This is a report on the therapeutic experience with 12 cases treated for ulcerative colitis in the Chiba National Hospital during the period of past 10 years.
This series consisted of 7 males and 5 females, and their age distribution varied from 21 to 58 years. Among them, 5 were treated conservatively and the remainder surgically.
The conservative group showed mere up-and-down in symptome, except for one case who responded to Chymoral.
The administration of steroides brought certain improvement postoperatively, but resulted in the recurrence or the leakage from anastomosis in some of them, therefore, this therapy was not applied to the last 5 cases.
There was one death in the operated group.
All the other, however, have rehavilitated to the social or house works postoperatively during the observation periods varying from 2 to 5 years. Of the 4 cases subjected to partial colectomy, one was cured, but the remainder required total colectomy eventually for recurrence. One case treated with permanent ileostomy and total colectomy showed satisfactory results.
The permanent ileostomy does not hinder their social rehabilitation. Therefore, those subjected to conservative therapy ineffectively should be treated with permanent ileostomy and total colectomy in an early stage of this diseas.

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1) Five cases of ulcerative colitis was treated surgically during from 1958 through 1965.
Four cases were atrophic colitis type and another was pseudopolyposis type. Three cases were treated with right hemicolectomy, one case had sigmoid-rectal amputation and another one received ileotransversostomy.
2) Two cases with right hemicolectomy and one case with sigmoid-rectal amputation were cured, but the another one developed anemia, and one case with ileotransversostomy died by diffuse peritonitis following perforated ulcer.
3) W e discussed indication for surgical treatment of ulcerative colitis and its methods from the above experience.

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The author found 88 cases with duodenal diverticulum among 2000 cases who received upper G. I, series This indicated that the incidence of duodenal diverticulum was 4.4% in our series. Analysis of the cases revealed that incidence in the cases below the age of fifty years was lower than the above, but 6.7% in the sixth decade, 13.6% in seventh decade and 21.4% in the eighth decade, showing sharp increase of incidence in higher age group. A prone position film with high voltage technique at the end of G. I, series may played the most important role in higher incidence of duodenal diverticulum in our series comparing with most of the other reports in our country.

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The total amputation of the rectum has been performed by Miler's abdo minoperineal method, and a artificial anus set up at the left iliacal part.
His method has broad indication on the radicality of the cancer.
But the artificial anus on the abdominal wall in usual life has a lot of disadvantages, that are a great inferior complex, non-control of evacuation, uncomfortableness, bad odor, uncosmeticity and unhygiene, etc.
Thus we discussed our technical method of the amputation of the rectum preserving sphincter muscle. Our method has undergone a few improvement on the Babcock-Bacon's method.
We considered problems of the radicality, the necrosis of the isolated colon, the quick healing of the anal wound for the filling of the sigma and the anal function after operation.

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We have reviewed 42 cases of massive upper gastrointestinal bleeding who were admitted to the Sendai National Hospital during the last six years (from 1960 to 1965)
The following results were obtained.
1) Although all patient were in shock at the time of admission because of melena or hematemesis, 23 cases of them relived of shock by the conservative treatment such as blood transfusion, hemostatic agents, and then performed surgical therapy after roentogenologic examination. Thirteen cases who had not relieved of shock were subjected to emergency operation and other 5 cases died because of severity and persistence of the bleeding before operation.
2) The cause of bleeding in 36 cases were sought by operation or autopsy. It was the result that 21 cases were due to gastric ulcer, 4 due to hemorrhagic gastritis, 4 due to duodenal ulcer, 3 due to steroid ulcer of the stomach (autopsy), 2 due to gastric cancer, one due to ulcer of gall bladder and one cases was unknown.
3) Surgical treatment was carried out in 33 cases, and 28 cases of them were relieved and 5 cases died by postoperative cardio-respiratory complication. Conservative treatment was carried out in 9 cases, and 3 cases of them were relieved and 5 cases died.
4) It is important to get satisfactory results in the treatment of massive upper gastrointestinal bleeding that the position and the degree of bleeding should be diagnosed accurately, quickly, and then proper surgical therapy should be carried out in proper time.

