In the past 2 decades, there has been a steady increase, in the frequency of Stage Ia carcinoma of the cervix. Radical hysterectomy with lymph node dissection has brought a excel-lent survival rate. The problem “May one treat Stage Ia less radically than the more extensive invasive cancer?” is now a important problem in the treatment of cervical cancer. Based on our series, problems of diagnosis and treatment of Stage Ia are investigated and clarified on what is important in management of Stage Ia and how it should be treated. Now the frequency of Stage I has come up to 41-43% out of total number of cervical cancer. About 50% cases are treated at hospitals with moderate size of capacity. As the diagnostic procedure, cone biopsy is applied on only 20% cases of Stage Ia. 53% cases have been decided finally as Stage Ia by punch biopsy, 21% cases by cone biopsy and 26% cases by removed uterus.
As to the operative method, the frequency of modified radical hysterectomy has been increasing up to 45% and those of radical hysterectomy and simple total hysterectomy have been decreased to 23% and 28%. Proposed criteria of Stage Ia by Uterine Cancer Committee are reasonable and useful for the determination of operative technique.
Based on this histological criteria, modified radical hysterectomy is enough for Stage Ia and no lymph node dissection is necessary. The method “modified radical hysterectomy with lymph node dissection” might be applied to the cases of early Stage Ib and also applied to the cases of carcinoma of the uterine body.

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A case of type IIIv (Konno's classification) of the ruptured aneurysm of Valsalva sinus which has been rarely reported in Japan is described and compared with types I and II of our cases.
The retrograde aortogram of type IIIv produced opacification of the right atrium and the right ventricle.
The phonocardiogram of types I and II showed a continuous murmur or a to-and-fro murmur with diastolic accentuation and a diastolic palpable thrill, whereas that of type IIIv of ours showed a continuous murmur with systolic accentuation and a systolic thrill.
In the echocardiogram, a prolapse of the right coronary cusp into the outflow tract of the right ventricle or an aneurysmal sac was revealed in types I and II, whereas in type IIIv, instead of those findings, a severe fluttering of the tricuspid valve was observed and disappeared after the surgical closure.
The electrocardiogram and the chest X-ray of type IIIv were not different from those of types I and II.

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CT scan has gained wide spread popularity and consistent use in most of large general hospitals, which has resulted in increase in opportunities to perform extirpation of orbital tumors.
There are three conventional approaches to the tumor in question: anterior, lateral and transfrontal approach, in all of which it is essential to protect the surrounding structures as much as possible and to maintain preoperative ocular function. The microsurgical technique is mandatory for this purpose. To do this, a generous operative exposure is essential.
We often experienced difficulty in dissection of the tumor by the conventional abovecited transfrontal approach only because of the location, size and nature. In such cases we developed the fronto-zygomatic approach. This method is characterized by a broader operative exposure obtained by excision of the superior lateral margin of the orbit temporarily. This gives a surgeon ample room to handle the pertinent area without compressing the adjacent vital structures.
Here we report two patients in whom fronto-zygomatic approach was used, and discuss pros and cons of this particular procedure comparing with other surgical approaches.

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Between 1966 and 1977, 50 patients were treated for superficial tumors of the urinary bladder at Atami National Hospital.
This is a statistical report on the recurrence of superficial bladder tumors and on the prophylactic effect of intravesical instillation of Mitomycin C on the tumor recurrence.
1) The recurrence of superficial bladder tumors was found in 21 of 50 patients (42.0%) and occured in most frequently within three years after first treatment, about three-fourth of all patients.
2) The recurrence rate of tumors in multiple type was slightly lower than in single tumors. The rate showed no significant difference between both groups.
3) The recurrence rate in the tumors of low grade was somehow higher than those of high grade. No significant difference of the recurrence rate was statistically found between the tumors of low grade and those of high grade.
4) The recurrence of tumors was frequently found in endoscopic operation (TUR TUC) than in partial cystectomy.
5) Intravesical instillation of MMC were employed for the purpose of prophylaxis of the recurrence of bladder tumors after removal of the tumor. Meaningful reduction of the recurrence was recognized in the postoperatively instillated group, compared with postoperatively non-instillated group. Recurrence rate of former was 9.2% after months follow up, while that of latter was 22.0%.
It is convinced that intravesical instillation of MMC may be effective for the prophylaxis of the recurrence after removal of tumor.

