A retrospective study was made of 110 aged patients over 80 years old operated on for gastrointestinal diseases to estimate operative morbidity and its relating factors.
Among a total of 123 cases of GI diseases including 36 of gastric cancer, 32 of colorectal cancer, 28 of cholelithiasis, and 27 of others, 110 cases underwent operations which included 41 gastric, 38 colorectal, 32 pancreatico-biliary and 8 other procedures. Eighty two postoperative complications occurred in 54 cases (49%) which were composed of 20 circulatory complications, 18 delirium, 12 respiratory and 32 others. Circulatory morbidity was significantly lower in the cases received NLA anesthesia than that in other kinds of anesthesia. Postoperative delirium was seen more frequently in males and emergency operation cases, and respiratory morbidity was higher in both emergent and long operations. The 30-day operative mortality for all patients was only 2.7%, and the total hospital mortality was as low as 4.5%.
These results suggest that, in the surgery for elderly patients and especially in the emergent situation, special care must be paid to shorten the duration of operation by employing a proper procedure and anesthesia.

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The number of participants in a mass screening program for breast cancer since 1973 in Kochi Prefecture reached 14.4% of the national figure in the 1986 fiscal year. A total of 238, 767 women had participated in mass screening for breast cancer up to the 1986 fiscal year all over Japan, and breast cancer was detected in 202 women (0.085%). In the subjected women, early breast cancer was detected in 54.5%, which was significantly higher than the figure in Kochi Prefecture. As for the prognosis, the 5-year survival rate was 88.9% and 10-year survival rate 80.0%. There was also a difference in the mortality rate 80.0%. There was also a difference in the mortality rate between the subjects in Kochi Prefecture and those nationally. A comparison of changes in the standardized mortality ratio (SMR) of breast cancer by municipalities with the rate of receipt of examination revealed that the SMR decreased when the rate of receipt was higher than 10%. From a questionnaire survey regarding the practice of self-examination and the stage of interim breast cancer, the campaign for mass screening is considered to be becoming steadily more accepted, and the mass screening steadily more accepted, and the mass screening in the mortality rate.

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Serum sialic acid (SA), immunosuppressive acidic protein (IAP) and carcinoembryonic antigen (CEA) were 23.3%, 35.0% and 28.8%, respectively. Serum SA tended to be higher in stage IV, serum CEA and its positive rate tended to be higher in stage III and IV, whereas serum IAP showed significantly higher levels in stage IV with higher positive rate. Furthermore postoperative serum SA decreased in curative and non-curative resected patients, while increased in non-resected patients. Sixty % of the patients examined were positive in any of SA, IAP or CEA, and positive rate increased as stage advanced. These results suggest that the measurement of SA is useful for screening, prediction of clinical stage and postoperative follow up of gastric cancer.

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Among 337 patiens undergone curative resections for primary colorectal cancers, 65 had the recurrences and 43 (15 with colon and 28 with rectal cancer) out of the 65 hematogenous recurrences. In these patients liver metastasis was observed in 30 (69.8%), pulmonary metastasis in 12 (27.9%), and bone or brain metastasis in 8 (18.6%). Hematogenous recurrences were most commonly observed within 3 years, in which an elevated serum CEA was the most useful indicator in detecting the recurrence. Histopathologically, there was no difference by tissue types, however, the recurrence was more frequently noted in patients group having vascular invasion and lymphnode patients group having vascular invasion and lymphnode metastasis. The recurrence rate was elevated with an advance of the stage of the disease. The hematogenous recurrent rate for cases in aneuploid was higher than that in diploid pattern. For 14 patients with recurrent liver metastasis, curative resection of liver metastatic lesions was carried out and the resulting 5-year survival rate was as favorable as 42.5%.

