The authors studied both surgical and post mortem cases of cancer of the cervix uteri to investigate it's proliferation and metastases. The materials in this report were consisted of surgical specimens which were extirpated by extended radical hysterectomy and pelvic lymphadenectomy from April, 1961 to June, 1963.
The primary focus was originated in portio vaginalis in all of 10 cases of first stage and cervical canal carcinoma was seen in 12 of 21 cases of second stage and one of third stage. Conclusively, there showed the tendencies that primary focus is the type of “Endophytisch Wachstum” in higher stages of cancer.
Macroscopic appearance of cancerous tissue was classified in 19 cases of protrudent tumor, 6 cases of ulcerative, 3 cases of infiltrative and 4 cases of erosion type respectively.
Histological maturity of primary focus was classified according to those of Japanese Obstetrical and Gynecological Society. In first stage, the intermediate form was seen relatively more and in second, third stages, the mixed form were predominant. It may be said that in relatively early carcinoma, cancer cells show almost identical histopathological pattern, but in the higher stage mixed type cancer in which the premature, intermediate and mature cells are co-existing was seen more. Namely, some of those higher stage of cancer showed the picture of “Carcinoma simplex” containing either polymorphological or giant cells. Therefore, the histological character of primary focus was different and was considered to be difficult to define as one form.
In CPL classification of primary focus, C-form was seen not infrequently in first stage and both P-and L-forms increased predominantly in second and third stages.
The incidence of lymphnode metastases and staging of cancer were as follows. The node metastases were noted in 1 of 10 cases or 10.0% in first stage, 8 of 21 cases or 38.1% in second stage and one or 100% in third stage.
In CPL classification of primary focus of 10 cases with proven lymphnode metastases, 5 cases were L-form and 5 were P-form. Namely, there seems to be close correlation_between CPL classification and node metastases.
The sites of proven metastases were mostly medial iliac, obturator and external iliac nodes but were not recognized in others including suprainguinal nodes.
Pathological modes of infiltrative proliferation from primary focus to parametrium and metastases to lymphnodes were as follows:
1) Evidences of cancer in both parametrium and pelvic lymphnodes were not proven in 14 cases of which 8 cases were first stage and 6 were second stage. In macroscopic findings of primary lesion 4 cases were erosion type, 7 cases were protruding tumor and 3 cases were infiltrative type respectively.
It is noteworthy that most of cases showed “Exophytisch Wachstum” excluding 3 cases of infiltrative type.
2) The cases with proven cancerous proliferation in parametrium but no metastases in lymphnode were 8 cases of which one case was first stage and 7 were second stage. Of those. the continuous proliferation was recognized in 5 cases and non-continuous type was 4 cases. The rest of 4 cases showed mixed type of both. In non-continuous type, cancerous proliferation was recognized mostly in the small nodes or intracapillary which located close to the uterine artery. The primary lesion of those cases showed marked “Endophytisch Wachatum”3) The cases with proven evidence of cancer in both parametrium and pelvic lymphnodes were 9 cases includng one case of first stage, 7 of second stage and one of third stage. The non-continuous type of infiltration was noted in one case, continuous type of 2 cases and mixed type was 6, in which all showed marked “Endophytisch Wachstum”. Above findings, the modes of proliferation to parametrium could be either continuous or non-continuous, and it was presumed that in latter type the cancerous tissues may enter

