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Purpose: The purpose of this study was to investigate the resolution property and the noise properties at the nonuniformity area in the slice plane of iterative reconstruction (IR)-CT image., Methods: CT images of a phantom with nonuniformity areas including multiple contrast (medium, high, and ultra-high contrast) signals were acquired at various scan dose conditions and reconstructed with different iterative intensity levels. The noise properties at the nonuniformity and the uniformity areas were evaluated by measuring normalized noise power spectra (nNPSs) using subtracted images from sequential scanning data under the same scan conditions. We investigated the relationship between the noise properties and the resolution properties evaluated by measuring task transfer function (TTF) using multiple contrast signals before the subtraction., Results: There was a correlation between the nNPS at the nonuniformity area and the TTF because the nNPS values at high spatial frequency were increased with superior TTF (higher dose, mild iterative intensity, and higher contrast level). The differences in the high spatial frequency component of the nNPSs among each task were decreased with the inferior TTF tasks., Conclusion: We conclude that the noise properties in the slice plane at the nonuniformity area and resolution properties of the IR-CT image were correlated similar to image quality properties of the linear imaging system due to the dependence of the nNPSs curve on the TTF value under each task.

In Japan, as the proportion of working-age cancer survivors is expected to increase, balance between cancer treatment and work is one of the most important topic in occupational health. This study is a first large-scale study investigating cumulative return to work(RTW)rate and work continuance rate among Japanese cancer survivors. Data on Japanese employees who experienced an episode of sick leave due to clinically certified cancer diagnosed between 1 January 2000 and 31 December 2011 were obtained from an occupationalheal th register. 1,278 cancer survivors(1,033 males and 245 females)experienced their first episode of sick leave due to cancer during the 12-year follow-up period. Of the subjects, 47.1% returned to work full time within 6 months of their initial day of sick leave absence, and 62.3% by 12 months. The cumulative RTW rate varied significantly by cancer type. Five-year work continuance rate after RTW was 51.1%. There was a steep decrease in work continuance rates during the first year after RTW, with considerable differences according to cancer site. In Japan, it seems to be more important to support employees with cancer.

Purpose: The aim of this study was to investigate the resolution property in XY-plane for half-reconstruction computed tomography (CT) image by measuring 360° multi-directional modulation transfer functions (MTFs)., Materials and Methods: The 360° multi-directional MTFs were measured by use of a wire method to obtain line spread function with 15° interval in XY-plane. The MTFs of half-reconstruction CT image were measured with 100 mm off-center positions on the X- and Y-axis (X +100 mm , X -100 mm , Y +100 mm , and Y -100 mm ) and compared with those of full-reconstruction CT image. We measured the MTFs of the half-reconstruction CT image at X +100 mm position with various X-ray tube positions of projection dataset., Results: There were obvious differences for the MTFs of the half-reconstruction CT image between the tangential and radial directions at each measurement position. The dependences of the resolution property for the half-reconstruction CT image on positions and directions in XYplane were similar to those for the full-reconstruction CT image. The higher and the lower MTFs of the half-reconstruction CT image at X +100 mm position were measured with X-ray tube position of projection dataset at +X side and at -X side compared with those of the full-reconstruction CT image, respectively., Conclusion: We conclude that the half-reconstruction CT image had similar resolution property in XY-plane to the full-reconstruction CT image and showed dependency on the X-ray tube position of projection dataset for MTF in the tangential direction.

The purpose of this study was to investigate the effect of the position in XYZ directions and acquisition parameters on the basic image qualities of for cone beam computed tomography (CBCT) in an angiography system with flat panel detector. The resolution property (modulation transfer function: MTF) and the noise property (Wiener spectrum: WS) of CBCT images in X-Y plane were measured with different acquisition parameters (scan matrix number and projection number) and the effect of the position in XYZ directions. The MTFs with 1024×1024 matrix were higher than those of 512×512 matrix and decreased in the peripheral areas due to the reduction of projection number. The highest and the lowest MTFs were measured at the X-ray tube side and on the detector side of the position in X-Y plane, respectively. The WS-doubled projection number showed about 50% lesser noise level. There were differences in the Wiener spectra (WS) at the position in XYZ directions. We conclude that the resolution and the noise property of CBCT image in X-Y plane showed dependences on the position in XYZ directions and acquisition parameters of the CBCT.

