The central nervous system leukemia (CNSL) is known as a complication of other diseases, particularly of acute pediatric leukemia, but recently since the survival periods of acute adult leukemia are extending, CNSL complications in adult cases are increasing. The occurences of adult CNSL are most frequently complications of AML, and this is because AML is the most frequent leakemia in adults. By age, the occurence is highest in people under 50 years, and by sex, most cases are male. In view of the regions in the body, CNSL complications are most frequent liver or spleen tumours or lymphnode tumours. In view of peripheral blood findings, CNSL complication is found more frequently in cases with higher wbc count or/and fewer blood platelet count. The period from the onset of an acute leukemia to CNSL complication is usually 20 weeks or longer, which is a relatively long survival for adult leukemia. In most of the cases the hematological findings at the time of CNSL onset is found in recurrence or progression. The common CNSL sysmptoms are headache, vomiting, papilledema, and others such as pain in the eye, facial paralysis, cramp and visual disturbance are also seen. In cases of acute leukemia where both subjective and objective symptoms are not clear, CNSL is often found by cerebrospinal fluid examination. It will be necessary to have cautions always in detection of CNSL.
Therapies recommended administration of MTX or Ara-C, combined with HDC, into the medullary cavity, which is the most common and most effective. In cases of children, radiation therapy is often used for prevention and treatment of CNSL, but in adult cases, this is limited to cases such as tumour formation. A quantitative administration of MTX or BCNU as a generalized medication is also in study, but the results are not yet satisfactory.
Since increase of CNSL complications in adult cases has become more frequent, how to cope with CNSL has become an important issue in treatment of acute adult leukemia, and we believe that preventive measures against CNSL will be necessary in adult cases as well as in pediatric cases.

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The vital role of alkaline phosphatase in vivo has, not so far been clearly understood. In this study, the alkaline phosphatase activity was demonstrated clearly at the cytoplasmic membrane of chondrocytes differentiating from chondroblasts in chondroblastoma cells. On the other hand, active chondrocytes of a normal fetal femur, studied as the control, showed only a trace activity of this enzyme despite the close ultrastructural resembrance to the chondroblastoma cells.
Alkaline phosphatase has been known to exist in the osteoblast in a large amount, and has been thought to play an important role on the bone formation. It is therefore suggested that chondroblastoma does not consist only of chondroblasts but includes multipotential cells, as far as the alkaline phosphatase activity is concerned. This idea is further supported by the fact that the isoenzyme pattern, studied histochemically, revealed the alkaline phosphatase in chondroblastoma cells to be identical to that of bone tissue.

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Depressive state of the aged 25 cases, with the onset mostly after sixty years, was studied:
(1) Life histories including the earliest experiences, were not recognized to be profoundly significant.
(2) In the most cases, physical diseases were found, but the correlation between the courses of them were not always parallel.
(3) The personality changes by aging and the situational ones as the causative factors seem to play more significant parts. Bipolar or multipolar structures of the personality stressed by increasing ages, lead to the loss of the balancee of psychological tension.
(4) Clinical pictures and the therapeutic problems of the old aged depression were discussed.

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The serum levels of anticonvulsants were determined in 145 epileptic children from Nov. 1977 to Nov. 1978 at the pediatric service in Okura National Hospital. The age of patients ranged from 1 to 18 years, 83 males and 62 females.
The clinical pharmaceutical approach (side effect, interaction of anticonvulsants, drug history and mother's opinion about their children taking anticonvulsants etc.) was also carried out by a clinical pharmacist.
The concentration of phenobarbital (PB) and diphenylhydantoin (DPH) were determined by gas-liquid chromatography according to Chin, Cooper, Estas et al.
Sodium valproate (DPA) was also determined according to the method of Akira Miike.
The results of the examination are as follows:
(1) The serum level of PB was correlated to daily dosage of anticonvulsants per kilogram.
High serum level of PB was obtained when several anticonvulsants were given with PB.
In some cases with complex febrile convulsants, effective level of PB was obtained by daily dosage less than 4 mg/kg.
(2) The serum levels of DPH were low compared with daily dosage, especially combined with PB.
The serum levels of DPH were influenced by particles of DPH.
From our experience, the clinical pharmaceutical approach cooperating with doctors are very useful for the treatment of epilepsy.

