Search

We used percutaneous cardiopulmonary support (PCPS) to resuscitate a 54-year-old man who had stabbed himself in the left anterior chest with a chopstick. Chest computed tomography showed that the chopstick had penetrated the heart. As he was in shock due to the development of tamponade while waiting for emergency surgery, we immediately decided to initiate PCPS. After cardiopulmonary bypass was established through a median sternotomy replacing PCPS, the chopstick was removed and the stab wounds were closed by mattress sutures. The postoperative course was uneventful.

Result and problems were studied in 12 patients who received percutaneous cardiopulmonary support (PCPS) after cardiac or aortic surgery. Causative diseases included acute myocardial infarction in 7 cases, rupture of the left ventricular septum after infarction, acute mitral valve regurgitation after infarction, rupture of the left ventricular free wall, a stuck valve, and an aortic aneurysm in the thoracicoabdominal region in each 1 case. The time of postoperative PCPS ranged from 2 to 361 hours, and the mean supply flow volume was 1.78 +/- 0.45 l/min/m2. Seven patients could be taken off the treatment or discharged from the hospital (58.3%). The comparison between surviving and non-surviving cases showed a significantly longer assisted circulation time in the latter. An increase of bleeding after surgery was found in all 8 patients who received PCPS for a long period postoperatively. This was assumed to be due to the thrombocytic activation by heparin.

Dye-filling rate of optic disc and choroid in normal human subjects was investigated using indocyanine green infra-red videoangiography and computerized image analysis. Only relative changes in the circulation of disc and choroid could be studied and the ratio (D/M) of dye-filling rate in normal subjects (age ranged 23-62) in disc (D) to choroid (M) was reliable. Intraocular pressure (IOP) was elevated to two levels with a pneumatic suction-cup. When D/M at normal IOP was 1, mean D/M was 1. 29 when mean IOP was 26.8 mmHg, and 1.48 when mean IOP was 38.4 mmHg. The results suggest that IOP elevation produced less change in the disc circulation than in the choroid. The ratio of dye-filling rate of the disc at 38.4 mmHg to normal IOP was significantly correlated (P < 0.05) with perfusion pressure at normal IOP, showing that the autoregulatory mechanisms in the disc blood flow may possibly reach the limit especially in subjects whose perfusion pressure is low.

A 51-year-old woman admitted to our hospital. Chest X-ray film showed infiltrations in left S4 region, which had been pointed out since two years before. On exploratory thoracotomy, lingual segmentectomy was performed because no metastatic lesions were found in the mediastinal and hilar lymph nodes. Pathological and immunohistological examinations revealed findings corresponding to pulmonary malignant lymphoma (diffuse, small cell type, B cell) with amyloid plaque. The patient is doing well 20 months after operation without any signs of recurrence. The clinical and histological findings of this case may suggest a close relationship between malignant lymphoma and production of amyloid.

A 70-year-old female was referred to our hospital because of swelling at her frontal neck and an abnormal shadow on a chest X-ray film. CT scan and MRI showed a 11.0 x 7.5 cm well-demarcated tumor in the upper mediastinum. Thyroidal scintigraphy revealed an slight accumulation, leading to a diagnosis of intrathoracic goiter. During operation the mass was found to be composed of two tumors. The upper tumor was attached with fibrous adhesion to the right lobe of cervical thyroid but no connection. Histological examination showed follicular but not malignant adenoma of the thyroid.

A case of left ventricular-right atrial (LV-RA) communication associated with a false aneurysm of membranous septum is presented. The patient was a 51-year-old woman. Using a left ventriculography this case was diagnosed preoperatively as LV-RA communication. We found that the right atrium was directly communicated with the left ventricle through a fibrous membranous aneurysm adhering to the septal leaflet of the tricuspid valve. It was suggested that a false aneurysm, made by jet lesion from the left ventricle, perforated to the right atrium. So the current case was considered an acquired infravaluvular type LV-RA communication formed in the course of the natural closure of the membranous ventricular septal defect.

