Biomedical subjects
Publications and source records attributed to M Kitano.
The first case of two separate tumors of the tongue, one cartilaginous and the other osteocartilaginous, is reported. The cartilaginous matrix of these two tumors contained elastic fibers and type II collagen. The histogenesis of these tumors is discussed.
We present a series of 16 consecutive patients who underwent the omental pedicle flap method in the field of thoracic surgery. Fourteen of 16 patients were chronic empyema with bronchopleural fistulae and/or thoracic fistulae. A pedicle of omentum containing the right gastroepiploic artery was passed through a tunnel in the anterior diaphragm into the empyema cavity. It was fixed by mono-filament sutures on the bronchopleural fistulae. All but two patients were cured successfully by single-stage procedures. We also used a omental pedicle flap for mediastinal infection and reconstruction of the chest wall. We conclude that the use of omental pedicle flap is a promising method for treatment of serious infection in the field of thoracic surgery.
Between 1974 and 1987, 14 patients (10 male and 4 female) underwent thoracotomy for treatment of pulmonary mycosis. They were studied on their clinical findings and surgical treatment. The median age was 48 years (range 19 to 71 years). Fourteen cases consisted of 9 aspergillosis and 5 cryptococcosis. None of them was either debilitated or immunosuppressed before falling ill. Five of the 14 patients had other pulmonary disease and 11 had symptoms; i.e. hemoptysis or bloody sputum in 4 cases, chest pain in 3, fever in 3, cough and sputum in 2. Nine aspergillosis consisted of 4 aspergilloma, 3 aspergillus pneumonia and 2 aspergillus empyema. Three cases of aspergillosis occurred in preexisting cavity. Five cryptococcosis consisted of 3 pseudotumorous, 1 disseminated small nodular, and 1 infiltrative types. Preoperative diagnosis was as follows; pulmonary mycosis 5, pulmonary tuberculosis 4, lung cancer 3, empyema 1 and hydropneumothorax 1. Four patients underwent partial resection, 8 lobectomy, 1 pneumonectomy, 1 muscle prombage and thoracoplasty. The prognosis is satisfactory. All patients are alive and has no recurrence. On histopathological examination, in aspergilloma cases, invasion of aspergillus to surrounding lung tissue was not seen. In addition to well-known fact that blood-borne dissemination hardly occurred in aspergilloma in contrast to cryptococcosis. These findings suggest that aspergilloma and solitary lesion of cryptococcosis should be resected, and adjuvant chemotherapy should be accompanied for cryptococcosis.
A 67-year-old woman to our hospital because of the swelling of lymph nodes in the right inguinal region. Eighteen months before, right lower lobectomy was performed for primary lung cancer (papillary adenocarcinoma). In September 1986, she noticed the swelling of lymph no does in the right inguinal region and low grade fever. At first she was suspected to have a metastasis of the lung cancer. Lymph node biopsy was performed. The pathological examination revealed purulent lymphadenitis with granulomatous change, and Gram-negative Warthin Starry stain positive rods were found. In addition, she admitted a history of keeping cats fourteen years. Therefore the diagnosis of cat scratch disease was made. Six months later, she became free of the associated symptoms. We feel pathological confirmation of suspicious lymph nodes is important in the treatment of patients with history of malignancy.
Three patients with pulmonary hypertensive crisis (PHC) after open heart surgery for ventricular septal defect are reported. These patients ranged in age from 2 to 47 months, with Rp from 7.0 to 10.6 U.m2, Pp/Ps from 0.67 to 1.0, and Qp/Qs from 1.6 to 1.79. Intraoperative lung biopsy showed pulmonary vascular obstructive disease of Health-Edwards grade 2 in each patient. Atelectasis or pleural effusion on their chest-XP films was found when PHC occurred. The PHC course of the last case was recorded continuously on ABP, PAP and LAP. Administration of prostaglandin-E1 directly through the pulmonary arterial catheter was effective on PHC. Continuous recording of ABP, PAP and LAP during the episode was useful to differentiate PHC from acute left heart failure and/or acute right heart failure.
A case of atresia of the coronary sinus orifice in a patient with transposition of the great arteries is reported. Inadvertent division of a drainage left superior vena cava during the arterial switch operation was fatal.
In June 1987, a 20-year-old man was diagnosed as T-cell acute lymphoblastic leukemia. In August, at a nadir period of the remission induction chemotherapy, he complained of high fever and dry cough. A chest roentgenogram also showed a nodular area of increased density in the left upper lobe. Since his clinical state deteriorated progressively despite the administration of broad-spectrum antibiotics, amphotericin B was administered intravenously (with an initial dose of 5 mg/day, increased up to 25 mg/day). Concomitant with bone marrow recovery and continued antifungal therapy, he became soon afebrile and improved over the next 2 months. The infiltrates also began to resolve. Then he abruptly coughed up about 800 ml of blood and suffered from acute respiratory failure. Bronchial arteriographic studies demonstrated active extravasation of contrast medium in the region of the cavity. After therapeutic embolization with Gelfoam, the extravasation was no longer observed. Active bleeding abruptly ceased and had not recurred until the left upper lobectomy which was performed 10 days after the embolization. This case typically demonstrates the value of bronchial arterial embolization in treating massive hemoptysis.
The technique of an axillary vertical incision thoracotomy sparing pectoralis major muscle and latissimus dorsi muscle for a closure of patent ductus arteriosus is presented. After an mid-axillary vertical incision, serratus anterior muscle is incised on the third intercostal space between pectoralis major muscle and latissimus dorsi muscle. The space between serratus anterior muscle and rib cage (Spatium intermusc. thoracale) is dissected with a finger, through this space the 3rd intercostal thoracotomy is performed in the axillary and dorsal portion. The ventral part of intercostal muscle is incised from inside of the thoracic cavity for sparing the pectoralis major muscle. We performed this technique in two patients aged 1 year, and secured equally good operative fields as could be secured by the original axillary vertical incision thoracotomy described by Browne.
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A case of tumor of the spinal cord with a long clinical history was described. At autopsy, the tumor was composed of a mixture of two elemental cells, i.e. matured but neoplastic ganglionic cells and anaplastic glial cells. The clinical manifestations suggested that the tumor in this case developed in a benign form with malignant evolution occurring during the latter part of its clinical course. The malignant evolution, however, was due to aggressive and anaplastic growth only of the elemental glial cells, while the cytologic features of the elemental ganglionic cells remained always benign.
Dorsal root entry zone (DREZ) lesions were made in the cervical dorsal horn in cat and monkey. Terminal degeneration was observed in the lateral cervical nucleus in cat and contralateral VPL in monkey by Fink-Heimer stain. WGA-HRP was injected in the cervical dorsal horn of cat and retrograde labelled cells were observed mainly in the raphe nucleus, parabrachial nucleus, locus coeruleus, Kölliker-Fuse nucleus, Eddinger-Westphal nucleus, and hypothalamic area, indicating that these descending fiber systems are involved by the DREZ lesion. The functional role of these fibers in regard to deafferentation pain relief seems now to be open to discussion.
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