The nutritional state in patients with advanced malignant disease may depend on the state of the tumor itself and complications resulting primarily from the tumor and the results of chemotherapy. Malnutrition is characterized by depletion and redistribution of carbohydrate, fat, protein and minerals, resulting in progressive abnormalities of the functions the vital organs and diosrdered immune defenses. The administration of nutritious foods appears helpful in maintaining or improving patients' nutritional state prior to the initiation of the cancer therapy. In addition, nutritional support may serve as an effe-ctive adjunct to chemotherapy if it can decrease the incidence of side effects from the treatment and also can increase the rates of responses to the treatment.

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The results of radiation therapy in 17 patients with inflammatory breast cancer were reviewed from 1963
Most cases were treated with combined therapy. Eleven patients died of the primary lesion and one patient died of the different lesion. Twelve patients treated with radiation showed fairly good local responses in relation to the histological changes from radiation. Median survival of 6 patients treated with radiation was 21.5 months (mean 26.2 months). One patient treated with combined radiotherapy and chemotherapy demonstrated the longest survival of 62 months. Five patients treated with radiotherapy survived 16, 18, 29, 44 and 51 months respectively.
These results suggested that the radiation therapy played a very important role in the combined therapy of this disease.

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Gray scale ultrasonography was performed in 37 patients with early breast cancer and 64 cases with benign lump (less than 2 cm in diameter), and the following results were obtained.
1) The diagnostic accuracy rate for early breast cancer was found to be very high, 81.1%. When subdivided histologically for non-infiltrating carcinomas, special types of infi-ltrating carcinoma and common types of infiltrating carcinoma, the accuracy rates were 33.3%, 66.7% and 89.3%, respectively.
2) Thirteen cases out of 64 benign lumps showed malignant findings, and the false positive rate was 20.3%.
3) The retrospective analysis of ultrasonographic patterns revealed that the frequency of malignant sign was 100% in shape, 78% in contour, 35% in internal echo content and 30% in posterior echo.
These results suggested that the irregularities of shape and/or contour were the most important findings in the ultrasonographic diagnosis of patients with early breast cancer.

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The purpose of this paper is to investigate indications for minor surgery in patients with breast cancer.
One hundred and twenty-one cases of the infiltrating type of breast cancer were ope-rated on at the Sagamihara National Hospital between 1962 and 1971, and 94 of them were followed up for 10 years following the surgery.
The 10-year-survival rates according to the stage of the disease in these cases were 92% for stage I, 56% for stage II, 36% for stage III and 0% for stage IV. The 10-year-survival rates according to the operative method were 56% for typical radical mastectomy (Br+Ax+Mj+Mn), 66% for paratypical radical mastectomy(Br+Ax+Mj), 73% for Auchin-closs' operation (Br+Ax) and 67% for simple mastectomy. The discrepancies between the 5-year- and 10-year-survival rates were 9%, 13%, 27% and 0%, respectively.
In addition, the 10-year-survival rate according to the stage and the status of involve-ment of the axillary lymph node (Ax. L. N.) was investigated. The results showed 100% for 5 cases of typical radical mastectomy, 88% for 8 cases of pararadical mastectomy and 100% for 7 who had Auchincloss' operation in stage I without Ax. L. N. metastasis; 0% for one who had Auchincloss' operation in stage I with Ax. L. N. metastasis; 73% for 15 cases of typical radical mastectomy, 89% for 9 cases of paratypical radical mastectomy and 100% for one who had Auchincloss' operation in stage II without Ax. L. N, metastasis; 41% for 17 cases of typical radical mastectomy, 30% for 10 cases of paratypical radical mastectomy and 0% for one who had Auchincloss' operation in stage II with Ax. L. N, metastasis; 100% for one who had typical radical mastectomy in stage III without Ax. L. N. metastasis; 30% for 10 cases of typical radical mastectomy, 100% for one of paratypical radical mastectomy and 0% for one who had Auchincloss' operation in stage III with Ax. L. N. metastasis; and 0% for one who had paratypical radical mastectomy in stage IV with Ax. L. N, metastasis.
We conclude that:
1) The stage at the time of surgery had a better correlation with the survival rate than did the operative method. But the indications for minor surgery should be carefully evaluated because of the great discrepancy in survival rates following such procedures.
2) The indications for minor surgery would be stage I or stage II without Ax. L. N. metastasis.
3) Auchincloss' operation should be indicated for stage I without Ax. L. N. metastasis or no evidence of such involvement.
4) Patey's operation should be done for stage I with Ax. L. N. metastasis or with suspected Ax. L. N. involvement as well as for stage II without Ax. L. N. metastasis because paratypical radical mastectomy is a less invasive procedure than Patey's operation.

