1. The present study was undertaken to understand the relation between multiple gastric ulcers and ulcer-cancers with 260 surgical cases of the former and 140 of the early ulcer-cancer.
2. The frequency of multiplicity in benign gastric ulcers was 30%, while that of malignant ones 22%; No significant difference between those two was obtained.
3. As to the age and sex of predilection, the cases of benign multiple ulcers with more than three were found in younger patients than in those with one or two. A similar tendency was also seen in the cases of malignant ulcers.
4. Benign multiple ulcers could be classified into the following four types, according to their distribution.
1) Kissing type, 2) Lesser curvature type, 3) Pylorus type and 4) Body type.
The lesser curvature type was most frequent, and the pylorus type, body type and kissing type followed in that order.
The frequency in each type of malignant multiple ulcers was roughly the same to that of benign ones.
5. Benign gastric ulcers were classified into the shallow and deep ones by the depth of the defect of gastric wall, and their frequency was investigated. In the cases of single ulcer, the deep form (penetrating ulcer) was much more frequent than the shallow one (limiting to the defect of muscularis mucosae). This relation reversed in the cases of multiple gastric ulcers, in which the shallow form was more common.
A similar tendency was found in the cases of malignant multiple ulcers.

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The authors have studied the diagnostic and therapeutic problems of peptic ulcers in 516 cases which were admitted to our hospital from 1962 to 1966. The main results are as follows:
1. The maximal incidence of gastric and duodenal ulcers was observed in the 50-59 and 30-39 age groups, respectively. The incidence rate in gastroduodenal ulcers revealed no significant difference in the age groups from 30 to 69.
2. Comparing the incidence rates in the sexes, the ratio of male to female was 3: 1 in gastric, 10: 1 in duodenal and 13: 1 in gastroduodenal ulcer. The ratio of cases treated surgically to the admitted ones was also lower in the female.
3. From our study of the reasons why some cases were misdiagnosed as carcinoma, it was concluded that the X-ray, endoscopical and gastric juice examination are all necessary to prevent misdiagnosis.
4. Multiple ulcers were observed in 37% of the cases which were misdiagnosed as carcinoma and treated surgically.
5. Occasions in which there is the possibility that gastric carcinoma is misdiagnosed as benign ulcer or overlooked were reviewed and an example was presented.
6) Specific foods, stress, drugs and hiatus hernia as factors which give rise to peptic ulcers were reviewed and two examples were presented.
7) We divided operative indication into the following 4 groups: (1) absolute indication (in cases of perforation, massive bleeding and stenosis), (2) relative indication (a: in cases of reexacerbation, b: in cases of reoccurrence), (3) social indication, (4) in cases in which the possibility of carcinoma could not be denied. We classified our cases according to this criteria and discussed the results.

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To evaluate surgical treatment for peptic ulcer, the 582 cases of gastric and/or duodenal ulcer, which elapsed three to ten years after gastrectomy, were investigated bycorrespondence and interviewing.
The results obtained were as followings.
1) The near mortality rate within one month after operation was 1.5% of the 582 gastrectomy cases (9 cases), of which seven cases underwent emergency operation because of perforation or large bleeding.
No mortality is expected by gastrectomy in the cases without severe complication.
2) The late results were based on the information of 370 cases out of the whole gastrectomy cases (63.5%), some of which suffered from intestinal obstruction, serum hepatitis and cardiovascular disease after leaving hospital and 16 cases were dead.
3) Various postoperative complaints such as pain or dullness of epigastrium, costipation and heartburn were brought by 27% of the cases. By the subjective composite decision, however, results of gastrectomy were excellent in 86%, fair in 12% and not improved in 2%.
Every unimproved cases had mild degree of ulcers or erosions of the stomach preoperatively, while most of all the cases with severe degree of ulcers gained excellent results.
4) Fluoroscopy of stomach and blood examination were carried out in 279 cases who visited this clinic. Then it was noticed that in the cases after Billroth II method adhesion of efferent jejunal loop had close relation with various postoperative complaints.
A few of the cases showed anemia, hypoproteinemia or dysfunction of liver.
On the basis of those results, the authors recommend rather active gastrectomy for peptic ulcer. Furthermore, to improve surgical result the effort for prevention of intestinal adhesion and serum hepatitis will be important.

