TNM classification has a history over 20 years, and it was revised three times. The fourth edition was published fully revised according to the Japanese proposal based on the analysis of 7, 742 patients registered from 1969 to 1978. Criteria of new T classification is changed from the length of the tumor to the depth of invasion, which reflects well the survival rate of the patients. For N classification, regional lymph nodes include not only the mediastinal nodes, which was the regional node in the third edition, but also the perigastric nodes excluding coeliac nodes. Because the patients with metastasis to the perigastric nodes have a better survival rate, it is inappropriate that these nodes are not included in regional nodes.
Stage classification was also changed. The combination of T, N, and M, are arranged in order of the survival rate. And they are divided into five groups, which have the same survival rate. These are the new stage classification.

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Psychogenic factors were analyzed in 80 mothers of school children with orthostatic dysfunction (OD). Egograms were 13.8±4.8 in critical parent (CP), 18.6±5.0 in nurturing parent (NP), 15.8±4.5 in adult, 12.7±4.3 in free child (FC), and 14.6±4.1 in adapted child (AC). It seemed that dependence, impatience, discontent or distress in daily life easily occurred in AC with higher values than FC, and NP with higher values was apt to fall into overinterference to children.
Tree-drawing tests resulted in possibly normal state by only 10%, simple type by 73%, immature type by 56%, nervous type by 12% and discontent type by 7%, which were occupied mostly by simple and immature types.
Simple or immature types might stand for dependent personality short of independence. The present results suggest the possibility that OD mothers easily get psychologically unstable and that their children might have accelerated psychological instability by incessant tension not only in the school life but also in the home.

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Essential features of borderline personality disorder are the instability of self-image, interpersonal relationships and mood. Borderline problem is, however, still on the way of further study. Recent researches on the emotional development in the early stages stressed the importance of subjective activity of the self. Though the concept of emotion, affect or sentiment should seem undefined, we divided it into laminar functions, i. e. emotion, mood, affect (desire) and others.
On the basis of the distance to the self, and intensity of sentiment d'appropriation au moi, emotion positions most closely to the self, and controls the others. By disturbances from environment, emotion would cease to develop or be confused, and fail to establish the frame of experiences, or the order of the various self-images, and those of objects.
Related problems were discussed from these points of view.

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Between 1970 and 1984, 166 patients with stages I, II breast cancer of inner or medial quadrants were treated historically with (A) radical mastectomy plus postoperative radiation therapy, (B) extended radical mastectomy, (C) radical mastectomy and (D) modified radical mastectomy, respectively. In this paper, we compared the long-term effects of each treatment modality, and the following results were confirmed. (1) Concerning the role of postoperative radiotherapy, no significant differences were obtained between Group (A) and (C) in both of 10-year disease-free and overall survival, and loco-regional control rate. (2) As for the efficacy of parasternal lymphnode dissection, prognosis of the patients treated with (D) was just the same to those of Group (B).
As a result, we conclude that modified radical mastectomy was the treatment of choice for the patients with stage I, II of inner or medial quadrants.

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The relationship between the prognosis and laparoscopic findings of the liver was studied in 78 patients with liver cirrhosis. As the sphericality of nodules increased, the prognosis of liver cirrhosis became poor. Hemisphere-shaped nodules were observed on the surface of the cirrhotic liver in the state of hepatic insufficiency, and in such cases, many cases died of hepatic insufficiency soon after the diagnosis was established. In mount-like shaped nodule type of liver cirrhosis, deaths were attributed to hepatic insufficiency and hepatocellular carcinoma.
In patients with highly active hepatitis, there was some chance that death would result from hepatic insufficiency. Flat nodule type of liver cirrhosis showed a hepatic surface peculiar to type B liver cirrhosis, in which HBe antigen was negative and hepatitis activity was subsided. Flat nodule type of liver cirrhosis showed the best prognosis and a good hepatic reserve capacity at the time of diagnosis. The prognosis of liver cirrhosis and its complications can be predicted by observing the hepatic surface. Laparoscopic examination is believed to be essential for the diagnosis and treatment of liver cirrhosis.

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To study a possible role of mucosal glycoprotein in pathogenesis of acute gastric mucosal lesions (AGML), we measured hexosamine content (HA) of gastric mucosa of 10 patients with AGML. Concentrations of HA were significantly lower at onset than after administration of teprenon. This finding suggests mucosal glycoprotein might be associated with pathologic mechanism of AGML.

