[Nd-YAG laser treatment for central airway lesions]. YAG laser treatment was conducted in 55 patients with central airway lesions over the last 8 years. The malignant lesions comprised 1 primary tracheal cancer, 1 chondroma of the trachea, 34 primary lung cancer, and 10 metastatic lung tumor. The benign lesions comprised one each of hamartoma, lipoma, bronchial lithiasis, post-tracheotomy granuloma, and bronchial web, and 3 other cases. Nd-YAG laser treatment was performed in 55 patients with airway lesions, with a success rate of 73%. The success rates in the above patients were 70% for primary lung cancer, 60% for metastatic lung tumor, 100% for primary tracheal cancer and chondroma of trachea, and 89% for benign lesions. In 34 patients with primary lung cancer, palliative widening of the airway was planned with the exception of 2 patients with endoscopically early lung cancer for whom curative vaporization was intended, 6 months-survival rate was 59.3% in patients in whom various combined treatments were performed after the laser treatment. For all patients with hamartoma or lipoma in those with benign lesions, curative vaporization was performed. The severe complication of lethal massive hemoptysis occurred in 3 patients. We consider that Nd-YAG laser treatment is a powerful therapeutic means of performing lifesaving or emergency, curative, and supplemental treatment.


[Tracheobronchial reconstruction in infants and children]. Fifty-eight infants and children with various tracheobronchial obstructions were surgically treated at Kobe Children's Hospital between 1980 and 1991. The lesions included subglottic stenosis (24), congenital tracheal stenosis (9), tracheomalacia (15), bronchomalacia (6), and others (4). The operative procedures included laryngotracheoplasty using costal cartilage or anterior cricoid split for subglottic stenosis, tracheoplasty with costal cartilage graft for extensive tracheal stenosis, aortopexy for tracheomalacia, and external stenting or bronchial resection with tracheo-bronchial anastomosis for bronchomalacia. In 46 of 58 patients, the endotracheal tube was successfully removed and the patient remained free of respiratory symptoms. These operative results encourage us to continue all surgical procedures except for external stenting for bronchomalacia, which did not correct the collapse of the bronchus.


[Surgical treatment of tracheobronchial lesions in children]. A total of 16 cases of tracheal and bronchial lesions such as bronchial tumor (4 cases), aspirated foreign body (5 cases), and tracheo-bronchial stenosis (7 cases) were surgically treated at the National Children's Hospital from 1965 to 1990. A mucoepidermoid tumor was excised via bronchotomy. Pulmonary lobectomy was indicated for another 2 mucoepidermoid tumors which arose from the middle and lower lobe bronchus. Pneumonectomy was indicated for a leiomyoma located at the stem of the left bronchus and showed extensive invasion into the bronchial wall. It is important to accurately diagnose the location and extent of the tumor by performing intraoperative bronchoscopy, bronchotomy, frozen section examination in order to avoid unnecessary pulmonary resection. Three aspirated foreign bodies (2 marking needles and a peanut) were removed via bronchotomy. Right lower lobectomy was performed in a patient who received an accidental injection of barium sulfate into the right lower bronchus. The barium remained for more than one year and caused recurrent pneumonia. A radiolucent toy plate aspirated into the left main bronchus of a 3-year-old girl was overlooked for more than 3 years. Suppurative changes of the left lung necessitated pneumonectomy. Tracheal resection with end-to-end anastomosis was carried out successfully in a 5-year-old patient suffering from segmental fibrogranulous stenosis of the mid-trachea. Extensive congenital stenosis in 6 patients was repaired by costal cartilage autograft, with a 67% mortality rate. Treatment of the associated cardiac anomalies and the possible postoperative complications such as anastomotic leakage, restenosis, exuberant granulation, and tracheomalacia are the major problems associated with this type of tracheoplasty.


[Diagnosis, incidence, clinicopathology and surgical treatment of acquired tracheobronchomalacia]. We report our recent findings on the diagnosis, incidence, appearance of the trachea at autopsy, and surgical treatment of acquired trachobronchomalacia. In the diagnosis of this disease, continuous dynamic CT scanning (1 slice/0.6 second) from inspiration to deep expiration was better than X-ray cine recording. It is difficult to observe the most collapsed airway on coughing using bronchofiberscopic recording, because its duration time was estimated to be 1/10 second by X-ray cine recording, whereas the findings at one instant were easily recorded by video-bronchoscopy on coughing. The degree of severity of this disease was classified into three groups. 1st degree 0-50% narrowing of airway caliber, 2nd degree 50-75%; and 3rd degree 75-100%. Severity of 2nd or 3rd degree was present in 542 (12.7%) of 4283 patients suffering from chest disease who underwent bronchoscopy. Seventy-two percent of patients were aged 50 to 80 years. Third degree tracheomalacia was found in 131 patients with an incidence of 3.1%, which increased from 2.2% at 50 years to 6.2% at 80 years. The autopsy findings of the trachea consisted of fragmentation of the tracheal cartilage and extension of the membranous portion. The pathogenesis may be varied with different types of collapse of the airway, including the saber sheath type and the crescent type. Surgical treatment consists of prevention of the airway collapse by wrapping the airway with Marlex mesh and bonding Lyodura (lyophilized dura mata) with fibrin glue, which is more reliable than the span plasty proposed by Nissen.


[Operative indications for tracheobronchomalacia]. Tracheobronchomalacia in 3 children and 4 adults was reviewed, and operative indications were investigated. Tracheobronchomalacia in children differed from that in adults in that the lesion was localized and spontaneous healing was effected by cartilage growth and hardening. In adults, tracheobronchomalacia was characterized by a notch on the expiratory flow volume curve and higher V peak of inspiratory flow volume curve than that of expiratory curve. Operative indications for tracheobronchomalacia are BP higher than 28.2 cmH2O and delta CT higher than 15.4 cmH2O. Of 2 patients with tracheobronchomalacia in whom airway pressure was measured, one was a candidate for operation, and in the other, surgery was contraindicated because of low BP due to chronic obstructive pulmonary disease.


[Role of psychological factors as a determinant of the hypercapnic ventilatory response and dyspnea sensation]. We examined, in 38 healthy adult subjects (male 15, female 23), the relationship between psychological background as assessed by manifest anxiety scale test and Yatabe-Guillford test, and the hypercapnic ventilatory response (HCVR), which was tested twice with and without inspiratory resistive loading (17 cmH2O/L/sec). In addition, we attempted to evaluate the possible role of psychological factors in dyspnea sensation felt during HCVR, which was simultaneously assessed by visual analogue scaling (VAS). The slope value of HCVR was positively correlated with the social extraversion score in the male group (r = 0.55, p less than 0.05) only when the test was conducted without resistive loading. In the female group, it was positively correlated with emotional instability in both conditions (r = 0.46, p less than 0.05) without resistive loading and r = 0.47, p less than 0.05 with resistive loading). With respect to dyspnea sensation, manifest anxiety score alone had a positive correlation with VAS score evaluated in relation to ventilation only in the male group (r = 0.61, p less than 0.05). From these findings, we conclude that psychological factors may play a role as a determinant of HCVR, regardless of the presence of inspiratory resistive loading, as well as a determinant of the sensation of dyspnea during HCVR.


[Leukocyte number, protein-inhibitor, and complement in smokers]. In the present study, the number of leukocytes was increased in smokers, dependent on the amount of exposure to smoke (duration and cigarette number/day). The differential leukocyte count did not differ between smokers and non-smokers. Leucocyte-associated serum components such as alpha 1-antitrypsin, alpha 2 globulin, and complements did not differ in smokers. There was no relationship between neutrophils in peripheral blood and BAL fluid. These findings suggest that an increased number of leukocytes in smokers is not attributable to activation of complement, and that anti-proteinase serum levels including alpha 1-antitrypsin and alpha 2 globulin are unchanged in both smokers and ex-smokers.


[A clinico-pathological study of 14 open lung biopsy cases of clinically suspected diffuse panbronchiolitis]. To elucidate the relationship between clinical and histopathological findings in diffuse panbronchiolitis (DPB), we reviewed 14 open lung biopsy cases clinically suspected of having DPB. According to the histopathological criteria for "PB unit lesion" proposed by Kitaichi in 1988, 11 cases were diagnosed as having DPB; 3 cases were excluded by the criteria. The pathological diagnosis was not concordant with the evaluation according to the clinical diagnostic criteria for DPB previously proposed by Homma et al. in 1983. The present results indicate 1) the necessity to reexamine the pathological criteria for DPB, especially in open lung biopsy cases, and 2) the difficult differential diagnosis between DPB cases and non-DPB ones by current clinical diagnostic criteria.


[Effect of enkephalinase inhibitor on endothelin-1 induced bronchoconstriction in guinea pigs]. Endothelin-1 (ET-1) is one of the most potent bronchoconstrictors in the guinea pig. The mechanism of its metabolism is still unclear. Phosphoramidon is known to be an enkephalinase inhibitor. We studied the effect of phosphoramidon on bronchoconstriction induced by ET-1. In the first in vitro study, a tracheal preparation was mounted in oxygenated Krebs-Ringer solution. The response was monitored by isometric transducer. Dose-response curves to ET-1 with or without phosphoramidon were obtained. Phosphoramidon potentiated ET-1 induced bronchoconstriction significantly. Next, the specific airway conductance (sGaw) was measured in conscious guinea pigs exposed to an aerosol of phosphoramidon or saline, followed by ET-1 aerosol inhalation. The ET-1 dose was increased by successively doubling the concentration. sGaw, after inhalation of phosphoramidon, was significantly reduced when exposed to ET-1. Phosphoramidon also potentiated ET-1 induced bronchoconstriction in vivo. Next, lung parenchymal tissues were prepared and placed in oxygenated Krebs-Ringer solution with or without phosphoramidon. ET-1 was added and incubated, and samples were injected into a high performance liquid chromatography column. Phosphoramidon inhibited an analysis of ET-1. These data suggest that enkephalinase plays a role in the break down of ET-1 in the airway of the guinea pig. Under the condition of decreased enkephalinase, ET-1 would potentiate bronchoconstriction.


[Evaluation of tissue eosinophils in eosinophilic pneumonia]. Transbronchial biopsy specimens from ten patients with eosinophilic pneumonia were analysed to see whether the tissue contained activated eosinophils or secreted eosinophil cationic protein. The specimens showed many infiltrated tissue eosinophils in the intraalveolar spaces, and thickened alveolar septae and perivascular areas. Most of these eosinophils stained clearly with degranulation by immunohistochemical studies with monoclonal antibody EG2 (for the secreted form of eosinophil cationic protein), indicating that they were activated eosinophils. On the other hand, although pleural tissue obtained at bullectomy performed after pneumothorax showed eosinophilic infiltration, EG2-positive cells were few. Activated eosinophils may play an important role in the development of pulmonary lesions of eosinophilic pneumonia.


