Assessment of cellular immunity was performed in 41 patients with squamous cell carcinoma of the esophagus to clarify factors associated with immune deficiency. Four parameters, total lymphocytes, numbers of T cell and B cell, lymphocyte blastogenesis in response to phytohemagglutinin and the purified protein derivative skin reaction were measured on admission, after preoperative radiation therapy, and 4 as well as 8 weeks after surgery. The assessment indicated that immune depression clearly existed in esophageal cancer patients on admission. Of the factors of age, dysphagia and stage of cancer, all were associated with immune depression. The effect of treatment for cancer on the immune status was also assessed. The parameters of cellular immunity were markedly depressed by surgery either with or without preoperative radiation therapy. Thus, these results indicate that treatment including surgery and radiation, dysphagia, stage of cancer and age, especially the treatment, are critical factors associated with immune deficiency in esophageal cancer patients.

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Data on 97 patients treated for gastric cancer with synchronous hepatic metastasis for 1974 through 1983 were analyzed to determine the influence of various therapeutic factors on survival. Overall 50% survival duration was 4.7 months; H₁ was 6 months in 26 cases, H₂ was 4.2 months and H₃ was 2.6 months in 38 cases. Early after the surgery, there was no significant difference in survival between patients with peritoneal dissemination and without. However all patients with peritoneal dissemination died of progressive disease within 18 months. Pathological features of poorly differentiated and well and moderately differentiated tubular adenocarcinoma affected the degree of increase in metastatic multiplicity. Fifty percent survival duration for patients receiving chemotherapy was better than for those receiving surgery alone (2.8 months versus 1.4 months). The combination of continuous infusion of 5-FU (25mg/day) via the hepatic artery improved survival in one case for 19 months after gastrectomy, 4 of 12 patients thus treated showing transient regression of the hepatic mass. In addition to gastrectomy, 8 patients without peritoneal dissemination underwent excision of a solitary hepatic metastasis. The prognosis was most favorable for these patients, including two who remained alive for 7 years 10 months and 10 years 2 months after the surgery. In patients with metastatic gastric cancer involving only a solitary liver metastasis, excision of the metastatic lesion and infusion chemotherapy via the hepatic artery results in an excellent prognosis.

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From January 1971 through March 1985, we experienced a total of 70 side-to-side choledochoduodenostomy procedures. Eighty percent of them were indicated for patients with gallstone diseases. Liver function tests returned to normal within 3 months after the operation. The size of the stoma and the width of the common duct were reduced about 30% within 3 postoperative months; however in 2 cases, they did not change for many years compared with the immediate postoperative sizes. In one of them, an anomalous junction of the pancreatico-biliary ductal system was demonstrated by ERCP. Intrahepatic gallstones recurred in these 2 patients 4 and 12 years after the operation, respectively. Postoperative cholangitis did not occur in the presence of an adequate stoma. Although clinical cholangitis was not observed except in 2 cases, histological cholangitis was constantly seen throughout a 10-yearfollow-up period. Gastric carcinoma developed in 2 cases 7 and 10 years after the operation, respectively. Its etiology is unknown.
In conclusion, strictness of operative indications, and periodical and long-term follow-up study of postoperative patients are mandatory to obtain better clinical results.

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There are many cases of polymicrobial infection experienced during daily clinical procedure in the surgical field, and it is important in such cases to clarify the types of bacteria responsible for the infection and constituting the infectious fields. These aspects were investigated by examining diseases known to have a high incidence.
In the present study, 1, 093 strains of bacteria, which were isolated from the bile, appendiceal contents, and ascites due to peritonitis, abdominal drainage and wound infection, were used. Polymicrobial infection was found for 42.3% of all strains, especially 65.5% of the strains isolated from cases of peritonitis. As for combinations of bacteria, the incidence of combination of Escherichia coli with Bacteroides fragilis was largest, while 98.1% of Bacteroids fragilis was isolated together with other strains. Experiments for observing changes in infectious virulence due to polymicrobial infection clearly revealed enhancement of virulence, suggesting that chemotherapy should be conducted for bacteria showing a high MIC value with regard to administration of antimicrobial agents for polymicrobial infection.