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The body weight of each of the severe mentally and physically handicapped patients was compared with the standard mean value (M) of Japanese in 1975. The severe handicapped patients were divided into 4 groups according to their body weights; M+1 SD≥A≥M-2 SD, M-2 SD>B≥M-3 SD, M-3 SD>C≥M-4 SD, and M-4 SD>D.
1) In one hundred and fourteen severe handicapped patients, A group was 24 cases (21.1%), B group was 31 cases (27.2%), C group was 36 cases (31.6%) and D group was 23 cases (20.2%).
2) The serum concentrations of phenobarbital were considerably lower in B+C+D group (under -2 SD in body weight) than in A group (above -2 SD) receiving similar oral doses. In groups A and B+C+D there were the significant correlation between doses and serum concentrations, the regression lines for the respective groups being y=9.417x+0.922 and y=3.622x+9.926.
3) The serum concentrations of diphenylhydantoin were lower in C+D group (under -3 SD) than in A+B group (above -3 SD) receiving similar doses.
In the severe handicapped patients, it is difficult to be noticed the side effects of anticonvulsants by our nursing staffs, and a few of them can complain of these symptoms. Therefore, the serum concentrations of anticonvulsants must be measured when the severe handicapped patients were treated with these drugs.

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The outpatient services of Musashi National Sanatorium have become continuously expanded, especially during the past 10 years. It was intended to investigate the changes and present status of activity of this Out-patient department to explore the problems underlying these changes.
1) While the number of outpatients newly visited our clinic, and total number of the outpatients in 1966, were 413 and 6, 556, they are 1, 205 and 50, 016 in 1978. This ratio of increase is considerably high compared to those of other institutes.
2) Changes can be attributed mostly to the rehabilitation-oriented patient care, and also to the strengthened activity in the specified fields such as epilepsy, alcoholism, organic and geriatric mental disorders, etc.
3) Related to the specified clinic for them, the patients of epilepsy and alcoholism had increased in number and the therapeutic demands come from large region. In the case of schizophrenia, this comes from wide areas as well as circumscribed areas.
4) The position of the admission is also shown by the study, where the limitation especially for the organic and senile patients is quite severe.
5) The patient care in community is important in the efforts to meet the situation with the community agencies.

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Actual present status of rehabilitation services were surveyed in August, 1977 on 94 National Hospitals & 160 National Sanatoriums under Medical Affairs Beurau, Ministry of Health & Welfare. About 35 questionaries were asked in following categories; 1. Number of patients who received rehabilitation and their diagnosis under provided classifications
2. Spaces of each department of rehabilitation service
3. Number of each rehabilitation team members
4. Administrative status and opinions on most concerned, also the number of institutions which are wishing to strengthen rehabilitation service in the future
As the result, 201 out of 254 institutions responded to the questionaries and 153 out of 201 treated rehabilitation patients amounting to 14, 984 Among these patients, cerebrovascular and musculoskeletal disorders were treated the most. It was obvious that their concern and interests on spaces are based on physiotherapy and related services. Same results were obtained on man power aspect. In over all view, it was clear that rehabilitation members are hardly supplied for their needs. Rehabilitation training programs are largely supplied for their needs. About 820 of 201 institutions are hoping to strengthen their rehabilitation services in the future and many institutions are seriously concerned on this matter.

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A thirty-years-old man was admitted to our hospital in Dec. 1975 with a chief complaint of pain in the distal end of the right middle finger.
One month before admission, he first noted tenderness of increasing severity in the finger.
Past history revealed that in 1974 the patient had experienced the operation for the paronychia of this finger.
Roentgenograms made at the time of admission revealed an osteolytic lesion in the distal phalanx of the right middle finger with marked thinning of the cortex.
The operation was performed with curettage and filling of the defect with bone grafts.
The pathological diagnosis was epidermoid cyst.

