Using rhenium colloid kit, RI-lymphography was performed in 70 patients, with malignant lymphoma, uterine cervix cancer, urogenital cancer, pelvic tumor, metastatic tumor of the lymphnode, lymphedema, and patients with post-traumatic chyluria. In 36 patients, lymphography was performed and the findings were compared with those of RI-lymphography. Lymphography was very difficult to perform in some patients, especially in severe lymphedema patients, and it needed operation with local anesthesia. Lymphography was one of the important procedures for the staging of the malignant lymphoma, but it's importance has been declined, because the images of the X-ray computed tomography are more convenient for the staging determination of these patients.
RI-lymphography is a simple and safe examination without danger of fat embolism, and needs no operation and local anesthesia. Compared with lymphography, the quality of the lymphnodes images is slightly poor in RI-lymphography, but it is proper to see the physiological flow of the lymphatics, because it is not a pressure flow. Rhenium colloid labeled with ^99mTc-O₄ can penetrate lymphatic canals easily, and accumulate well in lymphnodes. We compared the images of RI-lymphography and lymphography, and clinical efficacy of the former was discussed.

View full abstract

The findings of RI-lymphography were evaluated in twenty-three patients with breast cancer to examine lymphatic flow of the chest in these patients. Fifteen patients underwent this examination post-operatively, 2 pre-operatively, and the remaining 6 were cases of advanced cancer or recurrent cancer. Radioactive ^99mTc-Rhenium colloid was injected via epigastric point, 2cm below the xyphoid process of the sternum. Soon after the injection, dynamic study was started and continued for 60 minutes. Delayed scan was examined 90-120 minutes after the injection. Lymphatic flow of the chest wall with the post-operative breast cancer patients revealed many variations. Patients who had treated with extended radical mastectomy had poor flow of the operated site of parasternal lymphatic chain. There were several variations with parasternal lymphatic chain, and it was difficult to suspect the patterns of parasternal lymphatic canal. Lymphatic passages of the chest wall towards the axillary region was very complicated. If it recurred on the operated site, it was difficult to estimate the metastatic pathway through the lymphatic canal. Supraclavicular nodes were rarely visualized with RI-lymphography. It is useful to perform the RI-lymphography in the patients who undergo irradiation of both parasternal and supraclavicular region, after the operation for the breast cancer.

View full abstract

In recent years, accurate diagnosis of the fetal condition has become possible due to the progress of medical electronics (ME), while the forecast concerning the progress of delivery is difficult in many cases because there are no standards for the evaluation of the birth canal. This time, we re-evaluated the factors affecting the progress of the delivery on the basis of the measured values and the shape of the pelvis.
1) The measurement of the pelvis alone did not permit evaluation of the progress of delivery and choice of the delivery method.
2) The shortest anterior and posterior diameter rather than the true obstetric conjugate appeared to reflect the cephalopelvic disproportion (CPD).
3) The cesarean section was carried out in the cases of “interlocking” detemined by the inlet-space method.
4) Abnormalities of sacral shape were noted in some cases of cesarean section, where the measured values of the pelvis were judged to be normal.
From the results described above, sacral shape is largely involved in the progress of the delivery, and preparation of the diagnostic standard for CPD including sacral shape should be made in the future.

