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61.
Esophageal perforations are extremely difficult to diagnose and treat. We report herein our results of a review of 26 patients
with esophageal perforation which were spontaneous in 11, iatrogenic in 11, and caused by a foreign body in 4. Surgical treatment
was performed in 7 of the patients with spontaneous rupture, but the remaining 19 patients were treated conservatively. The
abnormality was found by plain radiography (X-ray) in 22 (85%) of the 26 patients, and by computed tomography (CT) in all
13 patients who underwent this procedure. The detection rates by esophagography and esophagoscopy were 100%, or all of 25
patients examined, and 60%, or 9 of 15 patients examined, respectively. Of 12 patients with underlying diseases, 4 (33%) died
after the perforation, whereas only 1 (7%) of 14 patients without any underlying disease died. Postoperative empyema developed
in all of 3 patients treated by intraoperative unfixed intrathoracic drainage (UID), but in none of the 4 treated by fixed
intrathoracic drainage (FID). Conservative treatment achieved satisfactory results for spontaneous esophageal ruptures confined
to the mediastinum, and for iatrogenic perforations and esophageal perforations caused by foreign bodies, provided there was
no serious underlying disease such as advanced cirrhosis. Moreover, intraoperative FID proved useful in helping to prevent
postoperative empyema. 相似文献
62.
Kiyofumi Morishita Satomi Inoue Toshio Baba Jyun-ichi Sakata Teruhisa Kazui Tomio Abe 《Artificial organs》1997,21(7):822-824
Abstract: We have used heparin-bonded partial cardio-pulmonary bypass to support distal aortic circulation during aortic cross-clamping. However, there were no cardiotomy reservoirs with fully reliable thromboresistance. To resolve this problem, a short-acting anticoagulant (nafamostat mesilate) was added into a cardiotomy reservoir. The present study was designed to evaluate the efficacy of our distal perfusion system. From May 1995 through the end of May 1996, 27 patients underwent descending thoracic and thoracoabdominal aortic aneurysm repairs with this adjunct, 4 being excluded from the experiment. Twenty patients who had undergone conventional partial cardiopulmonary bypass were defined as the control group. There were no significant differences between the 2 groups in the morbidity, mortality, gas transfer, or transfusion requirements despite the fact that more complicated surgical procedures (shown by a two-fold increase in the prevalence of reoperation) were required in the group that had received the current distal perfusion adjunct. the heparin-bonded group. In conclusion, our perfusion system is very effective for descending thoracic and thoracoabdominal aortic aneurysm repairs. 相似文献
63.
Mariko Kobayashi Yukihiro Takahashi Makoto Ando Naoki Wada Masamitsu Murata Toshio Kikuchi 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2005,53(12):635-637
A 6 month-old male infant (weight: 4.5 kg) with congenital aortic stenosis underwent aortic valve replacement with a pulmonary
autograft (Ross procedure). The right ventricular outflow tract (RVOT) was reconstructed with a polytetrafluoroethylene (PTFE)-valved
equine pericardial conduit. At the age of 5, re-RVOT reconstruction with an equine pericardial patch bearing a PTFE monocusp
was required because of severe pulmonary stenosis resistant to 2 attempts of percutaneous transluminal pulmonary valvotomy.
Currently, at the age of 8, the degree of aortic regurgitation is trivial and the pulmonary autograft is free of functional
deterioration despite somatic growth. 相似文献
64.
Tatsuo Uchida Takahiko Tokumaru Hiroshi Kojima Katsura Nakagawaji Munehisa Imaizumi Toshio Abe 《Surgery today》1992,22(3):265-268
A 36 year old woman was admitted to our department because of a chest X-ray which showed multiple developing shadows. She underwent bilateral exploratory thoracotomies and a total 5 tumors were resected and pathologically diagnosed as benign metastasizing leiomyoma, the largest of which was positive for the progesterone receptor and negative for the estrogen receptor. A histogram of this tumor using a flow cytometer showed a diploid pattern and 4.6 percent of the S phase which was not more than that of a leiomyoma of the uterus from another patient. Two months later, she underwent a hysterectomy and bilateral salpingo-oophorectomy for treatment of the positive progesterone receptor in the pulmonary lesions. The resected uterine myoma and normal myometrium showed positive estrogen and progesterone receptors. For the subsequent 28 months she has been free of any further symptoms. Benign metastasizing leiomyoma of the uterus is a rare disease and very interesting because of its histological benignity and hormonal dependency. However, according to the literature, it is often confused in entity due to the fact that normal lung tissue also possesses hormone receptors. Considering our data on hormone receptors, it is rational to think that multiple leiomyomatous lesions in the lung should only be diagnosed as benign metastasizing leiomyomas when they possess positive estrogen and progesterone receptors. 相似文献
65.
