Numerous investigations have been done about the relationship between splenomegaly and anemia since 1892, when Banti nominated as Morbus Banti about them.
Authors have been studying in past few years about initial stadium of splenomegaly and its hematopoiesis.
Clinical observation: from the view point of medical fields, the giant splenomegaly would be produced by following causal factors, i. e, repetitive episodes of latent splenomegaly, such as iron deficiency anemia after puberty, hyperthyroidism after puberty, infectious disorders, hepatitis and circulatory disturbances, and familial affinity in some cases.
Consideration from the study of splenic venal blood: main factor of splenomegaly at initial stadium would be produced by erythrocyte arrest within spleen, that was proved by decrease of erythrocyte count in the splenic venal blood, and that spleen releases these broken down erythrocytes thereafter. On the other hand, the splenomegaly, under some abnormal condition, such as phlebotomy, infectious process, hemolytic state and blood transfusion etc., prefers to release new born erythrocyte, which shows poor fragility, much oxygen and less CO₂ content, into the splenic vein, On analysis of the blood from liver and spleen, they compensate each other upon blood sugar level and G. O. T. value on each organ's dysfunction, An administration of steroids breaks up specific function of the spleen, reduces it's size by easy passage of blood stream through spleen.
Observation through venous blood from bone marrow: splenomegaly under the several experimental condition, the spleen suppresses release of the erythrocyte from bone marrow and oxygen consumption within bone marrow. It is true at bed side experiment too, that an administration of steroids facilitates the function of bone marrow just like the splenectomy, and that hypeffunction is only produced in presence of spleen, but it's administration rather evokes hypofunction under the splenectomy, That changes of bone marrow function under the splenectomy or administration of steroids were proved by Ferrokineticus utilizing ⁵⁹Fe, i. e. plasma clearance and incooperation of erythrocyte of ⁵⁹Fe from the venous blood of bone marrow presented obvious facilitation or prolongation earlier than that of peripheral blood.

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Six cases who died after head injuries were subjected in this study.
Gastro-intestinal bleeding and erosion were observed at postmortem examinations.
Hypophysis-adrenogenic factor (humoral factor) with neurogenic factor (mainly through vagal nerve) would be caused of these complications,

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Cerebral angiography is the most valuable diagnostic method for intracranial hematomas (epidural, subdural and intracerebral hematomas), cerebral angiospasm and elevated intracranial pressure, etc.
Here, we would like to demonstrate several interesting cases.
1. acute, chronic, epidural and subdural hematomas.
The differences in angiographic figure of each cases are demonstrated. Acute epidural hematoma and chronic subdural hematoma show the same angiographic findings.
2. bilateral intracranial hamatomas.
Three cases are demonstrated, The shift rate of anterior cerebral artery to hematoma's width (per cent shift of anterior cerebral artery) indicates the presence of unilateral or bilateral hematoma.
When anterior cerebral artery does not fill well, per cent shift of internal cerebral vein also indicates the presence of unilateral or bilateral hematomas.
3. traumatic obstruction of internal carotid artery.
On case is demonstrated. This occurs often by neck trauma and bleeding into the wall of artery may lead to carotid embolism and obstruction.
4. traumatic carotid-cavernous fistula.
One case is demonstrated. The etiology of this lesion is traumatic in 75% and spontaneous in 25%. Aneurysm, the rest of embrional primitive trigeminal artery or basal fracture are considered to de the cause of rupture of artery and arterio-venous communication. When this occurs, arterial blood flows into cavernous sinus and ophthalmic vein, facial vein and internal jugular vein, so that these become enlarged and pulsate, thus symptom of pulsating exophthalmos ensues

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One of the important problems to obtain standard technique for the thyroid scintigram was drawing of the actual figure of human thyroid gland by means of scintiscanning.
For this purpose, some experiments were carried out using model phantoms of various shaped ¹³¹I sources which resemble human thyroid gland in different size and form.
Consequently, a convenient method was deviced.
In this method, the width of energy-band of used radioiodine was corrected according to different ¹³¹I thyroid uptake rate.
A table was made from the relation of energy-band to uptake rate.
The scintigram obtained by application of this table could be more distinctly demonstrated as well as the actual figure of the material, which was confirmed by the phantom experiments and also with the patients.
This table and some scintigrams were demonstrated.

