From April, 1967 to March, 1970, 372 cases of vascular diseases were treated at Department of Cardiovascular-surgery of National Fukuoka Central Hospital, Fukuoka City. Vascular trauma was 11 cases, aneurysm was 26 cases and arterial occlusive diseases were 121 cases.
Surgical indication, operative procedures and follow up results were discussed about anomaly of vessels, pulseless diseases, coarctation, aneurysm, vascular trauma, arterial occlusive diseases, phlebothrombosis, varicose veins and angiodysplasia.
This paper was presented on the 24th National Hospital Congress at Fukuoka

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In the first place, general explanation of quantitative ultramicroanalyses will be given, and the basic procedures such as blood collection, pipetting, etc, are discussed. Next the future problems will be stated and finally actual examples of the analyses which were made in this hospital are displayed. (1) Explanation of quantitative ultramicroanalyses.
1. In the field of clinical chemistry, quantitative ultramicroanalyses are defined as an assay method which is carried out by using samples of 0.1ml or less, and routine tests have been already practised on this scale, and its necessity has gradually come to be widely appreciated.
2. There are various methods for this analyses, and the most ideal one is micromacro method which is done by using sample of ultramicro quantity and reagent of regular quantity.
3. In order to obtain a result of high precision, it is desirable that deproteiniztion should be avoided and the whole process must be completed in one test tube.
(2) From blood collection to separation of serum.
1. When the blood is collected from the sole of a foot by a capillary tube, the value of the chemical composition of the serum is almost the same as that of blood collected from cubital vein by an ordinary syringe.
2. As to potassium and lactate dehydrogenase, in most cases, the value is rather high in the blood collected by a capillary tube, and it is assumed that hemolysis and also mixing in of tissue fluid cause this.
3. Even in the case of blood collected by a capillary tube, the value of blood sugar became gradually low by the time of separation of serum unless the capillary tube had been coated with sodium fluoride. (3) Pipetting
1. It is desirable to collect sample and standard solution with the same pipet, and the viscosity and temperature should also be the same.
2. The contents of the pipet should be so completely blown out that no droplet is left on the inner surface of the pipet and one must be careful about the speed of blowing and using a clean pipet.
(4) In case of colorimetry.
When the amount of sample used for colorimetry is small and still a measurement of high sensitivity must be obtained:
1. Use microcuvette devised not to shorten the light path.
2. It is necessary to measure with light of narrow band width. (5) Future problems in quantitative ultramicroanalyses.
Generally speaking, as ultramicroanalyses progress, the precision of the test tends to drop. But this problem can be overcome by improving the method and mechanizing the tools and processes. The ideal aim is in the complete automation of ultramicroanalyses, and for the time being, our hospital introduced semiautomatic quantitative ultramicroanalyses of urea nitrogen and alkaline phosphatase using EEL Auto Chemist.
(6) Examples of quantitative ultramicroanalyses. Also the outline of examples of quantitative ultramicroanalyses which were discussed in our hospital were given: they were: Lactic acid (enzymatic colorimetry) Pyruvic acid (enzymatic method) Total bilirubin (fluorometry) Galactose (indirect and direct enzymatic method) Indocyanine green (ultramicro-colorimetry) Fibrinogen (nephelometry)

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The changes in blood pH, Pco₂, plasma bicarbonate and the electrcencephalogram were evaluated in 67 studies of 35 patients with uremia due to acute and chronic renal failure.
The pattern of the electroencephalogram frequencies has been quantated by the method of Kiley and Hines, all of whom were studied by serial electroencephalogram.
As uremia became worse, the electroencephalogram became abnormally slow. When uremia was relieved by recovery of renal function or by effective therapy, the electroen-cephalogram returned toward normal, but blood chemical leveles, blood pH, Pco₂ and plasma bicarbonate did not run parallel with. Our experiences suggest that the presence of slow activity less than 7 cps in 30 per cent of the electroencephalogram indicates need for peritoneal or hemodialysis.

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A considerable amount of research has been reported on clinical symptoms of gastric cancer, but little work has been done to study the relation between its symptoms and pathological findings. We studied on the relation of chief complaints to the size, the gross appearance, the location of tumor, the stage of cancer progress and to the acconmpanying gastritis of the resective stomach in the gastric cancer cases.
Five hundred forty eight gastric cancer cases operated during the last five years comprise the substance of this study.
The results obtained are summarized as follows:
1) Some gastric complaints (i.e.; nausea, epigastric discomfort, bloody vomiting, epigastric pain) was complained in 419 (81.1%) out of 513 cases and some general complaints (i.e.; anorexia, anemia, lassitude, emaciation) in 101 cases (19.7%), and also no pain in 52 cases (10.1%). The rate of appearance of the complaints was slightly increasing with the progress of lesion.
2) The chief complaint was independent of the size of the tumor. In the cases in which the tumor was located in the antrum the rate of appearance of complaints was higher than the others, and also epigastric pain more marked in the cases of gastric hyperacidity, but gastric complaint was independent of the Borrmann's classification.
3) The metaplastic severe atrophic gastritis was observed in 31 (45.6%) out of 68 cases and no gastric finding in 10 cases (14.7, %). There was no significant correlation between the chief complaints and the accompanying gastritis of the resective stomach.
4) Among 35 cases of the early gastric cancer, 22 cases (63%) complained gastric pain, but all cases complained no general symptom.

