Fourteen cases of leiomyoma operated in our surgical clinic during the past 12 years are reported.
Among these cases, 8 cases were located at gastrointestinal area, 1 at lung, 1 at retro-peritoneum, and 4 were at abdominal wall and extremities.
Eight cases were male, and 6 cases were female.
Case 1. 25-years-old female.
She was hospitalized by a solid tumor at her right lower abdomen.
At laparotomy, a fist sized tumor was found at the small intestine.
The tumor was removed surgically, and it was proved leiomyoma histologically.
Case 2. 49-years-old male.
He was hospitalized due to an abnormal shadow by chest X-ray examination.
At thoracotomy, a fist sized tumor was found at the middle lobe.
The tumor was removed surgically with middle lobe resection, and it was proved leio- myoma histologically.
Case 3. 42-years-old female.
Her chief complaint was a solid tumor at lower abdomen with gradual growing.
A fist sized solid tumor was found at retroperitoneum, and it was removed surgically, and was proved angioleiomyoma histologically.
These 3 cases, i. e. leiomyoma of small intestine, lung and retroperitoneum, are thought to be very rare.
As the treatment of leiomyoma, extensive surgical procedure should be recommended, even if the patient has no complaint.

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The glutamic acid in serum in the groups receiving 200 g of γ-ABOB had a high value with significant difference, compared with the value in the groups receiving no drugs.
The following results are particularly noted. The groups receiving γ-ABOB were compared with the non-receiving groups.
In the groups receiving 1.0 g, abnormal excretion of γ-ABOB in urine was not observed, but in the groups receiving 2.0 g/day for a long time, the excretion of γ-ABOB was observed in urine, in which the amount of excretion reaches 1/3 of the given dosage. The positive correlation was observed between the dosage per weight and the amount excreted per weight.
When γ-ABOB is administered to severely handicapped children for a long time for improvement of metabolism of the brain or as an antispasmodics, the amount of the drugs should be accurately determined and careful attention should be paid for the administration, because large amount of γ-ABOB is sometimes excreted in urine, even with the ordinary dosis.

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The epithelial reticular cells of the thymus of human newborn infants were studied by use of the freeze fracture method.
Thymus glands were obtained at postmortem examination from 13 human live-born infants who died with anencephaly (4 cases), premature births of unknown cause (2 cases) and each one case of hydrocephalus, brain hemorrhage, osteogenesis imperfecta, meningitis due to Coxsackie A virus, encephalitis thought to be due to viral infection and meconium peritonitis.
The epithelial cell is characteristic of the thymus as contrasted with other lymphoidorgans, and the ultrastructural features suggest functional activities such as having an important part in the differentiation of thymic lymphocytes.
The epithelial cells are usually irregular in shape with long cytoplasmic processes extending between the neighbouring lymphoid cells. The cell membrane is smooth with a scattering of fine intramembranous particles measuring approximately 80 Å in diameter. The nuclei are larger than that of the lymphocytes and are irregular in shape. The cyto-plasm is abundant with various organelles and various types of inclusions; that is, in the cortex 1) small spherical dense granules measuring up to 300 mμ in diameter with a fairly smooth surface, 2) large irregular saccular membrane-bound vacuoles measuring more than 1 μ in diameter, and 3) moderate sized spherical membrane-bound vacuoles contained fine dense materials and have a scattering of fine granules in the intramembranous surface. These vacuoles were present also in the medulla.
Some of the epithelial cells contained myofibrils in their cytoplasms.
In the medulla the prominent cell type is the epithelial cell.
With the freeze fracture procedure, the epithelial cells in the medulla present several morphological forms. One of the epithelial cell types is filled abundantly with cytoplasmic organelles and inclusions. The other shows homogeneous dense cytoplasm except for dispersed organelles and a small number of inclusions. Furthermore, transitions between these types are present.
The cytoplasm in the epithelial cells in contact with the lymphoblasts are usually homo-geneous with a scanty number of inclusions and organelles.
We counted the number of nuclear pores per unit area of epithelial cells. The density of these is usually higher in the medulla than in the cortex, and in Down's syndrome a number of epithelial cells with a high density of nuclear pores were present.
The phagocyic cells have irregular nuclei and abundant cytoplasm which contain cellular debris and inclusions. Some of them have clustering intramembranous particles in the cell membrane which are usually found in the T-derived cells.