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Among the cases of thyroid gland disease at our hospital during past 3 years, pretreated cases were 176 cases (34.3%), in which 143 cases (58.5%) were treated with antithyroid agents.
In the cases of hyperthyroidism, ca 70 per cent were treated with antithyroid agents, because of which enlargement or hypofunction of thyroid were frequently observed, In these cases the original thyroid function are hard to be detectable and lead to difficulty of treatment. Therefore treatment by antithyroid agents should be used in caution on selected cases only.
About 50 per cent of the patients of simple goiter and chronic thyroiditis were also had been treated with antithyroid agents, which caused enlargement of thyroid gland and may lead to develop cancer in future. Thus treatment by the antithyroid agents is no value. 3 cases of simple goiter were surgically treated but desiccated thyroid hab to be given, so that the surgical treatment of simple goiter seems to have little value.

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During 2 years and 10 months from Jan., 1962 to Oct., 1964, 146 patients of thyroid diseases were surgically treated in Tochigi National Hospital. They were consisted of 24 cases of hyperthyroidism, 7 cases of chronic thyroiditis, 85 cases of thyroid adenoma and 30 cases of thyroid carcinoma.
Hyperthyroidism; Operated cases were 14% of total hyperthyroidism, 44 patients were controlled by radioactive iodine therapy, and the rest of 98 cases were controlled and improved by medication only. The choice surgical treatment depends chiefly on the age of patient and toxicity of hyperthyroidism. Bilateral subtotal thyroidectomy was carried out on relatively younger patients and moderately advanced cases after improvement of signs and symptoms. The use of Lugol solution, methylthiourail, and, in some cases, steroid hormones, was the routine preparatory measure for surgery. As the aim of amount of surgical invasion, the rest dose after removal of thyroid gland was about the size of a little finger on each side. The results of operations were satisfactory, no case of hypothy roidism or recurrence of hyperthyroidism developed. Complications were not uncommon, there were 2 cases of hoarceness involved by recurrence nerve injury, a case of transient tetany caused by parathyroid gland injury, and death after dyspnea involved by para tracheal heamorrhage.
Chronic thyroiditis; In general, chronic thyroiditis itself is not indication for surgery, but to differenciate thyroid carcinoma, or to determine the diagnosis, partial resection of thyroid gland is carried out sometimes. And, in some cases which has been controlled by thyroxine, patients complain of dyspnea or an oppresive sensation on anterior neck lesion resulting from sclerosing struma. Resection of isthmus of thyroid gland is helpful to these patients. Out of 7 operative cases, 6 were Hashimoto's strumas and a case of Riedel's struma.
Thyroid Adenoma and Carcinoma; Cases of nodular goiter (benign adenoma) were 85 and those of thyroid carcinoma were 30. The pathological classification of the former is shown in table 1 and the latter in table 2.
It is so difficult to diagnose thyroid carcinoma that all nodular goiters have been resected and pathologically examined. The malignancy ratio of nodular goiters was 26%. To differenciate clinically thyroid carcinoma from thyroid adenoma, we have tried from several points of view; (1) how long the patient has suffered from struma, (2) whether the struma has enlarged rapidly or not, (3) multiple or not (4) size of nodule (5) presence of hoarceness and dysphagia (6) B. M. R. (7) E. S. R, (8) the localization of the struma in thyroid scintigram (9) presence of calcification on x-ray film of the neck, (10) Consistency of nodule.
As the result, (1)-(7) have no remarkable difference but (8)-(10) have some contributions to diagnosis. The localisation of tumor illustrated by scintigram scanning was often found in the upper or lower pole of thyroid gland in carcinoma, while adenomas chiefly occupy the middle of either lobe. The frequency of calcification was more often found in carcinoma than in adenoma. By palpation, consistency of thyroid carcinoma was rather hard. In the majority of cases, the tumor was fixed to surrounding tissues and could not be moved easily.
According to these clinical diagnostic points, the correct diagnosis of papillary adenocarcinoma was 72% and that of follicular type was 57%. All patients of thyroid carcinoma treated with radical neck dissection are alive and the recurrence of carcinoma has not be found.