[Clinical study on cough variant asthma]. Chronic cough may be the sole presenting manifestation of bronchial asthma (reference 3; Corrao et al, 1979), and "cough variant asthma (CVA)" has been used to categorize such patients. In order to clarify the clinical picture of CVA, we evaluated the clinical history, laboratory data, sputum cytology and pulmonary function in 14 subjects (5 males and 9 females, aged 14 to 65 years) compatible with the following diagnostic criteria: (1) chronic cough persistent for more than 8 weeks, (2) no wheeze nor dyspnea, (3) no rales, (4) no past history of asthma, (5) bronchial hyperreactivity to methacholine proven by Takishima's method (reference 13), (6) effectiveness of bronchodilators against cough, (7) normal chest X-ray film, (8) afebrile and negative CRP, (9) absence of sinusitis and postnasal drip, or if present, they are proved not to be responsible for the cough, and (10) no other causes of cough such as heart disease, prescription of ACE inhibitors, current smoking. The results were as follows. 1) Many of the subjects were atopic, with positive skin tests to one or more common allergens in 10 subjects, elevated serum IgE in 4 subjects, and past history and family history of atopy in 4 and 7 subjects, respectively. 2) Respiratory infection preceded the onset of CVA in 3 subjects. 3) Cough was generally nocturnal, but 2 subjects coughed only in the daytime. 4) FEV1.0% was decreased (less than 70%) in only 2 subjects, whereas V25 was decreased (less than 80% of predicted value) in 11 out of 12 evaluable subjects, which suggested peripheral airway obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)


[Experimental study on the role of prostaglandin D2 in the pathogenesis of bronchial asthma]. Various kinds of chemical mediators have been implicated in the pathogenesis of bronchial asthma. PGD2 is a cyclooxygenase product which has various physiological effects. In this experimental study, we investigated the role of PGD2 in the pathogenesis of bronchial asthma. In a bioassay system, PGD2 caused dose-dependent contractile responses in non-sensitized guinea pig trachea and lung tissue strips. The subthreshold concentration of PGD2 in both strips was 25 ng/ml. Acetylcholine-induced contractile responses in both strips were significantly increased by continuous infusion of PGD2. In the experimental model of bronchial asthma, the levels of PGD2 were significantly increased in serum, bronchoalveolar lavage fluid (BALF) and lung tissue of sensitized guinea pigs after antigen challenge. We have also reported that the levels of PGD2 in BALF were elevated in patients with stable state bronchial asthma. These results suggest that PGD2 may be a key substance that increases airway responsiveness and induces asthmatic attacks.


[The effect of oxygen administration on serum concentration of potassium during exercise]. Recently, there have been many reports on the role of serum concentration of potassium as a potential limiting factor during exercise. K+ is known to induce muscle fatigue and to increase ventilation by direct stimulation of peripheral chemoreceptors. These two K(+)-mediated effects are considered to be the factors that limit exercise capacity. This effect seems to be exacerbated in hypoxemic states. The occurrence of hypoxemia in chronic pulmonary disease patients during exercise is believed to cause the excessive efflux of potassium to the extracellular space from skeletal muscles. The present study evaluated the relationship between the changes in arterial concentration of K+ and hypoxemia during exercise in 37 chronic pulmonary patients and 9 healthy controls. The study was carried out after obtaining formal and written consent of the patients in accordance with the stipulations of the Helsinki Declaration. Patients were divided into two groups according to PaO2 level at maximum exercise capacity; group I: PaO2 less than 55 torr, group II: PaO2 greater than or equal to 55 torr. The arterial concentration of K+ in group I patients tended to be higher than that in group II and controls. In group II, K+ concentration was significantly elevated (p less than 0.05) compared to controls. In group II, PaO2 values were inversely correlated with K+ (r = 0.3026; p less than 0.025), whereas in controls and group II they were unrelated. These results suggest that the augmented serum level of potassium in patients with chronic pulmonary disease is an important limiting factor during exercise.


[Dyspnea and ventilatory muscle function during exercise on air and oxygen breathing in patients with chronic obstructive pulmonary disease (COPD)]. Exercise performance and dyspnea in COPD patients have been shown to be improved with supplemental oxygen, although the exact mechanisms resulting in the improvement are still unclear. The purpose of the present study was to investigate a possible relationship between ventilatory muscle function and sensation of dyspnea (modified Borg Scale) during exercise on 20% O2 and 30% O2. Eight patients with COPD (FEV1 1.06 L +/- 0.30 L) exercised on a treadmill two times breathing compressed air or 30% oxygen with a one hour rest in between. The electrical activity of the diaphragm (EMGdi) was recorded with esophageal electrodes, and that of the sternomastoid muscle (EMGsm) was recorded from the fine wire electrodes. The ratio of high frequency (150 to 350 Hz) to low frequency (20 to 47 Hz) power (H/L) of EMGdi was analyzed to assess diaphragmatic fatigue, which was defined as a 20% fall of H/L ratio from the control value. Flow, volume, O2 Saturation (SaO2), esophageal pressure (Pes) and transdiaphragmatic pressure (Pdi) were measured. Tension time index (TTdi) was calculated from Pdi and the ratio of inspiratory time to total time for one cycle (Ti/Ttot). At rest, we measured maximal esophageal pressure (Pesmax), maximal transdiaphragmatic pressure (Pdimax), maximal integrated EMGdi (EMGdimax) and EMGsm (EMGsmmax). Incremental exercise was discontinued by dyspnea. The walking distance achieved was increased in all patients on 30% O2. Dyspnea and desaturation were significantly improved on 30% O2 breathing, and the onset of diaphragmatic fatigue was delayed.(ABSTRACT TRUNCATED AT 250 WORDS)


[A case of thyroid medullary carcinoma-like tumor of the lung with amyloid stroma]. A 58-year-old man with history of productive cough and mild exertional dyspnea for several years was admitted to our hospital because of abnormal shadow on chest radiograph. Bronchofiberscopic examination revealed a polypoid tumor almost completely obstructing the right main bronchus. Bronchoscopic biopsy specimens showed amyloid-like deposits in the connective tissue surrounded by epithelium-like tumor cells with squamous metaplasia, but no diagnostic findings. Malignant tumor was suspected and right upper lobectomy was performed. The surgical specimen revealed nests of tumor cells surrounded by amorphous eosinophilic substance, which was confirmed to include amyloid fibrils by electron microscopy. A few tumor cells contained argyrophil granules by Grimelius staining, and some showed PAP staining for calcitonin. There was no evidence of involvement of other organs including the thyroid gland during the four year postoperative follow-up period. This case was diagnosed as thyroid medullary carcinoma-like tumor of the lung, which is a bronchopulmonary carcinoid-related tumor.


[A case of mediastinal lymphatic cyst possibly originating from the right thoracic duct]. A 33-year-old male was admitted to our hospital because of an abnormal shadow in the right superior mediastinum on chest X-ray, which was first noted about half a year before his admission. Several diagnostic procedures, including fiber bronchoscopy, CT scan and MRI; however, no final diagnosis could be made. Thoracotomy was performed with the presumed diagnosis of benign mediastinal cystic tumor. Entry of the right thoracic duct into the cyst was observed at operation. Histological examination revealed that the cyst was lined by mono-layered cuboidal epithelial cells with lymphocytic infiltration in the wall of the cyst. The mono-layered cuboidal epithelium of the thoracic duct gradually changed to the epithelium of the cyst. Twenty ml of colorless transparent fluid was aspirated from the cyst. Analysis of aspirated fluid revealed low concentration of several substances except LDH compared to the values of the previously reported normal standards and other reported cases. From these findings, the cyst was diagnosed as mediastinal lymphatic cyst. Entry of the thoracic lymphatic duct into the mediastinal lymphatic cyst is a rare occurrence, and it is of interest to speculate on its relationship to the origin of the lymphatic cyst.


[A case of Hand-Schüller-Christian disease with pulmonary fibrosis]. A 42-year-old man was admitted with dyspnea and abnormal shadows on chest roentgenogram, which showed bilateral reticulonodular shadows, multiple pulmonary cysts, and pleural effusion. A month after admission, he developed severe respiratory failure and chest X-ray revealed exacerbation of reticulonodular shadows. Steroid pulse therapy improved the symptoms and chest X-ray. He had atrophy of the mandible. Bone scintigram revealed multiple hot lesions. Bone biopsy of the right tibia showed lipogranuloma, and the diagnosis of Hand-Schüller-Christian disease (HSC) was made. The percentage of OKT6-positive cells (Langerhans cells) found by immunofluorescence was 16.1% of all cells in bronchoalveolar lavage fluid, indicating pulmonary involvement due to HSC. This is a rare case of Hand-Schüller-Christian disease with pulmonary fibrosis.


[A case of interstitial pneumonitis with hemoptysis, BOOP (bronchiolitis obliterans organizing pneumonia) pattern, granulomas and foreign body giant cells in lung biopsy]. A 66-year-old male presented to our hospital in January 1990 with chief complaints of hemoptysis and cough. These symptoms had developed 10 months previously and had gradually increased. Fine crepitations were audible over the right lower lung field. There were no results suggesting an inflammatory process such as leucocytosis, elevation of ESR or positive CRP reaction. Chest X-ray film on the first visit showed fine nodular shadows in the right lower lung field, and chest CT revealed fine nodular shadows and mild dilatation of the right lower lobe bronchus. Transbronchial lung biopsy specimens showed granulomas with multinucleated giant cells, alveolitis and Masson bodies. The open lung biopsy specimens showed numerous macrophages and foreign body giant cells, and extensive organizing exudates in the bronchioles and alveolar spaces. Proliferation of smooth muscle and fibrosis around the dilated bronchioles were also seen. Thus, this patient demonstrated BOOP pattern, with granulomas and foreign body giant cells. His hemoptysis appeared to have resulted from inflammation of dilated bronchioles. His symptoms and abnormal shadows on chest X-ray improved without any therapy after admission. After treatment with corticosteroid, the diffuse fine nodular shadows disappeared. There has been no recurrence of symptoms to date, although this patient has continued living in the same environment as prior to admission. BAL findings during his prolonged follow-up revealed decrease in lymphocytes and elevation of CD4/CD8 ratio. Although the presence of granulomas suggests the possibility of an allergic reaction, no antigenic material could be identified in this case.(ABSTRACT TRUNCATED AT 250 WORDS)


[A case of humidifier lung associated with BHL]. We encountered a rare case of hypersensitivity pneumonitis associated with bilateral hilar lymphadenopathy (BHL). The patient was a 53-year-old male, who developed dry cough and shortness of breath when using a humidifier since 1982. He was admitted to our hospital for further evaluation in 1987. Chest X-ray films showed BHL and ground glass appearance in the bilateral lung fields. Pulmonary function test indicated disturbance of diffusing capacity. Transbronchial lung biopsy revealed interstitial pneumonitis, and lymph node biopsy by mediastinoscopy showed lymphoid sinus histiocytosis without noncaseating granuloma. Provocation test using the humidifier was positive, and the diagnosis of humidifier lung with BHL was made.


