Recently, several papers reporting infections due to Mycobacterium nonchromogenicum complex (Mycobacterium nonchromogenicum-M. terrae-M. triviale) appeared in Japan and in the United States of America. The infections involved lungs or joints including bones. The causative organisms of all cases in Japan, 6 eases of lung infection and one case of foot joint infection, were identified as M. nonchromogenicum. In contrast, those of the United States, reported as M, terrae or M. triviale, remain still obscure, so far seen from the reported data.
The present study has shown the method of differentiation between M. nonchromogenicum and M. terrae-M. triviale.

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A tremendous amount of effort has been exerted to obtain an objective morphological classification of leukemia and malignant lymphoma and to establish optimum treatments for these diseases. In the last few years, great strides have been made in the classification of acute leukemia, the FAB classification and of lymphatic leukemia on the basis of the classification of T and B cells using surface markers. Although the problem is still in a flexible stage, the pathological differences, the relationship between the treatment and the remission rates of the various morphological types of these diseases are now being studiesd. These classifications have been recognized internationally, but before complete agreement can be reached, several problems need to be solved.
As to the concept of atypical leukemia, there are no true objective criteria. Historically it has undergone various changes, but there is as yet no established system of treatment for this disease. Five speakers will touch on these subjects. As regards non-Hodgkin's lymphoma, its classification is still in a flexible stage. Following Rappaport's classification, new classifications based on the Working Formulation have been proposed. In this country the LSG classification has almost taken root, and is used extensively because it is close to the Working Formulation.
On the other hand, classification based on surface markers have also taken root. Two speakers will talk about the relationship between the classification of non-Hodgkin's lymphoma and the therapeutic effects.
Lastly, discussions will be held on the specific features of T-cell leukemia and lymphoma both of which are quite common in this country.
Studies on the new approaches to classification of these diseases are ongoing, hand in hand, with the new advances in therapeutic methods for these diseases.

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The clinical findings and the chromosome abnormalities of acute leukemia according to FAB classification were evaluated. This study included 120 cases from Aug. 1965 to May 1982 and these cases were 108 cases of acute myeloid leukemia and 12 cases of lymphoblastic leukemia. The classification of the 108 cases with acute myeloid leukemia was as follows. M1:25 cases, M2:53 cases, M3:17 cases, M4:7 cases, M5:6 cases and M6:none. The male/female ratio was 1.4. The mean age wsa as follows. 39.4 years of age:M1, 42.6:M2, 34.1:M3, 45.6:M4, and 57.6:M5. There was a tendency to younger patients with M3 and older than 40 with most of M4, M5. Though there were no differences for RBC, hemoglobin among subgroups, in M 5, platelet was higher than others. The differences were not seen either for WBC, its leukemia cell ratio, and nucleated cell count in the bone marrow. Many cases in M 2, showed lower percentage of leukmia cell in the bone marrow. There was no differences for LDH and uric acid. Hepatomegaly was less common in both M3 and M5 than others, splenomegaly was not seen in M3, M4 and M5. Lymphadenopathy was seen in over 50% of both M4 and M5. Meningeal leukemia was seen in 36% of M1. Gum hypertrophy was highly seen in both M4 and M5, and skin infiltration was on M5. Chromosome abnormalities were observed in 43 out of 71 cases(60.6%) in which chromosome analysis was done. Abnormalities on each group were 13 out of 19 cases (68.4%) in M1, 18 out of 35 (51.4%) in M2, 11 out of 12 (91.7%) in M3, one out of 3 in M4 and none out of 2 in M5. The t (9;22) were found in 7 cases with M1 and one with M2, t (8;21) in 11 with M2, in which 4 cases were lack of sex chromosome, and t (15;17) were in 11 cases with M3. 50% survival time for each group were 9 months for M1, 6 months for M2, 1 month for M3, 6.3 months for M4, and 2 months for M5 respectively. Compaired to M1, when the complete remission (CR) was once established, M2 showed prolonged duration of CR. After the DCMP two step therapy was introduced in April 1977 the 50% survival time were 12 months for M2 and 9 months for M1.
Among 12 cases of acute lymphoblastic leukemia, 5 cases were L1, 7 were L2 and no L3 was observed. Most of the L1 cases had higher rate in leukemia cell of the bone marrow, hepatomegaly, splenomegaly and lymphadenopathy than L2.
There was no significant differences between L1 and L2 as to the surface markers and survival time.

