Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 32, Issue 4
Displaying 1-18 of 18 articles from this issue
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Contents
  • Changes of Spinal Cord Evoked Potential and Spinal Cord Blood Flow in Spinal Cord Traction
    KENZOU ITOH
    1986 Volume 32 Issue 4 Pages 445-455
    Published: December 10, 1986
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.32.445
    JOURNAL FREE ACCESS
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    Measurement of the spinal cord evoked potential as a method for evaluation of spinal cord function has gained increasing importance with the progress of spinal (cord) surgery. A change in the blood flow seems to be closely associated with acute spinal cord injury. Variation in the spinal cord evoked potentical in relation to a change in the blood flow under application of longitudinal traction was examined using cats. The spinal cord potential was evoked by stimulation of the epidural space (L1 level) from posteriorly and recorded at the epidural posterior region (C2 level) to observe its ascending wave patterns. The intensity of the stimulus was two to three time the threshold value. The blood volume was serially measured by the hydrogen clearance method at the region of the funiculus posterior of the spinal cord. The spinal cord evoked potentical basically consists of two wave patterns. Traction induces a tendency to latency prolongation and also extends the retention of the wave pattern. An increase in the duration of traction augments the wave height in most cases. This is immediately followed by rapid disappearance of the wave. The mean blood volume without traction was 10.3rn1/min/100g. The blood volume was reduced to approximately 50% at the time of transient augmentation of the wave height. The blood flow was not recorded when the wave disappeared. The changes in the wave of the spinal cord evoked potential were divided into four groups to examine the irreversibility of the change. Transient augmentation was a warning signal Subsequent reduction of the wave height, up to approximately half of the maximun change, seemed to be a reversible change.
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  • Clinical and Diagnostic Review of Biliary Tract Carcinoma
    SEIKOH SHIMAGUCHI
    1986 Volume 32 Issue 4 Pages 456-468
    Published: December 10, 1986
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.32.456
    JOURNAL FREE ACCESS
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    Diagnosis and treatment of 119 patients with biliary tract carcinoma, including 59 extrahepatic bile duct carcinomas and 60 gallbladder carcinomas, were reviewed. The diagnosis was histologically confirmed either by operation or autopsy. The male : female ratio was 1 : 1.429, and the average age of the patients was 64.1. Sixty three tumors was defined as tumor invasion mucosal layer and the proper muscle layer. In gallbladder carcinoma, tumor extension to the Rokitansky Ascoff sinus in the subserosa was included in early carcinoma. The clinical symptoms of patients with biliary tract carcinoma have been studied. The symptoms were divided into localized and generalized ones. Patients with early carcinoma presented both localized and general symptoms. In patients with unresectable tumor, generalized symptoms were common complaints. In early carcinomas, the period between the onset of symptoms and diagnosis was shorter than that of advanced carcinoma. Clinicopathological studies revealed that 55 patients (45%) had stones, either in the gallbladder or bile duct. Eight patients (7%) had abnormal union of the pancreatobiliary ducts. The relationship between tumor size and depth of invasion disclosed that carcinoma of less than 1 cm in diameter is early cancer. Most biliary tract carcinomas were readily diagnosed by an integrated approach using ultrasonography, computed tomography, direct cholangiography and angiography. However, flat invasive carcinoma of the bile duct and small tumors of the gallbladder associated with gallstones were difficult to diagnose. Follow up of 119 patients revealed that the mean survival time of unresectable tumors was 4.9 months. In the case of resected tumors, survival depended on the depth of invasion. In advanced carcinoma, five year survival was 33% in bile duct carcinoma and 5% in gallbladder carcinoma. In early carcinoma, the corresponding figures were 80% and 100%.
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  • Radiological Studies of Gastric Cancer Detection
    FUMINARI KAJI
    1986 Volume 32 Issue 4 Pages 469-478
    Published: December 10, 1986
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.32.469
    JOURNAL FREE ACCESS
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    A routine radiologic examination of the upper gastrointestinal tract was performed in 14,703 symptomatic patients who came to our department betwween January 1980 and December 1984. Of them, 2,566 were referred to endoscopy. In 82.9% of 158 patients who were diagnosed as having gastric cancer at a routine radiologic examination, endoscopy with biopsy confirmed the diagnosis. Gastric cancer was endoscopically detected in 13.1% of 175 patients whose radiologic findings were suggestive of gastric cancer. Furthermore, endoscopy detected gastric cancer in 41 patients who were radiologically diagnosed as having a benign gastric lesion or a vague inconclusive mucosal abnormality. With regard to the location of the lesions, the detectability and accuracy of routine X-ray diagnosis were examined. On the anterior wall, only characteristic lesions were noted. In contrast, on the lesser curvature and the posterior wall many false-positive findings were revealed. So as not to overlook advanced cancer, patients who were radiologically diagnosed as having not only cancers, but also benign gastric lesions and vague abnormalities, should be referred to endoscopy. Half of 26 early gastric cancers overlooked by routine radiologic examinations had coexistent cancers. Thus, the most important cause of oversight was the element of multiplicity. Early gastric cancers located on the anterior wall were most difficult to detect by routine radiologic examinations (oversight rate, 38.9%). Many early gastric cancers on the lesser curvature and the posterior wall were overlooked in X-ray film reading, while a number of them on the anterior wall were neglected because of bad X-ray film. Early gastric cancers of less than 1 cm in diameter were all overlooked. When they were between 1 cm and 3 cm, 28.6% of the elevated type and 18.2% of the depressed type were overlooked. A new radiologic technique for lesions located on the anterior wall is desired to improve the detectability of early gastric cancer in routine X-ray diagnosis. Excessive investigation with regard to findings on the lesser curvature and the posterior wall should be curtailed to increase the efficiency of early cancer detection in routine X-ray diagnosis.
