Treatment of fractures of femoral neck by operation is now generally accepted.
Many questions arise, however, especially when the patient is old and, sometimes, debilitated. Among these, two questions appear to be fundamentally important. 1) Is operation more beneficial than conservative means for the patient to survive? 2) Is primary prosthetic replacement for displaced medial fracture always indicated when the patient is old enough?
Literatures are reviewed and our own cases are analysed to get some idea to answer these questions.
The operative intervention for medial fracture is usually less extensive than for lateral (trochanteric) fracture, whereas the conservative treatment for the former is less reliable and needs longer period of recumbancy than for the latter. Hence, medial fractures should almost always be treated by operation. On the other hand, it is sometimes doubtful whether operation is necessarily indicated for lateral fractures. Our statistics on the treatment of lateral fractures show that satisfactory result could be obtained by conservative means provided a meticulous care for general condition of patients is afforded.
Primary prosthetic replacement is now getting increasing popularity in treatment of displaced medial fracture which is notoriously haunted by late complications……nonunion and avascular necrosis. However, it is apparent that the prosthesis cannot be a complete substitute of living bone. The indication for this procedure should more strictly be limited. Old age alone does not appear to justify indiscriminate use of the prosthesis. It seems necessary for us to try to decrease the occurence of late complications rather than to abandon to fix the fracture.

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In surgical area the antibiotics have been usually given to patients after operation to prevent the postoperative infection. In the present study, the relationship between the antibiotics prophylactically given after operation and the etiological organisms of postoperative infection was analyzed to re-evaluate the significance of the prophylactic use of antibiotics after operation.
Postoperative tracheobronchitis and pneumonia were caused by Str. viridans, Neisseria and Str. anhemolytics, and the majority of wound infections by E. coil, Klebsiella, Enterococcus and Staphylococcus aureus. Biliary tract was infected by E. coil and Enterococcus, and urinary tract by E. coil, Klebsiella and Pseudomonas aeruginosa. All of the etiological organisms of postoperative infections were resident flora. In addition, the organisms were resistant against the antibiotics given after operation. Thus, the antibiotics given to the patients after operation might not prevent postoperative infection but might select the resistant organisms from resident flora.
Therefore the practical use of antibiotics after operation should be reconsidered. It is more important to made an effort for early diagnosis of postoperative infection and for immediate use of the most efficient antibiotics.

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Ninety-five out-patients with neurotic disorders, recently visited this clinic, were examined and analyzed by questionaire-method to get a general view of the present activity for neurosis.
1. The patient were classified into three grades according to the degree of improvement of symptoms and disturbances of daily life. With the limitations of the observation period more than six months, without distinct classification of various states and other factors, the ratio of recovery including partial improvement were around 80%.
2. Main symptomes found were hypochondrical, anxiety and depressive states with some variations among two sexes. Hypochondrical state in male patients showed generally poor outcomes. The differences of situational influences on these two sexes were also pointed out.
3. Psychotherapy employed by most therapists were based on “acceptance” or “supportive” interview method, and non-directive attitude of them were found more often for the groups of the better improvement than the directive one.
4. Some attempts of the simplified application of systematic desensitization method were tried to find favorable results in some cases, but with still severity in the cases especially with high E-scores of MPI.
5. As well as the group therapy, the participation by the plural numbers of therapists including clinical psychologists and others influences the social image and attitude of patients rather favorably.
6. Increasing numbers of out-patients of neurosis in recent years have caused some practical problems, impeding to spare enough time for patient-therapist interrelations.
Other practical problemes were also discussed.

