[Successful surgical management of stridor and dysphagia caused by aberrant right subclavian artery, and etiological studies of literature].
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Biomedical subjects
Publications and source records attributed to S Inoue.
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A reappraisal was made of the relationship between exposure to atomic radiation in 1945 and the occurrence of salivary gland tumors in heavily exposed survivors. This was made possible by the discovery of 8 additional patients; the total now reported consists of 30 cases. In those exposed to 300+ rads, the number of cases was significantly (p less than .01) greater than expected. This was found for the combined group and for malignant types, but not for histologically benign tumors. Our prior conclusion regarding the high-dose radiation effect upon salivary gland neoplasia remains unchanged in the reanalysis; however, our suggestion that younger persons were at significantly greater risk is weakened.
Serial cytogenetic and cytological studies in 2 cases of erythroleukaemia in children indicated that erythropoiesis is not involved in the malignant process itself, but represents a response caused by unknown stimuli. A good correlation was observed between the percentage of aneuploid cells and blasts in mitosis, thus during the erythroid phase aneuploidy was minimal or absent, while during the myeloblastic phase a high percentage of members of the aneuploid clone was present. An inverse correlation between peripheral normoblast count and haemoglobin level indicated that erythropoiesis was under physiological control. Taken together these observations constitute evidence that, in the cases of erythroleukaemia studied, erythroid cells do not have inherent malignant properties. Cytogenetic analysis offers a tool for differentiating this type of erythroleukaemia from other forms of DiGuglielmo's syndrome.
Atomic bomb survivors who worked at the Atomic Bomb Casualty Commission in Hiroshima during the years 1968-71 and held handbooks identifying them as survivors took significantly more days of both annual leave and sick leave than did matched and paired control subjects. These differences in leave-taking patterns are considered to be due to behavioural causes as they could not be attributed to radiation dose-response effects.
Blood glucose, free fatty acid and insulin responses to oral glucose and the fasting serum lipids were measured in 3 groups: 32 non-obese (mean age: 47.5 years) and 9 obese (mean age: 84.5 years), male patients with coronary heart disease and 12 non-obese male controls (mean age: 46.5 years). The oral glucose tolerance tests were repeated after 3 years in 16 of the non-obese patients with coronary heart disease. The results were as follows: 1) Glucose tolerance was impaired in 19 of 32 non-obese patients (59.4%). There was a significant correlation between impaired glucose tolerance and hyperlipidemia (hypercholesterolemia and/or hypertriglyceridemia). 2) In obese patients FFA levels at 30, 60, and 120 min after oral glucose administration were significantly elevated and FFA decrease was delayed with a drop to minimum levels at 180 min. 3) The insulin response after oral glucose administration in the group of non-obese patients with normal glucose tolerance was similar to that of non-obese controls. In the group of non-obese patients with impaired glucose tolerance, serum insulin levels went up to normal levels, but the peak was delayed. The serum insulin levels in obese patients were significantly higher than those of controls of 0, 60, 120, and 180 min. After 3 years the change in insulin response to oral glucose was not related to anginal symptoms or ECG findings, but was related to body weight change in patients with minor changes in glucose tolerance. 4) The metabolic pattern in the non-obese group with impaired glucose tolerance resembled that of "mild diabetes" in delayed response of insulin and FFA, and mild hyperlipidemia. These findings suggest that obesity may contribute to hyperinsulinemia in patients with coronary heart disease and that impaired glucose tolerance observed in patients with coronary heart disease is in part due to "latent diabetes".
A study of 68 patients subjected to re-surgery for residual or recurrent gallstones provided the following results: Among the 68 patients, the stones were recurrent in only 4, residual in 38, and uncertain but mostly suggesting residual in the other 26 cases. In many of the residual stone cases, the previous operations were cholecystectomy alone, retrospectively suggesting insufficient search for residual stones and other abnormalities in the biliary tract during the operations. Of the 4 recurrent stone cases, 3 of them showed bile duct stricture, papillary stenosis and idiopathic choledochus dilatation, respectively, while the remaining one, though free of any sign of bile stasis, had a gallstone formed around a silk-thread core. The indications for additional sphincteroplasty and biliodigestive anastomosis in re-operations were strictly consistent with those in the first operations. Seven operative fatal cases (10%) were mostly those of long persistent gallstones with serious hepatic failure. The follow-up studies in 53 patients showed as many as 51 cases returning to the preoperative occupation without any significant complaints. These results emphatically suggest that retained gallstone cases should be referred to surgical treatment as early as possible.
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