In Hiroshima and Nagasaki a large number of people were exposed to atomic bomb radiation under the war time conditions, but these data have not been used for the estimation of LD₅₀ of man, because of the difficulty in separating mortalities caused by radiation itself from those caused by blast or heat.
Based on the retrospective survey of heavily A-bombed area of Hiroshima conducted by Hiroshima city authorities and members of the RINMB of Hiroshima University during the period of 1969 to 1976, there were 3, 215 persons who were exposed at distances of 500 to 1, 300 meters from the hypo center in the Japanese wooden houses. Of these, 1, 085 (33.7%) died on the day of the bombing, and the remaining 555 (26% of those surviving the first day) died during the following 60 days.
Our hypothesis was that the deaths on the first day were predominantly due to exposure to radiation itself and, therefore, the data obtained from our survey were suitable for an estimate of the LD_50/60 in humans under the war time conditions. Thus, the distance at which the mortality was 50% was calculated from the curve of probability of deaths at various distances for the above persons who died between 2 to 60 days after the bombing. This distance was 903±8 meters. The parameters required for the conversion of this distance to radiation dose will not be available until the end of 1987 because of the reassessment of A-bomb radiation dose, which is in progress. Age and sex differences in exposed distances for LD_50/60 were also examined. Namely, lethal effects of radiation exposure were somewhat higher in the population with over 50 years of age, and lower in females with under 40 years of age.

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Sixty-six children with psychogenic visual disturbances were examined.
Females were twice as males. Half of the patients revealed visual disturbances and spiral visual field. Eighty percent of the patients were emmetropic or slightly hypermetropic. The visual loss was corrected by plane lenses or combinations of lenses with zero power in 90% of the patients. Some cases were associated with psychogenic hearing loss. The source of stress were in the family in 49% of the cases, in the school and in some somatic diseases or slight traumas in 21%. The methods of treatment usually carried out were careful listening to the patient's complaints and providing the parents and children with reassurance and the opportunity to discuss the sources of conflict. The goal of the treatment should be not only to correct the visual acuity or visual fields but to resolve the conflict itself.

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One hundred and one patients with nasopharyngeal squamous cell carcinoma (NPC) were treated with irradiation. The UICC TNM staging system (1978) was applied: 6 patients were T1NO, 10 T2NO, 5 T3NO, 13 T4NO, 11 T1N+, 18 T2N+, 19 T3N+ and 19 T4N+. Since 1978, computed tomography (CT) was available, and 34 patients were examined with CT at first presentation. The technique of radiotherapy was markedly changed around 1978. The field to the primary site and neck were enlarged. Two-year relapse-free survival was significantly better for the post-CT era than pre-CT era. This was mainly due to improved local-recurrence-free survival and cervical-relapse-free survival. Improvement of local-recurrence-free survival, however, was appreciated in only T3+T4 patients, there were no differences in Ti+T2 patients. This failure to increase local-recurrence-free survival in the T1+T2 patients may relate to the fact that a large number of these patients showed T3 or T4 tumors on CT. In 34 patients with CT examination, 14 patients were upstaged based on CT findings alone. Since many clinical T1 or T2 tumors determined without CT information were upstaged to T3 or T4 after performing CT, we studied treatment results of them according to CT staging. Nine of 16 clinical T1+T2 tumors upstaged to T3 or T4 after performing CT, 3 of which had local recurrence. Seven patients remained as T1+T2 after performing CT, only one of which experienced local recurrence. It is suggested that mere enlarging of radiation fields or increasing radiation doses could not be curative for a certain group of patients. In order to further increase local control rates, we have started to use intracavitary irradiation with an after-loading technique as a boost. No acute or chronic complications due to intracavitary irradiation have developed. Preliminary results were encouraging.

