During the past 3 years, females with advanced breast cancer were submitted to endocrine treatment in our hospital, including adrenalectomy, oophorectomy, and administration of androgens, estrogens or diosphenolsteroids (2, 17 β-dihydroxy-4, 4'-dimethyl androst-1, 5-diene-3-one). The rate of objective responsiveness to the treatment were 52.5% among the 61 adrenalectomized, 20% among the 10 oophoretomized, 25% among 8 cases given androgens, 29.4% among 17 cases given estrogens and 18.2% among 22 cases given diosphenolsteroids respectively. In adrenalectomized patients, among various determinations of preoperative adrenal steroids, only urinary 17-ketosteroids value showed a statistically significant difference between the responsive and unresponsive cases, the levels of which were 4.0-8.0 (mean 6.24) mg/day and 1.1-4.2 (mean 2.98) mg/day respectively. The responsive cases with osseous metastases showed transient rises “flare” of alkaline phosphatase after treatment, indicating increase of regenerative activity of bone, while the unresponsive cases did not. These two results is considered to be of value in deciding indication and prognosis of surgical ablative therapy in advanced breast cancer.

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From May 1962 to December 1964, 576 cases of breast tumores were treated in the National Cancer Center Hospital. Those of 66.1 percent were primary case and 33.9 percent were secondary case. Breast cancer was classified by TNM classification, and lymphnodes in these cases were examined histopathologically. Those of 56.5 percent of primary cases had lymphnode invasions. Post-operative irradiation were performed on 108 primary cases.
1) Number of lymphnode of dissected breast cancers were 2 to 76, average 14-20. Number of invated lymphnodes of the patients who received post-operative irradiation were as follows; negative: 2.6%, 1 to 2: 36.9%, 3 to 5:20.1%, 6 to 9:8.8%, more than 10: 31.6%.
2) The patients of outer side breast cancer and negative lymphnode invasions were not irradiated post-operatively, and there were 115 cases belonged to this group.
3) Six thousand R of post-operative irradiation was given by telecobalt unit, fixed field irradiation in the axillary and supra-, infra-clavicular regions and tangential rotation therapy in the internal mammarial region and thorax wall were applied.
4) Radiation hazard was not observed within a dose of 6000 R, except the slight degree of lung fibrosis which weighed to 12.7%, but special therapies were not required.
5) Recurrence or metastasis after irradiation were found in 20 cases of 104 postoperative cases, during the period of more than one year observation. Six cases from recurrent 20 cases were died in above mentioned period.
6) Eight cases were recurrent from the group of 137 non irradiated cases, namely 2/5 cases from 2 lymphnode invasions, 1/14 case from 1 lymphnode invasion, 5/118 cases from non lymphnods invasion. But 2 cases were received irradiation and chemotherapy, and 2 cases had been received biopsy.
7) Under the dosis of 5000 R many recurrent cases were found, and more than 6000 R some cases shows recurrent. These cases were many lymphnode invasions or questionable cases for radical operability.
It will be considered that post-operative irradiation of breast cancer with lymphnode invasions was useful but post-operative irradiation for the cases without lymphnodes invasions supposed to be undesirable because of the lower rate of recurrence.

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We discovered carcinoma in situ of 31 cases (0.44%) out of 7.608 cases of the precise examination in our hospital.
30-44 years old patients have took 65.5 % of the whole patients of carcinoma in situ.
The diagnosis of carcinoma in situ consisted with the cell diagnosis, but it did not always consist with the colposcopy diagnosis. Therefore, the diagnosis of dubious patients should be made mainly by the all diagnosis and it finally should be decided by the histologic diagnosis with conic erasion.
There is no need of total extirpation of the uterus for medical treatment of carcinoma in situ, but as a principle this should be treated by simple extirpation. As it is able to remove almost perfectly the focus of cancer even by the Sturmdorf-operation, we may perform the operation on young person, especially on nullipara.

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There is increasing recognition of the infections due to gram-negative bacilli which were antibiotic resistant. Present study revealed a annual changing pattern of sensitivities of gram-negative bacilli which were isolated from materials of clinical sources. Antibiotic sensitivities of 2885 strains (except Salmonella) gained during a period from April of 1958 to March of 1935 at the First National Hospital were investigated by the technique with disks for streptomycin, chloramphenicol, tetracycline, kanamycin, colimycin and sulfapreparation.
Results:
1) It is noted that increasing numbers of resistant strains of gram-negative bacilli during a period from 1958 to 1960 was evident, although a slight decreasing tendency was seen after 1961 as a whole. More details, however, must be necessary on the changes of sensitivity for each antibiotic.
2) On 346 strains which were sensitive to one of six tested antibiotics, 76.2% were sensitive to colimycin and 17.9% to kanamycin. On 113 strains out of these which belong to Family Enterobacteriaceae, 52.2% were sensitive to kanamycin, 42.5% to colimycin and 3.5% to streptomycin.
3) On 521 strains which were sensitive to two of six tested antibiotics, 68.7% were sensitive to kanamycin and 84.1% to colimycin. On 293 strains out of these which belong to Family Enterobacteriaceae, 93.6% were sensitive to kanamycin and 75.1% to colimycin.