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Response to chemotherapy in two groups of adult acute non-lymphocytic leukemias was analysed according to FAB classification. One group consisted of our 59 cases and another was national hospital co-operative group of 69 cases. The mean age of patients was higher in M4+5 type. Distributions of number in subtypes of FAB classification were about 30% in M1 and M2, 20% in M4+5, 10% in M3 and M6. Remission rates and mean survival periods of each group were 51.5% and 12.5 months in our group, and 62.9% and 10.8 months in co-operative group respectively. Remission rate was highest in M2, followed by M1 and M4+5, and lowest in M3. Days for remission were shortest in M4+5, and longest in M6. Mean survival period was significantly longer in M2 of our group, and shorter in M3 type. Several long-term survivers were found in M2. Above data suggest that the response to chemotherapy was better in M2. More effective chemotherapy for acute leukemias according to FAB classification should be established.

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The degree of concordance among 65 observers on the FAB classification in 60 cases of bone marrow preparation with untreated acute leukemia were studied.
As a result, the percentage of concordance among observers were high in L3 (97.4%) and M3(77.85). However, agreement ratio among observers for M1, M2, M4, M5 and M6 were low percentage, namely 50.0, 54.4, 39.6, 37.9 and 34.1% respectively.
It was suggested that scoring system or maturation index were necessary for the classification of L1, and L2, M1 and M2, M5A and M5B. More clear classification for monocytic leukemia and erythroleukemia was essential to other additional histochemical stain and phagocytic tests. Therefore, new criteria for the diagnosis of acute leukemia including adult T cell leukemia would be necessary based on FAB classification.

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According to the FAB classification, acute myelogenous leukemia (AML) is divided into M1 and M2 by its degree of differentiation. We classified 98 cases of acute leukemia based on FAB classification and analysed 45 cases of AML. Of 45 cases only 34 could be analysed morphologically and clinically. There were 16 cases of M1, 9 males and 7 females, ages were between 13 and 83, mean 45.2, and 18 cases of M2, 13 males and 5 females, ages between 6 and 80, mean 45.4. The WBC count at the time of diagnosis was 2, 100 to 400, 000, mean 67, 800 in M1 and 3800 to 88, 800, mean 16, 500 in M2. The cases of more than 50, 000 of WBC were 6 in M1 and only 1 in M2. In the bone marrow, mean nucleated cell count was 542, 000 in M1 and 235, 000 in M2 and leukemic cells occupied 77% in M1 and 52% in M2. Hemoglobin value was 6.6±2.5g/dl in M1 and 7.9±2.7g/dl in M2. Erythroblasts remain 4.7% in M1 and 10.3% in M2. In response to chemotherapy, the complete remission was established in 50% of all cases of M1 and M2, but median survival was longer in M2, as M2 was 327 days compared to 248 days for M1. Because there are some differences between M1 and M2, it is useful to separate the two. In some cases, however, it is difficult to distinguish between M1 and M2. Thus, a more clear criteria need to be established.

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The hematological and clinical characteristics of 36 cases of atypical leukemia and the management and clinical course of these patients were studied, and the following results were obtained.
1) Atypical leukemia was observed more frequently in aged and male patients. Among the 36 cases, 21 were over 60 years old and 27 were male.
2) In atypical leukemia, physical findings such as hepatomegaly, splenomegaly, lymphadenopathy and hemorrhage appeared less than those in typical leukemia.
3) Twenty-seven of 36 cases showed leukopenia less than 4, 000/cmm and only one showed leukocytosis over 10, 000/cmm at the time of diagnosis of leukemia. And the percentage of leukemic cells in peripheral blood was as follows;0% in 21 cases and 1-5% in 7 cases.
4) Intensive chemotherapy such as VEMP or DCMP was conducted in only 6 cases, while the remainders were treated with conservative therapy or mild anti-leukemic chemotherapy.
5) The clinical course of atypical leukemia was generally uneventful but the remission rate was low, and 12 of 36 cases developed overt leukemia.

