Biomedical subjects
Publications and source records attributed to D Tabata.
Transverse sternotomy was performed in a 39-year-old man having bilateral lung metastatic lesions of yolk sac tumor. This approach provided an excellent operative field. Bilateral partial lobes including parietal pleura and diaphragma were readily resected. As described in this paper, transverse sternotomy is one of the beneficial method in the thorough surgical treatment for metastatic bilateral lung lesion.
A case of anastomotic recurrence after a radical operation for thoracic esophageal carcinoma is presented. A 68-year-old male was treated by subtotal esophagectomy and esophagogastrostomy through retrosternal route. One year after the operation he experienced dysphagia and anastomotic recurrence was detected by an upper gastrointestinal series and fiberscopy. He was admitted to our hospital for radiation therapy. The response was poor and dysphagia wasn't disappeared after radiation therapy at a dose of 10,200 rad. He was consulted to our surgical department for operative therapy. Cervical esophagectomy, partial resection of gastric tube and free jejunal transplantation for the reconstruction were performed. He had been eating anything of food after the operation.
Spontaneous rupture of iliac vein is rare, and only twelve Caucasian cases have been reported. To our knowledge, this is the first reported case in Japan, and the thirteenth in the world. An 80-year-old female complained of sudden pain in the left flank as she passed stools and then collapsed. At the emergency laparotomy, a large retroperitoneal hematoma was encountered and a tear of 2cm length was found in the left external iliac vein with fresh intravenous thrombus. After a complete thrombectomy, the rent was sutured and her postoperative course was uneventful. The surgeon should consider the possibility of spontaneous vein rupture in the differential diagnosis with the patient presenting hypovolemic shock of unknown cause, which is often accompanied by abdominal tenderness, particularly when the patient is a middle age female, and the lesion is on the left side.
Since October 1987, 80 patients underwent open-heart surgery without donor-blood transfusion. 50 (Group I) out of these 80 cases were selected to be paired with 50 patients (Group II) who underwent open-heart surgery with homologous blood transfusion in the same period. Twelve cases (Group III) underwent open-heart surgery without homologous blood transfusion but were transfused after surgery. To decrease the homologous blood requirements, ultra-filtration system as well as conservation and autotransfusion of autologous blood was employed. Peripheral blood count, blood chemistry for liver and renal function were analyzed and compared among these three groups. Although hematocrit of Group I was lower than that of Group II until the third postoperative day, there was no difference after the seventh postoperative day. The platelet count was more in Group I than in Group II or III on the first and the seventh postoperative day. The level of lactate dehydrogenase was higher in Group II than in Group I. Total bilirubin was more elevated in Group II than in Group I on the first and the fourteenth postoperative day. Direct bilirubin was also higher in Group II than in Group I till fourteenth postoperative day. Five cases in Group II fulfilled the criteria of the serum hepatitis. Blood urea nitrogen and creatinine were less in Group I than in Group II. The duration of the intra-tracheal intubation was shorter in Group I than in Group II or III. There was no difference in postoperative dosage or duration of catecholamines among three groups.(ABSTRACT TRUNCATED AT 250 WORDS)
A male neonate, two days of age, was admitted with cyanosis and tachypnea. Chest roentgenograms showed massive cardiomegaly and decreased pulmonary vasculatures. Echocardiographic and the right ventriculographic findings were interpreted as showing primary pulmonary atresia with secondary tricuspid incompetence. At a Brock operation, however, there was no resistance in passing the instrument through the pulmonary valve. The baby died twelve hours after surgery. Postmortem examination showed that the tricuspid regurgitation was a cause of the functional pulmonary atresia (FPA). It is important to distinguish FPA from pure pulmonary atresia because conservative therapy is the first choice for the FPA.