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Recently, because of abusive administration of broad spectrum antibiotics, the concept of urinary tract infection has been changed seriously. Certainly Pseudomonas infection in the urinary tract is still a clinical problem of large magnitude but infections due to so-called non-pathogenic organisms, namely, Serratia marcescens, Pseudomonas cepacia are getting to play a large part nowadays.
We experienced 27 in-patient cases and 3 out-patient cases of Serratia marcescens infections in the urinary tract during August 1 to December 31, 1977 and a clinical analytical study was performed to make sure what was the most important objective to be solved.
The summary is written below. 1) Serratia marcescens has a predisposition for elderly and/or debilitated and for patients previously treated with broad spectrum antibiotics, 2) from the chemotherapeutic point of view, the most important problem is how to improve the poor physical condition due to multitudinous disorders, 3) the antibiotics to be administered have to be chosen with care, thus, sensitivity tests in vitro are not absolute stand-points. So, 4) the thetherapeutic and/or prophylactic measures should be considered in host-parasites-drugs relationship.

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Diagnosis of endometriosis is made by combined examinations, and no definite approach is recommended as yet. Preoperative HSG figures were analysed in cases of endometriosis which were histologically confirmed.
High voltage, new SS high sensitivity intensifying screen was employed for HSG to diminish exposure dosis. Four photographs were taken under television view;1) immediately after tubal snapshot, 2) immediately after certification of peritoneal figure 3) lateral view 4) 5 minutes after total injection of contrast medium. 43 cases of confirmed endometriosis were contrasted with 143 pregnant cases of infertile clinic on HSG of abovementioned four types.
Characteristic findings of endometriosis were obtained in running angle and morphology of tubal figures including lateral view, Douglas's cul-de-sac figures of lateral view and peritoneal figures. Besides, co-relations were detected between these HSG figures and clinical grades (Beecham) of endometriosis. These new approach seems to elevate the utility and clinical significance of HSG in the diagnosis of endometriosis.

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Among the causes of 119 death cases of the HBsAg carriers, liver cirrhosis was found in 27 cases and hepatoma was found in 25 cases. Of the sex ratio in two diseases, the male occupied more than three times as much as the female.
Three of 17 cases of acute hepatitis B and 4 of 9 cases of posttransfusion hepatitis B were found to be a HBsAg carrier, but both types became non-carrier in the course of observation without the case of chronicity.
Of the cases which showed normal transaminase activity and contain a large amount of HBsAg in their sera initially, 21 cases became HBsAg negative on examination in 6 months. In 12 of the 21 cases, anti-HBsAg became detectable in the course of the follow-up study.
Of the cases which showed slight abnormality of transaminase activity and contain a large amount of HBsAg in their sera initially, 12 cases became HBsAg negative on examination in 6 months. Though anti-HBsAg became detectable only in 3 cases no tendency to chronicity was found.
Comparative review was made on the result of the follow-up studies of 458 HBsAg carriers, dividing them into three groups based upon the presence or absence of e-antigen and e-antibody. Abnormality of transaminase activity was found at high rate in e-antigen positive group, e-antibody positive group and group in which the antigen and antibody were not detected, respectively. The abnormality of transaminase activity was remarkable especially in male.
Conversion HBsAg carrier to non-carrier was noted in 15 cases, and after the disappearance of HBsAg, their liver function revealed normal value except one case.
The manifestation in HBsAg carrier seems to be ascribed to the presence of HBsAg itself rather than to that of e-antigen.

