Showing papers in "Surgery Today in 1990"

The treatment of lymph node metastasis from esophageal cancer by extensive lymphadenectomy.

Abstract: During the period between 1965 and the end of 1988, 560 patients with esophageal cancer were surgically treated in our University hospital. In an attempt to improve patient survival, three-field lymphadenectomy of the bilateral neck, mediastinum and abdomen was performed in 117 patients treated since 1983. The present study was undertaken to reveal the substantial rate of lymph node metastasis in esophageal cancer and to decide if three-field lymphadenectomy is mandatory or not for surgery of esophageal cancer. Despite the increased radicality of the operation, the mortality and morbidity rates decreased in the 1980's compared to the earlier periods, the operative death being 12.5 per cent in the 1960's, vs. 2.0 per cent in the 1980's. Moreover, the mortality rate of the patients receiving the three-field lymphadenectomy was as low as 2.6 per cent. The metastatic rate of cervical nodes in the patients receiving three-field lymphadenectomy was 32.5 per cent, while that of mediastinal and abdominal nodes was 47.0 per cent and 46.0 per cent respectively. The metastatic rate in the mediastinum was high in the bilateral recurrent nerve lymph nodes, bifurcation nodes and paraesophageal nodes, while in the abdomen, it was high in the bilateral paracardial nodes. Recurrent nerve paralysis, which had been rarely seen was observed in 12.0 per cent of the patients. Metastasis from esophageal cancer is often seen in the cervical nodes, however, the clinical importance of three-field lymphadenectomy will be decided by the data of patient survival in the near future.

The effects of a single high voltage electrical stimulation with an anticancer drug on in vivo growing malignant tumors.

Abstract: Giving a high voltage electrical stimulation (5 kv/cm, 2 msec) under bleomycin administration (5 mg/body, im) resulted in a significant size decrease of subcutaneously inoculated AH-109A hepatocellular carcinomas in Donryu rats. The tumor size decreased to an average 17 per cent of the initial mass 4 days after the treatment and the average survival period was extended to almost 200 per cent of that of the control. However, neither high voltage electrical stimulation nor bleomycin administration alone demonstrated an anticancer effect. It was thus concluded that the concomitant use of a high voltage electrical stimulation and an anticancer drug has the potential to be effectively applied in cancer treatment.

The clinical features and prognosis of hepatoblastoma: Follow-up studies done on pediatric tumors enrolled in the Japanese pediatric tumor registry between 1971 and 1980. Part I

Abstract: Retrospective follow-up studies were conducted on 101 cases of hepatoblastoma enrolled in the registry established by the Committee of Malignant Tumors of the Japanese Society of Pediatric Surgeons between 1971 and 1980. The disease was classified into the following 5 categories; namely, stages I, II, IIIA, IIIB and IV according to local involvement (factor C), vascular invasion (factor V), lymph node involvement (factor N), and distant metastasis (factor M). The results were analysed as the relation between two-year tumor-free survival rate (2YTFSR) and various factors. The overall 2YTFSR of 42 per cent was found to be related to the staging system, age and quality of resection, and our results indicated that cure could be achieved by complete resection of the tumor.

The influence of hyperthermia in vitro on the functions of peritoneal macrophages in mice.

Abstract: Total-body hyperthermia (TBHT) as a treatment for cancer may lead to a reduction in the host's immunocompetence as a result of the direct effects of heat on the immune system. Thus, we studied the influences of hyperthermiain vitro on the function of peritoneal macrophages from mice. Peritoneal macrophages from C3H/HeN mice were heatedin vitro for 3 hr at 37, 39, 40, 41 or 42°C. After exposure to heat, the phagocytic ability of the macrophages, as well as results of the nitroblue tetrazolium (NBT) reduction test and the cytotoxity test were examined. The changes in all these parameters showed almost the same pattern: a tendency for macrophage functions to be potentiated up to 40°C, and a tendency towards inhibited functioning at temperatures above 41°C. Although augmented functions of macrophages were observed after exposure to mild hyperthermia (<40°C), the possibility of TBHT (42°C)-induced inhibition of macrophage function must be further investigated in clinical trials of TBHT therapy for cancer.

