The pattern of the E. E. G. frequencies has been quantitated by the method of Romano and Engel, Kiley and Hines in 12 uremic patients, all of whom were studied by serial E. E. G.
As uremia became worse, the E. E. G. became abnormally slow. When uremia was relieved by recovery of renal function or by therapy, the E. E. G. returned toward normal.
Our experiences suggest that the presence of slow ave activity less than 7c/s in 30% of the E. E. G. indicates a need for effective therapy.

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We studied pathological findings of the spleens about 14 cases of liver cirrhosis and 3 cases of Banti syndrome, and following conclusions were obtained.
1. There were no mutual relation about the weight between liver and spleen in the cases of liver cirrhosis.
There was a tendency that marked fibrosis invited heavy weight of the spleen in the liver cirrhosis.
2. The characteristic histological findings of the spleen of the liver cirrhosis were fibrosis, distinct white pulp, and “Trabekel aufsplitterung”.
3. As compared with Banti syndrome, Banti spleen were markedly heavier than liver cirrhosis one.
But there were no essential difference between two diseases.
The histopathological changes on the Banti spleen were more marked than liver cirrhosis spleen.

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Changes in blood pressure and E. K. G. findings were observed when the position was changed in 100 patients with hypertension and 59 subjects who visited to the health service.
When the subject in the supine position was placed upright, the systolic pressure decreased over 20mmHg in 43% and over 30mmHg in 16% of hypertensive patients.
Of the health service subjects only 3% showed the decrease over 20mmHg.
The diastolic pressure decreased over 20mmHg in 10% of the hypertension group. But in the health service group there was none.
Many of the aged subjects showed the decrease in blood pressure.
Many of the subjects with greater decrease in blood pressure showed lower P. S. P. excretion and abnormalities in E. K. G.
Moreover the treatment was not effective for many of them.
There was no relation with electrolytes and cholesterol.
Followings are the changes in E. K. G. findings when the position was changed from supine to upright.
1) Shortening of R-R interval.
2) Increase in R/S ratio in V₁, V₂, V₃.
3) T wave depression in V₄, V₅, V₆.
4) Greater changes of St-T in upright than in supine.

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About the indications of tympanoplasty to otitis media chronica the followings are important. The bacteria detected before the operation staphylococcus was found most frequently, followed by pseudomonas aeruginosa, proteus vulgaris in the order. Different kinds of these bacteria revealed a variety of sensitivity to drugs. Therefore sensitivity-test of the bacteria should be done before the operation for the selection of the antibiotics.
For the functional recovery the tympanic mucosa must be preserved as much as possible and must keep the cavity, except the highly pathological parts. The findings of the antrum mastoidea do not show the same changes of the other portion of mastoid cells. We should exenterate the mastoid cells completely to obliterate the mastoid cavity.
It is useful method to block between the tympanic cavity and mastoid cell wound with the fascia at the aditus and antrum.

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The lymphographic study was made on 5 cases of penile cancer. Squamous cell carcinoma was verified by histologic study in 5 cases. For treatment, 3 cases were treated with total penectomy, radical groin dissection and irradiation. The other 2 cases were treated with total penectomy and irradiation. After the treatment, one died (after two months) and another 4 were still alive (two years, one year, one year and eight months, and seven months respectively). We also checked the metastatic changes of lymph nodes by applying lymphography to those patients of penile cancer. 3 cases out of 5, there were suspicious of metastasis of cancer and so the radical groin dissection of the inguinal region was performed. As the result, metastatic changes of cancer were verified in one of them and 2 were inflammatory. Then the radical groin dissection of lymphatic vessles in the back peritoneum was performed to the patient whose cancer showed metastatic changes. But this patient died in a month after the operation. Pure natural chlorophyll was applied for two cases to identify lymph nodes in order to make it easier at the operating table.