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A 4-year-old boy underwent tonsillectomy for obstructive sleep apnea syndrome. No sedatives were administered before operation. After awake intubation anesthesia was induced and maintained with halothane 0.5%, 67% nitrous oxide in oxgen and d-tubocurarine. Soon after extubation, upper airway obstruction occurred and the trachea was intubated again.
Then tracheostomy was performed under general anesthesia. There was a dramatic improvement of clinical symptoms shortly after tracheostomy.
However, when the tracheal stoma was closed, episodes of apnea due to upper airway obstruction were immediately seen even when he was fully alert in the daytime. Period of closure of the stoma became longer week by week and finally it could be closed all day long three months after operation. He has been followed for 18 months after surgery and the tracheal stoma was operatively closed.

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Owing to unique anatomical structure of the nose and paranasal sinuses surrounded by hard bones, subjective symptoms do not develop until a tumor grows extensively outside the cavity. When a tumor mass progresses to the superior, inferior or anterior region, patients visit a hospital relatively in early stage because of the symptoms of exophthalmus, palate swelling or cheek swelling, respectively. However, when a mass progresses in the posterior or lateral region, these cases are rather in advanced stage because of the late symptoms of trismus or trigeminal neuralgia.
For the purpose of improving prognosis of these advanced cases, we have been treating patients actively by surgery. Neurosurgical knowledge is needed when a dissection is to be performed at the basal region of the skull in advanced cancer of the nose and paranasal sinuses.
The detail of operations and prognosis of 13 cases treated with extended maxillectomy in Shikoku National Cancer Center Hospital were reported and discussed.

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There are many cases of subarachnoid, intracerebral and intraventricular hemorrhage among intracranial hemorrhage caused by the rupture of cerebral aneurysm, but there are only a few cases in which massive subdural hematoma is a main lesion. We had a case of the rupture of intracarotid aneurysm complicated with massive acute subdural hematoma. Since CT findings and the process of formation of hematoma were confirmed by surgery and autopsy, we present the case.
An 84-year-old female patient had been diagnosed as high blood pressure, but she had not taken any drugs. During a conversation in the morning of April 16, 1985, she suddenly fell unconsious. She received emergency treatment by a nearby doctor, who found a subdural hematoma by CT. The patient was transferred to our hospital 6 hours after attack. Her conditions on arrival were ; consciousness level: 200 (3-3-9 degrees), blood pressure: 112/86mmHg, pulserate: 86/min, respiration: 30/min, irregular, pupil 2mm anisocoria (—)· light reflex (—) and left hemiplegia: CT disclosed a subdural hematoma with a prominent midline shift accompanied by intracerebral hematoma in the left temporal lobe and intraventricular hemorrhage, but we suspected vascular accident since there was no history of trauma, and carried out the cerebral angiography, when multiple aneurysms were recognized in the left internal carotid artery.
By emergency surgery the hematoma was removed and ruptured aneurysm was clipped. The postoperative conditions became temporarily better, but cerebral edema, which were probably caused by ischemic brain damage, progressed. The patient died on the 8th day after surgery. Autopsy showed the aneurysm of internal carotid artery whose fundi were buried in the left temporal lobe, ruptured in the cerebral tissue and the blood flowed 1) from the inferior horn to the inside of ventricle and 2) from the temporal lobe to the subdural space in the middle fossa through the ruptured arachnoid membrane of cerebral surface. There was no trace of subarachnoid hemorrhage.
By presenting the above case in which massive subdural hematoma was the main lesion of the rupture of cerebral aneurysm and autopsy confirmed the direction of development of hematoma, we discuss the clinical characteristics of subdural hematoma caused by the rupture of cerebral aneurysm.

