The cellular, histological and clinical features of 72 cases of microinvasive carcinoma of the cervix were studied. The diagnosis of microinvasive carcinoma was made by application of the criteria of the Japanese Cervical Cancer Committee to classify cervical section of conized cervices; microinvasive carcinoma was defined as squamous cell carcinoma with histologically confirmed stromal invasion to a depth of 3 millimeters or less measured from the basement membrane of the overlying surface layer. Patients with vessel permeation or confluent invasion were excluded.
The accuracy of cytology with spatula was 72.2% in microinvasive cancer.
The cytologic findings of mitroinvasive cancer showed appearance of intermediated and surperficial type malignant cells aside from deep layer type malignant cells. A few bizarre cells and picnotic nuelei were more eminent in microinvasive carcinoma than CIS. Many of the atypical cells appeared in aggregates and large cancer cell-clusters were evident in 70% of the samples. The cellular debri was seen in 36% of the cases. These findings were helpful as an indicator of microinvasive carcinoma.
Modalities of treatment used for microinvasive carcinoma of the cervix were extended radical hysterectomy in 52 cases, sub-extended hysterectomy in 4 cases, and simple hysterectomy in 16 cases. Lymph node metastasis was not found in any of these patients and the 5-year-survival rate was 100%. Simple hysterectomy seemed justified for the patients without vessel permeation or confluent invasion at the conized cervices.
However, hysterectomy dose not mean the end of follow-up since there appears to be a significant risk of recurrences or new foci of disease in the vaginal vault after hysterectomy.

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In the past several years, the clinical courses of various renal diseases have been clarified along with popularization of renal biopsy technique and nation-wide surveys on renal diseases by Ministry of Health and Welfare. For the sake of patients, it is very important to elucidate the deteriorating factors of chronic renal diseases.
This study was done on 339 consecutive patients (150 males and 189 females) in our renal clinic in order to evaluate the contributing factors to the impairment of renal function.
Results and Discussion: 1) The number of patients with impaired renal function (serum creatinine>2mg/dl) was 42 in male and 30 in female. This indicates the male preponderance over female in becoming renal insufficiency (P<0.01). 2) The number of patients with impaired renal function and hypertension increased with aging. This tendency was more marked in male than in female, 3) About half of persistent hypertensives (>160 and/or 95 mmHg) have serum creatinine levels of more than 2 mg/dl. This indicates that persistent hypertension exerted an unfavorable effect on renal diseases. 4) The renal function was impaired in 39% of the patients taking a rest, 17% in working patients and 18% in overworking patients, respectively. We consider that these data do not necessarily deny the favorable effect of taking a rest on renal function. This result was mainly attributed to the relatively short follow-up period and the disparity of age distribution in these 3 groups. 5) Renal insufficiency was more frequently observed in patients with hypertension, urinary tract infections and those having renal impairment since pregnancy. 6) Seven women with renal disease had normal deliveries, but other 4 women experienced abortions or stillbirths. Furthermore, deterioration of the renal disease was seen in 7 women after delivery. Five of the 7 have been receiving chronic hemodialysis. Only one patient with renal disease showed normal urinalysis transiently in the 3rd trimester of pregnancy and relapsed after the delivery. 7) Eleven out of 339 patients died; 4 of them from nephrosclerosis, 3 from chronic glomerulonephritis, 1 from multiple myeloma, 1 from primary amyloidosis, 1 from lupus erythematosus and 1 from unknown cause. Causes of death were cerebral hemorrhage in 4, gastrointestinal bleeding in 3 and pneumonia in 3. These implicate the importance to maintaining blood pressure within normal range as well as keeping patients away from malnutrition.
Finally the risk factors of renal diseases were analyzed. These were age, sex, activities, infection, underlying disease, hypertension, pregnancy and so on. Our study revealed that hypertension and pregnancy were the major risk factors among them. Medical attendants should always keep in mind these risk factors and evaluate properly such laboratory findings as urinalysis, renal function tests and pathological changes in the management of chronic renal diseases.