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A thirty-years-old man was admitted to our hospital in Dec. 1975 with a chief complaint of pain in the distal end of the right middle finger.
One month before admission, he first noted tenderness of increasing severity in the finger.
Past history revealed that in 1974 the patient had experienced the operation for the paronychia of this finger.
Roentgenograms made at the time of admission revealed an osteolytic lesion in the distal phalanx of the right middle finger with marked thinning of the cortex.
The operation was performed with curettage and filling of the defect with bone grafts.
The pathological diagnosis was epidermoid cyst. precaution measures. Many factors may be attributed to intestinal perforation. At first, any intraperitoneal foreign body may cause intestinal perforation. The second factor is whether the tip of peritoneal shunt tube is sharp and hard or not. Although the incidence of intestinal perforation caused by the different types of shunt tube was almost equal in number. The third is the constant pressure of peritoneal catheter at the same location of intestinal wall for a long time, that is considered to be caused of the necrosis of intestinal wall. The fourth factor is the decrease in resistance of intestinal wall against the foreign body owing to poor condition of patient. The length and the location of the tip of shunt tube seem to have an intimate relation against intestinal perforation in this case. The surgical technique and the shunt tube material should be improved further in the future.

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The diagnosis of the extrauterine pregnancy is easy for a obstetrician, when the symptoms are typical, but may not even for the well experienced obstetrician when the symptoms are nontypical or chronic.
The extrauterine pregnancy shows the tendency of the increase after the Second World War, and is the important disease that holds 70% in the acute abdomen of the obstetrical field.
The abdominal pain is the most important chief complaint in this disease, while the author experienced the disease without abdominal pain. The patient was serious, fell into the shock, so that the patient came to the hospital by ambulance.
The immunological pregnancy test was negative in the case, but the diagnosis was established after the laparotomy.
The author performed the salpingectomia dextra, as the bleeding in the abdominal cavity was 1, 555g.
The post-operative course was good.

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For the elevation of achievement of treatment of cancer of the breast, improvement of surgical treatment for first cases is of course important and what seems more important is the management of recurrent cases. For the aim of prediction of the recurrent time, clinicopathological studies were carried out upon subjects recurrence-confirmed 112 cases among 525 cases which received surgery at Matsuyama National Hospital during the past 12 years, and we divided them by the period from surgery to the finding of recurrence.
Cases less than 1 year from surgery to recurrence were called early recurrent group (58 cases). They had large primary foci at operation already, and many showed highly advanced metastasis of lymph nodes. The incidence of early recurrence of the affected part and lymph nodes is high, so that a potent supplementary treatment is necessary from the time soon after surgery.
Cases of recurrence from over 4 years after surgery were named late recurrent group (20 cases). Concerning the period, they had slight difference from control cases in which recurrence is not seen over 5 years from surgery (170 cases), and prediction of recurrence is difficult. As the incidence of remote recurrence is so high, even if primary foci are small and lack of lymph nodes metastasis, association of general chemotherapy must be considered.
Recurrence from 1 year to 4 years after surgery was called middle recurrent group (34 cases). Since they had properties near to the early recurrent group, it seems appropriate to be treated similarly as in the early recurrent group.