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We reported a male child case of neuroblastoma discovered at the advanced stage who survived for a long period of time from the age of 2 years and $ months until 6 years and 4 months. The primary legion was left retroperitoneal lymph nodes which metast-atized to the right temporal bone and the right shin bone. Their histological findings were well differentiated and matured, and each different from others: i. e., ganglioneuro-blastoma of composite type in the primary legion, neuroblastoma of rosette-forming type in the temporal bone and ganglioneuroma in the shin bone.
The patient was treated with various agents such as a combined therapy of VCR, CPM, and ADM, a large-dose therapy of CPM, a three-week cyclic therapy of a weekly alternation of once-a-week administration of VCR, ADM, and Cisplatin, a weekly admin-istration therapy of Cisplatin, a combined therapy of DTIC, Bleomycin, and Vinblastin, as well as that of Cisplatin and VM 26. Each demonstrated some clinical improvement. However, at the age of 6 years and 4 months, he died of respiratory insufficiency.
The reasons for which this case could survive for a long time were: histologically the tumors were well differentiated and matured; it was possible to apply the above described therapeutic schedules, which were considered as effective for the advanced stage of the tumors; and certain remissions resulted from each therapy.

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A statistical analysis of neuroblastoma in Hokkaido was performed in relation to Chi-ldhood Cancer Registry in this prefecture. The number of this tumor amounted to 113 cases from 1969 through 1980, the third common cancer among 1157 cases of total childhood ma-lignancies including brain tumor (9.8%).
17.7% of neuroblastoma developed at the age of under 1 year, and over 80% of the cases occurred before 6 years of age. Ratio of male to female was 1:1.13. The adrenal gland was the most common site for primary tumor (57.6%), land the left adrenal gland was affected more frequently than the right one (1.6:1).
There were almost no cases coming in or going out of Hokkaido, and judging from the records of the registered hospitals, most patients visited Sapporo at least once. This may possibly be due to the presence of the pediatric oncologist, besides the instrument for radi-ation therapy being available.

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Ten cases of advanced cancer in childhood were reported. They consist of ganglio-neuroblastoma, nephroblastoma, acute leukemia, malignant lymphoma, rhabdomyosarcoma and retinoblastoma. Most of them were treated by multimodal therapy. Eight cases are still alive without any obvious symptoms for periods of 2 years 4 months to as long as 7 years. Experiences of successful cases were shown and discussed in order to improve the prognosis of advanced cancer.

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Since the original report of DiGeorge in 1965, 54 cases have been described up to 1977 with congenital abscence or hypoplasia of the thymus and parathyroid gland. We per-formed an autopsy in a case showing the complete type of DiGeorge syndrome.
The patient was a female infant who died at the age of 66 days.
Echovirus type 22 was isolated from the small intestine and lymphocytic meningitis was found.
The nuclear inclusions characteristic of cytomegalovirus infection were found not only in the alveolar epithelia, adrenal cortical cells and small intestine cells but also in the re-ticulum cells of the lymphnodes and spleen. It seems to be rare that the nuclear inclu-sions with the so-called “owl eye” appearance are contained in the reticulum cells.
The frequency of malignancy in patients with primary immunodeficiencies has been reported to be roughly 10, 000 times greater than that of the general age-matched population. However, no cases of neoplasia have been reported in a child with DiGeorge syndrome. This patient had a congenital polypoid tumor which projected into the left lateral ventricle where it seemed to extend from the normal ventricular ependyme and was separated from cerebral parenchyma relatively clearly. This tumor consisted of two kinds of cells. One had an abundunt cytoplasm and a small irregular chromatin-rich nucleus. The other had a poor cytoplasm and a regular oval chromatin-poor nucleus containing a relatively big nucleolus. Following several examinations it was concluded to be undifferenciated epe-ndymoma.
A case of astrocytoma with Wiskott-Aldrich disease and a case of glioma with ataxia-telangiectasia have been reported. And other cases of maligncy with cell-mediated immu-nodeficiencies have been also reported. Our case is an example suggesting that a tumor is developed due to cell-mediated immunodef iciencies.
Follicular cysts of both ovaries and the kidneys were also found.

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We report the experience of our new treatment of transcatheter arterial infusion of anticancer agents for 8 patients with carcinoma of the bladder since 1980.
A double lumem balloon catheter is applied to infuse the anticancer agents with a temporal occlusion of the internal iliac artery. Catheters are bilaterally inserted percutaneously through the femoral artery and placed into the distal part of internal iliac artery. Cis-platinum and adriamycin are administered as the chemotherapeutic agents.
The results were satisfactory. Four patients had a complete remission and 3 had a partial remission, while only 1 showed no change.
This method is characteristic of keeping the higher concentration of the anticancer agents into the affected tissue by interrupting blood flow and seems to be a more effective treatment even for the advanced bladder cancer.

