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.
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.
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.
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.
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).
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.
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.