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.

In order to obtain the physiological information during such outdoor exercises as cross-country running or skiing, mountain climbing or diving in the sea water etc, we developed a new device employing MEMORY IC. for monitoring and recording various biological information from the subjects during exercise with no restraint. The device is composed of detecting, data processing and recording units. The application of a semiconductor, CMOS MEMORY I.C. to the recording unit enabled us to construct the instrument, which is very compact (150g) and tolerant to the mechanical vibrations as well as the enviromental disturbances. The recorded data are read out by a microcomputor system. This device was applied to ten subjects during running, where the heart rate, respiration rate and body temperature were recorded. They covered a distance of 9 km within 60 minutes. The heart rate of five trained men was stabilized at nearly fixed level during running which was consistent results with those by the treadmill, but in the untrained men different results were shown from the trained. The heart rate of the untrained men showed that they encoutered the limits of the capacity on the way of running. These results showed wide applicability of this device for the physiological analysis of outdoor exercises.

A 67-year-old woman had left lateral chest pain. CT scan and digital subtraction angiography revealed coarctation of the abdominal aorta just distal from the renal artery and a fusiform aneurysm of the descending thoracic aorta with a maximum diameter of 60mm. The meandering mesenteric artery was significantly dilated as a collateral vessel from the superior mesenteric artery to the inferior mesenteric artery. Aortitis syndrome was suspected from the angiographic findings although inflammatory changes in laboratory data were not observed. She underwent aneurysmectomy followed by prosthetic graft replacement of the descending thoracic aorta under femoro-femoral bypass and an extraanatomical bypass grafting from the replaced graft to the abdominal aorta proximal to the aortic bifurcation via the retroperitoneal space. She was discharged on the 42nd day after operation without any complications and in the past year has returned to her usual daily life without any anastomotic site trouble.

In mechanical endovascular thrombectomy (MET) for acute basilar artery occlusion (ABAO) in the elderly, navigating a guide catheter via the femoral artery may be difficult due to the approach route’s significant tortuosity. To resolve this problem, we have been performing a technique that uses a direct brachial approach (DiBA) with a large-bore aspiration catheter. We reported our preliminary clinical experience with this technique. MET for ABAO using the DiBA technique was performed on 4 consecutive patients between August 2017 and December 2018. In all patients, thrombolysis in cerebral infarction 2B or 3 recanalization was achieved, but the modified Rankin Scale at 90 days was ≥4. There were no technical difficulties or complications with this technique. The DiBA technique is an effective and feasible approach in MET for ABAO. Although excellent clinical outcomes could not be achieved, the angiographic outcomes were excellent with no technical complications. This approach can be an alternative to the femoral artery approach, particularly for tortuous arteries in the elderly.

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.

A woman in her 50s underwent abdominal total hysterectomy for uterine myoma. She was discharged from the hospital on postoperative day (POD) 6 following an uneventful postoperative course but returned to the outpatient clinic on POD 11 with chief complaints of fever and abdominal pain. Blood tests at presentation showed a C-reactive protein level of 22.95 mg/dL and a white blood cell count of 21300/μL, indicating an increased inflammatory response. Transvaginal ultrasonography and contrast-enhanced computed tomography (CT) revealed a small amount of ascites and a thickened pelvic peritoneum. Based on these findings, pelvic peritonitis was diagnosed and the patient was readmitted to the hospital. After admission, antimicrobial treatment with cefmetazole 3 g/day was started, but transvaginal ultrasonography on POD 13 (3 days after readmission) revealed an intra-pelvic abscess. The abscess was punctured under transvaginal ultrasonographic guidance and the puncture fluid was submitted for microbiological examination, followed by CT-guided drainage. At the same time, the antimicrobial regimen was changed to sulbactam/ampicillin 9 g/day and doxycycline (DOXY) 200 mg/day (100 mg/day from the following day). On POD 18 (8 days after readmission), Mycoplasma hominis was detected in the abscess culture, leading to the decision to increase the dose of DOXY to 200 mg. Subsequently, with improvement of subjective and objective symptoms and reduction of the abscess cavity, the patient was discharged from the hospital on POD 21 (11 days after readmission). Although M. hominis is a common urogenital commensal, it can be a potential pathogen in a patient with a pelvic abscess that occurs as a late postoperative complication and does not respond to beta-lactam antibiotics, so treatment decisions should be made with this organism kept in mind.

The patient was a 36-year-old primipara with no comorbidities such as diabetes or hypertension. At 35 weeks and 3 days of pregnancy, she was admitted for rupture of membranes. She vomited often during the expulsive stage of labor, so a vacuum extraction was performed. Her vital signs were normal throughout the delivery. She vomited repeatedly after the delivery but did not complain of headache or arm weakness and her level of consciousness was Japan Coma Scale I-1. Head CT revealed right caudate hemorrhage and cerebral ventricular rupture. Head MRI showed no obvious cerebrovascular abnormality, so she was followed up with symptomatic treatment. Recovery was uneventful, without neurological sequelae, and she was discharged on postpartum day 27. Cerebral hemorrhage during pregnancy is caused in many cases by comorbidities such as cerebral aneurysm, cerebral artery malformation, and pregnancyinduced hypertension syndrome. Cerebral hemorrhage may occur in pregnant women with no risk factors, even when their vital signs are stable. It is necessary to pay attention to the appearance of new symptoms, such as vomiting, around the time of delivery.

The patient was a 68-year-old woman who was diagnosed with stage IIIA cervical cancer and pyometra. Concurrent chemoradiotherapy was planned. She was admitted to our hospital 3 weeks after the initial examination due to vaginal bleeding and worsening of lower abdominal pain. On hospital day 5, she developed a fever, and free gas in the peritoneal cavity and ascites were confirmed by contrast-enhanced computed tomography. Emergency surgery was performed for suspected generalized peritonitis attributed to perforation in the digestive tract or uterus. A large amount of purulent ascites and 2 perforations in the anterior wall of the uterus, but none in the digestive tract, were observed. Peritoneal lavage and drainage were performed, and a colostomy was created. The patient was managed in the intensive care unit until postoperative day 13 due to septic shock and acute renal failure. After the peritonitis resolved, radiation therapy alone was provided, and then chemotherapy was started to treat residual lesions. Pyometra recurred, and transvaginal drainage was performed to prevent perforation of the uterus. However, a few days later, a colouterine fistula and an enterocutaneous fistula developed simultaneously, and her general condition worsened. In advanced cervical cancer complicated by pyometra, various complications can develop that are difficult to manage (e.g., uterine perforation and fistula formation due to radiation enteritis and dermatitis). 　This case demonstrates the importance of uterine drainage at appropriate timing, which can contribute to improved prognosis.