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One hundred and one cases of non Hodgkin's lymphoma were diagnosed in 20 National Hospitals during the 3 years period between 1978 and 1981. These cases, as classified by LSG classification, consisted of 11 cases of follicular type and 90 cases of diffuse type.
In subtypes of these lymphomas, large cell subtypes amounted to 360, which were more than any other subtypes, all cases of follicular lymphoma were found in the age group older than 30 years, whereas middle-sized, polymophic or lymphoblastic type of diffuse lymphomas were encountered in the younger age group.
Among these cases, 46 cases of malignant lymphoma experienced in Nagoya National Hospital were analysed with respect to clinical stages, hematological data, serum immunoglobulin concentration and bone marrow infiltration.
We found 2 cases with abnormal immunoglobulin concentration, and 8 with bone marrow infiltration, all in the diffuse lymphoma group.
From the view point of therapeutic effect, follicular lymphoma responded favourably both to VEPAB and VEPA combination. In diffuse lymphoma, however, complete remission was achieved more frequently in VEPA group (27/39, 69.2%) than in VEPAB group (8/25, 32.0%).
Meanwhile, 50% survival in VEPA group was not significantly longer than that in VEPAB group (6.8 versus 7.2 months). This finding may suggest the importance of maintainance therapy in order to prolong the survival of malignant lymphoma.

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In this study, we evaluated patients with malignant lymphoma for clinical manifestation and prognosis according to the classification of T-cell, B-cell and Null-cell.
Twenty-five cases of non Hodgkin's malignant lymphoma were studied for surface markers at Shikoku Cancer Center Hospital from April 1980 to April 1952. Fifty-two percent (13 out of 25 cases) was found to be T-cell type, and 10 cases of B-cell type and 2 cases of Null-cell type were seen.
T-cell type lymphoma had apparent shorter survival period and poor prognosis after the therapy, compared with B-cell type. Especially, adult T-cell leukemia, which belonged to stage IV of T-cell lymphoma, was refractory to chemotherapy and lived very short.
Because lymphoid malignancies including malignant lymphoma are self-proliferating diseases, which have the character of surface markers with frozen state in the process of differentiation and maturation from lymphocyte stem cell, immunological surface marker study of lymphoma cells is the important examination for evaluating diagnosis, disease manifestation, therapy and prognosis.