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Lung metastasis from chorionepithelioma are quite common and have been discussed frequently in the literature. Epidural metastasis from chorionepithelioma are rare and have been reported only 7 cases in Japan. The following case of epidural metastasis is therefore being recorded.
Case:
A fifty-two-years-old woman was admitted to our hospital in May 1970 with chief complaint of the low back pain radiating down right leg posteriorly. One month before admission, she first noted tenderness of increasing severity in the lumbar region. Past history revealed that in 1969 the patient had experienced the hysterectomy for the uterine myoma. Myelogram made at the time of admission revealed spinal block at the upper border of the 5th lumbar vertebra. In June 1970, laminectomy exposed an extradural tumor which was a metastatic chorionepithelioma. She was given methotrexate and actinomycin D, but eleven months later she died of lung metastasis.

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In recent years primary pulmonary cryptococcosis, which was treated by surgical resection, has been recognized with increasing frequency. A case of pulmonary cryptococcosis, confirmed by transbronchial lung biopsy and brushing using bronchofiberscope, is reported.
A 73-years-old man with a mass survey in the right middle lobe who was suspected to be lung cancer. The right middle lobe resection was performed with success without post-operative chemotherapy such as an administration of Amphotericin-B.
Our case has been added to the 29 cases with surgical excision reported in the Japanese literatures.

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This report is presented of two cases of drug induced pulmonary disease. One case is a pulmonary infiltrate with eosinophilia (P. I. E.) syndrome due to hydrochlorothiazide and the other case is an interstitial pneumonitis due to streptomycin (SM).
Case 1. A 73-years-old male was came to our hospital because of elevation of temperature, coughing and expectoration in December, 1977. Finding of laboratory examination showed no significant abnormality except for ESR 64mm/h, CRP+6, WBC 12, 600/cmm, 37% eosinophils and IgE 3, 937u/ml. Chest X-ray revealed diffuse reticulo-nodular shadow in both lung field. After hydrochlorothiazide was discontinued, all of the above abnormalities turned to be normal. This case was considered to be a P. I. E. syndrome due to possible allergic reaction of hydrochlorothiazide.
Case 2. A 71-years-old male was admitted with active pulmonary tuberculosis and treated with SM (lg/day, 3/week), isoniazid and ethambutol since October, 1975. Three months later, chest X-ray showed considerable improvement. In March, 1976, after 55 injections of SM, the patient's temperature rose up to 38.1°C and there after, whenever SM was injected. The patient complained of increasing dyspnea on exertion since that time. Then chest X-ray revealed diffuse patchy shadow although laboratory examination demonstrated no abnormality. After injection of SM was discontinued, chest X-ray showed remarkable improvement and the patient's dyspnea on exertion subsided. This case was considered to be an interstitial pneumonitis due to SM.

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Recently it has been noted that patients with lung carcinoma occasionally are associated with SIADH. We report a 54-years-old female with lung carcinoma whose chest X-ray revealed no abnormalities despite fluctuated SIADH. After 5 months the patient complained of chest pain and coughed up bloody sputum. Sputum cytological diagnosis was small cell carcinoma, but chest X-rays showed only pleural fluid of the right side. ⁶⁷Gallium citrate scanning was useful for localizing the tumor in this patient.
Administration of demeclocycline was successful to elevate serum sodium level, to increase urinary output and to improve the symptoms (SIADH).
Autopsy examination revealed small cell carcinoma of the lung primarily originating from the right main bronchus.

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A case of the arachnoid cyst of the middle fossa surgically treated is reported. A 6-years-old boy complained of the buldging of the right temporal region since 3 years ago and it became gradually enlarged. Neither symptoms and signs of increased intracranial pressure nor other neurological abnormalities were noted. CT scan revealed a large low density area in the right middle fossa and other neuroradiological examinations also suggested arachnoid cyst of the right middle fossa. Because of the fear that the lesion might be a expanding lesion, craniotomy was performed and the cystic space was opened to the other subarachnoid cisterns. Postoperative CT scan suggested the decreased displacement of the right anterior horn of the lateral ventricle.