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We often encounter the cases in which ¹³¹I uptake and B. M. R. show the contradictory results, i. e.: ¹³¹I uptake rate is high, while B. M. R. gives low rate, or the former is lower, while the latter gives high rate, so that we are not able to decide whether there is hyperthyroidism or not, In these cases we have applicated the Triosorb test in order to diagnose the thyroid function accurately.
Analizing the results in these cases statistically, we have found that the Triosorb test rate has significant correlation with B. M. R., while the former has shown no significant correlation with ¹³¹I uptake rate. Therefore it is considerd that the Triosorb test is not only a substitute for ¹³¹I uptake test, but a specific test.

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An attempt had been made on the status of the psychoneurotic patients who visited the out-patient clinic of the Konodai National Hospital during the year of 1963.
The following results were obtained:
1) The 25-29 years old of the both sexes were found more frequently than those in other age groups. Female patients in climacteric period, however, were noticed having the second peak in the frequency of those, but that was not observed among the male.
2) Among the patients who indicated the above were reported to the clinic by somatic complaints more psychological symptoms. Therefore, the most of cases were seen by the non-psychiatric physician prior to their visit.
3) Reexamination upon the psychotherapy for the neurotics were needed.
4) The parallel use of the pharmacotherapy and the psychotherapy were noticeably effective for increasing frequency of their visits.
5) There were several types in frequency of hospital visit among the patients.
These types showed some important correlation with the patients' readjustment after their discharge.
6) The hospitalization itself has given a good influence in many ways on their condition even after discharge.

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This report was attempted to examine the clinical state and treatment of the neurotics who visited the Dept, of Neuropsychiatry, Sendai National Hospital from 1961 through 1963.
The results were as follows;
The percentage of neurosis among the all kinds of mental disorders treated here was ca, 30% of total outpatients and ca. 20% of inpatients. Two peaks appeared in patient's age distribution, that is twenties and thirties of their age. A half of all the patients came to our clinic from Sendai City and its suburbs, and 70-80% of the patients came to the clinic directly by themselves, but the others by introduction through another hospital or the other department of our hospital.
Duration of the disorder before the consultation was less than a year in many cases, and most of the patients have been treated already by another physician before the consultation was made.
The complaints of the patients were of much various kinds, including anxiety, irritability, depressive feeling, insomnia, headache and palpitation.
Most of the patients were classified into psychoneurosis, so-called nervousness, hypochondria and anxiety neurosis.
The chemotherapy, such as meprobamate and chlordiazepoxide, was applied in most of the patients and chiorpromazine, other phenothiazine derivaets and antidepressants were also used frequently, The shock therapies, mostly electroconvulsive therapy in about 50% of the inpatients and insulin subshock therapy only in a few cases have been used and it has proved helpful in many instances.
In was regretfully that direct psychotherapy has scarecely applied except a few cases.
It was observed that 20-25% of the outpatient improved, but 35-45% showed unknown outcome. On the other hand, most of the inpatient showed good prognosis, that is, complete recovery 22.5-39.1%, marked improvement 20.0-25.8%, improvement 21.8-50.0%, unimproved 2.5-4.3% and unknown outcome 2.5-4.3%. The duration of treatment was average six months.
232 cases who visited our clinic in 1961 were examined to know their present states by sending a letter of inouiry, (number of answer was 97, rats of answer 48.7%). At present time, the states of complete recovery and marked improvement have been maintained in 78 cases, and they have thought that it might be resulted from the change of thinking attitude besides medical treatments.

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