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大腸癌肺転移切除例21例 (24回手術) について長期予後を検討した. 対象の性別は男13例, 女8例で, 大腸癌切除から肺転移巣出現までの無病再発期間は平均25カ月 (0-85カ月) であった. 転移巣の個数は, 1個のみ17例, 2個以上4例, 一側性19例, 両側性2例で, 大腸癌の術後病期はII期3例, III a期5例, III b期8例, IV期5例であった. 術式は部分切除9例, 区域切除1例, 肺葉切除11例で, 術後の平均観察期間は48カ月で術後5年, 10生存率はそれぞれ46.9%, 23.4%であった. 術後5年以上再発なく生存した4例は, すべて単発例かつ区域切除以上の完全切除例であったが, 2個以上の多発例や肝転移の合併例は, ほとんどが2年以内に再発癌死し予後不良であった. また, 初回再発から60カ月生存した例もあり, 大腸癌肺転移の予後については, 術後5年以上の最終転帰を含めた長期間のfollow-upが重要と考えられた.

1987年から1999年までの肺縦隔手術例1, 005例を対象に術後合併症とその背景因子を検討した.術後合併症は106例 (10.5%) にみられ, その内訳は喀痰喀出不能33例, 肺瘻14例, 心房細動13例, 後出血11例, 術後膿胸6例, 気管支血管瘻1例, 冠動脈攣縮による急性心筋梗塞1例, 術後肺炎ARDS1例, 他35例であった.このうち心筋梗塞や気管支血管瘻など5例が手術死亡となった.1ヵ月以降の在院死亡の3例は気管支瘻後膿胸2例と肺癌の進行による癌死であった.これら手術死亡と在院死亡を合わせた術後死亡 (8例) はすべて肺癌症例で全手術例の0.8%, 肺癌手術例の1.6%であった.術式別では葉切除術の0.8%に対し肺全摘術11.1%と肺全摘術での術後死亡が高率であった.しかし, 1994年以降は高齢者の肺全摘の際に有茎心膜脂肪織の被覆を行い気管支瘻の例はなくなった.また, 最近の異型狭心症の例には周術期のリスクを評価する目的で術前に冠動脈攣縮誘発試験を導入した.

1994年7月までの原発性肺癌切除例299例を対象に術後5年以降の経過と10年以上の長期生存例について検討した. 術後5年以上の生存が130例 (44%) あり, その後の転帰は現在も生存中89, 再発癌死14, 他癌死13, 他病死9, 事故死1, 不明4であった. さらに術後10年以上の長期生存が24例 (同時期手術の22%) あった. 10年以上長期生存例の臨床病期はIA期とIB期の例が19例と大部分であったが, IIIA期 (pN2の扁平上皮癌) の2例とIIIB期 (同一肺葉内転移, 腺癌) の1例もみられた. 肺癌術後5年以内は肺炎など高齢者の他病死が多かったが, 術後5年以降は他病死より第二肺癌や消化器癌などの他癌死が多かったことより, 定期的な胸部単純写真に加えて消化器癌に対する検索も必要と考えられた.

髄膜腫はくも膜細胞由来の腫瘍であり, 中枢神経系以外に発生するのは稀である.本症例は他疾患経過観察中の54歳の女性で, 検診にて胸部異常陰影を指摘され, 胸腔鏡下左肺S6部分切除を行い, 病理組織学的および免疫組織化学的診断にて, 髄膜上皮腫型髄膜腫と診断された.脳, 脊髄腫瘍の手術既往がなく, MRI等の諸検査にて中枢神経系に腫瘍を認めないことから, 原発性肺髄膜腫と診断された.現在までに報告されている原発性肺髄膜腫は, 本症例を含めて19例と極めて稀な疾患である.