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Many cases of T-cell malignancy in adults have been found in Japan and adult T-cell leukemia having a poor prognosis was clustered on the southern parts of Japan-Kyushu island, Shikoku island and Ki peninsula. In this study, the clinical characteristics of T-cell malignancies especially of adult T-cell leukemia was described. On the other hand, the lymph nodes of 36 adult patients with T-cell derived malignancy was classified by means of LSG (Lymphoma Study Group).
(1) At the Kyushu National Cancer Center Hospital, 51 cases of malignant lymphoma was experienced from April 1980 till June 1982, which consisted of 36 cases of T-cell derived malignancy and 12 cases of B-cell derived malignancy and 3 cases having unclarified surface markers.
(2) Five cases of 36 cases of T-cell malignancy was diagnosed as adult T-cell leukemia. The age in these ATL ranged from 38 to 72 years. The birthplaces of the patients were Nagasaki prefecture (2 cases), Kagoshima prefecture (1 case), Saga prefecture (1 case) and Fukuoka prefecture (1 case). All of the patients were accompanied by lymphadenopathy and 4 cases of these patients had hepatosplenomegaly. The white blood cell count ranged from 5, 700 to 53, 700 In the peripheral blood, pleomorphic leukemic cells with a markedly deformed nucleus;“convoluted” lymphocytes appeared in a ratio of 4.5-76 per cent. The percentage of leukemic cells in the bone marrow was 1.6 to 23.2 per cent, which was relatively low compared with other leukemia. The disease was histologically classified into diffuse lymphoma-medium cell type (2 cases), diffuse lymphoma-large cell type (1 case) and diffuse lymphoma-pleomorphic type (2 cases) according to LSG classification.
Interstitial pneumonitis was seen in four patients and hypercalcemia was recorded in two patients. The survival time ranged from two months to five months.
(3) One case of malignant lymphoma of lymphoblastic type was presented. The patient was a 26 year old male. He had no leukemic manifestations but lymphadenopathy. After eight months of clinical course, the lymphoblasts appeared in the peripheral blood. T-lymphoblastic lymphoma (OKT 4, 6, 5/8, 10 positive or OKT 4, 5/8, 10, 1, 3 positive) will be differentiated from T-acute lymphoblastic leukemia (OKT 9, 10 positive) according to T-cell surface markers.
(4) Three cases of cutaneous lymphoma (T-cell type) was demonstrated. One of these cutaneous T-cell lymphoma was 71 year old female, who was accompanied by skin manifestations like mycosis fungoides and was diagnosed as malignant lympoma (diffuse, medium-sized cell type). Hepatosplenomegaly and lymphadenopathy were not observed. Leukemic abnormal T-cell did not appear in peripheral blood and bone marrow at the onset, but appeared in the peripheral blood and bone marrow after three months of the clinical course. The leukemic cells in the peripheral blood ranged 1 to 61 per cent and was OKT 3, 4 positive cells. The patient's serum had the antibody to adult T-cell leukemia associated antigen. It was reasonable that the patient was diagnosed as adult T-cell leukemia manifested mainly in the skin rather than cutaneous T-cell lymphoma.

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Seventy-one patients with chronic healed or arrested pulmonary tuberculosis, were followed-up regularly in outpatient clinic over a 10-year period. The mean yearly fall in %VC was about one percent, and the fall in the %FEV/predVC (FEV₁ expressed as percentages of the predicted VC) 0.7.
The decrease in %VC and %FEV/predVC per year was greater in patients who died than in those who lived longer.
Follow-up of operated patients was continued for at least 4 years. The preoperative %VC and %FEV/predVC were significantly lower in patients who received pneumonectomy or thoracoplasty than in those who received lobectomy or segmental resection.
There was a fall in parameters of ventilation during 6-7 years after pneumonectomy or thoracoplasty, although this failed to reach statistical significance.
Our studies have shown that the chronic respiratory insufficiency due to pulmonary tuberculosis in general is slowly progressive and carries a considerable cardiorespiratoy distress.

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Patients' sera collected from November 1981 to February 1983 at Shikoku Natioual Cancer Center Hospital were studied for antibody to adult T-cell leukemia-virus-associated antigen (ATLA).
Four cases of ATL patients showed positive titer. Two patients with T-cell type and one patient with B-cell type of non-Hodgkin's lymphoma were also positive. One positive patient with APL and two positive patients with aplastic anemia had the history of multiple blood transfusions.
None out of 56 healthy adults living in Matsuyama was positive for ATLA antibody.

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Progressive necrotic rhinitis includes diseases such as Wegener's granulomatosis, midline granuloma and malignant lymphoma. These diseases, pathologically characterized by the necrotic granulomatous lesion at the nose and the upper respiratory systems, show similar symptoms at their initial stages and the differential diagnosis is often difficult.
We observed four patients with nasal and paranasal granulomatous leions. Although all of them had been once diagnosed as Wegener's granulomatosis in their clinical courses, pathological examinations of biopsied specimens disclosed Wegener's granulomatosis in two cases, malignant lymphoma in one, and retroorbital panniculitis in the other. Based on the diagnosis, treatment of the patient was satisfactory and a long-term remission has been maintained in each case.
An importance of physicians' cooperation for treatment of patients with nasal and paranasal granulomatous lesions was stressed.

