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Seventeen patients having extracardiac valved conduits placed between the right ventricle and pulmonary artery were followed for 7 to 87 months postoperatively (mean, 42 months), at the Heart Institute, Kenritsu Amagasaki Hospital, Japan. There were no late deaths in the study group. Three conduits have been replaced, all because of conduit stenosis. In two-dimensional echocardiographic examinations, commissural fusion and calcification of the valve were noted in 6 out of 16 xenograft valved conduits. Mechanical valve immobility was found in one patient. Neointimal peel of the dacron graft was noted in 6 out of 17 cases, and marked left ventricular deformity in the short axis view was found in 6. Late cardiac catheterization was done in 6 patients who were suspected of having valve failure and right ventricular hypertension by two-dimensional echocardiography. All 6 of these patients showed a high pressure gradient between the pulmonary artery and right ventricle and also had elevated right ventricular pressure. In conclusion, two-dimensional echocardiography is a simple, non-invasive and very accurate method for detecting conduit stenosis and valve failure. An echocardiographic series should be performed for a long-time postoperatively because obstructions of valved conduits may be progressive, and an operation may be advisable in order to prevent the development of advanced right ventricular hypertrophy and deterioration.

Changes in the hemodynamics of six patients having received Fontan-like operations were closely observed during the first 48 h after the operation. Catheterization studies and simultaneous angiocardiography were also performed before and after the operation. Hemodynamic derangement was particularly severe during the first 24 h postoperatively as indicated by a low cardiac output of less than 2.01/min/m2, which persisted in spite of very high central venous pressure. Furthermore, the central venous pressure needed to re-establish the circulation soon after the Fontan procedure significantly correlated with the angiocardiographically assessed preoperative size of distal pulmonary arteries. Accordingly, the preoperative evaluation of the distal pulmonary arterial size is very important, that provides a good guide-line for the degree of circulatory volume expansion necessary to elevate the central venous pressure and to sustain the circulation in the early postoperative period.

The present study was conducted to investigate the usefulness of the direct leucocyte migration agarose method for studying cell-mediated immunity in vitro. Comparative studies of the purified protein derivative (PPD) skin test and the leucocyte migration inhibition test (LMIT) in which PPD was used as test antigen indicated a significant qualitative and a weak quantitative correlation between these two tests. Furthermore a positive correlation was found between the LMIT and the macrophage migration inhibition test (MIT) using ultrasonicated authochthonous tumor antigen. Comparative studies of the LMIT, MIT, PPD skin and DNCB tests on the same patients showed that cases responding positively to the the PPD skin and DNCB tests tended to respond positively to the LMIT and MIT. Patients with digestive organ cancers were examined by the LMIT. With the advance of cancer, decreased positive test test rates were found. After gastric cancer operations the LMIT findings were divided into two groups: one type changed from positive to negative, and the other type changed from negative to positive. The former response was suggestive of a successful operation, and the latter response was suggestive of a non-curative operation. These results indicated that the direct leucocyte migration inhibition agarose test was useful investigating cell-mediated immunity.

Gastrointestinal cancer patients were followed up for up to 30 months postoperatively and their clinical status related to a parameter of nonspecific immunity, the blastformation rate of peripheral blood lymphocytes against phytohemagglutinin. By the fourth postoperative week, the blastformation rate had recovered from the effect of the operation. In patients who had undergone curative resection, the postoperative level rose to exceed the preoperative level, whereas whereas in those in whom resection had not been possible, the blastformation rate failed to show this rise by the fourth week, and continued at the decreased immediate postoperative level. Results for long-term follow-up (30 months postoperatively) showed that the blastformation rate continued at high levels (almost all over 40%) in cases of curative resection without recurrence, but remained low (under 40%) in those in which the tumor could not be removed. The 40% level of the blastformation rate test thus correlated well with the prognosis. The blastformation rate, therefore, proved a very good parameter for following the pre-and post-operative clinical course of gastrointestinal cancer patients.

Operative treatment of fractures of the neck and trochanter of the femur does not always produce a satisfactory result. This is usually due to biomechanical problems with the available internal fixation methods. We studied the anatomy of the neck of the femur by roentgenograms and sectional specimens from 70 cadavers. In addition, various nail-plates were subjected to buckling tests and, by simultaneously attaching a strain-gauge, stress distribution was calculated. The results of these preliminary studies were then used to design a new nail-plate better than those available at present. Testing of this new nail-plate confirmed that it had a strength equal to that of the Holt nail-plate (the strongest of the available nail-plates).