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Early detection of leprosy is one of the most important programs in the modern leprosy control policy. In Okinawa leprosy household contact tracing, school survey, and mass survey have been performed from 1971 as leprosy case-finding program.
Twenty patients have been detected among 664 contacts, 2 patients among 6, 084 students and 3 patients among 2, 116 person in two leprosy high endemic villages. The most highest percentage of early detection is observed in contact tracing program.
Under the recent situation of leprosy in Okinawa, contact tracing is most effective and it should be emphasized in leprosy case-finding program. Mass survey which is combined with other public health survices should be emphasized as leprosy integration program only in highly leprosy endemic villages. School survey is not effective under recent leprosy epidemiological situation in Okinawa.

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This case was diagnosed as VSD with PH. On operation, VSD was not detected, a large PDA was disclosed. PDA with PH is often misdiagnosed as VSD with PH.
We operated under the aid of circulatory arrest for 41 minutes at the venous blood temperature of 20-23 °C to get a non blood field and successfully closed a large PDA with a pacth.
We consider this circulatory arrest method under circulatory cooling is a safe method, if care is taken of circulatory arrest duration and body temperature.

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The authors recently experienced 4 cases in which arteriogram was very useful in diagnosis. Since such cases were very rare, this paper reported the cases referring to some literatures.
Case 1 was a 24-years-old man with mesenterial chylocyst with the chief complaint of an abdominal mass.
Case 2 was a 38-years-old woman with leiomyoma in the cecum with the chief com-plaint of melena. She showed incomplete invagination of the tumor.
Case 3 was a patient with leiomyoma in the duodenum who was preoperatively diagnosed as submucosal tumor in the duodenum by upper gastrointestinal examination, duodenoscopy and superior mesenteric arteriography.
Case 4 was a 25-years-old woman had a history of hydatid mole two years ago. She visited the hospital because of severe melena and anemia. Since the superior mesenteric arteriography revealed tumor vessels and tumor stain in the jejunum, she was diagnosed as jejunal metastasis of chorioepithelioma.

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A Case report of cerebral arterial tortuosity and ectasia with saccular aneurysm is rare. We presented a case of remarkable carotid arterial tortuosity and megadolicho basilar artery with aneurysm of the anterior communicating artery.
The patient was a 49-years-old woman who suffered from initial stroke of subarachnoid hemorrhage. At first, the original site of subarachnoid hemorrhage was assumed from the megadolicho basilar artery, because the aneurysm of anterior communicating artery was failed to notice by the exaggerated elongation of bilateral C₂ and A₁ portions. At last, the aneurysm was discovered, and was definited as a hemorrhage site when the neck of aneu-rysm was clipped by direct operation.
The etiology and significance of these tortuosity and ectasia are still matters of contro-versy. In our patient, we postulate that the etiology of cerebral arterial tortuosity and ectasia has a basis of congenital defective lesion of vessels which may become exaggerated with aging, consequently the frequency that cerebral arterial tortuosity and ectasia are combined with aneurysms, may increase in future. We believed that such a case must be proceeded more precise investigation for cerebral angiogram.
A new method of the small area X-ray irradiation was more effective for a diagnosis of cerebral arterial tortuosity and ectasia with saccular aneurysm, was introduced.

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Yearly follow-up studies of SMON have been done in pursuit of the progress of the clinical manifestations since the onset on each cases, in which 961 cases were investigated 5 times and 30 cases were examined 4 times.
Ten items of the neurological signs and symptoms were listed, and 4 grade scores were set in each item, as the most severely affected was indicated 0 and the very mild or almost normal was 3. In case of sum total over 20 was called “mild”, 15 to 19 was “moderately advanced” and below 14 was “far advanced”.
The progress of the score were investigated, and the results obtained are as follows:
1. There is tendency to improve independently of the age or the extent of the illness at the onset, the improvement was most pronounced within 3 years after the onset but thereafter it could not be expected.
2. In the mild case, disturbance of the motor system was mild from the initial stage and closed to normal during the course of illness while disturbance of the sensory system left some residua.
3. In the moderately advanced case, disturbance of the motor system was recovered much, but improvement of the sensory system was delayed and less than the light case.
4. There was tendency of improvement even in the far advanced case, but the residua was left not only in the sensory system but the motor system.
5. In case of the equal degree of injuries of the young and aged person, the recovery
of the young one was rapid within 2 years after the onset, then became gradual and further improvement could not be expected after 3 years, though the rate of residua was lower than the aged.
6. The prognosis of the aged mild case was better than the young or middle aged moderately or far advanced case.

