The surgical treatment cases of 452 colorectal cancer patients at Tsuchiura Kyodo Hospital in the years 1973-87 were analyzed and the following results were obtained.
1) Operative cases of colorectal cancer have increased among the elderly. There was no difference between men and women. Recently, elder patients have been increasing with the advent of an aging society.
2) Survival prospects were better for women and younger patients.
3) There were no deaths in patients below 53 years of age. A high post-operative mortality rate was found in non-resectable cases.
4) Survival was significantly related to involvement of lymph nodes. Significant difference was recognized between the lymph node metastasis of n0 and n1. It showed good correlations with lymphtic invasion. Histological stages would reflect survival rates well as a factor predicting prognosis.
5) The cases of peritoneal dissemination were found more in younger patients than older ones. Age had nothing to do with liver metastasis. It was found more frequently in patients with serosal invasion, invaded by moderately differentiated adenocarcinoma and marked lymphtic and venous invasion.
6) There was a fall in the survival rate of patients undergoing curative resection almost according to age. Among them, significantly worse survival was found in patients aged 40-50 years, whose condition was mostly advanced on histological stage and Dukes classification.
7) Sufficient clearing of regional lymph node and considering of serosal invation for good prognosis from the surgical treatment are very important. For the future subject, to improve the surival rate, education about cancer. early detection and effect of multidisciplinary treatment are imperative.

During the twelve years from January 1978 to December 1989, a total of 1, 409 cases of gastric cancer were treated in the surgical department of Tsuchiura Kyodo Hospital, located in the southern agricultural district of Ibaraki Prefecture.
Observations on these cases revealed: 1) Cases of gastric cancer tend to decrease, 2) Results of surgical treatment are improving remarkably, in terms of the resection rate and five-year survival rate, and 3) Most of the patients who survived more than five years after surgery are in satisfactory conditions.
The main factor contributing to the improvement of the results of surgical treatment of gastric cancer was increased detections of cancer in relatively early stages through mass survey or total check-up in the asymptomatic stage.
The decline of the morbidity rate of gastric cancer is reported to be more prominent in younger generations. This fact and the aging of the population in our society, especially in rural areas, will increase the number of elderly gastric cancer patients.
The future of surgery of gastric cancer depends on how early we can detect cancer and treat elderly patients. For this purpose, mass survey and total check-up on older people will be the most effective means.

Three main factors that sway the postoperative prognosis of stomach cancer are, the curability of the surgical operation, the depth of the cancer lesion and the stage of the disease. With these factors in mind, we further studied what other factors could influence the long-term prognosis of stomach cancer.
We picked up two categories of patients from our file of stomach cancer cases. Category one; those patients who survived five years or longer after surgery, although the operations for them were not curative, or the depth of the lesion in these patients reached to the serosa, or the cancer was in stage IV. Category two; those patients who died of stomach cancer within five years after surgery, although the operations were curative, or the depth of the lesion reached only the submucosal layer, or the cancer was in stage I.
By comparing these two groups, we found out the factors that influence the prognosis.
1) In the cases of absolutely curative operations, the factors that made the prognosis worse, were that the lesion was advanced, that the lesion existed in the C region, and that the lesion was poorly differentiated histologically.
2) In the cases of noncurative operations, caused by P1, H1, ow (+) or aw (+), factors that brought a good prognosis were, that the lesion was not of diffuse type, that there was no lymph node metastasis, and that lymph node dissection was done effectively.
3) In the cases of early gastric cancer, lymph node metastases made the prognosis worse. Even when the lesion reached the serosa, prognosis was favorable if cancer cells did not invade other organs, had no peritoneal dissemination, or if lymph node dissection was perfect.
4) In the cases of stage I histologically, prognosis was poor when the cancer looked advanced to the naked eye.
5) In the cases of stage IV, when the degrees of lymph node metastasis was slight and lymph node dissection was done adequate, prognosis was good.

We began gastric mass survey at our hospital in May, 1980. During 3 years and 8 months since then, (May, 1980-December, 1983) we performed screening examinations to 16, 341 people by indirect radiography, and checked 2, 824 cases (17.3%) for thorough examination. Among these cases, 2, 083 (73.8%) received endoscopic examination actually, and 55 cases of gastric cancer were discovered. The discovery rate of gastric cancer was 0.336 per cent.
35 cases of these 55 gastric cancer were operated in the surgical department of our hospital. 34 cases were resected (rate of resection was 97.1%) and 33 cases were resected curatively (rate of curative resection was 94.3%). These results were better than that of gastric cancer cases from out-patient clinic of the same period. The results of cases from out-patient clinic of our hospital were: total number of cases 321, resected cases 254 (79.1%), curative resection 189 cases (58.9%), respectively.

