Here is described the fundamental and clinical problem of electron therapy on the basis of the author's experience and research concerning the electron therapy by means of Siemens 18MeV Betatron and Toshiba 13MeV Linac since July of 1963.
1. Development of electron therapy techniques: The explanation covers the methods and features of 6 kinds of therapy techniques which have been developed by us in order to make the best use of electron therapy and to cover up its demerits.
2. Results of electron therapy: The 670 cases of electron therapy by Betatron and Linac are classified according to the diseases, and the results are studied to find out the problem of electron therapy of each disease.
3. Features of electron therapy: 7 points of clinical features of electron therapy are summarized. Here is combined our clinical experience with the existing theories.
4. The electron therapy is limited comparatively to the superficial disease, but it proves to be more effective than the conventional radiation therapy.

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The management of medical records in Japanese hospitals are divided into three types: (I) centralized management system medical records are collected into the medical record office and statistics are made there; (II) central storage system …medical records are collected into the medical record office, but statistics are not made; (III) storage system by each division of clinical services…medical records are not collected into the centralized medical record office but stored separately in each clinical division.
Table 1 shows the change in the percentage of the patterns of the management of medical records among the mentioned three types between 1904 and 1970. As shown in Table 1, the percentage of the hospitals with type (I) has increased, whereas that of the hospitals with type (III) has decreased. As regards the technics used in the management of medical records, most hospitals rely on manual procedure, and some hospitals use simple machines like card-sorter or card-selector. But it seems to be new trend that some groups of hospitals under the same administration use jointly one computer of the EDP service center to accomplish statistics from case abstracts of medical records.
Five influential factors on the improvement of the management of medical records are supposed to be as follows:
1. Increased necessity of clinical information system for comprehensive patient care in each unit hospital
2. Increased importance of medical records as fundamental data of hospital administration and clinical care administration
3. Recognized importance of medical audit in hospital
4. Recognized necessity of community hospital program by each hospital
5. Increased necessity of the efficient feed-back system of clinical data to the medical research
The following policies should be implemented to improve the management of medical records
1. Establishment of authorized education for medical record librarians
2. Legislation of the qualification and registration of medical record librarians
3. Establishment of a centralized medical record office in each hospital
4. Establishment of a hospital medical care information center in the national level
5. Introduction of a central dictation system into hospitals
6. Establishment of scientific research program based upon discharge data reports.

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From January 1969 to March 1971, 102 patients of diabetes mellitus, of which 53 are male and 49 are female, were studied from the points of view as shown below.
(1) Disturbance of liver function are found in 23 cases (22.5%).
(2) The types of disturbance of liver function are as follows Chronic hepatitis 20 cases
Liver cirrhosis 2 cases
Occlusion jaundice 1 case

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We have used Prostaglandin (P) and Oxytocin (Ox) comparatively for induction of labor.
P and Ox were applied to primi para or multi para after 39 weeks gestation respectively.
(P: 51 cases) (Ox: 211 cases)
(Method)… in numerical order
1) one Delivarin tablet, 3 times, one each hour.
2) soap enema: 500ml.
3) 1, 000mmg P or 10 i. u. Ox in 5% dextrose solution, dripped at the rate of 40 drops a minute.
4) after labor pains induced and water bag distended, artificial rupture of the water bag was done.
(Result)
1) There is no difference between P and Ox on duration of delivery, numbers of asphyxia of new born baby and obstetric operations such as cesarian section, vacuum extraction and forceps delivery.
2) In case of using with P, bleeding volume in 3rd stage of labor is less than Ox with primi para.
3) Pattern of labor pains induced by P is more similar to natural than Ox's.
4) P is more effective to soften unripe hard cervix of uterus than Ox and more useful to primi para.
(Discussion)
From results above described, it is suggested that P without abnormal contraction works more naturally on uterus thank Ox and works to unripen and harden cervix of uterus effectively; thus using P with primi para, many profits can be expected.