View full abstract

In this report, the extent of. blood loss during radical operation of carcinoma colli was investigated in cases which were collected without any special selection. As a preliminarystudy, relations beween amount of blood loss and time of the operation were investigated in 55 cases which consisted of three groups, that is, 14 cases of the 1st stage of cancer, 32 cases of the 2nd stage and 9 cases of the 3rd stage. In 46 cases of the former two groups, mean value of amount of blood loss was 426 grams and mean time of operation was 2 hours and 12 minutes. In the third group, they were 587 grams each, and 2 hours and 42 minutes.
Then, all process of the operation was divided into four parts and amount of blood loss during each part was measured in order to discuss which part is mainly responsible for bleeding during the operation.
As the operative method the Ogino's modification of the Okabayashi's method was applied.
The esch part means as follows The Ist part: period until removement of the lymph glands from the beginning. The IInd part: period until cutting of the ligamentum cardinale from the end of the I st part.
The II rd part: period until panhysterectomy of the unterus from the end of the II nd part. The IVth part: period until termination of the operation from the end of the IIIIrd part.
Materials for this study were 22 cases in the I st and II nd stages of carcinoma colli,
The mean value of total amount of blood loss was 352 grams which consisted of 84 grams during the I st part, 83 grams during the I nd part, 121 grams during the III rd part and 64 grams during the IVth part. No remarkable differences in amount of blood loss among these parts were noted, though somewhat higher figure was shown in the III rd part. The mean time of the operation in these materials was 2 hours and 9 minutes,
To this series, 66 cases were added, which showed same results as the former.

View full abstract

Statistical observation upon perinatal death was done during five years from August, 1958 through July 1963.
Perinatal mortality cases were 106 and the mortality rate was 17.95‰, while the total number of delivery was 5, 904. There is no tendency of decrease year after year during that period of time.
About the time of death, post-partum death was in the majority, then ante-partum death was next and intra-partum death was the least. As to the cause of death is concerned, the premature baby birth was the most then that decreased as following order: the congenital malformation, the prolonged delivery and finally the toxemia. In addition to the above mentioned causes, the unknown cause of death was 18.87%.
Perinatal deaths were mostly accompanied with the maternal complications, and also were found much in abnormal delivery, mainly in the breech presentations.
The cases who had cloudiness of the amniotic fluid showed higher mortality rate than those of clear fluid among the perinatal deaths.

View full abstract

Frequency of cesarean section is 3.7% in 1961, 6.2% in 1962 and 12% in 1963. C. P. D. was increased in 1963.
In anesthesia, subarachnoid anesthesia was unfaborable and epidural anesthesia was the best.

View full abstract

Between the year of 1956 through 1963, 8, 979 patients were delivered. Out of 577, (6. 4 per cent) were delivered by cesarean section.
Maternal mortality: 577 cesarean sections were performed without a single death in this series.
Fetal mortality: the fetal mortality rate in cesarean section as compared with these in vaginal delivery are presented in Table 2, in which there is an incorrected fetal mortality rate of 2 per cent in cesarean section.
Indications: the recorded indications are listed in Table 3. The listed indication, however, are primary ones, and in those which might seem somewhat dubious there were. generally other secondary indications which strengthened the desirability of abdominal delivery.
Anesthesia: the local and additional inhalation anesthesia was used in 54.0 per cent of the cases, closed system in 30.0 per cent, spinal in 13 per cent, epidural in 3. 8 per cent.
There were no deaths ascribable to anesthesia nor were there any sequalae consequence following spinal anesthesia. At present currently, our preference is for spinal anesthesia unless there is some contraindication.

View full abstract

One hundred and severity seven cases of the cesarean section were undertaken during the last 5 years (1959-1963). 150 cases of them were operated under the spinal anesthesia.
An influence both upon the mother and new born infants was studied in this paper.
It is most important to observe the respiratory and the circulatory effect upon the puturients in the anesthesia. Percamin with high specific gravity was injected slowly. In this procedure, the anesthetic level, variability of the blood pressure, depression of the respiratory system and the pulse rate were carefully checked during the operation. It was found the duration and effect were good without any outward effect.
It may be concluded that the spinal anesthesia is a satisfactory method for the cesarean section

