Usefulness of CCU for the management of acute myocardial infarction has been well recognized. Three major problems are discussed here.
In the first, unless there is sufficient emergency medical system for early admission of the patients, the usefulness would be largely limitted as in Japan at present. In the second, establishment of educational program and authorization of specialty for CCU nurses are required. In the third, methods of management for severe pump failure and cardiac rupture which are almost all causes of death in CCU must be investigated.

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Questionnaires were sent to 229 National Hospitals and Sanatoriums, to survey the pre-sent state of things and problems in intensive care unit (ICU). One hundred and sixty four answers were given (rate of answer. 71.6%).
Thirty one per cent of institutes have operating ICU in a wide sense, 4.27 per cent have facilities of ICU but not in operating, 4.27 per cent have ICU under consideration, and 40.24 per cent hope to have ICU in the future.
Only 27.45 per cent of ICU have full-time physicians and 17.6 per cent have full-time nurses. In 60.8 per cent of ICU, only part-time nurses are assigned. In 21.6 per cent of ICU no physician and nurse are assigned. Only 5.9 per cent of ICU have more than 5 physicians and nurses in full-time.
In National Hospitals, patients of all services, cardiovascular surgery, cardiac failure, general surgery and internal medicine are the main customers of ICU. In National Sanatoriums, they are respiratory failure, cardiovascular surgery, thoracic surgery and emergency service.
The shortage of full-time personnel, especially nurses, physicians and technicians, is most critical and makes a 61.7 per cent of all answered problems. The shortage of e-quipment and apparatus, and that of space and facility make 18.9 per cent and 17.2 per cent respectively.
To meet the standard for management of specified intensive care unit by the Ministry of Welfare, an intensive care unit which has 4 beds, should be assigned more than 5 phy-sicians and 15 nurses in full time. Only 5.9 per cent of intensive care units have the person-nel to meet the standard.
The resolution of the critical shortage of personnel is a fundamental problems for the progress in ICU.

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From July 1978 through August 1980, forty three patients were operated by different procedures for peptic ulcer. They were allocated to three groups: 14 gastrectomy patients, 14 vagotomy and antrectomy patients and 15 vagotomy with or without drainage patients. As for humoral immunity, the present study was undertaken to determine changes in serum concentration of γ-globulin, immunoglobulin, complement in the patients who underwent surgical procedures on the 2nd and the 4th week. In cell-mediated immunity, changes of T lymphocyte, B lymphocyte, PPD and PHA in skintest were determined on the 2nd week.
Lymphocytes had reduced between 7.4% and 24.3% on postoperative 2nd week and then returned to preoperative values on the 4th week in three groups. There were no significant difference in them. Serum IgG level of gastrectomy patient had showed a statistically sig-nificant increasing rate of 20.2% on the 4th week than 2% of vagotomy with or without drainage patient such as γ-globulin (p<0.05). Alternations in serum concentration of IgA, IgM and IgE were increased slightly on the 2nd week and fallen on the 4th week in three groups on the same pattern. Changes in serum complement were as well as IgA, IgM and IgE, being no statistically significant difference in different operations. Mean diameters of PPD and PHA in skin test had reduced on the 2nd week, but no significant change was noted. T lymphocyte almost had fallen on 2nd week, and B lymphocyte almost had increased in three groups. Changes in serum CEA and AFP were a little postoperatively.
Compared with vagotomy with or without drainage, gastrectomy procedure had post-operatively a statistically significant increase at p<0.05 with regard to changes of γ-globulin and IgG on the 4th week, but changes of another values in humoral and cell-mediated im-munity were same patterns in three surgical groups.

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Herein I describe a new method for cystoplasty, by means of the regenerating ability of the bladder. The contracted bladder is opened with a crucial incision and enlarged by placing thin paper covered with liquid synthetic resin (nobecutane) like a cap over the opened bladder tissue. Within 3 to 4 weeks granulated tissue completely covers the artificial cap, which is then removed transurethrally. Thereafter, the bladder regenerates on its own.
The operation has been done at our hospital from 1970 to 1980 on 17 patients with con-tracted bladders owing to various pathologic conditions. Excellent results have been obtained on 15 patients with tuberculous contracted bladders. These 15 patients have regained normal bladder capacity and are able to void normally through the urethra. The technique has not been effective in 2 patients with interstitial cystitis, caused by generalized collagen disease in 1.

