Biomedical subjects
Publications and source records attributed to T Oka.
The method of pressure force in crown cementing was examined. Continuous occlusal force was always supported by the patients' personal occlusal force in cementing crowns. We found that continuous occlusal force continuously decreased as the occlusal force increased, and the decreasing morphologies were classified into four types, 'Rapid decrease', 'Step-wise decrease', 'Intermediate decrease' and 'Gradual decrease'.
A forty-seven-year-old woman visited our hospital in March 1987 suffering from the local recurrence of the tumor. Her right 7th and 8th rib had been resected 2 years and 11 months before because of the malignant fibrous histiocytoma (MFH) originated from the right 7th rib. In May 1987, wide resection of the right lateral chest wall and partial resection of the right diaphragm were done. Dacron meshed silicon plate (Silastic) and musculocutaneous flap of the right latissimus dorsi were used to reconstruct the chest wall. Seven months after the second operation, local recurrence occurred again on the anterior chest wall, involving the right diaphragm and right lower lobe of the lung. In March 1988, extensive resection of the anterior chest wall with partial resection of the right diaphragm and the right lower lobe was followed by reconstruction of the chest wall by Silastic. The patient recovered uneventfully without any respiratory disturbances after both operations which included wide resection of the chest wall. Multiple pulmonary metastases were found 4 months after the operation, and she died of respiratory failure 7 months after the final operation. Although MFH was one of the most common sarcomas of the soft tissues, only one case of the MFH originated from the rib had been reported previously in this country. Silastic was proved to be a useful prosthesis for the reconstruction of widely resected chest wall.
Pulmonary artery reconstruction for bronchogenic carcinoma was performed in 36 patients (5.8%) in our department between 1955 and 1988 for the purpose of preservation of pulmonary function. Twenty-six patients had squamous cell carcinoma (72.2%) and 24 had Stage IIIA. The operative procedures were sleeve resection of the main pulmonary artery (P.A.) and end-to-end anastomosis in 20 cases, wedge resection of P.A. and transverse suture in 14 and window type resection of P.A. and patch closure in 2. In 28 patients bronchoplastic procedures were combined. Three patients (8.3%) died within 30 days after operation. Postoperative complications were relatively high in the patients with combined operations. The 5-year survival rates were 45.7%. Postoperative pulmonary functions were evaluated with spirometric examinations and pulmonary scintigrams. There were no differences in postoperative pulmonary functions between pulmonary angioplastic procedures and simple lobectomies.(ABSTRACT TRUNCATED AT 250 WORDS)
Two cases of a pelvic evisceration have been performed, due to an irradiation-induced rectal cancer. Described are the cases of two women who had been treated with irradiation for a cervical cancer following a hysterectomy, one patient being 65 years old and the other 67. After a latent period that lasted for 12 and 24 years, respectively, each had developed a rectal cancer. In each case, case excised specimen showed diffuse fibrosis and a hyaline change, reflecting the effect of radiation on the tumoral tissue. Cases of an irradiation-induced rectal cancer are uncommon, and the symptoms of enterocolitis caused by irradiation are similar to those of a colorectal cancer. The authors therefore suggest careful and long-term follow-up of patients that have received pelvic radiation.
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A 44-year-old man was admitted for evaluation of dyspnea on exertion and subcutaneous nodules. The chest X-ray on admission revealed bilateral hilar lymph node swelling and diffuse micronodular shadows throughout both lung fields. Ga scintigram demonstrated diffuse abnormal uptake. Serum angiotensin converting enzyme was elevated significantly (86.6 IU/I). The TBLB specimen confirmed the diagnosis of sarcoidosis. The cell numbers in bronchoalveolar lavage fluid was increased (4.4 x 10(8), the percentage of lymphocytes was elevated (64%) and the ratio of Leu 3a+/Leu 2a+ was very high (16.07). We further evaluated the spontaneous IL-1 release in vitro by alveolar macrophages obtained by bronchoalveolar lavage. The results showed that large amounts of IL-1 alpha and beta were produced spontaneously by alveolar macrophages before therapy, followed by a decrease in production after corticosteroid treatment. Previously, the authors reported that no significant amount of IL-1 alpha and beta was detected in 5 normal volunteers and 6 other active sarcoidosis cases which improved without therapy. Therefore, significant amounts of spontaneous release of IL-1 alpha and beta in vitro from alveolar macrophages in sarcoidosis might be considered as an index for the necessity of systemic corticosteroid treatment.
