Sera taken from three patients with the idiopathic portal hypertension (IPH), a patient with liver cirrhosis, a patient with acute hepatitis (non-viral) and eight controls were evaluated for autoantibodies to several conventional organ antigens and for presence of antibodies to the specific organ antigens prepared. Specific organ antigens were prepared from the human liver, spleen and portal vein, which were homogenized and labelled with radioactive iodide (¹²⁵I) utilizing the lactoperoxidase catalyzed labelling technique. Immune complex was obtained by incubation of radiolabelled antigens with sera, then further incubation with protein A. Immune complex was analyzed in polyacrylamide gel electrophoresis under reduced condition. Sera from all patients with IPH were found one or more autoantibodies to conventional organ antigens. Organ specific antibodies were demonstrated on the sera from all patients with IPH, which bound to same antigens from the liver and the spleen. Molecular weights of antigens were different in each patients.

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Various policies are taken to treat urgent bleeding esophageal varices, but in cases of bad risk with hepatic encephalopathy or with hepatic cancer or portal vein thrombosis, an emergency operation cannot be performed, and sclerosing therapy under endoscopy and embolus therapy via the portal vein, which have been adopted recently, are difficult in practice, too.
We have modified transabdominal esophageal transection, performed so far as standard operation, simply and speedily with the stapling instrument to give minimal operative invasion, and applied it in cases of bad risk (for which even an emergency operation was withheld) with relaitvely good results as follows:
1) An emergency operation was performed in 11 cases. The operation time was as short as 30-65 min., 43 min. on the average, and the amount of bleeding during the operation was 685 ml on the average. Within 30 days after the operation 3 cases, 27.3%, died, which was a good result for the operation of bad risk case. Recurrent bleeding has been noted in no case so far. 4 cases returned to the work.
2) This operation was performed also in 6 severe cases with bsd laboratory and clinical findings without indication for the standard operation (cases without operative indication). Splenectomy was performed concurrently. There was no operational death, the operation time was 60-120 min., 106 min, on the average, and the amount of bleeding during the operation 1, 369 ml on the average, giving less operative invasion than the other standard operations. As to the prognosis, they are all well in 2-22 months after the operation, returning all to the work.
3) The main points of this operation are simple, rapid and sure stapling by simple esophageal transection without periesophageal devascularization (even without splenectomy).
The disadvantage is the complaint of stricture symptom at the site of stapling, which is recovered spontaneously in a short time, no case requiring a special treatment.

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Twenty patients with liver cirrhosis and 3 patients with idiopathic portal hypertension had treatment of bleeding from esophageal varices. All of the patients had had at least one major upper gastrointestinal hemorrhage.
Eighteen of 23 patients underwent emergency operation and 5 had therapeutic operation just a few days after stop of bleeding.
Transection of the esophagus was performed in 19 patients with liver cirrhosis. Portasystemic shunt was carried out in 4 patients, of which 3 with idiopathic portal hypertension had proximal spleno-renal shunt and one with liver cirrhosis had left gastric-caval shunt.
Patients with liver cirrhosis were 14 in grade C, 6 in grade B and no patient in grade A of Child's classification. Four died in the pstoperative period, primarily of problems related to hepatic failure already existed before operation. Six died after the postoperative period, of which 3 died of hepatocellular carcinoma developed after surgery and 2 died of alcoholic hepatic failure within one year postoperatively. Other 13 patients survive more than one year after operation with no recurrence of bleeding from varices and no postshunt encephalopathy.

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Of 32 cases with SLE, vascular injuries were found in nine cases (28%). These are six cases with finger ulcers (including one case with gangrene), two cases with necrobiosis on legs and one case with systemic vasculitis. Of the nine cases nRNP antibody was found in eight and Sm antibody in two. In one case of SLE without renal involvement, elevated DNA antibody titer, hypocomplementemia and finger ulcers developed simultaneously. All six cases with finger ulcers reacted to moderate amount of finger tip. This case reacted to intravenous drip infusion therapy of prostaglandin E₁.
Anti-nRNP antibody was found more frequently in the vasculitis patient group. But anti-nRNP antibody titers never fluctuated when the vascular injury developed in each patient. Immune complexes consisted of DNA and complement-fixing anti-DNA antibody or other antigen-antibody systems may play a role for the development of vascular injuries in SLE.

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Excessive salt intake is blamed for high frequency of hypertension in Japan. Japanese dietary habit is recently changing with expectation of less consumption of salt.
We picked up ten sanatorium scattering all over Japan and investigated exact daily salt intake among their in-patients on regular diet. Each of ten facilities chose volunteers of in-patients who agree to join this study and were instructed to eat all of their meal and on more than that. 24-hours urine were collected daily for 3 days to determine the amount of excreted sodium and creatinine per day. Urine sample with less than one gram creatinine were excluded as incomplete collection of 24-hours urine.
The average daily salt excretion among all ten facilities was 10.81±3.51g/day. This value was less than average Japanese salt intake and was very close to the guide line figure 10g/day by Ministry of Health and Welfare. However, there was wide distribution among facilities, ranging from 7.08±0.54g/day to 12.72±2.54g/day with ratio of 1 to 1.8.
Sodium excretion of three consecutive days were compared each other. Day 1 to Day 2, Day 1 to Day 3, and Day 2 to Day 3 were all well correlated respectively. So, single 24-hours urine sample could be enough to determine daily sodium excretion.

