By clinical investigations about 4, 456 cases of primary cancers of our hospital from May, 1962 until December, 1964, the incidence of skeletal metastasis was revealed in 225 patients, at the rate of 5 per cent.
The clinical evidences were usually supported by roentgenological surveys, but in 62 cases the metastatic bone lesions were discovered only at post mortem table.
The most common sources of bone metastasis in our series were indicated to be in the kidney (35.3%) and the prostate (32.0%).
Vertebral column and pelvis were the most common sites of metastasis, and metastatic deposits were sometimes osteosclerotic, most frequently in prostatic cancers (87.5%).
As for the treatment of extensive skeletal metastasis, especially of the hormone-dependent cancers, the endocrine therapy including the bilateral adrenalectomy with castration or oophorectomy have been proved to be most effective for the palliation of their conditions and the improvement of their bone lesions.

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The use of plasma volume expanders for the prevention and treatment of shock has increased because of increased knowledge of the deleterious effect of plasma volume reduction. Several expanders of different types are available. Among them, clinical dextran has remarkable advantage, that is, it can be metabolized and has no effect of accumulation. However, as well as other expanders, clinical dextran has the deleterious effects such as sludging, prolongation of the bleeding time and allergy which are chiefly due to the high molecular weight fractions of dextran. Low molecular weight dextran has solved the deleterious effects of clinical dextran and moreover it has the superior effect on the peripheral blood flow which is due to disaggregation of aggregated blood cells and to reduction of whole blood viscosity.
The indication for the use of low molecular weight dextran has been found in the following condition: burns, crush injury and fat embolism, toxic shock, oliguria, thrombosis, acute arterial insufficiency, vascular surgery, extracorporeal circulation, large doses of roentgen contrast medium intravascularly. Infusions of low molecular weight dextran have not been followed by untoward reactions. Contraindications may be present in pulmonary edema, marked thrombocytopenia and localized septic processes.

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The histopathological studies of calcification was made on 192 thyroid glands removed surgically during past 3 years (1963-1965).
Calcifications were found in 54 cases: 11 (10.7%) of 103 adenomatous goiter, 4 (20%) of 20 follicular adenomas, 1 (7.7%) of 13 cystadenomas, 23 (95.7%) of 24 papillary adenocarcinomas, 9 (64.4%) of 14 follicular adenocarcinomas and 6 (100%) of 6mixed carcinomas.
Calcifications were classified in four types according to histopathological findings;
1) board type was found more common in fibrous stroma of non-neoplastic goiters,
2) pin point type was found in stroma of a few papillary adenocarcinomas,
3) granular type was observed in stroma or intrafollicular position of some papillary adenocarcinomas and follicular adenocarcinomas,
4) psammoma type (psammoma body) was frequently presented in stroma or intrafolliculary of papillary adenocarcinoma and a few non-neoplastic goiters.
Psammoma body was differentiated from board type on histopathological findings, contained acid mucopolysaccharide, iron and other substances binds calcium. Psammoma body was frequently presented in fibrous stroma but also seen occasionally associated with tumor cells in the colloid lackes and basophilic colloid sometimes simulated psammoma body. These findings should suggest that psammoma body have relation to degenerated colloides and tumor cells.

