In 1964, of 1050 children with tuberculosis admitted to National Sanatoriums, 38 cases (3.6%) were so-called not easy curable tuberculosis. All of them were classified as “far advanced” by chest x-ray findings.
The tubercle bacilli from them showed resistances against one of SM, PAS and INH, or more.
In this country, there are 86, 000 tuberculous patients of children who are considered to need immediate treatment, therefore 3, 000 cases of them will be in this rate (3.6%) not easy curable tuberculosis.

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The Pulmonary function in children is different from adults, This is very distinctive in every age, so we cannot find reliable standard vital capacity in children.
As a first step for study on the pulmonary function test in children, we examined the vital capacity% of pulmonary resection cases, the healthy children, the cases of minimal and moderately advanced pulmonary tuberculosis by KYS-spirometer.
The result is as follows:
1) We examined the vital capacity of 440 healthy children from 5 to 17 years of age, and calculated the vital capacity by the formula of Baldwin, Funatsu and Ebina, The contribution of Baldwin and Funatsu was nearly the same, showing a decrease in the lower age bracket. The vital capacity of Baldwin was over 80% for boys over 14 years of age and for girls over 12 years of age. But the value of Ebina's study was found in the normal limit from 6 to 17 years of age.
2) In 28 cases of boys and girls, the pulmonary resection from 9 to 18 years of age, the vital capacity% of Baldwin and Funatsu decreased in the lower age bracket. But the value of Ebina was found in the normal limit in all cases. The prognosis after operation was very good in all cases.
3) In the cases of minimal and moderately advanced pulmonary tuberculosis, the vital capacity% of Baldwin, Funatsu and Ebina decreased according to the extent of lesion.

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We examined the vital capacity and Tiffeneau's test in 357 healthy children from 6 to 14 years of age for boys and girls by 9 litres Benedict-Ruth respirometer.
The result is as follows:
1) The inspiratory vital capacity (2 stage vital capacity) increased in the higher age bracket, The value of Baldwin was over 80% for boys over 14 years of age and for girls over 12 years of age.
2) The vital capacity showed an acute increase for boys and girls 12 years old and again a marked increase was noticeable for boys and girls in the 14 year age bracket.
3) One second vital capacity showed the same increase as the vital capacity, One second vital capacity/forced expiratory vital capacity was nearly the same in all ages regardless of age, sex and body height, showing no definite tendency.
4) The index for predicted vital capacity increased according to age and showed a marked increase in the 12 and 14 year age bracket for boys and girls.

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At Banzai National Sanatorium, we have operated on thirteen children in past decade and examined the results, which are as follows:
1) The patients were 8 boys and 5 girls aged between 12 and 15.
2) Lobectomies were performed in 3 cases and segmental resections in 10 cases.
3) The operative techniques were much the same as the those applied to the adult cases. Generally speaking, the children showed fewer adhesions in the pleural cavity and less bleeding (cc/kg) during and after the operations than the adults.
4) The post-operative reexpansion of the lung was satisfactory and we found very little decrease in the capacity of the lung, and the body weights increased favorably.
5) We met no complication in all thirteen cases, They are now all healthy and doing well as members of society or school children.

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During the last two years, ten cases of acute Leukemia in children were observed in the National Cancer Center Hospital. The age distribution was ranged from two years to 14 years old. The number of male was eight among the total number of ten. The initial symptoms of these cases were such as generalized malaise, pallor, fever and joint pain. Exophthalmos was observed in one case. Mediastinal mass was found in another case.
Nine cases of the total ten cases were treated in this hospital chiefly by steroids and 6-MP. Methotrexate, cyclophosphamide and mitomycine C were also used in some cases. Eight complete remissions and two incomplete remissions were obtained among 27 courses of the therapy. The average survival period of the total cases was nine months. In one case two complete and one incomplete remissions were obtained. And this case lived a year and eight months since the initiation of acute leukemia.

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The experience with cardiac surgery in the National Chiba Hospital is reported. A total number of out-patients in the Heart Disease Consultation Center accounts for 908, during the period from its inauguration, i. e. January 1962, to August 1964. This includes 131 cases of congenital heart disease and 490 cases of acquired, Of the 17 cases operated for heart disease up to September 1964, 8 were operated by closed technique and 9 operated in direct vision upon heart-lung machine. The former consisted of 4 cases with P.D.A. and 4 cases with mitral stenosis. All but one dying of ruptured aneurysm in the followup period were cured or improved. The latter consisted of 6 cases with V. S. D., 1 case with A.S.D., 1 case with V.S.D.+A.S.D., and 1 case with anomalous growth of trabecular muscles in the right ventricle. All of them were cured completely. Our heart-lung machine is roller-pumps and rotating-disc-oxygenator, and was made in Japan, This apparatus was particularly designed to secure its safty operation by a minimal number of people. Rheomacrodex, 3% CO₂, Mannitol and Tris buffer have been employed in our extracorpo real circulation to improve the circulatory physiology, The results thus far obtained were excellent. Our pre- and post-operative care are described, A case is also presented herein for each of P.D.A., mitral stenosis, V.S.D., V.S.D.+A.S.D., and anomalous growth of trabecular muscles in the right ventricle. Our experience is yet very small, however, it would be of significance for spread of cardiac surgery that our experience supports the feasibility of this subject in usual hospitals with numerous restrictions too, besides the university hospitals which have been generally believed as the only place for this kind of surgery in Japan.

