Forty-four cases of radical or palliative operations for the cancer of pancreas are collected and analized during recent ten years period at the Mito National Hospital.
We rather perform radical operation than palliative procedure, but it is very difficult to overcome the various problems of pancreatico-duodenectomy for the cancer of the head of the pancreas.
Courvoisier's sign and severe jaundice are always seen in the case of cancer of the head of the pancreas, because of obstruction of common bile duct by neoplasm.
Abdominal exploration reveals the significant stasis of portal vein and it is necessary to;confirm the diagnosis and determine resectability.
These portal vein stasis and severe jaundice cause hemorrhagic tendency and huge bleeding prevents the progress of operative dissection and the fare of portal vein replacement discourage the operator to carry out the pancreatico-duodenectomy. These are the reason why the resection rate of this operation is very poor such as 20% or so. The first trial to improve the poor resectability is to decompress the portal vein initially.
This procedure has the remarkable advantage to perform the pancreatico-duodenectomy. One is clear to determine the resectability because of complete separation of portal vein, another is to realize the remarkable decrease of bleeding by portal decompression. That is why our rate of resection become very high such as 826 in these 4 years.
In all of 28 cases except one, cancer invasion directly to the portal vein wall is not observed. This means most of the cases may be able to resect the head of the pancreas without portal veinn replacement.
Next problem concerned reconstrution is how to prevent the leakage from the part of pancreatico-jejunostomy caused auto-digestion by activated pancreas juics. We lost several cases owing to eritonitis from this anastomosis. Results of our clinical studies, the most important factor to prevent the leakage from this part, are to put the external drainage into the main pancreas duct as shown in atlas. After these procedure, leakage is not seen in all cases.
The third problem is concerned about the total pancreatectomy. Our experience is 3 cases. 2 cases died, another is alive more than one and a half year. He is controlled well by insulin and pancreatin. And his social work is active more than one year. That is why we prefere to recommend the total pancreatectomy.
Over the 3 years survival rate of pancreatico-duodenectomy is very poor, because the radical operation may be impossible owing to difficult early diagnosis.
So, if one expect radical operation, total pancreatectomy must be much better than pancreatico-duodenectomy, because of more radicality and safer surgical risk.
Conclusion;
1. It is recommended to separate the portal vein at first stage of operation to confirm resectability and to reduce portal vein stasis which is inhibiting factor to perform pancreatico-duodenectomy.
2. It is the most important factor to prevent the leakage from the pancreatico-jejunostomy to put the complete external drainage of pancreas juice by canulation into the main pancreas duct.
3. We are planning to perform the total pancreatectomy more often in near future and further biophysiological investigation after total pancreatectomy.
4. Pre- and post-operative management are discussed.

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The isoenzyme fraction activity was investigated in the serum of 12 patients, who were 5 primary carcinoms of the liver and 7 secondary metastatic (gastric origin) carcinoma of the liver.
The serum of all patients with primary carcinoma were found to contain α-feto-protein by the micro Ouchterlony's technique. On the other hand, the tissue isoenzyme patterns of LDH in liver, tumor and human fetus were studied.
In the present investigation, cellulose acetate electrophoresis and elution techniques were used to test for LDH-isoenzyme activity.
The average composition of the serum on 24 healthy students was found to be 23.9±3.8 (SD), 27.1±5.1, 20.3±4.4, 13.3±8, and 13.4±3.4, % of the total activity present for LDH 1, 2, 3, 4, and LDH5 respectively.
Mean values (96) of relative activity for LDH_4-5, obtained in the present study, for each group of patients were serum in patients with primary carcinoma, 18.3±2.4 (SD), 31.1±4.3, 19.9±2.9, 11.3±4.8 and 18.7±3.2 and serum in patients with metastatic carcinoma, 14.5±5.2 (SD), 31.4±6.5, 27.7±5.4, 17.3±4.5, and 9.2±5.8. The serum of patients with primary carcinoma showed a characteristic isoenzyme pattern, with a reduction in LDH₁ and a significant increase in LDH₅ and LDH₅, in four of five patients, in excess of LDH₄ to yield a ratio of LDH_{5: 4}>0.90.
In the serum of patients with metastatic carcinoma also showed a characteristic isoenzyme pattern, with a reduction in LDH₁, a significant increase in LDH₃ and LDH₄ and LDH₄ in excess of LDH₅ to yield a ratio of LDH_{5: 4}<0.85. In both primary and metastatic tumor tissues LDH₃, LDH₄ and LDH₅ were the more prominent isoenzymes, whereas in foetal tissue LDH₃ is the most prominent isoenzyme.
This investigation shows that determination of the LDH_{4: 5} ratio and relative activities in LDH₁, LDH₃, LDH₄ and LDH₅ clinically useful in differentiation between primary and secondary carcinoma of the liver.