前縦隔に発生した悪性リンパ腫 (ポジキン病) の1例について報告した.症例は36歳女性で胸部異常陰影のため当院入院となった.胸部CT写真では腫瘤は前縦隔にあり, 上大静脈と右肺に浸潤しており, 浸潤性胸腺腫が疑われた.経皮針細胞診にて診断がつかなかつたため, 前側方切開による開胸生検が行われ, 組織標本より悪性リンパ腫ポジキン病 (結節硬化型) と診断された.その後化学療法 (ABVD療法) が10クール行われ, 腫瘍は著明に縮小しCR (completeremission) と判定された.本邦では縦隔発生の悪性リンパ腫の報告は非ポジキンリンパ腫が大部分で, ポジキン病の報告はまれである.放射線が有効な浸潤型胸腺腫と化学療法が治療の主体となるリンパ腫では, 治療方法が異なることからその鑑別は重要である.

胸部異常陰影で受診した76歳の女性.胸部CTで左S6に胸膜嵌入像を伴った直径約10mmの腫瘤影を認めた.18F fluorodeoxy glucose positron emission tomography (FDG-PET) 検査では, 腫瘤影に一致して高い集積像を示し, 肺癌が疑われた.胸腔鏡下肺部分切除を行った結果, 原発性肺クリプトコッカス症と診断された.術後は髄膜炎の予防のために抗真菌薬を12ヵ月にわたって投与された.FDG-PETは肺癌の診断に有効な検査であるが, 孤立性の腫瘤を形成した原発性肺クリプトコッカス症では, 偽陽性を示すことがあり, 肺癌との鑑別がしばしば困難である.

von Recklinghausen病に合併した神経原性悪性腫瘍の2例を報告する. 症例1は16歳, 女性. 右前胸部痛にて, 近医を受診し, 右胸腔内に大量の血性胸水が認められた. 胸腔ドレナージ後の胸部レントゲン写真にて, 右後縦隔の腫瘤が明らかとなり, 腫瘍摘出を試みたが, 腫瘍からの出血が著しく, 試験開胸に終わった. 悪性神経鞘腫の病理診断にて術後3ヵ月後に癌死した. 症例2は, 39歳, 女性.呼吸困難にて入院. 胸部CT検査にて上縦隔に直径12cm大の辺縁明瞭な腫瘤が認められ, 上大静脈, 気管および左右主気管支を圧排していた. 通常の気管内挿管では呼吸管理できず部分体外循環下に腫瘍を摘出した. 病理学的に悪性神経鞘腫に横紋筋肉腫の成分が混在する悪性triton腫瘍と診断された. 術後, 左副腎に再発し開腹摘出術を受けたがその後は再発なく外来通院中である. von Recklinghausen病は神経原性腫瘍の合併が多く, 悪性化も稀ではなく注意が必要である.

Background. Nafamostat mesilate (FUT-175) is a synthetic serine protease inhibitor that inactivates coagulation, fibrinolysis, and platelet aggregation. Nafamostat mesilate may suppress the blood-foreign surface reaction similar to biocompatible materials by blocking factor XIIa. Methods. We performed an in vitro study of cardiopulmonary bypass (CPB) with fresh human blood among the following three groups: standard CPB sets (C), biocompatible CPB sets (B), and standard CPB sets with FUT-175 (10 mg/L) (F). A clinical study using these same CPB groups also was performed in 45 patients undergoing aortocoronary bypass operations (15 patients each). We injected FUT-175 at 40 mg/h during CPB. Results. In the in vitro study, both groups B and F showed significantly lower levels of coagulation factors, thrombin-antithrombin III complex, fibrinopeptide A, β -thromboglobulin, complement C3a, granulocyte elastase, and free hemoglobin than group C at the conclusion of the study. Thrombin-antithrombin III complex and free hemoglobin in group F also were lower than in group B. The platelet count remained at a higher level in group F than in the other groups. Separation of bradykinin was suppressed most significantly in group F. In the clinical study, group F also showed significantly lower levels of α 2-plasmin inhibitor plasmin complex and C3a than both groups C and B. There were minimal levels of free hemoglobin in group F. Conclusions. Nafamostat mesilate may contribute major beneficial effects toward conservation of blood during CPB and prevention of coagulopathy after CPB.