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We examined 95 cases of cataracts which were intracapsularly extracted at the Zentsuzi National Hospital from 1963 through 1966.
Modus of cataracta extraction is intracapsular extraction by presser technique with alpha-chymotrypsin which has been introduced by Y. Mitsui in 1960. The results are as follows:
1) The age of the patients ranges from 31 to 88 years old, but 85% of them are from 51 to 80 years old.
2) There were 87 eyes of cataracta senilis, 4 eyes of cataracta complicata, 2 eyes of cataracta diabetica, one eye of cataracta traumatica and one eye of no classifiable.
3) The complications are encountered as following: 8 (8.4%) eyes of vitreous loss, one (1.0%) eye of prolapsed iris, 3 (3.1%) eyes of ruptured capsules, 4 (4.1%) eyes of delayed reformation of the anterior chamber, 2 (2.1%) eyes of haemorrhage on the iris, 7 (7.3%) eyes of the astigmatism (2.0 D. over), one eye of glaucoma and one eye of retinal detachment.
4) Corrected visual acuity of 95 operated eyes ranged about 0.5 in the mean.
Prolapsed vitreous was not caused by the effect of the enzym, because it can be minimized by means of the control of intra ocular pressure.
Prolapsed iris and delayed reformation of the anterior chamber can be protected by means of extension of the conjunctival flap to all area of the corneal incision and the additional sclero-corneal suture at 10.30 and 1.30 o'clock position.
A pressure technique is worthy to employ in intra-capsular removal of the lens when alph-chymotrypsin is used, because this technique causes less damage of the posterior corneal surface and reduces the incidence of capsule rupture than foceps or suction technique for combining with alpha-chymotrypsin.
The important point of this procedure is the determination of the end-point of enzyme application.
Description of this “end-point checking-procedure” is found in the paper entitled “use of alpha-chymotrypsin in cataract surgery with special reference to the duration of application” by Y. Mitsui which appeared in the Tokushima Journal of Experimental Medicine, 7: 104-108, 1960.

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About the pain clinic, this report is particularly concerned with management of the pain caused by terminal cancer.
The patients who were placed on the treatment at the pain clinic, had been suffering from severe pain secondary to cancer, involving fairly various part of the body. Nerve blocks of different kinds are utilized, but occasionally combined with drug therapy.
The majority of patients were at first undergone to the nerve block, using ordinary local anesthetic agents, and the following points were observed during this procedure
1) To check the effect of nerve block.
2) To decide the region to be blocked.
3) To observe anyy possibility of alteration of the general condition.
Among various kinds of nerve block with local anesthetics, epidural lumbal continuous block did play the larger part. Intermittent infusion of 1% xylocain with epinephrin was applied via polyethylen catheter.
Patients, who did not have difficulty of urination or bowel movement, were subjected to have continuous epidural block.
Besides blocks with local anesthetics, neurosclerotic agents gave the great advantage to treat intractable pain from distal to lower chest. Mainly applied neruosclerotic drug was absolute alcohol, while 5% phenol in glycerin was also injected to some cases. From view point of effect, absolute alcohol was assumed to be more powerful in comparison with phenol in glycerin. Despite of this event, burning type of pain at the time of injection and in following few days, was recognized as disadvantage of absolute alcohol.
Also troublesome in keeping of the body position could be counted as hesitation in selecting absolute alcohol.
From the practical point at pain clinic, judgement of the effect is largely depends upon patient's subjective statments. And relatively many cases gave the impression of addiction to analgetics.

