to be preferably performed, because there was a high incidence of complications after pneumonectomy.
Type II: The cases in which the lesions indicating the upper lobectomy are found in both upper lung fields.
In this type, both of lobectomy and thoracoplasty showed poor results, especially the fomer showed a high incidence of severe postoperative complications. On the contrary, the results of cavernostomy were much more excellent and, if any, the postoperative complications were easily treated.
Type III: The cases in which the lesions indicating some surgical treatment are found in both lungs but the pre-operative % V. C. is below 60%.
In this type, the results obtained were almost the same as in type 2. Lobectomy and thora coplasty were unsuccessful in many cases, with a high incidence of severe complications, while most of cavernostomied patients had good results and were rehabilitated to works.
Type IV: The cases in which the pre-operative % V. C. is below 40%.
In this type, no method of operations was of good result. Complications were frequent and severe.
From these results, for severe pulmonary tuberculosis cavernostomy is believed to be one of the most favorable operations because of the slight loss in the pulmonary function and the low incidence of the postoperative complications.
Especially in types 2 and 3, in which effect of the other kinds of operation are discouraging, cavernostomy proves to be powerful and appears to be properly indicated.

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In recent years, the pathogenesis of central nervous system complication caused by exanthematous infectious disease has been the subject of study by many investigators, while the definite conclusion has not been established yet.
In this report, the pathogenesis of the secondary encephalomyelitis was discussed based on the clinical observations of our own experienced cases which had developed central nervous system involvement due to measles and varicella, three cases and one case respectively.
As the other investigators had pointed out, the secondary encephalomyelitis was produced by not only so simple as neuroallergic reaction, but various kinds of pathological disturbances such as electrolyte unbalance, cerebral vascular damage, cerebral edema and cerebral anoxia, etc, would be related.
The fundamental principle of the treatment should be strongly symptomatic; i. e. maintenance of proper electrolyte balance, sufficient oxygen supply, anticonvulsant agent and antibiotics, while ACTH and steroids should not be the first choice and must be used from consideration of the clinical sign or course of the patient.

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We have reviewed 145 patients of over age of sixty-five years old, who had undergone surgery for abdominal and pelvic diseases during the last five years (from 1957 to 1962) in our hospital. Among them, the malignant neoplasms were 59 cases (41%), showing the highest number.
Among thirteen death cases there were four cases of cholangitis and cholelithiasis, four cases of ileus and two cases of gastric cancer, which were not operable radically, while we never had any experience of direct death from gastrectomy in past.
The respiratory and circulatory complications must be kept in mind postoperatively.
In the cases of under sixty-five years of age with gastric cancer, cholangitis, cholelithiasis, ileus and carcinoma of rectum which were the major diseases in surgery, the mortality rate was 19.7%, while the aged one was only 3.0% unexpectedly, In case of combination of cholangitis and cholelithiasis, the cases of younger adults were four times much as the aged one.
Although emergency operation for the aged person usually shows higher mortality rate than the younger one, we believe that operation could be performed without much risk even for the aged, when we have sufficient pre-operative examination, adequate pre-operative treatment, suitable anesthesia and good postoperative care.

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The fluid-therapy as a postoperative care is important in the geriatric surgery because of the weak response of their body function physiologically.
On the determination of body fluid distribution, the decrease of total body water and the relative increase of extracellular fluid volume were observed especially in hypoproteinemic and dehydrated poor risk aged patients.
The influence of bleeding during surgery was noticeable in the aged patients, was found in much severe grade than that of the younger.
During postoperative course, the body weight of aged patients who had subtotal gastrec tomy, gradually decreased until the 4th or 5th postoperative day, and then slowly increased, The primary water balance declined to more positive than that of younger adults, The extracellular fluid remained in high level and the decrease of circulating plasma volume was much more than that of the younger. The salt balance declined to positive especially in the immediate postoperative days. Generally, the fluid volume given postoperatively in the aged should be a little smaller amount compared with that of the younger. Also the dosis of salt given, should be withheld within 2 or 3g per day.

