Use of Blunt Scalp Hooks for Abdominal Procedure in Lumboperitoneal Shunt Placement: Technical Note

In obese patients, we often find difficulty in laparotomy for placing a lumboperitoneal shunt catheter. The authors introduced an easy technique to get a sufficiently wide and shallow operative field through small abdominal incision in obese people. Four blunt scalp hooks and rubber bands, commonly used in craniotomy, were prepared. The fat layer and the rectus abdominis muscle layer were retracted and pulled up using these hooks. Blunt scalp hooks were useful for safe and effective retraction of abdominal wall, which made a sufficient and shallow operative field.     

Laparoscopic Wedge Resection of the Stomach for Submucosal Tumor

We performed laparoscopic wedge resection of the stomach in two patients with submucosal gastric tumor. Three trocars were inserted in addition to a laparoscope. After the blood vessels surrounding the tumors had been ligated with ENDO CUPs, we used ENDO GIA (a linear endoscopic stapling device) four times and then wedge resection was performed. The operative time was 3h33m in Case 1 and 2.5h in Case 2, and bleeding was minimal in both cases. The postoperative courses were uneventful, and intestinal peristalsis recovered rapidly with minimal wound pain. These results suggest that laparoscopic wedge resection of the stomach, a radical procedure, is indicated for submucosal tumor of the stomach.     

RESPIRATORY FUNCTION DURING CERVICAL AND THORACIC EXTRADURAL ANALGESIA IN PATIENTS WITH NORMAL LUNGS

Lung volumes, expired gas volumes, tests of ventilatory capacityand blood-gas tensions were measured in women before and afterinduction of cervical or thoracic extradural analgesia using2% mepivacaine. Inspiratory capacity, vital capacity, totallung capacity and FEV₁, all decreased significantly 30 min afterboth cervical and thoracic extradural blocks. The changes observedduring cervical block were significantly greater than thoseobserved during thoracic extradural analgesia. Expiratory reservevolume and functional residual capacity decreased significantlyafter thoracic cxtradural block, but did not change after cervicalextradural block. Reduction in expired minute volume was observedin the two groups. Pa_co2 and alveolar-arterial oxygen tensiondifference increased, and Pa_co2 decreased significantly 25 minafter both blocks. These results demonstrate that pulmonaryventilation is slightly impaired by the two blocks and to thesame degree, but ventilatory reserve and capacity are markedlyimpaired by cervical extradural block. ^* Present address: Department of Anesthesiology, Shimane MedicalCollege and Hospital, Izumo City, Shimane-Ken, Japan.     

An Evaluation of the Efficacy of Preoperative Therapy for Thoracic Esophageal Carcinoma Using Endoscopic Ultrasonography

Abstract: We performed endoscopic ultrasonography (EUS) to assess the therapeutic efficacy of thoracic esophageal carcinoma treatment and compared this assessment with that of histology. The subjects were 43 patients who underwent surgical resection following preoperative chemotherapy for advanced thoracic esophageal carcinoma. The region of maximal thickness and the cross-sectional area of the tumor were measured, and the percent reduction was taken to be the degree of reduction. Total assessment of metastatic lymph nodes was made on the basis of the degree of reduction in the major axis and cross-sectional area, and the three elements of morphology, border echo and inner echo. The histological findings were classified into Grades 0 through 3 according to criteria for the management of esophageal carcinoma and compared with the EUS findings. The reduction in tumor thickness was 30% or less in 16 patients, 14 (87.5%) of whom had Grades of 0 to 1. The degree of reduction was greater than 50% in 17 patients, 15 (88.2%) of whom had Grades 2 to 3. The degree of reduction was 60% or greater in eight patients, six (75%) of whom had a Grade of 3. Reduction in the cross-sectional area was less than 50% in 19 patients, 16 (84.2%) of whom had Grades of 0 to 1. Of the 19, all who showed a reduction of 30% or less had Grades of 0 to 1. The reduction in cross-sectional area was greater than 50% in 24 patients, 20 (83.3%) of whom had Grades of 2 to 3. A significant difference was noted in the correlation between reduction in thickness and histological assessment between Grades 0 to 1 and Grade 2 (p<0.01) and between of Grades 2 and 3 (p<0.02). The correlation between reduction in cross-sectional area and histological assessment was similar to that for reduction in thickness. None of the methods produced satisfactory results in relation to assessment of metastatic lymph nodes. Assessment of accuracy by down-staging did not prove useful.     

