At our Department of Surgery, 1, 255 patients underewent operations under general anesthesia in the last 10 years (from 1981 to 1990). 51 cases were over 80 years.
The aged operative cases over 80 years old included 16 gastric cancers, 13 colon cancers, 9 other malignant diseases and 13 benign ones.
They were divided into 22 emergency cases, and 29 standby ones. The operative mortality was 9, of which 8 were from emergency cases and one from standby cases.
In comparison with the operations for patients aged sixties, to the operations for patients over 80 years, the latter had less blood loss and shorter operating time.
As the result, it was suggested that a careful consideration had already been given to the operations for the very aged patients.

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We experienced 422 cases of early carcinoma of the colon except for villous type. We grossly classified them into three major groups as those of protruded, flat elevated, flat and depressed types. The size of tumor, absence or presence of adenoma, histological differentiation and depth of invasion in each group were microscopically examined. The probable relation between gross and microscopical features concerning pattern of growth and development, and morphogenetical sequence of adenoma-carcinoma or de novo carcinoma is discussed. We analyzed 13 cases of early colonic carcinoma with lymph node metastasis. The risk factors of lymph node metastasis were investigated. The results are followings. Almost all cases of depressed type were sm carcinoma and small in size and revealed histologically less differentiated structure, exclusively composed of carcinoma without adenoma. It is possible that almost all of them are de novo carcinoma. As risk factors of lymph node metastasis, the level of sm invasionl as well as lymph vessel permeation is emphasized, and less differentiated histological types in elevated type and surface depression were revealed to be risk factors. We experienced a peculiar case of early carcinoma, which appeared to be transitional form from elevated to flat elevated type. When we discuss morphogenesis of carcinoma, we should consider the size and surface lesion of the tumor and adjacent mucosal lesion.

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Measurement of endometrium thickness by endovaginal ultrasonography was conducted in 98 cases of a regular menstrual cycle group, 39 cases of an irregular menstrual cycle group, and 152 cases of a menopause group as a screening for endometrial cancer and endometrial hyperplasia. The endometrium thicknesses of the endometrial cancer, endometrial hyperplasia, and endometrial polyp showed significantly higher values than those of benign endometria in each group. The evaluation of the inspection of the three groups revealed that the regular menstrual cycle group showed a sensitivity of 0.6-0.67 and an accuracy of 0.84, the irregular menstrual cycle group showed a sensitivity of 0.71 and an accuracy of 0.84, and the menopause group showed a sensitivity of 0.86 and an accuracy of 0.9. These data showed that the inspection by endovaginal ultrasonography was a useful method for detecting diseases.
The detection ratio of endometrial cancer before and after menopause was 40% and 87.6%, respectively. With respect to the invasion of the myometrium before menopause, the group where the tumor limited to the endometrium showed 0%, the group where the invasion of the myometrium was found in the 50% or less showed 33%, and the group where invasion of the myometrium was found in more than 50% showed 100%. In cases after menopause, each group showed 50%, 85.7% and 100%, respectively. Measurement of endometrium thickness by measns of endovaginal ultrasonography is a very useful method for detecting endometrial cancer after menopause. However, it is an inadequate method for early detection of cancer invading the myometrium before menopause.

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Various 26 lesions involving anterior cranial fossa intradurally and extradurally, and invading the middle cranial fossa and extending to the high position of basal cistern, were approached by skull base surgical techniques as well as ordinary neurosurgical ones. To midline lesions of anterior cranial fossa, midline supraorbital approaches were applied and for more laterally placed lesions or extending to the middle cranial fossa, orbitozygomatic approaches were undertaken.
After completion of treatment of the lesions, the dural defects were patched by temporoparietal fascial flap and the skull bases were reconstructed doubly by galeal frontalis myofascial flap and by vascularized calvarial bone flap and for middle cranial defects, pedicled temporal muscles were packed to prevent cerebrospinal fluid leakage.
Four epidural abscesses and three temporal lobe edema and contusions were occurred after these procedures but other 19 cases were uneventful.
In conclusion, utilization of skull base surgery for neurosurgical disorders is very useful.