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Since 1959 bacteria in urine of cystitis and pyelonephritis (acute) have been cultivated on urological division. Gram negative bacilli were found generally over 80 per cent in culture and Escherichia Coli were mostly. But in cystitis which were infected owing to leave catheter after the operations of bladder and prostate, Klebsiella, Citrobacteria, Proteus Pseudomonas and A. cloacae were found more than Escherichia Coli.
Simple cystitis and acute pyelonephritis could be treated by sulfamethizol or an antibiotics, but in cystitis due to retrograde infection mulitiple-antibiotics resistant bacilli were frequently found and only sensitive to Colimycin and Kanamycin. These tendency become remarkable year by year.
The multiple-antibiotics resistant bacilli are not only Klebsiella, Proteus, etc., but also Escherichia coli recently.
The chemotherapy for the urinary tract infections become difficult, because more multiple-antibiotics resistant bacilli have been increasing recently.

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Bacteria were isolated from the urine of patients who, had been suffering from urinary intract fections, and visited the clinic of the Urological Department of the Fukuokachuo-Byoin National Hospital from February 1963 to August 1966.
The sensitivity tests to chemotherapeutic agents were performed on those bacteria, and the results were compared with the clinical effect of chemotherapeutic agents for these patients.
1) When E. Coli was isolated from the urine, the clinical study revealed the success of chemotherapy regardless the results of the sensitivity test.
2) When Proteus vulgaris was isolated, better clinical effect was produced by agents with positive sensitivity test than those with negative sensitivity test.
3) When Pseudmonas aeruginosa was isolated, the chemotherapeutical agents failed to produce good effects, unless the urological complications were eliminated.

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In Japan, physicians have little interest in rheumatoid arthritis, so that not a few patients are being treated by acupuncture, massage or other paramedical treatment. But I believe rheumatic patients should be treated by the physicians.
In our clinic, within latest 10 years, the ages of 450 in-patients are between 18 to 45 years old, and the ratio of male and female is 1:2.3. They come from various regions of the west part of Japan and just a few come from Tokyo, too. The reason of assembling from that wide area to Beppu means not only its communicational advantage of this spa, but also there are quite a few hospital accomodate them through Japan.
I should like to advocate feeling keenly the urgent necessity of some rheumatic hospitals or wards throughout the country. First of all, however, I think the most urgent problem is the very few of the physicians who. are going to participated in the rheumatic clinic.

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Daily doses of 20mg of oxymetholone (HMD) were given orally for 18 weeks to 8 male far advanced pulmonary tuberculous patients with multiple cavities. Six mg of 17α-ethylestrenol (EHE) were given to 8 male patients daily for 18 weeks. The placebo was given to 4 male patients. Each patient was given anti-tuberculosis drugs and essential amino acids preparations.
The serum total protein concentration was decreased since 4 weeks after the start of the anabolic steroids. (Table 1, Fig. 1) It decreased much more in EHE group than in HMD group. Serum albumin was decreased, and α1- andγ-globulin were increased in both groups. (Table 2, Fig. 2) Protein-bound hexose was decreased since 8 weeks after the start of the administration, and the decrease was more marked in EHE group. (Table 3, Fig. 3) There were no remarkable changes in serum protein-bound hexosamine (Fig. 4) and seromucoid. (Fig. 5)
Two to 4mg per day of EHE were given to 9 convalescent tuberculous children for 9 weeks. The serum total protein (Table 4, Fig. 7), serum protein fractions (Table 5) and glycoproteins (Table 6) showed no significant changes, in contrast to the results of far advanced tuberculous patients.