[A case of isolated absence of the right pulmonary artery]. A 40-year-old woman was admitted to our hospital for investigation of an abnormal chest roentgenogram. She had been well with normal exercise tolerance and had no history of pneumonia. The chest roentgenogram showed decreased vascularity of the right lung, ipsilateral small hemithorax, and shift of the mediastinum toward the right. In the right lung field, hazy and confluent micronodular shadows were seen, and the left lung was emphysematous and hyperlucent. Herniation of the left lung into the contralateral thorax was seen. Although lung perfusion scintigrams showed no detectable blood flow to the right lung, a krypton ventilation study revealed diminished but homogeneous ventilation of the ipsilateral lung. A bronchogram showed normal structure of the bronchi. Cardiac catheterization revealed normal pulmonary arterial pressure. A pulmonary angiogram showed no right pulmonary artery, and absence of other cardiovascular anomalies. Therefore, the diagnosis of isolated absence of the right pulmonary artery was confirmed. An aortic angiogram demonstrated collateral vessels originating from one of the bronchial arteries, the infradiaphragmatic artery, and the right coronary artery. Chest CT disclosed cystic changes in the right lung field.


[A case of bronchiolitis obliterans organizing pneumonia in a patient with rheumatoid arthritis who responded to corticosteroid and immunosupressant therapy]. A 56-year-old man with rheumatoid arthritis was admitted to our hospital with dyspnea on exertion, fever and right chest pain. Chest X-ray showed bilateral, predominantly lower interstitial shadows and right pleural effusion. Open lung biopsy specimen showed bronchiolitis obliterans organizing pneumonia (BOOP) with prominent alveolitis, and corticosteroid therapy was introduced. Because the patient showed little response to corticosteroids, an immunosupressant (cyclophosphamide) was added. There was marked clinical, physiological and roentgenographic improvement in response to combined therapy. The therapeutic response of some BOOP patients seems to vary according to its pathogenesis and pathological findings, and these should be taken into consideration in the selection of therapeutic strategies.


[A case of bronchogenic cyst in the subdiaphragmatic region]. A surgical case of subdiaphragmatic bronchogenic cyst is presented. A 44-year-old female was admitted because of a radiological abnormality of a mass lesion at the left diaphragm. Laboratory examinations did not reveal any significant abnormalities. Chest CT revealed the mass lesion with smooth margin, whose density was higher than that of water. Both MRI T1-weighted and T2-weighted images showed a relatively high intensity of the mass. On endoscopic ultrasonography, the lesion consisted of a thin wall with highly echoic contents, and its shape changed during respiratory movement. On the basis of the findings of these imaging modalities, the diagnosis was considered to be bronchogenic cyst. The mass was resected via laparotomy, and its histologic diagnosis was bronchogenic cyst containing turbid fluid. Subdiaphragmatic bronchogenic cyst is reported rarely. The characteristic findings of CT, MRI and endoscopic ultrasonography enable the diagnosis of a cyst with turbid contents.


[Diffuse large cell lymphoma with spontaneous regression in the lung and lymph nodes. Case report]. An 84-year-old woman was admitted to our hospital because of swelling of the cervical lymph nodes and multiple tumorous lesions observed on radiographic studies. Transcutaneous lung biopsy was performed, but necrosis of the tissue was too marked to make a diagnosis. The diagnosis of diffuse large-cell lymphoma was made based on a biopsy of the pretracheal lymph node. During the first two months after admission, the left cervical lymph nodes and most of the pulmonary lesions regressed not withstanding of special treatment for lymphoma. The patient eventually died of generalized peritonitis. At autopsy, metastasis of systemic organs by malignant lymphoma was observed. Most of the lung regions were cicatrized, but clusters of atypical lymphocytes were observed in the necrotic tissue. The tumor in the mucosa of the small intestine showed necrosis, which accounted for the intestinal perforation. The total clinical course after admission was about six months. Spontaneous regression of diffuse large cell lymphoma is rare, and this is the second reported case in Japan.


[Inhibitory effect of amlexanox on asthmatic attacks in an aspirin sensitive asthmatic]. The anti-allergic action of amlexanox is reported to be associated with inhibition of the release of LTC4, LTD4 and histamine, and with antagonistic activity on leukotrienes. The patient was a 18-year-old female who had suffered from bronchial asthma since the age of fifteen. We diagnosed the case as aspirin sensitive asthma because of development of a severe asthmatic attack with syncope after oral administration of an analgesic for treatment of a common cold at the age of seventeen. She also had sensitivity to toothpaste. Three-minute aerosol inhalation challenge with 0.1, 1 and 10% solution of sulpyrine was performed as a stepwise increment at 20 minutes intervals. This inhalation test was positive and it evoked simultaneous increases of LTC4, LTD4 and histamine in the peripheral blood. Since the commencement of oral administration of 150 mg per day of amlexanox, the patient has had no attacks for about 8 months. In the second inhalation test, premedication with amlexanox elevated the threshold of sulpyrine and inhibited the release of LTC4, LTD4 and histamine. We report that amlexanox was of use to control asthmatic attacks in this aspirin-sensitive asthmatic patient.


[A case of invasive thymoma responsive to preoperative chemotherapy]. A 38-year-old male was admitted with edema of the neck and face. Chest X-ray revealed a mediastinal tumor. On chest CT and MRI, a tumor infiltrating the superior vena cava and bilateral brachiocephalic veins in the upper mediastinum was observed. Venography revealed obstruction of bilateral brachiocephalic veins. The tumor was diagnosed as thymoma by percutaneous biopsy, but since it was of stage III according to Masaoka's classification, complete extirpation was considered to be impossible. Preoperative chemotherapy with multiple drugs (CDDP, ADM, VCR, CPA) was administered. The superior vena cava syndrome resolved and the tumor diminished in size. Because of leukopenia, rhG-CSF was also used. The tumor infiltrated the left brachiocephalic vein; therefore, total resection and left brachiocephalic vein reconstruction were performed. Histopathological examination showed extensive, necrosis and fibrosis containing residual thymoma. Postoperatively, similar chemotherapy and cobalt irradiation (40 Gy) to the superior mediastinum were performed. We thus present a case of invasive thymoma which responded to preoperative chemotherapy.


[Diseases and operative modes of tracheobronchoplasty]. In 251 patients of tracheobronchoplasty, the disease distribution and the indicative expansion were analysed. The largest series was lung cancer encountered in 49%, followed by thyroid cancer in 20%, posttracheostomy tracheal stenoses, primary tracheobronchial tumors, and tuberculosis in 7-8% respectively, and others in remaining 4%. In lung cancer, two way of operative modes have been tried, which were carinal resection extensively and sleeve or wedge segmentectomy limitedly. Laryngotracheal anastomosis increased applicable cases in thyroid cancer and posttracheostomy subglottic stenosis. Preoperative irradiation for adenoid cystic carcinoma increased the cases for operation. A new carinal reconstruction via the subaortic arch approach for tuberculous stenosis was successfully underwent. End-to-end anastomosis instead of partial suture was advisable in the early stage of traumatic bronchial rupture. Congenital airway malformation is a disease to be divised some operations which might furthermore increase operative modes. In summary, 38 operative modes have been experienced so far, and these might increase in number depending to diseases.


[Endoscopic surgery of airway lesions by Nd-YAG laser treatment]. Between April 1980 and November 1990, we treated 212 cases of airway lesion using an Nd-YAG laser via the fiberoptic bronchoscope. The Nd-YAG laser power output was usually 40 W (20-60 W) delivered in 2 sec. shots. The cases consisted of 98 primary lung cancer, 12 primary tracheal cancer, 53 metastatic airway lesion, 7 benign tumor, and 42 cicatricial and granulomatous lesions. The therapeutic effects of Nd-YAG laser treatment were evaluated based on alleviation of dyspnea, widening of airway, and curative vaporization for therapeutic purposes. Effectiveness was observed in 180 of a total of 212 cases (84.9%). Out of 75 emergency cases in which a lifesaving procedure was performed to widen the airway, effective results were obtained in 70 (93.3%) with dramatic improvement in condition. It was also effective in 90 of 109 cases (82.6%) in which the procedure was performed for staged (palliative) widening of airway. In 55 cases of advanced lung cancer (Stage III or IV, mainly non-small cell cancer) in which palliative widening procedure was performed, one year survival was 44%. In 13 of 18 cases (72.2%) in which the procedure was performed for curative vaporization of invasive cancer, successful results were obtained. In 7 cases of benign tumor in which vaporization was performed as a radical curative procedure, no recurrence was observed in any cases. In 53 cases of metastatic airway lesion, effective results were obtained 48 (90.6%). The primary lesions of these cases consisted of 14 cases of esophageal cancer, 9 cases of lung cancer, 7 cases of colo-rectal cancer, 7 cases of thyroid cancer, and 16 others.(ABSTRACT TRUNCATED AT 250 WORDS)


[A clinical assessment of efficacy in continuous retrograde cerebral perfusion method]. From November 1990 to June 1991, 8 patients underwent surgical repair using continuous retrograde cerebral perfusion (CRCP). We evaluated the effect of CRCP from these 8 cases. As a method of CRCP, we perfused with oxygenated blood from SVC canulae with a internal jugular vein pressure of 30-40 cmH2O. Simultaneously systemic perfusion from femoral arterial canulae was performed. At nasopharyngeal temperature of 15-21 degrees C, CRCP time was 46-115 minute. SVC perfusion flow was 280-900 ml/min, and femoral arterial perfusion flow was 450-1,200 ml/min. At 30 minute after starting CRCP, oxygen tension of the blood which was returned to aortic arch was 11-23 mmHg, whereas oxygen tension of the SVC perfusion blood was 210-398 mmHg. In only one patient, transient involuntary movement was seen after operation, but prolonged emergence from anesthesia was not seen. In conclusion, CRCP is considered as an useful method in the operation of the aortic arch.


[Clinical experience of continuous retrograde cerebral perfusion for assisted circulation during the surgical treatment of acute dissection of aorta: Stanford A type]. Surgical treatment of the dissection involving the ascending aorta or aortic arch represents one of the most complicated technical challenges. Recently continuous retrograde cerebral perfusion (CRCP) is sometimes applied in order to avoid cerebral complications. We compared two surgical groups, one of which was performed graft-replacement of ascending aorta using CRCP and another was utilized normograde cerebral circulation, about the technique of operation, total extracorporeal circulation (ECC) time, aortic clamp time, separate ECC time, total bleeding volume, and urination during operation. In the group using CRCP, separate ECC time was 53 min (mean), and intraoperative bleeding volume was only 1,170 ml. Good urination was obtained during operation. Postoperative courses were uneventful, and consciousness was smoothly and soon recovered. The new method of separate ECC has some advantages over the previously described methods, particularly for avoidance of cerebral complications. As it is not necessary to require dissecting, taping, and clamping of cephalic branches, operative procedure will be very simplified, easier and safer, leading to intraoperative bleeding is a fewer. It is our belief that this method should be widely applied in the operation of graft-replacement of ascending aorta or aortic arch in the near future.


