The use of chitin as a new absorbable suture material--an experimental study.

A comparative study of four absorbable suture materials, namely; poly-N-acetylglucosamine (Chitin), polyglycolic acid (PGA), plain catgut and chromic catgut, in terms of strength, elongation, tensile strength retention and tissue reaction, was undertaken. The straight pull strength of USP 3-0 size Chitin was over 2.6 kg, compared with PGA, which was over 3.4 kg and the catguts, which were over 2.0 kg. Chitin showed the lowest elongation among the four. The tensile strength retention (TSR) of Chitin in muscle was 45 per cent at 14 days and 7 per cent at 25 days, which was similar to that of PGA. The TSR of Chitin was maintained by 35 per cent in gastric juice, 97 per cent in bile and 100 per cent in pancreatic juice after immersion for 30 days. The corresponding values for PGA were 54 per cent, 0 per cent and 0 per cent, respectively, whereas both catguts had dissolved within 30 days. The tissue reaction of Chitin was similar to that of PGA, whereas the catguts caused more intense tissue reaction.

A laterally rotating surgical device attached to the operating table.

A laterally rotating surgical device that can be attached to conventional operating tables is described. The position of the patient can be safely and rapidly changed from a supine to a right or left lateral position of 60 degrees. This device is beneficial for performing operations using a thoracoabdominal approach such as is used in cases of resection of gastroesophageal cancer.

[Clinical studies on excretion in biliary tract with the antibiotic cefotiam].

Cefotiam (CTM) was administered through 1 hour intravenous drip infusion for the patients performed biliary tract surgery. The concentration of CTM in serum, gallbladder tissue and the excretion in bile of the choledochus were measured. Twenty-one patients performed cholecystectomy were followed the concentration of CTM in the gallbladder tissue and the results were studied with pharmacokinetic analysis. The simulation curve, which was described by computer system in two-compartment open model, showed the maximal concentration of CTM in the serum was 60.3 micrograms/ml at 1 hour after infusion and that in the gallbladder tissue was 27.1 micrograms/g at 1.07 hours. The concentration of CTM in the gallbladder tissue was presumed to be in proportion to that of CTM in the serum. Six patients performed bile drainage were followed the concentration of CTM in bile of the choledochus for 6 hours after infusion. The maximal concentration was 215.2 +/- 62.7 micrograms/ml at 3 hours after injection, and the mean biliary recovery was 1.66 +/- 0.55% through 6 hours. Neither any side effects nor any abnormal values in the laboratory analysis of samples were observed for CTM.

[Early esophageal cancer concomitant with leiomyoma of the esophagus--a case report].

Benign esophageal tumors concomitant with esophageal cancer are sometimes observed, however, it is rare that esophageal cancer is associated at the surface of the leiomyoma as a submucosal tumor. We report a 59-year-old man with a polypoid esophageal cancer. The polypoid tumor, 0.6 X 0.7 X 1.3 cm in size, was removed in 1976; histological findings showed that a large amount of the tumor was leiomyoma and that squamous cell cancer was associated at the surface of the leiomyoma. After polypectomy, he experienced recurrence and radical surgery was performed in 1981; histologically, the resected specimen showed early esophageal cancer.

Adjuvant long-term immunochemotherapy for squamous cell carcinoma of the thoracic esophagus.

Between 1965 and 1978, 131 patients with primary squamous cell carcinoma of the thoracic esophagus underwent subtotal esophagectomy. Since 1972 we hae used active therapy involving pre- and postoperative irradiation and postoperative long-term cancer immunochemotherapy. When the surgical results of the active therapy and the historical control group, in which postoperative radiotherapy was used primarily, were compared, active therapy appeared to be high effective. The one, two, and three-year survival rates were 54.7, 36.3, and 27.1 per cent, respectively, in the former, and 32, 14, and 12 12 per cent, respectively, in the latter group. With respect to noncurative cases, the one-year survival rate was 42.2 per cent in the active therapy group, and 20 per cent in the control group.

A safer and more reliable operative technique for esophageal reconstruction using a gastric tube.

A safer and more reliable method of esophageal reconstruction, using a gastric tube, is described. Th procedure to create an elongated gastric tube involves separate cutting of the seromuscular and mucosal layer along the line extending parallel to and 4 cm from the greater curvature of the stomach. The end of the cervical esophagus is anastomosed to the posterior wall of the gastric tube in end-to-side fashion. In addition, circumferential cutting of the seromuscular layer of the gastric tube about 5 cm from the anastomotic line is performed to avoid tension resulting from postoperative shrinkage of the gastric tube due to muscle contraction. Combination of these methods resulted in compete elimination of anastomotic leakage.

Lymphangioma of the esophagus presenting symptoms of achalasia--a case report.

A case of lymphangioma of the esophagus with symptoms of achalasia was presented. Compressible and folded intramural tumors were found from the middle to the lower part of the esophagus and the Mecholyl test was positive. After incisional biopsy at lower esophagus through full thickness of the wall, the opening was repaired with Thal-Hatafuku's fundic patch procedures to relieve achalasia. Postoperative course was uneventful and symptoms of achalasia completely disappeared.

An alternative one layer inverting suture technique for intestinal anastomosis.

An alternative method of anastomosis using a suture one layer inverting was proposed in which the sutures are placed the serosa, proper muscle layer, submucosal layer and muscularis mucosae, but not mucosa. An experimental study using canine intestine revealed that tensile strength as well as bursting pressure at the anastomotic site is significantly superior in our method to the end-on method.

The effect of cartilage-bone marrow extract (CBME) on the healing of intestinal anastomosis.

The intestinal anastomosis made under various conditions with and without treatment with cartilage-bone marrow extract were compared. The preoperative or postoperative administration of cartilage-bone marrow extract was found to increase mechanical strength of the intestinal anastomosis, even under unfavorable conditions such as hypoproteinemia, long term treatment of corticoid or reanastomosis. Formation of connective tissue and healing process were also found to be promoted by cartilage-bone marrow extract treatment.

Use of free peritoneal patch in reenforcing alimentary tract anastomosis.

The use of free peritoneal patch was evaluated for the effect on protection against intestinal anastomotic leakage in dogs. Free peritoneal patch was found to be effective in preventing the anastomotic leakage of the alimentary tract in borderline situation. Free peritoneal patch was more effective when applied with the 'smooth side out' than with the "smooth side in'. The usefulness of free peritoneal patch was also demonstrated in the treatment of the already established fistula of the cervical esophagus.