Factors influencing the prognosis in gastric cancer treated by curative resection include lymph node metastasis and the extent of invasion of the gastric wall. Lymph node metastasis can be removed surgically, but the extent of invasion is not amenable to external measures. Of these two factors, the extent of wall invasion has the greatest influence on prognosis in cases undergoing curative resection. With lymph node removal of equal extent the prognosis worsens in proportion to the depth of invasion. Further, lymph node metastasis increases with increasing depth of invasion. Metastasis was seen in Group 2 and 3 nodes in more than 60% of cancer with invasion beyond the Tunica muscularis propria (pm), indicating that wide lymph node removal is essential in cancers with deep invasion of the wall. The effects of extended radical operation on the host as illustrated by the indices of total serum protein and albumin levels were no different from those of less extensive resections. It was confirmed that extensive radical resection did not delay postoperative recovery.

The rate of blastformation of peripheral blood lymphocytes in response to stimulation by phytohemagglutinin (PHA) was assessed preoperatively in 393 patients with gastrointestinal cancer. The series consisted of 291 cases of gastric cancer and 102 cases of colon cancer, all patients being under 70 years of age. The blastformation rate was related to the stage of cancer ground at operation. Preoperative blastformation rates for both colon cancer and gastric cancer decreased as the cancer progressed. With Stage I gastric cancer 81.4% of those that underwent curative resection had preoperative blastformation rates greater than 40%. However, the number of those with blastformation rates over 40% decreased markedly in the curative cases of gastric cancer Stage II to stage IV. Eighty three percent of cases that underwent curative resection with colon cancer, including advanced cancer, had preoperative blastformation rates of over 40%. These results indicated that the correlation of the preoperative blastformation rate with success of curative resection better for colon cancer than for gastric cancer.

We studied deformity of the proximal end of the femur following open reduction using the wide exposure method for developmental dislocation of the hip. We reviewed radiographs of 22 children with unilateral dislocation of the hip who had undergone open reduction between one and three years of age. Ages at final examination ranged from 14 to 21 years. None of the patients in this study had undergone any additional surgery. Avascular necrosis of the femoral head was not observed in any patients. Radiographic measurements were observed when the children were 3, 6, 9, and 12 years old, and at the final examination. Coxa magna and valga were the factors associated with poor results. Coxa valga had occurred at 6 to 12 years of age, but rapidly improved thereafter. Throughout the course of treatment the epiphysis-femoral neck angle was within the normal range. The fusion of the epiphyseal growth plates on both sides occurred simultaneously. The coxa valga was due to valgus of the femoral neck, and not to valgus head tilt. These results suggest that, provided the mechanics of the joint have been properly corrected as in our operation, the biomechanics of the hip will improve until growth ceases, but that it may take more than ten years to attain normality.

Accurate assessment of elbow function is important to determine the total ability of the arm. The purpose of this study was to clarify the relationship between isometric muscle strength of the elbows of patients with rheumatoid arthritis (RA) and Larsen's X-ray evaluation. Fifty-six elbows of 45 RA patients aged 47 to 77 years (mean age, 63 years) were tested. Muscle strength was measured with an isometric torque-cell dynamometer. Test-retest reliability of the dynamometer was proven by measuring 12 elbows of 6 healthy young men. In RA patients, elbow flexion and extension strength decreased in proportion to increases in the severity of Larsen's grades from Grade 1 to 4. However, Grade 5 elbows had greater muscle strength than those in Grade 4. Forearm pronation and supination strength also decreased in proportion to increases in the severity of Larsen's grades from Grade 1 to 5. This quantitative study made it clear that the muscle strength of RA patients' elbows almost completely correlates to X-ray finding according to the grade of Larsen's evaluation based on X-rays. With regard to muscle strength of postoperative elbows, both flexion strength and supination strength after total elbow replacement (TER) were about two times greater than before TER, and after synovectomy it was as great as those in non-operative RA patients of Grade 2.