[Evaluation of calcified ascending aorta by thoracic computed tomography and technical pitfall for coronary artery bypass grafting]. The cumulative 94 coronary bypass patients were evaluated on calcification of the ascending aorta preoperatively by computed tomography (CT). CT demonstrated the calcification of the ascending aorta in 12 patients (12.8%). In these patients with severely calcified ascending aorta, we performed femoral cannulation (6 cases), distal anastomosis without aortic cross clamp (2 cases), proximal anastomosis through single aortic cross clamp (3 cases) and non proximal anastomosis to use arterial conduits (3 cases). In this series, we did not have any embolic episode. The thoracic computed tomography is effective for evaluation of calcified ascending aorta and in this situation, operative modifications are necessary for obviation of stroke.


[Result of surgical treatment of true or dissected thoracic aneurysm: determinants analysis in operative mortality and morbidity]. Between 1986 and 1990, 69 patients underwent surgery either for thoracic aneurysm (27 patients) or aortic dissection (42 patients). Sixty one patients (88%) survived and 8 patients (12%) died after surgery. Main determinants of deaths in 4 patients with true arch aneurysm were bleeding from the sites of aortic clamping or anastomosis and intraoperative severe LOS. Three patients with acute type A dissection died from bleeding due to clamp injury or myocardial ischemia. The cause of death in the patient with chronic type B dissection was associated with brain damage due to hypoxia developed during left heart bypass. Postoperative cardiac, pulmonary, hepatic and renal functions were analyzed in the operative survivors. Cardiac functions were maintained well in all patients except two patients with chronic type A dissection. Four patients, one with true arch aneurysm, 2 with chronic type A and one with chronic type B dissection, required tracheostomy. The mean of maximum total serum bilirubin exceeded 4 mg/dl in the patients with true arch aneurysm, acute and chronic type A dissection. The level of serum creatinine showed slight increase in all patients but prophylactic peritoneal dialysis was performed in one patient with chronic type A dissection. In conclusion, the cause of deaths in most patients with thoracic aneurysm was due to inappropriate operative techniques and circulatory supports during surgery. Without the complication described above, the patients could tolerate surgery well.


[A new hemodynamic diagram, using COP-PCWP and CI as parameters, after open heart surgery]. In 24 patients subjected to cardio-pulmonary bypass (CPB) operation, changes in colloid oncotic pressure (COP), cardiac index (CI), respiratory index (RI), and pulmonary capillary wedge pressure (PCWP) were measured within a 48 hour period. The patients were divided into two groups according to dose levels of catecholamine. In 18 patients received small catecholamine doses, a stable hemodynamic and respiratory status were maintained. However, 6 patients received catecholamine doses of more than 15 micrograms/kg/min exhibited low COP, low CI, high RI and high PCWP. In this study we designed a new hemodynamic diagram using COP-PCWP and CI as parameters of the cardiac function. We consider that these parameters are more suitable than Forrester's parameters to evaluate the patient's condition before and after open heart surgery.


[Coronary bypass surgery using arterial conduit and its pitfall]. Three patients with spasm of internal mammary arteries and gastroepiploic artery immediately after coronary bypass surgery were reported. On completion of the revascularization, all patients could not be weaned from cardiopulmonary bypass. The flow velocity waveforms of the arterial grafts measured by pulsed Doppler velocimeter showed only small systolic component without diastolic flow and the palpation revealed profound spasm partially in the arterial conduits. Although all patients could be weaned from cardiopulmonary bypass only after insertion of a saphenous vein graft, two of them died on the next day. In all patients, free flow measured prior bypass was considered to be sufficient and a technically satisfactory anastomosis was felt to be performed. If a profound hemodynamic instability as a result of intractable spasm of arterial conduit occurred after completion of coronary bypass surgery, an additional saphenous vein graft should be placed before discontinuation of cardiopulmonary bypass.


[A new balloon electrode for intraoperative endocardial mapping]. To enhance the utility of epicardial mapping in the intraoperative determination of the location of the arrhythmic source, we developed a new balloon electrode covered with Presnet-tubular dressing material including 46 snap electrode recording sites. The bipolar recording sites, 1.0 mm in diameter and spaced at intervals of 1.5 mm, are constructed of gold and directly attached steel wire. This new balloon electrode was effective intraoperative determination of the lesion in 2 patients one with Wolff-Parkinson-White syndrome and the other with ventricular tachycardia.


[Transatrial approach to provide exposure of the left atrium]. Surgical exposure of the left atrial structures including the mitral valve apparatus is occasionally problematic, when the left atrium is small or noncompliant in the presence of previously implanted aortic prosthesis. We operated eleven cases with an incision that is a modification of a maneuver proposed by Dubost and colleagues, and all but one provide an excellent exposure of the left atrium and mitral valve apparatus. In one case of combined valvular disease complicated by chronic pericarditis, operative view was not satisfactory. The preserves equine pericardial patch was utilized to close the incision in 5 cases. No serious arrhythmias as atrioventricular conduction block was experienced. With this maneuver, the application is recommended to provide excellent exposure into the left atrium and mitral valve apparatus.


[An experience of surgical treatment for catamenial pneumothorax with diaphragmatic and pulmonary endometriosis]. A case of catamenial pneumothorax with diaphragmatic and pulmonary endometriosis is presented. A 43-year-old, married woman had three times of recurrent right pneumothorax during the period from January to July on 1990. Each episode was apparently related to the onset of the menstruation suggesting catamenial pneumothorax. Right thoracotomy revealed a perforation of the diaphragm and five black spots on the visceral pleura. Involved portion both diaphragm and lung were excised. Microscopic examination of the excised specimens showed endometrial stroma in the diaphragm and subpleural layer of the lung. Although it has been postulated that intrathoracic endometriosis is a possible cause of the pneumothorax, very few cases have been reported in which pulmonary or pleural endometriosis was demonstrated histologically. Surgical and pathologic findings are documented discussing the relationship of both conditions in this report.


[Bochdalek diaphragmatic hernia in the elderly: a case report]. We successfully treated surgically an elderly patient, a 80-year-old woman, with Bochdalek diaphragmatic hernia. She had intermittent episodes of intestinal obstruction. A preoperative chest roentgenograph revealed a loop of gas-filled bowel in the left chest and elevation of the left diaphragm. CT scanning of the thorax revealed the bowels filled with gastrografin in the left thoracic cavity. She was treated surgically, through transabdominal and then transthoracic approaches. The herniated large bowel was reduced from the thoracic cavity and the hernial sac was excised. The posterolateral defect of the diaphragm, 5 x 6 cm in size was closed with interrupted mattress sutures. The patient has been well without any symptoms 6 months after the surgery. Bochdalek diaphragmatic hernia is the most common problem in infants with risky respiratory distress and high mortality, however it is preferable to carry out surgical treatment for adult patients because of good postoperative results. As a surgical route in the management of Bochdalek diaphragmatic hernia in adults, a transthoracic approach is preferable since it provides easy separation and reduction of herniated bowels from the thoracic cavity and easy closure of the diaphragmatic defect, furthermore there are no other serious gastrointestinal complications which are required specific repair.


[A case of so-called carcinosarcoma of the lung]. A 65-year-old male was admitted to our institute because of bloody sputum. A tumor in right S6 was detected by X-ray, CT and MRI. Bronchoscopic study showed that the right lower bronchus was occluded by the tumor, in which non-epithelial malignant cells were detected. Therefore right bilobectomy was performed. This tumor was a pedunculated endobronchial type measuring 6 x 4 x 3cm. Histologically, the tumor presented carcinomatous (squamous cell carcinoma and adenocarcinoma) and sarcomatous elements. Immunohistologically, many malignant cells were positively stained by vimentin and muscle-actin, which suggested differentiation from muscle components.


[A case of paraesophageal bronchogenic cyst with esophageal communication]. A case of mediastinal bronchogenic cyst communicating with the esophagus was reported. Previously, only 2 cases have been reported in the available literature. A 34-year-old man was admitted with a cystic mass communicating with the esophagus which was demonstrated on a barium study. Operation was performed with a suspect of esophageal diverticulum or congenital cyst with esophageal communication. At right thoracotomy, a mass measuring 6.0 x 5.0 cm with a well-defined patent communication to the esophagus was resected. It was a monolocular cyst containing a small amount of viscous mucus. Histologically, the cyst lined by a ciliated columnar epithelium, and it was diagnosed as a bronchogenic cyst because of the presence of the mucous glands, smooth muscle tissue and cartilage. This is the first case report of mediastinal bronchogenic cyst with esophageal communication appeared in the Japanese literature.


[A case report of solitary bone cyst of rib detected from pathological fracture]. A case of solitary bone cyst of rib was reported. The patient was 28-year-old man who was admitted to our hospital complaining of chest pain caused by pathological fracture of the left 10th rib. Chest x-ray film revealed a solitary cystic lesion of the 10th rib. The tumor was removed by extrapleural rib partial resection and the histological examination confirmed the diagnosis of solitary bone cyst.


[A case of a right subclavian arterial aneurysm associated with the aortic arch anomaly in childhood]. Aneurysms in the subclavian arteries are extremely rare in childhood. A 7-year-old boy was admitted with hoarseness and abnormal shadow in the chest film. Radiologic studies demonstrated a right subclavian arterial aneurysm associated with the aortic arch anomaly. Proximal and distal ligation of the subclavian arterial aneurysm and reconstruction of blood flow by an aorto-subclavian bypass using a 5 mm GORE-TEX prosthetic graft were performed through a standard median sternotomy incision with extension to the right supraclavicular space. The postoperative course was uneventful and he was discharged in 3 weeks. The literature of the subclavian arterial aneurysm was briefly reviewed.


[Surgical management of desmoid tumors of the chest wall: a case report and review of literature]. A 45-year-old man without special predispositions showed a chest wall tumor with tenderness. A needle biopsy revealed a desmoid tumor which had invaded the muscles. A wide resection from the second to fifth rib was carried out and 4 years have passed without recurrence. A resection, at least 3 cm away from the lesion, is necessary for desmoid tumors which seem to have clear margins.


