At the Second Department of Surgery, Fukushima Medical School, 253 patients were treated for breast cancer during the period from 1963 to 1982. The relationship between the age factor and the prognosis of breast cancer of these cases was investigated, and the clinical features of breast cancer in young and elderly women were reported. Sixteen cases were under 35 years of age (6.3% of the total group) and seventeen cases were over 70 years of age (6.6%). These groups were investigated clinically by comparing them with the middle-aged group over 35 and under 70 years of age as a control. In the young group the frequency of Tis cases was 12.5%, while the frequency of advanced cases in stage III or IV was 31.3%. In the elderly group the frequency of advanced cases in stage III or IV was 41.2% and higher than in other groups. Histologically, in the young group nonivasive carcinoma was seen in 13.3%. As age advanced, the frequency of scirrhous carcinoma was higher, and in the elderly group scirrhous carcinoma was seen in 57.1%. Regarding prognosis, in the middle-aged group the 5-year survival rate was 72.9% and the 10-year survival rate was 66.4%, in the young group the rates were 66.1% and 39.7% and in the elderly group they were 73.5% and 73.5%. It seemed that in the young group the prognosis was poor because the cases of stage III and IV (including cases of pregnancy or delivery) all died from carcinoma. In the elderly group, the prognosis was good because all cases in stage I, II and III were healthy.
For breast cancer in young women, the special endocrinological environment mast be paid attention to and early detection and early treatment mast be made. For breast cancer in elderly women, surgical treatment should be more actively undertaken.

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During the 16-year period between January 1969 and December 1984, the results of treatment of 132 cases of esophageal varices using portal nondecompression surgery, performed in the Department of Surgery, Hiroshima Red Cross Hospital, were investigated. Comparison of 31 cases of urgent surgery with 101 cases of elective or prophylactic surgery revealed a higher operative mortality and a lower survival rate on urgent surgery, but in the past two years operative mortality rate on every modes of surgery have been 0%, indicating that there are now hardly any problems with regard to the safety of surgery.
Comparison of surgical results in 72 cases using selective shunt with those in 60 cases using direct interruption indicated that there were many advantages in using the former, and that it is also important to select the surgical methods best suited to individual cases.
Surgery for esophageal varices in our department yields relatively satisfactory long-term prognosis and more expected macrobiotic effects than the prognosis of cases treated in the department of internal medicine.

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A comparison was made of the long-term postoperative results of segmental gastrectomy with or without vagotomy in regard to high gastric ulcer. Forty four patients with high gastric ulcer, or 17.9% of the total number of patients, underwent digestive ulcer operations. Twenty eight patients, or 63.6%, had intractable ulcer and seven patients, or 15.9%, experienced bleeding. As chief complaints, 29, or 66.0%, suffered from precordia pain and two patients, or 4.5%, experienced left hypochondralgia. Thus, thirty one patients, or a majority of 70.5%, experienced pain of some kind.
The acidity reduction rate was 50% for those patients who underwent segmental gastrectomy and 60% for those patients who underwent segmental gastrectomy with vagotomy. In both cases, five years after the operation the patients have far fewer complaints and are in satisfactory condition according to Vsick's index. The addition of the pyloroplastic operation has consequently increased the chance of dumping symptoms occurring.
Three out of twenty four patients who underwent segmental gastrectomy with vagotomy experienced a recurrence of the disease, while no recurrence was observed in the patients who underwent segmental gastrectomy alone.

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From 1970 to 1982, 103 primary Borrmann type 3 gastric cancers were curatively resected in our department. The prognosis of these patients was investigated according to the location of the cancer, namely C (upper portion), M (middle portion), A (lower portion). The survival rate for patients with cancers located in M was best, and it was the worst if the cancers were located in C. However, there was no significance in the three groups in histopathological factors, such as depth of invasion and lymph node metastasis. Only the type of gastrectomy and combined resection of other organs showed a significant difference, but the difference was not enough to explain the defference in the prognosis. From this study, it has become apparent that more efforts in the treatment and earlier diagnosis are necessary to improve the prognosis for patients with gastric cancers located in C.