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Vasa previa is a rare obstetric complication, and the diagnosis is made after delivery in most cases.
Vasa previa does not affect the mother's body, but the infant mortality (a fetal mortality) rate is said to be very high, between 50-100%, therefore early diagnosis and care is of great importance.
We experienced two cases of vasa previa at The 2nd Tokyo National Hospital in 1978
In one of these cases, we experienced very rare placenta previa partialis together with vasa previa. There was question regarding the possibility of vasa previa before delivery, and a Cesarean section was performed, but the fetus did not survive.
In the other case, an emergency Cesarean section was performed, because that the fetal heart tone became weak at the onset of labor. The fetus was saved and after delivery the diagnosis of vasa previa was made.
In the case of abnormal symptoms, not only in suspicion of vara previa, but also in sudden weakness of fetal heart tone without other signs, delivery must be performed immediately by Cesarean section, forceps delivery or vacuum extraction delivery etc.

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There were two case reports of leiomyosarcoma of vein without Caval vein in Japan.
We experienced a 38-years-old housewife complaining of the swelling of rt. lower extremity and tumor of rt, inguinal region who was diagnosed primary leiomyosarcoma of rt. iliac vein.
In this paper we reported this case and discussed the origin of leiomyosarcoma of iliac vein, diagnosis, operation and prognosis in reference to literature.

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Skin ulcers in patients with collagen diseases are considered to be vascular involvement by their disease process and are not infrequently intractable.
A forty-seven-years-old female patient with mixed connective tissue disease who had severe finger ulcer, a 73-years-old female patient with scleroderma who had a gangrene on her finger, and a 42-years-old female patient with malignant rheumatoid arthritis who had severe leg ulcers were treated by intravenous drip infusion of prostaglandin E₁(40-60 μg, twice a day) for one to two months.
All three patients showed considerable improvement and none of them showed any severe side effect.

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Gram-positive cocci had been predominant as etiologic agents of infectious diseases of children in the past. Frequent use of antibiotics and prevalence of adrenal cortical hormones, anti-tumor agents and radiotherapy has resulted in changes in drug-resistance and infection-preventing ability of the host. Thus, gram-positive cocci are being replaced by gram-negative bacilli, especially by glucose-nonfermenting microorganisms. Despite such an actual condition, gram-positive cocci, especially S. aureus, still occupy an important place as a causative agent of infectious diseases in the pediatrical field. In view of this fact, the authors conducted a study on changes in drug-sensitivity patterns distribution of resistant strains between in-and out-patients, cross-resistant picture, and incidences by phagetypes of S. aureus, isolated from various clinical materials of in-and out-patients of National Children's Hospital over the period from 1979 to 1981.
A total number of 20 agents including 3 types of penicillins, 3 of aminoglycosides, 9 of cephalosporines, 2 of tetracyclines, 2 of macrolides (MLs) and chloramphenicol (CP) were used. The drug sensitivity pattern varied from year to year and from one drug to another, but the number of strains resistant to the drugs used continously tended to increase slightly. As for the distribution of isolates resistant to each drug used between in- and out-patients, the number of resistant isolates was generally larger in the former.
However, it became more similar between the two groups of patients with years. In fact, the number of isolates resistant to cefatricin, MLs and CP was far greater in out-patients in 1981.
With regard to cross resistance organisms resistant to 5 drugs or less were more frequently isolated in the out-patients, whereas the incidence of those resistant to 6 drugs and more was markedly higher in the in-patients.
Organisms of phage type I and III were more predominant alternatively at intervals of 4 years from 1968 to 1981.

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A collective medical checking procedure for breast-cancer, which started in Sept. 1973 in the northern district of Nara-Prefecture, incorporates one medical checker, who offered his activity both in the stationary facilities and on widely spreaded localities. Of the persons of 20, 253 in total, who received the said medical investigation, 34 cases of breastcancer were discovered up to Sept. 1981 (discovery-rate 0.168) Less persons visited the stationary facilities than dispersed localities, but a higher discovery rate resulted in the former. When classified by age, the age-group of thirties is predominant. The discovery rate varies depending on age, such that it shows no remarkable variations between 30 and 59, falls to nil in twenties, but soars abruptly in the range higher than sixties. Incidence of cases requiring further investigation showed a higher rate within the first 2 years but declined thereafter with average figure of 3.80.
The discovery rate is distinctive also by locality where one lives: people dwelling in urban district, where many people are moving in, show a higher rate than those in country side. Breast-cancer cases discovered in the mass screening are mostly found in an earlier stage of their progress. 29 cases out of 34 cases were evaluated as of I stage (85.3%) with 6 cases found histologically under a state of lymphatic nodule metastasis.

