It is presumed that visceral ischemia is caused as a result of fighting between the lower limb and intraperitoneal organs to steal blood in aortoiliac occlusive disease (AIOD). Accordingly, an investigation has been made of this “aortoiliac steal” phenomenon. Out of 65 AIOD patients, the case in whom the main collateral circulation to the lower limb was found to originate in the intraperitoneal visceral arteries by angiography were only 2 (3%), both of which showed, however, no visceral ischemic symptom. Intraoperative changes in pelvic visceral hemodynamics were observed in 19 cases undergone either aorto-bifemoral or axillo-bifemoral bypass operation (AFB) using Doppler's ultrasonic trans-anal method. As a result, visceral circulation was maintained favorably even after AFB, further suggesting the possibility that not only the circulation of the inferior limb but the visceral circulation is improved directly by AFB. Visceral ischemia is considered to occur in the patient in whom concomitant stenotic lesion is present in the celiac artery or superior mesenteric artery, for which full attention should be paid to visceral circulation also in the patients with ischemia in the lower limb.

We perform color Doppler scanning for all patients with leg varix as a preoperative examination. We discovered a case of leg varix with inverse placement of femoral artery and vein by color Doppler scanning and comfirmed it by operation. A 69-year-old female was admitted with a 30-year history of bilateral leg varix and with leg skin ulcer and dermatitis. Color Doppler scanning showed that the femoral vein was lateral to the femoral artery and that the great saphenous vein crossed over the femoral artery from medial side. This was confirmed on operation. This is the first report of this anomaly in Japan.

Comparative studies were made mainly on malignant cases of cholelithiasis in 111 patients with gallstones detected in our regular chekup (group A) during the five-year period from 1985 to 1989 and 67 patients who had gallstones surgically removed together with malignancies (group B) during the same period.
The group A patients representing 4.2% of the total 2, 637 examinees were suspected to suffer from biliary obstruction and malignant tumors involving the digestive system. However, further examination found only one case of biliary tract cancer.
The group B patients account for 20.9% of the total 321 surgery cases. In 37 (55.2%) of the 67 patients, 45 legions were malignant-mostly cancer in the digestive organs. Cancer of the lower portion of the digestive tract was found in 11 patients (29.7%) of the 37. The occult blood test at hospitalization revealed that 8 patients (28.6%) in 28 were positive, and 9 were not clear. Follow-up examination showed the rate of false-positive reaction to blood test stood at 14.3%.
From the foregoing results, to detect cancer of the large intestine at an early stage in the regular medical checkup sponsored by the agricultural cooperative, the occult blood test using the stool of examines alone is not enough. It is high time to introduce endoscopic examinationinto the screening program. In view of the fact that most of the gallstone cases detected at the regular checkup were symptomless, careful followup examinations are deemed necessary with the possibleonset of gallbladder cancer and presence of malignancies in mind.