Paroxysmal nocturnal hemoglobinuria (PNH) is acquired chronic hemolytic anemia characterized by hemoglobinuria and/or hemosiderinuria but presents variable clinical signs.
In recent years significant number of PNH associated with aplastic anemia have been published and the relationship between these two diseases has been noticed. More recently PNH associated with myeloproliferative disorders-myelofibrosis, acute and chronic myeloid leukemia and so forth have been reported.
I have an interest in this problem and discussed association PNH with these blood diseases in the literature.
1) Association with aplastic anemia.
Most cases reported to develop to PNH from aplastic anemia were found to be PNH manifested with pancytopenia at the onset. There were a few cases developed to PNH from atypical or secondary aplastic anemia, a few cases developed to aplastic anemia-PNH syndrome from aplastic anemia (mainly atypical) and a case developed to PNH through aplastic anemia-PNH syndrome from atypical aplastic anemia.
2) Association with myeloproliferative disorders.
There were nine cases complicated with PNH and myelofibrosis. In six cases there was clear evidence for the development of PNH on preexisting myelofibrosis, in other three cases the time relationship between the onset of myelofibrosis and PNH was not clear. Only one case complicated chronic myeloid leukemia and PNH was found. There were eight PNH cases terminated in acute leukemia or erythroleukemia. It is interesting to note that in five cases followed-up hemoglobinuria and/or hemosiderinuria and abnormalities of PNH red cells disappeared before or after the onset or leukemia of erythroleukemia.

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Human T cells bearing Fc receptors for IgG (IgG-FcR⁺·T) and IgM (IgM-FcR⁺·T)were examined for the purpose of analysing immunopathological states in viral hepatitis, especially of type B.
It has been reported that IgG-FcR⁺·T fraction has an activity of suppressor and of a part of killer, and IgM-FcR⁺·T fraction has an activity of helper.
The present study showed that the IgG-FcR⁺·T was within the normal range on all types of liver diseases, but the IgM-FcR⁺·T was decreased in chronic hepatitis (p<0.01), unrelated to the presence or not of HBsAg. In the patients with HBsAg positive hepatitis, IgM-FcR⁺·T was decreased (p<0.01), especially in eAg positive cases the decrease was marked. In the patients with HBsAb positive hepatitis, the IgG-FcR⁺·T was decreased in comparison with that of HBsAg positive hepatitis and both negative hepatitis (p<0.02). It was shown, therefore, that there was a functional compensatory relationship between IgG-FcR⁺·T and IgM-FcR⁺·T in both the control group (p<0.01) and the liver disease group (p<0.01).
It was shown that the important difference between acute hepatitis and chronic hepatitis was that the IgM-FcR⁺·T was not decreased in the former whereas the decrease was marked in the latter, and that there was a strong reduction of cellular immunity and antibody production system especially in chronic hepatitis, and that hepatitis B virus infection affected strongly on the T cell subsets of viral hepatitis.

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The silent stone designated for the asymptomatic cholelithiasis is widely used. The asymptomatic stone, in a strict sense is rare, and it seems that in most cases of cholelithiasis an asymptomatic stage appears in natural course. Including these cases of silent stone, we discussed the surgical indications of these with a review of the literature.
More than half of these cases had acute symptoms in their course, especially in the old age group.
The results of the surgery for the gallstone are excellent recently, but the surgical risk in this acute symptoms, especially in the old age group is still high due to the hepatorenal insufficiency and cardiovascular complications.
The most careful attendance is required in the cases of acute symptoms of silent stone, especially in old age group.

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We reported two cases of false positive liver scintigram caused by left branch of the portal vein, demonstrated by angiography.
Case 1) A 49-years-old male was hospitalized because of epigastralgia. Liver scintigram showed a focal defect in the upper central portion of the liver parenchyma. Angiography showed no tumor vessels but the portal vein appeared to be dilated and the umbilical part of the left portal branch was seen in the same area where diminished uptake was shown by the liver scan.
Case 2) A 61-years-old female was hospitalized because of dyshepatia. Liver sintigram showed a band-like defect between both lobes. Angiography showed no tumor vessels and the left branch of the portal vein, was dilated, corresponded to the defect shown by the liver scan.
There are few reports on defects in liver scans due to the portal vein. Dilated portal vein and its intrahepatic branches should be included as one of the possible causes of false positive liver scan.

