[Home oxygen therapy (HOT) in patients with pulmonary tuberculosis sequelae--comparison between patients medically treated and those surgically treated].

In Japan there are about 40,000 patients under home oxygen therapy (HOT), of whom about 30 to 40% are pulmonary tuberculosis sequelae (TBS). These patients can be divided into three groups depending on the treatments they had, Group 1: those who had medical treatments only, Group 2: those who had artificial pneumothorax, and Group 3: those who had thoracoplasties or other surgical treatments. The purpose of this study was to observe the distributions and possible differences in the survival rates among these groups. The study included 1537 patients with TBS under HOT followed at National Hospitals and Sanatoriums nationwide in Japan. In 819 patients the treatments were specified and of those 354 were in Group 1, 29 in Group 2, and 436 in Group 3, so that the proportion of surgically treated patients in PTS was estimated between 28.4% (436/ 1537) to 53.2% (436/819). The ages at the onset of tuberculosis, at the start of HOT and the intervals in between were 36.6, 66.2 and 29.8 in Group 1, and 26.8, 65.5, and 38.1 in Group 3 respectively. Though the ages at the start of HOT were the same, those at the onset of tuberculosis were about ten years younger in Group 3 than in Group 1. Comparing Group 1 and 3, the survival rates after the initiation of HOT (Kaplan-Meier method) was better in Group 2 (surgically treated) than in Group 1 (medically treated). It is speculated that the reason could be a better preservation of the function of the remaining lung in the surgically treated and a higher incidence of obstructive impairments in the medically treated patients.

Heart valve replacement--a report of 8- to 17-year follow-up.

Forty-six heart valve prostheses were implanted in 37 patients from November 1974 to December 1982 at National Fukuoka Higashi Hospital. The patients consisted of 18 males and 19 females, with ages ranging from 14 to 66, mean 44.8 years. Bioprosthesis was used in 89.2% of the patients. There was no hospital death among the 30 single valve replacements, but one of the 7 patients receiving mitral and aortic double valve replacements died. The discharged survivors were followed up from a minimum of 8 to a maximum of 16 years (mean 9.3 years) with a cumulative follow-up period of 334.1 years with 100% completion. The actuarial survival rate at 13 years was 95 +/- 6% for mitral valve replacement (MVR), 71 +/- 17% for aortic valve replacement (AVR), and 58 +/- 19% for mitral and aortic double valve replacement (DVR), including 1 mitral and tricuspid valve replacement. This rate for overall cases was 40 +/- 29% at 17 years. Structural valve deterioration of the bioprosthesis occurred in 7 patients at the incidence of 2.4%/patient-year. The reoperation free percentage was 77 +/- 10% at 13 years in the Hancock porcine bioprosthesis (Hancock) group and 50 +/- 23% at 9 years in the Carpentier-Edwards porcine bioprosthesis (Carpentier-Edwards) group. Valve thrombosis was encountered in one case having Björk-Shiley aortic valve prosthesis with a linearized rate of 3.3%/patient-year in the group. A long-term follow-up study showed an increasing incidence of structural valve deterioration in the bioprosthesis group and thromboembolic complications in all types of prosthesis.

Long-term follow-up of cardiac rhythms after biatrial transseptal approach (Dubost's incision).

Biatrial transseptal approach (Dubost's incision) was performed 54 times on 47 patients from November 1973 to December 1982 at National Fukuoka Higashi Hospital in Japan. The patients consisted of 19 males and 28 females, with ages ranging from 14 to 66 (mean 45.9 years). Forty-four out of 47 cases had rheumatic heart disease while one had endocardial cushion defect, one had Lutembacher's syndrome, and one had left atrial myxoma. Preoperative electrocardiograph showed atrial fibrillation in 37 cases (78.7%) and normal sinus rhythm in 10 cases (21.3%). The follow-ups of the patients were a minimum of 8 years and a maximum of 16 years (mean 9.6 years) with 97.8% completion. Cumulative follow-up period was 448.9 patient years. Postoperatively, atrial fibrillation persisted in all except two. In those patients, normal sinus rhythm was observed until postoperative six months and seven years, respectively. Normal sinus rhythm persisted in six cases, and changed into junctional rhythm in four. One of them changed into atrial fibrillation at 10.6 years postoperatively. We conclude that Dubost's incision provides an excellent operative field for mitral and tricuspid valve surgery without serious internodal conduction disturbances.

Poorly differentiated adenocarcinoma of the rectum in a nephrotic patient with focal segmental glomerulosclerosis.

We report herein a case of poorly differentiated adenocarcinoma of the rectum occurring in a nephrotic patient with focal segmental glomerulosclerosis. The neoplasm which first appeared to be a submucosal tumor occurred in a 29-year old Japanese man with a nephrotic syndrome for 2 years and 6 months. Autopsy disclosed a large tumor located between the rectum and urinary bladder. Renal specimens showed changes consistent with focal segmental glomerulosclerosis.

Yellow nail syndrome associated with mental retardation in two siblings.

Two siblings with yellow nail syndrome and mental retardation are described. In addition to nail changes, the younger brother was found to have congenital lymphoedema and idiopathic pleural effusion, and the elder brother, lymphoedema praecox. They had in common a history of respiratory tract infections. Their intelligence quotient as measured by the Suzuki-Binet tests was 30% and 70%, respectively.