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The lipoma is a benign neoplasm of adult adipose tissue. The tumor may occur in any part of the body where fat exists, but is relatively rare in the oral cavity. In a review of the literature, the incidence of oral lipoma is 0.5-2.5% of all tumors of the oral cavity. The oral lipoma usually is a solitary, well-defined, submucosal, painless and slow-growing lesion. The cheek is the most common reported site, followed by the tongue, floor of the mouth, buccal sulcus, palate, lips and gingiva. A lipoma developing on the lip is relatively rare.
In this paper two cases of lipoma on the lower lip are presented.
Case 1: A 26-year-old man visited our hospital complaining chiefly of a tumor on the left side of the lower lip on April 12, 1982. He first noticed a rice-grain-sized tumor on the lower lip in 1978. The tumor gradually increased in size thereafter and measured 2cm in diameter in April 1982. Clinical examination disclosed a freely movable, domeshaped, elastic soft, yellowish lesion, measuring 2×1.5×1cm in the labial mucosa of right side of the lower lip. The clinical diagnosis was benign tumor and the tumor was enucleated under local anesthesia on April 14, 1982. From the histopathological examination, the diagnosis of simple lipoma was made.
Forty-nine months have passed after the surgery, and there have been no signs of recurrences.
Cases 2: A 65-year-old man. In April 1984, he was found to have a tumor on the right side of the lower lip after he bit his lower lip. Thereafter the tumor had been repeatedly increasing and decreasing in size, but did not decrease following an increase in size in March, 1985. Therefore he visited our hospital on April 12, 1985. Oral examination revealed that the tumor was a well-circumscribed, elastic soft mass measuring 7×7×4mm and part of the surface was whitish area considering hyper-kelatinization. The clinical diagnosis of mucocele on the lower lip was made and the lesion was excised under local anesthesia. Postoperative histopathological examination revealed that the lesion was not mucocele but was simple lipoma.
No signs of recurrences have been encountered during eighteen-month follow-up after the surgery.

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Paget's disease of the breast is regarded as a special type of breast carcinoma that originates in the ducts of the nipple and spreads to the nipple epidermis through the ducts.the lower lip in 1978. The tumor gradually increased in size thereafter and measured 2cm in diameter in April 1982. Clinical examination disclosed a freely movable, domeshaped, elastic soft, yellowish lesion, measuring 2×1.5×1cm in the labial mucosa of right side of the lower lip. The clinical diagnosis was benign tumor and the tumor was enucleated under local anesthesia on April 14, 1982. From the histopathological examination, the diagnosis of simple lipoma was made.
Forty-nine months have passed after the surgery, and there have been no signs of recurrences.
Cases 2: A 65-year-old man. In April 1984, he was found to have a tumor on the right side of the lower lip after he bit his lower lip. Thereafter the tumor had been repeatedly increasing and decreasing in size, but did not decrease following an increase in size in March, 1985. Therefore he visited our hospital on April 12, 1985. Oral examination revealed that the tumor was a well-circumscribed, elastic soft mass measuring 7×7×4mm and part of the surface was whitish area considering hyper-kelatinization. The clinical diagnosis of mucocele on the lower lip was made and the lesion was excised under local anesthesia. Postoperative histopathological examination revealed that the lesion was not mucocele but was simple lipoma.
No signs of recurrences have been encountered during eighteen-month follow-up after the surgery.
In the clinicopathological view, it is important to distinguish between Paget's carcinoma that has no palpable mass and Pagetoid carcinoma that has a palpable mass in the breast. From Jan. 1981 to Dec. 1985, we experienced five cases of Paget's disease. Of these five cases, there were three cases of Paget's carcinoma and two cases of Pagetoid carcinoma.
In this paper, we introduce these cases and report on their clinicopathological picture. We also refer to our surgical treatment of Paget's disease.

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A 66-year-old male came to the hospital because of general fatigue and loss of appetite. Laboratory examination showed that serum protein 12.5g/dl, albumin 2.53g/dl, α₁-globulin 0.13g/dl, α₂-globulin 0.32g/dl, β+γ-globulin 9.49g/dl, Immunoglobulin; IgG 8696mg/dl, IgA 130mg/dl, IgM 216mg/dl, IgE 380U/ml and serum electrolytes; Ca 9.0mg/dl, P 11.9mg/dl. Roentogenological studies revealed that calcification of ligamentum nuchae and soft tissue around cubital joints. Plasmacytosis was seen in bone marrow (11.6%) liver and lymphnode tissues. During about one month, Alkeran 2mg/day and Prednisolone 10mg/day were administered orally with transient effect. IgG gradually decreased to the level of 3000mg/dl and serum Ca and P levels also became normal after successive twelve months. Cause of calcification of various tissues and hyperphosphatemia were suspected to increased binding of calcium to hypergammaglobulin and subsequent lowering of calcium ion concentration.
By reviewing IgG producing cells of peripheral lymphocytes in vitro, it was proved that activity of helper T-lymphocytes were highly activated and that of suppressor T-lymphocytes were reversely dropped in this patient.