Lipoma of the esophagus—Report of a case and review of the literature

Abstract: We report herein, a rare case of esophageal lipoma and review the Japanese literature on this subject. Lipoma of the alimentary tract is relatively uncommon but that of the esophagus is extremely rare with only 17 cases having been reported in Japan. The majority of these cases occurred in the cervical esophagus with the most serious symptom being regurgitation of the pedunculated tumor which lead to asphyxia and death in one case. Only 2 cases occurred in the thoracic esophagus and these tumors were small in size and resected endoscopically. This is the first reported case of an esophageal lipoma being located in the thoracic esophagus which was resected through a thorocotomy. The clinical features of esophageal lipoma are also described herein.

Clinical experience of biliary tract carcinoma associated with anomalous union of the pancreaticobiliary ductal system

Abstract: Between 1978 and 1988, 15 patients with gallbladder cancer and 2 patients with bile duct cancer were seen among 49 patients with anomalous union of the pancreaticobiliary ductal system. Radiographic findings revealed two types of this anomalous condition: one in which the pancreatic duct entered the common bile duct(type 1) and one in which the common bile duct entered the pancreatic duct (type 2). In gallbladder cancer, the common bile duct presented no dilatation, or in some patients, mild dilatation, and type-1 anomalous union was frequently found among these patients. In contrast, the two patients with bile duct cancer had cystic dilatation of the common bile duct and type-2 anomalous union. The bile amylase level, which was determined in seven patients, was extremely high in all the patients. Histopathologically, the tumors in most patients showed papillary to papillo-tubular proliferation in the mucosal layer while atypical epithelial hyperplasia was noted in the vicinity of the tumor area. These findings suggest that this congenital anomaly in both ducts results in a loss of the normal sphincteric mechanism of the doudenal papilla, and that chronic relapsing cholecystitis or cholangitis, caused by the reflux of pancreatic juice into the biliary tract, can induced progressive changes to atypical epithelial hyperplasia which may develop into carcinoma.

Zinc in clinical surgery--a research review.

Abstract: Among the essential trace elements in mammals, zinc is somewhat unique in that it is a constituent of numerous metallo-enzymes having biologic significance in many respects The discovery of zinc deficiency in man induced the remarkable progress of studies on its physiology and it is now recognized that zinc deficiency manifests itself differently in different areas of clinical medicine It also appears reasonable to say that no trace elements have been more closely related to surgery than zinc We discuss herein, its significance, implications and role in such areas as; (1) wound healing: where the usefulness of zinc for promoting wound healing in the presence of low plasma zinc levels has been firmly established; (2) total parenteral nutrition (TPN): zinc free TPN may cause skin eruptions associated with abdominal symptoms presenting a picture closely resembling that of acrodermatitis enteropathica; (3) specific pathological conditions: patients with Crohn's disease and other benign diseases accompanied by mal-digestion or-absorbtion are often predisposed to zinc deficiency, similar to those manifesting clinical signs in the early stage of TPN; and (4) surgical stress: which triggers the release of various mediators, possibly increasing hepatic zinc deposition and decreasing plasma and skin zinc levels

Reappraisal of bronchial arterial infusion therapy for advanced lung cancer.

Abstract: As preoperative adjuvant therapy for advanced lung cancer, bronchial arterial infusion (BAI) of a chemotherapeutic agent was administered to patients with stage IIIa and IIIb hilar lung cancer. The infusion modality was changed for each term, from a single drug infusion, to a two drug infusion and then a three drug infusion, and the combination of infused drugs was selected in accordance with cell types. A significant radiographic shrinkage was observed after BAI therapy by the single, two and three drug infusions, being noted as 40.7 per cent, 61.8 per cent and 83.9 per cent, respectively. The effect on squamous cell carcinoma was more prominent than on other cell types. Upon microscopic examination of the resected specimens, significant histo-pathological effects were observed in 57.7 per cent of the patients who received single or two drug infusions, while the rate increased to as high as 92.2 per cent in the patients who received the three drug infusion. The histological effects of BAI therapy were also most marked in squamous cell carcinoma. It is of special interest that 5 of the 10 patients who received the three drug infusion of Carboquone (CQ)+ Mitomycin C (MMC)+Nimustine-HCL (ACNU) for squamous cell carcinoma, showed complete disappearance of viable cancer cells at the tumor site; something which was never observed after the single and two drug infusions. It was therefore concluded that BAI therapy for advanced lung cancer should be reappraised through the modification of infusion methods.