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With Sonolith 3000, a new extracorporeal shock wave lithotriptor, we performed extracorporeal shock wave lithotripsy (ESWL) on 34 patients with upper urinary stones, including 5 patients with target stones of this clinical application in both sides. The 39 target stones in the 34 patients were located in the renal calyx (13 cases), renal pelvis (14 cases), renal calyx and pelvis (1 case), renal pelvis and ureter (1 case), and upper ureter (10 cases). The ultrasound-aiming system gave a satisfactory imaging of the target stones in 94.9% of cases (37/39 cases). During the ESWL treatment, 32 patients (94.2%) did not need anesthesia, but 2 patients (5.9%) needed epidural anesthesia because of intolerable pain and/or terror of pain. The average number of treatments per case was 2.08, and the average dose of shock waves per treatment was 3,691.1. The stone-free rate on the 14th, 42nd and 90th days after the last ESWL treatment were 28.2% (11/39), 51.3% (20/39) and 64.1% (25/39), respectively. Out of 39 cases, 31 cases (79.5%) were either stone-free or had only sand-like residual stones on the 90th day. Most cases had minimal side effects, such as transient macroscopic hematuria (100.0%), skin eruption (50.0%) and back pain (41.2%), but one case needed a 1,200 ml transfusion because of perirenal hematoma immediately after 1st session of ESWL treatment with 2,300 shock waves (13 kv). The serum total bilirubin level on 1st day after the last session of ESWL treatment was significantly increased when compared with the preoperative level, but the level was not significantly increased after the 1st session.(ABSTRACT TRUNCATED AT 250 WORDS)
We reviewed cases of re-thoracotomy performed for early complications after bronchoplastic procedures. One hundred and sixteen bronchoplasties were performed in our department over 20 years. The diseases for which bronchoplasty was undertaken were lung cancer in 102 patients (87.9%), tuberculous stenosis of the bronchus in eight, esophageal cancer in three, and trauma in three. The most frequent postoperative complication was difficulty of expectoration and atelectasis, which generally improved with conservative treatment. Re-thoracotomy was performed for early postoperative intrathoracic complications on 11 patients. The reasons for re-thoracotomy were bronchial anastomotic dehiscence in five cases, obstruction of bronchial anastomosis in two, atelectasis in two, and occlusion of anastomosis of pulmonary arterial angioplasty in two cases. All except two underwent re-thoracotomy within two weeks of the first operations. The operative procedures performed were completion pneumonectomy in six cases, re-bronchoplasty in three, suture of anastomotic dehiscence in two, patch closure of pericardial defect with aspiration of secretions in the atelectatic lobe in one, and partial decortication with suture closure of the alveolar fistula in one. Pedicled omental wrapping was applied to two patients with re-bronchoplasty and one with completion pneumonectomy. Post-operative complications after re-thoracotomy were anastomotic insufficiency in two cases, bronchopleural fistula in two, and pneumonia in one. Two patients underwent a third thoracotomy. There was no anastomotic dehiscence or bronchopleural fistula in the patients with pedicled omental wrapping. One patient died due to bronchopleural fistula within 30 days of re-thoracotomy. Six patients died of recurrence or pneumonia from 39 days to one year after re-thoracotomy.(ABSTRACT TRUNCATED AT 250 WORDS)
A case of primary carcinoma in situ of the ureter in a 77-year-old man is reported. The patient had been to another hospital with right flank pain and macroscopic hematuria. Ultrasound sonogram showed right hydronephrosis. An excretory urogram showed right hydronephrosis and stenosis of right ureter. He was referred to our hospital for further evaluation and treatment. Retrograde pyelogram demonstrated a right ureteral stricture at the level of S1-2, but no space occupying lesion was detected in the ureter. Cytology of voided urine was negative for malignant cells and no other abnormal findings were present. Probe laparotomy was performed under the preoperative diagnosis of ureteral stricture. During the operation, frozen section examination of the stenotic ureter showed carcinoma in situ and so we performed right total nephroureterectomy with a bladder cuff. Pathologic diagnosis was primary carcinoma in situ of the right ureter. The patient has been doing well for six months postoperatively with no evidence of recurrent or metastatic disease.