In this study, we investigated a noncontact method of measuring plastic strain of metals using laser speckle. This method is based on observation of the change in laser speckle pattern with surface profile change due to plastic deformation. Analysis of the laser speckle pattern is performed on a computer-based image processing system. The relationships between speckle pattern and surface roughness and frequency characteristics of the surface profile were investigated. Surface roughness and surface profile were observed for steel specimens polished with emery paper or plastically deformed. The surface profile diagram was analyzed by means of the fast Fourier transform with a computer and distribution of the spatial frequencies was obtained. The results showed that distribution of light intensity of the speckle is related to frequency distribution of the surface profile, but it is not always related to surface roughness. It was also clarified that the laser speckle pattern is closely related to the magnitude of plastic strain.

症例は, 32歳, 女性, 多発性でかつ増大傾向を示していた胸部腫瘤影を指摘されて紹介入院となった.右上葉切除を施行し, 軟骨性成分が主体の多発性肺過誤腫と診断された.この症例は, 13歳の時に胃平滑筋肉腫にて胃全摘術を施行された既往歴があったことから, Carney's triad (gastric epitheloidleiomyosarcoma, pulmonary chondroma, functioning extra-adrenal paraganglioma) の2項目を満たし, 極めて稀なCamay's syndrome の1例 (本邦2例目) と考えられた.今後, paraganglioma の発生に関して厳重な経過観察が必要と思われる.

1992年12月より1993年12月まで, 確定診断のつかなかった肺末梢腫瘤影を有する17例の患者に胸腔鏡下楔状切除, 迅速組織診を施行した. 17例の性別は, 男9, 女8で, 年齢は34-76歳 (平均56歳) であった. 最終病理診断は, 肺癌7 (腺癌4, 扁平上皮癌2, 小細胞癌1), 肺結核7, 肺化膿症1, 器質化肺炎1, 転移性肺癌 (腎細胞癌) 1であった. 肺癌7例のうち4例は開胸し, 定型的肺葉切除, 縦隔リンパ節郭清を追加したが, 3例はCOPDなどの合併症により部分切除のまま終了した. 肺結核と診断された例には抗結核剤の投与を追加した. 手技上の問題として自動縫合器のトラブルや切離断端からの出血の例を認めた. 胸腔鏡下懊状切除の適応は, 従来の開胸生検の適応としていたものと基本的に同じであるが, 創痛が軽く回復も速やかであることから, 開胸生検にとって代る診断手技と思われる.

Pulmonary stenosis caused by calcium deposits on pulmonary valve is relatively rare. We experienced such as case in a 67-year-old man. In March 1992 the patient developed heart failure and internal treatment resulted in remission. Cardiac catheterization study and echocardiography showed a valvular PS. Chest CT and cineangiogram showed the calcified pulmonary valve and annulus. In July pulmonary valve replacement with a bioprosthetic valve was performed under thoracotomy and ASD was closed by a patch. There were severe calcification of the pulmonary valve, adhered commissure and sclerotic valve ring. Postoperative course was uneventful, however, the patient developed cardiac tamponade on the 12th day after the operation. Reoperation was carried out. No clear hemorrhage was found and only drainage was done. The patient gradually became worse to develop renal failure and DIC, and died of MOF on 34th postoperative day.