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Steroid hormones and immunosuppresants have generally been used in treating patients with collagen diseases and the significance of immunotherapy in such diseases has been recently reported in SLE nephropathy. It is said that abnormality of cellular immunity is involved and that the possible effect of immunotherapy might be expected in SLE nephropathy.
In this study, we administerated PS-K (Krestin) to 5 patients with SLE nephropathy who has relapsed 5-8 times. All of these patients have been treated with steroid hormones and immunosuppresants.
Doses administered was 3 grams PS-K per day combined with steroid for3-8 months, and observation period was 6-22 months.
Two out of 5 patients, relapse or recurrence was stopped in observation period and urinary protein excretion was also decreased.
This type of immunotherapy might be promising in SLE nephropathy in the future.

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It has been proved that the pathogenesis and deterioration of renal diseases particularly including nephritis are related to the abnormalities blood coagulation or the fibrinolytic system, and various types of anti-coagulant therapy are applied to the treatment for these diseases. Trimetazidine is known to have anti-platelet activity. We studied its effect on various kinds of nephritis by administering a large dose of 45 mg/day.
Decrease in proteinuria was observed in 2 out of 7 patients with chronic glomerulonephritis, 2 out of 3 patients with nephrotic syndrome and 1 patient with nephritis and purpura. More significant effect on decrease in red blood cells in urine was noted in 3 out of 7 cases with chronic glomerulonephritis, 1 out of 3 cases with nephrotic syndrome and 1 lupus nehritis and nephritis and purpura. Thus, the drug was considered to be effective for the treatment of proliferative nephritis.

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Hemodialysis (HD) has been most commonly used for the treatment of chronic renal failure. Peritoneal dialysis (PD) has several problems for long-term use. Two patients, 70-year-old male and 70-year-old female, treated with intermittent PD, three times a week were presented in this paper. For each cycle 2 litters of dialysate solution were introduced using an automatic exchanger. Total infusion volume was 15 liters for about 8 hours a day. The peritoneal cannula was left in the peritoneal cavity after each dialysis,
The duration of PD was 9 and 11 months for these two cases respectively. In the first case, frequent retention of ascites was observed 4 months after starting PD. Therefore, intravenous reinfusion of the fluid, after condensing the fluid by a hollow fiber dialyzer, was performed with antibiotics and anticoagulant agents, and consequently the serum hypoproteinemia did not develop. As it can be fatal or result in loss of peritoneal membrane for further dialysis if there is any chance for peritonitis, PD was done every day along with infusion of antibiotics and anticoagulant agents in the abdominal cavity in such a case.
Although continuous PD was designed in the beginning in order to increase effectiveness of the dialysis, peritoneal infection occurred frequently. Therefore, the patient was returned to intermittent PD because of abdominal fullness, anorexia or a sense of abdominal distension.
Thus, intermittent PD is a very useful method for long-term dialysis of chronic renal failure, and has much less load to the cardiovascular system and the blood pressure. The patient can be freely mobile with the application of the peritoneal cannula. In addition, it is necessary to check many factors including diet, water balance, infection and effectiveness of dialysis.

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We performed 26 operations for the 25 patients whose lives were sustained by hemodialysis.
Among 26 operations 20 were performed for benign diseases and 6 for the malignancies.
The operative mortality of the benign diseases was 5%, but that of the malignancies was as high as 33%.
The main causes of operative death of malignancies were anastomotic insufficiency and pulmonary complications.
As the countermeasure of anastomotic insufficiency we tried (1) to reduce the number of anastomosis between intestines and (2) to avoid the use of suture machine to reduce the tissue lesion around the anastomotic site and (3) to use non-absorbable atraumatic needle.
To prevent the pulmonary complications, especially in the older patients, we tried to use the respirator until they awoke from anesthesia so clearly that they could expectorate sputa completely by themselves and we made jejunostomia from which we inserted the gastric tube and advanced it retrogradely to the rest of stomach, aiming to facilitate expectoration by making the upper airway free from the gastric tube.