Transformation of human cells, both induced and spontaneous, is an extremely rare event, whereas rodent cells are relatively easily transformed when treated with a single carcinogenic agent. The present review addresses the question of why human cells are resistant to malignant transformation in vitro. To facilitate understanding of the problem, the process of transformation is divided operationally into two phases, i.e. phase I, immortalization; and phase II, malignant transformation. In human cells, one-phase transformation, i.e., the consecutive occurrence of phases I and II due to the action of a single carcinogenic agent, is observed only rarely. Once human cells are immortalized, however, malignant transformation by chemical carcinogens or oncogenes proceeds, suggesting that for human cells, phase I immortalization is a prerequisite for such transformation to take place. To date, about 20 papers have been published describing protocols for the two-phase transformation of a variety of human epithelial cells and fibroblasts. In most experiments, SV40, human papilloma viruses and their transforming genes are utilized for induction of phase I (immortalization) followed by the use of chemical carcinogens or activated oncogenes for induction of phase II (malignant transformation). Possible mechanisms that would render human cells refractory to transformation are discussed below. 相似文献
66.
Isao Iwamoto Hisamichi Baba Yasunori Koga Noriyuki Uchida Kazuhiko Matsuo Kiyoshi Ishii Toshio Onitsuka Kouichirou Shibata 《Surgery today》1990,20(2):158-162
In order to assess the accuracy of electroencephalography (EEG), in children who have undergone cardiac surgery under simple
deep hypothermia, the relation between IQ or schoolwork achievement and the duration of circulatory arrest was investigated
in 75 such children. Abnormal preoperative EEG's were found in 16 per cent of the children while abnormal postoperative EEG's
were found in 17 per cent. The children were divided into 4 groups, according to pre- and postoperative EEG results. Schoolwork
achievement scores ranged between 3.0 and 3.2, the difference among the groups being insignificant. Moreover, no significant
shift in IQ was found among the groups. Finally, regarding the number of children who were able to go on to a higher level
of education, including high school the college or university, again no significant differences were found among the 4 groups.
In a comparison with the number of such children in neighboring Nagasaki prefecture able to continue on to a higher level
of education, no significant differences were seen either. The findings and statistics of this investigation therefore indicate
that pre- and postoperative EEG's are not always a reliable reference for assessing the prognosis of cerebral activity. 相似文献
67.
Toshio Mizutani Ken-ichi Nakamura Mutsuo Enomoto Masuhiro Sakata Shigeo Yamada 《Neuropathology》1998,18(1):80-90
A neuropathological study on 1540 consecutive autopsy brains ranging from 60 to 107 years of age revealed the following points. (1) Of the of the demented cases of the plaque-predominant type, 93% were complicated with multiple tiny cortical infarcts. They showed a tendency for dementia to develop before or after the appearance or worsening of a systemic disorder such as cardiovascular disease, respiratory infection and cancer. However, there was no case showing Alzheimer-type dementia (ATD). (2) The plaque-predominant type might be an extreme condition of brain aging in terms of senile plaques (SP). It is likely that although the pathological appearance of SP alone is not responsible for dementia, its coexistence with multiple cortical infarcts could be the cause of dementia. Therefore, this type should be distinguished from ATD. (3) Primary hippocampal degeneration could also be an extreme condition of brain aging in terms of neurofibrillary tangles. This condition was different pathologically from the hippocampal lesion in ATD. (4) Several characteristics of old-old and oldest-old patients were clarified. 相似文献
68.
69.
Hidemi Kaname Toshio Yoshihara Yuji Yaku Tetsuo Ishii 《Medical Electron Microscopy》1993,26(2):99-104
Primary squamous cell carcinoma of the submandibular gland is a rare tumor. In this report, the histological and ultrastructural
features of a case of primary squamous cell carcinoma arising in the left submandibular gland is presented. Light microscopically,
the tumor consisted of well differentiated keratinizing squamous cell nests. Ultrastructurally, the tumor cells were oval
or spindle-shaped, and several tumor cells had intracytoplasmic desmosome-like structures, resembling intercellular desmosomes.
The majority of the tumor cells contained a large number of intermediate filaments (tonofilaments). Intercellular desmosomes
were well developed. No secretory granules were found. These ultrastructural features may enable us to distinguish primary
squamous cell carcinoma from mucoepidermoid carcinoma which is often misdiagnosed as squamous cell carcinoma. 相似文献
70.
The effect of halothane and enflurane on tracheal tone were studied in 21 patients during the induction of anesthesia. Endotracheal tube cuff pressure was used to measure tracheal tone. Anesthesia, maintained by nitrous oxide 70% in oxygen, was supplimented with succinylcholine drip infusion to immobilize the patient. Ventilation was controlled by a Volume-preset ventilator. In the halothane group, the initial cuff pressure was 14.8 ± 1.3 (mean ± SE) cmH2O but 10min after 0.15mg/kg of pancuronium injection, it increased to 21.7 ± 2.3cmH2O (control). Ten min after inhalation of 0.75% of halothane, cuff pressure decreased to 14.7 ± 2.3cmH2O (34 ± 11% decrease from the control value). In the enflurane group, the initial cuff pressure was 17.6 ± 1.8cmH2O and it increased to 21.0 ± 1.7cmH2O (control) 10min after pancuronium injection. Ten min after 1.7% of enflurane inhalation, cuff pressure decreased to 17.1 ± 2.3cmH2O (23.9 ± 6% decrease from the control value). Halothane and enflurane produced similar tracheal dilatation in healthy individuals.(Yasuda I, Irimada M, Hirano T et al.: Tracheal dilatation by halothane and enflurane in man. J Anesth 2: 46–49, 1988) 相似文献