A 33-year-old female who had undergone closure of VSD 20 years before, was hospitalized for sudden onset of dyspnea without history of febrile or traumatic disorder. On admission, she had cyanotic lips and nailbeds but no clubbed finger. Chest x-ray film showed neither lung congestion nor cardiomegaly. Arterial blood gas analysis revealed deep hypoxia (PaO2 = 49.6 mmHg). Echocardiogram clarified massive tricuspid regurgitation (TR) due to chordal rupture of anterior leaflet, small VSD jet stream through the membranous aneurysm and a great deal of R-L shunt on the atrial level through a persistent foramen ovale. Cardiac catheterization data confirmed 35% of R-L shunt. At operation, a torn chordal tendon of anterior leaflet and an adhered septal leaflet to aneurysm of membranous portion of ventricular septum were seen. There were two pledgets, used at the first surgery, at the base of the aneurysm and a couple of tiny holes (VSDs) above and below the pledgets were recognized. Following resection of anterior and posterior leaflet, plication of septal leaflet and closure of VSD, a Xenograft valve (Carpentier-Edwards 29-M) was implanted. Then persistent foramen ovale, 20 x 20 mm in large, was closed directly. Her postoperative course was excellent with disappearance of cyanosis, normalized oxygen saturation in arterial blood and improved activity without dyspnea.
Cystic adventitial degeneration is an uncommon cause of arterial obstruction. Its etiology is debated. We report a case in which the left external artery was affected and the cystic mass communicated with the hip joint. The findings of this case support the embryonic theory that the articular synovium and adventitial cysts have the same mesenchymal origin.
Fifty-two cases of abdominal aortic aneurysms including common iliac aneurysms operated on during July, 1981 and December, 1989 have been studied. They were divided into the following three of elective operation (n = 34), impending rupture (n = 5), and ruptured (n = 13) groups. Cases with abdominal operations without aneurysms were randomly selected as the control group (n = 12). Overall operative mortality was 9.6%, consisted of 30.8% of the ruptured, 20.0% of the impending rupture and 0% of the elective operation groups. Respiratory functions including FEV1.0%, V75, V50, V25 and V25/Ht were significantly lowered in the ruptured group. PaO2 of the ruptured group was also significantly lowered in comparison with both the control and the elective operation groups. Leukocytic granular elastase, playing a role of destruction of the elastin component in the pulmonary alveoli and the aortic media, was increased in the patients with ruptured aortic aneurysms, though the difference was not significant. The data suggested the possibility of aneurysm rupture in case with elevated leukocytic granular elastase. Surgery for abdominal aortic aneurysm, even in cases with decreased pulmonary function, should be considered aggressively to elimination of ominous result of aneurysm rupture.
A 61-year-old man with congenital bicuspid aortic valve associated with aberrant coronary artery origin is presented. His aortic valve was severely stenotic with marked calcification. At the aortic valve replacement, it was found that the valve was markedly calcified and the bicuspid valve and both coronary ostia were very close to each other in a posteriorly positioned sinus of Valsalva. There have been a few reports concerning the combination of the bicuspid aortic valve and aberrant coronary artery origin, and it is well known that the bicuspid aortic valve more frequently accompanies short left main trunk or left coronary arterial dominance than a normal aortic valve. Some genetic mechanisms surrounding the coronary artery, aortic valve and aorta are suggested to occur with such anomalies.
The congenital bicuspid aortic valves usually become stenotic with severe calcification or regurgitant due to infective endocarditis (IE). However, pure aortic valve regurgitation without calcification or IE may be occurred. We report seven these cases out of 30 bicuspid valved patients who underwent aortic valve replacements. Pathological findings of these resected valves revealed neither calcium deposit nor findings of infection, but commonly showed myxoid degeneration. They were operated on at the mean age of 39, while those with calcified bicuspid aortic valves had an average age of 56. Two rare cases in whom an anomalous fibrous band on the larger cusp attached to the aortic wall were also reported.
A 67-year-old female of Budd-Chiari syndrome was rapidly deteriorated and died. Autopsy revealed membranous obliteration of the inferior vena cava in the hepatic portion with a small hole. The inferior vena cava and right hepatic vein contained fresh and organized thrombi. The left hepatic vein was patent and opened above the membrane. The onset and the clinical course of this case seem to be atypical, probably because of the patent left hepatic vein and a small hole of the membrane. We call attention such a rare case in managing Budd-Chiari syndrome.
