[Surgical stabilization of multiple rib fractures successfully achieved with the use of long metalic plates].

Surgical stabilization of multiple rib fractures in 5 male patients was successfully achieved with the use of orthopedic A-O metalic plates, which are called reconstruction plates. In each patient, we prevented deformity of the rib cage and flail chest which frequently occurs after multiple rib fractures. Three of these patients received emergency operations because of severe hemopneumothorax and flail chest due to crushing injuries to the chest. They were treated by the standard thoracotomy, hemostasis of intrapleural bleeding, and stabilization of fractured ribs with reconstruction plates, in addition two of the patients underwent a single lobectomy to control the pulmonary hemorrhage. Another two patients were treated with mechanical ventilation and closed-tube thoracotomy following the chest trauma because their thoracic bleeding from drainage tubes was tolerable. But flail chest and respiratory insufficiency did not improve, in spite of positive controlled ventilation as a mode of internal pneumatic stabilization. Then surgical stabilization of the fractured ribs with these plates was carried out ten to twelve days after the accidents in each case. All patients tolerated the surgical procedures well and were successfully removed from the respirator, demonstrating complete stability of the chest wall. The long metal reconstruction plates with many perforations were very useful for the external fixation of segmentary fractured ribs as an external brace. This was because they were long enough to cover the whole length of the fractured ribs and moderately soft enough to be appropriately bent or twisted by hand at the time of operation. Moreover a number of holes in it allowed the suture to pass through the plate and rib, avoiding displacement of the prosthesis. This is the first report which describes the usefulness of orthopedic reconstruction plates for the stabilization of multiple rib fractures.

[Wide resection and reconstruction of chest wall: usefulness of A-O metal plate].

A 53-year-old male was admitted to our department with a chest tumor due to infiltration of lung cancer. Right upper lobectomy and a wide en bloc excision of the right upper chest wall were performed, including the 2nd, 3rd, 4th, and 5th ribs with upper lobectomy of right lung. The defect was replaced with three A-O metal plates, which joined both stumps of the ribs, from the third to the fifth rib. These metal plates were very useful because it was easy to bent and twist them to fit the defect in operation. And curved metal plates preserved a cone from of chest cage. Postoperative course was favourable without mechanical ventilation and wound infection.

[A case report of thymic carcinoid].

A 71-year-old man was admitted to our hospital because of abnormal shadow on the chest X-ray. CT scan showed two tumor masses in the anterior superior mediastinum. The operation was performed through median sternotomy. Two masses, 2.5 x 2.5 x 2.0 cm and 1. x 3.0 x 2.5 cm in size, were found to arise from the right lobe of the thymus. Total thymectomy including resection of the right pleura was performed, and mediastinal lymph nodes were dissected. The pathological diagnosis was thymic carcinoid with metastasis to the anterior mediastinal lymph node. The patient underwent postoperative radiation therapy of total dosage of 50 Gy, and had no evidence of recurrence one year after operation.

[Hemodynamic effects of Amrinone in patients following open heart surgery].

The hemodynamic effects of amrinone, a phosphodiesterase III inhibitor, were studied early after cardiac surgery in 10 patients. CI, SVI and SWI increased significantly. SAP, mPCWP, TSVR and PVR decreased significantly. DO2 and VO2 increased significantly. HR and DP were not affected. These data demonstrate that amrinone is a valuable inotropic agent with vasodilating effect for the early post-operative management of cardiac surgical patients, since it augments left ventricular performance without increase of myocardial oxygen consumption and induction of arrhythmia.

Nicotinamide, a poly (ADP-ribose) synthetase inhibitor, ameliorates B-cell function in partially depancreatized rats.