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Four patients (2 men and 2 women) with impalement injury between 8 and 52 years of age were treated at Iwakuni National Hospital.
The impalement has been due to iron bars and bamboo branches. The occurrence of impalement was most frequent in “fall”.
Symptomatology depended upon the location and extent of the impalement and whether the wound was intraperitoneal or extraperitoneal in type. So complete examination for abdomen, rectum, bladder and vagina was required for the accurate treatment.

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Failure of several vital organs including lung, kidney, liver, blood clotting system and gastrointestinal tract forms a clinical syndrome, multiple organ failure. The patient with multiple organ failure is commonly suffering from the systemic effects after major surgey. Acute renal failure associated with postoperative multiple organ failure was evaluated in this study.
Fifty-seven of 2438 patients were diagnosed as multiple organ failure after major surgery during nine years. Twelve of 57 patients had postoperative acute renal failure and were analysed. All patients were over 50 years old but one patient. Number of organs involved in multiple organ failure was 2 in 8 cases, 3 in 3, and 4 in 1 respectively. All patients except one could not survive beyond 60 days after surgery. Acute renal failure preceeded the damage of other organs in all cases.
The causes of acute renal failure in multiple organ failure were infection of intraperitoneal abscess subsequent to leakage of anastomosis, cholangitis, pneumonia or empyema in 10 cases, hepato-renal syndrome after hepatic failure caused by obstructive jaundice in 5, ARDS and DIC in one respectively.
In the diagnosis of acute renal failure it would be emphasized to check urine Na-K ratio which was less 2 in acute renal failure compared with over 2 in controls.
The treatment consists of drainage of abscess performed basically for releasing sepsis and hemodialysis, peritoneal dialysis or plasma exchange.

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Among 200 cases of lung cancer treated in our department during the past 10 years, 47 cases (23.5%) having a diseased period of more than 6 months were evaluated clinically.
The reason for the delay of the established diagnosis was present in patient's side in 23.4% of cases, in doctor's side in 70.2% of cases and in examiner's side in 6.4% of cases;demonstrating a very high percentage of iatrogenic factor. The 5-year-survival rate was 18.9% as a whole and 26.5% in the control group with no significant difference between these two groups. The most influential factor on the prognosis was the degree of radical operation, while the length of the disease did not directly affect the prognosis. However, when initial symptoms were compared to these noted at the time of the established diagnosis with respect to individual patients, 40% or more were aggravated at the time of the established diagnosis, which distinctly means that many patients miss an opportunity of receiving appropriate operation because of advanced conditions.
In the future, it is thus required to make every effort to at least avoid the iatrogenic factor, i. e., “delay of the established diagnosis”, and to enlighten and educate the general public about the importance of an easy detection for preventing lung cancer.

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Patients with newly-detected leprosy were investigated during forty six years from 1926 to 1982 in Ishigaki city, Taketomi-cho and Yonaguni-cho in Yaeyama Islands. There has been no institutes for leprosy in the island and leprosy segregation policy has been ineffective until 1960. In 1961 Yaeyama Public Health Center established leprosy out-patient depart ment in the island. Since 1967, Leprosy School Survey by Japanese Government has been done.
According to the collected data on new patients with leprosy in the island every year, the highest Leprosy Incidence Rate (0.95 per population 1, 000) was observed in 1967 and then the rate came down to 0.02 in 1983. Now, no case of children develop in the islands.
No children developed leprosy in Ishigaki city since 1983, Taketomi-cho since 1977 and Yonaguni-cho since 1974.
Recently, the leprosy situation in the island has been improving very much.
Epidemiologically only one thing on leprosy in the islands has not been solved. The decrease in number of new patients in Ishigaki city is slower than other areas, because leprosy in Ishigaki city has become “Urban Leprosy” type.
The leprosy control program should be more emphasized in the urban area of the island in the future.

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