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The immunological effect of ginseng extract was examined on in vivo and in vitro cell-mediated immunity in mice. The in vivo examination was performed in the reaction of delayed-type hypersensitivity against sheep red blood cells which were injected on the footpad of mice. The in vitro responses of spleen cells were also studied using T cell mitogen, concanavalin A and phytohemagglutinin.
The results demonstrated that the extract suppressed the reaction of delayed-type hypersensitivity, while it had no effects on in vitro responses of spleen cells to mitogens.
The study suggests that the suppressive effect of the extract on cell-mediated immunity does not occur through the direct inhibition of T cells, but that of macrophages.

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This study was aimed to investigate the effects of ginseng extract on the lymphocytes in irradiated mice with X-ray. After the extract was injected into irradiated mice, spleen cells were removed, and the number of lymphocytes, the number of plaque forming cells (PFCs) as well as lymphocyte subpopulations were investigated.
The results showed that the extract had no effects on the number of lymphocytes or lymphocyte subpopulations, but that the extract had a protective effect on the decrease of PFCs and also a restorative effect on the decreased PFCs.
Consequently, it is possible that the extract may have preventive effect and restoration on decrease antibody-formation ability of B cells affected with X-ray irradiation. In addition, the extract may act directly on B cells to activate antibody formation, but not on lymphocyte proliferation.

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Atrial fibrillation is a common but clinically important Condition because of many manifestations, of which cerebral embolism is one of the most serious complications. In patients with atrial fibrillation, therefore, prevention of stroke is of utmost importance. In the past, atrial fibrillation without valvular heart disease was considered innocuous, however, it is now well known that chronic atrial fibrillation, even without concomitant valvular heart disease, may precipitate cerebral microemboli which can be confirmed by CT or MRI, and that the incidence is disproportionately high even when the age is taken into account.
Both CT and MRI are expensive, have a limit in resolution, and do not necessarily reflect the cerebral function. For this reason, we tried EEG for patients with atrial fibrillation to see its effectiveness in screening cerebral microemboli. Though our experience is limited, EEG abnormalities such as appearance of slow waves were often seen in patients with cerebral microemboli. It is our impression that EEG is effective in screening cerebral microemboli in high risk patients.

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The pulmonary edema that occurs after re-expansion of a collapsed lung is known as re-expansion pulmonary edema (REPE). Its occurence has been thought to be rare before. But nowadays clinicians must be aware of this possible complicasion when appling the chest tube because of the increased incidence of spontaneous pneumothorax recently. According to some previous reports and our experience, its feature is characterized as follows; (1) It develops in a collapsed lung of long duration (more than 3 days). (2) It often develops in several hours after rapid and complete re-expansion, but occasionally develops after partial re-expansion. (3) Though it has been regarded to occur after continuous suction, it sometimes occurs inspite of using the device with flutter valve. (4) Its severity varies from death cases to almost asymptomatic ones. This suggests that the REPE occurs more frequently by close observation than previously believed.

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The validity of limited operation for lung cancer was evaluated on 14 patients with primary lung cancer who underwent either partial resection or segmentectomy.
The indications for limited operation were mainly impaired pulmonary function and the elderly over 75 years old. Overall 5-year survival rate was 53%. Five-year survival rate of the patients with stage I was 630. Recurrence rate was 57% (8/14) including 5 local recurrences and 3 distant metastases. Postoperative complications composed of one pyothorax and one death due to multi-organ failure following acute respiratory failure.
It is considered that limited operation is a beneficial therapeutic modality to obtain favorable prognosis for the selected patients with stage I primary lung cancer who are elderly and have an impaired pulmonary function.

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Intrusion of part of an organ (generally, the colon) into the space between the right half of the diaphragm and the liver is called Chilaiditi's syndrome. This condition is rare and is usually asymptomatic. We diagnosed symptomatic Chilaiditi's syndrome which was either reversible or permanent in 3 patients. This condition is usually found unexpectedly on chest or abdominal X-ray films, and no specific treatment is required in asymptomatic cases. However, careful examination of the gastrointestinal tract appeared to be necessary in any symptomatic patients.