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Twenty eight early rectal cancers (11 mucosal and 17 submucosal ones) treated between January 1973 to October 1988 were retrospectively evaluated, which were found in 11 males and 17 females with the average age of 62.0 years. The half of the patients complained of bloody stool, while five had no symptoms. The mucosal cancers were located equally over the all rectal regions, but almost of all submucosal cancers were placed on the lower rectum. Almost of all mucosal cancers occurred as focal cancers in adenomas, and many of submucosal cancers did not have any adenomatous components.
Intrarectal ultrasonic examination was valuable in diagnosing the depth of invasion of early rectal cancer. Webelive that intrarectal ultrasonic examination is necessary for deciding the protocol of treatment for rectal cancers.

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The significance of drug regimen with AT-III preparation was studied by determining the changes in the blood coagulation system. In this study celiotomic patients complicated by cirrhosis in their perioperative periods were subjected, which consisted of 3 patients with hepatic, 2 with residual gastric, and 2 with sigmoid colonic cancers. The AT-III preparation was administered in a dose of 1, 500 units/day for 3 perioperative days, and AT-III activity, platelet count, HPT, FDP, D-dimer and fibrinogen were measured over time. As a result, AT-III activity increased after administration of AT-III for 3 perioperative days and was successfully maintained at more than 50% of the normal level in 6 out of the 7 cases. It was also possible to inhibit postoperative decreases in platelet counts.However, one case exhibited a decreased AT-III activity and died after complications of DIC. Thus, it was considered necessary to extend the perioperative period of administering AT-III to cirrhotic cases to maintain AT-III activity at more than 50% of the normal level.

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Liver cirrhosis can cause specific circulatory dynamics such as hyperdynamic state, and a retension of Na or water, which easily result in irrerversible pathological changes. If perioperative management of hepatectomy for hepatocellular carcinoma associated with liver cirrhosis is performed without recognition of these circuratory states, sever postoaperative complications are often inevitable. Some reports had suggested the usefulness of limiting the fluid and sodium in postoperative management.
Postoperative complications after hepatectomy in 40 cases of cirrhotic hepatoma in our department were studied to estimate the effects of fluid management. As a result, the cases infused with a less than 45ml of fluid/kg/day or less than 3mEq of sodium/kg/day had good prognoses. It is important for appropriate perioperative transfusional management of a patient with cirrhotic hepatoma to comprehend his or her hyperdynamic state.

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Squamous cell carcinoma of the thyroid is of exceedingly rare occurrence and, because of its high degeee of biological malignancy, proves fatal within a year after onset in most instances as do anaplastic cell carcinomas. Reported in this paper is a case of this malignancy in which the patient has been surviving 19 months following an extensive radical operation. The patient was a 67-year-old woman who consulted us with the presenting complaints of an anterior cervical tumor mass and dysphagia. puncture and aspiration cytology of the thyroid, fluoroscopy and biopsy of the esophagus and neck CT led to a suspected diagnosis of adeno-squamous cell carcinoma of the thyroid and total thyroidectomy was performed together with bilateral cervical lymph node dissection and joint surgical removal of the trachea, larynx, cervical esophagus and hypopharynx. The esophagus was reconstructed with a free jejunal graft. Histopathologically, the tumor was identified as an admixture of papillary and squamous cell carcinoma and diagnosed as adeno-squamous cell carcinoma. The postoperative course was uneventful and the patient is alive now, 19 month after operation. The present case appears to point to the necessity of performing an extensive radical operation for the thyroid malignancy in question.

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Two cases of small-sized adenoid cystic carcinoma originating in the respiratory tract were reported, which could be successfully treated with tracheal or bronchial sleeve resection. Both cases had the common complaint of hemoptysis.
Case 1 was a 49-year-old man. Bronchoscopic examination revealed a samll mass on the tracheal wall at 3.5cm above the carina. Histological diagnosis of transbronchial biopsy specimens was adenoid cystic carcinoma. Four rings of the trachea were resected with end-to-end anastomosis. The tumor was 7.0×6.0mm in size.
Case 2 was a 46-year-old man. Bronchoscopic examination revealed a small mass on the mid part of the left main bronchus. Histological diagnosis of transbronchial biopsy specimens was adenoid cystic carcinoma. Three rings of the left main bronchus were resected with end-to-end anastomosis. The tumor was 6.0×5.0mm in size. Any reports of surgical cases of small-sized adenoid cystic carcinoma originating in the respiratory tract like these could not be found in the literature.