Expression of human epidermal growth factor and its receptor in esophageal cancer.

Abstract: The expression of human epidermal growth factor (hEGF) was examined immunohistochemically in 86 esophageal cancer lesions, comprising 67 primary tumors and 19 metastatic lymph nodes. In the normal esophagus, the parabasal and intermediate cell layers showed a weak expression of hEGF, however, hEGF-positive tumor cells were detected in 62 (92.5 per cent) of the 67 primary esophageal carcinomas and in 18 (94.7 per cent) of the 19 metastatic lymph nodes. In this study, the immunoreactivity of hEGF was classified into 4 grades according to the number of stained tumor cells. A significant correlation was observed between the histologic type and the grade of hEGF immunoreactivity (Chisquare test, p<0.01). hEGF immunoreactivity in well differentiated squamous cell carcinomas was significantly higher than in other squamous cell carcinomas, although there were no correlations between other pathological findings and hEGF immunoreactivity. Patients with hEGF immunoreactivities of grades II or III had much worse prognoses than those with grades 0 or I (p<0.05). In 22 esophageal carcinomas and 10 normal esophageal mucosae, EGF receptor (EGFR) contents were measured by the competitive binding assay. The average EGFR content (101.3±35.7 fmol/mg protein, mean±SE) of the esophageal carcinomas was significantly higher than that (5.3±1.2) of the normal esophageal mucosae (p<0.05). Moreover, in hEGF negative tumors, EGFR contents were lower than in hEGF positive tumors. These results suggest that hEGF and EGFR show increased production in squamous cell carcinomas and could to be useful prognostic factors in patients with esophageal cancer.

Mid-mediastinal parathyroid lesions: preoperative localization and surgical approach in two cases.

Abstract: Although hyperfunctioning mediastinal parathyroid lesions that require median sternotomy or thoracotomy for removal are occasionally present, the majority are located in the anterior mediastinum closely associated with the thymus. Only eight cases of ectopic hyperfunctioning parathyroid tumors in the middle mediastinum have been reported. We experienced two cases of either persistent or recurrent hyperparathyroidism in which abnormal parathyroid tissue was located in the aorticopulmonary window. One of the patients had a parathyroid adenoma and the other had metastatic lesions of parathyroid carcinoma. In both cases, thallium scanning proved useful in identifying the lesions while computed tomography scan was effective for mediastinal three-dimensional localization. In one case, single photon emission computed tomography imaging with thallium proved beneficial for both identification and localization of the middle mediastinal lesion. The surgical approach used in both cases was different. In one case, left thoracotomy was performed, after which the ligamentum arteriosum was divided, and an adenoma anterior to the left main bronchus and posterior to the left pulmonary artery removed. In the other case, two metastatic tumors of parathyroid carcinoma anterior to the right main bronchus and posterior to the right pulmonary artery were resected through a median sternotomy and opening of the pericardium.

Postoperative adjuvant immunochemotherapy with mitomycin C, tegafur, PSK and/or OK-432 for gastric cancer, with special reference to the change in stimulation index after gastrectomy.

Abstract: In order to evaluate the efficacy of combined immunochemotherapy with mitomycin-C, tegafur, PSK and/or OK-432 as an adjunct for curatively resected gastric cancer, a prospective randomized controlled study using the envelope method was performed, in which 266 institutions from around Japan participated. The 3 year survival rates for all cases, and for ps(+)·n(+) cases, were insignificantly higher in the immunochemotherapy groups receiving PSK and/or OK-432 than in the control group. However, because 28.2 per cent of the cases were excluded from the final statistical analyses, the results of this study may have questionable statistical credibility. Changes in the stimulation index (SI) suggest that the administration of PSK may result in an inhibition of the immunosuppressive activity of cancer patients. The high SI group showed a significantly higher 4 year survival rate than the low SI group.

Pilonidal disease of the umbilicus--a report of two cases.

Abstract: Two cases of umbilical pilonidal sinus are reported herein. Both patients were young adult males aged 21 and 27 years, respectively. The predisposing factors are briefly discussed, however, the exact etiology of this disease remains unknown. Umbilectomy is the most commonly offered treatment and although it is rare, this entity probably goes undiagnosed in the majority of cases.

A rectal carcinoid tumor of less than 1 cm in diameter with lymph node metastasis: a case report and a review of the literature.