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Amebic liver abscess is a relatively uncommon disease in Japan and an early diagnosis is not always easy. This short communication is to report a case of amebic liver abscess clinically simulating acute abdomen.
Patient is a 39-years-old Japanese male with a chief complaint of remittent fever and right lower quadrant pain for the abdomen for two days duration. Four months prior to admission, he traveled around south east Asia. Laboratory data was essentially unremarkable except leukocytosis. Antibiotics appeared to be ineffective. He was operated upon as an acute abdomen, possibly acute cholecystitis, on 9 days after admission, however no significant lesion could be found in the abdominal cavity.
Postoperatively, fever remained and right upper quadrant pain still persisted. Chest x-ray of 3 weeks postoperatively showed remarkable elevation of the right hemidiaphragm. Liver scan and computed axial tomography of the abdomen showed space-occupying lesion in the liver parenchyma of the right lobe. Although study of stool did not show cystic forms of entameba historitica, anti-amebic agent, metronidazole was started and the symptoms were immediately disappeared. Since diagnosis of liver abscess was correctly established, the abscess was drained by transcutaneous catheter, by which the abscess was finally disappeared. CT scanning and test administration of metronidazole appeared to be of diagnostic value for amebic abscess of the liver.

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Menstrual fistula is bleeding from the abdominal wall in concurrence with the menstrual period, and there is a direct communication between the wall and the uterus or fallopian tube.
We experienced a rare case of menstrual fistula without direct communication to the uterus or fallopian tube and that is histologically diagnosed endometriosis.

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Menstrual fistula is bleeding from the abdominal wall in concurrence with the menstrual period, and there is a direct communication between the wall and the uterus or fallopian tube.
We experienced a rare case of menstrual fistula without direct communication to the uterus or fallopian tube and that is histologically diagnosed endometriosis.

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I have experienced a case of atypical aplastic anemia with two episodes of pregnancy and delivery.
She had two different types of delivery; the first delivery was done by Caesarian section and the second delivery was done by vaginal delivery; both of them were successful.
The Caesarian section was better than vaginal delivery in the less amount of bleeding during delivery.
I think for the pregnany and delivery in the patient of aplastic anemia, the following three condition are indispensable;
(1) A medical and paramedical project team.
(2) The artificial induction of labor.
(3) An adequate supply of blood for transfusion.

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Hereditary spherocytosis is a hemolytic disease transmitted by autosomal dominant trait. The jaundice of the patients with HS in the neonatal period often becomes severe. Then patients with HS often have past history of blood exchange transfusion because of severe jaundice in the neonatal period.
We experienced a patient who was suspected to have HS soon after birth for her early jaundice and her family history, and blood exchange transfusion was done. The patient was a first born and the product of a 38 weeks gestational normal delivery weighing 2, 990g. The patient's mother, maternal grandfather and maternal aunt have HS and her mother and grandfather have past history of splenectomy.
Nausea and vomiting began at 17 hours after birth and jaundice on the skin appeared at 22 hours after birth. Serum total bilirubin level was 12mg/dl at 31 hours after birth and blood exchange transfusion was done immediately. Jaundice gradually disappeared and the patient's condition was favorable after that. But severe anemia was noticed at 40 days after birth. The value of hemoglobin was 7.6g/dl and 100ml of blood was transfused to the patient.
Moderate amount of spherocytes were seen in the mother's peripheral blood. On the contrary, spherocytes were scarcely seen in the patient's peripheral blood. When auto-hemolytic test was done at 3-months-old, 8.29% of the patient's red blood cells incubated for 48 hours without glucose hemolyzed and the red blood cells incubated with glucose became spherocytec. Osmotic fragility test of the patient's red blood cell showed normal. This result may be because of the influence of blood transfusion. Other hemolytic screening tests such as hemoglobin electrophoresis and Heinz body formation test were normal.
The cause of HS is considered to be decreased lipid on HS erythrocyte membrane. Severe hemolysis of HS newborns may be related to hypolipidemia in neonatal period. The value of total cholesterol of the patient's serum before blood exchange transfusion was 57mg/dl.