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Congenital hypertrophic pyloric stenosis is the most frequent surgical case in infancy.
This study is based on analysis of 42 cases of infants with cong. hyp. pyloric stenosis who are treated surgically at the National Children's Hospital of Japan from 1965 up to date.
1) We have prepared a line graph of the ages at onset in our series and in other foreign children Hospital (Fig. 1). In our series, the age of onset is the same time compared with other reports but the age at admission delays two or three weeks later than that of the other reports (Fig. 2).
2) The time of admission, we have examined routinely R. B. C., W. B. C., Ht, Hb volume, serum electrolytes and acid base balance using Astrup's micro gas analyser.
Of this total cases, about 90 percent were found to have hypochloremic alkalosis and 50 percent of this group were found to have severe alkalosis (Fig. 9).
3) At the preoperative preparation, we have usually used 5 percent glucose solution and normal saline solution intravenously. Potassium chloride has often been added to these fluids as soon as the urine output was established.
4) In extremely cachectic patients, we have given blood transfusion (10ml per-kilogram per-once) added to electrolytes fluids. Fig. 7, 8, 12, show preparation of Ht, Hb volume, acid base balance at the time of operation.

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We had 378 surgical cases of infants and children, 12% of all 3100 surgical cases, during the past three years and a half.
In the recent year, the surgical cases of neonates or infants are gradually increasing, on the other hand the cases of children are relatively decreasing.
The greater parts of these cases are hernia and acute appendicitis.
In this report, we discussed on the diseases of digestive tract of infants and children, especially qne gastric cancer, eight cases of congenital pyloric stenosis, one jejunum-atresia, five cases of intussusception and three cases of Hirschsprung diseases.
In the case of gastric cancer, fouteen-years-old boy, the surgical operation was done after medical therapy during about one year but was recurrent after 18 months.
The all cases of congenital pyloric stenosis was operatively treated and was improved.
The death cases were one atresia of jejunum and two cases among three Hirschsprung diseases.

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Although it was reported by M. W. Stearns et al. that rectal carcinoma could be treated with good results using pre-operative irradiation of X-ray, we examined the effects of pre-operative irradiation and the influences on surgical operations in the cases of rectal carcinomas irradiated pelvic cavity with ⁶⁹Co γ-ray.
Conclusions:
1) irradiation field 15×15cm
two opposed fields
each dose 250 R six times a week
total dose 5, 000 R/3∼3.5 weeks
interval between last irradiation and operation 10∼21 days
According to the above mentioned radiation method, there were no disturbances for the surgical operations and for the post-operative conditions.
2) Leucopenia, (under 3, 500/mm³) loss of appetite and diarrhea appeared as sideeffects of irradiation in a few cases. However it was not necessary to stop the radiation schedules when we used transfusion of nutritious fluids.
3) Pre-operative irradiations were very effective since unchanged cancer cells could not be seen in the most of removed tumor tissues.
4) Strict judgment on the value of pre-operative irradiation should be hold until we get the clear elevation of survival rate.

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The cases of Myelo-Optico-Neuropathy (SMON) with abdominal symptoms (a disease indicating numbness ascending from the legs, paresthesia, girdle sensation, dysbasia, and optic neuritis with abdominal symptoms such as diarrhea and abdominal aching as primary symptoms) diagnosed at the Kure National Hospital during the period from August, 1963, to September, 1967, total 157 including 55 males and 102 females. The frequency of this disease after 30 years of age is especially high in females.
Among the cases, 74 had abdominal surgery in the past. Those who showed leg dyspallesthesia number 136 among 152.
In this disease, the cases on which we could make follow up studies from the stage of only abdominal symptoms to that of appearance of neural symptoms number 29. Recording leg pallesthesia once a week on time basis from the stage of only abdominal symptoms, leg pallesthesia was decreased and disturbed prior to development of neural symptoms such as “numbness” and “dysbasia” appeared. From this fact, it is considered useful for an early diagnosis of SMON to measure leg pallesthesia.
Gastro-intestinal series on SMON patients revealed that the small intestine often showed hypertonia irrespective of the stage of abdominal symptoms or that of neural symptoms and the contrast medium passed through the small intestine very quickly. This is suggestive of vagotonia controlling the small intestinal region.
We have experienced the following fact as an instance of mass outbreak of SMON. In October and November, 1965, 28 cases of mass outbreak of dysentery due to B2 type were found in a small island in the Seto Inland Sea. In November, 1965, 5 SMON patients were found among the 28 cases.