Abstract: We report herein, a patient with a rectal carcinoid tumor of less than 1 cm in diameter with lymph node metastasis, and discuss a surgical policy for these lesions with reference to other such cases reported in the literature A 40 year old female was admitted with a rectal mass and colonoscopy revealed a subpedunculated lesion, 1 cm in diameter, with a depression in its tip A diagnosis of carcinoid was made by biopsy and transsacral excision performed The excised specimen revealed a subpedunculated lesion measuring 7×6×6 mm with a central depression The tumor was histologically confined to the submucosa but lymphatic invasion with pararectal lymph node involvement was observed A radical proctectomy was thus performed The incidence of metastasis from rectal carcinoids with a diameter of 1 cm or less is very low ranging from 15 to 34 per cent, and it therefore seems that most lesions of 1 cm or less in diameter can be treated by local excision alone Thus, although it is recommended that local excision be performed first to determine the extent of spread, lymphatic vessel invasion and lymph node metastasis, radical surgery is indicated if lymphatic invasion or nodal involvement is present, even when muscle invasion is absent

A tuberculous pseudoaneurysm of the thoracic aorta presenting as massive hemoptysis--a case of successful surgical treatment.

Abstract: Tuberculous aneurysms of the aorta need early diagnosis and prompt surgical intervention because if untreated, they lead to severe consequences. We report herein, a case of a 63 year old woman who underwent successful resection of a tuberculous pseudoaneurysm which had ruptured into the left upper lobe of the lung after a punch biopsy, performed under bronchoscopy, had caused severe bleeding. Subsequent CT and MRI examinations suggested a fistula between the mass and the aorta and proved useful in establishing the diagnosis of a pseudoaneurysm. We wish to emphasize the need for bronchoscopy to be done carefully because of the risk of inducing massive hemoptysis.

Nationwide investigations of intestinal obstruction in Japan.

Abstract: Two nationwide questionnaire surveys of intestinal obstruction in Japan were undertaken, covering two two-year periods, from January, 1975 to December, 1976 and from January, 1985 to December, 1986, respectively. The findings of a comparative review of these two surveys indicated that although the overall mortality of intestinal obstruction had not changed between 1975/76 and 1985/86, being 6.8 per cent and 6.5 per cent, respectively, simple adhesive obstruction had decreased from 3.2 per cent in 1975/76 to 2.0 per cent in 1985/86. The main cause of adhesion was laparotomy and in cases of both simple adhesive obstruction and strangulated adhesive obstruction, the rate of adhesion secondary to laparotomy of the upper gastrointestinal tract and colon and rectum had increased between 1975/76 and 1985/86. Obstructions caused by neoplasms had increased from 8.2 per cent in 1975/76 to 10.0 per cent in 1985/86, while those caused by adhesions had incresed further still, from 42.5 per cent in 1975/76 to 60.8 per cent in 1985/86. Among the latter group, nonoperatively treated cases had increased, which may be accounted for by the fact that facilities which adopt non-operative treatment using intestinal decompression as the first choice for simple adhesive obstruction cases have increased. In both surveys, the mortality of cases receiving nonoperative treatment was lower than that of operative cases.

Squamous cell carcinoma of the thyroid--a report of three cases.

Abstract: Three cases of squamous cell carcinoma of the thyroid are reported herein. In all cases, the carcinoma occurred in old age and was characterized by a rapidly growing tumor, usually associated with dyspnea and dysphagia. The prognosis of all 3 cases was poor, with a mean survival of only 6.3 months. Although squamous metaplasia is an accepted etiology of this disease, clinical investigation of the cases presented here does not favor it in consideration of the clinical features of papillary carcinoma of the thyroid with squamous metaplasia. The histological findings of our cases revealed areas of cystic formation, suggesting that some of these carcinomas may be derived from remnants of embryonic origin.

A case of pheochromocytoma with severe paralytic ileus

Abstract: We report herein a rare case of a 26 year old woman with pheochromocytoma complicated by paralytic ileus. She presented with remarkable abdominal distension and respiratory difficulty but was effectively treated by surgical removal of the tumor with preoperative and operative management using α and β adrenergic blocking agents. An excessive and persistent catecholamine production from large tumors or massive metastases characterizes this rare complication, and a review of the English and Japanese literature is given following this report.

The clinical significance of venous invasion in cancer of the stomach.