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The pulmonary function of 55 patients with Duchenne type progressive muscular dystrophy was investigated with distinction of such categories as their age, the curvature of their chest walls and the so-called Disease Grades established by Ministry of Welfare. The movements, due to exercise, of their ventilation and blood gas were also examined.
The results are summarized as follows:
(1) In proportion as the patients grew older, their disease grades and the curvature of their chest walls progressed.
(2) The fall of %VC·%MVV and Pao₂ was caused by the restrictive ventilatory disturbance of their pulmonary function. The older they grew, the worse their restrictive ventilatory disturbance became. The enlargement of their chest wall curvature promoted the development of their pulmonary function disturbance.
(3) The movements of their respiratory muscle force, whose debility gave rise to the low ventilation of their lung alveoli, firstly showed the fall of their inspiratory muscle force, and secondly showed that of their expiratory muscle force.
(4) The patients with Duchenne's DMP, after 13 years of age, went into the group of the disease grades, of which the patients were unable to walk. The pulmonary function of the patients of these disease grades got worse, and turned out to be respiratory failure. When their chest wall curvature was more than 31 degrees and their disease grades were over VII, their %VC decreased below 40% and Pao₂ below 75mmHg. It can be supposed that Paco₂ has a rising tendency.
(5) In the group of 60%>%VC>40%, the increase of their ventilation volume by exercise depended chiefly on their breathing frequency. And the respiration of the patients after exercise changed into a fast and shallow breathing. In this case the fall of Pao₂ and the rise of Paco₂ were found out.
(6) It can be thought that the changes of their pulmonary function for the worse are shown by the disease grades, which can be considered to be an index of debility of the muscle force of bodies, legs and arms. Considering that a group of patients above VII in the disease grades are in a state of chronic respiratory failure, with respect to their respiration good medical care should be taken of these patients. Regarding the V-VI grade, in which their inspiratory muscle force starts to decline, as a previous stage to respiratory failure, we should deal with the patients especially with care.

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A clinical and electroencephalographic study was carried out on 17 cases of presenile dementia, along with pathologic investigation of 7 cases.
1) Clinically they were classified into 4 groups.
Group I: early development of optico-spatial disturbance followed by aphasia.
Group II: early deterioration of personality with aphasia.
Group III: early deterioration of personality, without clear focal symptom.
Group IV: complexed form of optico-spatial disturbance and aphasia, with personality alteration.
We diagnosed Group I as Alzheimer's disease and Group II and III as Pick's disease, since their clinical aspects suggested the parieto-occipital lesion in the former and the temporo-frontal lesion in the latter. However, Group IV was difficult to be differentiated.
2) EEG investigation divided our cases into two types. In the first type alpha activity lasted as a dominant rhythm until the final stage.
In the second type alpha activity diminished in the early stage, and large slow wave rhythm (2-4c/s, 100-150 microvolt) dominated later.
All the cases of Group II and III belonged to the first type, and all the cases of Group I to the second type. Group IV was equally divided into two types (2 cases each). Differential diagnosis of Group IV might be possible electroencephalographically, in analogy to Group I to III.
3) The result of pathologic investigation was in accordance with the clinical and electroencephalographic differentiation between the two diseases.

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We found factors leading to psychiatric hospitalization were in social transformations, antisocial behaviours (wandering, accidents with fire etc.) and intellectual disabilities (dementia, incontinence etc.) of these senile patients.
This comparative inquiry are connected with factors between hospitalization and discharge of these senile psychotic patients (65 year over).
Finding of this inquiry were as follows:
1) Most of symptoms of discharged patients was organic brain syndromes as cerebral arteriosclerosis or senile deterioration etc.
2) Most factors of discharge were improvement or disappearance of antisocial behaviours.
3) Some difference was in factors of discharged patients between improved group and deteriorated group.
We are purposing to make more observations of details, and to increase number of improved group in these discharged senile patients in the future.

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The serum haptoglobin types and levels in 27 patients with senile dementia were studied by means of polyacrylamide gel electro- and immunoelectrophoretic method.
Haptoglobin 1-1, 2-1 and 2-2 phenotype were 11.1%, 40.8% and 48.1% respectively.
Haptoglobin 1 gene frequency was 0314.
Our comparison of senile dementia with healthy Japanese in several areas reveals no evidence of significant differences in the incidence of the genetically determined serum haptoglobins.
Haptoglobin levels in serum of senile dementia seems in normal range.

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A 32-years-old lady was hospitalized showing with C.C. of cough, sputa and fever. The patient showed infiltration in her both upper lobes, high eosinophilia (31%), leucocytosis (13, 800/mm³), acceleration of E.S.R. (116mm/1hr.) and obstructive ventilatory failure. She was treated with SM+INH+PAS for 2 months and thereafter with CPM+INH+PAS for 2 months. The infiltration in the lungs disappeared completely after 3 months. She showed the strongest reaction to tuberculin prepared from Mycobacterium scrofulaceum among tuberculins of M. tuberculosis, M, scrofulaceum and M. intracellulare. The case was considered to be Loeffler's syndrome.
The present case suggests that Loeffler's syndrome (pulmonary eosinophilia) may be caused by M. scrofulaceum.