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A case of acute myelogenous leukemia (AML) with 10 years history of preleukemic phase is reported.
Twenty-seven-years-old male was diagnosed as AML because of abnormal myeloblasts in the peripheral blood and bone marrow. This patient had been examined for bone marrow because of thrombocytopenia and anemia at the age of 17, when he had hematopoietic disorder due to sideroblastic anemia retrospectively.
His chief complaint on admission was the petechiae on the face, trunk and extremities. CBC showed 330×10⁴/mm³ of RBC, 4, 400/mm³ of WBC and 0.3×10⁴/mm³ of platelets. The bone marrow was hypoplastic and the differential revealed 10.8% of abnormal blasts with positive peroxidase reaction.
Sideroblastogram by iron stain showed presence of the ringed sideroblasts. Chromosome analysis by G-banding method revealed abnormal pattern of 47, XY, +8, 17p+, 19p+ in 7 cells out of 10 analyzed cells. Patient died suddenly of cerebral hemorrhage after 2 months follow-up, without leukemia chemotherapy.
This case was considered as sideroblastic anemia with 10 years duration terminating in AML and had chromosome abnormality of trisomy 8.
The significance to analyze the chromosome on the unusual cases of acute leukemia with preleukemic phase is stressed.

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We report two cases of Creutzfeldt-Jakob disease (C-JD), a brain disease thought to be a slow virus disease complicated with gastric disease. Case 1 is 69-years-old male, who visited our hospital with chief complaint of disturbed consciousness level. He died in one month and 11 days after the onset and autopsy disclosed gastric cancer, liver cirrhosis, pulmonary emphysema etc. Case 2, 69-years-old female, visited our hospital with chief complaint of melena and anemia. She also died in 15 days after the onset and autopsy revealed gastric ulcer, fatty liver, old lung tuberculosis, renal atrophy, ovarian cyst, retroperitoneal hemorrhage and so on. Histology of the brain of the two cases showed foamy degeneration and neuronal cell atrophy and disappearance. There were kuru plaques in substantia nigra and whose cores were positive for silver, PAS and congo red.
Twenty-seven cases of C-JD are only reported in Japan till 1975 by Mizuno, Y. A complicated case of C-JD and gastric disease is not reported yet. This complication was thought to be due to an accidental manner, a Cushing's ulcer-like mechanism and unbalanced autonomic nervous system. Other complications like two cases of skin disease arealso reported without clear mechanism.

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A retrospective study of 111 patients with unresectable gastric cancer seen at Fukuoka-Chuo National Hospital during a period of 10 years from Jan. 1, 1969 through Dec. 31, 1978.
One year direct survival rate of the unresected cases was 4.7 percent and mean survival period after the operation was 123 days. This results were noticed regardless of age, sex, and an additional treatment such as feeding procedures, gastroenterostomy and immunochemotherapy. On the contrary, patients who had palliative resection for stage IV carcinoma had a prolonged mean survival rate. This study demonstrated a real outcome of the unresectable gastric carcinoma and that palliative resections can significantly increase survival in patients with advanced gastric carcinoma.

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Fine-needle aspiration cytology (FNAC) has become to be widely popularized for diagnosis of the breast because of its simplified procedures and safety for complications.
Among 371 cases which received cytology of the breast during the past 18 months, 288 cases of FNAC except for those of nipple discharge and cystic fluid were subjected to comparison to palpation, xeromammography and ultrasonic examination to examine FNAC's application and limitation.
The right diagnosis rate by FNAC in 85 cases of cancer of the breast was 76.5% while those by palpation, xeromammography and ultrasonic examination were 65.9, 54.1 and 50.6% respectively.
To classify by histologic type, FNAC showed lower right diagnosis rate of scirrhous carcinoma compared with other diagnostic methods.
FNAC is, if tumors are properly aspirated to collect cells, able to diagnosis irrespective of size of tumors and advantageous for diagnosis of small tumors compared with other methods.
Comprehending the advantages and limitations of FNAC and combining with other diagnostic methods appropriately seem to improve diagnostic accuracy of disease of the breast.

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Very inveterate schizophrenic symptoms of hyperkinesia, impulsive-manneristic behavior and severe sleep diturbance which had been incorrigible by neuroleptics and/or lithium bicarbonate were successfully treated with help of GABA (γ-amino butyric acid) in two patients. After several relapses, one male patient stayed hospital for twenty-seven years in dilapidated state with recurrent psychomotoric excitement. The other male patient had had schizophrenia at thirteen years old and showed very regressive state for the last four years.
When 1.5g or 3g of GABA was given per os in combination with neuroleptics and lithium bicarbonate, the psychomotoric excitement and sleep disturbance disappeared a few days later. Whereas only GABA was withdrawn from the prescription, the psychomotoric excitement and sleep disturbance reappeared.
GABA can not penetrate into the brain because of unable to cross the blood-brain barrier. So GABA should work on the peripheral tissue, especially neuro-muscular system from which impulse originate and is sent to the brain. Impulse flow pattern plays a very important roll of forming stimulus-response level, i.e. threshold in the brain. Dramatically altered impulse flow pattern from the musculature under GABA may be forced to reset the threshold in the brain for the psychomotoric expression.

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