Even after successful operations, ugly postoperative skin scars are often distressing to patients and their parents. To judge the success of surgical methods and postoperative treatment, postoperative scars should be evaluated using a quantitative system. Height and width are easily measured, but scar redness is not. We have developed a simple and effective method for evaluating scar redness. According to the color definitions employed in computer graphics, each color can be expressed as RGB (red, green or blue) coordinates (r, g, b): 0 ≦ r, g, b ≦ 10. The degree of scar redness is defined by the following formula: redness score (RS) = (r₁ - r₀)² + (g₁ - g₀)² + (b₁ - b₀)². Here, (R₁, g₁, b₁) = coordinates of the scar color and (r₀, g₀, b₀) = coordinates of the surrounding skin color. RS was evaluated in 59 children (35 males, 24 females; ages 1 month to 12 years old) who had scar redness after congenital cardiac surgery. For each patient, scar color and surrounding skin color was identified on the color sample table. Scar redness was also evaluated by the conventional grading method: 1 = mild, 2 = moderate and 3 = severe. The RS of the colored scars ranged from 4 to 100 (38 ± 27). By the conventional grading method, 44 scars were grade 1, 15 grade 2 and none grade 3. RS was significantly higher among grade 2 than grade 1 patients, 52 ± 25 and 33 ± 27, respectively (P < 0.05). Given its subjectivity, the conventional grading method yields variable data; surrounding skin color, moreover, is not considered. Our new evaluation method using RS effectively and accurately defines scar and skin colors, and allows quantitative studies of these factors.

A 61-year-old man, who was diagnosed with superior vena cava syndrome by papillary thyroid carcinoma, was referred to our hospital. A bulky thyroid tumor with tracheal invasion extended from the left neck to the right atrium without distant metastases. The risk of sudden death due to airway occlusion, tumor embolism or obstruction of the tricuspid valve led us to elect surgery. Extended resection of thyroid cancer was performed with cardiopulmonary bypass. Peritoneal dissemination was found via laparotomy. A histological diagnosis of anaplastic carcinoma arising from transformation of papillary carcinoma was made. After the operation, bilateral ureteral occlusion by peritoneal dissemination and multiple lung metastases were detected. The patient died with acute renal failure on postoperative day 12. Intraatrial extension of thyroid cancer is rare, and only 12 cases have been reported in the literature. We present a case of thyroid cancer with intraatrial extension.

The LigaSure TM vessel-sealing system (VSS) represents a new approach to intraoperative ligation. This clinical study retrospectively examined the utility of the VSS in thyroid surgery. In this study, we analyzed 56 consecutive patients who underwent thyroid surgery. Characteristics such as operative duration, the volume of intraoperative hemorrhage, and postoperative course were analyzed and compared between thyroid surgery using the VSS or conventional handtie methods. The present results indicate no significant differences in operative duration, volume of intraoperative hemorrhage, postoperative course, or duration of postoperative drainage between surgeries using the VSS or conventional methods. However, the postoperative hospital stay was found to be significantly shorter (p<0.05) with the VSS. No serious postoperative complications were encountered, and no significant differences were observed in the frequency of postoperative complications between methods. The VSS may simplify procedures for thyroid surgery, and hemostasis is effective for both thyroid vessels and thyroid parenchyma. However, further evaluation is warranted to adequately determine the relative merits of the VSS compared to conventional handtie methods.

Cytogenetic and dermatoglyphic studies were performed on a group of 197 institutionalized patients with severe mental and physical handicaps in order to evaluate the contribution of chromosomal aberrations on the etiology of the condition, and to determine whether any association exists between the dermatoglyphics and the severe handicaps. There were 4 patients with trisomy 21 and 2 patients with a de novo balanced reciprocal translocation. In addition, 9 patients were found to have a pericentric inversion of chromosome 9 (inv (9) (p11q13)). Other chromosome variations identified included inv (1) (p11q11) (one case), elongation of 1 qh (one case), and telocentric chromosome 13 (two cases). Dermatoglyphics from the patients excluding cases with Down syndrome were compared with those from 500 normal controls. Significant differences were observed in several dermatoglyphic characteristics, including simian crease, fingertip pattern, mean a-b ridge count, thenar/first interdigital pattern, hypothenar pattern, and hallucal pattern. The present study indicated that de novo balanced translocation as well as chromosome duplication or deficiency is causally related to the severe combined handicaps. This study also showed that the incidence of inv (9) (p11q13) in the patients was 4.2 times higher than that in the general Japanese population. If a real association exists between the inv (9) (p11q13) and severe handicaps, the increase of inv (9) (p11q13) in the patients may be explained by the concept of a risk factor. Moreover, the dermatoglyphic deviations found in patients may be evidence that pathological factors had been operating during early embryonic life in some of them.