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  • The Carcinogenecity of Amylopectin Sulfate
    TOMONORI ISHIOKA
    1986 Volume 32 Issue 4 Pages 479-490
    Published: December 10, 1986
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.32.479
    JOURNAL FREE ACCESS
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    It has been well known that the oral administration of sulfated polysaccharide, including degraded carrageenan (d-CGN) and amylopectin sulfate (APS), induces ulcerative colitis in various laboratory animals. Furthermore, prolonged oral administration of d-CGN is carcinogenic to the colorectum of the rat. D-CGN first induces ulcerative lesions, secondarily squamous metaplasia and finally tumors. However, there has been no report concerning the carcinogenicity of and colorectal lesions caused by APS. The effects of the oral administration of APS on rats were studied. After F344 rats were fed diets containing APS (5 % W/W) for three, six or nine months, all the animals were fed a regular diet and killed 12 months after the initial administration. APS induced adenoma and adenocarcinoma in the colorectum of the rats. The incidence of the tumors was two out of 20 rats (10%) in the three-month group (group I), nine out of 20 rats (45%) in the six-month group (group II) and 12 out of 20 rats (60%) in the nine-month group (group III). All the tumors were protuberant. The sessile lesions were smaller than the pedunculated type, and the former had a tendency to submucosal carcinomatous invasion. In the control group, no colorectal tumors were present. Squamous metaplasia of the colorectum persisted in all the experimental rats. And hyperplasia of the squamous epithelium was not prominent. The length of the squamous metaplasia from the dentate line was 2.22 ア 0.50 cm in group I, 3.49 ア 0.4. cm in group II, 4.98 ア 0.85 cm in group III, showing statistically significant differences from one other (P < 0.01). On the other hand, foamy macrophages containing amylopectin sulfate remained in such areas as the colorectal mucosal lamina propria, colorectal submucosa, and regional lymph nodes. There were some macrophages in the liver and spleen. APS already induced epithelial degeneration or superficial erosions in the colon and rectum one week after initiation of the administration. The epithelial degeneration was found electron microscopically on the first or third day of the administration. The colorectal squamous metaplasia followed after two weeks of the administration. The mutagenicity Ames test of APS showed negative results.
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  • Ventriculoatrial Conduction in Patients with Sick Sinus Syndrome and Atrioventricular Block
    YUJI NAKAZATO
    1986 Volume 32 Issue 4 Pages 491-500
    Published: December 10, 1986
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.32.491
    JOURNAL FREE ACCESS
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    The Presence of ventriculoatrial conduction (VAC) gives rise to several problems, such as hemodynamic disadvantage in VVI pacing and sometimes causing pacemaker-mediated tachycardia (PMT) in DDD pacing. The clinical and electrophysiological significance of VAC was assessed in 48 patients with sick sinus syndrome (SSS) and 104 with atrioventricular block (AVB). Of the latter, 49 patients had advanced and 55 complete block, respectively. VAC was demonstrated in 15 patients (31%) with SSS, and in 11 patients (11%) with AVB. Of these 11 patients, nine had advanced AVB, and two had complete AVB. With respect to the blocked site, four of 44 (9%) BH block patients and seven of 38 (18%) with HV block had VAC, but no VAC was demonstrated in 22 AH block. Mean VAC time was 216 msec in both SSS and AVB. Development of chronic atrial fibrillation (AF) during VVI pacing was recognized in 12 patients (32%) with SSS; four of 11 (36%) with VAC and eight of 26 (31%) without VAC. In patients with AVB, chronic AF was recognized in 12 (12%), but the majority of them did not have VAC. Cerebrovascular embolism occurring after VVI pacing was recognized in two of 37 (5%) patients with SSS and in three of 104 (3%) with AVB. Four of these five (80%) had chronic AF. In conclusion, if VAC potentially exists, the real incidence of VAC and chronic AF during VVI pacing is higher in patients with SSS than in those with AVB. VAC may also be a cause of PMT in some cases. Therefore, careful evaluation of VAC in each patients is necessary before the selection of pacing mode.
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