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Usually the umbilical cord is clamped after pulsation. We studied the meaning of this clamping time. Hematologic examination was done in four hundred healthy full term infants after the cord was clamped at different time intervals after birth. And follow-up study of frequency of anemia was done during the first three months of life.
All mothers received intravenous Methergine injection (0.2mg) after the birth of the infant's head. The infant was placed about 25cm below the mid of introitus of vagina.
Early clamping of the cord may lead to an iron deficiency during the first three months of life. And so it should be avoided.
But it is not necessary to wait cease of pulsation. The umbilical cord may be clamped after crying of the baby.

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A fatal case of Strongyloides stercoralis is presented. A 56-years-old man developed vomiting and abdominal distension. A diagnosis of ileus was made and laparotomy was performed, but two days after the operation he died.
At autopsy numerous larvae were found in the gastro intestinal tract and invaded the wall of the small intestine by penetration the mucosa of the crypts of Lieberkahn. The larvae in the submucosa generally were transformed into the filariform type. In addition the filariform larvae were found in the lungs, trachea, bile ducts, mesentery and lymph nodes. The larvae caused the formation of numerous tubercle-like granulomas. The accompanying severe pulmonary hemorrhage appeared to be the immediate cause of death.

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The author reported 14 cases of thoracic aortic reconstructions. Ascending aneurysm was reconstructed I case using extracorporeal circulation, however, 2 cases of Arch aneurysm were unsatisfactory. 7 cases of descending aorta were reconstructed using mild hypothermia. The traumatic rupture of descending aorta was involved. Especially, dissecting thoracic aneurysm is one of the difficult operation. These operative procedure was discussed.

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We introduce our nasal allergy clinic through 67 cases we could ovserve from Jan, to June'67.
When allergen was discovered we chose hyposensitization (most of them were house dust) with rather good effeci. When allergen could not be found, we tried to use Histaglobin about 10 cases. But the drug seemed to be not of f ectiv.
When the attack is severe, in many hospitals Vidian Neurectomy is tried but this operation is rather difficult and so we tried ganglion block using fenol or alcohol. We injected the drug from foundation of middle turbinate in Fossa pterygoparatine and it inhibited nasal allergy attacks more than 6 months and side effect was negligeable.
For children or seasonable nasal allergy patients, we tried to use Disodium Cromogricate (Intal) spraying in nasal cavity, and recognized some results.

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In this hospital, about 20% of large volume solutions intended for intravenous administration in all parenteral injections were employed procedure. About 85% of these solutions were combinated with one or more drugs, and abost 20% of these admixtures were combinated with antibiotics.
We studies on incompatibility of 6 large volume intravenous solutions containing 5 antibiotics plus 10 additives. The test were visual examination and pH determination. In addition, bioassay were made about each solutions containing cephalothin sodium.
The results were as follows
1) Visual examination: we observed colour change in combination with aminoacid prepa rations and vitamin B₂, also in combination with vitamin B₂ and vitamin C. We did not observe the change of appearance in other drugs.
2) pH: the pH of large volume intravenous solutions mixed with additives and antibiotics indicated different degree according to each drug combinations, but the more combinated kind of drugs, the more pH variation decreased and indicated approximately constant. The pH of aminoacid preparations showed constant at every drug combinations.
3) Microbiological assay: the remarkable decrease of availability by drug combinations were not found in all of the solutions containing cephalothin sodium. Here after we intend to investigate antibiotic availability.

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