An investigation was performed about clinical histories before hospitalization in 1142 cases of gastric cancer during 16 years from 1969 to 1984.
The average term from onset of the disease to hospitalization was 4.53 months which tends to decrease becoming 3.49 months in the latest 5 years. The patients had visited 0.72 other doctor in average before coming to our hospital, 0.35 in early cancer cases and 0.83 in advanced cases. The sources of patients of our surgery were as follows ; 60.5% were introduced from medical department of our hospital, 20.2% were introduced from other clinics or hospitals, 10.6% visited our surgical department directly, and 8.7% came to us after visiting one or some other doctors. The rate of early cancer cases were high and unresectable cases were low relatively in cases from our medical department and direct visitors to our surgical department.
The causative factors of delay of hospitalization more than one month were considered from both sides of patient and doctor. The results were ; no delay 55.3%, delay due to patient's fault 28.2%, delay due to doctor's fault 19.9%. The delay of hospitalization due to either side's fault was one factor of decreasing early cancers and increasing advanced cases. Among those with no delay, however, 22.6% were unresectable cases. Gastric cancers are too malignant to be cured by visiting hospitals with complaints. Gastric mass survey among symptomeless people is the only reasonable way to come out of this difficult situation.

We did a retrospective review of 83 femoropopliteal bypasses with grafting of saphenous vein performed for two groups of limbs: those with arteriosclerosis obliterans (n=71) and thromboangiitis obliterans (n=12) over the past 15 years. The purpose of the study is to assess factors that influence long-term graft patency. We also examined methods used for reoperation. After a mean follow-up of 35 months (ranges, 1-164), the cumulative patency rate was 79% at 5 years and again 79% at 8 years, which was better than the patency of PTFE grafts or other prosthetics reported by other authors. The two groups were compared for the severity of ischemia, condition of the outflow tract, and whether anastomosis was above or below the knee. These factors were different between the two groups, but the difference in patency was statistically not significant. Two reoperations for claudication were needed. One was carried out with use of the bilateral saphenous veins from below the portions used earlier. The other was done for obstruction of a PTFE graft; anastomosis was done at the mid portion with the use of Vitagraft.

During the eleven years from January 1978 to December 1988, we experienced 1, 287 cases of gastric cancer, hospitalized in the surgical department of Tsuchiura Kyodo Hospital which is located in the southern agricultural district of Ibaraki Prefecture.
Among these 1, 287 cases, 1, 233 patients were operated on. Gastric resection was performed in 1, 059 cases including 337 cases of total gastrectomy with the resection rate of 85.9 percent (1, 059/1, 233). In 863 cases, resection gave histologically satisfactory results, and our curative resection rate was 70.0 percent (863/1, 233). Direct mortality rate was 2.35% in all operated cases and 1.32% in resected cases.
The five-year survival rate over the period from 1978 to 1983 was 57.7% in all resected cases and 69.3% in curatively resected cases.
Annual follow up observation showed increases in resection rate, curative resection rate, and five-year survival rate. However, there were no remarkable changes in the rate of total gastrectomy, rate of combined resection of other organs, and degree of lymph nodes dissection.
The main factor contributing to the improvement in the results of surgical treatment of gastric cancer was the increase in the detection rate of cancer in relatively early stages, through gastric mass survey or total check-up in the asymptomatic stage.

BACKGROUND: Placenta previa and placenta accreta associate with high morbidity and mortality for both mothers and fetus. Metal exposure may have relationships with placenta previa and placenta accreta. This study analyzed the associations between maternal metal (cadmium [Cd], lead [Pb], mercury [Hg], selenium [Se], and manganese [Mn]) concentrations and placenta previa and placenta accreta. METHODS: We recruited 17,414 women with singleton pregnancies. Data from a self-administered questionnaire regarding the first trimester and medical records after delivery were analyzed. Maternal blood samples were collected to measure metal concentrations. The subjects were classified into four quartiles (Q1, Q2, Q3, and Q4) according to metal concentrations. RESULTS: The odds ratio for placenta previa was significantly higher among subjects with Q4 Cd than those with Q1 Cd. The odds ratio for placenta previa was significantly higher for subjects with Q2 Pb than those with Q1 Pb. CONCLUSION Participants with placenta previa had higher Cd concentrations. However, this study was cross-sectional and lacked important information related to Cd concentration, such as detailed smoking habits and sources of Cd intake. In addition, the subjects in this study comprised ordinary pregnant Japanese women, and it was impossible to observe the relationship between a wide range of Cd exposure and placenta previa. Therefore, epidemiological and experimental studies are warranted to verify the relationship between Cd exposure and pregnancy abnormalities.
Adult ; Cross-Sectional Studies ; Female ; Humans ; Japan ; Metals, Heavy ; blood ; metabolism ; Placenta Accreta ; metabolism ; Placenta Previa ; metabolism ; Pregnancy ; Selenium ; blood ; metabolism