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It is difficult to assess the subvalvular morphology of mitral valve stenosis during mitral valve surgery. We, therefore, applied a 4.0mm flexible optic fiberscope in order to visualize the subvalvular complex during mitral valve reconstruction in a patient with mitral stenosis.
Intraoperative fiberscopic examination of the mitral valve allowed appropriate vale reconstruction enabled the restoration of sufficient valve function.

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Twelve operative deaths were seen in 169 patients who underwent aortocoronary bypass grafting for ischemic heart disease from 1975 to July, 1985.
The clinical, angiographic and intraoperative characteristics were evaluated to understand the factors predictive of operative mortality.
Clinical factors affecting operative mortality were age and unstable angina pectoris. Angiographic factors were coronary artery lesions including left main coronary trunk stenosis and 3-vessel disease. Intraoperative factors were incomplete revascularization and myocardial preservation.
There were no significant differences between operative mortality rates for patients with and without a history of prior myocardial infarction, diabetes mellitus and left ventricular dysfunction. The number of grafts did not affect operative mortality.
There was a strong association of operative mortality with incomplete revascularization in patients with severe coronary artery disease.

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Two patients with advanced lung cancer involving the aortic wall underwent concomitant resection and reconstruction of the aorta under a temporary bypass.
Case 1: A 62-year-old male had a left hilar lesion with severe stenosis of the main bronchus and athelectasis of the lower lobe. Left pneumonectomy combined with resection of the descending aorta was undertaken. The aorta was reconstituted with Dacron graft interposition. The pathological diagnosis was squamous cell carcinoma and the tumor extended to the media of the aortic wall. The postoperative course was uneventful. However, he died of acute pneumonia 12 months after surgery.
Case 2: A 64-year-old male was found to have a left upper lobe lesion and underwent left upper lobectormy combined with resection of the descending aorta, which was reconstituted with end-to-end anastomosis. The pathological diagnosis was adenocarcinoma and the tumor extension was restricted to the adventia. The postoperative course was uneventful and he is alive at present, seven months after surgery.
Even in advanced lung cancer involving the aorta, concomitant resection and reconstruction of the aorta may be justified if longer survival and higher curability are expected.

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Between January 1980 and April 1985, twenty-six patients with abdominal aortic aneurysm (AAA) were treated at Gunma University Hospital. Eight patients with ruptured AAA (mean age: 61 years) were all male.
Six patients underwent radical operations, and all of them survived. Four patients exhibited special types of rupure as follows: 1) an aorto-caval fistula, 2) a ruptured AAA with obstructed common iliac arteries, 3) a dissecting AAA, and 4) a cystic aneurysm ruptured into the retroperitoneal cavity.
Two patients who could not undergo radical operation died one day and two months, respectively, after the rupture.
The operative mortality of ruptured AAA is higher than that of non-ruptured AAA, especially in cases under shock.
However, the long-term survival rate of ruptured AAA undergoing radical operation is almost the same as that of non-ruptured AAA. Therefore, a positive policy should be taken in the treatment of ruptured AAA.

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A case of ischemic colitis following abdominal aortic aneurysmectomy in a 74-year-old male is reported.
The patient was admitted to the hospital with a complaint of severe abdominal pain. A ruptured abdominal aortic aneurysm was suspected, and emergency laparotomy was performed. At the operation a massive hematoma was encountered in the retroperitoneal space caused by rupture of an abdominal aortic aneurysm. Aneurysmectomy was performed uneventfully. The left colon appeared to be viable at the end of the procedure.
Three days after the operation he had diarrhea, and the symptoms of bowel ischemia progressed. Colonoscopy on the 7th day after the first operation revealed ischemic colitis. He was treated conservatively for 2 weeks without significant improvement. On the 19th postoperative day uncontrollable massive melena occurred. Emergency laparotomy was carried out again, and resection of the left colon and transverse colostomy were done. The postoperative course after the second operation was uneventful, and the patient is doing well now.
Although clinically significant ischemic colitis following aortic reconstruction is rare, colonoscopy after the operation is useful for early recognition of ischemic changes before clinical manifestations.