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Using the new extracorporeal shock wave lithotripsy (ESWL) apparatus (MODULITH SL-20 STORZ Medical Co.), 32 patients of gallstones were treated. Fragments were less than 3mm in 13 patients, and less than 5mm in 10. Gallstones disappeared completely in 6 patients. In 4 patients, the type of gallstones was Ia according to Tsuchiya's US classification, and fragments were less than 3mm and disappeared immediately.
In the case of calcified gallstones, fragmentation was also achieved by application of ESWL several times.
No analgesics was required. No abnormal findings of laboratory tests were found. Macroscopic hematuria was found in 1 patient. During the follow-up period, 2 patients suffered colic pain and 3 developed acute cholecystitis.
This new instrument is very useful for the treatment of gallstone, even in the cases of slightly calcified gallstones.

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The prevalence of Methicillin-resistant staphylococcus aureus (MRSA) colonization in nasal cavities was studied among 63 medical staff members (G-MS), 35 inpatients in the Department of Internal Medicine and 50 outpatients (G-OP) at Miyagi National Hospital. The number of G-MS who were found to be colonized with staphylococcus aureus (SA) was 19 (30.1%), with MRSA being detected in 6 of them. Excluding 5 inpatients infected with MRSA, 9 (30%) out of 30 inpatients (G-IM) exhibited SA colonization, but no case of MRSA colonization was identified. Among G-OP, 6 cases (12%) exhibited SA colonization and 2 cases (4%) showed MRSA colonization. The relatively high rate of MRSA colonization among G-MS in comparison to the other 2 groups suggests MRSA becoming prevalent among medical staff members, indicating the need for close watch over this group as a source of hospital infection. The 2 cases of MRSA colonization detected among G-OP had earlier hospitalization and this group may increase in the future. It is important that observation of MRSA colonization in nasal cavities be maintained while also watching out for the dangers of visitors carrying MRSA into hospital as well as community infection and retirement home infection.

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We experienced a case of HELLP syndrome complicated by eclampsia. In this report, the problems for diagnosis and management of this syndrome were discussed.
A 27-year-old primipara woman showed mild toxemia with mild epigastral pain in late pregnancy. At 35 weeks of pregnancy, a generalized convulsion was suddenly occured with marked hypertension and general edema. On admission, a thrombocytopenia and elevated liver enzymes were demonstrated and the fetal distress was diagnosed. An emergent cesarean section was selected and a female infant of 1312g was born. The second simliar case. A 27-year-old primipara woman with twin pregnancy, showed mild toxemia in late pregnancy. She also complained of mild epigastral discomfort in late pregnancy. After 36 weeks, an elevation of blood pressure, a thrombocytopenia and a disorder of liver enzymes were observed and gradually worsened. She delivered healthy infants of 2440g and 2058g in vaginal way. In these two cases, the clinical symptoms and abnormal laboratory data were rapidly restored and both mothers and infants survived.
As previously reported, HELLP syndrome is recognized as a severe disease because of its poor prognosis for mother and fetus, and early diagnosis and management are indispensable to improve its prognosis. It was concluded that the evaluation of liver enzymes and platelet count were very important to diagnose this syndrome, especially for patients complicated by upper abdominal indisposition besides toxemia of pregnancy.

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Considering recent trends of alcoholism treatment in Japan, we started day care programs for alcoholics in April 1987 at Kurihama National Hospital. The program we developed was 4-weeks long in each time, and was provided for a fixed group of approximately 10 alcoholics who had not been admitted to our hospital. The number of alcoholics who had completed the program in April 1991 was 141, and their average age was 47.2 years old ranging from 24 to 74. The most participants were from Tokyo (37 patients, 26.7%). Although most of the patients spent approximately 2 hours for commuting (one way), their attendance rate was as high as 97.2%. According to a follow-up study conducted in April 1991, among 119 patients who had completed the program before December 1990, 41 patients (34.5%) had continued total abstinence. The results strongly suggest that the day care program is effective as one modality of outpatient treatment of alcoholics.

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