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Epidural anesthesia by continuous injector was applied to 27 patients with terminal cancer, and the following conclusion was obtained.
1) The method is simpler than conventional continuous epidural anesthesia by repeated injection several times daily. It rarely causes BP fall and obstruction of the tube by sediments of blood or drug solution, and will not cause pain at the time of awakening from local anesthesia nor purulence in most cases.
2) 1-2% Carbocaine, Xylocaine, 3% Nesacaine, or 2mg Decadlon, 2-4mg Rindelon 40-100ml daily was injected for 9-120 days. Even such a large dose did not cause any side effect.
3) The method may be applied to any kind of pain in cancer occurring below the neck or to more than 3 sites of pain, and even to the cases of advanced diseases which are unable to stand or sit any more.
4) Treatment by the method is reversive and associated with little side effect as compared with semi-permanent nerve block by subarachnoideal injection of nerve corrosives, and may be used even in cases of metastatic cancer of vertebrae.
5) There is lower incidence of purulence than in conventional method. The reason may be less troublesome procedures involved and hence less hazard of contamination and bacteriostatic action of local anesthetics.
6) An epidural spread following dosage of some 2ml per hour of RISA (I¹³¹) was examined. According to this examination the substance spreads approximately over the area of 4-6 intervertebrae. The range stained by injecting Evans blue of 2ml/hr 2 days before death was same result. These help us understand the way local anesthetics spread.

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Several treatment plans for advanced cancer in radiotherapy are presented. Our big efforts are directed to elevate cure ratio among the group which belonged to advanced stage of cancer and usually considered to be incurable. Here, several cases which were treated with success were presented and some technical factors are shown.
1. Case reports in head and neck cancer
a) Cancer of tongue (T₄ N₁)
Combined irradiation with external X-ray beam (6 MeV Linac), volume implant of Radium needles through submandibular area, and later, Radon seed implantation and electron beam irradiation were performed. As shown in isodose curve, these combined treatment was excellent to control an advanced tumors.
b) Laryngeal cancer (T₄ N₀)
External irradiation with 6 MeV X-ray and 9 MeV Electron beam was performed, total 12, 960R was delivered. In several cases high dose of radiation could be delivered. In several cases high dose of radiation could be delivered without severe damage.
c) Hypopharyngeal cancer (T₄ N₀)
After laryngopharyngoesophagectomy, local reccurrence and metastases in lung were appeared, but successfully treated with radiation and survived more than 3 years, For lung metastases, grid irradiation of Linac X-ray was appeared to be excellent, perhaps because of its special dose distribution.
2. Metastases in cervical lymph nodes About 80% and 61% of lymph nodes metastases, diameter of which were less or more than 3cm respectively could be controlled, if more than 7000R were delivered. Among several treatment modalities, combined therapy with linac X-ray and electron beam was excellent. In this case, if the tangential part for the direction of radiation in the neck was protected with a lead block, higher dose can be delivered at this area by electron.
3. High pressure Oxygen chamber for radiotherapy
Patients were kept in 3 atmospheric pressures of pure Oxygen about 15 minutes before radiotherapy. From Jan. 1965 to March, 1966, 24 advanced cancer patients were treated. Nineteen cases were shown better responses to radiation than expected in radiotherapy in air.
4. High pressure Oxygen and Radiosensitizer
5-Fluorouracil was infused via external carotid artery for the cancer of maxillary sinuses. Radiotherapy was performed under high pressure oxygen and rapid disappearance of tumors were resulted.

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After combining several antitumor agents such as Nitrogen mustard N-oxide, Cyclophosphamide, Mitomycin C, and Chromomycin A₈ with LY culture media containing 20% inactivated bovine serum with KB cells for 30 or 60 minutes once at 37°C, the antitumor agents were washed out with Hanks' BSS, then new LY culture medium was added to the cell, and kept at 37°C for 1-7 days.
The effects of antitumor agents upon cell number, mitotic rate, and morphologic changes were studied.
The results obtained were as follows
1) Moderate inhibition of cell growth of KB cell was seen after combining either 1 mcg/ml or 1Omcg/ml of Nitrogen mustard N-oxide with the cells.
2) Very minor degree of inhibition of cell growth of KB cells was noted if either 2mcg/ml or 20mcg/ml of Cyclophamide was added to the cells.
3) Mitomycin C revealed moderate degree of inhibition of cell growth 2-5 days after combining either 0.04mcg/ml or 0.4mcg/ml of the drug with KB cell. Re-increase in mitotic rate, however, was seen after a days in the former experimental series despite of no increase in mitotic rate in the latter series.
4) Similar results to those in the experimental series of Mitomycin C were observed in the series of 0.01mcg/ml and 0.1mcg/ml of Chromomycin A₃.