View full abstract

A total of 110 patients with laryngeal cancer treated by radiotherapy during a period of 19 years between 1967 and 1985 were analyzed. Results were as follows;
1) Eighty-three patients (80%) were irradiated curatively with doses given more than 40 Gy and 21 patients (20%) were treated by postoperative irradiation. The mean age was 67.4 and the ratio of men to women was 8.1:1.
2) According to the primary site of laryngeal cancer undergoing a curative irradiation, glottic cancer was 70% (58 patients), supraglottic cancer was 29% (24 patients) and subglottic cancer was 1% (1 patient). As for the stage classification, 22 patients was in stage I, 26 patients in stage II, 20 patients in stage III and 15 patients in stage IV. The rate of early stages (stages I and II) was 72% in glottic cancer, but that of advanced stages (stages III and IV) was 79% in supraglottic cancer.
3) The five-year survival rate of 21 patients who had treated by postoperative irradiation was 37%, and that of 58 patients undergoing a curative irradiation was 32%. The five-year survival rate of curatively irradiated patients with glottic cancer was 84% in stage I, 48% in stage II and 17% in stage III and IV. In all of 21 patients with supraglottic cancer, the five-year survival rate was 15%.
4) Eighteen patients survived more than 5 years; 3 patients were postoperative irradiation and 15 were curative irradiation. In the curative irradiation, 12 patients were glottic cancer, and 3 were supraglottic cancer.

View full abstract

From 1967 through 1985, 86 patients with cancer of the paranasal sinuses and 6 patients with cancer of the nasal cavity (excluding sarcoma) were treated by irradiation at the Department of Radiology, Kumamoto National Hospital. The mean age was 60.7. The rate of men to women was 1.2:1.
The results were as follows;
1) Fifty-nine patients (51 cases of maxillary sinus carcinoma, 4 of ethmoid sinus carcinoma, and 4 of cancer of the nasal cavity) were treated with antrostomy followed by radiotherapy and regional arterial infusion of 5-fluorouracil alone or a combination of 5-fluorouracil and bleomycin. In 11 cases of these, salvage with total maxillectomy was performed and 10% of which were controlled for more than five years. In 9 cases of these, no case was salvaged with radiotherapy. An overall five-year survival rate was 32%.
2) The survival rate of the postoperative irradiation (11 cases of maxillary sinus carcinoma, 1 of cancer of the nasal cavity) was 42% at 2 and 4 years after the operations.
3) Twelve patients with cancer of the paranasal sinuses (11 cases of maxillary sinus carcinoma, 1 of ethmoid sinus carcinoma) survived more than five years. All of them were irradiated curatively with doses more than 40 Gy. In our series, there was no difference in long-term survival between 5-fluorouracil alone and a combination of 5-fluorouracil and bleomycin.

View full abstract

A total of 122 patients with pharyngeal cancer (55 cases), carcinoma of the oral tongue (28 cases) and carcinoma of the oral cavity (39 cases) were treated by external irradiation at the Department of Radiology, Kumamoto National Hospital. In the retrospective study, therapeutic results in pharyngeal cancer (39 cases), in carcinoma of the oral tongue (20 cases) and in carcinoma of the oral cavity (30 cases) were analyzed.
1) Thirty-nine cases of pharyngeal cancer consitituted 9 cases of epipharyngeal cancer, 17 of mesopharyngeal cancer and 13 of hypopharyngeal cancer. The five-year survival rate was 35% for epipharyngeal cancer, 13% for mesopharyngeal cancer and 10% for hypopharyngeal cancer.
2) Twenty cases of carcinoma of the oral tongue were treated by external irradiation and intraoral electron therapy. The five-year survival rate was 28%. Three cases survived more than five years; 2 were preoperative irradiation and 1 undergoing a curative irradiation was salvaged with surgery.
3) Thirty cases of carcinoma of the oral cavity consitituted 10 cases of carcinoma of the floor of the mouth, 9 of carcinoma of the cheek mucosa, 7 of carcinoma of the gum, 2 of carcinoma of the hard palate and 2 of carcinoma of the lip. An overall survival rate was 27%. Five cases survived more than five years; 3 were carcinoma of the gum and 2 were carcinoma of the cheek mucosa.