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A 52-year-old man with mitral stenosis and giant bullae of r-lung was operated on successfully. On admission the patient had functional disorders of the heart, liver, kidney and lung. Therefore, medical treatments including drug therapy, hyperalimentation, respiratory physiotherapy and blood transfusion were lasted for one month. After remission of the abnormalities, the patient had mitral valve replacement and pneumoplication with bullectomy at the same time.
We emphasize that preoperative critical estimation of the function of each organ and their careful management are very important when surgery is contemplated for a patient with valvular disease complicating by cardiac failure. In addition, careful consideration of merits and demerits in one or two step operation appears important in a patient who has some dysfunction in the other organs.

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We have experienced a case of Morgagni's hernia associated with panperitonitis which was caused by a perforation of strangulated transverse colon. Only 2 cases of Morgagni's hernia caused by perforation of the transverse colon like this case have been reported in the Japanese literature as far as we could review.
A 82-year-old woman suddenly suffered from severe abdominal pain 5 hours after an operation of cataract, and emergency operation was carried out. Morgagni's hernia was detected in the right diaphragm, and the transverse colon had been incarcerated into the hernia and perforated. We resected the perforated lesion of the transverse colon and closed the edge of the defect in the diaphragm with simple interrupted sutures, without resecting the sac of the hernia. The patient could recover satisfactorily, however died of formerly contracted uremia three months after the operation.
Usually, Morgagni's hernia is asymptomatic and often detected in the routine chest X-ray examination. It is nevertheless important for Morgagni's hernia that radical operation should be performed when it is detected, because 17 cases among 240 reported in Japan had obstruction and/or perforation of the intestine.

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We have experienced a case of esophageal carcinoma asociated with hiatal hernia of which follow-up was prolonged because of difficulties in differencial diagnosis from esophagitis. A 59-year-old man visited our hospital with the chief complains of dysphagia and epigastric pain. Barium X-ray and esophagoscopy revealed a slight stenosis and shallow errosion in the lower esophagus. The differential diagnosis between superficial esophageal carcinoma and esophagitis was difficult, and the biopsy examination was group III, so he was followed up.
Two years and two months later, his complaints became progressive and biopsy examination revealed squamous cell carcinoma, thus esophagogastrectomy was performed. The esophageal wall remarkably thickened ecause of muscular fibrosis whereas cancer cells remained within the muscle layer. A possibility that the cancer might exist at the first visit was considered, because histological feature of resected specimens was similar to that of the first biopsy specimens. Moreover the patient might have a longer history of esophagitis, under where esophageal cancer appeared to develop.

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This paper describes a case of early synchronous double cancer of the esophagus and stomach as well as a retrospective study of 6 resected and reconstructed cases of the same synchronous duuble cancer in our department.
In a situation that early synchronous double cancer has been found in as rare as 17 cases in Japan, the double cancer of the esophagus and stomach was found with relatively high insidence of 3.4% of 230 cases resected for esophageal cancer in our department. These double cancer cases included three having early gastric cancer and one of gastric cancer first diagnosed from resected specimen, indicating a necessity of preoperative minute examination.
Principally for thoracic esophageal carcinoma, right open chest esophagectomy was employed and for gastric cancer, the stomach was left as much as possible within the limit of keeping the radical operation. Reconstructive surgery was carried out in 2 cases by using the residual stomach, in 2 by pediculate colon after cardia-side gastrectomy, in 2 which the pediculate colon was elevated after total gastrectomy, and in one by the samll intestine after pulorous-side gastrectomy. It can be said that the therapeutic significance lie upon an accurate diagnosis of the location, depth, and extension of carcinomas, a good comprehension of individual condition, and an approprate selection of surgical procedure supported by those diagnostic informations.

