With a view to save banked blood and to prevent post-transfusion hepatitis, open heart oper-ations were performed without blood transfusion in 15 patients who had congenital heart diseases using a technique of surface induced profound hypothermia during the period from April 1972 to March 1973. Congenital heart diseases in 15 patients were VSD (9 patients), ASD (2), PS (2), and VSD with PS (2). The average age was 7.5 years, ranging 3 to 18 years.
From the above experiences, following results were obtained:
1) Open heart operations were successfully performed without blood transfusion in all of the 15 patients.
2) Blood loss during the surgery was 13.7ml/kg in average, ranging 7 to 28ml/kg of body weight, which was replaced with twice amount of Saviosol (3% Dextran 40 in RL-8 solution) instead of homologous blood.
3) Red blood cell counts and hematocrit showed approximately 30% decrease in maximum on the third postoperative day, and recovered to preoperative value 4 to 6 weeks after surgery.
4) None of these 15 patients developed post-transfusion hepatitis during follow up period for more than 10 months.
5) Usually, a tendency of hypotension due to low blood viscosity caused by hemodilution was observed after resuscitation, and Isoproterenol deteriorated the hypotensive state.
Isoproterenol should be used carefully during and immediately after resuscitation.
We belive that our experience demonstrates the feasibility of open heart surgery without blood transfusion especially in infants and children using a technique of surface induced profound hypothermia.

抄録全体を表示

Recently, it is widely adopted that auto-immune mechanism are deeply concerned with genetic factors of the collagen disease.
Synovectomy and Debride ment are cosidered reasonable way immunologically as the treatment of inflammatory joint in rheumatoid arthritis.
We presented our synovectomy of the knee, wrist and elbow joint and discussed inclusively about indications, operative-techniques, and post-op. treatment and its results. When joints are damaged severely, we perform various kinds of arthroplasties. Prosthetic joints have been improved remarkably and used widely in orthopedic fields. We are using total prosthetic joints of the hip, knee, and finger for the treatment of rheumatoid arthritis. We presented some cases and discussed indications of the prosthesis.
Now, we are trying widen the indication of these prosthesis, using these in ankylosis of the hip and knee joints.
Anyway, surgical treatment of rheumatoid arthritis should be done under the careful observation of general conditions, activity and course of RA.

抄録全体を表示

It has been reported that administration of adrenalin or predonisolone may cause change of peripheral blood corpuscle, mainly, increase and decrease of lymphocytes, and at the same time contraction of the spleen was clinically observed.
The patients with various diseases concerning splenomegaly were given 1 ml of 1, 000 ×adrenalin I.M, and also given 0.5 mg/kg body weight of predonisolone I.V, and the change of blood picture was examined with the lapse of time over 120 minutes after administration. Results obtained are as follows:
1) In comparison of essential hypochromic anemia and hemorrhagic anemia, the former showed larger change of blood picture than the latter.
2) The results obtained after splenectomy in the cases with Banti's disease and idiopathic thrombocytopenic purpura were similar to these in aplastic anemia.
3) In three cases with splenomegaly and decrease of total blood corpuscle, changes of blood picture before splenectomy were smaller in advanced liver cirrhosis, while blood corpuscle after splenectomy were clearly decreased.
From the above results, it can be concluded that the change of peripheral blood corpuscle were influenced by the presence of the spleen, especially by morbid state of the spleen with hyperf unction.