We employed cross circulation (CC) as an assist method for canine orthotopic cardiac transplantation in 8 dogs to obtain long term survivals. Hematological and biochemical examinations were performed intra- and postoperatively, to estimate usefulness of CC. The support dog weighted about 3 times as much as the recipient dog. Using different anesthesia, the systolic pressure of the support dog and the pressure gradient between the support and recipient were kept above 150 mmHg and 50 mmHg, respectively. Cyclosporin and prednisolone were administered for immunosuppressive therapy. All could be extubated on the 1st to 3rd postoperative day, and 6 survived more than 2 weeks. During the operation under CC, changes of LDH and lactic acid were much less, no free hemoglobin was detected, and total protein and hematocrit remained well compared with operation under heart-lung machines. CRK, CPKMB, GOT and GPT increased shortly after operation, but returned to the preoperative values within 2 weeks. In CC, owing to avoidance from mechanical destruction of red blood cells, coagulation disorders and hemodilution, hemolysis and hemorrhage could be decreased, and oncotic pressure remained well, and no severe damage occurred in the recipient organs. Thus, CC is useful as an assist method for canine orthotopic cardiac transplantation.
A 45 year-old male was admitted to Tokyo University Hospital because of a submandibular tumor. Biopsy specimen of the tumor showed medium-sized non-Hodgkin's lymphoma of follicular type and immunoperoxidase staining of frozen sections demonstrated an overwhelming predominance of B lymphocytes with IgM, lambda chain. In the meanwhile, chest X-ray taken on admission showed an ill-defined consolidation with a tumor-like appearance in the right middle lung field. Transbronchial biopsy of this lesion revealed massive infiltrations of small and medium sized lymphocytes, having the same markers as those of submandibular tumor (IgM, lambda chain) and an analysis of bronchoalveolar lavage showed a significant increase of CD19-positive B lymphocytes. Reviewing of check-up X-ray films showed the lung lesion to have preceded the submandibular tumor and to have increased its size in several years. On the basis of the similarity of histological and immunohistochemical findings between pulmonary and submandibular tumor, and considering the time course of the appearance of these tumors, we concluded that these tumors were of the same histological nature and had originated in the lung and metastasized to submandibular gland. This is a relatively rare case of pulmonary lymphoma metastasizing to the submandibular gland, in which transbronchial biopsy specimen and analysis of lymphocytes in bronchoalveolar lavage were helpful in establishing the diagnosis.
We have experimentally studied whether or not repeated episodes of acute gastric mucosal lesions can induce chronic gastritic changes. Rats received pyloromyotomy and repeated per os administration of acetic acid-glycerin. Gastric mucosal lesions thus induced were studied histopathologically in cardiac glandular areas using morphometric analysis. It was found that pyloromyotomy induced fibrosis between the bottom of the gland and muscularis mucosa. On the other hand, the per os administration of acetic acid-glycerin induced hyperplastic change of mucous neck cells. They were increased in number and in size. Distribution of mucous neck cells were distended vertically to the mucosal surface and towards the bottom of the gland. Greater the amount of acetic acid-glycerin administration, stronger the changes of mucous neck cells, i.e., the distended zone of mucous neck cells spread more and more from the cardiac area. Parietal and chief cells were decreased in number in the course of the mucous neck cell hyperplasia. Branching of glands was occasionally seen in rats receiving greater amount of acetic acid-glycerin. It was concluded that there are basic structural similarity between the gastric mucosal changes induced by repeated episodes of acute gastric mucosal lesions and the change seen in human chronic gastritis. Thus acute gastric mucosal lesions can be one of the cause of chronic gastritis.