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Both chronic and acute occlusion associated with abdominal aortic aneurysm are rare. Clinical symptoms of chronic occlusion present such typical symptoms of Leriche syndrome as intermittent claudication and impotence, both gradually exacerbating, in which it is difficult to obtain precise diagnosis for arotic aneurysm preoperatively by angiography. In the present paper, we report a recent experience of a patient with typical symptoms of Leriche syndrome associated with abdominal aortic aneurysm, and the lumen of the aneurysm was chronically occluded up to the area directly below the renal artery. The 61-year-old male patient was admitted to our hospital with chief complaints of intermittent claudication, atrophy of the lower extremities and impotence. The presence of abdominal aortic aneurysm was intraoperatively discovered and treated with implantation of Y-type artificial vascular graft. This case was described in the light of the related literature.

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Five octogenarians who survived resection of abdominal aortic aneurysms are reported. All of these patients were men and their ages ranged from 80 to 85 years (mean 82). Four patients had elective operations for nonruptured abdominal aortic aneurysms and the other patient had an emergency operation for a ruptured abdominal arotic aneurysm. There were no early deaths. Severe diarrhea was the sole major postoperative complication. All patients are doing well 6 months to one and one-half years postoperatively.
It is concluded that operations for large aneurysms or for symptomatic aneurysms in octogenarians should be performed unless the patients have a complicaing serious disease.

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The patient, an 11-year-old boy, visited our hospital with chief complaints of hematemesis and melena. Endoscopy revealed R-C sign-positive esophageal varices, and angiography revealed pylemphraxis in front of the liver and spontaneous splenorenal shunt, pediatric portal hypertension being diagnosed. Moreover, X-ray of the chest revealed a projection of the left second arch and ECG revealed hypertrophy of the right ventricle. Conclusive diagnosis of the patient as having pulmonary hypertension was achieved by right heart catheterization. Transection of the esophagus through the chest and secondary resection of the gastric varices and the spleen were performed.
Twelve cases of pediatric portal hypertension complicating pulmonary hypertension have been reported including this case Eight of the 12 cases had a past history of undergoing a shunt procedure while two cases had spontaneous port-systemic shunt, suggesting that the latter is related to the cause of pulmonary hypertension. The direct activity of a specific substance in the portal blood carried to the lung through the shunt, rather than through the liver, would cause pulmonary hypertension.

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Three cases of relatively rare peripheral aneurysms were reported.
The first patient was admitted to our clinic with a pulsatile mass in the left posterior cural region. Angiographically, the left posterior tibial artery had an aneurysmal dilatation with a dense hypervascular halo. The mass was resected under the diagnosis of an aneurysm and microscopically, it was found to consist of leiomyoma arising from the artery wall.
The second patient was hospitalized with a complaint of severe abdominal pain. She underwent an emergency laparotomy. At that time, a massive hematoma occupying the left half of the pelvis was found. Under the diagnosis of a ruputured aneurysm, double ligation of the origin of the left internal iliac artery was performed with success.
The last patient complained of a pulsatile mass and pain in the right subingunal region for a month. On the angiogram, the right deep femoral artery in general showed a tortuous and irregular contour, pressing against the superficial femoral artery. The aneurysm was successfully resected and replaced with an autologous saphenous vein segment.

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Three patients with popliteal artery entrapment syndrome were reported. These 3 patients, whose chief complaint was intermittent claudication, were a 21-year-old man, a 45-year-old woman and an 18-year-old man. According to Delaney's classification, the entrapment of the first patient was classified as type I bilaterally, of the second patient as type III in the right leg and of the last patient as type IV in the left leg and type II in the right leg. Of 40 patients documented in the Japanese literature, 32 were men and 7 were women, and 29 patients were less than 30 years of age. Angiographically occlusion of the popliteal artery was observed in 34 extremities of 31 patients, medial deviation in 36 extremities of 28 patients and poststenotic dilatation in 9 extremities of 8 patients. Twelve extremities of 11 patients were classified as type I, 12 extremities of 10 patients as type II, 6 extremities of 6 patients as type III and 1 extremity of 1 patient as type IV. Five extremities of 5 patients were not able to be placed in any type of Delaney's classification. The differential diagnosis of occlusive disease of the midpopliteal artery was also discussed.