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A long-term hemodialysis for chronic renal failure requires a shunt which assures an adequate flow, is expected to be kept open and useful over a long period and rarely causes complications. Every effort should be made to extend the tube supporting the life as far as possible.
A 38-year-old woman was admitted to the hospital on May 12, 1973 because of heart failure due to uremia. BUN was 250 mg/dl, creatinine 13.8 mg/dl, Hb 4.0g/dl. Peritoneal dialysis was started soon after admission. On May 21, an external shunt was made at the left forearm and the patient was subjected to hemodialysis. According to the Report of Journal of Japanese Society of Dialysis Therapy at that time, the ratio of external shunt was 49.5% and the open period of external shunt reported by many physicians was 7 to 12.3 months in the arterial side and 6.3 to 7 months in the venous side. It is said that external shunt is apt to cause complications and has a short life. This is a serious bottleneck for the long-term dialysis for as long as 5 to 10 years. Following arterial external shunt was made by the cardiovascular surgeon, the whole management of the shunt was put into a physician's hands. In January 1974, December 1975, and May 1977, the arterial external shunt was rebuilt on the same hand, which had been kept open for the mean of 25.1 months.
In May 1975, October 1977, and April 1980, venous external shunt was reformed, which was kept open for 27.3 months in average. During these 8 years and 5 months, external shunt was refor med 6 times, and declotting was performed 18 times, i. e. 2.1 times a year in average. According to our experience, in most cases the function of either the arterial or the venous side became ineffective first, resulting in clotting in another side. If the causal side is repaired in its early stage in these cases, the life span seems to be much prolonged. In addition to the daily care for prevention of infections, administration of an anticoagulant and washing of the shunt are performed, if any symptom suggesting slower blood flow is found. At the same time, arterial and venous shuntgraphy as well as venography of the hand is carried out, and the external shunt is utilized as long as possible. The reformation is put into a surgeon's hands. Additionally in order to save the patient's life the external shunt should be kept open as long as possible by the operation of autologous transplantion of superficial vein to the vein of the hand, and addition of the artificial vessel E-PTFE (Coretex) to the artery of the hand, and vessel of one side is used up completely.

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A 25-Year-old male developed glomerulonephritis-ike symptoms, and was admitted to our hospital with fever and myalgia of the lower legs. He had marked tenderness on the muscles of the upper arms and lower legs, and pains at the interphalangeal joints of the feet. Laboratory examinations revealed leucopenia, LE cells, massive proteinuria, positive LE test, antinuclear antigen, low compliment titer, marked increase in blood urea nitrogen, creatinine and potassium, and increase in myoglobulin both in the serum and urine. Under the diagnosis of systemic lupus erythematodes (SLE) with acute renal failure, steroid hormone was administered and hemodiaiysis was begun. His symptoms and laboratory findings improved temporarily. However, pneumonia developed on the 40th day after admission, and he died on the 72nd day. Autopsy revealed mesangiocapillary glomerulonephritis (MCGN) with diffuse proliferation of the mesangium cells and thickening of the capillary loops in every glomerulus.
Although various classifications are used for lupus nephritis, MCGN type lupus nephritis is rarely seen. MCGN is the most aggressive histological change in lupus nephritis. Renal failure of this patient should be due to MCGN. Whether acute tubular necrosis due to myoglobulinemia played a role in causing renal failure was not clear, since there were no myoglobulin casts in the renal tissue. Laboratory findings did not support the presence of polymyositis or viral myositis, and the cause of myoglobulinemia was unknown.