This study compared the cerebral microcirculation during retrograde cerebral perfusion with that during antegrade cardiopulmonary bypass under normothermic and hypothermic conditions.Brain tissue blood flow was measured with the hydrogen-clearance and colored microsphere (15 and 50 microns) methods during antegrade cardiopulmonary bypass and retrograde cerebral perfusion. Measurements were performed during normothermia (37 degrees C), moderate hypothermia (28 degrees C) and deep hypothermia (20 degrees C) in groups of mongrel dogs (n = 8).During antegrade cardiopulmonary bypass, the microsphere method showed a significant decrease in cerebral blood flow as body temperature decreased (40.1 +/- 20.8 ml/min/100 gm at 37 degrees C, 16.2 +/- 18.0 ml/min/100 gm at 20 degrees C with 50 microns microspheres) At 20 degrees C, the cerebral blood flow measured with the 15 microns microspheres was significantly lower than that assessed with the hydrogen-clearance method (11.3 +/- 7.0 vs 24.8 +/- 7.0 ml/min/100 gm). During retrograde cerebral perfusion, the microsphere method also showed a significant decrease in cerebral blood flow with cooling. At 37 degrees C, the cerebral blood flow measured with the 15 microns microspheres (0.8 +/- 0.7 ml/min/100 gm) was significantly lower than that assessed with the hydrogen-clearance method (10.1 +/- 3.5 ml/min/100 gm). At both 28 degrees and 20 degrees C, the hydrogen-clearance method showed significantly higher cerebral blood flow (10.1 +/- 5.8 and 8.2 +/- 3.7 ml/min/100 gm) than did the 50 microns microspheres (1.8 +/- 0.6 and 1.0 +/- 0.8 ml/min/100 gm) and 15 microns microspheres (0.23 +/- 0.14 and 0.18 +/- 0.15 ml/min/100 gm).(1) Cerebral blood flow that shunts to capillaries is increased during antegrade cardiopulmonary bypass under deep hypothermia. (2) During retrograde perfusion, the majority of the blood flow shunts away from brain capillaries, even under normothermic conditions, and blood flow through large venoarterial shunts increases as body temperature decreases. Although the cerebral microcirculation during retrograde perfusion is decreased, retrograde perfusion provides some degree of oxygenation to the body.

Currently, poststernotomy mediastinitis frequently is being treated by debridement and immediate closure with omental drainage. This method is useful, but subcutaneous infection occasionally occurs. Divided omental transfer to the presternal space may be helpful in preventing this complication.

Reimplantation of all intercostal arteries was performed with a T-shaped graft for spinal cord protection in a 64-year-old man who required long-segment replacement of the descending thoracic aorta. The T-shaped graft maintained blood flow to the intercostal arteries, and no neurologic deficits developed.

Mitral valve replacement was performed through a right thoracotomy using femorofemoral bypass under profound systemic hypothermia in a 62-year-old man who had undergone coronary artery bypass grafting using both internal thoracic arteries. The right thoracotomy approach minimizes the risk of injury to the arterial grafts, and deep hypothermia obviates the need to interrupt the grafts to administer cardioplegia. This technique provides excellent exposure of the mitral valve while minimizing the operative risk.

肺腺癌切除例42例を対象に核内封入体の頻度および形態を細胞診所見, 組織所見, 電子顕微鏡所見について検討し, 核内封入体観察の意義について考察した.核内封入体は, 細胞診で71%, 組織診で67%, 電顕で76%とかなり高率にみられた. その大部分は, 単に核膜が核内に彎入したもの (偽核封入体) で, 細胞診59%, 組織診40%, 電顕73%であり, 微小管状封入体および微細顆粒状物質のみられるもの (真の封入体) は, 細胞診27%, 組織診40%, 電顕9.8%とやや少ない. 分化度別にみると, 細胞診で高分化32%, 中分化22%, 低分化18%, 組織診で高分化59%, 中分化11%, 低分化27%とあまり差はみられないが, やや高分化腺癌で多くみられた. 真の封入体の起源に関しては不明な点が多いが, II型肺胞上皮型またはクララ型との関係が示唆されており, 予後との関係もみられている.以上より, 核内封入体を, 切除標本, 気管支生検および擦過細胞診などで観察することは, 組織亜型および予後の推定のうえからも重要であると思われる.

