Detection of common bile duct stones by hepatobiliary scintigraphy

Hepatobiliary scintigraphy and direct X-ray cholangiography were compared in 29 patients with common bile duct (CBD) stones confirmed at surgery. The scintigraphic findings included no visualization of the biliary system (NV), pooling of bile in the biliary system (PB), prolonged transit time over 60 min (PTT), filling defect in the CBD image (FD), and reflux of bile toward the intrahepatic ducts after gallbladder stimulation (RB). The positive rates of NV, PB, PTT, FD, and RB in patients with CBD stones were 7%, 31%, 17%, 48%, and 14%, respectively. One or more of these five findings was found in 83%. Although the NV was a useful finding suggesting complete obstruction of the CBD, it shared little in the diagnosis of CBD stone. The positive rate of the PB was relatively high and it would be a useful finding as an indication of the presence of passage disturbance of the CBD. The PB was usually accompanied by the FD. The PTT had some usefulness in the detection of incomplete obstruction of the CBD in patients with a visualized gallbladder. In patients with no visualization of the gallbladder, however, the transit time tended to be shorter than that of gallbladder visualized patients. Therefore, the judgment of PTT in patients with no visualized gallbladder needed another criteria. The FD was the most frequent among the five findings and the sites of FD correlated well with CBD stones on direct X-ray cholangiography. The FD would be a reliable finding indicating CBD stone or CBD stenosis. Although the RB was a finding limited in patients with a visualized gallbladder, it seemed to be a helpful findings for the detection of CBD stone in patients with a mildly dilated CBD.     

Modified open renal biopsy: results in 934 patients

Nine hundred and thirty-four cases of open renal biopsy using the 'Kawamura-modified forceps' have been performed over the past 9 years under general anesthesia. Sufficient amounts of renal tissue for routine histology, immunofluorescence staining and electron microscopy were obtained in all 934 cases. There were no serious major complications attributable to the procedure. It is concluded that this procedure can be performed easier and faster than the previous technique of percutaneous renal biopsy, although patients undergoing open renal biopsy with the Kawamura-modified forceps have to be transferred to the operating room for this procedure.     

A case of IgA nephropathy associated with adeno- and herpes simplex viruses

We report here an adult case of IgA nephropathy associated with episodes of recurrent tonsillitis. Various kinds of viral antigens were examined in the renal and tonsillar tissues by immunofluorescence. Granular depositions of adeno- and herpes simplex viral antigens were detected in the glomerular mesangial areas and in the tonsillar epithelial cells by immunofluorescence. IgA and IgA1 deposits were also observed in the glomerular mesangial areas. It was suggested that IgA nephropathy might be caused by multiple antigenic substances, including adeno- and/or herpes simplex viruses, located in the tonsillar regions.     

The remote effects of brain tumors on cerebral blood flow as measured by single photon emission CT

In order to assess the remote effects of supratentorial brain tumors, the cerebellar blood flow and cerebral blood flow of the symmetrical regions in the contralateral cerebral hemispheres were measured by single photon emission CT. Forty four patients with supratentorial brain tumors, such as gliomas, meningiomas and germ cell tumors etc., were included in this study. Contralateral cerebellar hypoperfusion (CCH) was exhibited in 51%, 18 of 35 unilateral brain tumors. Regarding tumor location, CCH was more correlated with frontoparietal lesions. The mean values of contralateral delta Cerebellar blood flows (delta CBFs) were lower than those of ipsilateral delta CeBFs, and also statistically, bilateral delta CeBFs significantly decreased. The greater the volume of lesions including peritumoral edemas, the lower the delta CeBF became. Among the 9 cases with obstructive hydrocephalus, the preoperative delta CeBFs which had decreased significantly, returned to normal postoperatively. Statistically, it seemed that there was no transcallosal suppression caused by unilateral brain tumors. However the delta rCBF of the mirror foci in postoperative patients decreased significantly. In conclusion, the remote effects on the cerebral blood flow, which are common in strokes cases, were demonstrated in many cases of supratentorial brain tumors and the occurrence of CCH was closely related to the frontoparietal lesion including the tumor and peritumoral edema. Also the mechanism of CCH was discussed with preference for a transneural suppression.     

