With recent progress in surgical techniques and postoperative managements, radical operations for lesions in the trachea and bronchus have been aggressively performed. Tracheoplasty is mainly performed in patients with tracheal stenosis secondary to tracheostomy, tracheal invasion of thyroid carcinoma, tracheal injuries and primary malignant tumors. Bronchoplasty is performed in patients with lung cancer, tuberculosis, bronchial injuries and benign tumors. Operations for lesions in the tracheobronchus consist mainly of sleeve resection and end-to-end anastomosis. It is now evident that primary anastomosis is possible even if it necessitates a wide resection of the trachea.
In tracheobronchoplasty, not only operative technique but also anesthetic technique is important. Accumulation of carbon dioxide and the occurrence of arythmia should be prevented.
This paper summarizes the indicaion, surgical method and anesthetic technique for surgery of the tracheobronchus.

抄録全体を表示

A case of successful reconstruction of the cervical trachea was reported. A 33-year-old male was involved in traffic accident and suffered damage to his cervical trachea. Annular excision of the stenotic trachea and end-to-end anastomosis was performed. Mobilization of the lower trachea at the upper mediastinum was done by splitting the sternal manubrium. Laryngeal release technique was not used. Procedures and advantages of this surgery were discussed.

抄録全体を表示

The blood serotonin level was measured in 144 subjects consisting of 23 normal subjects, 84 patients with bronchial asthma, 13 with nasal allergy, 16 with other pulmonary diseases and 8 with urticaria. In asthmatic patients, the data were specifically examined with reference to the other clinical and laboratory test results. The results were as follows;
1. The blood serotonin level in 23 normal subjects was within the range of 0.081±0.02μg/ml and there was no sexual difference.
2. The blood serotonin level was 0.108±0.027μg/ml in asthmatic patients, 0.120±0.013μg/ml in nasal allergy and 0.113±0.023μg/ml in urticaria. These values were signifantly higher than that in the normal subjects (p<0.01). The value in other pulmonary diseases tended to be higher than the normal but the difference was statistically insignificant.
3. Among different types of asthma, atopic type showed significantly higher blood serotonin level than the others (p<0.01). When the measurement was made in the subjects during their asthmatic attack, the value was evidently higher than in those in attack-free interval. In particular, the difference was statistically significant if the comparison was made within the same subject (p<0.01).
4. The blood serotonin level in the group showing positive skin reaction to allergen was higher than that in the negative group (p<0.001). However, there was no positive correlation between the blood serotonin level and serum IgE or the blood histamin level.
5. The blood serotonin level in type I and type II groups of CMI test was higher than that in type III and type IV groups (p<0.02). On the other hand, the results of Yatabe-Gilford test showed no positive correlation with the blood serotonin level.
6. There was a tendency toward decreasing blood serotonin level following the treatment with β-stimulator and corticosteroid. However, there was no change in the blood serotonin level by hyposensitization or gold therapy.

抄録全体を表示

Sixty-four cases of foreign bodies in the esophagus treated at the otorhinolaryngological clinic of Osaka Medical College, during the period from 1972 to 1977 were studied statistically.
The results were as follows:
1) The incidence of foreign bodies in the esophagus was highest in 1974 (19 cases) and decreased substantially thereafter.
2) Almost half of the patients were infants, with a high incidence in those aged 1 (12 cases) and 2 (14 cases).
3) Of the 64 cases, 43 were males and 21 were females, that is, the incidence was about twice as high in the males. The sex difference in incidence was observed more dominantly in children under 10 years old.
4) Fifty-eight percent of the foreign bodies were coins; 24 out of 37 were 10-Yen coins.
5) About 60% of the foreign bodies were located atthe first constriction of the esophagus.
6) Dental prosthesis was the most difficult of all types of foreign bodies to remove. Since the use of dental prosthesis has become more common even in the younger generation, the number of cases with detal prosthesis is increasing. The authors emphasized that improvements are necessary in the method of removing dental prosthesis foreign bodies.

抄録全体を表示

Correct diagnosis of a fish bone foreign body in the esophagus is not easy mainly because the foreign body is, in many cases, radiolucent.
Some important clues for the accurate diagnosis of a fish bone foreign body in the esophagus were reported as follows;
1. The presence of radiating pain to the back or anterior chest on swallowing is suggestive of the presence of a foreign body.
2. The elicitation of pain in the upper esophagus due to passive lateral movements of the thyroid cartilage is also suggestive of a foreign body in the hypopharynx or upper esophagus. Such pain is also known to occur in cases of cancer in the same regions.
3. X-rays from different directions may show a suggestive shadow of a foreign body in the esophagus due to the thickness of the foreign object in a certain direction.
Lateral views of the neck and the chest as well as routine posterior-anterior views, therefore, ought to be taken in order not to overlook a foreign body in the esophagus.
4. A contrast study of the esophagus using diluted barium is quite helpful, since it often shows a minimal retention of the contrast medium, filling defects or other unusual changes in the esophageal mucosa at the site of a foreign body.

抄録全体を表示

Based upon clinical experience with 20 cases with dental prosthesis esophageal foreign body, the following findings were reported.
1) In our 20 cases, 2 children and 1 teenager were included. Care must be taken about the lowering in age range, which is possibly due to recent development in clinical dentistry.
2) The incidence of dental prosthesis in the cases of esophageal foreign body is estimated as approximately 7% in Japan.
3) Sketching of the prosthesis by the patient himself should not be taken seriously, because it may contain an important mistake.
4) Stereorentogenography and rentogenological examination with barium, or other contrast medium, will be of great importance in estimating the shape and direction of the clasp and plate of the prosthesis.

抄録全体を表示

Robert's and Jackson's forceps are widely used for removal of foreign bodies in the air and food passages. In particular, Jackson's forceps with thinner jaws is usually used in the case of fragile foreign bodies such as peanuts. However, it is often difficult to catch the foreign body with this forceps because the jaws are pulled into its stem while trying to catch the foreign body.
We have been using a center-action brochoscopic forceps for removal of foreign bodies such as peanuts with satisfactory results. The foreign bodies are easily caught, as the jaws are fixed and symmetrically open in this type of forceps.

抄録全体を表示