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Statistical studies were made on 8, 453 operation cases of the gastric cancer collected by Hokkaido Cancer Research Center from total number of 349 main hospitals in Hokkaido and the results were compared with those from all over the country.
As far as the ratio of gastrectomy (79.4% on the average), total gastrectomy (17.5% on the average), ratio of the early stage cancer (18.396 on the average) and ration of B I anastomosis which was considered to be the ideal reconstruction method were concerned, the results showed the gradual improvement for 5 years (1963-1967).
Compared with the results from all over the country, all kinds of factors showed slightly lower rates. However, if the fact that the hospitals from all over the country except Hokkaido were equally large in scale was taken into consideration, our Hokkaido cases are by no means regarded to be on a low level.

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Although the results of therapy for malignant tumors are now remarkably improved by virtue of the progress in radiotherapy, varying degree of injury to the gastrointestinal tract is unavoidable side effect of irradiation and cases requiring surgical treatment after the irradiation generally show poor prognosis. In the present study, 8 cases of radiation injury requiring surgical treatment, which were experienced by us during the past 10 years, were reviewed and analyzed. This series comprised 4 cases of bladder cancer, 3 cases of cancer of the uterine cervix and 1 case of penile cancer, with the average length of time elapsing from irradiation to surgery being 11.8 months. The prognosis was very poor in these 8 cases, with 5 of them had a fatal outcome in due course of time and 4 of these 5 died in operative mortality. In only one instance the peritoneal cavity was found infiltrated by malignant cells at operation. The reason for such an ominous prognosis was considered to be threefold: (1) The primary disease requiring radiotherapy was an advanced carcinoma and as the radiation injury being mistaken for recurrence of malignancy, there was a delay of operation. (2) The length of time elapsing from irradiation to the manifestation of injury was too long for the physician to keep the effects of radiation exposure in his mind. (3) Adhesions of the injured intestine and fragility of intestinal walls were of higher degree in cancer than in non-cancerous patients and this made operation more difficult to perform.

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1. Current status of our intravenous hyperalimentation (IVH)
As discussed on our first report, formulation and preparation of IVH nutrient solution were carried out in our hospital pharmacy for the first 2 years from 1973 According to the clinical development of IVH for the past 7 years, the nutrient solution has been only prepared in individual units immediately prior to its administration. The preparation has been made with several combinations of fluid and drugs which are currently available in sterilized bottles and ampules. The basic nutrient solution consists of 10% glucose, 10% amino acid, electrolytes, minerals and vitamins. Fifty% glucose is added when caloric increase is undertaken.
2. Management on stability and safety of IVH nutrient Discussion has been made on serial decomposition of FAD (Vitamin B₂) and Vitamin K under light exposure.
One packed IVH system which supplies a whole mixture of the nutrient for 24 hours may have some pharmaceutical problems on stability and efficiency of the nutrient solution. Based on our experimental results, we have never used one packed IVH system.
In order to keep photo-stability of IVH solution, a light-proof cover was devised in our pharmacy. This covers a fluid bottle and minimizes decomposition of photosensitive vitamins during infusion.
3. Transrectal administration of fat soluble vitamins
Fat soluble vitamins such as Vitamins A, D and E are not given intravenously. Frequent multiple injection with pain is the sole problem for the patients who are unable to have oral intake during IVH. For this reason, transrectal administration has been undertaken experimentally on rabbits with suppositories containing these vitamins.
Although we have not yet had an expected result on rectal absorption, further investigation is in progress.

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The earthquakes occured frequently in Japan. Since the earthquake of Miyagioki arose on July 12th, 1978 at Miyagi Prefecture, the disaster of hospitals have been become the object of public attention. This symposium was recently held in this area.
The many wounded persons appear suddenly and the relief falls into disorder by the trafic mess and interruption of communication etc. The relief groups of large scale hospital must serve rather in their hospitals for the better use of medical technology integrated unit than their dispatch to actual space, because hospital must have the best therapeutic capacity for sudden disaster. And hospital administrator always must give public relation on the counterplan within the regional community.

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