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We devised a new method of cholecystectomy using surgical LASER. This new method is as follows; in stripping the gallbladder from the liver bed, the incision is given between the serosa of the gallbladder and the liver tissues bordering it, whereas in the traditional method the incision is given between the serosa and the submucosa of the bladder.
By this new method the duration of operation (cholecystectomy) is redused and bleeding volume is also saved.
The liver function was not disturbed by this method.
We think that the best indication of this method is the case whose gallbladder wall is remarkably hardened by inflammation.

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Immunosuppressive acidic protein (TAP, Matsuda et al. 1976) is a glycoprotein, having a molecular weight of 59, 000, described to be increased in tumor-bearing mice and in patients with malignancy.
In the present study, serum TAP concentration was determined in 409 patients with various malignancies and in 59 patients with non-malignant diseases. Raised levels of serum TAP were observed in 62.3, 46.0, and 32.7%, respectively, of the patients with carcinoma of the lung, the stomach and the breast, prior to surgery. On the other hand, elevation rate of TAP in the advanced cases of carcinoma of the lung, the stomach, and the breast were 73.0, 80.0 and 70.2%, respectively. Patients with hepatocellular carcinoma had relatively low positivity compared with other malignancies. Analyses of ai-acid glycoprotein and TAP in the same serum specimen showed the positive correlation.
We may conclude that IAP appears to serve as a marker for malignancy.

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The origin of multinucleated cells in giant cell tumor of bone has been the subject of considerable speculation and investigation. The most frequently speculated view is that the multinucleated giant cells are related to osteoclasts.
In the present study, we investigated the fine structural localization of acid and alkaline phosphatases in osteoclasts, osteoblasts and in tumor cells, in order to clarify the function, cytogenesis of these two cell types as well as their relationships.
In the study, althogh the giant cells of giant cell tumor bear a close ultrastructural resemblance to the osteoclast, there was clear difference existed; the giant cell lacks the well defined brush border and endocytosis of the osteoclast.
Cytochemically, the acid phosphatase activity was demonstrated clearly over lysosome-like organelles, which appear to be the primary lysosomes, Golgi apparatus, cytoplasmic vesicles and vacuoles in tumor giant cells. It was also demonstrated clearly over lysosomes of the osteoclasts.
On the other hand, the alkaline phosphatase activity was only demonstrated on the plasma membranes of tumor giant cells and type I stromal cells of the tumor, in despite of a close ultrastructural resemblance between tumor giant cells and osteoclasts. It is our conclusion, as far as the activity of the alkaline phosphatase is concerned, that at first, giant cell tumor of bone does not appear to be derived from the osteoclast, and secondly, tumor giant cells and type I stromal cells are functionally very close.
In addition, strong alkaline phosphatase activity was demonstrated on the plasma membrane and rough endoplasmic reticulum in osteoblasts. This finding of alkaline phosphatase activity in type I stromal cells suggests that these cells are functionally related to bone-forming cells (osteoblasts).

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As α² PAG (α²-pregnancy associated glycoprotein, or SP³), a specific protein that appear in the blood during pregnancy, is supposedly increased by malignant tumors, inflammatory diseases or oral contraceptives, we have evaluated its usefulness in the diagnosis of ma-lignant tumors. Similar studies were made of α²-HS (α²-heat stable glycoprotein), which is said to be decreased by malignant tumors and increased by acute inflammatory diseases, though its physiological function is not quite clear. As a result of the studies it was found that the quantitative determination of α²-PAG is diagnostically useful in cancer (especially in lung cancer), and that the quantitative determination of α²-HS is useful in the diagnosis of lung cancer in male patients. Nonetheless, as these are the results in comparison with healthy yound volunteers, it would be necessary to increase the sensitivity of this test in order for this to be utilized in early diagnosis or as a screening test for malignant tumors.

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The purpose of this paper was to estimate the normal range and value of the serum ferritin using various radioimmunoassay kits in the Nuclear Medicine Center, the 2nd Tokyo National Hospital.
Serum ferritin levels was examined in 138 healthy cases. When they were classified precisely according to the hematological and biochemical data, 66 cases were normal (46 males and 20 females) and 59 cases were abnormal with hypoferremia and hypoferritinemia (12 males and 47 females). Serum samples from these cases has been examined by four ferritin assay kits, i. e., S., G., R. P. and R. G.
The results can be summarized as follows:
1) Hypof erritinemia were sometimes seen in cases of healthy men and women without hypoferremia and others. 2) The serum ferritin levels which were determined at the same time correlated barely to each other kits, although there were noticeable variations. 3) The normal values were obtained 108.6+60.2 ng/ml(S.), 114.1+52.9 ng/ml(G.), 121.5+51.6 ng/ml(R.P.), 188.6+60.2 ng/ml(R.G.) in 46 adult men and 39.7+16.3 ng/ml(S.), 37.5+15.7 ng/ml (G.), 56.6+16.4 ng/ml (R.P.), 94.8+29.0 ng/ml (R.G.) in 20 adult women, respectively.
These results may be suggested that has troublesome possibility at standard level esti-mation on each kits.