[Closure of ventricular septal defect of interrupted aortic arch with left ventricular outflow obstruction]. Leftward shift of the infundibular septum (IS) in interrupted aortic arch (IAA) with ventricular septal defect (VSD) often develops significant left ventricular outflow obstruction (LVOTO). Seven-day-old boy with 2.6 kg body weight underwent the two-stage operation for this anomaly. The aortic arch was interrupted between the left common carotid and the left subclavian artery. At the first stage, a 5 mm GORE-TEX graft was used to connect the interrupted arch, and pulmonary artery banding was performed. In closure of VSD at the second stage, IS was penetrated by stitches for the VSD patch to left ventricular outflow tract. IS with leftward shift could be pulled toward right ventricular side with patch fixation and LVOTO was prevented by this method.


[A case of ischemic mitral regurgitation treated by mitral annuloplasty (MAP) and coronary artery bypass grafting (CABG)]. A 79-year-old woman with a previous history of myocardial infarction, suffered acute myocardial infarction again. A coronary angiogram revealed triple vessel disease, and a left ventriculogram showed severe mitral regurgitation. The patient fell into cardiogenic shock after cardiac catheterization, and IABP was started. She underwent MAP and saphenous vein bypass grafting to the left anterior descending coronary artery and left circumflex coronary artery. Although the postoperative course was complicated by acute renal failure and respiratory dysfunction, the patient recovered from the operation and was discharged on the 137th postoperative day. Since the operative mortality of conventional valve replacement combined with CABG in ischemic mitral regurgitation has been high, we preferred MAP for this case.


[A case of myocardial infarction with normal coronary arteriogram in combined valvular disease]. In this report, we presented a case of myocardial infarction with angiographically normal coronary artery, possibly caused by coronary thromboembolism due to combined mitral and aortic valvular lesions. Embolism arising from the mitral valve or left atrium might preferentially enter the coronary arteries because of the turbulence produced by the associated aortic valve lesion. Her impaired cardiac function, due to valvular lesions and myocardial infarction, has improved after double valve replacement.


[A case of simultaneous operation of coronary artery bypass and ascending aorta to bifemoral bypass for ischemic heart disease combined with bilateral leg ischemia]. A 58-year-old man was admitted to our hospital because of angina pectoris with severe intermittent claudication. Angiography showed triple-vessel disease of the coronary artery and complete obstruction of the bilateral common iliac arteries from their origins. Both femoral arteries were patent by collateral supplies. Combined revascularization of coronary and femoral arteries was performed. Coronary arteries were bypassed with in situ left internal thoracic artery, gastroepiploic artery and saphenous vein graft. Bilateral femoral arteries were bypassed with externally supported Dacron graft from ascending aorta through the preperitoneal space. The patient recovered well and postoperative angiography revealed all bypass grafts patent.


[A case report of replacement of the extracardiac conduit for tetralogy of Fallot: reconstruction with autogenous tissue around the conduit]. Replacement of the valved extracardiac conduit with autogenous tissue was performed on a 13-year-old female. The procedure was based on that reported by Danielson in 1987. She underwent the first operation for tetralogy of Fallot with pulmonary atresia using a valved extracardiac conduit (#16 mm Björk-Shiley valve) 8 years ago. Recently, she complained exertional dyspnea and chest pain. Reoperation was scheduled because of bleeding tendency, somatic growth of the patient, and severe distal anastomotic stenosis of the conduit by right ventriculogram. At operation, the valved conduit was removed under cardiopulmonary bypass, and autogenous connective tissue around the conduit was preserved as the posterior wall of the new conduit. An onlay patch (pericardial monocusp patch) was sutured to form the roof of the new tract. Postoperative catheterization showed no residual stenosis or pressure gradient between the right ventricle and the pulmonary artery. This technique is useful as the replacement of extracardiac conduit because of its simplicity, no necessity of postoperative anti-coagulant therapy, and possibility to make a generous-sized new outflow tract.


[Relationship between extent of bone metastases and effect of endocrine therapy evaluated with bone scintigraphy in stage D2 prostatic cancer]. Bone scintigraphy of metastatic lesion on 128 patients with prostatic cancer were classified according to the proposal by Soloway et al (Cancer, 61; 195-202, 1988). Since all patients received endocrine therapy, the response to therapy and survival were examined in relation to bone lesion. In extent of disease (EOD) 1, main metastatic lesions were located in the pelvis, lumbar spine, and with increasing number of EOD, metastases in the upper spine, rib, and skull appeared. Longer survival were noticed in EOD 1, followed by EOD 2 and EOD 3, and EOD 4 revealed the shortest survival. The survival of EOD 2 was similar to thus of EOD 3. However, when grades of tumor were considered, moderately differentiated cancer showed longer survival than poorly differentiated cancer in EOD 2 and EOD 3. The response as assessed by bone scintigraphy following 6-month therapy was well correlated with the number of EOD. When individual items for evaluation of response were examined, the results of local response of the prostate and values of PAP showed good correlation with survivals, however, that of bone lesions with bone scintigraphy failed to show such a correlation with prognosis. Therefore, it is concluded that the therapeutic evaluation of bone lesions with bone scintigraphy is difficult to interpret 6 months after initiation of treatment.


[Experimental and clinical study of intravesical BCG therapy. The role in the prevention of recurrence of superficial bladder tumor]. The effects of Tokyo strain bacillus Calmette-Guerin (BCG), which is available in Japan for treatment, were studied in an experimental murine bladder tumor (MBT-2) model prior to clinical study for treatment of superficial bladder tumor. The results were as follows: Tokyo-strain BCG is more effective on the local injection around the tumor than on systemic administration. BCG therapy is more effective at earlier time of small tumor burden. BCG also has a prophylactic effect against the tumor growth. Clinical trial of intravesical instillation of BCG was performed on patients with superficial bladder tumor for prophylaxis of tumor recurrence after transurethral resection of the tumor. In patients of 145 primary cases, the tumor recurrence rate after BCG therapy was estimated, comparing with that of historical control in our department. The historical control groups are consisted of 50 patients who were treated by some intravesical chemotherapy after TUR and 38 patients, who were treated by TUR alone. The tumor recurrence rate in BCG group was significantly lower than that in both control groups. No relationship between PPD responsiveness and the tumor recurrence rate could be detected. On the other hand, in the patients of 36 recurrent cases, evaluation was performed by the tumor recurrence rate comparing with those during the two years prior to BCG therapy. The results demonstrated a statistically significant decrease in recurrent tumor following BCG therapy. Although most of the adverse effects in this study such as bladder irritability, flu-like syndrome and macroscopic hematuria were minimal and tolerable. There were no significant side effects or serious complications attributable to BCG therapy in this series. These results indicate that intravesical Tokyo strain BCG instillation provide prophylactic effects against recurrence of superficial bladder cancer.


[Implantation of self-contained non-inflatable penile prosthesis in patients with organic impotence]. Between April, 1988 and August, 1990, the OmniPhase penile prosthesis, a non-inflatable self-contained penile prosthesis, was implanted in 34 patients, aged from 37 years to 79 years, averaging 54.2 years. The etiologies of the impotence were radical surgery for bladder cancer or rectal cancer in 17 patients, diabetes mellitus in 7 patients, vascular abnormality in 3 patients, spinal injury in 2 patients, penile disorders in 2 patients and others in 3 patients. Penile prosthesis was implanted by subcoronal incision under spinal or general anesthesia. Clinical results were evaluated 12 weeks after surgery. Thirty-two patients (94.1%) could have intercourse postoperatively. Eighteen patients (52.9%) were completely satisfied and 14 patients (41.2%) were satisfied, whereas one patient (2.9%) had no improvement and another patient (2.9%) deteriorated. There was no serious complication. However, prosthesis was explanted because of skin erosion in one patient. Pain, which lasted for more than 10 days, was seen in 3 patients (8.8%), penile edema in 11 patients (32.4%), and acute epididymitis in one patient. The obtained results showed that implantation of OmniPhase penile prosthesis is a safe and useful procedure for treatment of organic impotence.


[An electromyographic study of the feline urethral rhabdosphincter in the normal state and after sacral rhizotomy. Part 1. Characteristics of action potentials of the rhabdosphincter and micturition and continence reflexes]. To investigate functional property of the urethral rhabdosphincter, the male feline rhabdosphincter was examined by means of electromyography using fine electrodes. Experiments were performed on 28 normal (N group) and 13 rhizotomized cats under chloralose anesthesia, the latter being further divided into two groups: 4 cats of 1-3 weeks (SR group) and 9 cats of 10-24 weeks (LR group) after complete sacral rhizotomy. Frequency of action potentials of the rhabdosphincter at empty bladder in N, SR and LR group was 1.8 +/- 0.3, 16.4 +/- 2.0, 8.9 +/- 1.4 spikes/sec, respectively, with significant difference between N and the other two groups and also between SR and LR group. Spontaneous discharges of the rhabdosphincter in SR and LR group were not abolished after neuromuscular junction blockade. The duration of action potentials of the rhabdosphincter in N, SR and LR group was 3.34 +/- 0.08, 1.71 +/- 0.07, 1.72 +/- 0.04 ms, respectively, with significant difference between N and the other two groups. Micturition reflex was negative in both SR and LR groups, but in 7 cats of LR group with dorsal roots preserved, activities of the rhabdosphincter increased reflexly by vesicourethral or urethrourethral contraction reflex, while they did not in 2 cats of LR group without preservation of dorsal roots and in SR group. Bulbocavernosus reflex was negative in both SR and LR groups.(ABSTRACT TRUNCATED AT 250 WORDS)


[An electromyographic study of the feline urethral rhabdosphincter in the normal state and after sacral rhizotomy. Part 2. Responses of the rhabdosphincter to hypogastric nerve stimulation]. To investigate functional aspect of sympathetic innervation of the urethral rhabdosphincter, responses of the male feline rhabdosphincter to hypogastric nerve (HGN) stimulation were examined by means of electromyography using fine electrodes. Experiments were performed on 28 normal (N group) and 13 rhizotomized cats under chloralose anesthesia, the latter being further divided into two groups: 4 cats of 1-3 weeks (SR group) and 9 cats of 10-24 weeks (LR groups) after complete sacral rhizotomy. HGN stimulation (1 Hz, 0.3 ms pulse duration, 2-30 V) elicited responses of the rhabdosphincter in N and LR groups. In N group, HGN stimulation still elicited responses of the rhabdosphincter even after pudendal nerve was transected in advance, indicating that these evoked potentials were independent of somatic nerve inflow. The threshold stimuli and latencies of the evoked responses in N group (3.0 +/- 0.2 V, 81.7 +/- 5.7 ms, respectively) were not significantly different from those in LR group (2.9 +/- 0.3 V, 71.5 +/- 10.5 ms), but the amplitudes of the evoked responses were significantly larger in LR group than in N group (110 +/- 12 vs 18 +/- 2 microV, p less than 0.001). These evoked responses of the rhabdosphincter were resistive to prazosin (0.2 mg/kg) and atropine (0.5 mg/kg), but were abolished by hexamethonium (2 mg/min, 10-25 mg) and pancuronium (0.1-0.3 mg/kg) in both groups. In N group, repetitive stimulation (10-20 Hz) of HGN increased activities of the rhabdosphincter when the bladder was empty, but not when the bladder was full enough to trigger the vesicourethral relaxation reflex.(ABSTRACT TRUNCATED AT 250 WORDS)