A 62-year-old woman, with a past history of long-term non-steroidal anti-inflammatory drug use and gastric ulcer, was hospitalized for intestinal obstruction in April 2012. Two stenoses were identified in the ileum in association with small intestinal ulcers, and she underwent partial resection of the small intestine. Histologically, the two lesions were poorly differentiated adenocarcinomas; metastatic small intestinal cancer was suspected, but whole body examination revealed no other lesions. The final diagnosis was multiple primary small intestinal malignancies, necessitating additional resection of the small intestine in July. We report this case to raise awareness among physicians of the possibility of primary small intestinal cancer in patients with multiple small intestinal stenoses.

A 51-year-old man presented with a chief complaint of constipation. Rectal cancer was detected up to 13 cm proximal to the anal verge. The cancer was a fully circumferential type II tumor that was accompanied by prostate invasion and lymph node metastasis. After sigmoid colostomy, preoperative chemoradiotherapy with S-1/irinotecan (CPT-11; total 50 Gy) was administered, resulting in tumor volume reduction. However, because of residual invasion in some parts of the prostate, therapy with capecitabine and oxaliplatin (XELOX) plus bevacizumab was added to avoid pelvic exenteration. Because magnetic resonance imaging revealed no invasion prostate after 7 courses of the therapy, abdominoperineal resection of the rectum was performed. Pathological examination revealed no residual tumor cells, and a pathological complete response was thus confirmed. The addition of chemotherapy to preoperative chemoradiotherapy was considered to be an effective strategy for locally advanced rectal cancer in this case.

There are several causes of hypotension during anesthesia. We report a case of severe hypotension caused by external cardiac compression. A 72-year-old man was scheduled for resection of mediastinal tumor under general anesthesia. He had undergone mediastinal tumor resection four times uneventfully. Anesthesia was induced and maintained with target controlled infusion of propofol and continuous infusion of remifentanil. Tracheal intubation was facilitated with rocuronium. Massive bleeding and severe hypotension developed during the operation. Blood transfusion, cryoprecipitate, fresh frozen plasma, and percutaneous cardiopulmonary support were commenced. However, hemorrhage was not the only cause of hypotension. The transesophageal echocardiography revealed external cardiac compression by tumor and doctor's hand. Transesophageal echocardiography was useful for verifying the causes of hypotension. It is necessary to evaluate the causes of hypotension during the operation, because a certain number of problems may exist.

Cushing's syndrome is extremely rare during pregnancy, because it often causes amenorrhea and infertility. We experienced a case of Cushing's syndrome in the 23rd week of pregnancy receiving laparoscopic surgery. It was difficult to control the blood pressure and heart rate, but we succeeded in the safe management of both mother and fetus.

There are no specific symptoms of patients with carcinoma of the small intestine. Therefore, it is difficult to diagnose in the early stage by imaging modalities such as radiological enteroclysis, computed tomography, and classical endoscopy. However, double balloon endoscopy makes it possible to diagnose the carcinoma of the entire small bowel by taking tissue samples for pathological assessment. The characteristic of endoscopic findings is irregular ulcerated tumor with malignant stricture. It is still difficult to find carcinoma of small intestine in patients without symptoms and most cases are advanced when diagnosis is achieved. We should try to diagnose in early stage by combining images modalities, capsule endoscopy and double balloon endoscopy safely and efficiently, resulting in improving the patients' prognosis.

Small intestinal primary adenocarcinomas, carcinoids, gastrointestinal stromal tumors (GISTs) were cleared up inadequately because it was hard to examine for small intestine by modalities in the 20th century. Obscure gastrointestinal bleeding (OGIB) is often caused by these tumors. In future, these tumors will be more diagnosed in patients with OGIB by new modalities such as capsule endoscopy and double balloon endoscopy. We attempt to present these small intestinal malignant tumors using by capsule endoscopy and double balloon endoscopy.

Primary small intestinal lymphoma (PSIL) is a relatively rare form of non-Hodgkin lymphoma, often complicated by bleeding, obstruction, or perforation of the intestine during the clinical course. The initial diagnosis and management of these complications are often difficult in PSIL, because the small intestine is usually inaccessible in routine endoscopy. Recently, total enteroscopy with a double-balloon method, called double balloon endoscopy (DBE), has been developed for the diagnosis and treatment of small intestinal disorders. We report herein on 4 cases of PSIL (2 diffuse large B-cell lymphomas and 2 follicular lymphomas [FLs]). In these cases, DBE was useful in the diagnosis, decision to perform surgery after assessment of bleeding lesion, and treatment of the intestinal stenosis using enteroscopic balloon dilatation. Combination chemotherapy consisting of anthracycline, cyclophosphamide, vincristine, and prednisolone with rituximab was administered in 3 cases, and all achieved complete remission. One patient with FL of the duodenum was treated with rituximab alone, but with little effect. We conclude that DBE is useful in the management of PSIL. More PSIL cases must be analyzed to establish the optimal management of patients with this form of lymphoma.