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The authors reviewed 159 cases of jaw-cyst at the Department of Dentistry and Oral Surgery, the Nagoya National Hospital during 11 year period from April, 1978 to December, 1988.
Ninety-nine (62.3%) patients had dental radicular cyst, 29 (18.2%) had postoperative maxillary cysts, 15 (9.4%) had follicular cysts, 8 (5.0%) had fissural cysts, and 3 (1.9%) had epidermoid cysts.
The ratio of incidence between the odontogenic cysts and the non-odontogenic cysts was 2.9: 1, indicating the cysts derived from the dentition was approximately 3 times as many as the cysts of the non-odontogenic cysts.
Furthermore, the ratio of incidence between the dental radicular cysts and the follicular cysts indicated 6.6: 1.
With regard to the chief complaints, 72 (36.9%) patients had swelling, 37 (19.0%) had swelling and dolor, 23 (11.8%) had conflicting sense, and 19 (9.7%) had pains.
The total number of patients with these four symptoms was 151 (77.4%).

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This sudy was undertaken to determine whether thiopental alleviates sympathoadrenal response evoked by tracheal intubation in aged patients with hypertension. Anesthesia was induced with thiopental in sleep dose followed by succinylcholine, 0.1mg/kg. Heart rate and blood pressure were recorded before, 1 and 3 minutes after endotracheal intubation. Serum free and total catecholamine (CA) levels were measured in each time. Dopamine, norepinephrine and epinephrine (E) were determined in fluorescence derivatization with Biphenyl-ethylenediamine by HPLC.
Both systolic and diastolic and diastolic blood pressure rose significantly 1min, after endotracheal intubation (p<0.05). Systolic blood pressure at 3min, after intubation was lower than preinduction period (p<0.05). Heart rate did not change significantly after endotracheal intubation.
Free and total CA concentrations did not increase during a study period. Free and total E levels decreased significantly 3min. after intubation. The elevation in blood pressure without a rise in plasma CA suggests the possible role of vasoactive peptides other than CA.

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We devised a mixed tablet consisting of three different nonabsorbable antibiotics; Vancomycin (100mg), Amphotericin B (66.7mg) and Tobramycin (30mg). This device was called VAT tablet. A preliminary study was carried out with VAT tablets to suppress fecal flora in patients with hematological disorders who had increased incidence of severe infections. The results obtained were as follows;
1) With each group of three tablets, six tablets and nine tablets a day, fecal flora was strongly suppressed one week after administration of VAT tablets.
2) During administration of nine tablets a day, Klebsiella pneumoniae was detected.
3) Side effects with these drugs were not observed.

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We studied 4 cases of primary orbital malignant lymphoma and a review of the literature. All cases were diagnosed by biopsy. All cases received radiation therapy which was remarkably effective. The additional chemotherapy was given to 2 cases with residual tumor after irradiation. No relapse and recurrence were seen in all cases in this series. It is generally noticed that primary orbital malignant lymphoma was difficult to distinguish from pseudotumor, and it is still unclear how to treat and how to know prognosis of this type of lymphoma. It is concluded that biopsy, especially needle biopsy was helpful to diagnose this tumor, and to differentiate from pseudotumor. Furthermore, the immediate immuno-study is important to throw light upon this tumor. Radiotherapy should be the first choice for treatment in this disease because of its effectiveness, however, additional chemotherapy remains to be evaluated.

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A case of disopyramide-induced hypoglycemia is reported. A 64-year-old male was admitted to our hospital with complaints of dyspnea, heart failure, sweating and discomfort in the early mornings. Fasting blood sugar (FBS) demonstrated hypoglycemia (31mg/dl). Immunoreactive insulin (IRI) was low (<3μU/ml) in the state of hypoglycemia. When oral administration of 300mg/day disopyramide was stopped, complaints of sweating and discomfort in the early morning disappeared and FBS was normalized. Rechallenge with disopyramide showed hypoglycemia again (58mg/dl). But when disopyramide was stopped, FBS was normalized again. These results suggested that the mechanism of disopyramide-induced hypoglycemia in the morning might have not related to the level of plasma IRI level and rather related to the general condions in this case.

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A 45-year-old man was admitted because of nausea and bilateral pretibial edema. Patchy hemorrhage was noted on the optic fundi. Fasting plasma glucose level was 180mg/dl, blood urea nitrogen level 110mg/dl and serum creatinine level 12.1mg/dl. Emergency hemodialysis was performed for uremia. However, urinary excretion of protein was 0.2g/day, and a diagnosis of diabetic nephropathy was doubtful. Prominent bilateral hydronephrosis was revealed by abdominal echography, and residual urine of more than 500ml was found by urethral catheterization. After indwelling catheterization, hydronephrosis was gradually reduced during a period of three weeks, and the blood urea nitrogen and serum creatinine levels were decreased to 40mg/dl and 5.6mg/dl, respectively. Hemodialysis was discontinued. Glomerular lesions on the kidney biopsy specimen were minimal; only thickening of the glomerular basement membrane was present. However, it was evident that the specimen revealed tubular atrophy, interstitial cell infiltration and fibrosis probably due to hydronephrosis.
In this patient, possible reasons why the diabetic nephropathy was slight, in the presence of evident neuropathy and retinopathy, were considered as follows: (1) relatively short duration of diabetes mellitus, (2) the lack of familial history of hypertension and (3) the absence of hypercholesterolemia and atherosclerosis on the kidney biopsy specimen.