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The clinical features of 32 cases with primary lung cancer which were experienced during the past 5 years from April 1973 through March 1978 were investigated. The result were as follows.
Of 32 cases, 25 cases were men and 7 were women, and the ratio of men to women was 3.6:1. The aged patient over 70 years was obtained in 41% out of all cases, and the mean age was 64-years-old.
Twenty-four cases (75%) of all cases were found out by subjective symptoms, while the remaining 8 cases (25%) were discovered by mass chest X-ray survey. The average duration from discovery to the first medical examination was 4 months. Most of patients had subjective symptoms referable to the respiratory tract, and the most frequent symptom was cough which was observed in 84.4% of all cases. The histological type was determined by biopsy or operation. Squamous cell carcinoma was obtained in 15 cases (46.9%), adenocarcinoma was 8 cases (25%), and small cell carcinoma was 7 cases (21.9%).
Smoking was observed in 59.4% of all patients. Most of smokers showed squamous cell carcinoma, and most of non-smokers presented adenocarcinoma.
According to the chest X-ray classification of the Japan Lung Cancer Society, the peripheral tumor type was seen most frequently and obtained in 11 (34.4%) out of 32 cases.
According to T N M classification, Stage j was obtained in 2 cases (6.3%), Stage II in 7 (21.9%), Stage III in 11 (34.4%), and Stage N was in 12 (37.5%) of 32 cases. Only 2 cases underwent surgical operation, and 10 cases received symptomatic treatment.
The average duration of life is 5.3 months in 21 cases who were confirmed their death, and 90% of patients died within 1 year after treatment.

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Cyclophosphamide is one of antitumor agents widely used in the treatment of various types of tumor. This drug has been marketed in tablet form for oral administration in Japan.
Occasionally, doctors would express a need of administration of the drug orally in powder form. Cyclophosphamide was triturated with lactose, corn starch and potato starch, and stability of three triturations was studied. Furthermore, stability of Cyclophosphamide trituration with lactose packaged by Glassine-Poly-laminated paper and its compatibility with other 31 preparations were tested.
The present results were suggested;
1) Three triturations were stable if they were stored in refrigerator or at room temperature.
2) Cyclophosphamide trituration with lactose was unstable in ovens at 37°C.
3) When Cyclophosphamide trituration with lactose will be dispensed, pharmasists must advice patients that it will be stored in airy low temperature place (below 30°C).

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With a great decline of patients of pulmonary tuberculosis in National Sanatoriums, children with other chronic diseases have increased in recent years.
Because of this changing pattern of admitted patients, it is needed to develop a new task for managing daily life of children.
In order to clarify this problem, we sent questionnaire to every National Sanatorium and obtained the following results;
1) The number of wards with chronic diseases in children was found to be 68 (9.6%).
2) The percentage of night duty with more than 2 nurses per pediatric ward was 63.6.
3) The highest incidence of night duty was 10 per month.
4) The highest incidence of nurses number per ward was 13 to 15, and that of nurses aids was 2 to 3.
5) The highest incidence of number of admitted children in the hospital was less than 30 and the maximal number was 210.
6) Some problems on annexing school, number of pediatricians and daily life of patients in ward were discussed.

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Many spinal cord injuries have been treated in our hospital, and sixty cervical cord injuries have beeen discharged for these five years. There are still more than seventy quadriplegics in our spinal cord unit, who occupy half the beds in our unit. Though high quadriplegics have underwent proper orthopedic surgeries and accomplished adequate training in rehabilitation center, it is impossible to leave hospital and live by themselves. Conse-quently, in-patient quadriplegics are increasing so much that we are unable to manage our hospital effectively without difficulty. It is necessary, we propose, to construct nursing home for high quadriplegics because of securing dwelling for them and making the best use of medical faculties.

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In 1950, home deliveries by private-practising midwives occupied 95.4% of all child-births in Japan. Since then number of so-called institutional deliveries at either hospitals or clinics have increased tremendously, resulting the remarkable decrease of the perinatal mortality as well as the maternal mortality in this country. During the last 25 years, however, facilities and manpower of the hospitals and clinics have not been improved to meet the requirement produced by this change.
In order to investigate the situation, questionnaires were sent to the departments of obstetrics and gynecology of 75 national hospitals throughout Japan and the answers were received from 56 institutions. Average number of hospital beds in the departments of obstetrics and gynecology is 45.4. Total numbers of deliveries per year ranges from 0 to 1, 040, the average is 572. There are nine institutions where more than 1, 000 cases are delivered per year. Number of deliveries treated by one obstetrician per year ranges from 100 to 300.
The result suggests that the obstetricians/gynecologists are, in general, having heavier duties in the national hospitals compared to the physicians of other specialities.

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