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We have experienced 36 cases of bile stone. Authors were able to diagnose 10 cases by plane X-ray picture, 15 cases by tomography and 7 cases with combined. both methods In 4 cases the presence of stones were obscure with either or both methods. These results showed that gall bladder tomography has great advantage for the diagnosis of the bile stone.
Conversely we had 10 false positive cases. 5 cases of these misdiagnosis were caused by overlapping with intestinal gas in which 4 cases were taken by moving X-ray tube in 50 degrees of angle and 1 case was done in 20 degrees.
Our phantom experiments moving X-ray tube in 60, 50, 40, 30 and 20 degrees of angle showed that the shorter the moving distance of X-ray tube in tomography, the better the demonstrating gall bladder and bile stone even in the presence of disturbing intestinal gas.

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The diagnostic procedure of the hepatic lesions with selective hepatic arteriography has recently been developed to a great extent. During a period from 1965 to 1967, we performed the hepatic arteriography in 28 cases with various kinds of hepatic lesions.
Eleven cases hed benign hepatic lesions (5 cases of liver cirrhosis, 3 of chronic hepatitis, 2 of splenomegaly, and 1 of postinflammatory status). In 4 of them, Iaparoscopy was performed. The ages ranged from 18 to 59 years. Malignant tumors were found in remaiaing 17 cases (7 cases of gastric carcinoma, 5 of carcinoma of the hepatocholangeal system, 2 of rectal carcinoma, 1 of gastric sarcoma, 1 of pancreatic carcinoma and 1 of seminiferous carcinoma). The ages ranged from 25 to 68 years. In all these cases with malignant tumor, biopsy with iaparotomy or autopsy was performed.
The hepatic arteriograms were made by peroutaneous transfemoial teohnique with Seldinger's method. Ödman-Ledin's green catheter with curved tip was used, and 15-30ml of 80% Iothalamate or 76% Diatrizoate was injected as a contrast medium. There was no remarkable complication.
Major variations in the hepatic arterial system were noted in 4 of 28 case. In 2 of 4 cases, the common hepatic artery was divided from the superior mesenteric artery and the celiac axis bifurcated into the splenic and left gastric arteries. In the other 2 cases, the right hepatic artery arised from the superior mesenteric artery.
In liver cirrhosis, irregularity in outline with tortuosity of the intrahepatic arteries and dilatation of the stem arteries accompanying abrupt narrowing of the peripheral branches were significant. In some cases with liver cirrhosis, diminished hepatic volume was disclosed. Of these findings, irregularity of outline of the intrahepatic arteries was important and a pathognomonic sign.
In chronic hepatitis, the degree of such changes as shown in liver cirrhosis was mild, even if the arteries were narrow and curved.
In the hepatic tumors, the findings were depended on the degree of their vascularity. In the primary hepatocellular carcinoma, hypervascular changes were noted with early accumulation of the contrast medium, whereas in cholangiocarcinoma, pathologic vessels are scarcely found.
In the metastatic carcinoma of the liver of the hypervascular type, abundant tumor vessels with accumulation of the contrast medium could be revealed. However, there may be the tumors of the hypovascular type, and it characterized by vascular displacement by the tumor and defect in the parenchymatous phase. The tumor with rich vascularity could be detected easier than that with hypovascularity because of accumulation of the contrast medium. It may be difficult to determine whether the tumor is primary or not, especially in the case of hypovascular type.
In short, selective hepatic arteriography is very useful for diagnosis of hepatic lesions and it would be possible to improve the clinical presumptive diagnosis up to definite diagnosis in respect to decision of nature, degree, extent and location of the lesions.