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A new method of charcoal seroperfusion using IBM 2997 blood cell separator combined with DHP-1, which is the activated charcoal-filled tube, was developed by us and was applied to a patient with paraquat poisoning.
The patient was 33-year-old female, who took paraquat (glamoxan) for suicide. Charcoal seroperfusion was done three times over 3 days showiug concentrations of urinary paraquat decreased remarkably.
Charcoal seroperfusion is the method which can separate blood into blood cell components and serum by centrifugation and only the serum canbe passed through charcoal to adsorb the poisoning substance. This method is considered to be safer and more effective compared to the conventional hemoperfusion method, because there is no adsorption or destruction of blood cell to charcoal.
This patient died of acute circulatory failure following heart attack. Autopsy findings revealed interstitial myositis of the heart characteristic of paraquat poisoning. The histological findings of the lung, liver and kidneys were also described in detail.

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A clinico-pathological study was done on 5 cases with sclerosing hemangioma of the lung who were operated between 1973 and 1981. The number of cases with sclerosing hemangioma represented 1.9% of a total of 263 patients with resected lung neoplasms admitted to our hospital. Although the age range varied from 34 to 68 years, most of the patients were seen in their thirties and sixties. All cases were female and had no symptoms. Roentgenographically, shadows of tumors were round, sharply circumscribed and located predominantly in the periphery of the lung field and the subpleural region. Grossly, the lesions were round masses with sharply circumscribed borders and distinct pseudocapsules in all cases. Microscopic findings were consistent with typical sclerosing hemangioma of the lung described by Liebow and Hubbell. The ultrastructural features of the predominant cells were considered to be those of pneumocyte. Proliferation of immature endothelial cells and pericytes was not identfied. Findings of pre-existing inflammation were not obtained clinically and histologically. We conclude that sclerosing hemangioma of the lung is not of endothelial orgin but of epithelial orgin, and this tumor might be hamartoma of peripheral lung tissue rather than postinflammatory tumor.

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Dysuria is seen as complications of cordotomy. We studied the incidence of dysuria in twelve cases with open cordotomy and thirteen cases with percutaneous cordotomy.
The results suggest that dysuria is more likely associated with upper cervical cordotomy than lower one, and more likely seen in cases with motor weakness or cerebellar ataxia. These findings are cosistent with conventional view suggesting that dysuria occurs more often when the incision into the cord is deeper or extended into a more posterior direction.

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The joint study among 9 national hospitals was performed in order to establish early diagnostic system by nuclear medicine during the period from 1979 to 1981.
Recent progress in clinical nuclear medicine and development in instrumentation and radiopharmaceuticals are closely linked. Members of this study group had specialized field and it was necessary to have explosively increasing knowledge in related fields, such as biochemistry, biophysics and biomedical engineering. This required an ability to learn advanced technology other than medicine. During these 3 years we have tried to keep this in mind and have attempted to publish a monograph compiled in a single volume to present outstanding works. This basic cóncept supported the purpose of our group studies to provide broad insight into this subject.
Significant development has been made in the areas of both in vivo and in vitro nuclear medicine in our joint study group. However, some papers may be imcomplete because of a rapidly expanding knowledge. These problems may be filled in part by progress of current investigation.

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Without respiratory symptoms, a case of tracheopathia osteoplastica associated with esophagus cancer in a 67-years-old man is reported. This is the 17th case reported in Japan.
The diagnosis was made of the tracheal tomogram and the characteristic findings of the bronchoscope, but the flexible bronchoscopical biopsy was not successful.
After operation of the esophagus cancer, this case became asymptomatic in spite of no treatment.

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By sending questionnaires to cases subjected to operation by us, we tried to hold the entity of postoperative disorders of the breast cancer, studying their etiologies.
Among 657 cases of the primary breast cancer which were opeyated during the past 14 years at Shikoku Cancer Hospital, 355 cases were served as subjects excluding death and recurrence cases.
Lymphedema of the arm was observed in 54.9%, it is significantly frequent in cases of postoperative radiation to the axilla, and infrequent in cases of modified operation.
Limitation of movement of arm was seen in 10.4% frequent in advanced cases of TNM stage III and those of standard operation. Pain of the arm occured in 44.8% showing high level in standard operation.
In addition, size of tumor, age, obesity, etc. might be said to be the etiologies of postoperative disorders.
To lessen postoperative disorders of the breast cancer, it is important to find cases in an early stage, in which period it is able to be cured by conservative operation as well as to take meticulous care of postoperative management, applying the mind to considerable etiolgies of postoperative disorders.