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Lumbar discogram is very useful as the method of deciding the surgical technic. We attempt to class the discogram by 6 types and introduce the surgical method by those type.
The materials are 89 cases.
1. Form I (relief type): This picture makes an outline of the herniated nucleus. 10 cases (1100) are ranked in this form, and partial herniotomy are indicated.
2. Form II (tear type): We can see the stricture between the original nucleus and the herniated tumor.
9 cases (10%) are ranked in this type, and isolated removals are indicated.
3. Form III (degenerate-type): A very degenerated and flat nucleus accompanys this type.
33 cases (33%) are ranked in this type, and subtotal discotomy are indicated.
4. Form IV (short tail-type), : There is a short tail behind the normal nuclear picture. 16 cases (16%) are ranked in this type, and partial herniotomy are indicated.
5. Form V (false negative): Normal nuclear picture is only seen.
16 cases (16%) are ranked in this type, and partial herniotomy are indicated.
6. Form V (dorsal moved type): Almost normal nuclear picture modes posteriorly.
5 cases are ranked, and are eruptively removed.

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We examined the indirect dermadrome which had changed for the worse due to diabetes and skin disorders as is seen in the secondary diabetes.
Reactive skin disorders (eczema, dermatitis etc.…), fungal, bacterial and viral skin infection were seen very frequently.
We discussed the skin manifestation as is seen in the secondary diabetes, e.g. haemochromatosis, Cusing syndrome and steroid diabetes etc.… and we also discussed the skin manifestation as is seen in the special type of secondary diabetes, e.g. Werner syndrome, porphyria, Miescher syndrome, Morgagni syndrome, Tunner syndrome and Seip-Lawrence syndrome etc….
Hence to study the characteristics of these indirect dermadromes are most important for discovering diabetes.

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In recent 10 years many cases of subacute myelo-optico-neuropathy following abdominal symptoms (so-called SMON) in Japan were found and discussed as a topical problem.
We experienced a case of SMON which is described and discussed about causative factors, pathological findings and etc.
This was a 42-years-old female patient, who had been suffering from psoriasis which had been treated with adrenal cortical hormon for 15 years.
She complained of abdominal aching, diarrhea or constipation since May, 1967, ar. d 6 months later she developed numbness of both lower extremities and difficulty of walking which had been persisted for 2 years. She died of fever and delirious state with sudden onset.
Autopsy findings:
In spinal cord there were pseudosystemic, symmetrical, non-inflammatory and demyelinating changes confined mainly to the dorsal column of cervical and upper thoracic cord (specifically involved funiculus gracilis) and there were slight changes in lateral column of lower thoracic and lumbal cord.
In midbrain and spinal cord there were accumulation of corpora amylacea, accumulation of lipofuscin granules of nerve cells, and Marinesco's bodies abnormally increased from her age.
In cerebral cortex atrophy of nerve cells with gliosis were noted slightly.
This case is considered as an atypical case of SMON, because of luck of visual disturbance and non-pathological change of optic chiasm.
As the causative factors of SMON, metabolic disturbances, viral infections (Coxachie A, Echo 21 or slow viral infections etc.) and intoxications (particulary Chinoform intoxication) are considered and discussed, but no definite relationship is found at present.

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The cause of postcholecystectomic syndrom is still unknown. The purpose of this report is to clarify this question.
As the method of investigation, Pancreozymin Secretin test were done in 18 cases with postcholecystectomic syndrom. The results were compared with that of case with pancreatitis, gastritis and cholelithiasis.
The following results were obtained:
The moderate decrea of HCO₃ concentration was found in most cases with postchole-cystectomic syndrom. In some cases HCO₃ concentration decreased to 60mEq/L.
From these results it was concluded that the patient with cholelithiasis, even after cholecystectomy, showed decreased pancreatic function and this fact might be related with postcholecystectomy syndrom.

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We induced unilateral pulmonary function test by means of devided ventilation using carleus tube.
The following results were obtained.
1) Decrease in pulmonary blood flow on pulmonary tuberculosis was demonstrated by lung scintigram method using ¹³¹IMAA.
2) The response occured in some definite conditions. It is a useful complementary method of the roentgen-diagnosis of thorax.
3) Regional vasoconstriction in hypoxic lung area reduce the pulmonary blood flow.

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For the purpose of studying the clinical effect of the analgesic, sedative and antiemetic actions of hydroxyzine administered postoperatively the author conducted three series of clinical trials from January, 1968 to March, 1970.
As the result, it was found that, in the case of the operation of the stomach, a combination of hydroxyzine with a narcotic is desirable, while in the case of the gallbladder, kidneys, uterus and other organs the use of a non-narcotic analgesic brings a greater analgesic effect, and at the same time the nausea and vomiting can be inhibited better.
On studying of the differences of pain caused by the variety of operating methods on stomach and gallbladder, the difference was observed on the latter. Continuous administration of hydroxyzine during and after operation showed its favorable effect regarding to the postoperative analgesic effect. Furthermore, combined use of hydroxyzine with analgesics, told us the possibility of saving the doses of combined analgesics.

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