Abstract: Specimens from 235 surgically treated cases of gastric cancer were examined for venous invasion in order to investigate its clinical significance. A total of 87 (37.0 per cent) cases showed histologic evidence of venous invasion, with the incidence being 48.3 per cent of 180 cases, after the exclusion of 55 cases where cancerous invasion was limited to the mucosa. The frequency of venous invasion varied with the gross type of tumor, the depth of penetration and the degree of differentiation, being highest in tumors of type 2 and moderately differentiated adenocarcinoma. It increased proportionately dependeing upon the depth of penetration and the incidence increased in cases where there was evident lymphatic invasion or lymph node metastasis. The long term survival rate significantly decreased in patients with venous invasion when compared to those without it. In this report, we also discuss the marked difference in the incidence of liver metastasis between gastric and colorectal carcinomas in relation to venous invasion of the primary tumor. Double staining with Victoria blue and hematoxylin-eosin for elastic fibers proved useful for detecting venous invasion in the carcinomatous tissue, though endothelial markers have great specificity for differentiating small veins from lymphatics.

Metabolic changes following gastroplasty in Prader-Willi syndrome--a case report.

Abstract: A vertical banded gastroplasty was performed in an adult female patient with Prader-Willi syndrome in an attempt to prevent the metabolic deterioration caused by polyphagia. After her operation, the patient felt satiated with the scheduled amount of food and one month later, her fasting blood sugar concentration (FBS) decreased from 521 to 125 mg/dl, and her urinary sugar excretion (US) from 257 to 9g/day. Both glucose tolerance and insulin secretion were also improved. However, these parameters subsequently became worse after dietary control was lost since the surgical procedure alone was unable to continue to suppress the insatiable desire to eat food. Both her glucose tolerance and insulin secretion by the 31st postoperative month were better than before the surgery, but worse than at one month after the surgery. At the end of the 34th postoperative month, even under the temporary administration of 0.625 mg/day of glibenclamide, her FBS was 158 mg/dl and US, 38.1 g/day. Her body weight had also increased to over her preoperative value. Based on these results, we conclude that the effect of gastroplasty to prevent metabolic deterioration in our patient with Prader-Willi syndrome gradually diminishes.

Hepatobiliary and gastrointestinal imaging after pancreaticoduodenectomy--a comparative study on Billroth I and Billroth II reconstructions.

Abstract: This study was conducted to compare the passage of bile and food through the remnant alimentary tract between 2 and 6 months following pancreaticoduodenectomy in patients undergoing Billroth I (Imanaga) and Billroth II (Child) reconstructions, using dual scintigraphy. In the patients who underwent Child's operation (n=14), hepatobiliary scintigraphy showed a prominent stasis of bile tracer in the proximal jejunal loop and a significant time delay before the bile and food became mixed at the upper jejunum. On the other hand, in the patients who underwent Imanaga's operation (n=9) no bile stasis in the proximal jejunal loop was found and the time taken before the two agents became mixed was similar to that of healthy controls (n=7). The time taken for the two agents to mix at the upper jejunum was 65.8±7.9 min in the patients after Child's operation, 17.3±2.5 min in those after Imanaga's operation, and 18.5±2.8 min in the healthy controls, respectively. Continuous stasis of bile in the proximal loop and severe postcibal asynchronism in patients who undergo Child's operation can therefore cause reflux cholangitis and absorptive disturbances in the long postoperative term. The results of this study suggest that Imanaga's reconstruction is a more physiological procedure than Child's reconstruction following pancreaticoduodenectomy.

The antitumor effects of adriamycin entrapped in liposomes on lymph node metastases.

Abstract: Adriamycin (ADM) entrapped in liposomes (Lip-ADM) was prepared and its therapeutic effects studied using the mouse leukemia cell line, P388, which metastasized to axillary lymph nodes after inoculation into the foot pads of CDF1 mice. Lip-ADM injections (7.5 mg/kg) were given into the foot pad at two-day intervals. Two series of experiments were performed; one in which Lip-ADM was administered on days 1,3 and 5 following tumor inoculation, and the other in which it was administered on days 5 and 7. Both Lip-ADM injection regimens significantly inhibited metastases to the lymph nodes as compared with mice given injection of saline solution. Furthermore, the therapeutic effects of three Lip-ADM injections were significantly greater than the effects of free ADM. Histological examinations of lymph nodes revealed that three injections of Lip-ADM completely eliminated tumor cells, whereas viable tumor cells were still observed in the lymph nodes after treatment with free ADM. The results of this study suggest that Lip-ADM is useful for the treatment of lymph nodes metastases and that the local injection of Lip-ADM, through such means as endoscopy, would be recommended as a clinical mode of application.

