Gastroesophageal reflux (GER) after repair of esophageal atresia and tracheoesophageal fistula (EA-TEF) is well documented. In order to clarify the effect of gastrostomy on GER after EA-TEF repair, two groups of patients, with and without gastrostomy, were compared.
From 1978 to 1996, 63 consecutive patients with EA-TEF (Gross type C) underwent surgical correction without subsequent anastomotic leakage or recurrent TEF. Twenty-six patients underwent repair without gastrostomy and a routine gastrostomy was placed in 37. The two groups had similar clinical profiles and neither their mean esophageal gap between the proximal and distal esophagus nor their angle of His differed significantly. Ten patients (27.0%) with and six (23.1%) without gastrostomy developed GER and Nissen fundoplication was required in 6 of the former and 4 of the latter. There was no significant relationship between GER development and gastrostomy placement. The mean esophageal gaps in the GER and non-GER groups were 2.5 ± 0.9 and 1.2 ± 0.8cm, respectively, and they differed significantly (p<0.01). There was a significant relationship between the esophageal gap size and GER incidence (p<0.01). The mean angle of His was significantly greater in GER than non-GER patients and the angle of His correlated with the esophageal gap size.
In conclusion, there appears to no relationship between GER development and gastrostomy placement, whereas there is a correlation between the esophageal gap and GER development.

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The efficacy of an extracorporeal granulotrap column (G-1 column) against endotoxin shock was investigated using experimental rabbit models. G-1 column is a polycarbonate column filled with cellulose acetate beads. When extracorporeal circulation using a G-1 column was performed on rabbits (n=4) for 1 hour, 4.2 (±1.4) × 10⁷ CD-11b-positive cells (indicative of monocyte and granulocyte fractions) were adsorbed to the column. Approximately 14% of granulocytes in whole blood were eliminated by the G-1 column treatment at a flow rate of 2 ml/minutes for 1 hour. In addition, when extracorporeal circulation was performed for 1 hour following LPS intravenous administration (2mg/kg), the survival rate of the rabbits treated with the G-1 column were significantly higher than those treated with sham column and non-treated ones (p=0.014, p=0.009, respectively). Histopathologically, 6 hours after LPS administration, the degree of thickening of alveolar septum and infiltration of inflammatory cells in the lung was milder in the G-1 treated rabbits than in the other two groups. However, the G-1 column treatments did not affect the count of leukocytes in the peripheral blood nor the myeloperoxidase activity in the lung 6 hours after LPS administration, which was indicating granulocyte infiltration. These findings suggest that the G-1 column might suppress lung injury and improve the survival in endotoxin shock model by eliminating the activated granulocytes. Thus, the G-1 column may be useful in endotoxin shock therapy.

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Intravenous administration of Propionibacterium acnes (P.acnes, 16mg/kg) followed by a small amount of lipopolysaccharide (LPS, 200μg/kg) one week later caused severe liver injury in rats. In in vivo studies, the contribution of spleen-derived macrophages to the liver injury in this model was investigated. Splenectomized rats had lower levels of plasma tumor necrosis factor α (TNFα), growth related oncogene/cytokine-induced neutrophil chemoattractant 1 (GRO/CINC-1), purine nucleoside phosphorylase (PNP) and aspartate aminotransferase (AST) than non-splenectomized rats. In organ perfusion studies, the hypothesis that macrophage-derived reactive oxygen species mediate the liver injury was verified. Leakage of PNP into the perfusate immediately followed release of superoxide anion (O₂^-) which was measured by a chemiluminescence technique using a Cypridina luciferin analogue (MCLA) as a highly sensitive chemiluminescence probe for O₂^-. Increase of TNFα, GRO/CINC-1 and AST levels in the perfusate lagged behind PNP release. Simultaneous administration of superoxide dismutase and deferoxamine significantly suppressed PNP and AST release. From these results, we believe that spleen-derived macrophages have an important pathological role in P.acnes-LPS-induced liver injury in rats via release of O₂^-.

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Detection of the presence of the BCR/ABL fusion gene is essential for precise diagnosis of chronic myeloid leukemia (CML). To confirm the diagnosis of CML, demonstration of BCR gene rearrangement by Southern blotting has been used, but the reverse transcription-polymerase chain reaction (RT-PCR) is a more sensitive and simple method for detection of BCR/ABL gene alterations. However, non-specific bands are occasionally seen on ethidium bromide-stained gels and confirmation using RI-labeled probes is necessary. In this study, the RT-PCR amplified BCR/ABL fusion gene was searched for hybridization of biotin-labeled junctional probes (RT-PCR/biotin-probe method) instead of the laborious RI-based method. In a total of 18 CML patients (16 with Ph¹ and 2 without), cytogenetic and molecular analyses were performed, including the RT-PCR/biotin-probe method. BCR gene rearrangement study by Southern blotting in 9 of the patients (8 with and one without Ph¹) revealed no rearranged bands in 2 patients with Ph¹. All 18 CML patients were examined for the presence of BCR/ABL transcripts by the RT-PCR/biotin-probe method and nested PCR method. BCR/ABL transcripts were detected in 17 of the 18 patients (15 with and 2 without Ph¹) and the results of the two methods were completely consistent. These results suggest that the RT-PCR/biotin-probe method is useful for the diagnosis of CML.