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To determine more objectively whether or not palliative gastrectomy is indicated in patients with advanced gastric cancer, the influences of the gross findings of the cancer, the histological type and the patient's age on postoperative survival months were investigated by multiple regression analysis in 101 patients who underwent palliative gastrectomies. The results demonstrated that postoperative survival was shortened in patients less than 40 years old and in those with extensive peritoneal disseminations of more than P1, hepatic involvement, lymphatic spread beyound N3 and poorly differentiated adenocarcinoma. On the other hand, factors which prolonged the survival time were age of more than 40 years, peritoneal disseminations of less than P2, lack of hepatic involvement, lymphatic spread of less than N3 and highly differentiated adenocarcinoma. Patients who had more than four factors working to shorten the survival time demonstrated almost the same survival curve as that in unresectable cases and seemed not to be candidates for palliative gastrectomy.

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The results of treatment of eight cases of ulcerative colitis and five cases of Crohn disease experienced in our department were investigated. Five of the eight cases of ulcerative colitis achieved remission by conservative treatment alone, and the mean proportion of relapse into the active stage of the lesion, reckoned in months after discharge was 32%. As for surgical cases, total colorectectomy-ileostomy, subtotal colectomy-anastomosis of the ascending colon and rectum and the Kock method were respectively performed in each case. On the other hand, two of the five cases of Crohn disease showed postoperative relapse. In one case presenting relapse in the duodenum and pyloristenosis, gastrectomy (the Billroth II method) was performed and another case achieved remission using Salazopyrin. Many cases of ulcerative colitis are benign and are found in juveniles, necessitating the positive consideration of the conservative method of spontaneous anus. With regard to the surgery for Crohn disease, the cause of relapse is unknown, and there have also been cases of relapse reported from microlesions so small that they are impossible to diagnose during surgery. It may therefore be necessary to deal cautiously with excision of a skip lesion in which there is no complication or en bloc excision of each lymph node.

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The surgical technique of esophagojejunostomy in total gastrectomy using a machine is reported and its advantage and safety was compared with anastomosis by hand, performed during the same period. Provided that usage of the machine was well learned and that surgical procedure was carefully performed, the following advantages were obtained in esophagojejunostomy. 1. It facilitates the shortening of surgical time, thus resulting in expected relief of surgical stress. 2. It allows the positive performance of surgery with higher curability such as excision combined with other organs. 3. The volume of transfusion can be decreased as the volume of hemorrhage is small. 4. It facilitates the positive performance of total gastrectomy even for poor risk patients such as those advanced in age and those with complications in the heart, etc. 5. The incidence of postoperative complications such as suture failure is low.

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Recently, the average age of Japanese people has increased, and the proportion of elderly colorectal carcinoma patients has become larger. Therefore, we collected and studied colorectal carcinomas in order to differentiate between an edlerly group (over 70 years old) and a control group (under 69 years old).
The elderly group represented 44 among 218 cases (20.2%) during 15 years and had no characteristic symptoms. They had more right-sided colon carcinomas and cancers in other organs than the controls. The former showed a variety in macroscopic appearance and the latter in microscopic features, although there was no significant difference. Distant and lymph node metastasis, peritoneal dissemination, vascular and lymphatic invasions occurred at almost the same rate between them. However, lymph node metastasis and depth of invasion were milder in the elderly group. Thus, the stage was earlier than in the controls.
The five-year survival rate was, however, almost the same between them. We think that weakened physical ability and lowered expectations of life were some of the potential reasons. Nevertheless, we think that the better prognosis of the elderly group is still expected when resection is done. Thus, efforts to diagnose earlier, to manage better, and to choose more rational operative procedures are still needed.

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The patient was a 56-year-old female who complained of a swelling of the left axillary lymph node. Biopsy of the lymph node was performed and histological examination showed a metastatic medullary tubular adenocarcinoma. From these findings, the primary lesion was suspected to be in the breast, however no mass was palpable. No pathological findings were obtained by mammography, echography or xerography of the breast. No other systemic examinations of the gastrointestinal tract, lungs and genitourinary tract revealed an extramammary primary lesion. All these data suggested an occult carcinoma of the breast and radical mastectomy was finally performed. Surgicopathology showed slight atypical ductal hyperplasia in the breast and metastatic medullary tubular adenocarcinoma in the axillary lymph node, with no malignant findings. Neither estrogen receptor nor progesterone receptor were detected in the cancerous lymph node.
Adjuvant chemo-endocrine therapy was carried out for the patient and she has been doing well postoperatively for 11 months without any evidence of recurrence.

