Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 34, Issue 4
Displaying 1-19 of 19 articles from this issue
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Contents
  • Volumetric Determination of Breast and Mammary Gland Using Ultrasono-tomography
    HIROKO SUGINO
    1989 Volume 34 Issue 4 Pages 499-512
    Published: March 20, 1989
    Released on J-STAGE: November 20, 2014
    DOIhttps://doi.org/10.14789/pjmj.34.499
    JOURNAL FREE ACCESS
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    In mammaplasty, such as in breast reconstruction after mastectomy, reduction mammaplasty and augumentation mammaplasty, it is most important to achieve volumetric symmetry. Thus, to this end preoperative determination of breast volume is necessary and enables precise planning of mammaplasty. Although several methods have been developed to estimate breast volume, some are difficult to utilize clinically, while others are innacurate. As a result, there are few reports of normal values for breast volume. In order to develop a new volumetric method and establish normal values for breast volume, sequential ultrasono-tomographic images of the breasts of 62 healthy Japanese women were obtained by means of a fully automatic waterpath mechanical compound scanner. The contour of the breast and of the mammary gland was determined anually on each image using a digitizer. The volumes were computed by reconstruction technique. The precision of this method was confirmed by comparison with a water displacement technique using a breast phantom. The average volumes of the breasts were rt. : 321.0 ± 183.4cm3, 1t. : 314.9 ± 167.6cm3. No significant correlation was indicated between breast volume and age, but the breast volume correlated significantly with mammary gland volume and moderately with the obesity index. The average mammary gland volumes were rt. : 156.9 ± 91.3cm3, 1t : 152.0 ± 84.8cm3. The gland volume correlated poorly with age and moderately with the obesity index. The average ratios of glandular volume to breast volume (G/B ratio) were rt. :.495±. 109, 1t. :.486±.107. The G/B ratio correlated highly with reference to age and moderately to obesity index. Analysis of the G/B ratio differences between groups with or without milk feeding experience was approached, but no positive statistical significance was achieved. Thus, volumetric determination of the breast using ultrasono-tomography is shown to be a reliable method for mammaplasty, and also applicable for mammary glands, in various cases. These values may also indicate a quantative basis of the breast growth and atrophy during life.
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  • Experimental Study of the Vascularization of the Island Flap
    -Part II : Influence of Congestive and Ischemic Condition on Survival of a Vascular Pedicle Island Flap-
    KENICHI TSUZUKI, AKIRA YANAI
    1989 Volume 34 Issue 4 Pages 513-519
    Published: March 20, 1989
    Released on J-STAGE: November 20, 2014
    DOIhttps://doi.org/10.14789/pjmj.34.513
    JOURNAL FREE ACCESS
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    Necrosis of the distal portion of a flap is a common complication, but there still is some dispute as to the cause. Some investigators feel that venous inadequacy is the major factor, while others blame arterial insufficiency. In attempts to elucidate the problem, many experiments have been reported, but most were concerning rats. The skin of a rat has a vasculature so rich that necrosis of the distal part of the flap was not always obtainable, especially when the load was less than critical. With these points in mind, we investigated the relationship between necrosis and vascular insufficiency, after treatment of the vascular pedicle, using flaps designed such that constant necrosis in the distal portion is possible. This study showed arterial insufficiency to be more responsible than venous inadequacy for necrosis of the pedicle island flap. When the flap was so designed to allow both arterial insufficiency and venous inadequacy, the blood flow through the vascular pedicle was considered to be balanced, and the survival rate appeared to be the same as in control. However, the worst survival rate was observed in. this group. Based on findings regarding survival of the vascular pedicle island flap, it can be said that arterial insufficiency has a greater influence on necrosis than venous inadequacy, and when there is a low blood flow volume through the vascular pedicle, the survival rate worsened even though the blood flow was balanced.