We studied the effect of nicotinamide, a poly (ADP-ribose) synthetase inhibitor, on B-cell functions in 7-week-old male Wistar rats after 90% pancreatectomy (Px). Nicotinamide (0.5 g/kg body wt.) was injected once a day i.p. from 1 week before the surgery, and the injection was continued for 12 weeks after Px. Plasma glucose levels were significantly lower in Px rats treated with nicotinamide (NA rats) than in Px rats without treatment. In in vitro experiments with perfusion of the isolated pancreas, insulin secretion induced by 16.7 mM glucose was blunted in Px rats whereas insulin secretion induced by 19 mM arginine was increased. Nicotinamide treatment restored glucose-induced insulin secretion to normal and partly suppressed the hyperresponse of insulin to arginine. In addition, nicotinamide partially restored the priming effect induced by 28 mM glucose. The insulin content of the perfused pancreas was slightly but significantly greater in NA rats than in Px rats. Histological examination revealed fibrotic degeneration and degranulation in the islets of Px rats, whereas the normal structure was retained in most islets of NA rats. These results suggest that nicotinamide ameliorates islet function in partially depancreatized rats.

Heterotopic autotransplantation of a pancreas segment with enteric drainage after total or subtotal pancreatectomy for chronic pancreatitis.

Four patients with chronic alcoholic pancreatitis and one patient with idiopathic chronic pancreatitis, who had total or subtotal distal pancreatectomies for persistent pain, underwent simultaneous autotransplantation of a pancreas segment to preserve the pancreatic function. The segment was autotransplanted heterotopically to the iliac fossa with anastomosis of the splenic vessels to the iliac vessels to prevent reinnervation, and the pancreatic duct was anastomosed to the intestine to preserve exocrine function. Postoperatively, the patency of the graft vessels was confirmed by angiography in every patient. Complete pain relief has been obtained in all patients with a followup duration of 4-89 mo. Except for one patient who had been treated preoperatively with insulin injections for diabetes, the patients remained normoglycemic without exogenous insulin administration and demonstrated satisfactory insulin secretion during a 75-g oral glucose tolerance test. An exocrine pancreatic diagnostant test using p-aminobenzoic acid yielded nearly similar levels to the preoperative value for all patients. Heterotopic autotransplantation of the pancreas segment appears to be effective for preserving pancreatic function, as well as providing permanent pain relief for patients with chronic pancreatitis who require extensive resection of the pancreas.

Effects of reserpine on the content and uptake of dopamine and noradrenaline in rabbit arteries.

1. Change with time of the content and uptake of dopamine (DA) and noradrenaline (NA) in the renal, superior mesenteric and femoral arteries and abdominal aorta of rabbit after reserpine administration was examined. Endogenous DA and NA were measured by high performance liquid chromatography coupled with electrochemical detector. 2. A single dose of reserpine (3 mg/kg, i.p.) maximally depleted the endogenous DA and NA contents in the four blood vessels 24 h after the administration; the ratios of reductions were 70-90% and approximately 90% of the normal levels, respectively. The DA contents in all four vessels recovered to the normal level within 4 days after reserpine. However, NA content did not recover to the normal levels within 30 days after reserpine except in the mesenteric artery. 3. The activity of dopamine beta-hydroxylase (DBH) significantly increased in all four blood vessels 1 h after reserpine. Although the DBH activity returned to the normal level after 3 days in the mesenteric artery, it returned within 24 h in the other three vessels. 4. [3H]-Dopamine and [3H]-NA uptake were almost completely depressed 1 h after reserpine. The [3H]-NA uptake in four vessels recovered to the normal level 2-14 days after reserpine, and [3H]-DA uptake recovered after 30-45 days. Thus, the endogenous DA content in blood vessels was completely restored although DA uptake and NA content were still affected. 5. These results suggested that the recovery of stored DA after reserpine was faster than that of stored NA and the recovery of DA uptake after reserpine was slower than NA uptake.(ABSTRACT TRUNCATED AT 250 WORDS)

Heterotopic autotransplantation of the pancreas segment after pylorus-preserving total pancreatectomy: a case report of successful surgical treatment for chronic pancreatitis.

A 38-year-old man who had suffered for 5 years from persistent abdominal pain caused by alcoholic chronic pancreatitis, presented with diffuse calcification of the entire pancreas with cystic formation of the pancreatic head. After a pylorus-preserving total pancreatectomy, the pancreatic head, including the cyst, was removed extracorporeally by bench surgery, and the remaining segment of the body and tail autotransplanted heterotopically to the iliac vessels with a pancreaticojejunostomy. Total resolution of the pain was achieved postoperatively, and dietary intake has been satisfactory. Both endocrine and exocrine pancreatic functions have been well preserved, and no insulin has been needed. Three months after his operation, the patient has returned to leading a normal life.