Purpose: To investigate background, surgical method, complications, prognosis, and prognostic factors in patients undergoing vitrectomy for diabetic retinopathy., Subjects and Methods: Three hundred and forty eyes of 261 patients undergoing vitrectomy for diabetic retinopathy in five recent years were studied regarding background, surgical method, complications, and visual prognosis. Factors influencing postoperative visual acuity and complications were also examined using univariate and multivariate analyses., Results: Final postoperative visual acuity (FPVA) improved in 226 eyes (66%). FPVA of 0.1 or better and 0.5 or better was achieved in 80% and 45% of all patients, respectively. Postoperative complications occurred in 89 eyes(26%). In the vitreous hemorrhage group, FPVA improved in 86%, and FPVA of 0.5 or better was achieved in 60%. Postoperative complications were most common in the traction detachment group and the percentage was 40%. Factors influencing FPVA were preoperative visual acuity, postoperative complications, indications for surgery, and preoperative severity. Factors influencing postoperative complications were patient background, preoperative visual acuity, preoperative severity, and iatrogenic breaks., Conclusions: Vitrectomy is a useful method for diabetic retinopathy but postoperative complications must be managed.

A 22-year old man was admitted to the emergency room of our hospital with bleeding from scrotal wound. He had resected his own scrotum and both testes by himself with a small knife, since he thought that his testes had developed necrosis. He had thrown his scrotal skin and both testes away in a lavatory. We closed the wide wound surface and the surrounding skin after ligation of the spermatic cord. The post-operative course was uneventful. The patient was referred to the psychiatric department of our hospital and received supportive psychotherapy under diagnosis of schizophrenia. This is the 23rd case to be reported as self-injury of the external genitalia and the 7th case limited to testis in the Japanese literature.

Background: Choroidal hemangioma associated with bullous retinal detachment may be difficult to treat, due to varying results with conventional laser photocoagulation, radiotherapy, or surgical drainage. Here we report on a case of extensive bullous retinal detachment secondary to circumscribed choroidal hemangioma that was resolved after combined treatment with vitrectomy, silicone oil tamponade, and transpupillary thermotherapy., Case: A 29-year-old woman presented with a large choroidal hemangioma in her right eye associated with serous retinal detachment. The tumor measured 8 disc diameters in size and was located in the inferotemporal macula, abutting the fovea., Results: Laser photocoagulation of the tumor was unsuccessful in inducing absorption of subretinal fluid. Because of progressive bullous retinal detachment, surgery was performed consisting of external drainage of subretinal fluid, vitrectomy, endolaser photocoagulation of the tumor, and silicone oil tamponade. The silicone oil was removed four weeks postoperatively at which time almost complete resolution of the retinal detachment was observed. However, retinal detachment recurred eight weeks later, and transpupillary thermotherapy was then applied to the tumor. By four weeks after transpupillary thermotherapy, total reabsorption of subretinal fluid, visual acuity improvement, and decreased height of the choroidal hemangioma were noted., Conclusion: Transpupillary thermotherapy is an effective treatment for serous retinal detachment associated with choroidal hemangioma.

In vitro properties of a new hydroxypyridone antimycotic rilopirox (RIL) with special reference to its anti-Candida activities were studied in comparison with the three reference drugs, ciclopirox olamine (CPO), oxiconazole nitrate (OCZ) and isoconazole nitrate (ICZ), using several strains of Candida albicans and Candida glabrata as the test organisms. RIL was potently fungicidal for growing cultures of these Candida strains, whereas all the three reference drugs were slightly fungicidal or fungistatic. Unlike OCZ and ICZ whose anti-Candida activity was decreased by lowering pH or adding serum to culture media, the activity of RIL was scarecely affected by change in pH or serum addition. However, RIL became less potent in the presence of Fe3+ at concentrations of 10(-5) mmol/ml or above. These findings suggest that RIL will be useful as a topical anti-Candida agent.

