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.

The whole spectrum of patients infected with hepatitis C virus (HCV) who visited hospitals has not been fully clarified. It is also unknown whether such patients have visited the hospitals regularly thereafter for a long period. We studied 844 consecutive patients with liver diseases who visited our outpatient clinic located in the southern region of Ibaraki Prefecture. Five hundred eighty-three patients were HCV-infected. Among them, three patients were HBsAg-positive and another patient was IgM anti-HAV positive. Thus, 579 patients (68.6%) were considered to have HCV solely as a hepatotropic virus.Of these HCV patients, 60 were asymptomatic carriers and 15 others were unclassified because of the absence of either biopsy or imaging test records of the liver. As to the rest of the HCV patients, acute hepatitis was diagnosed in one patients, chronic hepatitis in 332 patients, cirrhosis in 130 patients and cancer of the liver in 41 patients.About half of the patients undergoing liver biopsy showed F1 in the degree of liver fibrosis. The rate of virological response to interferon mono-therapy in patients infected with genotype 2 was worse than the national average. The poor response was considered to be due to high viral load. It was suggested that the distribution of patients with each genotype was uneven in this region. After five years, the rate of patients still visiting our clinic were 68.1% for those with chronic hepatitis, and 50% for the healthy carriers. We deemed that it was important to clarify whether patients not visiting our clinic are followed up closely in other hospitals.
Hepatitis C virus ; Liver ; Clinic ; Infection as complication of medical care ; biopsy characteristics

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.

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 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.

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.