[Effects of oxygen free radicals on cell growth and productions of alpha-fetoprotein (AFP) and albumin (ALB) by human hepatoma cell line (HH2-6)].

Secreting and producing capacities of alpha-fetoprotein (AFP) and albumin (ALB) by human hepatoma cell line (HH2-6) exposed to oxygen free radicals generated by dihydroxyfumarate (DHF) were studied in vitro. It was found that cell number were declined in proportion to DHF concentrations for 48 hrs culture and cell proliferations were inhibited by DHF in growth curve. The amount of AFP secreted per cell (secreting capacity) was decreased at high concentration of DHF (50 micrograms/ml) for 48 hrs culture, and remarkable elevation of AFP-secreting capacity for growth stage was inhibited even by DHF (10 micrograms/ml). On the other hand, ALB-secreting capacity was not affected with DHF. Producing capacities of AFP and ALB were correlated with secreting capacities. Cu, Zn-superoxide dismutase (Cu, Zn-SOD) interfered these reactions. These results suggest that oxygen free radicals inhibit cell proliferations and suppress AFP-secreting and producing capacities of HH2-6 cells selectively.

Endothelium-dependent and -independent relaxation by dopamine in the rabbit pulmonary artery.

1. The relaxing response of dopamine (DA) was studied in the rabbit pulmonary artery. DA caused concentration-related relaxation in helically cut strips of the artery contracted with prostaglandin F2 alpha in the presence of prazosin. 2. The DA-induced relaxation in endothelium-denuded strips was reduced to about 40% compared with that in endothelium-intact strips. 3. Methylene blue and haemoglobin, inhibitors of endothelium-dependent relaxation, reduced the DA-induced relaxations in endothelium-intact strips to the level of endothelium-denuded strips. These results indicate that the DA-induced relaxation is partially mediated or modified by the release of endothelium-derived relaxing factor (EDRF). 4. Apomorphine, as a DA agonist, caused concentration-dependent relaxation in endothelium-intact strips. Bromocriptine, a DA2 agonist, produced only a little relaxation at higher concentration. 5. In endothelium-intact strips, haloperidol, a DA antagonist, and the DA1 antagonists, fluphenazine and SCH 23390 inhibited DA-induced relaxations. On the other hand spiperone and domperidone, DA2 antagonists, were inactive. 6. In endothelium-denuded strips, fluphenazine and SCH 23390 inhibited DA-induced relaxations, but domperidone was inactive. 7. These results indicate that the DA-induced relaxation is mediated by DA receptors, and that DA1 receptors are involved in both endothelium-dependent and -independent relaxation in the rabbit pulmonary artery.

[Effects of pH on the formation and dissociation of the complex of trypsin and PSTI].

The effects of pH on the formation and dissociation of the complex of trypsin and PSTI was investigated using pancreatic juice of two patients. Pancreatic juice was eluted from a Sephadex G100 column with the buffer in different pH values, and the trypsin inhibitory activity in the eluate was measured. Under alkaline and neutral conditions, the complex of PSTI and trypsin was observed, while in acidic condition, dissociation of the complex was occurred. Molar ratio of PSTI and trypsin in the complex was found to be one mole/one mole. Human serum, alpha 1-antitrypsin, and alpha 2-macroglobulin dissociated the complex of PSTI and trypsin.

Heterotopic autotransplantation of the distal pancreas segment after total pancreatectomy for cancer of the head of the pancreas.

Autotransplantation of the distal pancreas segment with pancreaticojejunostomy was performed in four patients with cancer of the head of the pancreas to preserve endocrine pancreatic function after extended total pancreatectomy. All patients had tumor involvement of both the celiac axis and the portal vein. The pancreatic graft was determined to be cancer-free by frozen section histologic and pancreatic juice cytologic examinations. The distal pancreas segment was autotransplanted to the iliac vessels heterotopically and placed in the extraperitoneal pocket to avoid untoward effects of any local recurrence or pancreatic leakage. This procedure, in the form of reconstruction, might be called modified subtotal pancreatoduodenectomy. Postoperatively, all patients remained normoglycemic without exogenous insulin administration, and their quality of life was considered satisfactory.