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A case of spinal muscular atrophy associated with myasthenic symptoms was reported. Clinical, pharmacological and electromyographic examinations on this patient were carried out. The study revealed different findings from classical myasthenia gravis and Eaton-Lambert syndrome. Discussion on the mechanism of symptomatic myasthenia with a special reference to the presence of significant defect of conduction in patients with diseases affecting the lower motor neurons was made.

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Pollution control systems (PCS) have been installed to prevent human from adverse effects of waste anesthetic gas on the health and safety of workers (e. g. anesthetists and nurses). The PCS (i. e. scavenging systems) employed in our operating room has function to collect gas, to transfer for outside and to release.
We achieved satisfactory result that occupational exposure to anesthetic gas was controled by the PCS, so that no worker has been exposed at a concentration greater than 25 ppm of N₂O and 0.5ppm of halothane corresponding ISO recommended target level. On the contrary, when our operating room was conditioned by 50% fresh air without any scavenging system, anesthetic gas concentrations in the operating room had ranged from 170 to 2000ppm for N₂O and from 2.8 to 9.5ppm for halothane during normal GOF anesthesia. In the PCS, independent stand type Interface was designed in our own way.
During frequent monitorings of gas, unexpectedly, leakage was found from the anesthesia apparatus. The leakage can be of sufficient size that efficient scavenging is virtually negated, accordingly, strict gas monitoring should be periodically taken.
And several studies were reviewed regarding that biologic and psychological effects of exposure to anesthetic trace levels exists to be real or not. However, it is emphasized that we should meet with this problem with the policy of “doutful should be punished”, though there seems no set decision concerning this situation.

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We have so far experienced about 5, 000 cases of epidural anesthesia. In the present study, we further examined whether or not a difference may occur in the run of the catheter when the local anesthetic is first infused and then the catheter is inserted into the epidural space, or vice versa, in 87 cases of lumbar, thoracic or cervical epidural anesthesia. The catheter for continuous epidural anesthesia used in this study was a polyethylene catheter manufactured by Hakko Co., Ltd., and 1-1.5% mepivacaine was used as the local anesthetic. 0.5ml of meglumine iocarmic acid was infused into the epidural catheter in order to confirm the location and course of the catheter. In the cervical and thoracic epidural anesthesia, almost 80% of the cases showed a straight course, irrespective of whether the catheter was inserted prior to or after the infusion of the local anesthetic, showing no significant difference between the two methods.
In the lumbar epidural anesthesia, almost 90% of the cases showed a straight course when the local anesthetic was infused prior to the insertion of the catheter, while only 50% of the cases exhibited a straight course when the catheter was inserted first, resulting in a significant difference between the two methods. Furthermore, we compared the results of two methods of catheter insertion: one, the usual method, inserting about 5cm of the catheter through the needle and withdrawing the needle alone, and the other, inserting about 20cm of the catheter through the needle and withdrawing them together to leave a proper length of the catheter behind (the latter method we reported at the 16th annual Kanto Koshin-etsu District meeting of Japan Society of Anesthesiology). No significant difference was noted between the two methods.

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We had 199 emergency cases at Dep. of OB-GYN in the Beppu National Hospital during 5 years from July of 1973 through December of 1977.
These emergency cases are those which required immediate treatment, minor or major surgery, but normal deliveries are excluded as emergency.
Total number of in-patients during this period at our Department was 2, 755, and the rate of emergency cases (199) revealed 7.2 percent.

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The patients who were consulted and/or treated at the Urological Department of Atami National Hospital in 1978 were statistically analysed.
1) The total number of outpatients was 1, 410 with 875 males and 535 females. The ratio of male and female was 1.6 to 1.
2) The total number of inpatients was 241 with 205 males and 36 females. The ratio of male and female was 5.7 to 1.
3) The total number of operations was 338 with 15 nephrectomies, 12 ureterolithotomies, 35 retropubic prostatectomies, 51 endoscopic operations and others.

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