The correlation of epidermal growth factor with invasion and metastasis in human gastric cancer.

Abstract: We examined the localization of epidermal growth factor (EGF) in 185 specimens of primary human gastric cancer using the avidinbiotin peroxidase complex immunohistochemical method on formalin-fixed paraffin-embedded sections. Thirty-four per cent of the gastric cancer specimens were positive for EGF, which was mainly located in the cytoplasm of the cancer cells and occasionally in the stromal cells, but was not detected in non-cancerous gastric epithelium. Moreover, the presence of EGF in gastric cancer was correlated with gastric wall invasion and lymph node metastasis. EGF was found more often in advanced cancers than in early ones (p<0.01), and also more often in cancers with lymph node metastasis than in those without (p<0.05). The five-year survival of patients with EGF-positive tumors was worse than that of patients with EGF-negative tumors (p<0.05). The presence of EGF in human gastric cancer may thus represent higher malignant potential.

The induction of a hypercoagulable state by medroxyprogesterone acetate in breast cancer patients.

Abstract: The effects of medroxyprogesterone acetate (MPA) on the mechanism of coagulation in postmenopausal patients were studied and compared with those of tamoxifen by a retrospective analysis The coagulation test parameters tested included platelet count, bleeding time, clotting time, prothrombin time, activated partial thromboplastin time, and the levels of fibrinogen, fibrin degradation products, factor II, factor V, plasminogen, alpha 2-plasmin inhibitor (alpha 2-PI) and alpha 2-plasmin inhibitor-plasmin complex (alpha 2-PI-P) A shortened APTT was noted and the levels of factors II, V, alpha 2-PI and alpha 2-PI-P were also out of the normal range during treatment in the MPA-treated group However, these abnormal parameters recovered to within the normal range from 6 months or more after the commencement of treatment without any termination of drug administration The patients were all asymptomatic In contrast, a slight prolongation of bleeding time which persisted for more than 6 months was observed in the patients treated with tamoxifen These data suggest that MPA causes a hypercoagulable state and that any change must be carefully monitored during treatment with either MPA or tamoxifen

Radiation-induced esophageal cancer: a case report and a review of the literature.

Abstract: A 63 year old woman who had been irradiated for thyroid carcinoma at 36 years of age developed a cervico-esophageal stricture, the biopsy specimens from which revealed squamous cell carcinoma. Total esophagectomy was performed and a small linear ulcer was found in the resected specimen. Histological examination revealed moderately differentiated squamous cell carcinoma with severe fibrosis around the tumor, indicating radiation-induced cervical esophageal cancer. The characteristics of radiation-induced esophageal cancers described in the literature are reviewed in context of the present case.

Heterotopic pancreas: A rare cause of bile duct dilatation —Report of a case and review of the literature—

Abstract: A case of a 77 year old woman with a heterotopic pancreas in the distal common bile duct is reported herein. The patient had no symptoms, but an ultrasound examination showed bile duct dilatation and subsequent endoscopic retrograde cholangiography demonstrated a spherical filling defect in the distal common bile duct. Under suspicion of a benign neoplasm in the common bile duct, resection of the common bile duct and hepaticojejunostomy using a Roux-en Y jejunal limb were successfully performed. Pathological examination revealed heterotopic pancreatic tissue in the distal common bile duct. This is only the ninth reported case of heterotopic pancreas occurring in the common bile duct or ampulla of Vater, and thus, a review of the literature is also given.

Diagnosis of cardiac allograft rejection by the detection of circulating plasma cardiac myosin light chains

Abstract: Twenty adult male Japanese monkeys of the species Macaca fuscata were randomly paired and subjected to heterotopic cardiac transplantation performed by the Ono-Lyndsey method. Without immunosuppression, graft survival ranged between 8 and 27 days, with a mean survival of 14 days. Plasma cardiac myosin light chains were measured by radio-immunoassay, which showed transient increases in myosin levels just following transplantation. Three hearts showed high values at this period and stopped beating when the myosin levels decreased (type 1). The other 7 hearts showed low myosin values after transient increases and 5 of them were rejected with a preceding reincrease in the myosin levels (type 2). Pathological study revealed myocardial necrosis, perivascular cuffing of mononuclear cells and/or neutrophils and/or plasma cells in the type 1 hearts. Measurement of the plasma myosin light chain level was therefore revealed to be of great value in the monitoring of cardiac allograft rejection.