冠動脈疾患におけるsleep apneaの出現頻度とその意義について検討した.まず健常者・心疾患患者94名に24時間呼吸心電図記録を行い, sleep apneaと心拍数変動との関係を検討した.その結果無呼吸持続時間とそれに伴う心拍変動数とはr=0.9の良い相関が示され, 心拍数変動様式からsleep apneaの推測が可能であると考えられた.そこで冠動脈造影により75%以上の有意狭窄が証明された59症例 (男49名, 女10名, 42～74歳) のホルター心電図記録を分析し, 労作性狭心症42例, 陳旧性心筋梗塞17例の86%, 65%にsleepapneaが観察された.max. apnea indexは各々平均18.2回, 16.8回であり健常者の6.5回に比し有意に大であった.冠動脈病変数, 病変部位とsleep apneaとの間には一定の関係は認められなかった.左前下行枝1枝病変16例において, sleep apneaと心係数との相関を検討したところapnea index, 無呼吸持続時間と心係数とは有意の負の相関を認め心係数の低下症例にsleepapneaの出現頻度が大きいことが示された.

肺小細胞癌の気管支擦過標本を用い, その細胞所見, 核内DNA量と化学療法に対する反応性, 予後との関係を検討した.化学療法に有効な症例は, 無効例に比較しあきらかにその予後は良好であり, 細胞診によりあらかじめその反応性を予測することは重要であると思われる.クロマチン所見から腫瘍細胞をI型: 腫瘍細胞が小型 (9μ前後) で粗顆粒, II型: I型より大型で粗顆粒, III型: 網状不均等, IV型: 細顆粒状均等, V型: 微細顆粒状均等, の5型に分類した.化学療法に有効な症例ではIV, V型の割合が多く, 無効例にはI, II型の割合が多かった.核内DNA量と腫瘍細胞の大きさとの問には相関関係がみられた.化学療法に有効な症例は, 無効例に比較し大型の細胞が多く, 核内DNA量もやや多い傾向がみられた.

細胞診および組織診のある肺小細胞癌16例を対象に, アルシャンブルー-PAS染色, ABC法でCEA, Keratin, SC, NSE染色を, さらに7例は電子顕微鏡による検索を行い, 小細胞癌の分化の多様性について検討した.NSEは16例中10例, 神経分泌顆粒は7例中4例が陽性で, 小細胞癌の神経内分泌系への分化が指摘される.一方, Kefatin6例, CEA9例, SC3例に陽性, AB-PAS染色も6例に陽性の部分がみられ, 電顕でも張原線維1例, デスモゾーム5例, 分泌顆粒5例, 微絨毛1例にみられ, 小細胞癌の上皮性としての性格がみられるなど, 分化の多様性がうかがわれる.

( 1 ) The sponge gourd, Luffa, are cultivated in Japan for the purpcse of dried fibers of mature fruits, widely used for industrial purposes; for instance, to make oil-filters in certin machine, dish cleaners, certain summer hat etc. The region near Hamamatsu citv., produced the greater part of these fibre in Japan. But recently, the sponge gourd cultivation is becoming ver.v unstable due to Fusarium wilt disease, and therefore we undertook the breeding works to induce certain wilt-resistant varieties, since several years ago. In the series of the breeding wark, we adapted polyplaidy breeding paralleled to many other methcds. Although the researches and the data are somewhat defective in certain points, as this wcrk was undertaken in the course of practical breeding work, we have attained some conclusion. This paper is offered to discuss this research of polyploidy breeding. ( 2 ) The tetraploids were induced by means of colchicin treatment in 1952. Their morphological charactor and fertility were investigated for two years in non-infected field at Shizuoka city, and the wilt resistance of them were examined in the second year in the infected field near Hamamatsu city where the Fusariun4 wilt was broken cut and about 50 percent of spange gourd were darnaged.

