Based on 246 experiences of portal hypertension patient, clinical and pathological features as well as surgical therapy for esophageal bleeding were discussed.
(1) Incidence of esophageal bleeding was varying according to the kinds of original disease: 11% in Banti's syndrome, 25% in cirrhosis of the liver and schistosomiasis japonica respectively, and 61% in prehepatic portal block. It was also found that patients with liver cirrhosis is prone to make massive hematemesis in bleeding episode.
(2) Autopsy examination of the cirrhotics revealed that the varices with irregularity thickened wall ruptured often, while those with simple dilatation with no thickening scarecely ruptured. This finding may suggest that the mechanical weakness of the varices is the major factor leading to the rupture.
(3) Here varying incidence in the the type of cirrhosis of Japanese and western patients should be mentioned. Portal cirrhosis, which responds well to medical treatment, is the most common type found in American patients. In Japanese patients, on the other hand, postnecrotic and Laennec cirrhosis are the types of highest incidence. Then, if the direct portacaval shunt is performed on cirrhotic patients with such poor liver function, portal blood avoids hepatic circulation and a hepatic anoxia may be more frequently encountered. Taking into account such a special circumstance of the Japanese patients, the most elective therapy has been worked out as follows.
In emergent cases, as a rule, shunt operation is contraindicated, and the transperitoneal proximal gastrectomy is recommendable. It is not seldom that the site of bleeding is not in the esophagus, but in the stomach. It should also be noticed that the stomach ulcer appears more often in the cirrhotic patients as compared in the controlled group.
Concerning the interval operation, referring to our experiences involving splenectomy alone, splenectomy with dissection of the gastric coronary vein, and shunt operations, it was concluded that the most reliable method for eliminating esophageal bleeding is to make a shunt between the portal and systemic circulation. And, I have pointed out to introduce a concept“Controlled Shunting”which materially implies a shunt that is so constructed that it does not impair hepatic circulation and at the same time achieves adequate decompression to prevent esophageal bleeding. In this sense, direct portacaval shunt does not meet the purpose. For realizing this concept, a new method of splenorenal anastomosis has been devised. The principle of the new technique is that the juncture angle between splenic vein and renal vein is made acute by utilizing an autogenous vein graft taken up from an anatomic bifurcation of the iliac vein. It has been proved that patency of the anastomosis was nearly 90%, and operative as well as follow-up mortality is very low, and satisfactory results for esophageal bleeding were obtained. It should be emphasized that difficulties of curing esophageal bleeding in Japanese has, to a major degree, been overcome by our new operative method of splenorenal anastomosis.

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In order to get a good results of treatment in case of patients with cancer it is necessary to diagnose and treat in early stage and with skilfulness. For the purpose of early diagnosis of the cancer of the larynx we examined 450 patients with hoarseness in 5 cities in our district. Among them we could find 5 patients with cancer of the larynx (1.7%). The stages in which they were found were as follows:
I stage…2, II stage…2,
III stage…3, IV stage…1.
The patients in I stage were cured with radioisotope and 6 patients with operation. One patient in III stage were too weak to be operated.
We hope that such attempt is to be realized all over the world and patients with cancer of the larynx are found in early stage.

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By using Image Intensifier and general anaesthesia, the authors have recently succeed easily and safely in removing an artificial tooth from the esophagus of 47-years old man who swallowed it by accident.

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A boy eleven years old, came in with foreign body (marking needle) which penetrated the left lower bronchial wall. The The needle could not be extract with only one grasping forcep because of the angle between the needle and the longitudinal axis of the bronchus where the needle penetrated, was right-angled. Then we devised specially combined forceps. We combined a grasping forcep with a expanding forcep right-angled. We tried to extract the foreign body with this forceps in a following way: first, grasp the foreign body with grasping forcep tightly, then extract the penetrated tip of the needle through widening the blades of the expanding forcep. Under using image intensifier, we could extract the needle with this specially combined forceps without any complication.

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An autopsy case of myasthenia gravis in an infant 7 months of age is reported. The characteristic changes of muscle fibers which undergo necrosis with resulting inflammatory cellular reaction and partially reveal a progressive atrophy of individual fibers are described._ The increased thymus in weight is histologically interpreted to be thymic hyperplasia without formation of germinal center. The relation of the thymus to lesions of skeletal muscle in myasthenia gravis is discussed.

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Recently, various gases have been used for domestic use, so that gas explosion has been frequent events in the human trachio-bron-chial tree.
Lately we have had a case who was 36 year old man with mediastinal & subcutaneous emphysema due to explosion of aspirated acethylene gas in tracheo-bronchial tree while working at shipyard.
As for study on this subject, there was a reasonable explication as in etiological factors of mediastinal & subcutaneous emphysema.

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