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From May 1962 to April 1071, 410 lung resections for primary lung carcinoma have been carried out. One hundred and sixty cases of these were resected more than 5 years ago.
The following results have been obtained from these resections.
1) The 5-year survival is 26.4 per cent of all resected cases, excluding operative deaths, and 54.4 per cent of patients who underwent curative operation.
2) The mortality rate within 30 days of resection is 5.6 per cent in the total series. Operative mortality is mainly related to type of resection (13.0 per cent after pneumonectomy, 2.4 per cent after lobectomy).
3) Concerning about :surgical adjuvant therapy, chemotherapy infusion through the bronchial arteries proved comparatively favourable prognosis in the stage 3 group. Preoperative radiation therapy did not show any merit to the results except for Pancoast type tumor or invaded cases into the chest wall. However, it is possible to make the advanced cases to live longer by effective usage of combined treatment of operation, radiation or chemotherapy.
4) The relationships between histologic grouping and survival rate after pulmonary resection were as follows: spuamous cell carcinoma is 404 per cent, adenocarcinoma is 18.0 per cent, large cell carcinoma is 16.7 per cent, small cell carcinoma is 0 per cent. The best prognosis associated with squamous cell carcinoma is due to the highest chance to receive curative operation. On the other hand, the worst prognosis associated with small cell carcinoma is due to the lowest chance to receive curative operation.
5) It was emphasized that clinical stage and histology of the patient are most important factors bearing on the treatment and the prognosis.

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In recent years the number of patients with spinal tuberculosis has been decreased, this is caused by improved preventive measures, widespread use of antituberculous chemotherapy and better surgical treatment
Progress in spinal surgery has been great and the surgical approach to every part of spine has been studied. The most widely accepted surgical regimen which has gained acceptance consists of curettage of the foci of infection in the vertebrae using an anterior approach followed by autogenous bone graft into the curetted area. The author has been using this particular regimem since 1955.
During the past five years, the author has operated on 288 cases of spinal tuberculosis cervical vertebrae, 3 cases; thoracic vertebrae, 57 cases; thoracolumbar vertebrae, 78 cases; lumbar vertebrae, 73 cases; and lumbosacral vertebtae, 77 cases.
The author approaches the region extending from the third cervical to the second thoracic vertebra by an incision along the anterior border of the sternocleidomastoid muscle.
In the thoracic vertebrae, the author prefers an extrapleural approach, since these cases experience less interference with respiratory function than does a transpleural dissection.
In the thoracolumbar region, the author uses the same extrapleural approach, the costai and lumbar fibers of the diaphragm are spread using blunt dissection. The retroperitoneal space is easily entered by reflecting the peritoneum with the fingers.
In the lower lumbar and lumbosacral region, a midline abdominal incision is made and the focus is approached retroperitoneally from the left side. However, when excessive scar tissue surround the infected focus and prevent adequate and safe retroperitoneal dissection, a transperitoneal approach is used.
The surgical correction of kyphosis in the thoracolumbar and lumbar region is possible, but in the thoracic region this is not satisfactory from the anatomical point of view. In surgical correction of kyphosis, the author use Herbert's method via a posterior approach and concomitant focal curettage through an anterior approach.
In paraplegic patients, the anterior radical operation has been carried out. The postopreative results have been well.

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Phototherapy has been performed for prevention and treatment of neonatal hyperbilirubinemia in our clinic since November 1970, In this series 70-group means the patients who admitted from November 1969 to August 1970, on the other hand 71-Group from November 1970 to August 1971. These groups were subdivided to A, B and C which were over 2, 501 gm, between 2, 001 and 2, 500gm, and below 2, 000gm of body weight at birth respectively.
Phototherapy was applied for the patients with 15mg/dl of total bilirubin in A group and 12mg/dl in B and C groups, and it was continued unintermittently until total bilirubin would become below 10mg/dl.
There had been a lot of cases of exchange transfusion for the patients with neonatal hyperbilirubinemia before phototherapy in our clinic. Only one exchange transfusion per month has applied for the patient who showed already hyperbilirubinemia at the time of been admission since November 1970 when we started phototherapy. Kernicterus has not seen in all cases which were treated with phototherapy. There were no differences between 70 and 71 groups in closed hemorrhage and blood incompatibility among A, B and C groups. Remarkable decrease of exchange transfusion in 71 group suggests that the excellent effects of phototherapy for treatment of neonatal hyperbilirubinemia without side effects.