[Vesical ultrasonography and internal examination of female patients with urethral syndrome]. Transabdominal ultrasonography of the bladder and internal examination were performed in 80 female patients without pyuria. They were divided into 3 groups: urethral syndrome with trigonitis (49 cases), asymptomatic trigonitis (16 cases) and normal bladder (15 cases) by cystoscopy. Ultrasonography of trigonitis with or without symptoms showed focal dilation of the submucosal low echo zone and mucosal irregularity around the bladder neck. On the sagittal view, the thicknesses from the surface of mucosa to that of muscle layer within 2 cm from the bladder neck were 4 +/- 1 mm (mean +/- standard deviation) in the group with urethral syndrome and in that with asymptomatic trigonitis, and 3 +/- 1 mm in the normal bladder group. Mucosa of the trigonitis with or without symptom is patients with significantly thicker than that of those with normal bladder (p less than 0.01). On internal examination, tenderness at the upper frontal wall of the vagina was present in 10 of 11 cases (91%) with urethral syndrome, in 2 of 8 cases (25%) with asymptomatic trigonitis and in one of 9 cases (11%) with normal bladder. There was a significant difference (p less than 0.005) between the degree of inflammation and the number of cases with tenderness at the frontal wall of the vagina. From these results, transabdominal ultrasonographic measurement of mucosal thickness around the bladder neck and internal examination for tenderness at the frontal wall of vagina are thought to be useful methods for diagnosis and follow-up of urethral syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)


[The pathogenesis of hypercalciuria from the aspect of the response to human parathyroid hormone in Ca containing stone formers]. In order to clarify the pathogenesis of hypercalciuria, the response to extrinsic human parathyroid hormone (h-PTH) was studied the 21 patients with calcium containing urinary stone(s) and 5 normal controls (NO). The stone patients were classified into 3 groups from the result of the oral calcium loading test, i.e. Non-hypercalciura (NH, n = 8) and absorptive hypercalciuria (AH, n = 8) and renal hypercalciuria (RH, n = 5). Only in the AH group, urinary excretion of calcium (u-Ca) was strongly correlated to that of sodium (u-Na) in pre-load of h-PTH, and both increments were also correlated in post-load of h-PTH. As of this fact the increase in Na excretion seems to be responsible for a cause of hypercalciuria in the AH group. There was a significant correlation between the value of %TRP in pre-load of h-PTH and the rate of urinary phosphorus (P) increment between pre-load and post-load of h-PTH in the NO and NH groups. However, this relationship was not found in the AH and RH groups. These findings indicate that there is response disorder of P to h-PTH. In addition, serum P was low, plasma 1,25 (OH)2D was high, N-c-AMP was low in the AH group, whereas both serum P and %TRP were low in the RH group in pre-load of h-PTH. These findings are compatible with the primary renal P leak.(ABSTRACT TRUNCATED AT 250 WORDS)


[Studies on the production of endogenous cytokines in patients with renal cell carcinoma]. This study was undertaken to determine the production of tumor necrosis factor (TNF) and interferon-gamma (IFN-gamma) by biological response modifier (BRM) in patients with renal cell carcinoma (RCC). Peripheral blood mononuclear cells (PBMC), which were donated from thirteen patients with RCC and five healthy controls, were cultured with streptococcal preparation, OK432, and/or macrophage-colony stimulating factor (M-CSF), and the TNF levels and IFN-gamma levels in the supernatant were evaluated. TNF activities were assayed by cytotoxicity to L929 cells and IFN-gamma activities were measured by inhibition of the cytopathic effects of sindbis virus on FL cells. The highest levels of TNF in the supernatant were 235.4 +/- 96.0 U/ml/1 x 10(4) cells in patients with renal cell carcinoma and 251.6 +/- 71.8 U/ml/1 x 10(4) cells in healthy controls, which were noted at 12 hours of incubation with the concentration of OK432 adjusted to 0.05 KE/ml. There was no statistically significant difference between the TNF activities induced by in vitro culture of PBMC obtained from patients with renal cell carcinoma and those from healthy controls. The production of TNF by in vitro culture of PBMC with OK432 of 0.05 KE/ml was augmented by adding 100 U/ml M-CSF especially at 48 and 72 hours of incubation, whereas M-CSF alone did not stimulated TNF production. The medium levels of IFN-gamma in six different cultures of PBMC with 0.05 KE/ml OK432 at 12, 24 and 48 hours of incubation were 1.15 +/- 0.34 U/ml/l x 10(4) cells, 2.23 +/- 0.93 U/ml/l x 10(4) cells, and 7.83 +/- 4.00 U/ml/l x 10(4) cells, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)


[Clinical analysis of multiple primary cancers associated with bladder cancer]. Among 321 bladder cancer cases from 1975 to 1989, 43 cases (13.4%) were found to have multiple primary cancers (MPC) and 278 cases without MPC (86.6%). These two groups were compared with regard to their clinical and pathological features. Mean age of patients when the bladder cancer was diagnosed was 68.9 +/- 8.9 in MPC cases and 65.7 +/- 12.3 (mean +/- S.D.) in cases without MPC. The male to female ratio was 3.8 to 1 and 2.6 to 1, respectively. The common sites of MPC were the lung, stomach and rectum, all of them being the organs often involved with cancer. Prostatic cancers in eight of 12 MPC cases were incidentally found in total cystectomy specimens. The sites of the synchronous and metachronous MPC involving lung, stomach and rectum cancers showed relatively even distribution. In males, the most common synchronous MPC included prostatic cancer, but in females, the diagnosis of uterine cancer tended to be made prior to the diagnosis of bladder cancer. In two cases, there was a strong suspicion that the therapy for the first cancer contributed to the occurrence of the second cancer. In the present study, no significant differences were noted with regard to clinicopathological characteristics of bladder cancer between the group with MPC and that without MPC. The five years survival rates from the beginning of bladder cancer treatment were 48.8% and 64.9%, respectively, indicating that the prognosis of the MPC cases was significantly worse (p less than 0.05) than that of cases without MPC. The most common cause of death in MPC cases was due to cancers other than bladder (36%).(ABSTRACT TRUNCATED AT 250 WORDS)


[Study of factors requiring more than two ESWL treatments]. Nine hundred and fifty cases with renal and ureteral stones were treated by extracorporeal shock wave lithotripsy (ESWL) with Siements Lithostar unit from September, 1988 to October, 1990 at Kinki University Hospital. ESWL treatments were performed twice or more on 110 cases (DIFFICULTY GROUP). Ninety-seven cases who were cured by only one ESWL treatment were selected randomly as the control group. The two groups were retrospectively compared to study the factors requiring more than two times of ESWL treatments. There was a significant difference in the time of spontaneous stone discharge before ESWL treatment, the degree of hydronephrosis and the incidence of staghorn calculi as well as middle-lower ureteral calculi between the two groups. There was not a significant difference but a tendency to a longer period of stone existing at the same position and a higher percentage of past history of percutaneous nephrolithotropsy (PNL) in DIFFICULTY GROUP. Because ESWL monotherapy is considered to have limitations, auxiliary procedures or other treatments such as PNL and transurethral lithotripsy are recommended for patients in who in the stones were poorly disintegrated by the first ESWL treatment.


[Utricular papillomatosis. A case report]. A case of utricular papillomatosis is reported herein. A 50-year-old male patient consulted our hospital with a complaint of asymptomatic macrohematuria. Endoscopic examination revealed papillomatous tumor tightly growing within the utricle. Transurethral resection of the tumor was performed. Histopathologically, the tumor consisted of numerous villous structures with slender fibrovascular cores and overlying cuboidal cells in 2 to 3 cell layers. Invasive growth or cellular atypia could not be found. Utricular papillomatosis is rare, and only one similar case was reported to my knowledge in the English literature for the last five years. Such rarity and peculiar clinicopathological characteristics prompted us to report this case.


[A case of penile necrosis in a patient with diabetes mellitus]. The patient was a 63-year-old male who was with having diabetes mellitus since 1967. Hemodialysis was carried out from June 1983 for diabetic nephropathy. Neuropathy and retinopathy were already present at that time. He complained pain in penile glans from the middle of June 1990. Three month later, partial penectomy was performed because of the development of black-mummy-shaped necrosis on the whole glans. Histopathological examination widely revealed luminal obstruction and formation of thrombus due mainly to vascular lesions as a result of diabetes mellitus. As far as we know, case reports of diabetes mellitus complicated with penile necrosis are extremely rare, and this present case seems to be the 2nd one in Japan and the 5th one in the world, including those reported previously in the West.


Use of generic software programs in management of patient records and clinical research. As personal computers become more cost-effective and user-friendly, they are bound to play an increasing role in the practice of medicine. This article is a description of how a commercially available database system adapted for medical record keeping has greatly facilitated the storage and retrieval of information. The designation of a data file for storage of patient records through the use of the systems menus, data entry, and conduct of searches for particular bits of data are described. Unique features such as custom-tailored computer reminders and project-specific programming are recommended as ways to improve the effectiveness of patient care and clinical research. When a single database system is used, the cost in terms of time, money and expertise is dramatically decreased, allowing the physician to optimize all aspects of the practice of medicine of exploiting computer technology with minimal to no knowledge of computer languages and/or programming.


[Analysis of surgical treatment of 220 patients with acquired left aortic valve defect]. The results of surgical treatment of 220 patients with acquired aortic valve malformations using two different methods were evaluated 5 years postoperatively. In 130 patients the aortic valve was replaced with "fresh" allograft and in the remaining 90 with prosthetic valve. In the group with allograft compared to patients after prosthetic valve implantation we have found: lower early mortality of 3% (p less than or equal to 0.01) (vs. 15.5%) higher probability of 5 years survival of 91.5% (p less than or equal to 0.001) (vs. 74.6%) low incidence of thromboembolic events of 1.7% (p less than or equal to 0.05) (vs. 8.8%) Allografts appear to be especially advisable and well tolerated in patients with active endocarditis. No statistically significant difference was found between both groups in relation to: probability of late death (5 years postoperatively), frequency of bacterial endocarditis during the postoperative course, frequency of valve failure. Slow increase of degenerative alterations during the succeeding postoperative years was distinctive for allografts, and the dysfunction of the implants appeared from the third postoperative year with the risk of 1.5% to 0.8% annually. Dysfunction of the prosthetic valve (perivalvular leak, thrombosis) was observed with the frequency of 5% to 1.3% annually. It developed quickly and usually was the cause of an urgent operation. The study demonstrates the advantages of allografts and their superiority over the prosthetic valves. Allograft implantation produces better life comfort for patients and diminishes or excludes the risk of thromboembolic complications.