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An attempt was made to investigate the early diagnosis of cancer and the effect of surgical operation to the patients by using paperchromatography for detecting some substances (not identified) in the urine qualitatively. By the method previously reported (Iryo, Vol. 20, No. 10, p. 49-52), cancer patients could be distinguished from non-cancer patients significantly. The present investigation was made to observe the effect of surgical operation on the urinalysis. Remarkable difference between before and after the operation of cancer was recognized on the urinalysis statistically, of the 144 patients with gastric cancer, only 1 was negative and 12 patients were doubtful, Of the 216 patients with cancer of some organ, 7 were negative and 22 were doubtful.
Further experiment is undergoing the effect of chemotherapy to cancar patients on the urinalysis.

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(1) As recent trend, an increase in number of patients whose complaints are the presence of a lump or thickening in their breasts has been remarkable. The main cause of this phenomenon is the growing recognition and anxiety for cancer of breast among women.
(2) The greatest majority of patients were in age of thirties, amounting to about 40% of all cases.
(3) The rate of operation has been higher in women beyond the age of 50. This was 50-70 per cent.
(4) Of the tumors of breast, a distinct majority was mastopathia, then fibroadenoma followed by cancer.
(5) The survival rate of cancer patients underwent operation after 5 year was 55 per cent.
In the aspect of the 3 year survival rate, simple mastectomy was higher than radical procedures and/or post-operative rentgenotherapy.
The data suggests that radical procedures and/or post-operative radiation therapy are not always demanded.

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In the period from 1957 to 1965, the author experienced 1173 cases of the breast disease including 519 cases (44.2%) of the mastopathia and following results were obtained: 24.3% in the group of 31 to 35 years of age, 22.7% of 31 to 35, 18.9% of 41 to 45, 14% of 46 to 50 indicate the trend of increase in the younger aged group.
The author suggests that the fact possibly caused by the unbalanced sexual hormons due to the modernized social lives and habits. The increased number of the mastopathia has been found by the recent social education on breast cancer which might induce the cancer neurosis.
The testosterone hormon therapy was effective for the treatment of mastopathia and careful observations of the therapeutic course were also important matter.
The differencial diagnosis between breast cancer and mastopathia was occasionally difficult.

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A severe tetanus patient was admitted and treated mainly by muscle relaxants with minute control of respiration, but in vain.
Through our case and an inquiry into tetanus literature, we could discuss the measures employed in the routine management of tetanus, which have been divided into several categories, care of the wound, tetanus antitoxin, toxoid, antibiotics, respiratory care and control of spasm.

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The preventive method of asthmatic disease of infants and children by B. Redner and H. Markow (JAMA, Aug. 31, 1963) with intradermal injection of minute dosis of gamma-globulin was very convenient and simple.
We assessed that method with our own materials.
Number of treated children was 40 (28 boys and 12 girls).
Gamma-globulin used was made by Green-Cross Co., Japan, containing 12% of protein, over 90% of which is gamma-globulin (gamma-A 86% and gamma-M 14%) Result:
(The patients of younger ages could more favorably respond than those of old ages. And about the difference of efficacy between both sexes, boys had been apt to show the better responses.)
As a conclusion, we think we could assume the effectiveness of this method for the prevention of asthmatic diseases of infants and children. Because, during the treatment more than 90% of the treated cases have either been completely released from the sufferings or been reduced in frequency, duration and intensity of attacks, and also after the treatment more than 60% of the cases have obtained excellent or good result.

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The operation procedure of proxymal gastrectomy preserving antrum and pylorus for the ulcer in fundal portion of the stomach was studied.
The pyroplasty is seemed to be important procedure in this operation to prevent gastric retention post-operatively.

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