View full abstract

General anesthesia was employed for 123 cesarean sections (including two twin deliveries) during a period of six years and two months from January 1958 through February 1964.
Two main anesthetic procedures were used. The first method used for 93 cesarean sections from 1958 through 1963 was as follows: the patients premedicated with oral barbiturates, intramuscularr pethidine and phenothiazine derivatives, were administered with cyclopropaneoxygen gas mixture through a mask during the early period of operations; following fetal deliveries, endotracheal tube was inserted with an aid of intravenous thiopenthal and succinyichaline, then anesthesia was maintained with nitrous oxide-oxygen gas mixture. The second method employedd for 30 sections from 1963, was consisted of: (1) premeditation with 0.5mg. of atropine sulfate; (2) intubation following i. v. thiopenthal (a sleep dose) and succinylcholine (40∼80mg.); (3) maintainance of anesthesia with nitrous oxide-oxygen gas mixture (if fetal distress presents, only pure oxygen was administered until ligation of the umbilical cord); and (4) additional i. v. thiopenthal and succinylcholine following neonatal deliveriesa No maternal deaths were associated with these procedures. Maternal blood pressure could be maintained relatively high during these procedures, especially in the second method.
Eight perinatal deaths (3.3%), including 3 intrauterine deaths prior to the operations, were observed in 95 babies delivered with the first method of anesthesia, while only one postnatal death (3.3%)was seen among 30 neonates with the second method. None of these deaths were primarily attributed to the anesthetic procedures. Asphyxia or retardation in the initial respiration was observed in 18 (18.9%) of the first group and in 6 (20.0%)of the second group. In 10 cases of the second group, fetal EKG were recorded through the abdominal leads, and found to demonstrate no remarkable changes during these anesthetic procedures.

View full abstract

From September, 1961 through August, 1963, there were 2, 846 deliveries at the Nagoya National Hospital, of which 35 or 1.3 per cent were done by cesarean section. Indication:
The number of each condition was as follows: placenta previa 11, cervical dystocia 8, uterine inertia 6, breech presentation 6, elderly primigravida 4, cephalo pelvic disproportion 4. uterine myoma 4, premature separation of the placenta 3, cervical cancer 1 and uterine rupture 1.
Although uterine inertia, cervical dystocia, breech presentation and elderly primigravida are, certainly unfavorable conditions for vaginal delivery, we did not take them as an immediate indication for cesarean section, unless one of these conditions was present in association with other complications. incidence of ruptured membrane:
The number of patients who had ruptured membrane for varying length, of time prior to cesarean section were 10, i. e., 29 per cent, which was relatively high, because of late decision of indication by the above stated principle. Type of operation:
During the period of this study, 28 of the operations were done using the low cervical technique. Of the rest of cases, 5 supravaginal hysterectomies. one hysterectomy. and one panhysterectomy were performed. Classical cesarean section was not done. Type of anesthsia:
In 18 cases, endotracheal anesthesia was done using either nitrous oxide, ether or cyclopropane with S. C. C. and D. T. C.. Low spinal anesthesia was used in 14 cases. Local anesthesia in combination with intravenous anesthesia was used in 3 cases. There were no deaths ascribable to anesthesia nor were there any sequelae of cinsequence following anesthesia. Complication:
No significant postoperative complications were observed except far one wound infection of the abdominal wall.
There was no maternal death, Three stillbirths occurred in patients operated for abrutio placentae.
Three neonatal deaths occurred in babies delivered in placenta previa, and prematurity was considered to be the cause of deat

View full abstract

A case of thecoma arisen from the left ovary was recently observed in a 31-years-old single female, in whom ovarial tumor was suspected before surgery.
A manifest left ovarial tumor was found with 1, 500cc, of serous fluid on laparotomy.The tumor was removed but the supravaginal amputation of the uterus was not performed, The tumor was solid with yellow colour in section. Microscopic findings revealed a dense band of bread or spindle shaped cells with intracellular and extracellular fatty deposit, corresponding with theca cell tumor.

View full abstract

The present case was that of 47 years old female complaining of genital bleeding. On examination a pigeon egg sized tumor was noted in the vaginal wall inferior to the external urethral orifice obliterating vaginal ostium. Surgically removed specimen, measuring 3X3X2.5 cm in diameter, was elastic and well encapsulated. Microscopical sections showed irregularly arranged fibrous fasciculi with occasional aggregates of cluster of the epithelial cells composed of concentric structure or vacuolated round cells. Histological findings are highly similar as that of possible mixed tumor of paravestibular gland origin, described by Hertig in A. F. I. P. fasciculus.

View full abstract