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Nine neonates were treated with aztreonam (AZT) and its clinical efficacy and side effects were evaluated. Six of the patients were treated with a combination of AZT and ampicillin. Ages of the patients ranged from 0 to 24 days, and their body weights ranged from 2,290 to 4,260 g. Doses of AZT ranged 18.8 to 23.7 mg/kg every 8 to 12 hours for 3 to 7 days. Three patients with infections including urinary tract infection, cervical abscess, and suspicion of sepsis, appeared to respond to the treatment of AZT alone. Among them, clinical results were excellent in 1, good in 2 patients. Those patients subjected to the combination therapy showed excellent response in 1 and good in 5. The drug was well tolerated, but 1 had diarrhea. The pharmacokinetics of AZT was studied in 9 patients. Their ages ranged from 0 to 30 days, and body weights ranged from 2,000 to 4,000 g. Serum concentrations of AZT were 27.2 to 48.3 micrograms/ml at 1 hour after single 20 mg/kg intravenous bolus injection, and the levels were 3.4 to 15.5 micrograms/ml at 6 hours in 5 infants heavier than 2,500 g. Elimination half-lives of AZT ranged from 1.57 to 3.72 hours (mean 2.72 hours). Serum concentrations of AZT were 21.6 to 41.8 micrograms/ml at 1 hour after single 20 mg/kg intravenous bolus injection, and the levels were 10.2 to 17.0 micrograms/ml at 6 hours in 3 infants lighter than 2,500 g. The elimination half-lives of AZT were 3.63 to 4.86 hours (mean 4.31 hours).(ABSTRACT TRUNCATED AT 250 WORDS)
A 3-month-boy weighing 1,968 gm with absent pulmonary valve associated with tetralogy of Fallot, who suffered from severe respiratory distress, underwent emergency operation. Preoperatively, the patient had atelectasis of left lung, since left main bronchus was compressed by aneurysmal dilatation of the main pulmonary artery. Aneurysmorraphy and suspension of the pulmonary artery with retrosternal fascia was performed successfully. This procedure is a simple and useful method of relief from airway obstruction at the first stage for such critically ill infants.
From January 1988 to May 1989, ten infant patients (15 times) with congenital heart disease were studied by digital subtraction angiography (DSA) pre and/or postoperatively. The diagnoses of the patients include total anomalous pulmonary venous return (TAPVR), transposition of great arteries, patent ductus arteriosus with pulmonary hypertension, giant hemangioma of the left leg, asplenia (two cases), tetralogy of Fallot (two), and tricuspid atresia (two). Two newborn patients (TAPVR, giant hemangioma) were in critical condition preoperatively, but were diagnosed precisely and nonivasively by DSA. Ten cases were studied for estimation of operative repair and consequently five of them were diagnosed to require reoperation. It is concluded that DSA is of use for diagnosis of congenital heart diseases and for postoperative evaluation of infant patients under critical condition.
A case of a 60-year-old man who had a chronic expanding hematoma with an intrapulmonary fresh hemorrhage in the right thorax is reported. He suffered blunt trauma of his right thorax in a traffic accident 25 years ago. He has no symptoms and signs after the accident. But he had hemoptysis twice and he was taken to our hospital. He underwent the resection of the chronic expanding hematoma and right lower lobe of the lung. The surgical specimen consisted of the hematoma measuring 17 x 13 x 6 cm. The chronic expanding hematoma contained aseptic brownish muddy substances. The patient recovered without complications and hemoptysis. Chronic expanding hematomas occur in many locations, often simulating neoplasms. Although the mechanism of chronic expanding hematoma is unclear, the self-perpetuating expanding nature of the lesion may appear to be due to the irritant effects of blood and its breakdown products, causing repeated exudation or bleeding from capillaries in the granulation tissue.