[Platelet activation in young men after myocardial infarction: its relation to metabolic coronary risk factors]. Selected parameters of platelet function as well as their relationship with metabolic coronary risk factors are studied in a group of 40 young survivors (aged 30-40 years) of myocardial infarction, now presenting stable coronary disease. Nineteen healthy men, of approximately similar age-span, constituted the control group. The following parameters were determined: platelet survival half-time (via non-isotope method), intraplatelet activity of cyclooxygenase and lipoxygenase pathway of arachidonic acid (by measurements of malondialdehyde concentration before and after incubation with acetylsalicylic acid acid) and 125-I-fibrinogen binding to platelets. Moreover, the plasmatic concentration of total cholesterol, HDL-cholesterol, triglycerides, phospholipids, Apo A and B, total beta lipoproteins, glucose, uric acid as well as percentages of beta, prebeta, alpha lipoproteins and glycosylated hemoglobin were also studied. Platelet survival half-time in patients was significantly shortened (3.64 +/- 1.37 days) when compared with the control group (4.97 +/- 1.7 days). A higher intraplatelet activity of lipoxygenase pathway (2.02 +/- 0.62 and 1.49 +/- 0.54 nmol MDA/10(9) platelets, respectively) was also found. However, activity of cyclooxygenase pathway of arachidonic acid and 125-I-fibrinogen binding to platelets remained unchanged. Shortened platelet survival half-time and the hyperactivity of intraplatelet lipoxygenase pathway correlated with a reduced plasmatic concentration of HDL-cholesterol (r = 0.323, p less than 0.05 and r = -0.451, p less than 0.05, respectively). The remaining parameters of platelet function were not statistically related to metabolic risk factors. The values of platelet function indicators in subgroups of patients divided according to family history of coronary heart disease, oral glucose load test result, and submaximal exercise test result did not differ significantly.(ABSTRACT TRUNCATED AT 250 WORDS)


[Transesophageal echocardiography for evaluation of the left coronary artery]. The aim of the study was to evaluate the clinical usefulness of transesophageal echocardiography in the imaging of the left main coronary artery. The group tested--consisted of 26 patients with angina pectoris and 8 controls. The identification and adequate images of the left main coronary artery were obtained in 33 of 34 (97%) patients. In 5 of 26 patients with angina pectoris we observed stenosis of the left main coronary artery. The diameter stenosis of the lesion was judged to be greater than 50%. In addition, we tried to asses Doppler-derived parameters of blood flow. We have demonstrated that the pulsed Doppler study of the left main coronary artery is feasible. Comparison of patients with angina pectoris with the control group showed lower systolic flow velocities (35 +/- 10 cm/s vs. 55 +/- 15 cm/s) and slightly higher diastolic flow velocities (75 +/- 20 cm/s vs. 70 +/- 10 cm/s). This transesophageal examination holds promise for detecting pathologic vascular status. Although the sensitivity and specificity of this findings cannot be determined by our study, we believe that transesophageal echocardiography can provide a reference for the evaluation of patients with known or suspected ischemic heart disease. Further studies including larger groups of patients are recommended.


[Sulfhydryl group levels and the succinate dehydrogenase activity in peripheral blood lymphocytes in patients with cancer of the stomach]. In patients with gastric cancer, decrease in the level of SH-groups and activity of succinate dehydrogenase (SDH) of the peripheric blood lymphocytes which is indicative of the disturbance in oxidation-reduction processes was revealed. Degree of decrease in the indices depended on stage of the disease and severity of the course of a pathological process. SDH lymphocytic activity is the more sensitive test than content of SH-groups. The indices mentioned are used as an informative test for evaluation of the effectiveness of treatment.


[Use of laser irradiation in the treatment of lung tumors]. Endobronchial laser therapy was employed in the complex of treatment of 90 patients with tumorous pulmonary diseases. An LG-75 helium-neon laser with the output power of 20 mW was used. A pronounced therapeutic effect was noted in 75 patients. Preoperative recanalization of the bronchi was performed in 25 patients. The YAG-laser based plant "Raduga-1" was used as a source of radiation. No complications after the operation were noted. An antineoplastic effect of the high-energy laser radiation was noted.


[Radical surgical treatment of patients with cancer of the stomach]. The results of surgical treatment of 158 patients with gastric cancer, using the original techniques for the esophago-gastric and esophago-intestinal anastomoses formation, have been summarized. Gastrectomy was performed in 65.2%, subtotal proximal reaction of the stomach--in 8.9%, subtotal distal resection--in 25.9% of the patients. The postoperative lethality was 3.2%. At late complex examination, I stage reflux esophagitis after gastrectomy was observed in 3 (3.4%) patients, after proximal gastric resection--in 1 (8.3%). After the operation, 32 (20.3%) patients are alive for 5 and more years.


[Diagnosis of gastric cancer and the quality of the examination of non-hospitalized patients in the polyclinic of an oncological hospital]. The methods for diagnosis of gastric cancer in 711 patients who were not hospitalized because of age and tumor dissemination have been analysed. The roentgenologic, endoscopic, morphologic and radionuclide methods of investigation in these patients were used less frequently than in patients treated in a hospital. The examination, being not thorough, didn't permit to establish the correct diagnosis and choose an adequate method for treatment.


[Surgical tactics in the treatment of villous adenoma of the stomach and intestine]. The results of endoscopic and surgical treatment of 183 patients with villous and tubular-villous adenoma of different location are presented. Adenoma of the stomach and duodenum are subject to malignization more often than colonic adenomas. Endoscopic polypectomy is a method of choice in treatment of benign adenoma with a diameter no more than 4 cm. Resection of the involved areas of the stomach and intestine is indicated in detection of a malignant mass and a large benign tumor causing considerable loss of fluid from the organism.


[Study of immunologic reactivity of patients with cancer of the stomach based on the data of the adhesive capacity of lymphocytes]. In patients with gastric cancer, the increase in adhesive lymphocytic capacity, as compared to a control, was revealed. It is indicative of the reduction in production of lymphokines, causing inhibition of adhesion. The highest value of the index was noted in IV stage gastric cancer. The results of study of the adhesive properties of the peripheric blood lymphocytes allow to judge about the state of cellular immunity, and in the complex with the other clinico-laboratory findings, are of a prognostic value.


[Multiple primary malignant neoplasms of the large intestine]. Of the 3182 patients with malignant tumors of the large intestine, in 140 (4.4%), the primary multiple malignant neoplasms were revealed: in 59 (42.1%) of them--the synchronous, in 81 (57.9%)--the metachronous ones. Surgical treatment was performed in 137 (97.9%) patients, including the radical treatment--115 (83.9%). The postoperative lethality was 7.3%. 75.3% of the patients are alive for five years, 21.3%--for ten years.


[Combined treatment of recurrent lung cancer]. The combined treatment of 36 patients for a pulmonary cancer recurrence included the performance of preoperative radiotherapy, reoperation and postoperative polychemotherapy. After reoperation, 3 (8.3%) patients died. In 17 of the 28 patients, the treatment was ineffective, all of them died. The mean lifetime was 20.8 mos. Eleven patients are alive for from 2 to 50 mos with no tumor recurrences, or metastases revealed.


[Measuring the depth of location of non-organic neoplasms in the small pelvis]. The objective technique for determination of the depth of location of the lower and upper poles of a non-organic mass in the small pelvic cavity, irrespective of sex and age of a patient, has been developed. The correct determination of a mass location permits to choose an optimal surgical approach, increase the operability rate of the tumors and reduce the incidence of complications.


[Expediency of preventive lymphadenectomy in patients with skin melanoma]. On the basis of the results of treatment of 87 patients with skin melanoma, the expediency of lymphadenectomy performance irrespective of the fact whether the regional lymph nodes were, or were not palpated was substantiated. Performance of this operation permitted 3-fold reduction of lethality.


[Late monitoring for predicting of the outcome of the treatment of gastric cancer]. The results of late monitoring of 114 patients with III stage gastric cancer who survived 10 years and longer after the radical operation performance are presented. Forty patients who developed recurrence and generalization of tumorous process within the first 5 years after the operation entered the control group. All the patients died. The quantitative and qualitative prognostic factors were established. On the basis of the data of blood analysis, a reliable prognostic index has been developed.


[Correction of endogenous poisoning in patients with peritonitis in gastric and intestinal tumors]. Peculiarities of endogenous intoxication in peritonitis in 63 patients with cancer of the stomach and intestine were studied. Three degrees of the intoxication syndrome severity were distinguished: the mild, moderate and severe ones. It is shown that the severity degree of intoxication depends on a phase of peritonitis, stage of tumorous process and state of anti-infective protection of an organism. The steps for surgical detoxication of an organism, depending on severity degree of endogenous intoxication, were defined. Use of a complex of treatment permitted to reduce postoperative lethality of the patients to 33%.


["No-stitch" cataract surgery as a routine procedure. Technique and experiences]. We present a modified self-sealing wound construction with a trapezoidal incision for No-Stitch-Technique. Due to the form of the incision and the elasticity of the sclera the 6 mm incision can be extended to about 8 mm which allows an implantation of conventional PMMA-IOL without excessive scleral stretching. Since the beginning of 1991 this technique has been used routinely in our clinic with over 1500 operations. The No-Stitch-Technique has, in comparison to the sutured corneo scleral incision, two main advantages: the wound closure has a five fold higher stability and an induced astigmatism of less than 1.0 dpt. Other postoperative complications, such as wound dehiscence, iris prolapse and hypotony syndrome, were significantly eliminated.


[Effect of intraocular administration of acetylcholine and carbachol on postoperative intraocular pressure after cataract surgery]. In a consecutive series of 90 patients we examined the effect of intracameral acetylcholine and carbachol on intraocular pressure following extracapsular cataract surgery. In all cases phacoemulsification and implantation of a folded polyhema intraocular lens under healon was performed. After evacuation of the viscoelastic substance from the capsular bag behind the inserted lens and wound suturing we instilled 0.5 ml 1% acetylcholine, 0.5 ml 0.01% carbachol or 0.5 ml balanced salt solution respectively into the anterior chamber. Without the influence of antiglaucomatous drugs applanation tonometry was performed 6 and 18 hours postoperatively. When compared with preoperative values intraocular pressure decreased in the carbachol group (-2.8 mm Hg) but increased in the acetylcholine group (+0.6 mm Hg) and control group (+4.7 mm Hg). 18 hours postoperatively the mean change was -3.0 mm Hg in the carbachol group, +0.8 mm Hg in the acetylcholine group and +2.3 mm Hg in the control group. Intraocular pressure exceeding 22 mm Hg at 6 hours was observed in 33% of the control group and 13% of the acetylcholine group but none of the carbachol group. At 18 hours intraocular pressure was still elevated in 13% of the control group, 10% of the acetylcholine group and 3% of the carbachol group. Reviewing our results we conclude that the evacuation of viscoelastic substances from the capsular bag behind the implanted lens reduces the incidence of pressure rises in the early postoperative period. This effect can be enhanced by the use of acetylcholine and, the more potent, carbachol.


