Igaku kenkyu. Acta medica最新文献

From February 1977 to January 1993, a total of 52 patients have undergone combined mitral and aortic valve replacement (MAVR) at the Fukuoka University Hospital. The ages at operation ranged from 35 to 72 years (mean, 55.3 years) for 16 males and 36 females. Twenty-five patients received two bioprosthetic valves (group BB); 6 received a combination of bioprosthetic valve and mechanical valve (group BM); and 21 received two mechanical valves (group MM). The previous intra-cardiac operations were performed on 24 patients (46.2%). The purpose of this study was to learn about the long-term clinical results of MAVR and to analyze the difference among three groups. Seven patients died within 30 days of operation or during initial hospitalization (early mortality: 13.5%). Two patients died at late period, 5.8 years and 6.9 years after operation, respectively (linearized occurrence rate: 0.9%/pt-yr). Patient survival rate including operative death was 82.9% +/- 5.7% at 5 years and 79.0% +/- 6.7% at 8 years in the total number of patients. Thromboembolism occurred in 2 patients in group MM (0.9%/pt-yr). Anticoagulant-related hemorrhage occurred only in 1 patient (0.4%/pt-yr in overall), in whom two bioprosthetic valves were implanted (group BB), in spite of being in good control with anticoagulants. No infective endocarditis was encountered in any patients during any of the periods. Reoperations were performed in 7 patients (3%/pt-yr in overall), 5 in group BB and 2 in group MM. Percentage freedom from reoperation was 86.4% +/- 5.9% at 5 years and 78.2% +/- 7.7% at 8 years in all. There was no difference among the three groups. Percentage freedom from overall morbidity and mortality was 74.5% +/- 6.9% at 5 years in all. Group MM showed higher morbidity and mortality at 8 years than other groups, but there were no significance (MM: 52.4% +/- 17.6%, BB: 76.5% +/- 9.5%, BM: 83.3% +/- 15.2%). We conclude that there were no significant differences in long-term results of NAVR which consisted of the following combinations of prostheses such as BB, BM, and MM. Redoing MAVR with New York Heart Association functional class IV and emergency cases were considered as in-hospital risk factors.

Scattering Vitamin C of a small dose on a bedsore, enhances remarkably bactericidal effect of antibiotics. With scattering of it, 1% cream of Sulfadiazine made antibiotics-resistant bacteria (Methicillin-resistant Staphylococcus aureus = MRSA, Pseudomonas aeruginosa etc.) negative on a bedsore. Also in MRSA-infection of respiratory organs, combined administration of Vitamin C gives more effective bactericidal efficacy to some antibiotics. In a case infected with MRSA, of which the Minocycline-therapy had been ineffective, the combined administration of Vitamin C with Minocycline led him successfully to the negativeness of MRSA.

In previous studies we reported that the abnormality of the gamma-GTP level was found not only in hepatobiliary diseases but also in obesity and ingestion of alcohol in healthy individuals. In relation to this results, the present study deals with the relationship between abnormal gamma-GTP level in serum on the one hand and obesity and ingestion of alcohol on the other hand on the basis of test data for 1493 cases (1256 male cases, 237 female cases) who were examined in the short-term human dry dock managed by the Fukuoka University Hospital. To observe how results of various measurements including the degree of obesity and the amount of alcohol ingested exert effects on one another, principle component analysis was done by means of SAS statistic package for computer analysis. In men, as the first principle main components, obesity rate, Hb, Ht, RBC, GPT, gamma-GTP, LAP, GOT, triglyceride and total protein were extracted. As the second main principle components, alcohol, gamma-GTP, MCH, MCV, and HDL were extracted. Theses result demonstrate that the obesity is accompanied by variations in Hb, Ht, RBC and triglyceride and that digestion of alcohol is accompanied by variations in MCH, MCV and HDL in male. In women, components related to erythrocyte and transaminase along with the degree of obesity were extracted as the first main principle components, and principle components related to erythrocyte and alcohol were extracted as the second main components. In either case, alcohol and gamma-GTP were not included.

The present study deals mainly with the relationship between abnormal gamma-GTP level in serum on the one hand and obesity and ingestion of alcohol on the other hand on the basis of data for 1,493 cases (1,256 male cases, 237 female cases) who visited our clinic for their health check in the short-term human dry dock managed by the Fukuoka University Hospital. Abnormality in gamma-GTP serum level (> 60 mu/ml) was noted in 28.9% of men, which was second highest after 33.5% for the rate of triglyceride abnormality among the laboratory examinations performed in the human dry dock. In women the rate of abnormal LAP level in serum was the highest at 22.0%, while the rate of abnormal level of gamma-GTP was not more than 3%. The rate of abnormal gamma-GTP in serum increased with elevation in the obesity rate. Particularly in men there was a close relationship between the rate of abnormal gamma-GTP in serum and the amount of alcohol ingested, and the rate of abnormal gamma-GTP was 30.8% in men who take between 1 and 2 "gou" of Sake (1 "gou" of Sake contains 30g of alcohol) a day but reached 71.6% in case of the alcohol ingestion exceeding 2 "gou" of Sake. The relative risk ratio for abnormal gamma-GTP in serum was greater for alcohol than for obesity with 6.80 for those who are not obese but drink alcohol and 2.23 for those who are obese but do not drink alcohol. In both men and women, obesity plus ingestion of alcohol brought about a synergistic rather than additional effect. In men the relative risk ratio in the group having both obesity and ingestion of alcohol amounted to 11.5.

