Myocardial Coagulation by Intraoperative Nd:YAG Laser Ablation and Its Dependence on Blood Perfusion

To investigate whether the efficacy of intraoperative laser ablation therapy is affected by myocardial blood perfusion, we irradiated 11 canine hearts through the epicardium with a Nd:YAG laser (10, 20. and 30 J/mm²) using air as the medium. Compared coagulated myocardial depth, width, and volume obtained in the red beating heart was compared with those in the white nonbeating heart infused with CC saline (cardioplegic model) via the coronary artery. Histologically, the macro- and microscopical findings were very similar. At each level of energy, the width and volume of red myocardium coagulated were significantly larger than those of white myocardium (P < 0.01). At 30 J/mn², the depth of coagulation of red myocardium was significantly larger than that of white myocardium (P < 0.01). The coagulated volume of the white myocardium was about 60% of that of the red myocardium. NdiYAG laser energy was absorbed by blood (red color = hemoglobin), and more energy was transferred in the higher temperature myocardium. During intraoperative Nd:YAG laser ablation, the presence of blood perfusion in cardiac tissue is thought to be an important factor affecting safe irradiation.     

Factors Influencing the Prognosis of Transitional Cell Carcinoma of the Renal Pelvis and Ureter

Forty-seven cases of transitional cell carcinoma of the renalpelvis and ureter were treated during the past 19 yr at theNational Cancer Center Hospital, Tokyo. Results of treatmentwere reviewed with special reference to the analysis of fatalcases. In fatal cases there were significantly longer intervalsbetween the onset of the disease and establishment of the diagnosisthan in nonfatal cases. Moreover, the histological grade ofmalignancy was significantly higher in fatal cases. More radicalsurgery was performed on patients who survived, but the contributionof this factor to the end results was not quantitatively elucidated.The 5-yr survival rates for patients with renal pelvic carcinoma,ureteral carcinoma and multiple renal pelvic and ureteral carcinomawere 73.5%, 48.7% and 58.5%, respectively.     

Molecular evaluation of the SRY gene for gonads of patients with mixed gonadal dysgenesis

AIM: To determine whether the SRY gene is present in the gonads of patients with mixed gonadal dysgenesis (MGD). METHODS: Molecular analysis was performed in three patients with MGD. Polymerase chain reactions were used to test for the presence of the SRY gene in the peripheral lymphocytes, testes and streak gonads. RESULTS: Chromosome analysis revealed 45,XO/46,XY in two patients, and 46,XY in the third patient. In the peripheral lymphocytes and testicular tissue, the SRY sequences were positive in all cases. However, the SRY sequence was detected in the streak gonad in only two of the three patients. CONCLUSIONS: It is interesting that we identified both SRY-positive and SRY-negative streak gonads. Although the SRY gene has a very important role in testicular differentiation, genes other than the SRY gene might also influence the development of the indifferent gonad in MGD.     

Substrate Characterization and Catheter Ablation for Monomorphic Ventricular Tachycardia in Patients With Apical Hypertrophic Cardiomyopathy

VT Ablation in Apical Hypertrophic Cardiomyopathy . Introduction: Monomorphic ventricular tachycardia (VT) is uncommon in apical hypertrophic cardiomyopathy (HCM). The purpose of this study was to define the substrate and role of catheter ablation for VT in apical HCM. Methods: Four patients with apical HCM and frequent, drug refractory VT (mean age of 46 ± 10 years, left ventricular [LV] ejection fraction; 54 ± 14%) underwent catheter ablation with the use of electroanatomic mapping. Endocardial mapping was performed in 4 patients and 3 patients underwent epicardial mapping. Results: In 3 patients, VT was related to areas of scar in the apical LV where maximal apical wall thickness ranged from 14.5 to 17.8 mm, and 2 patients had apical aneurysms. Endocardial and epicardial substrate mapping revealed low voltage (<1.5 mV) scar in both endocardial and epicardial LV in 2 and only in the epicardium in 1 patient. Inducible VT was abolished with a combination of endocardial and epicardial ablation in 2 patients, but was ineffective in the third patient who had intramural reentry that required transcoronary ethanol ablation of an obtuse marginal vessel for abolition. The fourth patient had focal nonsustained repetitive VT from right ventricular outflow tract (RVOT), consistent with idiopathic RVOT‐VT, that was successfully ablated. During follow‐ups of 3‐9 months, all patients remained free from VT. Conclusion: Monomorphic VT in apical HCM can be due to endocardial, epicardial or intramural reentry in areas of apical scar. Epicardial ablation or transcoronary alcohol ablation is required in some cases. (J Cardiovasc Electrophysiol, Vol. 22, pp. 41‐48, January 2011)     