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For the purpose of detecting the immune anomaly, serum R. A. test (R. A. T.) was carried out on the inpatients during past 3 years.
1) The positive incidence of R. A. T. was 15.1%, 63 out of 418, thereof in liver disease highest 32.1%, 34 out of 106 in blood disease next 29.2%, 14 out of 48, in others 5.7%, 15 out of 264.
2) As contrast, the positive incidence in subjects received health examination was 13 out of 367, 3.5%.
3) In liver diseases, the positive incidence was in the following order: in cirrhosis 16 out of 33, 48.5%, in cancer 7 out of 21, 33.3%, in chronic hepatitis 9 out of 32, 28.1%, in acute hepatitis, 2 out of 20, 10.0%.
It was noted that with the perpetuation of hepatitis, the positive incidence became higher.
4) In blood diseases, the positive incidence was in Banti synndrome 8 out of 11, in idiopathic thrombopenic purpura 2 out of 6, in aplastic anemia 2 out of 7, in malignant lymphoma and acute myelogenous leukemia, 1 out of 6 and 11 respectively, and in multiple myeloma 0 out of 4.
For the occurence of R. A. factor in blood diseases, especially in Banti syndrome, the gammaglobulin anomaly due to chronic active process in liver as in observed in liver diseases may be responsible, however, the autoimmune process which is specific for each disease or case must be considerd.

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During 7 years from 1960 to 1967, we had 26 cases of liver cirrhosis whose diagnosis were confirmed by autopsy. In these cases, Banti's syndrome and the cirrhosis due to heart failure or extrahepatic obstruction of the bile duct are excluded. 24 cases are male and 2 are female, Of 26 cases, 14 are accompanied by primary liver cancer. The age range extends from one year to the eighties with its highest frequency showing in the fifties in cirrhosis without cancer, but with cancer the age is from forty years to the sixties. 67% of the cases has a history of drinking habit. Average duration from initial symptom to death is two years and three months in cirrhosis without cancer, but it is ten months with cancer. At the stage near death, serum bilirubin increases in 30% of cases of cirrhosis without cancer and 80% with cancer. Serum protein content of most cases in both groups is maintained in normal level, but A G ratio is less than 0.5 in about 60% of the cases. The ratio shows no difference between the both groups. Moderate increase of serum glutamic oxaloacetic transaminase activity and glutamic pyruvic transaminase activity are found in most cases and there is a tendency that the titer of S-GOT is fairly higher than that of S-GPT in cirrhosis with cancer. Alkaline phosphatase is in normal limit in half of the cases of cirrhosis without cancer but it increaes in all cases with cancer. Average weigh of the liver is 1078g in cirrhosis without cancer but 2, 514g with cancer. 12 of 14 cases of cirrhosis with cancer are portal cirrhosis, but as a whole 6 cases are postnecrotic and 20 portal. 13 cases are hepatoma and only one is cholangioma. For reference, average weigh of spleen is 223g in cirrhosis without cancer and 212g with carer.
There are some special cases:
Cases 1. Male aged one year and three months. He had jaundice on birth. Autopsy showed portal cirrhosis accompanied by fatty degeneration.
Case 2. Female aged 21 years. She was suffering from liver disorder for four years and finally died from vaginal bleeing just after delivery. Autopsy showed portal cirrhosis.
Case 3. Male aged 65 years. He was suffering from liver disorder for one year and a half and during the course of illness he had an attack of unconciousness. Autopsy showed hepatolenticular degeneration of Inose type, which is typified by Alzheimer II cells in the brain and portal cirrhosis of the liver.

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With clinical observation of subjective and objective symptoms as well as laboratory examination of the hepatic dysfunction, we carried out quantitative measurement of blood ammonia along the course of treatment.
The result acquired as follows:
Clinical picture improved when blood ammonia level decreased.
On the contrary, in the case of no clinical improvement blood ammonia always increased gradually.

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We think that the definite diagnosis of cholelithiasis should be done by recongnition of stone-shadow through rentgenographic examination, especially by cholecystography.
Unsuccessful cholecystography is not infrequent, so in such cases rentgenographic examination is not powerful.
We could make definite diagnosis of cholelithiasis by recognizing stone echo wave through Ultrasonic Diagnostic Apparatus.
Upon 31 cases of the operated cholelithiasis, we had done ultrasonic diagnosis before surgery. Through comparison ultrasonic diagnosis with operative findings, we found Ultrasonic Diagnostic Apparatus was useful to make definite diagnosis of cholelithiasis.