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Emergency operation for the elderly patients often associates with risks such as complications, accordingly good selection of operative procedure appropriate for each condition is necessary.
A 90-year-old woman underwent emergency lapartomy with a diagnosis of general peritonitis, and perforations in both the anterior and posterior wall of pyloric antrum were found. When considered her age as old as 90 years, much delays after perforations, and a sever edema in the gastric wall, gastrectomy might be inevitably accompanied by suture repture. To avoid this risk, omentoplasty was performed for the perforated site at the posterior wall and external gastrostomy with gastric tube for the anterior perforated site, and each circumference was dually fixed to abdominal wall. It took one hour and 55 minutes for the operations. The postoperative course was uneventful. She could start to take meals orally on the 21st day and was discharged on 35th day after surgery.
Omentoplasty devised by Wakabayashi and others and external gastrostomy with gastric tube appear to be convenient and available procedures in that the procedures are accompanied by fewer complications differing from simple suture and closure.

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In the recent years, Dieulafoy's ulcer is clinically noted, and this paper describes two cases of Dieulafoy's ulcer or its analogue. Both cases presented with sudden hematemesis and melena. As bleeding could not be stopped by conservative treatments including endoscopic hemostasis, emergency operations, proximal gastrectomy in one having an ulcer in the lesser curvature just below cardia and conventional partial gastrectomy in the other having an ulcer in lower body, were carried out. The ulcers were both of shallow, small and acute type with less than 10 mm in major axis and could be differentiated into U1II. Moreover, in submucosal layer of the ulcer bases, arteries with outer diameters of 750μm and 1000μm respectively were recognized. It is common that Dieulafoy's ulcer is operated on with proximal or conventional partial gastrectomy which is used to be applied to peptic ulcers, and we also adopted it. However, when the severe bleeding in Dieulafoy's ulcer comes from the existence of the abnormal arteries in submucosal layer, proximal or conventional partial gastrecotmy may not be necessarily required and ligature and suture hemostasis or local wedge resection may be satisfactory.

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Acase of huge gastric leiomyoblastoma diagnosed before resection was reported with a review of 220 cases reported in Japan.
A 50-year-old male with a complaint of abdominal distension was found to have a huge mass in the upper abdomen. Endoscopic biopsy from the ulcerated area of the stomach revealed a histological diagnosis of leiomyoblastoma of the stomach before operation. The wedge resection of the gastric wall bearing the huge mass through a laparotomy resulted in a recurrence of the tumor in the liver 5 months later. The clinical findings of leiomyoblastoma are very similar to those of leiomyoma or leiomyosarcoma. But histologically, leiomyoblastoma is characterized by having round or polygonal acidophilic cells with a clear space around the nucleus. The prognosis is generally good. But the epithelioid leiomyosarcoma, which is a poorly differentiated type of the leiomyoblastoma, sometimes causes metastasis or recurrence. The postoperative care must be taken on a basis of histological findings.

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A rare case of gastric cancer associated with pylemphraxis for tumor is reported. The case was a 63 year-old man who had been suffering from poor appetite and flatulence around July 1986, and was admitted to our hospital for operation in February 1987 because upper alimentary series revealed a gastric cancer. Preoperative abdominal ultrasonography, CT, and angiography indicated pylemphraxis for gastric cancer. Left upper abdominal total exenteration and removal of pylemphraxis for tumor carried out. He can recover his daily activities.
Pylemphraxis for tumor in gastric cancer is a rare disease and only 10 cases including this have been reported in Japan. The prognosis is poor. Today's advance in imaging diagnostic methods might increase the opportunity to encounter the disease, where active expanded excision might be essencial for improvement of prognosis.

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Lymphangioma of the small intestine is so rare that only 28 cases have been reported in Japan. This paper describes a case of lymphagioma of the jejunum, together with a review of the literature.
A 30-year-old woman was admitted to our hospital with the chief complaints of nausea and lumbago. Urinalysis, haematological and biochemical screening were normal. Ultrasonography and computed tomography revealed a cyst of 10.0×8.5cm in size in the lower abdomen. On laparotomy, a 13×9×5cm multilocular cyst, filled with a clear yellow fluid was found in the jejunum 140cm distant from the Treitz's ligament. Partial resection of the jejunum was carrried out, and pathologically it was diagnosed as cavernous lymphangioma.