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During the past ten years from 1955 to 1964, a total of 1, 209 patients with upper gastrointestinal diseases were hospitalized and treated surgically in the Kyoto National Hospital. Seventy-two cases of them had fresh major hemorrhages within one week before admission. Surgical and histological findings revealed that the hemorrhages were due to stomach ulcers, duodenal ulcers, chronic gastritis and stomach cancers in forty-nine, five, six and twelve cases respectively. As to incidences of cases with the major hemorrhages in the various disease groups, these were 11.9 per cent in stomach ulcer, 5.6 per cent in duodenal ulcer, 5.6 per cent in chronic gastritis and 2.1 per cent in stomach cancer. The hemorrhages were consisted hematemesis in fifty cases and melena in twenty-two cases. And thirty-six, twenty-four and twelve patients had one, two and over three episodes of the hemorrhages respectively.
The author usually treated these patients, firstly, with blood transfusion of sufficient amount for a certain period between seven and ten days. Gastrectomy was then performed after improvement of anemia, over four millions in red cell counts and 11.6g/dl in hemoglobin, had been confirmed. Ten cases, however, were necessiated for emergency operations during the period of the preoperative treatment, because of major hemorrhages, even though the improvement had not yet been obtained. Three out of ten cases died within one week after the emergency operations. This mortality rate was very high when considered the fact that only one case died postoperatively in a group that had received the preliminary treatment sufficiently as mentioned above.
Mucosal findings of resected stomach of benign cases were classified into four groups. The first was gastritis type, showing innumerable hemorrhagic flecks widely on mucosal surface. The second was ulcer type with injured vessels exposed in bottom of the ulcer. The third was ulcer type with diffuse suggillation in the surrounding area. And, the fourth was mixed type with the first and third ones. Of all the benign cases, six cases (11.1%) were fallen in the first group, thirteen (24.0%) in the second, thirty-one (57.5%) in the third and four (7.4%) in the fourth. Eleven cases of the second group had repeated hemorrhagic episodes during the period of the preoperative treatment and eight cases of them were indicated for emergency operations. Accordingly, it is of clinical importance to estab fish a definite diagnosis as to whether or not patients under the preoperative treatment are fallen in this group.

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For the detection of gastric cancer in its early cancer, X-ray examination and gastro scope with gastrocamera and cytological diagnosis of gastric cancer was routinely underway at this hospital.
The hospital records of 32 with early cancer of the stomach admitted to the hospital from 1951 through 1965 were reviewed. The malignant changes were still early stage; one half of the lesion was still confined to the mucosa, and the others confined to the submucosa.
Symptomatology was usually characterized epigastric pain. In the 32 cases reported herein, the average age of the patients was 59.2 years, men of the 32 patients were 22 and 10 female.
We have operative early cancer of the stomach of 32 cases; 4 cases have grew np from polyp, 7 cases from ulcer and 27 cases from gastritis and others.
In the histlogical classification, Adenocarcinoma were registered 93.7% and Carcinoma solidum 6.2%.
On the relationship between the invasion grade into gastric wall and lymphatic spread, the lymphnodes metastatic rate was lower in those invasion limited to the mucosa than in those invasion reached to the submucosa, namely those rates were registered 0% on the mucosa and 31.2% on the submucosa.

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Previous reports have been made on early diagnosis of cancer by using paperchromatographic procedure for the urine of patients. The method is as follows: 24 hours urine of patients was collected and hydrochloric acid was added. An aliquot of the sample was extracted with ether, and the extract was evaporated to dryness. A small amount of acetone was added to the dryed sample to dissolve, and the solution was applied on one dimensional paper chromatographic paper. The development of chromatogram was carried out by using 1.5%. acetic acid as a solvent. The developed chromatogram was heated at 146°C after spraying Ehrlich's reagent to develop color. Results were judged as follws Blue spot on Rf 0.56 was negative, slight yellow was doubtedly and yellow to deep yellow was positive.
When the results were positive, the patients were examined carefully. In the cases of 250 patients with or without cancer, 91 cases were gastric cancer. Of the 91 patients with gastric cancer, 79 were positive, 11 were doubtedly and 1 was negative. Two cases of early stage of gastric cancer in the 91 were clearly positive.
The present procedure for the diagnosis of cancer showed negative in later stage of cancer, and showed positive occasionally in the liver damage. As shown in the data, the method can be used for the early diagnosis of gastric cancer.

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In order to improve the survival rate from the stomach cancer, it is greatly important to detect the gastric cancer in its early stage.
For the purpose of the roentgen examination of stomach diseases, we have used three kinds of techniques, that is mucosal relief roentgenography, ordinary filling methods and double contrast studies.
And, as to the positions of the patient examined, the prone and supine positions and erect positions are taken, in the latter of which frontal and oblique projections are applied.
As the result of the variable, three-dimensionally complicated shape and farm of the stomach, we must not be satisfied to use only one kind of X-ray technique, but apply several kinds of techniques which will compensate their disadvantages each other, when combined.