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By the development of the clinical enzymology, the anti-inflammatory and anti-edemic actions of the enzymes have begun to arouse attention of the clinicians. Bromelain (plant protease) were administered to 33 patients, who had operations for pulmonary tuberculosis, pulmonary suppration, bronchiectasis or lung cancer, and the following results were achieved.
1) Bromelain has no influence upon bleeding time, coagulation time, serum protein, A/G, GOT and GPT. There is no hazard of administration to the patient on the pulmonary surgery.
2) In case of patients who were treated with Bromelain, the difference of the density in chest film between the operated side and the another side of lungs were very little as compared with controls. It is expected that Bromelain have good effect on the post-operative pulmonary functions.
3) The clotting of the blood or exudate in the thoracic cavity were broken down smoothly and reabsorbed rapidly by the pleura. This is of great advantage to post-operative management; i. e. the thoracentesis after the removal of the theracotomy tube is not necessary.

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The source of electric power being AC 100v, 50-60c/s, maximum output 200ws, maximum charge voltage 1300v, pulse width 10 m sec, and 5m sec., condenser capacity 100μF and 50μF, output impedance 50Ω (10ms.) and 73Ω (5ms.), recharge time was less than 3 sec, and external and internal diameter of electrode being 80mm and 60mm.
This initial apparatus weighed 107kg, and was not practical, so the second one was devised and weight reduced to one fourth the initial one. The pulse width was determined to be 2.5 m sec., maximum charge voltage 4500v with 200 w sec. Furthermore discharge of less than 10 w sec, was not obtained because of prevention of danger. When the switch is off, accumulated potential was discharged automaticaly inside the apparatus to prevent discharge of high voltage on the hand of the manipulator due to stained surface of electrode.
In experiments on dogs, ventricular fibrillation was created by the induction of AC 100v for 2 sec. on the anterior chest wall. With external defibrillation, it was necessary to give more than 20 w sec, and with internal defibrillation, excellent results were obtained by more than 3 w sec. Contrary to this, the occurence of ventricular fibrillation was never observed at 1 w sec.
Internal defibrillation was attempted clinically on 2 cases of ventricular fibrillation at the time of operation and defibrillation was obtained at 200 w sec, on each case.

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Authors attemped to measure the lead equivalent of various kind of the x-ray protective barrier through the estimation of leakage doses by the use of a dosemeter, in order to control the radiation hazard.
A 70 KVp, 3mA and 50cm of focal distance of portable x-ray generator was generally used. 15 plates of various kind of thickness in the lead plates, cement plates mortared and Barrait plates mortared were appreciated as a protective barrier.
Results were as follows;
1) A 1.0mm of lead equivalent could be measured by the dosemeter, provided that the tube voltage of x-ray generator was about 70 kilovolts.
2) When the tube voltage was 70 KVp, a 0.3mm -thick of lead plate showed 1600-1850mR/hr. of the leakage doses measured by the dosemeter, 310-400mR/hr. to 0.5mm, 70-95mR/hr. to 0.8mm and 17-32mR/hr. to 1.0mm, respectively,
3) A 5cm of thickness of cement plate mortared consisted from 1:1 of sand and cement quantitatively, showed the same effect as the 0.3-0.5mm of lead equivalent, and a 10cm of these about 1.0mm of one.
4) A 2.5cm of thickness of Barrait plate mortared which constituted with 5kg/3.3m² of Barrait substance, revealed the same effect as the 0.1mm of lead equivalent. Moreover, these plate with 20kg/3.3m² of Barrait substance showed about 0.5mm and that with 40 kg/3.3m² of one about 1.0mm of lead equivalent, respectively.

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On the basis of previous report, the lead equivalents of each x-ray protective barrier in the 17 national hospitals and sanatoriums were determined on leakage doses under the same conditions.
On the other hand, the leakage doses in these surrounding area were also measured during daily work.
Results were as follows;
1) A 116 plates of protective barrier were observed on the lead equivalent, that was, to say, 62 plates showed over 1.0mm of lead equivalent, 0.8mm to 8 plates, 0.5mm to 37 plates, 0.3mm to 7 plates and below 0.3mm to 2 plates, respectively.
2) The lead equivalents permitted legally for the protective barrier was satisfied in all except one x-ray laboratory, which was exchanged from low power generator (75 KVp) to high one (150 KVp).
3) Sixtieth film-badges fixed at the both sides of these protective barrier as in random sampling method, were measured the integral absorbed doses of a month.
As a result, in the internal side of these barrier, 2 film-badge showed over 110mR, 60-100mR to 2, 20-50mR to 18, 0-10mR to 5, and none to 3, respectively. However, all film-badges in the external side revealed no absorbed doses.

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Various remedies were given orally to 10 cases of chronic urticariaa In their efficacy Insidon was the best. Every case treated in doses of 50 to 200mg Insidor, (one to four tablets) daily, from half month to sixteen months.
Three cases of non-allergic urticaria healed completely and the others recouered from frequent eruptions during insidon therapy.

