From June 1989 through December 1994, we experienced 242 operated cases with congenital heart disease, aged from 0 days to 15 years. All were admitted to our hospital. The incidence of surgical death was 8.3% (20 cases). Most of the 20 deaths belonged to the groups of neonates and infants under three months of age. Of the 242 operated cases, we performed percutaneous transluminal angioplasty (PTA) for 9 cases with postoperative stenotic lesions and percutaneous transluminal valvuloplasty (PTV) for 1 case with congenital aortic valve stenosis. PTA was effective in 3 patients with postoperative anastomotic stenosis after Blalock-Taussig shunt, 3 with aortic recoarctations after surgical repair of coarctation of the aorta and 1 with postoperative aortic stenosis after surgical repair of interruption of the aortic arch, but was not effective in 2 patients with pulmonary stenosis following total correction of transposition of the great arteries and truncus arteriosus communis. PTV was ineffective in one patient with congenital aortic valve stenosis. PTA, one of the interventional cardiac catheterizations, is a safe and effective procedure and may improve the prognosis of patients with stenotic arterial lesions after cardiac surgery.

View full abstract

We performed a quantitative analysis of rat seminal vesicle stromal proliferation with a computed image analyzer SP 500 system (Olympus Co., Ltd.). E 2-17β was administered to immature castrated rats and the seminal vesicles (SV) were removed. We studied Mallory stained maximum longitudinal sections of the SV. In measuring the area of the gland (epithelium and lumen) and the stroma, it was effective to use the “trace method” of the SP 500 system. “RGB color slice treatment” was effective in quantifying smooth muscle and collagen. In this condition, tissue eosinophil infiltration was seen to accompany the proliferation of the SV stroma. The granules of the tissue eosinophils were treated by “color extracting treatment”, “two value treatment” and “contour expansion treatment”. These treatments allowed single granules to be recognized as one eosinophil.
The SP 500 system can be widely applied to histological and morphological analysis and is easy to operate.

View full abstract

For 36 (37 stones) patients with upper urinary calculi, 41 extracorporeal shock wave lithotripsies (ESWL) were performed using the Dornier MFL 5000. Of these cases, 8 (9 stones) patients had renal calculi and the remaining 28 patients had a ureteral calculus. As for the treatment number, 34 cases received single treatment, 2 cases twice and 1 case 4 times.
Two patients received epidural anesthesia and the remainder received analgesic suppositories to suppress treatment induced pain. In order to accurately detect the location of the stone, ultrasound was selected as the method for 2 treatments, while fluoroscopic imaging was selected for 39 treatments. Average shock wave number per treatment was 3055 shots, and the average treatment time was 98 minutes. Auxiliary procedures before ESWL were required in 9 patients : four insertion ureteral catheter, one indwelling J stent, three saline infusions to the urinary bladder, and one nephrostography.
The overall success rate (stone free and residual fragments less than 4 mm, 1 month after ESWL) was 89.2%, and the rates were 88.9% for renal calculi and 89.3% for ureteral calculus. As for complications, slight hematuria occurred in 80% of 41 treatments.
ESWL, using a Dornier MFL 5000, were considered to be safe and effective.

View full abstract

A 53-year-old-women was admitted to our hospital complaining of hypercortisolism. The etiology was Cushing's syndrome but this had not been determined at a previous hospital. She had hirsutism, easy bruisability, muscle weakness, and hypertension. However, she did not have a typical “moon” face, cutaneous striae, or a “buffalo” hump. The endocrinological laboratory findings suggested that she suffered from Cushing's disease ; serum ACTH and cortisol were elevated and no diurnal rhythm were recognized ; a standard low-dose (2 mg) dexamethasone suppression test was negative, a high-dose (8 mg) dexamethasone suppression test was positive ; a bolus injection of 100μg CRF stimulated ACTH secretion. However, we could not determine the treatment because pituitary tumor could not be ruled out on MRI and CT scans.
It was recently reported that selective venous sampling by itself produces some false negatives in diagnose Cushing's disease. Thus, selective venous sampling combined with the CRF stimulation test was performed in thin case. Although, before the administration of CRF, there were no significant differences in basal ACTH concentration sampled between right and left carotid veins and between carotid and peripheral veins, 100μg CRF apparently caused a greater increase in the ACTH concentration sampled from the right carotid vein than from both the left carotid and peripheral veins. According to these findings, she was diagnosed as having Cushing's disease with a microadenoma in the right pituitary gland and was treated with transsphenoidal surgery. This surgery apparently improved her hypercortisolism. This case suggests that selective venous sampling combined with the CRF stimulation test is useful for determining the diagnosis of Cushing's disease, in which a microadenoma is not revealed by MRI and/or CT scans.

View full abstract

A 47-year old-woman with inflammatory carcinoma of the left breast underwent a radical mastectomy. Chemotherapy was performed before and after the operation. About three years after the operation, the patient was diagnosed as having inflammatory carcinoma of the right breast. Following neoadjuvant chemotherapy, she underwent an extended radical mastectomy. The histological diagnosis was metastatic carcinoma from the left breast. We report our patient as a rare case because contralateral breast metastasis with inflammatory change developed frominflammatory breast carcinoma. Four years and two months have passed since the first operation despite the poor prognosis of inflammatory carcinoma of the breast.

View full abstract

In a 65-year-old man who had been diagnosed as having lung cancer, invasive thymoma was pointed out on chest computed tomography. First, he underwent a right upper lobectomy. The pathological diagnosis was squamous cell carcinoma of the lung. After a month of the first operation, he underwent a thymothymectomy including left diaphragmatic nerve resection. Nearly 3 years after the second operation, he was urgently admitted to our hospital because of respiratory failure. A diagnosis of respiratory muscle failure due to diaphragmatic paralysis was made. He received mechanical ventilation followed by daily training for respiration. Mechanical ventilation was needed only at night. Thus, we decided that home mechanical ventilation (HMV) was possible. His present condition has been steady using HMV at home. HMV is effective for achieving a better quality of life.

View full abstract