A case of asynchronous triple cancer in an 88-year-old male is reported. Six years ago, he had received left radical nephrectomy for renal cell carcinoma, and 2 years ago partial hepatectomy for hepatocellular carcinoma detected by follow-up computed tomography (CT). During the post-operative follow-up, no metastasis of either the renal or hepatic carcinoma was detected. On February 12, 1997 he presented with macroscopic hematuria. Cystoscopy revealed a tumor emerging from the left ureteral orifice, while CT and magnetic resonance imaging (MRI) revealed a tumor mass in the left exterior of bladder. Diagnosis of residual ureter tumor, we performed both left ureterectomy and partial cystectomy. Histological diagnosis revealed transitional cell carcinoma of the residual ureter (G2 > G3, pT1, pV0, pL0, pR0). Convalescence was uneventful and 10 months after the operation, he is alive with no recurrence or metastasis. We stress the importance of careful follow-up not only to perceive the recurrence or metastasis of renal cancer but also to detect cancer in other parts of the body.

In vitro antifungal activities of rilopirox (RIL), a new topical hydroxypyridone antifungal agent, were studied against 7 species (31 strains) of yeast-like fungi and 15 species (17 strains) of mycerial fungi from stock cultures of a wide range of medically important fungi. Tests were carried out by the liquid dilution method using Neopeptone dextrose broth with ciclopirox olamine (CPO) and oxiconazole nitrate (OCZ) as reference drugs. RIL exhibited a broad spectrum of antifungal activities; the MIC of RIL against yeasts were about 1 microgram/ml, those against other fungi were 0.5-4 micrograms/ml. Antifungal activities were similar to CPO, and compare to OCZ, RIL showed characteristically little differences in its activities against different species or strains of target organisms.

A 65-year-old woman was admitted to the hospital because of an abnormal shadow on a chest X-ray film. Chest CT scans showed enlargement of the right mediastinal lymph nodes. However, no primary lesion was detected despite thorough examination. Mediastinoscopic biopsy revealed that the tumor was a lymph-node metastatic lesion of a squamous cell carcinoma of unknown origin. A thoracotomy was done and the mass was completely resected. Radiotherapy was given after the operation. We have followed the patient for 1 year since the operation, but no primary lesion has yet been detected. Metastasis of cancer of unknown origin to hilar or mediastinal lymph nodes is extremely rare, and only 6 cases have been reported previously in the Japanese medical literature.

Neurinoma of the bronchial tree is extremely rare. We report a case of bronchial neurinoma involving a 21-year-old woman. The patient was admitted due to an abnormal shadow on chest X-ray, with cough and sputum production. Chest CT and MRI showed that the tumor arose from the left lower bronchus and bronchofiberscopic examination revealed complete obstruction of the lower bronchus by a polypoid tumor. A left lower lobectomy was performed based on the histological diagnosis of benign neurinoma and the postoperative course was uneventful. The tumor was 7.0 x 6.0 x 5.0 cm in size and had grown endobronchially without penetrating the bronchial wall. Pathological diagnosis was Antoni A type benign neurinoma. Since malignant or metastasized tumors have been reported in cases of tracheobronchial or intrapulmonary neurinoma, complete surgical resection of bronchial neurinomas should be performed.

The relationship between bullous pemphigoid and malignancies of visceral organs is still controversial. A case of lung cancer associated with bullous pemphigoid is reported. A 63-year-old man admitted hospital because of multiple bullae of the whole body skin and continuous fever. The skin lesions were diagnosed as bullous pemphigoid by the skin biopsy. However, the chest x-ray on admission revealed a large tumor in the left upper lung field. The tumor was diagnosed as a lung cancer by trans-bronchial lung biopsy. The fever withdrew with the administration of prednisolone. The left upper lobectomy of the lung and mediastinal lymph node dissection were performed. The skin lesion disappeared 5 days after the surgery. This clinical course is thought to indicate the relationship of both diseases. Bullous pemphigoid is thought to have many problems during perioperative period, such as hypoproteinemia and delayed wound healing due to administration of the steroid, therefore intensive care is necessary in the perioperative care.