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Case 1. 10-years-old boy visited us with chief complaint of lumbago. He had no history of trauma in past. Tuberculin test became positive 4 years ago. Roentogenograms revealed slight flattening of the body of the second lumbar vertebra and narrowing of the inter vertebral space between the first and the second lumbar vertebra. He was diagnosed as tuberculous spondylitis, for which antituberculosis drugs were administered, and later surgery was performed. Roentogenographic examinations conducted 2 months after the operation revealed flattening and wegge formation due to compression. Roentogenograms taken 3 months after the operation showed the vertebra had been reduced of its thickness of a wafer, a finding typical of vertebra Plana Calve. The recovery process became evident on the front edge of the vertebral body about a year and 6 months after the operation, and the thickness of the vertebral body increased to about 4 times.
Case 2. 7-years-old boy visited us with chief complaint of back ache. No history of trauma was obtained and the tuberculin test still remainded negative. Roentogenograms showed slight flattening and appreciable sclerosing of the body of the eighth thoracic verte bra. Destruction of the bone was also noticeable along the front edge of the vertebral body. Six months after the first visit, the vertebral body became markedly dense and conspicuously flattened due to compression, but below the afflicted vertebra remained normal. No recovery process could be found as yet.
These two cases presented quite similar X-ray findings, in which one would encounter at the initial stage of tuberculous spondylitis, but repeated examination and continued obserrvation led to diagnosis of vertebra Plana Calve. Vertebral caries should be considered first as differential, but it has become clear recently that eosinophilic granuloma should also be taken into account as differential. The study of other reports as well as our 2 cases compels us to agree with the theory that the cause should be sought in primary circulatory disorder.

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Yearly increase of expense for drugs is one of the biggest troubles in the management of national sanatorium where there is restriction by the general account.
Here we have investigated whether these is any relation between the cost of antituberculosis drugs used for treatment and the severity of patient's symptoms in the study of 485 pulmonary tuberculosis patients.
In 35 percent out of 485 cases, the weekly cost of antituberculosis drugs was between 284 and 420 yen. Most of these patients were treated by combination therapy of SM, INH and PAS. Only in 9 percent of all patients, the weekly coat exceeded 700 yen as a result of treatment including one of three drugs KM, CS or TH. This low percentage is probably due to the fact that these data were collected just after revision of Therapeutic Standard of Tuberculosis (Tuberculosis Prevention Law).
Although it is roughly decided by Therapeutic Standard of 'Tuberculosis, final decision how to combine several antituberculosis drugs depends not only on patient's symptoms but also on the several factors such as GAKKEN classification, N. T. A. classification, result of microscopic examination of sputum for tubercle bacilli and sensitivity test, tuberculoss complication, history of operation, time from the onset of the disease and the opinion of the attending physician.
Degree of rest which is decided by putting all these factors together has close relation to the cost of antituberculosis drugs for each patient, In the group of patients exercising fifth degree of rest the weekly cost of antituberculosis drugs was less than 420 yen and in the majority of this group the weekly cost was less than 200 yen or no medication was required. In the group of patients with first degree of rest, the weekly cost exceeded 2000 yen in 33 percent.
In conclusion, degree of rest seems to be reliable standard in estimating the cost of antituberculosis drugs for each patient.

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Several other drugs besides antituberculosis drugs are also required in treating patients with pulmonary tuberculosis.
In this report we have investigated the relation between total cost of drugs used for treatment and symptoms of pulmonary tuberculosis patients.
Fifty-eight percent of drugs other than antituberculosis drugs were given by P. O., 18 percent were given by injection and 8 percent were by topica.
Weekly total drug cost used for treatment including antituberculosis drugs and other drugs ranged from 400 to 1, 000 yen in 41 percent of the cases, from 100 to 300 yen in 24 percent and cases ranging from 10, 000 to 25, 000 yen were 1 percent. In 5 percent of the cases no medication was required.
Total drug cost required in the treatment of pulmonary tuberculosis patients depends not only on chest X-Ray findings, results of microscopic examinations of sputum for tubercle bacilli and sensitivity tests but also on extrapulmonary complications, histories and surgical operations.
In estimating the total drug cast, however, degree of rest seems to be a reliable standard Patients with a lower degree of rest require a higher total drug cost. Even among patients with same degree of rest there is a considerable difference in total drug cost depending on the attending physician. This probably is due to the difference of economical condition of the patients who visit each physician.

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