Unruptured aneurysm of the right coronary cusp.

A 44-year-old man with an unruptured aneurysm originating from the right coronary cusp is reported. The patient was asymptomatic and a heart murmur and abnormal electrocardiogram were discovered incidentally. Echocardiography and aortography showed an unruptured aneurysm of the right coronary cusp. Surgical correction was successful using a Dacron patch and aneurysmal wall.

[Two successful cases of paraesophageal bronchogenic cysts].

Paraesophageal bronchogenic cyst is a rare disease. Only 24 cases have been previously reported in Japan. Recently, we experienced two successful cases of this disease. Two cases (64-year-old man and 31-year-old man) were both asymptomatic and pointed out by chance on the chest X-ray at the left posterior mediastinum. The second case was an intramural esophageal cyst. Microscopic examination showed the typical findings of the bronchogenic cyst, as the inner wall of the cyst was covered with ciliated columnar epithelium and the wall consisted of cartilage, mucous glands and smooth muscle. Both postoperative courses were uneventful. Resection was recommended because of the symptoms due to the compression of the cyst and the possibility of malignancy.

Surgical treatment of a huge hepatic artery aneurysm--a case report.

A debilitated 68 year old woman with an epigastric mass previously identified as a hepatic artery aneurysm (HAA) by selective angiography, developed acute epigastric pain radiating to her back. Impending rupture was diagnosed, and the patient successfully underwent surgical repair using a prosthetic patch to close the orifice of the aneurysm. HAA is uncommon, but the risk of rupture is great, being 44 per cent and the mortality rate high, being 35 per cent. Abnormal ultrasonography and CT may suggest the diagnosis, but selective arteriography is definitive. Surgical treatment is indicated in most patients, although embolization is appropriate for intrahepatic aneurysm and extremely poor risk patients.

Acute left main coronary artery occlusion--a case report and review of the literature.

Acute left main coronary artery (LMCA) occlusion is rare and typically fatal. According to the recent literature, only three cases have been reported surviving emergent coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) caused by total LMCA occlusion. We report the case of a 52-year-old man presenting with total occlusion of the LMCA associated with acute anterolateral myocardial infarction and cardiogenic shock. The patient's dominant right coronary artery did not supply the collaterals to the left coronary system. After ineffective thrombolysis the patient underwent successful emergent CABG for the management of uncontrollable cardiogenic shock. Emergent CABG, though controversial, appears to be a feasible approach for patients with AMI in life-threatening situations, when other attempts at reperfusion have been unsuccessful.

Repair of an aortoiliac aneurysm associated with chronic disseminated intravascular coagulopathy--a case report.

We report herein an unusual case of a 77 year old man who developed chronic disseminated intravascular coagulopathy (DIC) caused by an aortoiliac aneurysm. After preoperative heparin therapy, the aneurysm was successfully replaced with a prosthetic graft despite heavy blood loss. Moreover, the infusion of platelet concentrate and autotransfusion proved helpful during the operation and his hypofibrinogenemia and thrombocytopenia became normalized immediately after surgery. Thus, although preoperative heparin therapy can help control DIC, surgical repair of the aneurysm is the definitive treatment in this kind of case.

[Management of coronary artery bypass grafting surgery by continuous ambulatory peritoneal dialysis in a patient with chronic renal failure under hemodialysis].

A 64-year-old patient with chronic renal failure underwent coronary artery bypass grafting (CABG) because of the frequent severe angina during hemodialysis. Intraoperative hemodialysis and extra-corporeal ultrafiltration method (ECUM) was used during cardiopulmonary bypass. Postoperative management was successfully performed by continuous ambulatory peritoneal dialysis (CAPD), which made hemodynamics stable and prevented postoperative bleeding, providing with adequate fluid removal and satisfactory control of serum chemistry.