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Since October 1960, we have operated upon 22 patients for heart diseases. Closed cardiac technique was used on 18 and open technique on 4. The purpose of this paper is to report our operative experience, postoperative management and the results of these 22 cases.
I. Mitral valvular disease
A total of 14 patients with mitral valvular disease underwent closed repair. Nine of these patients had pure mitral stenosis, 4 had a slight degree of regurgitation and the remainder had marked regurgitation combined with the stenosis.
Better results were obtained by using cardiovalvulotome rather than by splitting with finger alone, Mitral commissurotomy has been successful in the patients with combined stenosis and slight degree of insufficiency, But in patients with marked insufficiency or with massive clotted blood in the left atrium, open mitral valvuloplasty is indicated.
II. Three patients with patent ductus arteriosus and one with tetralogy of Fallot were operated.
Surgery was successful in the three cases of patent ductus arteriosus. Blalock's operation was performed on the patient with tetralogy of Fallot, who had extreme cyanosis and malformation of the right upper limb, and died 12 days after surgery.
III. One patient with tetralogy of Fallot, one with pulmonary stenosis and two with ventricular septal defect underwent open repair using extra corporeal circulation.
The patient with tetralogy of Fallot died of postoperative bleeding. When breeding is massive or persistent, thoracotomy should be performed without delay.
In the two patients with ventrrcular septal defect, one showed good results, but the other one with patent ductus arteriosus died after administration of protamine sulfate. It is believed that her death was due to the side effects of protamine sulfate.
For the patient with pulmonary stenosis, adequate outflow tract of right ventricle was made with a view to prevent secondary infundibular stenosis after pulmonary valvulotomy. Namely, 8cm longitudinal incision was made at the origin of the pulmonary artery, and extending across the pulmonary orifice to the right ventricle. The pulmonary valve was exposed and the pulmonary orifice was enlarged under direct vision, The patient was discharged and has been doing well.

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Open heart surgery under direct vision was performed on 37 cases in our institution during the period from Sept. 1960 to Jan, 1965.
Hypothermia by surface cooling was employed in the 22 cases operated on prior to March, 1964, and extracorporeal circulation using the Davila-Pemco heart-lung unit was applied in the 15 cases operated on since April, 1964.
This heart-lung unit consists of two separated units, that is, the pump unit and the remote console. All necessary switches and meters are neatly arranged on the control panell of the latter. This feature greatly simplifies the control of multiple factors involved in this procedure.
The Gebauer's heat exchanger built in within the confines of the Kay-Cross rotating disc oxygenator affords reduction of priming volume as well as adequate exchange of heat.
The experimental and clinical data on the mechanism and performance of this unit as well as the operative results were presented.
We consider that the adequate flow rate in extracorporeal circulation under normothermia is 60% of the preoperative output. When combined with hypothermia, the flow rate can be further reduced. A flow rate between 1.3 and 2.0 L/M/min. was used.
Details of the cases are as listed; numbers in parenthesis indicate operative deaths.
In simple anomalies such as ASD and VSD, the duration of total by-pass or circulatory blockage under hypothermia was around 20 minutes on an average.
In both groups the results are considered nearly satisfactory on the whole.
There were 6 cases in which extracorporeal circulation was lasted over one hour. These are 2 cases of tetralogy of Fallot, 2 cases of trilogy of Fallot, and 2 cases of mitral insufficiency. In one of mitral insufficiency, constriction of the annulus fibrosis by suturing was accomplished, and in another, a Starr-Fdwards caged ball valve was installed.
Although extracorporeal circulation was smoothly carried out over one hour in all of the 6 cases, there were 4 operative deaths. The cause of death in 2 cases of T/F was postoperative failure of the right ventricle, In one case of trilogy of Fallot, death was due to a postoperative hemorrhage, In a case of artificial valve installment for mitral insufficiency, the heart failed to start forceful contrctions when the by-pass was to bestopped.

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A case of primary pulmonary hypertension with the aneurysm of pulmonary trunk was reported. The patient is 38 years old house wife with chief complaints of hemoptysiss and exertional dyspnea for 9 years duration. The findings of chest X-ray, EKG and physical examination were compatible with the primary pulmonary hypertension. Graham Steel diastolic murmur was heard at the left sternal border in 3rd, intercostal space. Cardiac catheterization on admission in Feb., 1963 revealed marked . high pulmonary arterial pressure with normal left atrial pressure and no evidence of intracardiac shunt, Angiocardiography confirmed the diagnosis of the aneurysm of pulmonary trunk. Following the administration of Nialamide (Monoamine Oxidase Inhibitor) 75mg in doses for 2 months, patient was recatheterized, and this test revealed moderate decrease of pulmonary arterial pressure with some improvement of subjective symptoms. Since then the patient has been placed on Nialamide and Persantin, At present she is still alive but her condition became worse with signs of right ventricular failure.
In discussion, review of the literatures concerning the primary pulmonary hypertension and the aneurysm of pulmonary trunk was made particularly in reference to their etiologic factors, differential diagnosis and treatment. The importance of differential diagnosis was stressed, since the exploratory cardiotomy for this condition usually terminate the disastrousresult, Two our own cases were presented with the signs and symptoms simulating this present case, However, angiocardiography revealed the presence of ventricular septal defect in one case, and the catheter was inserted in _the left atrium through the atrial septal defect in the other case.

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