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Duodenocolic fistula is an unusual condition, so far.
The first description of a benign duodenocolic fistula was done by Sanderson in 1863. There are 45 foreign literatures and only 3 Japanese up to date.
We experiences a case with malabsorption syndrome, who was a 64-years-old woman, entered to The 2nd Tokyo National Hospital with C. C. of anorexia, ascites and weightloss.
She had had appendectomy 10 years ago. Laboratory findings: haemoglobin 8.4 g/dl, serum protein 5.3 g/dl, iron 60 r/dl and total cholesterol 114 mg/dl.
Radiographic findings: the chest x-ray showed no abnormal findings. Upper G. I. series showed barium meal flowed away from ascending and transverse colon directly.
Laparotomy revealed duodenocolic fistula and microscopic examination of regional lymph nodes disclosed tuberculous origin. Post-operatively she has been doing well and gained weight 12 kg at present.

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We reported 2 cases of cystosarcoma phyllodes of 12 years of age.
Histologically, one case had the same general morphologic configuration as fibroade-nomas, but contained a more cellular, hyperplastic stroma. The another case was interested type, in which the degree of nuclear atypy of each components was more, and this case contained the same fibrous and myxoid variations in stroma as the f ibrosarcomas.
In Japan, the average age of cystosarcoma phyllodes was 31 years and teen-ager patients were reported total 7 cases only; 5 cases of 11 years, 1 case of 12 years and 1 case of 13 years of age.

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Roentgenography at mass screening revealed a massive shadow in a case in the left upper lung field despite no symptoms suggesting lung tumor. With a suspicion of lung tumor, left pneumonectomy was carried out. Benign leiomyoma of the lung was proved by postoperative histological examination of the excised lung. The patient, aged 55 years and engaged in agriculture, had received total hysterectomy due to myoma of the uterine 11 years before. A chest x-ray film taken at some hospital when she caught a cold 7 years ago showed nothing abnormal.
The postoperative course was uneventful and the patient was discharged 2 months after. Examinations on myoma of the bowel performed during hospitalization presented no anomaly, neither any residual myoma on gynecological tests. This successfully treated very rare tumor of the lung is believed to be the 13th case of primary benign leiomyoma of the lung reported in Japan. Considering the malignancy of most of lung tumors, it is stressed that lung tumors that are commonly regarded as hard to diagnose need to be surgically removed as early as possible.

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This is a case report of a 35-years-old female with SLE. The biopsy of the kidney showed very marked proliferation and crescent formation. She died of marked bleeding in spite of powerful treatments. At autopsy, however, these microscopic findings improved. In this present report, we discussed about such a improvement.

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Nine cases of hyperthyroidism in children have been observed for g years. Their chief complaints were malaise, palpitation, exophthalmos, excessive sweating, and so on.
They were treated with antithyrotoxic drug (Methimazole). Their clinical courses were various. Most patients must be treated for more than two years.
Blood TSH level was measured after TRH injection. TSH response was good in most cases after remission, but no response was shown in a few cases. TRH test was valuable to recognize their clinical conditions.

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This is a report of two sick sinus syndromes succesfully treated with the implantation of transvenous pacemaker. In case I, this was a 49-years-old housewife who had a few syncopal attacks and was manifested sinoatrial block with partly sinus arrest on electro-cardiograms. In case II, this was a 63-years-old man who showed sinus bradycardia, left axis deviation and complete right bundle branch block with partly sinoatrial block and several atrial arrhythmias. On cardiac evaluation of case II, the sinus node recovery time (SRT) was markedly prolonged after overdrive with atrial pacing at 120 beats/min, for one minute (SRT=5528msec. ).
The treatment for such case with syncopal attacks or possibility of this was described. At admission, intracardiac evaluations, such as His bundle electrograms and measurement of SRT with means of overdrive suppression, were performed, Then transvenous temporary pacing was started. Under temporary pacing, several drugs were administered and that effects were evaluated.
At the present, we considered the indications of pacemaker implantation on sick sinus syndromes; (1) no effective therapy, but pacing, (2) apparent Stokes-Adams syndrome or syncopal attacks from unknown origin, (3) in EKG, widespread abnormalities of impulse formation and conduction, (4) BTS, (5) important complications as congestive heart failure, or angina pectoris, and (6) prolonged SRT.

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