抄録全体を表示

1) On April 1971, a follow-up survey was made of all the schizophrenc patients who were discharged from 12 National Mental Sanatoria during the period of 3 years from January 1, 1965 through December 31, 1967.
2) As the rate of rehospitalization showed a significant correlation to the course after discharging, the prognosis of the patients was discussed mainly on the basis of the rate of rehospitalization.
3) Of the 561 patients who could be traced in the present survey, 260 had not been rehospitalized till the time of survey, 127 had been back home after rehospitalization, 155 had been again called back to the hospital for treatment, 16 were dead and 3 were unknown as to rehospitalization.
4) Of the patients discharged for remission and amelioration excluding those discharged unimproved, 48, 7% were rehospitalized.
This rate of rehospitalization is lower, compared with 53.7% for those of Matsuzawa Hospital reported by Hachiya. As for those hospitalized for the first time, the rate of rehospitalization was 25%, being remarkably lower than 65% reported by Nishizono and 52% reported by Shimazono.
5) Factors which are considered associated with the high rate of rehospitalization include:
(1) The prognosis of the disease at the time of discharge was incurable.
(2) The type of disease at its onset belonged to hehephrenia.
(3) The patients were males.
(4) The patients developed the disease in youth, that is, under 14 years of age.
(5) The course of disease was eventful and the patients were hospitalized time and again.
6) Factors which are not considered associated with the high rate of rehospitalization include:
(1) Period from onset of disease to initial treatment
(2) Treatments during hospital days
(3) Number of years after onset of disease
7) Patients surveyed in order to determine whether there existed a potential for a higher rate of rehospitalization for those treated in a hospital, whether continuously or intermittently, for a prolonged period. The survey revealed that the rate of rehospitalization was remarkably lower for the patients who had stayed in the hospital for a total period of 10 years or more.

抄録全体を表示

Our report concerns a case with apocrine gland carcinoma, which are rarely reported.
The case was 62-years-old male farmer, who had noticed a small subcutaneous node 20 years ago on the right submandibular region. It had been stationary for many years but recently markedly enlarged. The covering skin was not freely movable. There was no ulceration of the overlying skin. He was clinically examined and had no evidence of tumor on the other parts of the body. The tumor was removed and histologically examined. It was a well circumscribed, greyish white and hard mass measuring 5 ×5 ×7 cm. The tumor was composed of numerous large cells growing in sheets and cords and occasionally showed duct-like and alveolar structure. The cytoplasm of these cells was rich, clear and strongly eosinophilic. Nucleus was large, round to oval and located in the central portion of the cells. A prominent nucleolus was seen in the center of the nucleus. The cytoplasm of these cells was PAS positive in a few cells. There was no iron granule in the cytoplasm. At the margin of the alveolar structure, there was seen some myoepithelial like cells. Some hair follicles were involved in the tumor associated with sebaceous glands. There were normal looking eccrine glands around the tumor. The covering skin was thinned but not destructed.
Electronmicroscopic examination of biopsied material:
The tumor cells contained a few secretory granules, tonofilaments, rough surface endoplasmic reticula and a few mitochondria in the cytoplasm. Its nucleus was irregular oval shaped and rich in chromatin at the inner surface of the nuclear membrane. Myoepithelial cells observed on the light microscopy, were not found by electronmicroscope. From these findings, it was easy to determine sweat gland origin but difficult to know whether it is originated from apocrine sweat gland.
The diagnosis of the apocrine carcinoma was made chiefly by light microscope: examination and its long clinical history.

抄録全体を表示

Clinical and pathological findings of four autopsy cases of the advanced doubly-handicapped children were reported.
All of these cases were grossly mentally retarded and crippled due to cerebral palsy (three cases spastic and one case athetotic). Three cases suffered from epilepsy. There are no cases whosee parents intermarried. Laboratory findings revealed no common abnormalities: One case was hypogammaglobulinemic (0.5 mg/dl).
Neuropathological changes observed included granular atrophy of the cerebrum, status mar-moratus of the globus pallidus, focal gliosis and atrophy of the cerebellum. Two cases (case #7 and 8) were due to the pen-natal injury to the brain. One case was thought to be due to the migration anomaly during the development (case #10) and the postnatal injury (case #9).
Combined with six cases we have reported previously, three out of ten cases we examined were due to the developmental anomalies. The post-natal or pen-natal injuries were responsible in three and two cases, respectively.
Since the etiological factors of the doubly (physically and mentally) handicapped children were multiple, a large number of autopsy studies should be accumulated to guide in establishing proper medical care of these children.