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Our previous report described that Brompton mixture (BP), elixir containing morphine hydrochloride and cocain hydrochloride, might be effective and useful for the management of patients with chronic cancer pain which was already treated by the use of pentaaocine of more than 50 mg per day.
We reported laboratory findings of a series of 113 patients treated with BP. In conclusion, if BUN was high (≥36mg/dl) long term administration of BP should be avoided(χ²-test: P<0.05).
Serum level of total-morphine was determined by the method of spin-immunoassay and investigated in cancer patients after rectal (0.67 mg/kg), intravenous (0.09 mg/kg) or oral (0.20 mg/kg) administration.
These findings suggested that rectal administration of morphine might be useful for the management of chronic cancer pain.

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During the past 7 years and 9 months from Jan. 1974 to Sep. 1981, management of pain was performed on 87 cases with intractable pain caused by malignant tumors.
The locations of these cancers seen in patients with intractable pain were alimentary truct in 46 cases, lung, mediastinum and breast in 14, gynecologic in 11, otolaryngologic in 16, and etc.
Among 87 cases, 63 were treated by continuous epidural block, 35 by intrathecal phenol block, 4 by celiac plexus alcohol block, and 3 by trigeminal alcohol block.
Significant relief of pain was obtained in 35 cases with intrathecal phenol block and celiac plexus and trigeminal alcohol block.

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Electrocardiographic changes produced by unilateral right and left stellate ganglion block (RSB and LSB, respectively) using lidocaine (100 mg) were studied on 18 patients with no apparent cardiac disease. The results were as follows;
1) No significant changes in arterial blood pressure, heart rate, and QT interval were found in both RSB and LSB.
2) LSB increased the positivity of T wave more than 3 mm in 3 patients (33%), how-ever RSB caused no significant changes in T wave morphology. The result suggested that functional distributions of RSB and LSB in the heart were different.
3) Arrhythmias were found in 2 patients (11%). One patient treated with RSB showed sporadic ventricular premature beats. Another patient treatad with LSB demonstrated frequent ventricular and supraventricular premature beats as well as AV dissociation, lasting for 3 hours. Genesis of these arrhythmias remained unknown in the present study.

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In clinical field, one of the most considerable points is how to care for the shock. Especially in the case of allergic patients, various adverse reactions including anaphylaxy shock are the big problem. We presented several cases of shock in our department of allergy and described our method of countermeasure.
A. Various shock
Case 1: Intradermal skin test shock. Case 2: Hyposensitization therapy shock. Case 3: Hydrocortisone shock. Case 4: ACTH shock. (rapid ACTH test) Case 5: Antibiotics shock (CER). Case 6: lode and Ketamine HCl shock. Case 7: Withdrawal syndrome in the step of reducing steroid.
B. Our countermeasure
Case 1: Prick (Scratch) test should be done before intradermal test. Case 2: Fasten patient's arm at the upper area of injection as soon as possible, then give epinephrine both upper and lower side. Case 3: Inject slowly, and observe clinical findings carefully. Case 4: Skin test should be done before rapid ACTH test. One hour drip infusion method is recommended. Case 5, 6: Skin test and history taking were important. Case 7: During reduction of steroid, careful observation must be done and also checking 17-OHCS, 17-KS and 17-KGS in urine was recommended.
In this study, we emphasiszed following two points. First, if patient condition is allergic, skin test is useful to prevent adverse reactions. Second, physicians should prepare the emergency kit near the bed.

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