For 50 cases of fundectomy (gastroesophagostomy) and 29 cases of total gastrectomy, complains of postoperative reflux esophagitis, X-ray examinations, fiberscopic observations, biopsies, and determinations of esophageal pH were investigated, and the following results have been obtained :
1. Esophagitis symptoms were classified as, “moderate”, “mild”, and “sever”.
2. Endoscopic criteria were classified as, “mucosal color tone change type”, “erosion-ulcer type”, and “hyperplastic swelling type”. Endoscopy grade was devided into I, II, and III, mainly under reference of infiltration extent.
3. Biopsy criteria was used to judge neutrophil infiltration, parakeratosis, basal zone's change, expansion and increase of blood vessel on lamina propria, and fibrosis.
4. Observing the similarity of the pH curve of esophageal mucous membrane to that on jujunal interposition, it was shown that gastroesophagostomy is little influenced by gastric juice and duodenal juice.
5. As prevention against regurgitation, a slim stomach tube was used, and for anastomosis, the pointed end of esophagus was made to invaginate inside the tube.
6. In gastroesophagostomy, there were few occurrences of esophagitis. The symptoms were of light grade, and in the course of time after operation, they became very well.
7. During endoscopy investigations and gastroesophagostomy, there was observed slight and limited esophagitis near the anastomatic site, but there was no tendency toward worsening in the progress of time.

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小・中学生1461名について皮厚 (腹部) を計測し, ローラー指数を求め, 皮厚とローラー指数の年令推移や分布状況を考察し, さらに両者が肥満の指標として如何なる意義を有するかを検討し, 次のような結果を得た.
(1) 皮厚の平均値, 中央値は男女共に年令が進むにつれて増加し, 特にこれは10才以後において著しい.また皮厚は男より女の方が大きく, その差は年令とともに増大する.
(2) 皮厚の分布は双峯ないし三峯の分布を示した.すなわち, 男女共 5～6mmを中心とした第 1 ピークは6～9才で最高, 10～11mmを中 心とした第2ピークは12～14才で最高を示し, 15～16mmを中心とした第3ピークも13～14才で出現する傾向がうかがわれた.なお, この分布も大きい方に著しい歪みを有し, ちらばりは極めて大きい.
(3) ローラー指数の平均値, 中央値は男女共に6才→9才と漸減し, その後は男では14才まで殆んど変化ないが, 女では14才まで漸増の傾向にある. 分布は6～7才ではほぼ正規分布に近いが, 8才以後は年令が進むにつれて大きい方に歪みが増大して非対象分布となる. なお分布のピークは男女共6才→12才頃まで一律に小さい方に移行し, 12才でほぼ固定化, またやや大きい方に移行する.
(4) 皮厚と体重は高い相関関係にあり, しかもこの関係は身長の影響を除外しても同様である. また皮厚とローラー指数も高い相関関係にあり, 特にこの傾向は年令が進むにつれて著しくなる.
(5) 肥満判定にあたっては, 皮厚とローラー指数のそれぞれの特徴を考慮する必要があり, 皮厚とローラー指数を組合せて肥満を判定することが種々の不合理を解消し, より適切であるという見解を得た.
具体的には, 皮厚 (腹部) 15mm以上でローラー指数 160以上を肥満とする.但し, 単独に皮厚20mm以上あればローラー指数が160未満でも肥満とし, またローラー指数が160以上でも皮厚が15mm未満なら肥満から除外してもよいであろう. なお, これらの点に関する詳細は今後の検討にまちたい.

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The incidence of congenital atresia of the esophagus in generally quoted as 1 in 3, 000 live births. In majority, it is associated with a tracheoesophageal fistula. Prematurity and multiple severe congenital anomalies are the two most common causes of death in these infants.
A case of Gross A type atresia of the esophagus associated with high jejunal atresia, jejunal perforation and christmas tree deformity of the distal intestine was presented.
The patient, a seven-hour-old girl, was referred to the Department of Surgery, Gunma University Hospital, on March 23, 1974 because of increasing abdominal distention and recurrent cyanotic spells since birth. The up-right scout film of the distended abdomen on admission showed generallized flank opacity without intestinal gas. A Replogle catheter with radiopaque sentinel line was introduced but lodged in the upper third of the esophagus and could not be advanced.
Upon entering the peritoneal cavity, a large amount of bilious ascites was gushed out. A markedly distended proximal segment of jejunum ended abruply 5cm. distal to the ligament of Treitz. The remaining small intestine was coiled as an “apple peel” around a narrow mesentery attached at the ileocecal junction. A rupture was found at the apex of the distended proximal blind end of the jejunum. The perforated blind end was resected and end-to-side anastomosis was carried out. A Stamm gastrostomy was performed and a jejunal trans-anastomotic feeding tube was introduced. The abdomen was closed with a tube drainage. Immediately postoperative course was complicated with apneic spells but jejunal tube feeding was started from third p.o.day. She did well thereafter and she weighed about 8Kg. at eight months of age. She is now waiting a definitive operation.

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As to X-ray examination of the naviculare and tibiale externum bones, the authors worked out a way to project them obliquely as follows; A new X-ray projection technique for taking shots anteversio oblique at an angle of 28 degrees to the footbottom. The reason for determining the angle at 28 degrees is that it corresponds to the degree at which the space between the tibiale externum and naviculare can be most clearly projected. It was the average degree out of 21 samples taken. Using this oblique projection technique, the space along these two bones does not overlap and its shadow is projected sharply.
The figures of the naviculare and the tibiale externum of 540 adults (25-74 years old) on roentogenograph by means of such oblique projection are now classified as the Oneda-Katada classification in 6 divisions (A', A, B, C, D and E types) and 2 subdivisions (+S₁, or +S₂ and L, M, or S types) (cf. Figs. 8 and 9 and Tables 2, 3 and 4), referred to the dorso-plantar X-ray projection figures.
Further, using this oblique projection method, the authors classified the both bones of 1, 159 growing children from age 6-19 years old (cf. Tables 5, 6 and 7). It was concluded that the frequency of occurrensce of each type was about one or two years earlier for the female than for the male. Due to the frequency of occurrence of each type in each age group, the growth of the naviculare and the tibiale externum is assumed by the authors to be as Fig. 11.
It must by assumed therefore, that in some cases growth ceases in each type and that the bones remain unchanged.

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The present paper discussed the perinatal emergency care system for further improvement of child and maternal health in Gunma prefecture, Japan.
The possibilities for the prevention of perinatal deaths were estimated from the data about the causes and local distribution of hebdomadal deaths which were main concern of emergency care system.
The deaths from obstetrical causes, which were mostly preventable, were less than one third of the total cases. The rest of above were caused by environmental factors and most of them were difficult to prevent. Introduction of high risk care unit for pregnant women as developed in advanced nations was needed to reduce the number of deaths from environmental factors.
The frequency of toxaemia and bleeding in the rural under-doctored region and part of town area (previously published data) also urged the need of careful perinatal control in these area.
The definite plan for these emergency care system are under investigation analyzing the data from questionnaire.

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