Thirty-three patients who had transitional cell carcinoma of the bladder with stage PT1 and grade 3 components were treated between January 1980 and December 1992. Clinical study was done for these 33 patients on treatment modalities and it's problem, intravesical recurrence, disease progression and prognosis. Twenty-five of 33 patients underwent bladder-sparing surgeries and total cystectomy was performed for another 8 patients as initial treatment. Intravesical recurrence was observed in 18 (72%) of 25 patients who underwent initial bladder-sparing surgeries. Recurrence-free rate was 44% for 1 year and mean period to recurrence from initial therapy was 13.1 months. Although some adjuvant therapy after initial treatment was performed for 20 patients, it's efficacy in preventing intravesical recurrence could not be confirmed. Disease progression was recognized in 10 (40%) of 25 patients initially treated by bladder-sparing surgeries after median latent period of 33.7 months, whereas only one (12.5%) of another 8 patients who underwent total cystectomy showed progression, and 5-year progression-free rate after initial bladder-sparing surgeries was 55.6%. Three and five-year actural survival rate in all cases were 81.5% and 65.1%, respectively. According to initial treatment, 5-year survival rate was 62.2% for the patients treated by bladder-sparing surgeries, whereas it was 83.3% for the cases who underwent total cystectomy. However statistical significant difference was not recognized. In view of disease progression after initial bladder-sparing surgeries, patients with progression yealed a 45.7% 5-year survival rate compared to 81.5% for the patients without progression, and significant difference was demonstrated between them.(ABSTRACT TRUNCATED AT 250 WORDS)

A 61-year-old man received right middle and lower lobectomies for lung abscess caused by bronchiectasis in 1957. Since the right upper lobe was destroyed and multiple peripheral bronchopleural fistulae developed later, open thoracostomy was done in 1990. For this patient we performed transpericardial completion pneumonectomy with omental pedicle flap in 1993. He was complicated in a transient thoracic empyema. But he recovered by open drainage followed by surgical closure using Clagett's method and remains well 2 years after the radical operation. Transpericardial approach with omental pedicle flap though a median sternotomy seemed useful to prevent the postpneumonectomy bronchopleural fistula in this patient with thoracic empyema. But the primary closure of the empyema cavity should not be done, if dead space remains in the pleural cavity.

We report here two cases of priapism. One of these cases was suspected to be drug induced and high and low flow mixed type. The patient had taken the drugs, alpha-blocker for hypertension and dysuria by BPH for a long time. He was treated by a caveno-glandular shunt. After surgery, detumescence was obtained for some time, but erection appeared again soon. Transcatheter embolization of the internal pudendal arteries was then performed, and detumescence became permanent. The other case was an idiopathic and high flow type. Detumescence was achieved soon by transcatheter embolization of the internal pudendal arteries only, then he experienced morning erection imperfectly on the 9th day after this treatment. The management of priapism as reported to date is also reviewed.

The purpose of this study is to establish criteria of limited operation for bronchial carcinoid. Ten cases surgically treated in our hospital and 47 cases reported in Japan from 1981 to 1992 were examined. Thirty-nine cases had typical carcinoid tumor and 18 had atypical. Limited operation, such as pulmonary segmentectomy, wedge resection or partial resection, was performed in 12 cases. In these, all patients of typical type were alive except for a case died of other disease. However, two patients of atypical type died of distant metastasis of the tumor. No lymph node metastasis was revealed in all cases of typical type. On the contrary, in cases of atypical type, six had n1 and two had n2 disease. Moreover, two cases with n1 disease had pulmonary metastasis. Therefore, patients with typical bronchial carcinoid can be cured by limited operation, but radical operation should be indicated for atypical bronchial carcinoid.

The determinations of cardiac troponin T provide the highest diagnostic efficiency for the detection of myocardial cell necrosis. To assess perioperative myocardial infarction, serum levels of cardiac troponin T were determined in 14 patients undergoing coronary artery bypass grafting (CABG). The patients were divided into two groups: group I (n = 9), those whose troponin T was less than 1.00 ng/ml on the first postoperative day; group II (n = 5), those whose troponin T was more than 1.00 ng/ml on the first postoperative day. Troponin T levels in group II patients were significantly higher than in group I from the second to the seventh postoperative day. Two patients in group II had specific changes on the electrocardiogram detecting perioperative myocardial infarction as a new Q wave and R wave reduction. These results suggest that troponin T is a valuable marker of perioperative myocardial infarction following CABG.

A 62-year-old man who had undergone left lingual segmentectomy for pulmonary tuberculosis developed left chronic localized pleural empyema with multiple bronchial fistulae in the region of surgical gauze left in the thoracic cavity. We surgically removed the gauze and fenestrated the empyema. After disinfection of the region of suppuration, small fistulae which were less than 2 mm in diameter were closed by fibrin-glue-packing and consolidation of the orifices using 40% silver nitrate solution. Two and one-half months later a second operation was performed. Residual large fistulae were closed by fibrin-glue-packing and suturing of their orifices, and the empyema space was then obliterated by muscle flap plombage. The patient's postoperative course was good and the empyema was completely cured with this treatment.