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In these four and a half years, since our hospital started, seven cases of gastric submucosal tumors were operated.
These cases were as follows:
Case 1. I. N. 30y/0 male, aberrant pancreas (Fig. 1, A∼G).
Case 2. E. K. 44y/0 female, parasitic granuloma (Fig. 2, A∼F).
Case 3. M. M. 37y/0 male, neuroma (Fig. 3, A∼F).
Case 4. K. O. 59y/0 female, leiomyoma (Fig. 4, A∼E),
Case 5. R. S. 47y/0 male, leiomyoma+gastric ulcer scar.
Case 6. M. T. 59y/0 female, leiomyoma+gastric cancer in early stage (IIa+IIc).
Case 7. I. Y. 50y/0 male, leiomyoma+gastric cancer (Born. III).
In three cases (case 5, 6 and 7), the bridging folds were not seen in the X-ray pictures, since the tumor shadows were shown in profil.
On the other hand, the bridging folds veers seen in the other cases (case 1, 2, 3 and 4), of which the tumor shadows were shown en face. In case 3 and 4, the shadows of the bridging folds were resembled the peduncle of the polyp so closely that there was difficulty to distinguish the shadows from those of polyps.
The differentiations between bridging fold and peduncle in the X-ray pictures are as follows:
The peduncle as well as polyp shows sharp and clear-cut margin in double contrast study and the base of the peduncle is usually large (Fig. 6 A∼C, ∼Fig. 8A∼C).
On the contrary, the barium shadow of the submucosal tumor and it's bridging fold shows unclear margin, or appears sharp at the inner part of the margin and fades out outwards gradually. The base of the bridging fold is not large.

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A 10 month-old girl having congenital jejunal Stenosis was reported with the dis cussion of diagnosis and treatment.
The case was interesting in the relation of slow development of the symptom and kind of symptom to the age of the patient and to its pathologic findings.

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This is a case report on the ileus due to Pneumatosis Cystoides Intestinalis.
A 72-years-old male patient developed sudden onset and gradual progression of the upper abdominal aching accompanied with nausea, vomiting and distending abdomen. The patient was admitted to hospital with diagnosis of the ileus as emergency.
By laparatomy there was the multiple cysts with gas at any place of the small intestine, particularly they were remarkable at two third of the intestine, about I meter in length, and a part of them was adhesive with abdominal wall and developed ileus as the result. The intestine couldn't be resected because of the patient's serious condition, thus it anastomosed with the transverse colon by side to side.
This disease, Pneumatosis Cystoides Intestinalis, is so rare and is not known the pathologic mechanism. It observed in several article and described the symptom, pathologic physiology, gas content and treatment.

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The sarcomas are rare and interesting tumors comprising 1.1 to 8 per cent of all malignant neoplasms of the stomach.
We experienced only three cases; two of them were leiomyosarcoma and one was reticulum cell sarcoma.
These were discovered among 264 operated patients suffered from malignant lesions of the stomach, at the Kure National Hospital from Jan. 1, 1963 up to the date, and this patients was operated on March 9, 1967. Saroomas of the stomach accounted for 1.1 per cent of the malignant gastric lesions, encountered during this period, and leiomyosarcomas formed 0.76 per cent of 264 malignant lesions of the stomach in this hospital.
The purpose of this paper is to report a case and to show the significance of selective coeliac arteriography in diagnosis of exogastric type of sarcoma. Its angiographic characteristics are; (1) existence of the tumor arising from the gastric wall, (2) large vessels which run on the surface of the stomach are relatively intact, and (3) dominant vascularization in the tumor.

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A 15-year-old female was admitted to our hospital in January 1966, with chief complaints of anemia and abdominal tumor. She was diagnosed as anemia and had been treated by a L. M. D. during few months prior to admission.
On admission, there was severe anemia and the tumor was palpable in the epigastrium, but the liver, spleen and lymphnodes were not.
The laboratory examination: hemoglobin, 40%; R. B. C. 251×10⁴; W. B. C. 4800/cu mm, with a normal differential count; alkaline phosphatase, 3u.; Kunkel, 9.4u.; SGOT, 4u.; SGPT, 3u.; serum total cholesterol, 180mg%; serum total protein, 7.0g%; serum protein pattern, albumin, 43.5% globulin α₁ 2%, α₂ 12.8%, β 19.5%, γ 22.2%, ; there was no finding in urine, occult blood in stool was slighty positive.
An E. K. G. and a chest X-ray were nomal.
X-ray and endoscopic diagnosis were sarcoma of the stomach with multifocus (pyloric antrum and body).
On Jan. 9, 1966, the subtotal resection of the stomach (B II) was performed.
Pathohistological diagnosis; reticulum cell sarcoma without metastasis.
One year later, she looks well and the laboratory examination is within normal.

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