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The retardation of physical growth of C. P. patients are well known. The deformities of the patients' skulls are also common, although those distortions were asymmetrical and probably caused by the changeless postures due to impairments of motor functions of the crippled extremities.
But about the stunted skulls and their particular shapes, except asymmetrical distortion, and if there are any, few seems to be known. So an attempt was made to investigate these points about the C. P. patients being admitted in Aonohara Infirmary, Hyogo, Japan.
Among 88 C. P. patients (46 boys and 42 girls) rigid types were 54 and flacid types were 34, except 8 hydrocephalies and 10 microcephalies which were excluded from the statistics.
Growth retardation of head circumferences were clear, because 85% of the patients had smaller values than the mean values of chronologically 2 years younger children. About the measurements of X-ray figures of the skulls, the height (Z∼M) was most retarded.
Whether skull-shapes of C. P. patients have specific patterns was not yet conclusive. Seventy seven % were brachycephalic (having cephalic index of >81∼85), 45% were hypsicephalic (having vault index of >60) and 24% were dolicocephalic (having cephalic index of <76). (Among brachycephalic children 60% were also hypsicephalic.) There was no corelation between skull shapes and disease patterns.
Sella turcica (size and shape) had no abnormality in C. P. children.

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Attempt were made to evaluate changes of speech and quality and content of play in 18 autistic children aged 4.4 to 10.10 years for periods of time varying six months to six years and two months. As a result, these autistic children were classified into the following three groups. In group A, they could speak nothing or only a few fragmentary words while playing around with objects whose purposes were totally neglected, or just a simple constructive play. In group B, they could play a symbolic play, taking substantial functions of objects into account and speak two succesive words, greeting words and interrogatives. Their speech showed an increasing number of words. In group C, they were interested in a purposeful play and responded to a subject work. Their speech also showed an increasing number of words. These groups corresponded to mental subnormality, organic disorder, and early infantile autism, respectively. They differed also regarding affective contact in personal relationship. In group A, basic cognition of a person was absent and children could respond to a brief momentary contact, but could not keep up with a continuous one. In group B, they came in contact with mother in various ways and showed shyness to a certain person. In group C, they contacted to people indiscriminately and a difference in personal relationship was not always clear, although their cognition was accurate. Their emotional reaction was very weak.
It is suggested on the basis of the above described findings that the children in group A should be educated as possible as we can, under a directive outline which will gradually be narrowed. In group B, they should at first be approached acceptably like neurotic children, and then treated by directive methods. Pharmacotherapy is used in both group A and B. In group C, they should be approached individually in order to detect their own interest, which then leads to multidimensional approaches to children by more than one therapists.
It is proposed that the therapeutic methods should be evaluated at any time regarding nosological prediction after a certain period of time for observation, although many still disagree as to the concept of autism in children.

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The results of study in the IIIrd year period are as follows.
The relationship between the number of cases and consumption of Quinoform
We traced the yearly number of cases of SMON developed during treatment of abdominal symptom and the yearly consumption of Quinoform for 7 years period from 1965 through 1971 at 14 national hospitals in the nationwide scale; i. e. Noboribetsu, Sendai, Tochigi, Chiba, Konodai, the 1st Tokyo, the 2nd Tokyo, Yokohama, Nagoya, Tsu, Osaka, Okayama, Kure and kochi National Hospitals.
a) there is no relationship between the yearly numder of development of SMON during treatment of abdominal symptom and the yearly consumption of Quinoform at each hospitals.
b) although the each national hospital plays the important roll as the center in that district, there were some number of cases of SMON received Quinoform at some other hospital prior to visit us, and on the contrary there were some number of cases received Quinoform at the national hospital but treated by some other hospital, therefore these investigations are unsatisfactory to obtain distinct conclusion.
The effects of additional administration of Quinoform upon neurological state
In the stage after development of neurological signs and symptoms, we inquired about the effect of additional administration of Quinoform upon neurological state in 80 cases.
a) on the occasion of one round administration of Quinoform (26 cases), paresthesia, impairment of superficial and deep sensation, impairment of motor system and impairment of vision, etc. became worse in much cases, though there were still improved or invariable cases in considerable number. Particularly the worsen cases were below half the number among female below the age of the fourth decade
b) on the occasion of two rounds administration of Quinoform, and in the case received below 30gm as initial round (10 cases), aggravation of the neurological symptoms were below half the number, whereas in the case received over 31gm as initial round (5 cases) the aggravated cases were found more to some extent, though these cases were not enough to come to a distinct conclusion.
c) on the occasion of three rounds administration of Quinoform, in the case received below 30gm as initial and the second round (3 cases) the neurological symptoms became worse, and in the cases received over 31gm (3 cases) the neurological symptoms were not aggravated, but these cases were so few that it is hard to be interpreted.
The results of investigation on the prognosis
The prognosis of this illness was investigated on 130 cases, in which generally speaking the male was better to improve than the female, and it might be caused by the higher rate of contraction of the female (the ratio of male to female was 1 to 2.4) and more severe cases found in the female.
Only the rate of improvement of paresthesia was higher in the female than the male, but that is not so well evaluated because this kind of sensation is merely based on the subjective sense.
Speaking about the age, the rate of improvement of symptom is higher below the fourth decade than above that age group.
The rate of improvement concerning the time from the onset of illness, the group within 2 years is higher than the group over 3 years.
The effects of Quinoform on the enteric bacterial flora in mice
The investigations were designed to study the role of enteric bacterial flora on effects of Quinoform given by oral administration. The disturbances of enteric flora and histological alterations were demonstrated in the mice administered perorally with Quinoform 10mg per day, although the striking changes of distribution of enteric bacterial flora and histopathological findings have not been revealed in the mice introduced perorally with Quinoform 3mg per day.
It should be emphasized that qualitative and quantitative distributions of enteric bacterial flora would be associated with development