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Polycythemia is a rare disease in Japan, and gradually increasing recently. We experienced a case of polycythemia vera complicated with low diffusion capacity of the lung. The patient was 59-years-old woman, and visited our hospital complaining of erythromelalgia. This patient fulfilled many criteria of polycythemia vera. Treatment was done with pipobroman successfully without side effect.
Thrombosis is a most common complication in polycythemia vera, and most common cause of death. This patient accompanied peripheral thrombosis in left hand. Pulmonary function studies showed low diffusion capacity of the lung. Many authors said that thrombosis of the alveolar capillaries induce the decrease of diffusion capacity of the lung.

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Seven house-holds, except father, have developed leprosy in one family which consisted of eight house-holds in a certain village.
The village is located in the northern part of Okinawa and It's Leprosy Prevalence Rate is 6.9%.
These cases have been detected by examination of house-hold contacts. The contact tracing should be emphasized in leprosy case-finding program.

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Survivorship of 70 cases of inoperable primary lung cancer was studied. Results were as follows:
1. Adenocarcinoma was 44 percent and squamous cell carcinoma was 37 percent. In recent years small cell carcinoma inclined to increase.
2. Cytologic diagnosis was obtained from sputum in 53 percent of 70 cases. Others were diagnosed by means of transbronchial currettage, biopsy of metastasis or puncture of pleural exsudate etc.
3. Cases received chemotherapy and radiation therapy survived markedly longer than those without therapy.
4. Shortness of the interval from initial symptoms to treatment could not always contribute to the survival time. Several cases treated long after onset of initial symptoms survived very much longer, suggesting the relationship of potency and sensitivity of tumor to treatment and immunological capacity of individuals.

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Lately we often encountered chronic respiratory failure which had cyanosis, polycythemia and right cardiac failure. In this paper we discussed about arterial gas analysis and hematological examination in those two cases on acute phase and on chronic phase.
Then autopsies were performed. They revealed fundamental findings about respiratory failure. They were supposed restrictive ventilatory disturbance in the first case and obstructive ventilatory disturbance in the second case.
For the discussion about polycythemia, we calculated red corpuscular indices and mean corpuscular constants.
At polycythemic state, color index, saturation index and mean corpuscular hemoglobin were distinctly decreased on both cases.
Arterial gas analysis disclosed hypoxemia about 40mmHg to 60mmHg in spite of adequate supply of oxygen in both cases. Then we concluded that this fact indicated the worse prognosis. In the first case, latter half course at acute exacerbation was setted limits to chronic respiratory acidotic significance band in figure 2. But his acidotic edematous and somnolent state was not improved. His electrolytes were examined at the same time, and cloride concentration was slightly low, but potassium concentration ranged almost normal limits.
In the second case, [BE] and Pco₂ related each other, but hypocapnia caused the state outward from chronic respiratory acidotic significance band in figure 4. On this case renal insufficiency probably influenced to this state.
From the autopsy and spirometry, we guessed that the first case had restrictive ventilatory failure and the second case had obstructive one. But arterial gas analysis revealed the former had “hypoxemia with hypercapnia” and the latter had “hypoxemia without hypercapnia”.

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In the past 12 years, 510 specimens of the soft tissue tumors had been extirpated at the 2nd Tokyo National Hospital, Among them, histology proved to be 487 benignancies and others were malignant, which consistted of 4 specimens of fibrosarcoma, leiomyosarcoma, dermatofibrosarcoma and synovial sarcoma groups, 3 ones of rhabdomyosarcoma and neurogenic sarcoma, 2 ones of series of liposarcoma and angiogenic sarcoma and an undetermined one.

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With the recent progress of therapeutic medicine, positive etiological therapies are being administered even to incurable diseases which were formerly left to mere symptomatic therapies.
In this respect, it is important to improve the environment under which to treat these diseases in parallel with the development of novel therapies and therapeutic agents.
Particularly, in the treatment of abnormalities in the hemopoietic organs which bring about general hypoimmunity, that is, leukemia, malignant lymphoma and other diseases, bacteriologically clean environment is indispensable so as to protect the state easily susceptible to infection in such diseases.
The present paper described the actual state of medical care we are presently providing to these blood diseases and hypoimmunity and at the same time discussed how the hospital ward, an environment under which to treat these diseases should be improved in the future and what medical treatment should be conducted in there.

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