A 74-year-old man and a 66-year-old woman were diagnosed as angina pectoris with choledocholithiasis. Combined coronary artery bypass grafting and choledocholithotomy were performed successfully in the two cases. For the prevention of cardiac complications and mediastinal infection, coronary artery bypass grafting was performed prior to choledocholithotomy. However, skin incisions were different in both cases. In the case with the biliary tract infection, both two surgical procedure were performed through a single skin incision in order to prepare the gastroepiploic artery as a graft. The combined operation is considered to be useful in selected cases with ischemic heart disease and choledocholithiasis.

In two patients who had developed aspiration due to left recurrent laryngeal nerve injury during radical resection for lung cancer, low power Nd:YAG laser irradiation of the paralyzed vocal cord was performed through a bronchofiberscope. With irradiation, the paralyzed vocal cords of both patients swelled and became fixed at the median portion of the glottis. Thereafter, aspiration disappeared. Thus, this new application of Nd:YAG laser irradiation is apparently quite useful in treating aspiration due to unilateral vocal cord paralysis immediately after pulmonary resection.

Two cases were operated on simultaneously for coronary revascularization and lung resections for cancer. Case 1 was a 79 year-old man, diagnosed with two vessels coronary artery disease and squamous cell carcinoma of left lower lobe. At the end of aortocoronary bypass grafting to LAD and first diagonal branch using saphenous vein, median sternotomy was closed, and lower lobectomy was performed through left posterolateral standard thoracotomy. Case 2 was a 65 year-old man who underwent aortocoronary bypass grafting to LAD first and left lingular segmentectomy via median sternotomy simultaneously. We concluded that a simultaneous operation was definitively and ideally a preferable method in most selected cases. The order of two operations for coronary artery and lung was also discussed.

Twenty-four patients suffering from prostate hyperplasia were given venous injections of CDZM of either 1 or 2 g at specific intervals (30 min, 1, 2 and 4 hr) before surgery. Blood samples from the injected vein and tissue samples from the prostate were subsequently taken. In this study, the concentrations of CDZM in the prostate tissue (P) and in serum (S), as well as the ratio of the tissue to serum concentrations (P/S) were determined. In patients given 1 g injections, P ranged from 5.26-48.10 micrograms/g, while S ranged from 25.40-130.00 micrograms/ml and P/S ranged from 12.6-37.0%. In the patients given 2 g injections, P ranged from 9.40-49.20 micrograms/g, S ranged from 62.30-234.00 micrograms/ml and P/S ranged from 9.3-29.1%. CDZM exhibited excellent transmigration to the prostate tissue. Inflammatory bacteria present in prostatitis and urinary tract infections are generally those of E. coli, Proteus sp., but because the P range was much higher than the ratio of MIC, CDZM is expected to be useful against infections in the field of urology.

A 29-year-old female who complained of low grade fever was detected an abnormal shadow in the left pulmonary hilum on a chest roentgenogram. Thoracotomy revealed that the tumorous lesion originated from left hilar lymph node. Left hilar and mediastinal lymph nodes were extirpated. Histopathologically, three of all the resected lymph nodes were diagnosed as Castleman lymphoma (plasma cell type). Therefore, not only the main lymph node but also the associating lymph nodes should be completely extirpated, since, in this disease, especially plasma cell type, the lesions are often multicentric.

A 52-year-old man who had been pointed out cardiac tumor on echocardiography, CT, MRI and coronary angiography was admitted to our hospital. He was asymptomatic. The surgical excision of the tumor was performed under extracorporal circulation and the postoperative period was free of event. It was not certain whether it originated from interventricular septum or right ventricle. The histology was mixed hemangioma composed of capillary and cavernous type.

A 28-year-old man of DeBakey type I dissecting aneurysm was received graft replacement of the ascending and transverse aorta under the deep hypothermic circulatory arrest and continuous retrograde cerebral perfusion for cerebral protection during circulatory arrest. From 3 weeks before operation, autologous blood was collected from the patient with the intravenous administration of a recombinant human erythropoietin (rHuEPO) and was subsequently used in the operation. As result, the graft replacement of the ascending and transverse aorta was performed without homologous red blood cell transfusion and postoperative neurological complications. We believe autologous blood transfusion with rHuEPO and circulatory arrest with CRCP contributes operations of aortic aneurysms without homologous blood transfusion.