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A 71-year-old male with bilateral leg edema was admitted to our hospital on January 21, 1983.
On physical examination strong edema of bilateral legs, enlargement of superficial lymphnodes, tumor of left iliac region were observed. Digital examination revealed soft prostate with slight swelling of the left lobe. The biopsy of rigth cervical lymphnode suggested metastatic adenocarcinoma.
The upper GI series, barium enema and intravenous pyelography were also done. Abdominal CT scanning showed a large tumor shadow existing from pelvic cavity to upper abdominal cavity. The large tumor surrounded a vertebral body at umbilical height.
Needle biopsy of the prostate was done. The histological finding was adenocarcinoma.
Stilbestrol diphosphate was administered and the size of superficial lymphnodes reduced. Intraabdominal lymphnodes also reduced in size.
Lymphangiography showed the findings of obstruction of lymphvesels at external iliac artery lymphplexus. The metastasis of prostatic carcinoma to deep lymphnodes was the cause of leg edema.

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A 60 year-old-female patient noticed enlarged fingers and change in the tone of the voice at the age of 40, and menopause at 42. She was pointed out an abnormal shadow on her chest X-ray film in July '82 and was admitted 2 months later. Her physical examination disclosed enlarged both upper and lower extremities, goiter and milk discharge from her bilateral breast. Laboratory findings showed that serum growth hormone (GH) level was 71.5 ng/ml, prolaction (PRL) 350.6 ng/ml, although serum calcitonin was 150 pg/ml (normal). She was diagnosed as pituitary tumor (suspicious of adenoma) and malignant tumor of the thyroid gland by the close examinations. Her general condition was good during her hospital course. She was operated on in January (resection of thyroid tumor) and in February (excision of pituitary tumor) respectively. Serum values of GH and PRL markedly reduced after the operation of the pituitary tumor. Histology revealed chromophobe adenoma of the pituitary gland and follicular adenocarcinoma of the thyroid gland. The GH and PRL were positively stained in some of the tumor cells of the pituitary gland by the PAP (peroxidase antiperoxidase) method. Only 5 cases similar to the present case have been reported till 1982, so we think it is worthwhile reporting the present case.

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Clinical analysis of 19 patients with hypopharyngeal and cervical esophageal cancers was done, and the following results were obtained:
1) For the early detection of hypopharyngeal and cervical esophageal cancers, we must pay much more attention to the male patients older than 40 years old who smoke heavily.
2) The patients with metastatic cervical lymphnodes should be examined more carefully.
3) Even if the patients complaining of difficulty in swallowing have no abnormal findings on indirect laryngoscopy, they should be examined by X-ray fluoroscopy.
4) The patients with some abnormal findings a on indirect laryngoscopy should undergo further examinations such as X-ray fluoroscopy or direct esophagoscopy, etc.

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Fifty cases of primary osteogenic sarcoma have been treated in the Department of Orthopedics during 28 years since the opening of Nagoya National Hospital in September 1954 till August 1982. The results of treatment were assessed, discussed and reported.
Among 50 cases, there were 24 cases of osteosarcoma, 6 chondrosarcoma (2 of those 6 had multiple exostosis and became malignant), 6 fibrosarcoma, 2 reticulosarcoma, 4 Ewing's sarcoma, 2 malignant giant cell tumor, 1 mesenchymal malignant tumor, 2 chordoma, 1 malignant fibrous histiocytoma, and 2 periosteal osteosarcoma.
Twenty-five cases (50%) ranged in age from 10 to 19 years old, and there were 35 males and 15 females.
Radiotherapy, chemotherapy and/or surgery were used for therapeutic means. High dose M. T. X, therapy has been used recently.
In 75% of osteosarcoma and 65.3% of tumor other than osteosarcomas, the sites of tumor were the femur, tibia and fibula.
Of these various tumors, osteosarcoma, Ewing's sarcoma and reticulum cell sarcoma had bad prognosis, as reported by others.
In the relation between the site of onset and prognosis, the onset around the knee joint distal to the half femur and proximal to the half tibia showed a tendency to better prognosis than the onset in other sites. Further, concerning the preoperative period and prognosis, cases of longer preoperative period generally showed tendencies to better prognosis, suggesting the relation with the malignancy of tumor tissue.
Concerning the combination of chemotherapy with other treatments, no clear conclusion has been obtained about the effects, since the numbers of cases were few for each treatment.

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Patients with lung cancer treated in the department of surgery in our hospital were divided into two groups: one discovered by annual mass chest x-ray examination for tuberculosis (mass examination group) and the other mainly discovered by subjective symptoms (non-mass examination group), and compared these two groups from the clinical standpoint. About 25% of total cases belonged to the mass examination group and there was no relation with age in this group. The survival rate in mass examination group was significantly higher (28.4%) than in non-mass examination group (15.4%). The performance status, duration of the disease and the rate of resection in the former group were all favorable. However, in more than 70% of the cases of mass examination group, the location of the tumor was lung field type and half of them was in stage I+II with occasional case of peripheral type early cancer. On the other hand, more than 90% of lung hilum type were advanced cancers of stage III + IV with no cases of central type early cancer. In addition, the fact that more than 90% of the male patients were heavy smokers having Brinkman Index of 400 or more apparently indicated the importance of prophylactic measure for lung cancer such as stopping smoking. Especially, it is strongly desired to perform effective mass medical examination for lung cancer combined with sputum cytology in high risk group for detecting central type early cancers.

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