ABSTRACT
We experienced 2 rare cases of acute myocardial infarction (AMI) complicated by ventricular septal perforation (VSP) and right ventricular free wall rupture. Case 1 was a 70-year-old woman who developed VSP and cardiac rupture after percutaneous coronary artery thrombolytic therapy for AMI (total occlusion of left anterior descending branch (LAD) # 6) and died of cardiac tamponade. Postmortem examination showed right ventricular free wall rupture. Case 2 was a 76-year-old woman. She developed VSP 6 days after percutaneous coronary artery intervention (stenting) for AMI (total occlusion of LAD # 8). VSP was closed by the double patch repair technique. During operation, right ventricular free wall rupture (oozing type) was found, so hemostasis with fibrinogen was added. She was discharged in a satisfactory condition 4 weeks after surgery. Right ventricular rupture after AMI of the LAD region is rare. VSP may be associated with right ventricular free wall rupture complicated by AMI of LAD region because all of our cases were accompanied by VSP.
ABSTRACT
Methylprednisolone (MP) has anti-inflammatory properties. We evaluated the influence of MP on systemic inflammatory response syndrome (SIRS) in a conventional coronary artery bypass grafting (CABG) operation. We compared three groups: (1) the HD-MP group (high-dose MP group): injecting 30mg/kg MP before extracorporeal circulation, (2) the LD-MP group (low-dose MP group): injecting 5mg/kg MP, (3) the N-MP group (non-MP group): no MP injected. Postoperative SIRS duration was shorter in the HD-MP and LD-MP groups than in the N-MP group, although low-dose MP had a shortening effect on the duration of SIRS. Interleukin 6 (IL-6) and interleukin 8 (IL-8) showed lower values in the HD-MP and LD-MP groups than in the N-MP group, although low-dose MP had an inhibitory effect on the production of interleukin. However, there were no differences between the three groups in the organ protective action of MP, such as total dose of catecholamine (as an index of cardiac dysfunction), intubation period (pulmonary dysfunction), GPT/D-Bil abnormality (liver dysfunction), or BUN/Cr abnormality (renal dysfunction). The maximum value of the postoperative white blood cell count showed a higher value in the HD-MP group than in the N-MP group. In conclusion, the usage of low dose (5mg/kg) MP in a conventional CABG operation is able to shorten SIRS duration and inhibit the production of IL-6 and IL-8 without increasing the risk of infection.
ABSTRACT
Clinical cases of normothermic extracorporeal circulation (ECC) are increasing, but the possibility of brain damage is not clear.In emergencies, the brain protective effects of mild (33-34°C) hypothermic therapy have been clearly confirmed. Natural Temperature decrease ECC was conducted in this study, hoping to obtain the advantages of both normothermic ECC and brain protection by mild hypothermia. These were 12 cases at high risk of brain damage (10 cases of brain infarction and 2 cases of severe carotid artery stenosis). In all cases, coronary artery bypass grafting operation with natural temperature decrease ECC was performed. The average laryngeal temperature dropped to 33.0±0.3°C. There was no brain infarction or ICU syndrome. Evaluation of post-operative brain condition by the patients themselves and their families was good. The possibility of natural temperature decrease ECC for high risk cases of brain damage was demonstrated.
ABSTRACT
We report a rare case of surgical repair of an aneurysm of the membranous septum and mitral valvoplasty. A 57-year-old man suffered from an aneurysm of the membranous septum and mitral regurgitation. We resected the aneurysm completely, closed the defect with a patch in order to prevent further enlargement and consequent complications, and performed mitral valvoplasty using a flexible Duran ring. A postoperative cardiac catheterization indicated that there was no aneurysm of the membranous septum, ventricular septal defect or mitral regurgitation.