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An autopsy case of a 65-year-old woman with Kasabach-Merritt syndrome associated with gastric cancer (mucosal carcinoma) and vulva cancer was reported.
On her initial operation for gastric cancer, multiple hemangiomas of the liver were found. Her physical examination revealed coagulopathy. Three months after the second operation for vulva cancer which was histologically diagnosed as spindle cell carcinoma, progressive dyspnea with pleural fluid developed. Although tracheotomy and steroid therapy were done, her course was unfavorable.
Autopsy findings were summarized as follows: 1. Multiple cavernous hemangiomas of the liver and disseminated metastases were found. Histological examination showed many fibrin thrombus in hemangioma intermingling cancer cells. Moreover, many cystadenomas originating from intrahepatic bile duct were recognized. 2. Metastases were also found in the lung, kidney, adrenal, spleen, vertebral bone and right inguinal, right hilar, right supraclavicular lymph nodes, 3. Carcinomatous peritonitis with brown ascites (400ml) and right carcinomatous pleurisy with bloody fluid (560ml) were present. 4. Congestive hemorrhage, edema and right catarrhal pneumonia of the lung. Venous fibrin thrombus without cancer cell was seen in the left lung. 5. Tumor thrombus in renal vein was found bilaterally. 6. Red thrombus of the right ventricle without cancer cell was present. 7. There was no cancer recurrence in the stump of the stomach. But, hemorrhagic gastritis was seen.
This autopsy case suggests that consumption coagulopathy of Kasabach-Merritt syndrome may coexist with DIC due to metastasis of the vulva cancer.

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We report two patients who developed twice recurrences of herpes zoster. First case is a patient of SLE, and the 2nd case is unclassified collagen disease who had pulmonary fibrosis, fever and immuno-serological abnormalities. Both cases were treated with prednisolone 10mg per day.
The first case suffered from herpes zoster first time 7 years ago and second time 2 years ago, both on her right C_4-6 area after diagnosed as SLE. This time, however, she developed herpes zoster on her right Th_1-2 area. By comparison, the second case developed herpes zoster first time 18 years ago and second time 4 years ago, both on her left Th_6-7 area. This time, however, developed herpes zoster on her left C_4-5 area.
In both cases no worsening of the underlying collagen diseases were observed during third time herpes zoster, and antibody response to varicella-zoster virus was normal in both cases.
Generally it is known that relapse does not occur in herpes zoster. On the other hand, it is reported that patients with SLE have a tendency to recurrences of herpes zoster, however, it is very rare that herpes zoster relapses three times. Therefore, our two cases seem to be so rare and important.

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Kaposi's varicelliform eruption is characterized by a diffuse eruption of vesicles, most of which are umbilicated and grouped and develop successive crops. It is a clinical condition seen when a wide spread infection with vaccina or herpes simplex viruses occurs in a patient with a preexisting skin condition. The disease most commonly occurs with atopic dermatitis or Darier's disease, and the terms “eczema vaccinatum” and “eczema herpeticum” are synonyms.
We recently experienced a case of Kaposi's varicelliform eruption in a 18-year-old man secondary to atopic dermatitis complicated by herpes simplex virus infection.
He came to our clinic on May 10, 1983 with a chief complaint of dysphagia. Four days prior to admission, a painful vesicular eruption developed on his chin to neck followed by swelling of bilateral submandibular lymph nodes. The lesions were spreaded to face and upper trunk with fever 2 days prior to admission. Treatments including γ-globulin were performed by a certain dermatologist without success. On the first examination, the body temperature was 37.3°C and there was tender enlargement of bilateral submandibular lymph nodes. Umbilicated vesicles of 2-3mm in diameter were observed in cluster from face to neck. There was no vesicles and ulcerative lesions in oral mucosa. He was immediately hospitalized and administration of antibiotics and anti-inflammation drugs were started. To prevent secondary bacterial infection, he was given minocycline 200mg twice daily, cefaclor 500mg three times daily and ointment of mixed tetracycline and betamethasone topically. The vesicular lesions evolved into pustules which then became crusted. Pigmentation and superficial scars remained in the some area. He was discharged on May 28, 1983 and eventually healed.
When serum of this patient was assayed for antibody titer against herpes simplex virus by complement fixation test at various time intervals during the therapeutic period, this antibody titer during the recovery period showed four fold increase in comparison to that at onset of the disease.
Relapse of symptoms similar to those noted previously occurred about 11 months later, however, the lesions lasted about 2 weeks and cleared completely.