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Intestinal tumor, especially leiomyosarcoma associated with perforation is a rare disease. Recently we encountered a case of giant intestinal leiomyosarcoma associated with perforation.
The case is a 79-year-old female who was admitted to another hospital with complaints of right lower abdominal pain, poor appetite and anemia in December, 1987.
Examinations of the upper gastrointestinal tract and colon were normal and gynecologically she was diagnosed to have a left ovarian tumor. She was discharged and followed up.
On March 16, 1988, she complained of increased ritht lower abdominal pain and was urgently admitted to our hospital. Tumor with goose egg size was palpable at the right lower abdomen and tenderness was present at this point. Abdominal X-P showed a free air below the right diaphragm, and leukocytosis was found. Clinical examinations of barium-meal X-ray and computer tomography revealed an intestinal tumor. In laparotomy, it was found to be a giant intestinal leiomyosarcoma with a long axis size 15 cm. This tumor invaded the mesentery strictly, accordingly wide incision of the intestine was done. Postoperative course was uneventful and she was discharged June 20.

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A rare case of leiomyosarcoma of the ileum presenting with perforated peritonitis is reported together with a review of the literature.
In a 41-year-old woman first visited with the complaint of abdominal pain which started on the day before, an intensive pain centered around the right lower abdomen, muscular defense, and Blumberg sign were noted. Moreover, WBC was 12, 600/mm3 and abdominal series revealed a free air. the patient, accordingly, was diagnosed to have peritonitis due to acute appendicitis with perforation, and underwent emergency operation. On laparotomy extraluminal growing type of tumor which formed a lump was found approximately 150cm to oral-side from the ileocecal valve, which caused perforated peritonitis. Ileectomy ranging approximately 100cm was carried out. Histologically it was leiomyosarcoma grown extraluminally arising from the proper mucle layer, and had mitotic figures in high frequency.
In Japan perforation of leiomyosarcoma of the small intestine is extremely rare that only 24 operative cases have been reported.

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Duplication of the alimentary tract is a congenital and relatively rare disease. Especially the ileo-cecal type is uncommon in adults, because most of these cases are found during childhood. In this parer, such a rare adult case is reperted.
The patient is a 27-year-old female, who admitted because of acute abdomen, and a mass was palpated in RLQ with severe tenderness. Ultrasonography showed a cystic mass in the cecum and gall stones preoperatively.
Urgent laparotomy for intense abdominal pain revealed the mass in the ileo-cecal junction compressing the cecum. Ileo-cecal resection was done with cholecystectomy. Pathological diagnosis was duplication of the alimentary tract. Postoperactive course was uneventful and discharged in good condition.

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Two cases of primary malignant lymphoma of the ileocecal region are reported. Case 1-A 59-year-old woman complaining of a tumor at the ileocecal region underwent right hemicolectomy with a suspesion of malignant lymphoma after minute examinations. The excised tumor, 6.5×7.0cm in size, was like Borrmann type II and was difficult to differenciate from cancer macroscopically. Case 2-a 82-year-old man underwent emergency operation because of ileus symptoms. Perioperative findings revealed an ileus caused by ileocolic intussusception due to ileocecal tumor. After consideration of his age and general conditions, ileocecal excision was applied. The tumor, 5×6×2cm in size, presented with torous lesion. Histologic diagnosis for each case was diffuse middle cell type malignant lymphoma with regional lymph node involvement. Malignant lymphoma is usually said to be highly responsive to chemotherapy, however, in spite of chemotherapy, case 1 and 2 experienced recurrence and died 2 years and one month and 3 months after surgery, respectively.