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We had 31 cases of the carcinoma of the pancreas including the carcinomas of the Papilla Vateri and the intrapancreatic bile duct, in which laparotomy was rmade at the National Cancer Center Hospital, Radical excision was performed in only 5 among 9 cases of pancreatoduodenectomy or total pancreatectomy, and 3 cases of distal pancreatectomy were all palliative. The problem of the early diagnosis was discussed about these cases.
(1) Vague upper abdominal discomfort or pain was the chief complaint in 21 of 31 cases (68%), and jaundice was seen in 11 of 31 cases (35%). As the initial complaint, upper abdominal discomfort or pain was seen in 20 of 31 cases (65%) and jaundice was seen in three of 31 cases, Among 23 cases of the carcinoma of the head of the pancreas, jaundice was associated in 12 cases, of which the excision was done in 8 cases including four cases of radical excision, In other cases without jaundice, exploratory laparotomy or anastomosis was performed in 10 cases, except one case of radical excision of the early cancer. Therefore, early diagnosis of carcinoma of the head of the pancreas without jaundice is quite. important. In 16 cases with palpable tumor-mass, palliative excision was able to carry out in 4 cases, but among 6 cases which gall-bladder was palpated, curative excision was done in 2 cases.
(2) Examination of upper gastro-intestinal tract by barium meal is important procedure to differentiate other diseases and the pancreatic tumor. Abnormal findings, such as pressure effect to the stomach (Fig. 2) and duodenum, were seen in 27 out of 31 cases (87%). The pancreatic tumor was demonstrated on the X-ray film by means of the transverse axial stratigraphy of the upper abdomen (Fig. 4). The tumor shadow was well correspond with the anatomical location at the time of operation. Selective angiography of the pancreas was also useful tool for difficult cases to diagnose (Fig. 5). But both methods were scanty in case to diagnose early.
Although we have previously reported that the exocrine function of the pancreas measured by pancreozymin-secretin test was related to the location and the degree of obstruction of pancreatic duct, and was not always parallel to the size of the pancreatic tumor, radical excision of pancreatic tumor was more frequently performed in cases with slight dysfunction among cases with the carcinoma of the head of the pancreas. It was emphasized that the dysfunction by pancreozymin-secretin test and the positive cytology for duodenal content are useful for the diagnosis of relatively early stage of the carcinoma of the pancreas. The exfoliative cytology for duodenal content obtained by pancreozymin-secretin stimulation was positive in 6 out of 11 cases with the carcinoma of the pancreas, and the radical excision was made in 3 cases among those cases.
(3) The findings of the gall-bladder and the bile duct at the operation is also important for differential diagnosis in cases with jaundice, since the enlarged gall-bladder and bile duct without inflammatory change often indicate the carcinomatous obstruction of distal biliary tract. We had a case with adenocarcinoma of biliary tract in the head of the pancreas, about 1×0.8×1.2cm in sized (Fig. 7), and in this case pancreatoduodenectomy was made without biopsy, since the carcinoma of the head of the pancreas was strongly suspected by non-inflammatory enlargement of the gall-bladder and bile duct.

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It is very difficult to determine the effect of anticancer agents infused into hepatic artery in malignant hepatic tumors, of either primary or secondary.
We accepted hepatogram taken by water soluble radiopaque material (Urographin) as a indicator by fluctuation of the size of tumor, to find out the effect of intraarterial infusion. Hepatogram taken 10-12 seconds after portal infusion of radiopaque material recongnized the difference as much as 1.0 cm in diameter. To see the fluctuation of tumor, portal hepatogram is much excellent than the one through hepatic artery.
Hepatogram by oil soluble radiopaque material (Lipiodol ultrafluid) showed portal branches within liver by 24 hours after procedure, and thereafter showed sinusoid endothelial cells, that is, shadow of liver itself. Lipiodol ultrafluid remains as long as one month, and changing size of tumor could be pursued for long time.
The above mentioned method is simple and excellent to observe the effect of intrahepatic arterial infusion against hepatic tumors.
This method has little effect on liver function and can be taken in ordinary radiography.

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In an established solid MH134 tumor in C3H/He mice, necrotic part increased in size after a time while viable part got smaller, At this stage, many lymph node metastases emerged stimulating the compensatory growth for the reduction of viable part. This fact appears to suggest that a well-established tumor bearing host can sustain a certain amount of viable part of tumor and that the emregence of metastases is, to some extent, delayed if the reduction of viable part is prevented. In fact, it was recently found that the viable part contains substances, inhibiting DNA-synthesis in MH134 cancer cell.
In an attempt to inhibit metastasis and recurrence, the primary tumor was removed and the viable part of this tumor was incubated for 7 hours under 37°C in 7% bicarbonate solution and was autotransplanted. The effect of 7% bicarbonate solution on the cancer cell is as follows:
1) According to our experiments in vitro, the bicarbonate treated cancer cell reduces its O₂ consumption reversibly. This fact indicates that the enzymatic activity of the bicarbonate treated autograft continues in the host for a while.
2) It prevents the reduction of tumor-graft that otherwise should have occurred in a well established MH134 tumor. This fact indicates that it stabilizes the viable part, releasing the inhibitor continuously against dispersed cancer cells in the tumor bearing host.
3) It has no effect upon the inhibitor of the viable part in vitro.
4) It inhibits the growth of tumor cell.
The result of this treatment was as follows:
(I) 149 mice bearing 2 to 3 weeks old MH134 tumor underwent removal of the tumor. 77 of them received bicarbonate-treated tumor autograft and 72 none. Survival rate during 300 days period after operation was threefold higher in the treated than in the controls. For example after 90 days it was 14/77(18.6%) in the treated and 4/72(5.6%) in the controls.
(1) In C3H mice of spontaneous mammary cancer, survival rate of the thus treated was 5/14 (35.7%) while 0/11 (0%) in the controls 154 days after radical mastectomy.
Autotransplantation of bicarbonate-treated tumor did not reverse the fall of serum albumin and the increase of alpha globulin, but it did rectify, to some extent, the fall of liver catalase activity the increase of serum lactic dehydrogenase and the involution of thymus. In such an occasion, splenomegaly was noted with accompanying lymphopoesis. Some clinical experience on 20 gastric cancer patients who have received this treatment is to be presented.