Interleukin 8 and granulocyte elastase α1 proteinase inhibitor complex in the tracheobronchial aspirate of infants with chronic lung disease following intra-uterine infection

In order to elucidate the role of interleukin 8 (IL-8) in the development of chronic lung disease (CLD) of neonates with intra-uterine infection, serial and simultaneous measurements of the concentration of IL-8 and granulocyte elastase α₁ proteinase inhibitor complex (E-α₁PI) in the tracheobronchial aspirate of low birth weight infants were conducted. Infants with a high serum IgM level at birth, and who subsequently developed CLD, showed significantly high concentrations of IL-8 and E-α₁PI in the first 48 h. It seemed that IL-8 stimulated neutrophils to release neutrophil enzymes which, in turn, caused the lung tissue injury, resulting in the development of CLD following intra-uterine infection.     

Granulocyte elastase α1-proteinase inhibitor complex measurement in very low birthweight infants with severe intraventricular hemorrhage

We investigated the relationship between the levels of granulocyte elastase α₁-proteinase inhibitor complex (E-α₁-PI) in plasma and severe intraventricular hemorrhage (IVH) in very low birthweight infants. The concentrations of E-α₁-PI and the ratio of the concentrations of E-α₁-PI to polymorphonuclear leucocyte counts within 24 h of birth in infants with severe IVH were significantly higher compared with those in infants without severe IVH. E-α₁-PI seems to be a useful indicator of IVH.     

Sarcoidosis induced by interferon therapy for chronic myelogenous leukaemia

A 31-year-old male was diagnosed as having chronic myelogenous leukaemia and has been treated with hydroxyurea and interferon-α since February 1995. After 16 months, he complained of low-grade fever and a cough. Bilateral hilar lymph node enlargement was detected on the chest X-ray film and multiple subcutaneous erythematous nodules appeared. A skin biopsy revealed subcutaneous sarcoid granuloma. Two months after the cessation of interferon therapy, the subcutaneous nodules and the hilar lymph node enlargement resolved. It is possible that continuous interferon administration can promote granuloma formation in sarcoidosis by activating T cells and macrophages.     

Carcinosarcoma of the Penis: A Case Report of Its Development after Radiotherapy

Carcinosarcoma is a rare disease and postirradiation sarcomais seldom seen in the urogenital organs. A case of penile tumor,which is thought to have consisted of recurrent cancer and postirradiationsarcoma, is described.     

Clinical Evaluation of Endoscopic Gastric Mucosal Resection

Abstract: Endoscopic gastric mucosal resection (EGMR), by which a large specimen can be obtained, has been developed for the diagnosis and treatment of the borderline lesion (B. L.) or early gastric cancer (EGC), since biopsy specimens obtained by conventional techniques are too small to make an accurate diagnosis in number of cases. Thirty-eight lesions in 35 cases (26 lesions in 23 cases with B. L. and 12 lesions in 12 cases with EGC) were resected for the purpose of treatment by EGMR, and 24 lesions (6 submucosal tumors, 3 B. L. s, 14 cases of EGC and 1 malignant lymphoma) for the purpose of diagnosis. By means of histological examination of the bite biopsy specimens following EGMR, twenty-three lesions in 26 cases (89%) with a B. L. and 8 in 12 cases (67%) with EGC for treatment by EGMR were found to have been completely resected. After further histological examination of EGMR specimens obtained for diagnosis, one out of 3 B. L. s was diagnosed as EGC (IIa) and the others as bengin lesions. Out of 14 EGC cases, 6 were diagnosed as carcinoma, 3 as B. L. s and 5 as benign lesions. In Group III lesions obtained by conventional endoscopic biopsy, 8 out of 40 lesions (20%) were defined as EGC, 28 lesions (70%) as a B. L. and 4 lesions (10%) as benign lesions respectively by means of histological examination of the EGMR specimens. Although obvious side effects were observed in 4 cases, these patients could be treated by endoscopic management or drug therapy. It can be concluded that EGMR, by which large specimens can be obtained, is a useful procedure for the purpose of diagnosing and treating gastric mucosal lesions without causing major risk.