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We present nine cases of an annular eczematous lesion in infancy. The lesion is composed of fine, dry scaling in the center and slightly raised erythematosquamous borders. Mild itching is at times accompanied. The differential diagnosis includes tinea corporis, pityrosporum infection, napkin psoriasis, eczematid, seborrheic eczema, and atopic dermatitis. Fungal culture and KOH preparation for fungi are all negative. The lesion shows sufficient response to treatment of a corticosteroid ointment. We assume that the lesion is clinically diagnosed as an atopic dermatitis or seborrheic eczema in infancy. While seborrheic eczema may be confused with atopic dermatitis in early childhood, it seems best to consider the annular lesion as a peculiar type of an ordinary infantile eczema. Allergy to a microorganism may be involved in the pathogenesis of the lesion because of an occurrence of nummular eczema in the same patients.

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Serum theophylline (THP) concentration of 2 and 6 hours after oral administration of sustained-release preparation of THP during R. T. C. therapy were compared. The mean age of patients (N=20) was 64.8 years (S. D.=8.31) and the mean weight was 50.0kg (S. D.=9.07). The serum THP concentration was measured by T. D. X. method.
The following results were obtained: The regression equation of 2 (X) and 6 hours (Y) was indicated by Y=1.17X+0.42, and the coefficient of correlation was 0.968. The ratio of 6 and 2 hours was about 1.23 and the S. D, was 0.14.

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Interventional angiography was performed in 96 cases from March 1981 to March 1986 at the department of radiology, Kumamoto National Hospital. Seventy-eight cases of them underwent embolization, fifteen underwent one-shot infusion therapy and only two underwent angioplasty. In our series, Interventional angiography was mainly performed in the treatment of neoplasms (78%).
Thirty-four cases of hepatocellular carcinoma were treated by transcatheter arterial embolization (TAE) by using Lipiodol with anticancer drug and geratin sponge dipped in MMC solution. Cumulative survival rate was 50% at 13 months and 20% at 27 months. Eight cases survived more than one year and the longest was 2 years and 7 months. Furthermore, in 7 cases of metastatic liver tumor, TAE resulted in favorable response, and the 50% survival period was 12.5 months.
TAE for renal tumar was performed in 17 cases, in which 7 cases were done as a preoperative management and 10 cases were done as a conservative therapy. The 50% survival period of the conservative therapy was 5 months, and the longest was 2 years and 7 months.
Trans-ileocolic vein obliteration of the gastroesophageal varices was performed in 7 cases; 4 cases were esophageal vavices, and 3 were cardial varices. Two of 3 cases of cardial varices were successfully controlled and survived more than one year.
Four cases of metastatic bone tumor with intractable pain and five cases of uncontrolled bleeding with hematuria and gastrointestinal hemorrhage, were well controlled by TAE.
As a result of our experience, we ensured that interventional angiography is one of the most important therapeutic procedure in the treatment of neoplasms and control of bleeding.

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A computer-assisted instruction system for the diabetics with impaired visual acuity was constructed using a commercially available voice-composing unit, and it was clinically applied to subjects who were legally blind.
The program was easily made by BASIC. However, great efforts were made for inputting the information concerning Japanese intonation. A digitalized dictionary of such information should be supported for further application of this unit.

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