A 11-year-old girl diagnosed as having pulmonary atresia with uncommon systemic-pulmonary artery underwent on March 6, 1991. The collateral artery was derived from the left subclavian artery and divided from the descending aorta. Right ventricular outflow reconstruction was performed using a non-valved conduit of the autologous pericardium, and anastomosis of the conduit and pulmonary artery was successfully performed prior to extracorporeal circulation, because of the conduit's flexibility. Thus, we could reduce extracorporeal circulation time. Postoperative course was excellent, and patient is free from the morbidity associated with prosthetic valve. It is considered that a non-valved conduit of the autologous pericardium may be effective, but will require a long term follow-up.

It is sometimes difficult to repair the pulmonary artery in extreme tetralogy of Fallot and other similar complex heart diseases, such as pulmonary atresia with major aorto-pulmonary collateral arteries, because of their complexity. Therefore, cardiopulmonary bypass takes longer in these patients than in those with usual tetralogy of Fallot. We undertook reconstruction of the pulmonary artery in 4 cases of extreme tetralogy of Fallot and other similar complex heart diseases before cardiopulmonary bypass. We investigated the cardiopulmonary bypass time in these patients and compared it with that in patients with usual tetralogy of Fallot. There was no significant difference in cardiopulmonary bypass time between the two groups. In the 4 extreme cases, the postoperative course was uneventful. We conclude that this attempt reduced the cardiopulmonary bypass time and facilitated the surgical correction.

Our hospital recently installed one of the newest types of extracorporeal shock wave lithotripters, a Dornier MFL 5000-(U). We conducted preliminary clinical trials with the apparatus from April to June 1991. In this report we discuss our experience with the first 40 patients (52 stones) treated in a total of 52 extracorporeal shock wave lithotripsy (ESWL) sessions. Follow up observation was conducted for three months. Except in one case, invasive anesthesia was not used. A double J-catheter was inserted in 13 cases, a ureteral catheter in 7 cases, and percutaneous nephrolithotripsy (PNL) was used after ESWL in one case. After one month of follow-up, 27 patients (67.5%) were completely free from stone fragments, while at 3 months after treatment, 34 patients (85.0%) were free from stone fragments. No serious complications were observed after ESWL. We concluded that the Dornier MFL-5000-(U) apparatus is effective for renal and ureteral stones and generates no serious complications.

Statistical analyses were conducted on bacterial strains isolated from the urine of patients with urinary tract infections (UTI) in the Department of Urology at Aichi Medical University from January 1988 through December 1991. The drug sensitivity of the bacterial strains isolated from patients with complicated UTI between 1988 and 1991 was analyzed and compared. Among the outpatients with uncomplicated UTI, a total of 352 strains were isolated. E. coli was isolated the most frequently (90.1%). Among the outpatients with complicated UTI, a total of 829 strains were isolated. Enterococcus sp. was isolated the most frequently (21.2%). P. aeruginosa and S. aureus showed a tendency to increase. Among the inpatients with complicated UTI, a total of 671 strains were isolated. Enterococcus sp. was isolated the most frequently (22.5%). P. aeruginosa and S. aureus showed a tendency to increase, while E. coli and Enterobacter sp. showed a tendency to decrease. E. coli was highly sensitive to all drugs except ampicillin (ABPC). Proteus sp. and Klebsiella sp. were highly sensitive to norfloxacin (NFLX). P. aeruginosa was highly sensitive to gentamicin (GM). The frequency of NFLX-sensitive P. aeruginosa significantly dropped from 84.6% to 40.9% among the outpatients (P < 0.01), and from 75.0% to 44.4% among inpatients (P < 0.05). S. aureus was highly sensitive only to minocycline (MINO). The frequency of NFLX-sensitive S. aureus significantly dropped from 66.6% to 23.3% among inpatients (P < 0.05). Enterococcus sp. was highly sensitive to ABPC and MINO. Of the new quinolones, tosufloxacin (TFLX) had the strongest antimicrobial activity followed by (ciprofloxacin) CPFX on all the bacterial strains tested.

We reported a resected case of thymolipoma, which has been hardly experienced. The patient was 21-year-old female and consulted a doctor for general fatigue. Chest roentgenogram revealed a mass-like shadow at the right lower mediastinum, which was suspected mediastinal tumor. The mass of right anteroinferior mediastinum, which was clearly shown by chest CT scan and MRI, was continued to the right lobe of the thymus. Under a diagnosis of anterior mediastinal tumor, operation was carried out. The tumor, which was 10 x 8 x 7 cm in diameter and 160 g in weight, was removed together with right lobe of the thymus. Histological diagnosis of thymolipoma was obtained from the resected specimen.