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We experienced 14 patients with breast cancer who had pleural effusion as a direct consequence of metastatic disease. The mean age of the patients was 47.3 years with a range of 36 to 68 years. The majority of the patients were in advanced stages (stage I:1, stage II:2, stage III:4, stage IV:7). Survival time after developement of the effusion was less than 1 year in 8 of the cases. However, there were 5 patients who survived more than 1 year. Interestingly, in 4 of these 5, estrogen receptor was positive and intrathoracic injection therapy was effective. Also, we had 2 long survivors of more than 1 year among the 4 patients who had pleuritis preoperatively. Even the stage IV breast cancer patient with preoperative pleural effusion may have a possivility of long survival if treated aggresively with a combination of radical mastectomy, adjuvant chemo-endocrine therapy and appropriate intrathoracic injection therapy.

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Desmoid tumor is a rare, noncapsulated, nonmetastasizing, yet locally invasive neoplasm arising from musculoaponerotic tissue. It occurs most commonly as an abdominal wall mass in multi-gravida or as an extra-abdominal tumor in a variety of locations, particularly in the shoulder and pelvic girdle areas.
Five patients with desmoid tumor who were treated from 1972 to 1984 in the First Department of Surgery, Gifu University, were reviewed. There were two males and three females ranging in age from 24 to 60 years, with a mean age of 49 years. All the patients presented with a firm or hard growing mass.
The tumor developed in the abdominal wall in two patients and in the lateral chest, neck and mediastinum in one each.
Three patients were treated with resection and two patients were treated with resection in combination with postoperative radiation. At present, all patients are alive and disease free at a mean follow up of 7 years.

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Fifty-four cases of gastrojejunocolic fistula, a rare and serious complication of marginal ulcer after surgical treatment of the stomach, have been reported in Japanese literature from 1931 to 1985. Recently, we experienced a further case of gastrojejunocolic fistula with malabsorption syndrome 16 years after gastrectomy. The case was successfully treated with surgical procedures.
A 36-year-old man was admitted to our hospital with complaints of severe diarrhea and weight loss during the past six months. He had undergone distal partial gastrectomy with Billroth II and retrocolic anastomosis for duodenal ulcer 16 years earlier. At a second operation, Braun's anastomosis had been carried out for afferent loop syndrome five years ago. Radiologic and endoscopic examinations revealed gastrojejunocolic fistula and a radical operation subtotal gastrectomy with partial resection of the jejunum and transverse colon was successfully performed. There was a gain of 10kg in weight two months after the operation and gross recovery in enteral absorption was also seen.

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A giant adipose mass in the great omentum with a pathology of partial lipodystrophy was radically cured by surgery, and a sutyd on it was performed.
A 4-year-old boy had had no problems at delivery or in infancy. However, from about one and half years of age, his development began to slow down. A gradual decrease in meal volume, an advance in oligotrophy and marked wasting of the limb were observed. Therefore, various examinations were performed. CT revealed abnormal accumulation of adipose tissue intraperitoneally and laporotomy was applied. As a result, an adipose tumor was confirmed in the greater omentum. The adipose tumor was perfectly extirpated. It weighed 1.6kg, 14.3% of the body weight. Pathohistological examination showed a collection of benign lipomas. After the operation, with an increase in diet, rapid growth for a short period and development of subcutaneous fat were achieved. Three years after the operation, his course is satisfactory and there has been no recurrence.
This report on such a tumor in the greater omentum may be the first in this country. This tumor was named omental lipomatosis because of the occurrence of more than 100 lipomas in the greater omentum.

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During the last 10 years, 35 cases of perforation of the small bowel were treated. 16 cases (45.7%) were due to post operative adhesive ileus, 10 (28.6%) to abdominal trauma and 4 (11.4%) to inguinal or femoral hernia. Operative mortality was 17.1%. Thirty-six hours after operation, mortality was 4.3%, but over 36 hours mortality was elevated to 41.7%. In cases of small bowel perforation due to abdominal trauma and hernia, operations were undertaken sooner than in cases of perforation, due to adhesive ileus. In these cases, prognosis was good. On the other hand, all cases of small bowel perforation due to malignant tumor and mesentery arterial thrombosis died within 30 days of operation; thus the prognosis of these cases was extremely poor. Abdominal free air, leucocytosis (over 10, 000) and muscular defense were decisive factors in undertaking operation. Leucocytosis was found in 51.4% of all cases, and abdominal free air in only 34.3%. On the other hand, muscular defense was found in 85.7%, so that it was necessary to observe the patient's condition, espcially abdominal signs, carefully.