To reduce mortality rate of gastric cancer by the gastric mass survey, the effectiveness of gastro-endoscopy was compared with the direct fluoro-radiography as the close examination. By means of the indirect fluoro-radiography, the gastric mass surveys was performed for 695, 703 subjects in the period of 6 years starting from 1985 April to 1991 March in the Kagoshima Prefecture. 327 gastric cancers (0.66%) out of 49,545 subjects were found by the direct fluoro-radiography as the close examination, 261 gastric cancers (0.98%) out of 26,642 subjects were found by the gastro-endoscopy as the close examination. Furthermore the gastro-endoscopy (detection rate: 2.5%) showed higher efficiency and effectiveness than the direct fluoro-radiography (detection rate: 1.3%) on the aged group. Therefore further improvement of the accuracy of the gastric mass survey in the aged group can be achieved by the gastro-endoscopy as the close examination. As the accuracy of the gastric mass survey was different from the institution to the institution and from the area to the area, particularly in the direct fluoro-radiography, but not in the gastro-endoscopy, depending on the training group of area, the later should be performed for the subjects for whom the former had been done at first. In addition to lectures, demonstration of practical techniques of the examinations should be displayed for the improvement of the gastric mass survey. The necessity of the gastro-endoscopy for the final diagnosis of gastric cancer should be understood by the subjects who was examined and person engaged in the gastric mass survey by the enlightment movement.

A middle-aged woman who developed Cotard's syndrome after suffering from chronic schizophrenia is described. She had the delusion of negation believing that she had no possessions, but also her lung, heart, and intestines were gone. She also considered herself immortal. Medication was not useful in removing her delusions of negation and immortality.

Multiple regression analysis in 1493 cases (1256 male cases, 237 female cases) who were examined in the short-term human dry dock managed by the Fukuoka University Hospital, was done with gamma-GTP as the dependent variable and other parameters as the independent variables. As the result, 16 variables including LAP, alcohol, GPT, triglyceride, HDL and obesity rate were selected as the variables explaining gamma-GTP by stepwise methods in men. The standard regression coefficient of alcohol is shown to be greater than that of obesity on gamma-GTP. On the contrary, neither alcohol nor the obesity rate was included in this regression formula in women.

A topological study was made of the structure about the acromion using cadavers. Clinical application of arthroscopic surgery: A total of 110 patients underwent operation by my newly devised arthroscopic procedure. Through anatomical studies and the development and clinical trials of auxiliary devices (Step Cannulation System and Acromion Gauge) a safer and more reliable procedure of arthroscopic surgery for impingement syndrome was esablished. A therapeutic plan, involving arthroscopic surgery, for sports-related labral injury was established. Labral injuries were classified into 3 types. procedures of arthroscopic surgery suited for individual types were developed and aftertherapy was carried out on my own program, and all patients returned to sporting activities. Arthroscopic surgery for rotator cuff tear and rheumatoid disease of shoulder was established.

We have injected emulsion of activated carbon particles (CH 40), into the mediastinal lymph nodes at the bifurcation of trachea and examined whether carbon impregnated black lymph node is useful as a guide for more accurate and more appropriate lymphadenectomy at the esophagectomy. The patients subjected to our study were 112 patients with carcinoma of esophagus experienced from 1974 to 1991. Among them, 20 cases underwent 3-field lymph nodes dissection with CH 40 (CH group) and as control groups 41 cases received 2-field lymphadenectomy (2-F group), and 51 patients received 3-field lymphadectomy without CH 40 (3-F group). The average numbers of the lymph nodes dissected in CH group (24.5) was significantly larger in comparison with 2-F group (9.1) and 3-F group (10.5) (p < 0.05). The rate of the number of metastatic lymph nodes per number of lymph nodes dissected in the mediastinum in CH group (55.0%) was higher in those of 2-F group (24.3%) and 3-F group (33.3%). Postoperative pulmonary complications were observed in 20% in the of CH group, but in 41% of 2-F group and 60.0% in 3-F group. Cumulative 3-year survival rate in CH group was better than others. Therefore, it was concluded that the 3-field lymphadenectomy with CH group was useful in the operation of the carcinoma of the esophagus to improve the prognosis and decreasing the postoperative pulmonary complications.

Two cases with mixed symptoms of anxiety and depression are described. In both cases, a low dose of sulpiride was effective, improving patients anxious and depressive symptoms without severe side effects. These findings suggest that a low dose sulpiride treatment can be useful in the treatment of anxious and depressive patients.