In previous papers we have already discussed about (1) the development by tetraploids and (2) the development by direct selection. But in this one we are going to described about (3) the development by hybridization. Hybridizations were made between the varieries (A) Tokado and Daruma, (B) Daruma and Beikan and also by (C) three-way-crossing, and we have got two new Fusariulee-wilt resistant varieties developed from (B) and (C). Materials and Methods Varieties. (1) Daruma (D) : An excellent commercial fiber-using variety. This was considered previously as susceptible, because the population of this variety, used as parents of these hybrids, was nighly susceptible to the wilt. Later, some resistant lines weredeveloped from the progenies of this population as shown in report 2. (II) Tokado (T) : A Formosan edible variety of poor fiber. This had been considered as a highly resistant variety. In our recent research, it was infected by inoculation in seedling stage. Mature plants also were injured in September by wilt together with nematode rootknot. (III) Beikan (B) : A Formosan edible variety not suitable for fibber-quality as these fibers are too short, thick and at the sametime coa, rse. But it has been considered as a resistant variety. About 70% of the Beikan population, used in the hybridizations, survived under the infected field condition. (IV) Tsurukubi (Tu) : A fiber-using variety having somewhat longer and weaker fiber than Daruma. It has been considered as a perfect susceptible variety. Methods. Methods used in this research were the same as in report 2, except the crossing practice. First, intervarietal crossing was used. Then, seeds were grown by selfing after F2 generation.

Nine series of ω-substituted PAS alkyl esters, namely, ω-chloroalkyl, ω-aminoalkyl, ω-diethylaminoalkyl, ω-phenylethylaminoalkyl, ω-morpholinoalkyl, ω-pyrrolidinylalkyl, ω-piperidinoalkyl p-aminosalicylates and alkylene bis-p-aminosalicylates in which the alkyl length varied from ethyl to decyl were synthesized and their evaluations were made with testing their tuberculostatic activities and with measuring their physicochemical properties such as partition coefficients and degrees of protein binding that might considerably influence biological effects of these substances when administered in animal body. These synthesized derivatives have activities as same extent as the parent compound and are more lipid soluble and some of them are less protein bound than PAS. From these observations, it is considered that some of the defects of the parent compound are improved by these chemical modifications. Relationship between structures and these characteristics are also revealed.

A normal-phase high performance liquid chromatographic determination of adriamycin and its metabolites, adriamycinol and adriamycinone, in human body fluids (plasma, urine and pleural fluids) is described. Samples were collected from lung cancer patients who had received adriamycin by peripheral vein infusion, bronchial arterial infusion and intrapleural infusion. Adriamycin and its metabolites were easily and efficiently extracted from each biological fluid by the use of an Extrelut[○!R] column. High performance liquid chromatographic separation was carried out in the presence of Mg2+ and the limits of determination of adriamycin, adriamycinone and adriamycinol were found to be 0.52, 0.72 and 0.48ng/ml, respectively. Chromatographic analyses were completed within 8min. The present method was also applied to pharmacokinetic studies of adriamycin, and it was found that the metabolic fate of adriamycin can be well explained by a two-compartment model.

The effects of nitroglycerin, dopamine and dobutamine on pulmonary gas exchange were determined in 21 adult patients during two-lung and one-lung ventilation. Nitroglycerin, in 1 microgram.kg-1.min-1, decreased cardiac index (CI) and PaO2 during both two- and one-lung ventilation, and increased in Qs/Qt during one-lung ventilation. There were no significant changes in the measured variables during infusion of dopamine, 5 microgram.kg-1.min-1. Dobutamine, 5 microgram.kg-1.min-1, increased CI and PaO2 did not change during two-lung ventilation. During one-lung ventilation, PaO2 increased from (mean value +/- SD) 168 +/- 46 to 201 +/- 52 mmHg (P less than 0.01) with dobutamine infusion. Qs/Qt decreased from 29.2 +/- 7.0 to 26.0 +/- 6.2 per cent (P less than 0.05) without any change in pulmonary vascular resistance index during one-lung ventilation. We conclude that dobutamine has advantages over dopamine and nitroglycerin during one-lung ventilation.