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Two cases of sigmoid-rectal intussusception in adults were presented and together with a review of other five cases of intussusception in adults for the past twenty years in our hospital. Of the 7 intussusceptions, one was in the small intestine and the other 6, in the colon. The youngest patient was 30 years old and the oldest, 82. Four patients were females over 70 years old. Malignant neoplasms were responsible for 4 intussusceptions of the colon. Macroscopically, 5 tumors were of non-ulcerative protuberant and non-circular types. Two of these were benign villous adenomas. Although it is generally agreed that resection without reduction is preferable for the treatment of adult colonic intussusception because of the high probability of malignancy, in some cases having poor risks such as an advanced age and ileus, initial reduction seems necessary so as to minimize surgical intervention.

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We experienced a case of carcinoid tumor of the descending colon. A 63-year-old female patient was admitted to our department for ileus. Ba-enema revealed an entire narrowing legion of 7cm in length in the descending colon. Laparatomy was performed based on the diagnosis of ileus caused by the tumor in the descending colon. The tumor was found to be in stage V (H₃P₀S₂N₄), and thereby curability could not be expected. Therefore left hemicolectomy with colostomy was performed. Histopathological examination revealed the carcinoid tumor originating in the descending colon. Chemothrapeutic regimen with endoxan and methotrexate was carried out, but she died of the tumor 4 months after the operation.
Forty cases of colon carcinoid including this case have been reported in Japan up to now, but that of descending origin is very rare. We recognized this case was the second of descending colon carcinoid in Japan.

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Colonic carcinoma associated with ossification is very rare as Dukes reported that it might occur with frequency of around 0.4%. We report a case of the disease together with a review of the literature.
A 59-year-old man who noticed blood in the stoll was transferred to our hospital because he was diagnosed to have a carcinoma of the sigmoid colon. He had no remarkable family nor past history, and barium enema and colorectal fiberscopy could confirmed the diagnosis sigmoidectomy being carried out.
Preoperative blood CEA level was within normal limit. Histological examination revealed a well differentiated adenocarcinoma and according to general rules for clinical and pathlogical studies on cancer of colon, rectum and anus, the feature were drawn as follows S, type II, 2/3 occupation of the circumference, 3×4cm in size, ss, ly0, V₂ n(-), and Dukes b. there were two polyps in the resected specimen. Ossification was found adjacent to carcinoma in one of the two adenomatous polyps.

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A case of inflammatory pseudotumor of the liver with colon cancer is reported and discussed with other literature. A 49-year-old male was hosptialized complaining of right hypochondralgia. He was diagnosed to have a colon cancer, at the same time when a small liver tumor was detected by some examinations. Since careful examinations could not deny a possibility that the colon cancer had metastasized to the liver, right hemicolectomy and partial resection of the liver were performed. The lesion of the liver was diagnosed as inflammatory pseudotumor pathologically. Postoperative course was favorable in fourteen months.

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Primary sclerosing cholangitis (PSC) is a rare disease characterized by chronic fibrosing inflammation of the bile ducts, resulting in obliteration of intrahepatic bile ducts and biliary cirrhosis. The etiology of PSC is still unknown. Although various diagnostic criteria have been proposed, they have not been settled yet. We report a case of PSC associated with cholecystolithiasis, which has a segmental narrowing of the common bile duct on cholangiogram. Less cases have been reported in Japan than in Europe and America. That is probably because in Japan the terminology is still confused and many cases associated with gallstones have been excluded indiscriminately. Recently the criteria of PSC proposed by RuLusso are generally accepted and one of the criteria is on elevation of seurm alkaline phosphatase (ALP) level. However, this case has suggested that ALP level is not always necessary for diagnosis of PSC, but is only an index of cholestasis and indicates the extent of ductal involvement.

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A 67-year-old man was admitted with obstractive jaundice. Percutaneous transhepatic cholangiogram showed clots in the CBD, but we mistook them for biliary stones at first. As these clots disappeared by the cholangiography 4 days later, we could diagnose this case as hemobilia. After bleeding had stopped with biliary drainage, percutaneous transhepatic cholangioscopy (PTCS) and angiography were performed, but no bleeding lesion was revealed. He was discharged after benign course 2 months later. Hemobilia is a rare status, especially there are few cases of unknown origin. This case of idoopathic hemobilia is reported with reference to the literature. Diagnostic value of PTCS in hemobilia is also mentioned.