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The cases of carcinomatous degeneration from benign gastric ulcer have been frequently observed.
Concerning the determination of existence of carcinomatous degeneration, there are following four important viewpoints.
I) As the macroscopic features of ulcerocancer, following eight remarkable characteristics have been reported by MURAKAMI et al. Namely;
1. The prominence of surrounding wall of ulcer.
2. The undermining of surrounding wall of ulcer.
3. The double contour.
4. The irregularity of the contour.
5. The giant ulcer.
6. The plicae sclerosing.
7. The erosion of distant portion.
8. The granular flare of surrounding mucous membrane of ulcer.
II) Among the flat ulcer, the carcinomatous degeneration cases have been frequently found.
III) Under the observation of course, either prolongation of cure or conversely magnification of ulcer which can be considered as the sign of cacinopnatou degeneration.
IV) It is not rare that gastric cancer arise from a scar of ulcer. Therefore, it is necessary to observe the post cure course.
For the qualitative diagnosis of gastric ulcer by X-ray examination, above mentioned four viewpoints must be kept always in mind.
Therefore, it is necessary to find the minute changes of ulcer and its surrounding mucous membrane by a very accurate X-ray examination technique. For this procedure, the most successful photographs have been made with the application of the compression method and the double contrast method, devised by SHIRAKABE et al.

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1) During the past 8 years from 1957 up to date, 431 patients with carcinoma of the stomach received gastrectomy in our hospital.
At the time of operation, 16 cases were at the so-called early stage of the carcinoma. Histological diagnosis of the superficial carcinoma were 16 cases.
2) It is concluded that gastrocamera and fiberscope examinations are very usefull in diagnosis of carcinoma of the stomach at the early stage.

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Esophageal bleeding is apparenly one of the most serious complication of portal hypertension, It may be prevented surgically, but indication of operation must be carefully evaluated. This is especially true in a case of cirrhosis of liver, in whom indication should be determined on the basis of histological pattern of the liver, degree of portal hypertension and splenoportographic finding.
In this clinic, for preoperative evaluation of cirrhotic patients with esophageal varices, under a small, left subcostal incision of abdominal wall biopsy of the liver, splenoportography and measurement of portal venous pressure are made. The findings of these together with the results of liver function tests and general condition, provide of basis for determining indication and type of surgery.
In this report, a case, 54 years of age, having portal cirrhosis of liver histologically with esophageal varices, in whom the varices were successfully not evidenced after the splenorenal-shunt (Inokuchi), is described.
In this procedure an autogenous vein graft taken from the right iliac vein is interpolated between the splenic and renal vein, The features of splenorenal-shunt (Inokuchi) are that the anastomotic stoma is large and the anastomotic juncture angle is made acute by utilizing the physiologic juncture angle of bifurcating veins.
Portal venous pressure of the patient was decreased from 470mm H₂O to 230mm H₂O after the shunting, and that was controlled to 300mm H₂O under partial tucking of splenic vein.
In the patient presented blood ammoniac levels rose to 0.4mg % and total serum protein content fell also to 5.5g. % postoperatively, but was returned to normal levels afterwards, and then no hepatic coma was resulted.
Liver function tests were not deteriorated, but preferably B S P retention, C C F test and serum albumine levels got better postoperatively, 40 days after the splenorenal-shunt (Inokuchi), esophageal varices of the patient could not be evidenced by fluoloscopy.

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A 20 year old woman was admitted to the Kyoto National Hospital with a chief complaint of anemia. She had had a long-standing history of preprandial pain in the upper abdominal region and had experienced black tarry stool shortly before the admission.
Upon admission, the blood pressure was 108 systolic, 60 diastolic. The blood studies showed red blood cells 1.21 million, hemoglobin 25%, hematocrit 16% and white blood cells 13, 800 with 70% neutrophils. Examination of the gastro-intestinal tract revealed a circumscribed globular filling defect at the lesser curvature side of the stomach.
Total gastrectomy with end to side esophago-jejunostomy was performed. The intragastric tumor measured approximately 7 by 7cm, and the histological picture was that of leiomyosarcoma.
She is now living and well two years following the operation with no evidence of recurrent disease.

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