Chronic calcifying pancreatitis associated with primary hyperparathyroidism--report of a case and review of the literature.

Abstract: A 34 year old male was hospitalized because of severe abdominal pain and diarrhea An abdominal X-ray revealed multiple calculi in the head of pancreas and blood tests showed his serum calcium level to be high He underwent surgery of the parathyroid gland and a parathyroid tumor was removed Two months later, resection of the head of the pancreas was also performed Eighteen months after his operation there has been no recurrence of abdominal pain or diarrhea and his serum calcium level is within the normal range We report this case herein and also discuss the possible cause and effect relationship between primary hyperparathyroidism and pancreatitis, and the appropriate management, in relation to a review of the literature

Computed tomography and nonoperative treatment for blunt abdominal trauma.

Abstract: Studies were undertaken to determine if computed tomography (CT) could reliably assist physical examination in the initial assessment of blunt abdominal trauma, and also to examine how various abdominal injuries were managed with the guidance of CT A total of 255 patients underwent emergency abdominal CT following blunt abdominal trauma over a period of seven years One hundred and fifty two patients had abnormal CT scans, including 58 hepatic, 36 renal, 25 splenic and 9 pancreatic injuries as well as 67 patients with intra-abdominal hemorrhage and 21 patients with free abdominal air A comparative study on the detection of pneumoperitoneum revealed CT to be far superior to plain radiography One hundred and three patients had normal CT scans, all of whom were managed nonoperatively, except for three false-negative cases and two nontherapeutic cases The patients with injury to the parenchymal organs were given nonoperative treatment if they had stable vital signs and no evidence of associated injuries demanding immediate surgery and the majority of these patients were managed well nonoperatively CT was thus found to be a useful adjunct in the management of victims of blunt abdominal trauma, since in a rapid and noninvasive fashion, CT accurately defined the extent of parenchymal organ injury and also disclosed any other abdominal injuries

The effect of adjuvant therapy with or without tamoxifen on the endocrine function of patients with breast cancer.

Abstract: The ovarian and pituitary functions of 64 operable breast cancer patients undergoing adjuvant therapy with cytotoxic chemotherapy and/or tamoxifen were investigated. The post menopausal patients, divided into 3 treatment groups, one with tamoxifen alone, one with tamoxifen and chemotherapy and the other with chemotherapy alone had serum estradiol 17-β (E2) and progesterone levels lower than the evaluable limits. Although there was no significant difference in the level of estrone sulfate (E1-S) between these three groups, the level of lutainizing hormone (LH) and follicle stimulating hormone (FSH) in the patients treated with tamoxifen alone and tamoxifen and chemotherapy were significantly lower than those treated with chemotherapy alone. The decrease in gonadotropin levels induced by tamoxifen treatment was reversible as it appeared after the initiation of tamoxifen and recovered after its cessation. In the premenopausal patients, a group treated with tamoxifen and chemotherapy had significantly higher E1-S, E2 and progesterone levels and significantly lower gonadotropin levels than a group treated with chemotherapy alone or one treated with a cyclophosphamide regimen. These increases in the levels of estrogen and progesterone were also reversible, and induced by tamoxifen. Thus, adjuvant endocrinochemotherapy causes profound alteration in the hypothalamo-pituitary-ovarian axis and therefore, monitoring a variety of hormonal levels is thought to be necessary for assessing the consequences of adjuvant therapy in breast cancer patients, especially in premenopausal patients using tamoxifen.

Duodenal obstruction caused by acute appendicitis with intestinal malrotation in an adult. A case report.

Abstract: A 55 year old man with a short history of continuous vomiting and recent episodes of midabdominal pain and high fever was discovered to have a complete duodenal obstruction caused by acute appendicitis and intestinal malrotation. A fibrous adhesion caused by the inflamed appendix in the high caecum involved the duodeno-jejunal junction. This case is unique in that the onset of acute appendicitis triggered duodenal obstruction in the presence of an asymptomatic malrotation.