Chronological Endoscopic and Pathological Observations in Russell Body Duodenitis

A 64-year-old man was found to have a nodule in his right lung. He also complained of nausea and abdominal pain during the clinical course. Esophagogastroduodenoscopy revealed a duodenal ulcer associated with severe stenosis and a suspicion of malignancy. However, three subsequent biopsies revealed no evidence of malignancy. The fourth biopsy showed scattered large eosinophilic cells with an eccentric nucleus, leading to a diagnosis of Russell body duodenitis (RBD). RBD is an extremely rare disease, and little is known about its etiology and clinical course. The pathogenesis of RBD is discussed based on our experience with this case.

Blood Conservation in Open-Heart Surgery. Avoiding Predonated Autologous Blood / 日本心臓血管外科学会雑誌

Background: Operative blood loss during open-heart surgery has been decreasing recently. We have stopped predonated autologous blood transfusions to reduce hospital stay and cost. Material and methods: In 70 consecutive elective open-heart cases, we used intraoperative hemodilutional autologous transfusions and intraoperative autotransfusions to avoid homologous blood transfusion. Predonated autologous blood transfusion was not used. All patients received an infusion of high-dose tranexamic acid prior to and after cardiopulmonary bypass (CPB). Results: Homologous blood transfusion was not required in 77.1% of patients who underwent open-heart surgery. When further classified, 84.5% of patients who underwent primary open-heart surgery, 41.7% of patients who underwent a reoperation, and 33.3% of patients who were preoperatively anemic did not require homologous blood transfusion. In patients who undergo reoperation and who are preoperatively anemic, the rate of homologous blood transfusion is high. Therefore, during the reoperation, intraoperative autologous blood transfusion should be used before starting CPB, and iron should be given to anemic patients prior to reoperation. Conclusion: Our strategy of blood conservation consists of intraoperative hemodilutional autologous transfusion, intraoperative autotransfusion, infusion of high-dose tranexamic acid prior to and after CPB and, avoiding predonated autologous blood transfusion. Based on our experience, predonated autologous blood transfusion is usually unnecessary for cases who undergo surgery for the first time and are not anemic. Predonated autologous blood transfusion should be reserved only for high risk patients with anemia and reoperation cases. For further blood conservation, we need to study the safety limits of non-transfusion in open-heart surgery.

Surgical Treatment of Aortic Stenosis in Patients Aged 70 Years and Older / 日本心臓血管外科学会雑誌

<i>Background</i>. In recent years, aortic valve stenosis in the elderly is increasing. To determine the treatment of aortic stenosis in the elderly, we retrospectively evaluated the patients who underwent aortic valve replacement. <i>Method</i>. Between 1992 and 1997, 22 patients older than 70 years underwent aortic valve replacement for aortic stenosis. There were 15 women and 7 men, with a mean age of 73.0±4.0 years. Seven patients underwent concomitant procedures: 5 patients required coronary artery bypass grafts, 1 mitral valve plasty and 1 aortic root plasty. SJM prosthetic valves of sizes 19mm, 21mm and 23mm were used in 11, 8 and 3 patients respectively. Nobody underwent aortic annuloenlargement. Three patients underwent supraannular aortic valve replacement. All patients had New York Heart Association (NYHA) class III or IV symptoms. <i>Results</i>. There was no operative or hospital death. Five patients had atrial fibrillation after operation. There was only one late death, due to a traffic accident, and there was no significant complication during the follow up period. Of the 22, 21 patients improved to NYHA class I or II after operation. There were significant differences between patients who were 70 years or more and those under 70. BSA in these two groups were 1.495 and 1.615m²; <i>p</i><0.01, and the amounts of blood transfusion were 918±702 and 408±428ml, <i>p</i><0.01. However, there was no significant difference between these two groups in terms of ACC time (56.8 and 59.9min), CPB time (88.7 and 92.1min), ICU stay (4.0 and 3.3 days) and hospital stay (29.5 and 25.5 days). <i>Conclusion</i>. The results of aortic valve replacement in patients aged 70 years or more, were satisfactory. If the aortic annulus being small, a small mechanical valve prosthesis is suitable, and supraannular positioning yielded good results.

INFLUENCE OF ENVIRONMENTAL FACTORS ON MATERNAL AND CHILD HEALTH (No.1) / 日本農村医学会雑誌

I. We made a factoranalytical research of these indicators by Thurstone's centroid method and extracted five common factors.<BR>II. We calculated the Z-scores (I) of the above 12 variables which were closely related with five common factors and the Z-scores (II) of the another 10 variables by prefectures which were live birth rate, premature infant birth rate, live birth rate by hospitalization, infant mortality rate, neo-natal mortality rate, α-index, artifical foetal death rate, etc., and computed the cofficient of correlation between the Z-scores (I) and the Z-scores (II), and investigated the influence of environmental factors on mate rnaland child health.

INFLUENCE OF ENVIRONMENTAL FACTORS ON MATERNAL AND CHILD HEALTH (NO.2) / 日本農村医学会雑誌

I. We made a factoranalytical research of these indicators by Thurstone's centroid method and extracted four common factors.<BR>II. We calculated the Z-scores (I) of the above 19 variables which were closely related with four common factors and the Z-scores (II) of the another 5 variables by urban and rural which were live birth rate, premature infant birth rate, infant mortality rate, α-index and maternal death rate, and computed the cofficient of correlation between the Z-scores (I) and the Z-scores (II), and investigated the influence of environmental factors on maternal and child health.