Between April 1991 and August 1992, we diagnosed 51 cases of CFS who met definition of CFS designated by CDC, 1988. They are 41 female and 11 male, and 78% are women. At first visit, their ages are ranged from 16 to 64 years old, and approximately 45% is 20 to 30 years old. In periods of illness from onset, 39.2% of the patients are in period of 6 month to 1 year, 19.6% within 2 years, and 15.6% within 3 years, respectively. The sufferer who have symptoms of CFS over 10 years long are in 6 cases. Most of patients have already been examined by many other clinics and hospitals. They have been told as no abnormal medical condition, or often as neurosis, depressive state and autonomous imbalance etc. Interesting things are trigger of CFS. 77.5% of patients have onset of flu-like symptom, including 5 cases of acute infectious mononucleosis. In many female patients, symptoms of CFS begun after hand work in addition to psychological factors. Specific laboratory results are not shown in CBC, urinalysis, biochemical studies and inflammatory marhers. 6 cases hare positive Rheumatoid factor and positive ANF are shown in 16 cases (31.3%). Specific patterns of anti EBV antibodies are not shown. Lymphocyte subsets used by monoclonal antibodies are not specific. At the present, prognosis is good and 56.8% of CFS patients are generally improved. For severe cases, NSAID, Sulpiride, Amitryptiline and minor tranquilizer are used.

This case report describes a patient with Graves' disease who underwent heart surgery and we studied changes in thyroid hormone and antithyroid autoantibodies. TBII index of this case, which was high value before surgery, was decreased after surgery for two years, and the patient did not need any antithyroid drug. It is suggested that these changes may be due to cardio-pulmonary bypass and administration of steroids during heart surgery. This case indicates that heart surgery may influence the clinical course of Graves' disease.

The concentrations of pituitary hormones (TSH and PRL), thyroid hormones (free-T4 and free-T3), thyroid hormone binding protein (TBG) and lipids (TG and FFA) in the blood were measured in order to examine the physiology of nonthyroidal illnesses that occurred as a result of heart surgery as well as their effects on the pituitary and thyroid glands. The subjects of the study consisted of 30 adults with congenital and acquired heart disease. Blood concentrations of TSH, PRL, free-T4, free-T3, and TBG decreased, and those of FFA increased, on the 2nd day following surgery. On the 2nd day following surgery, the decrease in the concentrations of free-T4 and free-T3 in the blood were considered due to a decrease in secretion of T4 from the thyroid gland, as well as due to a decrease in the activity of iodothyronine 5'-deiodinase in the peripheral organs. In the 3rd week following surgery, the concentrations of these items returned to their original values on the day prior to surgery.

Right ventricular function was studied in 9 patients with mitral valve stenosis who underwent mitral valve replacement (St. Jude Medical valve 29-31 mm) (MVR). The right ventricular systolic pressure/end-systolic volume index (RVSP/ESVI) correlated well with right ventricular ejection fraction (RVEF) in the normal control group thus it considered to be a index of right ventricular contractility. At rest, RVEF in the MVR group was significantly lower than that in the control group. However there was no difference in the RVSP/ESVI between both groups. In the MVR group, the total pulmonary resistance index (TPRI) and mean pulmonary arterial pressure (mPAP) were higher than those in the control group. During exercise, the RVSP/ESVI became higher in both groups, but RVEF did not increase in the MVR group. In the control group, RVEF became higher during exercise. In addition, TPRI and mPAP increased in the MVR group but the control group did not show significant changes during exercise. In conclusion, low RVEF after MVR, which reflects pump function of the right ventricle, was not caused by contractile dysfunction of the right ventricle but mainly by excess afterload due to irreversible pulmonary vascular resistance persisting after operation as a result of chronic pulmonary vascular hypertension.

Serum human placental lactogen levels (HPL) were measured serially during the last three weeks before full term deliveries of 69 normal and 60 high risk pregnant women with the method of latex agglutination (Gestefollow 'Eiken'). Except pregnancies complicated with diabetes mellitus, no fetal distress were observed when deliveries were made while HPL levels were increasing. The incidence of fetal distress was only 3.7 per cent when the range of variation of HPL levels was within 20 per cent for 3 weeks before delivery. On the contrary, the incidence of fetal distress increased to 29.4 per cent when infants were delivered after decreasing of HPL levels to less than 80 per cent of the highest HPL levels. It was also demonstrated that single determinations of HPL levels were not clinically useful in predicting fetal distress or fetal growth retardation.

Erythrocyte deformability and erythrocyte adenosine triphosphate (ATP) levels were measured in normal pregnancy and puerperium. Erythrocyte deformability was determined by measuring filtered volumes of red cell-plasma or buffer suspension per second. Erythrocytes from pregnant women at 16-27 weeks, 28-31 weeks and 36-41 weeks of gestation were found to be significantly less deformable than erythrocytes from non pregnant women. On 0-1 day after delivery, erythrocyte deformability was significantly reduced, compared with that at 36-41 weeks of gestation. Erythrocyte ATP levels at 16-27 weeks, 28-31 weeks and 36-41 weeks of gestation were significantly lower than that in non pregnant women. In puerperium, erythrocyte ATP levels dropped significantly compared with those in late gestational period. From these results, it was suggested that the depressed erythrocyte deformabilities were accompanied by a lowering of erythrocyte ATP levels in pregnancy and puerperium.