[Complications of laser keratomileusis with the excimer laser (193 nm)]. Complications of photorefractive keratectomy (PRK) for myopia correction are presented based on 615 procedures with a follow-up of up to 2 years. Intraoperative complications with experienced surgeons are extremely rare. The used laser system worked without technical failures for the last 18 months. Gross eccentricities of the ablative zone (1.0 mm to 1.5 mm) occurred in two eyes (0.3%). Also, epithelial disorders are very rare. Recurrent erosions did not occur. Increased intraocular pressure due to the postoperative steroid medication (dexamethasone 0.1% or prednisolone 1%) was manifest in about 30% in patients with a baseline myopia of up to -9.0 D. In myopia over -9.0 D the incidence of steroid glaucoma was about 50%. Steroid responders reveal an increased risk of overcorrection. Subepithelial haze is a common symptom after PRK. Scarring interfering with vision correlates with the amount of attempted correction: up to 6.0 D the incidence of scars is about 0.5% and increases to more than 10% in corrections of more than 10 D. Also, undercorrections of more than 1 D depend strongly on the attempted correction. The most severe complication was a noninfectious corneal ulcer in a patient with systemic lupus erythematosus. Therefore, autoimmune and connective-tissue diseases represent an absolute contraindication for PRK. Corrections of more than 6.0 to 7.0 D should be considered as a relative contraindication for PRK at this time.


[Retinal circulation and current blood glucose value in diabetic retinopathy]. In 42 type II diabetic patients with nonproliferative diabetic retinopathy the arm-retina time (ART) and arteriovenous passage time (AVP) were measured by means of videofluorescein angiography. Glycosylated hemoglobin (HbAlc) as a parameter of longterm diabetic control and the blood glucose level were determined. The ART in the diabetics was similar to the ART of normals and the AVP was significantly prolonged. HbAlc level ranged between 5.6 and 12.2% (8.6 +/- 1.7%) and the blood glucose level between 4.5 and 22.9 mmol/l (11.4 +/- 4.5 mmol/l). Significant correlations were found between AVP and blood glucose (r = 0.37) and between AVP and HbAlc (r = 0.49). No correlation was found neither between ART and blood glucose nor between ART and HbAlc. A multiple stepwise regression analysis shows that of both investigated parameters HbAlc is the predicting variable for AVP. These results show that in diabetic patients the retinal blood flow is more influenced by the longterm diabetic control than by the blood glucose level at the time of examination.


[A new surgical procedure in angle block glaucoma]. Authors show the results obtained in 29 eyes of 29 patients with closed angle glaucoma operated with ECCE plus posterior chamber IOL implantation. After a follow up varying from 1 to 35 months (mean = 20.7) all eyes are under good control (25 without therapy, 4 with topical therapy) of I.O.P. Authors report on the "rationale" of their surgical approach: particular anatomo-functional features of the eyes affected by closed angle glaucoma. Pre-op. and post-op. biometrical and gonioscopical findings are described and discussed.


[Study of blood flow velocity in the central retinal artery using pulsed Doppler sonography]. Using the method of pulsed-wave ultrasound-Doppler-Sonography (2 MHz-probe; sample volume 10 mm; variable invading depth by using a so-called "flow-pipe"; transmission range 10 mW/m2), the author demonstrates an objective, reproducible and exact clinical test to examine blood-circulation in central retinal artery. Because of the fact, that the angle of ultrasound is nearly zero-degrees to central retinal artery, accuracy of measurement flow velocity is nearly hundred percent. Method can be applied without problems by using intracranial Doppler-Sonography (ICD). It is less expensive than Duplex-Sonographie for instance.


[Orbital, osseous, meningeal and cerebral findings in oculodermal melanocytosis (nevus of Ota). Clinico-histopathologic correlation in 2 patients]. In two patients suffering from congenital oculodermal melanocytosis (nevus of Ota) orbital, osseous, meningeal, and cerebral manifestations are documented. In a 38-year-old European with a nevus of Ota on the right side an ipsilateral orbital tumor was diagnosed and surgically removed. The histological examination revealed a primary spindle shaped malignant melanoma of the orbit. In addition, many benign melanocytes were found in the optic nerve, in the extraocular muscles, in the orbital fat tissue, and in the dura of the sphenoid. In a 17-year-old Ethiopian with a nevus of Ota of the right side an increase in size of the pigmented process was observed during puberty in the orbital fat tissue, in the extraocular muscles, in the optic nerve, in the periorbital bones, in the temporal muscle, and in the cortex of the frontal brain lobe. A deep excision from the lower eye lid revealed a histologically benign oculo-orbito-dermal melanocytosis. An irradiation was performed because of growth again after segmental excision, however without success. In the ipsilateral eye a secondary open-angle glaucoma was diagnosed. In the nevus of Ota an involvement of the orbit and of the meningo-cerebral tissue must be considered.


[Bilateral colobomatous microphthalmus with orbital giant cysts in incomplete tetrasomy 22]. A case of bilateral microphthalmos with orbital cysts is presented with clinical, echographic, CT and genetical findings. An incomplete trisomy 22 is shown as the likewise cause of the malformation. No further symptoms known to be part of the cat-eye-syndrome could be detected.


[Results of animal experiment study of a new enucleation filling of bio-vitroceramics--Bioverit I and II (bioactive and biocompatible)]. The results with two new enucleation prothesis made of Bioverit are presented. After unilateral enucleation 14 rabbits received bioreactive, 14 rabbits biocompatible and 9 rabbits nylon prostheses. Implantation periods: 1-13 months. The tissue surrounding of the prostheses was studied histologically, the ceramic electron microscopically. Of 28 ceramic prostheses, 26 were adapted very well. Bioverit ist excellently suited as orbital prosthetic material, even half-open implants are possible.


[Reproducibility of the results of two non-contact tonometers. Comparison with the Goldmann applanation tonometer]. Two non-contact tonometers (Keeler "Pulsair" and Reichert NCT II) were compared regarding the reproducibility of their readings mutually and with referring literature about Goldmann applanation tonometry. Differences of maximum 2 mmHg were found using Pulsair tonometer/NCT II in 61%/83% for two subsequent readings, in 73%/89% for subsequent mean values of 3, in 86%/95% for subsequent mean values of 6 and in 97% each for subsequent mean values of 9 readings. The confidence intervals of 90% were +/- 5.87 mmHg/+/- 3.38 mmHg for subsequent readings, +/- 3.75 mmHg/+/- 2.29 mmHg for mean values of 3, +/- 2.63 mmHg/+/- 2.00 mmHg for mean values of 6 and +/- 2.13 mmHg/+/- 1.61 mmHg for mean values of 9 readings, signifying the high scatter of Pulsair measurements; reaching the NCT II's reproducibility, which is comparable to that of the Goldmann readings of an experienced observer, requires mean values of a higher number of Pulsair readings. The discreet pressure lowering effect occurring with repeated NCT II applications could not be observed during Pulsair measurements. Perhaps the Pulsair instrument might be interesting for scientific questions, but it is not recommendable for routine diagnostic.


[Current problems of clinical radiation medicine]. Results, prospects of studying the effects of ionizing radiation on human beings are considered with regard to the outcomes of the Chernobyl catastrophe and the results of a 5-year implementation of the All-Union Programme C-27. Present-day problems and approaches to investigation for the nearest 5-year period are formulated.


[Fibrinolysis, interleukins and coronary atherosclerosis]. The study of the fibrinolytic system and the activity of interleukin 1 and 2 in 75 patients with various cardial manifestations of atherosclerosis (angina of effort, angina decubitus, arrhythmia, symptomatic hypertension) revealed a decrease in the activity of plasminogen--a blood activator--in patients with angina of effort, angina decubitus and cardiac arrhythmias. In those with atherosclerotic hypertension the activatory activity was in the normal limits. A decrease in the activity of interleukin 1 and 2 was noted in all those examined.


[State of hemostasis during naphthalane treatment of patients with obliterating atherosclerosis of the vessels of the lower limbs]. A total of 67 patients with obliterating atherosclerosis of the vessels of low extremities were followed up in the treatment at the Naphthalane health resort. The patients with the disease stages I, IIA and IIB were subjected to sitting and general naphthalane bath therapy. The studied patients were investigated for the values of the blood coagulation and functional abilities of thrombocytes before and after naphthalane treatment. Analysis of the results obtained demonstrated a favourable effect of naphthalane on hemostasis displaying hypocoagulative effect and improving the blood viscosity. The use of naphthalane as a multiprofile factor in the treatment of the aforementioned patients was found to be advisable and could be considered as a pathogenetic method of treatment for those suffering from this disease.


[Prospective course of therapy arresting attacks of atrial fibrillation in patients with preexcitation syndromes]. A comparative study of antiarrhythmic drugs was performed in 81 patients with atrial fibrillation attacks in the presence of preexcitation syndrome. The first intravenous administration of cordarone was effective in 84.06%, disopyramide--in 69%, ajmaline in 44.8, verapamil in 42.1, novocaine amide in 39.4 and ethacizin in 38.5% of the patients. The first oral administration of quinidine and kinilentin arrested 80.4% of arrhythmia attacks, disopyramide 66.7% propranolol and mexitil 37.5 and 33.3%, respectively. Prospective evolution of antiarrhythmic therapy manifested with decreased therapeutic efficacy of the drugs from 55.7 to 26.2% in the whole group during the period of 1-5 years.


[Possible use of glucocorticoids in the diagnosis of lung lesions and anemia in autoimmune diseases]. The author described a new pattern of the diagnosis of autoimmune processes in the lungs based on the results of a short-term pharmacological load with glucocorticoids (prednisolone, 30 mg per day for 7-10 days) and the successive evaluation of the X-ray picture time-course in the lungs in the frontal roentgenographic view before and after the load. He accounted for the alteration in the number and size of infiltrations and foci as well as the contents of the fluid in the pleura and interlobular fissures. The usage of the load proposed made it possible to reduce the terms and increase the preciseness of the diagnosis of pulmonary autoimmune conditions and to define the practicability of prolongation of the glucocorticoid treatment. Glucocorticoid load technique originated with the author permitted one to establish the autoimmune nature of anemia with regard to its tendency towards the regression and thus to define the policy of its further treatment as well as to differentiate autoimmune anemia in rheumatic patients from the anemia in the patients with paraneoplastic rheumatic syndromes.