Seven continuous days of balneotherapy was applied to 17 patients with psychosomatic disease or neurosis at Sukawa Spa in Iwate prefecture. Several physiological parameters (e. g. blood pressure, heart rate, T wave amplitude of ECG, plasma catecholamines, and CV_R-R) were measured before and after that therapy. Subjective symptoms were also surveyed through a questionnaire and the correlations with the changes in such physiological parameters were studied. The subjects were divided into the effected group and non-effected group according to the evaluation of therapeutic effect.
Physiological paramenters other than plasma catecholamines tended to converge into a constant direction during the balneotherapy. While the physiological paramenters of the effected group tended to converge, those of the non-effected group did not show a trend. These results suggest that therapeutic effect of balneotherapy on psychosomatic diseases and neuroses is based upon not only the psychological effect of the environment of a hot spring but also the biological effect of non-specific alterative action of autonomic nervous system due to hot spring bathing itself.

A total of 1, 236 cases of gastric cancer operated at Hiraka general hospital during the 14 years from 1975 to 1988, were analyzed and the following results were obtained.
1. There was a distinct tendency to increase in the numbers of early-staged cancer cases and patients over 70 years of age.
Any decrease in the number of operated gastric cancers could not be obeseverd during this period.
2. The ratio of patients aged over 70 years increased to reach 26.4% recently and the ratio of early staged cancer increased to 59.3% in 1988.
3. The over all resection rate was 90.8% and curative resection was performed in 85.2% of resected cases.
4. The cumulative 10-year survival rate in curative resected cases was 74.0%.
5. The rate of the multiple cancer cases was as high as 5.0%.

A total of 417 operated cases of colorectal cancer at Hiraka General Hospital during the 15-year period from 1974 to 1988 were analyzed and the following results were obtained.
1. There was a distinct tendency to increase in the numbers of resectable cases. By region, cases of cancers in sigmoid colon and upper third of rectum (S+Rs) and right side colon (C+A) were on the rise.
2. The ratio of patients aged over 70 years increased to reach 36 % recently. But the ratio of early stage cancer cases was 7.1 % on the average.
3. The over all resection rate was 90.6 %, and curative resection was performed in 78.5 % of colon cancer cases and 82.0 % of rectal cancer cases respectively.
4. The cumulative 10-year survival rate in curative resected cases was 74.7 % for colon cancer and 70.8 % for rectal cancer.
5. The rate of multiple cancer cases was as high as 13.4 %.

A 27-year-old woman was given a diagnosis of infectious endocarditis with severe tricuspid regurgitation. Despite adequate antibiotics therapy, her general condition did not improve, and moreover multiple pulmonary abscesses were detected by computed tomography. Therefore surgery was indicated. Surgery consisted of removal of vegetation and tricuspid valve plasty with autologous pericardial patch augmentation of the anterior leaflet. Tricuspid valve plasty was carried out without prosthetic materials. Her postoperative course was uneventful with only mild tricuspid regurgitation. One year after surgery, neither recurrence of infection nor worsening of tricuspid regurgitation was noted. This method could be a useful technique for young patients with severe infection.

We described a patient with free wall rupture followed by papillary muscle rupture due to acute myocardial infarction. A 69-year-old man was transferred complaining of transient unconsciousness. His clinical history, electrocardiogram, and chest CT showed myocardial infarction with free wall rupture indicated that several days had passed since the onset. Coronary angiography showed occlusion of the right coronary artery and severe stenosis of the left anterior descending artery. Since cardiac rupture was at inferior wall and hemorrhage wasn't active, repair of the rupture using fibrin glue and fibrin sheet and coronary artery bypass grafting to the left anterior descending artery was performed without cardiopulmonary bypass. On the 10th postoperative day, his arterial oxygen saturation suddenly deteriorated. Transesophageal echocardiography revealed papillary muscle rupture and severe mitral regurgitation. Emergency mitral valve replacement was performed. After two emergency operations, he gradually recovered and were discharged to home. In three months after discharge, he was admitted again due to congestive heart failure with left ventricular aneurysm at inferior wall and recovered in response of conservative treatment. Surgical experience of double rupture is rare. Based on this case, it may be necessary to perform reperfusion therapy toward even this case of recent myocardial infarction, to prevent papillary muscle rupture. It also may be better to use a patch on free wall rupture to prevent cardiac aneurysm.