The flow property of blood, the blood viscosity was measured under such gynecological conditions that were potentially hypercoagulable: in the post-operative state for myoma uteri corporis, in the use of oral contraceptives and in the advanced stage of malignant uterine and ovarian tumors. The viscosity was measured at a shear rate of 0.989 sec-1 and at 37 degrees C. Blood viscosity after operation rose to 15.6 +/- 3.7 cp (mean +/- SD), which was significantly higher than that of pre-operative state (12.4 +/- 3.7 cp). This was due to increased hematocrit and fibrinogen levels. The viscosity returned to preoperative level on the 3rd day of post-operation. The blood viscosity of users of oral contraceptives was 15.1 +/- 2.7 cp, not being significantly higher than that of control women (13.4 +/- 2.8 cp). The blood viscosity of patients suffered from malignant tumors was 10.5 +/- 2.0 cp and was significantly lower than that of control. Comparison of viscosity at the same hematocrits revealed, however, that the viscosity of patients of malignant tumors was significantly higher than that of control. Such rheological characteristics in the patients of malignant tumors were due to decreased hematocrit and markedly increased fibrinogen levels. It was suggested that dehydration and infection should be avoided to prevent thrombus formation in the gynecological patients with potentially hypercoagulable state.

In order to elucidate the tendency to erythrocyte aggregation in gestational diabetes, blood viscosity at a standard hematocrit of 45% (corrected viscosity) was measured at low shear rates in the third trimester of normal pregnancy and pregnancy with gestational diabetes. The mean values (+/- S.D.) for corrected viscosity of 20 gestational diabetic patients were 69.2 +/- 16.6cp at shear rate of 0.11 sec-1, 34.9 +/- 5.3cp at 0.54sec-1 and 27.9 +/- 5.0cp at 0.99sec-1. They were significantly higher than those of 40 normal pregnant patients (55.2 +/- 11.4cp at 0.11sec-1, 29.0 +/- 2.6cp at 0.54sec-1 and 24.4 +/- 2.4cp at 0.99sec-1). The mean value of fibrinogen of gestational diabetic patients was 408.8 +/- 106.7 mg/dl and significantly higher than that of normal patients (313.3 +/- 65.1 mg/dl). The increased tendency to erythrocyte aggregation observed in the diabetic patients was due to increased fibrinogen and would induce microcirculatory disturbance and mild hypoxia in the placental tissue. The cytotrophoblastic cell proliferation which is a characteristic morphological finding of diabetic placenta would be induced as a result of the reaction of placental tissue to the hypoxia thus produced.

Lately there is a tendency for an increase in the incidence of endometrial cancer both in this country and other industrialized countries such as the United States. The routine cervicovaginal smear method is generally poor for the detection of endometrial carcinoma as compared to that used for the diagnosis of early cervical neoplasms. The principal reason for the poor detection rate is that the cells are not obtained directly from the lesion as is the case with disease of the cervix. Various techniques for obtaining endometrial cells directly from the lesions have been described, but none has enjoyed wide acceptance by the clinicians. The patients for this study consisted of 138 women who were referred to us for diagnostic curettage. We employed the new disposable device, the Endocyte, and Masubuchi's endometrial aspiration and compared the results. After obtaining specimens with both methods curettage was performed on all patients. In addition, the Endocyte was employed on 8 patients with endometrial carcinoma in another hospital, and the following results were obtained. 1. With the Endocyte it is possible to obtain a larger volume of cells than by aspiration. 2. Although a certain amount of difficulty is encountered in the insertion of the Endocyte in some cases, it is much easier than the brush method used heretofore. 3. No significant difference in the amount of bleeding after insertion could be observed between the two methods. 4. In patients with bleeding in the endometrium and pyometra it is easier to obtain specimens from the endometrium with the Endocyte than by aspiration. 5. With the Endocyte contamination of the cells of the cervix was less than after aspiration. 6. Although pain during collection of cells with the Endocyte was somewhat stronger than during aspiration, analgesics were not necessary in any one of the cases. 7. The Endocyte was used on 13 patients with endometrial carcinoma, and all specimens were positive for carcinoma. From the results of our study we conclude that for endometrial cytology the Endocyte is as useful as the aspiration method. Furthermore, it should pose no difficulty to the gynecologists to use the Endocyte because the Endocyte resembles IUD structurally.