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One hundred and forty two cases of gastric remnant were examined by gastro-fiberscopic camera during the period from January, 1964 till December, 1965.
Those patients were checked by fiberscope at 3 to 4 weeks, 3 months, 6 months and one year after the gastrectomy and simultaneously the fluoroscopic examination were also performed. The results obtained are as follows:
1) The types of anastomosed stoma were classified as three criteria, a) closed type b) semi-open type c) open type. As the time elapses closed type and semi-open type gradually became open type, and at 6 months after the surgery most of them showed open type.
2) Comparing with Billroth I method of gastric resection, Billroth method of gastric resection had more tendency to become open type at earlier stage.
Within one month of gastric resection the remnant of chronic gastritis cases relatively revealed closed type comparing with other gastric diseases.
3) Within one month after gastric resection, two-third gastric resected groups showed less tendency to become open type comparing with subtotal gastric resected groups.
There were no close relation between the diameter of gastric stoma at the time of surgery and their type after one month post-operatively.
4) Within one month after the operation the patients who showed high acidity of gastric juice pre-operatively became open type more likely.
5) In several cases erosion and ulcer which probably caused by anastomosed sutured silk at the stoma were frequently observed, but those patients had not always post-operative complaints.
6) At the early stage of Billroth I method operation, duoderial stasis mostly observed and formed so called “Ersatz-Magen”.
7) There were certain relation between post-operative gastritis of the remnant and post operative complaints. The patients who comlained post operative gastritis had mostly suffered from hazard of passage in anastomosed portion right after the operation.
8) By using atropine or pilocarpine the movement and function of anastomosed portion were weakened or stimulated.
9) The discharge of content in gastric remnant was greatly influenced by tonicity of anastomosed jejunum.
10) By deep breathing anastomosed stoma showed deformed movement.
11) Among some cases of Billroth I method, the jejunal mucous membrane just under anastomosed stoma formed lengthwise folds after 6 months of surgery.
12) After 3 months of Billroth II resection, some cases showed tendency to move the location of efferent loop of anastomosed jejunum to left side of the gastric remnant.

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1) Experimentally, gastric lymphvessels and its lymphnodes were well stained by the coloring matters (3% directsky blue) which injected in gastric submucosa.
As a result, it was recognized that the anomalous ref lux of lymphf low appeared because of artificial ligations of lymphvessels.
2) In man, the coloring matters were injected at the submucosa near to the tumor through the fiber-gatroscope before the laparatomy, but the infiltrated area of gastric wall and metastatic lymphnodes were not stained.
3) Our method of vital staining is very convenient at the time of radical operation of gastric cancer.

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Treatment and clinical control of recurrence of gastric cancer is one of the most important problems for clinicians.
One thousand and thirty five cases of gastric cancer have been admitted to our clinic to be operated for the past 11 years. One hundred and eighteen of them were recurred cases, and these account 11.4% of all gastric cancer. All recurrent cases suffered from symptoms of chronic intestinal stenosis such as vomiting, abdominal inflation and pain jaundice, and palpable tumor. Fifty nine cases of them could be operated.
Seventeen of 59 cases passed a half to one year, 18 cases one to two years and 12 cases over 2 years from the first to the second operation.
Method of operation was varied with symptoms, i. e. 22 cases of intestinal anastomosis, 12 cases of laying of the gall fistula, 8 cases of exstirpation of tumor, 6 cases of esophagojejunostomy, 15 cases of probe laparotomy and others. Total exstirpation of the rest of stomach was performed for only one case.
In all cases severe cancerous adhesion, dissemination of cancer nodes or metastasis of lymph nodes were found at laparotomy, therefore radical operations could not be performed.
Severe complication developed after operation in many cases, namely, suture leak was 13.5% of operated cases, acute heart insufficiency and postoperative pneumonia was 8.5% each.
Fifteen cases of them died within one month after operation. The chief causes of these death were suture leak and general prostration due to cancer.
Eighteen cases were successfully operated and 6 cases of them were alive over 6 months.
Cases of recurrent gastric caner visited hospital usually within one month after appearance of complaints, nevertheless, cancer advanced so severely that radical operation could not be performed, although there were not few cases which were improved by palliative operation and 6 of our cases could be expected to prolong duration of survival.

