[Prevention of parenchymal air leakage after lung resection; comparison of effectiveness in drug formation of fibrin adhesive].

We investigated the comparative effectiveness of the seat and glue types of fibrin adhesive, to clarify which is more useful in preventing postoperative parenchymal air leaks after lung resection. One hundred sixteen patients received fibrin adhesive to prevent postoperative air leakage after lung resection carried out by the same surgeon. Ninety-two lobectomies and 24 partial resections were assessed. There were 29 patients with emphysematous lung. In the seat type group, an average of 2.6 postoperative days elapsed before chest drain removal. In the glue type, this average was 3.2 days, a significant difference. This difference was also evident in the lobectomy group. However, among emphysematous lung patients and the partial resection group, there was no apparent difference. Prolonged air leakage was seen in 2 patients with emphysematous lung, but no difference in terms of drug formation could be seen. The seated type of fibrin adhesive was more useful than the glue type in preventing postoperative air leaks, but in emphysematous lung patients, better surgical technique would seem to be the critical factor.

[Combined medical and surgical treatment of 74 cases of acute type III aortic dissection].

In the early period up to 1986, our treatment of acute type III dissection was anti-hypertension drug therapy as a rule, and Collins operations were performed in two cases of progressive hemothorax. Among 21 patients receiving medical therapy, five died of rupture, and three operated cases died of multiple organ ischemia, and then the hospital mortality was 40%. Since 1987, we have selected hypotensive treatment of strictly maintaining blood pressure less than 120mmHg for the completely thrombosed type of the dissected lumen, and the emergency operation of ringed intraluminal graft insertion (RIG operation) for the blood-flow type and aneurysm formation type of the dissected lumen, diagnosed by the emergency cine-angiography. As the result, among 51 cases having hypotensive therapy, one died of respiratory failure. In the 23 operated cases, in which RIG operation and/or arterial reconstruction was performed, four died of multiple organ ischemia. The hospital mortality was 8%, which was significantly improved compared with that of the early period.

[Clinical study of paragangliomas in the thorax].

Four cases of paraganglioma in the thorax, consisted of 3 cases originating from the mediastinum and a case of pulmonary metastasis from the posterior peritoneum, were clinically investigated. Three were malignant and one was benign with noradrenaline secretion. On surgical excision, preoperative arterial embolization was assumed to be useful for reducing hemorrhage during procedure. Pre and intra-operative circulatory management was also mandatory in case of functioning paraganglioma. Of the 3 malignant cases, 2 survived for more than 10 years with radiotherapy alone or surgical resection of multiple metastatic nodules in the bilateral lungs. The other one, though inoperable due to extensive invasion to right and left atria, showed highly sensitivity to intra-arterial infusion chemotherapy of CDDP. These results suggested that long term survival might be expected even in metastatic or inoperable cases. There were no reliable histologic features distinguishing malignant from benign tumors, however 2 malignant cases with local invasion showed aneuploid patterns in the DNA histograms, which might offer a adjunct possibility in the assessment of malignancy.

Combined apical hypertrophic cardiomyopathy and left atrial myxoma.

A patient had apical hypertrophic cardiomyopathy and left atrial myxoma. We believe that this is the first description of such a combination.

[Operative risk of splenic repair for isolated but complex splenic injuries due to blunt abdominal trauma].

Surgical repair for complex splenic trauma is often controversial, because the operative risk of splenic salvage may exceed the risk of overwhelming postsplenectomy infection (OPSI). To determine the operative risk of splenic salvage for such injuries, 19 cases of isolated but complex injuries among 73 cases of blunt splenic trauma were examined retrospectively. Shattered spleens were excluded from the study. Splenic repair was accomplished successfully in all 10 attempted cases. Prior to the repair, vascular isolation and temporal occlusion of splenic artery was done to control the bleeding from injured spleen. In another 9 cases, splenectomy was immediately performed after laparotomy. Total amount of blood loss and operative morbidity in each group were not different, and no death occurred in both groups. Operative time was longer in group of splenic repair (112 +/- 20 min) in comparison to splenectomy group (71 +/- 23 min). Postoperative peripheral platelet count, serum IgM level, and finding of RBC scan showed adequate functional activity of the repaired spleen. In conclusion, it is felt that surgical repair should be attempted for isolated but complex splenic injury, and that the spleen should be preferably repaired even with associated injuries, unless prolonged operative time does not increase operative risk to more than that of OPSI.

[A case of mediastinal teratoma--differentiation from lung abscess and bronchogenic carcinoma].

A 38-year-old man was admitted with persistent productive cough and right anterior chest pain. Chest X-ray showed two large masses connected with each other, one in the right lung field and the other in the anterior mediastinum. A tentative diagnosis of either lung abscess or bronchogenic carcinoma was initially made, because of elevated serum tumor markers (SLX and SCC) and persisting refractory inflammatory sings. However, open chest drainage revealed a few fine hairs and atheromatous materials within the masses, and the diagnosis of teratoma was made. We removed these masses, and investigated the reason for the elevation of tumor markers. Staining with SLX monoclonal antibody demonstrated that the pancreatic tissue in the masses contained SLX. Although this is the first reported case of teratoma producing tumor marker (SLX), it is highly possible that tumor markers may be elevated in the majority of patients with teratoma because of the genesis of this tumor.