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  • Rotational Seizures in Tuberous Sclerosis
    SHIGEKI TANAKA, YOSHIKO NOMURA, MASAYA SEGAWA
    1989 Volume 34 Issue 4 Pages 520-527
    Published: March 20, 1989
    Released on J-STAGE: November 20, 2014
    DOIhttps://doi.org/10.14789/pjmj.34.520
    JOURNAL FREE ACCESS
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    Five cases of tuberous sclerosis with rotational movement or backward or forward falling attacks following psychomotor seiures were studied. We noted in all cases subependymal nodules on the thalamostriate sulcus. Three girls with unilateral nodules rotated to the side contralateral to the nodules; two boys with bilateral nodules fell backwards or forwards. Pharmaco-behavioral observation and polysomnography (PSG) were conducted to elucidated the pathophysiology of these phenomena. PSG findings in one case revealed a pattern of dopaminergic hyperactivity. Furthermore, small doses of L-dopa exacerbated the rotational attacks and induced right-left asymmetry in the incidence of twitch movement (TM) of the limbs on PSG, whereas pimozide alleviated both rotational attacks and asymmetric TM. These results suggest that the observed rotational or falling attacks in tuberous sclerosis are mostly caused by dopaminergic hyperactivity, the direction of rotation depending on the nodule location.
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  • Clinico-pathological Studies on Neonatal Intracranial Hemorrhages
    TAROU MASAOKA
    1989 Volume 34 Issue 4 Pages 528-536
    Published: March 20, 1989
    Released on J-STAGE: November 20, 2014
    DOIhttps://doi.org/10.14789/pjmj.34.528
    JOURNAL FREE ACCESS
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    Although the progress in perinatal medicine has remarkably lowered perinatal mortality, the incidence of intracranial hemorrhage seen in autopsied cases is increased. To search for causes of this increase, 653 autopsied neonates dying at specified institutes between 1955 and 1986 were reviewed with regard to maternal and neonatal course during pregnancy and delivery and the clinical course of neonates. Among significant pulmonary diseases as underlying diseases of brain lesions hyaline membrane disease, pneumonia and pulmonary bleeding- pulmonary bleeding was noticeably decreased, while the other two lesions remained almost unchaged. Regarding acute subdural bleeding due to injury during delivery, both Beneke type in mature infants and Trotter type in premature infants were increased. The incidence of intracerebral bleeding was obviously increased, and so it is not possible to simply attribute the occurrence of this bleeding to the immaturarity of cerebral vascular system and hypoxemia. Consequently, it is considered sig nificant that with the development of hypoxemia, the administration of sodium bicarbonate glucose transfusion provokes cerebral edema leading to compression of the internal cerebral veins in the fornix and considerable congestion of the thalamostriate veins.
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  • Application and Significance of Rapid Cytological Diagnosis of Brain Tumors during Surgery
    --Comparison with Final Histological Diagnosis--
    KAZUSUKE DOI
    1989 Volume 34 Issue 4 Pages 537-550
    Published: March 20, 1989
    Released on J-STAGE: November 20, 2014
    DOIhttps://doi.org/10.14789/pjmj.34.537
    JOURNAL FREE ACCESS
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    In 309 cases, the rapid cytological diagnosis of brain tumors during surgery was evaluated with regard to clinical usefulness, and compared with histological diagnosis. The overall diagnostic coincidence rate was 90.5% ; this can be improved wit h special attention, given to the method of specimen sampling. The application of immunological staining of cell specimen improved the correct diagnoticrate to 95.1 %, thus this method is considered to demonstrate satisfactory clin ical usefulness. In 45 patients with astrocytomae and 16 with glioblastome, a satisfactory coincidence was observed in the cytological judgement of tissue type, cytological classification, and histological grading. In 54 meningiomae, a disagreement of cytological and histol ogical diagnoses was rated in 3 cases (5.6%), but no error in the classification of the degree of malignancy was detected. It is vital in cytologica judgement of brain tumors to obtain an adequate amount of cells and to make observation at low magnification in order to assume tissue structure from the arrangement of cells. The degree of abnormal karyoty pe and the frequency of nuclear division can provide information useful in judgement of malignancy grading.
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