[Lung laceration caused by penetrating chest wall injury in Hanshin & Awaji earthquake: a case report].

A 36-year-old man having a left lower lobe laceration caused by penetrating chest wall injury was operated on 5 hours after Hanshin & Awaji Earthquake. At thoracotomy, significant destruction of the left lower lobe was observed. Therefore, we gave up repairing a lung, and performed left lower lobectomy, with a satisfactory outcome. Our hospital is located on 30 km south of seismic center, but the function of our hospital was not completely paralyzed. In Awaji island, emergent treatments were done satisfactorily.

[Nineteen multiple primary cancer cases of 100 patients undergoing lung cancer resection].

In our department, half of 100 consecutive lung cancer resection cases were over the age of 70 years. In the same 100 patients, nineteen cases had multiple primary cancers. Sixteen cases had double, two cases had triple, one case had quadruple primary cancers. The incidence rate of multiple primary cancers involving the lung was 19%. This incidence of 19% is higher than the others ever reported in Japan. It was concluded, when lung cancer patients were elder, that there was increasment in the frequency of multiple cancer cases involving lung, and there was a high possibility of the occurrence of 2nd and 3rd primary cancers.

Beneficial circulatory support by left heart bypass with a centrifugal (BioMedicus) pump for aneurysms of the descending thoracic aorta.

A comparative study between left heart bypass with a centrifugal (BioMedicus) pump and with a temporary external shunt was performed to assess the efficacy of distal organ perfusion in the surgical treatment of 31 patients with aneurysm of the descending thoracic aorta. Eighteen patients were supported with a centrifugal pump, and the remaining 13 were supported by temporary shunt with either a Gott shunt or a Dacron graft. Heparinless bypass with a centrifugal pump provided a significant decrease of intraoperative blood loss and blood transfusion by the combined application of Cell-Saver. The pressure difference between upper and lower extremities decreased (p < 0.05) in the centrifugal pump group even with aortic cross-clamping, and the urine output increased during operation. Among 13 patients supported with the temporary shunt, 3 had postoperative renal failure, and 2 died of it. All patients with a centrifugal pump survived without any complications. It could be concluded that the left heart bypass with a centrifugal (BioMedicus) pump was safe and was favorable for support of the distal circulation during aortic cross-clamping and to prevent ischemic complications such as renal failure and spinal cord injury.

[Effects of oxygenation and/or SOD on addition to St. Thomas' Hospital cardioplegic solution].

The effects of oxygenation (95% O2 + 5% CO2) and/or SOD (400 mg/l) on addition to St. Thomas' Hospital cardioplegic solution were examined by hemodynamic, cytochemical and biophysical assessments in the isolated working rat heart subjected to hypothermic ischemic arrest (22 degrees C in temperature, 180 min in ischemic time) with multidose cardioplegic infusion. According to the feature of used cardioplegic solution, thirty-two rats were divided into four groups (8 animals per group): That is, Group I; O2 (+) SOD (+), Group II; O2 (-) SOD (+), Group III; O2 (+) SOD (-), Group IV (control); O2 (-), SOD (-). Aortic flow (AF) recovery, expressed as a percent of pre-arrest AF, was 76.7 +/- 11.7% in Group I, 66.9 +/- 7.1% in Group II, 73.9 +/- 11.6% in Group III and 57.7 +/- 12.9% in Group IV (mean +/- SD). Differences in recovery between Group I vs III and Group III vs IV approached statistically significance (respectively, p < 0.01, p < 0.05). The birefringence ratio (ATP value/air value) of the biopsy specimen was 2.49 +/- 0.53 in Group I, 1.96 +/- 0.44 in Group II, 2.04 +/- 0.29 in Group III and 1.65 +/- 0.39 in Group IV (mean +/- SD). Difference between Group I and Group IV indicated statistically significance (p < 0.05). The birefringence ratio (X) had good correlation with the AF recovery ratio (Y): Y = 29.7 + 19.1X (R = 0.74). No statistical difference was seen from cytochemical assessment (myosin ATPase stain) in four groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Closure of patent ductus arteriosus in elderly cases].

A technique for closure of patent ductus arteriosus in the elderly cases is described. We have operated on eleven adult cases of patent ductus arteriosus cases in 10 years. In five cases cardiopulmonary bypass used and in the other six cases it was not used. The cardiopulmonary bypass was used especially for the patients with pulmonary hypertension (pulmonary artery mean pressure greater than 40 mmHg), or high aged (older than 40 years) patients. No operative death have occurred in both groups, and no complication from air embolism or hemorrhage have been encountered. The technique embodies the profound hypothermia, low flow, and direct suture of the pulmonary end of the ductus arterious through a pulmonary arteriotomy. The ductus has been obstructed by using a Hegar's dilator before core cooling was started. Hegar's dilator is useful for establishing profound hypothermia and satisfactory visualization of the operative field.