[A case of a 10-year survivor with squamous cell carcinoma of the lung, treated with radiation after an exploratory thoracotomy].

We have experienced a rare case of an unresectable lung cancer in a male patient who has survived 10 years after radiation therapy. The patient was aged 58 at the time of diagnosis. In May 1978, he was hospitalized because of an abnormal shadow in the upper left lung filed, and the diagnosis of squamous cell carcinoma was made by TBLB. Since subsequent surgery revealed an extensive tumor invasion to the large blood vessels, an exploratory thoracotomy was performed. Following postoperative 60 Gy radiation therapy, tumor regression was observed on examination of chest x-ray films. In July, 1988, 10 years and 3 months after this surgery, a back pain developed due to the recurrence of the tumor, and radiation therapy was given again. This relieved the pain. As of December 1988, he receives treatment on an outpatient basis and his performance status has been excellent.

[Influences of irradiation on the anastomotic sites of artificial grafts].

To examine the acute influences of irradiation on the anastomotic sites of EPTFE vascular grafts, an experimental study was performed using dogs. After replacement of superior vena cava and bilateral femoral arteries with EPTFE grafts, a total of 20 to 100 Gy doses were given at the anastomotic sites of superior vena cava and right femoral artery. There was no degradation of grafts themselves or rupture in the anastomoses at cumulative radiation doses of 20 to 100 Gy. However, in many dogs, receiving over 50 Gy doses at the anastomotic sites of superior vena cava, stenoses and/or overgrowth of granulation tissues were observed, although at those of right femoral artery, no remarkable differences were observed between dogs which received and those which did not receive irradiation.

[Diffuse B-cell lymphoma of anterior mediastinum cured by short-term administration of CDDP-containing regimen].

The following report is of a case of diffuse B-cell lymphoma of the anterior mediastinum that was originally treated by resection and radiation in a patient who had pleural and subcutaneous metastases four months after operation. A total dose of 120 mg of CDDP, 60 mg of BLM, and 15 mg of VBL was administered in five weeks. The metastases completely disappeared by this dose alone, and the patient is alive and well seven and a half years after the chemotherapy.

Evaluation of intracardiac thrombus with computed tomography.

Left atrial (LA) and left ventricular (LV) thrombus was evaluated by computed tomography in 56 patients. The patients were divided into 2 groups: Group I, 28 patients with mitral valve disease, and Group II, 28 patients with myocardial infarction. Computed tomography and 2-dimensional echocardiography were performed in all the patients studied. Cineangiocardiography was performed in all Group I and in 13 Group II patients. Open heart surgery or autopsy was performed in all Group I and 4 Group II patients. The sensitivity in detecting LA thrombus was 100% with computed tomography, 70% with angiocardiography, and 60% with 2-dimensional echocardiography. The specificity in detecting LA thrombus was 91% with computed tomography, 86% with 2-dimensional echocardiography, and 88% with angiocardiography. Thrombi located at the LA appendage were associated with great difficulties in detection by other methods, but were well delineated with computed tomography. LV thrombus was also visualized by computed tomography with similar or greater accuracy than other diagnostic methods, although the sensitivity and specificity were not ascertained because surgery or autopsy was performed in only a minority of Group II patients. Therefore, as far as the detection of intracardiac thrombus is concerned, computed tomography has the advantage of offering uniform slices of the heart in an attempt to detect thrombi in unknown areas of cardiac chambers, including the LA appendage or LV apex, without being disturbed by the surrounding cardiac and noncardiac structures. Thus, computed tomography has excellent accuracy in the detection of intracardiac thrombus.

Comparison of protected isolation techniques between the laminar airflow room and the life island unit.

The use of laminar airflow rooms and a life island unit for comprised patients was evaluated. Six patients spent a total of 170 days in the laminar airflow rooms and 112 days in the life island unit, and none acquired any exogenous infection. Patients were febrile for 7 out of 170 days (4.1%) in the laminar airflow rooms and 4 out of 112 days (3.6%) in the life island unit. No significant difference in the rate of deposition of organisms on settling plates and surface samples was found between the laminar airflow rooms and the life island unit. The advantages of the laminar airflow rooms are freedom of movement for patients and hospital personnel and patient comfort, while those of the life island unit are much lower purchasing and operating costs and portability.

Computer assisted medical record retrieval system.

A medical record retrieval system for access to patients' records has been developed as the first step toward constructing a medical record data base. Since retrieval is a logical process, a logical system was used to describe the retrieval conditions. For access to a patient set having a number of medical data of interest, the patients concerned are taken as one set for each data item. and a logical computation is carried out between several selected sets to obtain the required set. The retrieval conditions can be designated in two categories, admission and history, thus enabling quite flexible retrieval condition to be described. Since retrieval is one-line, the major file key was introduced to reduce response time and file access frequency.

Clinical application of cardiovascular computed tomography.

The application of computed tomography to cardiovascular diagnosis was attempted. One hundred and four consecutive patients with various cardiovascular diseases were studied with a third-generation computed tomographic three-second whole body scanner. Identification and evaluation of abnormalities of the great vessels, atria, ventricles and interventricular septum were possible by cardiac computed tomography. Sizes and locations of intracardiac thrombi were accurately assessed by computed tomography. Computed tomography was valuable for the evaluation of pericardial effusion because distribution of the effusion as well as the gross nature of the fluid could be estimated by the CT number.