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The combination of the continuous epidural analgesia using 0.5, 1.0 and 2.0% Xylocaine ®, with the light endotracheal anesthesia maintained with nitrous oxide or GOE, was applied for the abdominal surgery of the aged 89 cases ranging from 42 to 80 years old, for the purpose of overcoming many troublesome problems in the aged such as blood pressure fluctuation during anesthesia and prolonged respiratory depression, poor expectorating force, bronchial secretions, chest complications, declined renal function and others in the postanesthetic period.
The patients were comfortable and the surgeons were offered very quiet operating fields by this anesthetic method.
While hypertension during anesthesia was much alleviated, hypotension was in high degree than by single GOE tecnique, but the hypotension easily restored by administration of vasopressor such as Mexan ®, Ephedrine or Carnigen ®.
Muscle relaxation during operation was satisfactory by the epidural analgesia and assistance of only small doses of the muscle relaxants.
Immediately after anesthesia, the patients were awakend and bucked powerfully against the bronchial suction, exhibiting enough expectorating force. There was no case of prolonged respiratory depression.
In postanesthetic course, the bronchial secretions of the patients anesthetized by our method was obviously less than of those by single GOE tecnique and the chest complications were never experienced in this series, The continuous epidural block through indwilled tube in postoperative time, as well as low concentration of ether during operation, early recovery from anesthesia and powerful expectoration were profitable to avoid the chest complications.
Among the cases undertaken gastrectomy, the postoperative decrease of urine volume was less in the cases by our method of anesthesia than in those by single GOE tecnique.

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This study is a review of 430 patients above the age of 65 years old who were subjected to surgical operations at our clinic from Jan. 1951 to Dec. 1962.
The results obtained are as followings.
1) Pulse, temperature and respiration rate of the aged patients during operation and in postoperative period were stationary in comparison with those of younger surgical patients, while fluctuation of blood pressure during operation were recognized in the aged cases more than in younger cases.
2) The cases with hypotension or tachypnea over 25/min. even after the second postoperative day, or with tachycardia more than 100/min, , fever above 38.5°C on and after the 4th postoperative day were hard to recover and showed high mortality.
3) The over-all mortality in one month after operation was 11% with 47 deaths, many of which were due to peritonitis and to pyo- or pneumothorax by leakage of esophagogastrostomy, 14 and 7 cases respectively. Cardiac failure and pneumonia as the cause of death were found in less incidence than by other several reports.

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Patients over 65 years of age admitted to the surgical section, Kyoto National Hospital were totaled 212 during the past five and half years.
One hundred and three out of these patients recived laparotomy, 59 per cent of whom have had gastric diseases and 51.5 per cent malignant tumors.
Statistical observations were made on the patients and the results obtained are as follows;
1) With the laboratory examinations made as preoperative routines, abnormal findings of ECG were detected in 76.0 per cent, anemia in 25.2 per cent, hypertension in 35.7 per cent, hypoproteinemia in 30.1 per cent and prolongation of bromsulfalein excretion in 17.4 per cent of the aged patients.
2) Among the patients with abnormal findings in ECG, those complicated with hypoproteinemia and/or abnormal retention of bromsulfalein showed high mortality after operation.
3) Postoperative complications developed more frequently in the advanced age group than in the young. And once the complications occurred, the aged showed less favorable prognosis for recovery from them.

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Homogenizer-method for treatment of sputum was studied as co-operative experiment by Kanagawa National Sanatorium, National Sanatorium Tokyo Hospital and Murayama National Sanatorium.
The sputum was divided into 4 parts as follows:
1) 1ml of the sputum and 4ml of 1% NaOH were mixed in a test tube and treated by the homogenizer.
2) 1ml of the sputum and 1ml of 2% NaOH were mixed in a test tube and treated by the homogenizer.
3) 1ml of the sputum and 4ml of 2% NaOH were mixed in a test tube and treated by the homogenizer.
0.1ml of the homogenized sputum was inoculated into 1% Ogawa's medium and 8ml of 0.1% semi-solid Kirchner agar medium (pH6.2).
4) The sputum was treated by the pipette method and was inoculated into 3% Ogawa's medium.
In the case of 1% Ogawa's media, the rate of positive cultures and number of colonies were almost equal among these four methods, but the contamination-rate was a little bite higher in the homogenizer-method using 1% NaOH and in the homogenizer-method using 2% NaOH (2).
In the case of semi-solid agar media, the rate of positive cultures and contamination rate were almost equal among these four methods. but the number of colonies was a little fewer in the homogenizer-method.

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