Left-sided inferior vena cava (IVC) was identified preoperatively in the case of abdominal aortic aneurysm. At operation, the left-sided IVC and bilateral common iliac veins were severely pressed by the huge aneurysm, and the walls of these vessels were thin and fragile at the site adhered to the aneurysm. Careful dissection around the common iliac arteries resulted in a successful operation. Without an awareness of such anomaly, accidental injury of IVC and the common iliac veins may occur. Preoperative diagnosis and accurate information from echography, CT scan, and venography of the vena cava are recommended in such rare cases.
For 17 patients with bone and soft tissue sarcoma, 32 bolus and maintenance infusions of high-dose methotrexate (MTX) were performed to induce rapid elevation of plasma MTX concentration and to maintain it. At the doses of 200-300 mg/kg, plasma MTX concentrations were measured by enzyme assay. It needed four hours to reach the steady state by five hours' constant rate infusion, with the plasma plateau concentration at about 1 X 10(-3) M/L. On the other hand, bolus infusion of MTX needed only one hour to reach over 5 X 10(-4) M/L, and the plateau concentration lasted during the maintenance infusion period. By the constant rate infusion as well as bolus infusion, it was possible to maintain the plasma concentration over 1 X 10(-4) M/L for 12 hours, but both infusions can not maintain 1 X 10(-3) M/L for a long time. From these results, clinical effects of high dose MTX against sarcomas seemed to be evaluated by the plasma MTX plateau concentration and the maintenance time.
Twenty cases treated with high-dose methotrexate (MTX) infusions were studied to determine whether urinary beta 2-Microglobulin (beta 2-M) is a reliable indicator to predict impaired excretion of methotrexate. Before and after MTX infusions, the levels of urinary beta 2-M were measured along with serum creatinine, uric nitrogen, and creatinine clearance. MTX clearance was found to be impaired in four of the 20 infusions, although concentrations of serum creatinine and uric nitrogen, and creatinine clearance were normal prior to the infusions. In the four cases that resulted in impaired excretion, a significant increase of beta 2-M levels was noted before and after the high-dose MTX infusion (p less than 0.01). Although one of the four cases showed a normal level of beta 2-M before the infusion, the post-infusion level of beta 2-M extremely high. This raised level of beta 2-M was thought to be caused by impaired excretion due to decreased amounts of urine. We conclude that urinary beta 2-M is a sensitive indicator of impaired excretion of high-dose MTX infusion, and especially when levels of more than 250 ng/ml of urinary beta 2-M are found to exist, it seems to difficult to clear the drug following high-dose MTX treatment.
A successful emergency operation for a 75-year-old man with aorto-caval fistula secondary to rupture of the abdominal aortic aneurysm is reported. A definite diagnosis of aorto-caval fistula was made by echography with characteristic engorgement of the caval vein. Clinical signs and symptoms characterized by lung edema, sudden onset, and circulatory collapse were also noticeable. In the operation, the fistula was closed via inside of the aneurysm with several mattress sutures following control of aortic flow and opening of the aneurysm. Back-flow of the blood through the fistula was readily controlled by finger tip. The aneurysm was replaced conventionally by a vascular prosthesis. There might be several suitable surgical selection available properly to individual case. No delay in surgical treatment depending on definite diagnosis by echography in such urgent condition should be stressed.
A 30-year-old man with peripheral neuroepithelioma which was present in the retroperitoneum underwent surgical treatment under the diagnosis of germ cell tumor. Subsequently he died of local recurrence and multiple metastases to the liver seven months after surgery. To our knowledge, this is the second case of peripheral neuroepithelioma which was observed in the retroperitoneal space in the literature of the world. We also reviewed 20 cases of peripheral neuroepithelioma reported in Japan.
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