View full abstract

The premature separation of the normally implanted placenta is one of the main causes of the disseminated coagulation syndrome (DIC). The selection of treatment for the disease greatly affects the prognosis and, therefore, from this point of view, this disease possesses important gynecological sinificance.
Forty-seven cases of premature separation of the normally implanted placenta observed in the past 12 years were analyzed statistically. The incidence was found to be 0.49%. When the relation between the method of delivery and prognosis of the infant's development was considered, 28 cases (59.6%) were vaginal deliveries, 23 (82.1%) being live-births and 5 (17.9%) being still-births. On the other hand, 19 cases (40.4%) were delivered by cesarean section, 14 (73.7%) being live-births and 5 (263%) being still-births.
When the relation between complications of the mother and the condition of the babies was considered, severe toxemia of pregnancy was found in 7 cases (14.9%) and DIC in 6 (12.8%). Among the mothers suffering from DIC, 2 cases (33.8%) delivered live-births and 4 cases (66.7%) still-births. Forty-one did not suffer from DIC, 35(85.3%) having live-births and 6 (14.6%) still-births.
Four cases of DIC underwent a Porro operation, including one who suffered from premature separation of the normally implanted placenta. Occurrences of the mother's death were none. Melena was seen in 2 of the new-born babies.
In Japan, toxemia of pregnancy is considered to be one of the main causes of premature separation of the normally implanted placenta. However, recent observations revealed strong evidence to indicate that the premature separation of the normally implanted placenta is simply an accidental complication during the pregnancy. In addition, with regard to the mechanism by which DIC is induced during the premature separation, the influx of the serum components from the retroplacental hematoma into the maternal blood stream, influx of tissue thromboplastin from the site of placenta separation into the blood stream, or loss of blood coagulation factor are currently under consideration.
Treatments for the premature separation of the normally implanted placenta include treatment for bleeding, recovery of blood loss, shock and abnormality of blood coagulation. In addition, treatment for precipital labour and post-delivery complications should be included. However, the most important treatment for the premature separation of the normally implanted placenta is to correct the abnormality in blood coagulation, in particular hypofibrinogenemia (a period of lowered coagulating abillity), i. e. intravascular coagualtion (organic damage).
During DIC, a complication of the premature separation of the normally implanted placenta. the period of increased blood coagulation is often short. Therefore, most of the clinically encountered premature separations of normally implanted placentas are in the state of consumption coagulopathy and, thus, treatment with heparin is contraindicated.

View full abstract

From April 1976 to June 1986, we treated 202 cases of oral malignant tumors, and 30 of these cases required reconstructive operations. We studied the changing concepts and problems of our reconstructive operations. Recently we have achieved good results using microvascular free forearm flaps and free jejunal transfers. We started to use free jejunal transfers from 1983 and free forearm flaps from 1984. During the last four years, 6 cases of free jejunal transfers, 8 cases of forearm flaps, one case of a free scapular flap and one case of a free groin osteocutaneous flap were treated. Especially in order to reduce functionl disorder, we used free jejunal transfers for the cases requiring hemiglossectomy.

View full abstract

Our study group analyzed clinically the collected 343 cases treated with blood products, mainly plasma products to clarify their clinical objectives.
Results were as follows;
1) Most cases (98.8%) were treated with plasma products. Cases treated with human serum albumin were 43.4%, those with globulin products for intravenous use were 38.3% and those with heated human plasma protein were 15.7%. However, cases treated with fresh frozen human plasma were only 2.1%.
2) About 60% of cases treated with human serum albumin were patients suffering from malignant tumors, and they were mainly the elderly.
3) Notably, about 25% of cases treated with globulin products for intravenous use were operative patients, especially those with cardiac surgery.
4) About 70% of cases treated with heated human plasma protein were pre- or postoperative patients. About 40% of these were cases of cardiac surgery and about 30% were cases of brain surgery.
5) There were only 7 cases that were treated with fresh frozen human plasma, but its clinical objectives of these cases were uncertain.