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Neurogenic tumors of the mesentery are very rare. We report two such cases that were treated recently. The first case was 55-year-old male who was admitted to our hospital with complaints of fever, melena and abdominal pain. Computed tomography and abdominal echo revealed a tumor in the lower abdomen with a liver cyst. Operatively, this was diagnosed to be a primary tumor of the ileal mesentery. Pathological diagnosis was neurofibrosarcoma. Postoperative recovery was good. Nine months later, however, he died because of diffuse invasion of the tumor. The second case, a 45-year-old female, was admitted to our hospital complaining of abdominal pain. Abdominal echo suggested an ovarian tumor. At operation this tumor was also diagnosed to arise from the ileal mesentery. Pathological diagnosis was again neurofibrosarcoma. Postoperative course was uneventful.

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A case of lymphangioma of the cecum with intussusception in a 40-year-old woman is reported. She developed cramping in the right flank and came to our clinic. On her first consultation, a painful abdominal tumor was found. Abdominal ultrasonography, computed tomography and barium enema revealed an ileocecal cystic tumor accompanied by intussusception. Ileocecalectomy was performed, and during the operation incomplete fixation of colon was discovered. The tumor was dark brown, measuring 7×5×4cm and fluctuating. Macroscopically, its cut surface was cystic and it contained a yellowish, serous fluid. A histological diagnosis of cavernous lymphangioma with partial cystic degeneration was made.
In reviewing the international literature, we could find only two case reports of cecal lymphangioma with intussusception. The large size of the tumor might be regarded as the cause of the complicated intussusception. However, the incomplete fixation of the colon might have been partially responsible.

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This paper describes our recent experience with a case of a retrograde intussusception due to a sigmoid polyp in light of the related literature. The patient was a 72-year-old woman who was admitted to our hospital because of abdominal pain and fullness. Abdominal X-ray showed the air-fluid level and a tumor-like mass in the gas contour of the intestine. Barium enema examination showed shortening of the sigmoid colon and tapering and obstruction of the descending colon. Judging from above information, we diagnosed mechanical obstruction of the descending colon due to malignant lesion, and laparotomy was immediately performed. The tumor was palpated in the splenic flexure of the descending colon, and it was clear that the sigmoid colon invatinated into the descending colon retrogradely. We could not rule out the existense of malignant tumor at the top of the intussusceptum, so the colon, from the splenic flexure of the descending colon to the upper half of the sigmoid colon, was resected with reginal lymphmodes. The resected specimen showed a large-sized polyp (10.0×5.5×1.0cm) at the top of the intussusceptum. Microscopic examination clarified that the polyp was a tubulovillous adenoma with malignant change. Because almost all intussusception in adults is due to organic lesions, the resection of intussuscepted lesions with lesional lymphmodes should be performed without reposition, if malignancy has not been ruled out.

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In the adult, benign urachal cyst is a rare developmental anomaly. Prompt diagnosis and management are important to avoid complications.
A successfully operated case of infected urachal cyst is reported in this paper.
A 49-year-old woman was admitted with the complaint of abdominal tumor in her lower abdomen. Infected urachal cyst was suspected from the physical examination and proved by sonography and CT scanning. Considering the infection, cystectomy was performed by two-stage surgery.
Sonography and CT scanning are significantly useful in correctly diagnosing urachal cyst.

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A patient, who died of cerebral hemorrhage resulting from a marked hemorrhagic tendency caused by a snake (Rhabdophis tigrinus, which has previously been considered to be atoxic) bite, was experienced.
The patient, a 14-year-old boy, was bitten on the back of the left hand by the snake, and developed a headache some ten minutes later, with subsequent swelling of the region of the lesion. A hemorrhagic tendency occurred about 16 hours after the snake bite, and the patient fell into a coma after about 19 hours, resulting in respiratory arrest some hours after that. CT scan of the head revealed cerebral hemorrhage in the left lobe and occipital lobe. No remission occurred in spite of exchange transfusion, and the patient died on the tenth day after the snake bite.
With regard to Rhabdophis tigrinus bite, when the toxic liquid secreted from the Duvernoy gland in the posterior part of the maxilla is injected into the human body, a hemorrhagic tendency is induced. In Japan, eight case including this case have been reported since the case of Sakamoto, all of them involving a hemorrhagic tendency. It is therefore necessary to guard against the occurrence of a hemorrhagic tendency in patients bitten by animals and to perform early exchange transfusion or antitoxic serm injection.

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