The importance of aortic compliance as a prognostic factor after aortic valve replacement

A variety of clinical variables and physiological parameters have been discussed in relation to postoperative survival and symptoms in aortic regurgitation (AR). Many of them have been derived from left ventricular morphology and functions, but there has been no parameter from aortic functions. As the heart is united with the aortic tree to form a circulatory system and both heart and aorta affect each other, aortic functions also have an important prognostic value after aortic valve replacement (AVR). This study was performed to clarify the participation of aortic functions in determining the prognosis after AVR. Fifteen consecutive patients undergoing isolated AVR for AR were evaluated. Twenty-one preoperative hemodynamic and dimensional variables of both heart and aorta were analyzed to determine the risk factors for early postoperative morbidity. These variables were obtained from chest X-ray film, electrocardiogram, echocardiogram, cine-aorto-ventriculogram and pressure manometries. All patients were divided in two groups according to the postoperative course. Group I composed of 10 patients took relatively smooth postoperative course, except two patients suffering from cardiac tamponade. Group II composed of 5 patients suffered from low cardiac output syndrome (LOS) and/or dangerous arrhythmias postoperatively. Two out of them died of uncontrollable ventricular arrhythmias. There were no statistic differences between two groups in the factors derived from preoperative examinations, i.e. CTR, LVDsI, PWT, R/Th, %FS, EDVI, EF, CI, LVEDP, etc. Mean aortic compliance of group II, (3.8 +/- 2.1) X 10(-4) mmHg-1, was, however, significantly lower than that of group I, (21.7 +/- 4.8) X 10(-4) mmHg-1, (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

A treatment of intractable sternal osteomyelitis--significant use of pedicle muscular flaps

In recent years, the greater omentum of pedicle muscular flap has been used to treat chest wall infection and Sternal Osteomyelitis following cardiac or respiratory surgery. In Japan, however, there has been an increasing number of cases in which neither the greater omentum Nor the rectus muscle can be used due to the comparatively young age of the patient. There are also many cases undergoing abdominal surgery for malignant tumor and bypass surgery of the coronary artery in which the internal thoracic artery (ITA) and gastroepiploic artery (GEA) are used. We studied three such cases; a case of coronary aortic bypass graft (CABG) where ITA from both the right and left sides were used following stomach resection; a case in which CABG and gallbladder resection were carried out simultaneously; and a case of sternal osteomyelitis is years following surgery for ventricular septal defect. All three cases had undergone reconstructive surgery using the pectoralis major muscle or a pedicle muscular flap from the latissimus dorsi muscle. It is estimated that cases of CABG using both the right and left sides of ITA and GEA, cases of the elderly as well as cases of children will continue to increase. Consequently, cases of sternal osteomyelitis in which neither the omentum nor rectus muscle can be used will also increase. Therefore, it is considered that treatment using pedicle muscular flaps from the breast or dorsal area may be very effective. Herein, we report on the choice of treatment and its results.     

Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1985). II. Background of patients

We have investigated relationships between patients' backgrounds and isolates from urinary tract infections in reference to various conditions, such as sexes, age distribution by sex, species of causative organisms by sex, age distribution according to species and types of infections, species and infections before and after treatment with antibacterial agents, and species and detected places. As for the relationship between sexes and types of infections, although simple urinary tract infections were consistently found at about 20% in men and at about 80% in women between 1981 and 1983, these infections were seen at 24.4% in men and at 75.6% in women in 1984, and at 26.6% and at 73.4% in 1985, indicating slight decreases in the ratio of women. By contrast, complex urinary tract infections were found in men at about 60-70% from 1981 up to 1985, regardless of the presence or absence of indwelling catheter. There were no noticeable changes according to age during this 5-year period in incidences of infections including simple urinary tract infection and complex urinary tract infection with or without indwelling catheter. Thus, backgrounds of patients with urinary tract infections, including sex, age and simple or complex infections, were fairly consistent throughout this period, while there were relatively large changes in species of isolates. Enterococcus faecalis was isolated at about 8% of both men and women in 1982 and 1983, but its isolation rates were increased to 22.5% of men and 17.9% of women in 1984. In 1985 this species was isolated in 14.9% of men and 7.6% of women, and in 11.2% of all patients. Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus spp. and Enterococcus spp. were detected at rates of 3.2%, 8.1%, 0.7% and 1.0%, respectively, and 24.2% of isolated strains were Gram-positive organisms. When species of isolates before treatment with antibacterial agents and their isolation rates were analyzed, it was found that the isolation rate of E. faecalis increased dramatically in 1983, and that this tendency was still seen in 1984. The isolation rate of Gram-positive organisms was 25% in 1984 and 24.3% in 1985. Escherichia coli was consistently isolated at about 40%, but, as far as simple urinary tract infections are concerned, its isolation rate decreased by about 10% in 1985, compared to 1982 and 1983. These results suggested that causative organisms for simple urinary tract infections became similar to those for complex urinary tract infections. In other words, isolates obtained from complex urinary tract infections before treatment were similar to those of simple infections.(ABSTRACT TRUNCATED AT 400 WORDS)