View full abstract

Adult cases of intussusception constitutes about 5% of all the cases. We investigated two cases of intussusception that occurred between ascending colon and transverse colon. The first case was idiopathic, and the second was complicated with colon cancer. About 90% of adult cases of intussusception are associated with intestinal neoplasma, polyp, ascaris worms, and mobile cecum and ascending colon. Idiopathic intussusception are very rare. In the past, barium enema was used for the first choice of examination to confirm the diagnosis of intussusception, but now ultrasonography has become so effective as a diagnostic method, because it demonstrates very characteristic signs for intussusception.
We studied the ultrasonographic findings of our two cases.

View full abstract

Two year and 4 month old boy complained of abdominal pain and vomiting. Next morning he developed vomiting after meals and jelly-like bloody stool. Air enema under general anesthesia revealed the intussusception proceeding to the middle of transeverse colon.
After hospitalization of one night for observation, massive rectal bleeding and severe anemia (Hb. 5.0g/dl) occurred. Emergency operation revealed the Meckel's diverticulum in the ileum 50cm oral from the ileocecal valve from where the intestinal lumen was filled with blood. And there was no intussusception except the several swollen mesentric lymph nodes in the mesenteric stalk. The diverticulum was resected in a wedge shape. Specimen included U1-III ulcer with thick arteries just beneath the crater and migration of gastric mucosa and pancreatic tissue. His postoperative course was good.

View full abstract

A 67-year-old man with dull right lower abdominal pain was admitted to our hospital. Barium enema revealed a polyp with a stalk in the terminal ileum. The polyp with a stalk was detected 3cm oral to Bauhin valve by endoscopy, which was polypectomized without any complications. The resected polyp was 5×3×3mm in size with a stalk, whose surface was smooth, Its histology was consistent with hyperplastic polyp. A benign tumor of the small intestine is less frequently found than a cancer, and there have been few reports about the ileal polyp.

View full abstract

We often see a hepatomegaly or an abnormal liver function test during the clinical course of patients with leukemia. In these cases, it is very difficult for us to diagnose exactly what the liver disease is like. So, histological findings of the biopsied specimen from the liver become diagnostically most important. We report here two cases of liver disease, liver cirrhosis and liver injury complicating with chronic myelocytic leukemia (CML), which were based on a histological evidence.
Case 1 was 56-year-old male, who was admitted due to chest pain caused by an attack of angina pectoris. He was diagnosed as CML for the first time upon this admission. Peritoneoscopy showed cirrhotic liver with splenomegaly and histology disclosed pseudolobule formation consistent with liver cirrhosis without an invasion of CML cells.
Case 2 was 61-year-old male, who was diagnosed as CML in October 1985. He had persistent hepatomegaly and biopsied liver tissue revealed leukemic cell infiltration with portal fibrosis.
The cases of liver disease, especially liver cirrhosis associated with CML with a histological evidence of the liver damage have been very rarely reported till now.

View full abstract

A 59-year-old female patient visited our hospital with a complaint of a tumor mass at the extragenital region. The tumor was located near the external urethral orifice, and it was brown in color and a thumb-tip in size. Histological examination of a biopsy specimen revealed malignant melanoma. En bloc wide resection of the tumor including the external genital organ, urethra, urinary bladder, and uterus was carried out and the urinary tract was reconstructed by using ileal conduit. Postoperative course was uneventful.
She remains free from recurrence or metastasis 20 months after the operation and has been currently treated with DTIC.

View full abstract

A 79-year-old woman had the multiple cutaneous nevus pigmentosus since her childhood.
On Jan. 1986, she developed high fever and her chest roentgenogram revealed abnormal shadows in the right lower lung field. She was admitted to our hospital with a tentative diagnosis of pulmonary cancer on March 5.
Naproxen was effective against tumor fever of this malignant melanoma. Her condition progressively deteriorated despite administration of OK432 and UFT. She died on May 20, 1986
The autopsy revealed malignant melanoma in the right lung, extensive metastasis to the liver, adrenal gland, peritoneum and jejunum.
It is suggested that the lesion of the pulmonary malignant melanoma was metastasized from the cutaneous nevus pigmentosus with its malignant change.

View full abstract