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Serum concentration of ferritin was determined in 71 pregnant women (10.21 and 40 of 1st, 2nd and 3rd trimester, respectively) and compared with that of 16 normal women. It decreased progressively with the course of pregnancy: 25.4±12.4 ng/ml, 12.3±6.5 ng/ml and 8.9±5.6 ng/ml during 1st, 2nd and 3rd trimester. A positive correlation between serum ferritin and blood hemoglobin concentration was noted. From these data and a well-known fact that the serum ferritin concentration reflects iron stores in the body, it was suggested that the anemia during pregnancy may result from iron deficient state.
Therefore, serum ferritin concentration may be a useful parameter to diagnose latent anemia and to monitor iron replacement therapy during pregnancy.

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A 72-years-old male patient was admitted to our hospital on Jan. 29. 1980 with the chief complaint of left chest wall tumor and pain. He had presented several attacks of explosive cough about four years before, and fever and hard chest wall tumor (6×6 cm) four months prior to admission.
Laboratory studies disclosed high serum ferritin level (450 ng/ml). He took a downhill course with left chest pain and dyspnea and died on the 59th hospital day. The autopsy demon-strated pleomorphic rhabdomyosarcoma of the chest wall infiltrating to pleura, diaphragm and lung (left side) without distant metastases. On microscopic examination, cross stri-ations were found in a few tumor cells. This disease is relatively rare in Japan with 398 cases during 9 years from 1967 through 1975. High activities in serum CPK, GOT, LDH and HBD activities were reported. Moreover, high serum AFP level is reported in a few cases of rhabdomyosarcoma of the liver. AFP is said to be elevated in a rather well differentiated type of hepatoma. Ferritin is considered to be one of fetoproteins, so the elevation in well differentiated or pleomorphic type of rhabdomyosarcoma like this case is instructive to think of the functional aspect of this tumor.

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Criteria for the diagnosis of radiation-induced sarcoma have been previously described. All cases must have a history of irradiation and the second neoplasm must have arisen in the area of the radiation field. A latent period of several years must have elapsed after irradiation before clinical evidence of a second malignant neoplasm. Most important thing is that, all suspected cases must have been proved histologically.
We have experienced 3 cases of radiation-induced sarcoma, they were 42-years-old man who developed an osteosarcoma of the lumbar spine at the field of postoperative irradiation for seminoma 7 years previously, 69-years-old woman who developed a malignant fibrous histiocytoma of the buttock at the field of radical radiation for uterine carcinoma 7 years previously and 59-years-old woman who developed an extraskeletal osteosarcoma of the abdominal wall at the field of postoperative irradiation for uterine sarcoma 7 years previonsly. The last case is very rare and only 8 cases of radiation-induced extraskeletal osteosarcoma have been reported.
Since there has been a definite trend in the treatment of cancer toward employing radiation for more favorable cases, in addition to technical improvements in the adminis-tration of radiotherapy and more modern equipment, survival data may have been altered considerably in many malignant tumors. Accordingly, more radiation-induced tumors may be encountered in the future.
The clinical presentation and histopathology of these radiation-induced sarcomas are presented with a review of the literature.

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An autopsy case of neuroblastoma in aged woman was reported.
A 70-years-old lady was admitted to Akashi national hospital with pain and edematous change on her right lower extremity. She began to feel pain on the back of right thigh since June, 1977. Her right leg became edematous since July, 1978. The pain and edema increased in severity gradually in spite of continuous physical therapy. She was referred to us on September 19, 1978.
On admission, positive physical findings were dilated veins upwardly at the theupper abdominal wall and remarkable swelling of the whole right lower extremity. No superficial venous dilatation was seen on the both lower extremities.
Laboratory data reveald elevated serum value of CEA. Abdominal X-P showed destruction of L2 and L3 vertebrae. DIP failed to visualize the right kidney and ureter. Abdominal CT scan demonstrated low density areas in the right kidney and liver.
The patient expired 2 months after admission regardless of continuous cancer chemo-therapy.
An autopsy revealed an over-hen's egg sized tumor near the right adrenal region with invasion to lumbar vertebrae and metastatic lesion in the liver, serosal side of gastrointesti-nal tract and lymphnodes around the head of pancreas. The neuroblastoma was diagnosed histologically.
More than 90% of neuroblastoma is reported to occur below the age of 10, and the cases in old age is very rare. It was discussed that significant elevation of CEA activity observed in this case, suggested release CEA by the neuroblastoma.