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Massive gastritis bleeding occures in the normal stomach if the stimulant is too strong. On the other hand there is chronic gastritis which bleeds easily even if the stimulant is weak, and we demonstrated such easily bleeding cases in our article.
Sixty-seven cases of massive bleeding in gastritis were admitted to our hospital during the past 11 years. The causes were; alkohol 48 (78%) salicylates 3, cortico-steroids 2, anabolic steroids 2, D860 and other oral drugs for diabetes 4, other oral drugs 4 & other causes 5.
The gastric acidity of these cases is apt to be high, and a careful histological examination often reveals figures of healing erosions or ulcers. So we suppose that the bleeding may be due to ulcerations or erosions which easily heal in a short time.
We experienced several cases which were found to be cancer several years after the episode of massive gastric bleeding.
Massive gastritis bleeding caused by oral drugs is not infrequent. We must be careful in using new drugs which have not been proved safe from the stand point of gastric bleeding.

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In the same 76 cases of urticaria who have been treated and observed in our Allergy Centre during the past one year and partly reported in Part 1, the results of clinical studies especially on the examinations of gastro-intestinal and hepatic function and on the routine clinical examinations are as follows:
1) It is considered that urticaria has relation to digestive disorders, because 54.2% of cases had complaints of obstipation, diarrhea or abdominal discomfort.
2) In more than half of 14 cases with chronic urticaria who received gastric juice analysis, the decrease of gastric acidity was observed (achylia in 2 cases, and hypoacidity in 6 cases). One of 3 cases, was diagnosed as gastritis by G.I. series, which revealed the prolongation of gastric emptying time and a tendency of passage acceleration of small Intestine due to hyperkinesis.
It is considered that the gastro-intestinal symptoms in cases of (urticaria have two meanings: either (1) gastrointestinopathia allergica concurrent with urticaria, or (2) gastro-intestinal symptoms as the cause of urticaria, that is, as the routh of allergens.
3) In only 2 cases with chronic urticaria, chronic hepatitis was confirmed by liver function test. By treating of chronic hepatitis the eruption due to urticaria disappeared.
4) Serum total protein was normal in most of the cases; however, A/G ratio had tendency to increase, and y-globulin fraction decreased.
5) Serum electrolyte (Na and K) was in normal level in almost all subjects, except few had slight increased or decreased level.
6) In the clinical routine examinations, the following results were obtained.
a) Hypertension was seen in 14.9 of the patients ; and in the majority of hypertensives, the increase of serum total cholesterol was noted.
b) Leucocytosis was seen in 22.5%, and eosinophilia in 22.8%.
c) Albuminuria was observed in 6.2% of the patients. Glycosuria was not proved in all subjects. Increase of urobilinogen in the urine was seen in 49.2%.

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The Rheumatic Fever Working Party of National Hospital was founded to study the effect of the steroid hormon on rheumatic fever since 1962.
During past three years, 128 children under the age of 16 were admitted to the trial in 27 national hospitals. These patients were devided into four treatment groups under investigation.
Dosage schedules.
A) Short-term hormon therapy:
41 cases; daily dosage of Betamethasone 8mg for the first 4 days, 6.5mg for the following 3 days for whose weighing 30kg or more.
Daily dosage of 0.25per kg of body weight for whose weighing less than 30kg for the first 4 days. 0.2mg per kg of body weight for the following 3 days.
B) Long-term hormon therapy:
I) 17 cases; initial Betametl atone 0.2mg or more per kg of body weight for the 2-4 weeks or more.
II) 46 cases; initial dosage etamethasone 0.1-0.2mg per kg of body weight for the 2-4 weeks or more.
III) 24 cases; initial dosage Betamethasone less than 0.1mg per kg of body weight for the 2-4 weeks or more.
Each method of long term-therapy was followed by a tapering off during the next for the 12 weeks or more, after initial dosage, untill the result of non-specific laboratory tests return to normal.
Patients were divided into three groups according to the length of time of disease, that is the period from the date of onset to the date at which therapy began. These three duration-from-onset groups were (1) 2 weeks or less, (2) 2-6 weeks and (3) 6 weeks and more.
The result of treament were measured in relation to separate manifestation of the disease-namely: temperature, erythrocyte sedimentation rate, C R P, joint involvement, such aspects of the status of the heart as heart size, murmur and atrioventricular conduction time.
There were no evidence that any of .the four treatments resulted in uniform termination of the disease.
Side effects and serious untoward reaction are rarely encountered with short-term steroid therapy.
Short-term therapy was recommended from the point of view of side effects.

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