During about thirty years, from April 1969 to December 1999, we experienced 2, 987 cases of gastric cancer, hospitalized in the surgical department of Tsuchiura Kyodo General Hospital.
Clinical and pathological observations revealed that the most important factor to improve the post-operative survival is to diagnose and treat as soon as possible, regardless of patients' subjective symptoms.
We divided our gastric cancer cases into three categories. Category one: those who visited our hospital with some abdominal symptoms. Category two: those who were checked by indirect radiography in gastric mass screening. Category three: those who were examined by direct gastric radiography or gastric fiberscopy, as a part of total health check-up, or during following-up of other diseases than stomach trouble.
The results were as follows. In category one, total operated patients were 1, 994, those who died were 1, 218, and those who died of gastric cancer were 985 (49.4% of operated cases). In category two, total operated patients were 517, those who died were 118, and those who died of gastric cancer were 86 people (16.6%). In category three, total operated patients were 449, those who died were 117, and only 53 patients (11.8%) died of gastric cancer.
It became clear that to get gastric examination radiologically or endoscopically before any abdominal symptoms appear, is critically beneficial to avoid deaths by gastric cancer.

The rates of suicide to all deaths, or suicide mortality rates in Japan, observed in time series, show cyclic changes with high and low rates occurring alternately throughout the pre-and post-war periods. The number of suicides correlates to changes in social environment. It was on a high level during the pre-war panic age of rural communities (1932-1933), recorded an extraordinary low value during the Second World War, rose suddenly with the unprecedented prosperity of post-war days, dropped gradually as the Japanese economy was entering a stable, growth period (in the latter half of 1960's), remained at a relatively low rate after that, and went up sharply in 1983 and posed a social problem.
In Japan, suicide mortality is higher in agricultural districts than in urban areas, and is higher among full-time farmers than part-time farmers. In developed countries in the West, it is higher in big cities. This difference is remarkable.
We performed a multiple regression analysis to examine the relationship of suicide mortality and some socio-economic factors using data in 1985 when suicide mortality was still on a high level. The age-adjusted suicide mortality of each prefecture was given as an object variable and the explanatory variables included such socio-economic factors as income index per capita and mobility ratio of each prefecture. Added to these were the number of persons who died of illness and the number of psychotics as indices of desease and psychopathy which could be regarded, as the main motives for committing suicide.
The outcome was that a multiple regression formula with the social economic factors held as an estimator. The two facors, per capita income index and social mobility ratio, were significant explanatory variables, and proved to be important social economic elements concerning the sharp increase in suicide mortality.

This study was performed to evaluate management of cancer pain in 322 patients who were treated in our pain clinic between January 1986 and December 1997. For this purpose, the change in the number of cancer patients and the annual morphine consumption during the period in our hospital were investigated. We found that as morphine consumption increased, the number of cancer patients visited the pain clinic decreased. Although 90% of them who visited the pain clinic underwent neural block therapy before 1996, the parcentage dropped to only 79% in 1996 and 50% in 1997. The increasing rate of morphine consumption in our hospital was on a par with the national average between 1986 and 1996. The use of adjuvant drugs did not change throughout the 12-year period.
We believe the consumption of morphine is not enough. It is necessary for us to become more skilled in using narcotics for relief of cancer pain along the guidelines of the World Health Organization.

In order to know the present state of mass survey for large-bowel cancer in rural areas, we gathered the results of colorectal screening in 1989 from 45 hospitals or cancer detection center related to agricultural cooperatives of all over Japan.
In all of the 45 institutions, method of screening was fecal occult blood test, and in most of them, the stool study was immunological, of one day, and without meal restriction. Methods of further precise examination such as barium enema, total colonoscopy, sigmiodoscopy, or proctoscopy, solely or combined, were employed depending to the facilities.
The total number of examinees were 194, 834, and 8, 523 (4.4%) had a positive reaction for occult blood. Further precise examinations were performed in 4, 351 (59.7%) examinees, and 148 cases of large-bowel cancer were detected. The detective rate of cancer in total examinees was 0.08%. Among these 148 cases of colorectal cancer, 43 cases (51.8%) were in early stage. Examinees in their fifties were the most in number, and both the rate of positive reaction and the rate of cancer detection were increased as the age gets older.

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.

We encountered a case of far advanced hepatomas involving the lungs and portal veins. The patient was a 38-year-old woman. Chemoembolization had transient effects. Cachexia occurred. After repeated episodes of upper gastrointestinal bleeding, she died. An autopsy revealed a deep gastric ulcer to which a nodule of the hepatocellular carcinoma adhered. Histopathologically, the infiltration of the hepatoma was not evident. These findings suggested that circulatory distarbances of the gastric wall due to the adhesion of the growing hematoma had caused the ulceration.

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.