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Oat cell cancer is known to develop in various organs of the body including the lung, however, reports on oat cell cancer originated in the biliary system are rare. Recently we encountered a case of oat cell cancer originated in the gallbuladder. The case is a 63-year-old man who was diagnosed as having a cancer of the gallbladder and underwent surgical operation. The tumor was formed as a mass from the neck of the gallbladder to the bile duct. Lymphatic metastasis from the retroperitoneum to the area around the arota was prominent. Since it was difficult to resect the primary lesion. T-tubes were inserted into the gallbladder and common bile duct and used as external biliary drainage. Histologically. the tumor cell was uniformly small sized, lacked in cell body and was proliferated while forming a massive cell nest. The patient died of cancerous cachexia 2 months after operation. Surgical operation in the early stage is the only one treatment for cat cel cancer. Some cases have been reported to be responsive to chemotherapy, however, the prognosis is still poor.

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In the recent three years (1986-88), we have experienced four cases of adrenal incidentaloma, which were all incidentally detected by abdominal computed tomography (CT) with no symptoms nor abnormalities in the endocrine function. Surgical exploration was performed in all the cases. Pathological examination showed 3 of them to be nodular hyperplasia and one cortical adenoma. Adrenal incidentaloma may be detected more frequently with an increasing use of CT or magnetic resonance imaging (MRI). One hundred and four cases, reported in Japan, including these cases, were reviewed and discussed.

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This paper describes a case of pyelouretic cancer accidentally detected by urinary cytology together with some discussion on the disease and the cytology.
In a 55-year-old woman complaining of residual urine, dysuria and hematuria, urinalysis revealed the presence of blood, purlent matter and bacteria. These symptpms completely disappeared after one-week antibiotic regimen. Two months later, however, she presented again with exactly the same symptoms, urinary pus and blood were found again and urine culture was positive. Since the results of urinary cytology were also positive, cystoscopy, DIP and retrograde urography were performed and the findings indicated a right pyeloureteric cancer. Radical surgery was performed, and histopathological examination indicated transitional cell carcinoma of pT₂N₀M₀.

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A rare case of struma ovarii with hyperthyroidism following surgical removal of the tumor is reported. A 72-year-old female had a multicystic tumor measuring 10×9×5cm in the right ovary, which was accidentally found at laparotomy for perforated duodenal ulcer. Microscopic examination revealed the tumor to be composed solely of a follicular structure resembling thyroid tissue. Immunohistochemically, most follicules contained triiodothyronine (T3), thyroxine (T4), and thyroglobulin. A month after the operation, thyroid function tests revealed elevated serum T4 and free T4 levels.
Most cases of struma ovarii occur within ovarian teratomas. It is believed that teratomatous thyroid component has predominantly overgrown the remainder of the components. The apparently high incidence of cervical goiter in the patients with this disease raises the possibility of stimulation of both strumas by a circulating factor, though serum TSH level is suppressed and TSH receptor antibody is negative like in this case.

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During the past 11 years we have experienced 16 patients with hematological disorders who underwent gastroenterological surgeries. In this paper, we ahve reviewed the records of these 16 cases and reported 3 instrucitve cases for reference.
Fourteen out of the 16 cases were known to have hematological disorders before operation but the remained 2 were found after operaiton. In these 2 cases, postoperative complications led to the diagnosis. Postoperative complications occured in 5 out of the 16 cases, which included postoperative bleeding, suture rupture, and ileus. There were 2 deaths related surgery.
Patients with hematological disorders have certain risk factors due to their conditions such as anemia, bleeding tendency, thrombotic tendency, susceptibility to infection and disturbance of wound healing. These risk factors increase the chance postoperative complications developing.
When we treat patients with hematological disorders, careful consideration should be paid for these risk factors, and such patients need to be identified before operaiton.

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