抄録全体を表示

Hydrops fetalis is a rare disease which is most commonly associated with morbus haemolyticus neonatorum due to fetalmaternal blood incompatibility of the Rh antigens.
In Japan, during 5 years from 1966 through 1970, there were 37 cases (0.46%) of hydrops fetalis reported among 7, 992 autopsy cases of the fetal and neonatal infants.
We discussed chiefly the causes of hydrops fetalis reported in two of our autopsy cases, in which one showed pathologically similar findings to those of morbus haemolyticus neonatorum without evidence of fetal-maternal blood incompatibility and another showed morbus haemolyticus neonatorum due to blood incompatibility in the Rh (C) factor.
Although the most cases of morbus haemolyticus neonatorum are a consequence of fetal maternal blood incompatibility in the Rh factor, chiefly D antigens, and the ABO factor, it has not been rare to find those, which are due to maternal antibody against C or E antigens of fetal Rh factor in Japan.
Some of the hydrops fetalis are unassociated with morbus haemolyticus neonatorum. Among them, maternal hypoalbuminemia may be one of the most important factor to occurence of hydrops. Notably the high incidence of toxemia in cases of hydrops has been generally recognized as our cases, in which their placenta has revealed microscopically marked syncytial budding and/or necrotic foci fused with fibrinous materials.
Not only major feto maternal disorders as shown Driscoll et al, but also their several abnormal conditions may have some connection with occurence of hydrops, for examples edema, hypoalbuminemia and anemia of mother and immaturity of the fetal organs found in cortical cysts of kidney and adrenal gland and enlargement of adrenal fetal zone in our cases.
We noted several cases of hydrops fetalis in the literatures associated with infantile arterial calcification, with Gaucher disease and with both of these diseases showing feto-maternal blood incompatibility.
It has been well known that hyperplasia of the pancreatic islets with hypersecretion of the insuline has occured in most cases with hemolytic disease and hydrops.
Dr. Furuta, one of the writers of this article, recently presented a case of so-called infantile arterial calcification and said the calcification of the arterial wall is not main pathological findings but same kinds of degeneration occured in the wall which seemed to have connection to polysaccharide element and the case showed also hypertrophic and hydropic islets of the pancreas.
These findings are thought to be a glucometabolic disorder due to excess insulin concentration and there must be present some connection among these diseases.

抄録全体を表示

Although the early diagnosis of acute myocardial infarction (A. M. I.) is very important for acute coronary care, the E. K. G. interpretation may be sometimes difficult because of the pre-existing abnormalities of the E. K. G. such as W. P. W. syndrome, bundle branch block etc. In such cases, the determination of serum enzyme activities plays very important role in the early diagnosis.
Four serum enzyme activities (S-C. P. K., S-G. O. T., S-L. D. H., S-α-H. B. D. H.) were determined by the U. V. method (wave length 340 nm). The precision of the determined values by this method are as follows:
S-G. O. T. 30.8×2.0mU/ml C. V. 6.6%
S-L. D. H. 128×8.5mU/ml C. V. 6.6%
5-α-H. B. D. H. 189×6.6mU/ml C. V. 3.5%
S-C. P. K. 116×1.4mU/ml C. V. 1.2%
The above precision is satisfactory enough for our clinical purpose.
Studied patients were divided into five groups;the groups of controls (10 cases), angina pectoris of effort (5 cases), angina pectoris at rest (5 cases) and A, M, I, (10 cases) The serum enzyme activities of each of the groups were determined with the following results:
No statistical difference of the serum enzyme activities was obtained between the groups of control and either angina pect. of effort or angina pest, at rest. But significant differences of each of the four enzyme activities was obtained between the control and A. M. I. groups. In A. M. I. groups, S-C. P. K., and S-G. O. T. levels showed rapid elevation and rapid falling;these two enzyme values returned to normal on the 7th day of the attack. On the contrary, S-L. D. H. and S-α-H. B. D. H. levels showed slow elevation and slow falling;these two enzyme values still remained high even on the 7th day of the attack.
As the above results coincide with the data formerly reported by other investigators and the time required for the enzyme determination is short, the U. V. method can be useful method for the early diagnosis of A. M. I.

抄録全体を表示