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In a 48-years-old woman, papilloedema and incomplete external ophthalmoplegia seen at the first medical examination remitted spontaneously. When this patient was examined again after 5 years, homonymous hemianopic central scotoma and Foster-Kennedy syndrome were observed. The former indicates the abnormality of the endings of the optic radiation, and the latter is the funduscopic findings seen in tumors of the anterior cranial fossa, etc. In the areas corresponding to these findings, two meningiomas were noted. Therefore, craniotomy was performed by procedures for cerebral surgery. As a result, the patient made favorable progresses, such as the improvement of the visual field, which had been affected by transitory right hemianopsia, and the disappearances of hemianopic central scotoma and diplopia. Histological examination revealed that the isolated tumor as meningioma. I reported one rare case of multiple meningioma symptoms of which completely disappeared transitorily during the long-term observation.

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A case of 13-years-old boy with fibrous dysplasia involving the right frontal cranial bone was reported. The carotid angiogram showed abnormal vasculature at the right frontal region. A histological and roentgenographic analysis of this case was presented on this paper.

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Sixty-nine-years-old hypertensive male was hospitalized for evaluation of severe disori-entation to place and memory loss. On the previous day, he was found at midnight by his wife that he became disoriented within his house and could not go to the bath-room from his bedroom.
For several years he had sometimes experienecd slight fainting spell during walk.
On admission, he was confused and was found slightly demented like Korsakoff's syndrome. There was disorientation to time and place. Especially as space (geographical) disorientation was severe, he could not find his way to the bath-room nor his own room at the ward. Recent memory and new learning ability were highly impaired. Slight con-structional apraxia was found, those aphasia, agraphia and alexia were not found. Neurological examination revealed bilateral superior hemianopia without visual agnosia, very slight left hemiparesis and left hemisensory impairment.
Computed tomography demonstrated low density area in the bilateral lower medial parts of occipital lobes. A right vertebral angiogram showed occlusion of the right vertebral artery at the level of C3 and thyrocervical-vertebral anastomosis. A left vertebral angi-ogram was normal.
Spatial disorientation is a rare symptom and seems to be related to infarcts of the bilateral lower medial parts of occipital lobe.

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Two pediatric cases of XY females with normal female external genitalia and caused by different etiologies are presented.
Case 1 (2-months-old girl) was admitted for bilateral inguinal masses and measurement of serum testosterone levels suggested the diagnosis of infantile testicular feminization syndrome. Results of exploratory laparotomy and biopsy of the gonads confirmed the diag-nosis.
Case 2 (8-years-old girl) had the normal external genitalia without palpable gonadal masses. Serum levels of LH and FSH were elevated whereas serum testosterone level was low. Exploratory laparotomy revealed the presence of the uterus and fallopian tubes with bilateral gonadal masses which were removed. Histologically, the both gonads con-tained areas compatible with “bilateral gonadoblastoma occurring in XY-gonadal dysgenesis”.

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A total of 136 laryngeal cancers were studied about tobacco smoking and alcohol drink-ing. It was affirmed that tobacco was the most important factor in relation to inducibility in laryngeal cancer.
a) The proportion of smokers of 136 laryngeal cancers, which were ranged in age from 35-to 85-years-old and had sex ratio of about 9:1, was 100%, which was significantly higher than that of controls. (P=0.05 in male, P=0.001 in female)
Average Brinkman Index of laryngeal cancers (988) was also significantly higher. (P=0.001)
b) Alcohol drinkers were 72% of the laryngeal cancers. Alcohol was found to signifi-cantly increase the risk of laryngeal cancer. (P=0.05)
c) Tobacco and alcohol consumption were clarified to potentiate laryngeal cancer.
d) Regarding the smoking started age, there was no significant difference between laryngeal cancers and controls. The age of starting smoking was seemed to be not so important in relation to laryngeal cancer.
e) Stopping smoking was most important to reduce laryngeal cancers.

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