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We investigated the transition of tuberculous treatment, since our hospital was established in 1966, referring to the fixed number of doctors in our hospital, the number of beds for tuberculous patients, the number of new inpatients, the mean duration of hospitalization, and the mean daily number of new inpatients.
In result, the mean duration of hospitalization of tuberculous patients has fairly shortened, and the mean daily number of new inpatients has remarkably decreased. However, the annual number of new inpatients has scarcely changed, because the whole number of beds for tuberculous patients has decreased in Chiba Prefecture.
On the third Wednesday of November, 1988, the mean age of inpatients was 58.0 years old, and many of them had serious complications.
It is necessary for bringing up and getting the specialists of tuberculosis, that, (1) the education of tuberculosis on university course will be more reinforced, (2) the communication with university and other national medical institutions will be more intimate, (3) the fixed number of doctors will be increased, and (4) the establishment and the instrument will be more supplied.

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This paper presents a case of intrafamilial infection of pulmonary tuberculosis from a daughter to a father. Establishment of methods for the control of pulmonary tuberculosis and advancement of chemotherapy have contributed to the remarkable decrease in the incidence of pulmonary tuberculosis and the mortality by this disease. However, in a society in which uninfected low-age people and infected middle-and high-age people are living together, there is a high risk of mass infection among young people. The risk of infection is especially high for family members who reside with an infective patient in the family. Such a unit of society is a highest risk group. It is, therefore, very important to try early detection and treatment by persuading all family members to recieve examination when this disease is symptomatically suspected and also by repeating the screening of family members against intrafamilial infection.

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A 66-year-old man with von Recklinghausen's disease since his age of about 30 without family history, was admitted to Maizuru National Hospital, complaining of anal bleeding. After examination, rectal cancer was diagnosed. Combined abdominoperineal resection of rectum was performed. There was no other abnormal findings including neurofibroma in the peritoneal cavity.
It is well recognized that tumors originating from neural crest occur frequently in patients with von Recklinghausen's disease. In contrast, the concurrence of cancer of alimentary tract, as in our case, is relatively rare. An analytical study of relationship of von Recklinghausen's disease and cancer of alimentary tract revealed documentation of 46 Japanese cases.

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We experienced a resected case of metastatic lung tumor originated in hepatocellular carcinoma (HCC) after hepatectomy. A 56-year-old male underwent extended right hepatic lobectomy for HCC without liver cirrhosis. At twenty-two months after the operation, the chest X-ray film showed the coin lesion in the right lower lobe of the lung, so right lower lobectomy was done. Histological study of the resected tumor showed the Edomondson II type HCC. He was discharged without any complications.
Since Thomford reported the cases following resection of metastatic lung tumor in 1965, these operations have been being performed actively in Japan. However, the report of resection of metastatic lung tumor originated in HCC is rare. We consider that we would like to operate on similar cases.

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Two cases of infected urachal cyst were reported. One case was a 54 year old woman with complaints of lower abdominal pain and pollakisuria, and another case was a 23 year old woman with complaints of lower abdominal pain, fever and pain on urination. In both cases, ultrasonography and CT showed a cystic mass compatible with infected urachal cyst. Percutaneous puncture and drainage for abscess was done. Volume of pus was 60ml in one and 30ml in another, and the culture of pus yielded Staphylococcus aureus and Pseudomonas aeruginosa. After chemotherapy, resection of urachal cyst with partial cystectomy was performed.

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We report two families of benign infantile convulsions (BIC) proposed by Fukuyama in 1963. Despite Fukuyama's definition, in which BIC was said to be nonfamilial, several reports of BIC with familial occurrence have been published. Kajiyama first described a clinical entity of BIC with familial aggregation and named “familial BIC” in 1987. Together with previous reports and the present experience, the characteristics of familial BIC were summarized as follows. (1) Familial occurrence is noted. (2) The age of onset is from 3 to 5 months old. (3) Convulsion occurs without any precipitating factors such as gastroenteritis and upper respiratory infection. (4) Convulsion has a tendency to occur in clusters within a day. (5) In the same family, the onset of age and the incidence of attack are similar.

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