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Hemangiopericytoma, a vasogenic tumor which can occur anywhere there are blood vessels and which is a relatively rare disease, was reported by Staut and Murray in 1942. Some cases of hemangiopericytoma have a clinically malignant course such as regional relapse and metastatsis to the liver or lung. especially in the case of retroperitoneal tumor, discovery is difficult until the tumor itself has grown to a rather large size, and furthermore, there are many cases in which it is very difficult to excise the tumor totally due to the rich supply of blood vessels attached to it. We have experienced a case of hemangiopericytoma in which preoperative embolization using Gelfoam was performed to control intraoperative bleeding and in which the tumor was completely excised together with the adhesive ureter and a part of the urinary bladder upon surgery. With regard to treatment of such cases, it is considered that angiography would be useful in diagnosis and that the tumor should be treated as a malignant tumor upon surgery.

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Malignant fibrous histiocytoma (MFH), that occurs mainly in the extremities, is usually treated successfully by wide local excision. In contrast, when it occurs on the abdominal wall, as is less frequent, the prognosis may be poor, because radical surgical resection may be difficult, and in addition, there is little information on chemotherapy or radiation therapy fully effective against MFH.
We experienced a recurrent case of MFH arising in the muscle layers of the abdominal wall. We treated it initially by a local excision, and postoperatively with a combination chemotherapy regimen, consisting of adriamycin, cyclophosphamide and vindesine sulfate. It recurred later, after a disease-free interval of 8 months.
Thallium scanning and gallium scanning were performed preoperatively, and both scannings showed positive accumulation in the tumor site. From the histogram showing the changes in thallium accumulation at the foci of abnormal activity, it was difficult to discriminate a malignant lesion from a benign one. Nevertheless we belive thallium scanning is a useful tool for following up patients with MFH.

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We operated on 4 cases of pancreatic cyst during a 3-year period. There were 3 pancreatic pseudocysts and 1 true cyst. Of the 3 pancreatic pseudocysts, one was a calcified pancreatic cyst and the other a hemorrhagic pancreatic cyst.
An ultrasonogram of the calcified pancreatic cyst showed a strong echo with acoustic shadow and the other 3 pancreatic cysts showed hypoechoic areas with posterior echo enhancement. Ultrasound-guided percutaneous puncture for the hemorrhagic pancreatic cyst was useful in making a differential diagnosis.
Surgical procedures for the 3 pancreatic pseudocysts were cyst-jejunostomy in two and resection of the cyst in one. Resection of the cyst was performed in the one true pancreatic cyst.

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This is a case report of a 74-year-old female typhoid carrier with history of typhoid fever 45 years earlier.
When her granddaughter was suffered from sepsis caused by Salmonella typhi, she was tested and found to be a typhoid carrier. On further investigations, a complicating cholecystolithiasis was detected. Another lesion, an early gallbladder cancer located in the mucosal layer, was found at the time of cholecystectomy for radical therapy. On histopathological study, infiltration of inflammatory cells and marked intestinal metaplasia were observed in the cancerous and the noncancerous regions of the gallbladder.
Since it is well known that complicating cholelithiasis is usually seen in typhoid carriers who have discharged the bacteria for a long time, we studied the relationship between cholelithiasis and gallbladder cancer in typhoid carriers. Gallbladder cancer was found in 9.4% of patients treated by cholecystectomy for the purpose of complete cure. Deaths from cancer of the hepatobiliary system accounted for 5.9% of all deaths of typhoid carriers. Furthermore, the ratio of cancer deaths among carriers with cholelithiasis was significantly higher than that among carriers without cholelithiasis.
On the basis of these facts, for carriers who have a complicating cholelithiasis, we must make prudent plans for treatment and examination, considering the possibility of a complication such as cancer of the hepatobiliary system including gallbladder cancer.

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