ABSTRACT
A clinical study was made on a total of 478 stomach cancer cases that had been subjected to surgery during the 12-year period from 1978 to 1989. Of the total, 34.1% were accounted for by the patients aged 70 years and above. Those old patients were divided into the two groups-those in their 70s and those in their 80s and above. The clinical cases of the two aged groups were studied in comparison with the cases of the patients aged 69 and below (65.9%). The number of early stomach cancer cases was smallest in the 70s age group. However, in this age group, advanced cancer was largest in number, metastases to lymph nodes, peritonea, and the liver were observed in many cases, and the curative resection rate was low. In the age group of 80 and above, either early cancer or advanced cancer was large in number. Apparently moderation was exercised in performing surgerical operations on the persons of advanced age. It was found that R2 lymph node dissection had been confined to 68.4% of the patients aged 80 and above, but that the curative resection rate was highest with 84.2% probably because limited lymph node metastasis. In this age group, a majority of cancers occurred at the antral region. A tendency was observed that cancer occurs less at the lesser curvature and on the posterior wall of the stomach and much more freqently at the greater curvature and on the anterior wall. Histologically, the tumor cells were mostly of a highly differentiated, localized type. Although high risk is involved in surgery in the elderly patients, many cases of stomach cancer are operable. So, it would be worth physicians' intention to risk operations while taking precautions against postoperative complications, with a view to improving the cure rate and helping the patients to upgrade the quality of life in their remining years.
ABSTRACT
Study was made on total of 304 cases of cancer of the large intestine resected during the period of 12 years from 1978 to 1989.<BR>Colon cancer accounted for 56.8% of the total and rectal cancer 43.2%. There were no sexual differences. Those people aged 50 and older represented 86.0% of the total number of the cases. By age group, those in their 60s topped the list with 27.3%, followed by those in 70s with 24.4%. Almost all the cases (95.1%) were of the patients who had visited the hospital, having noticed symptoms themselves. A very few cases were detected among the people without subjective symptoms when they received group medical Checkups.<BR>By region, 39.4% of the colon cancer cases were found in S, followed by A. In the cases of rectum cancer, Rb accounted for 50.7%. Of the total caces, 74.5% had cancer on the left side of the large intestine.<BR>Resection rate was 91.5%. The rate of resection leading to cure was 71.8%. Broken down by histological staging, stage I came to 11.7%; stage II, 30.9%; stage III, 21.8%; stage IV, 11.7%; stage V, 23.8%.<BR>The 5-year-survival rete averaged 57.1%. In pre-surgery tests, the positive rate of CEA was as low as 46.6%. The positive rate for early cancer was extremely low. Measurement of CEA levels as an auxiliary diagnosis, therefore, did not prove itself to be useful in searching for cancer.
ABSTRACT
A total of 478 resected gastric cancer cases were studied. The male-female ratio was 1.6, -294 males and 184 females. The patients were divided into two groups, namely, the elderly group (patients aged 70 and over) and the non-elderly group (patients aged 69 and below). In the elderly group males were predominant over females. The number of elderly patients accounted for 34.1% of the total number of stomach cancer cases. This percentage is higher than the national average. In the elderly group, cases detected by stomach health screening or health diagnosis tests were a few, but many cases were in stage IV. The number of inoperable cases was somewhat high, radical gastrectomy was performed on a few of the patients, and the resection rate was somewhat low. A tendency was observed for multiple cancer focuses ; in regard to the regions of occupation or spreading and tissue type, the upper region was less likely and the lower region was more likely to be affected, the anterior wall and the circle were likely to be affected. A tendency was observed for the localization of highly differentiated tissue in the patients. Although no difference was observed in the direct surgical mortality rate, the 5 year survival rate was unfavorable, suggesting the patients might have died due to other diseases. In the elderly group, those who suffered from diseases and preoperative complications comprised 92% of the total, and abnormalities during preoperative examinations were detected in 96% of these patients. Postoperative complications developed in 42%. Postoperatively, psychological problems must be taken into consideration. In elderly patients who are operable, although it is desirable to actively perform surgery aiming at radical operations, it is thought necessary to cope carefully with resection of the stomach. If a radical operation is performed after carefully evaluating preoperative risks and with adequate preparations, it is thought possible for elderly patients to achieve favorable therapeutic results and improvement in their QOL differing little from non-elderly patients.