Treatment of superior vena cava syndrome (SVCS) caused by advanced lung cancer is still controversial. We inserted Gianturco expandable metallic stents (GEMS) in 5 patients with SVCS due to the extension of lung cancer. GEMSs were introduced intravenously through the catheter after intraluminal balloon dilation of the stenotic sites. SVCS was successfully and easily relieved by this method without any significant complication. GEMS placement seems to be a useful alternative to bypass grafting procedure for the treatment of SVCS.

Treatment of postpneumonectomy pyothorax due to bronchopleural fistula (BPF) is troublesome, especially with methicillin-resistant staphylococcus aureus (MRSA) infection. Moreover, in a bypass-grafting case, the management becomes more complicated. We reported a successful treated case of MRSA pyothorax due to BPF after grafting and pneumonectomy. In a 48-year-old woman performed grafting and pneumonectomy for traumatic aneurysm of the thoracic aorta, MRSA pyothorax due to BPF occurred. BPF was successfully closed by fibrin-glueing under bronchofiberscopy. However pyothorax was not improved by thoracic irrigation for a month. Therefore, open pleural drainage underwent. At the same time, bronchial stump and graft surface was covered with the omental pedicle flap. The open wound had become sterile in two months, and the thoracic window was closed three months after the open drainage.

Ten cases of central airway obstruction mainly caused by extrinsic compression due to the growth of extratracheal malignant tumors or longitudinal extension of tracheal adenoid cystic carcinomas, underwent palliative intubation subsequent to endoscopic Nd-YAG laser treatment. Mean length of the severe stenosis in these cases was 4.4 cm (3-7 cm). Sole application of endoscopic Nd-YAG laser to the stenosis failed relief of the symptom and an immediate palliative intubation was recommended. Mean time of the temporary intubation was 7 days (4-11 days). Airway was maintained by this intubation and also retained enough after extubation. Therefore, it seemed that, in a palliative treatment of the central airway severe stenosis, usefulness of the combination management of Nd-YAG laser with following temporary intubation was revealed. However, in order to maintain the airway for recurrence of the obstruction, use of indwelling airway stents seemed a better application. The longest period of follow-up in the cases treated by indwelling airway stents was 6 months and one of the cases is a now in comfortable state.

Postoperative pulmonary complications cause the decrease of the flow of remaining pulmonary circulation. We examined the effects of the difference of resected lobes on the postoperative course and remaining pulmonary circulation of the lobectomized lung cancer patients using a pulmonary digital subtraction angiography. In all cases with preoperative pulmonary complications, circulatory flow of the remaining lung on the operated side significantly decreased. In the cases without preoperative pulmonary complications, only the cases performed left upper lobectomy developed the decrease of the circulatory flow on the operated side. This seemed to be chiefly caused by a postoperative continual atelectasis of the remaining lower lobe due to kinking of the bronchus. On the other hand, the postoperative decrease of the residual pulmonary circulatory flow on the operated side was not developed in the cases undergoing a segmentectomy, even with pulmonary complications. Therefore, for any case requiring a left upper lobectomy or the case with an impaired lung requiring any type of lobectomy, contralateral pulmonary function should be exactly evaluated preoperatively.

In order to investigate the mechanism of recurrence in herpes simplex keratitis, it is very important to establish an animal model. As a first step, mice were examined with the slit-lamp biomicroscope to determine whether they spontaneously showed recurrent epithelial keratitis after healing of primary herpetic keratitis. Among 90 eyes of 45 inbred C57BL/6 mice, recurrent epithelial keratitis stained with fluorescein was observed in 10 eyes of 9 mice during the observation period up to 50 days after the primary corneal infection with herpes simplex virus (HSV) type I Amakata strain (virulent strain). Recurrent epithelial keratitis was observed in 17 eyes of 15 mice among 116 eyes of 58 ddy mice infected with HSV-I Ska strain (avirulent strain). The epithelial lesions showed punctate or dendritic patterns and continued for one to 7 days. HSV antigen was detected by the fluorescent antibody technique in the cornea of 5 out of 8 eyes which showed recurrent epithelial keratitis using another ddy mice group tested. It was limited in the epithelium of the cornea. These results show that mice herpetic keratitis recurs spontaneously.

Chylothorax was complicated on the 10th postoperative day in a 66-year-old male who underwent left pneumonectomy with mediastinal lymph node dissection for squamous cell carcinoma of the lung. After the leakage point was determined by lymphangiogram and CT, fibrin gluing was performed via flexible fiberoptic thoracoscope. By this procedure the chylous fistulas were completely controlled. Application of fibrin glue through thoracoscope appeared very useful for the treatment of postoperative chylothorax.