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To assess the limitation of standard cisplatin-based combination chemotherapy for metastatic germ cell tumor, clinical records of 37 patients with metastatic testicular cancer and extragonadal germ cell tumor treated with primary chemotherapy were reviewed. Thirteen patients of 37 had limitation of the treatment. We categorized the mode of treatment limitation into 5 criteria according to the response of tumor marker levels and radiographic findings, and recurrence. Tumor volume was strongly associated with the limitation of the treatment. Indiana University Staging System, not Royal Marsden Hospital's classification clearly discriminated the patient with limitation of standard cisplatin-based combination chemotherapy. High dose chemotherapy was effective for patients to whom the initial chemotherapy with standard cisplatin-based regimen was effective. It did not offer any benefit to patients with refractory tumor. We conclude that it is important to introduce more aggressive chemotherapy regimens as an initial chemotherapy to patients with large volume tumor.

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The degree of hemiplegia in 12 patients with cerebrovascular diseases (9 with cerebral infarction and 3 with cerebral hemorrhage ; 64.6 ± 11.6 years of age) was assessed by the Brunnstrom and Ueda classifications for comparison with the transcutaneous oxygen tension, and arterial and venous oxygen tensions. The patients with severe hemiplegia showed a significant increase in the difference between the transcutaneous oxygen tensions of the paralyzed and healthy limbs, a significant increase in the difference between transcutaneous and arterial oxygen tensions of the paralyzed limb, and a significant decrease in the difference between arterial and venous oxygen tensions of the paralyzed limb. Thus, the difference between transcutaneous oxygen tensions of paralyzed and healthy limbs was suggested to be useful in determining the grade of hemiplegia. This difference might be derived from vasomotor dysfunction, autonomic nerve palsy, opening of an arterio-venous shunt, and disorders of muscle and fatty tissue metabolism in the paralyzed limb.

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A 77-year-old man who had undergone right simple nephrectomy in 1976 was admitted to our hospital with complaint of fever and left flank pain. X ray film showed a staghorn calculus. CT and MRI revealed a heterogeneous mass on upper pole of the left kidney. Angiography demonstrated proliferation of abnormal vessels. He was diagnosed as having a left renal tumor and underwent left radical nephrectomy with resection of pancreatic body and splenic flexure of the colon, and of the spleen because of adhesions. Pathologically, well-differentiated squamous cell carcinoma had invaded to pen-renal adipose tissue, but did not the pancreas, colon and spleen. He underwent hemodialysis via a femoral catheter and died of MRSA infection 42 days after the operation.

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A 53 year-old man with complaints of macrohematuria and urinary disturbance revealed to have a polyp of prostatic urethra prolapsing into bladder. The polyp was resected transurethrally. Pathological finding was inverted papilloma. We showed the endoscopic findings of the polyp and demonstrated the mechanism of obstruction of the urethra by the polyp.

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Completion pneumonectomy (CP) is an operative procedure in which a surgeon totally removes a residual part of partially resected lung previously. The rationale, indication and prognosis of CP have been discussed, because this procedure is seldom indicated and the operative mortality and morbidity are higher compared with a standard pneumonectomy. We report a case of CP for recurrent lung cancer in the left upper bronchus after a lower lobectomy of the left lung with lymph node dissection (R2a).

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We describe marked prostate volume decrease attained by transurethral balloon laser thermotherapy (TUBAL-T) in a patient with benign prostatic hypertrophy (BPH).
A 64-year-old man was referred to our department for dysuria. His diagnosis was BPH with severe subjective and moderate objective symptoms judged by the Japanese Urological Association criteria. He was initially treated by oral administration of α1-adrenergic blocker, but in vain. Four months later, TUBAL-T was performed. Subjective and objective symptom improvement was achieved month by month. After 14 months of the treatment, he has almost no urinary symptoms and the prostate volume is decreased by almost 50%.

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Lung cancer invading the trachea is classified as T4 and the prognosis is considered to be poor. However, when a curative operation is performed, good prognosis is expected. We experienced a 65-year-old male patient with moderately differentiated squamous cell carcinoma invading the trachea. He underwent a right upper lobectomy accompanied by the reconstruction of the carina with the assistance of extra corporeal membrane oxygenation (ECMO). His postoperative course was uneventful. The patient has been in good condition and free from recurrence for three and a half years. ECMO is a useful technique for reconstruction of the carina for advanced T4 lung cancer.

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Two patients with chronic mastitis clinically similar to breast carcinoma are presented. The pathological findings revealed to be chronic mastitis as the subsequent change to duct ectasia in one and to be granulomatous mastitis in the other. Whenever breast lump is diagnosed, chronic mastitis clinically similar to breast carcinoma must be in consideration.

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Dr. Philip Franz von Siebold was the surgeon-major, formerly commissioned with naturehistoric research. In this paper, as a result, what became clear from these discovered documents is the fact that “von Siebold Incident” differed from the information told in the history. Although the “Edo Journey” was an investigation of valuable studies of medicine and natural history, the Japanese government did not have a clue of what was happening. On the other hand, they preferred to believe it was only an act against the Japanese law. These unreleased documents were discovered for the first time after more than 150 years of its sleep in the archive. It is necessary to take time and re-examine these documents from medical and scientific point of view. All of the documents were released to the discoveries he had made, an investigation including the new “von Siebold Incident” in the history of medicine, and perhaps, all of these will be another page in the history.

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