<P>1) Nach Entfemung der Epithelkorp erchen nimmt das Korpergewicht des Versuchstieres allmahlich ab. 2) Dagegen nimmt es nach und nach zu, wenn die Schilddruse entfernt wird. 3) Nach der Thyreoidektomie entwickelt sich der Colgische Apparat der Leberzellen etwas besser. 4) Nach der Parathyreoidektomie tritt der Apparat in den Hintergrund, indem seine Elemente allmahlich in feine Komchen zerfallen, um endlich ganz zu verschwinden. Dabei zeigen die Leberzellen selbst eine erhebliche Veranderung, besonders am 7. Tage nach Operation. 5) Auch nach der Parathyreo-thyreoidektomie verandem sich die Leberzellen nicht weniger als nach der Parathyreoidektomie. Zum Schluβ halte ich es fur meine Pflicht, Herrn Emerit. Prof. Dr. K. Kosaka meinen aufrichtigen Dank fur seine hochst wertvollen Ratschlage und seine freundliche Anleitung bei der Ausfuhrung dieser Untersuchung auszusprechen.</P>

Generally, of all the visceras, the ovary is the commonest place for cyst-formation, and the majority of all the ovarial cysts are multilocular pseudomucinous forms. Lieppert states that it occupied 53.6% and by Stubler and Branders, 30.6% and by Pfannestiel, ca. 2/3 of all the ovarial cyst. ･ In many cases, it is one sided (ca. 90%) and moreover is pedunculated, and as the epitherial proliferarion of the tumor is almost unlimitedly repeated and so it is, indeed, possible to become a wonderful size. We have never seen any other tumor which can grow so large like the ovarial pseudomucinous tumor. Therefore, when I consider the reason that, even now, we sometimes meet with a gigantic ovarial cyst like these, considering from the side of patient, I can cite the following facts ; first : the extreme terror of surgical operation, second : they have been left behind in the march of progress of civilization, and third : the poverty of their family, etc. In my cases, all the patients are either country people living far off from the civilized city, or those disliked the operation, and on the other side, the wrong diagnosis of the doctor and the midwife, which took it for pregnancy. These facts should be also considered in connection with it. Probably it may not be an error to attribute one of these reasons in Case 1. Such a monstrous tumor looks as if it occupies the whole abdorninal cavity and it extremely presses the abdominal visceras and diaphragma. The Kaufmanns case mentioned previously shows that the height of its diaphragma is in the Ist intercostal space in the left side and the 4th rib at the right. Consequently the thoracic visceras are also pressed and causes some trouble in the heart and lungs. These disorders are, however, gradually recovered after removal of the cyst, as all of my cases have proved. The carrier of the head and extremities are rather the appendages of the tumor. Still the patient becomes very thin and her face characteristically shows the so-called "" Facies ovarica "" which is quite different from cachexy, but a similarity of feature is observed in those who are suffering from the said disease and it appears as if they are related each other. The development of the cyst is generally very slow but its monstrous one is rapidly enlarged at certain period. It appears at any age, old or young, mostly between 20 and 50, and especially Mainzer, Olshausen and the author have reported cases of very aged woman. The size of cyst varies from the very small to the marvellous monster one and it is not infrequently reported as mentioned before that the weight of cyst exceeds the body-weight. The gigantic cyst, of course, interrupts pregnancy, delivery and puerperium. The monstrous cyst consists of the so-called a large main chamber and many small accessory chambers and some are very tense in consistence. It, is mostly spherical in shape and all of my cases are like irregular gourd which is generally seen in literature. The surface of cyst is generally white-pearty, glittering appearance, but following the alteration of the content, of each chamber, its surface changes to yellow, black and yellowish-brown or dark red-color. The contents of the cysts are changeable ; sometimes are very diluted serous or mucinous but generally thick mucous and frequently become very viscid. The monstrous cyst posseses various substances secondarily. As to the constitution of the contents, Scherer and Eichwald ever said that it consists of paralbumin and metalbumin but as a matter of fact there exists no albumin. Hammarsten named it pseudomucin, illustrating from his view point ; Pfannenstiel noted that it is not so simple substance and Mizukoff proved the existence of paramucin. Histologically the lumen of cyst is lined by a single layer of irregularly arranged cylindric epithelium having nuclei and glittering protoplasmas that lie at the bases of the cells and they quite resemble to the germinal epithelium of the intestine. Lahm reported that there are rarely seen the dark black colored spots on the inner surface of the cyst lumen and these are consisted of the cells which contained lipoidofuchsin-group-pigments. No particularity was noticed in my cases. There are also found various secondary changes in ca. 60% of all the cases. The torsion is said to occur in from 10 to 20% of cases, and sometimes it fil]ally goes to the resection of the peduncle. The rupture of cyst-wall is not so infrequent and it results the seed-metastasis of the benign tumor of same kind. Metastasis after removal of the cyst is very rare but Olshausen and Baumgarten reported the benign metastasis in the parietal cicatrix and Schrader and Polano, the malignant metastasis. The perforation of cyst to the adjacent viscera is very infrequent Hemorrhage, infection, suppuration and calcareous infiltration are sometimes observed. Again, the complication of pregnancy also cannot be excepted and this is also seen as that of dermoidcyst but its occurrence is ca. 2%. Pfannenstiel marked that pseudomucinous cyst is frequently combined with the dermoidcyst. It is, however, infrequent (4- 5%) from the stand point of my experience and I can not agree with the view that the cyst-formation of dermoidcyst is proliferated from the pseudomucinous cyst. The most frequent occurrence in the secondary changes is the adhesion to the adjacent visceras. But it is not serious and even if it is in an advanced stage can be removed easily. Of all the changes, the malignant degeneration is the most troublesome (according to Stubler and Branders it is 6.7%) and its etiology is still unknown. It is said that in long existence of the cyst in advanced aged woman, the malignant degeneration appears but in my case 3 in aged woman, though I devoted myself to its observation up to her death. I could not find any symptom of malignant degeneration, and the author had experienced in an aged woman of 86 years old whose ovarial cyst gradually grew in two or three years after it was found, and it attained to the size an adults head but he was unable to find the symptoms of malignant degeneration either. On the contrary, I even had an experience of miserable case of a woman of 23 years old in pseudomucinous ovarial cyst, who in only a year's progress after the cyst was found, it clearly happened to be carcinomatous degeneration and came to a sad end of exploratory laparotomy. How does this malignant degeneration occur ? As to its causes , I have contributed nothing but explain with many vague words which now require further investigation. I think that it can not be put in one class at all and I attribute this to an individuality of the cyst-carrier. It may be convenient to settle the question, if I explain it, as a cause of carcinoma also. Such a malignant degeneration, in this case, is very infrequent and it would certainly be an object of research in future. Finally, the auther expresses his respectful thanks to Dr. Ando, Professor of the Okayama Medical University for his revisal.