Liver metastases from colorectal carcinoma commonly form nodular lesions in the liverparenchyma. We report a case of liver metastasis from rectal adenocarcinoma that extendedpredominantly into the bile duct. A 62-year-old Japanese man underwent low anteriorresection for rectal adenocarcinoma 9 years ago. Approximately 3 years later, he underwentradiofrequency ablation therapy for a metastatic liver tumor. Nine years after surgery, atumor in liver segment III exhibiting intrabiliary extension was discovered; it wasunclear if this was a metastatic liver tumor or intrahepatic cholangiocarcinoma.Accordingly, we performed a left hepatectomy with lymph node dissection. The tumor wasnegative for cytokeratins 7 and 20, and was histologically similar to the primary rectaladenocarcinoma; it was diagnosed as rectal carcinoma metastasis. The patient has survivedfor 3 years after the hepatic surgery, for 9 years after radiofrequency ablation therapy,and for 12 years after the primary surgery. This case shows that liver metastasis fromcolorectal carcinoma can present as a predominantly intrabiliary growth that mimicsintrahepatic cholangiocarcinoma on imaging. Moreover, our case provides evidence for thesuperiority of anatomical hepatectomy over partial hepatectomy for metastatic liver tumorswith intrabiliary growth arising from rectal adenocarcinomas.

Cystic adventitial disease of the popliteal artery is a rare cause of lower extremity occlusive disease. We report 2 cases of this disease. Two male patients aged 27 and 59 year old complaining of intermittent claudication visited our vascular service. Angiography showed a smooth sharp defect of the popliteal artery. Postcontrast computed tomography (CT) scanning and magnetic resonance image (MRI) showed a cystic lesion around the popliteal artery. One patient underwent resection of the cyst, which in the other patient endscopic surgery was performed with the aid of intravascular ultrasonograpy and intravascular endscope. Fifty three cases of this disease have been reported in Japan so far. These patients included 45 men and 8 women with a mean age of 47.7, ranging from 19 to 76 years old. Chief complaints were commonly intermittent claudication and sensory disturbance. In all cases, angiography revealed a smooth sharp defect. Recently 3D-CT scan, ultrasonography and magnetic resonance angiography (MRA) also are accurate for cystic lesions around the popliteal artery and these new technologies easily distinguish such cases from arteriosclerosis obliterans, Buerger disease and popliteal entrapment syndrome. Treatment consist resection of the cyst, in 27 cases reconstruction of the popliteal artery using a saphenous vein graft or artificial graft in 19 cases, percutaneus aspiration under the guide of CT and endscopy in 2 cases and 1 with spontaneous resolution, was seen in 1 case. In conclusion, we encountered 2 cases of cystic adventitial disease of the popliteal artery. 3D-CT scan, ultrasonography and MRA were useful for preoperative diagnosis and evaluation of postoperative condition.

Fourty-four cases with psychosomatic disease or neurosis were studied during serial immersion in hot sulfate spring for 7 days at Sukawa Spa in Iwate prefecture. Before and after the balneotherapy, blood specimen were taken for endocrinological analysis of plasma catecholamines with use of high-speed liquid chromatography. One, two and three years after balneotherapy, long term prognostic efficacy was evaluated by questionnaire in order to examine the relationship between efficacy and changing pattern of plasma catecholamines.
The results of this study presented that the plasma levels of norepinephrine had decreased during balneotherapy in effective cases (p<0.05). Furthermore, the same changing pattern of plasma norepinephrine was observed in the cases which had improved after long interval. On the otherhand, in non-effective cases and cases with recurrence, the plasma levels of norepinephrine had increased significantly (p<0.05) during balneotherapy.
It was thought that response pattern of plasma catecholamines to serial immersion in hot spring reflected the therapeutic mechanism of balneotherapy, thus it would be an appropriate mediator for evaluating the prognosis.