An attempt of radar chart expression of a self-rating scale for sleep disturbance

Abstract We made an attempt to express a complaint of sleep disturbance by a self-rating scale of radar chart mode. The questionnaire for sleep disturbance is made up of eight items. Each item was scored from grade 1 to 4. The score of each item was projected to the MY radar chart, designed by us. It is noted that this method is useful in following the effect of hypnotics on sleep disturbance.     

Recurrence of Thymoma with Appearance of Myasthenia Gravis 18 Years after Surgery: A Case Report

A 59-year-old woman was admitted to the hospital because ofrecurrence of thymoma with appearance of myasthenia gravis 18years after excision of an invasive thymoma. Recurrence wasobserved in the anterior mediastinum, right pleura, pericardiumand left supraclavicular lymph node. Hashimoto's thyroiditis,vitiligo vulgaris and leukopenia were also seen. After creationof a pericardial window for pericardial effusion, she receivedvincristine, then carbazilquinone intravenously as single chemotherapeuticagents based on the chemosensitivity by clonogenic assay ofthe supraclavicular tumor, but response was not achieved. Atone and a half years after radiotherapy to the mediastinum,she is now doing well without symptoms and is receiving a fairlylow dose of anticholinesterase medication.     

Surgical Treatment of Lung Cancer in Patients over the Age of 70 Years

The number of elderly patients receiving surgical treatmentfor lung cancer is rapidly increasing. There were 199 patients over the age of 70 yr among 1,210 patientswho underwent lung resection for lung cancer. Among the 199,156 were between the ages of 70 and 74, 36 between 75 and 79and seven over the age of 80. One hundred and sixty-nine received lobectomy, 25 pneumonectomyand five a smaller lung resection. Mediastinal lymph node dissectionwas carried out in 145 cases. The crude 5-yr survival rate of84 patients who were operated upon during the period from 1962to 1976 was 30% and was similar to that of patients less than70 yr old. Because of the higher postoperative mortality rateof patients with pneumonectomy and with combined resection oflung and neighboring organ(s), 16% and 15% respectively, itwas considered reasonable that the use of these two operativemodalities for elderly patients should be limited. From these results patients over the age of 70 yr can be saidto be a proper target of lung surgery for lung cancer when alobectomy shows that such surgery is indicated.     

Total Colectomy, Rectal Mucosectomy and Ileoanal Anastomosis for Familial Polyposis Coli -- Use of Tube Ileostomy --

Radical cancer-preventive management of familial polyposis coliis total removal of the colon and rectum. We have carried outthis procedure with ileoanostomy for seven young patients withfamilial polyposis coli. There was no significant morbidity and all ileoanal anastomoseswere completed without any problems of leakage or abscesses.Side-to-end anastomosis is very effective in preventing complicationsof ileoanostomy. Simple tube-ileostomy is also effective andis recommended rather than loop ileostomy. Restoration of analfunction was excellent except in one patient whose internalsphincter muscle was injured during rectal mucosectomy. Our results show that ileoanal anastomosis without postoperativecomplications has no effect on the postoperative social rehabilitationof the patient, although the frequency of defecation is threeor four times a day.