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Fracture of the femoral neck in five cases of the hemiplegic patients were treated during past one year in our clinic. All cases were operated to osteo-synthesize after the direct extension for several days. These cases were characterized by several points from the same injury of the nonhemiplegic patients, as follows:
(1) All injuries were occured on the hemiplegic side.
(2) The effect of the direct extension was little avail and the reposition of the fragments were hard in according with the spasticity and the muscle rigidity of the lower extremity and the articular contracture of it.
(3) There were always the circulatory disturbance in the hemiplegic limb.
(4) It was difficult to gain the strong internal fixation by McLaughlin nail, Lipmann nail and the multiple pinning being due to the senile, disused and the paralytic atrophy of the bone.
(5) It was not indicated to use the postoperative plaster of Paris and to be bedridden for a long time. It was necessary to enter the rehabilitation program as soon as possible comparing with the non-hemiplegic patients.
(6) All these fractures were united with the tendency of the varus-deformity of the femoral neck.
(7) These accidents were all occured in our hospital during the rehabilitation procedure, overturning beside the bed, colliding against the automatic door of the elevator and sliding on the corridor or on the toilet floor.
(8) The general anesthesia was applied for the operation in all cases.

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A case of lymphosarcoma of the right spermatic cord, a man aged 30, was reported. At the same time lymphosarcoma at retroperitoneal space just behind the stomach was found.
But we could not decide the original focus, because the postmortem examination was refused.

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It is known that INH has side effect for skin, gastro-intestinal organs, hematopoetic tissue and peripheral nervous system. There are no prominent side effect within the dosis of 4 to 8mg/kg except slight headache, dizziness, thirst, exaggeration of tendon reflexes, sensory disturbances and constipation. There are some reports of CNS involvement with experimental animals, but there is few in human, which is only reported by Glaubitz and Shiozaki et al.
This case is a thirty-two-years-old male. During his admission with pulmonary and laryngeal tuberculosis he had much headache, vomitting and fever. He could not take INH per os anymore, then switched to INH injection (100mg) every day. Several hours later he had frequent epileptic seizure, on some day he had about fourty times of grand mall. Besides he had hallucination and delusion especially at evening and night. After cessation of the injection of INH still he had psychotic state in following several months, then appeared affect disturbance (mostly apathetic and euphoric), disorientation and dementia. At present, three years after intoxication, still he has dementia and personality change.
This case is a severe INH intoxication of the central nervous system with status epilepticus and symptomatic psychosis, and later on he showed personality change and dementia.

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I reported a case of the porzellengallbladder experienced recently.
This patient was 68-years-old, and she has closed jaundice by gallstones in papilla and colk bile.
This is a rare disease, in which all wall of gallbladder are calcified.
According to the Niizuma's report, the reported case of the porzellengallbladder is five and the operated case is three in Japan.
This case was accompanied with obstruction of cystic duct and gallstones in choledocus, led to a conclusion that, the cause of gallstone and porzellengallbladder has something in common.
The theory that majority of gallstone is made in the gallbladder, must be correct.

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