1) Im Kaninchenorganismus werden die intravenos verabreichten verschiedenen Zucker in der Reihenfolge Frucht zucker, Traubenzueker. Mannose und Galaktose ansteigend im Harne ausgeschieden. 2) Bei experimentellem Stauungsikterus wird die Zuckerausscheidung im Harne am 2. Tage nach der Operation in der Reihenfolge Traubenzucker, Fruchtzucker, Mlannose und Galaktose absteigend herabgesetzt, wahrend sie am 5. Tage naeh der Operation in der Reihenfolge Fruktose, Glukose, Mannose und Galaktose absteigend herabgesetzt wird. Diese Herabsetzung der Zuckerausscheidung tritt am 5. Tage nach der Operation viel deutlicher hervor als am 2. Tage. 3) Der Glykogengehalt der Leber, sowohl bei normalen Kaninchen als auch bei denen mit experimentellem Stauungsikterus, wird in der Reihenfolge Lavulose, Glukose, Mannose und Galaktose absteigend gebildet. Die Glykogenbilduntg der Leber aus verschiedenen Zuckern bei experimentellem Stauungsikterus wird am 2. Tage nach der Operation uber normal gesteigert, wahrend sie am 5. Tage nach der Operation unter normal herabgesetzt wird. 4) Die Glykogenbildung der Leber aus verschiedenen Zuckern geht am 5. Tage nach der Operation bei experintentellem Stauungsikterus nicht parallel mit der herabgesetzten Zuckerausscheidung im Harne. Diese Erscheinung ist nach meiner Meinung durch die infolge des Hungerns verursachte Steigerung der Zuckerverbrennung im Organismus bedingt, die eine unter normal herabgesetzte Glykogenbildung am 5. Tage nach der Operation zur Folge hat. Die uber normal gesteigerte Glykogenbildung am 2. Tage nach der Opeation scheint mir auf der durch Rtickfluss der Galle, vermehrten Gallensaure im Blute zu beruhen. zum Schlusse ist es mir eine angenehme Pflicht, Herrn Prot. Dr. T. Shimizu fur seine freundliche Leitung und Anregung i:n verhbufe dieser Versuche meinen herzlichsten Dank auszusprechen.